The document provides a comprehensive overview of various medical topics relevant to nursing students, emphasizing renal failure, urine analysis, and surgical instruments used in various procedures. It details urine volume and characteristics during different phases of renal failure, renal function indicators such as creatinine clearance, and the implications of lab findings. Additionally, it describes various surgical instruments, their uses, and applications in procedures, enhancing the practical knowledge necessary for nursing students.

1. PRACTICAL EXAM PREPARATION
FOR NURSING STUDENTS
PREPARED BY:MR.JAGDISH SAMBAD
M.SC. NSG - NUN, (ACLS,BLS,ITLS,BLSO.)
IKDRC-ITS COLLEGE OF NURSING & CIVIL HOSPITAL AHMEDABAD

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46. UROBAG

47. • Urine
• Volume: Usually less than 100 mL/24 hr (anuric phase) or 400 mL/24 hr (oliguric phase), which occurs within 24–48
hr after renal insult. Nonoliguric (more than 400 mL/24 hr) renal failure also occurs when renal damage is associated
with nephrotoxic agents (e.g., contrast media or antibiotics).
• Color: Dirty, brown sediment indicates presence of RBCs, hemoglobin, myoglobin, porphyrins.
• Specific gravity: Less than 1.020 reflects kidney disease, e.g., glomerulonephritis, pyelonephritis with loss of ability to
concentrate; fixed at 1.010 reflects severe renal damage.
• pH: Greater than 7 found in urinary tract infections (UTIs), renal tubular necrosis, and chronic renal failure (CRF).
• Osmolality: Less than 350 mOsm/kg is indicative of tubular damage, and urine/serum ratio is often 1:1.
• Creatinine (Cr) clearance: Renal function may be significantly decreased before blood urea nitrogen (BUN) and serum
Cr show significant elevation.
• Sodium: Usually increased if ATN is cause for ARF, more than 40 mEq/L if kidney is not able to resorb sodium,
although it may be decreased in other causes of prerenal failure.
• Fractional sodium (FeNa): Ratio of sodium excreted to total sodium filtered by the kidneys reveals inability of tubules
to reabsorb sodium. Readings of less than 1% indicate prerenal problems, higher than 1% reflects intrarenal
disorders.
• Bicarbonate: Elevated if metabolic acidosis is present.
• Red blood cells (RBCs): May be present because of infection, stones, trauma, tumor, or altered glomerular filtration
(GF).
• Protein: High-grade proteinuria (3–4+) strongly indicates glomerular damage when RBCs and casts are also present.
Low-grade proteinuria (1–2+) and white blood cells (WBCs) may be indicative of infection or interstitial nephritis. In
ATN, proteinuria is usually minimal.
• Casts: Usually signal renal disease or infection. Cellular casts with brownish pigments and numerous renal tubular
epithelial cells are diagnostic of ATN. Red casts suggest acute glomerular nephritis.

59. Closed circuit suctioning

69. Renal biopsy needle

74. Bone Marrow Biopsy And Aspiration Needle

75. THORACENTESIS PROCEDURE SET

76. PARACENTESIS PROCEDURE SET

77. CVP PROCEDURE SET

80. PERITONEAL DIALYSIS PROCEDURE SET

85. Deaver retractor
• Deaver retractor - used to retract deep abdominal or chest incisions. Used
in Cholecystectomy (removal of gallbladder) for retraction of right lobe of liver.
Used in Truncal vagotomy (division of the main trunk of the vagus nerve) for
retraction of left lobe of liver.

86. Deaver’s Retractor
 Used in Cholecystectomy
for retraction of right lobe
of liver.
 Used in Truncal vagotomy
for retraction of left lobe
of liver.
 Used in kidney
operations toretract the
anterior abdominal wall.

87. • A retractor is a surgical instrument by which a surgeon can either actively
separate the edges of a surgical incision or wound, or can hold back
underlying organs and tissues, so that body parts under the incision may be
accessed. The two are each available in many shapes, sizes, and styles.

88. Surgical retractor
• A retractor is a surgical instrument used to separate the edges of a surgical
incision or wound, or to hold back underlying organs and tissues so that body
parts under the incision may be accessed. The general term retractor usually
describes a simple handheld steel tool possessing a curved, hooked, or
angled blade and fitted with a comfortable handle, that when in place
maintains the desired position of a given region of tissue.

89. Babcock tissue forceps
• Babcock Forceps are finger ring, ratcheted, non-perforating forceps used to
grasp delicate tissue in laser procedures. They are frequently used with
intestinal and laparotomy procedures. Babcock Forceps are similar to Allis
forceps; however, may be considered less traumatic due to their wider,
rounded grasping surface. The jaws are circumferential and the tips are
triangular and fenestrated with horizontal serrations.

90. Babcock’s TissueForceps
 Used to pick up
appendixduring
appendectomy.
 Used to hold delicate
visceral organs.
 Used to hold cut
margins of bladder
during open
prostatectomy.

91. RAMPLEY’S SWAB HOLDING FORCEPS
 Used for cleansing theskin
with swab
 It is used for removing
laminated membrane and
daughter cysts fromHydatid
cyst.
 Used to hold fundus and
Hartman’s pouch during
cholecystectomy.

92. Bard Parker’s Handles
 Blades 10,11,12 and 15
fit in B.P handle3.
 Blades18,19,20,21,22, 23
and 24 fit in B.P
handle 4.

93. Spencer Well’s HaemostaticForceps
 Used to hold bleeding
vessels.
 Used to split internal
oblique and transverse
abdominis during
appendectomy.
 Used to doblunt
dissection.

94. Kocher’s Haemostatic Forceps
 Used to crush the base
of the appendix during
appendectomy.
 Used to hold meniscus
during menisectomy.
 Used to do subtotal
thyroidectomy.

95. Mosquito Haemostatic Forceps
 Used to hold fine
bleeding vessels.
 Used to puncture the
mesoappendix at an
avascularsite.
 Used in operations of
infants.

96. Lister’s Sinus Forceps
 Used to do I&D of
abscess by Hilton’s
method.
 Used to hold gauge
swab to cleanabscess
cavity.

97. Allis’ Tissue Forceps
 Used to hold skin
while raising skin
flaps.
 Used to pick up a fold
of peritoneum during
laparotomy.
 Used to hold lineaalba
while closing midline
incisions.

98. Plain Dissecting Forceps
 Used to hold delicate
visceral organs
 Used to hold blood
vessels and nerves
whiledissecting.
 Used to hold the
hernial sac in hernia
repair.

99. Toothed Dissecting Forceps
 Used to hold tough
structures like skin
while suturing.
 Used to hold scalp
while scalpsuturing.
 Used to hold rectus
sheath while closureof
abdomen.

100. Needle Holders
 Used to hold needles
while suturing.

101. Mayo’s Scissors
 Used to tough structures
like linea alba,rectussheath
during entry in to the
abdomen.
 Used to cut delicate
structures like hollow
viscus, investing layer of
deep fascia of the neckin
thyroid surgery.
 Used to raise skin flapsby
sharpdissection.

102. Heath’s Suture Cutting scissors
 Used to cut sutureson
skin and mucous
membrane.

103. Langenbach’s Retractor
 They are used to help
better visualization of
theoperative
field, tissue handling
is minimized and
bleeding better seen
and controlled.

104. Morris Retractor
 Used while making
and closingabdominal
incisions for ease of
working in the deeper
layers.
 Used to retract
Pectoralis major in
MRM for better
visualizationduring
axillary dissection.

105. Joll’s Thyroid Retractor
 It is a self retaining
retractor used in
thyroid surgeries to
retract theskin.

106. Metallic Probe
 Used in fistulectomies.
 Used to assess the
depth of penetrating
injuries.
 Used to assessthe
length of sinus.

107. Lahey’s Right Angled Forceps
 Used to dissect thecystic
duct and artery in
cholecystectomy.
 Used in Vagotomies to
dissect the vagus nerveand
pass ligatures aroundthem
beforedivision.
 Used in thyroid surgeries to
dissect and ligate middle
thyroid vein,superiorthyroid
pedicle,etc.

108. Desjardin’s Choledocholithotomy Forceps
 Used to removestones
from common bile
duct.
 Used to remove stone
from kidney, bladder
stone.

109. Metallic Bougie
 Used to dilateurethra
in urethral strictures.
 Used to dilateurethra
beforecystoscopy.
 Used to repair
ruptured urethra by
railroad technique.

110. Bakes’ Dilator
 Used in
Choledocholithotomy, after
removing the stones from
the bile duct, it is used to
sound the bile duct for any
retained stones.
 The patency of theampulla
can checked, In impacted
stones or ampullary
stenosis,it is not possibleto
pass the dilator in to the
duodenum

111. Doyen’s Intestinal Clamps
 Used in gutresection
and anastomosis.

112. Suprapubic CystolithotomyForceps
 Used in suprapubic
cystolithotomy to
extract the stonefrom
the bladder.

113. Mayo’s Veinstripper
 Used to do strippingof
varicoseveins.

114. Giglie’s Saw
 Used to cut bonesin
amputations.
 Used to do
craniotomies.

115. Suprapubic Cystostomy Trocarand Cannula
 Used to perform
suprapubiccystostomy
secondary urethral
rupture to relieve
urinary retention.
 Used to perform
suprapubiccystostomy
secondary to distal
urethral obstruction.

116. Bone cutter and BoneNibbler
 Used to reshape the
bone during
osteotomies, amputati
ons.

117. Bone Chisel and Osteotome
 Used to chip outbone.
 Used toperform
osteotomies.

118. Rib Cutter
 Used to cut ribs incase
of draining empyema
thoracis.
 Use to resecta partof
the rib.

119. Bone Saw
 Used to cut bonein
caseamputation.
 Tocutcasts.

120. Periosteum Elevator
 Used to elevate the
periosteum during
amputations.