FON Unit 10- Blue print Qns Answers.

Short notes- 5 marks each.

1. Explain the complications of neglected oral hygiene?

Answ:

The oral cavity is an ideal platform for the growth of bacteria. The number
of bacteria in the mouth depends on the degree of cleanliness.A neglected
mouth can cause various complications. These are;
1. Halitosis: I t is the offensive odious of the breath.It may be an early
indication of either poor oral hygiene gastrointestinal disorder.Halitosis
caused by inadequate oral hygiene can be alleviated by cleansing the teeth
and oral mucous.
2. Dental caries:Dental careis or cavity occurs due to the destruction of
enamel and dentin .A bacteria acidophilus normally present in the oral cavity
acts on the left over carbohydrate on the surface of the teeth and cause
formation of cavity.
3. Dental plaque: It is a soft thin food debris mucus and and dead
epithelial cells that is deposited on the teeth and provides a medium for the
growth of bacteria. When dental plaques present, teeth appear dull and
yellowish.
4. Calculus or tartar: when the dental plaque remains on the teeth,it
become hardened to form calculus or tartar. Calculus is the primary cause of
gum diseases and dental caries.
5. Periodontal deceases or pyorrhea: It is the pus formation in the sockets of the
teeth.This is the common cause of the lose of teeth in people over 40. It develops in
4 stages. The first stage there will be gingivitis(inflammation of gum); in the
second stage (periodontitis) chronic gingivitis cause the inflammation to spread and
destroy the underlying bone causing periodontitis.In the 3rd stage acute necrotizing
ulcerative gingivitis develops with loosening of the teeth and with purulent
discharge associated with severe pain.In the 4th stage because of the destruction of
the teeth supporting stonueluces, the teeth becomes very loosely attached or falls
out.
6. Sordes: Brown crusts( collection of food , mucus and bacteria).Which
are formed on the teeth and lips are called sordes.
7. Cheilosis: It is a cracking or ulceration of the lips and angles of the
mouth. It commonly occures in patients with riboflavin deficiency and dry
mouth.
 8. Bleeding gums: Using hard and stiff brush for brushing can lead to
bleeding gums.
9. Stomatitis: It is the inflammation of the mucus membrane of the mouth.
It can occur In people with poor oral hygiene.
10. Infection of the neighbouring structures: If these minor complications
are not treated on time ,it can lead to parotitis (inflammation of parotid gland),
sinusitis, otitis media, adenitis and tonsillitis.
11. Systemic infection: Untreated oral complication can cause systemic
infection like Rheumatic arthritis, bacterial endocarditis, Nephritis, Gastritis
etc.

2) Discuss the role of nurse in prevention Decubitus ulcer or pressure

sore?
Answ: Excellent skin care is an attribute of quality nursing care. Lack of
skin care and various other factors can lead to pressure sore development,
which can increase morbidity and mortality. Most pressure injuries are
preventable if appropriate measures are implemented.

Prevention.
Prevention requires an ongoing risk assessment, consideration of
conservative factors and implementation of appropriate preventive measures.
Education of patients and families.
Education to the patient and family members has to be provided about the
importance of daily skin care ,position changes, and also about nutrition to
maintain a healthy skin.
Skin Integrity assessment.
The nurse need to assess the skin integrity of the patient and it is an integral
part of every day nursing care.The factors which need to assess are
appearance of skin any discoloration, any change in temperature in some
areas of skin( cold or warm), nature of skin-,damp/ dry or oily.She also needs
to check whether there is any sign of skin break down, oedema or swelling
etc.

Nutritional status assessment.

The patient nutritional status has to be assessed. Whether he or she is eating
a balanced nutrition.Amount of fluid intake also need to be monitored.
Prevention and management of pressure injuries include intake of protien, Vit
C, Vit A, and Zink.

Skin care.
-The patients skin has to be kept clean and dry.
- If the patient has incontinence of urine or stool, it has to be managed well
and skin areas should be cleaned and kept dry.
- Use skin emollients to maintain hydration of skin.

Re-Distribution of pressure.
-Use of pressure relieving devices to prevent pressure injuries.(Prosthetic
devices like cushion, pillows, rings etc.)

Position change.
- the position can be changed frequently. The nurse need to check the
positioning of body prominence, when changing the position.

Moisture..

- Moisture on the skin increase the risk of pressure development.

-Incontinence of urine / stool has to be managed properly and the skin areas
has to be maintained clean and dry.
-Over dryness of skin also can cause pressure sore .So emollients can can be
used for such kind of skin.

Massage.
-If the patient lying in supine position more time there is a chance of pressure
sore development in different areas of back like, scapula, sacrum coccyx,
occiput, sole etc providing massage can prevent pressure ulcer development to
an extend.

The nurse is the person who is always in contact with the patient and she can
implement a variety of measure to prevent the occurrence of pressure sore.

3) Describe the factors affecting the nutritional needs?

Answ:

There are various reasons a persons nutrient requirement may differ. Those
are.
1. Developmental considerations:
Through out the life circle , nutrient need needs change in relation to
growth, development, activity and age related changes in metabolism and
body composition.
Infants: Infants major source of nutrition for the first 12 months is from
breast milk.
Children; the children are active and growth takes place erratically. The
nutritional needs increase s because of their active level and energy
requirement.

Adults; With adulthood growth ceases and the nutritional needs also level
up, weight gain results if adjustment in calorie intake are not made.

Pregnant and lactating women; Nutritional needs during pregnancy increase

to support the nutritional requirement of both the mother and the fetus. Key
nutrient needs include protein, carbohydrate, iron, folic acids, calcium and
iodine during lactation nutrition than pregnancy is needed to maintain the
quality of breast milk.

Older adults; because of the decrease in BMR and physical activity and loss
of lean body mass, energy expenditure decreases. Dental problems, decrease
in thirst sensation, digestion problems etc. are more common dduring this age,
and all of these contribute to less nutritional intake.

2) Gender.
Men differ from women in their nutritional requirements due to
differences in body composition and reproductive function. Due to larger
muscle mass men need more nutrition than women. Women of childbearing
age require more iron related to menstruation.

3) State of health.
The requirement of nutrition alters during illness and trauma. During
fever more calories and water is needed. Chronic disorder like DM, HTn,
Heart diseases etc also influence nutritional intake.

4) Alcohol Abuse;
Alcohol abuse can alter body’s use of nutrients and thereby its
nutritional requirements.

5). Medication.
Many drugs influence the requirements of of nutritional intake E.g
Antacids,Diuretics Antibiotics etc.

6. ) Sociocultural and psycho-social factors.

Dietary choices or restrictions are also influenced by culture,
religion and personal feelings and marriages associated with food.People eat
for many reasons in addition to satisfy hunger and provide nutrition, food
may signify celebration, a social gathering , reward or a punishment.
Emotional status such as boredom., anger,depression, loneliness, stress
etc can influence the quality and quantity of food eaten.

7. ) Religion:
Dietary restriction associated with religion might affect a client’s
nutritional requirements.Eg, Hindu Brahmin are strict vegetarians.

8.)Economics;
The adequacy of a person’s food budget , increasing food cost coupled
with limited purchasing power, may result in decrease in the nutritional
quality of the diet.

9.) Culture;
Culture influences what is eaten. How it is to be prepared and what
combinations of foods are permitted.

10.) Life style factors;

Life style factors are related to food habits G-A busy scheduled life
style can lead to a less nutritional intake or more consumption of junk foods.

4. Explain the steps of back care.?

Scientific form of messaging the back using different massaging strokes to
provide cutaneous stimulation and thus promote comfort.

Providing back massage will help to, relive muscle tension, promote physical
and mental relaxation, relieve insomnia , stimulate blood circulation, assess
skin condition and to prevent bed sore.

The different massaging strokes used in back massage ( steps ) are,

Effleurage

They are long sweeping strokes that alternate between form and right pressure
and which can be performed using the palm of the hand or the fingertips . the
knots and tension in the muscles to get broken with this massage technique.

Petrissage

This is the technique of kneeding the muscles of the body to attain deeper
massage penetration. The thumbs and the knuckles of the body and squeeze
of the fingers are used to knead the muscles of the body and squeeze them to
prepare them for the other massage techniques that follow.

Tapotement or Rhythmic Tapping

As the name suggests , it consists of rhythmic tapping that uses the fists of the
cupped hands. This helps to loosen and relax the muscles being manipulated
and also helps to energize them.

Friction

This move seeks to create heat to bring about relaxation of the muscles. The
palms of the hand are rubbed together vigorously with each other or they are
rubbed together vigorously with each other. Or they are rubbed on to the skin
of the person being massaged in order to produce heat by friction. This
technique can be used as a warm up for the muscles of the body to be treated
for deeper massage.

Vibration shaking

this helps to loosen up the muscles by using a back and forth retion of the
fingertips or the heel of the band ever the skin. The muscles of the body are
literally shaken up to loosen and relax the muscles.

Special cosiderations
- For patients with history of hypertension and dysrhythmia, assess pulse and
blood pressure

Consider cultural preferences

= Do not give massage if any discoloration of skin present.
-A back massage should take about 5-10 mts and can be given with the
patients, bath, before bed time or at any other time during the day.

- Determine if any allergies or skin sensitivities exist before applying lotion to

the patients skin.

- the greatest relaxation effort of a massage occurs when the rhythm of the
massage is coordinated with the patients breathing.

5. Explain gastrostomy feeding

Gastrostomy is an opening in the stomach made surgically , usally connecting
the stomach to the outside of the abdomen so that a feeding tube or gut
decompression tube can be passed to the stomach.

Defn: Gastrostomy tube feeding is the administration of feed directly into the
stomach in liquid form through a gastrostomy tube which is placed through a
surgical opening into the stomach.

Purposes
- To provide long term nutritional support.
- To regulate the flow of liquid nourishment by bolus , by continuous and
intermittent feeding or by the feeding pump method.

General instructions

- It is essential that the area of the skin around the tube be kept clean and dry.
- A water, proof ointment such as zink oxide may be applied around the tube
to protect the skin from irritation.

Methods of administration

1. Intermittent feeding: is given 4 to 5 times a day. Volume for formula is

usually 205to 450 ml. It is administered through a large syringe attached to
the tube.

2. Intermittent gravity drip: Administration through drip method. The volume

of feed delivered is same Ie 205-450 ml delivered at the rate of 20-30ml per
minute for 4-6 times a day.

3. Continues administration:- Deliver fluid through a small lumen tube at a

constant rate.

Preliminary assessment.

- Check the doctors order for any specific instruction.

-Check the level of consciousness of the patient.
-Assess the self care ability of the patient.
-Check the mental status of the patient.\

Articles.
- Disposable garage bag and tubing.
- 50-60ml syringe.
- Stethoscope.
- Feed.
- Kidney tray.
- Mackintosh & towel.
- IV stand.
- Administration set.
- Sterile lubricant.
- Sterile dressing/gauze pieces.
- A glass of drinking water.

Procedure.
1. Identify the patient’s need.
2. Assess the patient for allergies
3. Verify the physicians order, formula, rate and frequency.
4. Auscultate for bowl sounds before feeding.
5. Assess gastrostomy site.
6. Explain procedure to the patient.
7. Provide privacy.
8. Arrange articles to the bedside.
9. Place the patient in comfortable position.(Fowler’s position)
10. Keep the environment clean and tidy.
11. Wash hands thoroughly.
12. Place the mackintosh and towel, clean the surrounding area of the
opening , cover the wounds with sterile guaze peace.
13. Prepare bag and tubing to administer feed.
-Connect tubing and bag
- Fill the tube with feed.
14. Check placement of the tube , aspirate content and check ph

15. Initiate feeding.

16. Clamp the proximal end of the tube when feeding is not -
given.

17. If any medicine is there , give irt after feeding.

18. Administer water after medicine.
19. Rince tubing after feeding.
20. Monitor intake and output every shift.
21.Weigh patient daily.
22. Record and Report the procedure- amount & type of the feed ,
patient’s tolerance etc.
After care.

-Remove the mackintosh and towel.

-Position the patient comfortable.
-Secure the tube with plaster.
-Replace the articles to utility room.
-hand washing should be done.
-Record and Report the procedure.

6) Describe the characteristics and composition of urine

Characteristics of urine:-

1. Volume; An amount of 1000 to 2000 ml of urine is exereted in 24 hrs.The

urine output depends up on the water intake and the type of weather .In cold
weather it is increased and in hot weather it is decreased.

2. Color; A freshly voided specimen is pale yellow, straw colored or amber,

depending upon its concentration.

3. Odor; The normal urine has aromatic odor. As urine stands , it often
develops an ammonia odor because of bacterial action.

4. Reaction; The reaction of the normal urine is slightly acidic (PH below7).

5. Urine PH; The normal PH is about 6 with range of 6-8. Urine alkalinity or
acidity may be promoted through diet to inhibit bacterial growth or urinary
stone development or to facilitate the activity of certain medications. Urine
becomes alkaline on standing when co2 diffuses into the air.

6. Specific gravity; This is a measure of the concentration of dissolved

solids in the urine. The normal range is 1.015to 1.025.

7. Turbidity; Fresh urine should be clear or As urine stands and cools, it

becomes cloudy.

8. Appearance; The normal urine is clear with no deposit.

 Special consideration.

-The Urine is darker than normal , when it is scanty and concentrated.Urine

is lighter than normal when it is excessive and diluted
- Some foods cause urine to have a characteristic odor Eg:-Asparagus cause
urine to have a strong musty odor,
Urine high in glucose content has a sweet odor, Infected urine has a fetid
odor.
-Cloudiness observed in freshly voided urine is abnormal and may be due to
the presence of RBC,WBC’s, bacteria, vaginal discharge, sperm or prostatic
fluid.
- A high protein diet, causes the urine to become excessively acidic. On the
other hand certain foods such as citrus fruits, diary products and vegetable
especially legumes make the urine acidic.
- Concentrated urine will have a higher than normal specific gravity ,and
diluted urine , a lower than normal specific gravity.

Composition of urine.

The normal constituents of urine are water 96 percent, urea 2 percent and
the remaining 2 percent consist of urea acid, urates, creatinine, chlorides,
phosphates, sulphate and oxalates.

Organic constituents:- are urea , uric acids, creatinine hippuric acid, Indicon,
urine pigments and undetermined nitrogen.

Inorganic constituents;-are ammonia, sodium chloride, traces of iron,

phosphoros, sulfure, potassium and calcium.

Abnormal constituents of urine include blood,pus, albumin, glucose, ketone

bodies,casts, gross bacteria and bile

7) Explain Benedict’s test for urine sugar

Prompt and correct collection and testing of specimen is essential for the
diagnosis, treatment and recovery from the patient.

Benedict’s test is a simple chemistry test used to detect the presence or

absence of sugar in urine .

Objectives;
-To determine the presence or absence of reducing sugar in urine.
-To determine the glucose concentration in urine.

Articles;

A tray containing ,

- Urine specimen - Kidney tray

- Test tube - Rag pieces
- Test tube holder - Dropper
- Spirit lamp/lighter
- Benedict solution

Preliminary steps and & general instruction .

- A freshly void en specimen need to be obtained for the procedures.
- Before the collection of specimen explain the procedure and purpose to the
patient.
- Provide an appropriate specimen container and explain how to use it.
- Instruct the client not to contaminate the out side of the container.

Principles involved.

- Specimen serves as a medium of disease transmission. So handle it

carefully.
- The accuracy and reliability of findings depend upon the correct method of
collection& transportation of specimen.
- Contaminated and improperly collected specimens will produce false results.
- All equipments used for urine testing must be clean.

Procedure.

Take 5ml of Benedict’s solution in a test tube and bring it to boil over a
spirit lamp, holding it away from your face.It is done to check of the purity of
the Benedict’s solution. If the re is no color change then add 8-10drops of
urine with a dropper or pipette in to the test tube. Boil it again and then
remove it from the fire and allow it to the cool.The result is recorded
according to the color of the solution.
If the color of the solution is blue with no deposits- absence of
sugar.Green liquid without deposits- trace or ( 500mg/dl)or 1 per sent
Green with precipitate- 1-1.5%(500-1000mg/dl) sugar.
Yellow precipitate- 2%(1000-1500mg/de) sugar.
Orange precipitate- 3%(1500-2000mg/dl) sugar.
Brick red precipitate- 5% or above( 2000mg/dl) sugar.
 After care.

-Record the result according to the color of the solution.

- Discard the urine.
- Take the articles to the utility room for cleaning/ discarding.
- Wash hands thoroughly.
- Record and report the result.

8) Explain factors affecting bowel elimination

Answ; Various factors can affect bowel elimination such as.

1). Developmental consideration:-
Age affects what a person eats and the body’s ability to digest
nutrients and eliminate waster.
-Infants;-The stool of breast feed babies are yellow in color . Infants have
more frequent number of stools. With formula or cows milk feedings,the
infant’s stools vary from yellow to brown .Breastfed infants pass 2-10 stools
daily, whenever bottlefed infants pass 1-2 stools daily.
-Children:-Children more than 1-3 years will have a fully developed
sphincter and control on defecation is possible during this age toilet training
can be given at this age.
Adults:-In normal healthy adults the number of stool is 1-2 per day and the
color is brown.
Older Adults:-In older adults because of less food intake and digestive
problems constipation is a common problem. Diarhea, fecal impaction or
fecal incontinence can also result from physiologic or life style changes.

2) . Daily pattern:
Most people have individual pattern of bowel elimination involving
frequency , timing consideration position and place changes in any of these
patterns may upset a person’s routine and lead to constipation. Most people
defecate after breakfast and squatting position is the common position
assumed. Privecy is an important factor.
3) . Food and fluids;
Both the type And amount of foods eaten and the amount of fluids
ingested affect elimination. A high fibre diet and a daily intake of 2000 to
3000ml water facilitate bowel elimination.
4) . Activity and muscle tone:
Regular exercise improve s gastrointestinal motility and muscle
tone, where as inactivity decreases both patients on prolonged bed rest are
prime candidates for constipation.
5) . Life style:
A person’s daily schedule, occupation and leisure activities may
contribute to defecation pattern.

6) . Psychological variables:
Psychological stress affects the body in many ways.In some people
anxiety seems to have a direct influence in gastrointestinal motility and cause
diarrhea.Persons who chronically worry and those with certain personality
types who tend to hold into problems and negative feelings may experience
frequent constipation.

7) . Pathologic condition:
Diarrhea may result from condition such as diverticulitis from
obstruction , infection.malabsorption syndromes, neoplastic diseases, diabetic
neuropathy etc. Constipation can occur in pts with colon or rectal diseases or
injury degeneration of the spinal cord.

8) . Medication:
Medication like cathartics and laxatives promote , peristalses, where
as antidiarrheals inhibit peristalsis, opioids,
Antacids containing aluminium, iron sulphate and anticholinegies disease
gastric motility and cause constipation.

9) . Diagnostic studies:
For some diagnostic studies patient may need to fast and this may
cause constipation. This ingestion of barium for enema can cause
constipation.

10) Surgery and Anaesthesia:

Due to surgery the peristalting movement is --------------and result
in paralytic cleus. Normally n this will resolve in24-48 hrs, but if it is not
resolved in time it can lead to bowel distension and obstruction.

(9). Define constipation and explain the nursing measures to prevent

constipation?.

Constipation is dry, hard stool, persistently difficult passage of stool,

and or incomplete passage of stool.

Causes.
 -Inadequate irregular and restricted diet .
- Decreased gastric motility
- Insufficient fluid intake
-Insufficient intake of roughage in diet
- Lack of exercise and prolonged rest
Emotional upset, nervous tension, worry anger, fear etc.
-Lack of privacy, life style.

The above mentioned causes can contribute to constipation. Prevention and

management of these cause will help to solve constipation.

Nursing measures to prevent constipation.

Nursing measures related to the prevention of constipation include:

1) Promoting regular bowel habits;
Encourage the well and ill patients to maintain regular bowel habits, by
giving attention to the time and position. The most favourable time for many
people is in the morning after breakfast. Sitting upright on a toilet or coode
promote defecation.

2) .Privasy;
Because most people consider elimination a private act, always respect the
patient’s need to be alone while defecating, , unless the patient’s condition
makes this impossible.Provide privacy by means of certain or drapes if the
patient is using commode. If any visitors are present , ask them to step out
side for a few minutes.

3) .Nutrition/ Diet;
Ask the patient to eat adequate amount diet and encourage them to
include roughage in the diet. Roughage will help to from the stool and
elimination easy,Eg; of diet with roughage vegetarian, fruits, whole grain
cereals etc.

4) .Fluid:
The nurse need to encourage the patient to drink at leas1500 to 2500ml
of fluids daily Fluid intake promote peristalses and prevent constipation .

5).Exercise:
Regular exercise improve gastro intestinal motility and aids in
defecation.Abdominal and perenial exercise will improve the muscle tone of
the specific area and improve peristaltic movement.

6).Relaxation techniques:
 Relaxation technique like yoga meditation, or including in some
activities that give comfort to the body and mind allow the person to
relax.Provide a relaxed environment because tension anger, worries etc can
hinder defecation.

7). Use of laxatives, suppositories and enemas:

When all he other preventive measures fait one of these measures can be
used but their continuous use must be discouraged.

(10) Explain the technique of administering proctclysis enema?

Definition:-
Proctclysis is a type of enema in which, a slow injection of large
quantities of fluid (saline solution) is given in to the rectum in supplementing
the liquid intake of the body.

Type of solution;
-Phosphate saline enema
- Lubricant enema
- Soap and water.

Indication,
-Pregnancy (before child birth ) - coma patients.
-Intestinal obstruction -Before surgery
-paediatrics -Before rectoscopy
-For retention enema

Contra indication,
-Hemorrhage
-Peritoritis
-Proctoclysis enema mostly comes in a packet.
It is a prepared instant enema. It usually comes as 100ml.

The enema solution comes in a olastic bag with a tubing and plastic bag.

Technique of administering proctoclysis enema,

- Wash hands
- Take the plastic bag with enema from the packet
- Cut the end tip of the tube
- Lubricate the tip of the tube with a lubricating jelly.
 - Release the clamp and allow the fluid to run through the tube.Fill the tube
with fluid in order to expell the air from the tube.
- Insert the tip of the tube into the rectum by keeping the patient in the left
lateral position.
- Squeeze the bag with enema to promote the administration of the enema ,
till the bag is empty
- Do not allow air enter into the rectum
- After the procedure, remove the tube from the rectum
by keeping a gauze piece around the anal opening in order to prevent
injury.

After care,
- Replace the articles to utility room
- Assist patient to commode or toilet
-Wash hands
- Record and report the result.

(11) Explain the procedure of sits bath?

Definition:-
Sits bath or hip bath is a type of bath in which only the the hips but locks
are soaked in water or saline or any other prescribed solution.

Purpose:-
- To relieve congestion of the pelvic organ
- To relieve the pain following cystoscopy
- To reduce inflammation
- To soften the crust & for the easy removal of the crust
-To promote drainage of rectal absuss & hemorrhoids.

Solution used:-
- Potassium permanganate solution1:5000,Boric acid, Eusol solution etc.
Temperature:; the temperature of the solution is 10-125degree F and the
duration of the bath is 15-30mts.

Contra-Indication:-
- Pregnancy - Renal Inflammation
- Menstruation - Increased irritability of genital
Organs.

Procedure;
- Explain procedures to the patients
- Provide privacy
- Test the temperature of water I tube with thermometer
- Assist the client tothe tube for sitz bath
- Wrap a towel around the shoulder to prevent exposure and chilling
- Monitor for signs of weakness, faintness, pallor, rapid pulse etc. If present,
stop the bath and assist the patient to bed.
- Check the temperature of water in between & maintain temperature.
- Do not leave the client alone to the bath bed
- When the bath is completed , assist thee client to come out of the tube and
dry well.
- Assist the patient to redress and return to a position of comfort.
- Discard soiled supplies and perform hand hygiene.

After care:

- Document the procedure , time duration and water temperature.

- Skin condition, Assistance required & patients response.
- Report any changes in patients condition to the supervisor.