PAPER - I - FUNDAMENTALS OF NURSING, PHARMACOLOGY AND MICROBIOLOGY I.

DEFINE Unit-1
Mother of modern nursing Lady with the lamp International nurses day

Unit-2
Hospital ICU medical hospital OPD isolation ward nurse small hospital medium hospital large hospital government hospital pathology department nursing superintendent Maternity home Paediatric hospital Cardiac hospital radiology department anaesthetist CSSD

Unit-3
disease Micro organism nutritional need bedpan elimination need diarrhoea social need spiritual need medication need

Unit-4
cotton ring air mattress water mattress ice cap cardiac bed fowlers bed Hot water bag mackintosh dr sim's position high fowler position amputation bed prone position sand bag recovery bed fracture bed supine position lithotomy position trendlenburg position

Unit-5
micro organism infection medical asepsis sterilization cross infection disinfection intestinal /enteric isolation autoclaving contamination terminal disinfection droplet infection surgical asepsis

Unit-6
foliz catheter forceps kidney tray medicine glass syringe sponge holder thermometer scissor needle holder

Unit-7
routine admission emergency admission radioactive injury septic injury DAMA DOR D&T to other hosp mechanical injury thermal injury chemical injury electrical injury

MLC
deficiency disease malnutrition

Unit-8
congenital disease ophthalmoscope cyanosis palpation

autoscope nasal speculum vital signs

diagnosis sphygmomanometer stethoscope

percussion auscultation thermometer

Unit-9
Temperature Pulse Respiration Blood pressure rate of pulse tachycardia brady cardia dyspnoea clinical thermometer rectal thermometer normal temperature pyrexia inspiration expiration rate of respiration pulse pressure centigrade and Fahrenheit formula thermolysis thermo genesis normal respiration rate cyanosis blood pressure hypertension normal Blood pressure

Pathology nursing
CBC MP SGPT NBM S.Widal LFT FBS pecimen PP2BS RBS NPO

investigation Laproscopy bronchoscopy gastroscopy cynosis

woll'f bottle

x-ray
ultrasonic scan USG MRI CT scan

colonoscopy Oxygen administration

Asphyxia flow meter

x-ray

regulator pressure meter

Elimination
defecation enema dehydration soap water enema ice water enema dysentery typhoid food poisoning nutrition enema sedative enema retention enema small enema large enema medicinal enema anaesthetic enema

Hot and cold fomentation

hot application cold application skin dermis cold pack endodermis functions of skin hydrotherapy hot water bag tepid sponge sit's bath poultices steam bath cold compress

Unit-13
Pint Vein flow Hole sheet vacuum inj Prostodin inj zobid

Scalp Sponge holder Forceps Speculum Gloves Kidney tray

suction machine EDT bulb Suction Canula Dilator inj Methargin Cord clamp

inj rantac inj epidosin inj cintocin inj pitocin inj ondasetron Scissor

Pharmacology
Pharmacology sublingual administration Instillation Subcutaneous Intravenous Tranquillizer Appetizer laxative pint ounce O.D. sc IM IV antipyretic Antibiotic s.o.s. t.d.s. b.d. stat h.s. side effect over dose Antacid

Injection
expiry date location of IM injection BT DNS whole blood Pack cell venous cut down Universal donor blood group Blood group Rh factor Cross infection Universal recipient blood group

Surgical nursing
Cosmetic surgery Transplant Transfusion Emergency surgery Diagnostic surgery Transfusion OT OR NPO NBM Surgery Major surgery NG tube general anaesthesia spinal anaesthesia

Surgical instruments
scissor straight mayo curved mayo mosquito thumb forceps tissue forceps chromic suture vicryl suture catgut suture OT table OT light informed consent towel clip retractor DAMA discharge scrub nurse circulatory nurse

Personal hygiene
Gingivitis Parotitis Stomatitis Head bath Bedsore Pyrrhoea Tonsilitis Anorexia Bed bath

Short and detailed questions

1. 2. 3. 4. 5. 6. 7. Life of Florence nightingale Write and explain pledge of Florence nightingale nie>T)>gln) p\(tXi lK) (vgtvir smjivi[ various functions of hospital in details hi[(ApTlni kiyi[> classification of hospital hi[(ApTln& vg)<krN classification of hospital wards hi[(ApTl vi[D<n& vg)<krN Emergency wards Various departments of hospital and their importance hi[(ApTlni (v(vF (DpiT<m[T an[ t[n& mhRv 8. Various health team members and their duties (v(vF h[YT)m m[bs< an[ t[ni kiyi[< 9. Causes of disease ri[g Yvini kirNi[ n& vg)<krN 10. Various needs of the patient 11. Explain morning-evening and bedtime care of the patient 12. List some mechanical devices to promote comfort to the patient (comfort devices) hi[(ApTlmi> apiti airim vFirvi miT[ni k>fi[T< D)vies pr ni[>F lKi[ 13. Explain bed making in details 14. Classification of various bed 15. Various positions in hospital 16. Various isolation techniques 17. Various sterilization techniques in hospital 18. Various discharge methods in the hospital 19. Various injuries in the hospital 20. Explain vital sign. Explain procedure taking TPR vieTl sien smjiv) TPR l[vin) pF(t smjivi[ 21. Explain BP taking method with drawing aikZ(t siY[ BP mipvin) pF(t smjivi[ 22. Explain thermometer with drawing 23. Oral temperature and rectal temperature indications and contra indications ai[rl T[pr[cr an[ r[kTl T[pr[cr kyir[ l[vi an[ kyir[ n le Skiy t[ (vgtvir smjivi[. 24. Explain various urine and blood tests 25. X-ray technique 26. Explain modern techniques of radiology with comparisons i.e. CT scan, USG , MRI and Endoscopy . CT scan, USG , MRI an[ Endoscopy j[v) aiF&(nk r[D)yi[li[J T[kn)k n) srKimN) kr) (vgti[ smjivi[ 27. Draw oxygen bottle and explain functions of all parts ai[(ksjn bi[Tl di[r) dr[k Bigni kiyi[< smjivi[ 28. Explain various oxygen administration methods and indication of oxygen administration ai[(ksjn kyir[ aipvi[ pD[ t[ s>ji[gi[ smjiv) ai[(ksjn aipvin) (v(vF pF(t smjvi[ 29. Various types of enema 30. Explain constipation in details 31. Explain diarrhea in detail 32. Explain various cold applications on skin 33. Explain various hot applications on skin 34. Explain various diet plan for sick mi>di y(kt miT[ (v(vF DiyT lin smjivi[ 35. Explain various tube feeding methods with drawing aikZ(t siY[ (v(vF Ty&b f)D)>g pF(t smjivi[

36. Importance of five rights during medicine administration dvi aipt) vKtn) pi>c sic) bibti[n& mhRv smjivi[ 37. Form of drugs. i.e. tab, syrup etc.. dvini p\kir di.t. tab, syrup vg[r[ 38. Draw and explain injection 39. Classification of injection 40. Administration of IV injection 41. Indication and administration of BT lD T^i>Afy&znn) j$r)yit an[ pF(t 42. Preoperative care 43. Classification of surgeries 44. Bedsore: definition, causes and management b[Dsi[r: yiyi, kirNi[ an[ sirvir 45. Bed bath 46. Importance of personal hygiene and various personal hygiene care of patient hi[(ApTlmi> a>gt t>d&rAt)n& mhRv an[ (v(vF personal hygiene pF(tai[
PAPER II ANATOMY & PHYSIOLOGY,SOCIOLOGY, PSYCHLOGY, FIRST AID I. ONE WORDS:-

CCN-3 Anatomy and physiology: definitions : question bank Anatomy Physiology Sociology Psychology Pathology Mitochondria Golgi apparatus Serous membrane superior Unit-2 the skeletal system bone Long bone Frontal bone Temporal bone Vertebral column L1-L5 radius Pelvic girdle Unit-3 the muscular system Virus Bacteria Communicable disease WHO cytoplasm Synovial membrane anterior inferior Thorasic cavity Skeletal system cartilage Short bone Zygomatic bone vertebrae fibula scapula Shoulder girdle Living matter Cell Tissue Organ System Organelle Muscular tissue Posterior Dorsal cavity Skeleton Bone marrow Flat bone Joint Cranial bones Maxilla T1-t12 clavicle

Elasticity of muscle Skeletal muscle Smooth muscle Involuntary muscle Unit: 4 circulatory system CVS artery blood Leukocytes Normal WBC count Pulmonary valve Tricuspid valve Systemic circulation Cardiac cycle Unit 5 digestive system GI system teeth Enzyme Gastric juice Duodenum Liver Pancreatic juice Rectum Unit 6 respiratory system larynx Bronchial tree Primary bronchi carina Medulla oblongata Unit-7 urinary system Urinary system kidney Urinary bladder Unit-8 nervous system Axon Spinal cord Medulla oblongata epidermis

Muscular system Visceral muscle Cardiac muscle Trapezius muscle Circulatory system plasma Thrombocytes Blood clotting Pulmonary artery Pulmonary circulation Blood pressure Rh factor Fetal circulation metabolism emylaze Cardiac sphincter Peristalsis Bile juice Insulin Appendix Gall bladder Respiratory system Expiration Nasal cavity Trachea Bronchiole urination ureter nephron Neuron CNS brain forebrain

Short muscles Voluntary muscle Deltoid Gluteus maximus Capillary Erythrocytes Haemoglobin Normal RBC count Normal hb count Mitral valve Coronary circulation Antibody ECG Diet Salivary gland Pyloric sphincter Peptic acid Ileum Ascending colon Sigmoid colon Descending colon Inspiration Bronchi Alveoli pleura diaphragm Micturation Urethra Renal artery PNS Cerebrum Pituitary Sweat gland 6

Taste bud Tympanic membrane retina Unit-10 Endocrine system Endocrine system Pituitary gland thyroxin Parathyroid hormone Gonalds Unit 11 disease and disorders influenza Urine incontinence Dialysis Diabetes diagnosis Bodiache swelling ulcer Tumor arthritis hernia aneamia Heart attack HTN malignancy chemotherapy appendicitis Ulcerative colitis Asthma First aid
crushed wound stab wound fracture complicated fracture impacted fracture depressed fracture crepitus

cerebellum hypothalamus Cornea

Iris Olfactory bulb Middle ear

Master gland ovary Prostate gland adrenocotricotropine Thymus gland Intestinal Burning urination paralysis Life style disease RS dizziness N/V itching amenorrhea CT scan Diarrhea Acute poliomyelitis Angina pectoris Leukemia radiotherapy gastroenteritis jaundice Hepatitis-B First aider
closed fracture open fracture pain Oedema tenderness Paralysis

Hormone Hypothalamus Thyroid gland TSH Pineal gland Pneumonia Cardiac UTI Renal failure Stroke Healing Deficiency Dehydration Pain Anorexia Paralysis MRI Chronic Fracture Gangrene Tetanus Cancer Cirrhosis Tuberculosis

Shock fainting wound crack fracture direct force fracture indirect force fracture Burn

Short and detailed questions Unit-1 1. Draw cell 2. How body forms from cell 3. Characteristics of living matter 4. Classification of tissue 5. Classification of membrane 6. Body cavities 7. Systems of body Unit-2 8. Functions of skeletal system 9. Classification of bones 10. Rib cage 11. Vertebral column 12. Upper limb 13. Lower limb Unit-3 14. Functions of muscular system 15. Classification of muscular system Unit-4 16. Functions of blood 17. Composition of blood 18. Blood cells 19. Explain RBC 20. Explain WBC 21. Explain platelets 22. Explain haemoglobin 23. Structure of heart 24. Circulation of blood through heart 25. Coronary circulation 26. Pulmonary circulation 27. Systemic circulation 28. Comparison of arteries and vein 29. Heart valve diagram 8

30. Importance of blood group Unit-5 31. Draw digestive tract 32. Draw small intestine 33. Draw large intestine 34. Functions of digestive system 35. List juices secreted during digestion 36. Functions of small intestine 37. Functions of large intestine 38. Functions of liver 39. Importance of gall bladder 40. Importance of pancreas Unit-6 41. Respiratory process 42. Draw respiratory system 43. Importance of nose and nasal cavity 44. Pharynx 45. Larynx 46. Structure of lungs 47. Lobes of lungs 48. Bronchial tree 49. Importance of alveoli Unit-7 50. Urinary process 51. Structure of kidney 52. Functions of kidney 53. Draw urinary tract Unit-8 54. Draw neuron 55. Classification of nervous system 56. Draw brain anatomy 57. Functions of brain 58. Draw skin 59. Draw eye anatomy Unit-10 60. List endocrine glands 9

61. Explain pituitary gland 62. Thyroid gland 63. Gonalds 64. Pancreas 65. Thymus gland 66. Prostate gland Unit-11 67. Classification of disease 68. Explain anaemia 69. Myocardial infraction 70. Hypertension 71. Classification of cancer 72. Appendicitis 73. Causes of constipation 74. Management of constipation 75. Causes of diarrhea 76. Ulcer 77. Asthma 78. Tuberculosis 79. Diabetes First aid 80. Explain importance of first aid and qualities of first aider fAT< a[eDn& mhRv smjiv) fAT< a[EDrni g&NFmi[< smjivi[ 81. Explain fracture with its types and first aid (v(vF f\[kcrni p\kir an[ f\[kcrn) fAT< a[eD smjivi[ 82. Explain various wounds and their first aid (v(vF wound an[ t[n) fAT< a[eD smjivi[ 83. Explain various hemorrhage and their first aid (v(vF h[mr[jni p\kir an[ t[n) fAT< a[eD smjivi[
PAPER III- NUTRITION, FAMILY PLANNING, COMMUNICABLE DISEASES I. ONE WORD:

Unit 1-2 reproductive system Reproduction Menopause Vaginal orifice Uterus Female pelvis Puberty 10

Vagina Fallopian tube Estrogen

midwife

ovum Progesterone Spermatozoa

midwifery

Hymen Endometrium Menstruation

obstetrics

Unit-3
Ovulation fertilized ovum Foetus placenta Amniotic fluid Umbilical cord fertilization Premature infant

Unit-4
Abnormal pregnancy HRP Morning sickness quickening Amenorrhea Missed period

Unit-5
Antenatal care abortion still birth TPAL GPA Gravida EDD LMP Anaemia Multi Gravida Nulipara ectopic pregnancy Multi Para Abdominal girth Doppler pre-eclampsia Primi para

Unit-6
first stage of labour second stage of labour third stage of labour cord prolapse foetal distress domiciliary midwifery

Unit-7
Lochia post natal exercise postnatal visit

Unit-8
abortion threatened abortion inevitable abortion incomplete abortion septic abortion habitual abortion APH PPH complete abortion missed abortion criminal abortion

Unit-9
suction Vernix Capet haemetoma Neonatal jaundice grasping reflection imperforated anus rolling eye NICU malnutrition breast feeding Artificial feeding weaning

Unit-10
Cesarean section Forceps delivery Episiotomy LSCS FTND Hystrectomy MTP D&C Local anesthesia

Unit-11 11

Immunization Immunity Maternal immunity vaccine

D&T Measles Mums Rubella

BCG MMR Hepatitis B DPT

Unit-12
Contraception IUCD STD Vasectomy Tubal Litigation Male sterilization

Diet
nutrition complete diet diet HPD LFD protein fat tube feeding NG feeding Gastrostomy feeding AFD BFD LPD DD Gastrostomy feeding

Communicable disease
infection inflammation communicable disease infectious disease hepatitis C toxin hepatitis hepatitis A toxin Meningitis HIV AIDS Causes of AIDS Chicken pox hepatitis B

Short and detailed questions 1. Draw and explain internal reproductive organs of Female. A#i) ai>tr)k jnnt>#i aikZ(t siY[ (vgtvir smjivi[ 2. Fertilization process 3. Placenta 4. Signs and symptoms of positive pregnancy 5. TPAL and GPA method of history taking 6. High risk pregnancy 7. Diet during prenatal period 8. Vaccination schedule 9. Explain FTND conduction 10. Domiciliary midwifery 11. Classification of abortion 12. MTP act 13. Breast and artificial feeding 14. Classification of deliveries 15. Classification of immunity 16. Male related family planning methods 17. Female related family planning methods 12

18. Various communicable disease (v(vF s>k\imk ri[gi[ 19. AIDS 20. Tuberculosis

PAPER IV General English and computer fundamentals Computer: Definitions and short question (1-2 marks) 1. Computer, CPU, Monitor, Key board, Mouse, Printer 2. Internet, E-mail, Community services 3. Facebook, orkut, google 4. File 5. Folder 6. Ctrl functions 7. Formulas in excel 8. Word art Short question (5 marks) 1. Importance of computer 2. Explain window xp desktop 3. Explain regarding parts of computer ( Computer, CPU, Monitor, Key board, printer etc) 4. How to turn off , restart, standby computer 5. Different lay outs of computer 6. Aligning the text (center, left,right, justify etc) 7. Font 8. How to setup and run slide show in power point presentation 9. Explain excel Descriptive question (10-15 marks) 1. Importance of computer and internet 2. Explain email 3. My documents/my computer/recycle been 4. Shortcut commands in word 5. Preparing a table in word 6. Explain power point presentation English: Definitions and short question (1-2 marks) 1. a[.v. mi> f[rvi[, b.v. mi> f[rvi[ 2. yi[y aiT)<kl m&ki[ 3. (vFinviky/p\niY<viky/nkiriRmk viky mi> f[rvi[

13

4. 5. 6. 7. 8. 9.

use of can/may/will/shall/should/must use of preposition on/at/in/behind/of/to/for/with/by/and/but use of or/so/for/yet/if/because/either or/ neither nor definitions of singular/pleural/noun/count noun/pronoun/verb your name and address make list of . (vocabulary )

Short question (5 marks) 1. Importance of English in health sector 2. Explain indefinite articles a/an 3. Explain definite articles the 4. Write essay on - Human Body - MY SELF - MY HOBBY - MY FATHER - MY MOTHER - MY FAMILY - MY NURSING SCHOOL - THE HOSPITAL - THE DOCTOR - A NURSE - GOOD HEALTH - A MORNING WALK - My city/village, - My best friend, - Visit to a blood bank - Picnic - My favourite: teacher - My country: India Descriptive question (10-15 marks) 1. Explain tenses 2. Write your biodata and application for job 3. List characteristics of good nurse 4. Explain importance of English in Nurse life 5. Explain various prepositions

14

Computer basics ki[y&Tr b[z)kn) ki[e pN b&k m[Lv) t[mi>Y) n)c[ m&jbni m&d`iai[n) t]yir) krv)
What is a Computer? What is an Operating System? What are the Basic Parts of a Desktop Computer? The Windows XP Desktop o Start button: one of the most important tools you will use while working with Windows XP. The Start button allows you to open menus and start applications. o Taskbar: primarily used to switch between open windows and applications. Learn more about using the Taskbar in a later lesson. o Icons (or graphical pictures): represent applications, files, and other parts of the operating system. By default Windows XP provides you with one desktop icon, the Recycle Bin. Learn more about the Recycle Bin in a later lesson. Turn Off and Restart the Computer Minimizing, Maximizing, and Restoring Windows What is a File? Some common file name extensions are: o o o o doc: Word or WordPad document xls: Excel spreadsheet htm or html: HTML file (web page) ppt : PowerPoint presentation

Creating, Renaming, and Deleting Files What is a Folder? All Windows XP folders include the following features: o Title bar:contains the name of the folder o Menu bar: contains the File, Edit, View, Favorites, Tools, and Help menus. 15

o Navigation bar: contains the Back, Forward, Up, Search, Folders, and Views buttons. o Address bar: shows current folder location. Use the drop down arrow to navigate your computer's places. o White space: displays contents of the folder (folders and files) o File and Folder Tasks list: a convenient list of tasks o Other Places: convenient list of your computer's places o Details: describes the folder Creating, Renaming, and Deleting Folders What is a Drive? Introduction to My Documents o My Documents is a folder that provides you with a convenient place to store your important files and folders. Remember, you can quickly reach My Documents in the Start menu or by double-clicking the My Documents icon on your desktop. o My Computer is another tool you can use to manage files and folders. With this tool, you can create, rename and move folders and copy, print, move, delete and rename files. It also allows you to gain access to other system tools. Copying Files and Folders What is the Recycle Bin? Opening the Search Companion Change in View o Normal view is best used for typing, editing, formatting and proofreading. It provides a maximum amount of space without rulers or page numbers cluttering your view. o Web Layout view shows you what your text will look like on a web page. o Print Layout view shows you what your document will look like when it is printed. Under Print Layout view you can see all elements of the page. Print Preview shows you this as well. o Outline view is used to create and edit outlines. Outline view only shows the headings in a document. This view is particularly handy when making notes. o Full Screen view displays ONLY the document that you are working on. All the other pieces of the Word window are removed except for one button that allows you to Close View Screen. Saving a New File Save As Dialog Box Backspace and Delete 16

o Use the backspace and delete keys (on your keyboard) to erase text in your document. o The backspace key erases the text to the left of the insertion point one character at a time. o The delete key (located under the Insert key) erases the text to the right of the insertion point. Using Undo - Ctrl + Z Using Repeat - Ctrl + Y o The Repeat feature allows you to repeat the last action and can help to save a lot of time as you create your document. Cut and Paste: Copy and Paste: Ctrl+C = copy Ctrl+X = cut Ctrl+V = paste Using Find - CTRL + F Using Replace - CTRL + H Aligning Text Click the Align Left, Center, Align Right, or Justify button on the Formatting toolbar.

Using Page Setup to Specify Margins Bold, Italics and Underline

Font Using Color Font Size Bullets and Numbering To Create a Bulleted List:

Names

17

To Create a Numbered List: Use of Symbols Working with Tables Row - A row runs horizontal in a table and is divided by borders. Borders - Separating lines in the table. Column - A column runs perpendicular in a table and is divided by borders. Cell - A cell is the box that is created when your rows and your columns intersect each other. The cell contains your data or information. Creating Tables Using the Insert Table Dialog Box: Inserting and Deleting Columns and Rows To Add Rows to Your Table: To Insert Rows in the Middle of the Table: To Delete Rows: To Delete Single Table Cell: To Adjust Columns, Rows, and Cell Size: Adding Borders Add Shading Introduction to Word Graphics o AutoShapes: including Lines, Curves, and Textboxes o WordArt drawing objects

WordArt Drawing Objects

Inserting Clip Art Inserting Pictures from your Computer Changing the Appearance of your Pictures Powerpoint presentation: Essay on preparing powerpoint presentation How to design new slide in presentation? How to run presentation. Micro soft excel Preparing table in excel 18

Formulas in excel sum, deduction, multiplication

General English
Importance of English in Nursing: Singular and Plural Nouns : a[k vcn an[ bh& vcn
A noun names a person, place, thing, or idea. : Noun a[Tl[ nim For the plural form of most nouns, add s. bottle bottles cup cups For nouns that end in ch, x, s, or s sounds, add es. box boxes watch watches For nouns ending in f or fe, change f to v and add es. wolf wolves wife wives Some nouns have different plural forms. child children woman women man men Nouns ending in vowels like y or o do not have definite rules. baby babies toy toys A few nouns have the same singular and plural forms. sheep sheep deer deer Indefinite::Articlesa,an anused before singular count nouns beginning with a vowel (a, e, i, o, u) or vowel sound: gN) Skiy t[vi nim ni p\Ym axrni[ ucir Avr hi[y Ryir[ an apple, an elephant, an issue, an orange aused before singular count nouns beginning with consonants (other than a, e, i, o, u): gN) Skiy t[vi nim ni p\Ym axrni[ ucir y>jn hi[y Ryir[

a stamp, an honest

19

an M.B.A. a B.B.A. 2. Definite Article (the) Used to indicate a noun that is definite or has been previously specified in the context: ci[kks p\kirn& nim aYvi agiuni vikymi> vpriy[l hi[y t[ nim b)ji vikymi> vprit& hi[y t[ni miT[ Please close the door. I like the clothes you gave me. Used to indicate a noun that is unique: any hi[y t[v& nim Praise the Lord! The Narmada River is near to Bharuch.

Unit : 3 Capitalization
Capitalization means using a capital letter (for example, A instead of a). Always capitalize the following: The first word in a sentence. vikyni[ p\Ym axr I grew up in India. She left a message on my phone. The pronoun I. I = h&> Yt& hi[y Ryir[ This country is where I dreamed of. The first letter of a proper noun (specific name). nim , aTkni[ p\Ym axr David wants to play soccer with us. The first letter of months, days, and holidays (but not seasons). Mh)ni, (dvsi[ an[ rjiai[ni[ p\Ym axr, t&ai[ nh). Today is June 8, 2011. Sushils birthday is this Thursday. The first letter of nationalities, religions, races of people, and languages. riOT^)yti, Fm<, ji(t, BiPini p\Ym axr We often eat Italian food. The first letter in a persons title. This is Dr. Simon. I got it from Mr. Tom. Geographic areas: cities, states, countries, mountains, oceans, rivers, etc. Sh[r, rijy, d[S, pv<ti[, sm&Wi[, nd)ai[ vg[r[ My destination is Mumbai, India. The first letter of each major word in the title of a book, movie, article, etc. p&Atkni (SP<k an[ ai p\kirni lKiNni dr[k Sdi[ni[ p\Ym axr Lord Krishnas Shrimad Bhagvad Gitais my favorite novel. Count nouns gN) Skiy pen, computer, bottle, spoon, desk, cup, television, chair, shoe, finger, flower, camera, stick, balloon, book, table, comb, etc.

20

Non-count nouns gN) n Skiy water, wood, ice, air, oxygen, English, Spanish, traffic, furniture, milk, wine, sugar, rice, meat, Possessive Nouns mil)k) dS<k a[.v.

John's book Kerry's car Grandma's mirror The kids' toys My parents' house The teachers' lounge

b.v.

A pronoun takes the place of a noun. : nimn) jyia[ vipr) Skiy Personal Pronouns y(ktdS<k I go to school. You are a student. The word it' refers to an object {vAt& aYvi y(kt}: I drank it. It is big. Memorize the personal pronouns: Singular Singular Singular Plural Plural Plural Subject Object Reflexive Subject Object Reflexive First Second Third Male I you he me you him her it C[. t[n) myself yourself himself herself itself siY[ we you they they they subject = us you them them them (vPy ourselves yourselves themselves themselves themselves ji[Diy[l hi[vi[ ji[ea[.

Third Female she Third Neutral it Be

(k\yipd

a(AtRv

dSi<v[

I am a doctor. ah)> am be C[ jyir[ doctor subject C[. He is sleepy. Negative sentences need not' after the verb. nkiriRm viky I am not a doctor. He is not sleepy. The verb comes first in interrogative sentences. p\niY< viky Am I a doctor? "Are not" (is not) can be shortened to "aren't" (isn't). He isn't sleepy.

21

We aren't there. Present I am You are He is She is It was We are You are They were Negative I am not You are not (aren't) He is not (isn't) She is not (isn't) It was not (wasn't) We are not (aren't) You are not (aren't) They were not (weren't) Interrogative Am I? Are you? Is he? Is she? Was it? Are we? Are you? Were they?

Action Verbs Action verbs express action and are the most common verbs. t[ kimg)r) dSi<v[ C[ an[ yipk p\miNmi> vpriy C[. Action verbs need s at the end with third-person, singular subject. a[.v. vikymi> (k\yipdn) piCL s lgivi[ He eats bread. She walks to the station. Negative sentences need do not, does not, or did not. I do not eat bread. It does not float on the sea. Interrogative sentences begin with do, does, or did. Do you eat bread? Does he eat bread? Affirmative Sentence I sing a song. You sing a song.

Negative Sentence I do not (don't) sing a song. You do not (don't) sing a song.

Interrogative Sentence Do I sing a song? Do you sing a song?

He (she) sings a He (she) does not (doesn't) sing Does he (she) sing a song. a song. song? We sing a song. They sang a song. We do not (don't) sing a song. Do we sing a song?

They did not (didn't) sing a Did they sing a song? song.

Unit 8 Tense kiL

Verb tense tells you when the action happens. There are three main verb tenses: present, past, and future. Each main tense is divided into simple, progressive, perfect, and perfect progressive tenses.

22

(k\yi kyir[ bn) t[ verb tense Y) jiN) Skiy C[. m&y kiL #iN p\kirni C[. vt<min kiL, B&tkiL an[ B(vOy kiL, dr[k m&y kiL fr) sidi[, cil&, p*N< an[ cil& p*N< a[m cir Bigmi> vh[>ciy[li hi[y C[. n)c[ dr[k kiL miT[n) viky rcni aip[l) C[. Simple Present finish Past Future finished will finish Progressive am/is/are finishing was/were finishing will be finishing

Simple Tense sidi[ kiL kiym) aYvi (nym)t bnt) GTni miT[ sidi[ kiL vpriy. sidi vt<minkiLmi> be ni $p tr)k[ do vpriy C[ j[ni[ simiy vikyp\yi[gmi> li[p Yiy C[ {#i).p&.a[.v. mi> does vpriy C[ j[ni[ li[p Ye (k\yipd piCL s lgivvimi> aiv[ C[.} run

I run a marathon this year. (present) I ran a marathon last year. (past) I will run a marathon next year. (future) You eat lunch now. You ate lunch an hour ago. You will eat lunch in one hour.

eat

see They see a movie once a week. They saw a movie yesterday. They will see a movie tomorrow. Progressive Tense j[ t[ vKt[ (k\yi cil& C[ t[v& dSi<vvi progressive tense vpriy C[ j[mi> be ni $p tr)k[ am/is/are/was/were/will be/shall be + (k\.p.n& ing viL& $p vpriy C[. run

I am running a marathon right now. (present progressive) I was running a marathon at this time last year. (past progressive) I will be running a marathon next Sunday. (future progressive) You are eating lunch now. You were eating lunch when you saw me. You will be eating lunch in the meeting.

eat

Unit 10 Auxiliary Verbs shiyk (k\yipd

23

An auxiliary verb n& kiy< main (full) verb n[ mdd krvin& C[ t[Y) t[n[ "helping verb." pN kh[ C[. Can : Skv& - xmti Used to express ability (to be able to do something): xmti dSi<v[ I can make jewelry. He cant speak French. Can you open this jar? May : Skyti Used to ask for formal permission: ai]pcir)k s>m(t m[Lvvi May I come in? May I say something now? May I ask one question? Will : hS[ Used to express desire, preference, choice, or consent: eCi, ps>dg) aYvi s>m(t dSi<vvi I will take this duty. Will you stop talking like that? Used to express the future: B(vOy dSi<vvi It will rain tomorrow. The news will spread soon. Shall : hS[ Mainly used in American English to ask questions politely (it has more usages in British English). For the future tense, will is more frequently used in American English than shall. American English mi> t[ni[ vFir[ upyi[g Yti[ nY) pr>t& mZdZtip*v<k p\n p&Cvimi> vpriy C[. Shall we dance? Shall I go now? Lets drink, shall we? Should : krv& ji[ea[ : frj Often used in auxiliary functions to express an opinion, suggestion, preference, or idea: mt, s*cn,ps>dg) aYvi (vcir dSi<vvi You should rest at home today. I should take a bus this time. He should be more thoughtful in the decision-making process. Must : krv& j ji[ea[ - aig\h Used to express something formally required or necessary: ai]pcir)k r)t[ j$r) bibt dSi<vvi- aig\hni aY<mi> I must complete the project by this week. The government must provide health care for everybody. Have to /Has to : krv& j pDS[ - frj piDvimi> aiv[ Ryir[ Used to express something compulsary required or necessary: frJyit r)t[ j$r) bibt dSi<vvi- aig\hni aY<mi>

24

I have to complete the project by this week. The government has to take care of health of everybody.

Unit 11 Prepositions nimyi[g) ayy

"On", "At", and "In" A preposition is a word that links a noun, pronoun, or noun phrase to some other part of the sentence. nim, sv<nim aYvi Sdsm&h nimn[ ay viky siY[ ji[Dti Sdn[ preposition kh[ C[. Preposition nkk) krvi miT[ ki[e Kis (nym hi[tin Y) , vi>c)n[ aYn[ si>BL)n[ mi[Ti Big[ ayis Ye jiy C[. to the office ai[f)s pr at the desk m[j pr on the table T[bl pr in an hour a[k klikmi> about myself miri (vP[ A preposition is used to show direction, location, or time, or to introduce an object. (dSi, AYin, smy aYvi ki[e vAt&ni p(rcy miT[ preposition vpriy C[. On upr Used to express a surface of something: ki[e vAt&n) spiT) dSi<vvi I put an egg on the kitchen table. Used to specify days and dates: (dvs an[ ti(rK dSi<vvi The garbage truck comes on Wednesdays. Used to indicate a device or machine, such as a phone or computer: vAt& aYvi m(Sn dSi<vvi He is on the phone right now. Used to indicate a part of the body: S(rrni Big dSi<vvi The stick hit me on my shoulder. At : pr Used to point out specific time: ci[kks smy dSi<vvi I will meet you at 12 p.m. Used to indicate a place: ki[e AYL dSi<vvi There is a party at the club house. In : mi>, a>dr Used for unspecific times during a day, month, season, year: (dvs, m(hni[, t& aYvi vP<mi> aci[kks smy dSi<vvi She always reads newspapers in the morning. Used to indicate a location or place: AYin aYvi AYL dSi<vvi She looked me directly in the eyes.

25

Behind : n) piCL, Beside : n) bij&mi, Below : n) n)c[, Above : n) upr, Near : n) nJk, Opposite : n) sim[ Used to indicate a location or place: AYin aYvi AYL dSi<vvi I am currently staying in Maa Kaamal Hostel My hostel is behind my school. My school is located beside Police station, Mahidharpura Police station is near Bhagal. My hostel is opposite to temple. My room is on first floor above room no 5 and below room no 16 of second floor. Of : n&> Used for belonging to, relating to, or connected with: sb>F dSi<vvi The secret of this game is that you cant ever win. The highlight of the show is at the end. Used to indicate reference: s>dB< dSi<vvi I got married in the summer of 2000. This is a picture of my family. Used to indicate an amount or number: jYi[ aYvi s>yi dSi<vvi I drank three cups of milk. A large number of people gathered to protest. To : n[ Used to indicate the place, person, or thing that someone or something moves toward, or the direction of something: n) trf gt) dSi<vvi I am heading to the entrance of the building. The package was mailed to Mr. Kim yesterday. Used to indicate relationship: sb>F dSi<vvi This letter is very important to your admission. My answer to your question is in this envelop. Used to indicate a time or a period: smy aYvi smygiLi[ dSi<vvi I work nine to six, Monday to Friday. It is now 10 to five. (In other words, it is 4:50.) For : miT[ Used to indicate the use of something: ki[e vAt&ni vpriS dSi<vvi This place is for exhibitions and shows. I baked a cake for your birthday. Used to mean because of: kirN dSi<vvi I am so happy for you. Used to indicate time or duration: smy aYvi smygiLi[ dSi<vvi Hes been famous for many decades. With : siY[ Used to indicate being together or being involved: siY aYvi ji[DiN dSi<vvi

26

I ordered a sandwich with a drink. He was with his friend when he saw me. Used to indicate feeling: ligN) dSi<vvi I am emailing you with my sincere apology. He came to the front stage with confidence. Used to indicate agreement or understanding: s>m(t aYvi smj*t) dSi<vvi Are you with me? She agrees with me. By : ni oiri Used to indicate proximity: Can I sit by you? Used to indicate a mean or method: miym aYvi pF(t dSi<vvi Please send this package to Russia by airmail. I came here by subway.

Unit 12 Coordinating Conjunctions and Correlative Conjunctions

A conjunction joins words or groups of words in a sentence. vikymi> b[ aYvi b[ krti vFir[ Sdi[n[ ji[Dvin& kiy< conjunction n& C[. 1. Coordinating Conjunctions Connect words, phrases, or clauses that are independent or equal Avt>#i aYvi srKi Sdi[, vikyi[ aYvi vikyi>S n[ ji[D[ C[. and, but, or, so, for, yet, and not 2. Correlative Conjunctions Used in pairs ji[D)mi> vpriy C[. both/and, either/or, neither/nor, not only/but also 3. Subordinating Conjunctions Used at the beginning of subordinate clauses vikyn) S$aitmi> m&kiy although, after, before, because, how, if, once, since, so that, until, unless, when, while, where, whether, etc. Coordinating Conjunctions 1. Andmeans "in addition to": an[ We are going to a zoo and an aquarium on a same day. 2. Butconnects two different things that are not in agreement: pr>t& I am a night owl, but she is an early bird. 3. Orindicates a choice between two things: aYvi Do you want a red one or a blue one? 4. Soillustrates a result of the first thing: t[Y), agiuni vikyni an&s>Finn[ aigL vFirvi This song has been very popular, so I downloaded it. 5. Formeans "because": n[ kirN[

27

I want to go there again, for it was a wonderful trip. 6. Yetindicates contrast with something: ti[ pN He performed very well, yet he didnt make the final cut. Correlative Conjunctions 1. Either/or a[k aYvi b)j& I am fine with either Monday or Wednesday. You can have either apples or pears. 2. Neither/nor ph[l& pN nh) an[ b)j& pN nh) He enjoys neither drinking nor gambling. Neither you nor I will get off early today. 3. Not only/but also ph[l& ti[ Kr& j pr>t& b)j& pN Not only red but also green looks good on you. She got the perfect score in not only English but also math. Subordinating Conjunctions 1. Althoughmeans "in spite of the fact that": Cti pN Although it was raining, I ran home. 2. Afterindicates "subsequently to the time when": bid Please text me after you arrive at the shopping mall. 3. Beforeindicates "earlier than the time that": ph[li He had written a living will before he died. 4. Becausemeans "for the reason that": kirN k[ Because he was smart and worked hard, he was able to make a lot of money. They stopped building the house because it was pouring. 5. Ifmeans "in the event that": ji[ hi[y/Yiy ti[ If it is sunny tomorrow, we can go to the beach. 6. Sincemeans "from the time when": ci[kks smy Y) Ive been a singer since I was young. 9. Whenmeans "at that time": t[ smy[ When I came in the room, everyone looked at me.

Unit 13 Wh questions
Wh questions ni[ upyi[g (v(vF AYL, (AY)t), y(kt, vAt&, smy an[ kirN jiNvi miT[ Yiy C[. WH- word + do + SUBJECT + VERB PHRASE Who: ki[N Who is known as God of Cricket? Sachin Tendulkar is known as God of Cricket. Who is your Father? My father is a farmer.

28

Who killed Mahatma Gandhi? Nathuram Godse Killed Mahatma Gandhi. Whose: ki[n& Whose book is this ? This is Rameshs book. Whose performance is best in class? Ashas performance is best in class. What: S&>? What hit the dog? A car hit the dog What if Radhas favourite subject? English is Radhas favourite subject. What is your name? My name is Akash Patil. What did Nita buy? Nita bought umbrella. When: kyir[? When was Vijays appointment? Vijays appointment was at four oclock. When did Nitin arrive? Nitin arrived afternoon. When is Diwali? Diwali is in the month of October. Which: ky&? Which book do you like most? I like Shrimad Bhagvad Gita most. Which window is broken? The second window is broken. Which car met accident? GJ 5-2250 met accident. Where: kyi> Where do you live?

29

I live in Surat. Where did Gandhiji born? Gandhiji born in Porbandar. Where are the keys? The keys are on the table. Why: Si miT[? Why is Mitul thin? Mitul is thin because he is sick. Why do you worry? I am worried for my exams. Why did Sita kidnapped? Sita kidnapped as she crossed Laxman Rekha How : ke r)t[? How beautiful is Priya? Priya is very beautiful. How did Rakesh run to school? Rakesh ran quickly to school. How was your day today? It was very fine.

Unit 14 Conversation vitc)t

Greeting a(Bvidn

Hi, hello. Good morning, good afternoon, good evening. How are you? How are you doing? How do you do?

Introducing yourself: pi[tini[ p(rcy aipvi[ Introducing others: ayni[ p(rcy aipvi[

Unit 15 Vocabulary SdB>Di[L

People

30

Man, woman, baby, boy, girl, child, old man, Gender: (l>g a>g\[J g\imrmi> pN g&jrit)n) j[mj #iN l)>g aiv[l) hi[y C[. p&l)>g p&$Pvick : Masculine Man, father, uncle, boy, husband A#i)l)>g- A#i) vick : niytr ji(t: Neuter Feminine Woman, mother, aunt, girl, child, cousin, wife relation, parents

teacher,

Family members Daughter, son, father, mother, brother, husband, wife, children, parents, grand parents, grand father, grand mother, uncle, aunty, neighbour, cousin, nephew, in laws (brother in law, son in-law) Cardinal Numbers: Zero, one, two...., ten, twenty, thirty,..., hundred, thousand, lac,..., Ordinal Numbers - used for ranking: 1st: first, second, third, fourth, fifth, sixth, seventh, eighth, ninth, tenth, eleventh, twelfth, twenty second, twenty third, fiftieth, hundredth, etc... Months days and times of the day January, February,...., Monday, Tuesday...., Morning, Early morning, noon, afternoon, evening, night, Midnight Seasons Summer, Winter, Monsoon, autumn, spring Weather: What is the weather like? It is rainy. Rainy, cloudy, windy, snowy, sunny, nice, fine, cold, warm, hot etc Occupations (jobs) Carpenter, cook, farmer, fireman, fisherman, gardener, doctor, engineer, teacher, advocate, lawyer, journalist, nurse, laboratory assistant, surgeon, physician, plumber, mechanic, painter, postman, policeman, secretary, singer, taxi driver, soldier, waiter, pilot, tailor, actor, goldsmith etc.. Colours Black, white, blue, green, yellow, pink, brown, grey, orange, purple, red etc Parts of the body Arm, back, beard, ear, elbow, eye, eyebrow, eyelashes, face, finger, foot, hair, hand, leg, mouth, neck, nose, shoulder, tongue, tooth, lips, moustache, knee, head etc..

31

Rooms and Places in the Home Bedroom, Living room ,Bathroom, Hall, Shed, Basement, Porch, Terrace, Study room, Balcony etc. Objects of the home Television, remote control, power point, plug, arm chair, chair, table, dining table, door, door handle, ward rob, bedside table, bed, carpet, mirror, curtain, drawer, towel, vase etc Animals Lion, cheetah, tiger, fox, buffalo, cow, goat, dog, cat, monkey, donkey etc Birds Parrot, sparrow, peacock, dove, cuckoo, hen Flowers Rose, lily, sunflower, lotus etc Electrical - Electronic appliances Fridge, television, radio, iron, fan, air conditioner, oven, air cooler etc Cities, Villages, States, Countries, Male names, Female names, Surnames Complete this list Write essay on - Human Body - MY SELF - MY HOBBY - MY FATHER - MY MOTHER - MY FAMILY - MY NURSING SCHOOL - THE HOSPITAL - THE DOCTOR - A NURSE - GOOD HEALTH - A MORNING WALK - My city/village, - My best friend, - Visit to a blood bank - Picnic - My favourite: teacher - My country: India

32

BHARAT SEVAK SAMAJ

NATIONAL DEVELOPMENT AGENCY, PROMOTED BY GOVERNMENT OF INDIA

CENTRAL BOARD OF EXAMINATIONS BSS NATIONAL VOCATIONAL EDUCATION MISSION

Paper-I COMMUNICATIVE ENGLISH AND COMUTER FUNDAMENTALS (MS-OFFICE) __________________________________________________________________________________
TIME : 3 HOURS MARKS: 100

INSTRUCTIONS: Write answer to each question in proportion to the marks allotted During the first 15 minutes read the questions carefully __________________________________________________________________________________ I. Fill in the blanks: 10 x 1 = 10 1. The police booked ________ F.I.R. (a , an, the ) 2. It is ______ operation theatre (a, an, the ) 3. Put _________ sugar in this cup. (have , some, many) 4. ________ Taj Mahal is in Agra (a , an, the ) 5. I ________ not found any inquiries useful. (have to, has, have) 6. ____________ provides the facility to find and replace specific in worksheet 7. www stands for __________________________________ 8. ___________________is used to create charts and graphs 9. ______________ is the shortcut command of select all 10. ______________ is the shortcut command of copy the selected portion II. Write short notes on following 1. CPU 2. Software 3. Noun 4. Verb 5. Discipline 6. Biodata 7. Phrase 8. Article A and An 9. My computer 10 x 2 = 20

33

10. Face book

III. 1. 2. 3. 4. 5. 6. 7. 8. IV.

Write brief answers for 5 questions Why English is known as link language? Explain article the Write about internet explorer Explain kinds of computers Explain importance of hardware and software What is the importance of page setup? Explain copying cutting and renaming files Prepare your detailed biodata Write long answers for 3 questions 45

5 x 5 = 25

15x 3 =

1. What is the importance of preparing presentation in power point? Explain some important commands to prepare powerpoint presentation 2. Explain simple and continuous present tense with examples. 3. Explain WH questions 4. Write an essay on (nb>F lKi[ A hospital and medical paramedical staff hi[(ApTl an[ m[(Dkl, p[rim[(Dkl ATif 5. Explain what is the importance of internet? eTrn[Tn& mhRv smjivi[ 6. Describe use of computer in now a days world. aiF&n)k jgtmi> ki[y&Trni upyi[g smjivi[ mi> kiml si]n& kyiN kr[

34

BHARAT SEVAK SAMAJ

NATIONAL DEVELOPMENT AGENCY, PROMOTED BY GOVERNMENT OF INDIA

CENTRAL BOARD OF EXAMINATIONS BSS NATIONAL VOCATIONAL EDUCATION MISSION

__________________________________________________________________________________ PRACTICAL NURSING COURSE - ONE YEAR , EXAMINATION 2011-12 Paper-II FUNDAMENTALS OF NURSING, PHARMACOLOGY AND MICROBIOLOGY __________________________________________________________________________________
TIME : 3 HOURS MARKS: 100

INSTRUCTIONS: Write answer to each question in proportion to the marks allotted During the first 15 minutes read the questions carefully __________________________________________________________________________________ I. Fill in the blanks: 10 x 1 = 10 1. Florence Nightingale is known as ________ 2. Hospital having 350 bed is known as __________ hospital. 3. _______________ Position is advisable conducting delivery. 4. Anthalmetic enema is given to _______________________ 5. Normal temperature of human body is _______ F that is _______C. 6. Pulse over 100 is known as __________________. 7. Toxicology means_____________________ 8. Analgesics are used for ____________________ 9. Blue discoloration of skin and mucous membrane is known as ______________ 10. Study about drugs is known as _______________. II. Write short notes on following 1. Anatomy 2. Microbiology 3. Pyrexia 4. bd, tds , sos, stat 5. Vital signs 6. Bed sore 7. Nurse and Nursing 8. Bed bath 10 x 2 = 20

35

9. Functions of hospital 10. Five rights of nursing

III. 1. 2. 3. 4. 5. 6. 7. 8.

Write brief answers for 5 questions

5 x 5 = 25

Define body temperature, list temperature taking sites and classification of thermometers. Define Enema and classification of enema. Explain classification of hospital on various aspects. Explain letter wise meaning of NURSE. List various hot cold fomentation techniques and indications. Explain various bacteria. Prevention and management of constipation. Explain classification and forms of drugs.

1. 2. 3. 4. 5.

IV. Write long answers for 3 questions 15x 3 = 45 Write paragraph on Life of Florence Nightingale. Explain various positions in the hospital for comfort. Define blood pressure, factors effecting blood pressure and blood pressure taking procedure with details. Importance of personal hygiene of the patient and various procedures for personal hygiene. Write notes on microbiology. mi> kiml si]n& kyiN kr[

36

BHARAT SEVAK SAMAJ

NATIONAL DEVELOPMENT AGENCY, PROMOTED BY GOVERNMENT OF INDIA

CENTRAL BOARD OF EXAMINATIONS BSS NATIONAL VOCATIONAL EDUCATION MISSION

__________________________________________________________________________________ PRACTICAL NURSING COURSE - ONE YEAR , EXAMINATION 2011-12 Paper-III ANATOMY & PHYSIOLOGY,SOCIOLOGY, PSYCHLOGY,FIRST AID __________________________________________________________________________________
TIME : 3 HOURS MARKS: 100

INSTRUCTIONS: Write answer to each question in proportion to the marks allotted During the first 15 minutes read the questions carefully __________________________________________________________________________________ I. Fill in the blanks: 10 x 1 = 10 11. Respiration process is being controlled by ______________ portion of brain. 12. There are total __________ bones in human skeleton. 13. Muscles of heart are known as __________ muscles. 14. __________ blood group is known as universal donor blood group. 15. ________ is known as master gland of endocrine system. 16. ____________ is the largest part of brain anatomy. 17. Liver secrets ________________ juice. 18. Clusters of grape like structure in lungs are called ____________. 19. CNS is ______________________________. 20. ___________ is liquid connective tissue. II. Write short notes on following 10 x 2 = 20 11. Fertilization 12. Placenta 13. Psychological disorder 14. Heart valves 15. Hormone 16. Membrane 17. Thyroid gland

37

18. First aider 19. Haemoglobin 20. Parts of small intestine

III. 1. 2. 3. 4. 5. 6. 7. 8. IV. 1. 2. 3. 4. 5.

Write brief answers for 5 questions Draw and explain anatomy of human cell. Draw large intestine and describe its functions. Explain blood composition. Role of society in preventing epidemic diseases. Describe mechanism of respiration with drawing of respiratory system. Classification of skeletal system and bones. Classification of wounds and their first aid. Define sociology, How illness effect the society?

5 x 5 = 25

Write long answers for 3 questions 15x 3 = 45 Write paragraph on anatomy and physiology of heart with neat drawing. Draw Gastro intestinal system and explain each organ in detail. Describe classification of bones and joints with examples. Explain female reproductive system in details. Define psychology, Need for psychological support to sick persons, mental adjustments of sick person mi> kiml si]n& kyiN kr[

38

BHARAT SEVAK SAMAJ

NATIONAL DEVELOPMENT AGENCY, PROMOTED BY GOVERNMENT OF INDIA

CENTRAL BOARD OF EXAMINATIONS BSS NATIONAL VOCATIONAL EDUCATION MISSION

__________________________________________________________________________________ PRACTICAL NURSING COURSE - ONE YEAR , EXAMINATION 2011-12 Paper-IV NUTRITION, FAMILY PLANNING, COMMUNICABLE DISEASES & MIDWIFERY __________________________________________________________________________________
TIME : 3 HOURS MARKS: 100

INSTRUCTIONS: Write answer to each question in proportion to the marks allotted During the first 15 minutes read the questions carefully __________________________________________________________________________________ I. Fill in the blanks: 10 x 1 = 10 1. Midwifery is defines as ______________ 2. MTP means ______________ 3. Example for Vitamin - A deficiency disease is _____________ 4. BCG vaccine is given to prevent _________________ 5. LMP is _______________________ 6. Mal nutrition is __________________________ 7. _________________ is rich source of protein. 8. Causative factor of typhoid fever is ________________ 9. Neonatal jaundice is _________________________ 10. Inflammation of liver is known as ____________________ II. Write short notes on following 1. Fertilization 2. Active immunity 3. Under nutrition 4. Asthma 5. Function of Iodine 6. Causative agent of Malaria 7. Domiciliary midwifery 10 x 2 = 20

39

8. Benefits of breast feeding. 9. MMR vaccine. 10. Habitual abortion.

III. 1. 2. 3. 4. 5. 6. 7. 8. IV. 1. 2. 3. 4. 5.

Write brief answers for 5 questions Positive signs of pregnancy. AIDS High risk pregnancy. Explain various micro nutrients. Instrument tray to conduct normal delivery. Stages of labour Define Hepatitis and its classification. Polio vaccination program.

5 x 5 = 25

Write long answers for 3 questions 15x 3 = 45 Draw and explain Female reproductive system. Define antenatal care. Explain antenatal visit and prepare sample antenatal card. Explain various communicable disease caused by contaminated food and water. Explain duties and characteristics of good midwife. Define abortion and explain its classification mi> kiml si]n& kyiN kr[

yin aipSi[
- sdr p[fl[Tlmi> dSi<yi m&jb p(rxin) t]yir) krSi[. ai siY[ aip[l) kv[ynb[>kni dr[k (vPyni (vgtvir jvib t]yir kr) hi[l T)k)T m[Lvvi aivi[ Ryir[ btivvini rh[S[. kv[ynb[>kni jvib sbm)T Yyi vgr hi[l T)k)T mLvipi#i nY). - ti. 2-4-2013 m>gLvirY) p(rxi S$ YS[, 2/4- a>g\[J an[ ki[y&Tr, 3/4-p[pr-1 {n(s<>g (sFi>ti[}, 4/4-p[pr-2 {a[niTi[m)} an[ 5/4- p[pr-3 {m)Dviefr)} - bik) rh[t) f) bibt ki[e g[rsmj n Yiy t[ miT[ tm[ Br[l) f) n) dr[k rs)d siY[ riKvin) rh[S[. - bik) rh[t) f) kl)yr kr) ti. 25-3-2013 s&F)mi> tmir) hi[l T)k)T m[Lv) l[v), bik) rh[t) bF)j f) kl)yr kyi< vgr hi[l T)k)T mLvipi#i nY) an[ hi[l T)k)T vgr p(rxiK>Dmi> p\v[S mLS[ nh). - bx) p>cni (vwiY)<ai[n) Aki[lrS)p m>j*r Yen[ aiv) gy[l hi[y bik) rh[t) bF)j f) kl)yr ky[< an[ pi[tini b[>kKitin) (vgti[ {a[kiuT n>br, b[>k n& nim, b\icn& nim an[ IFSC

40

ki[D } jmi krivviY) (dn-1 mi> tmiri Kitimi> Aki[lrS)pn) rkm jmi Ye jS[. SC/ST (vwiY)<ai[n) Aki[lrS)p m>j*r Yen[ aiv) nY). aivS[ a[Tl[ trt jiN krvimi> aivS[. - an&s&(ct ji(t an[ an&s&(ct jnji(tni (vwiY)<ai[n) (Dli[mi ki[P<n)j Aki[lrS)p m>j*r Yiy t[m hi[y tm[ b)j& vP< ki[P< cil& riKvini Ci[ t[ sbbn& bi>h[Fr)p#i jmi krivvin& rh[S[.

PAPER - I NURSING SOCIAL AND PREVENTIVE MEDICINE SYLLABUS 1. 2. 3. 4. 5. 6. 7. 8. 9. unit 10-18 from fundamentals by Dr. Gohil Hand washing Mask technique gown technique Gloves technique (page-25) Catheterization IV infusion All irrigation techniques NG feeding Lumbar puncture Classification of anaesthesia Bedpan- urinal

Question bank: Questions 5 marks / 10 marks / 15 marks 1. Explain various nutrients and their role (Gujarati book page no: 49) 2. Explain classification of diet (Gujarati book page no:51 ) 3. Explain various tube feeding methods (NG feeding method) (Gujarati book page no:51 ) 4. Classification of drugs (Gujarati book page no: 52) 5. Explain storage of medicines(Gujarati book page no:56 ) 6. Explain various fluids used in treatment(Gujarati book page no:58 ) 7. IV infusion 8. Blood transfusion indications and procedure(Gujarati book page no:60 ) 9. Oxygen administration indications and procedure(Gujarati book page no:61 ) 10. Explain various blood-urine tests for various conditions(Gujarati book page no:64 ) 11. Serous fluid examination procedures(Gujarati book page no: 65) 12. USG/CT scan/MRI(Gujarati book page no: 68) 13. Various endoscopy mehods(Gujarati book page no:68 ) 14. Classification of enema(Gujarati book page no:70 )

41

15. Giving and removing bedpan(Gujarati book page no:71 ) 16. Gastric lavage(Gujarati book page no: 72) 17. Rectal irrigation(Gujarati book page no: 72) 18. Bladder irrigation(Gujarati book page no: 72) 19. Eye/Ear irrigation(Gujarati book page no: 73) 20. Perineal care(Gujarati book page no: 73) 21. Various hot fomentation procedures(Gujarati book page no:75 ) 22. Various cold fomentation procedure(Gujarati book page no: 76) 23. Classification of surgeries(Gujarati book page no: 77) 24. Operative room set up(Gujarati book page no: 78) 25. Operation team(Gujarati book page no: 78) 26. Pre operative preparation(Gujarati book page no:79 ) 27. Dressing and bandaging(Gujarati book page no: 80) 28. Explain procedures 1. Hand washing 2. Surgical dressing 3. Retention enema 4. Bedpan giving / taking 5. Sitz bath 6. Rectal suppository 7. Cold compress 8. Ice cape 9. Hot water bag 10. Blood and urine specimen collection 11. Intake Output record 12. Blood Transfusion 13. Bladder irrigation 14. Gastric lavage 15. I.V. Infusion 16. N.G. Feeding 17. Oxygen administration 18. Catheterization male/female 19. Lumbar Puncture 20. Gloving 21. Gowning 22. Ear/Eye/Nose instillation 23. Ear irrigation

Preparation material:
Hand Washing Technique (Medical Asepsis) PURPOSE: To cleanse the hands to minimize the cross infection to an each patient self and in the environment for aesthetic sense REQUIREMENTS: 1. Soap in a dish 2. A sink equipped with a tap 3. Towel 4. A nail brush and hand brush 5. A nail file 6. A container with disinfectant 7. A timer. HAND WASHING TECHNIQUE: 1. Stand well away from the sink, turn on the tap and adjust its flow. 2. Wet hands, for arms and, elbow thoroughly. Holding them down ward over the sink to allow the water to run toward the finger tips. 3. Apply enough soap on hands and fore arms to make a good lather. 42

4. Rinse soap cake and replace to the soap dish. 5. Scrub each hand with the other creating friction by interlacing the fingers and moving the hands back and forth. Continue scrubbing for 1-2 minutes starting from the areas around the finger nails in N.B. 1. Washing of the hands should be done for 2 to 3 minutes with a brush if the hands are grossly contaminated. 2. A nail file is used to clean the sub ungula area, if the nails are dirty. 3. Use paper pieces if sink is used with and controlled tap to open or to close the tap, depending up on the areas whether it is clean or contaminated. 4. Scrubbing the hands with a brush is not re-commended for medical aseps is because brushing may force some bacteria into the skin crevices while others are being brushed out. 5. Always use running water as it removes the bacteria and dirt along with soap mechanically. 6. If a tap is not available an assistant is needed to pour the water for hand washing.

GENERAL RULES OF CLEANING 1. Warm water dissolves grease easily and dirt, so it is more effective in cleaning than the cold water. 2. Cold water dissolves aluminous water therefore articles soiled with body wastes, blood and so forth should be rinsed in cold water before being washed in hot soapy water. 3. Soap lowers the surface tension of water and therefore should be used in sufficient amount to remove dirt. 4. hold the cleaning cloth in such a manner so as allow a large area of cleaning as far as possible at one time. 5. Friction will speed the removal of dirt, Friction is accomplished by the movement of the cleaning equipment over the surface. Cleaning cloth spread over the palm of the hand will facilitate this. Mild abrasives can be used to further increase the friction. 6. Start to clean area closer to you and work away from yourself start clean are a near t far. 7. Proceed from the higher are to floor. 8. All surfaces of the articles should be cleaned. This includes creases and crevices etc. 9. The movement of cleaning should be so organized as to avoid cleaning the same surface more than once. 10. Maintaining articles adequately dry will discourage the growth of the micro-organisms replaced. 11. Keeping the living place clean and free from waste food will help to keep the vermin animal, pets, away. Food should be stored and kept in reserved containers. The chief danger from pets is it spread of communicable disease. 12. Sun light and ultra violet rays help to control the bacteria in he air and there by on the articles which are exposed to Sun light for 6-8 hours. SURGICAL DRESSING PURPOSE:

43

1. To promote healing of the wound. a) To cleanse the wound. b) To apply pressure to promote haemostatic. c) To prevent further injury and infection and to absorb secretions. 2. To provide cosmetic effect. 3. To prevent deformities and loss of function. EQUIPMENT: GENERAL TROLLEY CONTAINING 1. Sterile dressing sets .6 2. Each set consists swabs 6 3. dressing gauze 1 4. gauze pad ....1 5. dissecting forceps ...3 pair 6. bowl 1 7. Sterile cotton balls 1 pack 8. Sterile suture removal scissor ...1 pair 9. Sterile surgical scissors packs 2 10. Vaseline, gauze. 11. Instruments tray containing: - Probe 1 - Director .1 - Sinus forceps ..1 pair - Spatula S.S. ...1 - Paper bags 1 - bandages 4 .6 - bandages 6 ..12 - Bottles containing antiseptic solution 4 - Antiseptic cream 1 - Bottles containing antibiotic powder .1 - Bottles with cleansing agent ..1 - Kidney tray.6 large - Treatment mackintosh and towel ..6 large - Bandages scissors 1 pair - Adhesive tape ..1 roll - Normal saline bottle ..1 - Large bowls 6 - Safety pins ..6 INDIVIDUAL TROLLEY: 1. A tray containing ..1 2. Sterile dressing set ...1 3. Sterile spatula 1 4. Normal saline bottle .1

44

5. Bottle with spirit .1 6. Required medication 7. Bandage 1 8. Bandage scissors 1 pair 9. Adhesive tape .1 roll 10. Treatment mackintosh + towel ..1 set 11. Paper bag 1 12. A bowl with disinfectant .1 13. Kidney tray 1 ONE NURSE TECHNIQUE PURPOSE: 1. Explain procedure to the patient 2. Screen the patient 3. Bring the individual trolley to bed side 4. Expose only the site to be dressed 5. Protect bed linen with mackintosh and towel 6. Place kidney basin with paper bag with in the reach 7. Remove outer dressing with hand and discard it in the paper bag 8. Wash hands and dry. 9. Open the dressing set 10. Arrange the equipment conveniently 11. Moisten the swabs with saline. 12. Remove inner dressing withy one forceps and discard dressing into the paper bag and forceps in to disinfectant. 13. Squeeze out the solution from swab using 2nd and 3rd forceps. 14. Cleanse the wound thoroughly starting from the center towardsperiphery, use one swab for each stroke. 15. Cleans the skin around the wound with saline, wipe with dryswabs and clean with spirit. 16. Take the required medication with sterile spatula and spread it in a thin layer over a guaze piece and cover the wound. 17. Apply sterile dressing. 18. Discard used instruments into the disinfectant. 19. Secure the dressing. 20. Remove mackintosh and towel place it on the lower shelf of thetrolley. 21. Discard soiled dressing and swabs in to the wash receptacle. 22. Wash hands. 23. Straighten bedclothes, make the patient comfortable. 24. RECORD. 25. Take the trolley to the work room replace clean articles in general trolley. 26. Discard towel in soil linen box. 27. Wash instruments bowl, kidney tray mackintosh with soapand water, dry and replace. N.B:-

45

1. Soiled dressing should never be handled with bare fingers but useforceps or glove in extensive wounds. 2. Disinfect mackintosh and kidney tray if grossly contaminated. 3. Keep sterile safety pins if required. 4. Keep a cheatle forceps in a bottle with disinfectant, if packs are not available. RETENTION ENEMA PURPOSE: 1. To obtain the hardened faces and gently stimulate peristalsis. 2. To supply food and fluid 120 ml to 180 ml. 3. to administer medication: a) Stimulating enemata - coffee b) Sedative enemata - starch and opium enema c) Anesthetic enemata -paraldehyde avertin. 4. To aid in diagnosis 5. To produce local emollient effect.

EQUIPMENT : - Screen - A tray containing: - -draw mackintosh and draw sheet - Funnel with 12 length or rubber tubing with glass connection and - screw clamp - Rectal catheter No.12 - Jug or a bowl for solution - Vaseline - Paper square - Kidney basin - Measure for making solution - Bed blocks Two - Lotion thermometer PROCEDURE: 1. Screen the patients and explain the procedure. 2. Prepare the required amount of solution at 100 F or 37.66 Oillenemas and nutritive enemas, other enemas at 105 For 40.6 C. 3. Carry the tray to the bedside. 4. Turn the patient in left lateral position and place on pillow under the hips. Raise the foot end of the bed by using the bed blocks. 5. Place the mackintosh and draw sheet under the patient. Drape the patient with the top sheet. 6. Take the funnel and tubing in one hand, lubricate the rectal catheter 3-4. 7. Fill the funnel with solution, open the screw clamp and allow the solution to flow in the tube. 8. Pinch the catheter and insert 4-6. 46

9. Release the tubing and elevate the funnel not higher than 8 allowing the solution to enter in the rectum slowly. 10. Keep the funnel full with solution for 15-20 minutes until the entire solution has entered into the rectum. 11. Pinch the rectal catheter and withdraw slowly. 12. Wrap the soiled part of the rectal catheter with paper, disconnect it from the glass connector and place it in the kidney basin. Place the funnel and tubing in the tray. 13. Encourage the patient to take deep breathing and apply the pressure over the anus by holding the two buttocks together to help the patient to retain the solution according to the purpose of the enema. 14. Straighten the bedding. Leave the comfortable. 15. Take the tray to the clean up area. Wash the funnel and tubing 16. with soap and warm water, rinse. Boil for 5 minutes. 17. Replace the equipment. 18. Remove screen and pillow from the patients hip. 19. Record: treatment, solution used amount and retention results. 20. Keep the foot end of the bed raised for 30 minutes.

BED PAN-GIVING AND REMOVING PURPOSE: 1. To facilate elimation for a patient confined to bed. 2. to provide test EQIUPMENT OR REQUIREMENT: - Screen - Bed pan cover if available - Bed pan towel - Basin and towel - A tray containing: - Soap in soap diah - Jug with water - 2 3dry cottons swabs - paper bag duster N.B. if you have to swab the patient who is unable to do it herself / himself , bowl with 6-8 wet swabs, kidney tray and forceps. PROCEDURE OR ACTION: 1. Screen the patient. 2. Obtain clean dry bed pan with cover if available carry to the bedside and place it on the stool. 3. Remove blanket and counterpane. 4. Fan fold draw sheet to the opposite side. 5. Remove bed pan cover and tuck under the mattress. 6. Remove the lid and place it up side down on stool.

47

7. Lift the top sheet. Ask the patient to flex the knees and pull patients skirt or dhoti up to the waist. 8. Place left hand under the back and help the patient to lift the hips while passing the bed pan with the right and be sure the patient is properly centered on the bed pan. 9. Leave the patient alone if not very ill. Instruct the patient that you will return. 10. Collect the articles for cleaning the patient and carry to the bedside. 11. Fold back the top sheet. 12. Pour warm water over the genitalia. 13. Patient will clean the genital area with her hand and wipe with the dry cotton swabs and discard them into paper bag. 14. Remove the bed pan with the right hand and place it on stool. Cover it with the lid and bed pan cover. 15. Turn the patient to the side and dry the back well. 16. Let the patient wash her hands with soap and water then dry them. 17. Remove the tray and bed pan to the clean up area. 18. Observe the contents. 19. Wash hands record observations and report if it is necessary.

NOTE: 1. When patient is unable to care for herself turn down the top sheet to the groin and put them down. At the midpoint to form a drape pour the warm water over the genitalia pick up the wet cotton swabs with the forceps and the area down to the anus making one down ward stroke with each cotton swab and discard in paper bag. 2. In the same manner wipe the area with the dray swabs. 3. Discard forceps in the kidney tray. AFTER CARE OF EQUIPMENT: - Empty the contents of the bed pan into the flush. Rinse with cold water and clean with the bed pan brush or mop. - Rinse again in the cold water and immerse the bedpan into the tubcontaining disinfectant phenol 2% for 30 minutes wash the kidney tray and the forceps with soap and running water Boil for 10 minutes and replace. SITZ BATH PURPOSE: 1. To relieve pain and congestion of the pelvic organs or areas. 2. To promote voiding following cystoscopy or circumcision. 3. To promote healing following perineal and anal area surgery. EQUIPMENT OR REQUIREMENT: 1. Small tub [size to ensure that water covers the suprapubic areawhen the patient is sitting] 2. Two bath towels. 3. One rubber ring with cover. 4. A pad. 5. Sheet. 48

6. Two safety pins. 7. Lotion thermometer. 8. Jug of solution at 150 F or 65.5 C. 9. Patients gown. 10. Dressing set and kidney tray as needed. 11. Solution as ordered by the Doctor. SOLUTION: - Commonly used. - Potassium permanganate 1: 10,000. - Magnesium Sulphate 2-5%. - Boric acid 4 gms or 1 gram per pint of water. PROCEDURE OR ACTION: 1. Explain the procedure to the patient. 2. Place the tub on the floor. 3. Prepare the solution in the tub [temperature 105 F to 115 F]40.6 C to 46.1 C. 4. Fill tub to half full. 5. Place the inflated rubber ring, in the tub. 6. Place bath towel over the edge of the tub to provide pad under the knees. 7. Assist the patient to dressing in the hospital gown and the slippers, remove dressing if it is there. 8. Pin the gown high around the chest, using the sheet to avoid exposure. 9. Assist the patient to sit in the tub. 10.Fasten the sheet about the shoulders. 11.During of the treatment 10-30 minutes. 12..Adjust the bath towels under the knees and a pad at theback. 14.,If the water cools down, assist the patient to rinse and add water to bring temperature to 105 For 40.6 C. 13. At completion of the treatment assist the patient to rise. 14. Dry well unpin the gown wrap the sheet about the soulders and assist the patient to the bed. 15. Apply dressing if needed. 16. Clean and replace the equipment.

RECTAL SUPPOSITORIES PURPOSE : - To produce a bowel action. . - To soften the feces - To relieve pain - To soothe the bowel REQUIREMENT : - Screen - A tray containing - Suppository - Finger cot - Small container with water or oil - A covered container with cotton swabs

49

- A paper bag and a kidney tray - Draw mackintosh and draw sheet necessary) PROCEDURE: 1. Explain the procedure to the patient 2. Carry tray to bedside and provide privacy 3. Fan fold blanket to the foot end of the bed 4. Put the patient in left lateral pasting 5. Place the mackintosh and draw sheet under the patient. 6. Expose the part . 7. Put on finger cot 8. Lubricate the rectal suppository 9. Separate the buttocks with thumb and fore finger 10. Insert the tapered end of the suppository into the anal canal and push it upward sweil beyond the internal sphincter. 11. To retain the suppository. Encourage the patient take deep breathing and apply the 1pressure over the anus by holding the two buttocks together. 12. Record and report, the effect of the treatment N.B. :Use cotton swabs while separating the buttocks to protect fingers from contamination. COLD COMPRESS PURPOSE : 1. To reduce temperature 2. To reduce congestion and inflammation 3. To check haemorrhage. EQUIPMENT OR REQUIREMENT : - A tray containing - ice in a bowl ' - Treatment mackintosh and towel - Gauze squares

PROCEDURE OR ACTION : 1. Bring equipment to the bed side. 2. Place treatment mackintosh and towe! 3. Put two compresses into the ice water until they are saturated. 4. Wring out excess water from one compress. 5. Apply the compress to the part. 6. Wring the other compress take off the first one and apply second. 7. Continue the treatment for 20 minutes, changing compresses frequently. 8. Dry the part. Remove mackintosh and towel make the patient comfortable. 9. Clean and replace equipment. NOTE : 1. Cold compress should be applied on the fore head at 101 OF or 30.330C

50

2. Thickness of the compress should 1/2 to 1 cm. cut or fold layers of gauze, 3. Since on contact with cold may cause a skin burn therefore application should be on for 20 minutes and so on. 4. Temperature of the cold compress should be above the freezing point 0C or 32F. ICE CAP PURPOSE : 1. To reduce temperature 2. To reduce congestion and inflammation 3. To check haemorrhage. EQUIPMENT OR REQUIREMENT : - A tray containing - Ice in a bowl - Salt - Table spoon - Wooden hammer and canvas bag - Ice cap and cover - Treatment mackintosh and towel - Duster PROCEDURE OR ACTION : 1. Keep ice in the canvas bag and break into pieces with hammer 2. Wash ice pieces with water and put them into the ice cap 3. Add salt to the ice pieces. 4. Squeeze the ice cap to expel air and screw the cap 5. wipe the outside of the ice cap and put into the cover 6. Carry filled ice cap. treatment mackintosh and towel to the patient's bedside. 7. Explain the procedure to the patient. 8. Place treatment mackintosh arid towel under the area. 9. Apply the ice cap and secure. 10. Continue for 20 minutes or for the time specified Empty waterand refill the ice cap as needed. 11. Record time, duration and effect. AFTER CARE OF EQUIPMENT : - Empty water from the ice cap - Wash exterior of the ice cap with soap and water - Dry, powder, fill with air, screw cap and replace. NOTE : - Application of the ice cap is indicated for the patient's have temperature 102F or 38.9C. Range varies for the application of the ice cap with the hospital policy. HOT WATER BAG PURPOSE : ' 1. To supply heat to an area. 2. To relieve pain 3. To hasten healing 4. To promote suppuration

51

5. To relieve retention of Urine EQUIPMENT : - Jug with hot water - A tray containing Bath thermometer - Hot water bag with cover - Duster PROCEDURE: 1. Collect equipment. Pour hot water into jug and cold water until temperature of 120F or 48.8C is obtained. 2. Fill hot water bag. 3. Expel air by putting the hot water bag flat on a hard surface and push the water level up to the mouth of the bag. 4. Screw in the stopper. 5. Turn the bag upside down and check for leakage. 6. Dry the bag throughly and put into the cover. 7. Take to patients' bedside. 8. Explain the procedure to the patient. 9. Apply the hot water bag over an affected area. COLLECTION OF SPECIMENS FOR LABORATORY EXAMINATION PURPOSE : To collect specimens as ordered for laboratory examination in a manner so as to assist in the diagnosis of the patients disease. GENERAL RULES FOR COLLECTION OF SPECIMEN : 1. Specimens must be collected in clean or sterile receptacles and transferred into dean sterile containers for sending to the laboratory. 2. Each specimen container must be labeled so as to include :Ward - Patent's name - Reni-ter Number . - Bed Number - Nature of specimen - Date - Time 3. The external side of the container to be sent to the laboratory must be kept from contamination. 4. Specimens must be delivered for examination in a form consistent with the laboratory needs for example. Stools sent for amoeba must be examined within 1/2 hour of defecation or maintained without drying and at body temperature until examined. 5. Explaining the patient before hand of the need for collection of specimens to facilitate the correct diagnosis of disease and obtaining the laboratory reports as promptly as possible. 6. Specimens should not be contaminated with other bodily excretion. 7. Collect the required amount of specimen for the examination. PROCEDURE : 1. Explain the procedure to the patient. 2. Collect the specimen in a proper receptacle. 52

3. Transfer specimen to the container for sending to the laboratory. 4. Write the label as follows. 5. Affix label to the specimen container. 6. Send specimen with the requisition form to the Laboratory. 7. Chart the specimen Collected and sent to the Laboratory. 1. The sputum specimen must be obtained from the bronchi and not of the aeliva from the mouth. 2. 2 An order must be obtained for a catheterization to collect the urine specimen if a female 3. patient is menstruating. 4. The stool specimen must be free of urine. - Ward Register No. - patient's Name - Bed No - Specimen - Examination required - Time Date

INTAKE AND OUTPUT RECORD PURPOSE : - To maintain an accurate record of fluid intake and out-put when ordered or when this - information is important as a basis for therapeutic planning for the patient. NECESSARY EQUIPMENT : - Intake and out-put work sheet - Pint measure for measuring urine, drainage etc. - Patient's chart. INSTRUCTION : An intake and out-put record Ingl-axis will be maintained routinely for the following patients : 1. Those receiving diuretics, digitalis. 2. Patients on intravenous fluid therapy 3. Nothing by mouth patient 4. Patients with uremia, nephritis, nephrosis 5. Urinary retention 6. Following surgery of the kidney or bladder 7. Patients with hyperpyrexia, severe dehydration 8. Persistent vomiting and diarrhoea cases 9. Semi-conscious or unconscious patients 10. As ordered by the Doctor a. Intake and out-put will be recorded in ml. and totalled at 8-00 a.m. Totals are transferred to the appropriate columns in the patient's chart. b. The work sheet for intake and out-put will be kept at the bedside affixed on the bedside chart back.

53

c. The nurse in-charge of the patient will be responsible for maintaining the record. However the patient and or his attendant if capable can be taught to do so. d. For intake, measure the patient's own drinking glass and mark at 60 ml. 120ml.180 ml. with sticking plaster or with wax pencil. e. Fluids will be recorded when given to the patient. If solution remains after dis-continuing I.V. that amount is to be substracted from the original amount and recorded on the work sheet. f. Food which will be recorded as fluid intake includes : i. Milk, Fruit Juice, Butter milk ii. Conjee, Soup. g. Patients receiving diuretics will be weighed daily. h. For urine out-put, class IV employees will be instructed that the out-put records to be kept properly. The will report to the nurse incharge of the patient the amount of urinary out-put. The nurse will maintain the out-put record. i. Vomitus, ryle's tube aspirations, drainages, bleedings should be measured and recorded as out-put and totalled up along with the 24 hours urine out-put. j. For patients on forced fluids because of fever or dehydration, fluids will be given so as to minimum of 100 ml. urinary out-put in 24 hours.

BLOOD TRANSFUSION PURPQSE : To replace blood through the vain 1. To prevent shock 2. To treat shock 3. To correct anaemia EQUIPMENT: Same as for Intravenous Infusion except the following changes 1. Needile gauge No. 18 or 19 and 11 K:-2" length. 2. A wrapper for the bottle 3. Anti histamin drug PROCEDURE : 1. Check the order for transfusion. 2. Confirm blood group of the patient 3. Send the specimen of blood for cross-matching along with the requisition form to the blood bank 4. Collect the equipment. 5. Receive the blood. 6. Check along with the Doctor, for name, register number, ward, bed number and blood group of the patient. 7. Wrap the bottle with wrapper. 8. Follow the steps as per the I.V. infusion 54

9. Observe the reaction 10. Record : - The type of transfussion whole blood or packed cells) - Group of the blood - amount - time - rate of flow - Antihistamin, if added name of the Dr., who started - transfusion pulse and the respiration of the patient. 11. Record on the temperature chart-the amount and group of the blood transfused. N.B.: When the patient has the reaction. 1. Stop the transfusion 2. Notify the Doctor, 3. Record the condition of the patient. 4. Send the entire blood and I.V. set with the form to the blood bank, 5. Administer on emergency drug as per the order.

BLADDER IRRIGATION PURPOSE : To cleanse the bladder of irrigating substances To relieve pain and congestion EQUIPMENT : 1. To equipment for catheterization add 2. Container with sterile as ordered by doctor 3. Sterile 20 cc. syringe (with adaptor if needed to facilitate attachment to catheter) OR Sterilp funnel with rubber tubing and glass connection 4. Large kidney basin. 5. solutions commonly used a. Normal saline b. Acriflavin, 1 : 5000 c. Potassium permanganate. 1:6000 d. Biniodide of mercury, 1 : 8000 Temperature of solutions for treatment of inflammation 100 to 11.0F PROCEDURE OR ACTION : 1. Prepare solution at room temperature unless ordered specifically. 2. Catheterize the patient. When the urine flow has ceased, attach the barrel of the syringe to the catheter (or the funnel and rubber tubing) 3. Replace small kidney basin with the large one.

55

4. Introduce 2 to 4 ounces of the solution into the barrel of the syringe or the funnel and allow to flow into the bladder. 5. Lower syringe or funnel and allow solution to return into the kidney basin. 6. Continue introducing solution and allowing it to flow out of bladder until return flow is clear or the amount of solution ordered has been used. 7. Complete the procedure as for catherization. GASTRIC LAWAGE OR GASTROSTOMY TUBE FEEDING PURPOSE : To introduce liquid food or medication directly into the stomach.

EQUIPMENT : 1. In addition to equipment needed for naso-gastric intubation 2. Feeding or medication as ordered. 3. Feeding cup with water 4. Funnel (if gastrostomy feeding) PROCEDURE : 1. Prepare or obtain feeding. If cold, place In basin of warm water, 2. If tube is not already in place insert following procedure for naso-gastric intubation 3. If gastrostomy feeding, attach funnel if feeding is to be given through naso gastric tube, replace syringe with funnel if desired 4. Introduce a small amount of water through tube. 5. Slowly introduce feeding or medication Keep funnel or syringe barrel full until total amount has been introduced. 6. Clear tube by introducing a small amount of water. 7. Disconnect funnel or syringe barrel. 1. 8 Clamp tube if it is to be left in place-otherwise, remove tube, Place in kidney basin. RECORD: - Time - Diet - Medication & treatment Nursing Noted - 10A.M. Milk Feeding through 150cc. gastrostomy tube - Egg. 1 Complains of Sugar Slight nausea - 2 tea sponns K. Lalitha After care equipment: - 1 Rinse equipment in cold water. - Wash in soap and water Dry. - Replace ready for next feeding. INTRAVENOUS INFUSION

56

PURPOSE : To introduce fluids into the vein. 1. When a rapid effect is needed. 2. To restore or to maintain fluid and electrolyte balance. 3. When drug is irritating or in effective, when administered by other routes. 4. To provide nourishment when the patient is unable to take or retain oral fluids. 5. When the fluids are to be administered in large quantities. To dilute and excrete poisons and toxins to maintain life line. EQUIPMENT : A tray containing : 1. Mathy, Spirit 70% ' 2. Clean cotton balls in a covered container 3. Sterile mizur (5 cc, 10 cc, 20 cc) 4. Needles guage No. 18-21 length 11/2"-2" 5. Ampoule file 6. Kidney tray 7. Bowl of water with pad 8. Adhesive plaster 9. Dressing mackintosh and towel 10. Sterile l.V. set 11. Prescribed solution and / or medication 12. l.V. stand 13. Hanger 14. Tourniquet. 15. Arm board and bandage 16. Screw clamp 17. Scissors INTRAVENOUS INFUSION PROCEDURE: Check order Explain to patient and carry out any Nursing procedures eg., offering bad pan, care changing linen etc. Assemble equipment and table the bottle. Place dressing mackintosh and towel under the selected site where I.V. is to be started. Place tournipuet. Place the hanger as the I.V. bottle and place the kidney tray near to the site. Wash and dry hands Open the I.V. set Connect it to the solution bottle and hang the bottle about 2-3 feet above the level of bed. Expel air by allowing the fluid to run through the tube into the kidney tray and pinch the tube then raise the tube above the level of fluid in the bottle, release the tubing until! all the air is expelled from tubing, link the tube and clamp the tubing tight. Cover the adapter with sterile cover until it is fixed. Apply tourniquet when doctor is ready with the syringe and needle.

57

 After the insertion of the needle into the vein fix the adpter to the needle, loosen screw clamp and fix the adhesive plaster. Adjust the Infusion rate to desired speed. Secure the needle to tubing in place with adhesive plaster on the hub of the needle. Apply bandage to the arm.Observe the flow of solution and placement of needle in vein. NASO GASTRIC INTUBATION PURPOSE : To introduce a naso gastric (Rhylcs tube) so as to produce aminimum of discomfort to the patient EQUIPMENT : Tray containing: 1. Naso-gastric tube in bowl containing cold water 2. Adhesive strip 3. Kidney tray 4. Gauze pieces 5. Treatment mackintosh 6. Screen 10 cc. syringe. PROCEDURE : 1. Assemble equipment and bring to bedside 2. Explain procedure, screen patient 3. If possible, place patient in Fowler's position with shoulders and head will supported in hyper extension. 4. Place covered treatment mackintosh over chest. 5. Measure distance for insertion of tube from tip of stermum to nares and mark with adhesive. 6. Insert tube through nostrile to pharynx. 7. Have patient I.P. head forward and swallow. Each time patient swallow, advance tube into egophagus as for as possible continue until adhesive mark is reached. 8. Attach barrel of syringe to end of tube. Invert barrel into water to check that tube is not in respiratory passage. Aspirate to see that tube is in stomach. 9. Continue with aspiration, lavage or gavage as indicated (See specific procedures). 10. Quickly withdraw tube and place in kidney basin. Leave patient comfortable. RECORD : - Time - Diet - Medication & treatment Nursing Noted 1. 2p.m. Rhyles tube inserted Distention -relieved 2. After care equipment:

58

Rinse tube with cold water. Wash with soap and water. Place in boil water and boil for 5 minutes. Rinse, wash and dry remaining equipment and replace.

OXYGEN THERAPY PURPOSE : To administer Oxygen EQUIPMENT : 1. Oxygen cylinder stand 2. Oxygen cylinder 3. Key to open and close cylinder. 4. Flow meter 5. Gauge 6. Woulfo's bottle 7. Rubber tubings 2 (one short and one long) 8. Glass connection 9. Nasal catheter 10. Cotton bag tied to stand 11. A tray containing : Small bowl of water Adhesive plaster 12. Safety pin Torch. PROCEDURE : - Check set up and bring to bedside. - Explain Procedure to patient Take adhesive strips On catheter, measure distance from nares to ear lobe Open the fine value Lubricate tip of nasal catheter in bowl of water Insert the - nasal catheter, to mark on catheter. - Secure with adhesive strips. Fix the tubing firmly by pinning it on to the Bottom sheet. - Check location of catheter - tip in phyarynx Clean and dry articles and replace. After care equipment: When the treatment is discontinued, remove adhesive strips disconnect nasal catheter, clean with soap and water, put in boiling water for 3 minutes. Replace Catheter in the bag tied to cylinder ready for use. If no oxygen guage is available, adjust flow by frequent taking of pulse and respiration rate. Increase oxygen flow-if pulse, and respiration decrease following adjustment. Maintain flow at adjusted rate when pulse and respiration rates are stabilized. CATHETERIZATION (Female) PURPOSE : - To remove urine from the bladder under aseptic conditions and without trauma to the mucosa. - This treatment might be ordered : - To relieve urinary retention. - To obtain a sterile urine specimen. - To empty the bladder before certain operations - To determine urinary residual. 59

EQUIPMENT : Sterile: . Covered tray containing : Small bowl with 3 cotton swab moistered with 2% dettol., Small bowl containing sterile water 8 dry cotton swabs 2 artery forceps 2 catheters (six according to need. 12, 13, 16 French) Treatment towel Kidney basin Gloves Specimen bottle UN-STERILE : Large tray Treatment rubber and cover 500 cc. measure Kidney basin Sheet Treatment lamp or torch as needed PROCEDURE : 1. Assemble and take equipment to bedside 2. Screen patient and explain treatment 3. Fanfold bedding to foot of bed replacing with sheet 4. Place treatment rubber and cover under erinens 5. Put patient in lithotomy position and cape 6. Wash hands 7. Remove cover from sterile tray 8. Loosen cover of specimen bottle if, specimen is to be collected. 9. Turn back corner of drape to expese Perineum 10. Place tray with equipment convenient to use 11. Put on sterile gloves 12. Place sterile towel with edge slightly under buttocks. 13. Place kidney basin containing one cathteer on sterile towel. 14. Separate label with thumb and forefinger hand using two dry cotton swabs to helpoly labia apart. 15. Hold in artery for downward strokes discarding each of time after reaching recturm. Discard cotton unsterile kidney basin. 16. Discard artery forces unsterile kidney. 17. Keep labin separated with fingers of left hand with right hand pick up to catheter 3 inches from holding rest of catheter coiled in had. More tip of catheter with sterile water. (If gloven not available - use stetile artery forceps to catheter). 18. Drop end of catheter into sterile kidney basin and move basin close to perineum to received urine. 19. Gently insert catheter through urinary mentus until flow of urine starts.

60

20. Hold catheter in place with right hand until flow of urine stops. 21. If a sterile specimen is to be collected remove cover from specimen bottle, please bottle against cup of kidney basing, lift end of catheter and direct full of urine into bottle. When sufficient urine has collected for a specimen bottle on tray cover. NOTE : 1. Second catheter is on tray in case of contamination of the first. 2. If necessary discontinue flow of urine by pinching end of catheter and emptying kidney basin into measures. 3. When flow of urine stops emptying urine into measure remove catheter and place into kidney basin, replace latter on tray. 4. Using artery forceps and swabs dipped into sterile water, cleanse over urinary meatus and perineum, Use 3 swabs and downward strokes only - discharging each swab after cleansing perineum. 5. Use remaining 3 swabs to day area Discard swabs and artery forceps into unsterile kidney basin. 6. Turn patient to side and dry buttocks with treatment towel. 7. Remove, treatment rubber and cover. Replace bidding and remove crape. 8. Remove equipment to clean up area Secure cover of specimen bottle, label and send to laboratory. 9. Clean and replace equipment. CATHERIZATION [MALE PATIENT] (USUALLY DONE BY DOCTOR) PURPOSE : Same as for female EQUIPMENT : As female add : STERILE 4X4 gauze sponge Cotton swab moistened with liquid paraffin, dry cotton swabs only 3 needed. PROCEDURE : 1. Assemble and take equipment to bedside. 2. Screen the patient and explain the treatment. Fanfold bedding to mid-thighs replacing with sheet. 3. Place treatment rubber and cover under buttocks. 4. Place tray convenient for reach. 5. Wash hands. 6. Turn back sheet to expose the part. 7. Uncover small sterile tray. 8. Loosen cover of specimen bottle if specimen is to be collected. 9. Put on gloves. 10. Place sterile towel ever thighs and under penis. 11. Lubricate catheter and place in sterile kidney basin. 61

12. Using gauze sponge, grasp penis with left hand, hold in 13. position at right angle to body and with foreskin retracted 14. Using forceps and dettol swabs (3) clean the glands penis Discard swabs and for keeps into un sterile kidney tray. 15. Pick up the catheter, 3 inches from the tip. 16. Insert gently through the meatus until flow of urine (second catheter available if the first becomes contaminated) 17. Remainder of procedure as desired in catheterization female 18. patient (only two cotton swabs moistened with water are needed for cleaning after removal of catheter and one drying cotton swab for drying). 19. To discontinue keep sterile tooth dissecting for sterile gesture removal set, bandage, skin tray, mackintosh and removal, 20. Dress the wound. */- Mosquito straight artery forceps 2 LUMBAR PUNCTURE PURPOSE : 1. To with draw Cerebrospinal fluid to relieve pressure 2. To secure specimen of fluid for diagnostic purposes 3. To inject sera or drugs in the treatment of a disease 4. To inject a spinal anesthetic 5. To introduce an opaque liquid before x-ray for diagnosis of card and brain lesions R. To measure the pressure of the spinal fluid under varying conditions. Equipment: Tray containing sterile 1 - 2 ml. Syringe 1 -25 GX1" needle 1 -23 GX 1 1/4" needle 1 - 18, 19, or 20 G X 3" spinal needle 2 - Small bowels 1 - 5" toothed thumb forceps 1 - fenestrated drape 6 - cotton balls 1 - Gauze sponge 1 - surgical towel Skin preparation tray and in addition collect 1 - pair of sterile gloves local anesthetic 1-2% procaine 3 - sterile specimen bottles 1 - sterile dressing set. Adhesive, screen, stool. Water manometer Foot Blocks if required PROCEDURE :

62

Assemble equipment and bring to bed side Explain procedure to the patient and screen ; Shave the lumbar region if needed Wash the area thoroughly with soap and water Cleanse the skin with savlon and spirit Fan fold the top linen down to the foot end of the bed Position the patient on his side and bring near to the edge of the bed. Ask the patient to flex his keens and bring his head and shoulders down as close possible o his knees. Place small pillow under the patient's head and between his knees for comfort. 8. Place mackintosh and towel under his lumbar region to protect the linen. 9. Place paper bag in a kidney tray at convenient place 10. Open sterile tray. 11. Open dressing set and take, the forceps, Hand over the surgical towel from the sterile tray to the doctor 12. Open sterile glove pack 13. Assist doctor as needed 14. Collect C.S.I, into the labeled specimen bottles if needed 15. Atere the lumbar puncture needle is removed cover the wound with gauze piece and secure it with adhesive plaster 16. Place the patient in dorsal equipment position and raise the foot end of the bed. Remove equipment and leave unit orderly. 17. Send the specimen with requisition form to the lab. 18. Wash, dry and replace equipment: NOTE : 1. If patient is lying on spring cot use fracture board under the mattress. 2. The usual site for insertion of the needle is in between the 4th and 5th lumber vertebrae 3. Instruct the patient not to move about while inserting the needle. 4. Observe the patient's reaction, pulse, and respiration carefully. Report to the doctor immediately, if anything unusual is observed. 5. Record Pulse and respiration Q 1/2 H for at least 4 hrs. 6. Remove the blocks used to. raise the foot and of the bed after 6 hours. GOWNING PURPOSE : 1. To prevent bacteria present on the uniform from being transferred to the patient's wound during surgery. 2. To permit the wearer to come close to the sterile field. EQUIPMENT : Sterile gown PROCEDURE: 1. Grasp the back of the gown in one hand, lifting it directly from the package. 2. Holding the neck band with both hands, gently shake the folds from the gown. 3. Slip the hands into the .arm holes, holding the hands upward. Tapes are given to circulating nurse by means of sleever of the gown.

1. 2. 3. 4. 5. 6. 7.

63

GLOVING PURPOSE : 1) To prevent bacteria present on the hands from being transferred to the patient's wound. 2) To permit the wearer to handle sterile equipment. EQUIPMENT : Sterile gloves in a bag French chalk powder Basin for used bag and powder PROCEDURE: 1. Have the sleeve of the gown approximately 3" below the tips of the fingers. 2. Remove the sterile gloves from the bag with your fingers inside the sleeve of the gown. 3. Unfold the glove put powder inside the glove. 4. Take glove of the right hand, fold the cuff of the gown upon itself so that it is small enough to place into the glove. 5. Hold the glove by means of the fingers of the left hand which are inside the gown sleeve. 6. Insert the folded cuff of the right sleeve inside the glove. 7. Manipulate the fingers of the right hand so that the hand is inside the glove. 8. The cuff of the gown at the wrist is now covered by the cuff of the glove. 9. Pick up the left hand glove with the right gloved hand apply left hand glove in same manner. 10. Discard the glove bag in a basin. EAR DROPS INSTILLATION PURPOSE : 1. To administer medication locally to external ear canal. 2. To soften wax. To Relieve pain. To apply local Anesthesia, 3. To destroy Organisms & insects. EQUIPMENT : 1) Sod bicarbonate solution, 1/2% 2) Oil to soften cerument 3) H O to remove wax 4) Burrows sol. Aluminum acetate 5% 8% 5) Medicine dropper. 6) Prescribed medication (warmed to body temperature) 7) Cotton swabs in container 8) Kidney basin 9) Paper bag PROCEDURE: 1. Assemble equipment Bring to patient. 2. Have patient sit or lie with ear to be treated uppermost. 3. If discharge is present, cleanse outer ear and entrance to canal with cotton swab. 4. Moistened with Sod bicarbonate solution. Discard cotton into paper bag. 5. Draw medication into dropper. 6. Straighten ear canal as follows :

64

For adult : draw pinna up and back. For child : draw pinna down and back. 7. Insert loose cotton swab. Do not push when the ear is draining. 8. Instill prescribed amount of medicine, Discard medicine dropper into kidney basin. 9. If possible, have patient remain in same position for 10 minutes. AFTER CARE EQUIPMENT : Wash, rinse, dry and replace all equipment EYE DROPS, INSTILLATION PURPOSE : To administer medication locally to the eye. EQUIPMENT : Covered container with saline cotton swabs Forceps in jar containing sterile water. PROCEDURE: 1. Wash hands Assemble equipment. 2. Make solution if necessary and lable with name, strength date and initials of person preparing [Do not use solution more than24 hours old] 3. Bring equipment to patient Explain procedure wash hands. To look upward during instillation. The medicine may change the vision or the appearance of eye for a short time. 4. Remove cotton swab with handling forceps. 5. Wipe effected eye with cotton swab from inner to outer cathus. Discard swab. 6. Draw medication into dropper 7. Steady the hand in which the Dropper is held by placing the little finger against the forehead in the temporal region. Ask the patient to look up, place the thumb. If the other hand below the margin of the lower lid and gently press downward. 8. Bring the end of- the dropper close to the outer contuse of the lower lid and express the drop or the medicine. 9. Have patient close eye slowly. Hold cotton swab at inner can thus over lacrimal duct for a couple of seconds. Discard cotton swab. EYE IRRIGATION PURPOSE : 1. To cleanse the eye prior to instillation of medication. 2. To remove irritating material or. foreign bodiea from the eye 3. To apply heat to inflamed mucus membrane. 4. To relieve pain and congestion. EQUIPMENT : Sterile : Undine or medicine dropper Bottle of sterile solution as ordered (luke warm) Cotton swabs in covered container

65

 Ounce glass Kidney basin Handling forceps in sterile container Mackintosh and towel paper bag. PROCEDURE: 1. Wash hands 2. Assemble equipment and bring to bedside. 3. Explain procedure 4. Position patient lying down or sitting up with head titled toward affected eye to be irrigated. 5. Place mackintosh and towel over shoulders, kidney basin at side of face. 6. Full undine with solution ordered. 7. If eyelids are adhered together, cleanse with moist cotton. 8. Separate eye lids, direct flow of solution from inner to outer canthus a continuous flow until eye is clean or of discharge foreign object removed. 9. Dry eyelid with cotton swab.

NOSE DROPS INSTILLATION PURPOSE : 1. To relieve nasal congestion. 2. To administer medication to the nasal passages. EQUIPMENT : Tray Medicine dropper in clean container Medication ordered Kidney basin. Paper wipe or tissue. PROCEDURE: 1. Assemble equipment and bring to bedside. 2. Explain procedure. 3. place patient in position so that head is lower than shoulders or head is well tipped back and tipped to side Parkinson. a) Proetzposition: To treat ethmoid and sphenoid sinuses. b) Pasrkinson Position: to treat frontal land maxillary sinuses and nasal passages. Draw the solution into the draper 1/3 to fill passages or more. 3. Hold the medicine dropper in a slanted position and place the dropper inside the near approximately 1/3 and instill the prescribed medication. 4. Discard medicine dropper into kidney basin. 5. Have patient remain in position for 5 minutes or until medication is felt or tasted at back of throat.

66

PAPER - II SURGICAL NURSING SYLLABUS Principles and rules to follow while practicing sterile technique Medical / surgical asepsis (Gujarati fundamental book unit-5) Surgical nursing (Gujarati fundamental book unit 17) Various surgical procedures as per literature in English Various disease as per literature in English First aid (Gujarati fundamental book unit-5)

Question bank Surgical nursing questions (5 marks/10 marks/15 marks) 1. Explain following with types, causes, signs, symptoms, surgical procedures 1. Bowel obstruction 2. Septoplasty 3. Tonsillitis 4. Hemorrhoids 5. Glaucoma 6. Anal Fissure 7. Appendectomy 8. Lung abscess 9. Cataract 10. Otitis media 11. Fracture (From gujarati book of fundaments of nursing) 2. Explain following with types, causes, signs, symptoms and management 1. Stroke 2. Obesity 3. Conjuctivitis 4. Hepatitis 5. Diabetes Mellitus 6. Shock (From first aid unit of gujarati book of fundamentals of nursing) 67

7. Wound (From first aid unit of gujarati book of fundamentals of nursing) 3. List of surgical instruments and their usage 4. Pre operative preparation 5. Consent 6. Operation team members 7. How to scrub in operation theatre 8. Skin preparation of patient before operation 9. Post operative care of the patients 10. Classification of anaesthesia 11. Explain CPR (From first aid unit of gujarati book of fundamentals of nursing) 12. Explain indications of hysterectomy and its methods 13. List of various surgeries on various parts of the body 14. Skin preparation for operation 15. Explain scrubbing 16. Explain Post operative bed 17. Types of sutures 18. Postural drainage 19. Types of needles 20. Laperotomy basic set of instruments 21. List surgical instruments for following procedures 1. Appendectomy 2. Rectal fistualla 3. Haemorrhoidectomy

Literature - Surgical nursing

Principles and Rules to Follow While Practicing Sterile Technique 1. All articles used in operation should be sterilized prior to Surgery. Instruments may be sterilized immediately preceding operation and remove directly from the sterilization to the sterile table. Linen, packs sponges, dressings can be considered sterile for 7 to 14 days after autoclaving. 2. If in doubt about sterility of any object consider it not. 3. If a sterile appearing package is found in a non - sterile 4. Work-room consider unsterile. 5. If you are unsure about the actual timing of the sterility. 6. If a non-sterile person close to a sterile table. It is non sterile 7. Tables are sterile only at table level. 8. Linen or sutures falling over table edge arc discarded. 9. Sterile nurse does not touch the part hanging below table. 10. Arms are considered sterile only from waist to shoulder level in front sleeves.

68

11. Sterile person keeps hand in front and above waist level. 12. Hands should be kept away from face and elbows close to side. 13. Arms are never folded there is apt to be perspiration in auxiliary region. 14. Articles draped below waist level are discarded.

List of various operations

1. OPERATIONS ON NECK : 1. Biopsy of neck glands. 2. Excision of neck glands. 3. Tracheostomy 4. Shave antorilor surface of the neck starting from chin to the clavicle line. a) Thyroidectomy b) Laryngectomy 5. Shave antrior surface from the chin to the nippleline extended posteriorly from hair line behind the ear covering the hair line to bed line. a) Resection of sub maxillary gland. b) Resection of mandible. 6. Same as above and include area starting from maxillary line anteriorly. N.B.: Obtain permission for female patients. 2. OPERATION ON CHEST : 1. Lobectomy 2. Pneumone ctomy 3. Operations on the Oesophagus 4. Heart surgery 5. Hiatus Hernia 6. Oesophago Jejunostomy Anteriorly shave the area starting from the neck upto superior iliac spine' extended posteriorly . to the affected side 3. OPERATION ON BREAST : 1. Simple mastectomy 2. Redical mastectomy 3. Excision of Lump in the breast same as above & the corresponding side of the arm upto elbow. 4. OPERATION ON ABDOMEN 1. Laparotomy 2. Gastrojejunostomy 3. Gastrectomy (partial) 4. Chole Cystectomy 5. Caesarean 6. Hysterectomy

69

7. Hernia N.B. : for males from nipple line upto mid thighs including pubic area, for females start from below the breasts. 5. OPERATION ON THE KIDNEY 1. Nephrectomy 2. Nephrectomy 3. Pyelolithotomy Shave from the nipple line to anterior superior iliac spine & posteriorly, extending upto soine from top shave lower border of scapula upto the sacral line. a) Prostatectomy b) Suprapubic Cystostomy 4. Shave as for abdomen operation. 6. OPERATIONS ON THE SPINE : a. Haemorrhoidectomy b. Fistulectomy c. Amputation of the cervix d. Vaginal hysterectomy e. Manchester repair f. D&C g. Conisation h. Sterilization i. Periniorrhahaphy j. Hydrocele 7. OPERATION ON THE BONE ? a. Amoutation of leg below hip joint and above knee joint shave the whole leg starting from hip joint totoes. b. Amputation of hand : shave whole had from the shoulder to the finger nail 187 SKIN PREPARATION for operation PURPOSE : To prepare the skin for surgery / surgical procedures. EQUIPMENT : 1. A tray containing : 2) Articles for cleaning : 2. Sterile Surgical towel - Basin 3. Dressing set Sponge cloth 4. Bowel of warm water- Jugs 5. Razor set with blade- Bucket. 6. Bowel with 6 cotton balls 7. 6-gauze squares 3) Screen. 8. Soap dish with soap 9. Bottle of Savion 1:30

70

10. Bottle of ether 11. Bottle of spirit. 12. Torch 13. Kidney tray 14. Draw mackintosh 15. Treatment bowel 16. Paper bag 17. Bandage or binder safety pins/plaster and pair of scissor 18. ' PROCEDURE: 1. Check pre-operative instructions and consent of the patient foroption. 2. Explain the procedure to the patient. - . . 3. Assemble the equipment. 4. Expose the operative area to good light. 5. Screen the patient. 6. Wash hands 7. Place the draw mackintosh area to good Sight towel under the part to be prepared 8. Expose the part to be prepared 9. Arrange the equipment. 10. Apply soap to the area to be shaved with cotton swabs/sponge cloth. 11. Stretch the skin to be shaved by holding the cotton ball in between the forefinger. 12. Loosen the screw of the razor and rinse it in the water as often as required to remove loose hair. 13. Remove all the soap and loose hair from the skin with sponge cloth. 14. Inspect the area carefully under good light for missed hair, chest and cuts. Shave and clean if necessary. 15. Scrub the area thoroughly with soap and water using sponge cloth and remove the soap completely. 16. Scrub the area with other using gauze squares. 17. Wash hands. 18. Open dressing set. 19. Clean with savlon using sterile forceps and gauze squares and dry the skin with cotton 20. Apply spirit using sterile forceps and cotton swabs. 21. Place sterile towel over the prepared part. 22. Apply binder or bandage 23. make binder or bandage. 24. Replace screen 25. Record PRE-OPERATIVE PREPARATION AND DRAPING IN OPERATING ROOM Skin preparation is done to render the operative site as free as possible from bacteria, so the incision can be made through it with a minimum danger of infection from the source. After shaving, final skin preparation is done, then draping is done with sterile towels leaving only the operative site to create and maintain a sterile field during the operation.

71

SCRUBBING PURPOSE : 1) To prevent possibility of contamination of the operative wound by bacteria on the hands and arms. - The finger nails should be clean be clean before entering surgery. EQUIPMENT : 1. Sterile bowl with brushes 2. Bowl for used brushes 3. Soap PROCEDURE: 1. Adjust turban and mask. . 2. Roll sleeves of scrub dress 3" above the elbows. , 3. Open the tap and regulate the flow. ' 4. Check time in clock before starting scrubbing. , 5. Apply soap and wash hands 6. Take a sterile brush from the container, apply soap to the 7. brush Scrub nails, fingers in between fingers, hands, fore 8. arms and up to the elbow by circular motion. I 9. After completion of one arm and start scrubbing for other 10. hand, throw used brush in I container. I 11. Rinse hands and arms. I 12. Keep the hands higher than elbow. POST - OPERATIVE BED PURPOSE : To facilitate reception of the patient after surgery and the giving of care from the time patient returns from the theatre until he has fully recovered from anesthesia. EQUIPMENT: - Linens as for an open bed - Rubber and cotton draw sheet - Treatment mackintosh and towel - Blanket if weather is cold - Kidney basin - Bowl with gauze - Paper for recording observations of condition - Additional equipment according to the kind of surgery and anesthesia and anticipated orders of the doctor. PROCEDURE: 1. Assemble equipment and take to bedside. 2. Strip bed turn the mattress and dust bed and mattress. 3. Make foundation of bed using clean linen if possible. 4. Apply rubber and cotton draw sheets.

72

5. Place treatment mackintosh covered with towel at head of 6. bed. 7. Place top covers as for an open bed but do not tuck at foot 8. of bed. 9. When bed is completed or opposite side, fanfold top 10. bedding to edge of mattress on side opposite to which the 11. stretcher will be brought. 12. Place pillow upright against the bed rails at the head of the 13. bed. 14. Place kidney basin and bowl with gauze on locker. 15. Clip paper to chart board. POSTURAL DRAINAGE PURPOSE : 1. To drain excessive secretions and pus from the lungs. 2. To remove Radiopaque substances used in X-ray examination. EQUIPMENT : Stool of suitable height Pillows Kidney Basin Rag pieces Paper bag pint measure Warm solution for gargle (Kmno4) PROCEDURE: 1. Explain the procedure to the patient and screen. 2. Assemble equipment and bring to bed side. 3. Arrange stool at side of the bed with pillows on top. 4. Place rag pieces with in the reach of the patient. 5. Place kidney basin over the paper on floor. 6. Ask patient to lie across the bed on his abdomen with head and chest extending over the edge of the bed, have patient support himself on clovow place stool of convenient height. 7. Encourage patient to cough and to take deep breathings with diaphram. 8. Collect drainage into the Kidney basin. 9. Watch patients need for rest and degree of fatigue (pulse, respiration and colour) 10. Have patient maintain position for 5-10 mts. 11. Return patients to normal position. 12. Give mouth gargle. 13. Measure Drainage. 14. Discard paper bag with dirty rag, piece wash, rinse and dry kidney basin and replace. KINDS OF SUTURES Sutured are classified into absorbable and non-absorbable.

73

1. ABSORBABLE SUTURES : are those which can be absorbed during the healing process by the tissues in which they are embedded. 2. PLAIN CATGUT : has No. 2, 1, 0, 2/0, 3/0. No. 2/0 or 0 plain catgut used for ligation of the bleeding points, plain catgut is used for subcutaneous tissues. 3. CHROMIC CATGUT : with resist absorption for longer time No. 2, 1, 0, 2/0. 0 or 1 chrome catgut is used for the muscles and peritoneum suturing. 2/0 or 3/0 is used for the soft tissues such as intestines and stomach. 1 or 2 is used for the repair of the hernial sac. 4. NON-ABSORBABLE SUTURES : These suture materials are not absorbed in tissues during the process of wound healing and generally the material remains encapsulated or walled off by the tissue around it Eg. Surgical cotton. Surgical nylon - used for skin suturing surgical line - used for skin and used for ligation of blood vessels in gastrectomy. Black silk thread - used for skin sutures in plastic surgery. Stainless steel mesh - used for the repair of hernia Michel clips - used for the skin. SUTURE NEEDLE : Classified into Eye needle Eyeless needle Eyeless needle Non-cutting Cutting 1. NON-CUTTING NEEDLES : are around bodied and are used on tissue that offers small amount of resistance to needle as it pass through 2 types - curved - straight.Curved needle is use for peritoneum, appendix and suturing of bleeding points. 3. Straight needle is used for anatomizing of stomach and Jejunum (soft tissue) 2. CUTTING NEEDLES : These make a slight tear in tissues while suturing, used for tough tissue such as skin, fascia and muscles. Straight cutting needle - used for the skin. 3. ANEURYSM NEEDLE - blunt needle with an eye at the end of it. Needle form a right or oblique angle to the handle, which is one continuous unit with the needle. It is used to ligate the blood vessels in Thyroideectomy and chest surgery. EYELESS OR ATRAUMATIC NEEDLE : There is only one thickness of suture to pull through the tissue. ' Need not be threaded Produce a minimum of tissue trauma used for soft tissues such as intestines and stomach.

74

BASIC SET OF INSTRUMENTS ALSO CALLED : (a) Laparotomy set (b) General set. 4 towel clips - to hold drapes in place 2 sponge holders to prepare patient's skin. 2 scalpels one to cut the skin and fascia., another one used for tissues. 2 dissecting or thumb forceps with teeth to hold the tissues while cutting or suturing 1 plain dissecting forceps to hold the soft tissues while cutting or suturing 18 artery forceps or haemostates : 6 straight 12 curved to clamp the blood vessels stop haemorrhage 4 allis clamps or tissue forceps to hold the tissues without injuring them 1 Landenberg retractor 1 moris retractor 2 needle holders to hold the needle while suturing NEEDLES : 1 round needle for peritoneum 1 cutting curved needle for tissue (mu*les) cutting or straight needle for skin SUTURES AND LIGATURES : plain catgut No. 20/0 for ligation chromic catgut No. 1 for muscles and peritoneum.

APPENDECTOMY INSTRUMENTS : Same as Lapartotomy 1 extra suture scissors suction apparatus SPECIAL POINTS : All instruments which touch the stump are contaminated and should be discarded in a kidney tray and removed from the table. GASTRO - JEJUNOSTOMY) DEFINITION The making of an opening between the stomach and the intestines. This is done so that the food may pass directly from the stomach to the small intestines, without passing over the ulcer. This helps the ulcer to heal, INSTRUMENTS : 2 Stomach clamps straight twin clamps used in clamping the stomach and intestines Cautery suction apparatus SPECIAL POINTS : a) Special small swabs are used for wiping away stomach and intestines contents. b) all instruments touching the inside of the stomach are considered contaminated and are discarded.

75

c) plenty of strife towels should be on hand for keeping exposed abdominal contents wet and protected. HAEMORRHOIDECTOMY DEFINITION : Removal of haemorthoidsor piles POSITION OF THE PATIENT : Lithotomy INSTRUMENTS : 4 towel clips 1 scalpels 2 scissors ......... a) curved b) straight 6 curved artery forceps 12 straight artery forceps 1 proctoscope 1 needle holder Drainage tube Cautery Vaseline gauze NFEDLES : 3 non cutting curved needles with No 2 linen No 10 thread for ligation. OPERATION FOR RECTAL FISTULA The excision of rectal fistula Lithotemy position. INSTRUMENTS : 4 towel clips 1 scalpel 2 scissors a) 1 straight for suture o 1 curved for tissues 2 dissecting forceps 1 probe director artery forceps straight 12 curved artery forceps 2 kocher clamps 4 lain tissue forceps Vaseline gauze No 10 thread for ligation After the probe is inserted, the tract is excised completely, if possible failing this the tract maybe laid open and curetted. Then the cavity is packed with Vaseline gauze and encored he from within. Bowel Obstruction What is a bowel obstruction?

76

A bowel obstruction happens when either your small or large intestine is partly or completely blocked. The blockage prevents food, fluids, and gas from moving through the intestines in the normal way. The blockage may cause severe pain that comes and goes. What causes a bowel obstruction? Tumors, scar tissue (adhesions), or twisting or narrowing of the intestines can cause a bowel obstruction. These are called mechanical obstructions . In the small intestine, scar tissue is most often the cause. Other causes include hernias and Crohn's disease, which can twist or narrow the intestine, and tumors, which can block the intestine. A blockage also can happen if one part of the intestine folds like a telescope into another part, which is called intussusception. In the large intestine, cancer is most often the cause. Other causes are severe constipation from a hard mass of stool, and narrowing of the intestine caused by diverticulitis or inflammatory bowel disease. What are the symptoms? Symptoms include:

Cramping and belly pain that comes and goes. The pain can occur around or below the belly button. Vomiting. Bloating. Constipation and a lack of gas, if the intestine is completely blocked. Diarrhea, if the intestine is partly blocked.

How is a bowel obstruction diagnosed?

An abdominal X-ray, which can find blockages in the small and large intestines. A CT scan of the belly, which helps your doctor see whether the blockage is partial or complete.

How is it treated? Most bowel obstructions are treated in the hospital. In the hospital, your doctor will give you medicine and fluids through a vein (IV). To help you stay comfortable, your doctor may place a tiny tube called a nasogastric (NG) tube through your nose and down into your stomach. The tube removes fluids and gas and helps relieve pain and pressure. You will not be given anything to eat or drink.

77

Most bowel obstructions are partial blockages that get better on their own. Some people may need more treatment. These treatments include using liquids or air (enemas) or small mesh tubes (stents) to open up the blockage. Surgery is almost always needed when the intestine is completely blocked or when the blood supply is cut off. You may need a colostomy or an ileostomy after surgery. The diseased part of the intestine is removed, and the remaining part is sewn to an opening in the skin. Stool passes out of the body through the opening and collects in a disposable colostomy bag.

Septoplasty
What is the nasal septum? The nasal septum is the vertical wall that divides the nose into two nasal cavities. It is made up of cartilage (septal cartilage) in the front and thin bone (perpendicular plate of the ethmoid and vomer) in the back. The nasal cavities and nasal septum are lined with a thin membrane of tissue called mucosa. In order to simplify the anatomy, the nose will be depicted as an isoceles triangle with the septum as the height dropped from the apex.

What is septal deviation? At birth, the nasal septum is usually straight and remains straight in childhood, however, as age progresses, there is a tendency for the septum to bend to one side or the other, or for an irregular shelf of cartilage or bone to develop (septal spur). Often, there is no history of injury to account for the irregular septum. In some individuals, the septum loses its midline position during the growth process rather than as the result of injury. Few adults have a septum that is completely straight. Sometimes the septum is bent as a result of birth trauma. During childhood or adult life, trauma plays a major factor in producing septal deviation. What is septoplasty? Septoplasty is an operation to correct a deformity of the nasal septum. It is sometimes referred to as submucous resection of the septum (SMR) or septal reconstruction. The usual purpose is to 78

improve nasal breathing, but it may also be performed to allow adequate examination of the inside of the nose for treatment of polyps, inflammation, tumors, or bleeding. When the nasal septum is deformed, there is no medicine that will cause it to be straightened, so surgery is the only solution to this problem. How is septoplasty done? Septoplasty is performed under general or local anesthesia. It takes about one hour and is usually carried out on a day surgery basis. A small incision is made inside the nose. The mucosal lining of the septum is detached from the cartilage and bones of the septum. The deviated portions of the septum are removed or straightened. The nasal lining mucous membrane is replaced. Splints or packs are placed in the nose for a few days. These splints / packs have a straw that allows the patient to breathe from the nose and makes swallowing much easier. There are no external bruises or swelling of the eyes because the outer nasal bones are not broken or interfered with as in cosmetic nasal surgery (nasoplasty / rhinoplasty). Tonsillitis Definition: Tonsillitis is an infection of the tonsils, glands that rest in the back of the mouth. Tonsils are part of the infection-fighting immune system and can become infected themselves. When tonsils become infected, they become red, swollen and very painful. If they become infected repeatedly, a surgery to remove the tonsils, a tonsillectomy, may be necessary. What is a Tonsillectomy? A tonsillectomy is the surgical removal of the tonsils, glands in the throat that are meant to help fight infection. In some cases, the tonsils are large, or repeatedly become infected instead of fighting infection and must be removed. The tonsillectomy procedure is often combined with an adenoidectomy, which is the removal of an additional set of glands that are also in the throat. Tonsillectomies are most commonly performed on children, but adults do have the surgery, often when the tonsils are causing a breathing problem like sleep apnea. Tonsillectomy Surgical Procedure In most cases, a tonsillectomy is an outpatient procedure, which allows the patient to go home once they are fully awake from surgery. The procedure is performed under general anesthesia, so the patient is asleep through the surgery, which is usually completed in less than an hour. Instead of the typical method of intubation, where a breathing tube is passed through the mouth into the airway, the patient is intubated nasally, with the tube inserted in the nose and down into the airway, keeping the mouth available for the surgical procedure. Once the patient is asleep, the surgery begins. An instrument is used to hold the mouth open, allowing the surgeon to work without the teeth in the way.

79

The tonsils are then cut away with a scalpel, a laser or a heated instrument. The bleeding is typically controlled by cauterizing the incision. If necessary, an adenoidectomy is also performed, using the same technique. Once the tonsils and potentially the adenoids are removed and the bleeding is controlled, the surgery is over. The anesthesiologist stops the anesthesia and gives a drug to help the patient wake. When the patient is awake enough to breath without assistance, the breathing tube is removed and the patient is taken to the PACU, or post anesthesia care unit, until they wake completely. CONJUNCTIVITIS Conjunctivitis, also called "pinkeye", is defined as an inflammation of the conjunctiva. The conjunctiva is the thin membrane that lines the inner surface of the eyelids and the whites of the eyes (called the sclera) (figure 1). Conjunctivitis can affect children and adults. The most common symptoms of conjunctivitis include a red eye and discharge. There are many potential causes of conjunctivitis, including bacterial or viral infections, allergies, or a non-specific condition (eg, a foreign body in the eye). All types of conjunctivitis cause a red eye, although not everyone with a red eye has conjunctivitis. This topic review discusses the signs and symptoms, evaluation, and treatment of the various types of conjunctivitis. TYPES OF CONJUNCTIVITIS There are four main types of conjunctivitis: viral, bacterial, allergic, and non-specific. Most cases of infectious conjunctivitis are viral in adults and children; however, bacterial conjunctivitis is more common in children than in adults. Viral conjunctivitis Viral conjunctivitis is typically caused by a virus that can also cause the common cold. A person may have symptoms of conjunctivitis alone, or as part of a general cold syndrome, with swollen lymph nodes (glands), fever, a sore throat, and runny nose. (See "Patient information: The common cold in adults (Beyond the Basics)" and "Patient information: The common cold in children (Beyond the Basics)".) There is no cure for viral conjunctivitis. Recovery can begin within days, although the symptoms frequently get worse for the first three to five days, with gradual improvement over the following one to two weeks for a total course of two to three weeks. Some people experience morning crusting that continues for up to two weeks after the initial symptoms, although the daytime redness, irritation, and tearing should be much improved. (See 'Viral conjunctivitis treatment' below.) Bacterial conjunctivitis Bacterial conjunctivitis is highly contagious, often affecting multiple family members or children within a classroom. Bacterial conjunctivitis is spread by contact, usually with objects which have come into contact with the infected person's eye secretions. As examples, the

80

bacterium can be transmitted when an infected person touches their eye and then touches another surface (eg, door handle) or shares an object that has touched their eye (eg, a towel or pillow case). The most common symptoms of bacterial conjunctivitis include redness and thick discharge from one eye, although both eyes can become infected. The discharge may be yellow, white, or green, and it usually continues to drain throughout the day. The affected eye often is "stuck shut" in the morning. Allergic conjunctivitis Allergic conjunctivitis is caused by airborne allergens that come in contact with the eye. Symptoms (most commonly redness, watery discharge, and itching of both eyes) may be sudden in onset (acute), seasonal, or present year-round (perennial), depending upon the allergen. Allergic conjunctivitis is discussed in a separate topic. (See "Patient information: Allergic conjunctivitis (Beyond the Basics)".) CONJUNCTIVITIS TREATMENT The treatment of conjunctivitis depends upon the cause. For this reason, it is important to have the correct diagnosis before treatment begins. Viral conjunctivitis treatment A topical antihistamine/decongestant eye drop may help to relieve the irritation of viral conjunctivitis. These drops are available without a prescription in most pharmacies. However, particular care must be taken to avoid spreading viral infections from one eye to the other. Apply drops only to affected eye and wash hands thoroughly after application. Similar to cold medicines, this treatment may reduce the symptoms but does not shorten the course of the infection. Another option is to use warm or cool compresses, as needed. Bacterial conjunctivitis treatment Bacterial conjunctivitis is usually treated with an antibiotic eye drop or ointment. When started early, treatment helps to shorten the duration of symptoms, although most cases do resolve spontaneously if no treatment is used.

Hepatitis
Hepatitis means inflammation (swelling and pain) of the liver. The liver is important for a range of functions in the body. These include regulating metabolism, making proteins, storing vitamins and iron, removing toxins and producing bile. If the liver doesnt work properly, it can cause serious illness or sometimes even death. Hepatitis may be caused by infection, viruses, chemicals, alcohol, drug use and other factors. Chronic hepatitis means ongoing inflammation of the liver, irrespective of the underlying cause. The various forms of viral hepatitis are named after different letters of the alphabet. These include hepatitis A, B, C, D and E. They are also sometimes called hep A, hep B, hep C and so on. While all these viruses affect the liver, they are spread in different ways and have different treatments. The most common types of viral hepatitis in Australia are A, B and C.

81

Other viruses may also cause hepatitis, such as the yellow fever virus and the virus that causes glandular fever. Symptoms

Not everyone with hepatitis has symptoms. Generally speaking, when symptoms occur, they may include:

Fever Nausea Abdominal discomfort Dark urine Lethargy (tiredness) Painful joints Oedema (swelling) Easy bruising Jaundice (yellow skin and eyes).

Hepatitis A

Anyone can be infected if they come in direct contact with the hepatitis A virus through food, drinks or objects contaminated by the faeces (poo) of an infected person. Symptoms may last several weeks but the person usually recovers completely. Infection with hepatitis A will give lifelong immunity. However, this doesnt offer immunity against the other types of hepatitis. A vaccine is available to protect against hepatitis A. Hepatitis B

Hepatitis B virus is found in the blood and, to a lesser degree, in body fluids such as semen and vaginal secretions. You can get hepatitis B through unsafe sex, sharing contaminated injecting drug equipment and other activities where the blood of an infected person enters your bloodstream. Mothers who have long-term or chronic hepatitis B sometimes pass the virus to their children, either through the womb (rarely), at the time of birth or (more commonly) shortly after birth. People who become infected with the hepatitis B virus may develop a long-term hepatitis B infection, which occurs when the virus stays in their body for their entire life. Babies and children who become infected are more likely than adults to develop long-term hepatitis B. A vaccine is available to prevent hepatitis B infection. It is included in the standard immunisation schedule, beginning in infancy. Screening the mother before birth can prevent infection of newborn

82

infants. If a mother tests positive, hepatitis B immunoglobulin is given to the baby when they are born, as well as hepatitis B vaccination. Hepatitis C

Hepatitis C is a blood-borne virus that is spread when blood from an infected person enters another persons bloodstream. In Australia, the most common way it is transmitted is through sharing unsterile injecting drug equipment. Around 20 to 30 per cent of people who have been infected with hepatitis C may clear the virus from their blood with no treatment. These people no longer have hepatitis C and are not infectious. Around 70 to 80 per cent of people infected with hepatitis C, if untreated, may continue to have the virus in their blood and are likely to have chronic hepatitis C. Of these, about 10 to 20 per cent will develop cirrhosis, which is scarring of the liver. This can take 20 years or more to develop. A small number of people with cirrhosis may develop liver cancer. Combination treatment with the medicines pegylated interferon and ribavirin has greatly improved the outcomes for people with hepatitis C. These treatments can help decrease inflammation in the liver and can clear the virus in 30 to 65 per cent of people, but there are some side effects. There is no vaccine available to prevent hepatitis C infection. Diagnosis Tests used to diagnose hepatitis may include blood tests and a liver biopsy (a small piece of liver tissue is taken for laboratory examination). Treatment Treatment depends on the type of hepatitis. Please consult your doctor for specific information about treatment. Chronic viral hepatitis whether due to hepatitis B or C can, after many years, lead to cirrhosis and primary cancer of the liver. Things to remember

Hepatitis means inflammation of the liver and has a range of causes, including infection with a virus. The various forms of viral hepatitis are named after different letters of the alphabet and include hepatitis A, B, C, D and E. Immunisation is available for hepatitis A and B.

Hemorrhoids
Rectal lump; Piles; Lump in the rectum

83

Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus. Causes, incidence, and risk factors Hemorrhoids are very common, especially during pregnancy and after childbirth. They result from increased pressure in the veins of the anus. The pressure causes the veins to swell, making them painful, particularly when you are sitting. The most common cause is straining during bowel movements. Hemorrhoids may be caused by:

Straining during bowel movements Constipation Sitting for long periods of time Anal infections Certain diseases, such as liver cirrhosis

Hemorrhoids may be inside or outside the body.

Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. E External hemorrhoids occur at the anal opening and may hang outside the anus.

Symptoms Symptoms of hemorrhoids include:

Anal itching Anal ache or pain, especially while sitting Bright red blood on toilet tissue, stool, or in the toilet bowl Pain during bowel movements One or more hard tender lumps near the anus

Signs and tests A doctor can often diagnose hemorrhoids simply by examining the rectal area. If necessary, tests that may help diagnose the problem include:

Stool guaiac (shows the presence of blood) Sigmoidoscopy Anoscopy

Treatment Treatments for hemorrhoids include:

84

Over-the-counter corticosteroid creams to help reduce pain and swelling Hemorrhoid creams with lidocaine to help reduce pain Stool softeners help reduce straining and constipation

Witch hazel (applied with cotton swabs) can reduce itching. Other steps to reduce this itching include:

Wear cotton undergarments. Avoid toilet tissue with perfumes or colors, use baby wipes instead. Try not to scratch the area.

Sitz baths can help you to feel better. Sit in warm water for 10 to 15 minutes. Surgery that may be done to treat hemorrhoids includes rubber band ligation or surgical hemorrhoidectomy. These procedures are generally used for patients with severe pain or bleeding who have not responded to other therapy.

Glaucoma
Open-angle glaucoma; Chronic glaucoma; Chronic open-angle glaucoma; Primary open-angle glaucoma; Closed-angle glaucoma; Narrow-angle glaucoma; Angle-closure glaucoma; Acute glaucoma; Secondary glaucoma; Congenital glaucoma Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve. This nerve carries visual information from the eye to the brain. Causes, incidence, and risk factors Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma:

Open-angle (chronic) glaucoma Angle-closure (acute) glaucoma Congenital glaucoma Secondary glaucoma

The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is always being made behind the colored part of the eye (the iris). It leaves the eye through channels in the front of the eye in an area called the anterior chamber angle, or simply the angle. Anything that slows or blocks the flow of this fluid out of the eye will cause pressure to build up in the eye. This pressure is called intraocular pressure (IOP). In most cases of glaucoma, this pressure is high and causes damage to the optic nerve. Open-angle (chronic) glaucoma is the most common type of glaucoma.

85

The cause is unknown. An increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve. Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are at particularly high risk for this disease.

Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure in the eye.

Angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which painlessly and slowly damages vision. If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment. Dilating eye drops and certain medications may trigger an acute glaucoma attack.

Congenital glaucoma is seen in babies. It often runs in families (is inherited).

It is present at birth. It is caused by abnormal eye development.

Secondary glaucoma is caused by:

Drugs such as corticosteroids Eye diseases such as uveitis Systemic diseases Trauma

Symptoms OPEN-ANGLE GLAUCOMA

Most people have no symptoms Once vision loss occurs, the damage is already severe There is a slow loss of side (peripheral) vision (also called tunnel vision) Advanced glaucoma can lead to blindness

ANGLE-CLOSURE GLAUCOMA

Symptoms may come and go at first, or steadily become worse Sudden, severe pain in one eye Decreased or cloudy vision, often called "steamy" vision Nausea and vomiting Rainbow-like halos around lights Red eye Eye feels swollen

86

CONGENITAL GLAUCOMA

Symptoms are usually noticed when the child is a few months old Cloudiness of the front of the eye Enlargement of one eye or both eyes Red eye Sensitivity to light Tearing

Signs and tests A complete eye exam is needed to diagnose glaucoma. You may be given eye drop to widen (dilate) your pupil. The eye doctor can look at the inside of the eye when the pupil is dilated. A test called (tonometry) is done to check eye pressure. However, eye pressure always changes. Eye pressure can be normal in some people with glaucoma. This is called normal-tension glaucoma. Your doctor will need to run other tests to confirm glaucoma. Treatment The goal of treatment is to reduce eye pressure. Treatment depends on the type of glaucoma that you have. If you have open-angle glaucoma, you will probably be given eye drops. You may need more than one type. Most people can be treated successfully with eye drops. Most of the eye drops used today have fewer side effects than those used in the past. You may also be given pills to lower pressure in the eye. Other treatments may involve:

Laser therapy called an iridotomy Eye surgery if other treatments do not work

Acute angle-closure attack is a medical emergency. Blindness will occur in a few days if it is not treated. If you have angle-closure glaucoma, you will receive:

Eye drops Medicines to lower eye pressure, given by mouth and through a vein (by IV)

Some people also need an emergency operation, called an iridotomy. This procedure uses a laser to open a new pathway in the colored part of the eye. This relieves pressure and prevents another attack. Congenital glaucoma is almost always treated with surgery. This is done using general anesthesia. This means the patient is asleep and feels no pain.

87

If you have secondary glaucoma, treatment of the underlying disease may help your symptoms go away. Other treatments may be needed.

Anal Fissure
What is an anal fissure? An anal fissure is a tear in the lining of the lower rectum (anus) that causes pain during bowel movements. It is a common condition. Anal fissures do not lead to more serious conditions. Most anal fissures heal with home treatment after a few days or weeks (acute anal fissures). If you have an anal fissure that has not healed after 6 weeks, it is considered a long-term problem (chronic). You may need medicine to help a chronic anal fissure heal. Surgery may be necessary for fissures that do not heal with medicine. Anal fissures affect people of all ages, particularly young and otherwise healthy people. They are equally common in men and women. Sometimes an anal fissure and a hemorrhoid develop at the same time. What causes an anal fissure? Anal fissures are caused by injury (trauma) to the anal canal. Injury can happen if:

You pass a large stool that stretches the anal canal. You are constipated and try to pass a hard stool. You have repeated diarrhea.

Childbirth can also cause trauma to the anal canal. During childbirth, some women develop anal fissures. Fissures can also be caused by digital insertion (as during an examination), foreign body insertion, or anal intercourse. Because many people get constipated or have diarrhea without getting anal fissures, many experts believe there is some other cause of anal fissures. Some people may have excessive tension in the two muscular rings (sphincters) controlling the anus. The external anal sphincter is under your conscious control. But the internal anal sphincter is not under your control. This muscle remains under pressure, or tension, all of the time. A fissure may develop if the internal sphincter's resting pressure becomes too high, causing spasm and reducing blood flow to the anus. This high resting pressure can also keep a fissure from healing.

88

In some cases, an anal fissure may be caused by Crohn's disease, an inflammatory bowel disease (IBD) that causes bloody diarrhea, abdominal (belly) pain, fever, weight loss, and fissures or fistulas near the anus. What are the symptoms? An anal fissure causes a sharp, stinging, or burning pain during a bowel movement. The pain, which can be severe, may last for a few hours. Fissures may itch. They often bleed lightly or cause a yellowish discharge. You may see a small spot of bright red blood on toilet tissue or a few drops in the toilet bowl. The blood is separate from the stool. Very dark, tarry stools or dark red blood mixed with stool indicates some other condition, possibly inflammatory bowel disease (IBD) or colon cancer. You should contact a doctor if you have any bleeding with bowel movements. Sometimes an anal fissure may be a painless wound that won't heal and that bleeds intermittently but causes no other symptoms. Most doctors can diagnose an anal fissure from symptoms and by looking at the anus. Usually, the doctor can see the fissure by gently separating the buttocks. A doctor may use a gloved finger (digital rectal examination) or a lighted instrument (anoscope) to examine the fissure. But if the fissure is extremely painful, the doctor will usually wait until it has begun to heal before performing a rectal exam or using an anoscope (anoscopy) to rule out other problems. A topical anesthetic may be used if an immediate examination is necessary. During an exam, a doctor can also find out whether another condition may be causing the fissure. If you have several fissures or have one or more in an area of the anus where fissures usually do not occur, you may have another condition such as inflammatory bowel disease, syphilis, a suppressed immune system, tuberculosis, HIV infection, or anal cancer. Most fissures occur along the midlinethe top or bottom-of the anus. How is it treated? Most acute fissures need some home treatment, including soaking in a shallow tub of warm water (sitz bath) 2 or 3 times a day, increasing fiber in the diet, and taking stool softeners or laxatives. Some people find relief in a day or two of home treatment. Although your pain may go away, it may take several weeks for the fissure to heal completely. Sometimes fissures heal without treatment. Try to prevent constipation, because it can keep a fissure from healing. The pain of a fissure may make you anxious about having bowel movements. But trying not to have bowel movements will only increase constipation and create a cycle that keeps the fissure open and painful. Drinking lots of water or other fluids also will make stools softer and easier to pass.

89

You may want to use a nonprescription ointment such as zinc oxide, Preparation H, Anusol, or 1% hydrocortisone to soothe anal tissues. But evidence suggests that fiber and sitz baths help symptoms better than nonprescription creams.1 Talk with your doctor about whether you should use these medicines for a short period of time. If a fissure lasts a long time, prescription medicine may help. Prescription medicines used to treat anal fissure include nitroglycerin, high blood pressure medicines, and botulinum toxin (Botox). You may need to consider surgery if medicines do not stop your symptoms. The most commonly used surgery is lateral internal sphincterotomy. In this procedure, a doctor cuts into part of the internal sphincter to relax the spasm that is causing the fissure. Peptic ulcer Ulcer - peptic; Ulcer - duodenal; Ulcer - gastric; Duodenal ulcer; Gastric ulcer; Dyspepsia - ulcers A peptic ulcer is a defect in the lining of the stomach or the first part of the small intestine, an area called the duodenum. A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer.

Gastritis Gastroesophageal reflux disease (GERD)

Causes, incidence, and risk factors Normally, the lining of the stomach and small intestines is protected against the irritating acids produced in your stomach. If this protective lining stops working correctly and the lining breaks down, it results in inflammation (gastritis) or an ulcer. Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation. A perforation is a medical emergency. The most common cause of such damage is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Most people with peptic ulcers have these bacteria living in their gastrointestinal (GI) tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer. The following also raise your risk for peptic ulcers:

Drinking too much alcohol Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs). Taking aspirin or NSAIDs once in a while is safe for most people. Smoking cigarettes or chewing tobacco Being very ill, such as being on a breathing machine

90

Having radiation treatments

A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas. This tumor releases high levels of a hormone that increases stomach acid. Many people believe that stress causes ulcers. It is not clear if this is true, at least for everyday stress at home. Symptoms Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding. Abdominal pain is a common symptom, but it doesn't always occur. The pain can differ from person to person. Other symptoms include:

Feeling of fullness -- unable to drink as much fluid Hunger and an empty feeling in the stomach, often 1 - 3 hours after a meal Mild nausea (vomiting may relieve this symptom) Pain or discomfort in the upper abdomen Upper abdominal pain that wakes you up at night

Other possible symptoms include:

Bloody or dark tarry stools Chest pain Fatigue Vomiting, possibly bloody Weight loss

Signs and tests To diagnose an ulcer, your doctor will order one of the following tests:

Esophagogastroduodenoscopy (EGD or upper endoscopy) is a special test performed by a gastroenterologist. A thin tube with a camera on the end is inserted through your mouth into the GI tract to see your stomach and small intestine. Upper GI is a series of x-rays taken after you drink a thick substance called barium.

Upper endoscopy is also done on people who are at high risk for stomach cancer. Risk factors include being over age 45 or having symptoms such as:

Anemia

91

Difficulty swallowing Gastrointestinal bleeding Unexplained weight loss

Testing for H. pylori is also needed. Your doctor may also order these tests:

Hemoglobin blood test to check for anemia Stool occult blood test to test for blood in your stool

Treatment Treatment involves a combination of medications to kill the H. pylori bacteria (if present), and reduce acid levels in the stomach. This strategy allows your ulcer to heal and reduces the chance it will come back. Take all of your medications exactly as prescribed. If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the following medications for 5 - 14 days:

Two different antibiotics to kill H. pylori, such as clarithromycin (Biaxin), amoxicillin, tetracycline, or metronidazole (Flagyl) Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium) Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria

If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin or NSAIDs, your doctor will likely prescribe a proton pump inhibitor for 8 weeks. You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions. Other medications that may be used for ulcer symptoms or disease are:

Misoprostol, a drug that may help prevent ulcers in people who take NSAIDs on a regular basis Medications that protect the tissue lining (such as sucralfate)

If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Methods used to stop the bleeding include injecting medicine, or applying metal clips to the ulcer. Surgery may be needed if bleeding cannot be stopped with an EGD, or if the ulcer has caused a tear (perforation).

92

Lung abscess Lung abscess is defined as necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection. The formation of multiple small (< 2 cm) abscesses is occasionally referred to as necrotizing pneumonia or lung gangrene. Both lung abscess and necrotizing pneumonia are manifestations of a similar pathologic process. Failure to recognize and treat lung abscess is associated with poor clinical outcome. Pathophysiology Most frequently, the lung abscess arises as a complication of aspiration pneumonia caused by mouth anaerobes. The patients who develop lung abscess are predisposed to aspiration and commonly have periodontal disease. A bacterial inoculum from the gingival crevice reaches the lower airways, and infection is initiated because the bacteria are not cleared by the patient's host defense mechanism. This results in aspiration pneumonitis and progression to tissue necrosis 7-14 days later, resulting in formation of lung abscess. Other mechanisms for lung abscess formation include bacteremia or tricuspid valve endocarditis, causing septic emboli (usually multiple) to the lung. Lemierre syndrome, an acute oropharyngeal infection followed by septic thrombophlebitis of the internal jugular vein, is a rare cause of lung abscesses. The oral anaerobe F necrophorum is the most common pathogen. Causes The bacterial infection may reach the lungs in several ways. The most common is aspiration of oropharyngeal contents.

Patients at the highest risk for developing lung abscess have the following risk factors: o Periodontal disease o Seizure disorder o Alcohol abuse o Dysphagia Other patients at high risk for developing lung abscess include individuals with an inability to protect their airways from massive aspiration because of a diminished gag or cough reflex, caused by a state of impaired consciousness (eg, from alcohol or other CNS depressants, general anesthesia, or encephalopathy). Infrequently, the following infectious etiologies of pneumonia may progress to parenchymal necrosis and lung abscess formation: o Pseudomonas aeruginosa o K pneumoniae o S aureus (may result in multiple abscesses) o Streptococcus pneumoniae o Nocardia species o Fungal species An abscess may develop as an infectious complication of a preexisting bulla or lung cyst.

93

An abscess may develop secondary to carcinoma of the bronchus; the bronchial obstruction causes postobstructive pneumonia, which may lead to abscess formation.

Procedures Diagnostic material uncontaminated by bacteria colonizing the upper airway may be obtained for anaerobic culture from the following:

Blood culture Pleural fluid (if empyema present) Transtracheal aspirate Transthoracic pulmonary aspirate Surgical specimens Fiberoptic bronchoscopy with protected brush Bronchoalveolar lavage with quantitative cultures

Expectorated sputum and other methods of sampling the upper airway do not yield useful results for anaerobic culture because the oral cavity is extensively colonized with anaerobes. Blood cultures are infrequently positive in patients with lung abscess, and empyema is rare. The other modalities listed are invasive, costly, and require laboratory expertise. Bronchoscopy using a protected brush to obtain a specimen uncontaminated by the upper airway or quantitative culture of organisms from the bronchoalveolar lavage fluid has been advocated to establish bacteriologic diagnosis in lung abscess. However, the experience with this technique in diagnosis of anaerobic lung infections is limited and the diagnostic yield is uncertain. Perhaps most importantly, cultures obtained by any of these methods are unlikely to be positive after the initiation of antibiotics. [11] Flexible fiberoptic bronchoscopy is performed to exclude bronchogenic carcinoma whenever bronchial obstruction is suspected.[12] Medical Care Treatment of lung abscess is guided by the available microbiology and knowledge of the underlying or associated conditions. No treatment recommendations have been issued by major societies specifically for lung abscess; however, a guideline summary from the Infectious Diseases Society of America, Practice guidelines for outpatient parenteral antimicrobial therapy, is available.[13] Some clinical trials referred to below have included patients with aspiration pneumonia with or without lung abscess. Surgical Care Surgery is very rarely required for patients with uncomplicated lung abscesses. The usual indications for surgery are failure to respond to medical management, suspected neoplasm, or congenital lung malformation. The surgical procedure performed is either lobectomy or pneumonectomy.

94

When conventional therapy fails, either percutaneous catheter drainage or surgical resection is usually considered. Endoscopic lung abscess drainage is considered if an airway connection to the cavity can be demonstrated. Success of this treatment represents an additional option other than percutaneous catheter drainage or surgical resection.[19, 20, 21] Diabetes Mellitus (Also Called 'Diabetes Mellitus', 'Type 1 Diabetes', 'Type 2 Diabetes') What is diabetes? Diabetes mellitus is a disease that prevents your body from properly using the energy from the food you eat. Diabetes occurs when either:

The pancreas (an organ behind your stomach) produces little insulin or no insulin at all. (Insulin is a naturally occurring hormone produced by the beta cells of the pancreas that helps the body use sugar for energy.)

-Or

The pancreas makes insulin, but the insulin made does not work as it should. This condition is called insulin resistance.

Understanding metabolism To better understand diabetes, it helps to know more about how the body uses food for energy (a process called metabolism). Your body is made up of millions of cells. To make energy, the cells need food in a very simple form. When you eat or drink, much of your food is broken down into a simple sugar called glucose. Glucose provides the energy your body needs for daily activities. The blood vessels and blood are the highways that transport sugar from where it is either taken in (the stomach) or manufactured (in the liver) to the cells where it is used (muscles) or where it is stored (fat). Sugar cannot go into the cells by itself. The pancreas releases insulin into the blood, which serves as the helper, or the "key," that lets sugar into the cells for use as energy. When sugar leaves the bloodstream and enters the cells, the blood sugar level is lowered. Without insulin, or the "key," sugar cannot get into the body's cells for use as energy. This causes sugar to rise. Too much sugar in the blood is called "hyperglycemia" (high blood sugar) or diabetes. Two main types of diabetes Type 1 diabetes Type 1 diabetes occurs because the insulin-producing cells (called beta cells) of the pancreas are damaged. People with Type 1 diabetes produce little or no insulin, so sugar cannot get into the 95

body's cells for use as energy. This causes blood sugar levels to rise. People with Type 1 diabetes MUST use insulin injections to control their blood sugar. The damage to the insulin-producing cells in Type 1 diabetes occurs over a period of years. However, the symptoms of Type 1 diabetes might occur over a period of days to weeks. Type 1 is the most common form of diabetes in people younger than 20 years old, but it can occur at any age. Type 2 diabetes People with Type 2 diabetes produce insulin. However, there is either not enough insulin or it doesn't work properly in the body. When there is not enough insulin or the insulin is not used as it should be, sugar cannot get into the body's cells for use as energy. This causes blood sugar to rise. Type 2 diabetes is most common in people over age 45 who are overweight. Some people with Type 2 diabetes can manage it by controlling their weight, watching their diet, and exercising regularly. Others might also need to take an oral medicine and/or insulin injections. Other types of diabetes Specific types of diabetes might result from pregnancy (gestational diabetes), surgery, use of certain medicines, various illnesses, and other specific causes. What are the symptoms of diabetes? The symptoms of diabetes include:

Increased thirst Increased hunger (especially after eating) Dry mouth Frequent urination Unexplained weight loss (even though you are eating and feel hungry) Weak, tired feeling Blurred vision Numbness or tingling of the hands or feet Slow healing sores or cuts Dry and itchy skin (usually in the vaginal or groin area) Frequent yeast infections

Diabetes risk factors

A family history of diabetes Race or ethnic background Being overweight History of hypertension (high blood pressure) Abnormal blood cholesterol or triglyceride levels Advancing age

96

Certain drugs (These might increase blood sugar.) Years of heavy alcohol use Smoking History of gestational diabetes or delivery of a baby weighing more than 9 pounds. History of autoimmune disease Being at risk for diabetes

It is important to note that sugar itself does not cause diabetes. Eating a lot of sugar can lead to tooth decay, but it does not cause diabetes. How is diabetes diagnosed? Diabetes is diagnosed with fasting sugar blood tests or with A1c blood tests, also known as glycated hemoglobin tests. A fasting blood sugar test is performed after you have had nothing by mouth (eating or drinking) for at least 8 hours. Normal fasting blood sugar is less than 100 mg/dl. You do not have to be fasting for an A1c blood test. Diabetes is diagnosed by one of the following:

Your blood sugar level is equal to or greater than 126 mg/dl. You have two random blood sugar tests over 200 mg/dl with symptoms. You have an oral glucose tolerance test with results over 200 mg/dl. Your A1c test is greater than 6.5% on two separate days.

An A1c test should be performed in a laboratory using a method that is certified by the National Glycohemoglobin Standardization Program (NGSP) and standardized to the Diabetes Control and Complications Trial (DCCT) assay.

Otitis Media
About Middle Ear Infections Inflammation in the middle ear area is known as otitis media. When referring to an ear infection, doctors most likely mean "acute otitis media" rather than the common ear infection called swimmer's ear, or otitis externa. Acute otitis media is the presence of fluid, typically pus, in the middle ear with symptoms of pain, redness of the eardrum, and possible fever. Other forms of otitis media are either more chronic (fluid is in the middle ear for 6 or more weeks) or the fluid in the middle ear is temporary and not necessarily infected (called otitis media with effusion). Doctors try to distinguish between the different forms of otitis because this affects treatment options. Not all forms of otitis need to be treated with antibiotics. 97

Causes Kids develop ear infections more frequently in the first 2 to 4 years of life for several reasons:

Their eustachian tubes are shorter and more horizontal than those of adults, which allows bacteria and viruses to find their way into the middle ear more easily. Their tubes are also narrower and less stiff, which makes them more prone to blockage. The adenoids, which are gland-like structures located in the back of the upper throat near the eustachian tubes, are large in children and can interfere with the opening of the eustachian tubes.

A number of other factors can contribute to kids getting ear infections, such as exposure to cigarette smoke, bottle-feeding, and day-care attendance. Ear infections also occur more commonly in boys than girls, in kids whose families have a history of ear infections, and during the winter season when upper respiratory tract infections or colds are frequent. Signs and Symptoms The signs and symptoms of acute otitis media may range from very mild to severe:

The fluid in the middle ear may push on the eardrum, causing ear pain. An older child may complain of an earache, but a younger child may tug at the ear or simply act irritable and cry more than usual. Lying down, chewing, and sucking can also cause painful pressure changes in the middle ear, so a child may eat less than normal or have trouble sleeping. If the pressure from the fluid buildup is high enough, it can cause the eardrum to rupture, resulting in drainage of fluid from the ear. This releases the pressure behind the eardrum, usually bringing relief from the pain.

Cataract
Lens opacity; Age-related cataract Last reviewed: September 16, 2011. A cataract is a clouding of the lens of the eye. This article focuses on cataracts in adults. For information on cataracts in children, see: Congenital cataracts

98

Causes, incidence, and risk factors The lens of the eye is normally clear. It acts like the lens on a camera, focusing light as it passes to the back of the eye. Until a person is around age 45, the shape of the lens is able to change. This allows the lens to focus on an object, whether it is close or far away. As we age, proteins in the lens begin to break down and the lens becomes cloudy. What the eye sees may appear blurry. This condition is known as a cataract. Factors that may speed up cataract formation are:

Diabetes Eye inflammation Eye injury Family history of cataracts Long-term use of corticosteroids (taken by mouth) or certain other medications Radiation exposure Smoking Surgery for another eye problem Too much exposure to ultraviolet light (sunlight)

In many cases, the cause of cataract is unknown. Symptoms Adult cataracts develop slowly and painlessly. Vision in the affected eye or eyes slowly gets worse.

Mild clouding of the lens often occurs after age 60, but it may not cause any vision problems. By age 75, most people have cataracts that affect their vision.

Visual problems may include the following changes:

Being sensitive to glare Cloudy, fuzzy, foggy, or filmy vision Difficulty seeing at night or in dim light Double vision Loss of color intensity Problems seeing shapes against a background or the difference between shades of colors Seeing halos around lights

Cataracts generally lead to decreased vision, even in daylight. Most people with cataracts have similar changes in both eyes, although one eye may be worse than the other. Many people with this condition have only mild vision changes.

99

Other symptoms may include:

Frequent changes in eyeglass prescription

Signs and tests A standard eye exam and slit-lamp examination are used to diagnose cataracts. Other diagnostic tests are rarely needed, except to rule out other possible causes of poor vision. Treatment The following may help people who have an early cataract:

Better eyeglasses Better lighting Magnifying lenses Sunglasses

As vision gets worse, you may need to make changes around the home to avoid falls and injuries. The only treatment for a cataract is surgery to remove it. Surgery is done if you cannot perform normal activities, such as driving, reading, or looking at computer or video screens, even with glasses. If a cataract is not bothersome, surgery is usually not necessary. Cataracts usually do not harm your eye, so you can have surgery when it is convenient for you. However, some people may have additional eye problems, such as diabetic retinopathy, that cannot be treated without first having cataract surgery. For information on surgery, see: Cataract surgery

Obesity
Morbid obesity; Fat - obese Obesity means having too much body fat. It is not the same as being overweight, which means weighing too much. A person may be overweight from extra muscle, bone, or water, as well as from having too much fat. Both terms mean that a person's weight is higher than what is thought to be healthy for his or her height.

100

Causes, incidence, and risk factors Taking in more calories than you burn can lead to obesity because the body stores unused calories as fat. Obesity can be caused by:

Eating more food than your body can use Drinking too much alcohol Not getting enough exercise

Many obese people who lose large amounts of weight and gain it back think it is their fault. They blame themselves for not having the willpower to keep the weight off. Many people regain more weight than they lost. Today, we know that biology is a big reason why some people cannot keep the weight off. Some people who live in the same place and eat the same foods become obese, while others do not. Our bodies have a complex system to help keep our weight at a healthy level. In some people, this system does not work normally. Other factors that affect weight include:

The way we eat when we are children can affect the way we eat as adults. The way we eat over many years becomes a habit. It affects what we eat, when we eat, and how much we eat. We are surrounded by things that make it easy to overeat and hard to stay active: o Many people do not have time to plan and make healthy meals. o More people today work desk jobs compared to more active jobs in the past. o People with less free time have less time to exercise.

The term "eating disorder" means a group of medical conditions that have an unhealthy focus on eating, dieting, losing or gaining weight, and body image. A person may be obese, follow an unhealthy diet, and have an eating disorder all at the same time. Sometimes, medical problems or treatments cause weight gain, including:

Underactive thyroid gland (hypothyroidism) Medicines such as birth control pills, antidepressants, and antipsychotics

Other things that can cause weight gain are:

Quitting smoking. Most people who quit smoking gain 4 - 10 pounds in the first 6 months after quitting. Some people gain as much as 25 - 30 pounds. Stress, anxiety, feeling sad, or not sleeping well For women: o Menopause -- women may gain 12-15 pounds during menopause o Not losing the weight they gained during pregnancy

101

Signs and tests The health care provider will perform a physical exam and ask questions about your medical history, eating habits, and exercise routine. The two most common ways to assess your weight and measure health risks related to your weight are:

Body mass index (BMI) Waist circumference (your waist measurement in inches)

BMI is calculated using height and weight. You and your health care provider can use your BMI to estimate how much body fat you have. Your waist measurement is another way to estimate how much body fat you have. Extra weight around your middle or stomach area increases your risk for type 2 diabetes, heart disease, and stroke. People with "apple-shaped" bodies (meaning their waist is bigger than their hips) also have an increased risk for these diseases. Skin fold measurements may be taken to check your body fat percentage. Blood tests may be done to look for thyroid or hormone problems that could lead to weight gain. However, these tests are usually normal. Treatment CHANGING YOUR LIFESTYLE An active lifestyle and plenty of exercise, along with healthy eating, is the safest way to lose weight. Even modest weight loss can improve your health. You will need a lot of support from family and friends. When dieting, your main goal should be to learn new, healthy ways of eating and make them a part of your daily routine. Many people find it hard to change their eating habits and behaviors. You may have practiced some habits for so long that you may not even know they are unhealthy, or you do them without thinking. You need to be motivated to make lifestyle changes. Make the behavior change part of your life over the long term. Know that it takes time to make and keep a change in your lifestyle. Work with your health care provider and dietitian to set realistic, safe daily calorie counts that help you lose weight while staying healthy. Remember that if you drop pounds slowly and steadily, you are more likely to keep them off. Your dietitian can teach you about:

Healthy food choices

102

Healthy snacks How to read nutrition labels New ways to prepare food Portion sizes Sweetened drinks

Extreme diets (fewer than 1,100 calories per day) are not thought to be safe or to work very well. These types of diets often do not contain enough vitamins and minerals. Most people who lose weight this way return to overeating and become obese again. Learn new ways to manage stress, rather than snacking. Examples may be meditation, yoga, or exercise. If you are depressed or stressed a lot, talk to your health care provider. MEDICATIONS AND HERBAL REMEDIES You may see ads for supplements and herbal remedies that claim they will help you lose weight. Many of these claims are not true. Some of these supplements can have serious side effects. Talk to your health care provider before using them. You can discuss weight loss drugs with your doctor. Most people lose between 5 and 10 pounds by taking these drugs. Most people also regain the weight when they stop taking the medicine, unless they have made lasting lifestyle changes. SURGERY Bariatric surgery can reduce the risk of disease in people with severe obesity. These risks include:

Arthritis Diabetes Heart disease High blood pressure Sleep apnea Some cancers Stroke

Surgery may help people who have been very obese for 5 years or more and have not lost weight from other treatments, such as diet, exercise, or medicine. Surgery alone is not the answer for weight loss. It can train you to eat less, but you still have to do much of the work. You must be committed to diet and exercise after surgery. Talk to your doctor to learn if this is a good option for you. Weight-loss surgeries include:

Laparoscopic gastric banding Gastric bypass surgery

103

Sleeve gastrectomy (less common)

Stroke
Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke ischemic; Cerebrovascular accident; Stroke - hemorrhagic Last reviewed: June 24, 2011. A stroke happens when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack." Causes, incidence, and risk factors If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage. There are two major types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:

A clot may form in an artery that is already very narrow. This is called a thrombotic stroke. A clot may break off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain. This is called cerebral embolism, or an embolic stroke.

Ischemic strokes may be caused by clogged arteries. Fat, cholesterol, and other substances collect on the artery walls, forming a sticky substance called plaque. A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely. See also:

Aneurysm Arteriovenous malformation (AVM)

STROKE RISK FACTORS High blood pressure is the number one risk factor for strokes. The other major risk factors are:

Atrial fibrillation Diabetes

104

Family history of stroke High cholesterol Increasing age, especially after age 55 Race (black people are more likely to die of a stroke)

People who have heart disease or poor blood flow in their legs caused by narrowed arteries are also more likely to have a stroke. The chance of stroke is higher in people who live an unhealthy lifestyle by:

Being overweight or obese Drinking heavily Eating too much fat or salt Smoking Taking cocaine and other illegal drugs

Birth control pills can increase the chances of having blood clots. The risk is highest in woman who smoke and are older than 35. For more information, see: Stroke risk factors Symptoms The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not know that he or she has had a stroke. Symptoms usually develop suddenly and without warning. Or, symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse. A headache may occur, especially if the stroke is caused by bleeding in the brain. The headache:

Starts suddenly and may be severe Occurs when you are lying flat Wakes you up from sleep Gets worse when you change positions or when you bend, strain, or cough

Other symptoms depend on how severe the stroke is and what part of the brain is affected. Symptoms may include:

Change in alertness (including sleepiness, unconsciousness, and coma) Changes in hearing Changes in taste Changes that affect touch and the ability to feel pain, pressure, or different temperatures Clumsiness

105

Confusion or loss of memory Difficulty swallowing Difficulty writing or reading Dizziness or abnormal feeling of movement (vertigo) Lack of control over the bladder or bowels Loss of balance Loss of coordination Muscle weakness in the face, arm, or leg (usually just on one side) Numbness or tingling on one side of the body Personality, mood, or emotional changes Problems with eyesight, including decreased vision, double vision, or total loss of vision Trouble speaking or understanding others who are speaking Trouble walking

Signs and tests A complete exam should be done. Your doctor will:

Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving. Listen for an abnormal sound, called a "bruit," when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by abnormal blood flow. Check your blood pressure, which may be high.

Tests can help your doctor find the type, location, and cause of the stroke and rule out other disorders.

Angiogram of the head can show which blood vessel is blocked or bleeding Carotid duplex (ultrasound) can show if the carotid arteries in your neck have narrowed CT scan of the brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwards Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart Magnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brain

Treatment A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek urgent medical care at the first signs of a stroke. It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.

106

Most of the time, patients must reach a hospital within 3 hours after symptoms begin. Some people may be able to receive these drugs for up to 4 - 5 hours after symptoms begin. Treatment depends on how severe the stroke was and what caused it. Most people who have a stroke need to stay in a hospital. TREATMENT IN THE HOSPITAL Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. This medicine breaks up blood clots and helps bring back blood flow to the damaged area. However, not everyone can get this type of medicine.

For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding. If the stroke is caused by bleeding instead of clotting, clot-busting drugs (thrombolytics) can cause more bleeding.

Other treatments depend on the cause of the stroke:

Blood thinners such as heparin or warfarin (Coumadin) may be used to treat strokes due to blood clots. Aspirin or clopidogrel (Plavix) may also be used. Other medicine may be needed to control symptoms such as high blood pressure. In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up. If bleeding occurred, surgery is often needed to remove blood from around the brain and to fix damaged blood vessels. Surgery on the carotid artery may be needed.

LONG-TERM TREATMENT The goal of treatment after a stroke is to help the patient recover as much function as possible and prevent future strokes. The recovery time and need for long-term treatment is different for each person. Problems moving, thinking, and talking often improve in the weeks to months after a stroke. A number of people who have had a stroke will keep improving in the months or years after the stroke. Anesthesia Anaesthesia has traditionally meant the condition of having sensation (including the feeling of pain) blocked. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. The word was coined by Oliver Wendell Holmes, Sr. in 1846. Another definition is a reversible lack of awareness, whether this is a total lack of awareness (e.g. a general anaesthestic) or a lack of awareness of a part of a the body such as a spinal anaesthetic or

107

another nerve block would cause. Anesthesia differs from analgesia in blocking all sensation, not only pain. Classification: A. General Anesthesia - is the loss of all sensation and consciousness. Protective reflexes such as cough and gag reflexes are lost. A general anesthetic acts by blocking awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur. General anesthetics are usually administered by intravenous infusion or by inhalation of gases through a mask or through an endotracheal tube inserted into the trachea. Advantages: 1. Because the client is unconscious rather then awake and anxious, respiration and cardiac function are readily regulated. 2. The anesthesia can be adjusted to the length of the operation and the clients age and physical status. Disadvantage: 1. It depresses the respiratory and circulatory systems. 2. Some clients become more anxious about a general anesthetic that about the surgery itself. Often this is because they fear losing the capacity to control their own bodies. B. Regional Anesthesia Regional anaesthesia is the temporary interruption of the transmission of nerve impulses to and from a specific area or region of the body. The client loss sensation in an area of the body but remains conscious. Several techniques are used: Topical (surface) Anesthesia Is applied directly to the skin and mucous membranes, open skin surfaces, wounds, and burns. The most common used topical agents are lidocaine (Xylocaine) and benzocaine. Topical anesthetics are readily absorbed and act rapidly. Local Anesthesia (Infiltration)is injected into a specific area and is used for minor surgical procedures such as suturing a small wound or performng a biopsy. Lidocaine or tetracaine 0.1% may be used. Is a technique in which the anesthetic agent is injected into and around a nerve or small nerve group that supplies sensation to a small area of the body. Major blocks involve multiple nerves or a plexus (e.g. the brachial plexus anesthetizes the arm); minor blocks involve a single nerve (e.g. a facial nerve) block (Bier Is used most often for procedures involving the arm, wrist and

Nerve Block

Intravenous

108

block)

hand. An occlusion tourniquet is applied to the extremity to prevent infiltration and absorption of the injected intravenous agent beyond the involved extremity.

Spinal anesthesia It requires a lumbar puncture through one of the interspaces (Subarachnoid block) between lumbar disc 2 (L2) and the sacrum (S1). An anesthetic agent is injected into the subarachnoid space surrounding the spinal cord. Categorized into Low Spinals (saddle or caudal blocks) are primarily used for surgeries involving the perineal or rectal areas. Mild Spinals (below the level of the umbilicus T10) can be used for hernia repairs or appendectomies. High Spinals (reaching the nipple line T4) can be used for surgeries such as cesarean sections. Epidural anesthesia (peridural) Is an injection of an anesthetic agent into the epidural space, the area inside the spinal column but outside the dura mater.

Conscious Sedation may be used alone or in conjuction with regional anesthesia for some diagnostic tests and surgical procedures. Conscious sedation refers to minimal depression of the level of consciousness in which the client retains the ability to maintain a patent airway and respond appropriately to commands. Intravenous narcotics such as morphine or fentanyl (Sublimaze) and antianxiety agents such as diazepam (Valium) or midazolam (Versed) are commonly used to induce and maintain conscious sedation. Conscious sedation increases the clients pain threshold and induces a degree of amnesia but allows for prompt reversal of its effects and a rapid return to normal activities of daily living. Procedures such as endoscopies, incision and drainage of abcesses, and even balloon angioplasty may be performed under conscious sedation. Risk Factors for Complications During the Procedure:

Current or past health problems Taking medications, supplements, or herbal remedies, blood thinners Allergies (eg, food allergies, medication allergies, latex allergies)

109

Smoking Drinking alcohol Taking recreational drugs Personal or family history of adverse reactions to anesthesia

Possible Complications:

Pain and tenderness around the injection site Bruising, infection, or bleeding of the injection site Hematoma (a mass of clotted blood that forms in a tissue, organ, or body space as a result of a broken blood vessel) Spinal headache (a severe headache that may occur after spinal or epidural anesthesia) Decrease in blood pressure Nerve damage Medication mistakenly injected into a vein; symptoms include dizziness, rapid heartbeat, and funny taste or numbness around the mouth Horners syndrome (change of pupil size on one side) Ptosis (drooping of the eyelid) Pneumothorax (air trapped between the lung and rib cage)

PAPER - III MIDWIFERY SYLLABUS : Gujarati book of midwifery

Question bank 1. Draw and explain female reproductive system 2. Draw and explain male reproductive system 3. Draw and explain female pelvis 4. Placenta 5. Explain TPAL and GPA method 6. Explain High risk pregnancy 7. Delivery tray 8. Conducting normal delivery 9. Classification of deliveries 10. Causes of prematurity, signs and symptoms of premature baby, care of premature baby 11. Male and female sterilization 12. APH and PPH 13. Multiple pregnancy and its management 14. Draw and explain mal presentation 15. Explain cord prolapsed 110

16. Foetal and maternal distress 17. Puerperal pyrexia 18. Abnormalities of new born 19. Explain version in details 20. Various methods of caesarean section 21. Induction of labour 22. Laparoscopy 23. Explain indications of hysterectomy and its methods Short questions and definitions Reproduction Gynaecoid pelvis True pelvis Hymen Endometrium Placenta Hagars sign HCG hormone Hyperemesis Gravidarum Gravid definitions on page Yellow atrophy of the 38/39 liver Para IUCD Pre-eclampsia EDD TL/Vasectomy Monozygotic/Dizygotic twins LMP Induced abortion Polyhydramnios definitions on page APH/PPH Malpresentation -21 Domiciliary Placenta abruption Cord prolapsed midwifery Puerperium Placental praevia Conjoined twins Cephalic version Brow presentation Oligohydramnios External version Shoulder presentation Complete breech Atonic and Traumatic PPH Asphyxia neonatorum All definitions on page: 60 and Version Incomplete breech Frank breech Vertex presentation Face presentation Involution

Quickening Laparoscopy Ectopic pregnancy Endometriosis Internal version Midwifery Gynaecology Obstetrics Episiotomy Embryotomy Dilatation curettage

BHARAT SEVAK SAMAJ

NATIONAL DEVELOPMENT AGENCY, PROMOTED BY GOVERNMENT OF INDIA CENTRAL BOARD OF EXAMINATIONS BSS NATIONAL VOCATIONAL EDUCATION MISSION

AHS005-BSS DIPLOMA IN NURSING ASSISTANT TWO YEARS (FINAL YEAR) EXAMINATION NOVEMBER-2012
AHS005-09 NURSING,SOCIAL AND PREVENTIVE MEDICINE

111

TIME: 3 Hours Marks: 100 INSTRUCTIONS * 33 questions are there in total * Write answers to each question in proportion to the mark allotted * During the first 15 minutes read the questions carefully I. FILL IN THE BLANKS 1 x 10 = 10 1) World Tobacco day is--------------. 2) Lumbar puncture is used totap --------------. 3) A steile technique is used by 4) Which is haemorrhage from long used termed. 5) Which is instrument to open the closed path. 6) What is a visual examination of the stomach 7) What is mean by FRCS? 8) Which growth and development of micro-organisms 9) The procedure & feedinng the delirious patient 10) LMP: 28.4.11______ II. DEFINE THE FOLLOWING 2 x 10 = 20 1) Common solution used for IV infusion. 2) Type of Blood groups 3) Write about measurement of the size in Baby 4) Define Anaethesia. 5) Define Paediateric. 6) Risk factor of surgery. 7) Vital points be observed. 8) Define Mores reflex. 9) Define tonic neck reflex. 10) Define Convalision care of infnts. 1 III. WRITE BRIEF ANSWER FOR ANY 5 QUESTIONS 5 x 5 = 25 1) Write the difference between digestive track & respiratory track. 2) Procedure of skin preparation. 3) Explain the type of Anaesthesia. 4) Write about General instructions of the Gastric lavage. 5) Write about Hot application procedure. 6) Write down the general rules while suturing wound 7) ain care of buttocks and clothing Newborn. 8) Nurses and surgeons room IV. WRITE LONG ANSWER FOR ANY 3 QUESTIONS 15 x 3 = 45 1) Briefly explain the Nasal feeding

112

2) Briefly Explain the Gastrostomy. 3) Describe the intravenous infusion. 4) Explain about the Cold application? 5) Artificial needing-nasal gastric gavage and gastrostomy.

BHARAT SEVAK SAMAJ

NATIONAL DEVELOPMENT AGENCY, PROMOTED BY GOVERNMENT OF INDIA CENTRAL BOARD OF EXAMINATIONS BSS NATIONAL VOCATIONAL EDUCATION MISSION

AHS005-BSS DIPLOMA IN NURSING ASSISTANT TWO YEARS (FINAL YEAR) EXAMINATION NOVEMBER-2012
AHS005-10 SURGICAL NURSING

TIME: 3 Hours Marks: 100 INSTRUCTIONS * 33 questions are there in total * Write answers to each question in proportion to the mark allotted * During the first 15 minutes read the questions carefully I. FILL IN THE BLANKS 1 x 10 = 10 1) Hep - B incubation period ....... 2) Causative agent of tonsillitis ........ 3) Tonsillitis is ....... 4) Inflammation of Peritoneum is called ...... 5) Types of haemorrhoids ...... 6) What is paralysis ....... 7) Enlargement of spleen is ....... 8) Otoscopy used in ......... 9) What is reduction ........ 10) What is CCF ....... II. DEFINE THE FOLLOWING 2 x 10 = 20 1) Define fissure? 2) Define Hypertension 3) Define Haemorrhoids types? 4) Define intestinal obstruction? 5) Define viral conjunctivitis? 6) Define Retinal detachment? 7) Clinical manifestation in meningitis? 8) Signs, symptoms of peptic ulcer? 9) The maintenance of air way any two points 10) Definition of premedication

III. WRITE BRIEF ANSWER FOR ANY 5 QUESTIONS 5 x 5 = 25

113

1) Bone TB ? 2) Varicose vein? 3) Hep - E 4) Retinal detachment? 5) Acute thyroiditis? 6) Cataract surgical management? 7) Fibroid uterus? 8) Scald? IV. WRITE LONG ANSWER FOR ANY 3 QUESTIONS 15 x 3 = 45 1) Splenomegaly? 2) Heat stroke? 3) Burns? 4) COPD 5) Explain the post-operative care

BHARAT SEVAK SAMAJ

NATIONAL DEVELOPMENT AGENCY, PROMOTED BY GOVERNMENT OF INDIA CENTRAL BOARD OF EXAMINATIONS BSS NATIONAL VOCATIONAL EDUCATION MISSION

AHS005-BSS DIPLOMA IN NURSING ASSISTANT TWO YEARS (FINAL YEAR) EXAMINATION NOVEMBER-2012
AHS005-11 MIDWIFERY

TIME: 3 Hours Marks: 100 INSTRUCTIONS * 33 questions are there in total * Write answers to each question in proportion to the mark allotted * During the first 15 minutes read the questions carefully I. FILL IN THE BLANKS 1 x 10 = 10 1) Fetal blood flow through the placenta ----------2) Uterus measures during pregnancy ------3) Full dilatation of the cervix ---------------4) Third stage usually lasts between ------------5) What is APH? 6) What is LMP? 7) What is mean by dizygotic twins? 8) What is ptylism? 9) What is mean by oslander sign? 10) LOA means...............

114

II. DEFINE THE FOLLOWING 2 x 10 = 20 1) Define puberty 2) Define lie 3) Mention about the presumptive sign 4) Define mechanism of labour 5) Signs of placental separation 6) Define puerperium 7) Types of labour complication 8) Signs of preterm baby 9) Complication of puerperium 10) List out the abnormal fetal presentations III. WRITE BRIEF ANSWER FOR ANY 5 QUESTIONS 5 x 5 = 25 1) Describe about uterus and its function 2) Describe the different type of pelvis 3) Describe antenatal exercise 4) Describe about funis and its function 5) Principles of breast feeding 6) Tubal pregnancy 7) Hydatidiform mole 8) Weaning IV. WRITE LONG ANSWER FOR ANY 3 QUESTIONS 15 x 3 = 45 1) Management of second and third stage of labour 2) Physiological changes during pregnancy and fetal development 3) Explain polyhydramnious and its management 4) Explain physiology of puerperium, involution, factors influencing involution and lochia 5) Describe about congenital abnormalities.

yin aipSi[
- sdr p[fl[Tlmi> dSi<yi m&jb p(rxin) t]yir) krSi[. ai siY[ aip[l) kv[ynb[>kni dr[k (vPyni (vgtvir jvib t]yir kr) hi[l T)k)T m[Lvvi aivi[ Ryir[ btivvini rh[S[. kv[ynb[>kni jvib sbm)T Yyi vgr hi[l T)k)T mLvipi#i nY). - ti. 3-4-2013 b&FvirY) p(rxi S$ YS[,3/4-p[pr-1 {n(s<>g (sFi>ti[}, 4/4-p[pr-2 {sJ<kl n(s<>g} an[ 5/4- p[pr-3 {m)Dviefr)} - bik) rh[t) f) bibt ki[e g[rsmj n Yiy t[ miT[ tm[ Br[l) f) n) dr[k rs)d siY[ riKvin) rh[S[. - bik) rh[t) f) kl)yr kr) ti. 25-3-2013 s&F)mi> tmir) hi[l T)k)T m[Lv) l[v), bik) rh[t) bF)j f) kl)yr kyi< vgr hi[l T)k)T mLvipi#i nY) an[ hi[l T)k)T vgr p(rxiK>Dmi> p\v[S mLS[ nh). - bx) p>cni (vwiY)<ai[n) Aki[lrS)p m>j*r Yen[ aiv) gy[l hi[y bik) rh[t) bF)j f) kl)yr ky[< an[ pi[tini b[>kKitin) (vgti[ {a[kiuT n>br, b[>k n& nim, b\icn& nim an[ IFSC
115

ki[D } jmi krivviY) (dn-1 mi> tmiri Kitimi> Aki[lrS)pn) rkm jmi Ye jS[. SC/ST (vwiY)<ai[n) Aki[lrS)p m>j*r Yen[ aiv) nY). aivS[ a[Tl[ trt jiN krvimi> aivS[.

116