BNMC || Medical & Surgical Nursing 2025 Full Question Solve

GROUP “A”

Short Questions

Question 1: 

a. Define acute illness and chronic illness.

b. Write down the differences between acute and chronic illness.

Answer:

a. Definition:

• Acute Illness: An acute illness is a condition that has a rapid onset of severe symptoms and a relatively short duration (usually lasting less than 6 months or a few weeks), resolving with treatment or self-limiting (e.g., acute appendicitis, influenza).
• Chronic Illness: A chronic illness is a prolonged and persistent disease or condition that lasts for a long period (typically 6 months or longer), develops gradually, has periods of remission and exacerbation, and requires continuous medical management and nursing care (e.g., Diabetes Mellitus, Hypertension, COPD).

b. Differences between Acute and Chronic Illness:

Question 2: 

a. Define UTI. 

b. State the causes of UTI.

Answer:

a. Definition of UTI: Urinary Tract Infection (UTI) is an inflammatory condition and microbial infection of any part of the urinary system, which includes the kidneys, ureters, urinary bladder, and urethra.

b. Causes and Risk Factors of UTI:

1. Causative Organisms:
   • Escherichia coli (E. coli) (responsible for >80% of cases).
   • Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus saprophyticus.
2. Predisposing & Contributing Factors:
   • Female Anatomy: Shorter urethra located close to the anus.
   • Urinary Stasis / Incomplete Emptying: Prostatic hyperplasia (BPH), neurogenic bladder, urinary retention.
   • Mechanical Obstruction: Renal calculi, urethral strictures.
   • Invasive Procedures: Indwelling urinary catheterization (CAUTI), cystoscopy.
   • Immunosuppression & Comorbidities: Diabetes mellitus, HIV, corticosteroid therapy.
   • Poor Hygiene: Incorrect perineal wiping (back-to-front), infrequent hydration.

Question 3: 

a. Define COPD. 

b. Mention the causes of COPD.

Answer:

a. Definition of COPD: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable progressive pulmonary disorder characterized by persistent respiratory symptoms and chronic airflow limitation due to airway and/or alveolar abnormalities, typically presenting as a combination of Chronic Bronchitis and Emphysema.

b. Causes of COPD:

1. Tobacco Smoking: Active cigarette, bidi, or pipe smoking (accounts for >85% of cases) and passive secondhand smoke exposure.
2. Biomass Fuel & Indoor Air Pollution: Cooking smoke from poorly ventilated clay stoves using wood, coal, or dung.
3. Occupational Exposure: Industrial dust (silica, coal dust), chemical fumes, and toxic gases.
4. Outdoor Air Pollution: Heavy vehicular exhaust and industrial smog.
5. Genetic Factors: Severe hereditary deficiency of \alpha_1-antitrypsin (AAT).
6. Severe Childhood Respiratory Infections: Recurrent viral or bacterial pulmonary infections that hinder lung growth.

Question 4: 

a. Define hypertension. 

b. Enlist the types and risk factors of hypertension.

Answer:

a. Definition of Hypertension: Hypertension is a chronic clinical condition characterized by a persistent and abnormal elevation of systemic arterial blood pressure, defined in adults as a sustained resting systolic blood pressure \ge 140\text{ mmHg} and/or a diastolic blood pressure \ge 90\text{ mmHg} measured on two or more separate healthcare visits.

b. Types and Risk Factors:

• Types of Hypertension:
  1. Primary (Essential/Idiopathic) Hypertension: Elevated BP without an identifiable, specific secondary medical cause (accounts for 90–95% of cases).
  2. Secondary Hypertension: Elevated BP resulting from an identifiable underlying cause such as renal artery stenosis, chronic kidney disease, pheochromocytoma, Cushing's syndrome, or primary aldosteronism (5–10% of cases).
  3. Isolated Systolic Hypertension: Systolic \ge 140\text{ mmHg} with diastolic < 90\text{ mmHg}, common in elderly individuals due to arterial stiffness.
  4. Malignant / Accelerated Hypertension: Rapid, severe elevation of BP (> 180/120\text{ mmHg}) associated with acute target organ damage.
• Risk Factors:
  • Non-Modifiable: Advanced age, family history/genetic predisposition, male gender (pre-menopause), ethnicity.
  • Modifiable: High dietary sodium/salt intake, obesity/sedentary lifestyle, cigarette smoking, excess alcohol consumption, chronic emotional stress, dyslipidemia, diabetes mellitus.

Question 5: 

a. What does conjunctivitis mean?

b. List the clinical features of conjunctivitis.

Answer:

a. Definition: Conjunctivitis (commonly known as "pink eye") is an inflammation or infection of the conjunctiva—the thin, translucent membrane that lines the inner surface of the eyelids and covers the sclera (the white part of the eyeball).

b. Clinical Features of Conjunctivitis:

1. Redness / Hyperemia: Marked pink or red discoloration of the sclera due to conjunctival vascular engorgement.
2. Discharge:
   • Purulent or mucopurulent discharge with crusting of eyelids upon waking (bacterial).
   • Watery/serous discharge (viral).
   • Stringy, mucoid discharge (allergic).
3. Foreign Body Sensation: Gritty feeling, burning, or scratching sensation in the affected eye(s).
4. Ocular Discomfort & Pruritus: Mild pain, itching (very pronounced in allergic types).
5. Photophobia: Sensitivity to light.
6. Eyelid Edema & Chemosis: Swollen eyelids and conjunctival swelling.
7. Preauricular Lymphadenopathy: Palpable and tender preauricular lymph nodes (characteristically in viral conjunctivitis).

Question 6: 

a. What do you mean by STDs?

b. Write down the modes of transmission of STDs.

Answer:

a. Definition of STDs: Sexually Transmitted Diseases (STDs), also referred to as Sexually Transmitted Infections (STIs), are a broad group of communicable infections caused by bacteria, viruses, parasites, or protozoa that are predominantly passed from person to person through sexual contact.

b. Modes of Transmission of STDs:

1. Direct Sexual Contact: Unprotected vaginal, anal, or oral intercourse with an infected partner.
2. Mother-to-Child (Vertical Transmission):
   • Transplacental transmission during pregnancy (e.g., Congenital Syphilis, HIV).
   • During delivery through the birth canal (e.g., Neonatal Gonorrhea, Chlamydia ophthalmia neonatorum, HSV).
   • Postpartum through breastfeeding (e.g., HIV).
3. Blood-Borne Transmission: Transfusion of unscreened blood or blood products, organ transplantation, and sharing contaminated needles/syringes among intravenous drug users (e.g., HIV, Hepatitis B & C, Syphilis).
4. Skin-to-Skin Mucocutaneous Contact: Direct contact with active lesions, ulcers, or warts (e.g., HPV, HSV, Molluscum contagiosum).

Essay Questions

Question 1: 

List the etiology and clinical features of congestive cardiac heart failure. As a nurse, how will you manage a patient with congestive cardiac heart failure?

Answer:

1. Etiology of Congestive Heart Failure (CHF):

• Coronary Artery Disease (CAD) / Myocardial Infarction: Ischemic death of myocardial tissue leading to loss of contractile function.
• Systemic Hypertension: Chronic high afterload causing left ventricular hypertrophy and eventual pump failure.
• Valvular Heart Disease: Mitral stenosis/regurgitation, aortic stenosis/regurgitation.
• Cardiomyopathies: Dilated, hypertrophic, or restrictive cardiomyopathy.
• Cardiac Arrhythmias: Atrial fibrillation, ventricular tachycardia causing compromised cardiac output.
• Congenital Heart Defects: Ventricular septal defect, coarctation of aorta.
• Non-Cardiac / Secondary Causes: Severe chronic anemia, thyrotoxicosis, chronic renal failure, severe pulmonary hypertension (Cor pulmonale).

2. Clinical Features of CHF:

• Left-Sided Heart Failure Features (Pulmonary Congestion):
  • Dyspnea on exertion (DOE), Orthopnea (dyspnea when lying flat), Paroxysmal Nocturnal Dyspnea (PND).
  • Dry cough progressing to frothy, pink-tinged sputum (in acute pulmonary edema).
  • Bilateral basilar lung crackles/crepitations, tachypnea.
  • Fatigue, weakness, cyanosis, and hypoxia due to low systemic output.
• Right-Sided Heart Failure Features (Systemic Venous Congestion):
  • Bilateral dependent pitting peripheral edema (ankles, feet, pretibial, sacral).
  • Jugular Venous Distension (JVD) elevated above normal.
  • Hepatomegaly, right upper quadrant tenderness, and Ascites.
  • Anorexia, nausea, and abdominal bloating resulting from gastrointestinal tract congestion.
  • Nocturia and unexplained rapid weight gain from fluid retention.

3. Nursing Management of a Patient with CHF:

• A. Assessment & Monitoring:
  • Monitor vital signs continuously (BP, HR, respiratory rate, pulse oximetry \text{SpO}_2).
  • Auscultate heart and lung sounds regularly to detect worsening crackles or S3 gallop.
  • Record daily body weight at the same time each morning using the same scale to monitor fluid overload.
  • Maintain a strict intake and output chart (I/O chart).
• B. Promoting Oxygenation & Rest:
  • Place the patient in a High-Fowler’s position (head of bed elevated 60–90°) with legs dependent to reduce venous return (preload) and facilitate lung expansion.
  • Administer humidified oxygen therapy as prescribed via nasal cannula or face mask to maintain \text{SpO}_2 > 92\%.
  • Provide a quiet, restful environment and cluster nursing activities to minimize myocardial oxygen demand.
• C. Fluid & Nutritional Management:
  • Implement prescribed fluid restriction (typically 1.5–2 L/day).
  • Provide a low-sodium diet (< 2\text{ g/day}) to minimize fluid retention.
  • Offer small, frequent meals rather than heavy meals to avoid diaphragmatic elevation.
• D. Medication Administration & Monitoring:
  • Diuretics (e.g., Furosemide): Administer in the morning; monitor urine output, BP, serum potassium, and electrolyte panels.
  • ACE Inhibitors / ARBs (e.g., Enalapril, Losartan): Monitor for hypotension, hyperkalemia, and persistent dry cough.
  • Beta-Blockers (e.g., Carvedilol, Bisoprolol): Check resting pulse before administration; withhold if heart rate < 60\text{ bpm}.
  • Inotropic Agents (e.g., Digoxin): Check apical pulse for 1 full minute prior to dosing; withhold if \text{HR} < 60\text{ bpm}; observe for signs of digoxin toxicity (anorexia, nausea, yellow-green visual halos).
• E. Patient & Family Education:
  • Educate on strict compliance with medications and never skipping doses.
  • Teach the patient how to recognize and immediately report red flag signs: sudden weight gain (> 1\text{–}2\text{ kg} in 2 days), worsening dyspnea, increased swelling of ankles, or waking up breathless.

Question 2:

Define peptic ulcer disease. Mention the clinical features and explain the nursing management of peptic ulcer disease.

Answer:

1. Definition of Peptic Ulcer Disease (PUD): Peptic Ulcer Disease (PUD) is an ulceration or erosion of the mucosal lining of the gastrointestinal tract exposed to acidic gastric juice and pepsin, occurring most commonly in the stomach (gastric ulcer) or the first part of the duodenum (duodenal ulcer).

2. Clinical Features of PUD:

• Epigastric Pain / Discomfort:
  • Duodenal Ulcer: Burning/gnawing pain occurring 2–3 hours after meals or during the night (11 PM – 2 AM), classically relieved by food or antacids ("Hunger pain").
  • Gastric Ulcer: Dull, aching epigastric pain occurring 30–60 minutes after eating, exacerbated or aggravated by ingestion of food.
• Dyspeptic Symptoms: Nausea, vomiting, heartburn (pyrosis), early satiety, and abdominal distension/bloating.
• Hematemesis or Melena: Coffee-ground vomitus or black tarry stools indicating upper gastrointestinal bleeding.
• Anorexia & Unintended Weight Loss: Frequent in gastric ulcers due to fear of eating.
• Signs of Perforation (Emergency): Sudden, severe, sharp "knife-like" abdominal pain, rigid board-like abdomen, tachypnea, tachycardia, and shock.

3. Nursing Management of Peptic Ulcer Disease:

• A. Assessment & Stabilization:
  • Assess pain intensity, characteristics, relationship to meals, and history of NSAID use or smoking.
  • Monitor vital signs and watch for signs of hemorrhage (pallor, tachycardia, hypotension) or perforation.
  • Screen vomitus and stool for occult or frank blood.
• B. Dietary Management:
  • Instruct the patient to eat regular, unhurried, small, frequent meals to neutralize gastric acid.
  • Avoid foods that stimulate gastric acid secretion or irritate mucosa: caffeine, alcohol, black pepper, spicy foods, very sour citrus fruits, and smoking.
  • Avoid late-night eating immediately before bed.
• C. Pharmacological Management & Monitoring:
  • Administer Proton Pump Inhibitors (PPIs) (e.g., Omeprazole, Esomeprazole) 30–60 minutes before breakfast.
  • Administer \text{H}_2-Receptor Antagonists (e.g., Famotidine) at bedtime or as prescribed.
  • Administer Mucosal Protectants (e.g., Sucralfate) on an empty stomach 1 hour before meals.
  • Administer Antibiotic Therapy for H. pylori: Ensure complete adherence to triple therapy (PPI + Clarithromycin + Amoxicillin/Metronidazole) for 14 days.
• D. Lifestyle Modification & Education:
  • Strongly counsel the patient to avoid all ulcerogenic medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) and Aspirin.
  • Encourage smoking cessation and complete abstinence from alcohol.
  • Teach stress management techniques (relaxation, adequate sleep).
  • Educate regarding symptoms of complications requiring immediate emergency attention (vomiting blood, black stools, sudden excruciating abdominal pain).

Question 3: 

Define surgical nurse. Describe the responsibilities of a surgical nurse.

Answer:

1. Definition of Surgical Nurse: A surgical nurse (perioperative nurse) is a specialized registered nurse who provides comprehensive, skilled, and safe nursing care to surgical patients throughout the perioperative continuum, which encompasses the preoperative (before surgery), intraoperative (during surgery), and postoperative (after surgery) phases.

2. Responsibilities of a Surgical Nurse:

• A. Preoperative Phase Responsibilities:
  1. Preoperative Assessment: Obtain a comprehensive health history, allergies, medication use, baseline vital signs, and nutritional status.
  2. Informed Consent Verification: Ensure that the surgical informed consent has been properly signed, witnessed, and placed in the chart.
  3. Patient Preparation: Verify NPO (nil per os) status, perform skin antisepsis/preparation, administer preoperative sedative/antibiotics as ordered.
  4. Removal of Foreign Objects: Ensure dentures, contact lenses, jewelry, hairpins, and nail polish are removed.
  5. Preoperative Teaching: Instruct on deep breathing exercises, coughing, incentive spirometry, and early ambulation.
• B. Intraoperative Phase Responsibilities:
  • As a Scrub Nurse:
    1. Perform surgical hand scrub and don sterile gown and gloves.
    2. Set up sterile fields, drape the patient, and prepare sterile surgical instruments and supplies.
    3. Hand instruments, sponges, and sutures to the surgeon efficiently.
    4. Perform accurate, strict sponge, needle, and instrument counts with the circulating nurse before incision and before wound closure.
    5. Handle and label tissue specimens properly for pathology.
  • As a Circulating Nurse:
    1. Verify patient identity, surgical procedure, site, and consent (Conduct Surgical Safety Checklist / "Time-Out").
    2. Position the patient correctly and safely on the operating table, protecting pressure points and nerves.
    3. Maintain aseptic technique throughout the room and monitor the surgical team for contamination.
    4. Manage fluid balance, record intraoperative documentation, manage suction, electrocautery, and lighting.
• C. Postoperative Phase Responsibilities (PACU / Ward):
  1. Airway & Respiratory Management: Maintain patent airway, assess respiratory rate/depth, administer oxygen, prevent tongue obstruction.
  2. Hemodynamic Monitoring: Monitor vital signs every 15 minutes initially; watch for signs of hemorrhage or surgical shock.
  3. Wound & Drain Assessment: Inspect surgical dressings for active bleeding or excessive drainage; monitor surgical drains (Jackson-Pratt, Redivac).
  4. Pain Management: Assess pain score and administer prescribed analgesics (IV opioids or NSAIDs); evaluate pain relief.
  5. Fluid & Elimination Management: Monitor IV fluid infusion rate, check urine output via catheter (\ge 30\text{ mL/hr}), monitor return of bowel sounds.
  6. Preventing Complications: Assist with early ambulation, apply compression stockings/pneumatic devices to prevent Deep Vein Thrombosis (DVT), promote incentive spirometry to prevent atelectasis.

GROUP “B”

Short Questions

Question 1:

a. Define cancer.

b. Write down the warning signs of cancer.

Answer:

a. Definition of Cancer: Cancer is a large group of diseases characterized by the uncontrolled, abnormal, and autonomous proliferation of transformed cells that have lost normal regulatory mechanisms, with the ability to invade surrounding healthy tissues and metastasize to distant anatomical sites via blood and lymphatic vessels.

b. Warning Signs of Cancer (CAUTION Acronym):

• C – Change in bowel or bladder habits (persistent diarrhea, constipation, hematuria).
• A – A sore that does not heal within a normal timeframe.
• U – Unusual bleeding or discharge (hemoptysis, hematemesis, abnormal vaginal bleeding).
• T – Thickening or lump in the breast, testicles, or elsewhere.
• I – Indigestion or difficulty in swallowing (dysphagia).
• O – Obvious change in a wart or mole (size, color, shape, border).
• N – Nagging cough or persistent hoarseness of voice.
• (Additional sign) – Unexplained, rapid weight loss and persistent fatigue.

Question 2: 

a. Define pain. 

b. Write down the methods of pain management.

Answer:

a. Definition of Pain: Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Clinically, pain is whatever the experiencing person says it is, existing whenever they say it does.

b. Methods of Pain Management:

1. Pharmacological Methods:
   • Non-Opioid Analgesics: Paracetamol (Acetaminophen), NSAIDs (Ibuprofen, Ketorolac, Naproxen) for mild pain.
   • Weak Opioids: Tramadol, Codeine for moderate pain.
   • Strong Opioids: Morphine, Pethidine, Fentanyl for severe/acute post-operative or cancer pain.
   • Adjuvant Medications: Anticonvulsants (Gabapentin, Pregabalin), Antidepressants (Amitriptyline), Muscle relaxants for neuropathic pain.
   • Patient-Controlled Analgesia (PCA) & Epidural Infusions.
2. Non-Pharmacological Methods:
   • Physical Modalities: Heat and cold therapy, massage, therapeutic repositioning, Transcutaneous Electrical Nerve Stimulation (TENS), acupuncture.
   • Cognitive-Behavioral Techniques: Distraction (music, television), guided imagery, deep breathing relaxation exercises, meditation, biofeedback.
   • Psychological Support: Providing reassurance, reducing anxiety, and establishing trust.

Question 3: 

a. Define typhoid fever. 

b. Mention the clinical features of typhoid fever.

Answer:

a. Definition of Typhoid Fever: Typhoid fever (Enteric fever) is an acute, life-threatening systemic bacterial infection caused by Salmonella enterica serotype Typhi (and to a lesser extent Salmonella Paratyphi), transmitted through the ingestion of food or water contaminated with feces or urine of infected individuals or chronic carriers.

b. Clinical Features of Typhoid Fever:

1. Step-Ladder Pyrexia: High-grade continuous fever that increases in a step-ladder fashion over the first week (103\text{–}104^\circ\text{F} or 39\text{–}40^\circ\text{C}).
2. Relative Bradycardia (Faget’s Sign): Pulse rate slower than expected for the degree of elevated temperature.
3. Rose Spots: Transient, faint salmon-pink maculopapular rash on the trunk and abdomen (seen in 2nd week).
4. Gastrointestinal Manifestations:
   • Abdominal pain, tenderness, distension.
   • Constipation (common in early adult stages) followed by "Pea-soup" diarrhea (typical in 2nd/3rd week).
5. Typhoid Tongue: Coated tongue with red, clean margins and tip.
6. Hepatosplenomegaly: Palpable enlargement of liver and spleen.
7. "Typhoid State" (Coma vigil): Profound apathy, toxic confusion, muttering delirium in severe 3rd-week cases.
8. Complications: Intestinal hemorrhage and ileal perforation (serious life-threatening surgical emergencies).

Question 4: 

a. What do you mean by anesthesia?

b. Enlist the types of anesthesia with example.

Answer:

a. Definition of Anesthesia: Anesthesia is a temporary, medically induced state of loss of sensation and awareness, with or without loss of consciousness, achieved through pharmacological agents to allow surgical procedures to be performed without causing pain or distress to the patient.

b. Types of Anesthesia with Examples:

1. General Anesthesia (GA):
   • Produces complete loss of consciousness, analgesia, amnesia, and skeletal muscle relaxation.
   • Examples: Inhalational agents (Isoflurane, Sevoflurane, Nitrous oxide); Intravenous agents (Propofol, Thiopental sodium, Ketamine).
2. Regional Anesthesia:
   • Blocks sensation in a large specific region of the body without affecting consciousness.
   • Spinal Anesthesia: Injection into subarachnoid space (e.g., Bupivacaine for Caesarean section, TURP).
   • Epidural Anesthesia: Injection into the epidural space (e.g., Bupivacaine/Lidocaine for painless labor, lower abdominal surgery).
   • Nerve Blocks: Brachial plexus block, femoral nerve block.
3. Local Anesthesia (LA):
   • Loss of sensation in a small, localized area of tissue by topical application or local infiltration.
   • Examples: 2% Lidocaine/Lignocaine injection (for suturing wounds, tooth extraction), Lignocaine gel.
4. Procedural Sedation / Monitored Anesthesia Care (Conscious Sedation):
   • Depressed level of consciousness with maintained airway reflexes and response to verbal commands.
   • Examples: Midazolam + Fentanyl (for endoscopy, colonoscopy).

Question 5: 

a. Define appendicitis.

b. State the signs and symptoms of appendicitis.

Answer:

a. Definition of Appendicitis: Appendicitis is an acute inflammation and bacterial infection of the vermiform appendix, a small finger-like pouch attached to the cecum, most commonly caused by luminal obstruction by a fecalith (hardened fecal mass), lymphoid hyperplasia, foreign body, or tumor.

b. Signs and Symptoms of Appendicitis:

• Symptoms:
  1. Periumbilical to Right Lower Quadrant (RLQ) Pain: Pain begins as dull, crampy periumbilical discomfort, then shifts within 4–12 hours and localizes to the right iliac fossa (RLQ) as sharp, continuous pain.
  2. Anorexia: Universal feature ("if the patient is hungry, question the diagnosis of appendicitis").
  3. Nausea and Vomiting: Usually follows the onset of pain.
  4. Low-Grade Fever: Typically 99\text{–}101^\circ\text{F} (37.5\text{–}38.3^\circ\text{C}); high fever suggests perforation.
  5. Constipation or Mild Diarrhea.
• Signs (Physical Findings):
  1. McBurney’s Point Tenderness: Severe localized tenderness at McBurney's point (one-third the distance from the anterior superior iliac spine to the umbilicus).
  2. Rebound Tenderness (Blumberg's Sign): Sudden release of pressure in RLQ causes sharp pain.
  3. Rovsing’s Sign: Palpation/pressure on the left lower quadrant causes pain in the right lower quadrant.
  4. Psoas Sign: Pain upon hyperextension of the right hip.
  5. Obturator Sign: Pain upon internal rotation of the flexed right hip.
  6. Abdominal Guarding & Rigidity: Involuntary reflex spasm of abdominal wall muscles.

Question 6: 

a. What does intestinal obstruction mean? 

b. List the clinical features of intestinal obstruction.

Answer:

a. Definition of Intestinal Obstruction: Intestinal obstruction is a mechanical or functional blockage of the small or large intestine that prevents the normal, progressive flow of intraluminal contents, fluids, and gas through the gastrointestinal tract.

b. Clinical Features of Intestinal Obstruction (The 4 Cardinal Signs):

1. Colicky Abdominal Pain: Intermittent, cramping abdominal pain that coincides with waves of peristalsis (in small bowel); continuous and generalized pain suggests strangulation/ischemia.
2. Vomiting:
   • Early and profuse: In high small bowel obstruction (clear/gastric content progressing to bile-stained).
   • Late and feculent: In low small bowel obstruction.
3. Abdominal Distension: Prominent in lower intestinal and large bowel obstruction; less marked in proximal small bowel obstruction.
4. Absolute Constipation (Obstipation): Inability to pass both feces and flatus.
5. Abdominal Hyperperistalsis: High-pitched, tinkling, metallic bowel sounds (borborygmi) in mechanical obstruction, which progress to silent abdomen in paralytic ileus.
6. Signs of Dehydration & Shock: Tachycardia, hypotension, dry mucus membranes, sunken eyes, oliguria, and electrolyte imbalances.

Essay Questions

Question 1: 

Define burn. Describe the management of a patient with 3rd degree burn.

Answer:

1. Definition of Burn: A burn is an injury to the skin and deeper organic tissues caused primarily by exposure to thermal sources (fire, flame, scalds, hot objects), chemicals (acids, alkalis), electrical currents, radiation, or extreme friction.

• Third-Degree Burn (Full-Thickness Burn): An injury involving destruction of the entire epidermis, dermis, and underlying subcutaneous tissue, and sometimes extending into fascia, muscle, or bone. The burned area appears leathery, waxy white, charred, or dark brown, is completely insensate (dry and painless to touch due to nerve ending destruction), and does not blanch on pressure.

2. Management of a Patient with 3rd Degree Burn:

• A. Emergent / Resuscitative Phase (First 24–48 Hours):
  1. Airway & Breathing (Primary Survey):
     • Secure and maintain patent airway. Suspect inhalation injury if facial burns, singed nasal hairs, or carbonaceous sputum are present; prepare for early endotracheal intubation.
     • Administer 100\% humidified oxygen.
  2. Fluid Resuscitation (Crucial Step):
     • Calculate Total Body Surface Area (TBSA) burned using the Wallace Rule of Nines.
     • Insert two large-bore IV cannulae (14\text{–}16\text{ G}) through unburned skin if possible.
     • Calculate fluid using the Parkland Formula: \text{Total Ringer's Lactate in first 24 hours} = 4\text{ mL} \times \text{Body Weight (kg)} \times \%\text{TBSA burned}
     • Infusion Schedule: Give \frac{1}{2} of total calculated volume in the first 8 hours (from the time of burn injury), and the remaining \frac{1}{2} over the next 16 hours.
     • Monitoring Resuscitation: Insert indwelling Foley catheter. Titrate fluids to maintain urine output at 0.5\text{–}1\text{ mL/kg/hr} (30\text{–}50\text{ mL/hr} in adults).
  3. Pain and Anxiety Management:
     • Administer intravenous opioids (e.g., IV Morphine, Fentanyl) in small, frequent doses. Never administer IM/SC injections due to poor tissue perfusion.
  4. Prevention of Hypothermia:
     • Maintain a warm room temperature; cover with dry, clean sterile sheets.
  5. Tetanus Prophylaxis:
     • Administer Tetanus Toxoid / Tetanus Immunoglobulin as indicated.
• B. Acute / Intermediate Phase (48–72 Hours Post-Burn until Wound Closure):
  1. Wound Care & Infection Control:
     • Cleanse wounds under strict aseptic conditions using sterile saline or chlorhexidine.
     • Apply topical antimicrobial agents: Silver Sulfadiazine (SSD) 1\% or Mafenide acetate.
     • Prepare for early surgical debridement and escharotomy (to relieve compartment syndrome in circumferential burns) and subsequent skin grafting (split-thickness autografts).
  2. Nutritional Support:
     • Third-degree burns induce extreme hypermetabolism and catabolism.
     • Provide a high-calorie, high-protein diet via enteral nutrition (nasogastric/nasojejunal tube) started within 24 hours.
     • Supplement with Vitamin C, Vitamin A, Zinc, and Glutamine to promote wound healing.
  3. Prevention of Gastrointestinal Complications:
     • Administer IV \text{H}_2-blockers or PPIs to prevent stress ulcers (Curling’s ulcer).
• C. Rehabilitation Phase:
  1. Contracture Prevention: Splint joints in functional extension positions; perform active/passive range-of-motion (ROM) exercises daily.
  2. Pressure Garments: Use custom elastic compression garments to minimize hypertrophic scarring.
  3. Psychosocial Rehabilitation: Address body image disturbance, depression, and post-traumatic stress disorder (PTSD).

Question 2: 

Define dengue fever. Mention the clinical features and explain the nursing management of a patient with dengue fever.

Answer:

1. Definition of Dengue Fever: Dengue fever is an acute, mosquito-borne viral infection caused by the Dengue virus (DENV, serotypes 1–4, belonging to the Flaviviridae family) and transmitted to humans through the bites of infected female Aedes mosquitoes (primarily Aedes aegypti and Aedes albopictus).

2. Clinical Features of Dengue Fever:

• Febrile Phase (Days 1–3/4):
  • Sudden high-grade fever (39\text{–}40^\circ\text{C} or 104^\circ\text{F}) of 2–7 days duration.
  • Severe frontal headache and retro-orbital pain (pain behind the eyes aggravated by eye movement).
  • Severe myalgia, arthralgia, and bone pain ("Break-bone fever").
  • Flushing of face, maculopapular/erythematous rash.
  • Nausea, vomiting, metallic taste, and generalized anorexia.
• Critical Phase (Days 3–7, Around defervescence / temperature dropping):
  • Plasma leakage due to increased capillary permeability (pleural effusion, ascites).
  • Progressive leukopenia followed by rapid thrombocytopenia (platelet count < 100,000/\mu\text{L}) and rising hematocrit (HCT \ge 20\% rise) indicating hemoconcentration.
  • Warning Signs (Dengue with Warning Signs): Severe abdominal pain/tenderness, persistent vomiting, mucosal bleeding (epistaxis, gingival bleeding), clinical fluid accumulation, lethargy/restlessness, hepatomegaly > 2\text{ cm}.
  • Severe Dengue / Dengue Shock Syndrome (DSS): Hypotension, narrow pulse pressure (\le 20\text{ mmHg}), cold clammy skin, profound shock, severe hemorrhage (hematemesis, melena), and organ failure.
• Recovery Phase (Days 7–10):
  • Gradual reabsorption of leaked fluid, stabilization of BP/hematocrit, "islands of white in a sea of red" rash with intense generalized pruritus, and return of appetite.

3. Nursing Management of a Patient with Dengue Fever:

• A. Close Monitoring & Hemodynamic Surveillance:
  • Monitor vital signs every 1–4 hours (BP, Pulse rate, Pulse pressure, Temperature, Respiratory rate).
  • Monitor for danger signs of plasma leakage and early shock.
  • Track daily complete blood counts (CBC), specifically Hematocrit (HCT) and Platelet count.
  • Maintain strict Intake and Output (I/O) balance charting every 4–6 hours.
• B. Fluid Replacement & Hydration:
  • Oral Rehydration: Encourage liberal oral fluid intake (Oral Rehydration Salts [ORS], coconut water, fruit juices, soup, plain water) to replace losses from fever and vomiting.
  • Intravenous Fluid Therapy (in Critical Phase / Warning Signs):
    • Infuse isotonic crystalloids (Normal Saline 0.9\% or Ringer's Lactate) at maintenance/calculated rate as prescribed.
    • Titrate IV infusion rate against hematocrit, vital signs, and urine output (> 0.5\text{ mL/kg/hr}).
    • Avoid fluid overload during the recovery phase.
• C. Fever & Symptom Control:
  • Perform warm/tepid water sponging.
  • Administer Paracetamol (Acetaminophen) for fever and pain: Adults 500\text{–}1000\text{ mg} maximum 4 times daily (not exceeding 4\text{ g/day}).
  • STRICT CONTRAINDICATION: Strictly avoid NSAIDs, Aspirin, Ibuprofen, Diclofenac, or Ketorolac as they exacerbate bleeding and gastric erosions.
• D. Bleeding Precautions:
  • Handle the patient gently, minimize invasive punctures, use soft toothbrushes, avoid intramuscular injections.
  • Check skin, gums, nose, urine, and stools for any evidence of active bleeding.
  • Prepare blood products (Platelet concentrates, Fresh Frozen Plasma) if prescribed for severe bleeding.
• E. Mosquito Precautions & Infection Control:
  • Nurse the patient under a mosquito bed net (especially during the febrile viremic phase) to prevent mosquitoes from biting the patient and spreading the infection to others.

Question 3: 

Define post-operative care. Describe the nursing management of a post-operative patient.

Answer:

1. Definition of Post-Operative Care: Post-operative care is the specialized, continuous nursing and medical management provided to a patient immediately following the completion of a surgical procedure, beginning in the Post-Anesthesia Care Unit (PACU) and continuing throughout the hospital stay until full physiological recovery, wound healing, and discharge.

2. Nursing Management of a Post-Operative Patient:

• A. Immediate Care in PACU (Phase I Recovery):
  1. Airway, Breathing & Oxygenation:
     • Maintain open airway; position unconscious patient in lateral recovery position (or head tilted to side) to prevent tongue obstruction and aspiration.
     • Administer supplemental oxygen via nasal cannula/mask; check \text{SpO}_2, respiratory rate, depth, and auscultate lungs.
  2. Circulation & Hemodynamics:
     • Record BP, pulse, and temperature every 15 minutes.
     • Inspect surgical dressing over the wound for immediate strike-through bleeding or hematoma.
     • Observe skin color, temperature, and capillary refill time.
  3. Monitoring Recovery from Anesthesia:
     • Evaluate consciousness, neurological status, pupil reaction, and return of motor/sensory function (Aldrete Score \ge 8\text{–}9 required before transfer to ward).
• B. Subsequent Care in Surgical Inpatient Ward:
  1. Positioning & Comfort:
     • Place the patient in a comfortable position suited to the surgery (e.g., Semi-Fowler's position after abdominal surgery to relax abdominal musculature and improve diaphragmatic excursion).
  2. Pain Management:
     • Assess pain score using visual analog or numerical scale (0\text{–}10).
     • Administer prescribed analgesics (IV/IM/Oral) on schedule or via Patient-Controlled Analgesia (PCA); assess for relief and side effects (e.g., sedation, respiratory depression).
  3. Wound & Surgical Drain Care:
     • Maintain sterile surgical dressing for the first 24–48 hours; perform aseptic dressing changes thereafter.
     • Note amount, color, and consistency of wound drainage.
     • Ensure surgical drains (JP, Hemovac, Corrugated) are patent, secure, and under appropriate negative suction.
  4. Fluid, Electrolytes & Nutrition:
     • Regulate prescribed intravenous fluid rate.
     • Maintain NPO status until return of bowel motility (presence of bowel sounds, passing flatus).
     • Reintroduce oral fluids gradually (sips of water \rightarrow clear liquids \rightarrow soft diet \rightarrow normal diet).
  5. Urinary Elimination:
     • Monitor for post-operative urinary retention; ensure the patient voids spontaneously within 6–8 hours of surgery.
     • If catheterized, maintain closed drainage and measure output hourly (\ge 30\text{ mL/hr}).
• C. Prevention and Management of Post-Operative Complications:
  1. Respiratory Complications (Atelectasis, Pneumonia):
     • Teach and encourage deep breathing and coughing exercises every 1–2 hours.
     • Use incentive spirometry; splint the surgical incision with a pillow during coughing.
  2. Cardiovascular / Thromboembolic Complications (DVT, Pulmonary Embolism):
     • Encourage and assist with early ambulation (dangling on bedside, walking on Day 1).
     • Encourage active ankle-pumping and leg exercises in bed; apply anti-embolism stockings (TED hose) or sequential compression devices (SCDs).
     • Administer prophylactic low-molecular-weight heparin (LMWH) if prescribed.
  3. Gastrointestinal Complications (Paralytic Ileus, Nausea):
     • Administer antiemetics (e.g., Ondansetron) for post-operative nausea/vomiting.
     • Encourage mobilization to stimulate gastrointestinal motility.
  4. Surgical Site Infection (SSI):
     • Practice strict hand hygiene; monitor wound for redness, heat, swelling, purulent discharge, or spiking fever.
• D. Discharge Planning and Education:
  • Educate patient on wound care, recognizing infection signs, pain medications, dietary guidelines, lifting restrictions, and scheduled follow-up visits for suture/staple removal.