Q P Code: 212010. Reg. No.

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Second Year B.Sc Nursing Degree Supplementary Examinations, April
- 2019
Medical Surgical Nursing ( Adult Including Geriatrics) I
Surgical Nursing
(2016 Scheme)
Time: 3 hours Max Marks: 75
● Answer all questions
● Draw diagram wherever necessary

Short Essays
(2x7=14 )
1. Define glaucoma. Discuss the medical and Surgical management of
glaucoma (1+ 3 +3)
Glaucoma is a complex disease in which damage to the optic nerve leads
to progressive, irreversible vision loss. Glaucoma is the second leading
cause of blindness. Glaucoma is actually a group of diseases. The most
common type is hereditary.

Medical management : The damage caused by glaucoma can't be

reversed. But treatment and regular checkups can help slow or prevent
vision loss, especially if the person catch the disease in its early stages.

Glaucoma is treated by lowering eye pressure (intraocular pressure).

● Eye Drops: Glaucoma treatment often starts with prescription eye drops.
These can help decrease eye pressure by improving how fluid drains
from the eye or by decreasing the amount of fluid, eye makes.
Prescription eye drop medications include:
○ Prostaglandins: These increase the outflow of the fluid in the eye
(aqueous humor), thereby reducing the eye pressure. Medicines in this
category include latanoprost (Xalatan), travoprost (Travatan Z),
 tafluprost (Zioptan), bimatoprost (Lumigan) and latanoprostene bunod
(Vyzulta).
○ Beta blockers: These reduce the production of fluid in the eye, thereby
lowering the intraocular pressure. Examples include timolol (Betimol,
Istalol, Timoptic) and betaxolol (Betoptic).
○ Alpha-adrenergic agonists. These reduce the production of aqueous
humor and increase outflow of the fluid in the eye. Examples include
apraclonidine (Iopidine) and brimonidine.
○ Carbonic anhydrase inhibitors: These medicines reduce the
production of fluid in the eye. Examples include dorzolamide (Trusopt)
and brinzolamide.
○ Miotic or cholinergic agents. These increase the outflow of fluid from
the eyes. An example is pilocarpine (Isopto Carpine).
● Oral medications : If eye drops alone don't bring the eye pressure down
to the desired level, doctor may also prescribe an oral medication,
usually a carbonic anhydrase inhibitor.

Surgical management : Other treatment options include laser therapy and

various surgical procedures. The following techniques are intended to
improve the drainage of fluid within the eye, thereby lowering pressure:
● Laser therapy. Laser trabeculoplasty is an option if he/she have open-
angle glaucoma. It's done in doctor's office. Doctor uses a small laser
beam to open clogged channels in the trabecular meshwork. It may take
a few weeks before the full effect of this procedure becomes apparent.
● Filtering surgery. With a surgical procedure called a trabeculectomy,
surgeon creates an opening in the white of the eye (sclera) and removes
part of the trabecular meshwork.
● Drainage tubes: In this procedure, eye surgeon inserts a small tube
shunt in the eye to drain away excess fluid to lower the eye pressure.
● Minimally invasive glaucoma surgery (MIGS). Doctor may suggest a
MIGS procedure to lower eye pressure. These procedures generally
require less immediate postoperative care and have less risk than
 trabeculectomy or installing a drainage device. They are often combined
with cataract surgery. There are a number of MIGS techniques available,
and doctor will discuss which procedure may be right for each person. .

2. Hiatus Hernia
A hernia occurs when internal tissue or part of an organ pushes through a
weakness in the wall of a body part that would usually hold it in place. A
hiatal hernia occurs when the upper part of the stomach bulges through the
large muscle separating the abdomen and chest.

Types:
There are generally two types of hiatal hernia: sliding hiatal hernias and
fixed, or paraesophageal, hernias.
● Sliding hiatal hernia: This is the more common type of hiatal hernia. It
occurs when the stomach and esophagus slide into and out of the chest
through the hiatus. Sliding hernias tend to be small. They usually don’t
cause any symptoms. They may not require treatment.
● Fixed hiatal hernia: This type of hernia isn’t as common. It’s also known
as a paraesophageal Hernia. In a fixed hernia, part of the stomach
pushes through the diaphragm and stays there. Most cases are not
serious. However, there is a risk that blood flow to the stomach could
become blocked. If that happens, it could cause serious damage and is
considered a medical emergency.

Causes and risk factors: The causes of the structural weaknesses that lead
to a hiatal hernia are not clear. One potential cause might be pressure on
the diaphragm, the risk of which may be higher in some people due to
certain genetic factors. Other risk factors include an upward force that
occurs due to weightlifting, straining to empty the bowel, or persistent
coughing or vomiting. These actions temporarily increase the pressure
inside the abdominal cavity.
 Clinical manifestations : It’s rare for even fixed hiatal hernias to cause
symptoms. Common symptoms include:
● Heartburn that gets worse when you lean over or lie down
● Chest pain or epigastric pain
● Trouble swallowing
● Belching

Management :
Pharmacologic therapy : Treatments to relieve acid reflux symptoms are
available over the counter. These include antacids, which come in the form
of liquids or chewy tablets and reduce the acidity of the stomach contents.
Surgical management : In rare cases, a person with a hiatal hernia may
require surgery under general anesthesia. The operations for hiatal hernias
are laparoscopic. Surgeons perform these procedures through small
"keyhole" cuts, so they are less invasive than surgery that requires a large
incision. A laparoscopic Nissen fundoplication (LNF) is one of the standard
procedures for treating sliding hiatal hernias.

3. Enucleation
Enucleation is a surgical procedure that involves removal of the entire
globe and its intraocular contents, with preservation of all other periorbital
and orbital structures.

Indications :
The following are indications for enucleation:
● Intraocular malignancy or high suspicion for intraocular malignancy (most
commonly uveal melanoma and retinoblastoma)
● Trauma
● Blind, painful eye
● Sympathetic ophthalmia
● Microphthalmos
Complications :
Complications of an enucleation include the following:
● Intraoperative:
○ Damage to or loss of extraocular muscles
○ Hemorrhage
● Postoperative:
○ Infection
○ Hemorrhage
○ Wound dehiscence
○ Extrusion of the conformer
○ Contraction of the fornices
○ Exposure of the implant
○ Extrusion of the implant
○ Migration of the implant
○ Ptosis
○ Ectropion
○ Entropion
○ Hollow or deep superior sulcus
○ Poorly fitting prosthesis
○ Enophthalmos
○ Socket contracture
○ Orbital cellulitis