SHORT ANSWER QUESTIONS

Q. Explain the 3 primary processes of wound healing

1. **Inflammatory Phase:** This initial stage involves blood clotting and inflammation to control
bleeding and prevent infection. White blood cells remove debris and bacteria, preparing the
wound for the next stages.

2. **Proliferative Phase:** During this phase, new tissue is generated. Fibroblasts produce
collagen, the main structural protein in connective tissue, helping to rebuild the damaged area.
Blood vessels also grow to supply nutrients and oxygen to the developing tissue.

3. **Maturation Phase:** Also known as the remodeling phase, it focuses on strengthening and
organizing the newly formed tissue. Collagen fibers undergo rearrangement, making the tissue
more resilient. The wound gradually contracts and gains strength over time.

Q. Outline 5 causes of fluid and electrolyte imbalance

1. **Dehydration:** Insufficient fluid intake, excessive sweating, vomiting, or diarrhea can lead to
dehydration, disrupting the balance of fluids and electrolytes in the body.

2. **Kidney Disorders:** Conditions affecting the kidneys, such as kidney disease or failure, can
impair the body’s ability to regulate fluid and electrolyte levels.

3. **Gastrointestinal Issues:** Disorders like severe diarrhea, vomiting, or malabsorption can

disturb the balance of electrolytes, particularly sodium and potassium.

4. **Medications:** Certain medications, such as diuretics or laxatives, can impact fluid and
electrolyte balance by promoting excessive fluid loss or disrupting normal absorption.
 5. **Endocrine Disorders:** Conditions like diabetes or adrenal insufficiency can influence fluid
and electrolyte balance due to hormonal imbalances affecting water and electrolyte regulation.

Q. Explain 5 signs and symptoms of hypovolemic shock

Hypovolemic shock occurs when the body loses a significant amount of blood or fluids, leading
to a decrease in blood volume.

1. **Rapid Heart Rate (Tachycardia):** The body attempts to compensate for decreased
blood volume by increasing the heart rate to maintain adequate blood flow to vital
organs.

2. **Low Blood Pressure (Hypotension):** With reduced blood volume, blood pressure
drops, compromising the ability to deliver oxygen and nutrients to tissues and organs.

3.**Cool and Clammy Skin:** Insufficient blood circulation may result in cool, pale, and clammy
skin as the body redirects blood flow to vital organs to maintain essential functions.

4. **Weakness and Fatigue:** Reduced blood supply to muscles and organs can lead to weakness
and fatigue, and the individual may feel lightheaded or dizzy.

5. **Decreased Urine Output:** The kidneys respond to decreased blood volume by conserving
water, leading to reduced urine production. Dark urine may indicate concentrated waste
products due to inadequate fluid intake.

Q. Outline the roles of a nurse in medical surgical nursing

1. **Assessment and Monitoring:** Conducting thorough patient assessments before and after
surgical procedures, monitoring vital signs, and assessing the overall health status to identify any
deviations or complications.

2. **Patient Education:** Providing patients and their families with information about their
condition, treatment plans, medications, and post-operative care. Ensuring patients understand
and adhere to prescribed interventions.
3. **Medication Management:** Administering medications as prescribed, monitoring for side
effects, and educating patients on proper medication management. Ensuring accurate
documentation of medication administration.

4. **Wound Care:** Monitoring and caring for surgical incisions or medical wounds, preventing
infections, and promoting healing. Educating patients on wound care protocols and signs of
complications.

5. **Collaboration with Healthcare Team:** Working collaboratively with physicians, surgeons,

therapists, and other healthcare professionals to coordinate and deliver comprehensive patient
care. Communicating effectively to ensure continuity of care.

6. **Pain Management:** Assessing and managing pain levels through medication administration,
non-pharmacological interventions, and evaluating the effectiveness of pain management
strategies.

7. **Advocacy:** Advocating for patients’ needs and ensuring their rights are respected. Serving as
a liaison between patients and the healthcare team, addressing concerns, and facilitating
communication.

8. **Prevention and Health Promotion:** Implementing strategies to prevent complications, such

as deep vein thrombosis (DVT) or pressure ulcers. Promoting health and wellness through
patient education and lifestyle modifications.

9. **Emotional Support:** Providing emotional support to patients and their families, addressing
fears and concerns, and offering guidance through the emotional aspects of illness or surgery.

10. **Documentation:** Maintaining accurate and thorough documentation of patient

assessments, interventions, and responses. Ensuring compliance with legal and regulatory
standards.
 LONG ANSWER QUESTIONS

Q. A 70 year old man is admitted in to your ward having sustained 15% burns.

(A) state the systemic response to burns

Burn injuries, even if localized, can trigger a systemic response affecting the entire body. In the case of a
70-year-old man with 15% burns, the systemic response can include:

1. **Inflammatory Response:** The body initiates a widespread inflammatory response to

the burn injury. This can lead to the release of inflammatory mediators, increased
capillary permeability, and the migration of immune cells to the site of injury.

2. **Fluid Shifts:** Burns can cause fluid shifts, leading to increased capillary permeability
and the movement of fluids from the bloodstream into the interstitial spaces. This can
result in edema and a decrease in circulating blood volume.

3. **Cardiovascular Changes:** The body may experience a decrease in blood pressure

due to fluid loss, leading to hypovolemia. The heart rate may increase as a compensatory
mechanism to maintain cardiac output.

4. **Metabolic Response:** Burn injuries often lead to an increased metabolic rate as the
body attempts to repair damaged tissue. This can result in an elevated demand for
nutrients, such as protein and calories, to support the healing process.

6. **Immunosuppression:** Severe burns can suppress the immune system, making the individual
more susceptible to infections. The compromised skin barrier provides an entry point for
pathogens, increasing the risk of systemic infection.

7. **Hypermetabolism:** Burn injuries can induce a state of hypermetabolism, causing increased

energy expenditure. This can lead to muscle wasting, weight loss, and nutritional deficiencies if
not adequately addressed.
 8. **Temperature Regulation:** Burned skin may impair the body’s ability to regulate temperature,
leading to difficulties in maintaining normal body temperature. Hypothermia can be a concern,
especially in the acute phase.

9. **Electrolyte Imbalance:** Burns can disrupt the balance of electrolytes in the body, particularly
sodium and potassium. Fluid shifts and increased metabolic activity contribute to these
imbalances.

(B) State any 4 complications that occur following burns

Burn injuries can lead to various complications during the acute and post-acute phases of recovery. Here
are four common complications following burns:

1. **Infection:** Burned skin is more susceptible to infection as the protective barrier is

compromised. Bacterial, viral, or fungal infections can occur, leading to local or systemic
complications if not promptly treated.

2. **Hypovolemic Shock:** Severe burns can result in a significant loss of fluids and electrolytes,
potentially leading to hypovolemic shock. This condition is characterized by inadequate blood
volume to meet the body’s needs, causing a drop in blood pressure and compromised organ
perfusion.

3. **Respiratory Complications:** Inhalation injuries, often associated with burns, can lead to
respiratory problems. Exposure to smoke or hot gases can damage the airways and lungs,
causing conditions like pneumonia, acute respiratory distress syndrome (ARDS), or respiratory
failure.

4. **Hypertrophic Scarring and Contractures:** During the healing process, burn injuries may lead
to the formation of hypertrophic scars or contractures. Hypertrophic scars are raised, thickened
scars that can limit movement, while contractures involve the tightening of skin and underlying
tissues, potentially affecting joint mobility.

(C) Describe the nursing management of a patient with burns

The nursing management of a patient with burns involves a comprehensive approach to address
physical, emotional, and psychological needs. Here are key aspects of nursing care for a patient with
burns:

1. **Assessment:**

- Conduct a thorough initial assessment, including the extent and depth of burns, associated injuries,
and any pre-existing medical conditions.

- Monitor vital signs, fluid balance, and neurological status regularly.

- Assess pain levels using appropriate pain scales.

2. **Wound Care:**

- Implement meticulous wound care to prevent infection and promote healing.

- Administer prescribed topical treatments and dressings.

- Monitor and document the appearance of the wounds, assessing for signs of infection or
complications.

3. **Fluid Resuscitation:**

- Initiate and monitor fluid resuscitation to address hypovolemia and maintain hemodynamic stability.

- Adjust fluid therapy based on the patient’s response and ongoing assessments.

4. **Pain Management:**

- Administer analgesics as prescribed to manage pain effectively.

- Utilize non-pharmacological pain management techniques, such as positioning, distraction, or

relaxation exercises.

5. **Nutritional Support:**

- Collaborate with the nutrition team to provide adequate caloric and protein intake to support healing
and prevent malnutrition.

- Monitor nutritional status and address any deficiencies.

6. **Psychosocial Support:**
 - Offer emotional support and reassurance to the patient and their family.

- Facilitate communication and provide information about the treatment plan.

- Collaborate with mental health professionals if needed.

7. **Mobility and Positioning:**

- Encourage and assist with early mobilization to prevent contractures and maintain joint flexibility.

- Use appropriate positioning devices to support comfort and prevent complications.

8. **Infection Prevention:**

- Implement strict infection control measures, including hand hygiene and aseptic techniques.

- Monitor for signs of infection and promptly initiate antibiotic therapy if indicated.

9. **Collaboration with Multidisciplinary Team:**

- Work closely with physicians, surgeons, physical therapists, and other healthcare professionals to
coordinate care and address specific needs.

10. **Patient Education:**

- Provide education about wound care, medications, nutrition, and signs of complications.

- Involve the patient and family in the care plan to enhance their understanding and participation in
recovery.