OLD CART  O-Onset

 L-Location  D-Duration  C-Chracteristics  A-Aggravating factors  R-Radiation  T-Treatment

Q NO 2. Give at least five techniques of skilled interviewing ? (6) ANS. Following are some techniques of skilled interviewing .

 Active listening  Guided Questioning  Nonverbal communication  Emphatic Response  Validation  Reassurance  Partnering  Summarization  Transitions

 Empowering the patient

Quizlet Q3: Briefly explain four types of health history and when they are used06

In order to effectively determine a diagnosis and treatment for a patient, nurses make four assessments: initial, focused, time-lapsed and emergency. One of the most important parts of nursing education, as well as the health care industry overall, is the group of routine procedures and processes involved with patient assessment and care. As a result, nurses and other health care professionals are able to quickly assess and determine the best treatment for an ailing patient.

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The initial assessment, also known as triage, helps to determine the nature of the problem and prepares the way for the ensuing assessment stages. The initial assessment is going to be much more thorough than the other assessments used by nurses. Components may include obtaining a patient's medical history or putting him through a physical exam, or preparing a psychosocial assessment for a mental health patient. Other components may include obtaining a patient's vital signs and taking subjective statements from the patient, as well as double-checking the subjective symptoms with the objective signs of the condition.

Focused Assessment

The focused assessment is the stage in which the problem is exposed and treated. Due to the importance of vital signs and their ever-changing nature, they are continuously monitored during all parts of the assessment. Depending on the malady, initial treatment for pain and long-term treatment for the root cause of the malady is administered and monitored. Part of the goal of the focused assessment is to diagnose and treat the patient in order to stabilize her condition. Focused assessments may also include X-rays or other types of tests.

Time-Lapsed Assessment

Once treatment has been implemented, a time-lapsed assessment must be conducted to ensure that the patient is recovering from his malady and his condition has stabilized. Depending on the nature of the malady, the time-lapsed assessment may span the length of one or two hours or a couple of months. During the time-lapsed assessment, the current status of the patient is compared to the previous baseline during and prior to treatment. Similar to the focused assessment, the time-lapsed assessment may also include lab work, X-rays or other diagnostic medical testing.

Emergency Assessments

During emergency procedures, a nurse is focused on rapidly identifying the root causes of concern for the patient and assessing the airway, breathing and circulation (ABCs) of the patient. Once the ABCs are stabilized, the emergency assessment may turn into an initial or focused assessment, depending on the situation. If the nurse is not in a health care setting, emergency assessments must also include an assessment for scene safety so that no other individuals, including the nurse himself, are hurt during the rescue and emergency response process.

Nursing Process: Step One "Assessment": 2004 Nursing Crib: Assessment – First Step in the Nursing Process: 2008 Q4. Enumerate the components of adult health history? 06

1. Identifying data: Includes age, gender, occupation and marital status. Source of history (patient or family member).Reliability: pt. s memory, mood and trust.

2. Chief Complaints: the reason for the visit. This should be subjective data, always put in quotations.

3. Present Illness: Amplifies chief complaint. Should include the development of each symptom (location, quality, quantity or severity, timing which includes onset, duration and frequency, setting, aggravating and alleviating factors, allergies, any medications include OTC.

4. Past History: Childhood illnesses, adult illnesses, which includes surgeries and psychiatric, immunizations, lifestyles and home safety.

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5. Family History: diseases in the family, cause of death of parents, siblings, grandparents. Document presence or absence of common illnesses, such as HTN, CAD.

6. Personal and Social History: Education level, family of origin, personal interest and lifestyle.

7. Review of Systems: Head to toe questions focusing on symptoms. Physical Examination Approach and Overview

General Survey: Observe the patient for height, state of health, facial grimacing, odor, grooming etc.

Vital Signs: Height, weight, BP, pulse, resp. rate and rhythm, temp.

Skin: Identify lesions, location, distribution, and arrangement type, color. Assess skin as you assess the rest of the body.

HEENT: Head: examine hair, scalp, skull and face. Eyes: assess visual acuity, visual fields, position and alignment of eyes, eyelids, conjunctiva and sclera. Ears: inspect auricles, canals, auditory acuity. Nose and sinuses: examine external nose, nasal mucosa, septum and turbinate. Throat: inspect lips, oral mucosa, gums, teeth, tongue, palate, tonsil and pharynx. Neck: inspect and palpate cervical lymph nodes, deviation of trachea, thyroid gland. Back: inspect spine and back muscles.

Posterior thorax and lungs: Inspect, palpate and percuss the chest, auscultate the lungs. Breast, Axillae and Epitrochlear Nodes: In women inspect breast, in both, inspect axillary lymph nodes.

Anterior Thorax and Lungs: Inspect, palpate and percuss the chest, auscultate the lungs. Cardiovascular System: Jugular venous pulsation/pressure, inspect and palpate carotid pulsation and bruit, apical pulse, listen for S1, S2.

Abdomen: Inspect, auscultate, palpate and percuss abdomen.

Lower Extremities: Peripheral vascular system, musculoskeletal system, nervous system. Nervous System: Mental status, cranial nerves, motor system, sensory system, reflexes. Rectal Examination on men/women.

http://thestudentnurse.com/class_notes/adulthealthassessment/adulthealthassessment_physic al-exam-history-taking/ Pathophysiology

Q. 5

A) What are types of diabetes mellitus? 02

There are number of different types of diabetes some of which are more prevalent than others.  Type 1

 Type 2

 Gestational diabetes &

 Other forms of diabetes e.g. steroid induced diabetes

American board of Diabetes & Davidson’s essentials of Medicine Page no 381

b) Give its clinical manifestation. 02

 Increase thirst  Frequent urination

65  Extreme hunger

 Presence of ketones in urine  Fatigue

 Irritability  Blurred vision  Slow healing sores  Unexplained weight loss Q 6.

A) What is acquired immune deficiency syndrome? 02

A disease of immune system due to infection with HIV .HIV destroys the CD4, T Lymphocytes (CD4 cell) of the immune system, leaving the body vulnerable to life threating infection and cancers. AIDS is the most advance stage of HIV infection. To be diagnosed with AIDS person with HIV must have an AIDS-defining condition or have a CD4 count less than 200cells/mm3.

Medical Surgical Nursing Basavanthapa Page no 177

B) How is it transmitted? 02

HIV is a fragile virus.it can only be transmitted under specific conditions. 1. Sexual practices

 Unprotected sex  Multiple sex partners  Anal or oral sexual activity.

 Improper Condom or condom breakage  Open sores, irritation in the genital area. 2. Perinatal exposure

 During pregnancy  Breast feeding 3. Contaminated needle 4. Contaminated blood

Medical Surgical Nursing Basavanthapa Page no 178

Advance Concept In Clinical Nursing

Q NO 7 . What are the complication of I.V therapy ? (5)

ANS. Complications of I.V therapy .

 Air embolism

 Septicemia, other infections

 Infiltrtion , extravasation  Phlebits  Thrombophlebitis  Hematoma  Clotting , obstruction  Circulatory overload

Q NO 8. Discuse the Nursing intervention of the patient in pain? (5)

66 ANS. Nursing Intervention

 Use pain scale to assess pain and discomfort characteristics .location, quality, frequency, duration, etc, at baseline and on an ongoing basis.

 Assure patient that you know the pain is real and will assist him or her in reducing it.

 Assess other factors contributing to patient pain. Fear ,fatigue ,other symptoms ,psychosocial distressed

 Provide education to patient and family regarding prescribed analgesics regimen and importance of analgesics (e.g, around the clock, long acting analgesics for breakthrough pain episodes).

 Address myths or misconceptions and lack of knowledge about the use of opioid analgesics.

 Collaborate with patient, primary provider, and other health care team members when changes in pain management are necessary.

(brunner & suddarths medical surgical nursing volume 1. 13th Edition) page 38,354 ) Q NO 9. What is pneumonia? Give five sign and symptoms of early bacterial pneumonia. (1+4)

ANS. Pneumonia

Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria , fungi, abd viruses.

Sign And Symptoms Of Early Bacterial Pneumonia

 Sudden onset of chills

 Rapidly rising fever(101* to 105*F)

 Pleuritic chest pain that is aggravated by deep breathing and coughing

 Fatigue

 Shortness of breath

( brunner & suddarths medical surgical nursing volume 1, 13th Edition page 573,577) Submitted By:

Rahila Khalid Qurrat ul Ain

DATE 24.3.2016