🏥 Nurses Revision Uganda
📱 WhatsApp: 0726113908 | 🌐 Website:https://nursesrevisionuganda.com
Medical Nursing I & Pharmacology I - Paper CN 211
SECTION A: Objective Questions (20 marks)
💡 Pharmacology Focus: Master the definitions! Efficacy vs Potency vs Affinity are frequently tested concepts. Remember: Affinity = binding, Potency = dose needed, Efficacy = max effect.
1
Which of the following terms refers to how tightly a drug binds to a receptor?
(c) Affinity
Affinity is the measure of the strength of binding between a drug and its receptor. High affinity means the drug binds strongly at low concentrations. This is distinct from efficacy (the maximum biological effect a drug can produce) and potency (the amount of drug needed to produce a specific effect). Agonism describes the type of action (activation), not binding strength.
DRUG-RECEPTOR TERMS: "APE" - Affinity (Binding), Potency (Dose), Efficacy (Max effect)
2
Which of the following patient features does the nurse NOT base on to determine a drug prescription?
(c) Volume
Volume is not a patient feature - it's a measurement of space or fluid. Drug dosing is based on patient characteristics like age (affects metabolism), weight (used for mg/kg dosing, especially in pediatrics), and height (used to calculate BMI and body surface area for some drug calculations). "Volume" in this context is nonsensical as a patient feature.
⚖️ Pediatric Dosing: Always use weight (mg/kg) or BSA (mg/m²) for children. Adult doses are fixed but must be adjusted for extremes of age and obesity.
3
Which of the following is an advantage of the sublingual route of drug administration?
(a) Prevent first pass effect
The sublingual route bypasses the hepatic first-pass metabolism because drugs are absorbed directly from the highly vascular buccal mucosa into the systemic circulation. This results in rapid onset and higher bioavailability compared to oral administration. GTN for angina is the classic example, acting within 1-3 minutes.
ROUTES AVOIDING FIRST-PASS: "SIQ" - Sublingual, Inhalation, Intravenous, Rectal (partially), Intramuscular
4
Which of the following does the Nurse consider before administering an oral medication?
(c) Patient's consciousness
Patient's consciousness level is a critical safety consideration. An unconscious or severely drowsy patient cannot swallow safely, risking aspiration pneumonia. The nurse must assess gag reflex and ability to protect airway before oral administration. If compromised, use alternative routes (IV, NG tube) or hold medication.
⚠️ Aspiration Risk! Use "swallow test" with small amount of water first. If patient coughs/chokes, withhold oral meds and notify prescriber. Check for cough/gag reflex!
5
Which of the following terms refers to how much of a drug is required to elicit a pharmacological response?
(c) Potency
Potency is the amount of drug (dose or concentration) required to produce a specified effect, typically 50% of the maximum response (EC50). A more potent drug requires a lower dose. This differs from efficacy (max effect possible) and therapeutic index (safety margin). High potency doesn't mean better - it just means smaller doses are needed.
POTENCY vs EFFICACY: "Potency = Price, Efficacy = Performance" - Cheap car (low dose) may still get you there (high efficacy), but they're different concepts!
6
Which of the following blood components is decreased in anaemia?
(b) Erythrocytes
Anemia is defined as a decrease in erythrocytes (red blood cells) or hemoglobin concentration below age- and sex-specific norms. This reduces oxygen-carrying capacity, causing fatigue, pallor, tachycardia, and dyspnea on exertion. Platelets, lymphocytes, and leukocytes are different cell lines not primarily affected in anemia (though some conditions like aplastic anemia affect all lines).
BLOOD COMPONENTS: "RBCs carry Oxygen, WBCs fight Infection, Platelets stop Bleeding"
7
What priority intervention does the Nurse perform for an anaemic patient who develops difficulty in breathing?
(c) Administer oxygen
Following ABC priorities, airway and breathing come first. Dyspnea in anemia indicates tissue hypoxia from inadequate oxygen delivery. Supplemental oxygen immediately increases oxygen content in remaining RBCs, relieving hypoxia while preparing for definitive treatment (transfusion, iron). Propping up helps but doesn't address oxygenation. Vitals are important but secondary to oxygen.
🫁 ABC Protocol: Airway, Breathing, Circulation. Always address the life-threatening issue first. Oxygen can be given while taking vitals simultaneously!
8
In which of the following conditions does the Nurse most likely hear a patient complain of soreness behind the sternum?
(a) Bronchitis
Bronchitis is the most likely condition where a patient complains of soreness behind the sternum. This is because bronchitis involves inflammation of the **bronchial tubes**, which are located directly behind the sternum. The persistent coughing and inflammation characteristic of bronchitis frequently lead to chest discomfort, often described as a burning or sore sensation in the retrosternal area.
🩺 Clinical Tip: Persistent cough and retrosternal discomfort are classic symptoms of bronchitis, often exacerbated by deep breaths or coughing.
9
Which of the following is a clinical manifestation for rheumatic heart disease?
(c) Jerky movements
Jerky movements refer to Sydenham's chorea, which is one of the major diagnostic criteria for Acute Rheumatic Fever (ARF). ARF is the inflammatory disease that can lead to Rheumatic Heart Disease (RHD). Sydenham's chorea is a neurological manifestation of the autoimmune response to a Group A Streptococcus infection and is a direct clinical sign of the rheumatic process. While not a cardiac manifestation itself, it is a key indicator of the underlying disease that causes RHD.
Major Criteria for Acute Rheumatic Fever (JONES):
- Joints (Polyarthritis)
- Obvious Carditis
- Nodules (Subcutaneous)
- Erythema Marginatum
- Sydenham's Chorea (Jerky movements)
10
Which of the following pieces of advice does the Nurse share with a client diagnosed with deep vein thrombosis?
(d) Use stockinnetes
Compression stockings (stockinnetes) are standard treatment for DVT. They provide graduated compression (30-40 mmHg at ankle) to reduce venous stasis, prevent clot propagation, and reduce post-thrombotic syndrome. Must be worn during the day for at least 2 years after DVT. Elevate leg, avoid massage, and maintain anticoagulation are also key interventions.
🦵 DVT Triple Therapy: (1) Anticoagulation (DOACs/warfarin), (2) Compression stockings, (3) Elevation. NO massage (risk of embolism)!
11
The most appropriate nursing intervention for a patient with thick sputum and persistent coughing is to
(b) increase fluid intake of the patient
Adequate hydration (2-3 liters/day) is the most effective way to thin thick, tenacious sputum. Water liquefies secretions, making them easier to expel through coughing and preventing mucus plugging. This is more effective than positioning alone. Mucolytics may help but hydration is primary. Decongestants dry secretions (counterproductive), and diet is long-term, not immediate.
12
Which of the following is a medical condition of the lower respiratory tract?
(a) Pleurisy
Pleurisy is inflammation of the pleura (lining of lungs), which is part of the lower respiratory tract. It causes sharp, pleuritic chest pain that worsens with breathing. All other options are upper respiratory tract conditions: pharyngitis (pharynx), tonsillitis (tonsils), and coryza (common cold - nasal passages).
RESPIRATORY DIVISION: "Upper = Nose to Larynx, Lower = Trachea to Alveoli"
13
The nurse records the whistling musical sound heard during exhalation in patients with respiratory disease as
(d) Wheezing
Wheezing is defined as a high-pitched, whistling musical sound heard during expiration due to turbulent airflow through narrowed bronchioles. Classic sign of asthma, COPD, bronchiolitis. Indicates lower airway obstruction. Stridor is inspiratory (upper airway), croup is a disease (laryngotracheobronchitis), grunting is expiratory sound in infants with RDS.
SOUND-LOCATION: "Wheeze = EXpiration (EXit), Stridor = INspiration (IN)"
14
Which of the following refers to inflammation and accumulation of fluid in the layer enclosing the heart?
(b) Pericardial effusion
Pericardial effusion is the accumulation of fluid in the pericardial sac surrounding the heart. Can be inflammatory (pericarditis), infectious (TB, viral), malignant, or due to heart failure. If large, causes cardiac tamponade (Beck's triad: hypotension, JVD, muffled heart sounds). Medical emergency requiring pericardiocentesis.
PERICARDITIS vs PLEURISY: PeriCARDial effusion affects the CARD (heart), Pleural effusion affects the LUNGS
15
Nurses elevate the head of the bed while caring for a patient with heart failure to
(c) increase drainage in the heart and lungs
Semi-Fowler's position (30-45° head elevation) reduces venous return to the heart (preload) and facilitates lung expansion, improving gas exchange. Counteracts pulmonary congestion and orthopnea. Reduces cardiac workload and symptoms of breathlessness. Does not affect appetite, drug absorption significantly, or monitoring capability.
HF POSITIONING: "Up in HF" - Elevate head, Up legs for edema (when not in acute distress)
16
Nurses caring for a client with acute myeloid leukemia aim to prevent
(d) haemorrhage
The #1 cause of death in AML during induction chemotherapy is hemorrhage due to profound thrombocytopenia (platelets <20,000). Platelet function is also impaired by leukemic blasts. Bleeding can be catastrophic: intracranial hemorrhage, pulmonary hemorrhage, GI bleed. Nurses must enforce bleeding precautions (no IM injections, soft toothbrush, electric razor, avoid falls).
🩸 Bleeding Precautions in AML: Platelet transfusion threshold <10,000 (or <20,000 if fever). No rectal temps, no injections, pressure x10 min after venipuncture. Watch for petechiae, ecchymosis, mucosal bleeding!
17
Which of the following strategies do nurses apply at the tertiary level of disease prevention?
(c) Rehabilitation
Tertiary prevention focuses on managing existing disease to prevent complications and maximize function. Rehabilitation (physical therapy, occupational therapy, speech therapy) restores function after disease has occurred. Examples: stroke rehab, cardiac rehab, pulmonary rehab. Health education and screening are primary/secondary; immunization is primary prevention.
PREVENTION LEVELS: "Pri-Sco-Tert" - Primary (prevent onset), Secondary (early detection), Tertiary (rehabilitation)
18
Which of the following is NOT an investigative specimen obtained to screen for Pulmonary Tuberculosis?
(a) Urine
Urine is NOT used for pulmonary TB diagnosis. TB bacilli are not excreted in urine from pulmonary infection (unless there is genitourinary TB, which is extrapulmonary). Sputum/phlegm is the PRIMARY specimen - send 3 early morning samples for AFB smear and culture. Blood can be used for TB PCR or cultures in disseminated TB, and pleural aspirate is used for TB pleural effusion.
TB SPECIMENS: "SPUTUM-B" - Sputum (primary), Pleural fluid, Urine (only for GU TB), Tissue biopsy, Blood (disseminated), Urinary lipoarabinomannan, Mediastinal lymph nodes
19
Which of the following conditions causes primary hypertension?
(a) Idiopathic
Primary (essential) hypertension accounts for 90-95% of cases and has no identifiable cause. It's multifactorial: genetics, obesity, salt intake, age, lifestyle. Idiopathic means "unknown cause." All other options are secondary hypertension causes: glomerulonephritis (renal), thyrotoxicosis (endocrine), and chronic stress can contribute but is not a primary cause.
📊 HTN Classification: Primary = No cause (95%), Secondary = Identifiable cause (5%) - renal, endocrine, vascular, drug-induced
20
Which of the following manifestations is NOT normally associated with Tonsilitis?
(c) Normal body temperature
Fever (elevated temperature) is a hallmark sign of tonsillitis, whether bacterial or viral. The inflammatory response to infection releases pyrogens (IL-1, IL-6, TNF-α) that raise hypothalamic set point. Temperatures can reach 38-40°C. Normal temperature would be unusual and might suggest non-infectious causes like allergic tonsillitis or irritation. All other options are classic findings.
TONSILLITIS TRIAD: "F-P-L" - Fever + Pain on swallowing + Lymphadenopathy
SECTION B: Fill in the Blank Spaces (10 marks)
21
Medicines that have a high abuse potential and not medically used belong to schedule ________________
Schedule 1 (or Class I / Narcotic Schedule I)
Schedule 1 drugs (e.g., heroin, LSD, cannabis in some jurisdictions) have high abuse potential, no accepted medical use, and lack safety even under supervision. These are prohibited substances. Schedule II (e.g., morphine, cocaine) have high abuse potential but have medical use with strict controls.
22
A gradual decrease in response to a drug as a result of repeated administration is known as ________________
Tolerance
Tolerance is a pharmacological phenomenon where higher doses are required to achieve the same effect. Mechanisms include receptor downregulation, increased metabolism (enzyme induction), and physiological adaptation. Common with opioids, benzodiazepines, and alcohol. Leads to dose escalation and dependence.
TOLERANCE vs DEPENDENCE: Tolerance = need more for same effect, Dependence = withdrawal symptoms without it, Addiction = compulsive use despite harm
23
Medication that comprises of sugar solution in water is called ________________
Syrup (or Simple Syrup)
Syrup is a concentrated aqueous solution of sucrose (sugar) with or without medicinal agents. Simple syrup contains 85% w/v sucrose. Acts as sweetening agent, preservative, and vehicle for drugs. Mask bitter taste, especially important for pediatric formulations. Example: cough syrups, pediatric antibiotics.
24
The most convenient route of drug administration is called ________________
Oral route (by mouth)
Oral administration is most convenient, economical, and safe. Requires no sterile technique, equipment, or trained personnel. Suitable for self-medication. Allows use of various formulations (tablets, capsules, syrups). However, has slower onset, may have erratic absorption, and is unsuitable for unconscious/vomiting patients or drugs destroyed by gastric acid/first-pass metabolism.
💊 Oral Route Facts: 80% of medications are taken orally. First-pass metabolism through liver can reduce bioavailability significantly (e.g., morphine, nitroglycerin).
25
Specialized field of nursing that focuses on the unique health care needs of older adults is called ________________
Gerontological nursing (or Geriatric nursing)
Gerontological nursing is a specialty focused on care of older adults across health-illness continuum. Addresses multiple chronic conditions, polypharmacy, cognitive impairment, functional decline, and end-of-life care. Requires knowledge of normal aging changes, geriatric syndromes (delirium, dementia, falls, incontinence), and family dynamics. Certification: Gerontological Nursing Certification (GNC).
26
Enlargement of the heart muscle is referred to as ________________
Cardiomegaly (or Myocardial hypertrophy)
Cardiomegaly refers to increased heart size seen on imaging (CXR: cardiothoracic ratio >0.5). Can be from chamber dilation (volume overload) or myocardial hypertrophy (pressure overload). Causes: hypertension, valvular disease, cardiomyopathy, ischemic heart disease. Leads to decreased cardiac efficiency, arrhythmias, heart failure. Requires echocardiogram for definitive diagnosis.
27
The process of blood clotting is called ________________
Coagulation (or Hemostasis)
Coagulation is the complex cascade process forming a fibrin clot to prevent blood loss. Involves intrinsic and extrinsic pathways converging to activate Factor X → Factor Xa → Factor Xa converts prothrombin → thrombin → thrombin converts fibrinogen → fibrin threads forming mesh that traps blood cells. Requires calcium ions, platelets, and clotting factors (I-XIII). Deficiency leads to hemophilia, von Willebrand disease, or overdose with anticoagulants.
28
Decreased blood supply to the tissue is medically referred to as ________________
Ischemia
Ischemia is inadequate blood flow to meet metabolic demands. Can be temporary (angina) or permanent (infarction). Caused by atherosclerosis, thrombosis, embolism, or vasospasm. Leads to hypoxia, anaerobic metabolism, lactic acidosis, and cell death if prolonged. Critical in myocardial infarction, stroke, limb ischemia. Symptoms: pain, pallor, paresthesia, pulselessness, paralysis (5 P's).
ISCHEMIA SIGNS: "5 P's" - Pain, Pallor, Paresthesia, Pulselessness, Paralysis (late sign)
29
The other name for peritonsillar abscess is ________________
Quinsy (or Peritonsillar Cellulitis)
Quinsy is a collection of pus between tonsil capsule and superior constrictor muscle. Complication of untreated tonsillitis. Features: severe sore throat, fever, trismus (lockjaw), "hot potato" voice, uvula deviation away from affected side. Requires urgent ENT referral for incision and drainage + IV antibiotics (ceftriaxone + metronidazole). Can progress to deep neck space infection, airway obstruction, or sepsis.
30
A condition in which a patient experiences an irregular and faster heart beat is called ________________
Arrhythmia (or Dysrhythmia) - specifically could be Atrial Fibrillation, Tachycardia, or Palpitations
Arrhythmia is any abnormal heart rhythm - irregular, too fast (tachycardia >100 bpm), or too slow (bradycardia <60 bpm). Atrial fibrillation is most common - irregularly irregular rhythm, increased risk of stroke. Causes: electrolyte imbalance, ischemia, drug toxicity, cardiomyopathy. Can be asymptomatic or cause palpitations, dizziness, syncope, heart failure. Diagnosis: ECG. Treatment depends on type: beta-blockers, calcium channel blockers, amiodarone, cardioversion, ablation.
SECTION C: Short Essay Questions (20 marks)
31
(a) With an example for each, state six (6) sources of medicines. (6 marks)
Medicines can be derived from various natural and synthetic sources:
1. Plants (Herbal sources): Example: Morphine from opium poppy (Papaver somniferum), Digoxin from Digitalis foxglove, Quinine from cinchona bark.
2. Animals: Example: Insulin from porcine/bovine pancreas (historical), Heparin from pig intestinal mucosa, Premarin from pregnant mare urine.
3. Minerals/Inorganic compounds: Example: Magnesium sulfate (anticonvulsant), Lithium carbonate (mood stabilizer), Calcium carbonate (antacid).
4. Microorganisms: Example: Penicillin from Penicillium fungus, Streptomycin from Streptomyces bacteria, Insulin from recombinant E. coli.
5. Synthetic/semisynthetic chemicals: Example: Aspirin (acetylsalicylic acid), Paracetamol, Metformin - manufactured entirely through chemical synthesis.
6. Biotechnology/Genetic engineering: Example: Human insulin (Humulin), Erythropoietin (EPO), Monoclonal antibodies (Trastuzumab).
🌿 Traditional Medicine: 80% of world population uses plant-based medicines. Modern pharmacology began with isolating active compounds from plants (e.g., morphine 1806).
31
(b) Outline the four (4) pathways of pharmacokinetics. (4 marks)
Pharmacokinetics describes drug movement through the body via four processes:
1. Absorption: Movement of drug from site of administration into systemic circulation. Routes: oral, IM, IV, SC, transdermal, rectal. Factors: lipid solubility, blood flow, surface area. IV route has 100% bioavailability.
2. Distribution: Drug transport via bloodstream to target tissues and organs. Influenced by plasma protein binding, tissue perfusion, lipid solubility, and blood-brain barrier. Volume of distribution (Vd) determines loading dose.
3. Metabolism (Biotransformation): Chemical alteration of drug, primarily in liver via cytochrome P450 enzymes. Converts active drug to inactive metabolites (or prodrug to active form). Can be affected by genetics, age, liver disease, drug interactions.
4. Excretion (Elimination): Removal of drug/metabolites from body. Main route is renal (glomerular filtration, tubular secretion). Also biliary/fecal, pulmonary, saliva, sweat. Half-life determines dosing frequency.
PHARMACOKINETICS: "ADME" - Absorption, Distribution, Metabolism, Excretion
32
(a) State five (5) manifestations of respiratory diseases. (5 marks)
Respiratory diseases present with characteristic signs and symptoms affecting breathing and oxygenation:
1. Dyspnea (shortness of breath): Subjective sensation of difficulty breathing. Can be exertional or at rest. Graded by NYHA scale. Indicates hypoxemia, airway obstruction, or pulmonary congestion.
2. Cough: Reflex action to clear airways. Acute (<3 weeks) vs chronic (>8 weeks). Productive (with sputum) vs dry. Character: barking (croup), hacking (pneumonia), paroxysmal (whooping cough).
3. Sputum production: Abnormal airway secretions. Color: clear (viral), yellow/green (bacterial), rust-colored (pneumococcal pneumonia), frothy pink (pulmonary edema). Amount and consistency indicate disease severity.
4. Chest pain (pleuritic): Sharp, stabbing pain worsened by deep inspiration or coughing. Indicates pleural inflammation (pleurisy), pneumothorax, or pulmonary embolism. Distinguish from cardiac chest pain.
5. Cyanosis: Bluish discoloration of lips, tongue, nail beds indicating severe hypoxemia (O2 saturation <85%). Central cyanosis (heart/lungs) vs peripheral (circulatory). Late sign of respiratory failure.
🫁 ABNORMAL BREATH SOUNDS: Crackles (fluid), Wheezes (narrowing), Ronchi (secretions), Stridor (upper airway obstruction), Diminished (pneumothorax, COPD).
32
(b) State five (5) general causes of diseases in the human body. (5 marks)
Diseases arise from multiple etiological factors that disrupt normal homeostasis:
1. Genetic and chromosomal abnormalities: Mutations in DNA (sickle cell disease), chromosomal disorders (Down syndrome), multifactorial inheritance (diabetes). Can be inherited or spontaneous mutations.
2. Infectious agents: Pathogenic microorganisms including bacteria (TB, pneumonia), viruses (HIV, influenza), fungi (candidiasis), parasites (malaria). Transmitted via various routes.
3. Nutritional deficiencies and imbalances: Malnutrition (kwashiorkor, marasmus), vitamin deficiencies (scurvy, rickets, beriberi), mineral deficiencies (iron deficiency anemia, iodine deficiency disorders).
4. Environmental and lifestyle factors: Pollution, radiation, chemicals (carcinogens), tobacco use, alcohol abuse, physical inactivity, poor diet, stress. Major contributors to chronic diseases (COPD, cancer, heart disease).
5. Immunological dysfunction: Autoimmune diseases (rheumatoid arthritis, lupus), hypersensitivity reactions (asthma, anaphylaxis), immunodeficiency (HIV/AIDS, SCID). Immune system attacks self or fails to protect.
DISEASE CAUSES: "G-E-N-E-I" - Genetic, Environmental, Nutritional, External agents, Immunological
SECTION C: Long Essay Questions (50 marks)
33
(a) List five (5) clinical manifestations of congestive heart failure. (5 marks)
CHF manifestations result from inadequate cardiac output and fluid overload:
1. Dyspnea and orthopnea: Shortness of breath on exertion progressing to breathlessness at rest. Orthopnea: dyspnea when lying flat, requiring 2-3 pillows (NYHA Class III-IV). Paroxysmal nocturnal dyspnea: acute breathlessness waking patient from sleep.
2. Peripheral edema: Dependent pitting edema in ankles, feet, sacral area due to right-sided failure and fluid retention. Worse at end of day, improves with elevation. May progress to anasarca (generalized massive edema).
3. Fatigue and weakness: Reduced cardiac output causes poor tissue perfusion and oxygen delivery. Exercise intolerance, inability to perform ADLs, mental confusion in severe cases due to cerebral hypoperfusion.
4. Pulmonary congestion: Bibasal crackles on auscultation from alveolar fluid. Productive cough with frothy pink sputum in acute pulmonary edema. Pleural effusions may cause diminished breath sounds.
5. Jugular venous distension (JVD): Visible bulging of neck veins >3 cm above sternal angle indicating elevated right atrial pressure. Positive hepatojugular reflux: pressing on liver increases JVD. Sign of right ventricular failure.
💔 Left vs Right Failure: Left = Pulmonary congestion (dyspnea, crackles), Right = Systemic congestion (edema, JVD, hepatomegaly). Most patients have biventricular failure.
33
(b) Outline (15) fifteen nursing care actions performed for a patient admitted with congestive heart failure for the 1st 72 hours. (15 marks)
First 72 hours are critical for stabilization and preventing decompensation:
1. Continuous cardiac monitoring: Monitor heart rate, rhythm for arrhythmias (AF common), ST changes. Attach to cardiac monitor with alarms set. Document rhythm strips every shift.
2. Strict fluid balance chart: Record intake (IV, oral) and output (urine, vomit, stool) every hour. Use fluid balance sheet. Report negative balance or oliguria (<0.5 mL/kg/hr) immediately.
3. Daily weights: Weigh patient every morning at same time, after voiding, same clothing. Weight gain of >1 kg/day indicates fluid retention. Target weight loss 0.5-1 kg/day with diuretics.
4. Administer prescribed medications: Diuretics (furosemide) in morning to prevent nocturia, ACE inhibitors (enalapril), beta-blockers (carvedilol), digoxin. Monitor for side effects: hypotension, bradycardia, hypokalemia.
5. Position patient upright (semi-Fowler's 45°): Facilitates lung expansion, reduces venous return to heart, decreases cardiac workload, and relieves dyspnea. Provide oxygen via nasal cannula at 2-4 L/min.
6. Monitor vital signs every 2-4 hours: Watch for hypotension (SBP <90 mmHg indicates cardiogenic shock), tachycardia (>100), tachypnea (>24), fever (infection trigger). Use MEWS score.
7. Assess respiratory status: Auscultate lung fields for crackles, monitor SpO2, observe for increased work of breathing. Report SpO2 <90% or frothy sputum immediately.
8. Restrict sodium and fluids: Limit sodium to <2g/day (no added salt) and fluids to 1.5-2L/day. Educate on dietary restrictions. Monitor compliance and weight changes.
9. Monitor electrolytes daily: Diuretics cause hypokalemia, hyponatremia, hypomagnesemia. Check U&E daily. Replace potassium with supplements or IV as prescribed. Hypokalemia precipitates arrhythmias.
10. Pressure injury prevention: Edematous skin is fragile. Turn every 2 hours, use pressure-relieving mattress, keep skin dry, inspect bony prominences. Apply barrier cream to edematous areas.
11. Provide small frequent meals: Large meals increase cardiac workload (splanchic blood flow). Offer 6 small low-sodium meals. Weigh patient to assess nutritional status.
12. Monitor urine output: Measure hourly via catheter or calibrated container. Expect diuresis within 1-2 hours of furosemide. Report if urine output <30 mL/hr (indicates worsening renal perfusion).
13. Psychosocial support and anxiety management: Explain all procedures, provide reassurance, teach relaxation techniques (pursed-lip breathing). Anxiety increases sympathetic drive and cardiac workload.
14. Monitor for medication side effects: ACE inhibitors: watch for hypotension, cough, hyperkalemia. Digoxin: monitor for toxicity (nausea, visual disturbances, arrhythmias). Beta-blockers: watch for bradycardia.
15. Patient and family education: Teach about disease process, medication regimen, daily weighing, symptom monitoring (increasing dyspnea, edema), when to seek help. Provide written instructions.
33
(c) List five (5) complications that may occur in a patient with congestive cardiac failure. (5 marks)
1. Acute pulmonary edema: Life-threatening fluid accumulation in alveoli causing severe dyspnea, frothy pink sputum, hypoxemic respiratory failure. Requires immediate intubation and ICU care.
2. Arrhythmias (especially atrial fibrillation): Atrial enlargement and fibrosis predispose to AF (20-30% of CHF patients). Increases risk of stroke (5x) and worsens cardiac output. Requires anticoagulation and rate control.
3. Cardiogenic shock: End-stage pump failure with SBP <90 mmHg, cool extremities, altered mental status, urine output <30 mL/hr. Mortality >50%. Requires inotropes, IABP, or mechanical circulatory support.
4. Thromboembolism: Stasis from immobility and AF increases risk of deep vein thrombosis, pulmonary embolism, and stroke. Requires prophylaxis with LMWH and anticoagulation if AF present.
5. Renal failure (cardiorenal syndrome): Reduced cardiac output causes renal hypoperfusion. Diuretics worsen prerenal azotemia. Leads to volume overload and metabolic acidosis. Requires careful balance of diuresis vs perfusion.
34
(a) Define a prescription. (1 mark)
A prescription is a written or electronic order from a licensed medical practitioner to a pharmacist authorizing the dispensing of a specific medication, dosage, route, frequency, and duration for an individual patient. It is a legal document that establishes the therapeutic relationship and provides instructions for medication administration. Must contain patient details, prescriber details, drug information, and prescriber signature.
(b) Explain seven (7) reasons why people use medicines. (14 marks)
1. Treatment of diseases: To cure infections (antibiotics for pneumonia), eradicate pathogens (anti-TB drugs), or reverse pathological processes (chemotherapy for cancer). Goal is complete resolution of illness.
2. Symptom relief and palliation: Alleviate suffering without curing underlying cause. Analgesics for pain, antipyretics for fever, antiemetics for nausea. Improves quality of life in chronic and terminal illnesses.
3. Prevention of diseases: Prophylactic use to prevent illness before it occurs. Vaccines prevent infectious diseases, prophylactic antibiotics prevent surgical infections, PrEP prevents HIV transmission, antimalarials for travelers.
4. Diagnosis: Aid in medical investigation and diagnosis. Contrast media for radiological imaging, radioactive isotopes for scans, phenylephrine eye drops to differentiate pupils in neuro exam.
5. Maintenance of health and nutritional status: Replace deficient substances. Vitamins for deficiency, insulin for diabetes, thyroxine for hypothyroidism, iron for anemia, enzyme replacements.
6. Family planning and reproductive health: Contraceptives prevent unwanted pregnancy, fertility drugs assist conception, oxytocin induces labor, misoprostol manages postpartum hemorrhage.
7. Cosmetic and lifestyle purposes: Enhance appearance or performance. Minoxidil for hair growth, Botox for wrinkles, sildenafil for erectile dysfunction, anabolic steroids (abuse). Controversial but significant use.
(c) Outline ten (10) features of a good prescription. (10 marks)
1. Patient identification details: Full name, age, gender, weight (especially for children), address, and identification number. Ensures correct patient receives medication and allows for age/weight-based dosing.
2. Date of prescription: Essential for legal validity and determining expiration (typically 6-12 months). Allows tracking of medication supply and prevents dispensing of outdated orders.
3. Superscription (Rx symbol): Traditional symbol meaning "take thou" or "recipe." Legally required element that establishes document as prescription rather than note.
4. Inscription (drug details): Generic or brand name of medication, strength, dosage form (tablet, capsule, syrup). Must be legible to prevent dispensing errors. Generic names preferred to avoid confusion.
5. Subscription (dispensing directions): Quantity to be dispensed and dosage form. Specifies number of tablets or volume of liquid. Prevents over/under-supply.
6. Signatura (patient instructions): Clear directions for patient on how to take medication: dose, frequency, route, duration, special instructions (with food, avoid alcohol). Written in simple language patient can understand.
7. Renewal/refill instructions: Specifies if prescription can be refilled and how many times. Controlled drugs: no refills. Chronic medications: specify refill number or duration.
8. Prescriber identification: Name, qualifications, registration number, signature, and contact information. Legally required for accountability and follow-up queries from pharmacist.
9. Special cautionary labels: "Take with food," "May cause drowsiness," "Avoid alcohol," "Keep out of reach of children." Alerts patient to important safety considerations.
10. Legibility and clarity: Handwriting must be clear (or use electronic prescriptions). Avoid dangerous abbreviations (U for units, q.d. for daily). Use metric system. Illegible prescriptions cause medication errors and patient harm.
PRESCRIPTION PARTS: "PSSSR-ISL" - Patient, Date, Superscription, Inscription, Subscription, Signatura, Renewal, Identification, Special labels, Legibility
⚠️ Legal Document! Prescription errors are leading cause of medication errors. Always double-check calculations, drug interactions, and patient allergies before signing.