2. • Define MI. Enlist the signs & symptoms of MI.
• What are the symptoms of MI. What are the
investigations to be carried out for an acute
MI patient . write the nursing mgt og a case of
ac. MI
3. ACUTE MYOCARDIAL INFARCTION
It is the irreversible “ necrosis” of part of heart
muscles due to reduced blood supply.
Causes
1. Narrowing of coronary artery due to
atherosclerosis, spasm, complete occlusion due to
emboli.
2. Decreased blood flow and an imbalance between
myocardial oxygen supply and demand.
4. SIGNS AND SYMPTOMS
• CHEST PAIN
Crushing , constricting, or heaviness
Unrelated to exertion
Radiate to the shoulder, either arm or jaw
Not relieved by rest
Epigastric, upper abdominal distress
6. INVESTIGATION
ECG
ST segment elevation or depression
Appearance of pathological “Q” wave
Inversion of T waves
In early stage T waves are tall and peaked.
Reciprocal ST-T changes in opposite leads.
7. CARDIAC ENZYMES
• CK MB rise with in 4-6 hrs, peak during 2nd
day, disappears in 2-3 days.
• AST- aspartate amino transferase rises in
2-3 days, disappears by 3rd day.
• LDH rises by 2nd day, peak 3-4 days, disappears
with in 10 days.
• Troponin T It is a regulatory contractile
protein , presence shows myocardial cell
damage. Rises with in 12-16 hrs, peak 24-32
hrs, returns 10-12 days.
8. • X RAY signs of heart failure and pulmonary
edema.
• Serial ECG s may be done at 2- 4 hrs intervals.
10. INITIAL MANAGEMENT
• Admission in CCU
• Place the patient in comfortable position
• Administer 100% oxygen
• Attach a cardiac monitor
• Secure an intra venous cannula
• Administer sublingual nitrate if not taken
• If no relief give IV morphine 3-5 mg, repeat
after 5- 10 mts.
11. • Give aspirin 150 mg (to be chewed)
• Tab clopidogrel, atrovastatin stat
• Assess peripheral perfusion by
-assessment of vitals
-monitor body temp
Mental changes – apathy, confusion,
restlessness
• evaluate urine out put
• Provide psychological support
• Inv for CBC , Sr biochemistry including ur,
creat, LDH, CKMB, Trop T
12. • Specific therapy
• Thrombolysis
• IV beta blockers
• Treat complications
• Diet
• General measures
• Elimination
• Excercise
• Health education
13. • Describe the difference between disinfection ,
antisepsis & sterilization .enumerate the
various method of disinfection and
sterilisation. how will you ensure prevention
of cross infection in a chronic surgical ward
14. • DISINFECTION..........…. Selective elimination of
certain undesirable microorganisms in order to
prevent their transmission
• • ANTISEPSIS ................... Destruction of
vegetative forms of microorganisms but not their
permanent forms
• • STERILIZATION ............ Complete killing of all
microorganisms
15. Methods of disinfection & sterilisation
PHYSICAL
HOT AIR OVEN
STEAM UNDER PRESSURE
IONOISING RADIATION
CHEMICAL
GAS
VAPOUR
SOAKING IN LIQUID CHEMICALS
16. Prevention of cross infection
– Hand washing by the patient and nursing assistant
– soiled linen should be disinfected before washing
– Restrict number of visitors
– nursing assistant suffering from respiratory diseases
should not attend to the patient
– Safe disposal of dressings & discharges from the wound
– Disinfection of the articles contaminated with the wound
discharges
– Use of mosquito nets
– Use of PPE(personal protective equipment)
i.e. cap ,mask ,gown ,gloves ,goggles ,shoe cover
17. • Define bronchial asthma . what are the signs
and symptoms of bronchial asthma? What are
the nursing mgt of status asthmaticus. Write
the health education given to the patient on
discharge from the hospital
18. BRONCHIAL ASTHMA
Definition
It is an inflammatory disease of small air ways
characterized by recurrent episodes of wheezing ,
breathlessness, chest tightness, cough and is
generally associated with a hyper responsiveness to
a variety of stimuli
19. Signs and symptoms
Early symptoms
• Dry cough and mild chest tightness
Progressive symptoms
• Wheezing, coughing, shortness of breath
• Prolonged expiration and laboured inspiration ,
dyspnoea, weak pulse, sweating, productive
cough, restlessness, anxiety, apprehension, use
of accessory muscles , hypercapnoea, resp
acidosis, hypoxia.
20. STATUS ASTHMATICUS
• It is an acute severe life threatening episodes
of Bronchospasm that lasts for more than 24
hrs. The critical distressing condition is not
relieved by conventional bronchodilator
therapy and leads to respiratory insufficiency
and hypoxia . Attacks may lasts for many days
with out relief and terminate in death.
21. Treatment and nursing care
• Careful monitoring of patient
• ABG analysis
• High concentration of O2 therapy
• High dose of beta agonist by nebulization
• Systemic corticosteroid
• IV Aminophillin
• Assisted ventilation- when medical therapy
fails.
• Adequate hydration –IV infusion
22. Health education
• The patient should be advised to avoid
irritants such as tobacco, smoking, dust, mold,
excessive automobile exhaust, fumes, avoid
crowds
33. Signs
Sharp demarcation & clear borders
Noncoherent silvery scales
Glossy erythema (under the scale)
Auspitz sign positivity
( small droplets of blood appear on
mechanical removal of scales)
May present as generalised redness & scaling >
90 % body surface area
34.
35.
36.
37.
38.
39.
40. Treatment
Education of patients
Remissions & relapse & cure not
possible
Reassurance & emotional support
stressing the non-contagious and
benign nature of the disease
41. Topical Treatment
Tar
Thick viscous liquid obtained from
the distillation of petroleum
Anthralin or Dithranol
A tree bark extract, chrysarobin (earlier)
Anti inflammatory properties
Being irritant not used over face, folds &
genitalia
Corticosteroids
42. Treatment With Ultraviolet Light
• Photochemotherapy (PUVA)
Psoralen (8 – methoxypsoralen) a potent
photosensitizer given 0.6 – 0.8 mg/kg PO
followed after 2 hrs by exposure
to minimum erythema dose of UVA
Given on alternate days
UV protective goggles on treatment days
Usually 19 – 25 treatments required
• UVB Therapy is also helpful
43. Systemic Therapy
• Methotrexate
Inhibits DNA synthesis
Dose 10–25 mg/week (started
as 2.5 mg tablet taken 3 times 12 hrs apart)
Causes leukopenia, thrombocytopenia,
lung fibrosis, azoospermia & hepatotoxicity
Weekly blood counts and periodic LFT
are essential during therapy
45. Type of waste in hospital:
Non-infectious waste
(80-85%)
Infectious waste
(15-20%)
Type of waste
There are more than 60 types of waste generated in the
hospital premises.
46. Basic concept:
• To minimise the risk of infections to health
personnel & common public.
• To minimise the reuse of waste, which can be
more dangerous.
47. Segregation of waste:
• waste should be segregated according to
colour coding
• Waste should be segregated at the generation
itself
48. Colour coding:
• Yellow colour container with bag: all infectious waste
collect in this bag. (Incineration)
• Red colour container: all plastic waste collect &
disinfect. (Chlorinated Plastic can not be incinerated,
disinfection – Sodium Hypochloride Solution)
• Blue container: all sharps collect in this & disinfect
before disposal.
• Green container: paper, kitchen waste etc. collect &
dispose in Corporation bin.
49. COLOUR TYPE OF CONTAINER
• Yellow Plastic bags
• Red Plastic container/ bag
• Blue/ white Transparent Plastic /puncture proof container
• Green Plastic bag
50. Fill in the blanks
• Inflammation of cornea is known as keratitis
• In CPR cardiac compression and ventilation
are given at the ratio of 30:2
• Presence of blood in urine is hematuria
• An agent which prevent the growth of
bacteria is bacteriostatic
• Antidote for organophosphorus poisoning is
atropine
51. • Insulin is produced by pancreas
• The longest and strongest bone in the body is
femur
• Paralysis of lower half of the body is
paraplegia
• Life threatening hypersensitivity reaction to an
allergen is known as anaphylaxis
52. • Full form of abbrevation
• AIDS :Acquired Immuno Deficiency Syndrome
• CSOM: Chronic Suppurative Otitis Media
• DPT: Diptheria Pertusis Tetanus
• CPR: Cardio Pulmonary Resuscitation
• CECT:Contrast Enhanced Computed Tomography
• ESRD:End Stage Renal Disease
58. Treatment
• There is no medical treatment for cataract.
• The only treatment is surgical removal of the
lens like Posterior Chamber Intra Occular lens
implantation (PCIOL) and laser surgery
59. Preop nursing care of the patient
• Physical Orientation
• The patient should be observed for tendencies
to cough or sneeze smoker's cough, allergies
• Education
60. Postoperative nursing care
• Place the call bell within easy reach of the
patient's head and let the patient know exactly
where it is located
• Remind the patient that he should not cough,
sneeze, or blow his nose.
• Reinforce the physical orientation given during
the preoperative period by verbally reviewing the
locations of objects in the room.
• Orient the patient to other people in the room.
61. Contd
• Avoid dislodgement of the eye dressings by
securing them with an eye shield or reinforcing
loose tape
• ALWAYS speak to the patient upon entering his
area and before touching him.
• Allay the patient's fears by explaining each
procedure or activity fully
• No reading.
• Minimal television.
66. • Press the nose from side tightly
• Advice patient to breath through mouth
• Advice cold pack, for atleast 15 – 20 mins
till clot formation and bleeding stops
• Anterior nasal and posterior nasal pack
• Transfer to hospital for further evaluation
IF BLEEDING DOESN’T STOP
67. AFTER BLEEDING STOPS….
• Apply few drops of an oily suspension (nasal
drop)
• Advice not to blow the nose forcefully for
atleast 24 hrs
68. Fill in the blanks
• Drugs that help in the clotting of blood is called
Coagulants
• Cracking and ulceration of the lips and angles of the
mouth is called cheilosis
• Malaria is caused by plasmodium and transmitted by
anopheles
• Complete washing of stomach is called gastric lavage
• After tuberculin test, the patient is asked to report
back after 72 hours.
• Sweetish or fruity odour is due to the presence of
ketone seen in diabetic patient.
69. • Strength of normal saline is 0.9%
• The immediate disinfection of all
contaminated articles and body discharges
during the course of an illness is called
Concurrent disinfection
• Inflammation of cornea is known as keratitis
• In CPR cardiac compression and ventilation
are given at the ratio of 30: 2
70. True or false
• Normal saline is given in case of burns as a first
choice. FALSE – RL..
• Minimum score of GCS is zero.FALSE- 3..
• Report is a legal document. TRUE
• Tab Enalpril is an oral hypoglycemic agent. –
FALSE– ANTIHYPERTENSIVE(ACE INHIBITIORS)
• Tonic clonic convulsions occur in grandmal
epilepsy.-TRUE
• Troponin I is done in case of poisoning.-true – in
case of CO poisoning
71. • Tab Oseltamivir is given in case of H1N1
influenza. – true
• Myelosuppresion is not a side effect of
Chemotherapy. –true
• Mumps is an inflammation of parotid glands.
• Inj Morphine is given in head injury cases.-
false
77. Blood transfusion
complications
A transfusion reaction is systematic response by the body to
blood incompatible with that of the recipient .
It is caused by:
•RBC Incompatibility
•Allergic sensitivity to leucocytes, platelets and plasma
proteins.
•Due to preservatives.
78. TYPES OF REACTIONS
• ACUTE HAEMOLYTIC REACTION.
Develops with in first 5 to 15 minutes.
RBC ruptures and release free hemoglobin .
It is due to
• ABO AND Rh incompatibility
• Improper storage of blood.
• Uncontrolled refrigeration
• Storage beyond 21 days
• Warming of blood above 40degree C
• Exposure to 5% dextrose solution.
79. WHEN A REACTION IS
SUSPECTED…
• Recognize
•
• React
• Report
80. SIGN & SYMPTOMS
• Burning & pain along infusion site
• Fever with chills, sweating, feeling of
impending doom
• Back (lumbar) pain
• Tachycardia, tachypnea, hypotension
• Hemoglobinuria, oliguria, anuria, Ac renal
failure
• Oozing from IV site, DIC
81. ACTIONS TO BE TAKEN
• Stop transfusion
• Save bottle & tubing
• Keep IV patent
• Recheck labels
• Draw blood samples
Sterile
EDTA
SODIUM CITRATE
BLD CULTURE
• Post transfusion urine
• 12-24hrsS
82. EMERGENCY TREATMENT
• IV Fluids
• Lasix
• Ionotropics
• Antihistaminic/ steroids
• Oxygen/ ventilatory support
• DIC therapy, Renal support
83. PYROGENIC REACTION
• Occurs with in 6 hrs
• It is characterized by fever with chills
nausea ,vomiting ,diarrhoea , headache,
• Back ache ,delirium, shock and renal failure
84. ALLERGIC REACTION
• Occurs during or 1 hr after transfusion
• It is characterized by rashes, itching laryngeal
edema ,and bronchial spasm in severe
condition
• Treatment
• Antihistamines and corticosteroids
85. ANAPHYLACTIC REACTION
• It develops immediately after transfusion of only
few ml of blood. It is characterized by
Dyspnoea,tachycardia, tachypnoea, hypotension
and cyanosis.
• Gastrointestinal disturbances _nausea, vomiting,
diarrhoea and cramping.
• Treatment_ Immediately stop the transfusion.
• Observe vitals
86. TRANSMISSION OF DISEASES
• HIV
• MALARIA
• HEPATITIS
• SYPHILIS
• All units of blood to be screened for.
87. CIRCULATORY OVERLOAD
• Administer blood slowly
• Check vitals frequently
• Examine neck vein for fullness
• Monitor CVP
• Observe for any symptoms
• Give minimum qty of blood.
• Stop at once in case of symptom
90. DEFINITION
• Bleeding from the upper gastro- intestinal tract
• Blood is dark coffee coloured and vomited out
91. CAUSES
• History of peptic ulcer
• Patient under aspirin (Disprin) and other NSAIDS
and had taken in empty stomach
• Swallowed blood Eg., Bleeding from mouth or
from throat
• Accidental fall or blow over the stomach
• Esophageal varices incase of portal hypertension
92. FIRSTAID
• Reassure the patient
• Nil orally
• Monitor vital signs
• Treatment of shock
• Evacuate the patient to nearby hospital as
early as possible
94. • An acute systemic allergic reaction
• The result of a re-exposure to an antigen that
elicits an IgE mediated response
• Usually caused by a common environmental
protein that is not intrinsically harmful
• Often caused by medications, foods, and insect
stings
• It is a Type I hypersensitivity
95. Prevention of anaphylaxis
• Avoid the responsible allergen (e.g. food, drug,
latex, etc.).
• Keep an adrenaline kit (e.g. Epipen) and
chlorphenaramine maleate on hand at all times.
• Medic Alert bracelets should be worn.
• Venom immunotherapy is highly effective in
protecting insect-allergic individuals.
97. Treatment of anaphylaxis
• Place patient in Trendelenburg position.
• Establish and maintain airway.
• Give oxygen via nasal cannula as needed.
• Place a tourniquet above the reaction site
(insect sting or injection site).
• Epinephrine (1:1000) 0.1-0.3 ml at the site of
antigen injection
• Start IV with normal saline.
98. Fluid resuscitation
• Changes in vascular permeability during
anaphylaxis might permit transfer of 50% of the
intravascular fluid into the extravascular space
within 10 minutes.
• The patients whose hypotension persists
despite epinephrine should receive intravenous
crystalloid solutions (saline) or colloid volume
expanders.
• Adults – 1-2 liters ; 5-10ml/kg in 5 minutes.
• Children- up to 30ml/kg in the first hour.
99. • Inhaled B adrenergic agonist
– Salbutamol 0.5 ml for resistant bronchospasm
• Glucocorticoids
– No immediate effect, useful to prevent relapse of severe
reaction
– Methylprednisolone 125 mg / Hydrocortisone 500mg
• Antihistamines
– Relieve skin symptoms, shorten duration of reaction, no
immediate effect
• H2 Receptor antagonist
– Beneficial
101. CARDIAC ARREST
DEFINITION
It is a sudden and unexpected cessation of the
heart beat and effective circulation that results in
inadequate delivery of oxygenated blood to vital
organs.
104. CAUSES OF RESPIRATORY ARREST
• Drowning
• Stroke
• Airway obstruction
• Drug over dosage
• Electrocution
• Suffocation
• Accident/ injury
• Head injury
105. SIGNS AND SYMPTOMS
• ABSENCE OF PULSE IN LARGE ARTERIES
• IMMEDIATE LOSS OF CONSCIOUSNESS
• ABSENCE OF RESPIRATION
• ASHEN GREY COLOR OF SKIN
106. MANAGEMENT
Aims
1. To establish effective circulation and
respiration promptly .
2. To prevent irreversible cerebral damage
Cardio pulmonary resuscitation is carried
out to rescue patients with acute circulatory
or respiratory failure or both.
107. Basic Life Support
• Basic life support includes :-
• Air way
• Breathing
• Circulation
When any cardiac or respiratory arrest
occurs :-
1. Determine the responsiveness by gently
shaking the patient. Do not shake the head
or neck unless trauma to this area has been
excluded .
108. 2. Position the patient on a firm flat surface .
3. Assess the patency of air way and presence of
respiration.
Position the patient by :-
• Head tilt and chin lift
• Neck lift and head tilt
• Jaw thrust - and observe for spontaneous
respiration.
4.Assisted ventilation is started by :-
a) Mouth to mouth or mouth to nose
Give two full breath slowly
109. b) Ambu bag may be used in hospitals . Observe
for rise and fall of chest and escape of air
during expiration.
5. Palpate the carotid pulse for 5 seconds , if
palpable continue ventilation @ 12 breath /
mts. If not palpable start external cardiac
compression.
EXTERNAL CARDIAC COMPRESSION
This means applying pressure to lower half of
the sternum which causes blood to be
pumped out of the heart. Each time when you
release the pressure the heart refills.
110. STEPS OF PROCEDURE
1. Lay the casualty flat on a firm surface and
kneel down beside him. Locate the point
where the rib cage meet in the middle on
top of Xiphisternum . Position your middle
finger here and the index finger on the bone
above. Place the heel of your other hand on
the xiphisternum, cover that hand with the
other and lock your fingers together.
111. 2. Kneel upright so that your shoulders are directly
over patient’s sternum and your arms are straight.
Press down about 1 ½ - 2 inch , then release the
pressure. Complete 15 compressions followed by 2
breath to give at least 80 compressions / mt .
Continue the procedure till the circulation returns.
Check carotid pulse and if you can feel stop
pumping and continue ventilation.
The procedure should be continued till
advanced life support is made available.
112. • Automated external defibrillator
AED s are capable of analyzing cardiac
rhythm and if appropriate deliver an electric
counter shock.
• Precordial thump – it should not be
attempted in un witnessed cardiac arrest.
REASSESSMENT
After performing 4 cycles of CPR reassess the
patient. Continue CPR if the patient is still in
cardiopulmonary arrest.
113. RECOVERY POSITION
• Once the patient starts breathing and has
palpable pulse, turn him into recovery
position.
• Kneel besides the patient, turn the head
towards you and tilt it back to open the air
way. Tilt the chin forward to straighten the
throat.
• If the patient is injured and a cervical spine
injury is possible turn him as a log onto one
side.
114. ADVANCED LIFE SUPPORT
• ALS consists of BLS and the use of special
equipments and drugs for establishing and
maintaining effective ventilation and circulation.
• Advanced air way support :-
• Use of nasal and oral air ways, bag and mask,
endotracheal and nasotracheal intubation and
tracheostomy.
• Advanced cardiac support:-
It includes use of drugs and defibrillator to
control the activity of heart so as to achieve good
cardiac out put.
115. VENTRICULAR FIBRILLATION ( VF )
As soon as the defibrillator is available it should be
used for conversion of fibrillating heart to normally
contracting heart.
PROCEDURE:-
• Lubricate the paddles with adequate amount of a
water- soluble jelly.
• Charge the defibrillator to desired energy level.
• Place one paddle to the upper part of sternum, and
the other in mid - axillary line lateral to the left
nipple.
• Apply adequate pressure
116. • Deliver three successive shocks in quick
successions at the level of 200J, 300J, and 360 J
while confirming the absence of pulse before each
shock.
• Ensure no one in contact with the patient at the
time of delivering shock.
• Drugs
• If initial defibrillation is not successful, restart CPR
and consider drugs.
1. IV Adrenalin 1mg to be repeated every 2- 5 mts.
Each dose of Adrenalin is followed by 10 CPR and
shock at 360 J.
117. 2. Inj. Lignocain – if patients does not recover
with 4 Doses of Adrenalin and 12 shocks
administer lignocain.
bolus dose- 1-1.5 mg / kg followed by 1-4 mg /
kg /hr in infusion.
3. INJ . Amiodarone – 300 mg bolus and 150 mg
IV push in 3-5 mts
119. DEFINITIVE THERAPY
• Endotracheal intubation and mechanical
ventilation
• IV access and infusion, administration of drugs.
• Suctioning
• Continuous cardiac monitoring and stabilize
rhythm
• Haemodynamic monitoring
• Arterial blood gas analysis
• CPR is continued until patient can maintain vitals
, pulse resp, and BP or results are unsuccessful.
120. Q. Discuss in detail the nursing management of
a case of acute myocardial infarction
121. Q. Enumerate the causes of coma. discuss in
detail the nursing management of a patient in
coma.
130. Q. Define
a. Rhinitis: it may be defines as an inflammation of
the nasal mucosa
b. Cryosurgery:it may be defined as the use of
subfreezing temperature to destroy tissue,
especially in treatment of abnormal cells.
c. Hysteria:
d. Keratoplasty
e. Laproscopy
f. Ligature
131. Q. Fill in the blanks
1. ABST is administered by intradermal route.
2. adrenaline is the first drug of choice in
anaphylaxis.
3. AIDS stands for Acquired Immuno Deficiency
Syndrome
4. Night blindness is caused by deficiency of
Vitamin A
5. Visualization of joint is called arthrogram
132. Q. Match the following
a.Hydrophopia 1.Hypocalcemia
b.ERCP 2.ASV
c.Tetanus 3.Rabies
d.Thoracocentesis 4.Vector
e.Snake bite 5.Mastoidectomy
f.Tetany 6.Photophobia
g. Dialysis 7.Tracheostomy
h. Malaria 8. Pleural effusion
i.Stridor 9.Endoscopy
j.CSOM 10.Acute renal failure
134. Q. What does the following stands for
1.TMT: Tread Mill Test
2.CKD:Chronic Kidney Disease
3.MRI: Magnetic Resonance Imaging
4.IFT: Inter Ferential Therapy
5. PTBV:Percutaneous Transluminal Ballon
Valvuloplasty
6. PTC: Percutaneous Transhepatic
Cholangiography
