ence os e between dry refuse and wet refuse lof refuse disposal pace of home visit in primary healthcare flks on purchase and preparation of fo consideration in administering antimicrobials Pelvic inflammatory disease © Giteot patient with indwelling catheter Pitaton of nosocomial infection | Tfibting and taking over of a ward Gateofpatient with burst abdomen aces between urge incontinence and stvess incontineuce sesponsibilities in obtaining urine specimen for creatinine nee test... miyelitis ep of triage in the emergency department iulmonary resuscitationsysiology of micturition staid management of epistaxis... ‘aid management of snake bite. st aid management of fracture... aid management of foreign body in the nose... aid management of shock. Berd?ietios ology ofinflammation.... HINES nesennes eatment of patent with unconsciousness of record keeping gudititypes of nursing audit......... fisadvantage of nursing audit....... f objective structured clinical examination (O.S.C.E) for nurses... QUESTIONS AND ANSWERS FOR GENERAL NURSES, UNIVERSITY STUDENT NURSES SIC MIDWIVES STUDENTS. tiene ae : Midwifery sain pregnancy matory disease following TUCD i insertion... ponents of reproductive health, a pec of record keping inthe hosp. ies of portable water... 3PART I: GENERAL NURSING FOR BASIC/POST BASIC NURSING, BASICMIDWIFERY AND UNIVERSITYNURSING STUDENTSmanagement of a patient with electrolyte imbalance | ‘state the tonicity of five(5) commonly used crystalloid (4) items ina tray that is set up for intravenous infusion and state th ch (4mks) A QUESTION 1 m electrolytes (any 6 points) on ms that could occur as a result of electrolyte imbalance (any 6 points) ‘Metabolic alkalosis Coma Depression ). Lethargy Flaceid paralysis [management of a patient with electrolyte imbalance "Assess the level of electrolyte imbalance through history and biochemical examination of the patient to identify and treat the cause of imbalance Admit patient into a medical ward and reassure. eck vital signs example T.P.R.and B.P, weigh patient daily. Observe client for central nervous system changes € twitching, seizure ete Monitor jugular venous pressure and the lungs for crepitations, jand treating the underlying problems causing the electrolyte imbalance ion of intravenous fluids For example, eating a diet rieh in po Tow potassium levels, or resiricting water intake if the person has a low sodium levelfour (4) classifications of epilepsy (3mks) = the stages of grand mal epilepsy and the nursing management stage. (Smks) lentify five (5) supportive measures that should be pr family and the community (4mks) ovided by the patie! FOR QUESTION 2 © a. Epilepsy is a disorder of cerebral function with sudden attacks of altered consciousness, motor activity, OF st ‘Phenomenon, Or Epilepsy is an organic disorder in which there is an episodic and involuntary movements, loss ‘consciousness and disturbances of behavior, due to an abnormal electrical discharge in the brain. classifications of epilepsy 1. Petitmal (minor epilepsy) 2. Grandmal epilepsy (major epilepsy) 3. Tacksonian fit 4. Temporal lobe epilepsy 5. Status epilepticus _ Stages of grand mal epilepsy and Nsg Mgt at each stage. ‘The warning stage: this stage is usually marked with irritability, restlessness and uneasy feelings ‘Nursing Management erthe vital signs of the patient and record it. ‘the patient and pack away any injurious article that is near the patient. ‘monitor the patient. nt to safer surrounding for example, ‘burning during the convulsive ssing Management: ‘Make the patient as comfortable as possible, put to bed or place comforiable on a cout 1Ds not try to rouse the patient. Allow consciovsness to return gradually. Leave the patient to lie quietly after consciousness returns munication Is An Essential Skill In Nursing Practice. Define communication (1mks) ) Describe with illustrations five (5) elements of communication. (10mks) (¢) Enumerate ten (10) barriers to effective communication. (Smks) (2) verbal and two (2) non-verbal (@) Briefly describe with examples two ‘communication. (4mks) R FOR QUESTION 3 1} communication is any means of exchanging information or feeli 10 or more people. It can also be ified as a process by which ideas and information are transmitted betw more individuals 4 Elements of communication Messcge™ Decoding (Receiver Figure: Elementsof Communication Process ORvomnutication, | Leite RE 1. Sender: the sender, person or group wio wishes to convey a message to another. cas be considered 1° *° Ne (encoder). This term suggests that person or group ‘eiding the message must haye an Wea oF TeaSO" | communicating and must put the idea or feeling into a form that can be transmitted. Encoding involves # Selection of specific signs and symbols (codes) to transmit the message, such as which language and words 10 8, how to arrange the words, and what tone of voice and gestures to use, For example, ifthe feceiver speaks 1e source English, the sender usually selec's English words, Message: the second element of the communication process is the mestage itself/what is actually said or written, the body language that accompanies the words, and how the message is being transmitied Channel: this is the medium used to convey the message. It can target any of the receiver's senses. It is important for the channel to be appropriate for the message and it should belp make the intent of the mest Receiver: the receiver, the fourth element of communication process is the listener, who must listen, observe, and attend. This person is the decoder, who must perceive what the sender intended (interpretation). Perception uses all ofthe senses to receive verbal and non verbal messages. To decode means to relate the message perceived to the receiver's storehouse of knowledge and experience and to sort out the meaning of message. Ineffective communication occurs when the message sent is misinterpreted by the receiver. { Response: the fith element of the communication process, response isthe inessage tha the feoeiver returns to the sender. It is also,called feedback. Feedback can be either verbal, non-verbal or both. Either way, feedback allows the sender to onset oF ward a message. Barriers to effective communi nication, oor nurs-patientslationship Laiguage Use of big graHin place of or i conjunction with speech. Gxstice includes a facial expression is ‘of more motions or positions of the muscles beneat Bes re woot vine of anal bs Obl eye contact, ete. ae a 13 year old JSS 2 student was rushed into the medical er where you are the nurse on duty with severe attack of Bronchial ‘Asthma. jal between Bronchial and C: ribe the pathophysiology of Bronchial Asthma. (6mks) ves th Describe in detail the management of Miss Ovie within the first two (2) hours im “the hospital. (7mks) Outline a health talk to group of asthmatics on measure to prevent attack (4mks) jiac Asthma. (3mks) ie TO QUESTION 4 ae IIS Ad aierences herween bronchial and cardiac Asthma A Bronchial Asthma Cardiac Asthma ie Ti involves respiratory system aie ia i ages fe Caused by left sided heart failure and pulmonary 4 Tt is caused by narrowing of the bronchial Caused by left sided heart pil it | oe . ae Afack could be atalltimes proximal nocturnal dyspnea (at night) Pscates ‘Dyspnea not relieved by siting vp s relief of dyspnea by being in sitting up position bedback ‘Atack caused by alleray and emotion “complication of congestive cardiac failure (CCE) Obstruction of airway could occur i and palpitation within the heart Broncho dilator as_treaument Cardi glycoside could be used as treatment : There may or may not be cough. | Coughs always dry initially later it becomes productive, Pathophysiology of bronchial asthma 1 | Bronchial asthms is a hyper-responsive state of the bronchial tree which may be due to alles hemical substances cause anaphylaxis and prostaglandin release in responses to the presence of antigen, often ing abnormal contraction of the respiratory smooth muscles, which trigger of antigew/antibody reaction and that sympathetic nerves ineffective. the reaction of the airways to these stimuli causes edema and thickening of mucus and the diffuse narrowing of etacheo-bronchial tree and obstructive to air flow which increases broncho mucosal oedema the narrowing of the causes difficulty in breething in and ovt especially out of the alveoli, In order to obtain a sufficient ventilation | ie lugs in the preseace of this increased resistance to airflow, the accessory muscles of respiration are mobilized Ss fag sir into the alveoli. The characteristic patter of breathing in asthma, therefore is difficult with prolonged _ jons without much increase in the respiratory rate. ‘The attack comes rapidly with increased respirato is and expiratory dyspnea. Patient bends forward and threw the head back in order to bring into action ‘of respiration, There is usually cough which is a reflex action to the inflammatory process if ee. The difficulty experienced by the passage of air in and out of the narrowed bronchial tree pto suffers a sensation of suffocation, coughing attack follow, palor and due to reduced oxygenation of the blood. awetherapy: oy P ‘education Miss Ovie must be educated on how to use ae _shle to recognize the signs and symptoms of bronc ‘Nutrition: she should not be given anything per ‘orally, adequate nutrient must be provided: “Health talk to a group of asthmatics on measures to prevent attack “The health educatorshould explain briefly, Asthma, it’s signs ‘and Identify the cause or what triggers the attack and tell them to abstain ‘Warming signe should be identified such as malaise, shortness of breath, rs ‘and seeking for medical help should be encouraged. : Drinking of plenty warm fluid to maintain liquefied intr Effort should be made to detect the cause through clinical investigation: occupation or trade is the cause of attack, effort Would be made to ‘change occupation or trade. ‘Take prescribed drugs to prevent tke attack and ensure regular CHECKUPS. 9.9 6 | 4 a-bronchial secretion: Avoid excessive exposure o cold. “Avoid excessive! strenuous exercise that will predispose you to the attack: 5, Madam Gigar, a 60-year old local gin seller was admittes Into the medical ward with | the diagnosis of liver cirrhosis. (a) With the aid of a well labeled diagram, describe the liver. (6mks) (b) List four (4) clinical manifestations of this condition. (6mks) (c) State four (4) investigations that may be carried out on Madam Gigar. (2mks) (d) Describe the medical and nursing management of madam Gigar (mks) {e) Enumerate four (4) complications of this condition. (2mks) ANSWER TO QUESTION 5the body weighing between 1-2.3k. it iss P ‘the hypochondriac region, part of the epigastric regi sion. 7 ose cates sree are cmooth and cre to the under vrice ofthe diaphage, face i irregular in Gutline, i ibdominal wall. diaphragm and anterior abdominal wall. ch, bile ducts, duodenum, hepatic flexure of the colon, right kidney and adrenal gland. us inferior vena cava, aorta, gal bladder, vertebral column and diaphragm, ‘ribs and diaphragm liver i enclosed in a thin inelastic capsule and incompletely covered by a layer of peritoneum, folds of Supporting ligaments attaching the liver to the inferior surface of the diaphragm. It is held in position partly ents ad partly by pressure of the organs in the abdominal cavity liver has four lobes, the two most obvious are the large right lobe and the small, wedge shaped, left lobe. ro, caudate and quadrate lobes, are areas on the posterior surface Fissure; this isthe name given to the region on the posterior surface of the liver where various structures iilave the gland. The portal vein enters, carrying blood from the stomach, spleen, pancrease and the small and The hepatic artery enters carying arterial blood. It a branch ftom the coslic artery, which is a branch somal sort ipply: fibres, sympathetic and parasympathetic enter here. The right and left hepatic ducts leave, carrying bile Drainage: Iymph vessels leave the liver, draining some lymph to abdominal and some to thoracic nodes ste hepatic anery andthe potal vein tke blood tothe live, venous return is by variable number of hepatic eaves the posterior surface and immediately enter the inferior vena cava just below the diaphragm. th lies ofthe liver are made up of tiny functional units called lobules, which ate just visible wo the naked divs lobules are hexagonal in outline and ate formed by cubical shaped cells, the hepatocytes, arranged in Pairs of indiaing from a central vein. Between two pairs of column of cells are sinusoids (blood vessels with incomplete maining a mixture of blood from the tiny branches ofthe portal vein and hepatic artery. This arrangement allows fal blood and portal venous blood (with a high concestration of mutrents) to mix and come into close contact with soids are hepatic macrophage (Kupffer vhose function is to ingest lemyy wornout blood cells and any foreign particles present in the blood flowine through the liver. Blood drain ftom the sinusoid into central or centri-obular vein. These thea join with veins from other lobules, ais ig veins, until eventually they become the hepatic veins. Whick leave the liver and empty into the inferior stent One of functions of the liver i o secrete bile. Therefore, bile canaliculi run between the columnas of liver cells fs that cach column of hepstocyts has a bod simssoid on one side and a bile canaliculus on the other, The Set toin up to form larger bile canals until eventusly ney form the right and left hepatic duets, which dnc bi SFA ver. Lymphoid tissue and a system of lymph vessels are also present in each lobule i ofthe liver ers an extremely active organ, Its functions include: Carbohydrate metabolism Fat metabolism Deamination of amino acids Transmination S)ntbesis of plasma proteins and most blood clothing factors ‘tom amino ats, Sieakdown of erythrocytes and defense against microbes, , Detoxification of drugs and toxic substances ‘nsctivation of hormones Secretion of bile Production of beat Storage of bilehada if Radioisotope liver scans “Medical management a bowtt ‘The management of the patient with cirthoss is usualy based on the: ‘Medication antacids or histamine -2 (H2) antagonists are pre possibility of G1 biceding. ° 7 Vitamin and nutritional supplements promote healing. of damage, H¥@%, Fee in im to decrease ascites. These di Potassirm sparing diuretics ¢g, spironolactone or tiamterene,(Dyrenini t9 €SesS= 7° tes. “7 sis. | sents. are preferred because they minimize te fid and elesolytes changes commonly see a the patient's general, CColehicines: this anifammatory agent may increase survival ime inpatients wath mild #9 Other medications shown to possess confitrotic activity for the treatment.of eithost> includes, angiotens system inhibitors, statins, diuretics, immune suppressants, and glitazoress 9 Diet: an adequate diet and avoidance fat are essential. Although the Sibrosis of the ershoie progression may be halted or slowed by such measures. liver cannot be reversed, i Nursing management of madam Gigar fadam Glgar with cirshoss requires rest and other supportive measure to permit the liver to reestab iis functional ability ‘Since she is hospitalized, weight and fluid intake and output are measured and recorded daily. The nurse adj the patients position in bed for maximal respiratory efficiency which is especially important if ascites is marked, becaug it imerferes with adequate thoracic expansion. Oxygen therapy may be required in liver fails to oxygenate the dam ‘cells and prevent further cell destruction. Rest also reduces the demands on the liver and increases liver’s blood supply. | Improving nutritional status: if madam Gigar's cirhosis has no ascits, edema or signs of impending hepatic coma receives 2 nutritious, high protein diet, if tolerated, supplemented by vitamins of the B-complex as well as A, C, and the nurse encourages her to eat, If ascites is present, small, frequent meals is encouraged because of the abdomin ‘pressure exerted by ascites, Patients preferences are considered. Patients with prolonged or severe anorexia and those ‘are vomiting or eating poorly for any reason may receive nutrients by the enteral or parenteral route, _Patiens with fatty stools (steatorthoea) should reecive water-soluble forms of fat-soluble vitamins A, D folic acid and iron are prescribed to prevent anaemia, If she shows signs of impending or advancing coma, the a ‘protein in the diet is decreased temporarily, Protein is restricted if encephalopathy develops. 1 ati ‘protein to meet protein needs may decrease the risk of encephalopathy, Sodi iiss Wis ae “one encephalopathy. Sodium restriction is also necessary to roy Skin Care: providing careful skin care is important because of subcutaneous edema, Jeneat ‘increased susceptibility o skin breakdown and infection, Frequent changes in ere ‘ulcers. Iritating soaps and the use of adhesive tape are avoided to prevent trauma a rritated skin. The nurse takes appropriate measure to minimize skin irritation, tothe skin,nd any significant changes in nervous system function reported to appropriate Potential Complications: the nurse monitors and manage ‘potential complications of susceptibility to infection hypertension 5 admitted into the surgical ward with gun, a 75 year old university don is cancer. (5 mks) the ald of a well lebelled diagram, desc! plain four (4) risk factors for prostate cancer (6 mks) Discuss nursing management of Prof. tlugun following radi ecoridition is known to respond well to treatment if diagnosed early. .o the prostate gland. (4mks) ical prostatectomy ion (MGSE) (5 F— seminal vesicle duct ejaculatory duct-and Nerve Supply Of The Prostate ‘supply: branches ofthe internal iliac vessels, bra ‘or obturator artery. P drainage: the blood from the accessory sex glands drains via vesicopro : i : is wut 30% of semen, 5 it it's ‘supply: parasympathetic and sympathetic nerve Ee Pee ois a0 a ilky fluid thet makes up abatt 30% of sem Hs Sere a i cciarecatng reynen niin egg weogeietaes®. TINE the likelihood of semen being retained close to the cervix, 1 pudendal artery weches from the middler aternal iliac veins. (6 Ris factors or prostate cancer (4 poins) 1. Increasing age: the incidence of prostate cancer increases pid after the age oF 50 yeas) Fe ec in rcajove 65 years of one | 2. Race: Affican American men have the highest incidence of prostate cancer inthe world. Fam : i occur in 5% to 109% of eases of presale & 3. Family History: a familial predisposition may oc ms ng ‘or brother with prostate cancer doubles the risk, the risk increases further‘if ‘several relatives have had pros I roa olan were young ot dngnons 4. Diet high in ed eat and fat increases the rik for prostate cancer. and more than 70% ancer. Having a father 6¢ Nursing management of Prof Ilugun following radical prostatectomy. Pre-Operative Nursing Care The mutse allays Prof. lugunis anxiety related to sexual functioning post-operatively. © Privacy is provided and he is being encouraged to verbalize his f ‘The murse provides detailed explanation of immediate post-operative period including catheters and drainage. also the possitility of sexual dysfunction post-operatively should be discussed with him. + The nurse monitors the patients voiding patterns and obsecves for bladder distention, When catheterization is ‘carried out, care of Prof. llugun should be considered, Post-Operative Nursing Care Here the nurse focus on preventing major complications ike hemorrhage, bladder spasms, thrombosis, cathete obstruction and infection, and restoring urinary control, Observation: the nurse observes Prof, llugun's urine for the presence of blood which is expected to clear in 3-4 dx Post-operatively. If brightly red bleeding with increased viscosity and numerous clots persists, Burse avoids displacement of the catheter to prevent hacmorthage, He is observed for restless pallor, all which may indicate severe hemorehige and shock. fe is also observ “Vital signs observed and recorded. Input and output record should be maintain Bladder Training: bladder control is not regained immediately bburing sensation may occur. Bladder training can be achieved 1 ho i 8, He is encouraged to shut off urinaty stream after starting to void for ining full bladder control may take up to one the surgeon is alerted. nes, cold, sweating, ski ‘ed for signs of post operative infection. also informs him that rey the dressing is usually changed by the surgeon on the the responsibility. Careful aseptic technique must first day pol be observed{for male genital self examization (MGSE) ‘examination of the male genital looking for changes that may indicate the prese Z t to perform genital self-exam at the same Je to check for abnormalities on the t other unusual condition. It is most convenient ar sei examination, Testicular self exam TSE is used by ma “be a result of testicular cancer ge TSE is performed ufter a bath or shower when serotum is warm and most relaxed: A ma fe his ence penta area, looking for lumps, sores, ulcers, on the serotum, on the penis 6 3 the ing the geatals (the pubic hair area and upper thighs) he should also be alert tothe presen of any Bee cchn. ie, ‘Arman should look on the underside as well as top of the penis, If he is uncircumcised 2 man should gently pull, Ff ‘ack the fore skin to look for any changes there as well : S Anyabnormality observed or noticed should be reported as soon as possible toa health ease provider. | "Ais the man grasp his testis with both hands an palpate gently between thumbs and forefingers | ‘Thetestis should fee! smooth, eag-shaped and firm to touch, “The epididymis located behind the testis, should feel like a soft tube ® Anysbnormal lumps or changes inthe testes should be reported to a physician orto a nurse “Write short notes on the following diseases using the guidelines below Onchocerciasis Pertussis Cholera Rabies (5 mks each)rt is a highly contagious ‘bacterial disease that causes uncontrollable violent coughing. respiratory tract infectuion. pertussis, ‘Period: 6 weeks, but can last as long as 10 weeks. a symptoms: severe episodes of coughing, vomiting, a short lo “spells, Pertussis symptoms include, running nose, slight fever and diarrhea. . “Treatment: if started early enough, antibiotics such as enthromycin can make symptoms go aay quickly. ‘ Constant supervision for infants younger than 18 months because their breathing may temporarily stop during cough spells ‘An oxygen tent with high humidity may be used. Fluids may be given through a vein if coughing spells are sever enous! ‘enough fluids. ‘Sedatives may be prescribed for young children ‘Avoid cough mixtures, expectorants and suppress: ss of consciousness, choking Jh to prevent the person from drinking Prevention: vaccination using DPT vaccine ii, Cholera Definition: this is an infection of the small intestine caused by the bacterium vibrio cholera. ‘Cause: vibrio cholera ‘Incubation period: a day to 5 days. Signs and symptoms: profuse diarrhea, blood in the stool, vomiting, dehydration, electrolyte imbalances, lethargy, snken eyes, dry mouth, cold clammy skin, decreased skin turgor, kussmail breathing, hypotension, decreased urine output, muscle cramping and weakness, altered consciousness, seizures and coma due to electrolytes losses and ion shit. ‘Treatment: this includes, = Continue eating Continue breastfeeding Fluids (oral rehydration therapy) Intravenous rehydration using Ringer's lactate Electrolytes replacement Antibiotics treatment for one to three days shorten the course of the disease and -verit Example of antibiotics used are daeelie, cotrimoxazole, erythromycin, apes ae ie ‘ » chlorampbenical and Warnings about possible cholera contamination should be i soure i : posted around contaminated water on how to decontaminate the water purification, 4 alth education(HRIG) and four dose of rabies vaccine over a 14 days period jon: immunization or vaccination using the human diploid cell rabies vaccine. dogs, cuts, rabbits and ferrets against wild animals or strays ng an animal control officer upon observing a wild animal or a stray, especially if the animal is acting ely ny an animal, washing the wound with soap and water for 10 to 15 minutes and contracting a health care sider to determine if post-exposure prophylaxis is requited, Gatua walked into the Out Patieat Department of your hospital with the complaint of vision on the right eye. Onhistory taking, Mr.Gatua said he sustained an eye injury (3) months ago on the right cyo.Since thes, he has been experiencing blurred reduced vision, reduced visual acuity and light scattering, He was booked for extraction. th the aid of a well labelled diagram describe the cross section of the ey: (mks) ‘Outline six (6) causes of cataract.(3 mks) Utilizing nursing care pian, _and two (2) post-operative nursing diagnoses of Mr. Gatua.(9 mks) te the advice you will give to Mr Gatua on discharge.(2 mks) Identity and solve in order of priority one (1) pre-operativeACROSS SECTION OF THE EYE DESCRIPTION OF THE CROSS SECTION OF THE EYE ‘The eye is the organ ofthe vision. It is located within the orbital cavity SHAPE: Itis spherical in shape. STRUCTURE: There are three layers of the eye these are’ a. The outer fibrous layer - sclera and cornea b. The middle layer - Choroig, iris and ciliary muscle cc _ Theinner layer - Retina ‘OUTER LAYER (SCLEARA AND CORNEA) '* The sclera is located posteriorly, while the cornea is located anteriorly, '* _ It is white in color and cornea has no blood supply. © The comea obtains nutrient for sustenance from the aqueous humour. THE MIDDLE LAYER |[Nursing Objectives INaving Order Scientific Rationale Evaluation [Mr Gatua will ask few of nursing action, relationship, the condition patient is improving questions. Establish aurse-patient| - Explain the nature of| to the Introduce the patient to fanother patient who has had cataract surgery and| |- Allow patient to ask| |- Answer the patient's questions honestly. -Makes patient feel safe -This will make the} patient understand! his condition better. - This increases the| patient confidence - This will clarify patient doubts. - This will make! patient calm. "The patient asked. fewquestions after 2hours of] nursing intervention, Rilix. 4F and|data— for pain through verbal P Inursing intervention. ‘communication. This promotes comforter * | Place patient in supine}and reduces pressure on] it sd eye. [position the affecte Instruct patient to|- This ensures rest and | minimize movement |reduce pain. while on bed, |- Tt reduces pain by| - Administer prescribed} blocking pain pathway. analgesics e.g. pentazocine Self care defici|Mr. _Gatua willl Assess patien’s ability]- This serves as base Tine|Mr. : related to|participate _in|to participate in activities} for nursing intervention. participated i locchusion of thelactivities of daily|ot daily living. - This. boost patient's|activities of daily leye evidenced by |living within 48]-Assist patient _in/morale and selfesteem. living 48 kours ~ care|- This will ensure that}of nursing patient have easy access to| intervention. [patients inabiliry|hours of nursing] performing self to —_performaction. activities. activities of daily -Place necessary|the materials without living, materials useful to|stress. (ambulation, patient at close range. _|- This promotes patient| bathing, oral care - Encourage patient tolindependence when hel ete), ry out self care and|perfarms his self care with| OTHER PRE OPERATIVE NURSING DIAGNOSIS + Impaired visual perception related to trauma evidenced by blurred vision/patient complain, * Activity intolerance related to reduced visual acivity evidenced by inability of the patient to carryout simgh taskactivty * Knowledge deficit related to outcome of surgery evidenced by patient asking question. '* _ Risk for infection related to trauma. OTHER POST OPERATIVE NURSING DIAGNOSIS * Activity intolerance related to occlusion ofthe eye evidenced by patientimability 1 carry out simple task * Knowledge deficit related to post-op care ofthe eye evidenced by patientasking questions * Risk for infection related to surgical incision, *® Disturbed body image related to padding ofthe eye evidenced by patient complaints of the eye pad, 4 ADVICE ON DISCHARGE Always wash hands before touching or cleaning the operated eye, ‘Wear sun glasses during the day and metal shield at night for 1 -4 weeks, ‘Wear corrective lenses all the time. Avoid lying on the affected eye, but lie on back or on the unaffected cyc, Avo bending/ straining at soo), iting, coughing, sneezing and squeezing the eye Eat high fibre diet and copious fluid intake. Resume driving and strenuous activities as directed by the physician, Avoid chewing hard strong foods, ‘Take drugs as prescribed.halogram (EEG) is a record ofthe eleciric current generated in the brain. It is obtained through es applied on the scalp or through microelectrodes placed in the brain tissue. OR technique for recording electrical activity fiom different partsof the brain and converting it into travingis called an electroencephalogram The machine that records this activity is known as phalogram, The pattern of EEG reflects the state of the patient's brain and his level of consciousness. ja characteristic manner. OR is an investigation that is carried out by the means of a machine which records the electrical activities of the n by means of small electrodes placed on the scalp. provides assessment of cerebral electrical activity Tseful for diagnosing and evaluating seizure disorder {Coma or organic brain tumors, brain abcess, blood clots and infections that may cause abnormal pattems in dectrical activity = Determination of brain death ‘To wean (discontinue) antiepileptic medications organic encephalopathy or delirium from primary psychiatric syndromes such as catatonia Eectrodes are applied to the scalp to record electrical activities in various regions of the brain. Fich electrode is connected to one input of a differential amplifier or a different cathode while a common system telerence electrode is connected to the other input of each differential amplifier. Patient may be asked to hyperventilate for 3-4 mins or to look at the bright flashing light for photo stimulation, Asleep EEG may be recorded after sedation because some abnormal brain waves are seen only when the patient isat sleep. ING RESPONSIBILITIES jure ® thatthe procedure isnot painful and does not cause anyelectrie shock. Patient that the test take normally 45 - 60 minutes ‘which includes vital organs physical and psychological care Psychological support.ption in conscious and awake state in the absence of external stimulus. ras nis a peretion experienced in the absence of external stimu to the sense organs end with # to a true perception. ae 4s experienced as originating in the outside world (or within ones own body) like * perception, theming like imagery. ‘Tt may be provoked by psychological illness eg. schizophrenia. = Ikmay also be caused by physical disorder in the brain such as temporal lobe epilepsy of stroke. = Iteanalso be caused by drugs and sensory deprivation. ‘Examples ‘Visual hallucination Auditory Tactile” Gaustatory Olfactory — 4 Autoscopic ii) DISORIENTATION Definition-- Disorientation is a change in cognition in which the individual clarity of awareness is reduced. oR The loss of proper bearing or state of mental confusion to time, place or personal identity. oR “he state produced by loss of awareness of space, time and personality Speech and behavior tend to be moduled and the person often cannot answer questions about time, date, present locati same and address Causes ‘tis usually due o 2 head injury, intoxication ora chronic brain disorder are less commonly after severe stress. Examples: Disorientation abou = Space - Time = Persons fi) _ AMBIVALENCE Definition - Iti the simultaneous experience of contrasting feelings about a person, object ot action, OR The condition of holding opposite feelings such as love and hate for the same person or objest ; OR tis the experience of having thoughts o: emotions of ether positive or negative valence towards someone or so The term also refers to situation where mixed feelings of amore general sort are experienced ot where a person ¢ _eeriaity or indecisiveness concerning something,compulsive disorder/Hysteria isorders/phobic neurosis depressive neurosis ntiate between dryrefuse and wet refuse, give at least three (3) differences (3 mks)& __ Methods of Refuse Disposal i) — Burning ‘Buuring is the process of destroying solid refuse by combustion (through the use of fire). OR Process of setting of solid refuse on fire. ‘Method Refise is collected in empty drums, pit or open ground ete. Fire is set on the refuse and itis allowed to burn, vantages: = Itis cheap = Aneasy method = No technology is required Disadvantages; ~~ Itereates atmospheric pollution Risk of fire outbreak Half burnt refuse provides breeding places fo rodents, flies, pests ete. Contibutes to global warming : = _Non targeted objects may be burnt 4‘ ii.Compostings Definition "| = Its aprocess of nature where by organic : compose i oR = _ Iti aprocess of decomposing organic matters to furly table humus by aerobic microbes, Method: ~ Wet and dry refuse is heaped in alternative layers into a pit of about 2.4m* to-a depth of about 1.5m, ‘with a thin layer of cil Itis allowed to decompose and mix with the soil for a minimum of 90 days, It willbe tuned frequently to mix properly and become humus Advantages = Can be used as manure (agricultural value) = Itdoes not require technology - lis cheap Disadvantages: = Turing is laborious = _Itproduces offensive odour ~ _ Itfavours the breeding of flies and organisms iit) Open dumping Definition: Itisa process of unsanitary dumping of refuse in open land OR ‘A method of refuse disposal in which the waste materials are dumped in an open space, matter breaks downunder bacterial action resulting in the for Refuse and garbage are collected and dumped on open hills or ground,posal whereby refuse are dumped into an incinerator and burt. OR into an incinerator where the materials are burnt, , z ‘the combustion of waste materials contained in a deposited into the incinerator and burt incinerator magnetic separators remove metalebjects before the rest are burnt in the enclosure, ate discarded appropriately. ‘most acceptable method atmospheric pollution if itis a modem incineration, plant es ess fire éanger or it may not occur at all It doesnot favour breeding of flies, pests and rodents the volume of materials for ultimate disposal. af generated by incineration can be used to generate lectcity stly (expensive) high technology and manpower longer time to bum lary to hypertension. @ well labelled diagram, describe the circulation of blood through the (5 mks) ate the pathological changes in congestive cardiac fallure?(Smks) lop a Nursing Care Plan to solve three (3) nursing diagnoses of Mallam (9 mks) (2) home care assessment of Mallam Tsoho.(1 mk)Left ventricle Right ventricle Interior ona cava DIAGRAM SHOWING THE CIRCULATION OF BLOOD THROUGH THE HEART Cireulation of blood through the Heart ~ Fromthe superior and inferior vena cava Deoxygerated blood enters the right atrium. Contraction of thea forces blood through the right atrio-ventricular valve into the right ventricle - Fromthe right ventricle, blood is pumped through the pulmonary valve into the carrying de-oxygenatedblood The pulmonary artery divides into right and ‘oxygenation of blood ‘The oxygenated blood is transported to the left atrium through the pulmonary veins. ‘Through the mitral valve (atrio ventricular valve) arcrial blood enters into the thick walled left ventricle Blood is pumped into the gereral circulation through the aortic valve into the aorta when the Cardio-pulmonary congestion wll lead to Dysproca - Hydrothorax = Haemoptysis Pericardial effusion Left ventricular failure = Valvular disorder - Cardiomegaly Congestion in the venous system will produce: Impaired cerebral function Hepatomegaly Jugular vein distension ;pairment will lead to Oligutia Pitting Oedema Ascitis Increase in creatinine level Other Pathological changes include ~ Tissue Hypoxia = Club bed fingers branches,in a fowlers position Loosen tight clothing around the chest. and neck Monitor and record vital sins (BP, pulse and respiration) ‘Administer ‘oxygen PRN Give prescribed drugs eg. lauis, digoxin hragm 3. Allows free flow of blood & maximum expansion of the thoracic cage. 4. Monitors patient's progress 5, Improves tissue perfusion 6. Frusemide: loop diuretics that enhance sodium & water excretion _ thereby reducing fluid volume. Digoxin is a digitalix that strengthens the myocardial contability, thereby increasing output of the heart Fluid volume excess related 10 veinous congestion evidenced by edema Patient will not show any sign of oedema after 1 week of using intervention Reduce fluid and sodium intke Weigh pationt daily Monitor and record intake aand output Give prescribed diuretics eg, lexis and mineral supplement slow K 1 Reduces oedema and prevents further accumulation of fluid | 2. Assess the progress of treatment 3. To assess fluid status 4. Lexis is a loop diuretic that increases urine output, by preventing tubular reabsorption of salt and water 5: Replaces potassium lost by diuresis Patient did not show any sign of | Oedema after 5 days of nursing, intervention Patient will verbalise less fear and be seen discussing fiedly with other patients and relations within 24 hours Establish go0d nursing patient relationship Explain procedure to the patient Keep patent in controlled guiet atmosphere Listen 10 the patient and 1 Contibuie tothe patients confidence and security 2, Explanation allay anxiety, proves helpful and reassuring 10 the patient 3.Quiet environment allays fears by reducing tension.» 4, Facilitate the reduction of stressors. S.Bad news excite thenutrition less than body requirement related to restriction in diet evidenced by weight loss. related to disease process evidenced by patient asking too many questions Self-care deficit related to fatigue evidenced by inability to carry out activities of daily living. 4A, Disturbed eleep pattem related to dyspnea evidenced by insomnia '$. Chest pain related to myocardial ischemia and congestion evidenced by verbalization. 6. Impaired tissue perfusion related to raised blood pressure evidenced by cyanosis. na. 2 Home Care Assessment of MalamTsoho 1. Dietary assessment 2. Blood pressure 3. Weight 4, Compliance with home therapy 5, Physical assessmente.g. for Oedema 6. Assess level of activity 12. (a )What do you understand by the term “deficiency diseases"?(2 mks) (6) List six (6) deficiency diseases and state their causes.(3 mks) Discuss the importance of Home Visiting in Primary Health Care.(5 mks) f i Outline the content of the health talk you would give to mothers of the low income group on the purchase and preparation of food for the fami preventmainutrition.(10 mks) ANSWER FOR QUESTION 12 12A, Pathological condition or diseases caused by lack/absence of some particular mutrient, vitamins, amino acid (m ‘and macro nutrients) leading to severe -consequences on growth, development and health, B. SN. DISEASE CONDITION CAUSES Vitamin A deficiency Vitemin BT (Thiamine) deficiency Vitamin C deficiency Vitamin D deficiencynt of identified health problems ‘maternal and infant mortality + Greeting and self-introduction Solicit for anemtion can buy cheap locally but nutritive food or get from their farm to make a balance diet ‘purchase or whatever they can afford. ce on what they need to buy or get from their farm to cook a meal to balance their diet ‘handsare one of the main ways germs are spread 4 Tant to wash them thoroughly with soap an water before cooking, after touching the bin, fier touching raw foodas cytotoxic agents into their groups.(5 mks) Highlight ten (10) conditions that can be treated effectively | cephalosporin.(5 mks) FOR QUESTION 13 “+ Ensure the five rights in administering -antimicrobial ‘+ Take history of hypersensitivity to any ingredients of the drug, Ensure that culture and sensitivity testis done Monitor the gereral condition of the patient such as temperature, allergic reactions ete. ‘Instruct the patient on antimicrobials that can be taken with meals, aftermeals or before meals for effect absorption- Ensure that the drug is administered stictly with time to promote lessvariation in peak and serum levels Monitor patientscompliance to the use of the drug to avoid drugresistance Ensure that theantimicrobials are not taken with dairy products andantacids to ensure effective absorption avoid crystallization of interaction * Advice patient to take copious uid to decrease the effect ofnephrotoxiity Reconsttuted oral and injections should be preserved and stored appropriately andused within specified peria by the producer so as to maintain potenciesof the drugs * Precautions should be taken before administering the drug topregnant and lactating mothers to reduce adverse | effects on foctus or baby Monitoring of ipput and output to detest early onset of nephrotoxity Patients should be informed that antimicrobisls may make oral contraceptives less effective so as to preven unwanted pregnancy’ Six (@ side-effects of antifungal = Neusea - Vomiting Anaemia = Diarthoea = Constipation ~ Dry mouth = Headache = Hepatotoxicity Fever (Chills ‘Renal impairment Hypersensitivity Gastrointestinal disturbances RashesSex hormones such as Androgens, oestrogen, progesterone, ete +b, Corticosteroids such as predinsolone, dexamethosone, hydrocortisoneet: 4 Oestrogenantagonist such as Temoxafen . Antiadrenal suck as Amino gluthimide alkaloidy plant alkaloids/mitotic group a. Vincristine, b. Vinblastine ¢. Vindesirie nunosuppressants/immnunomodulatin Azathioprine (Imuran), b. Interferons ¢. Interleukin & Levamisole ete By Misccllancous agents; c.g, a Cisplanitin (Platinol) b. Hychoxyureaprocarbazine ¢ Amsacrine 4. Radio-active-isotopes ©. Mitoxantrone eve B Cephalesporins are broad spectrum antibiotic used inthe trea B- Pneumonia Tonsilitis Gonorthoes Otitis media i nt of infections such as: Osteomyelitis Meningitis Epiglotitis Septic arthr Stapiyloco ons Uneomplicay fectal infection Haemophilus Ith Pelvic Pin: (PID) Shigelisis Some skin infections e.g. Boils, impetigo, carbuncles ‘Surgical prophylaxis Cellulitis & = Dental care and provedures ina infections such as “Urinary tract infections-e en, cystitis | Ear, nose, thioat infectionsr traction commonly a nursing care plan to solve three (3) nursing diagnoses: of Mr. week of application of traction.(9 mks) “Enumerate four (4) complications that Mr. Brown may develop applicationof the traction.(2 mks) as a result of ANSWER FOR QUESTION 14 Facet arian wih aclabueen cf pals Lines aspera e DIAGRAM OF TH®LERT FEMUR "The femurs the longest and heaviest bone of jest bone of the bod) proximal end articultes with the hip bone and sea 5 one and is distal end articulates withthe tibia ofthe femar angles medaly anda esl, the Toss i esateanother vertical ridge called the linea aspers. ‘extends downwards and divide to form the medi ession called popliteal surface ridges serve for the attachment for several thigh muscles femur distal end of the femur is expanded and includes the medial condyle and lateral condyle, These articu) the medial condyle and-lateral condyle of the tibia, riot to the condyles are the medial epicondyle and lateral epiconclyle Kpressed area between the concyles on the posterior surface is the intercondylar fossa. patella surface is located between the condyles on the anteriot surface. ‘Supply: arterial= femoral arery, venous dreinage'- femoral vein tion ittransmitthe weight of tne body through the bones.below the knee to the foot SOF TRACTION Straight or running traction Balanced suspension traction ‘Skin traction Skeletal traction Manual traction xs of traction are as follows ‘Bucks extension traction Hamilton Russell traction Bryant's traction Braun's traction Pelvic belt traction | Perkin’s waction s traction ing diagnoses are; te pain related to traction and fracture evidence by verbalization dety related to health condition and the traction devices evidencedby client asking any que deficit (grooming) related to traction/immobilization ae d physical mobility related to musculoskeletal disorder and traction ficient knowledge related to traction application for impaired skin integrity related to immobilityhealth condition and the use of” traction Mainiain immobilization of the affected part Analgesic Administer reduces pain prescribed and muscle analgesics sun __ i Brown ss level of ‘Assessment ow Piecemored) |e ie cates | veblized es. the taction devices as_| verbalize Encourage quantification | anxiety within evidenced by Brown | less anxicty | _verbalizationof | __of level of hours of nursing asking many question | within1~3| concern and anxiety intervention hours of fears Verbalization nursing | 3. Reassure Mr. helps Brown to intervention | Brown remove focus &relatives e. on the problem explain health Reassurance condition and relieves the use of tension traction devices Itraises Show Brown Brown’s hope others with of recovering Selfcare deficit Mr. Brown sess level of ‘Assessment | Patient required (grooming) related to | will require self-care deficit helps to know | minimal traction/immobilization | minimal Assist Brown to the extent of | assistance in assistance carryout patents rt f. in activities of inability to performing daily living eg, cary out self | one self-care cating, bathing, care nursing, activities dressing, Assistance within a toileting ete with activities week of InvolveBrown of daily living intervention in his daily care prevent stress Involve on traction significant provide time others in Mr. forpatient to Brown care gradually intervention resume activities COMPLICATIONS OF TRACTION APPLICATION Pressure ulcers Neurovascular impairment ofthe ae (for patients in skeletal traction) : -density (secondary toextended period of immobility) : anorexia‘a diagnosis of Pelvic Inflammatory Disease four (4) possible causes of this condition (2 mks) in detail the nursing and medical management of Miss John from till discharge (12 mks) (4) complications of this condition(2 mks) , the content of the health talk you will give to Miss John on discharge(4 FOR QUESTION 15 SSIBLE CAUSES OF PELVIC INFLAMMATORY DISEASE (PID) ia trachomatis sea gonorthea na genitalium seal vaginosis pohilus influenza chia coli la spp ler Sp pdononas spp plcoccus (group B) Eptybcoccus aureus msing factors include bortion/nstrumentation ah idouching Enicinecontiaceptive device insertion mrosopy led Nursing and Medical Management of Ms. Jobn NANAGEMENT isbn: admit the patient in the fernale/gynae ward. pbgical care: encourage Ms.John to express/verbalize her concems, Reassure her obtain comprehensive history. History should include social,medical, surgical, family, sexual history place the client in semi fowier’s position, to aid drainage ofdischarges. fa examination: take and record vital signs. Assess and documentlevel of pain. Observe and record the istics and amount ofvaginal discharge (o serve as a guide for treatment ons: collect or assist in collecting specimen for all investigations sare: the nurse should assist the client in maintaining personalhygiene by careful andling of perineal h gloves, discusdingsoiled pad according to universal guidelines. Apply heat to the lowerabdomen 10 ion; high prot, high calorie and high vitamin in semi-solid or liguid diet should be served, The diet tlso havea highfibre/ roughage content to prevent constipation, at; encourage intake of copious fluid of up to 2L/day.Monitor and regulate intravenous fluids, if ‘the colourand volume of urine output.a ‘commonly treated with antibiotics, analgesic andantipyretics A eee eee i _eeftriazone, doxycycline, metroridazole, ciprofloxacin ec, : Analgesic like diclofenac, ibuprofen may be prescribed to relieve pain _Antipyretics like paracetemol/ acetaminophen, aspirin can be prescribed to reduce temperature, ‘TIONS OF PELVIC INFLAMATORY DISEASE Infertility - ‘Ectopic pregnancy: Pelvic abscess ‘Chronic pelvic pain ‘Secondary dysmenorrhea Dyspareunia Peritonitis Bacteriaemia/septiceamia OF HEALTH TEACHING Maintenance of good personal hygiene Practice of safe sex. Treatment of partners Avoidance of douchine Adherence to treatment regimen Prompt and proper treatment of sexually transmitted infections Avoidance of multiple sexual partners Avoid sexual activity until treatment is complete Precaution against infecting others Describe your responsibilities as a nurse in the following: (2) Care of a patient with indwelling catheter (b) Prevention of nosochomial infection (c) Handing and taking over a ward (d) Care of patient with burst abdomen (5 mks each) ANSWER FOR QUESTION 16 NURSING RESPONSIBILITIES IN PATIENT WITH INDWELLING CATHETER: Care of patient with an indwelling catheter Observe meatus for redness rash or pus, Assess the system as a whole. Observe colour of urine, Promote personal Hygiene. (Cate of the catheter and urine bag éaily and with each bowel movement, Regular emptying of urine bag, ‘Change of catheter when necessary (5-7 days) Bladder irrigation should be done regularly Assisting with intermittent self-catheterization, Proper positioning ofthe patient, _and output should be monitored.| disinfection of the ward jon precaution with known suspected infection, safety of needle stick injury jofumigation of ward bed spacing DING AND TAKING OVER OF THE WARD. avery important procedare of the Nurse gand taking over the ward occur between two or more Nursing officers ly takes place at the end of any shift se of handing over should be highlighted ig and taking over includes inventory taking such as Equipment which are usually taken over by the Nurse Condition of the patient Nursing care rendered Observations that indicate medical/nursing plan care Special investigations/test ‘Nursing care plan. Nurses go round the ward to see the patients, ‘Nurse handing over gives the summary of the report on each patient during the round, utse should greet the patient if conscious and but not sleeping, ert safe areas of patient care. tolicer taking over should counter sign the report of handing over officer after taking over all the patients, ARE OF PATIENT WITH BURST ABDOMEN, Sure the patient and family to allay anxiety ent in the semi-Fowler's position (15-45°) tient knee to reduce abdominal tension. he doctor immediately wound with a storile, moist dressing spt to push back content. en the patient last took food and fluid so that necessary precautions are taken to prevent aspiration. for secondary suture, to his relation consent form to sign after explanation, vid anything that will inerease abgominal pressure,‘Ojo, a 60-year hed to medical a old obessed politician was rus! ith the history of urinary incontinence. A diagnosis of overactive bladder was made. (a) With the aid of a well labelled diagram, describe the gross anatomy kidney.(6 mks) (6). Explain the role of the kidney in maintaining normal regulation of | pressure.(4 mks) (c) Differentiate between urge incontinence and stress incontinence under headings. i. Description i. Causes ili. Management (6 mks) ae | () Explain the specific nursing responsibilities in obtaining urine specime creatinine clearance test.(4 mks) ANSWER FOR QUESTION 17 — Segmental artory (Gece) itu (centation) Fenat aa ‘onal pyramid ee Major calyx Miner calyx ——_| — Rena potvia ‘Ranat papi Wie Uroter Meditiary rays Gross Anatomical Structure of The Kidn Description: Introduction: The kidney is a bean — sha extends from T12 to 13 and measures 12em in an adultis 150g, Position: The Kidney lies on posterior abdominal wall, one on cach side to-th and below the diaphragm, _ Structure: Each kidney is composed of two lo “medulla is darker and comprises of medulla ‘is received by a minor calyx. ey (Longitudinal Section) pedorgan located behind the peritoneum at the posterior abdominal n in length, 6cm jn width and 3em in thickness. The average mass of a he vertebrat column behind the peri vyers: Outer Cortex and Inner Medulla, The Cortex is granular wh ry Pyramids. Each pyramid has two parts: A base and an apex.liver, the duodenum and hepatic flexure. m, muscle of the posterior abdominal wall adrenal gland. ‘spleen, stomach, pancrease, jejenum, splenic flexure of the colon. si abtne postecior abdominal wall etic and Parasympathetic nerve Kidney in Maintaining Normal Regulation of Blood Pressure, dates blood pressure through the Renin — AngiotensinSystem. frctivated by low blood pressure, low blood volume, low plasma sodium. tion, the Juxtaglomerular (granular) cells sense the blood pressure in th bela. me els rious tissues, especially the lungs Il, produced, acts in many ways to increase the blood pressure; fent vasoconstrictor, it activates smooth muscle of arterioles throughoutthe body, constricting them and Btulates r-absorption of sodium, both directly and indirectly by triggering the release of aldosterone rom ase blood volume and blood pressure Fhulates the hypothalamus to release antidiuretic hormone and actwvates the hypothamamic thirst centre to Both increase blood Brect helps to revert high blood pressure as a feed fences Between Urge Incontinences and Stress Incontinences iption - An involuntary release or leakage of urine related to bladder iritation,reduced bladder etrusor muscle Increased urine concentration S Useof caffeine Use of alcoho! Enlarged prostate agement Reassure the patient ‘Assess and document patient’s pattern of voiding including frequency a episodes. Urine culture ‘Treat urinary tract infection (UT!) ‘Avoid caffeinated drinks and alcohol Encourage fruits that leave an acid as in the urine to minimize occurrence of UTI e.g, cxauberry,Rea the patient through health education Nand document patients’ voidingpattern, time, amount voided, amount 0 “fluid intake followed by voxding, ‘Assist in bladder training programme especially kegel exercises. ‘Avoidance of caffeinated drinks and alcohol. : ‘Encourage patient to avoid events that can lead to stress incontinence Use of incontinence pants Surgical repair Catheterization may be done d Trars-vagiral electrical stimulation to elicit passive contraction of pelvic floor muscles “d. Specific Nursing Responsibilities in Obtaining Urine Specimen for Creatinine Clearance Test Creatinine clearness performed using a Hed urine specimen collection over a 24 hour period (Normal 100 120n/min), 1. Gain patients’ consent, reassure by health education, then provide privacy Tl. Provide clean receptacle 16 collect urine Til, Encourage adequate fluids hefore, during and after the tes. IV. Have the client void and discard the urine before timing starts CObiain a specimen container with preservative (If indicated) from the laboratory. Save all urine produced dusing the timed collection period with container in are Encourage client to completely empty the bladder after the timing period and save the specimen Send the entire amoiint of urine to the laboratory in a covered and labeled container number, hospital number, end period of collection). Document collection of specimen, time started and completed and any pertinent observations of urine Patient should be informed to void into a separate receptacle before defecating to avoid contarninating specimen 4° (a) Describe the process of bone formation. (4 mks) 4) Explainthe pathophysiology of acute osteomyelitis.(5 mks) (c} Develop a Nursing Care Plan to solve three (3) Nursing diagnoses of Mrs. Justi ations of osteomyelitis.(2 mks) ANSWER FOR QUESTION 18 488. = The process of bone formation is.also called osteogenesis, — _Ithegins from birth to 21 years of life; bone develops from osteogenic cells. ~The process involves 3 stages * Osteoblast + Osteooytes * — Osteoclasts: site process of development: Jong bone develops from cartilage, + Flat bone fom membrane and © — Sesamoid bone develop from tendon siology of Acute Osteomyelitis teomyelitis is an acute inflammation of bone and bone marrow infection may be throvgh haematogenous routes (blood) dtect inoculation of the bone nae *“Assess the level of [Action 1. Serve as # base. the pain line data for management, Reassute the patient F by introducing him |Action 2, reduces petients to other improved anxiety thereby calming the cases patient. ‘Aliow the patient 0 assume comfortable |Action 3. This will reduce position, ‘comfort and reduces pain. 4, Provide patient with divertional therapy, [Action 4, Put the patient 3. Immobilize the [mind off the pain. affected limb, ‘Administer prescribe |Action 5. Itreduces Jérugs.eg. ibuprofen _|muscles spasm and reduces | |400me bd and pain. ciprofloxacin 500mg, Action 6 Ciproflaxia inhibits growth of microorganism thereby reducing infection and jtab ibuprofen inhibits inflammatory process and also relieves pain Patient's acivities of daily living willbe met throughout the period of immobilization. ‘Assist patient in bed [Actions 1,2, & 3 enhances bat {personal hygiene and well Assist in oral care. |being. Offer paticat with | Action 4 , these promotes bed pan, blood. eireulation Tum the patients’ _|therebypreventing pressure position 2 hoi sore and treat pressure areas PRN. Patient will move lout of bed and become mobile ‘within 4-5 days of| Nursing intervention Aisist pane wih helps to prevent ReGR passive exercise [deformity thereby Offer the patient promoting nealing action with working aids [283 facliate early egclutches ambulation Be wraps be patient ro initiate active movement of the limb. Patients activities of daily living were| met through the period of hospitsilization Paticnt move out af] bed and became mobile after 4 days of Nursing vention, elated to inflammatory process evidenced by clinicalthermometer reading 38°C, disturbance related to disease condition evideaced by swollen limb, elated 10 unknown outcome of the condition,4 “| i " a Ps d and Emergency trained nurse is sometimes brought in at a time-with urgent medical conditions explain-the concept of triage in the emergency department of your Describe the currently recommended guidelines/procedures for resuscitation.(7 mks) 'c) As a member of the Emergency Squad, enumerate ten (10) golden emergency care which you must observe.(5 mks) a) Describe the coordinating roles of the nurse in disaster management(3mks) ANSWER FOR QUESTION 19...) a) Cocaplles + On getting to victim remove the victim from the source of danger Lay the victim down facing up on a hard surface Shout help, help ‘When the helper comes ask hinvher 10 activate EMS or SMS or the Ambulance ‘Andto get the A-ED. Automated Fxternal deftiberator ‘Turn the victim head 1-2 inch and check for Carotic Artery for pulse Ifo pulse shout for help and say no pulse ‘Then start 30 compression and count it out and ‘This should be done up to 5 cycles When the helper comes, stop the compressions ard switch on the AEB ‘The AEB has two pads, plece the pads on each point of the right breast above and left breast below. The AEB will command Clear ~ You will respond 1 am cleared and everybody is cleared and I am cleared - The AEB will also command Apply shock and clear ‘You apply shock by pressing the bleaking button and ‘When shock has been alternated then AEB will command Give 30 compression and give (2) two breaths If the vist regains clean up the victim and send hinvher to the Accident and Emergency Hospital and hand over to the Doctor. eo igh quality cardio-pulmonary resuscitation. The universal compression to ventilation ratio ‘Is recommended with a compression rate of 100 beats/minute and compression di i ‘while in infantis dem a we 2 breathsfrom patient or relative when possible worst ister first Aid for the gravest possibility ember to identify yourself to the vietim if conscious to ensuretrust de comfort and emotional support spect victim modestly and physical privacy yealm and as direct as possible for the most serious injury first ist the victims with his/her prescribed medication p on looker away from injured person idle the victim to the nearest minimum loosing tight clothings snot eave the victim alone except to get help inot assume the victim obvious injury are the only one ting roles of the Nurse in disaster management the key personnel involved in thedisaster management e.g, emergency care physicians, Allied health nel, law enforcement agent official sation procedure to the government head of health sector fer organization plan chart 3g of volunteers ation programme triage strategy to treat victim plain casualty list and other data ll information related to hospitalization jent communication both in and out of health sector fer documentation of the activity ¢ for drugs and LV fluids Dstibution of duties de reassurance, support and assistance to deceased loved ones buld panicipate in counseling of other staff members, victims and relatives ive communication to lessen anxiety in patient/relatives thus gaining their cooperation, the agencies that can heip fovide shelter care in a temporary housing area,Pylorus Duodenu Right calc: flexure = Transverse Duodeno- colon jejunal juretion Ascending Eth S| Jejunum colon ’ leocecal ES Descending junction Waa colon ‘The smaii intestine Locstion ‘The small intestine is one of the organs of the digestive system located in the abdominal cavity. This is continue J she stomach atthe pyloric sphincter and leads into the large intestine and the ileocaecal valve, ® litte over S meters jong and lies in the abdominal cavity surrounded by thelarge intestine. ‘The smal intestine comprises three; main sections ‘The duodenum which is about 25 cm long and it curves at the head of the pancreas ‘The jejunum is the middle section of the small intestine and is about 2 meters long, ‘The ileum is about 3 meters long and ends at the ilcocaecal valve, which controls flowof materials from ileum to the eaecurn, . Sicucture avail intestine has four layers of tissues: e layer of loose fibrous tissue the peritoneum,A ‘i 4 1 exvity bebe ‘of the organs of the digestive system, Tocated in the abdominal jass and tefreinating at the rectum and anal canal deep in the pelvis: qh the crecum, ascending colon, transverse colon, descenditg colon, sigmotd colon: feet and se intestine. The arrangement 6f Sayers of tissue described in the small intestine also apply in the large intestine fed mule fore Is modified in the colon. They do nol run continuously but are collected tke ‘bands nenia col situated at regular imervals round the colon ’ fis by the superior mesenteric arteries. which supply the caecum, ascending <9'¢n and most of the BEOTHS inferior cnecencaric srtvies supply the remainder of the colon and proximal part af tle teal Wy by the sympathetic and parasympathetic nerves. orption of water, mineral salts, vitamins ete Microbial activity ~ E.coli produces vit. K food materials pseudomens: upnured Appendix foeaied Typhoid citoneat Dialysis OF MRJAGO. 1 of the peritoncum and abdominal distentionas evidenced By tient facial expression, verbalization of pain, and restlessnes ity related to outcome of disease and surgery as evidenced by 1 ative utterance and tense facial outlook ammatory process as evidenced by temperature of 38,7% isk for ineffective airway clearance relatedto ani production and dyspnca {elated to surgical incision as evidenced by facial expression, verbalization of pain and restlessness. for infection related lo surgical intervention as evidenced by-skin warmth and wound breakdownAdmit patient into a surgical ward, Assess patients level of pain ‘Assessment forms @ | Place patient in a.| base line for measuring semi-recumbent patient response to position with knees | intervention. flexed, ‘Semi-ropamibent . Pass nasogastric | position helps reduce tube & aspirate pressure on the Give prescribed | abdominal muscle and analgesic eg. | thereby relieve pain. paracetamol Intubation helps to injection 500mg | decompress the bowel pin or Fortwin | and thereby relieve pain 30mg LM. pn Prescribed analgesics inhibit the production of —_ prostaglandin thereby relieving paia ‘Anniety related | Patient will |- Explain the surgical |- Insight into the disease | Patient looked less to outcome of | look Jess | procedure to the | process makes patient | anxious and made disease process | emxious ie. not | patient and give | understand his ailment | positive comments and surgery; as | tense and will | reassuring words. idence instills trust _| indicating hope evidenced by | express hope |- Show patient other | - Verbalization of | for a positive | negative for a positive | people who had | feelings and the asking | outcome of utterances and | outcome of | similar problem & | of questions help in | surgery tense outlook | surgery within | are recovering from | sharing of problem and one hour of | surgery (ifany) reduction of fear and hospitalization | Allow patient to | anxiety express his fear and |- Correct _gfeption anxiety through | improves _tonfidence ions about his | and rapport Diversional therapy pationts | takes the mind away from the problem diversional therapy eg. provision of music | therapeutic touch POST OPERATIVE NURSING CARE PLAN FORMR.JAGO__ SIN] NURSING [OBJECTIVE | NURSING ACTION/ | SCIENTIFIC EVALUATION DIAGNOSIS INTERVENTION PRINCIPLE/ RATIONALE. Risk for | Patient will |- Place patient in a dorsal |- Dorsal or recumbent | Patient was able Ineffective air | have cleared air | position, without a pillow | position without a | to breathe 18 to May clearance | way within 10 | and neck tured to one side. | pillow and head | 20. eyeles toISminues of |- Allow the patient to| tumed to one side | minutes nursing remain in dorsal position | facilities easy | unconscious intervention with neck tumed to one | breathing and tung side until he shows signs | expansion” when of recovery of |_ unconscious consciousness + Suetioning removes ~ Suction excess secretions | excess with suction machine = Monitor vital signs everyWal] Keep patient ina dorsal ‘of | position “of pain|- Encourage patient to by | within 24 hours | inform the nurse about the “type and severity of pain Greatly | ant effectvenessof| severly of pin and intervention when | effectiveness of conscious intervention isthe ~ Encourageeatly most reliable guide to smbulation and simple | the severity of pain movement such as flexing | experienced by patient toes, feet and legs. = Early ambulation ~ Give _prescribedstrong | promotes the retum of analgesics e.g. morphine | normal _ physiological activities such as gastrointestinal peristalsis Morphin is a narcotic analgestic which acts con pain center of the cerebrum reducing pain perception Uba was admitted into your ward with a medical diagnosis of Chronic Renal With the aid of a well labelled diagram, describe the cross section of the kidney.(6 mks) List six (6) causes of renal failure.(3 mks) Utilizing the Nursing Care Plan, identify and solve in order of priority three (3) Nursing diagnosis of Mr Uba.(9 mks) Enumerate four (4) complications of renal failure.(2 mks) beef FOR QUESTION 21 Fl, Setion A; Question 17 for Structure of the kidney nof the Kidne bein shaped organ, abou! 11cm long, Gem wide, 3em thick and weigh 150g, They are embedded in and held byzmass of fat. A sheath of fibroclastic renal fascia encloses the kidney and the renal fat. I fs lie on the posterior abdominal wall, one on each side of the vertebral column, behind, the peritoneum and piragm, They extend from the level of the 12"thoracic vertebra to the 3" lumber vertebra, receiving some m the lower rib cage, the right usually slighily lower than the left, probably because of the considerable by the liver. - th the Kidneys drenal gland be of the liver, the duodenum and the hepatic flexure of the colon, , and muscies of the posterior abdominal wall,It surround the kidney. ene ‘isa reddish -brown layer of tissue, immediately below the capsule b m - Is the concave medial bode of the kidney where the renal blood and lymph vessels, The Renal pelvis - Isa funnel-shaped structure which acts as a receptable for the urine formedby the ki “has a number of distal branches called calyces, each of which surrounds the apex of a renal pyramid. d in the kidney pastes through a papilla at the apex of a pyramid, into minor calyx, then into a m passing through the pelvis into the ureter. . ‘walls of the pelvis contain smooth muscles and are lined with transitional epithelium. Peristalsis of the ‘originating in pace maker cells in the walls of the calyces propels urine through the pelvis and ureter bladder. This is an intrinsic property of the smooth muscle and is under nerve control Blood Supply — Renal artery ‘Venous drainage ~ Renal vein ‘Nerve supply — sympathetic and parasympathetic nerve. 2(b) The eauses can be acute or chronic. A Acute (@) Pre-renal Causes Due to impaired blood supply volume deptet = Haemorthage - Excessive use of diuretics = Vomiting ~ Diarrhoea, = Naso gastric suctioning ~ Glycosuria - Bums Impaired Cardiac Function = Myocardial infarction Congestive heart failure ~ Cardogenic Shock ~ Pericardial temponade - Dystthythmias = Acute pulmonary emobolism Fluid shift that may lead to vasodilation = Sepsis = Anaplylaxis = Anti hypertensive medications + _ Other drugs that cause vasodilation, Tncreased Vascular Resistance = Anaesthesia ~ \_ Hepato - renal syndrome ‘Vascucular Occlusion = Bilateral renal occulusion ~ _ Dissecting aneurysm 2 Renal Causes (intre-renal Causes) € 10 actual parenchymal damage from disease or nephrotoxins, ~ Shock Trauma/crush injury Transfusion reactionMale diseases eg. Diabetesmelitus, hypertension, lupus erythematosus,polyarterit, side cell disease, myloidosis. ingdiagnoses include: Excess fluid-volume related to decreased urine output evidenced by oedema Aipbalanced Nutrition, less than body requirements related to anorexia, nausea, dietary restiction evidenced by lass of weight. Activity intolerance related to anaemia and inadequate renal function evidenced by fatigue nowledge deficit related to disease process and its treatment evidenced by eauest for information. [aasity related to unknown outcome of disease evidenced by facial expression and verbal expressiol SCARE PLAN FOR MR UBA WITH CHRONIC RENAL FAILURE < OBJECTIVES | NURSING ORDERS SCIENTIFIC EVALUATI | PRINCIPLE/RATIO ‘ON Z, \ NALI F. 5 Mr. Uba’s “Assess fluid status by | 1. Assessment Mr. Uba oedema will monitoring daily weight, | provides baseline & | demonstrated reduce within 5 skin turgor and presence | ongoingdata base | no rapid days of of oedema for monitoring hospitalization Monitor intake & output charges and Limit fluid intake to evaluation of throughout prescribed volume and intervention hospitalizatio ‘monitor intravenous This shows the n Or Mr, Uba fluid rate quantity of Quid | Oedema Identify potential taken and excreted | reduced sources of fluid e.g. per 24 houts, after 4 days medication or fluid used | 3. This checks and of nursing to take drugs. reduces circulatory | intervention Explain to patient and over load family members why the | 4, This will help restriction identity Encourage frequent oral | unrecognized care. sources of excess fluid . Understanding promotes patient and family cooperationwith, Aluid restriction 6. This minimizes dryness of oralwill eat 2/3 of the food served throughout period ‘of hospitalization nausea or vomiting, lack of understanding of dietary restrict stomatitis ete |. Provide patients food preference within dietary restriction Encourage high calorie, low protein, low ~ ‘sodium and low potassium snacks between meals Promote intake of high biologic valve protein foods e.g. eas, meat, dairy products Explain rationale for dictary restrictions end relationship to kidney digeate and increase ur and creatinine levels, . Provide pleasant surroundings at med time Weigh patient daily at the same time with the same scale 10. Provide written tists of foods allowed and suggestion for improving their tasteswithout use of sodium and pot these factors may help promotes adequate dietary intake |, This encourage increase dietary intake . This provides calories for energy sparing protein for tissue growth and healing This provides for positive nitrogen balance needed for growth and healing, It also makes it possible for essential amino acid to be used. more efficiently with less nitrogen waste. Promotes patient understanding of relationships between dict, urea and creatinine levels to renal disease Unpleasant factors. can contribute to patient's anorexia This allows ‘monitoring of fluid and nutritional status and also controls faulty readings List provides a positive approach to dietary restrictions and a reference for patient and family to Use at home Client will Fave a balance of rest and activity, absence of fatigue ‘within the period of hospitalization i Assessfor factors contributing to fatigue © anaemia, irritability 2. Assist with activities of dailyliving with minimal disturbance 3. Encourage alternating, activity with rest This served as a the severity of fatigue | activity, This promotes activities and. exercisewithin limitsrenal function and its coniequences at patients level of understanding. ‘Assist patient to identify ways to incorporate changes related to illness an its treatment into lifestyle. Provide oral and written information as appropriate about renal function ar failure, about renal and treatment as he is ready to understand and accept the diagnosis and consequences ‘This makes patient see that his or her life does not have to revolve around the disease ‘This provides a reference for patient and family use at home. frersion due to sodium and waste retenti sition of uremic waste products ‘throcyte life span, bleeding in the GI ‘on and malfunction of the renin ~ angiotensin aldosterome system alcium levels, abnormal vitamin D imerateten (10) causes of obesity.(5 mks) cribe three (3) management approaches to obesity.(9 mks) eight (8) complications of obesity.(4 mks) QUESTION 22 ssity is ¢ condition in which the body mass Index (BMI) is greater . 0 7 : is greater than 30kg/m' is @ condition in which total body weight is 25% for menand 35% for women over ideal bodywith: muscles de id laced by fat. Also, ‘increasing age, muscles decrease and is rep! : ‘and both changes lead to increase in weight andpredisposition to obesity. “Occupational factor e.g. sedentary workers — ‘Behavioural facts food selection practices with vale for high fahigh, calorie det xii, Drugs- ‘use of corticosteroids (prednisolone), antidepressants eg. Elavil. xiii, otis a ec scone factors which promote consumption of available but fatting food "xiv, Ignorance resulting in consumption of High carbohydrate, c Diet therapy Physical activity or exercise Behaviour therapy or modification Combined therapy 3. Pharmacotherapy or medication 6. Surgery, Diet Therapy ~ The diet should be low in kilocalories and fat and contain adequate nutrients, minerals and fibre Selection of foods fromall. food groups helps ensure adequate nutrient consumption. { ‘Weight loss should be gradual, not more than 455g — 910g (1-2 pounds) per week. Thisusually means a di 1,000 to 1,500 keal/day. ‘The composition of the diet should be modified to minimize other cardiovascular risk factor Regular meals with small servings are recommended Dietary education is a necessary ingredient in achieving adjustment, to a low caloric die(LCD). For) achievement of dietary therapy, educational factors should pay particularattention to the following topics. Energy value of different food Food composition: fats, carbohydrates (including dietary fibre), and proteins Reading nutrition labels todetermine caloric content and food composition, Food preparation: avoiding high-caloric ingredients during cooking (e.g. fats and cil) or of unsaturated fats, ‘Maintain adequate water intake Reducing portioa sizes and Limiting alcohol consumption. Physical Activity or Exercise = An increase in physical activity is an. important component of weight loss therapy since it leads to expenditure of energy Exercise should be within the limit of client's health. Eremely obese persons (morbid obesity) may need to start with simple exercise that can gradually intensified, For most obese patients, physical activity should be initiated slowly, and the intensity should be in gradually. Some of these activities include fitness walking, i ae a j ‘4 tennis or volleyball, but care must be taken to avoid eee ne i ee ~ _ Patient should be encouraged to build physical activities into each day. or moaitestion = wviour strategies to reinforce changes in diet and physical activity can pro i i + The seaustonof new habis is paicularty mporan or logtemelah muinteranes ence eo cee a Boat of behaviour therapy i to alter the eating and activity habits of an obese patient. ‘behavioural strategies include the followings; ‘i Purchasing low-calorie foods by shopping from a prepared list. Sraet portions of food to eliminate leftovers ‘overeating and eating between meals frequency of eating out at restaurantseduce the absorption of fat from the Gastrointestinal tract leading to weight loss e.g. Oristat (xenical) musi be used in combination with diet and exercise to be successful. reserved for morbidly obese individuals ‘aim of surgery is to modify the gastrointestinal tract to reduce food intake. ly used surgical procedures cither restrict stomach capacity thereby limiting foodintake or both restrict ‘capacity and absorption of nutrient from the stomach andduodenum. interventions commonly used, include gastroplasty, gastric partitioning and gastric bypass risk of nutritional deficiencies, iron and calcium in particular, due to malabsorption is higher with these Therefore. vitamtins and mineral clement should be supplemented. disease such as high blood pressure (hypertension), stroke, coronary heart disease and heart mellitus (type 11) hological effect such as loss of self esteem respiratory function lity ‘operative complications e.g. pneumonia, wound infections, wound separation with delayed wound healing, tion to pressure sores Gallstones feakness of abdominal wall and risk of hernia faricose veins or mobility and ritk of osteoarthritis fincontenence Eancer of the breast, uterus, prostate and colon, Differentiate between drug abuse and drug misuse.(2 mks) List six (6) causes of substance abuse.(3 mks) Describe the characteristics of drug dependence.(5 mks) Outline the steps for counselling a-25-year old young man who is addicted to “cannabis.(10 mks) FOR QUESTION 23 pabuse is the use of a drug for non-medicalpurposes, mostly for altering consciousness. It may include self fon or self administration of drugs resulting in psycho-physical dependence, functional impairment and in ffom approved social norms, Sa wrongful use of drugs with no regards to prescriptionor compliance.system becomes used to the drag which leads toincreased need to the “As te user begins to use the drugs, “There is evidence of hostility in discussing drugs, This makes it dificult for any closeperson to note that cus. Poor performance The individual exhibits poor performance in academics and jobs. This is due to short attention span and d ‘concentration, as the drugs affect the brain Untidiness ‘The individual appears unkept with dirty and shabby dressing, most times, the hair not brushed, dirty lon ete. Relationship problems ‘The drug user changes friends frequently because of confiontations about use of drugs Anitability. ‘The drig user is irritable and restless. Everything around teems to be a disturbance. He is uneasy Denial/dishonesty , This is 2 strong characteristic that needs to be counteracted before effective treatment. The individual de use strongly any time itis mentioned Tnereased absenteeism and tiredness The individual is increasingly absenting himself from school or work, and is not punctual when present, ‘Reduced motivations The drug user is not motivated by anything around him, He seems so uninterested in activities he used to Frequent arrest There are otherwise termed ‘unlawful citizens? because they are always arrested by law enforcement because of suspicion of hard drugs use Poor nutritional status The individual has loss or decreased appetite which is as a result of drug intake. He is emaciated, has dq looses weight and pale. Libido The effect of the drugs could manifest as reduced or increased libido, Effects of withdrawal syndrome These are symptoms that manifest when there is cessation of drug use. It depends on substance of abu ‘common ones include irritability, seizures, euphoria, stupor, restlessness, coma ete. Steps in Counseling Identification of drug problem Create relationship Gain Confidence Ensure Consent Reassurance —bothfamily & the individual Education-the family must be made to understand the need to integrate and accept theindividual into the fa Motivation — To open up or verbalize freely Explain disadvantages of drug use, relating his experience to reality ‘Stress the need for living a meaningful and controlled life. Advise him to avoid consorting with drug-taking acquaintances (Bad company) Assist in gradual reduction by encouraging the reduction in smaller quantities(not totalabstinence)your Meas onthe individual Mr. Fredrick, a 19-year old undergraduate was admitted Into your ward with the of Acute Lymphocytic Leukaemia. a schematic diagram, describe the formation and maturation cells.(5 mks) lain the pathophysiology of Mr. Fredrick’s condition. (4mks) four (4) other types of leukemia, (2 mks) Utilizing the nursing care plan, identify and solve in order of priority, jursingdiagnoses of Mr. Frodrick,(9 mks) of white three (3) OR QUESTION 24 Justo tonapob (emograteas) commen yi roger 2.2. @ pes mmo ks | So 8 wee a Sf Ba arog EH Wome | “@ scoping Pree oc jaumarow or ware niponcneee + tad be ation And Maturation Of White Blood Cells ate nimed according to ther appearance and are spherical cell with a nucleus white in colour becuse i isknown as leucocytes,[produce more lymphocyte as they migrate through the blood 18 the tissue/ Mei polation i te pon anes ie, the lymph nodes, spleen, tonsils iy ‘The eatiest recognizable cell is the myetoblast with a large round to oval nucleus, There ‘and cytoplasm is basophilic without granules. The promyelocyte is slightly larger than a blast and. -granles.At ths stage, the cell becomes a myelocy‘, it is smaller than promyelocyte. ‘ peytes have round oval nuclei and isfollowed by development of metamyclocyte which are smaller than life span of white blood cells is shorter than the red blood cells. Immunity i. B cells produce antibodies for destruction of bacteria T cells protect against viruses and other intacellular microorganism Pathophysioto, ; ‘The malignant cells of acute lymphocyticleukaemia arelymphoid precursorcells (i.e. lymphoblasts) th arrested in an early stage of development This srrest is caused by abnormal expression of genes often as a result of chromosomal translation, The lymphoblasts replace the normal marrow elements, resulting in a marked decrease in the prod normal blood cells. Consequently, anaemia, thiombocytopenis, and neutropenia occur tovarying degree. The lymphoblasts alco proliferate in organs other than the marrow. Particularly the liver, spleen and lymph nodes Asa result, leukocytes cannot perform its piysiological function as itis not mature. Thereby exposing the patient to risk of infection Other types of Leukaemia Chronic Iymphocytic leukaemia Acute, myelogenous leukaemia ‘Chronic myelogenous leukaemia Acute promyelocytic leukaemia Hairy cell leukaemia Prolymphocytic leuksemia NURSING CARE PLAN FOR MR. FREDRICK WITH ACUTE LYMPHOCYTIC LEUKAEMIA NURSING | NURSING NURSING SCIENTIFIC EVALUATION DIAGNOSIS _| OBJECTIVES | INTERVENTION RATIONALE : Acute pain | Patient will 7. Allow patient to | 1. Reduces the work | Patent related to | verbalize less | assume load on the limbs, | verbalized less increased bone | pain within 24] comfortable thereby reducing | pain within 24 marrow ours of | position pain activities nursing 2, Use bed cradle to | 2. Reduces pressure evidenced by | intervention clevate the weight | on the patient body patient of the Linen Reduces the verbalization 3. Administer production” of i prescribed prostaglandin and analgestic e.g. | _reduce the pain pyroxican 4, To take the patient's 4, Give diversional | mind away from therapyincrease energy respiratory tact | 7. Prevent growth of infection microbes Avoid unnecessary invasive procedure e.g. injection Encourage adequate diet Ensure personal and environmental hygiene Palen wit | 1s Perform oral 1 Stimalate patient | Patient gained goin 0.5-tkz | hygiene before | appetite 2kg within one within one | and after meal ‘Aids in digestion | week of nursing week of | 2. Serve meal of | and absorption and | intervention nursing patient choice in| boost patient intervention attractive manner immunity Provide liquid and | 3. To ensure variety of fruits with | nutrients for the different taste and | patient iextures | 4 To note | Weigh patient on | improvement in sltomate days patieat health fluid volume (anaemia) hay intolerance dd Mrs. Alabo had been married for 15 years without a child. fine infertility.(1 mk) weribe the menstrual cycle(5 mks) three (3) causes each of infertility in both male and female.(3mks) rentiate between primary and secondary infortility(2 mks) ite eight (8) investigations that will be carried out on this couple. (4 mks) psycho-social and cultural implications of this condition.(5 mks) QUESTION 25 |as a couples inability to achieve pregnancy after | year of regular unprotected sexual intercourse OR based on 24 months of ying to getpregnant is recommended as useful clinical practice and res menstrual cycle is a seties of physiological change that occurs within a woman of. fe depends on individual woman, It varies in length with average cycle taken to be as