UNIT – VII

NURSING MANAGEMENT OF PATIENT IN MERGENCY & DISASTER

SITUATIONS

SHORT ESSAY ( 5 Marks )

Q1. Explain the Disaster management cycle .

Ans : Definition

 WHO defines as any occurrence that causes damage , ecological disruption , loss
of human life , deterioration of health and health services , on a scale sufficient to
warrant an extraordinary responses from outside the affected community or area .

There are mainly two types of disaster:

A. Natural Disaster
B. Man-made Disaster

Meaning

 The disaster management cycle is a series of steps that organizations and

individuals use to prepare, contain and mitigate unexpected events.

Goals

 Reduce loss
 Ensure assistance
 Encourage recovery

Disaster management cycle

A. THE DISASTER EVENT

 This refers to the real-time event of a hazard occurring and affecting the ‘elements
at risk’.
 The duration of the event will depend on the type of threat, for example, ground
shaking may only occur for a few seconds during an earthquake while flooding
may take place over a longer period of time.

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B. RESPONSE

 The response phase is the actual implementation of the disaster plan.

 The best response plans use an incident command system, are relatively simple, are
routinely practiced, and are modified when improvements are needed.
 Response activities need to be continually monitored and adjusted to the changing
situation.
 Activities a hospital, healthcare system, or public health agency take immediately
during, and after a disaster or emergency occurs.

C. RECOVERY

 Once the incident is over, the organization and staff needs to recover. Invariably,
services have been disrupted and it takes time to return to routines.
 Recovery is usually easier if, during the response, some of the staff have been
assigned to maintain essential services while others were assigned to the disaster
response.

Activities undertaken by a community and its components after an emergency or disaster

to restore minimum services and move towards long-term restoration.
 Debris Removal
 Care and Shelter
 Damage Assessments
 Funding Assistance

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D. EVALUATION/DEVELOPMENT

 Often this phase of disaster planning and response receives the least attention.
After a disaster, employees and the community are anxious to return to usual
operations.
 It is essential that a formal evaluation be done to determine what went well (what
really worked) and what problems were identified.
 A specific individual should be charged with the evaluation and follow-through
activities.

E. MITIGATION

 These are steps that are taken to lessen the impact of a disaster should one occur
and can be considered as prevention and risk reduction measures.
 Examples of mitigation activities include installing and maintaining backup
generator power to mitigate the effects of a power failure or cross training staff to
perform other tasks to maintain services during a staffing crisis that is due to a
weather emergency.

F. PREPAREDNESS/RISK ASSESSMENT

 Evaluate the facility’s vulnerabilities or propensity for disasters.

 Issues to consider include: weather patterns; geographic location; expectations
related to public events and gatherings; age, condition, and location of the facility;
and industries in close proximity to the hospital (e.g., nuclear power plant or
chemical factory).

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Q2. Explain the principles of disaster Nursing .

Ans : Definition

 Disaster nursing can be defined as “the adaptation of professional nursing

knowledge, skills and attitude in recognizing and meeting the nursing, health and
emotional needs of disaster victims.”

GOALS OF THE DISASTER NURSING

Goals of disaster nursing are the following:

 To meet the immediate basic survival needs of populations affected by disasters
(water, food, shelter, and security).
 To identify the potential for a secondary disaster.
 To appraise both risks and resources in the environment.
 To correct inequalities in access to health care or appropriate resources.
 To empower survivors to participate in and advocate for their own health and well-
being.
 To respect cultural, lingual, and religious diversity in individuals and families and
to apply this principle in all health promotion activities.
 To promote the highest achievable quality of life for survivors.

PRINCIPLES OF DISASTER NURSING

Principles of nursing during special (events) circumstances and disaster conditions

include:
a. Rapid assessment of the situation and of nursing care needs.
b. Triage and initiation of life-saving measures first.
c. The selected use of essential nursing interventions and the elimination of
nonessential nursing activities.
d. Adaptation of necessary nursing skills to disaster and other emergency
situations. The nurse must use imagination and resourcefulness in dealing
with a lack of supplies, equipment, and personnel.
e. Evaluation of the environment and the mitigation or removal of any health
hazards.
f. Prevention of further injury or illness.
g. Leadership in coordinating patient triage, care, and transport during times of
crisis.
h. The teaching, supervision, and utilization of auxiliary medical personnel and
volunteers.
i. Provision of understanding, compassion, and emotional support to all
victims and their families.
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Q3. Discuss the types of natural disaster.

Ans: Definition

 WHO defines as any occurrence that causes damage , ecological disruption , loss
of human life , deterioration of health and health services , on a scale sufficient to
warrant an extraordinary responses from outside the affected community or area .

There are mainly two types of disaster:

A. Natural Disaster
B. Man-made Disaster

Natural Disaster

Definition
 A natural disaster can be defined as “A major event caused by Earth’s natural
processes that leads to significant environmental degradation and loss of life.”
 A natural disaster is frequently preceded by a natural hazard. The Gujarat
Earthquake, for example, which struck on January 26, 2001, was a natural
calamity.

Types of Natural Disasters

I. Geological Disasters,
II. Hydrological Disasters,
III. Meteorological Disasters, and
IV. Biological Disasters are the four broad types of natural hazards.

i. Geological Disasters

 Geological hazards, or dangers caused by geological (i.e., Earth) processes, such as

plate tectonics, are a type of risk.
 Earthquakes and volcanic eruptions are examples of this.
 In general, geological extreme events are beyond human control, however, humans
have a significant impact on the events’ consequences.

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 ii. Meteorological Disasters

 Hazards caused by meteorological (i.e., weather) phenomena, particularly those

related to temperature and wind, are known as meteorological hazards.
 Heat waves, cold waves, cyclones, hurricanes, and freezing rain are all examples of
this.
 In the Atlantic, cyclones are known as hurricanes, while in the Pacific, they are
known as typhoons.

iii. Hydrological Disasters

 Hazards caused by hydrological (water) processes are known as hydrological

hazards.
 Floods, droughts, mudslides, and tsunamis are examples of natural disasters.
 Floods and droughts may cause havoc on agriculture and are one of the leading
causes of famine.
 The 1931 Central China floods killed three or four million people, making it the
greatest natural disaster in history (excluding pandemics).

iv. Biological Disasters

 Biological dangers are those that arise as a result of biological processes.

 This comprises a wide range of diseases, including infectious diseases that move
from person to person and pose a significant threat to vast populations of people.
 Biological hazards are often left out of discussions about natural hazards, instead
of falling under the purview of medicine and public health.

Geological Disasters Meteorological Disasters Hydrological Disasters Biological Disasters

– Sinkholes – Limnic Eruption – Cyclonic – AIDS
– Landslides – Flood – Storm – Tuberculosis
– Volcanic Eruption – Tsunami – Blizzard – Hepatitis A
– Earthquakes – Cold waves – Hepatitis B
– Avalanche – Drought – Hepatitis C
– Hailstorms
– Tornadoes

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Q4. Explain the role of nurse in Disaster Preparedness .

Ans : Meaning

 Disaster preparedness consists of a set of measures undertaken in advance by

governments, organisations, communities, or individuals to better respond and
cope with the immediate aftermath of a disaster, whether it be human-induced or
caused by natural hazards.

 The objective is to reduce the loss of life and livelihoods.

 Disaster preparedness refers to measures taken to prepare for and reduce the effects
of disasters. That is, to predict and, where possible, prevent disasters, mitigate their
impact on vulnerable populations, and respond to and effectively cope with their
consequences.

DISASTER PREPAREDNESS Activities: are

 Disaster Preparedness Plan
 Emergency communication plan
 Prevent spread of disease outbreak
 Public Education and awareness

Role of nurse in Disaster preparedness

 Simple initiatives can go a long way, for instance in training for search and rescue,
establishing early warning systems, developing contingency plans, or stockpiling
equipment and supplies.
 Disaster preparedness plays an important role in building the resilience of
communities.
 Nurses, working with physicians and other members of the health care team, play a
central role in response. Before, during, and after disasters,
 Nurses provide education, community engagement, and health promotion and
implement interventions to safeguard the public health.
 They provide first aid, advanced clinical care, and lifesaving medications; assess
and triage victims; allocate scarce resources; and monitor ongoing physical and
mental health needs.
 Nurses also assist with organizational logistics by developing operational response
protocols and security measures and performing statistical analysis of individual-
and community-level data.
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Other Roles: are

 Identify Hazards in the Home

 Learn First Aid and CPR Skills
 Develop an Emergency Evacuation Plan
 Establish a Disaster Meeting Place and Family Contact
 Prepare Adequate Water and Food Supplies
 Store Emergency Supplies
 Care for Pets
 Prepare for Disaster in a Vehicle
 Prepare for Disaster at Work or School
 Practice, Modify, and Maintain the Plan

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Q5. Explain the principles of emergency nursing.

Ans : Meaning

 Emergency nursing is a specialty within the field of professional nursing focusing

on the care of patients who require prompt medical attention to avoid long-term
disability or death.
 Emergency nursing is a specialty area of the nursing profession like no other.
 Emergency nurses must be ready to treat a wide variety of illnesses or injury situ
ations, ranging from a sore throat to a heart attack.

PRINCIPLES OF EMERGENCY NURSING

Principles of Emergency Nursing includes –

1. Guiding principles for emergency care

 Quick assessment of the casualty and situation to institute life saving
measures.
 Keep casualty in dorsal position and cover his/her body with whatever
cloth is available to prevent heat loss.
 Avoid unnecessary handling except to remove the victim from additional
danger.
 Give first aid to the injured part.
 Observed and keep a medical record of the casualty’s initial condition till
he reaches the hospital.
 Reassurance should be given to the victim and relatives that he/she is in
safe hands.
 Prevent people crowding near the victim; allow fresh air to circulate
around the victim.
 Do not give water to drink to the victims with abdominal injuries may
requiring immediate surgery.
 Make arrangements for safe transportation to hospital after first aid.
 In few emergencies like unconsciousness, uncontrollable bleeding,
respiratory difficulties etc., require coordinated efforts for speedy
transportation for medical facilities with simultaneous lifesaving
appropriate care is important.

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2. Principles of emergency management
 Maintain patent airway & provide adequate ventilation employing
resuscitation measures when necessary
 Control hemorrhage & its consequences
 Evaluate and restore cardiac output
 Prevent and treat shock, maintain or restore effective circulation
 Carry out a rapid initial and ongoing physical examination
 Assess the patient consciousness, whether the patient can follow commands
or not, evaluate the size & reactivity of pupils.
 Start ECG monitoring if appropriate
 Apply Splint of suspected fractures sites including cervical spines in patients
with head injuries
 Protect wounds with sterile dressings
 Start a flow sheet of patient’s vital sign, neurological state, to guide in
decision-making.

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Q6. Discuss the legal aspects of disaster nursing.

Ans: Definition

 Disaster nursing can be defined as “the adaptation of professional nursing

knowledge, skills and attitude in recognizing and meeting the nursing, health and
emotional needs of disaster victims.”

GOALS OF THE DISASTER NURSING

Goals of disaster nursing are the following:

 To meet the immediate basic survival needs of populations affected by disasters
(water, food, shelter, and security).
 To identify the potential for a secondary disaster.
 To appraise both risks and resources in the environment.
 To correct inequalities in access to health care or appropriate resources.
 To empower survivors to participate in and advocate for their own health and well-
being.
 To respect cultural, lingual, and religious diversity in individuals and families and
to apply this principle in all health promotion activities.
 To promote the highest achievable quality of life for survivors.

Legal aspects of Disaster Nursing

 Licensure
 Good Samaritan law
 Good rapport
 Standard care
 Standing care
 Written consent for operation and procedures
 Correct identity
 Drug maintenance
 Documentation
 Protection of patient property
 Reporting

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Q9. Explain the concept of triage.

Ans: Meaning

 Triage is the process of prioritizing casualties according to the level of care they
require.

 It is the most important, and psychologically most difficult, mission of disaster

medical response, both in the prehospital and hospital phases of the disaster.

The determinants of triage in disasters are, however, based on three parameters

 Severity of injury
 Likelihood of survival
 Available resources (logistics, personnel, evacuation assets).

 The major objective and challenge of triage is to rapidly identify the small minority
of critically injured patients who require urgent life-saving interventions, including
operative interventions, from the larger majority of noncritical casualties that
characterize most disasters.

Disaster medical triage may be conducted at three different levels depending on the level
of casualties (injuries) to capabilities (resources).

Field Triage
 Field triage, often the initial triage system used at the disaster scene in MCIs, is the
rapid categorization of victims potentially needing immediate medical care where
they are lying or at triage sites.
 Victims are designated as “acute” or “nonacute”.
 Simplified color coding may be used.
 Once the victims are transported to casualty collection centers (fixed or mobile
medical facilities), medical triage according to severity of injury/disease may be
performed.

Medical Triage
 Medical triage is the rapid categorization of victims, at a casualty collection site or
fixed or mobile medical facilities, by the most experienced medical personnel
available to identify the level of medical care needed based on severity of injury.

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  Triage personnel must have knowledge of the medical consequences of various
injuries (e.g., burn, blast, or crush injuries or exposure to chemical, biological, or
radioactive agents). Color coding may be used .

Evacuation Triage
 Evacuation triage assigns priorities to disaster victims for transfer to definitive care
facilities.
 Burns, blast and crush injuries, and pediatric trauma are among key priorities for
early transfer because of the complexity of injuries and frequent need for
multidisciplinary surgical teams.

Triage system involves a color-coding scheme using red, yellow, green, white, and
black tags:

 Red tags - (immediate) are used to label those who cannot survive without
immediate treatment but who have a chance of survival.

 Yellow tags - (observation) for those who require observation (and possible later
re-triage). Their condition is stable for the moment and, they are not in immediate
danger of death. These victims will still need hospital care and would be treated
immediately under normal circumstances.

 Green tags - (wait) are reserved for the "walking wounded" who will need medical
care at some point, after more critical injuries have been treated.

 White tags - (dismiss) are given to those with minor injuries for whom a doctor's
care is not required.

 Black tags - (expectant) are used for the deceased and for those whose injuries are
so extensive that they will not be able to survive given the care that is available.

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 In a disaster or mass casualty situation, different systems for triage have been
developed.
 One system is known as START (Simple Triage and Rapid Treatment).
 In START, victims are grouped into four categories, depending on the urgency of
their need for evacuation.
 If necessary, START can be implemented by persons without a high level of
training.

The categories in START are:

 The deceased, who are beyond help

 The injured who could be helped by immediate transportation
 The injured with less severe injuries whose transport can be delayed
 Those with minor injuries not requiring urgent care.

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Q10. Explain the Nurse’s role in triage.

Ans: Meaning

 Triage is the process of prioritizing casualties according to the level of care they
require.

Triage system involves a color-coding scheme using red, yellow, green, white, and
black tags:

 Red tags - (immediate) are used to label those who cannot survive without
immediate treatment but who have a chance of survival.

 Yellow tags - (observation) for those who require observation (and possible later
re-triage). Their condition is stable for the moment and, they are not in immediate
danger of death. These victims will still need hospital care and would be treated
immediately under normal circumstances.

 Green tags - (wait) are reserved for the "walking wounded" who will need medical
care at some point, after more critical injuries have been treated.

 White tags - (dismiss) are given to those with minor injuries for whom a doctor's
care is not required.

 Black tags - (expectant) are used for the deceased and for those whose injuries are
so extensive that they will not be able to survive given the care that is available.

Nurse’s Role in Triage

 It may sound like triage nurses only check temperature, pulse, and respiration and
then move patients through to the next station.
 They do so much more than TPRs and writing notes on a patient’s chart.
 Triage nurses act as a gatekeeper for the emergency room.
 They sort patients according to the severity of their medical condition.

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This is what the triage nursing process looks like from the moment you first speak with
your patient:

 Assess patient
 Prioritize patient
 Communicate patient status with ER staff
 Transport patient to the treatment area
 Provide immediate medical treatment if necessary
 Educate patients

In this position nurses also re-assess patients and communicate updates on wait times,
etc.

 In situations when a patient’s condition is life-threatening, Triage Nurses also

provide immediate medical treatment.
 One thing is certain—you won’t get bored.
 If you’re looking for something other than the daily grind, this may be the perfect
nursing career for you. There is no such thing as a typical day in the life a triage
nurse.
 Some days you’ll see nothing but broken limbs and people who have influenza.
 Other days you’ll have patients with heart attack symptoms, knife wounds, and
foreign objects in their eye.

Other Role of Triage Nurse

 Greet patients and identify your self

 Maintain privacy and confidentiality
 Visualize all incoming patients even while interviewing others
 Maintain good communication between triage and treatment area
 Maintain excellent communication with waiting area .
 Use all resources to maintain high standard of care .
 Teaching – use of thermometer , first aid
 Crowd control
 Telephone
 Communicate with team leader and seek feedback on decisions .

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Q11. Explain the national policies related to disaster management.

Ans: Meaning

 Disaster management is a process of effectively preparing for and responding to

disasters.
 It involves strategically organizing resources to lessen the harm that disasters
cause.
 It also involves a systematic approach to managing the responsibilities of disaster
prevention, preparedness, response, and recovery.

The objectives of the National Policy on Disaster Management : are

 Promoting a culture of prevention, preparedness and resilience at all

levels through knowledge, innovation and education.
 Encouraging mitigation measures based on technology, traditional
wisdom and environmental sustainability.
 Mainstreaming disaster management into the developmental planning
process.
 Establishing institutional and techno-legal frameworks to create an
enabling regulatory environment and a compliance regime.
 Ensuring mechanism for identification, assessment and monitoring of
disaster risks. Developing contemporary forecasting and early warning
systems backed by responsive and fail-safe communication with
information technology support.
 Ensuring efficient response and relief with a caring approach towards the
needs of the vulnerable sections of the society.
 Undertaking reconstruction as an opportunity to build disaster resilient
structures and habitat for ensuring safer living.
 Promoting a productive and proactive partnership with the media for
disaster management.

Policies related Disaster management

A. First come , first treated , principle will not be followed during emergencies
B. Triage protocol

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C. ABCDE care is provided
 Airway
 Breathing
 Circulation
 Disability limitations
 Exposure

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Q8. Describe the physical rehabilitation of victims of natural disaster .

Ans :

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Q9.Describe the psychosocial rehabilitation of victims of disaster .

Ans :

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Q14. Describe the guidelines for Cardiopulmonary resuscitation .

Ans : Introduction

 Cardiopulmonary resuscitation (CPR) consists of the use of chest compressions

and artificial ventilation to maintain circulatory flow and oxygenation during
cardiac arrest .

Definition

 Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of

chest compressions often combined with artificial ventilation in an effort to
manually preserve intact brain function until further measures are taken to restore
spontaneous blood circulation and breathing in a person who is in cardiac arrest.

Indications
 Cardiac arrest
 Respiratory
 Both

Guidelines for CPR

The steps of CPR include:

 Check that the area is safe for you and your patient, and don appropriate PPE.
 Check for alertness/responsiveness with a tap of the shoulder (AVPU).
 Activate or (direct someone to activate) 911 or call ALS backup as appropriate,
also if not already available bring or have someone bring an AED to the patients
side.
 Place the person on their back on a hard surface.
 Open the patients airway with a head tilt to slightly lift the chin.
 Simultaneously assess for carotid pulse in adults (brachial pulse in children and
infants) and breathing for no more than 10 seconds.
 If patient is unresponsive and is not breathing or has abnormal breathing (ie.
Agonal breathing) and no definitive pulse was, immediately begin chest
compressions of at least 2 inches in depth (≥ 1/3 the anterior-posterior depth of the
chest in children or infants) at a rate of 100-120 compressions per minute, allowing
for full chest recoil.

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  After performing 30 compressions administer two (2) rescue breaths via BVM,
mouth to mouth, mouth to mask or through stoma as appropriate. For children and
infants, if there are two rescuers performing CPR, the ratio of compressions to
ventilations changes to 15:2.
 After the two rescue breaths have been administered immediately resume chest
compressions.
 Repeat the cycle of 30 chest compressions and two rescue breaths and use
the AED/Defibrillator as soon as it is available. Continue CPR until properly
relieved by rescue personnel.

How to perform chest compressions

Compressions for an Adult/Child

 Place one hand over the other with your fingers interlocked (for very small adults
and small children you may optionally only use one hand).
 Place your joined hands palm down with the heel of your hand on the lower half of
the patient's breastbone. For an average adult, this means that your middle finger
should be somewhat in line with the patient's nipple. Be careful to avoid placing
your hands too low as compressions performed too low can cause the xiphoid
process break off, lacerate the liver, etc.
 Place yourself so that you can compress straight down at a 90° angle to the
patient's chest with your arms fully extended.
 Compress to the correct depth at a rate of 100-120 compressions/minute, allowing
for full chest recoil after each compression. Avoid leaning on the patient's chest as
this will not allow for full chest recoil.
1. For an adult: Push down at least 2 inches (5 cm) but no more than 2.4
inches (6 cm) for each compression.
2. For a child: Push down at least 1/3 the anterior-posterior diameter of the
chest for each compression. Do not exceed a depth of 2.4 inches (6 cm).
 Follow proper protocol for the rate of compressions to ventilations. For adults and
children with a single rescuer, this is generally 30:2. Two-rescuer CPR with a child
uses a 15:2 compression to ventilation ratio.

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Compressions for an Infant

Compressions for an infant follow the same basic rules as those for adults and children,
but hand placement and compression depth differ.

 Hand placement for compressions changes depending on whether there are one or
two rescuers.
1. One rescuer: Position yourself at the side of the patient to minimize time
lost when performing ventilations. Place two fingers in the center of the
patient's chest, just below the nipple line.
2. Two rescuers: Position yourself at the patient's feet. Place both thumbs in
the center of the patient's chest, just below the nipple line with the rescuer's
hands encircling the patient. The second rescuer will be at the patient's head.
 Compress at a rate between 100 and 120 compressions/minute (120 for neonate)
and allow for full recoil of the chest between compressions. Avoid squeezing the
patient in your hands when performing two-rescuer compressions.
 Compress to a depth of at least 1/3 the anterior-posterior diameter of the patient's
chest (approximately 1.5 inches).
 Follow proper protocol for the rate of compressions to ventilations. For single
rescuer CPR this is 30:2, two rescuer CPR changes to 15:2.

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Q15. Explain the Disaster management cycle .
Ans : Definition
 WHO defines as any occurrence that causes damage , ecological disruption , loss
of human life , deterioration of health and health services , on a scale sufficient to
warrant an extraordinary responses from outside the affected community or area .

There are mainly two types of disaster:

C. Natural Disaster
D. Man-made Disaster

Meaning

 The disaster management cycle is a series of steps that organizations and

individuals use to prepare, contain and mitigate unexpected events.

Goals

 Reduce loss
 Ensure assistance
 Encourage recovery

Disaster management cycle

A. THE DISASTER EVENT

 This refers to the real-time event of a hazard occurring and affecting the ‘elements
at risk’.
 The duration of the event will depend on the type of threat, for example, ground
shaking may only occur for a few seconds during an earthquake while flooding
may take place over a longer period of time.

B. RESPONSE

 The response phase is the actual implementation of the disaster plan.

 The best response plans use an incident command system, are relatively simple, are
routinely practiced, and are modified when improvements are needed.
 Response activities need to be continually monitored and adjusted to the changing
situation.
 Activities a hospital, healthcare system, or public health agency take immediately
during, and after a disaster or emergency occurs.
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C. RECOVERY

 Once the incident is over, the organization and staff needs to recover. Invariably,
services have been disrupted and it takes time to return to routines.
 Recovery is usually easier if, during the response, some of the staff have been
assigned to maintain essential services while others were assigned to the disaster
response.

Activities undertaken by a community and its components after an emergency or disaster

to restore minimum services and move towards long-term restoration.
 Debris Removal
 Care and Shelter
 Damage Assessments
 Funding Assistance

D. EVALUATION/DEVELOPMENT

 Often this phase of disaster planning and response receives the least attention.
After a disaster, employees and the community are anxious to return to usual
operations.
 It is essential that a formal evaluation be done to determine what went well (what
really worked) and what problems were identified.

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  A specific individual should be charged with the evaluation and follow-through
activities.

E. MITIGATION

 These are steps that are taken to lessen the impact of a disaster should one occur
and can be considered as prevention and risk reduction measures.
 Examples of mitigation activities include installing and maintaining backup
generator power to mitigate the effects of a power failure or cross training staff to
perform other tasks to maintain services during a staffing crisis that is due to a
weather emergency.

F. PREPAREDNESS/RISK ASSESSMENT

 Evaluate the facility’s vulnerabilities or propensity for disasters.

 Issues to consider include: weather patterns; geographic location; expectations
related to public events and gatherings; age, condition, and location of the facility;
and industries in close proximity to the hospital (e.g., nuclear power plant or
chemical factory).

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Q16. Define Shock. Explain the different types of shock.

Ans: Introduction

 Shock is a life-threatening condition of circulatory failure, causing inadequate

oxygen delivery to meet cellular metabolic needs and oxygen consumption
requirements, producing cellular and tissue hypoxia.

Definition

 Shock is defined as a state of cellular and tissue hypoxia due to reduced oxygen
delivery, increased oxygen consumption, inadequate oxygen utilization, or a
combination of these processes.

Types of Shock: are

A. Obstructive Shock
B. Cardiogenic Shock
C. Distributive Shock
D. Hypovolemic Shock .

A. Obstructive shock
 Obstructive shock is a form of shock associated with physical obstruction of
the great vessels of the systemic or pulmonary circulation.
Causes: are
 Pneumothorax (collapsed lung)
 Hemothorax (blood collects in the space between the chest wall and lung)
 Cardiac tamponade (blood or fluids fill the space between the sac that surrounds
the heart and the heart muscle)

B. Cardiogenic shock

 Damage to your heart can decrease the blood flow to your body, leading to
cardiogenic shock.

Common causes of cardiogenic shock include:

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  damage to your heart muscle
 irregular heart rhythm
 very slow heart rhythm

C. Distributive shock

 Conditions that cause your blood vessels to lose their tone can cause distributive
shock.
 When your blood vessels lose their tone, they can become so open and floppy that
not enough blood pressure supplies your organs.

Types of distributive shock : are

i. Anaphylactic shock

 It is a complication of a severe allergic reaction known as anaphylaxis. Allergic

reactions occur when your body mistakenly treats a harmless substance as harmful.
This triggers a dangerous immune response.
 Anaphylaxis is usually caused by allergic reactions to food, insect venom,
medications, or latex.

ii. Septic shock

 It is another form of distributive shock.
 Sepsis, also known as blood poisoning, is a condition caused by infections that lead
to bacteria entering your bloodstream.
 Septic shock occurs when bacteria and their toxins cause serious damage to tissues
or organs in your body.

iii. Neurogenic shock

 It is caused by damage to the central nervous system, usually a spinal cord injury.
This causes blood vessels to dilate, and the skin may feel warm and flushed. The
heart rate slows, and blood pressure drops very low.

28
D. Hypovolemic shock

 Hypovolemic shock happens when there isn’t enough blood in your blood vessels
to carry oxygen to your organs.
 The most common cause of hypovolemic shock is hemorrhage (internal or
external), vomiting and diarrhea are more common causes in children.
 Other causes include burns.

Nursing Management: Write common points

 Nursing Diagnosis
 Goal
 Interventions

Q17. Explain the emergency management of patient with Cardiogenic Shock .

Ans : Introduction

29
  Cardiogenic shock, also known as cardiac shock, happens when your heart cannot
pump enough blood and oxygen to the brain and other vital organs.

 Damage to your heart can decrease the blood flow to your body, leading to
cardiogenic shock.

Common causes of cardiogenic shock include:

 damage to your heart muscle

 sudden blockage of a blood vessel in the lung (pulmonary embolism)

 rupture of the wall of the heart due to increased pressure

Signs and symptoms: are

 Pressure, fullness or a squeezing pain in the center of your chest that lasts for more
than a few minutes.
 Pain spreading to your shoulder, one or both of your arms, your back, or even your
teeth and jaw.
 Increasing episodes of chest pain.

Emergency management

 Emergency treatments may include delivering enriched oxygen via a tube or

mask; breathing assistance, using a ventilator; and intravenous (IV) fluids and
medications to support blood pressure or heart function.

Medications Such as

 Clot-busting drugs, such as tissue plasminogen activator (tPA) to dissolve coronary

artery clots
 Anticlotting medicines – such as aspirin, clopidogrel or heparin – to prevent new clots
 Drugs to increase the heart's pumping ability, such as dobutamine, dopamine and
norepinephrine
 Nitroglycerin to relax and widen blood vessels
 Drugs that decrease the heart's workload and pain, relieve anxiety or regulate heart
rhythm

30
 If medications don't stabilize your condition, your doctor may advise use of a support
device that can temporarily take over the job of pumping your blood, restoring proper
blood flow and giving your heart time to recover.

Options include:

 Intra-aortic balloon pump : A tiny balloon is placed in the aortic artery (the heart's
main artery) via a thin, flexible tube called a catheter; the balloon inflates and deflates
to move blood coming from your heart.
 Impella heart pump : Delivered via a catheter threaded through an artery, this small
pump is implanted in the left side of the heart. It draws oxygenated blood from the
heart and pushes it out to the body.
 Extracorporeal membrane oxygenation (ECMO) : An external device is used to
pump and oxygenate your blood, allowing your heart and lungs to rest.

For a coronary artery blockage, treatments include:

 Coronary bypass surgery – a procedure to create a new route that allows blood to
flow around a narrowed or blocked artery
 Percutaneous coronary interventions – minimally invasive procedures that use
catheters to open a blocked artery and restore blood flow

Q18. Enumerate types of Poisoning and their antidotes.

31
Ans : Introduction

 Poisoning is the harmful effect that occurs when a toxic substance is swallowed,
is inhaled, or comes in contact with the skin, eyes, or mucous membranes, such as
those of the mouth or nose.

Types of Poisoning

The five most common types of poisoning include food, carbon monoxide, household
chemicals, alcohol, and drugs.

Food Poisoning
 Food poisoning is illness caused by food or water contaminated with pathogens
(bacteria and viruses), parasites, or toxins.
 This can be caused by eating unwashed fruits and vegetables or eating raw meat,
poultry, and seafood.
Carbon Monoxide Poisoning
 Carbon monoxide (CO) is a toxic gas produced by the burning of gasoline, wood,
propane, charcoal, and other fuel. CO has no taste, smell, or color.
 If you inhale too much CO into your lungs, a dangerous condition known as carbon
monoxide poisoning can occur.
Household Chemicals Poisoning
 Common household chemicals include antifreeze, motor oil, latex paint, batteries,
all-purpose cleaners, bleach, pesticides, and more.

 Ingestion or inhalation of these chemicals can cause serious to life-threatening

conditions, even death.

Alcohol Poisoning
 Alcohol poisoning occurs when large quantities of alcohol are ingested in a short
period of time (binge drinking).
 This can lead to a wide range of symptoms and complications, including
seizures, cyanosis (blue coloration due to lack of oxygen in the blood),
and hypothermia (low body temperature).
Drugs Poisoning
 Drug poisoning (or drug overdose) is the most common type of poisoning in
adults. It occurs when drugs are abused or taken in large amounts.

 Drug poisoning can alter the way the liver functions, causing irrevocable liver
damage or failure.
32
Antidotes Poisoning or Overdose Indications

 Acetylcysteine  Acetaminophen toxicity

 Antivenom  Black widow spider envenomation
 Atropine  Bradydysrhythmias, cholinesterase inhibito
 Benztropine  Acute dystonia
 Botulinum antitoxin / trivalent ABE  Botulism
 Calcium disodium EDTA  Lead, copper, zinc, cobalt, cadmium toxicit
 Calcium gluconate 10%  Hydrofluoric acid exposure, calcium chann
 Crotalinae polyvalent immune FAB  Crotalinae (rattlesnake) envenomation
 Cyproheptadine  Serotonin syndrome

 Dantrolene  Malignant hyperthermia, neuroleptic malig

 Deferoxamine mesylate  Iron toxicity

Q19. Describe the management of Heat stroke .

Ans : Introduction
 Heatstroke, also called sunstroke, is the most severe form of hyperthermia, or heat-
related illness

Definition

33
  It’s defined as a body temperature above 104 degrees Fahrenheit (40 degrees
Celsius).
Signs and symptoms of heatstroke

 Anhidrosis (dry skin that doesn’t sweat, which is more common in non-exertional
heatstroke).
 Ataxia (problems with movement and coordination).
 Balance problems.
 Delirium (confusion or disorientation).
 Dizziness.
 Excessive sweating that continues after you’ve stopped exercising (more common
in exertional heatstroke).
 Hot, flushed skin or very pale skin.

First aid treatments for heat stroke

First and foremost, cool the victim.

 Get the victim to a shady area, remove clothing, apply cool or tepid water to the
skin , fan the victim to promote sweating and evaporation, and place ice packs
under the armpits and groin.
 If the person is able to drink liquids, have them drink cool water or other
cool beverages that do not contain alcohol or caffeine.
 Monitor body temperature with a thermometer and continue cooling efforts until
the body temperature drops to 101 to 102 F (38.3 to 38.8 C).

Management

Heatstroke requires immediate medical treatment. If you’re waiting for an ambulance to

arrive, try to cool the person as much as possible by:

 Applying ice packs to the neck, groin and armpits.

 Encouraging them to drink slightly salted fluids, such as sports drinks or salted
water.
 Having them lay down in a cool, shady, well-ventilated environment.
 Immersing them in cool water, if possible.
 Misting them with water and blowing air across their bodies (evaporative cooling).
 Monitoring their breathing carefully and removing any airway blockages.
34
  Not giving any medications, including aspirin and acetaminophen.
 Removing any clothing that is tight or heavy.

At the hospital, the person with heatstroke may receive:

 Cooled intravenous fluids through a vein in their arm.

 Cooling blanket.
 Ice bath.
 Medication to prevent seizures.
 Supplemental oxygen.

Nursing Management: write common points

 Nursing Diagnosis
 Goal
 Interventions

Q20. Explain the sign and symptoms of Frost bite & their management .

Ans : Meaning
 Frostbite is an injury caused by freezing of the skin and underlying tissues.

35
Causes: are

 Frostbite occurs when skin and underlying tissues freeze.

 The most common cause of frostbite is exposure to cold-weather conditions.
 But it can also be caused by direct contact with ice, freezing metals or very cold
liquids.

Signs and symptoms of frostbite include:

 At first, cold skin and a prickling feeling

 Numbness
 Skin that looks red, white, bluish-white, grayish-yellow, purplish, brown or ashen,
depending on the severity of the condition and usual skin color
 Hard or waxy-looking skin
 Clumsiness due to joint and muscle stiffness
 Blistering after rewarming, in severe case
Management

Medical treatment may involve rewarming, medications, wound care, surgery and various
therapies, depending on the severity of the injury.

a. Rewarming of the skin.

 If the skin hasn't been rewarmed already, your doctor will rewarm the area using a
warm-water bath for 15 to 30 minutes.

b. Oral pain medicine

 Because the rewarming process can be painful, your doctor will likely give you a
drug to ease the pain.

c. Protecting the injury.

 Once the skin thaws, your doctor may loosely wrap the area with sterile sheets,
towels or dressings to protect the skin.
36
d. Removal of damaged tissue (debridement).

 To heal properly, frostbitten skin needs to be free of damaged, dead or infected

tissue.

e. Whirlpool therapy or physical therapy.

 Soaking in a whirlpool bath (hydrotherapy) can aid healing by keeping skin clean
and naturally removing dead tissue.

f. Infection-fighting drugs.

 If the skin or blisters appear infected, your doctor may prescribe oral antibiotics.

g. Clot-busting drugs.

 You may receive an intravenous (IV) injection of a drug that helps restore blood
flow (thrombolytic), such as tissue plasminogen activator (TPA).

h. Wound care.

 A variety of wound care techniques may be used, depending on the extent of

injury.

i. Surgery.

 People who have experienced severe frostbite may in time need surgery or
amputation to remove dead or decaying tissue.

j. Hyperbaric oxygen therapy.

 Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room.

Some patients show improved symptoms after this therapy.

Nursing Management: Write common points

 Nursing Diagnosis
 Goal
 Interventions
37
Q21. Explain the management of a patient with snake bite .

Ans : Meaning

 A snakebite is an injury caused by the bite of a snake, especially a venomous

snake. A common sign of a bite from a venomous snake is the presence of
two puncture wounds from the animal's fangs.

38
  Venomous snake bites can produce an array of symptoms, including localized pain
and swelling, convulsions, nausea, and even paralysis.
 First symptom of all snakebites is an overwhelming fear, which may contribute to
other symptoms, like nausea and vomiting, diarrhea, vertigo, fainting, tachycardia,
and cold, clammy skin.

First aid

 Call 911 immediately.

 Note the time of the bite.
 Keep calm and still as movement can cause the venom to travel more quickly
through the body.
 Remove constricting clothing or jewelry because the area surrounding the bite will
likely swell.
 Don’t allow the victim to walk. Carry or transport them by vehicle.
 Do not kill or handle the snake. Take a picture if you can but don’t waste time
hunting it down.

At the emergency department you may be given:

 Antibiotics to prevent or treat developing infections

 Medicine to treat your pain
 A special type of antivenin depending on the type of snake that bit you and the
severity of your symptoms

Management of snakebite

 First aid treatment

• Transport to hospital

• Rapid clinical assessment and resuscitation

• Investigations/laboratory tests

39
• Clinical assessment and species diagnosis, if possible

• Antivenom treatment

• Observing the response to antivenom

• Deciding whether further dose(s) of antivenom are needed

• Supportive/ancillary treatment

• Treatment of the bitten part

• Follow-up

• Rehabilitation

Q22. State the regimen of Anti rabies treatment .

Ans : Introduction
 Rabies is a preventable viral disease most often transmitted through the bite of a
rabid animal.
Meaning

40
  Rabies is a viral zoonotic disease that causes progressive and fatal inflammation of
the brain and spinal cord.

Signs and symptoms

 Pain or itching at the site of the bite wound (in 80% of cases)
 Fever, malaise, headache lasting for 2–4 days.
 Hydrophobia (fear of water)
 Intolerance to noise, bright light or air
 Fear of impending death
 Anger, irritability and depression

Regimen

 The rabies PEP regimen involves administration of human rabies immune globulin
(HRIG), which is given only once, and a series of four 1.0 mL rabies vaccinations

A. Human rabies immune globulin (HRIG)

 Human rabies immune globulin (HRIG) is infiltrated around the site of the bite(s),
and provides rapid passive immune protection with a half-life of approximately 21
days.
 It is administered only once, on the first day of the PEP regimen.
 No more than the recommended dosage of HRIG should be given because
excessive HRIG can partially suppress active production of antibody.
 The recommended dosage of HRIG is 20 IU/kg body weight for all ages including
children.
 Infiltrate as much of the HRIG as possible into and around the bite wound.
 Administer the remaining HRIG intramuscularly (IM) at a site distant from the first
vaccination site, generally in the quadriceps or deltoids.

B. Rabies vaccine

 The standard schedule is five doses on days 0, 3, 7, 14 and 30, with day ‘0’ being
the day of commencement of vaccination.

41
  A 1.0 mL dose of rabies vaccine is given IM in the deltoid area of adults or the
anterolateral thigh of young children on Days 0, 3, 7, and 14 of the rabies PEP
regimen.
 The first vaccination is given concurrently with the HRIG at a site distant from the
HRIG.
 An additional fifth dose of rabies vaccine is given on Day 28 to
immunocompromised patients.
 The standard schedule is five doses on days 0, 3, 7, 14 and 30, with day ‘0’ being
the day of commencement of vaccination.
 A regimen of 5 one-mL doses of rabies vaccines should be administered IM to
previously unvaccinated persons.
 The first dose of the 5-dose course should be administered as soon as possible after
exposure.

Q23. Explain the emergency management of Status Asthmaticus.

Ans: Meaning

42
  Status asthmaticus is a medical emergency, an extreme form of asthma
exacerbation characterized by hypoxemia, hypercarbia, and secondary respiratory
failure.

Causes

 respiratory infections
 severe stress
 cold weather
 severe allergic reactions
 air pollution
 exposure to chemicals and other irritants
 smoking

Symptoms include:

 short, shallow breaths

 wheezing
 coughing

Emergency management

 Status asthmaticus is an emergency that requires immediate care in the hospital.

 A doctor will prescribe treatments to improve a person’s breathing as quickly as
possible.
 In the first instance, doctors typically treat status asthmaticus with albuterol.
 This is a short-acting beta-agonist, which helps to make the airways wider.
 The person will need to wear a mask or nasal cannula that will deliver extra
oxygen.

43
Important measures : are
Helium therapy
 The same gas used to inflate balloons can help treat status asthmaticus. Inhaled
helium with oxygen can help to reduce turbulent airflow in the lungs.

Oxygen
 A doctor will often prescribe additional oxygen via a facemask or nasal cannula.
 Ideally, this can help prevent hypoxia in a person with status asthmaticus.

Ketamine
 Doctors may use this medication in anesthesia.
 It has the beneficial effect of bronchodilation, or opening of the airways.

Inhaled anesthetics
 Also known as anesthesia gases, inhaled anesthetics can relax the smooth muscle
of the airways.

Magnesium
 Magnesium is an electrolyte that causes smooth muscle relaxation when delivered
in high enough amounts.
Steroids
 Steroids are inflammation-reducing medications that usually start to work a few
hours after a doctor administers them.
 They will not immediately relieve asthma symptoms, but they will begin to help in
the 24 hours after a person starts treatment.

Nursing Management: Write Common points

 Nursing Diagnosis
 Goal
 Interventions

44
Q24. Explain the emergency management of Cardiogenic Shock .

Ans : Introduction

 Shock is a life-threatening condition of circulatory failure, causing inadequate

oxygen delivery to meet cellular metabolic needs and oxygen consumption
requirements, producing cellular and tissue hypoxia.

Cardiogenic shock

 Cardiogenic shock is a life-threatening condition in which your heart suddenly

can't pump enough blood to meet your body's needs.

Cardiogenic shock signs and symptoms include:

 Rapid breathing
 Severe shortness of breath
 Sudden, rapid heartbeat (tachycardia)
 Loss of consciousness
 Weak pulse
 Low blood pressure (hypotension)
 Sweating
 Pale skin
 Cold hands or feet

Emergency management

Emergency life support

 Most people who have cardiogenic shock need extra oxygen.

 If necessary, you'll be connected to a breathing machine (ventilator).
 You'll receive medications and fluid through an IV line in your arm.

45
Medications
 Fluids and plasma are given through an IV.
 Medications to treat cardiogenic shock are given to increase your heart's pumping
ability and reduce the risk of blood clots.

Vasopressors

 These medications are used to treat low blood pressure.

 They include dopamine, epinephrine and others.
Inotropic agents
 These medications, which help improve the pumping function of the heart, may be
given until other treatments start to work.
 They include dobutamine, dopamine and milrinone.
Aspirin
 Aspirin is usually given immediately to reduce blood clotting and keep blood
moving through a narrowed artery.
Antiplatelet medication
 Emergency room doctors might give you drugs similar to aspirin to help prevent
new clots from forming.
 These medications include clopidogrel (Plavix), tirofiban (Aggrastat) and
eptifibatide (Integrilin).

Other blood-thinning medications.

 You'll likely be given other medications, such as heparin, to make your blood less
likely to form clots. IV or injectable heparin usually is given during the first few
days after a heart attack.
Surgeries and other procedures

Angioplasty and stenting

 If a blockage is found during a cardiac catheterization, your doctor can insert a
long, thin tube (catheter) equipped with a special balloon through an artery, usually
in your leg, to a blocked artery in your heart.

Balloon pump

 Your doctor inserts a balloon pump in the main artery off of your heart (aorta).

46
  The pump inflates and deflates within the aorta, helping blood flow and taking some
of the workload off your heart.

Nursing Management: Write Common points

 Nursing Diagnosis
 Goal
 Interventions

47
 Q25. Write in detail about procedure of CPR .

Ans : Introduction

 Cardiopulmonary resuscitation (CPR) consists of the use of chest compressions

and artificial ventilation to maintain circulatory flow and oxygenation during
cardiac arrest (see the images below).

Definition

 Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of

chest compressions often combined with artificial ventilation in an effort to
manually preserve intact brain function until further measures are taken to restore
spontaneous blood circulation and breathing in a person who is in cardiac arrest.

Indications
 Cardiac arrest
 Respiratory
 Both

Procedure of CPR

The steps of CPR include:

 Check that the area is safe for you and your patient, and don appropriate PPE.
 Check for alertness/responsiveness with a tap of the shoulder (AVPU).
 Activate or (direct someone to activate) 911 or call ALS backup as appropriate,
also if not already available bring or have someone bring an AED to the patients
side.
 Place the person on their back on a hard surface.
 Open the patients airway with a head tilt to slightly lift the chin.
 Simultaneously assess for carotid pulse in adults (brachial pulse in children and
infants) and breathing for no more than 10 seconds.
 If patient is unresponsive and is not breathing or has abnormal breathing (ie.
Agonal breathing) and no definitive pulse was, immediately begin chest
compressions of at least 2 inches in depth (≥ 1/3 the anterior-posterior depth of the
chest in children or infants) at a rate of 100-120 compressions per minute, allowing
for full chest recoil.
48
  After performing 30 compressions administer two (2) rescue breaths via BVM,
mouth to mouth, mouth to mask or through stoma as appropriate. For children and
infants, if there are two rescuers performing CPR, the ratio of compressions to
ventilations changes to 15:2.
 After the two rescue breaths have been administered immediately resume chest
compressions.
 Repeat the cycle of 30 chest compressions and two rescue breaths and use
the AED/Defibrillator as soon as it is available. Continue CPR until properly
relieved by rescue personnel.

How to perform chest compressions

Compressions for an Adult/Child

 Place one hand over the other with your fingers interlocked (for very small adults
and small children you may optionally only use one hand).
 Place your joined hands palm down with the heel of your hand on the lower half of
the patient's breastbone. For an average adult, this means that your middle finger
should be somewhat in line with the patient's nipple. Be careful to avoid placing
your hands too low as compressions performed too low can cause the xiphoid
process break off, lacerate the liver, etc.
 Place yourself so that you can compress straight down at a 90° angle to the
patient's chest with your arms fully extended.
 Compress to the correct depth at a rate of 100-120 compressions/minute, allowing
for full chest recoil after each compression. Avoid leaning on the patient's chest as
this will not allow for full chest recoil.
1. For an adult: Push down at least 2 inches (5 cm) but no more than 2.4
inches (6 cm) for each compression.
2. For a child: Push down at least 1/3 the anterior-posterior diameter of the
chest for each compression. Do not exceed a depth of 2.4 inches (6 cm).
 Follow proper protocol for the rate of compressions to ventilations. For adults and
children with a single rescuer, this is generally 30:2. Two-rescuer CPR with a child
uses a 15:2 compression to ventilation ratio.

49
Compressions for an Infant

Compressions for an infant follow the same basic rules as those for adults and children,
but hand placement and compression depth differ.

 Hand placement for compressions changes depending on whether there are one or
two rescuers.
1. One rescuer: Position yourself at the side of the patient to minimize time
lost when performing ventilations. Place two fingers in the center of the
patient's chest, just below the nipple line.
2. Two rescuers: Position yourself at the patient's feet. Place both thumbs in
the center of the patient's chest, just below the nipple line with the rescuer's
hands encircling the patient. The second rescuer will be at the patient's head.
 Compress at a rate between 100 and 120 compressions/minute (120 for neonate)
and allow for full recoil of the chest between compressions. Avoid squeezing the
patient in your hands when performing two-rescuer compressions.
 Compress to a depth of at least 1/3 the anterior-posterior diameter of the patient's
chest (approximately 1.5 inches).
 Follow proper protocol for the rate of compressions to ventilations. For single
rescuer CPR this is 30:2, two rescuer CPR changes to 15:2.

50
 Q26. Explain the nursing management of patient with respiratory alkalosis.

Ans : Meaning

 Respiratory alkalosis is a condition marked by a low level of carbon dioxide in the

blood due to breathing excessively.

Causes
 Anxiety or panic
 Fever
 Over breathing (hyperventilation)
 Pregnancy (this is normal)
 Pain
 Tumor
 Trauma
 Severe anemia
 Liver disease
 Overdose of certain medicines, such as salicylates, progesterone

Symptoms
 Dizziness
 Lightheadedness
 Numbness of the hands and feet
 Breathlessness
 Confusion
 Chest discomfort

Treatment
 Panic and anxiety-related causes
 Treating the condition is a matter of raising carbon dioxide levels in the blood.

Breathe into a paper bag

 Fill the paper bag with carbon dioxide by exhaling into it.
 Breathe the exhaled air from the bag back into the lungs.
 Repeat this several times.
51
Get reassurance

 Having a calm loved one provide reassurance could help get your breathing under
control.

Restrict oxygen intake into the lungs

 To do this, try breathing while pursing the lips or breathing through one nostril.
 For the second approach to be useful, the mouth and the other nostril need to be
covered.

Nursing Management: Write Common Points

A. Nursing Diagnosis
B. Goals
C. Interventions

52
Q27. Explain the management of patients with seizures.

Ans: Meaning

 A seizure is a burst of uncontrolled electrical activity between brain cells that

causes temporary abnormalities in muscle tone or movements (stiffness, twitching
or limpness), behaviors, sensations or states of awareness.

Types of Seizures: are

A. Focal seizures
Focal seizures result from abnormal electrical activity in one area of your brain. Focal
seizures can occur with or without loss of consciousness:

 Focal seizures with impaired awareness. These seizures involve a change or loss
of consciousness or awareness that feels like being in a dream.
 Focal seizures without loss of consciousness. These seizures may alter emotions or
change the way things look, smell, feel, taste or sound, but you don't lose
consciousness.

B. Generalized seizures

Seizures that appear to involve all areas of the brain are called generalized seizures.
Different types of generalized seizures include:

 Absence seizures. Absence seizures, previously known as petit mal seizures, often
occur in children and are characterized by staring into space or by subtle body
movements, such as eye blinking or lip smacking. .
 Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures
usually affect muscles in your back, arms and legs and may cause you to lose
consciousness and fall to the ground.
 Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of
muscle control, which may cause you to suddenly collapse, fall down or drop your
head.

53
  Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking
muscle movements. These seizures usually affect the neck, face and arms on both
sides of the body.
 Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or
twitches of your arms and legs. There is often no loss of consciousness.
 Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal
seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss
of consciousness, body stiffening and shaking.

Management of Seizures

A. Pharmacological Management

Anticonvulsants or Antiseizure medications are used to control the seizure.

i. Benzodiazepines like

 Clonazepam
 Clorazepate
 Diazepam

ii. Phenytoin

iii. Carbamazepine

iv. Lamotrigine

v. Valproate

vi. Phenobarbitol

B. Dietary therapy
 Following a diet that's high in fat and very low in carbohydrates, known as a
ketogenic diet, can improve seizure control.

54
C. Surgery

 Lobectomy (lesionectomy). Surgeons locate and remove the area of your brain
where seizures begin.
 Multiple subpial transection. This type of surgery involves making several cuts in
areas of the brain to prevent seizures.
 Corpus callosotomy. This surgery cuts the network of connections between the
neurons of the right and left halves of the brain.
Electrical stimulation

Other procedures that may offer seizure relief include:

 Vagus nerve stimulation. A device implanted underneath the skin of your chest
stimulates the vagus nerve in your neck, sending signals to your brain that inhibit
seizures.
 Responsive neurostimulation. During responsive neurostimulation, a device
implanted on the surface of your brain or within brain tissue can detect seizure
activity and deliver an electrical stimulation to the detected area to stop the seizure.
 Deep brain stimulation. Doctors implant electrodes within certain areas of your
brain to produce electrical impulses that regulate abnormal brain activity.

Nursing Management: Write common points

 Nursing Diagnosis
 Goals
 Interventions

55
Q28. Explain in detail about crash cart.

Ans : Meaning

 A crash cart or code cart or "MAX cart" is a set of trays/drawers/shelves on wheels

used in hospitals for transportation and dispensing of emergency
medication/equipment at site of medical/surgical emergency for life support
protocols (ACLS/ALS) to potentially save someone's life.
 The contents and organization of a crash cart vary from hospital to hospital,
country to country, and specialty to specialty, but typically contain the tools and
drugs needed to treat a person in or near cardiac arrest or another life-threatening
condition.
These include but are not limited to:

 Monitor/defibrillators, suction devices, and bag valve masks (BVMs) of different

sizes
 Advanced cardiac life support (ACLS) drugs such
as epinephrine, atropine, amiodarone, lidocaine, sodium bicarbonate, dopamine,
and vasopressin
 First line drugs for treatment of common problems such as: adenosine, dextrose,
epinephrine for IM use, naloxone, nitroglycerin, and others
 Drugs for rapid sequence intubation: succinylcholine or another paralytic, and
a sedative such as etomidate, propofol or midazolam; endotracheal tubes and
other intubating equipment
 Drugs for peripheral and central venous access
 Pediatric equipment (common pediatric drugs, intubation equipment, etc.)
 Other drugs and equipment as chosen by the facility

Best Way to Arrange A Crash Cart

Here is a simple and effective way to arrange your crash cart.

Top of the Crash Cart

 The top of a crash cart should carry gloves, monitors, and other related life support
tools, defibrillators with leads and paddles, and a sharps disposal container.
 Make sure the defibrillator you put on your crash cart is multipurpose so that it can
be used in various emergency situations.
 The sides and back of the crash cart should carry things like the oxygen tank,
regulators, backboard (cardiac), and handheld suction tools.

56
First Drawer
 The first drawer should have the ECG gel and all the electrodes for both adults and
children.
 The electrodes are attached to a machine that registers the heart’s electrical
activity.
Second Drawer
 Use the second drawer to manage your airways.
 This drawer is also referred to as the intubation drawer, as it carries all the
necessary intubation materials.
 An intubation drawer should carry important items such as the endotracheal tubes,
nasopharyngeal and oropharyngeal airways, laryngoscope handle and blades, a
flashlight, syringes to inflate the cuff on the endotracheal tube, bite block, nasal
filter lines, tongue depressor, battery, stylets, ET tubes, Magill forceps, disposable
airways, syringes, pieces of Dyna plaster, and laryngeal masks.
Third Drawer
 As you organize your crash cart, make sure that the equipment needed to start an
IV is kept in a separate drawer from the other materials needed to maintain an IV,
including the fluids in the tubes.
 This drawer should therefore carry all the necessary IV materials, including an IV
start kit, catheters, disinfectants, disposable syringes, tourniquet tubes, vacutainers,
and IV solutions.
 You can also keep your pressure monitoring line, disposable needles, disposable
kidney tray, Burette set, posiflush, 3-way stopcocks, and IV sets with extensions in
this drawer.
Fourth Drawer
 This drawer is also known as the medication drawer as it carries different types of
medications including high-alert medications such as Adrenaline 1mg/ml-1,
Amiodarone 150mg/3ml-2, Dopamine 200mg in 5ml-2, Dobutamine 250mg in 5ml
or 20ml-2, and 50% Dextrose 50ml-1.

Fifth Drawer
 In the fifth drawer, you should keep all your IV fluids, including 1000 ml each of
D5W, RL, NS, 500 ml each D5W, NS, and 100 ml NS-2.

Tips For Arranging Your Crash Cart

There are several important steps you need to follow when arranging your crash cart.
Such as

57
 Clearly labeling all your drawers to indicate the contents inside. That way, your
medical staff won’t waste time going through every drawer in search of a particular
item.
 Clearly distinguishing pediatric items from adult supplies. You can do so by
keeping them in separate compartments inside the drawers.
 Designating one person to restock and manage the crash carts. This creates
uniformity in all the carts, making it easier for your medical staff to use the carts
during different emergency situations.
 Placing your crash carts in an easy-to-access area. If possible, put your carts in a
low-traffic area so your medical professionals don’t have to go through many
people to get to the emergency room. The carts should only be moved from this
location when they are in use.
 Educating your hospital staff on proper patient care and how to use, restock, and
locate crash carts during an emergency.

58
Q29. Discuss the drugs used in Emergency department.

Ans: Meaning

 Emergency drugs means those drugs critical for patient care and approved by the
institution’s pharmacy and therapeutics committee or equivalent committee.

Categories of Emergency Drugs

 Emergency drugs may be divided into two categories.

 The first category is drugs that are essential and should be part of every emergency
drug kit.
 The second category consists of drugs that are useful but are optional or additional

Essential Emergency Drugs

Emergency Drug Indication

Oxygen Almost any emergency

Anaphylaxis
Epinephrine Asthma unresponsive to
albuterol/salbutamol

Nitroglycerin Angina pain

Diphenhydramine Allergic reactions

Albuterol/salbutamol Asthmatic bronchospasm

Aspirin Myocardial infarction

Glucose Hypoglycemia
59
 (patient unconscious)

Additional Emergency Drugs

Drug Indication

Clinically significant
Atropine
bradycardia

Adrenal insufficiency
Hydrocortisone
Recurrent anaphylaxis

Angina pain
Morphine or nitrous oxide unresponsive to
nitroglycerin

Reversal of opioid
Naloxone
overdose

Lorazepam or Midazolam Status epilepticus

Flumazenil Benzodiazepine overdose

Acetaminophen
Acetylcysteine
Overdose

Systolic Ventricular
Adenosine
Tachycardia

60
 Amiodarone Pulseless VF/VT

Dobutamine Heart failure &

Hypotension

Heart failure &

Dopamine Hypotension

Pulmonary edema
Furosemide

Thrombo-embolism
Heparin

Q30. Discuss in detail about thoracentesis.

Ans : Meaning
 A thoracentesis is a procedure that involves the use of a needle to remove excess
fluid from the pleural space between the lungs and the chest wall.
61
Purposes

 Diagnostic reasons: A thoracentesis can help doctors identify the cause of the
pleural effusion.
 Therapeutic reasons: Too much fluid in the pleural space compresses the lungs,
making it difficult for a person to breathe properly. Removing the fluid reduces
pressure on the lungs, alleviating pain and shortness of breath.

Indications

 Traumatic pneumothorax
 Hemopneumothorax ‘
 Pleural effusion
 For diagnostic purpose
 Therapeutic purpose

Procedure

 A thoracentesis usually takes between 10 and 15 minutesTrusted Source,

depending on the amount of fluid in the pleural space.
 The more fluid there is to drain out, the longer the procedure will take.
a. Prior to the procedure
 Before the procedure, the doctor may perform a chest ultrasound to identify the
area with the greatest amount of fluid.
 Later, the doctor will insert the needle into this space.
 Before carrying out the procedure, the doctor will sterilize the injection site and
administer a local anesthetic.
b.During the procedure
 People usually remain awake for a thoracentesis.
 A doctor may ask the person to position themselves sitting on the edge of a chair or
bed with their head and arms resting on a table.
 Sitting in this position helps spread out the spaces between the ribs, making it
easier for the doctor to insert the needle into the pleural space.

62
  The doctor may ask the person to hold their breath during the procedure. Some
people report the urge to cough as the fluid drains out and their lung re-expands.
 It is very important to stay as still as possible throughout the procedure to avoid
any accidental damage to the lungs.
 If there is a lot of fluid to remove from the pleural space, a doctor may attach a
tube to the needle to aid drainage.
 At the end of the procedure, the doctor will remove the needle and cover the area
with a dressing.

c. After the procedure

 A person will receive an X-ray after the thoracentesis to check that the procedure
was a success.
 They will then undergo a period of careful monitoring to ensure that they do not
develop complications.
 A doctor will send fluid samples to a lab to help identify the cause of the pleural
effusion.
 The results will help the doctor make an accurate diagnosis and provide
appropriate treatment

Pre-operative Care: Write common points

Post-operative Care: Write common points

UNIT – I

ENT

SHORT ESSAY ( 5 Marks )

63
Q1. Explain Post operative management of Mastoiditis.

Ans: Meaning

 Mastoiditis is a bacterial infection of the mastoid air cells surrounding the inner and
middle ear.

Causes
 Bacteria from the middle ear can travel into the air cells of the mastoid bone. Less
a growing collection of skin cells called a cholesteatoma, may block drainage of
the ear, leading to mastoiditis.

Mastoiditis Symptoms

 Fever, irritability, and lethargy

 Swelling of the ear lobe
 Redness and tenderness behind the ear
 Drainage from the ear
 Bulging and drooping of the ear

Treatments
 Antibiotic therapy is the mainstay of treatment for both acute and chronic mastoiditis.
Surgery
 Surgery may also be needed to drain the fluid from the middle ear, called a
myringotomy.

Post operative care

 Do not lift anything heavier than 15 pounds.

 Do not bend at the waist. Bend at the knee if you need to reach something on the
floor.
 Do not blow your nose.
64
  Sneeze with your mouth open.
 No water in the ear.
 For those patients who have had ossicular reconstruction it is most important to
avoid any activity that would put you at risk of falling or being hit in the head. No
jogging or jarring motion.

DRESSINGS

 The large dressing over the ear and the wound drain will be removed in our office
the day after surgery.
 Use prescribed ear drops after dressing removal. After using drops, place a new,
clean cotton ball in the ear canal.
 Ten to fourteen days of drainage is normal. The first few days, you may need to
change the cotton ball more frequently. Each day it will be less in amount. The
color of the drainage will change from red to yellow to clear, and then stop.
 Keep water out of the ear by using ear plugs.

Other Post Operative care

 Keep your head elevated with several pillows when lying down for 2 weeks
following surgery.
 Do not blow your nose until your doctor has told you that your ear is healed.
 Any accumulated secretions in the nose may be drawn back into the throat and spit
out if desired.
 Do not “pop” your ears by holding your nose and blowing air through the
Eustachian tube into the ear.
 Sneeze with your mouth open.
 Do not allow water to enter your ear until advised by your doctor.
 The outer cap may be removed 48 hours after surgery.
 After you have removed the outer cap, clean the incision with hydrogen peroxide
twice a day until it has healed.
 Apply a small amount of Bacitracin or Neosporin to the incision after cleansing.
 The sutures are dissolvable and will fall out on their own.

Q2. List the causes and management of Epistaxis.

Ans: Meaning

 Epistaxis (also called a nosebleed) refers to a minor bleeding from the blood
vessels of the nose.
65
Causes

The most common cause of nosebleeds is dry air.

Other common causes of nosebleeds include:

 Nose picking.
 Colds (upper respiratory infections) and sinusitis, especially episodes that cause
repeated sneezing, coughing and nose blowing.
 Blowing your nose with force.
 Inserting an object into your nose.
 Injury to the nose and/or face.
 Allergic and non-allergic rhinitis
 Blood-thinning drugs (aspirin, non-steroidal anti-inflammatory drugs, warfarin,
and others).
 Cocaine and other drugs inhaled through the nose.
 Chemical irritants (chemicals in cleaning supplies, chemical fumes at the
workplace, other strong odors).
 Deviated septum

Management

 Nasal packing. Gauze, special nasal sponges or foam or an inflatable latex balloon
is inserted into your nose to create pressure at the site of the bleed.
 Cauterization. This procedure involves applying a chemical substance (silver
nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel.
 Medication adjustments/new prescriptions. Tranexamic (Lystedaâ), a
medication to help blood clot, may be prescribed.
 Foreign body removal if this is the cause of the nose bleed.
 Surgical repair of a broken nose or correction of a deviated septum if this is
the cause of the nosebleed.
 Ligation. In this procedure, the culprit blood vessel is tied off to stop the bleeding.

Nursing Management: Write common points

 Nursing Diagnosis , Goal and Interventions .

Q3. Explain the rehabilitation of a patient with hearing loss.

Ans: Meaning

 A person is said to have hearing loss if they are not able to hear as well as someone
with normal hearing, meaning hearing thresholds of 20 dB or better in both ears.

66
Treatment

Options include:

 Removing wax blockage. Your doctor may remove earwax using suction or a small
tool with a loop on the end.
 Surgical procedures. Some types of hearing loss can be treated with surgery,
including abnormalities of the eardrum or bones of hearing (ossicles).
 Hearing aids. If your hearing loss is due to damage to your inner ear, a hearing aid
can be helpful.
 Cochlear implants. If you have more severe hearing loss and gain limited benefit
from conventional hearing aids, then a cochlear implant may be an option.
Rehabilitation measures

 Hearing aid orientation: The process of providing education and therapies to

persons (individual or group) and their families about the use and expectations of
wearing hearing aids to improve communication.
 Listening strategies: The process of teaching hard of hearing persons common and
alternative strategies when listening with or without amplification to improve their
communication.
 Speechreading: The process of using or teaching the understanding communication
using visual cues observed from the speaker’s mouth, facial expressions, and hand
movements.
 Auditory Training: The process of teaching an individual with a hearing loss the
ability to recognize speech sounds, patterns, words, phrases, or sentences via audition.
 Unisensory: Therapy philosophy that centers on extreme development of a single
sense for improving communication.
 Cued speech: The process of using and teaching manual hand or facial movements
used to supplement an auditory-verbal approach to the development of
communication competence.
 Total communication: The process of using and teaching speech, language, and
communication skills simultaneously using manual communication, speech, and
hearing.
 Manual communication: The process of using and teaching communication via
finger-spelling and with a sign language.

Methods of rehabilitation

67
  Parental guidance
 Hearing aid
 Speech & language therapy
 Education of deaf
 Vocational guidance

Nursing management: Write Common points

 Nursing diagnosis
 Goal
 Interventions

Q4. Explain the management of common cold.

Ans: Meaning

68
  The common cold, also known simply as a cold, is a viral infectious disease of
the upper respiratory tract that primarily affects the respiratory mucosa of
the nose, throat, sinuses, and larynx.

Causes

 A group of viruses known for causing the common cold.

 The common cold is an infection of the upper respiratory tract which can be caused
by many different viruses.
 Allergy
 Exposure to Cold climate
Transmission
 The common cold virus is typically transmitted via airborne droplets (aerosols),
direct contact with infected nasal secretions, or fomites (contaminated objects).
Signs and symptoms

The typical symptoms of a cold include cough, runny nose, sneezing, nasal congestion,
and a sore throat, sometimes accompanied by muscle ache, fatigue, headache, and loss of
appetite.

Management

 Treatments of the common cold primarily involve medications and other therapies
for symptomatic relief.
 Getting plenty of rest, drinking fluids to maintain hydration, and gargling with
warm salt water are reasonable conservative measures.

Symptomatic Treatment
 Pain medication and medications for fevers such as ibuprofen and acetaminophen
(paracetamol).
 In adults short term use of nasal decongestants may have a small benefit.
 Antihistamines may improve symptoms in the first day or two; however
Antibiotics and antivirals
Zinc
 Zinc supplements may shorten the duration of colds by up to 33% and reduce the
severity of symptoms if supplementation begins within 24 hours of the onset of
symptoms.

69
Alternative medicine
 there are many alternative medicines and Chinese herbal medicines supposed to
treat the common cold,

Nursing management: Write Common points

 Nursing diagnosis
 Goal
 Interventions

Q5. Describe the nursing management of Sinusitis.

Ans: Meaning

 Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses.

70
Causes

Sinusitis can be caused by a virus, bacteria, or fungus that swells and blocks the sinuses.
A few specific causes include:

 The common cold.

 Nasal and seasonal allergies, including allergies to mold.
 Polyps (growths).
 A deviated septum.
 A weak immune system from illness or medications.

Signs and symptoms of sinusitis

 Post nasal drip (mucus drips down the throat).

 Nasal discharge (thick yellow or green discharge from nose) or stuffy nose
 Facial pressure (particularly around the nose, eyes, and forehead), headache and or
pain in your teeth or ears.
 Halitosis (bad breath)
 Cough.
 Tiredness.
 Fever.

Management

A simple sinusitis infection is treated with:

 Antibiotics (for seven days in adults and 10 days in children).

 Oral or topical decongestants.
 Prescription intranasal steroid sprays.
 Decongestants.
 Over-the-counter cold and allergy medications.
 Nasal saline irrigation.
 Drinking fluids (sinusitis is a viral infection and fluids will help).
 Topical antihistamine sprays or oral pills.
 Leukotriene antagonists to reduce swelling and allergy symptoms.

Nursing management: Write Common points

 Nursing diagnosis
 Goal
 Interventions
71
Q6. Discuss the meaning, causes and clinical manifestations of Pharyngitis.

Ans: Meaning

 Pharyngitis is inflammation of the back of the throat, known as the pharynx

72
Causes

There are numerous viral and bacterial agents that can cause Pharyngitis such as

 measles
 adenovirus, which is one of the causes of the common cold
 chickenpox
 croup, which is a childhood illness distinguished by a barking cough
 whooping cough
 group A streptococcus

Signs and Symptoms: are

 sneezing
 runny nose
 headache
 cough
 fatigue
 body aches
 chills
 fever (a low-grade fever with a cold and higher-grade fever with the flu)

Medical treatment
 Antibiotics like Amoxicillin and penicillin are the most commonly prescribed
treatments for strep throat.

Nursing management: Write Common points

 Nursing diagnosis
 Goal
 Interventions

Q7. Explain medical and nursing management of tonsillitis.

Ans: Meaning

 Tonsillitis is an infection of your tonsils, two masses of tissue at the back of your
throat.
73
 Causes

 A virus, such as the common cold, can trigger tonsillitis. Bacterial infections, such
as strep throat, are also possible causes.

Symptoms

 a very sore throat

 difficulty or pain while swallowing
 a scratchy-sounding voice
 bad breath
 fever
 chills
 earache
 stomachache
 headache
 a stiff neck
 jaw and neck tenderness from swollen lymph nodes
 tonsils that appear red and swollen
 tonsils that have white or yellow spots

Medical management

 Pain medicines to relieve the sore throat can also help while the throat is healing.
 Salt warm water mouth gargling
 Betadine solution mouth gargling
 Lozenges eg : Strepsills
 Antibiotics
Surgical Management
Tonsillectomy
 Surgery to remove the tonsils is called a tonsillectomy.
74
Nursing management: Write Common points

 Nursing diagnosis
 Goal
 Interventions

Q8. Explain surgical and nursing management of tonsillitis.

Ans : Meaning

 Tonsillitis is an infection of your tonsils, two masses of tissue at the back of your
throat.
75
 Causes

 A virus, such as the common cold, can trigger tonsillitis. Bacterial infections, such
as strep throat, are also possible causes.

Symptoms

 a very sore throat

 difficulty or pain while swallowing
 a scratchy-sounding voice
 bad breath
 fever
 chills
 earache
 stomachache
 headache
 a stiff neck
 jaw and neck tenderness from swollen lymph nodes
 tonsils that appear red and swollen
 tonsils that have white or yellow spots

Medical management

 Pain medicines to relieve the sore throat can also help while the throat is healing.
 Salt warm water mouth gargling
 Betadine solution mouth gargling
 Lozenges eg : Strepsills
 Antibiotics
Surgical Management
Tonsillectomy
 Surgery to remove the tonsils is called a tonsillectomy.
76
Methods

 Dissection and snare method: Removal of the tonsils by use of a forceps and
scissors with a wire loop called a snare .
 Electrocautery: Electrocautery uses electrical energy to separate the tonsillar tissue
and assists in reducing blood loss through cauterization.

Post Operative Care : Write Common Points

Nursing management: Write Common points

 Nursing diagnosis
 Goal
 Interventions

Q9. Explain care of patient with Tracheostomy.

Ans: Meaning

 A tracheostomy is a medical procedure that involves creating an opening in the

neck in order to place a tube into a person’s trachea, or windpipe.
77
INDICATIONS

 the need for prolonged respiratory or ventilator support

 congenital abnormalities of the airway
 airway burns from the inhalation of corrosive material
 obstruction of the airway by a foreign object
 obstructive sleep apnea
 injury to the larynx, also known as the voice box
 severe neck or mouth injuries
 bilateral vocal cord paralysis

Care of Patient with Tracheostomy

Caring for your tracheostomy tube

 A nurse will teach you how to clean and change your tracheostomy tube to help
prevent infection and reduce the risk of complications.

Speaking

 Generally, a tracheostomy prevents speaking because exhaled air goes out the
tracheostomy opening rather than up through your voice box.
 But there are devices and techniques for redirecting airflow enough to produce
speech.

Eating

 While you're healing, swallowing will be difficult.

 You'll receive nutrients through an intravenous (IV) line inserted into a vein in
your body, a feeding tube that passes through your mouth or nose, or a tube
inserted directly into your stomach.

Coping with dry air.

 Putting small amounts of saline directly into the tracheostomy tube, as directed, may
help loosen secretions. Or a saline nebulizer treatment may help.

78
  A device called a heat and moisture exchanger captures moisture from the air you
exhale and humidifies the air you inhale.

Managing other effects.

 Your health care team will show you ways to care for other common effects related
to having a tracheostomy.
 For example, you may learn to use a suction machine to help you clear secretions
from your throat or airway.

Nursing management: Write Common points

 Nursing diagnosis
 Goal
 Interventions

Q10. Briefly describe the causes, signs and symptoms of Otitis media.

Ans: Meaning

 Otitis media is inflammation or infection located in the middle ear.

Causes: are

 Middle ear infections are usually a result of a malfunction of the eustachian tube
79
  A cold or allergy which can lead to swelling and congestion of the lining of the
nose, throat, and eustachian tube
 A malformation of the eustachian tube
 Upper respiratory tract infection
 Accumulation of pus behind the eardrum .

Signs and Symptoms: are

 ear pain
 irritability
 difficulty sleeping
 tugging or pulling at the ears
 fever
 loss of balance
 problems hearing
 nausea and vomiting
 diarrhea
 decreased appetite
 congestion

Treatment may include:

 Antibiotic medication by mouth or ear drops

 Medication (for pain and fever)
 Observation
 A combination of the above

Nursing management: Write Common points

 Nursing diagnosis
 Goal and Interventions

Q11. Clinical manifestations and nursing management of patients with otitis media.

Ans: Meaning

 Otitis media is inflammation or infection located in the middle ear.

Causes: are

 Middle ear infections are usually a result of a malfunction of the eustachian tube
80
  A cold or allergy which can lead to swelling and congestion of the lining of the
nose, throat, and eustachian tube
 A malformation of the eustachian tube
 Upper respiratory tract infection
 Accumulation of pus behind the eardrum .

Signs and Symptoms: are

 ear pain
 irritability
 difficulty sleeping
 tugging or pulling at the ears
 fever
 loss of balance
 problems hearing
 nausea and vomiting
 diarrhea
 decreased appetite
 congestion

Treatment may include:

 Antibiotic medication by mouth or ear drops

 Medication (for pain and fever)
 Observation
 A combination of the above

Nursing management: Write Common points

 Nursing diagnosis
 Goal and Interventions

Q12. Discuss causes and signs and symptoms of speech disorders.

Ans: Meaning

 A speech disorder is a condition in which a person has problems creating or

forming the speech sounds needed to communicate with others. This can make the
child's speech difficult to understand.

Common speech disorders are:

81
  Articulation disorders
 Phonological disorders
 Disfluency
 Voice disorders or resonance disorders
 Speech disorders are different from language disorders in children. Language
disorders refer to someone having difficulty with:
 Getting their meaning or message across to others (expressive language)
 Understanding the message coming from others (receptive language)

Causes
 Genetic abnormalities
 Emotional stress
 Any trauma to brain or infection
 Articulation and phonological disorders may occur in other family members
 Problems or changes in the structure or shape of the muscles and bones used to
make speech sounds. These changes may include cleft palate and tooth problems.
 Damage to parts of the brain or the nerves (such as from cerebral palsy) that
control how the muscles work together to create speech.
 Hearing loss.
Signs & symptoms

Stuttering is the most common type of disfluency.

Symptoms of disfluency can include:

 Repetition of sounds, words, or parts of words or phrases after age 4 (I want...I

want my doll. I...I see you.)
 Putting in (interjecting) extra sounds or words (We went to the...uh...store.)
 Making words longer (I am Boooobbby Jones.)
 Pausing during a sentence or words, often with the lips together
 Tension in the voice or sounds
 Frustration with attempts to communicate
 Head jerking while talking
 Eye blinking while talking
 Embarrassment with speech
ARTICULATION DISORDER

 The child is not able to produce speech sounds clearly, such as saying "coo"
instead of "school."
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 PHONOLOGICAL DISORDER

 The child does not use some or all of the speech sounds to form words as expected
for their age.

Treatment
 Speech therapy may help with more severe symptoms or any speech problems that
do not improve.
 In therapy, the therapist may teach your child how to use their tongue to create
certain sounds.

If a child has a speech disorder, parents are encouraged to

 Avoid expressing too much concern about the problem, which can actually make matters
worse by making the child more self-conscious.
 Avoid stressful social situations whenever possible.
 Listen patiently to the child, make eye contact, don't interrupt, and show love and
acceptance. Avoid finishing sentences for them.
 Set aside time for talking.

Nursing management: Write Common points

 Nursing diagnosis
 Goal
 Interventions

Q13. Explain the care and maintenance of hearing aids.

Ans: Meaning

 A hearing aid is a device designed to improve hearing by making sound audible to

a person with hearing loss.

The four primary types of devices are:

 behind-the-ear (BTE)
 in-the-canal (ITC)
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 in-the-ear (ITE)
 receiver-in-canal (RIC)
Uses of Hearing aids: are

 Hearing aids are used for a variety of pathologies including sensori-neural hearing
loss, conductive hearing loss, and single-sided deafness.
Care of hearing aids

The following suggestions will help you care for hearing aids:

 Keep hearing aids away from heat and moisture.

 Replace dead batteries immediately.
 Clean hearing aids as instructed.
 Do not use hairspray or other hair care products while wearing hearing aids.
 Turn off hearing aids when they are not in use.
 Keep replacement batteries and small aids away from children and pets.
 Be careful not to drop the hearing aid.

Maintenance of Hearing aids

1. Never skip daily cleanings. Always use a soft, dry cloth to wipe down your hearing
aids’ interior and exterior.
2. Replace parts as needed. Depending on the type of hearing aids you use, you may
need to regularly replace batteries, tubing, wax guards and/or wax filters.
3. Keep your hearing aids clean and dry. Hearing aids constantly exposed to
potentially damaging particles including lotions, hair sprays, rain, snow, earwax,
dirt and dust.
4. Take hearing aid batteries out at night. This offers several benefits, including: it
will extend the life of the batteries, allow your hearing aids to dry out thoroughly,
prevent your devices from being accidentally turned on when not in use, and
encourage proper cleaning of the battery compartment, including the battery
contacts.
5. Schedule two to four “clean and checks” annually. Clean and check
appointments are very important, as they allow your audiologist to assess your
devices to ensure you’re hearing at your very best.
6. Troubleshoot at home. Many times, minor issues can cause your hearing aids to
function poorly or stop working altogether.
7. Utilize your audiologist. Today’s devices are very complex and imperfect
programming can have a substantial effect on how well your hearing aids are
performing.
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 8. Don’t forget your warranty. Hearing aids are always backed by a manufacturer’s
warranty; it is important to remember the terms of your warranty to ensure you get
any repairs you need
9. Ask about accessories. In almost every case, there is an effective solution for your
concerns using either special programming techniques or one of the many hearing
aid accessories on the market.
10.Avoid outdated technology. Hearing aids have been rapidly advancing for the past
several years since the advent of digital technology.

Q14. Explain the role of nurse in communicating with hearing impaired patients.

Ans: Meaning

 The term "hearing impaired" is often used to describe people with any degree of
hearing loss, from mild to profound, including those who are deaf and those who
are hard of hearing.

Causes

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  Aging and exposure to loud noise may cause wear and tear on the hairs or nerve
cells in the cochlea that send sound signals to the brain.

Types

The three basic categories of hearing loss are

 Sensorineural hearing loss,

 Conductive hearing loss and
 Mixed hearing loss.

The Role of a nurse in Communicating with People with Hearing Loss is

Explanation:

 A communication needs the efforts of all people who are involved in a conversation.
 Even though the person with hearing loss utilizes hearing aids and active listening
strategies, it is important that others are involved in the communication process
consistently with the good communication strategies.
 The roles of nurses in communicating with hearing impairment and muteness are:
 Face the hearing-impaired person directly with the same level and in good light
whenever possible.
 Do not talk from another room or far away from the patient having hearing
impairment.
 Speak clearly, slowly, distinctly, but naturally, without shouting or exaggerating
mouth movements.
 Don't get frustrate while speaking again if the patient don't understand.
 Use simple words with the patient.

 Face the hearing-impaired person directly, on the same level and in good light
whenever possible
 Speak clearly, slowly, distinctly, but naturally, without shouting or exaggerating mouth
movements.
 Shouting distorts the sound of speech and may make speech reading more difficult.
 Say the person's name before beginning a conversation.
 This gives the listener a chance to focus attention and reduces the chance of missing
words at the beginning of the conversation.
 Avoid talking too rapidly or using sentences that are too complex.
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 Slow down a little, pause between sentences or phrases, and wait to make sure you
have been understood before going on.
 Keep your hands away from your face while talking.
 If the hearing-impaired listener hears better in one ear than the other, try to make a
point of remembering which ear is better so that you will know where to position
yourself.
 Be aware of possible distortion of sounds for the hearing-impaired person. They may
hear your voice, but still may have difficulty understanding some words.
 Most hearing-impaired people have greater difficulty understanding speech when there
is background noise. Try to minimize extraneous noise when talking.
 Some people with hearing loss are very sensitive to loud sounds. This reduced
tolerance for loud sounds is not uncommon. Avoid situations where there will be loud
sounds when possible.
 Recognize that everyone, especially the hard-of-hearing, has a harder time hearing and
understanding when ill or tired.
 Pay attention to the listener. A puzzled look may indicate misunderstanding. Tactfully
ask the hearing-impaired person if they understood you, or ask leading questions so
you know your message got across.
 Take turns speaking and avoid interrupting other speakers.
 Enroll in aural rehabilitation classes with your hearing-impaired spouse or friend.

Q15. Explain the nursing management of patients with Meniere’s disease.

Ans: Meaning

 Meniere's disease is a disorder of the inner ear that can lead to dizzy spells
(vertigo) and hearing loss.

Causes

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  Improper fluid drainage, perhaps because of a blockage or anatomic abnormality
 Abnormal immune response
 Viral infection
 Genetic predisposition
Signs and symptoms of Meniere's disease include:

 Recurring episodes of vertigo. You have a spinning sensation that starts and stops
spontaneously.
 Hearing loss. Hearing loss in Meniere's disease may come and go, particularly early
on. Eventually, most people have some permanent hearing loss.
 Ringing in the ear (tinnitus). Tinnitus is the perception of a ringing, buzzing,
roaring, whistling or hissing sound in your ear.
 Feeling of fullness in the ear. People with Meniere's disease often feel pressure in
an affected ear (aural fullness).
Management

 Motion sickness medications, such as meclizine or diazepam (Valium), may reduce

the spinning sensation and help control nausea and vomiting.
 Anti-nausea medications, such as promethazine, might control nausea and
vomiting during an episode of vertigo.
Noninvasive therapies and procedures

Some people with Meniere's disease may benefit from other noninvasive therapies and
procedures, such as:

 Rehabilitation. If you have balance problems between episodes of vertigo,

vestibular rehabilitation therapy might improve your balance.
 Hearing aid. A hearing aid in the ear affected by Meniere's disease might improve
your hearing. Your doctor can refer you to an audiologist to discuss what hearing aid
options would be best for you.
 Positive pressure therapy. A device called a Meniett pulse generator applies
pulses of pressure to the ear canal through a ventilation tube. Middle ear injections

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  Gentamicin, an antibiotic that's toxic to your inner ear, reduces the balancing
function of your ear, and your other ear assumes responsibility for balance. There is
a risk, however, of further hearing loss.
 Steroids, such as dexamethasone, also may help control vertigo attacks in some
people. Although dexamethasone may be slightly less effective than gentamicin, it's
less likely than gentamicin to cause further hearing loss.
Surgery

 Endolymphatic sac procedure. . During the procedure, the endolymphatic sac is

decompressed, which can alleviate excess fluid levels.
 Labyrinthectomy. With this procedure, the surgeon removes the balance portion of
the inner ear, thereby removing both balance and hearing function from the affected
ear.
 Vestibular nerve section. This procedure involves cutting the nerve that connects
balance and movement sensors in your inner ear to the brain (vestibular nerve).
Nursing management: Write Common points

 Nursing diagnosis
 Goal
 Interventions

UNIT – II
EYE
SHORT ESSAY ( 5 Marks )
Q1. Discuss the type’s refractive errors.

Ans: Meaning

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  A refractive error is a very common eye disorder. It occurs when the eye cannot
clearly focus the images from the outside world.
 The result of refractive errors is blurred vision, which is sometimes so severe that
it causes visual impairment.

The four most common refractive errors

A. Myopia
B. Hyperopia
C. Astigmatism
D. Presbyopia

A. Myopia

 Myopia, also called nearsightedness, is the inability to see distant objects clearly.
 Objects at a distance look blurred, making it difficult to read a school blackboard
or street signs.
 Myopia occurs when refracted light is focused in front of the retina instead of
onto the retina.
 This may occur if the eyeball has an elongated shape or if the cornea has too
much curvature.
 Myopia usually first appears in childhood and tends to run in families.

B. Hyperopia

 Hyperopia, also called farsightedness, occurs when distant objects are easier to
see clearly than nearby objects.
 If Hyperopia is significant, vision may be blurry at any distance.
 Hyperopia occurs when light is refracted behind the retina instead of onto the
retina.
 This may occur if the eyeball is too short or if there is too little curvature in the
cornea.
 Hyperopia can occur at any age.

C. Astigmatism

 Astigmatism is blurred vision caused by an unusually shaped cornea.

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  In people with astigmatism, the cornea is shaped more like a football or an egg
than a sphere.
 Light that hits an eye with astigmatism is distorted and refracted to multiple focus
points within the eye instead of on one focus point on the retina.
 Most of the time, people with astigmatism have difficulty seeing objects close up
and far away.
 There are two types of astigmatism: regular, in which the eyeball is not spherical
but is symmetrical
 Irregular, in which the eyeball is not spherical and not symmetrical. Regular
astigmatism is much more common than irregular astigmatism.

D. Presbyopia

 As you age, you may notice that your ability to focus up close, especially while
reading, worsens. Known as presbyopia, this happens to most people at some
point after age 40 as the eyes’ lenses, which focus light, gradually lose their ability
to adjust their shape to allow you to focus on near objects.
 Presbyopia is not the same as macular degeneration, which is damage to a small
spot, called the macula, located near the center of the retina.
 Presbyopia only affects the lens of the eye and causes the entire field of vision to
blur when you try to focus on something up close.

.Management

 Eye doctors can correct refractive errors with glasses or contact lenses, or fix the
refractive error with surgery.

Glasses. Eyeglasses are the simplest and safest way to correct refractive errors.

Contacts. Contact lenses sit on the surface of your eyes and correct refractive errors.

Surgery. Some types of surgery, like laser eye surgery, can change the shape of your
cornea to fix refractive errors. Your eye doctor can help you decide if surgery is right for
you.

Q2. Plan health education for a patient after cataract surgery.

Ans: Meaning

 A cataract is a clouding or opacity of the normally clear lens of eye .

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Signs and symptoms

 Clouded, blurred or dim vision

 Difficulty with vision at night
 Sensitivity to light and glare
 Double vision in a single eye

Management

Phacoemulsification

 In this method, surgery can usually be performed in more minutes and usually
requires only minimal sedation.
 Numbering eye drops or an injection.

Extracapsular cataract extraction surgery

 This procedure is used mainly for very advanced cataracts where the lens is too
dense to dissolve in to fragments.

Intracapsular cataract surgery

 This surgical technique requires an even larger wound than Extracapsular surgery
and surgeon removes the entire lens and surrounding capsule together.

Aphakia

 It is corrected by the use of eyeglasses and contact lenses.

Health Education

 Advising the patient to wear sunglasses during exposure

 Advising the patient to take analgesics to reduce pain
 Advising the patient to take proper diet
 Advising the patient to take care of eyes after surgery
 Advising the patient to prevent eyes from dirt and dust
 Advising patient to preventing eyes from trauma
 Advising patient to report to doctor for early complications
 Advising patient to increase activities gradually as directed by health care provider
 Caution against activities that cause patient to strain
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  Instructing patient and family in proper use of medications
 Advising patient to apply plastic shield over the eye at night to avoid accidental
injury during sleep .
 Infirming about fitting temporary corrective lenses for the first 6 weeks .

Nursing Management: Write Common Points

 Nursing Diagnosis
 Goal
 Nursing Interventions

Q3. Discuss the causes, signs and symptoms and management of patient with
conjunctivitis.

Ans: Meaning

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  Conjunctivitis, also known as pink eye, is inflammation of the outermost layer of
the white part of the eye and the inner surface of the eyelid.

Causes
 Infective conjunctivitis is most commonly caused by a virus.
 Bacterial infections, allergies, other irritants, and dryness are also common causes.
 Both bacterial and viral infections are contagious, passing from person to person or
spread through contaminated objects or water.
 Contact with contaminated fingers is a common cause of conjunctivitis.
Viral
 Adenoviruses are the most common cause of viral conjunctivitis
Bacterial
 The most common causes of acute bacterial conjunctivitis are Staphylococcus
aureus, Streptococcus pneumoniae, and Haemophilus influenzae.

Allergic
 Conjunctivitis may also be caused by allergens such as pollen, perfumes,
cosmetics, smoke and dust mites.

Signs and symptoms

 Red eye, swelling of the conjunctiva, and watering of the eyes are symptoms
common to all forms of conjunctivitis.
 Conjunctivitis is identified by inflammation of the conjunctiva, manifested by
irritation and redness.

Management
Viral
 Viral conjunctivitis usually resolves on its own and does not require any specific
treatment.
 Antihistamines (e.g. diphenhydramine) or mast cell stabilizers (e.g.cromolyn) may
be used to help with the symptoms.

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Allergic
 In more severe cases, nonsteroidal anti-inflammatory
medications and antihistamines may be prescribed.
 Persistent allergic conjunctivitis may also require topical steroid drops.
Bacterial
 Fluoroquinolones, sodium sulfacetamide, or Trimethoprim/polymyxin may be
used, typically for 7–10 days.

Chemical
 Conjunctivitis due to chemicals is treated via irrigation with Ringer's
lactate or saline solution.
 Chemical injuries, particularly alkali burns, are medical emergencies, as they can
lead to severe scarring and intraocular damage.

Nursing Management: Write Common Points

 Nursing Diagnosis
 Goal
 Nursing Interventions

Q4. Discuss the causes and management of patient with blindness.

Ans: Meaning

 The term blindness strictly refers to the state of being totally sightless in both
eyes, and a completely blind individual is unable to see at all.

Cause of blindness: are

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  Glaucoma refers to damage of optic nerve
 Macular degeneration
 Cataracts cause cloudy vision.
 A lazy eye can make it difficult to see details.
 Optic neuritis
 Retinitis pigmentosa refers to damage of the retina.
 Tumors that affect the retina or optic nerve can also cause blindness.

Symptoms of Blindness

 Cloudy vision
 An inability to see shapes
 Seeing only shadows
 Poor night vision
 Tunnel vision

Management

 Eyeglasses
 Contact lenses
 Surgery
 Medication

The treatment of visual impairment or blindness

 Many people have poor vision as a result of a refractive error, merely

prescribing and giving glasses will alleviate the problem.
 Nutritional causes of blindness can be addressed by dietary changes.
 There are millions of people in the world who are blind from cataracts.

96
  Inflammatory and infectious causes of blindness can be treated with
medication in the form of drops or pills.
 Corneal transplantation may help people whose vision is absent as a result of
corneal scarring.

Nursing Management: Write Common Points

 Nursing Diagnosis
 Goal
 Nursing Interventions

Q5. List ocular emergencies and discuss preventive aspects of ocular emergencies.

Ans: Meaning

 An eye emergency occurs any time you have a foreign object or chemicals in your
eye, or when an injury or burn affects your eye area.

List the Ocular Emergencies : are

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Preventive aspects

 Wear protective eyewear when you use power tools or engage in high-risk
sporting events.
 Follow the directions carefully when working with chemicals or cleaning supplies.
 Keep scissors, knives, and other sharp instruments away from young children.
Teach older children how to use them safely and supervise them when they do.
 Don’t let your children play with projectile toys, such as darts or pellet guns.
 Childproof your home by either removing or cushioning items with sharp edges.
 Use caution when cooking with grease and oil.
 Keep heated hair appliances, like curling irons and straightening tools, away from
your eyes.
 Keep your distance from amateur fireworks.

98
Other preventive measures: are

 Eye injuries can happen anywhere, including at home, work, athletic events, or on
the playground.
 Accidents can happen during high-risk activities, but also in places where we least
expect them.
 Wearing protective eyewear when use power tools or engage in high-risk sporting
events.
 Follow the directions carefully when working with chemicals or cleaning supplies.
 Keep scissors, knives, and other sharp instruments and keep away from the reach
of young children.
 Teach older children how to use them safely and supervise them when they do.
 Don’t let the children play with projectile toys, such as darts or pellet guns.
 Childproof the home by either removing or cushioning items with sharp edges.
 Use caution when cooking with grease and oil.
 Keep heated hair appliances, like curling irons and straightening tools, away from
the eyes.
 Keep distance from amateur fireworks.
 To decrease the chances of developing permanent eye damage, always see an eye
doctor after experience an eye injury

Q6. Explain causes, signs and symptoms and management of Uveitis.

Ans: Meaning

 Uveitis is a form of eye inflammation. It affects the middle layer of tissue in the
eye wall (uvea).

Causes

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  An autoimmune or inflammatory disorder that affects other parts of the body,
such as sarcoidosis, ankylosing spondylitis, systemic lupus erythematosus or
Crohn's disease
 An infection, such as cat-scratch disease, herpes zoster, syphilis, toxoplasmosis or
tuberculosis
 Medication side effect
 Eye injury or surgery
 Very rarely, a cancer that affects the eye, such as lymphoma

Symptoms

 Eye redness
 Eye pain
 Light sensitivity
 Blurred vision
 Dark, floating spots in your field of vision (floaters)
 Decreased vision

Treatment

 Antibiotics, antiviral or antifungal: These medications treat Uveitis caused by an

infection.
 Eye drops: Dilating (widening) the pupils with eye drops can reduce pain and
swelling.
 Steroidal anti-inflammatory: Medications that contain corticosteroids (steroids)
alleviate eye inflammation.
 Immunosuppressants: These medications calm the immune system’s response to
autoimmune disease or system wide inflammation.
 Corticotrophin
 Biologic agents

Nursing Management: Write Common Points

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  Nursing Diagnosis
 Goal
 Nursing Interventions

Q7. Discuss in detail about National Blindness Control Progamme .

Ans : Introduction

 National Programme for Control of Blindness and Visual Impairment (NPCB&VI)

was launched in the year 1976 as a 100% centrally sponsored scheme with the
goal of reducing the prevalence of blindness to 0.3% by 2020.

Main Causes of blindness

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  Cataract , Refractive Error, Corneal Blindness , Glaucoma , Surgical
Complicati ,Posterior Capsular Opacification

Main objectives

 To reduce the backlog of avoidable blindness through identification and

treatment of curable blind at primary, secondary and tertiary levels .
 Strengthening and up-gradation of Regional Institutes of Ophthalmology (RIOs) to
become centre of excellence in various sub-specialities of ophthalmology
 Strengthening the existing infrastructure facilities and developing additional
human resources for providing high quality comprehensive Eye Care in all
Districts of the country;
 To enhance community awareness on eye care and lay stress on preventive
measures;
 Increase and expand research for prevention of blindness and visual impairment;
 To secure participation of Voluntary Organizations/Private Practitioners in
delivering eye Care.

Best practices adopted under the programme

 To reach every nook and corner of the country to provide eye-care services,
provision for setting up Multipurpose District Mobile Ophthalmic Units in the
District Hospitals of States/UTs as a new initiative under the programme. ·
 Provision for distribution of free spectacles to old persons suffering from
presbyopia to enable them for undertaking near work as a new initiative under
the programme.
 Emphasis on the comprehensive eye-care coverage by covering diseases other
than cataract like diabetic retinopathy, glaucoma, corneal transplantation, vitreo-
retinal surgery, treatment of childhood blindness including retinopathy of pre-
maturity (ROP) etc. These emerging diseases need immediate attention to
eliminate avoidable blindness from the Country;
 Strengthening of Tertiary Eye-Care Centres by providing funds for purchase of
sophisticated modern ophthalmic equipments.
 Ensure setting up of superspecialty clinics for all major eye diseases
including diabetic retinopathy, glaucoma, retinopathy of prematurity etc. in state
level hospitals and medical colleges all over the country.
 Linkage of tele-ophthalmology centres at PHC/Vision centres with superspecialty
eye hospitals to ensure delivery of best possible diagnosis and treatment for eye
diseases, specially in hilly terrains and difficult areas.
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  Development of a network of eye banks and eye donation centres linked with
medical colleges and RIOs to promote collection and timely utilization of donated
eyes in a transparent manner.

Future Plans
·

 Setting up of more PHC/Vision Centres to broaden access of people to eye care

facilities.
 To extend financial support to NGOs for treatment of other eye diseases like
Diabetic Retinopathy, Glaucoma Management, Laser Techniques, Corneal
Transplantation, Vitreoretinal Surgery, Treatment of Childhood Blindness, free of
cost to poor people.
 Integration of existing ophthalmic surgical/ non-surgical facilities in each district,
State by associating few units to next higher unit.
 Inclusion of modern ophthalmic equipment in eye care facilities to make it more
versatile to meet modern day requirement.
 Upgradation of software for Management Information System for better
implementation and monitoring and monitoring.
 Digitalization of eye care services – IEC messages, whats app. Groups for
stakeholders etc.
 Provision for setting up Multipurpose District Mobile Ophthalmic Units in District
Hospitals for better coverage.

Q8. Discuss briefly about retinal detachment.

Ans: Meaning

 Retinal detachment describes an emergency situation in which a thin layer of tissue

(the retina) at the back of the eye pulls away from its normal position.

Causes and Risk factors

 Aging
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  Previous retinal detachment in one eye
 Family history of retinal detachment
 Extreme nearsightedness (myopia)
 Previous eye surgery, such as cataract removal
 Previous severe eye injury
 Previous other eye disease or disorder, including retinoschisis, Uveitis.

Types of retinal detachment: are

 Rhegmatogenous (reg-ma-TODGE-uh-nus). These types of retinal detachments

are the most common.
 Tractional. This type of detachment can occur when scar tissue grows on the
retina's surface, causing the retina to pull away from the back of the eye.
 Exudative. In this type of detachment, fluid accumulates beneath the retina, but
there are no holes or tears in the retina

Symptoms

 The sudden appearance of many floaters — tiny specks that seem to drift
through your field of vision
 Flashes of light in one or both eyes (photopsia)
 Blurred vision
 Gradually reduced side (peripheral) vision
 A curtain-like shadow over your visual field .

Management

 Injecting air or gas into your eye. In this procedure, called pneumatic retinopexy,
the surgeon injects a bubble of air or gas into the center part of the eye.
 Indenting the surface of your eye. This procedure, called scleral buckling, involves
the surgeon sewing (suturing) a piece of silicone material to the white of your eye
(sclera) over the affected area.
 Draining and replacing the fluid in the eye. In this procedure, called vitrectomy
the surgeon removes the vitreous along with any tissue that is tugging on the retina.
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 Air, gas or silicone oil is then injected into the vitreous space to help flatten the
retina.
 Vitrectomy may be combined with a scleral buckling procedure.

Nursing Management: Write Common Points

 Nursing Diagnosis
 Goal
 Nursing Interventions

Q9. Discuss the causes, signs and symptoms and medical management of a patient
with corneal ulcer.

Ans : Meaning

 A corneal ulcer is an open sore on your cornea.

 A corneal ulcer is an open sore on your cornea, the thin clear layer over your iris. It’s
also known as keratitis.

Causes of corneal ulcers: are

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Infections

 Bacterial infections. Bacterial infections are the most common cause of corneal
ulcers. Eg: Pseudomonas aeruginosa, coagulase-negative
staphylococcus and staphylococcus aureus
 Viral infections. Viruses that can flare up and cause corneal ulcers include cold
sores (herpes simplex) and shingles (herpes zoster).
 Fungal infections. Aspergillus, Fusarium, Scedosporium apiospermum,
phaeohyphpmycetes and candida species are common fungal causes.
 Parasitic infections. Acanthamoeba is an amoeba found in air, fresh water and
soil.

Other causes

 Corneal abrasions
 Corneal burns
 Severe dry eyes
 Eyelid closure problems
 Autoimmune diseases
 Vitamin A deficiency

Corneal Ulcer Symptoms

 Redness
 Severe pain
 The feeling that something is in your eye
 Tears
 Pus or thick discharge from your eye
 Blurry vision
 Pain when looking at bright lights
 Swollen eyelids
 A round white spot on your cornea

Corneal Ulcer Treatment

Medications
 Antibiotic, antiviral, or antifungal eye drops.
 To treat pain, your doctor may also give you oral painkillers or drops to widen (dilate)
your pupil.
 Your ophthalmologist may prescribe steroid or anti-inflammatory eye drops after
your infection has improved or is gone.

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Surgery

A corneal transplant can replace your damaged cornea with a healthy donor cornea to
restore vision.

Nursing Management: Write Common Points

 Nursing Diagnosis
 Goal
 Nursing Interventions

Q10. Define Tonometry and list the types of tonometers and explain the procedure
of Tonometry.

Ans: Definition

 Tonometry is a diagnostic test that measures the pressure inside your eye, which
is called intraocular pressure (IOP). This measurement can help your doctor
determine whether or not you may be at risk of glaucoma.

Types

Some of the most common types of tonometry include

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 A. Non-contact tonometry.

 Also known as air-puff tonometry, this test uses a puff of air to flatten your
cornea.
 Non-contact tonometry isn’t the most accurate way to measure the pressure
inside your eye.

B. Applanation (Goldmann) tonometry.

 During this diagnostic assessment, your provider uses a small probe to flatten
your cornea.
 They then use a slit lamp to examine your eye.
 Applanation tonometry is extremely accurate and is often performed after air-puff
tonometry has detected high intraocular pressure.

C. Electronic indentation tonometry.

 This type of tonometry test uses an electronic device to measure intraocular

pressure.
 Your healthcare provider places a small instrument directly on your cornea and
the test results are read on a computer screen.

Procedure

There are three main methods of measuring eye pressure.

The most accurate method measures the force needed to flatten an area of the
cornea.

 The surface of the eye is numbed with eye drops.

 A fine strip of paper stained with orange dye is held to the side of the eye.
 The dye stains the front of the eye to help with the exam. Sometimes the dye is in the
numbing drops.
 You will rest your chin and forehead on the support of a slit lamp so that your head is
steady.
 You will be asked to keep your eyes open and to look straight ahead.
 The lamp is moved forward until the tip of the tonometer just touches the cornea.
 Blue light is used so that the orange dye will glow green.
 The health care provider looks through the eyepiece on the slit-lamp and adjusts a dial on
the machine to give the pressure reading.
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 There is no discomfort with the test.
A second method uses a handheld device shaped like a pen. You are given numbing
eye drops to prevent any discomfort.

 The device touches the surface of the cornea and instantly records eye pressure.

The last method is the noncontact method (air puff). In this method, your chin rests
on a device similar to a slit lamp.

 You stare straight into the examining device. When you are at the correct distance from
the device, a tiny beam of light reflects off of your cornea onto a detector.
 When the test is performed, a puff of air will slightly flatten the cornea; how much it
flattens depends on the eye pressure.
 This causes the tiny beam of light to move to a different spot on the detector. The
instrument calculates eye pressure by looking at how far the beam of light moved.
Results
 According to the Glaucoma Research Foundation, the normal eye pressure range is
12 to 22 mm Hg.
 The measurement “mm Hg” means “millimeters of mercury,” which are the units
used to record eye pressure.
 If your test comes back with a pressure reading that’s higher than 20 mm Hg, you
may have glaucoma or pre-glaucoma.
 eye pressure is just one symptom of glaucoma and your doctor will do additional
testing to confirm the diagnosis
Q11. Explain the surgical interventions in cataract.
Ans: Meaning

 A cataract is a clouding or opacity of the normally clear lens of eye .

Signs and symptoms

 Clouded, blurred or dim vision

 Difficulty with vision at night
 Sensitivity to light and glare
 Double vision in a single eye

Surgical Interventions : are

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Phacoemulsification

 In this method, surgery can usually be performed in more minutes and usually
requires only minimal sedation.
 Numbering eye drops or an injection.

Extracapsular cataract extraction surgery

 This procedure is used mainly for very advanced cataracts where the lens is too
dense to dissolve in to fragments.

Intracapsular cataract surgery

 This surgical technique requires an even larger wound than Extracapsular surgery
and surgeon removes the entire lens and surrounding capsule together.

Aphakia

 It is corrected by the use of eyeglasses and contact lenses.

Nursing Management: Write Common Points

 Nursing Diagnosis
 Goal
 Nursing Interventions

Q12. Explain the medical and surgical management of Glaucoma.

Ans: Meaning

 Glaucoma is a group of eye diseases that can cause vision loss and
blindness by damaging a nerve in the back of your eye called the optic nerve.

Causes

 Glaucoma is the result of damage to the optic nerve.

 Elevated eye pressure is due to a buildup of a fluid (aqueous humor) that flows
throughout the inside of your eye.
 Glaucoma tends to run in families.

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Symptoms

Open-angle glaucoma

 Patchy blind spots in your side (peripheral) or central vision, frequently in both eyes
 Tunnel vision in the advanced stages
Acute angle-closure glaucoma

 Severe headache
 Eye pain
 Nausea and vomiting
 Blurred vision
 Halos around lights
 Eye redness
Medical management

A. Eyedrops
 Glaucoma treatment often starts with prescription eyedrops. These can help
decrease eye pressure by improving how fluid drains from your eye or by
decreasing the amount of fluid your eye makes.

 Prostaglandins. These increase the outflow of the fluid in your eye (aqueous
humor), thereby reducing your eye pressure.
 Beta blockers. These reduce the production of fluid in your eye, thereby lowering
the pressure in your eye (intraocular pressure).
 Alpha-adrenergic agonists. These reduce the production of aqueous humor and
increase outflow of the fluid in your eye.
 Carbonic anhydrase inhibitors. These medicines reduce the production of fluid in
your eye. Examples include dorzolamide (Trusopt) and brinzolamide (Azopt).
 Rho kinase inhibitor. This medicine lowers eye pressure by suppressing the rho
kinase enzymes responsible for fluid increase.
 Miotic or cholinergic agents. These increase the outflow of fluid from your eye. An
example is pilocarpine (Isopto Carpine).

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Surgery and other therapies

 Laser therapy. It's done in your doctor's office. Your doctor uses a small laser
beam to open clogged channels in the trabecular meshwork.
 Filtering surgery. With a surgical procedure called a trabeculectomy , your surgeon
creates an opening in the white of the eye (sclera) and removes part of the trabecular
meshwork.
 Drainage tubes. In this procedure, your eye surgeon inserts a small tube shunt in
your eye to drain away excess fluid to lower your eye pressure.
 Minimally invasive glaucoma surgery (MIGS). Your doctor may suggest
a MIGS procedure to lower your eye pressure. These procedures generally require
less immediate postoperative care and have less risk than trabeculectomy or
installing a drainage device.

Nursing Management: Write Common Points

 Nursing Diagnosis
 Goal
 Nursing Interventions

Q13. Explain the types of Cataract in detail.

Ans : Meaning

 A cataract is a clouding or opacity of the normally clear lens of eye .

Signs and symptoms

 Clouded, blurred or dim vision

 Difficulty with vision at night
 Sensitivity to light and glare
 Double vision in a single eye

Types of cataract: are

 Nuclear Sclerotic Cataracts

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  Cortical Cataracts
 Posterior Sub capsular Cataracts

A. Nuclear Sclerotic Cataracts

 A nuclear cataract is the most common type of cataract, beginning with a gradual
hardening and yellowing of the central zone of the lens also known as the nucleus.
 Over time, this hardening and yellowing will expand to the other layers of the lens.

B. Cortical Cataracts
 A cortical cataract forms in the shell layer of the lens known as the cortex and
gradually extends its “spokes” from the outside of the lens to the center.
 These fissures can cause the light that enters the eye to scatter, creating problems
with blurred vision, glare, contrast and depth perception.

C. Posterior Subcapsular Cataracts

 Primarily affecting one’s reading and night vision, this type of cataract begins as a
small opaque or cloudy area on the posterior (back surface) of the lens.
 Subcapsular cataracts can interfere with reading and create halo effects and glare
around lights.

Management

Phacoemulsification

 In this method, surgery can usually be performed in more minutes and usually
requires only minimal sedation.
 Numbering eye drops or an injection.

Extracapsular cataract extraction surgery

 This procedure is used mainly for very advanced cataracts where the lens is too
dense to dissolve in to fragments.

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Intracapsular cataract surgery

 This surgical technique requires an even larger wound than Extracapsular surgery
and surgeon removes the entire lens and surrounding capsule together.

Aphakia

 It is corrected by the use of eyeglasses and contact lenses.

Nursing Management: Write Common Points

 Nursing Diagnosis
 Goal
 Nursing Interventions

Q14. Define Blindness? Discuss the measures to prevent and treat Blindness?

Ans: Definition

 The term blindness strictly refers to the state of being totally sightless in both
eyes, and a completely blind individual is unable to see at all.

Cause of blindness: are

 Glaucoma refers to damage of optic nerve

 Macular degeneration
 Cataracts cause cloudy vision.
 A lazy eye can make it difficult to see details.
 Optic neuritis
 Retinitis pigmentosa refers to damage of the retina.
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  Tumors that affect the retina or optic nerve can also cause blindness.

Symptoms of Blindness

 Cloudy vision
 An inability to see shapes
 Seeing only shadows
 Poor night vision
 Tunnel vision

Management

 Eyeglasses
 Contact lenses
 Surgery
 Medication

The treatment of visual impairment or blindness

 Many people have poor vision as a result of a refractive error, merely

prescribing and giving glasses will alleviate the problem.
 Nutritional causes of blindness can be addressed by dietary changes.
 There are millions of people in the world who are blind from cataracts.
 Inflammatory and infectious causes of blindness can be treated with
medication in the form of drops or pills.
 Corneal transplantation may help people whose vision is absent as a result of
corneal scarring.

Preventive Measures for Blindness : are

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Blindness can be control by the different level of prevention

A. Primary Prevention
B. Secondary Prevention
C. Tertiary Prevention

A. Primary Prevention

 To prevent the disease to ever occurring

 Example: Good nutrition, Good water & sanitation, Rubella & measles
Immunization

B. Secondary Prevention

 To prevent loss of vision from established disease

 Example: Cataract Surgery, Glaucoma Medical & surgical, Diabetic retinopathy

C. Tertiary Prevention

 Restore vision to a blind person

 Example : Cataract Surgery , Corneal scarring Keratoplasty and Low vision aids

Other preventive measures: are

 Your eyes are an important part of your health

 Have a comprehensive dilated eye exam
 Maintain your blood sugar levels
 Know your family’s eye health history
 Eat right to protect your sight
 Maintain a healthy weight
 Wear protective eyewear
 Quit smoking or never start
 Be cool and wear your shades
 Give your eyes a rest
 Clean your hands and your contact lenses—properly
 Practice workplace eye safety.

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Nursing Management: Write Common Points

 Nursing Diagnosis
 Goal
 Nursing Interventions

Q15. Discuss in detail about Trachoma?

Ans: Meaning

 Trachoma is a contagious bacterial infection that affects the surface of the eyes.

Causes: are
 Trachoma is caused by Chlamydia trachomatis .
 It is spread by direct contact with eye, nose, and throat secretions from affected
individuals, or contact with fomites .
 Flies can also be a route of mechanical transmission.
 Blinding endemic trachoma occurs in areas with poor personal and family hygiene.
 Many factors are indirectly linked to the presence of trachoma including lack of
water, absence of latrines or toilets, poverty in general, flies, close proximity to
cattle, and crowding.

Symptoms
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  Itching and irritation of the eyes and eyelids
 Discharge from the eyes
 Eye pain
 Light sensitivity, and
 Blurred vision

Treatment

 Antibiotics are effective in treating early cases of trachoma.

 Azithromycin (single oral dose of 20 mg/kg) or topical tetracycline (1% eye
ointment twice a day for six weeks).
 More advanced cases may need surgery. The surgery repositions eyelashes that
are growing inward toward the eye.
 An ophthalmologist can also treat severe scarring from trachoma with corneal
transplantation.
 Good hygiene, such as hand washing and face washing, can help prevent the
spread of trachoma.

In order to eliminate trachoma as a public health problem, there is a WHO-recommended

“S.A.F.E.” strategy which includes:

 Surgery for trichiasis

 Antibiotics to clear Chlamydia trachomatis infection
 Facial cleanliness, and
 Environmental improvement to reduce transmission.

Nursing Management: Write Common Points

 Nursing Diagnosis
 Goal
 Nursing Interventions

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 UNIT – IV

NURSING MANAGEMENT OF PATIENT WITH DISORDERS OF FEMALE

REPRODUCTIVE SYSTEM

SHORT ESSAY ( 5 Marks )

Q1. Explain the steps of Breast Self Examination

Ans: Meaning

 Breast self-examination is a procedure performed by an individual to physically

and visually examine herself for any changes in the breasts and underarm areas of
the body.

Purposes

 To rule out breast cancer

 To identify any breast disorder

Steps of Breast Self Examination

Step 1: Do a Visual Exam

 Start by undressing to the waist.

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  Stand in front of a mirror large enough to visualize both breasts, and place your
hands on your hips.

 There should not be any dimpling, puckering, or bulging of the breasts.

Your nipples should not be in a different position or unusually inverted (sucked
in).
 There should also not be any redness, soreness, rash, or swelling.

 If there are, speak with your healthcare provider as soon as possible.

Step 2: Lift Your Arms

 Next, place your hands behind your head, noting how your breasts move.

 Both the left and right breast should move in the same way without shifting or
pulling. They also should be of more or less the same size, shape, contour, and
color.

 Look under both arms, checking for any swelling or lumps in the armpits.
 You are looking for swollen lymph nodes, which any number of things can cause,
from a simple case of flu to cancer.
Step 3: Check Your Nipples

 The next step is to examine your nipples.

 Start by lowering your left arm.
 Next, with your right hand's index and middle fingers, gently squeeze the left
nipple, pulling it forward and letting it go.
 The nipple should spring back rather than slowly sinking back into the breast.

 Check for any unusual bumps, indentations, dimpling, or signs of retraction.

 Also, note if any fluid is leaking from one or both nipples.

Step 4: Stand and Stroke

 Next, raise your left arm overhead.

 With the fingers of your right hand, slowly stroke your breast from the top to the
bottom and then from the inside of the breast all the way into your armpit area.

 Use firm but gentle pressure.

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  Finally, move your hand in a circular motion, being sure to cover the entire breast
area. Take note of any changes in the texture, color, or size of your breast.

Step 5: Lie Back and Stroke

 Finally, lie down with your left hand behind your head.

 Use your right hand to stroke your left breast and underarm.

 The easiest way to do this step is to lie on your bed with your head and shoulders
resting on a pillow.

 Take note of any changes in the texture or size of your breasts.

Q2. List the causes and explain the management of toxic shock syndrome.

Ans: Meaning

 Toxic shock syndrome is a sudden, potentially fatal condition. It's caused by the
release of toxins from an overgrowth of bacteria called Staphylococcus aureus,
or staph .

Causes: are

 Toxic shock syndrome is caused by a poison produced by Staphylococcus

aureus bacteria.
 A tampon saturated with blood is a supportive place for rapid growth of bacteria.
 It also seems to matter what the tampon is made of. Polyester foam provides a
better environment for the growth of bacteria than either cotton or rayon fibers.
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  In some cases resulting from menstrual sponges, diaphragms, and cervical caps,
the device had been in the vagina for a long time -- more than 30 hours.
 In the case of sponges alone, pieces of the sponge remained in the vagina.
 The way in which bacterial poisons enter the bloodstream may also be related to
tampon use.

Risk factors for toxic shock syndrome

 Recent childbirth
 Use of a diaphragm or vaginal sponge to prevent pregnancy
 An open skin wound
 Use of superabsorbent tampons
 Nasal packing

Management

 Antibiotics
 Medicine for low blood pressure
 Fluid to replace your body’s loss of water
 Other supportive care

Other possible treatments include:

 Medication to stabilize blood pressure

 Gamma globulin injections to suppress inflammation and boost your
body’s immune system
 Surgical debridement (removal of infected deep tissue)

Other treatment methods for TSS vary depending on the underlying cause.

 If a vaginal sponge or tampon triggered toxic shock, your doctor may need to
remove this foreign object from your body.

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  If an open or surgical wound caused TSS, the doctor will drain pus or blood
from the wound to clear any infection.

Nursing Management: Write Common Points

 Nursing diagnosis
 Goal
 Interventions

Q3. List the side effects of Hormonal replacement therapy and their management.

Ans : Meaning

 It is also known as menopausal hormone therapy used to relieve sweating, hot

flashes, and other symptoms of menopause. It can also reduce the risk
of osteoporosis.

Side effects of Hormonal therapy

 Acne
 Bloating
 Indigestion

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  Breast tenderness
 Swelling in the breasts or other parts of the body
 Abdominal or back pain
 Leg cramps
 Headaches
 Migraine
 Nausea
 Vaginal bleeding
 Mood changes
 Depression

Management for side effects of Hormonal Replacement Therapy

A. Hot flashes

 A hot flash is also called a hot flush. It is a sudden rush of warmth to the face,
neck, upper chest, and back, with or without sweating.
Measures: are
 Megestrol acetate is a form of progesterone called progestin. It seems to ease hot flash
severity.
 Antidepressants, such as venlafaxine
 Gabapentin
 Relaxation training

B. Vaginal dryness and other vaginal issues

Measures

 Vaginal moisturizers and lubricants can help with this symptom. Vaginal
moisturizers can be used as needed to keep the vagina moist.
 Vaginal infections with antifungal creams can provide relief for yeast infections.

C. Fatigue

Some ways to prevent fatigue are:

 Go to bed at a regular time.
 Take short power naps during the day.
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 Eat healthy foods and drink fluids.

D. Nausea and vomiting

 Women can help manage symptoms by eating bland foods, such as crackers, toast,
and cereal.
 Also drink lots of fluids–-6 to 8 glasses of liquids daily. This includes water, broth,
or electrolyte solutions.
 Your healthcare provider may advise antinausea or antianxiety medicines that
prevent or treat nausea or vomiting

E. Diarrhea

 This includes eating a bland diet and staying away from foods such as dairy
products and spicy foods.
 Medicines such as loperamide and diphenoxylate can be used to treat diarrhea.

F. Constipation

Measures
 Exercising every day.
 Eating high-fiber foods. These include fruits, vegetables, and whole-grain breads and
cereals.
 Drinking lots of liquids—6 to 8 glasses a day
 Administer softener or laxative.

Q4. Classify abortions and state the MTP Act .

Ans : Meaning

 Abortion is the termination of a pregnancy by removal or expulsion of

an embryo or fetus.

Classify Abortion
Classification of Abortion

Type Definition

Early Abortion before 12 weeks gestation

Late Abortion between 12 and 20 weeks gestation

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 Type Definition

Spontaneous Noninduced abortion

Vaginal bleeding occurring before 20 weeks gestation without

Threatened
cervical dilation and indicating that spontaneous abortion may occur

Vaginal bleeding or rupture of the membranes accompanied by

Inevitable
dilation of the cervix

Incomplete Expulsion of some products of conception

Complete Expulsion of all products of conception

Recurrent or
≥ 2 to 3 consecutive spontaneous abortions
habitual

Undetected death of an embryo or a fetus that is not expelled and that

Missed causes no bleeding (also called blighted ovum, anembryonic
pregnancy, or intrauterine embryonic demise)

Serious infection of the uterine contents during or shortly before or

Septic
after an abortion

The Medical Termination of Pregnancy Act 1971 ( MTP Act 1971 )

Meaning

 India amended the MTP Act 1971 to further empower women by providing
comprehensive abortion care to all.

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Q5. Illustrate the provisions provided under MTP Act .

Ans : Introduction

 The Govt of India launched Medical Termination of Pregnancy Act in 1971 for
doing abortions in certain situations.

3 Criteria for MTP

A. The conditions under which a pregnancy can be terminated

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 B. The person or persons who can perform such terminations and
C. The place where such terminations can be performed.

A. The conditions under which a pregnancy can be terminated under MTP Act
1971

There are 5 conditions

a. Medical: Where continuation of the pregnancy might endanger the mother’s life or
cause injury to her physical or mental health.
b. Eugenic: Where there is substancial risk of the child being born with serious
handicaps.
c. Humanitarian: Where pregnancy is the result of rape.
d. Socio –economic: Where actual or reasonably foreseeable environments could
lead to risk of injury to the health of the mother.
e. Failure of contraceptive devices : Unwanted pregnancy resulting from a failure
of any contraceptive devices.

The written consent of the guardian is necessary before performing abortion in women
under 18 years of age and in lunatics even if they are older than 18 years.

B. The person or persons who can perform abortion

 Registered Medical Practitioner having experience in gynecology and obstetrics to

perform abortion, where length of pregnancy does not exceed 12 weeks.
 When the pregnancy exceeds 12 weeks and not more than 20 weeks , opinion of 2
Registered Medical Practitioners is necessary to do abortion.

C. The place where such terminations can be performed.

 No termination of pregnancy shall be made at any place other than a hospital or

maintained by government or place approved for the purpose .

Q6. Explain the indications and procedure of PAP smear.

Ans: Meaning

 A Pap smear, also called a Pap test, is a screening procedure for cervical cancer.
 It tests for the presence of precancerous or cancerous cells on your cervix.

Indications for Pap Smear

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Sexually Active ?

 Any age
 Every year
 What else
 Urine Culture for Gonorrhea and Chlamydia

Not sexually active?

 At Age 18 years
 Repeat 3 years

 Vaginal discharge
 Suspected cervical cancer
 Uterine Polyp
 Cervicitis

Preparations for Pap Smear Test?

 The best time to have a Pap smear is when the woman is not menstruating.
 For two days before the Pap test, avoid the following because these might
interpretation of the test more difficult:
 Intercourse
 Douches
 Vaginal medications (except as directed by your doctor)
 Vaginal contraceptives such as birth control foams, creams, or jellies

Procedure for Pap smear

 The woman will lie on the examination table on her back with her knees up and
bent and her feet in stirrups (rests).

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  While she is lying on an examination table, her health care provider will use a
small metal or plastic instrument called a speculum to open the vagina so that the
walls of the vagina and cervix can be seen clearly.
 A sample of cervical cells and mucus will be obtained from the cervix
 Formerly, a sample of cells was evenly applied to a glass slide and sprayed with a
fixative. This sample was sent to the lab for close and careful examination under a

 Comfort during the test may occur. Most women feel nothing at all or feel
pressure. Staying relaxed will help stop any discomfort.
 The woman should breathe slowly and concentrate on relaxing her stomach and
legs.

Pap smear Results

 A negative or normal test finding means that the cervix looks healthy. All the cells
are of a healthy size and shape.
 A positive or abnormal test finding means that something unusual is in the sample.
The test found abnormal cells of a different size and shape.

Q7. Explain the indications and procedure of Endometrial Biopsy.

Ans: Meaning

 Endometrial biopsy, a small piece of tissue from the lining of the uterus (the
endometrium) is removed and examined under a microscope for cancer and other
cell irregularities.
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Indications

 Abnormal uterine bleeding

 Post menopausal bleeding
 Cancer screening

Pre menopausal women

 Any change in the menstrual cycle

 Breakthrough bleeding

Post menopausal women

 Vaginal bleeding above 12 weeks

 Breakthrough bleeding

Preparation for Endometrial Biopsy

 Endometrial biopsy during pregnancy can lead to miscarriage.

 Your doctor might want you to take a pregnancy test before the biopsy to ensure
that you aren’t pregnant.
 Your doctor may also want you to keep a record of your menstrual cycles before
the biopsy.
 Tell your doctor about any prescription or over-the-counter medications you are
taking. You might have to stop taking blood thinners before an endometrial biopsy.
 These medications can interfere with the blood’s ability to clot properly.
 Your doctor will probably want to know whether you have any bleeding disorders
or if you’re allergic to latex or iodine.

Procedure for Endometrial Biopsy

The procedure for an endometrial biopsy is as follows:

 A person will lie down on the exam table, with their feet and legs supported.

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  A doctor will then perform a physical exam to understand the person’s pelvic
anatomy. They will also assess the orientation of the uterus to find out its size,
whether masses are present, or if pain occurs.
 The doctor will then place a speculum into the vagina to make it easier to see
the cervix.
 Using an antiseptic solution, they will clean the cervix.
 They will then use a numbing spray or inject a numbing solution into the area.
This step is optional and not always performed.
 The doctor will use an instrument to hold the cervix steady. This may cause
some cramping.
 They will then insert a uterine sound, which is a rod-like instrument, into the
cervical opening. This is to find the location for the biopsy. A person can expect
to feel some cramping. After this, they will remove the uterine sound.
 The doctor will insert a catheter through the cervical opening and into the
uterus. Inside the catheter is a small tube. The doctor will withdraw the inner
tube, creating a light suction.
 They will then withdraw the catheter and place the contents into a specimen
cup.
 The doctor will carefully remove the instrument that held the cervix steady, and
ensure that there is no bleeding from where the cervix was stabilized.
 They will remove the speculum.

Results

 An endometrial biopsy is normal when no abnormal cells or cancer is found.

 Results are considered abnormal when:

 a benign, or noncancerous, growth is present

 a thickening of the endometrium, called endometrial hyperplasia, is present
 cancerous cells are present
Q8. Explain the indications and procedure of Cervical Biopsy.

Ans: Meaning

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  A cervical biopsy is a procedure to remove tissue from the cervix to test for
abnormal or precancerous conditions, or cervical cancer.

Indications

 Abnormal Pap smear

 A positive test for high-risk strains of human papillomavirus (HPV)
 Abnormalities detected during a pelvic examination
 Symptoms of cervical cancer, such as vaginal bleeding after sexual intercourse,
irregular or heavy menstrual bleeding, pelvic pain, or vaginal discharge1

Before the Procedure

It's also important to tell your healthcare provider what medications you're taking, as
some can increase the risk of bleeding. Aspirin

 Advil (ibuprofen)
 Aleve (naproxen)
 Blood thinners like Coumadin (warfarin)

Don't use tampons, vaginal creams or medicines, or douche for 24 hours before the
procedure, and refrain from sexual intercourse for 24 hours before a cervical biopsy.

Procedure

 A cervical biopsy begins much like a Pap smear. You will lie down and put your
feet in stirrups.
 You may be given a local anesthetic, but this is not always necessary with small
biopsies.
 The healthcare provider will insert a speculum into your vagina to hold it open and
provide access to your cervix.
 They also may use a colposcope, an instrument with a special lens like a
microscope, to get a close look at your cervical tissue.
 Before taking the sample, your healthcare provider will clean the cervix. If you
have any sensation, this may burn a bit, but it should not be painful.
 Next, your cervix will be swabbed with iodine for the Schiller’s test.
 The iodine will turn abnormal tissue a different color so that it's easy to see. It is
from the whitest areas that samples will be taken.
 The amount of tissue removed and where it is removed from depends on the type
of biopsy you have. When this is done, you may feel a slight pinch or cramp.

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  If you have a cone biopsy, your healthcare provider may use a loop electrosurgical
excision procedure (LEEP) or the cold knife cone biopsy procedure. With the cold
knife cone biopsy, a laser or a surgical scalpel may be used to remove tissue.

Bleeding from the biopsy site may be treated with medication, and if necessary, they may
also use a probe (electro cauterization) or stitches to stop the bleeding.

Results

 If they're normal, it most likely means you do not have cervical cancer.
 Abnormal results can indicate low-grade dysplasia (mild), high-grade dysplasia
(moderate to severe), or cervical cancer.
 Cervical dysplasia means there are precancerous changes to the cervix.

Q9. Explain the indications and Procedure of Calposcopy.

Ans: Meaning

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  A colposcopy is a procedure to check your cervix, the wall of your vagina and your
vulva for signs of cancerous or pre-cancerous tissue.

Indications

 Had abnormal Pap test, or Pap smear, results.

 Had abnormal results during a pelvic exam.
 Had a positive HPV test (human papillomavirus).
 Postcoital bleeding
 Patients with external vulval warts
 Evaluation of sexual assault victims

Preparation

To prepare for your colposcopy, your doctor may recommend that you:

 Avoid scheduling your colposcopy during your period

 Don't have vaginal intercourse the day or two before your colposcopy
 Don't use tampons the day or two before your colposcopy
 Don't use vaginal medications for the two days before your colposcopy

Procedure

During the colposcopy

 The procedure typically takes 10 to 20 minutes.

 You'll lie on your back on a table with your feet in supports, just as during a pelvic
exam or Pap test.
 The doctor places a metal speculum in your vagina.
 the speculum holds open the walls of your vagina so that your doctor can see your
cervix.
 Your doctor positions the special magnifying instrument, called a colposcope, a
few inches away from your vulva.
 Your doctor then shines a bright light into your vagina and looks through the lens
of the colposcope, as if using binoculars.
 Your cervix and vagina are swabbed with cotton to clear away any mucus.
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  Your doctor may apply a solution of vinegar or another type of solution to the area.
This may cause a burning or tingling sensation.
 The solution helps highlight any areas of suspicious cells.

During the biopsy

 If your doctor finds a suspicious area, a small sample of tissue may be collected for
laboratory testing.
 To collect the tissue, your doctor uses a sharp biopsy instrument to remove a small
piece of tissue.
 If there are multiple suspicious areas, your doctor may take multiple biopsy
samples.

Results

 A normal result means your cervix appears healthy.

 About 6 out of 10 women who have a Calposcopy have abnormal cells in their
cervix.

Q10. Explain the Indications and Procedure of Breast Biopsy.

Ans: Meaning

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  A breast biopsy is a simple medical procedure in which a sample of breast tissue is
removed and sent to a laboratory for testing.
 A breast biopsy is the best way to evaluate if a suspicious lump or portion of your
breast is cancerous.

Indications

 Any suspicious lump or lesion in the breast

 Breast biopsy is indicated in any patient with a complex cyst, solid mass,
indeterminate or suspicious solid mass.

Procedure

Fine-needle aspiration biopsy.

 For the procedure, you lie on a table.
 While steadying the lump with one hand, your doctor uses the other hand to direct
a very thin needle into the lump.
 The needle is attached to a syringe that can collect a sample of cells or fluid from
the lump.
 Fine-needle aspiration is a quick way to distinguish between a fluid-filled cyst and
a solid mass.
 It may also help avoid a more invasive biopsy procedure.
 If, however, the mass is solid, you may need a procedure to collect a tissue sample.
Ultrasound-guided core needle biopsy
 This type of core needle biopsy involves ultrasound — an imaging method that
uses high-frequency sound waves to produce precise images of structures within
the body.
 During this procedure, you lie on your back or side on an ultrasound table.
 Holding the ultrasound device against the breast, the radiologist locates the mass,
makes a small incision to insert the needle, and takes several core samples of
tissue.
Q11. Define family planning. List the objectives of National Family welfare
Programme.

Ans: Definition

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  Family planning means planned regulations of pregnancies through adoption of
contraceptives by the couple to avoid unwanted pregnancies and maintain small
size family.

National Family welfare Programme

Introduction

 The Govt of India launched national family planning programme in 1952.

 In 1977, the Govt of India redesignated the national family planning programme as
national family welfare programme.

Objectives: are

 To promote the adoption of small family size norm

 To promote the use of spacing methods
 To ensure adequate supply of contraceptives to all eligible couples within easy
reach.
 Reducing the birth rate
 Raising couple protection rate
 Reducing Net reproduction rate

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Q12. Explain any two strategies of National Family welfare programme.

Ans : Introduction

 The Govt of India launched national family planning programme in 1952.

 In 1977, the Govt of India redesignated the national family planning programme as
national family welfare programme.

Objectives: are

 To promote the adoption of small family size norm

 To promote the use of spacing methods
 To ensure adequate supply of contraceptives to all eligible couples within easy
reach.
 Reducing the birth rate
 Raising couple protection rate
 Reducing Net reproduction rate
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Q13. Enumerate the causes, clinical manifestations and medical management of
Vulvovaginitis.

Ans: Meaning

 Vulvovaginitis is inflammation or irritation of the vagina and vulva (external

female genital area).

Causes: are

The common causes

 Bacteria eg : Streptococcus or Staphylococcus

 Viruses eg : human papillomavirus (HPV).
 Parasites
 Environmental factors : Poor hygiene and allergens can also cause this condition.
 Sexually transmitted infections (STIs)

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  Exposure to chemical irritants and allergens

Clinical manifestations: are

 Irritation of the genital area

 Itching
 Inflammation around the labia and perineal areas
 Increased, strong-smelling vaginal discharge
 Discomfort while urinating

Medical management: Medications for this condition may include:

 oral antibiotics
 antibiotic creams (applied directly to the skin)
 antibacterial creams (applied directly to the skin)
 antifungal creams (applied directly to the skin)
 oral antifungal pills
 oral antihistamines, if an allergic reaction is a possible cause
 estrogen creams

Home remedies

 vaginal creams
 suppositories
 topical ointments
 oral pills

Medications for this condition may include:

 oral antibiotics
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  antibiotic creams (applied directly to the skin)
 antibacterial creams (applied directly to the skin)
 antifungal creams (applied directly to the skin)
 oral antifungal pills
 oral antihistamines, if an allergic reaction is a possible cause
 estrogen creams

Measures for Vulvovaginitis

 Maintain a personal hygiene routine to help heal the infection and prevent it from
recurring.
 Sitz baths and wiping properly after using the toilet.
 wearing loose clothing and cotton underwear to allow for air circulation and to
reduce moisture in the area.
 Removing underwear at bedtime may also help prevent vulvovaginitis.
 Proper cleansing is important and may help prevent irritation
 Avoid using bubble baths, perfumed soaps, douches, and washing powders.
 A cold compress may also relieve pain on swollen or tender areas.

Nursing Management: Includes

 Nursing Diagnosis
 Goal or Objective
 Nursing Interventions.

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Q14. Describe the pathophysiology of Pelvic Inflammatory Diseases.
Ans: Meaning
 Pelvic inflammatory disease (PID) is an infection of the organs of a women’s
reproductive system. They include the uterus, ovaries, fallopian tubes, and cervix. It’s
usually caused by a sexually transmitted infection (STI), like chlamydia or gonorrhea.

Causes : are

 Gonorrhea or chlamydia infections are the most common. These bacteria are
usually acquired during unprotected sex.
 This can happen during menstruation and after childbirth, miscarriage or abortion.
 Rarely, bacteria can also enter the reproductive tract during the insertion of an
intrauterine device (IUD) — a form of long-term birth control — or any medical
procedure that involves inserting instruments into the uterus.

Pathophysiology
 In PID organisms usually ascends from lower tract to upper side , this commonly
occurs during pregnancy .
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 Infection can cause perihepatic inflammation when the organism invades the
peritoneum.
 In gonorrheal infection , the gonococci pass through the cervical canal in to the
uterus during menstruation .

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Nursing Management: Includes
 Nursing Diagnosis
 Goal or Objective
 Nursing Interventions.

Q15. Briefly explain the components of health education for Pelvic Inflammatory
Diseases.
Ans: Meaning
 Pelvic inflammatory disease (PID) is an infection of the organs of a women’s
reproductive system. They include the uterus, ovaries, fallopian tubes, and cervix. It’s
usually caused by a sexually transmitted infection (STI), like chlamydia or gonorrhea.

Causes: are

 Gonorrhea or Chlamydia infections are the most common. These bacteria are
usually acquired during unprotected sex.
 This can happen during menstruation and after childbirth, miscarriage or abortion.

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  Rarely, bacteria can also enter the reproductive tract during the insertion of an
intrauterine device (IUD) — a form of long-term birth control — or any medical
procedure that involves inserting instruments into the uterus.

Management
 Patient’s with mild infections are treated in our patient department
 Bed rest
 Intravenous fluids
 Broad spectrum antibiotics
 Nasogastric intubation and suction are initiated
 Treatment of sexual partner is also needed .

Components of Health education

Patient Education

 Patient needs to be informed about the nature of the infection & the importance
of taking the full course of medication
 Counsel patients on possible complications of sexually transmitted infection
(STI)
 Inform the patient of the possible short-term effects of PID (eg tubo-ovarian
abscess) as well as long-term consequence (eg infertility, ectopic pregnancy,
chronic pelvic pain)
 Patients should be advised to avoid unprotected sex until they & their partners
have completed therapy & follow-up

Advice patients on how to lower their risk of acquiring sexually transmitted

infections (STIs)

 Tailor counseling to the patient’s specific risk factors

 Abstinence, condom use
 Careful selection of partners

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Q16. Explain the causes, signs and symptoms of Menopause.
Ans: Meaning
 Menopause is the end of a woman’s menstrual cycles.

Causes : are
 Menopause is a regular part of aging when it happens after the age of 40.
 It can be the result of surgery, like if their ovaries are removed in a hysterectomy, or
damage to their ovaries, such as from chemotherapy.
 Menopause happens when the ovaries no longer release an egg every month
and menstruation stops.

Signs and Symptoms

First signs of menopause
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  Uneven or missed periods
 Vaginal dryness
 Sore breasts
 Needing to pee more often
 Trouble sleeping
 Emotional changes
 Dry skin, eyes, or mouth

Symptoms of menopause

 Fatigue
 Depression
 Crankiness
 Racing heart
 Headaches
 Joint and muscle aches and pains
 Weight gain
 Hair loss
 Changes in libido (sex drive)

Treatment

 Hormone replacement therapy (HRT) : This is also called menopausal hormone

therapy.
 Topical hormone therapy : This is an estrogen cream, insert, or gel that you put in
your vagina to help with dryness.
 Nonhormone medications : The depression drug paroxetine (Brisdelle, Paxil) is
FDA-approved to treat hot flashes.
 Medications for osteoporosis : You might take medicines or vitamin D supplements
to help keep your bones strong.

Nursing Management: Includes

 Nursing Diagnosis
 Goal or Objective
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  Nursing Interventions.

Q17. Explain the clinical manifestations and collaborative management of

Fibrocystic disorders of the breast.
Ans: Meaning
 Fibrocystic breast disease, commonly called fibrocystic breasts or fibrocystic
change, is a benign (noncancerous) condition in which the breasts feel lumpy.

Clinical Manifestations of fibrocystic breasts

 Breast lumps or areas of thickening that tend to blend into the surrounding breast
tissue
 Generalized breast pain or tenderness or discomfort that involves the upper outer
part of the breast
 Breast nodules or lumpy tissue change in size with the menstrual cycle

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  Green or dark brown nonbloody nipple discharge that tends to leak without pressure
or squeezing
 Breast changes that are similar in both breasts
 Monthly increase in breast pain or lumpiness from midcycle (ovulation) to just
before your period and then gets better once your period starts

Collaborative Management

 Symptomatic management
 Hormonal manipulation
 Drug therapy – Vitamins C , E and B complex
 Diuretics
 Avoidance of caffeine
 Reduction of dietary fat
 Mild analgesics

Lifestyle and home remedies

 Wear a firm support bra, fitted by a professional, if possible.

 Wear a sports bra during exercise and while sleeping, especially when your
breasts are extra sensitive.
 Limit or avoid caffeine, a dietary change many people report as helpful,
 Eat less fat, which may decrease breast pain or discomfort associated with
fibrocystic breasts.
 Reduce or stop taking hormone therapy if you're postmenopausal
 Use a heating pad or warm water bottle to relieve your discomfort

Surgical options
Treatment options for breast cysts include:

 Fine-needle aspiration. Your doctor uses a hair-thin needle to drain the fluid from
the cyst.
 Surgical excision. Rarely, surgery may be needed to remove a persistent cyst-like
lump that doesn't resolve after repeated aspiration and careful monitoring or has
features that concern your doctor during a clinical exam.

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Nursing Management: Includes
 Nursing Diagnosis
 Goal or Objective
 Nursing Interventions.

Q19. Differentiate between uterine prolapsed, rectocele and cystocele.

Ans :
Features Uterine Prolapse Rectocele Cystocele
Meaning Uterine A rectocele is a A cystocele is a condition
prolapse occurs condition where in which supportive tissues
when the uterus sags weakened tissues in around
or slips from its your pelvis cause your the bladder and vaginal wall
normal position and rectum to sag onto weaken and stretch,
into the vagina (birth your vaginal wall. allowing the bladder and
canal). vaginal wall to fall into the
vaginal canal.
Causes Pregnancy/childbirths Pregnancy and  giving birth vaginally
childbirth  having a history of
Weakness in the pelvic surgery such
pelvic muscles with Aging as a hysterectomy
advancing age  being overweight or
Chronic
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 having obesity
Weakening and loss cough or bronchitis  having a family
of tissue tone history of pelvic
after menopause and Chronic constipation
organ prolapse
loss of natural
estrogen

Signs & A feeling of fullness A soft bulge of tissue a vaginal bulge or the
Symptoms or pressure in your in the vagina that feeling that something is
pelvis (it may feel might come through falling out of the vagina
like sitting on a small the opening of the
ball) vagina pressure in the vagina or
Low back pain pelvis
Trouble having a
bowel movement
Feeling that
something is coming Feeling pressure or
out of your vagina fullness in the rectum

Q20. Write the pre –operative and post operative nursing management for woman
with total abdominal hysterectomy.
Ans: Meaning
 An abdominal hysterectomy is a surgical procedure that removes your uterus
through an incision in your lower abdomen .

Indications

 Gynecologic cancer
 Fibroids
 Endometriosis.
 Uterine prolapse

Pre –operative management

 Assess general condition of the patient

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  Check vital signs of the patient
 Keep NBM
 Prepare the operated part
 Give TT and xylocaine
 Administer IV fluids
 The day before and morning of your surgery, you will be instructed to shower
using soap provided by your surgeon to reduce your risk of infection.
 A preoperative cleansing of your vagina (vaginal douche) or preoperative
cleansing of your rectum (enema) also may be done.
 Immediately before surgery, you'll receive an intravenous antibiotic medication to
minimize your risk of infection after the procedure.

Before surgery, Tests may include:

 Cervical cytology (Pap test), which detects the presence of abnormal cervical cells
or cervical cancer
 Endometrial biopsy, which detects abnormal cells in the uterine lining or
endometrial cancer
 Pelvic ultrasound, which may show the size of uterine fibroids, endometrial polyps
or ovarian cysts

Post operative Management

 Check vital signs of the patient

 Assess conscious level of the patient
 Monitor you for signs of pain
 Give you medicine for pain and to prevent infection
 Encourage you to get up and walk around soon after surgery
 Inspect operated site for bleeding and infection
 Follow aseptic techniques during dressing
 Encourage for early ambulation of patient
 Use sanitary pads for vaginal bleeding and discharge

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  Administer IV fluids
 Administer antibiotics
 Get plenty of rest.
 Don't lift anything heavy for a full six weeks after the operation.
 Stay active after your surgery, but avoid strenuous physical activity for the first six
weeks.
 Follow your doctor's recommendations about returning to your other normal
activities.

Nursing Management: Includes

 Nursing Diagnosis
 Goal or Objective
 Nursing Interventions.

Q21. Define abnormal uterine bleeding. Write about its types.

Ans: Meaning

 Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than
usual or that occurs at an irregular time.

Definition
 Abnormal uterine bleeding is bleeding from the vagina that occurs frequently or
irregularly or lasts longer or is heavier than normal menstrual periods.

The signs of abnormal uterine bleeding

 Heavy menstrual bleeding (formerly called menorrhagia).

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  Bleeding at unusual times (between periods, after intercourse).
 Unusually long periods (seven days or longer).
 Inconsistent menstrual cycles.

Types of Abnormal Uterine bleeding

A. Poly menorrhea: Frequent menstruation more than 21 days at regular intervals
B. Menorrhagia: Excessive or prolonged menstruation
C. Metrorrhagia: Excessive or prolonged menstruation at irregular intervals
D. Menometrorrhagia: Both
E. Intermentrual bleeding: Episodes of uterine bleeding between regular
menstruations
F. Hypomenorrhoea: Scanty menstruation
G. Oligomenorrhea: Infrequent menstruation .

Medications

Medications used to treat abnormal uterine bleeding include:

 Birth control pills.

 Progestin
 Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
 Gonadotropin-releasing hormone (GnRH) agonists can temporarily stop or
reduce bleeding by preventing ovulation.
 Gonadotropin-releasing hormone (GnRH) antagonists (elagolix®) can manage
heavy period bleeding related to fibroids.

Nursing Management: Includes

 Nursing Diagnosis
 Goal or Objective
 Nursing Interventions.

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Q22. Explain the role of nurse in prevention of Cervical cancer.

Ans: Meaning

 Cervical cancer is a type of cancer that occurs in the cells of the cervix — the
lower part of the uterus that connects to the vagina.

Clinical features

 Blood spots or light bleeding between or following periods

 Menstrual bleeding that is longer and heavier than usual
 Bleeding after intercourse, douching, or a pelvic examination
 Increased vaginal discharge
 Pain during sexual intercourse
 Bleeding after menopause
 Unexplained, persistent pelvic and/or back pain

Management

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Treatment

Surgery, radiation, chemotherapy or a combination of the three may be used.

Surgery
Early-stage cervical cancer is typically treated with surgery.

 Surgery to cut away the cancer only. For a very small cervical cancer, it might be
possible to remove the cancer entirely with a cone biopsy.
 Surgery to remove the cervix (trachelectomy). Early-stage cervical cancer might
be treated with a radical trachelectomy procedure, which removes the cervix and
some surrounding tissue.
 Surgery to remove the cervix and uterus (hysterectomy). Most early-stage
cervical cancers are treated with a radical hysterectomy operation .

Prevention of Cervical Cancer

 Delaying first sexual intercourse until the late teens or older

 Limiting the number of sexual partners
 Practicing safer sex by using condoms and dental dams
 Avoiding sexual intercourse with people who have had many partners
 Avoiding sexual intercourse with people who are infected with genital warts or
who show other symptoms
 Quitting smoking .

Role of Nurse in Prevention of cervical cancer

A. Primary prevention role
B. Secondary prevention role
C. Tertiary prevention role

Primary Prevention Role

 Nurse should identify the high risk factors

 Nurse should advise the mother to avoid use of cancer causing agents
 Encourage the mother for healthy life styles
 Inform the mother to report early for any abnormal bleeding and pain
 Health education should give to mother about cervical cancer

Secondary Prevention Role

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  Early diagnosis and appropriate treatment is important
 Action taken to prevent occurrence of complications

Tertiary Prevention Role

 Rehabilitation measures are given to treat cervical cancer
 Action taken to prevent spread of cancer to other areas .
 Health education can be given for prevention of cervical cancer .

Nursing Management: Includes

 Nursing Diagnosis
 Goal or Objective
 Nursing Interventions.
Q23. Explain the nursing management of a woman who is a victim of sexual
violence.
Ans: Meaning
 Sexual violence is any sexual act or attempt to obtain a sexual act
by violence or coercion, act to traffic a person, or act directed against a
person's sexuality, regardless of the relationship to the victim

Risk factors

 Alcohol and drug use

 Delinquency
 Empathic deficits
 General aggressiveness and acceptance of violence
 Early sexual initiation
 Coercive sexual fantasies

Nursing Management

 Establish trust and rapport

 Provide strict confidentiality
 Approach the client in a nonjudgmental manner
 Never use judgmental language
 Explain to the client signs and symptoms that many people experience during the
long-term phase
 Stress that they did the right thing to save their life.

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Nursing Management: Includes
 Nursing Diagnosis
 Goal or Objective
 Nursing Interventions.

Q24. Briefly explain the causes and clinical manifestations of Endometriosis.

Ans: Meaning
 Endometriosis is a condition in which tissue resembling that which grows in the
uterus develops in other areas of the body.

Causes

 Genetic factors, as it appears to run in families

 Problems with menstrual flow, resulting in blood and tissue not leaving the body
 Imune system problems, in which the immune system does not eliminate unwanted
tissue
 High levels of the hormone estrogen in the body
 Surgery to the abdominal area, such as a cesarean delivery or hysterectomy
 Alcohol and caffeine consumption

Clinical Manifestations

 Painful cramping, similar to menstrual cramps

 Long-term lower back and pelvic pain
 Periods lasting longer than 7 days
 Heavy menstrual bleeding
 Bowel and urinary problems, including pain, diarrhea, constipation, and
bloating
 Blood in the stool or urine
 Nausea and vomiting

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  Fatigue
 Pain during sex
 Spotting or bleeding between periods
 Difficulty becoming pregnant

Treatment

A. Pain relief

 They include nonsteroidal anti-inflammatory drugs such as ibuprofen and drugs to

relieve painful menstruation.

B. Hormonal treatment
 A doctor may recommend birth control pills or other hormonal methods of birth
control, such as the Mirena device.
 In some cases, they may recommend gonadotrophin-releasing hormone.
C. Surgery
 In some cases, a hysterectomy with removal of both ovaries may be necessary.

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Q25. List the congenital abnormalities of female reproductive system and briefly
explain about the septate uterus.
Ans: Meaning
 Congenital abnormalities of the female reproductive tract are developmental issues
that form in the embryo.
 It can be in the vagina, cervix, uterus and fallopian tubes that occur while the child
is growing in the womb.

Types of female reproductive tract congenital abnormalities:

a) Congenital abnormalities of the uterus

 Septate uterus

 Bicornuate uterus
 Arcuate uterus
 Unicornuate
 Didelphys

b) Congenital abnormalities of the vulva

 Labial hypoplasia

 Labial hypertrophy

c) Congenital abnormalities of the hymen

 Imperforate hymen
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 Microperforate hymen
 Septate hymen
d) Congenital abnormalities of the vagina
 Transverse vaginal septum
 Vertical or complete vaginal septum
 Vaginal agenesis
e) Congenital abnormalities of the cervix
 Cervical agenesis
 Cervical duplication

Septate Uterus
Meaning
 A septate uterus is a congenital anomaly where a membrane runs down the middle
of the uterus, splitting it into two parts.
 This membrane is called the septum and it can vary in thickness and length.

Types

Septate uteruses are divided into three types:

 Partial septate uterus. When the septum tissue doesn’t include the cervix.
 Complete septate uterus. When the septum also includes the cervix, which is the
opening of the womb.
 Septate uterus and vagina. When the septum extends into the vagina.

Causes
 A septate uterus is congenital.

Signs and Symptoms: are

 Frequent miscarriages.
 Painful menstruation.
 Pelvic pain

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The Diagnosis

 M‌ RI
 2‌ D or 3D ultrasound
 Hysteroscopy

Treatment

 A procedure called hysteroscopic metroplasty is the most common treatment for a

septate uterus.

Q26. List the causes of uterine Displacement. Describe about the Pessary .
Ans : Introduction
 Uterine Displacement is also called as Uterine prolapse .

Meaning
 Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and
weaken and no longer provide enough support for the uterus. As a result, the uterus
slips down into or protrudes out of the vagina.

Causes: are

 Pregnancy
 Difficult labor and delivery or trauma during childbirth
 Delivery of a large baby
 Being overweight or obese
 Lower estrogen level after menopause
 Chronic constipation or straining with bowel movements
 Chronic cough or bronchitis
 Repeated heavy lifting

Symptoms
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  Sensation of heaviness or pulling in your pelvis
 Tissue protruding from your vagina
 Urinary problems, such as urine leakage (incontinence) or urine retention
 Trouble having a bowel movement
 Feeling as if you're sitting on a small ball or as if something is falling out of your
vagina
 Sexual concerns, such as a sensation of looseness in the tone of your vaginal tissue

Pessary
 A pessary is a removable device that is inserted into the vagina (birth canal) to
provide support in the area of a prolapse.

Types of pessary

a. Support Pessary
b. Space-filling Pessary .
 They are all usually made from medical-grade silicone, which makes them durable
and resistant to absorption.
 The most commonly used support pessary is the ring pessary with support.
 The most commonly used space-filling pessary is the Gellhorn pessary.

Uses of Pessary
 Genital Prolapse
 Urinary stress incontinence
 Cervical incompetence
 Retrodisplacement

Side effects: are

 Mild side effects from pessary use, such as vaginal irritation, foul-
smelling discharge, and urinary tract infections.

Caring for the device

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  Once removed, clean it with mild soap and warm water and then rinse before
replacing it.
 You doctor may prescribe a vaginal estrogen cream to apply inside your vagina
while the pessary is out to prevent irritation.

UNIT – VIII

NURSING CARE OF THE ELDERLY

SHORT ESSAY ( 5 MARKS )

Q1. Explain Psychosocial aspects of aging .

Ans : Introduction

 Ageing is a not a problem but it is a ggradual , life long biological process that
affects irreversible changes .
 Natural ageing process is called as senescence.

Meaning

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  Natural ageing refers to to inexorable and universal physiological changes that
occur with ageing.

Healthy ageing

 Retention of physical , physiological , psychological and social fitness to its

maximum and to lead a normal life as possible like in earlier years .

Aspects of ageing: are

A. Physical changes
B. Psychological changes
C. Social changes
D. Spiritual changes

PSYCHOSOCIAL ASPECTS OF AGEING

Psychological and Mental stressors change

 Psychological changes of normal ageing include loss of self esteem, acceptance or

non-acceptance of Physical changes, coping with personal loss, slower process of
information and possible depressions.
 Mental changes include gradual mental dysfunction due to gradual decline in
intelligence, memory, sensory changes resulting in inaccurate communication,
disruption of sleep.

 Emotional disorders result from social maladjustment the degree of adaptation to

the fact of ageing is crucial to a man's happiness in this phase of life.
 Failure to can result in bitterness, inner withdrawal, depression, weariness of life,
and even suicide.
 Sexual adjustment between 40 and 50, there is cessation of reproduction by women
and diminution of sexual activity on the part of men.
 During this phase, physical and emotional disturbances may occur. Irritability,
jealousy and despondency are very frequent.

Sociological changes

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  some of the Sociological changes that come with increasing life span include
reduced income, change in life style, widowhood, loss of other family members
and friends, failed relationship, social isolation, isolation from services and
activities.

Spiritual changes

 The Spiritual changes are both internal and external.

 Due to functional disabilities, lack of company, shortage of funds and related
means and facilities.
 All these change may cause feeling of rejection, hopelessness, helplessness,
depression, powerlessness, loneliness, anxiety and insecurity.
 Some are fully satisfied with their life and have lived fully and are thus ready for
the ultimate experience of life. Often they say, they are ready to die.

Q2. Explain legal issues in care of elderly.

Ans : Meaning

 Elderly care also called as senior care, is a specialized care service that is designed
to meet the needs and requirements of senior citizens at various stages.

LEGAL ISSUES IN CARE OF ELDERLY

A. NEGLIGENCE
B. MALPRACTICE AND
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 C. OMISSION.

A. NEGLIGENCE
 It is the failure to exercise adequate care.
 Negligence, in law, the failure to meet a standard of behavior established to protect
society against unreasonable risk.
 Negligence is the cornerstone of tort liability and a key factor in most personal
injury and property-damage trials.

Four elements to a negligence action : are

A. duty: the defendant has a duty to others, including the plaintiff, to exercise
reasonable care,
B. breach: the defendant breaches that duty through an act or culpable omission,
C. damages: as a result of that act or omission, the plaintiff suffers an injury, and
D. causation: the injury to the plaintiff is a reasonably foreseeable consequence of the
defendant's act or omission.

B. MALPRACTICE
 It is the negligence on the part of a professional person in providing care to
another person.

Examples
 Surgical errors or unnecessary surgery.
 Prescribing the wrong medication.
 Disregarding or failing to consider appropriate patient history.
 Not ordering proper tests.

Four elements of medical malpractice include:

 The doctor or facility owed a professional duty of care.
 There was a breach of duty.
 The victim suffered injuries as a result of the negligence.
 There were financial or intangible losses.

C. OMISSION
 Omission defines that 'a failure to perform an act agreed to, where there is a duty to
an individual or the public to act or is required by the law.
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  The rights of the elderly are abused when the family does not give them adequate
care and attention

Example
 In general terms, doctors and hospitals have a duty to provide appropriate care for
their patients, and an omission may breach that duty except where an adult patient
of ordinary capacity terminates the duty by refusing consent.

D. INTENTIONAL TORTS

 Torts are wrongful acts that cause someone to suffer harm .

 Torts can be categorized as intentional or unintentional

INTENTIONAL TORTS

 An intentional tort is a willful act that violates a patient's rights. Willful and
intentional means that the act was done knowingly and on purpose.
Assault

 Assault is a threat made against a person that makes them fearful.

Battery

 In nursing torts, battery is the touching of a patient, without consent, that causes
harm.
 For example, you administered a medication to a patient after they refused, that
would be battery.

False Imprisonment

False imprisonment is the act of keeping someone somewhere against their will, when
they should otherwise be free to go.

E. DEFAMATION
 Written or spoken communication that holds a person up to ridicule or scorn and
tends to harm his or her reputation.
 Libel – written defamation
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  Slander – spoken defamation

Q3. Discuss the age related changes in cardiovascular system among elderly.

Ans: Introduction

 Age-related Changes in the Cardiovascular System normally occur, with aging

being an independent risk factor for cardiovascular disease .

A. Age-Related Heart Structural Changes

Structural changes with ageing involve the

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  Myocardium
 Cardiac conduction system
 Endocardium.

 There is a progressive degeneration of the cardiac structures with a loss of

elasticity, fibrotic changes in the valves of the heart, and infiltration with
amyloid.
 The pumping capacity of the heart is reduced with age due to a variety of
changes affecting the structure and function of the heart muscle.

Functional Changes : are

 Maximum cardiac output and aerobic capacity are reduced with age.
 Stroke volume is changed little by aging.
 In general, most older people have a moderate increase in blood pressure .

B. Cardiac conduction system

 Cardiac conduction is affected by the decrease in the number of pacemaker

cells in the sinoatrial node with age.
 Beginning by age 60 there is a pronounced decrease, in the number of
pacemaker cells in the sinoatrial node, and by age 75 less than 10% of the cell
number found in the young adult remains.

C. Valves

 An age-related increase in valvular circumference has been reported in all four

cardiac valves (aortic semilunar valve, semilunar valve, bicuspid valve,
tricuspid valve), with the greatest changes occurring in the aortic valve
 older adults, severe aortic valvular stenosis and mitral valvular insufficiency
are related to degenerative changes with age.

D. Age-Related Changes in the Blood Vessels

 The aorta becomes thicker, stiffer, and less flexible.

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  This is probably related to changes in the connective tissue of the blood vessel
wall. This makes the blood pressure higher and makes the heart work harder,
which may lead to hypertrophy of the myocardium.
 Ateries thicken and stiffen.
 In general, most older people have a moderate increase in blood pressure.

E. Heart

 The reduction in maximal heart rate is thought to be due to changes in the

autonomic nervous system , along with age-related decrease in the number of
cells in the sinoatrial node.
 Reduction in Contractitility of Vascular Walls: This contributes to the slowing
of heart rate.

F. Blood

The blood itself changes slightly with age.

 Normal ageing causes a reduction in total body water. Consequently there is

less fluid in the bloodstream, so blood volume decreases.
 Red blood cells are produced more slowly in response to stress or illness is
reduced. This creates a slower response to blood loss and anemia.
 Neutrophils decrease in their number and ability to fight off bacteria. This
reduces the ability to resist infection.

Q4. Explain the care of elderly with dementia.

Ans: Meaning

 Dementia is a loss of cognitive function that occurs with certain diseases. It affects
memory, thinking, and behavior.

Care of Elderly

Tips for reducing confusion in people with dementia include:

 Have familiar objects and people around. Family photo albums can be useful.

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 Keep lights on at night.
 Use reminders, notes, lists of routine tasks, or directions for daily activities.
 Stick to a simple activity schedule.
 Talk about current events.
 Taking regular walks with a caregiver can help improve communication skills and
prevent wandering.
 Calming music may reduce wandering and restlessness, ease anxiety, and improve
sleep and behavior.
 People with dementia should have their eyes and ears checked. If problems are
found, hearing aids, glasses, or cataract surgery may be needed.
 Supervised meals can help with feeding.
 People with dementia often forget to eat and drink, and can become dehydrated as
a result.
 Talk to the provider about the need for extra calories due to increased physical
activity from restlessness and wandering.

Also talk to the provider about:

 Watching for risk of choking and what to do if choking occurs

 How to increase safety in the home
 How to prevent falls
 Ways to improve bathroom safety
.

LONG-TERM CARE

A person with dementia may need monitoring and help at home or in an institution.
Possible options include:

 Adult day care

 Boarding homes
 Nursing homes
 In-home care
Many organizations are available to help you care for a person with dementia. They
include:
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 Adult protective services
 Community resources
 Local or state government departments of aging
 Visiting nurses or aides
 Volunteer services
 In some communities, dementia-related support groups may be available.
 Family counseling can help family members cope with home care.
 Advance directives, power of attorney, and other legal actions may make it easier to
decide on care for the person with dementia.
Nursing Management

 Assessment data for the patient with dementia should include a past health and
present medical history.

Nursing Interventions

 Use simple sentences with simple words

 Speak clearly and slowly
 Stand in front of the client and look in to his face and talk
 Observe clients verbal and nonverbal responses
 Don’t argue with the client
 Personal hygiene
 Toilet habits
 Fluid management
 Recognition of family members .

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Q5. Explain the nursing management of elderly with fracture of femur.

Ans: Meaning

 A broken thighbone, also known as a femur fracture, is a serious and painful

injury.

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  The femur is one of the strongest bones in the body, and a break or fracture in the
femur bone is often caused by old age due to falls.

Causes

 Falls in old age

 Osteoporosis
 Osteomalacia
 Fragile bones

Symptoms: are

 Symptoms of a femur fracture include severe pain, swelling, tenderness, physical

deformity and often, the inability to walk.

Treatment

 Setting the leg

 Immobilization through a splint or cast
 Pain medication
 Surgical fixation of bones

Nursing Management

Nursing Care

 Application of cold packs

 Administration of pain medication
 Neurovascular assessment
 Observe for shock
 Cast care
 Skin care

Nursing Diagnosis

 Acute pain
 Risk for peripheral neurovascular dysfunction
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  Risk for infection
 Impaired physical mobility
 Disturbed sensory perception.

Q6. Discuss the ethical issues in care of elderly.

Ans: Meaning

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  Elderly care also called as senior care, is a specialized care service that is designed
to meet the needs and requirements of senior citizens at various stages.

Ethical issues in Care of elderly

A. Decision making capacity

B. Informed consent
C. Refusal of treatment
D. Advance directive
E. Psycho-social aspects of aging .

A. Decision making capacity

Competency : Legal determination by a judge as to mental disability or incapacity ,

whether a person is legally fir and qualified to give testimony or execute legal
documents.

The law presumes that all adults are competent and have decision making capacity to
make health care decisions.

B. Informed consent

 Can make a choice

 Understand and appreciate the issues
 Rationally manipulate information
 Make a stable and coherent decision

Age related factors

 Hearing and visual impairment

 Impaired communication
 Values and beliefs
 Diminishes decision making ability.

c. Refusal of Treatment

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  The right to refuse treatment even if refusal hastens or results in their death.

Requisite capacity must be determined

 Can make a choice

 Understand and appreciate the issues
 Rationality manipulate information
 Make a stable and coherent decision

d. Advance directive

Patient Self Determination Act (PSDA) mandates: are

 Provide all adult patient with written information concerning care decisions
 Ask patients whether they have an advance directive
 Maintain policies
 Honor advance directive
 Educate patients about advance directive
 Conduct community education
 Do not discriminate.

e. Psycho-social aspects of aging

 Fear of aging – changes in roles

 Retirement and perceived non –productive, sense of negative feelings
 Common stressors of old age – normal aging changes that impair physical
functioning activities and appearance, disabilities due to chronic illness.

f. Confidential and Disclosure

 Ethical oaths and specific statutes protect the confidentiality of physician patient
communications, ethical legal bedrock of therapeutic relationship.
 Even well meaning family involvement without the patients consent violates the
patient’s right of confidentiality.

Q7. Discuss the components of health education to an elderly with constipation.

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Ans: Introduction

 Constipation is a condition in which you may have fewer than three bowel
movements a week; stools that are hard, dry, or lumpy; stools that are difficult or
painful to pass; or a feeling that not all stool has passed.

Causes: are

 Low fibre diet

 Physical inactivity
 Other medications eg : opioid analgesics , anticonvulsants .

Components of Health education for constipation

 Increase intake of fibre , especially fruits and cooked vegetables

 An apple or banana each day is helpful.
 Drink 7 – 8 glasses of water each day
 Have midmorning soup with spinach and tomato
 Take daily morning and evening walks for at least 20-30 minutes each .
 Eat whole grains and nuts
 Avoid removing bran from the flour
 Regular period of Elimination
 Toilet training
 Provide privacy during elimination
 Evaluate pattern of laxative and enema use, type and frequency
 Provide laxatives, suppositories and enemas only as needed .
 Teach how to establish a bowel routine and explain that having a regular time for
defecation.
 Explain how an exercise regimen , increased ambulation and abdominal muscle
toning to propels the colon contents .
 Explain the normal position ( semisquatting )
 Avoid over use or long term use of stimulant laxatives .
 Provide dietary information

Nursing Management : Write Common points

Nursing Diagnosis , Goal and Interventions .

Q8. Discuss the methods of stress management in elderly.

Ans: Meaning
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  Stress is a feeling of emotional or physical tension .
 Stress can come from any event or thought that makes you feel frustrated , angry or
nervous .

Common sources of stress for elderly include:

 Changes of lifestyle and financial status after retirement
 Caring for grandchildren
 Caring for a sick spouse
 Death of relatives, beloved or close friends
 Deterioration of physical abilities and chronic illness
 Worries for not being able to live independently
 Worries for institutionalization

Common signs and symptoms of stress:

A. Physiologica
 insomnia, nightmare
 loss of appetite, palpitation
B. Emotional and psychological
 anxiety, fear, frustration, depression
 restlessness, poor concentration, forgetfulness

Stress management
 The elderly can share their difficulties and feelings in facing stress, and their way
of coping, with those they can confide (e.g. relatives and friends).
 This helps to ventilate emotions and facilitate the learning of different strategies
of coping with stress.
 An active social life, healthy lifestyle and relaxation exercises are all useful ways
to handle stress.
 Positive thinking, such as appreciating one's achievements and strengths, can help
to enhance self-confidence and to cope with stress.

METHODS OF STRESS MANAGEMENT

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A. Read Words of Inspiration or Just Read

 Find a story that inspires you! Read a biography that shares the story of a hero, find
a poem that quiets your soul, or enjoy a piece of classic literature.
 Stories from the Bible are filled with acts of courage, trials that were overcome,
and proverbial words of wisdom.
 Make reading a regular habit and allow yourself to simply read because it gives
you pleasure and enjoyment.

B. Meditate and Be Thankful

 Meditation is easier than you think.

 Start with choosing a comfortable area and try practicing some deep breathing.
 Allow yourself to relax and find a quiet inner place of peace, where you can feel
content and at rest.

C. Play with a Pet!

 Take a walk with your dog, cuddle your cat.

 Pets offer soothing comfort to their owners; they are fun, loving, companions
known for their ability to improve mental well-being.

D. Change the Pace – Go Mall Browsing!

 An indoor or outdoor shopping mall is a perfect place to do something different

with your day.

 Shopping or browsing is a popular pastime for seniors, and it’s easy to see why.

 Mall browsing always offers something new or different: you can simply enjoy the

ambiance, the comfortable temperature and the interesting people who walk by.
 Browse through books or magazines at the bookstore .

E. Take Care of Yourself- Exercise, Explore the Outdoors and Don’t Forget to
Laugh

 Develop healthy eating habits and don’t neglect your rest.

 A good night’s sleep can revive your body, mind, and spirit.

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  Daily exercise can give you a sense of accomplishment and help to refresh your
mood. Whenever you feel like you are starting to fall into the rut of stressful habits,
try spending some time outdoors.

Q9. Discuss the factors influencing coping among elderly.

Ans: Introduction

 Coping involves adjusting to unusual demands or stressors.

 Coping is the process of contending with life difficulties in an effort to overcome
or work through them .

Factors influencing coping among elderly

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Religion and Spirituality: Widely recognized as major coping resources that have a
positive effect on many aspects of psychosocial function for older adults .

 Cultural considerations

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Q10. Describe the role of a nurse in meeting the nutritional needs of elderly.
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 Ans: Introduction

Meeting Nutritional Needs of Elderly

A. Eat foods that give you lots of nutrients without a lot of extra calories, such as
 Fruits and vegetables (choose different types with bright colors)
 Whole grains, like oatmeal, whole-wheat bread, and brown rice
 Fat-free or low-fat milk and cheese, or soy or rice milk that has added vitamin
D and calcium
 Seafood, lean meats, poultry, and eggs
 Beans, nuts, and seeds

B. Avoid empty calories. These are foods with lots of calories but few nutrients, such as
chips, candy, baked goods, soda, and alcohol.

 C. Pick foods that are low in cholesterol and fat. You especially want to try to avoid
saturated and trans fats. Saturated fats are usually fats that come from animals. Trans fats
are processed fats in stick margarine and vegetable shortening. You may find them in
some store-bought baked goods and fried foods at some fast-food restaurants.

 D. Drink enough liquids, so you don't get dehydrated. Some people lose their sense of
thirst as they age. And certain medicines might make it even more important to have
plenty of fluids.

 E. Be physically active. If you have started losing your appetite, exercising may help
you to feel hungrier.

Role of Nurse

 Nurses play equally important roles which complement the role of the dietitian to
ensure adequate nutrition for elderly patients.
 In Australia, the nurses’ role is to ensure patients are well supported and their
nutritional intake is well monitored and documented.
 The process of ageing affects nutrition needs and can be associated with changes in
lifestyle.
 It has been widely recognised for a long-term illness, such as dementia, that
prioritisation of nutrition is extremely important.
 Older people are at risk of becoming even more malnourished.
 Nurses play a significant role in understanding the importance of nutrition basics
and need to be able to explain the facts about healthy food choices to elderly
patients.
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  Nurses are expected to deliver healthy diet education.
 However, nurses working across both primary and secondary care have inadequate
knowledge in both their nutrition education and their pivotal role in helping to
detect risk factors in order to improve patients’ health outcomes.
 Nurses must raise awareness of their role in nutritional supports for their patients
and elderly.
 Moreover, inter-professional and collaborative working is also encouraged to
improve patients’ health outcomes.
 There is need to continue to raise the awareness of the importance of
multidisciplinary nutritional care in improving health outcomes for both primary
and secondary care.
 Finally, nutritional training, which aims to deliver both nutrition basics and
emerging nutritional knowledge, is highly recommended.
 These trainings can help nurses and all health professionals further deliver better
evidence-based care that meets the nutritional needs of elderly patients

Q11. Write a short note on elderly abuse.

Ans: Meaning

 Elder abuse is an intentional act or failure to act that causes or creates a risk of
harm to an older adult.

Types of Elderly abuse: are

 Physical abuse : happens when someone causes bodily harm by hitting, pushing,
or slapping.

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  Emotional abuse, sometimes called psychological abuse, can include a caregiver
saying hurtful words, yelling, threatening, or repeatedly ignoring the older adult.
 Neglect occurs when the caregiver does not try to respond to the older adult's
needs. This may include physical, emotional, and social needs, or withholding
food, medications, or access to health care.
 Abandonment is leaving an older adult who needs help alone without planning for
his or her care.
 Sexual abuse involves a caregiver forcing an older adult to watch or be part of
sexual acts.
 Financial abuse happens when money or belongings are stolen from an older
adult. It can include forging checks, taking someone else's retirement or Social
Security benefits, or using a person's credit cards and bank accounts without their
permission.

Risk factors for Elderly abuse: are

 Has memory problems (such as dementia)

 Has a mental illness, either long-standing or recent
 Has physical disabilities
 Has depression, loneliness, or lack of social support
 Abuses alcohol or other substances

Signs of elder abuse

 Lacks medical aids such as glasses, walker, hearing aids

 Displays signs of emotional trauma
]
 Broken eyeglasses/frames, or physical signs of punishment or being restrained
 Displays signs of insufficient care or unpaid bills despite adequate financial resources
 Broken bones or fractures
 Poor physical appearance
 Changes in mental status
 Frequent infections
 Bruising, scratches, welts, or cuts
 Unexplained weight loss
 Refusal to speak
 Signs of dehydration
 Lack of cleanliness

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Management of Elderly abuse

Discuss concerns related to suspected abuse or neglect

 Include in the treatment plan and enlist their active support and participation .

Involve professionals from other disciplines

 To assist in the evaluation 

Continued contact w/ a trusted family physician

Significantly enhance the intervention process

Prevention of elder abuse

 Discussion with the elderly and their caregivers.
 Intervention and not indifference when is suspected an elder abuse
 Training on other people for the recognition and reporting of elder abuse.

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Q12. Explain about medications used for elderly people.

Ans: Introduction

 As you get older, your doctor is likely to recommend certain medications to improve
your health and longevity.
 These might include a prescription for a specific health concern or over-the-counter
remedies like pills, liquids, creams, vitamins, eye drops, or supplements.

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Commonly Used Medications for Older Adults

Some health concerns are more common with age, and doctors prescribe medications to
help treat them.

Amlodipine besylate : This is used alone or together with other medicines to treat high
blood pressure (hypertension). High blood pressure overworks your heart and puts
pressure on your arteries.

Azithromycin : This antibiotic medication works by killing bacteria or preventing

bacterial growth. However, it does not work for colds, flu, or other viral infections.

Levothyroxine : This is used to treat hypothyroidism, a condition whereby the thyroid

gland does not produce enough thyroid hormone.

Lisinopril : This is similar to amlodipine besylate and is also used alone or together with
other medicines to treat high blood pressure (hypertension).

Metformin : This medication is used for type 2 diabetes. It can lower blood sugar levels,
help your body to heal, and make sure that food gets correctly converted into energy.

Omeprazole : This is used to treat excess stomach acid, which can result in ulcers, erosive
esophagitis, and acid reflux disease, for example.

Simvastatin : This is commonly used to treat high cholesterol and fat levels in the blood. It
helps to prevent heart attacks, strokes, and other serious medical conditions linked to
clogged blood vessels.

Hydrocodone : Its often called with acetaminophen, is a pain medication and

Hydrocodone is only prescribed to patients suffering from severe pain.

Hydrochlorothiazide: Hydrochlorothiazide is a blood pressure medication often sold

under the brand name Microzide. It is a diuretic .

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Q13. Describe the use of hearing aids for elderly people.

Ans: Meaning

 A hearing aid is an electronic, battery-operated device that amplifies and changes

sound to allow for improved communication.

Components of Hearing Aids : are

Microphone: Receives sound and converts it into electrical impulses. (picks up sound)
Amplifier: Intensifies electrical impulses. (makes sound louder)

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Receiver: Translates those electrical impulses into louder sounds. (delivers amplified
sound into ear-miniature loudspeaker)
Battery: Serves as power source for device.
Earmolds (earpieces) : directs the flow of sound into the ear and enhance sound quality.

Indication: Hearing loss

Uses : Hearing aids are primarily useful in improving the hearing and speech
comprehension of people who have hearing loss that results from damage to the small
sensory cells in the inner ear, called hair cells.

Model of the efficiency of hearing aid use.

Care of hearing aids

 Keep them away from heat, moisture, hair care products, children, and pets.
 Clean them as directed.
 Turn off your devices when you are not using them.
 Replace dead batteries right away.
 Hearing aid batteries may last from several days to a couple of weeks. Battery life
depends on the battery type, hearing aid power requirements, and how often you use
it.

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 In general, hearing aids can last for 3 to 6 years. You may need a new one sooner if
your hearing loss gets worse.
 Behind-the-ear hearing aids give you more flexibility since they can be programmed
for a wider range of hearing loss.
 Digital hearing aids get stronger and better every few years as computer technology
improves. This often prompts people to upgrade their devices.
 Remove hearing aid before using hairspray, perfumes, shaving lotions.
 Never immerse hearing aid in water
 Don't try to lubricate hearing aids
 Remove hearing aid before any medical procedures that involves scanning
 Keep hearing aid out of children and pets.

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