It is a Saturday Morning and you are in the surgical ward for a service ward round. You passed through a patient who has been in the ward for three days with the diagnosis of diabetic ulcer. Your plan is sloughectomy and wound dressing. List five (5) equipments for wound dressing. :(5 Marks)
Answers: Any five
Trolley
Clean gloves
Sterile gloves
Moisture- proof bag
Sterile dressing set
Culture tube with swab and culture medium
Completed label for each container
List five (5) equipment contained in a tray for instillation of ear drops:
Answer:
Prescribed ear drops.
Sterile ear dropper.
Galipot with sterile swabs.
Clean gloves.
Cotton- tipped applicator.
Kidney dish for used swab.
Sterile pipette if the medicine bottle has no dropper
Mention five (5) indications for Catheterization. (5marks)
Answer
Relieving retention of urine when other nursing measures have failed.
Emptying the bladder before giving a bladder irrigation or instillation.
Ensuring that the bladder is empty before, during and after pelvic surgery.
Obtaining a sterile urine specimen when collection of ‘Mid–stream’ specimen of urine is impractical, for example when a woman is menstruating or when the patient is incontinent.
Splinting the urethra following urethral surgery or trauma.
A 45 years old man was admitted in the ward due to severe malaria, Intramuscular quinine injection was prescribed by doctor on call. Outline FIVE advantages of this route (5 Marks):
Answer:
Advantages of Parental Route
The drug acts quicker than by the oral route
It is a route of choice when a patient is unconscious
It is also useful in emergence
The route is useful for uncooperative patient who refuses to take drug orally e.g. (psychiatric patient)
Desired dosage can be determined more accurately
Some patients get psychological satisfaction with injection
Write down five (5 ) purposes for performing wound dressing. (5 Marks)
Answer--Purposes
To protect the wound from further injury or infection.
To absorb exudates such as pus or serum.
To immobilize and support the injured part.
To apply pressure on the wound to control bleeding or approximate the wound edges.
To provide psychological and physical comfort for the patient
Mention five ( 5) Sites for Intravenous Injection. (5 Marks)
Answer:
The basilic and cephalic veins located at the inner aspect of the elbow.
The accessory cephalic or the median ante-brachial veins in the forearm.
The dorsal metacarpal veins at the back of the hand.
The commonly used leg veins are the saphenous and femoral veins in the thigh and saphenous at the ankle.
In children scalp veins may be used.
List five (5) equipments for urethral catheterization. (5marks)
Aswer:
Equipment. Any five
Sterile catheter of the appropriate size
Sterilization kit containing
Water proof drape
Antiseptic solution
Cleansing cotton wool balls
Sterile gloves
Dissecting forceps
Water soluble lubricant
Urine receiver
Specimen container
Outline five (5) routes of drugs administration(5 Marks):
Answer:
Oral
Parental
Topical
Inhalational
Rectal
SECTION E: ESSAY QUESTIONS (30 MARKS)
INSTRUCTIONS:
This section consists of three 3) questions which are supposed to be answered in a narrative way
Write your answer on a separate sheet of paper provided; each question should start on a new page.
Write your examination number on each answer sheet you are using
A 70-year old man is admitted to the hospital due to urine retention. A community health worker who brought this patient reported that he has been diagnosed with prostate cancer for three years. Describe how you are going to catheterize this Mzee. (10 Marks)
Answer 1mark @
Wash hands and wear gloves
Expose the genital area and swabs the glans of penis
Add lubricants to the urethral penis
Take off the catheter from its sterile packet
Hold the penis straight and insert the catheter to the urethra
Connect the foley catheter with the urine bag
Take Syringe and draw water of injection or normal saline
Ballon the catheter
Cover the patient and leave at good state
Take off gloves and wash hands
Yuri is 12 year old boy, admitted in paediatric ward after sustained burn injury at the abdomen. Explain step-by-step procedure on how are you going to dress his wound. (10 Marks)
Answers: intro wound dressing ………….1mark
Procedure ……..1marks @
1- Explain procedure to the client .
2- Wash hands.
3- Provide for client privacy
4- Remove binder and tape
-remove binder if used and place them aside .
- If adhesive tape used ,remove it by holding down the skin and pulling the tape toward the wound .
- Use solvent to loose the tape if required
5- Remove and dispose of soiled dressing .
- Put on clean gloves to remove outer dressing or surgipad .
- Place outer dressing away from client .Place the soiled dressing in moisture proof bag without touch the outside the bag .
- Remove the under dressing , taking care not to dislodge any drains , if the gauze sticks to the drains , support the drain with one hand and remove the gauze with other.
6- Setup sterile supplies .
- Open the sterile dressing set using aseptic technique .
- Place the sterile drape beside the wound .
- Open the sterile cleaning solution pour it over the gauze sponges .
- Put on sterile gloves
7- Irrigate the wound :
-Instill a steady stream of irrigating solution into the wound .
- Position the basin below the wound to receive the irrigating
-Use either a syringe with a catheter attached or with irrigating tip to flush the wound
-Continue irrigating until the solution becomes clear.
-Dry the area around the wound
8- Clean the wound .
- Clean the wound using your gloved hands or forceps and gauze swabs moisture with cleaning solutions.
Use the cleaning method .
Use a separate swab for each stroke and discard each swab after use .
9- Apply dressing to the drain site and incision.
-Place a precut 4 in 4 gauze around drain .
-Apply the sterile dressing one at a time over the drain and incision .
-Apply surgipad , remove gloves and dispose of them .
-Secure the dressing with tape or tie.
- Wash your hands.
-Document the procedure and all nursing assessment
3. Mr. Majimoto is admitted in the ward due to cut wounds. He was involved in a fight at one of the night clubs in town. He is interested to know the fate of his wounds. As a health care provider, describe types of wound healing process and factors that may affect wound healing (10 Marks).
Answer:
Factors affecting wound healing: (6 points, 1 mark each)
Extent of the wound: A small superficial wound heals more quickly than bigger and deeper wounds.
Nutritional status: Poor nutrition delays wound healing.
Provision of adequate amounts of protein, vitamin C and calories hastens the healing process.
Location of the wound: Wounds on the feet and legs or less clean heal more slowly than wounds on the face or head.
Age of the patient: Healing is more rapid in children and young adults than in elderly people.
Foreign bodies: Healing will not take place until foreign bodies are removed from the wound.
These foreign bodies may be in the form of damaged tissues, imbedded fragments of wood, and metals of drainage tubes.
Hemorrhage and haematoma: These prolong the healing time since they provide a good culture medium for the growth of micro-organisms.
Presence of other diseases: Diseases such as diabetes mellitus prolong the healing time of wounds owing to a high amount of glucose in the blood.
Certain drugs: Drugs that may alter healing rate include anti-inflammatory drugs, such as cortisone, and some immune-suppressive and cancer drugs.
Answer
Wound Healing (8 points, 0.5 marks each)
Healing by Primary Intention (4 points)
Healing by first intention occurs when the wound edges are well approximated and infection is absent.
There is little granulation and scar formation is minimal.
There is very little reaction and healing is usually fast.
Most surgical incisions heal by first intention because the instruments used for cutting are sterile and the wound edges are sutured.
Healing by Second Intention (4 points)
Healing by second intention occurs when the wound is infected and the wound edges are not approximated.
A large amount of granulation tissue is required to fill the opening before healing takes place.
The healing process takes a longer time and the resultant scar is large.
In some patients the scar formation can be excessive and is known as ‘keloid’.
