EXECUTIVE PRODUCER RGN K MADHLANGOVE

COMPILED BY RGN MUDZINGWA CADIOVASCULAR

CONDITIONS:
Cardiac cycle
Anatomy:
Factors that affect heart rate.
Control of blood pressure nervous control.
Conducting system of the heart.
Describe the myocardium.
Factors that assist in maintenance of blood pressure.
Draw and describe the conducting system of the heart.
Draw and describe blood flow thru the heart.
Describe the pericardium.
Pathophysiology of myocardial infarction.

Conducting System of the Heart

Introduction
For the heart to pump blood effectively. It has to generate its
own electrical impulses and beats independently with
nervous or hormonal control. The sympathetic and
parasympathetic autonomic nerve fibres which increase the
heart rate, it also responses to hormones epinephrine and
thyroxine.
There are specialised neuromuscular cells in the myocardium
that initiate and conduct impulses causing heart contraction

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that is coordinated and synchronised.
Sino atria Node.
It lies in the wall of the right atrium near the opening of the
superior vena cava. The instability of the sinoatrial node
enables them to discharge electrical impulses regularly and
frequently. The instability leads them to depolarise
[discharge] between 60 to 80 times per minute. After
depolarisation then follows repolarisation [recovery]. It sets
the rate of the heart and is called the pacemaker of the
heart. Its firing triggers atrial contraction.
Atrioventricular node [AV node]
This is situated in the wall of the atrial septum near the
atrioventricular valves. They transmit electrical signals from
the atria into the ventricles. There is a delay in the
transmission to allow the atria to finish contacting before the
ventricle start. The signal takes 0.1 of a second to pass
through into the ventricles. It has a secondary pacemaker
function which is slower than that of the SA node. It can take
over the transmission of impulses if they are problem with
the SA node or transmission of impulses. The heart rate is
between 40 – 60 per minute
atrioventricular bundle X his
originate from the atrioventricular node. The AV node
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crosses the fibrous ring that separate atria and ventricles. It
divides into right and left bundle branches at the upper end
of the ventricular septum. within the ventricular
myocardium the branches break up into fine fibres called the
purkinje fibres. The AV bundle, bundle branches and the
purkinje fibres transmit electrical impulses from the AV node
to the apex of the myocardium where the wave sweeps
upwards and outwards pumping blood into the pulmonary
artery and aorta.
Nerve supply to the heart.
The heart is influenced by the autonomic [sympathetic and
Parasympathetic nerves originating in the cardiovascular
centre in the medulla oblongala. The vagus nerve
[parasympathetic] supply the SA and AV nodes and atria
muscle. This reduces the rate at which impulses are
produced decreasing the rate and force of heart beat. The
sympathetic nerves supply the SA and AV nodes and the
myocardium of the atria and ventricles sympathetic
stimulation increases the rate and force of the heart beat.
At rest the health adult heart is likely to beat at a rate of 60 –
80 beats per minute. During the heart beat or cardiac cycle
the heart contraction is called systole.
Relaxation is called diastole. The cycle lasts about 0.8 of a

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second atrial systole contraction of the atria. Ventricular
systole contraction of ventricles complete cardiac diastole
relaxation of the atria and ventricles. deoxygenated blood
from the superior and interior vena cana, as well as
oxygenated blood from the four pulmonary veins is brought
into the atriums, and it flows passively into the ventricles.
The atrioventricular valves are open allowing the passive
flow of blood. A wave of impulse triggered by the SA node
completely empties the atria and completing ventricular
filling atrial systole 0.1 seconds. The electrical impulse is
slowed down as it reaches the AV node delaying
atrioventricular transmission. The delay results in atrial
contraction lagging behind the electrical activity by a fraction
of a second allowing the atria to finish emptying into the
ventricles before they start to contract. After the delay a
wave of contraction sweeps upward from the apex of the
heart and cross the walls of the ventricles pumping blood
into the pulmonary artery and the aorta. [ventricular systole
0.3 seconds] this is triggered by a electrical impulses from
the AV node which spreads to the ventricular muscle via the
AV bundle, bundle branches and Purkinje fibres. Back flow of
blood from the aorta is prevented by pressure which close
the atrioventricular valves. After contraction of the ventricles
there is complete cardiac diastole a period of 0.4 seconds.
The atria and ventricles are relaxed, giving the myocardium
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time to recover and prepare for the next heart beat.
Atrioventricular valves close when pressure in the ventricles
is higher than that in the atrias. The pulmonary artery and
aorta valves open when pressure in the ventricles is higher
than that in these vessels. when the ventricles Relaxes the
pulmonary and aortic valves close then the atrioventricular
valves open, this ensures that blood flows in one direction
Heard through the stethoscope, when placed on the chest
wall a little below the left nipple and nearer the midline.
They are 2 heart sounds corresponding to the events in the
cardiac cycle.
The lub dup
The first sound lub is fairly loud and is due to closure of the
atrioventricular valves. The second is the dup is softer and is
due to the closure of the aorta and pulmonary valves
corresponding with ventricular diastole.
The electrical activities within the heart can be defected as
body fluids are good conductors of electricity. The apparatus
used is the electrocardiograph [ECG] and the trans is called
on electrocardiograph. The normal ECG tracing shows five
wave which are P. QR. S and T

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 CONDITIONS
qn
A 26 yr old businessman is admitted with myocardial
infarction
1. Alterd comfort pain related to reduced oxygen
supply.
Interventions
I. create a therapuetic nurse pt relationship so that
patient will verbalise his fears and concerns if pain
is there will verbalise.
II. Monitor and document characteristic of pain,
noting verbal, non verbal cues (moaning, crying,
grimacing, restlessness, diaphoresis, clutching of
chest) and Bp or heart rate changes to estimate
the degree of pain.
III. give prescrbd narcotic analgesia eg morphine 2,5 -
5mg iv to block pain perception.
IV. give pt complete bed rest, resting on a cardiac
table to reduce oxygen consumption there by
reducing pain.
V. give prescribed humidified oxygen 4-6 litrs pr face
mask per minute to promote oxygen supply to the
myocardium thereby reducing oxygen demand
thus reducing pain.
VI. give prescrd vasodilators e.g nitroglicerine 10 ---40
mg orally tds to dilate the coronery atery therby

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 allowing blood flow to the myocardium therby
reducing oxgygen demand that cozs pain.
VII. monitor using pain intenstity scale.
VIII. clustering of nursing activities as usual to allow pt
to rest thereby reducing oxygen demand that cozs
pain.
IX. give prescd anticoagulant e.g aspirin 300mg initialy
then 150 mg for long term to dissolve the clot
thereby allowing blood flow as well as oxygen to
the myocardium therby reducing pain.
X. Place patients belonging close to the pt to pvnt
straining that increases oxygen demand and coz
pain.
XI. give prescd stool softener to prvnt straining during
defaecation that increases oxygen demand and
coz pain.
XII. give small frequent meals to prvnt blood being
shunted to the GIT which will reduce blood flow to
the myocardium and coz pain.
XIII. involve significant others e.g wife for
physchological support therby blocking pain
perception.
XIV. Administer oxygen to increase oxygen supply
thereby blocking pain perception
Anxiety related to fear of death.
Interventions

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 I. Reassure the pt that everything is being done
possible to normalise the condition for
psychological reasons.
II. nurse explains all procedures e.g use of oxygen to
normalise oxygen saturation to alley anxiety.
III. Nurse keeps calm and avoids panicking as this
triggers anxiety.
IV. Familiarise pt with the environment and new
experience or pple to allay anxiety.
V. Interact with pt in a peaceful manner to allay
anxiety.
VI. Accept pt’s defences do not dare ague or debate
to alley anxiety.
VII. Help pt determine precipitants of anxiety that may
indicate interventions.
VIII. Avoid unnecessary reassurance, this may increase
undue worry.
IX. Assist the pt in developing new anxiety reducing
skills e.g relaxation, deep breathing, postve
visualisation, and reassuring self statements to
allow pt discover new coping methods to manage
anxiety.
X. Provide massage and backrubs for pt to reduce
anxiety.
XI. Educate pt and family about the symptoms of
anxiety for them to be able to cope with anxiety.
XII. Teach pt to visualise or fantasize about the
absence of anxiety or pain to alley anxiety.
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 XIII. Maintain confidence (manner without falls
reassurance) as honest answers can alley anxiety.
XIV. Oberve for verbal and non verbal signs of anxiety
(restlessness, changes in vital signs), and stay with
pt to intervene if pt present destructive behaviour.
XV. Orient pt and SO to routine procedures and
expected activities to alley anxiety.
XVI. Answer all qns factually and provide consistent
information, repeat as indicated to enhance
knowledge to alley anxiety.
XVII. Provide privacy for pt and SO to enhance mutual
support and promote more adaptive behaviors.
XVIII. Administer anti anxiety and hypnotics as indicated
alprazolam, diazepam to promote relaxation and
alley anxiety.
qstn
A 60 yr old man is admitted with congestive cardiac
failure.
Part A:- descrb the pathophysiology of congestive
cardiac failure.
describe pathophysiology of left heart failure.
1 Fluild volume excess related to water and sodium
retention.
goal:- pt to loose weight when oedema subsides.
Interventions
I. Weigh pt iniatially and ct daily usng same scale and
light clothes expecting pt to loose weight of 0.5kg
pr wk.
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 II. Assit the dr to collect blood for U AND E checking
levels of potasium and sodium to intervene
correctly.
III. give a specific typ of fluild l forgot the name
confirm plzz.
cannulate pt to create an iv access line.
IV. Nb use the formular for fluild replacement in
EDLIZ.
V. Give pt bed rest in a recumbent position to
promote diuresis thrby reducng fld excess.
VI. give prescrbd pottassium 20-40 mg in a vacolitre of
normal saline to increase pottasium levels.
VII. Cartherterise the pt and do strict intake and
output to prvnt fluild volume overload.
VIII. give low salt diet 2-3 grams a day to prvnt sodium
and water retention.
IX. giv prscrbd loop diuretic e.g frusemide 20 -40 mg
iv od to promote diuresis.
X. Continue monitoring signs of fluild volume
overload by auscultating abnormal lung sounds e.g
crackles.
XI. Position pt in a semifolwers position to prmt full
lung expansion thereby increasng breathing hence
increasing cardiac output.
2 Decreased cardiac out put related to reduced stroke
volume.
Interventions

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 I. educate relatives about the importance of
restricting fluids to pvnt fluid volume overload.
II. Nrse to do 4hrly bld prsure checks to monitor if pt
is responding to rendered mgt.
III. Give ice chips to moisturise mucus membrane
thereby prvntng dryness of mucus membrane
which may coz pt to drink a lot of fluild:
IV. teach pt deep breathing exercises to increases
breathing pattern which will increase cardiac
output.
V. give prescribed humidified oxygen to increase
breathing pattern therby increasing cardiac
output.
VI. give small frquent meals to prvnt blood being
shunted to the Git therby increasing cardiac
output.
VII. gv prscrb digitalis e.g digoxin 0.75 to 1.5mg orally
6-8 hourly, to increase contractility of the heart
therby increasing cardiac output.
VIII. give prescbd stool softeners to prvnt straining on
defaecation which will reduce cardiac output.
NB EFFECT OF RESPIRATORY PUMP ON CARDIAC
OUTPUT: ANATOMY:
3. Activity intolerance related to reduced oxygen
supply to the tissues.
Goal: to conserve energy.
Interventions
I. complt bed rest to conserve energy.
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 II. Nb some points l mentioned on cardiac output can
manage activity intolerance.
III. eg stool softers.
IV. small frequent meals.
V. do passive exercises and encourage pt to do active
exercises and stop when pt show signs of tiredness
in order to conserve energy.
VI. put pt belongings close to the pt to prvnt straining
therby conserving energy.
VII. introduce activities gradually as tolerated.
VIII. give high carbohydrate diet to give energy.
IX. Teach pt to use a trapeze to save energy.
A 60 yr old man is admitted with right heart side
failure.
formulate two specific nursing diagnosis and manage
the patient.
1.Decreased cardiac output related to reduced stroke
volume.
2. Fluid volume excess related to sodium and water
retention.
Nb COPY INTERVENTIONS FROM CCF
clinical features she will present with.
pathophysiology.
Par B:
1 Impaired gaseous exchange related to pulmonary
congestion.
2Decreased cardiac output related to reduced stroke
volume.
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 1 Impaired gaseous exchange.
Interventions
I. monitor using pulse oximetry as usual.
II. nurse pt on a cardiac table to prmt full lung
expansion thereby increasing breathing pattern.
III. gv prscbd humidifd oxygen as usual.
IV. collect blood for arterial blood gases.
V. do lung percursion to mobilise pulmonary
secreations thrby promoting breathing pattern.
VI. auscultate all lobes of the lungs to check for air
entry.
VII. monitor signs of reduced oxygen as usual e.g
cyanosed membranes.
VIII. teach patient deep breathing exercise to promote
tidal volume thereby promoting gaseous
exchange.
IX. monitor using vitals with special consideration to
resp as usual to note rate of breathing.
X. encourage pt to mobilise in order to mobilise
pulmonary secretions thereby promoting
breathing pattern.
XI. encourage pt to change positions in bed to allow
inflation of all lobes of the lungs.

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XII. Put pt close to an open window for full aeration
and oxygenation.
XIII. Prescrb sunction to clear airway therby promotng
breathing pattern.
NB plzzz, interventions for decreased cardiac output
and impaired gaseous exchange are the same so look
on mark allocation, do not repeat points plzz.
2 Decreased cardiac output copy from ccf.
PartA
A 25 year old woman is admmitted with iron
defficiency anemia.
IRON DEFICIENCY ANEMIA
Nb Give us subjective and objective data she will
present with.
causes of iron deficiency anaemia.
classify anaemia.
clinical features she will present with.
Subjective data.
I. history of heavy menstrual bleeding.
II. patient mighty be pregnant.
III. pt may complain of shortness of breath due to
reduced oxygen carrying capacity.
IV. head ache due to reduced oxygen supply to the
brain.
Objective data.
I. preg test may be positive
II. fbc reduced haemoglobin levls less than 9 grms
per decilitre.
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 III. fatigue due to reduced o2 carrying capacity.
IV. collect blood for iron serum levels there may be
reduced.
V. on inspection there may be cyanosis.
VI. on vital obs reduced respiration rate less than 16-
22 c/m.
VII. collect blood for ABG, reduced levels of partial
pressures of oxygen less than (60-110mmhg).
1 Ineffective breathing pattern related to reduced
oxygen carrying capacity
Qn
formulate 3 ND and manage the patient.
Interventions
I. monitor oxygen saturation using pulse oximetry as
usual.
II. Assess for signs of ineffective breathing pattern
such as pt hving a noise breating wheezing sound
in order to intervene appropriately.
III. give oxygen as usual 4-6 litres per face mask to
improve breathing pattern.
IV. blood for Abg to note o2 saturation in bld
circulation.
V. Semi-folwers position as usual to promote lung
expansion.
VI. give food rich in iron e.g liver to promote synthesis
of red bld cells thereby increasing oxygen carrying
capacity.

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 VII. transfuse pt using red blood cells if hb is less than
9 gdl to increase oxygen carrying capacity.
VIII. give iron supplements e.g ferrous sulphate 120mg
-180mg orally 8 – 12hrly to promote synthesis of
red blood cells so as to increase oxygen carrying
capacity.
IX. ct monitoring using vitals to note improvement in
the continuity of care.
X. Nurse in a well ventilated rm to improve air
circulation.
XI. Ask the pt to state what he thinks is causing
ineffective breathing pattern for effective
intervention.
XII. put pt close to an open window for full oxgenation
and airation.
XIII. monitor signs of reduced oxygen e.g cyanosis to
increase o2 giving rate.
XIV. Encourage pt to do deep breathing exercises to
prevent hypostation wc impairs breathing.
XV. An incentive spirometer is used to allow lung
expansion thereby improving breathing pattern.
XVI. Haemoglobin test to detect o2 carrying capacity of
blood for interventions.
Nb no percussion or mobilisation, pt does not have
secretions.
Alterd nutrition related to reduced dietary intake of
iron, nausea and vomiting.
Interventions
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 I. give small frequent meals as usual to normalise
nutritional status.
II. weigh pt initially and ct weekly expecting pt to
have a weight gain of 0,5kg a week.
III. give food rich in iron to increase iron levels.
IV. gv multivitamin supplements 2 tablets per oral to
promote appetite.
V. do oral care 4 hourly to stimulate taste buds
therby boasting appetite.
VI. modify environment eg removal of bed pans and
urinals to promote apetite.
3. Activity intolerance related to reduced oxygen
supply.
Interventions
I. complt bed rest to conserve energy.
II. Nb some points l mentioned on cardiac output can
manage activity intolerance.
III. e.g stool softers.
IV. small frequent meals.
V. Give iron supplements to enhance bld oxygen
carrying capacity to increase energy.
VI. do passive exercises and encourage pt to do active
exercise and stop when pt shows signs of tiredness
in order to conserve energy.
VII. put pt’s belongings close to the pt to prvnt
straining therby conserving energy.
VIII. Introduce activities gradually as tolerated.
IX. give high carbohydrate diet to give energy.
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Gastrointestinal
longtudinal section of the stomach.
cross section of the stomach.
functions of the stomach.
functions of gastric juices.
functions of small intestines.
draw and describe the colon
phases of secretion of gastric juices
diagram of the Git.
Qn
A 50 yr old business man is admitted with severe
haemorrhage from petptic ulcers.
describe layers of stomach
describe the peritoneum.
predisposing factors of peptic ulcers.
formulate three nursing Diagnosis and manage the pt.
compare and contrast gastric and duodenal ulcers.
1 fld vlm dfct related to bleeding
Interventions
I. Assess for signs of hematemesis or melena to
check if there is internal blding.
II. Canlte pt usng a large bore cannular 16 gauge to
create an iv line.
III. Monitor vital signs and observe Bp and heart rate
for signs of orthostatic changes, a decrease in
Blood pressure and and an increase in heart rate
with changes in pstn is an early indicator of
decreased circulatory volume.
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 IV. assist doctr to collect full bld count for cross match
and transfsn.
V. chk haemoglobin levels if less than 13 gdl
transfuse usng whole blood.
VI. Instruct pt to immediately report symptoms of
nausea, vomiting dizziness, shortness of breath, or
dark tarry stools to note any signs of internal
bleeding.
VII. do capilary refill by pressing fingr nail beds and
normal shld return to pink colour in three seconds.
VIII. gv prscrbd fluid vlm expnders as ordered e.g ringrs
lactate 1 litr fast then 4-6 hly to increase
circulatory fluild volm.
IX. Catherterise pt and do strict intake and output by
documenting on fld balancing chart checkng urine
output and normal urine output shld be 30-60 mls
per hour.
X. contnue monitoring signs of reduced circulatory
vlme e.g cold clammy skin.
XI. Do stool culture to estimate blood loss in stool.
XII. Measure abdominal girth using a tape measure to
rule out internal bleeding.
XIII. gv prscbd MMT to reduce secreation of gastric acid
which causes ulceration and bleeding.
XIV. gv plenty of oral fluilds 2-3 litrs a day to increase
circulatory volume.
XV. nb managmnt based mainly on counselling pt on
predisposing factors of peptic ulcers.
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 Acute pain related to abdominal distention evidenced
by early satiety.
Interventions
I. assess the pt’ pain including the location,
characteristics, precipitating factors, onset,
duration, frequency,quality, intensity and severity
to assess effectiveness of pain reducing
medication.
II. counsel pt not to smoke as cigarets contain
nicotine which causes vasoconstritn and reduces
ulcer healing as well as causing pain.
III. pt not to take spicy foods why coz thy coz
secretion of gastric acid which cozes pain.
IV. Instruct pt to avoid NSAIDs like aspirin to prevent
irritation of the gastric mucosa causing pain.
V. Instruct pt that meals shld be eaten on regularly
paced intervals in a relxed setting not to interfere
with regular administration of medications.
VI. clustering of nursing activities e.g bathing and
feeding to allow pt tyme to rest thereby reducing
pain stimulation.
VII. diversional therapy soft music.
3 knwdge defct related to new condition and
treatment evidenced by multiple questions.
Interventions
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 I. assess the pt’s knowledge and misconceptions
regarding peptic ulcer dzz, life style behaviours,
and treatment regimen to have a base line to work
from.
II. Explain the pathophysiology of the dzz and how it
relates to the functioning of the body to ehance
knowledge.
III. Instruct pt on wht signs and symptoms to report to
the health care provider to enhance knowledge.
IV. Discuss therapeautic options and the rationales for
using these options to prmte rapid healing of the
peptic ulcers.
V. Discuss the life style changes required to prevent
further complications or episodes of peptic ulcer
disease to enhance knowledge.
Part A
nb Just counsel pt to avoid thoz predisposing factors.
QN
A 20 yr old man is admitted with interstinal
obstruction.
Qn
formulate 3 prioritised ND and manage the pt.
1 risk for fld vlm deficiet related to vomiting.
clinical features
pathophysiology
Interventions
I. gv prcrbd fluild vlm expanders e.g rngers lactt fast
then 4-6hly to increase circulatory vlm.
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 II. Insert a nasogastrc tbe to estmate fluid loss thru
vomitus.
III. assit doc to collect blood for U and E checkng
levels of potassium and sodium, levls of pottasium
shld be 3,5-5,5mmllos and sodium 135 to 145
mmols.
IV. cannlte the pt using a 16 guage cannular to create
iv line for fast infusion.
V. do capillary refill by pressing on nail beds and
normal shld return to pink colour in 3 seconds.
VI. ct monitoring signs of reduced circulatory vlm for
example cold clammy skin.
VII. cathetrise the pt and do strick intake and output
by docmntng on fld balancing chat and normal
shld be 30 -60 mls an hour.
VIII. give prescribed antiemetic e.g promethazine orally
25-75mg 8hrly to suppress vomiting.
IX. weigh the pt for calculation of theatre drugs to
prvt over or underdosing the pt.
2 Risk for injury related to pending surgery
Interventions
I. strap wedding ring to prevnt risk of electrocution.
II. aftr analysing U and E gv prbsd pottassium 20-
40mmols to increases pottassium levels.
III. NB PLZZ do not gv plnty of oral fluilds this is an
emergency, PT TO THEATRE.
IV. catherterise pt to prvnt bladder trauma in theatre.

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 V. put a name tag bearing age sex etc, the nature of
operation to be done.
VI. do chest Xray to note any chest infections.
VII. make sure pt signed an informed consent in case
of anything, it can be used for legal purposes.
VIII. check blood sugar levels to rule out DM which may
coz hypoglycermia when pt is in theatre.
IX. do vital obsvtions checking bp and temp if bp
elevated it may predespose pt to bleedng
intraopp.
3 Anxiety related to pending surgery
Interventions
I. nurse keeps calm and avoid panicking which
causes anxiety.
II. explain all procedures to the pt to pvnt anxiety.
III. explain the competence of theatre staff that it will
be done by qualified doctors and nurses so as to
relieve anxiety.
IV. reassure the pt that medication to relieve pain,
post opp will be available to relieve anxiety.
APENDICITIES
give us specific clinical features pt will present with.
Part A
Nb Noo diversional therapy this is an emergency.
Qn
A 19 year old boy is admitted in the ward wth
appendicitis and is going for appendicetomy.
Signs and symptoms
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 I. periumbilical pain which is poorly localised which
will be localised on the right lower quadrant.
II. positive rosvings sign that is palpable on right
lower quadrant, pt fills pain on the left.
III. pain on defaecation shows the tip of the appendix
is resting on the rectum.
IV. pain on urination shows the tip of the appendix is
resting on the bladder.
V. pain on macburns point.
VI. nausea and vomiting due to interstinal blockage.
qtn:-describe the structure and function of the
appendix.
Using three prioritised nursing diagnoses manage
the pt.
1 risk for fluild vlm deficiet related to vomiting.
2 risk for injury related to pending surgery.
3 Anxiety related to pending theatre procedure.
GNYNAECOLOGICAL CONDITIONS
cross section of the uterus diagram.
describe the menstrual cycle.
diagram of the female reproductive orgarns.
A 25 year old woman is admitted wth septic abortion.
classiffy Abortions
1fluild vlm deficiet related to bleeding.
Interventions
I. do intake and out put checkng urine output and
normal shld be 30- 60 mls an hour.
do pad check 2 hourly to estimate blood loss.
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 II. do cappillary refill by pressing on the nail bed, a
normal shld return to pink colour in 3 seconds.
III. gv prscrbd fld volme expanders e.g ringers lactate
1litr fast then 4-6 hourly to prmte good fld
circulation.
IV. Collect blood for fbc for cross match.
V. Encourage oral fluids.
2 risk for infection spread to other organs rlted to
nature of condition.
Interventions
I. gv prescrbd tripple therapy e.g ceftriaxone 1g bd,
metronidazole 500mg tdsx7days, doxycycline
100mg bd for 7days and ceft 1g iv.
II. ct monitrng by doing vital obs 4 hly with special
consideration to temp of which continuos
elevation of temp indicate presence of infection.
III. teach pt perenial hygiene that is to clean from
inside going outside to prevent introducing
infection.
IV. high protein diet to prmt synthesis of antibodies
which will help to fight infection.
V. give prescrbd antipyretic e.g paracetamol lg orally
tds to reduce temp.
VI. collect bld for white cell count of which continuos
elevation my denote infection.
VII. Collect deep vaginal swab for msc and give
antibiotics according to sensitivity results.

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 Nb If pt has hpyerthermia
Interventions
I. Nrse assess the degree of temp if above 37,2
degrees celcius and implement action.
II. Brain scan to detect tumours wc interfere wth the
heat reglting centre wc causes elevation of temp.
III. remove excess linen to allow heat loss by
conduction therby reducing temp.
IV. prepare pt for evac for removal of retained
products of conception therby reducing temp.
V. position pt close to an open window to allow heat
loss by convection.
VI. Put on a fan to allow free circulation of air to cool
the room thrby reducing temperature.
VII. 4hrly temp checks to assess if temp is going down.
VIII. Antibiotics are given to treat infctn wc cause
elevation of body temp.
IX. Fbc to assess wbc as elevation indicates infctn wc
cause evelevation of temp.
X. High fld in take up to 2-3litres a day to cool the
body.
XI. Pt is encouraged to suck ice cream or ice cubes to
lower temp.
XII. Bath pt wth luke warm water to reduce body
temp.

26
XIII. Bld for MPS to be collected to rule out malaria wc
cause temp rise.
XIV. Give antipyretic drugs like pct1 g po tdsx 3 days to
reduce temp.
XV. Nrse pt in a well ventilated rm to allow free
circulation of air thrby redcing temp.
XVI. clinical features.
pathophysiology.
Qn:-A 25 year old woman is admitted with pelvic
inflamatory dizz.
formulate two prioritised nursng diagnoses and mange
the pt.
1 Alter cmfort pain related to inflamatory procces.
Interventions
I. use a bed craddle to prvnt linen from putting
pressure on the abdomen whch causes pain.
II. position pt on semisiting postn to allow drainage
of puss therby reducng pressure which cozs pain.
III. offer diversional therapy e.g giving pt newspaper
to read so as to relieve pain.
IV. give prescrd NsAids diclofenac 75mg im tds to
reduce inflamation whch causes pain.
V. clustering of nursing activities e.g aftr bathing the
pt give the drug to allow pt tyme to rest therby
relieving pain.
VI. monitor using pain intensity scale where 0 –is no
pain 1-3 mild pain and 4-7 moderate pain 8-10

27
 severe pain so as to advocate to the doctor to
increase or decrease analgesia.
VII. give prscrd stool softeners e.g liquid paraffin to
prvt straining on defacaetion which causes pain.
Staging of cervical cancer.
A 25 year old woman is admitted with cervical cancer.
2 Risk for infection spread COPY TO SEPTIC ABORTION
1 Altered comfort pain related to inflamatory process.
Interventions
I. offer a bed craddle to prevent linen from putting
pressure on the abdomen which causes pain.
II. give prescrbd stool softers e.g liquid parafin to
prevent straining on defacation which causes pain.
III. gv prscbd narcotic analgesia e.g morphine or
pethidine give doses so as to blck pain perception.
IV. monitor using pain intensity scale where 0 no pain
1-3 mild pain , 4-7 moderate pain 8 -10 severe pain
so as to advocate to the doctor to incres or decrs
dos of analgelsia.
V. clustering of nursing activities e.g after feeding the
patient give the drug to allow patient tyme to rest
so as to minimise pain stimulation.
2 Altered nutrition related to nasea and vomiting
secondary to chemotherapy and cancer drugs.
Interventions
I. Nrse assess wt, waist circumference, and calculate
body index mass (BMI) to note degree of
nutritional defcincy.
28
 II. Assess pt’s knowledge of a nutritious diet and
need for supplements.
III. Set appriate shrt term and long term goals to
relieve pain for pt not to loose concern in
addressing the dilemma without realistic short
term goals.
IV. Provide companionship during meal times to assist
pt be able to eat more food.
V. gv food while still warm to promote appetite and
increase oral intake.
VI. Give small frequent meals to improve nutrtnal
status.
VII. giv mult vitamin supplements 2 tablets a day to
prmot appetite.
VIII. Consider six small nutrient dense meals instead of
three larger meals daily to lessen the feeling of
fullness and decrease the stimulus to vomit.
IX. Determine time of day when pt’s appertite is at
peak to enable pt take more food.
X. Encourage relatives to bring pt’s favourate food
from home as pts wth ethinic or religious
preferences or restrictions may not consider fd
from the hosp.
XI. do oral care 4 hrly or bfr and aftr feeding to
stimulate taste buds thereby promoting appetite
and increase oral intake.
XII. give food in the morning as anorexia increases
during the day to promote appetite.
29
 XIII. Modify environment to promote appertite eg
removing urinals and bed pans during meal times.
XIV. Offer liquid energy sumplements easy to digest to
easil promte good nutrnal status.
XV. Avoid caffeinated or carbonated beverages as they
depress hunger and lead to early satiety.
XVI. Encourge light exercises to increase metabolism
and utilisation of nutrients thrby increasing
appertite.
XVII. Promote prper positioning e.g elevating the head
of the bed 30degrees to aid swallowing and reduce
risk of aspiration with eating.
XVIII. Take a ntrinal history with the participation of
significant others to get more accurate details on
the pt’s eating habbits.
XIX. Schedule rest periods before meals and cut up
food for pt to conserve energy to be used during
meal times by chewing.
XX. Offer high protein supplements on individual
needs to increase carlories and protein without
conflict to voluntary food intake.
3. body image disturbances related to loss of hair,
weight loss secondary to chemotherapy
Interventions
I. Assess meaning of loss or change to the pt and
impact on cultural and religious beliefs to assist pt
accordingly.

30
 II. Assess to determine the extent of body image
disturbance so as to determine the mgt needed.
III. advice pt to wear loose fitting clothes to cover up
for weight loss.
IV. Exhibit positive caring in routine activities to
encourage pt dvlp more positive responses to the
changes in his or her body.
V. Be realistic and positive during treatments in
health teaching and in setting goals within
limitations to enhance trust and rapport btwn pt
and nurse.
VI. Encourage fmly interaction with each other and
rehabilitation team to provide on going support
for pt and fmly.
VII. Support pt in identifying ways of coping that hve
bn beneficial in the past to help pt adjust to the
current issue.
VIII. Refer pt and caregivers to support groups
composed of individuals with similar alterations
for psychological support.
IX. Refer to physical occupational therapist to enable
pt cope with the body image disturbance.
X. pt to wear wigs to cover up hair loss thrby reducng
body img disturbance.
XI. Perenial hygiene, frequent change of pads to
reduce odour that causes body image disturbance.
XII. patient to spray using perfumes and lotions to
reduce odour from viginal discharges.
31
XIII. apply lotions on the skin to prevent skin dryness
tht may predispos to skin breakdown.
XIV. Counselling is done to pt on the need to rely and
accept the new appearance so as to learn to live
with it.
XV. Encourage pt to groom in order to boost self
esteem.
XVI. Nrse to maintain non-judgemental attitude to
promote self esteem.
RENAL CONDITIONS
microscopic i.e nephron.
descrb urine formation.
draw microscopic structure of the kidney.
functions of the kidney.
draw gross structure of the kidney.
pathophysiology
anatomy of the kidney:
Qn:- A 25 year old boy is admitted with acute
glomerular nephritis.
clinical features.
PART B
1 Risk for infection related to loss of plasma proteins.
2 fluild volume excess related to sodium and water
retention.
3 Alterd nutrition less than body requierements related
to protein restriction, nausea and vomiting secondary
to azotemia

32
 1 Risk for infection
Interventions
I. Assess temp, chills sore throat; cough presence or
recurrence as this reveals persistence of
streptococcal infction.
II. Obtain throat culture for analysis and sensitivity to
indentify streptococcal microorganisms and
sensitivity to treat accordingly with antibiotics.
III. Beds are carborlised when pt is discharged to
avoid infections to the incoming pt.
IV. Weekly swabs shld be coolected from any part of
the ward for mcs to detect bacteria wc causes
infection.
V. Routine ward urinalisis is done to detect any
urinary tract infection early so as to prevent
infection.
VI. Floors shld be moped and ceaned to remove dirt
wc harbours infctn.
VII. Nurse to observe body fluids colour changes,
odour or consistency to detect signs of infection.
VIII. Daily baths with anti bacteria soap to remove dirt
wc harbours infection.
IX. Damp dusting daily before aseptic procedures to
prevent infection.
X. Encourage pt to take fluids 2-3 litres a day to flush
out toxins.

33
 XI. Deep breathing exercises to prvnt complications
like hypostatic pneumonia.
XII. gv prescribd antibiotics eg ciprofloxaccillin 500mg
oral bd to treat infection.
XIII. Teach hand hygiene to prevent infection.
XIV. Teach proper refuse disposal to prevent infctn.
XV. Encourage importance of taking full crse of
antibiotics to prevent antibiotic resistance to infcn.
XVI. Isolate the pt to prevent infctn.
XVII. collect urine for MCS then give antibiotics
according to MCS results.
XVIII. ct monitoring by doing 4 hlrly vital obs with spcial
consideration to temp of above 37,2 indicate
infection is still there immunocomromised.
XIX. After analysing levels of U and E if they are low
give high protein diet to promote synthesis of
antibodies which will help to fight infection.
XX. Cannulate pt to create an iv infusion line for
parenteral antibiotics.
XXI. collect bld for fbc to detect infection wc can be
relvealed by raised wbc count.
2 Fluild volume excess related to sodium and water
retention.
Interventions
I. Assess levels of potasium shd be 3,5 to 5,5 mmlos
to intervention.
II. Auscultate breath sounds for presence of crackles
wc indicate fluid accumulation in the lungs.
34
 III. low salt diet less than 2-3grams a day to reduce
fluild retention that may worsen condition.
IV. do strick intake and output by docmntng on fluild
balancing chart and normal urine output shld be
30-60 mls an hour.
V. aftr analysing levels of U and E, give prscrbd
potassium 20-40mmols in a vacolitr of normal
saline.
VI. teach the relatives the importance of minimising
fluids to prvnt fluid overload.
VII. gv prescrbd loop direuretic e.g frusemide 40 - 80
mg iv 0d x 3 days to prmote diuresis.
VIII. moisturise mucus membranes using ice chips to
prvnt dryness of mucus membrane which may
require more oral fluid intake.
IX. Elevate edematous body parts while in bed to
promote venous return.
X. Nurse to restrict oral fluids intake by adding the
previous day output plus 500mls to recover
insensible loss.
XI. Nrse to administer prescribed electrolyte
replacement of potassium chloride 6oomg once
daily to replce lost electrolytes due to diuresis.
XII. Nrse to measure abdominal girth to assess if ascitis
is subsiding.
XIII. Nrse to assist doctor to do abdominal paracentesis
to remove excess fluid.
XIV. Regarding edema to assess progress of therapy.
35
 3. Altered nutrition less than body requirements.
Interventions
I. small frequent meals to promote appetite therby
promoting oral intake.
II. weigh pt iniatly and ct daily using same scale and
light clothes.
III. pt shld loose weight and later gain when oedema
subsides.
IV. give prscrbd multivitamins two tablets per oral to
promote appetite.
V. oral care 4 hrly to stimulate taste buds therby
promoting appetite.
VI. if levels of U and E is increased prepare pt for
dialisis therby reducing azotermia which cause
nausea and vomiting.
VII. give prescrbd anti- emetic eg metochloperamide
10 mg iv tds to suppres vomiting therby increasing
oral intake.
VIII. give food in the morning as anorexia increases
during the day to promote appetite.
IX. encourage relatives to bring food from home as
valued by patient to promote good ntrnal status.
X. non odourous environment to promote appetite.
Acute renal failure
pathophysiology

36
Qn
A 40 yr old man is admitted with acute renal failure
Phases of acute renal failure.
causes of acute renal failure.
oliguric phase
PHASES ARE BELLOW .
initial phase
Nb PLZZZ PLZZZ there is diffrent betwn phases and
causes.
PHASES
recovery phase
diuretic phase.
will discuss adding flesh.
Part B
Pre renal causes
Post renal causes.
Intra renal causes
2 Alterd nutrition less than body requirements related
to nausea and vomiting and protein restriction.
Interventions
I. assess and document dietary intake to note
nutritional deficiencies.
II. Provide freqnt small meals to minimise anorexia
and nausea associated with uremic state or
diminished peristalsis.
III. Give pt/ SO a list of permited foods and fluids and
encourage involvement in menu choices to

37
 enhance a measure within dietary restrictions and
appertite.
IV. Offer freqnt mouth care with diluted acetic acid
solution to enhance appertite
V. Weigh daily to assess progress of dietary measures
expecting pt to gain weight to note any changes in
fluid shifts.
VI. Monitor lab studies-BUN, albumin, transferring,
sodium and potassium to note the nutritional
needs.
VII. Consult dietician for guidance on the proper
nutritional supplements.
VIII. Provide high carlorie foods, low to moderate
protein diet to give energy and repair of tissues.
IX. Maintain proper electrolyte balance by strictly
monitoring levels to ensure proper electrolyte
balnce not to cause more renal injury.
X. Restrict potassium, sodium and phosphorous
intake as indicated to prevent further renalinjury.
XI. Administer iron supplements to prevent anemia
and GI function impairement.
XII. Administer vit D to facilitate absorption of calcium
from the GI tract.
XIII. Administer antiemetics-prochlorperazine to relieve
nausea and vomiting and ehance food intake.
NEPHROTIC SYDROME
1 Fluild volume excess related related to sodium and
water retention.
38
 Interventions
I. Monitor vitals 4hrly noting any significant changes
for baseline to intervene correctly.
II. Auscultate breath soundsfor presence of crackles.
Observe for increased wrk of breathing, cough and
nasal flairing to note fluid accumulation in the
lungs.
III. Weigh pt with the same scale at the same time
daily to monitor fluid accumulation wc may be
indicated by weight gain.
IV. Measure and record abdominal girth daily to not if
there is any fluid accumulation.
V. Administer diuretics as prescribed to decrease
plasma volume and edema by causing diuresis.
VI. Instruct SO to maintain fluid restrictions as
indicated to maintain good kidney function state.
VII. Position changes 2hrly to lessen pressure on body
parts and prevent accumulation of fluid in the
dependent areas.
VIII. Elevate edemoutos body parts while in bed or
sitting in a chair to help move fluid away from
dependent body parts through gravity.
IX. Explain the condition to pt and SO about signs and
symptoms, diagnosis and mgt to to enhance
understanding of thr dzz wc increases compliance
wth treatment regimen.
X. Refer to dietician for consultation to develop a
meal plan low in sodium, potassium, and protein
39
 that includes preferred foods as allowed to assist
in proper mgt of the dzz.
plzz also copy interventions from
glomerulanepritis thank u
formulate two prioritised nursing diagnosis.
pathophysiogy read it plzz.
A 25 yr old man is admitted with nephrotic syndrome.
Part A.
plzz copy interventions from acute
glomerular nephritis.
2 Altered nutrition.
ENDOCRINE CONDITIONS
Anatomy
functions of insulin.
functions of thyroid homones.
functions of the thyroid gland.
draw and describe negative feedback mechanism of
thyroxine.
describe anatomy of the pancreas.
Thyroid hormone functions.
1. Required for normal maturation of the nervous
system in the foetus and infant.
Deficiency: Mental retardation (cretinism)
2. Required for normal body growth because they
facilitate the secretion of and response to growth
hormone.
Deficiency: Deficient growth in children
3. Required for normal alertness and reflexes at all
40
ages.
Deficiency: Mentally and physically slow and lethargic
Excess: Restlessness, irritable, anxious, wakeful
4. Major determinant of the rate at which the body
produces heat during the basal metabolic state.
Deficiency: Low BMR, sensitivity to cold, decreased
food appetite
Excess: High BMR, sensitivity to heat, increased food
appetite, increased catabolism of nutrients
5. Facilitates the activity of the sympathetic nervous
system by stimulating the synthesis of one class of
receptors (beta receptors) for epinephrine and
norepinephrine.
Excess: Symptoms similar to those observed with
activation of the sympathetic nervous system (for
example, increased heart rate)
QN
A 30 year old man is admitted with type 2 diabetis
mellitus in a state of hyperglycermiC COMA.
A 25 year old newly diagnosed diabetic pt is admitted
in a state of hyperglycermia
A 25 yer old known diabtic pt is admitted in a state of
hyperglycermia.
NB LASTLY A 25 yer old NEWLY DM pt or KNOWN DM
PT is admitted in a state of hyperglycermic coma.
Using two prioritised nursing diagnoses manage this pt.
Nb whn the sterm of the qtn says newly dm pt in a
state of hyperglycermia u formlate these two.
41
 1 Fluild vlm deficiet related to polyurea.
2 knowlede deficiet regarding the condition
predisposing factors clinical features managment and
complications.
1 Fld vlm dfct related to polyurea.
Interventions
I. canulate pt using a large bore which is 16 guage
canular to create an iv infusion.
II. assit the doc to collect blood for random blood
sugar (RBS) as well as U@E checkng levels of
pottasium and sodium.
III. give prescrbd fast acting insulin Actrapid 10 iu iv
intialy to facilitate uptake of glucose by cells and
muscles therby reducng glucose levels which is
causing polyurea.
IV. give prescrbd fluild vlm expanders eg normal
saline litre fast running with 10 iu of Atrapid in it
then 4-6 hourly to nutralise blood sugar which is
cozng polyurea.
V. catherterise the pt and do strick intake and output
by documenting on fluild balancing chart and
normal urine output shld be 30-60 mls an hour.
VI. treat infections promptly to rule out
hyperglycermia cozed by infections.
VII. when sugar levels are below 16 mmols give
actrapid 10 iu per sliding scale intramasculary to
reduce sugar levels which cozes polyurea.
42
VIII. ct monitoring by doing haemo check half hourly,
hourly then continue 4 hourly to rule out
hyperglycermia.
IX. do cappilary refil by pressing in the nail bed for ten
seconds and normal shld return to pink colour in 3
seconds.
X. give small frequent meals containing no sugar to
prvnt exessive accumulation of sugar which cozs
polyurea.
XI. After analysing levels of U and E whn pottasium
levels are below 3,5--5,5 mmols give prescrbd
potassium 20-40 mmols in a vacolitre of normal
saline.
XII. ct monitoring signs of reduced circulatory volume
e.g cold clamy skin etc.
XIII. if pt is fully awake allow him to mobilise as
exercises promote uptake of glucose by cells and
muscles.
XIV. if pt can tolerate giv plenty of oral fluilds to
increase circulatory fluild volume, oral fluilds
ranges from 2-3litres a day.
2 KNOWLEDGE DEFICIET
Interventions
I. Assess the knowledge level of the pt about the
condition to have a base line to wrk from.
II. Teach pt to rotate insulin injection sites to prevent
fat deposits.

43
 III. Explain importance of inserting the needle
perpendicular to skin to ensure deep
subcutaneous admstn of insulin.
IV. Teach pt to follow a diet that is low in simple
sugars, low in fat and high in fiber and whole
grains to help control cholesterol and triglycerides.
V. Explain that long acting insulin only nd to be
injected once or twice a day to enhance
knowledge.
VI. create a therapuetic nurse pt relationship based
on trust so that pt can verbalise her feelings and
concerns.
VII. explain the condition in full PLZZZ e.g diabetis
mellitas is an endocrine disorder characterisd by
inbalance btwn insulin supply and demand why so
that pt can understand and cooperate and comply
to treatment management.
nb on knowledge deficiet include the following:-
1 exercises
I. teach pt that exercise helps to promote uptake
and utilisation of glucose by cells and muscles.
II. advice pt to record blood sugar levels before and
aftr exercising to prvnt hypoglycermia.
III. advice pt not to over exercises as this predisposes
to hypoglycermia.
IV. pat to wear a brace let during exercises indicating
that he is a dm pt why incase he collapse pt can be

44
 easily indntfied and rushed to a nearest hospital
facility.
V. pt to wear sport shoes during exercises why to
prevent injury as there is poor wound healing.
2 diet.
I. pt to take small frequent meals of low sugar diet
to prvent exessive accumulation of blood sugar.
II. pt to record sugar levels bfr and aftr feeds to check
for sugar levels.
III. pt to take snacks inbetween meals why to
promote glucose metabolism.
IV. pt to take low fat diet to reduce exessive weight
gain.
Inslulin adminstration
I. advice the pt that the drug does not cure the
condition but helps to relieve symptoms so that
the pt does not stop talking the drug aftr being
relieved of symptoms.
II. advice the pt about the sites of injection eg
abdomen chest thigh and deltoid muscle.
III. advice to change sites for injection to prvnt
lipodystrophy.
IV. pt to check sugar levels bfr adminstration to prnvt
hypoglycermia.
V. teach pt about care and storage of the drug in
refregerators to maintain potency.

45
VI. advice pt about specific side effects of the drug
why so that pt does not stop taking the drug when
he exprience thoz side effects.
care of feet.
I. Teach pt to dry in bettween toes to prvnt fungul
infection.
II. pt to wear fitting shoes to prevent injury as there
is poor wound healing.
III. pt to stay away from fire to prvnt burns coz there
is reduced sensation esply on the peripheries
Additional points.
I. refer pt to diabetic associations where they are
given coping mechanism.
II. advice pt to come for review dates for effective
monitoring of interventions.
III. Nb Plzzzz when the questions,says known Dm pt
plzzz remove knowledge deficiet coz pt already
knows the condition.
IV. Knowledge deficiet patient is unconcious hancho.
Nursing diagnosis for pt in hypeglycaemic coma
priority.
1 Fluild volume deficit u manage as above.
2 Risk for aspiration related to unconciusness
OR
Others manage Risk for aiway clearance related to
unconsciousness.
Pathophyisiology of type 1 diabetis mellitus.
Pathophysiology of type two diabetis mellitus.
46
 compare and contrast type 1 and type 2 diabetics
mellitus.
compare and contrast hyperglycermic coma and
hypoglycermic coma.
QN- A 24 year old man is admitted wth toxic nodular
goitre.
HYPERTHYRODISM
functions of thyroid hormones.
describe anatmy of the thyroid gland. clinical features
he will present with.
1 Alterd nutrition less than body requiremnts related
to increased metabolism
Interventions
I. Monitor daily food intake, wigh daily and record
losses to monitor effctivness of food therapy.
II. gv prescrbd parentral fluilds e.g maintylite 1000
mls iv 12 hourly to give energy to the pt.
III. give prescrbd antithyroid hormones eg lugos
iodine check doses to reduce levels of thyroxine
therby reducing metabolism and increase oral
intake.
IV. After analysing U AND E giv prscrbd pottasium 20-
40 mmols in a vacolitr of normal saline to increase
potasium levels( nb electrolytes are part of
nutrition).
V. Nb If pt have no appetite gve. multivitamins and
oral care mighty not be important.

47
 VI. give prescrbd antidiarhea e.g loperamide or zinc
sulphate 20 mls per loose stool to stop diarrhea.
VII. monitor pt during feeds to reduce hyperactivity
which reduces oral intake.
VIII. give small frequent meals to promote absorption
of food.
IX. Provide a balncd diet, with six meals per day to
promote wt gain.
X. Avoid foods tht increase peristalsis and flds tht cse
diarrhoea which may impare absorption of needed
nutrients.
2.Altered thought procces.
Interventions
I. do no argue wht the pt but emphasise the truth so
as to orient the pt.
II. create a therapuetic nurse pt relationship so that
pt verbalise his feelings and concerns.
III. nurse pt in a room wth an open window so that pt
can distiquish between day and nighty.
IV. reoriente pt to self tyme and place this will help in
reorientation.
V. involve phschologist for pyschological counselling
this helps in reorientation.
VI. involve family membrs this will bring a feeling of
love and belonging and help in reorientation.
HYPOTHYROIDISM.
Part B

48
 A 25 yr old woman is admmitted with
Myxoedema(hypothyroidism).
state the clinical features she will present with.
formulate two nursing daignosis and manage the pt.
1Alterd nutrition more than body requirements related
to reduced metabolism.
Nb if pt is obese.
Interventions
I. allow pt to exercise to increase peristalsis and
increase metabolism.
II. weigh the pt iniatialy and ct daily pt shld loose
weight at first then gain later a weight of 0,5 kg a
week.
III. give low fat diet to prevnt weight gain.
IV. give priscrbd thyroid drugs eg thyroxine check
dose so as to increase metabolism.
V. nb pt is obese; alopecia.
2 Body image disturbance.
Interventions
I. give food rich in iodine to promote sythesis of
thyroxine which will increase metabolism.
II. give small frequent meals to promote absorption
of food and reduce excessive weight gain.
III. advice pt to exercise to reduce weight.
IV. pt to eat low fat diet to prvnt exercise gain of
weight.
V. pt shld wear wigs so as to reduce body image.

49
VI. pt shld wear scuffs to cover the necks
qtn difficulty.
RESPIRATORY CONDITIONS
using boylaw descrb mechanism of respiration.
using dawltons law descrbe mechanism of respiration.
descrb nervous control of respiration.
draw diagram of either right lung or left lung.
draw diagram of the respiratory tree.
descrb proccess of external respiration.
discrb the plueral and the plueral cavity.
PART A
QN:-Mrs chipo a teacher is admitted wth asmathtic
attack, describe process of internal respiration.
Predisposing factors for asthma.
Pathophysiology of Asthma.
Part B:- manage the pt using two prioritised nursing
diagnoses.
monitor oxygen saturation using pulse oximetre and
normal shld be 96- 100 percent.
1 Ineffective breathing pattern related to inability to
clear secreations.
Interventions
I. Assess the resp rate, depth and rhythm changes
wc may indicate impending resp distress.
II. Assess pt’s level of anxiety wc may result from
struggle of not being able to breath properly.

50
 III. position pt in a semifolwers position 30-40degres
using a back rest to prmt full lung expansion
therby prmtng breathng pattern.
IV. give prscbd humidified oxygen 4-6 litrs per face
masks per minute to increase oxygen saturation.
V. ct monitorng by assitting doc to collect blood for
aterial blood gasses checking partial pressures of
oxygn (60-110mmhg) and carbon dioxide( 35-
45mmhg).
VI. do lighty chest percussion to mobilise pulmonery
secreations thereby promiting breathing pattern.
VII. give prescrbd anti inflamatory drugs e.g
hydrocortisone 1v 200mg once only to reduce
inflamation therby allowing breathing pattern.
VIII. gv prescrbd brochodilators eg salbutamol
nabulised 1:2 mls prn to dilate the briochioles
therby allowing breathing pattern.
IX. alscultate all lobes of the lungs to check for air
entry and to monitor for any wheezes.
X. advice pt to change postion to allow inflation of all
lobes of the lungs.
XI. if prescrbd sunction the pt to clear secreations
therby clearing the airway.
XII. allow pt to mobilise to allow mobilisation and
drainage of pulmonery secreations.
XIII. monitor using vitals as usual.
XIV. measure lung function using lung spirometry.

51
 XV. teach patient deep breathing exercises to promote
full lung expansion and increase tidal volume.
XVI. monitor signs of reduced circulatory volume e.g
bluish discolouration of mucus membranes if any
advocate to the doc to increase oxygen infusion
rate.
XVII. explain the condition in full plzz e.g asthma is a
chronic airway condition charactersd by airway
hyperesponsvness, airway narrowing brocheo
oedema etc why? so tht pt understand and comply
to the treatment.
2 Knowledge deficiet regarding condition predisposing;
clinical features; management and complications.
Interventions
I. create therapuetic nurse pt relationship based on
trust so that pt will verbalise her feelings and
concerns.
II. explain trigering factors, qn says teacher, so advice
pt that asthma may be triggered by chalk.
III. advice pt to honour review dates for monitoring
effectiveness of drug therapy.
IV. advice pt to avoid trigering factors.
V. teach pt to avoid over the counter drugs eg aspirin
why this may triger asthma.
VI. advice pt on specific side effects of the drug eg
palpitations so that pt does not stop taking the
drug aftr expriencing thoz side effects.

52
VII. advice pt to carry an inhalor when ever travelling
so that she can nabulise if the condition starts.
VIII. refer pt to asthmatic associtiations where she can
be given coping mechanisms.
IX. educate pt about the action of the drug Eg
Salbutamol does not treat the condtion but helps
to dilate the brochioles and relieve symptoms so
that pt does not stop taking the drug whn relieved
of symptoms.
PLZZ SAME QTN:-
3 Mrs chipo a teacher is admitted wth STATUS
ASTHMATICUS.
status asthmaticus is repeated episodes of asthma.
1 Infective breathing pattern nb copy from above.
2 Anxiety related to fear of suffocation.
plzz note this KNOWLEDG DFCT NOW OUT WHY PT
already knows her condition coz it has been repeatng
thank uu.
Nb if qtn says formulate 2 prioritised nursing
diagnoses.
2 Anxiety related to fear of suffocation.
Interventions:-
I. Asses for signs of anxiety- feelings of panic, fear
and uneaseness as asthma can become much
worse with anxiety since it causes rapid shallow
breathing.

53
 II. Provide calm, quiet environment with soft music
to reduce o2 consumption and the wrk of
breathing.
III. Ensure to update significant others to prevent
trsnsfer of their anxiety to the pt.
IV. reassure the pt that everything is done possible to
normalise the condition.
V. explain all procedures to the pt so as to allay
anxiety e.g sunctioning to clear the airway.
VI. explain the use of oxygen e.g to increase oxygen
saturation.
VII. nurse keeps calm and avoid panicking inorder to
allay anxiety.
VIII. involve church ministers for spiritual support
therby allaying anxiety.
IX. offer diverssional therapy e.g newspaper to read
whn condition normalise to allay anxiety.
THYRODECTOMY.
A 25 year old man is admitted for thyredectomy.
part B
describe the post operative managmnt of this patient.
1 risk for fluild volume deficiet related to bleeding.
Interventions
I. monitor the bandage for soaking if soaked apply a
pressure bandage to arrest haemorrhage.
II. ct givng prescribed fluild volume expanders from
theatr e.g ringers lactate fast then 4-6 hourly

54
 checking if cannular is in situ to increase
circulatory fld volume.
III. do strck intake and output by documenting on
fluild balancing chart checkng urine output and
normal shld be 30-60 mls an hour.
IV. monitor for rapid clearing of the throat which may
indicate internal bleeding.
V. monitor for the presents of oedema on the back of
the neck wich may indicate internal bleeding.
VI. monitor for the amount colour and the
consistence of potoavac drain.
VII. do cappilary refil as usual.
VIII. monitor using vitals as usual esp to blood
pressure.
IX. advice pt not to hyperextend the neck as this may
coz gaping of sutures.
X. advice pt on diet to prvnt secondary haemorrdge.
2.Altered comfort pain related to surgical procedure
done
Interventions
I. Assess vrbal and non vrbal reports of pain, noting
location, intensity, (0-10)scale) and duration to
have a base line to wrk from.
II. Keep call bell and frequently nded items within
easy reach to limit streching of muscle strain on
operative area.

55
 III. Maintain head and neck in a neutral pstn and
support during pstn chnges to prvnt stress on the
suture line and reduces muscle tension.
IV. support the neck with sand bags to prvnt flexetion
of the neck wch cozes pain.
V. gradualy elevate the head of the bed to prmote
venous return and reduce oedema which cozes
pain.
VI. diverstnal therapy to prevent pt giving attention to
pain.
VII. give prscbd analgesia eg diclofenac suppositories
100 mg per rectal tds for 5 days so as to reduce
pain.
VIII. monitor using pain intensity scale as usual.
IX. secure the drainage tube to prvnt traction whch
cozes pain.
X. offer ice collar to prmt vasoconstrition and reduce
oedema which cozes pain.
XI. cluster nursing activities as usual.
3. risk for infection related to surgical procedure
done.
Interventions
I. Isolate pt to prvnt infctn.
II. keep the bandage intact as prescrbd to prvnt
entrance of microbes that may coz infection.
III. give prescribd antibiotic prophylaxis e.g
ceftriaxone lg iv od to prvnt infection.
IV. monitor doing 4 hourly vitals esp to temp.
56
 V. assist doc to collect blood to check for white cell
count as usual.
VI. dress using asceptic technique, using prescribd
lotions to prvnt introducing infection.
VII. monitor for discharge if any collect pus wab for
mcs then give antibiotics accrding to mcs results.
NUEROLOGY.
Draw diagram of circle of willis.
draw diagram of the meninges.
drw diagram showing production and flow of csf.
describe production and flow of csf.
diagram of non mylenated neurone.
draw diagram of the lumbr vertebra.
NB is either right lumbar or left.
name the blood vessels that supply the circle of willis.
diagram of the vertebra colum
NEUROLOGICAL CONDITIONS
describe the action potential.
EPILEPSY
Stages of grandmal seizure
Part A
1 Risk for injury
QN:-Ms Ngwenya a house wife is admitted with
epileptic attack. Formulate two prioritised nursing
diagnosis and manage the patient.
compare and contrast grandmal and petitimal seizures.
remove any potentialy harmfull object that may injure
the pt during a seixure.
57
 2 knowledge deficiet regarding the condtion,
predisposing factors, management, as well as
complication.
nurse pt in a cortbed with padded rails to prvnt injury
from falls.
NB Risk for injury is managed in three phases.
1 Risk for injury related to seuzure activity
Before the seuzure.
I. put a pillow underneath the head to prvnt head
injury during a seizure.
II. do not restrain the patient during a seuzure as this
may coz fracture.
III. remove any constrictive clothing , nicklesses, that
may inferer wth blood circulation during a seizure.
IV. give prscrbd antiseizure medication eg diazepam
10 mg iv per fit to reduce seuzure activity.
After seuzure activity.
I. monitor for incontinence.
II. catherterise pt to prvnt urinary incontinence.
III. do not insert anything by mouth during a seuzure
as this may result in fracture jaws
During a seizure
I. inspect for any cynosis if any gv prescrbd
humidified oxygen to increase oxygen saturation.
II. stay with the patient during a seizure recording
duration, parts involved so as to monitor pt from
falls.

58
 III. keep oral airway in situ to promote drainage of
secreations and prevent aspiration.
IV. do haemocheck to rule out hypoglycermia cozed
by overactivity of muscles.
V. offer bed pans to prvnt bowel incontinence.
VI. reorient the patient to self tyme and place to prvnt
risk for injury to self and others cozed by alterd
thought process.
VII. teach pt about predisposing factors eg fire so that
pt can avoid predisposing factors and prvnt further
attack.
VIII. warn the pt about signs of impending attack eg
feeling nausea and vomiting, changing of mood etc
so that pt seeks a safe place.
IX. explain the conditiob that epilepsy is chronic a
condtn cozd by over discharge of impulses from
central nervous system so that pt can undrstand
and cooperate to the management.
2 knowled dfct
Intervetions
I. Ascertain levl of knowledge, including anticipatory
nds to assess readiness to learn.
II. Determine client’s abilty or readness and barriers
to lerning to determine if pt is physically,
emotionally, or mentally capable to learn.
III. Recomend taking of drugs with meals, if
appropriate to reduce incidence of gastric
irritation, nausea and vomiting.
59
 IV. Give printed items about epilepsy for pt to raedy
at own spare time to enhance knowledge.
V. create a therapuetic nurse pt relationship based
on trust so tht pt verbalises her feelings and
concerns.
VI. Advice patient to lie in a lateral position to
promote drainage of secreations therby
preventing aspiration.
VII. advice pt to owner review dates for monitoring
effectiveness of drug therarapy.
VIII. warn the pt that she shld be aware of occurance of
epilepsy during menses due to hormonal
imbalance.
IX. inform the pt about specific side effects e.g
drowsiness so that patient does not stop taking
the drug aftr expriencing such side effects.
X. Familiarise proper use of diazepam rectal gel
Diastat) with pt and care giver as appropriate to
enhance knowledge.
XI. Advice pt to wear identification tag or bracelet
stating the presence of a seizure disorder that
he/she be able to be assisted in case of a seizure.
XII. NB PLZZ IF the qtn says Mrs Chipo a house wife is
admitted wt Status Epilepticus why remove
KNOWLED DEFICIET PLZZZ and put low self esteem
related to feeling of loneliness.
XIII. educate the patient that the drug phenyntoin does
not treat the condition but help to reduce the
60
 incidence of occurrence of seizures activity so that
the pt does not stop takng the drug well feeling
well.
XIV. NB manage as the following.
XV. refer pt to epileptic assosiations wher pt can be
given coping mechanism.
XVI. if the patient is on combined oral contraceptves
warn her about drug interaction with phenyntoin
so that she can if possible change family planning
method.
XVII. advice pt to do brain CT SCAN this may help to
determine or indentfy some cozes of epilepsy such
as tumours.
XVIII. create a therapuetic nurse patient relation ship
based on trust so that pt verbalises her feelings
and concerns.
XIX. advice pt that with proper compliance the risk of
sezure occurance is reduced.
CEBRO VASCULAL ACCIDENT (CVA)
A 50 year Old man is admitted with hemiparesis from
CVA.
Part A
diagram of the circle of willis.
PART B
describe the nursing management of this patient using
the following nursing diagnoses.
Describe the blood vessels that supply the circle of
willis.
61
 1 impaired physical mobility related to paralysis.
Interventions
I. offer a foot board to prvnt foot drop which will
reduce mobility.
II. do passive exercises and encourage pt to do active
exercises on the unaffected side to promote
muscle tone and promote blood circulation.
III. give prescribed anticoagulant eg clexane 20 -40 mg
subcut bd to prvt dvt which reduces mobility.
IV. put patients belongings closer to the pt’s locker to
promote independence as well as mobility.
V. involve physiotherapist who will teach the patient
excersises.
VI. do chest physiotherapy to prevent aspiration
pnuemonia which will delay mobility.
VII. teach patient occupational therapy e.g bathing the
face using the hands to promote mobility.
VIII. 2 hourly change of position to prvent development
of pressure sore which will delay mobility.
IX. give patient assistive devices for example
wheelchair to promote mobility.
2 Alterd thought process related to reduced brain
perfusion.
Interventions
I. do not argue with the pt but speak the truth to
promote reorientation.
II. reorient pt to time, place and self for the pt to gain
thought process.
62
 III. create a therapeutic nurse patient relationship so
that patient will verbalise her feelings and
concerns.
IV. nurse patient in a room wth a window so that pt
can distinquish btwn day and night this will
improve thought process.
V. involve physhologist for counselling therby
increasing thought procces.
VI. involve significant others for pyschological thereby
promoting thought process.
VII. encourage relatives to visit the patient to promote
socialisation as well as reorientation.
NB IF THE STERM SAYS QUDRIPLEGIA ie paralysisi of
both limbs u formulate
self care deficit related to quadriplegia.
nurse does the following:-
I. 2 hourly change of position to prvnt developmt of
pressure sores.
II. insert a nasogastric tube to feed the the pt and
prvnt aspiriation.
III. cartherterise the pt to promote urinery
elimination.
IV. do passive exercise to prmote circulation and
prvnt contractures.
V. position pt in a lateral position to promote
drainage of secreations and prvnt aspiration.

63
VI. do chest physiotherapy e.g percussion to mobilise
pulmonary secreations and reduce complications
suchs as aspiration pneumonia.
VII. offer bed pans to promote bowel elimination.
Ineffective Cerebral tissue perfusion related to
interruption of blood flow: occlusive disorder,
haemorrhage, cerebral vaso- spasm, cerebral edema
evidenced by altered level of consciousness.
Goal: Patient to demonstrate stable vital signs and
abscence of signs of ICP.
Interventions
I. Assess factors related to individual situation for
decreased cerebral perfusion and potential for
increased ICP to have the correct choice of
interventions
II. Closely assess and monitor neurological status
frequently and compare with baseline to note any
signs of impending thrombotic CVA.
III. Monitor vital signs in blood pressure; compare Bp
readings in both arms to note any fluctuations in
pressure which may occur becoz of cerebral injury
in vasomotor area of the brain.
IV. Monitor heart rate and rhythm, assess for murmus
to note any brain damage or cardiac dzz which
may have caused by CVA.
V. Monitor respirations noting patterns and rhythm
to check for irregularities wc may indicate ICP and

64
 need for further interventions including possible
respiratory support.
VI. Evaluate pupils noting size, shape, equality, light
reactivity to determine if the brain sterm is intact.
VII. Document changes in vision, reports of blurred
vision, alterations in visual field, depth pereception
to note area of brain involved for good choice of
interventions.
VIII. Administer supplemental oxygen as indicated to
reduce hypoxia wc can cause cerebral vasodilation
and increase pressure or edema.
IX. Administer anticoagulants as prescribed (warfarin
sodium) to improve cerebral blood.
X. Stool softeners to prevent straining during bowel
mvt wc may cause ICP.
XI. Assess for nuchal rigity, twitching, increased
restlessness, irritability, onset of seizure activity to
note if there is increased ICP or cerebral injury
requiring further evaluation and interventions.
XII. Maintain bed rest, provide quite and relaxing
environment, restrict visitors and activities to
reduce ICP.
XIII. POSITION Bed slightly elevated and in neutral
position to promote venous drainage and improve
cerebral perfusion.
XIV. Assess higher functions, including speech, if
patient now alert to note location and degree of

65
 cerebral involvement wc may indicate
deterioration or ICP.
XV. Monitor for presents of secretions which may
cause impairement of cerebral tissue perfusion.
Other nursing diagnoses Neurology
I. Impaired physical mobility r/t perceptual or
cognitive impairement evidenced by limited range
of motion.
II. Impaired verbal communication.
III. Ineffective coping.
IV. Disturbed sensory perception.
V. Self-cre deficit.
VI. Risk for impaired swallowing.
VII. Activity intolerance.
SPINAL CORD INJURIES.
A 24 yer old boy is admitted with paraplegia following a
road traffic accident.
PART A
descrbe the clinical features he will present with.
clinical features of spinal cord injury depend on the
level of injury.
difficulties in breathing due to interferance wth nerves
that supply the diaphragm.
bowel incontinence due to interference wth nerves
that supply the Git.
urinary incontinence due to interference with nerves
that supply the bladder.

66
 loss of function in the lower limbs due to interference
wth nerve supply to the lower limbs.
decreased sensation in the lower limbs due to reduced
nerve supply to the lower limbs.
formulate 2 nursing diagnosis and manage the pt.
1 lmpaired physical mobility related to paralysis.
Interventions
I. do passive exercises and encourage pt to do active
exercises to promote mobility.
II. give prescrbd anticoagulant e.g clexane 20-40 mg
subcut to prvnt dvt thereby promoting mobility.
III. use of a monkey chain to strengthen the muscles
of the spine therby promoting mobility.
IV. offer a footboard to prvnt foot drop therby
promoting mobility.
V. 2 hourly change of position to prvnt develpmnt of
pressure sores which will delay mobility.
VI. put patient belongings close to the pt to promote
individualism as well as mobility.
VII. use a lumbar brace to support the spine and prvnt
twisting therby promoting mobility.
VIII. log roll the pat using two nurses when turning to
prvnt twisting of the spine thereby promoting
mobility.
URINARY INCONTINENCE
2 impaired bowel and urinary incontinence.
Interventions

67
 I. Assess the pt’s pattern of elimination to serve as a
basis for determining appropriate interventions.
II. Note the pt’s age and gender to note if the
incontinence might be due to old age.
III. cartherterise the pt to promote urinary
elimination.
IV. give plenty of oral fluilds 2-3 litrs a day to promote
urinary elimination.
V. do 4 hourly blader training exercises to promote
urinary elimination.
VI. palpate the blader for fullnes to prvnt urinery
retention therby promoting urinery elimination.
VII. open a nearby tape to promote urinary
elimination.
BOWEL ELIMINATION
Interventions
I. give high fibre diet to prvent constipation therby
promoting bowel elimination.
II. do 4 hourly bowel training exercise to promote
bowel elimination.
III. if patient is consispated do bimanual evacuation of
stool to promote bowel elimination.
IV. encourage pt to do exercises to promote
peristalsis thereby promoting elimination.
V. offer a commode to reduce constipation therby
promoting bowel elimination.
MENENGITIS.
A 25 yr old Man is admitted with bacterial meningitis.
68
 Part A
describe production and flow of cerebospinal fluild.
draw and desrcibe the meninges.
Part B
formulate 2 prioritised nursing diagnosis and manage
the patient.
1 Alterd cmfort pain related to inflamatory procces.
Interventions
I. gv patient bed rest to minimise movement that
aggravates pain.
II. Prevent stimulation and restrict visitors to reduce
intracranial pressure wc increases pain.
III. Control environment to encourage rest to reduce
pain.
IV. give prescrbd anti inflamatory drugs e.g diclofenac
75mg im tds to reduce inflamation and pain.
V. monitor using pain internisty scale as usual.
VI. clustering of nursing activities for example after
giving patient food give the drug to allow pt tyme
to rest thereby minimising pain.
VII. gradualy elevate the bed 35-45 degres using a
back rest to promote venous return and reduce
oedema which cozes pain.
VIII. nurse patient in a dim lighty to prvnt photophobia
that causes pain.
IX. give prescrbd antibiotics e.g chloraphenicol 500mg
iv bd 7 days to treat infection therby reducing
inflamation that cozs pain.
69
 2 Alterd cerbral tissue perfusion related to increased
intracranial pressure.
Interventions
I. give prescrbd humidified oxygen 4-6 litres per face
mask per minute to prmote cerebral tissue
oxygenation.
II. give prescrbd osmotic diuretic e.g mannitol course
300 mg stat then 100 mg tds ; 100 bd, 100mg od,
to reduce oedema therby promoting cerebral
tissue perfusion.
III. give prescrbed stool softerners e.g liquid parraffin
10-20 mls po to prvnt straining of defaecation
which increases icp and reduce cebral tissue
perfusion.
IV. give prescibed cough syrup e.g soflex 10 -20 mls
po to suppres cough reflex which increase icp and
affect cebral tissue perfusion.
V. nurse to prvnt suddern arousal of the the pat as
this increases icp and affect cerebral tissue
perfusion.
VI. nurse patient with head and neck in alignment to
promote venous return and reduce icp and
oedema therby promoting cerebral tissue
perfusion.
VII. assist doc to collect blood for arterial blood gases
checkng partial pressures of carbon dioxide(35-
45mmhg) and partial pressur of oxygen(60-
110mmhg) of which increase in partial pressure of
70
 carbn dioxide increases blood flow to the brain
and increases icp thus affecting cerbral tissue
perfusion.
VIII. ct monitoring using glassgocoma scale mention
ranges.
plzz note factors that increase and affect cebral
tissue perfusion also coz pain balance yr points.
THYRODECTOMY
part B
A 25 year old man is admitted for thyredectomy.
1 risk for fluild volume deficiet related to bleeding.
describe the post operative managmnt of this patient.
Interventions
I. monitor the bandage for soaking if soaked apply a
pressure bandage to arrest haemorrhage.
II. ct givng prescribed fluild volume expanders from
theatre e.g ringers lactate fast then 4-6 hourly
checking if cannular is in situ to increase
circulatory fld volume.
III. do strck intake and output by documenting on
fluild balancing chart checkng urine output and
normal shld be 30-60 mls an hour.
IV. monitor for rapid clearing of the throat which may
indicate internal bleeding.
V. monitor for the presents of oedema on the back of
the neck wich may indicate internal bleeding.
VI. monitor for the amount colour and the
consistence of potoavac drain.
71
VII. monitor using vitals as usual esp to blood
pressure.
VIII. do cappillary refil as usual.
IX. advice pt not to hyperextend the neck as this may
coz gaping of sutures.
X. support the neck with sand bags to prvnt flexetion
of the neck wch cozes pain.
2. Altered comfort pain related to surgical procedure
done.
Interventions
I. advice pt on diet to prvnt secondary haemorrdge.
II. monitor using pain intensity scale as usual.
III. give prscbd analgesia eg diclofenac suppositories
100 mg per retal tds for 5 days so as to reduce
pain.
IV. secure the drainage tube to prvn traction whch
cozes pain.
V. gradualy elevate the head of the bed to prmote
venous return and reduce oedema which cozes
pain.
VI. offer ice collar to prmt vasoconstrition and reduce
oedema which cozes pain. cluster nursing activities
as usual.
VII. monitor doing 4 hourly vitals esp to temp.
VIII. keep the bandage intact as prescrbd to prvnt
entrance of microbes that may coz infection.
IX. give prescribd antibiotic prophylaxis e.g
ceftriaxone lg iv od to prvnt infection.
72
3 risk for infection related to surgical procedure done.
assit doc to collect blood to check for white cell count
as usual
AMPUTATIONS.
QN:-A 27 year old bus driver is admitted with crush
injuries from RTA and is for below knee Amputation.
diagram of the snovial joint.
drescrb the snovial joint.
Part A
drw and describe a femur.
indications of amputations.
Formulate three post op nursing diagnosis and manage
the pt.
1 Alterde comfort pain (phantom) related to surgical
procedure done.
2 Impaired physical mobility related to surgical
procedure done.
INDICATIONS OF AMPUTATIONS
bone cancers eg osteosarcoma.
peripheral vascular dizz which lead to ischemia, death
of tissues.
gas gangere.
chronic osteomylities whch failed to respond to
antibiotics.
flail limb with no function.
1 altered comfort pain.
Interventions

73
 I. gv prescbd nacotic analgesia e.g pethidine1mg per
kg body weighty up to 100mg 6hourly to block
pain perception.
II. gv pt complt bed rest to reduce mvmt that coz
pain.
III. elevate the residual limb using a pillow to promote
venous return and reduce oedema which cozes
pain.
IV. allow pt to touch and feel the stumb so that pt can
accept that the limb has been removed.
V. offer a bed craddle to prvnt linen from putting
pressure on the residual limb so as to prvnt pain.
VI. secure the drainage tube so as to prvnt traction
which cozes pain.
VII. support the residual limb using sand bag so as to
prvnt muscle spasm which cozs pain.
VIII. advice patient to report tighteness of sutures and
report to the doc as this cozs pain.
IX. monitor using pain intensity scale as usual.
X. cluster nursing activities eg aftr bathing u dress the
pat to giv pt time to rest therby reducing movmt
that agravates pain.
XI. inspect for haematoma formation on the residual
limb as haematoma cozs pain inform doc for
evacuation of haematoma.
XII. massage the residual limb if prescrbd to allow
mobilisation of oedema therby reducing pain.

74
XIII. give prescrbd antispasmodic eg diazapum 5-10mg
im od to reduce muscle spasms that cozes pain.
XIV. Offer diversional therapy e.g giv pt newspaper to
read so as to divert mind thereby managing
physchological pain.
2 Impaired phsyical mobility
Interventions.
I. aftr removal of the bandage dress in a conical
shape to allow fittness of prosthesisi therby
prmotng mobility.
II. use of monkey chain to excersise the muscles
therby promoting mobility.
III. gv prscrbd anticoagulant e.g clexane 20-40mg od
to pvnt deep vein thrombosis therby promotng
mobility.
IV. offer assistive devices e.g wheel chair to promote
mobility.
V. allow the patient to lie wth the stomach after 24
hours to pvnt flexition and rotation deformity
therby promoting mobility.
VI. high protein diet to promote healing therby
promoting mobility.
VII. patient locker close to the patient to
independence and mobility.
VIII. 2 hourly change of position to prvnt pressure sores
therby
promoting mobility.

75
 IX. do passive and encourage pt to do active exercise
to promote muscle tone thereby promoting
mobility.
X. support the residual limb together with other limb
to prvnt abduction deformity therby promoting
mobility.
3. Body image disturbance.
Interventions
I. advice the pt that he/she can still drive to relieve
anxiety and grieving whch affect body image.
II. allow the pt to pass thr grivieng process for
maximum acceptance.
III. create a therapuetic nurse pt relationship based
on trust so that pt verbalise his feelings and
concerns.
IV. involve significant others e.g wife and counsel the
significant others so that she will speak positvly to
the patient.
V. counsel patient on use of prosthesis to cover for
the residual limb.
VI. refer patient to grief support groups e.g NASSA
where he will be taught coping mechanism.
VII. patient to wear long trousers to cover
disfigurement
Qn
A 25yr is old man is admitted with cholecystitis and is
going for cholecystectomy
CHOLECYSTECTOMY
76
 dscb production and flow of bile.
draw diagram of the billiary tree.
manage the the pt using three nursing diagnosis post
opp.
1 Altred cmfort pain related to surgical procedure
done.
Interventions
I. position pt on lateral position on affected side to
prvnt pressur which causes a pain.
II. secure the drainage tubes using a safety pin to
prevent traction.
which cozes tension on the suture line.
III. advice pt to splint the incision using a pillow to
prvnt tension on the incsion line whch coz pain.
IV. gv prescrbd analgelsia eg diclofenac suppositories
100mg bd per rectal 5 days to reduce pain.
V. clustering of nursing activities eg aftr feeding the
patient give drug to allow pt tym to rest therby
prvnt pain stimulation.
VI. monitor using pain intensity scale as usual.
advice pt to report tightness of sutures which cozs
pain if tight.
VII. inform doctor for reloosening of sutures.
VIII. offer a bed craddle to lift up linen to prevent
pressure of linen which might coz pain.
IX. encourage ealy mobilisation to promote peristalsis
and reduce flatus that cozs gas pain.

77
 X. aftr alscultation for bowel sounds gv prescrbd
stools softerners e.g liquid paraffin 10 -20mls to
prvnt straining on defacaetion which increases
pressure therby cozing pain.
XI. offer diversional therapy as usual.
2 Risk for infection related to surgical procedure done.
Interventions
I. keep the bandage intact to prvnt entrance of
microbes that may coz infection.
II. after removal of bandage dress using acceptic
technique using prescrbd lotion e.g povidone
iodine to prvnt infection during dressing monitor fr
any discharge then collect puss swab for mcs then
give antibiotics accrding to mcs results.
III. give prescrbd antibiotic prophylaxis e.g ceftriaxone
1g iv od x 5days to prvnt infection.
IV. aftr removal of cartheter take catherter tip for mcs
and give antibiotics according to mcs results.
V. ct monitoring doing 4 hly vital observations espcl
to temp of which temp above 37,2 may indicate
infection.
VI. do cathertor care 4 hrly to prvnt risk of accending
infection.
VII. ct monitoring by assitng doc to collect blood for
white cell count as usual.
VIII. give high protein diet which help in the synthesis
of white cell which helps to fight infection.

78
 3 risk for impared skin interigrity related to leakage of
bile and also presence of T TUBE.
Interventions
I. advice pt to scratch using nuckles to prvnt skin
breaking.
II. apply vaselline on the skin around the drains to
prvnt dryness which predesposes the skin to
break.
III. monitor the skin around the the drain for any
rashes changes in colour e.g redness which may
predespose it to breaking down.
IV. cut pt nails to prvnt scratching that breaks the
intetgrty of the skin.
V. monitor for leakage of bile on the skin around the
drain that may cause skin irritation.
VI. position drainage bottle close to the patient to
prevnt traction and kinking that coz the skin to
break.
VII. gv prescbrd antihistamine eg chopherinamine 4
mg po tds to prvnt itching caused by leaking bile.
VIII. apply calamine lotion on the skin around the drain
to prvnt itchnes cozed by leakage of bile that my
result in scratching and affecting skin intergrty.
IX. blood for white cell count.
SURGERY
A 5 year old boy is admitted with tosnsilities and is
going for tonsilectomy
Tonsilectomy
79
 indications for tonsillectomy.
descrbe the function and structure of the tonsils.
describe the subjective and objective data elicit from
the patient
PART B
describe the post opp magmnt using the followng
nursing diagnosis.
nurse does the following:-
1 risk for fluild volum deficiet related to surgical
procedure done.
nb no incision is made, procedure is done via the
mouth.
Interventions
I. ct givng prescbd fluid vlm expanders from theatr
eg l litre ringers fast then 4-6 hourly to increase
circulatory fluild vlm.
II. lie patient in lateral position to allow drainage of
secreations of which bright red secreation indicate
patient is bleeding.
III. monitor for rapind clearing of the throat which
may indicate internal bleeding.
IV. monitor for the presents of oedema on the back of
the neck which may indicate internal bleeding.
V. do cappillary refill as usual.
VI. monitor signs of reduced cerculatory fluild volume
eg cold camy skin etc.
VII. when patient can tolerate oral fluilds give plenty of
oral fluilds to increase circulatory fluild volm.
80
 2. ineffective airway clearance related to inability to
clear secreations.
Interventions
I. position patient in a lateral position to allow
drainage of secreations and keep airway patent.
II. gradualy elevate the head of the bed for full lung
expansion therby promoting breathng patern.
III. give prescrbd humidified oxygen 2-4 litres per face
mask per minute to promote breathing pattern.
IV. monitor oxygen saturation as usual using pulse
oximetry.
V. if prescribed u can sunction to clear secreations.
VI. Aterial blood gases.
VII. auscultate to check for air entry in all lobes of the
lung.
VIII. postion patient near an open window for full
airation and oxygenation.
IX. monitor vital observation special consideration to
respiration as usual.
X. monitor for signs of reduced oxygen supply e.g
cynanosis etc
nb the examiner may ask u the following.
Alterd comfort pain related to surgical procedure done.
Interventions
I. care giver to stay with the child to minimise crying
wth causes pain.
II. give pt complete bed rest to minimise pain
perception.
81
 III. apply an ice collar to promote vasoconstrition and
reduce oedema which causes pain.
IV. gradualy elevate the head of the bed to promote
vasoconstriction and reduce oedema which causes
pain.
V. do not give spicy food to prvnt throat irritation
which causes pain.
VI. give prescribed minor analgesia e.g paracetamol
250 iv tds x 5 days to reduce pain perception.
VII. give soft diet to minimise swallowing therby
reducing pain perception.
VIII. give diversional therapy e.g toys to play with
therby reducing pain perception.
2 Altered nutrition related to inability to swallow.
I. nb patient does not have swallowing reflex
initially.
II. give parentral fluilds e.g half DD to give energy to
the patient.
III. weigh initially then continue daily using same scale
and light clothes expecting patient to have a
weight gain of 0,5kg per week then start feeding
using liguid diet for easy swallowing then followed
by soft food etc.
IV. small frequent meals to promote appetite.
V. oral care bfr and after meals to stimulate taste
buds therby boosting appetite.
VI. modify environment e.g removing bed pans urinals
etc not to disturb pt’s appertite for food.
82
VII. depending wth age if breasting age advice care
giver to continue breastfeeding to promte good
nutritional status.
VIII. Give pt’s favorate food to promte good ntritnal
status.
Thyredectomy.
A 25 year Old boy is admitted wth toxic nodular goitre
and is going for thyredectomy
PART A
draw diagram of the thyroid gland.
functions of the thyroid hormones.
draw the negative feed back mechanism secreation of
thyroxine.
functions of the thyroid gland.
indications for thyredectomy.
anatomy of the throid gland.
PART B.
descrb the post opp management using the following
nursing diagnosis.
1 risk for fluild volm deficiet related to post opp done.
Interventions
I. chck bandage for soaking if soaked apply a
pressure bandage to minimise further blood loss.
II. Monitor input and out put to assess fluid volume
circulation and kidney function.
III. ct gving fluilds from theatre as usual.
IV. monitor for rapid clearing of the throat which may
indicate internal bleeding.
83
 V. encourage plenty oral flds if pt can tolerate to
maintain good fluid circulation.
VI. monitor for the presents of oedema on the back of
the neck which may indicate internal bleeding.
VII. apply an ice collar to promote vasconstrition
therby minimising further blood loose.
VIII. patient not to hyperextend the neck to prvnt
gaping of sutures which may coz internal bleeding.
IX. do cappilary refill as usual.
X. do vitals as usual1/1 hourly half hourly etc
nb patient has potovac drain.
XI. monitor signs of reduced circulatory volume as
usual.
XII. monitor colour amount and the consistency of
drainage bottle.
XIII. Fbc to monitor hb level if less than.... transfuse
with whole blood to improve fld volume
circulation.
2 Altered comfort pain related to surgical procedure
done eg oedema on the back of the neck.
nb points to manage fluild can be used to manage pain.
Interventions
I. patient not to hypextend the neck.
II. give prescrbd minor anagesia paracetamol 1g iv
tds to relieve pain.
III. secure drainage tube to prvnt kinking which cozes
pain.
IV. monitor using pain intensity scale as usual.
84
 V. cluster nursing activities as usual.
VI. copy to tonsillectomy.
nb PLZZ HOME MANAGE risk for injury post opp.
Trasnsurethral prostactectomy.
A 60 year old man is admitted wth benign prostatic
hyperplasia and is going for transurethral
prostactectomy.
PartA
types of prostactectomy.
male reproductive system diagram.
clinical features of benign prostactectomy.
PART B
using two specific nursing diagnosis manage the
patient post opp
1 Altered urinary elimination related to presents of the
catherter.
Interventions
I. ct prescrbd flvd vlm exapanders from theatr to
promote urinary elimination.
II. ct bladder irrigation to flash out clots therby
promoting urinary elimination.
III. position the urine bag below the level of the
patient to promote gravitational drainage of urine
therby promoting urinary elimination.
IV. monitor for the patency of urine tube to promote
urine elimination.
V. milk the cartherter to promote urinery
elimination.
85
 VI. after removal of the cartherter open a nearby tape
to promote urinary elimination.
VII. if the patient can tolerate give plenty of oral fluilds
2-3 litres a day to promote urinery elimination.
VIII. do 4 hourly bladder training exercises to promote
urinary elimination.
IX. palpate bladder for fullness to rule out urine
retention.
X. encourage patient to mobilise to promote full
bladder emptying as the patient will assume a
normal position which allows bladder emptying.
2 risk for infection related to surgical procedure done
and also presents of the carthertor.
Interventions
I. give prescbd antibiotics eg ciprofloxaccillin 500 mg
bd for 7 days to pvnt infection.
II. do 4hourly cartherter care using prescribed lotions
to prevent infection.
III. monitor using vitals as usual esp to temperature.
IV. ct monitoring by assiting doc to collect blood for
white cell count as usual.
V. collect urine for MCS then give antiobics according
to mcs results.
VI. give high protein diet to promote sythesis of
antibodies which will help to curb infection.
Qn:-A newly born baby was diagnosed with pyloric
stenosis. Describe the pre-op care using 3
prioritised nursing diagnosis.
86
1 fluild vlm deficiet related to vomiting.
2 risk for injury related to pending surgery.
3 anxiety care giver.
Tonsilectomy
A 5 year old boy is admitted with tosnsilitis and is going
for tonsillectomy.
PART A.
indications for tonsillectomy.
descrbe the function and structure of the tonsils.
describe the subjective and objective data ,elicit from
the patient.
PART B.
describe the post opp magmnt using the followng
nursing diagnosis.
1 risk for fluild volum deficit related to surgical
procedure done.
Interventions
nb no incision is made, procedure is done via the
mouth.
I. ct givng prescbd fluid vlm expanders from theatr
e.g l litre ringers lactate fast then 4-6 hourly to
increase circulatory fluild vlm.
II. lie patient in a lateral position to allow drainage of
secreations of which bright red secreation indicate
patient is bleeding.
III. monitor for rapind clearing of the throat which
may indicate internal bleeding.

87
 IV. monitor for the presents of oedema on the back of
the neck which may indicate internal bleeding.
V. do cappillary refill as usual.
VI. monitor signs of reduced circulatory fluild volume
e.g cold calmy skin etc.
VII. when patient can tolerate oral fluilds give plenty of
oral fluilds to increase circulatory fluild volm.
2 ineffective airway clearance related to inability to
clear secreations.
Interventions
I. position patient in a lateral position to allow
drainage of secreations and keep airway patent.
II. gradually elevate the head of the bed for full lung
expansion thereby promoting breathng patern.
III. give prescrbd humidified oxygen 2-4 litres per face
mask per minute to promote breathing pattern.
IV. monitor oxygen saturation as usual using pulse
oximetry to give more oxygen when there is need.
V. monitor aterial blood gases.
VI. if prescribed u can sunction to clear secreations.
VII. auscultate to check for air entry in all lobes of the
lung.
VIII. postion patient near an open window for full
airation and oxygenation.
IX. Encourage change of pstions to allow flation of all
lung lobes.
X. monitor vital observations especial consideration
to respiration as usual.
88
 XI. monitor for signs of reduced oxygen supply e.g
cynanosis etc.
Nb examner may ask u the following:-
Alterd comfort pain related to surgical procedure done
Interventions
I. give pt complete bed rest to minimise pain
perception.
II. care giver to stay with the child to minimise crying
which causes pain.
III. apply an ice collar to promote vasoconstrition and
reduce oedema which causes pain.
IV. gradualy elevate the head of the bed to promote
vasoconstriction and reduce oedema which causes
pain.
V. do not give spicy food to prvnt throat irritation
which causes pain.
VI. give prescribed minor analgesia eg paracetamol
250mg iv tds 5 days to reduce pain perception.
VII. give diversional therapy e.g toys to play with,
therby reducing pain perception.
VIII. give soft diet to minimise swallowing therby
reducing pain perception.
2 Altered nutrition related to inability to swallow.
nb patient does not have swallowing reflex initially.
I. give parentral fluilds e.g half DD to give energy to
the patient.

89
 II. weigh pt initialy then continue daily using same
scale and light clothes expecting patient to have a
weight gain of ?plz ask.
III. then start feeding using liguid diet for easy
swallowing then followed by soft food etc.
IV. small frequent meals to promote appetiete.
V. oral care bfr and after meals to stimulate taste
buds therby boosting appetite.
VI. modify environment e.g removing bed pans urinals
etc to promote appertite.
VII. depending wth age if breasting age advice care
giver to continue breastfeeding.
Thyrodectomy
A 25 year Old boy is admitted wth toxic nodular goitre
and is going for thyredectomy.
PART A
draw diagram of the thyroid gland.
functions of the thyroid hormones.
draw the negative feed back mechanism secreation of
thyroxine.
functions of the thyroid gland.
anatomy of the throid gland.
indications for thyredectomy.
PART B.
descrbe the post opp management using the following
nursing diagnosis.
1 risk for fluild volm deficiet related to post opp done.
Interventions
90
 I. chck bandage for soaking if soaked apply a
pressure bandage to minimise further blood loss.
II. ct gving fluilds from theatre as usual.
III. monitor for rapid clearing of the throat which may
indicate internal bleeding.
IV. monitor for the presents of oedema on the back of
the neck which may indicate internal bleeding.
V. apply an ice collar to promote vasconstrition
therby minimising further blood loose.
VI. patient not to hyperextend the neck to prvnt
gaping of sutures which may coz internal bleeding.
VII. do cappilary refill as usual.
VIII. do vitals as usual1/1 hourly half hourly etc
monitor signs of reduced circulatory volume as
usual.
nb patient has potovac drain, so monitor colour
amount and the consistency of drainage bottle.
2 Altered comfort pain related to surgical procedure
done.
nb points to manage fluild can be used to manage pain,
eg oedema on the back of the neck.
Interventions
I. patient not to hyperextend the neck.
II. secure drainage tube to prvnt kinking which cozes
pain.
III. give prescrbd minor anagesia e.g paracetamol 1g
iv tds to relieve pain.
IV. cluster nursing activities as usual.
91
 V. monitor using pain intensity scale as usual.
VI. 3 breathing u copy to tonsilectomy
nb PLZZ HOME MANAGE risk for injury post opp.
Trasnsurethral prostactectomy.
A 60 year old man is admitted wth benign prostatic
hyperplasia and is going for transurethral
prostactectomy
PartA.
types of prostactectomy
clinical features of benign prostate.
male reproductive system diagram.
PART B.
using two specific nursing diagnosis manage the
patient post opp.
1 Altered urinery elimination related to presents of the
catherter.
Interventions
I. ct prescrbd flvd vlm exapanders from theatre to
promote urinary elimination.
II. ct bladder irrigation to flash out clots therby
promoting urinary elimination.
III. position the urine bag below the level of the
patient to promote gravitational drainage of urine
therby promoting urinery elimination.
IV. monitor for the patency of urine tube to promote
urine elimination.
V. milk the cartherter to promote urinery
elimination.
92
 VI. if the patient can tolerate give plenty of oral fluilds
2-3 litres a day to promote urinery elimination.
VII. after removal of the cartheter open a nearby tape
to promote urinery elimination.
VIII. do 4 hourly bladder training exercises to promote
urinary elimination.
IX. palpate bladder for fullness to rule out urine
retention.
X. encourage pt to mobilise to promote full bladder
emptying as the patient will assume a normal
position which allows bladder emptying.
2 risk for infection related to surgical procedure done
and also presents of the cartherter.
Interventions
I. give prescbd antibiotics e.g ciprofloxaccillin 500
mg bd for 7 days to pvnt infection.
II. Do 4hourly cartherter care using prescribed lotions
to prevent infection.
III. monitor using vitals as usual esp to temperature to
note persistent elevation which may mean
presence of infection.
IV. ct monitoring by assiting doc to collect blood for
white cell count as usual.
V. collect urine for MCS then give antiobics according
to mcs results.
VI. give high protein diet to promote sythesis of
antibodies which will help to curb infection.

93
 Mastectomy
A 25 year old woman is admitted with cancer of the
right breast and is going for radical mastectomy.
PART A
Types of mastectomy.
staging of breast cancer.
Give us specific objective data which lead us to
diagnosis of breast cancer.
give us subjective and objective data u elicit from this
patient.
diagram of the breast.
Part B
descrb the post op of pt using two/three prioritised
nursing diagnosis.
1Altered comfort pain (phanton) related to surgical
procedure done.
In terventions
I. position pt on unaffected side that is left lateral to
minimise pain stimulation.
II. give prescrbd narcotic analgesia ie pethidine as
usual.
III. offer a bed cradle to lift up linen theby prvnting
pain stimulation.
IV. advice patient to splint the incision as usual to
prvnt pain stimulation.
V. allow the patient to touch and feel the incision site
for maximum acceptance.

94
 VI. elevate the affected arm above the level of the
heart to promote venous return therby reducing
oedema whch cozes pain.
VII. secure the drainage tube to prvnt traction which
causes pain.
VIII. advice patient to report tighness of sutures which
cozs pain.
IX. advice patient to get out of the bed using
unaffected side.
X. teach patient mastectomy exercises e.g rope
turning to reduce odema which cozes pain.
XI. clustering of nursing activities as usual.
XII. monitor for hematoma formation on the incision
site as hematoma cozes pain.
XIII. do not collect blood or do blood pressure on the
affected arm to minimise pain perception.
XIV. if prescrbd massage the affected arm to promote
mobilisation of oedema which causes pain.
2 risk for fluild vlm deficiet related to surgical
procedure done.
nb this may not be priority why procedure is done as
an out patient and patient may be discharged after the
procedure.
Interventions
I. monitor for soaking of bandage if soaked apply a
pressure bandage to arrest haemorrage and
inform the doc.

95
 II. ct wth prescbd flvd volume expanders from
theatre eg ringers lactate fast then 4-6 hourly
checkng if cannular is in situ to increase circulatory
fld vlme.
III. do strick intake and output by documenting on fld
balancing chart checking urine input and urine
output shld be 30-60 mls an hour.
IV. do cappilary refill by pressing on a finger nail bed
for 30 seconds and normal shld return to pink
colour in 3 seconds.
V. do vitals as usual 1/4 hly ; 1/2 hly 1hly then 4 hly
that is bp , temp , resp , pulse with special
consideration to blood prssure of which bp blw
90/60mmhg indicate reduced circulatory fluid vlm.
VI. monitor signs of reduced circulatory vlm as usual.
VII. NB if pt had potto ovac drain, record the amount
colour and consistency of filling of the pottovac
drain.
VIII. if pt can tolerate give plenty of oral fluilds that is 2-
3 litres a day to increase circulatory fluild vlm.
3 grieving related to loss of body part or body image
disturbance related to loss of body part.
NB these 2 nursing diagnoses usualy work hand in
hand i.e grieving is related to body image disturbance
secondary to loss of body part then someone wth body
image disturbance is grieving.
nurse does the following:-

96
 I. create a therapuetic nurse patient relationship
based on trust so that pt verbalie his feelings and
concerns.
II. allow pt to pass thru grieving procces for maximan
acceptance.
III. explain the reason for the procedure that it is
done to prvnt mertastasis for maximum
acceptance.
IV. allow patient to touch and feel the removed breast
for maximum acceptance.
V. refer patient to mastectomy associations wher pt
is given coping mechanisms.
VI. counsel pt on breast reconstraction surgeries why
to cover for the disfiguremnt (body image
disturbance).
VII. wear lose fitting clothes to cover for the
disfigurement (body imge disturbnce).
VIII. involve significant others for physchological
support (grieving).
IX. refer patient to grief support groups for
psychological support.
qn:-give us two specific nursing diagnosis for this
patient
1 body image disturbance related to loss of body part
(nb u manage as above)
2 Impaired physical mobility of the affected arm(nb pt
have lymh oedema on the arm she can not mobilise
the arm).
97
 3 Alterd comfort pain (u manage as above.
NB LET ME MANAGE IMPAIRED PHYSICAL MOBILITY
FOR U
Impaired physical mobility related to lymh oedema of
the affected arm.
I. Interventions.
elevate the affected arm above the level of heart
to promote venous return and reduce oedema
thereby promoting mobility.
II. do mastectomy exercise to reduce oedema therby
promoting mobility.
III. massage the affected arm to promote mobilisation
of oedema thereby promoting mobility.
IV. advice pt to do minor activities wth the affected
arm e.g bathing the face to promote mobility of
the arm.
CATARACT
Qn
A 60 yr old man is admitted for cataract extraction
PARTA:-draw cross section of the eye.
describe anatomy of the lens.
describe physiology of sight.
describe production and flow of acqueous humour.
PART B:- Using 3 prioritised nursing diagnosis manage
this pt post opp.
1 Alterd comfort pain related to surgical procedure
done
Interventions
98
 I. nurse pt on unaffected side to reduce pressure on
the affected part which cozes pain.
II. gradualy elevate the head of the bed to prmt
venous return and reduce oedema wich cozes
pain.
III. cluster nursing activities as usual.
IV. gv prescrbd anagelsia eg diclofenac suppositories
100mg per rectal tds to reduce pain.
V. advice pt not to bend to reduce increase in iop
which cozes pain.
VI. give patn prcsrbd stool softeners e.g liquid paraffin
10-20mg po tds to reduce straining on defacaetion
which cozes pain, point above straining on
defaecation increases iop which cozes pain.
VII. after removal of the eye shield, pt not to face
direct sunlight to prvnt irritation which cozes pain.
VIII. monitor using pain intensity scale as usual.
IX. gv prescrbd anti inflamatory drugs e.g gutt
predinisolone eye drops to reduce inflamation and
oedema which cozs pain.
X. pt not to squeze the eye to prvnt dislodging of the
lens which cozes pain.
2 Risk for infection related to surgical procedure
done.
Interventions
I. keep the eye pad intact as prescbd to prvnt
infection.

99
 II. gv antibiotic prophylaxis e.g ceftriaxone as usual.
do vitals as usual.
III. aftr removal of eye shield dress using prescbd
lotions to prvnt infection.
IV. monitor for any eye discharge if any collect eye
swab for mcs then giv antibiotics according to
sensitivity results.
V. do eye care cleaning from the inner canthers to
the outer canthers to prvnt infection.
VI. give high protein diet to promote synthesis of
antibodies wch will hlp to curb infection.
3 impaired sensory perception visiual related to
surgical procedure done
Iterventions
I. speak facing the patient so that the pt can see
facial expression.
II. talk to the pt using unaffected eye to promote
visiual perception.
III. pt to use prescbrd sun glasses to promote visual
perception.
IV. nurse pt close to a nurses station for easy
understanding and monitoring.
V. monitor visiual perception using sinelen chart.
VI. apply prescrbd TEO to prvnt infection thereby
promoting sensory perception
COLOSTOMY.
20 yr old lady is asmitted with cancer of the colon and
is going for colostectomy.
100
 PART A.
draw and desecrbe the colon.
PART B
USing 3 nursing diagnosis manage the patient post
opp.
1 risk for impaired skin intergrity related to fashioning
of the colostomy.
Interventions
I. make sure the colostomy bag is 2-3 mm greator
than the stoma to prvnt leakage of the gastric
contents whch cozes skin irritation.
II. monitor the skin around the stoma for any signs of
pimples which may indicate skin breakdown.
III. support the colostomy bag bfr opening to prvnt
pulling of the skin which predispose to skin
breakdown.
IV. cut patients nails to prvnt scratching which
predisposes to skin breakdown.
V. apply calamine lotion on the skin around the
stoma to reduce itchness which predisposes to
scratching hence skin breakdown.
VI. give prescribed antihistamine e.g chlopherinamine
4 mg po tds 5 days to reduces itchness.
VII. offer diversional therapy to divert pt’s mind from
scratching which predisposes to skin breakdown.
VIII. nb point above diversional therapy to reduce pts
mind from scratching remove word skin.

101
IX. sooth the skin around the stoma wth vaseline to
prvnt dryness of the skin which cozes skin
breakdown.
2 Altered nutrition related to the presents of
colostomy.
Interventions
I. weigh pt initialy and continue weekly using same
scale lighty clothes expecting pt to have a weight
gain of 0,5 a week.
II. remove the colostomy bag bfr feeds to reduce
odour which interfere wth oral intake.
III. give small frequent meals up to 6 meals a day to
promote appetite thereby increasing oral intake.
IV. do not give gas forming foods e.g beans as they
coz rupturing of the colostomy bag.
V. give prescrbed multivitamin suplements 2 tablets
per oral to promote appetite therby increasing
oral intake.
VI. modify enviromnt as usual e.g remove bed pans to
prevent bed odour wc interfere with oral intake
etc.
3 body image disturbances related to the presents of
the colostomy.
Interventions
I. create a therapuetic nurse patient relationship so
that the pt will verbalise his feelings and concerns.
II. allow patient to pass thru grieving procces for
maximum acceptance.
102
 III. explain the reason for the procedure that it was
done to prvnt metastasis for maximum
acceptance.
IV. refer pt to colostomy associations where ptnt is
given coping mechanisms.
V. ptnt shld always carry extra colostomy bag to
change whn its 3/4 full to prvnt bursting of the bag
which will affect body image.
VI. apply perfumes to masks the odour that will affect
body image.
VII. pt shld wear shirts with pockets to put the
colostomy bag to prvnt body image disturbance.
MASTEIDECTOMY.
Qn:- A 60 yr old man is admitted with mastoditis and is
going for mastodeictomy.
Part A
cross section of the ear diagram.
physiology of hearing.
Part B
Using three prioritised nursing diagnoses manage the
patient.
Post opp
1 Altered comfort pain related to surgical procedure
done.
Interventions
I. Position pt on affected side to promote drainage
of puss thrby reducing pressure which cozes pain.

103
 II. give prescrbd analgesia e.g diclofenac
suppositories 100 mg tds to reduce pain.
III. monitor using pain intensity scale as usual.
IV. clustering of nursing activities as usual.
V. noisy free environment as noise agravates pain
(specific).
VI. give prescrbd stool softeners as usual.
VII. crush meat bones to minimise chewing whch cozes
pain.
VIII. give prescrbd cough syrup e.g sophlex 10-20mls
oral tds to suppress cough reflex which cozes pain.
2 Risk for infection related to surgical procedure done.
Interventions
I. keep bandage intact as usual.
II. give antibiotics prophylaxis from theatre as usual
e.g amoxy.
III. monitor using vitals.
IV. ct monitoring by assisting doc to collect blood for
white cell count.
V. high protein diet as usual.
aftre removal of the bandage dress using aceptic
technique using prescribd lotions e.g povidone
iodine to prvnt infection.
VI. monitor for presence of pass swab if any collect
pass swab for mcs and give antibiotics according to
mcs results.
3 Impaired sensory perception (auditory) related to
surgical procedure done.
104
 Interventions
I. nurse pt close to nurse’s station for easy
understanding.
II. use of pictures in comunication e.g bed pans
urinals since pt depends on visiual.
III. speak to the patient using unaffected ear to
promote understanding.
IV. use of sign laguage to prmote understanding.
V. if pt is able to read and write give a paper and a
pen to promote understanding.
VI. monitor auditory perception using webers test etc.
VII. speak facing the patient so that the patient can
understand by noting facial expressions to
enhance understanding.
AMPUTATION
Qn
A 40 Year Old bus driver is admitted for below knee
amputation following road traffic accident.
Part A
draw the structure of the long bone.
draw and drescribe the femur.
draw the snovial joint.
describe the snovial joint that is the, characteristic of
the snovial joint.
bone healing.
Indications of amputation
Part B
manage this pt using the following:-
105
 1 Alterd comfort pain (phanton) related to surgical
procedure done.
Interventions
I. give pt complete bed rest to pvnt pain stimulation.
II. give prescrbd narcotic analgesia eg pethidine 1mg
per kg body wt up to 100 mg 6hourly for the first
24 hours to prvnt pain stimulation.
III. elevate the the stump to prmote venous return
therby rdcng oedema whch cozs pain.
IV. when the pt is fully awake allow the pt to touch
and feel the residual limb for maximum
acceptance.
V. gv prescrbd antispasmodic iv eg carbamazapine
400mg bd 3-5 days to reduce muscle spasms which
cozes pain.
VI. cluster nursing activities as usual.
VII. monitor using pain intensity scal as usual offer a
bed craddle to prvnt linen from puting pressure on
the affected limb which cozes pain.
VIII. secure the drainage tube to prvnt traction on the
suture line which will coz pain.
IX. assist the doctor to do transcutaneous electrical
nerve desensatisation to desensatize the nerves
thereby reducing pain.
X. teach patient about early mobilisation therby
managing pyschological pain(med search book).
XI. keep patient awake and this helps to relieve
pain(medsurg book).
106
 XII. dress patient in a cornical shape, this helps to
prvnt pain during fitting of prosthesis.
XIII. give prescribed mood stabilizers eg amytripline 25
mg nocte 3-5days therby managing pyschological
pain.
XIV. Nb Although phanton pain is psychological pain, u
can’t manage it whout giving the drug, patient will
die of nuerogenic shock.
Risk for fluild volume deficiet
Interventions
I. check bandage for soaking if soaked apply
pressure bandage to arrest haemorrhage.
II. ct prescrbd fluild vlm expanders from theatre e.g
ringers lactate fast then 4-6hourly checking that
cannula is in situ to increase circulatory fld volm.
III. do strick intake and output by documntng on fluild
balancing chart.
IV. check urine output and normal shld be 30-60mls
an hour, if less that 30-60mls u can increase
circulatory fluild vlm.
V. Assist doc to collct bld for post opp hb if
haemogloblin is less than 13 grms per decilitter
transfuse using whole blood.
VI. monitor the amount, colour and consistence of
filling of the pottovac drain to estmate blood loss.
VII. do vitals as usual.

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VIII. ct monitoring by doing cappilary refill that is
pressing the nail bed for 10sec and normal shld
return to pink colour in 3 seconds.
IX. ct monitoring signs of reduced circulatory fluld
volm eg cold clamy skin etc.
X. if pt can tolerate giv plenty of oral fluilds 2-3 litres
a day to increase circulatory fluild volum.
3 risk for infection related to surgical procedure done.
Interventions
I. keep bandage intact as prescrbd to prvnt entrance
of microbes to prvnt infection.
II. giv antibiotics prophylaxis e.g cef lg iv bd for 7days
to prvnt infection.
III. monitor vitals as usual.
IV. give high protein diet as usual.
V. monitor vitals as usual 4hourly.
VI. analyse white cell count as usual.
VII. after removal dress using asceptic technique as
usual.
VIII. monitor presence of puss, collect puss swab as
usual etc.
3 Impaired physical mobility related to surgical
procedure done:
Interventions
I. dress in a conical shape to allow fittness of
prosthesis.

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 II. give prescrbed anticoagulant e.g clexane 20-40 mg
subcut 3-5days to prevent deep vein thrombosis
which will delay mobility.
III. give prescribed assistive devices e.g crutches to
promote mobility.
IV. counsel pt on the use of prosthesis to promote
mobility.
V. do passive exercises and encourage to do active
exercises to promote muscle tone and prvnt
contructures therby promoting mobility.
VI. use of monkey chain to stregthen muscles of spine
thereby promoting mobility.
4 Body image disturbances related to loss of body part.
Intervetions
I. create therapuetic relationship based on trust so
tht pt will verbalise his feelings and concerns.
II. allow patient to pass thru grieving procces for
maximum acceptance.
III. allow pt to touch and feel the residual limb for
maximum acceptance.
IV. pt to wear long trousers to cover for the
disfigurement.
V. refer patient for amputations associations e.g
NASSA where pt is given coping mechanisms.
VI. counsel pt about use of prosthesis to cover the
disfigurement.
VII. involve significnt others for pyschological support
therby promoting good coping mechanism.
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 Clept lip and palate
Qn
A 9 month old baby is admitted for repair of clept lip
and palate.
draw diagram of the left mandible.
draw diagram of right mandible.
draw diagram of the tooth.
describe the post opp management using the followng
nursing problems.
1 Altered nutrition less than body requiremnts related
to inability to feed.
Interventions
I. weigh the pt initially and contnue daily using same
scale and light clothes and a patient shld have a
weight gain of 0,5kg per week.
II. care giver to hold the baby in a same sitting
position during breastfeeding to prvnt
regurgitation from the nose.
III. advice the caregiver to position the nipple on the
corner of the childs mouth away from the clept lip
and palate to allow the baby to suck the milk.
IV. if the child is not breatfeeding, caregiver to
practise bottle feeding.
V. if the the child is not breastfeeding well advice the
care giver to express breast milk.
VI. advice the care giver to practice hygiene why to
prvnt infections, which may coz diarhea which
which impairs absorption of nutrients.
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VII. advice the care giver to continue breastfeeding
regulary since breast feeding contains all the
nutrients required by the baby.
VIII. advice the caregiver to bath the baby 30 minutes
after breastfeeding to prvnt regurgitation of food
from the mouth.
2 knowledge deficit caregiver related to home care.
Interventions
I. create a therapeutic nurse caregiver relationship
based on trust so that the care giver will verbalise
her feelings and concerns.
II. explain the reason for the procedure that it was
done to allow normal feeding pattern so that the
caregiver understand and cooperate to the mgt .
III. the caregiver to stay with the child to prvnt crying
which may coz gaping of sutures.
IV. the caregiver to cover the mouth of the child
emediately post opp why to prvnt infection (nb
the child is not able to cover his mouth).
V. the caregiver to continue breastfeeding coz
breatfeeding contains all the nutrients required by
the baby.
VI. advice the caregiver not to insert anything in the
childs mouth post opp why to pvnt gaping of
sutures.
VII. advice the caregiver to come for regular weighing
of the child why to check whethr child is gaining
weight or not.
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VIII. caregiver to owner review dates for checking
effectivenesss of treatment and progress of the
child.
IX. refer caregiver to clept lip and palate associations
so that the caregiver can be taught how to cope
with the problem etc.
X. advice caregiver to report upper respiratory track
infections which may reduce the feeding of the
baby.
Hydrocephalus and shunt insertion.
Qn
A 9 month old boy is admitted with hydrocephalus and
is going for insertion of intraventricular peritoneal
shunt.
Part A: descrb production and flow of csf.
drescribe the meninges.
draw diagram of the meninges.
drw diagram which shows production and flow of csf.
descb action potential.
draw the circle of willis.
drw and descrb the circle of willis.
drw diagram of the mylenated nuerone and non
mylenated neurone.
PART B:- descrb the post operative magnt of this
pt using the following nursing diagnosis:-
1 Alterd cerebral tissue perfusion related to the
blockage of the shunt
Interventions
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 I. Assess vital signs hrly, noting for any
irregularities in breathing and heart rate and
rhythm and measure the pulse pressure to
recognize early signs of increased intracranial
pressure for early intervention.
II. Initially position pt on a lateral position why to
prvnt excessive drainage of csf which affect
cerebral tissue perfusion.
III. gradually elevate the head of the bed to
promote venous return therby reducing icp
thus promoting cerebral tissue perfusion.
IV. Examine the pupils by notting its size, shape,
equality, and position of thr pupils and their
response to light to note to assess the brain
function.
V. Note the quality and tone when the child cries
to note if there is icp indicated by a high
pitched cry.
VI. Measure the child’s head circumference and
appearance of anterior fontanelle to check for
csf fluid accumulation.
VII. Provide a non stimulating environment and
adequate rest periods to prevent icp.
VIII. Elevate the head of the bed gradually about
15-45 degrees as indicated and maintain the
child’s head in neutral position to reduce
arterial pressure by promoting venous
drainage and enhance cerebral perfusion.
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 IX. monitor for the signs of blockage of the shunt
e.g nausea and vomiting.
X. monitor for the presents of oedema around
the shunt which may coz blockage of the
shunt and affect cerebral tissue perfusion.
XI. give prescrbd osmotic diretic e.g manittol
check the dose , to promote diuresis and
reduce icp which affects cerebral tissue
perfusion.
XII. minimise sudden arousal of the child which
increases icp and affect cerebral tissue
perfusion.
XIII. caregiver to stay with the child to minimise
crying which increase icp and affect cerebral
tissue perfusion.
XIV. ct monitoring signs of blockage of the shunt
e.g buldging fontanele.
XV. give prescrbd humidified oxygen 2-3 litres per
minute per nasal prones to promote cerebral
tissue oxygenation.
XVI. advice the care giver to bath the child 30mins
after breastfeeding to prvnt vomiting which
increases icp and affect cerebral tissue
perfusion.
2 risk for infection related to surgical procedure done.
Interventions
I. Assess site for inflammatory process, temp
elevation, increased wbc, characteristics of
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 drainage on dressings to any indication of infection
wc affects shunt function.

II. ct giving prescrbd antibiotics from theatre eg

ceftriaxone per kg body weight, plzz check dose, to
prvnt infection.
III. Monitor temp 4hrly if continuosly elevated may
mean infection.
IV. Follow aseptic technic when dressing the pt to
prevent infection.
V. Teach parents about wound care and dressings,
and the importance of handwashing techniques to
prevent infection.
VI. Teach parents about signs and symptoms of
infection of site and shunt tract to promote early
detection of infection.
VII. advice care giver to continue breastfeeding since
breast milk contains antibodies which will help to
fight infection.
VIII. ct monitoring by assisting doc to collect blood for
white cell count.
IX. during dressing monitor for the presents of wound
swab if any collect wound swab for mcs then give
antiobitics according to mcs results.
X. give high protein diet for example, food rich in
peanut butter to promote synthesis of antibodies
which will help to fight infection.
Skin conditions
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 Herps zoster
structure of the skin
Functions of the skin
Acute/chronicle pain r/t nerve pain{most commonly
cervical, lumbar, sacral, thoracic ,or ophthalmic
division of trigeminal nerve} evidenced by alteration in
muscle tone/ reports of burning, dull, or sharp pain.
Interventions
I. assess the pt’s description of pain or discomfort,
severity, location, quality,duration, precipitating or
relieving factors to intervene correctly.
II. Assess for nonverbal signs of pain or discomfort to
evaluate the level of pain.
III. Pt to wear loose and non restrictive clothing made
of cotton to allow evaporation of misture to
reduce skin irritation.
IV. Apply cool, moist dressings to pruritic lesions
with/without burrows’s solution several times a
day to provide relief and reduce the risk for
secondary infection.
V. Avoid rubbing or scratching the skin or lesions to
prevent the risk of secondary infection.
VI. Use topical steroids (anti-inflammatory effect, anti
histamines(anti-itching effect particularly at bed
time) and anal gesics to provide relief to skin
irritation.
VII. Administer medication as indicated by the doctor
to manage the condition.
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VIII. Teach the pt handwashing to prevent introduction
of infection wc may aggravate pain.
IX. Create good nurse pt relationship to allow pt
verbalise his/her concerns to intervene correctly
to pain.
X. Ask pt what pain medication relieves pain most to
assist the pt accordingly.
XI. Diversional therapy- soft music.
Risk for infection r/t itching and scratching.
Interventions
I. Assess for the presence and location of skin lesions
wc may influence infection.
II. Assess for pruritus or irritations from the lesions,
and the amount of scratching wc may cause
infection.
III. Assess for localised signs of infection, eg redness
and drainage from lesions for early intervene to
curb infection.
IV. Assess for lesions around the eye or ear to prevent
the virus causing damage to these special organs
eg blindness and otitis media.
V. Assess the client and family’s immunization status
and past history of chicken pox to prevent spread
of infection to others.
VI. Puss swab for mcs and treat according to results to
curb infection.
VII. Teach pt contact isolation to prevent spreading of
infection to others.
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VIII. Instruct pt to avoid contact with pregnant women
and immunocompromised individuals to prevent
infection spread.
IX. Use aseptic technic when dressing the pt’s lesions
to prevent infection.
X. Suggest the use of gauze to separate the lesions in
skin folds to reduce irritation, itching and cross
contamination wc promtes infection.
XI. Discourage scratching of lesions to reduce chances
of infection.
XII. Advice pt to trim the finger nails wc may cause
scratching when pt touches self to prevent
infection.
XIII. Advice pt to adhere to antivirals as prrscribed to
curb infection.
XIV. Do barrier or reverse barrier nursing to prevent
infection spread to other pts.
Risk for disturbed body image r/t preoccupation with
changed body part or visible skin lesions.
Interventions
I. Assess the client’s perception of his or her
changed appearance to give assistance coping with
changes in appearance.
II. Note verbal references to skin lesions to assist pt
in preoccupation with appearance.
III. Assist the pt in articulating responses to qns from
others reguarding lesions and infectious risk to
provide reassurance.
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IV. Suggest the use of concealing clothing when
lesions can be easily covered to cover up for
disturbed body image.
V. Refer pt to the psychologist for counselling to
allow pt be able to live with the condition till
healed.
VI. Explain the pathophysiology of the disease to
assist pt be able to cope with the condition till
healed.
Aids (hiv positive patients
Hiv life circle.
Prevention methods to hiv.
Complications to hiv infection.
Imbalanced nutrition less than body requirements r/t
inability or altered ability to ingest, digest nutrients
evidenced by reduced wt loss.
Interventions
PSYCHIATRIC INTERVENTIONS
Risk for self harm related to feelings of helplessness,
loneliness or hopelessness secondary to psychiatric
disorder.
Objective
Patient not to harm himself during and after
hospitalization.
Nursing Interventions
Nurse does the following:-
I. Establish good nurse patient relationship for the
patient to co-operate and verbalize his concerns.
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 II. One hourly suicidal observation to prevent the
patient committing suicide.
III. Make sure that the patient is not left alone at any
time during hospitalization to prevent self harm.
IV. Remove all injurious objects from patient’s room
as patient may use these to commit suicide.
V. Advocate for psychologist counseling of the
patient to promote understanding and good self
esteem.
VI. Explain to the patient about his condition to
promote understanding, acceptance of the
condition.
VII. Diversional therapy, play music or take patient to
the television room to avoid patient concentrate
on his intention to commit suicide.
VIII. Assists patient identify thoughts, feelings and
behaviors that leads up to the patient wanting to
commit suicide to prevent self harm.
IX. Educate the family members how to recognize
levels of impending self harm that may be
committed by the patient to prevent self harm.
X. Educate the patient that self harm is a choice not
something uncontrollable at discharge for the
patient not to commit suicide out of hospital.
Risk for injury to self, staff, and other patients related
to aggressive behavior of the patient.
Objective

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 Patient not to harm anyone nor self during and after
hospitalization.
Nursing interventions
Nurse does the following:-
I. Establish a therapeutic relationship conveying
empathy and unconditional positive regards
towards the patient so as to promote his co-
operation in the management of the condition.
II. Alert all the medical staff in the ward about the
aggressive behavior of the patient to prevent
injuries.
III. Always keep a distance from the patient to avoid
injuries.
IV. Ask to know why the patient is aggressive to
intervene accordingly.
V. Give health education to significant others to be
always cautious about the patient’s aggressive
behavior to prevent injuries.
VI. Ensure the patient takes medication according to
prescription to prevent relapse.
VII. Remove all injurious objects from the ward and
patient’s room as patient can use these to injure
anyone.
VIII. Staff offices must have a set up which allows one
to escape for safety in case one is attacked by the
patient.
IX. All medical staff to avoid giving their back to
corners when attending to the patient to prevent
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 any attack by the patient.

Impaired social interaction related to self isolation as

evidenced by the patient withdrawing from others
Objective
Patient to be able to interact well with nursing staff
and other patients after a week of nursing
interventions.
Nursing interventions
Nurse does the following:-
I. Maintain good nurse patient relationship for the
patient to open up and verbalize his concerns.
II. Assess to see how the patient is interacting with
nursing staff and other patients to have a baseline
to work from.
III. Involve patient in daily activities like bed making to
promote good socialization.
IV. Monitor to make sure that patient do not sit alone
during meal times to promote him be able to keep
company.
V. Involve patient in recreational activities to
promote him Keep Company.
VI. Advocate for cognitive therapy in order to bring
insight about his condition.
VII. Give health education to significant others that
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 they should not stigmatize patient because of his
condition to help patient be able to keep
company.

VIII. Advocate for the social worker to assess the

situation at home to find out if there is any cause
to self isolation.

HYPERTENSION
NURSINGINTERVENTIONS:
Risk for decreased cardiac output r/t increased
afterload,vasoconstriction,myocardial
ischemia,ventricular hypertrophy.
INTERVENTIONS:
I. Monitor and measure blood pressure in both
hands, using a cuff and proper techniques in terms
of measuring blood pressure.
II. Auscultation of breath sounds and heart tone.
Observe skin colour, moisture, temperature and
capillary refill time.
III. Note the presence, quality of the central and
peripheral pulses.
IV. Maintain restrictions on activities such as rest in
bed or chair.
V. Assist in performing self-care activities as needed.
Provide a quiet environment, convenient, and
therapeutic and reduce activity.
VI. Note the general oedema.
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VII. Monitor response to medication to control blood
pressure.
VIII. Give fluid and dietary sodium restriction as
indicated.
IX. Medical collaboration in the provision of drugs as
indicated.
Acute pain: headache related to increased cerebral
vascular pressure.
INTERVENTIONS:
I. Minimize disruption and environmental stimuli.
Give a fun action according to indications such as
ice packs, the position of comfort, relaxation
techniques, counselling imagination.
II. Limit patients in the activities.
III. Maintain bed rest, quiet neighbourhood, a little
light.
IV. Avoid constipation.
V. Medical collaboration in providing analgesic and
sedative drugs.
Ineffective Tissue Perfusion cerebral, renal, cardiac r/t
impaired circulation.
INTERVENTIONS
I. Assess blood pressure at admission in both arms,
sleeping, sitting with arterial pressure monitoring
if it is available.
II. Measure the input and output.
III. Observe the sudden hypotension.

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IV. Ambulation within your means and avoid fatigue
in patients.
V. Monitor electrolytes, creatinine according to
medical advice.
VI. Maintain fluids and medications according to
medical advice.

Knowledge deficit r/t lack of information about the

disease process and self-care.
INTERVENTIONS:
I. Discuss the importance of maintaining a stable
weight.
II. Discuss the need for low-calorie diet, low in
sodium.
III. Explain the importance of a peaceful environment
and theraupetic, and management of stressors.
IV. Discuss the importance of avoiding fatigue in the
activity.
V. Describe the nature of the disease and the
purpose of the procedure and the treatment of
hypertension.
VI. Explain the need to avoid constipation in the
bowel movement.
VII. Explain importance of maintaining proper fluid
intake, amount allowed, and restrictions such as
caffeinated coffee, tea and alcohol.
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VIII. Discuss the symptoms of relapse or progression of
complications reported to the doctor: headache,
dizziness, fainting, nausea and vomiting.
IX. Talk about drugs: the name, dosage, time of
administration, purpose and side effects or toxic
effects.
X. Explain the need to avoid drug-free, without a
doctor's examination.

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