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📝 CON 520 - Nursing Paper Solution

(Marathi-English Mix - Marks Anusaar)

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✅ Q.1 (a) MCQ - Select the Most Appropriate Answer (05 Marks)

H. Pylori bacteria stomach cha lining damage karte aani peptic ulcer create karte.

Glycogen che breakdown होऊन glucose तयार होतो - हे Glycogenolysis आहे. Glycogen Synthesis उलट process आहे.

Thyroid gland वाढणे = Goitre. Hyperthyroidism = overactivity, Myxedema = hypothyroidism.

Louis Pasteur ne 1885 madhe rabies vaccine shodh केला. (Note: spelling "Pasture" = Pasteur)

Endoscopy = GI tract (stomach, intestine) baghण्यासाठी वापरतात - G.I. Disease madhe.

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✅ Q.1 (b) Match the Following (05 Marks)

Explanation:

• Koilonychia = spoon-shaped nails → iron deficiency anaemia chya lakshan
• Cushing Syndrome → cortisol excess → moon face, buffalo hump
• GOUT → uric acid crystals joints madhe jam होतात → serum uric acid वाढते
• Epistaxis = nasal bleeding
• Myasthenia Gravis → neuromuscular disease → Phenytoin (anticonvulsant) sometimes वापरतात

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✅ Q.1 (c) True or False (05 Marks)

First degree burn (sunburn) madhe nerve endings intact असतात त्यामुळे जास्त दुखते. Third degree madhe nerves जळतात - त्यामुळे pain कमी होते.

Diabetes Insipidus = ADH (Antidiuretic Hormone) ची कमतरता. Insulin कमी = Diabetes Mellitus.

Cyanosis = oxygen कमी झाल्यामुळे skin/lips निळी होतात.

Rabipur = rabies vaccine, dog bite नंतर prophylaxis साठी वापरतात (PEP - Post Exposure Prophylaxis).

Asepto (bulb) syringe = bladder irrigation/wash साठी वापरतात.

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✅ Q.2 Short Notes - Any THREE (15 Marks - प्रत्येकी 5 गुण)

(a) Role of a Nurse in Recovery Room (5 Marks)

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(b) Wound Healing (5 Marks)

• Bleeding थांबवणे - platelet plug तयार होतो
• Vasoconstriction, clot formation

• Redness (rubor), warmth (calor), swelling (tumor), pain (dolor)
• Neutrophils आणि macrophages bacteria साफ करतात

• Fibroblasts collagen तयार करतात
• Granulation tissue form होते
• Re-epithelialization होते

• Collagen mature होतो
• Scar tissue तयार होते, tensile strength वाढते

• Primary intention (clean surgical wound)
• Secondary intention (infected/open wound)
• Tertiary intention (delayed closure)

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(c) Hypovolaemic Shock (5 Marks)

• Haemorrhage (trauma, surgery)
• Burns (plasma loss)
• Dehydration (vomiting, diarrhea)
• Internal fluid loss (peritonitis)

• Tachycardia (HR > 100)
• Hypotension (BP ↓)
• Pale, cold, clammy skin
• Decreased urine output (< 0.5 ml/kg/hr)
• Anxiety, restlessness, confusion
• Reduced JVP

1. Position: Trendelenburg/legs elevate करा
2. O2 therapy द्या - 100% O2
3. Large bore IV cannula (2 lines) - rapid fluid resuscitation
4. Crystalloids (Normal Saline, Ringer's Lactate) द्या
5. Blood transfusion (if haemorrhage)
6. Vital signs दर 15 min monitor करा
7. Urine output hourly measure करा (Foley catheter)
8. Warm blankets द्या

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(d) Glasgow Coma Scale (GCS) (5 Marks)

• Total = E + V + M (Min 3, Max 15)
• 13-15 = Mild head injury
• 9-12 = Moderate
• ≤ 8 = Severe (intubation consider करा)
• 3 = Deep coma / brain death

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(e) Diet in Peptic Ulcer (5 Marks)

• Small, frequent meals (6 वेळा थोडे थोडे)
• Bland, soft food - khichdi, boiled vegetables, banana
• Milk (buffer म्हणून - alkali)
• Antacid foods - oatmeal, white rice
• High fiber diet (constipation टाळण्यासाठी)
• Water भरपूर प्या

• Spicy food (मिर्ची, तिखट) - acid secretion वाढवते
• Fried, fatty foods
• Coffee, tea, alcohol (acid उत्तेजित करतात)
• Carbonated drinks
• NSAIDs (aspirin, ibuprofen) - ulcer worse करतात
• Smoking टाळा
• Empty stomach राहू नका

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✅ Q.3 COPD - Answer (15 Marks)

(a) Define COPD (02 Marks)

"COPD ही एक progressive lung disease आहे ज्यामध्ये persistent airflow limitation असते जी पूर्णपणे reversible नसते. हे mainly emphysema आणि chronic bronchitis चे combination असते."

• Characterized by reduced FEV1, normal or near-normal FVC
• FEV1/FVC ratio < 0.70

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(b) Causes of COPD (03 Marks)

1. Smoking - सर्वात महत्वाचे कारण (80-90% cases)
2. Air Pollution - industrial dust, chemical fumes
3. Occupational exposure - coal dust, silica, cotton dust
4. α1-antitrypsin deficiency - genetic कारण (emphysema)
5. Recurrent respiratory infections - childhood infections
6. Biomass fuel - लाकूड, शेण जाळणे (indoor pollution)
7. Age - 40 वर्षांनंतर जास्त

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(c) Pathophysiology of COPD (03 Marks)

Smoking/Irritants
      ↓
Airway Inflammation (Neutrophils, Macrophages)
      ↓
Proteases release (elastase)
      ↓
Alveolar wall destruction (Emphysema)
+ Mucus gland hypertrophy (Chronic Bronchitis)
      ↓
Air trapping → Hyperinflation → Barrel chest
      ↓
V/Q mismatch → Hypoxemia + Hypercapnia
      ↓
Cor Pulmonale (Right Heart Failure)

• Emphysema: Alveolar elastic tissue नष्ट होते → air trapping
• Chronic Bronchitis: Mucus hyperproduction → airway obstruction
• Both मुळे FEV1 कमी होते

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(d) Signs & Symptoms of COPD (03 Marks)

• Chronic progressive dyspnoea (श्वास लागणे)
• Productive cough with sputum
• Wheezing
• Exertional intolerance

• Barrel chest (AP diameter वाढलेला)
• Pursed lip breathing
• Use of accessory muscles
• Prolonged expiration
• Cyanosis (severe cases)
• Clubbing (chronic hypoxia)
• Cor pulmonale signs: ankle oedema, elevated JVP
• "Pink Puffer" (emphysema) vs "Blue Bloater" (bronchitis)

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(e) Medical and Nursing Management of COPD (04 Marks)

1. Semi-Fowler's position (45°) - breathing सोपे होते
2. Controlled O2 therapy (2-4 L/min nasal cannula) - hypoxic drive जपा
3. Deep breathing exercises, Incentive spirometry
4. Chest physiotherapy - postural drainage, percussion
5. Adequate hydration - sputum loose होते
6. Activity tolerance monitor करा, rest periods द्या
7. Smoking cessation counselling
8. Nebulization द्या
9. Patient education - inhaler technique, trigger avoid करा

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✅ Q.4 CVA (Cerebrovascular Accident) (15 Marks)

(a) What is CVA + Causes (05 Marks)

CVA म्हणजे brain ला blood supply अचानक बंद होणे किंवा blood vessel फुटणे ज्यामुळे brain cells मरतात. याला Stroke असेही म्हणतात.

• Ischaemic Stroke (85%) - clot मुळे artery block
• Haemorrhagic Stroke (15%) - blood vessel rupture

1. Hypertension (HTN) - सर्वात common cause
2. Atherosclerosis - artery hardening, plaque
3. Atrial fibrillation - clot formation → embolic stroke
4. Diabetes mellitus
5. Hyperlipidaemia
6. Smoking, alcohol
7. Oral contraceptive pills
8. Family history, old age

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(b) Signs & Symptoms of CVA (05 Marks)

• F - Face drooping (तोंड वाकडे होणे)
• A - Arm weakness (एक हात कमजोर)
• S - Speech difficulty (बोलता येत नाही/अस्पष्ट)
• T - Time to call 108

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(c) Nursing Management of Unconscious Patient (05 Marks)

• Airway clear ठेवा - suction करा
• Head tilt, chin lift (cervical spine injury नसल्यास)
• Airway adjuncts - OPA/NPA वापरा
• Intubation (if needed)

• O2 therapy द्या (100%)
• Respiratory rate, depth, pattern monitor करा
• Ventilator support if needed

• BP, pulse, ECG monitor करा
• IV access - 2 large bore IV lines
• Fluids, medications द्या

• GCS दर घडीला assess करा
• Pupil size & reaction check करा
• Blood sugar check करा

• Pressure areas check करा
• 2-hourly positioning / turning (bed sores टाळा)

• Indwelling urinary catheter (Foley) - urine output monitor
• NGT - nasogastric tube for feeds
• Mouth care, eye care, skin care
• Passive ROM exercises - contracture टाळणे
• Family support and reassurance

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✅ Q.4 (OR) Chronic Renal Failure (15 Marks)

(a) Define Chronic Renal Failure (02 Marks)

CRF = Chronic Renal Failure म्हणजे 3 महिन्यांपेक्षा जास्त काळ kidney चे function progressive आणि irreversible कमी होणे. GFR < 60 ml/min/1.73m² for > 3 months.

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(b) Causes of CRF (04 Marks)

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(c) Signs & Symptoms of CRF (04 Marks)

• General: fatigue, weakness, weight loss
• GI: nausea, vomiting, anorexia, uraemic fetor (तोंडाला uremic smell), hiccups
• CVS: hypertension, pericarditis, oedema, pulmonary oedema
• Neurological: drowsiness, confusion, peripheral neuropathy, restless legs
• Renal: oliguria/anuria, nocturia (early)
• Haematological: anaemia (EPO कमी), bleeding tendency
• Skin: pruritis (खाज), sallow complexion, uraemic frost
• Musculoskeletal: renal osteodystrophy, bone pain

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(d) Medical & Nursing Management of CRF (05 Marks)

1. Fluid balance monitoring - daily weight, I/O chart
2. Low protein, low potassium, low phosphate, low sodium diet
3. Dialysis care (AV fistula care, peritoneal catheter care)
4. Skin care - pruritis साठी emollient cream, नखे कापून ठेवा
5. Anaemia management - Iron supplements, EPO injection
6. BP monitoring - antihypertensives वेळेवर द्या
7. Patient education - diet compliance, fluid restriction
8. Psychological support - chronic illness, transplant counselling

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✅ Q.5 Acute Abdomen (15 Marks)

(a) What is Acute Abdomen? (02 Marks)

"Acute Abdomen म्हणजे अचानक आलेली severe abdominal pain ज्यासाठी immediate medical किंवा surgical intervention लागते. हे एक clinical syndrome आहे - specific diagnosis नाही."

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(b) Etiological Factors of Intestinal Perforation (03 Marks)

1. Peptic Ulcer (duodenal > gastric) - सर्वात common
2. Typhoid fever - Peyer's patches necrosis → ileum perforation
3. Appendicitis - appendix rupture
4. Trauma - blunt/penetrating abdominal injury
5. Crohn's disease - transmural inflammation → perforation
6. Bowel obstruction - ischaemia → necrosis → perforation
7. Colonic perforation - diverticulitis, colorectal cancer
8. Iatrogenic - colonoscopy दरम्यान perforation
9. NSAIDs/Corticosteroids - ulceration → perforation

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(c) Signs & Symptoms - Intestinal Perforation (03 Marks)

• Sudden severe abdominal pain (knife-like, worst ever)
• Pain - initially localized, नंतर generalized
• Nausea, vomiting
• Fever, chills

• X-ray: Free air under diaphragm (erect CXR) - pathognomonic

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(d) Pre & Post Operative Nursing Management (05 Marks)

1. Informed consent घ्या
2. NPO (nil per oral) - minimum 6-8 hours (emergency = NGT)
3. IV fluids सुरू करा - resuscitation
4. Antibiotics द्या (broad spectrum - Metronidazole + Cefotaxime)
5. NGT (Nasogastric tube) - decompress stomach
6. Urinary catheter (Foley) - urine output monitor
7. Vital signs monitor करा, IV access ठेवा
8. Patient education - surgery बद्दल सांगा, anxiety कमी करा
9. Skin preparation (shaving, antiseptic)
10. Blood investigations, cross match
11. Pain assessment, analgesics द्या

1. Airway - recovery position, O2 therapy
2. Vital signs monitoring (15 min × 4, नंतर hourly)
3. IV fluids continue, fluid balance chart
4. NPO - bowel sounds येईपर्यंत, नंतर liquid → soft diet
5. Wound care - dressing sterile technique ने
6. Drain care - type, colour, amount note करा
7. Pain management - PCA / scheduled analgesics
8. Deep breathing exercises, early ambulation
9. Watch for complications: bleeding, SSI, anastomotic leak
10. NGT output monitor करा

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(e) Health Advice at Discharge (02 Marks)

1. Wound care: Dressing कसे करायचे ते शिकवा, suture removal date सांगा
2. Diet: Soft, bland diet घ्या; spicy food टाळा; हळूहळू normal diet
3. Activity: Heavy lifting 6 weeks टाळा; gradually activity वाढवा
4. Medications: Antibiotics, analgesics पूर्ण course घ्या
5. Follow-up: OPD date द्या; histopathology report साठी या
6. Warning signs: Fever, wound discharge, severe pain, vomiting असल्यास लगेच या (Emergency)
7. Hygiene: Wound ओला करू नका, स्वच्छ ठेवा

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📊 Marks Summary

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Note: Q.2 madhe any THREE choose kara (5 marks each). Q.4 madhe CVA किंवा CRF (OR) - एकच paper solve kara.

Kahi doubt असल्यास विचारा! All the best for your exam! 🎯