Supple question

Group: A
Short answer questions (SAQ): Answer any three (03) questions of the following
1. What do you mean by critical care nursing? Write down the roles of critical care nurse.
Definition of critical care nursing:
Critical care nursing is a specialized field of nursing focused on the care of patients with
life-threatening conditions, requiring comprehensive and continuous monitoring and
treatment in intensive care units (ICUs).
Roles of a Critical Care Nurse:
 Monitor and assess patients' vital signs and symptoms.
 Administer medications and treatments.
 Operate and manage life support systems.
 Provide care and support to patients in critical condition.
 Collaborate with a multidisciplinary healthcare team.
 Educate and support patients' families.
 Respond to emergencies and perform life-saving interventions.
 Maintain accurate and detailed patient records.
2. Define burn. List the risk factors of burn.
Definition of burn:
A burn is an injury to the skin or other tissues caused by heat, radiation, electricity,
chemicals, or friction.
Risk Factors of Burns:
 Exposure to open flames or hot surfaces
 Contact with boiling liquids or steam
 Electrical hazards
 Handling chemicals without proper protection
 Prolonged sun exposure without adequate protection
 Smoking or careless use of fire
 Lack of safety measures in industrial or kitchen environments
 Children playing with fire or hot objects
3. What is palliative care? Write down the importance of palliative care.
Definition of palliative care:
Palliative care is specialized medical care focused on providing relief from the symptoms
and stress of a serious illness, aiming to improve the quality of life for both the patient
and their family.
Importance of Palliative Care:
 Provides pain and symptom management
 Enhances the quality of life for patients with serious illnesses
 Supports emotional, psychological, and spiritual well-being
 Assists with complex decision-making about treatment options
 Offers support and counseling to families
 Facilitates better communication between patients, families, and healthcare providers
 Helps coordinate care across different healthcare settings
 Reduces unnecessary hospitalizations and medical interventions
4. Define Cardiac arrhythmia. As a CCU Nurse How will shortly manage case of SVT?
Definition of cardiac arrhythmia:
Cardiac arrhythmia is an irregularity in the heart's rhythm, which can cause the heart to
beat too fast, too slow, or with an irregular pattern.
 Management of SVT (Supraventricular Tachycardia) by a CCU Nurse:
 Monitor vital signs.
 Attach the patient to a cardiac monitor to observe the heart rhythm.
 Assess the patient's symptoms (e.g., palpitations, dizziness, chest pain).
 Perform techniques such as the Valsalva maneuver or carotid sinus massage.
 Prepare and administer medications as ordered by the physician (e.g., adenosine).
 Monitor the patient's response to the medication.
 Continuously monitor the patient's cardiac rhythm and vital signs.
 Record all interventions, patient responses, and changes in condition accurately and
promptly.
Essay questions (EQ): Answer any two (02) questions of the following
1. What is mechanical ventilation? As an ICU Nurse how will take care of a ventilated patient?
Definition of mechanical ventilation:
Mechanical ventilation is a medical intervention in which a machine, known as a ventilator,
is used to support or replace spontaneous breathing by delivering a controlled flow of
oxygen and air into the patient's lungs. This technique is employed to ensure adequate gas
exchange in patients who are unable to breathe effectively on their own due to various
medical conditions, such as respiratory failure, severe illness, or during anesthesia for
surgery.
Care of a Ventilated Patient by an ICU Nurse:
1. Continuously monitor the patient's respiratory status, including oxygen saturation,
respiratory rate, and tidal volume.
2. Regularly check the ventilator settings and alarms to ensure proper function.
3. Perform frequent respiratory assessments, including auscultation of lung sounds.
4. Monitor arterial blood gases (ABGs) to assess gas exchange and adjust ventilator
settings as needed.
5. Provide oral care to prevent ventilator-associated pneumonia (VAP).
6. Reposition the patient regularly to prevent pressure ulcers.
7. Facilitate communication with the patient using non-verbal methods, such as writing
boards or communication devices.
8. Administer sedation and analgesia as prescribed.
9. Ensure proper nutrition and hydration.
10.Maintain strict aseptic techniques during suctioning to prevent infections.
11.Be prepared to manage ventilator malfunctions or emergencies, such as accidental
extubation or respiratory distress.
12.Accurately document all assessments, interventions, and patient responses in the
medical record.
2. Mention the causes and signs & symptoms of hypovolemic shock. Explain the nursing
interventions of hypovolemic shock.
Definition of hypovolemic shock:
Hypovolemia refers to a state of low extracellular fluid volume, generally secondary to
combined sodium and water loss.
Causes of Hypovolemic Shock:
 Severe blood loss due to trauma or surgery
 Significant fluid loss from burns
 Dehydration from excessive vomiting, diarrhea, or sweating
 Internal bleeding (e.g., gastrointestinal bleeding, ruptured aneurysm)
 Conditions leading to fluid shifts, such as pancreatitis or severe infections
 Signs & Symptoms of Hypovolemic Shock:
 Rapid, weak pulse
 Low blood pressure
 Rapid breathing
 Cool, clammy skin
 Pale or mottled skin
 Reduced urine output
 Altered mental state, including confusion or unconsciousness
 Weakness or fatigue
 Thirst
Nursing Interventions for Hypovolemic Shock:
1. Monitor vital signs frequently, including blood pressure, heart rate, respiratory rate,
and oxygen saturation.
2. Assess level of consciousness and neurological status.
3. Observe for signs of bleeding or fluid loss.
4. Administer intravenous fluids promptly, as prescribed (e.g., normal saline or
Hartmann's solution)
5. Monitor fluid input and output to ensure adequate resuscitation and prevent fluid
overload.
6. Use invasive or non-invasive methods to monitor hemodynamic status (e.g., central
venous pressure, arterial blood pressure).
7. Adjust fluid administration based on hemodynamic parameters and patient response.
8. Provide supplemental oxygen to maintain adequate tissue oxygenation.
9. Use nasal cannula, or mechanical ventilation if necessary.
10.Apply direct pressure to external bleeding sites.
11.Prepare for potential surgical or interventional procedures to control internal bleeding.
12.Administer medications such as vasopressors or inotropes as prescribed to support
blood pressure and cardiac output.
13.Provide pain management to ensure patient comfort.
14.Position the patient supine with legs elevated (Trendelenburg position) to improve
venous return and enhance cardiac output.
15.Continuously check vital signs.
16.Document all assessments, interventions, and patient responses accurately.
17.Provide emotional support to the patient and family.
3. List the clinical features of burn and briefly discuss the general intervention of 3rd degree
burns.
Clinical Features of Burns:
 1st Degree Burns:
o Redness
o Mild swelling
o Pain
o Dry skin without blisters
 2nd Degree Burns:
o Red or pink skin
o Blisters
o Severe pain
o Swelling
o Wet or weeping surface
 3rd Degree Burns:
o White, blackened, or charred skin
o Lack of pain (due to nerve damage)
 o Dry and leathery texture
o Swelling
o Potential involvement of underlying tissues, including fat, muscle, and bone
General Interventions for 3rd Degree Burns:
1. Monitor vital signs, fluid balance, and signs of infection closely.
2. Assess and support organ function, including renal and respiratory systems.
3. Perform a primary survey to assess airway, breathing, and circulation (ABCs).
4. Administer oxygen and support ventilation if needed.
5. Initiate IV access for fluid resuscitation and medication administration.
6. Administer IV fluids using the Parkland formula (4ml x kg in body weight x total
percentage of body surface are burned.)
7. Monitor urine output to ensure adequate renal perfusion (aim for at least 0.5
mL/kg/hour in adults).
8. Clean the burn wound with sterile saline.
9. Apply appropriate dressings to maintain a moist wound environment and prevent
infection.
10.Administer analgesia as needed for patient comfort.
11.Use anxiolytics for severe anxiety related to pain and trauma.
12.Administer prophylactic antibiotics if indicated.
13.Debride dead tissue as necessary.
14.Use sterile techniques during dressing changes and wound care.
15.Provide adequate nutrition to support healing and metabolic demands.
16.Provide psychological support to the patient and family.
17.Perform skin grafting or other reconstructive surgeries as needed.
18.Initiate physical and occupational therapy to prevent contractures and maintain
function.
19.Educate the patient and family on wound care, signs of infection, and follow-up care.
Group: B
Short answer questions (SAQ): Answer any three (03) questions of the following.
1. What do you mean by suicide? What are the preventive measures of suicide?
Definition of suicide:
The act of intentionally causing one's own death. It is a serious public health issue that
can result from a complex interplay of psychological, social, and biological factors.
Preventive Measures of Suicide:
 Encourage mental health support and counseling.
 Increase public awareness and education about mental health.
 Foster strong social connections and support networks.
 Improve access to mental health care services.
 Identify and support at-risk individuals through regular screening.
 Promote crisis intervention strategies and hotlines.
 Restrict access to common means of suicide (e.g., firearms, medications).
 Encourage healthy coping mechanisms and stress management.
 Ensure continuity and follow-up care for individuals at risk.
 Engage community organizations in prevention efforts.
 Advocate for supportive mental health policies and reduce stigma.
2. What is respiratory failure. Shortly describe the types of respiratory failure
Definition of Respiratory Failure:
Respiratory failure occurs when the lungs fail to adequately exchange oxygen and carbon
dioxide, leading to a disruption in normal respiratory function.
Types of Respiratory Failure:
 Type 1 (Hypoxemic Respiratory Failure):
o Inadequate oxygenation of arterial blood.
o PaO2 < 60 mmHg on room air.
o Causes include pneumonia, pulmonary embolism, and acute respiratory distress
syndrome (ARDS).
 Type 2 (Hypercapnic Respiratory Failure):
o Inadequate removal of carbon dioxide from the blood.
o PaCO2 > 50 mmHg with pH < 7.35.
o Often due to conditions affecting respiratory drive or mechanics, such as chronic
obstructive pulmonary disease (COPD), neuromuscular diseases, or drug overdose.
3. Define end of life care. List the importance of end-of-life care.
Definition of end-of-life care:
End-of-Life Care: End-of-life care refers to the supportive and compassionate care
provided to individuals in the final stages of a terminal illness or nearing the end of their
life.
Importance of End-of-Life Care:
 Provides comfort and pain management.
 Supports emotional and spiritual needs.
 Ensures dignity and respect for the patient's wishes.
 Offers guidance and support to family members.
 Facilitates open communication and decision-making.
 Enhances quality of life during the final stages.
 Coordinates care across healthcare providers.
4. What do you mean by multi organ failure? What are the causes and clinical features of
DKA?
Definition of multiple organ failure:
Simultaneous failure of two or more organ systems. Causes by Sepsis, Severe trauma,
Shock, Severe burns, Severe pancreatitis. Characterized by Hypotension, Tachycardia,
Altered mental status, Hypoxemia, Oliguria or anuria.
Causes of DKA:
 Insulin deficiency (type 1 diabetes or uncontrolled type 2 diabetes)
 Infection
 Stress (e.g., trauma, surgery)
Clinical Features of DKA:
 Polyuria (excessive urination)
 Polydipsia (excessive thirst)
 Abdominal pain
 Nausea and vomiting
 Kussmaul breathing (rapid, deep breathing)
 Altered mental status
Essay questions (EQ): Answer any two (02) questions of the following
1. Define head injury. As a critical care Nurse how will you manage such cases?
Definition of Head Injury:
Injury to the scalp, skull, or brain is called head injury.
Nursing Management of Head Injury:
Assessment
 ABCs (Airway, Breathing, Circulation)
 Glasgow Coma Scale (GCS) to assess level of consciousness
 Neurological assessment (pupil size and reactivity, motor and sensory function)
 Vital signs monitoring
 Assessment for signs of increased intracranial pressure (ICP)
Nursing Diagnosis
 Ineffective cerebral tissue perfusion related to increased ICP
 Risk for impaired gas exchange related to compromised airway or respiratory
function
 Risk for ineffective cerebral tissue perfusion related to decreased cardiac output
Planning
 Maintain patent airway and adequate oxygenation
 Prevent secondary brain injury
 Manage ICP within acceptable limits
Interventions:
 Maintain a patent airway (positioning, suctioning if necessary)
 Ensure adequate oxygenation (administer oxygen as needed)
 Monitor and manage ICP (elevate head of bed, avoid excessive stimulation)
 Implement neuroprotective measures (avoid hypotension, maintain normothermia)
 Administer medications as prescribed (e.g., antiepileptics, osmotic diuretics)
Evaluation
 Stable vital signs within normal limits
 Maintenance of neurological status or improvement in GCS
 Absence of complications related to head injury or interventions
2. What is acute renal failure? Write down the causes & nursing management of acute renal
failure.
Definition of acute renal failure:
Acute renal failure (ARF), characterized by sudden loss of the ability of the kidneys to
excrete wastes, concentrate urine, conserve electrolytes, and maintain fluid balance.
Causes of Acute Renal Failure
 Pre-renal causes:
o Hypovolemia (e.g., hemorrhage, dehydration)
o Decreased cardiac output (e.g., heart failure, shock)
o Renal artery stenosis
 Renal causes:
o Acute tubular necrosis (e.g., ischemic injury, nephrotoxic injury)
o Acute glomerulonephritis
o Acute interstitial nephritis
 Post-renal causes:
o Urinary tract obstruction (e.g., kidney stones, bladder obstruction)
 Nursing Management of Acute Renal Failure:
Assessment
 Fluid balance assessment (input and output monitoring)
 Electrolyte levels (especially potassium, sodium)
 Vital signs monitoring
 Daily weights
 Urine output monitoring
 Assessment for signs of fluid overload or dehydration
Nursing Diagnosis
 Excess fluid volume related to compromised renal function
 Risk for electrolyte imbalance (e.g., hyperkalemia)
 Impaired urinary elimination related to decreased kidney function
Planning
 Restore and maintain fluid and electrolyte balance
 Prevent complications (e.g., hyperkalemia, fluid overload)
 Promote renal function recovery if possible
Interventions:
 Monitor fluid balance closely.
 Adjust fluid intake based on renal function and urine output.
 Administer intravenous fluids as prescribed.
 Monitor electrolyte levels regularly, especially potassium.
 Administer electrolyte supplements or medications as prescribed.
 Implement dietary restrictions as needed.
 Collaborate with dietitian to develop a renal-specific diet plan.
 Provide adequate protein while limiting potassium and sodium.
 Administer medications as prescribed (e.g., diuretics, phosphate binders).
 Monitor for side effects and therapeutic response.
 Assess for signs of fluid overload or dehydration.
 Perform ongoing assessment of renal function and electrolyte balance.
 Educate patient and family about kidney function and disease process.
Evaluation
 Stable fluid and electrolyte balance
 Improved urine output
 Resolution of symptoms associated with acute renal failure
3. What do you mean by diabetic ketoacidosis? Describe the nursing management of diabetic
ketoacidosis.
Definition of Diabetic Ketoacidosis (DKA)
Diabetic ketoacidosis is a serious complication of diabetes mellitus characterized by
hyperglycemia, ketosis, metabolic acidosis, and dehydration.
Nursing Management of Diabetic Ketoacidosis
Assessment
 Assess vital signs, including blood pressure, heart rate, and respiratory rate.
 Monitor neurological status and level of consciousness.
 Check blood glucose levels, ketone levels, and electrolyte levels.
 Evaluate fluid status and urine output.
Nursing Diagnosis
 Fluid volume deficit related to osmotic diuresis and dehydration.
 Risk for impaired gas exchange related to respiratory compensation for metabolic
acidosis.
 Risk for unstable blood glucose levels related to insulin deficiency.
Planning
 Restore fluid and electrolyte balance.
 Correct metabolic acidosis.
 Normalize blood glucose levels.
 Prevent complications such as cerebral edema and cardiac arrhythmias.
Interventions:
 Administer intravenous fluids (typically isotonic saline) to correct dehydration and
improve perfusion.
 Adjust fluid rate based on hemodynamic status and electrolyte levels.
 Initiate continuous intravenous insulin infusion to lower blood glucose levels and
inhibit ketogenesis.
 Monitor blood glucose closely and adjust insulin infusion rate as needed.
 Replace electrolytes (potassium, sodium, bicarbonate) as indicated by laboratory
values.
 Monitor electrolyte levels frequently, especially potassium, to prevent hypokalemia or
hyperkalemia.
 Monitor vital signs, neurological status, and urine output regularly.
 Assess for signs of cerebral edema (e.g., changes in mental status, headache).
 Continuously monitor blood glucose and ketone levels until stabilized.
 Educate patient and family about signs and symptoms of DKA and the importance of
compliance with diabetes management.
 Provide guidance on insulin administration, monitoring blood glucose levels, and
preventing recurrence.
Evaluation
 Improved fluid and electrolyte balance.
 Resolution of metabolic acidosis.
 Stabilization of blood glucose levels within target range.
 Absence of complications related to DKA management.