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Concept:-

• Electroconvulsive therapy was first introduced by Bini and Cerletti in April 1938. From 1980 onwards ECT is being considered a unique psychiatric treatment.
• Voltage-70-120 volts.
• Duration-0.7-1.5 seconds.
• Frequency: 3 times per week or as indicated.
• Total number: 6-10 up to 25 may be preferred as indicated.

Important Points

Indication:

• Major depression, severe catatonia, severe psychosis.

Contraindication:

• Raised ICP (absolute contraindication, congestive heart failure, cerebral hemorrhage, retinal detachment, pneumonia, acute myocardial infarction, brain tumor, cerebral aneurysm.

Drugs used

• Inj. succinyl choline 0.5 mg/kg (Muscle relaxant).
• Inj. thiopentone sodium 3 mg/kg (Anesthetic). Inj. atropine 3 mg/kg (To reduce respiratory secretions and prevent aspiration).

Nursing responsibilities:

• Informed consent, empty stomach before for 4-6 hours prior to ECT, hold the medication that can increase the threshold of seizure, head shampoo, environment preparation oxygen, suction, medication, monitors.
• During ECT, the patient may have a lack of oxygen, which makes it difficult for him to breathe.
• A pulse oximeter is placed in the patient's finger, which will measure the amount of oxygen in the patient's blood, to show whether the patient is breathing normally during ECT.
• Side-lying position after ECT.

Side effects

• Fracture and short-term memory loss

Types of ECT:

Concept:-

• Muscle: it is a contractile tissue that brings about movements.
• Muscles can be regarded as motors of the body.

Explanation:

• Trapezius muscle: it is a broad, flat, superficial muscle extending from the cervical to thoracic region on the posterior aspect of the neck and trunk.
• The muscle is divided into three parts: descending, ascending, and middle.
• The muscle contributes to scapulohumeral rhythm through attachments on the clavicle and scapula, and to head balance through muscular control of the cervical spine.
• Origin: spines of cervical and thoracic vertebrae.
• Insertion: lateral 1/3 of clavicle + acromion and spine of the scapula.

Additional Information

• Biceps:  muscle located in the front of the upper arm.
• Temporalis: it situated within the temporal fossa. It is responsible for closing the mouth and retraction.
• Masseter: it arises from the zygomatic bone and is inserted at the rear of the mandible.

Explanation: 

• Milieu therapy is the planned therapy given in case of mental disorders and maladjustment disorders in which treatment is planned as per the patients existing conditions and circumstances.
• This therapy also involves the modification of the existing environment for a better outcome.

Additional Information

• Borderline personality disorders are Emotionally unstable personality disorders in which a person is having a distorted sense of self as well as of others.
• Behavioral therapy is the most common and effective treatment plan for such disorders.
• Milieu therapy also plays an important role in such cases with personality disorders.

Explanation:

• Crude Death Rate: indicates the number of death per 1000 mid-year population.
• CDR is calculated as:
• CDR =   D x K  divided by P

1. D=total number of deaths registered during the calendar year
2. P= total mid-year estimated population or the total population of the middle of the year
3. K=a constant usually taken as1,000

Key Points

• Natural population growth happens because of the following

1. Birth Rate
2. Death Rate

• The natural increase in birth rate and death rate causes natural population growth.
• Basic components of population change-
• The fertility rate in women
• Mortality
• Migration
• Natural increase is the difference between the no. of births and deaths in the population.
• Crude Birth Rate - It is the total number of live births per 1,000 population divided by the length of the period in years. 
• current rate - 18.2births/1000
• Crude Death Rate - the ratio of deaths to the population of a particular area or during a particular period of time, usually calculated as the number of deaths per one thousand people per year.

Concept:

• Pulse rate: it reflects the number of times the heartbeats per minute.
• When the pulse rate is irregular, it is best to count the apical pulse for a full minute (1-minute bpm).
• Irrespective of any cause if pulse is irregular nurse must assess the apical pulse for a minute for clear and sound diagnosis and assuring if patient is in life threatening condition or not.
• The apical pulse is a pulse site on the left side of the chest over the pointed end, or apex, of the heart.
• So it is always a better intervention for nurse to check apical pulse is pulse is irregular.

Pulse sites:

• Radial
• Temporal
• Carotid
• Apical
• Branchial
• Femoral
• Popliteal
• Posterior tibial
• Dorsalis pedis

Explanation:

• Apical pulse: the pulse located on the left side of the chest, just below the nipple.
• Apical pulse rate is taken for a full minute to ensure accuracy.

Purposes of apical pulse assessment:

• To obtain the heart rate of newborns, infants, and an adult with irregular pulse rates.
• To identify whether the pulse rate is within the normal range.

Correct Answer: 1) Haemophilus influenzae type b

Rationale:

• Acute bacterial meningitis can be caused by various pathogens, but specific organisms are more common in different age groups. In the age group of 6 months to 5 years, Haemophilus influenzae type b (Hib) used to be the leading cause of acute bacterial meningitis.
• However, effective vaccination programs have significantly reduced the incidence of Hib meningitis in many parts of the world.

Let's analyze each option:

1) Haemophilus influenzae type b:

• This is the correct answer. Before the introduction of the Hib vaccine, Haemophilus influenzae type b was the most common cause of bacterial meningitis in children aged 6 months to 5 years. The advent of routine Hib vaccination has virtually eradicated this cause of acute bacterial meningitis in this age group in countries with high vaccination coverage.

2) N. meningitides:

• Neisseria meningitidis is also a significant cause of bacterial meningitis, particularly in adolescents and young adults. It is less common in the 6 months to 5 years age group compared to Hib before the widespread use of the Hib vaccine.

3) Cryptococcus neoformans:

• Cryptococcus neoformans is an opportunistic fungal pathogen that commonly causes meningitis in immunocompromised individuals, such as those with HIV/AIDS. It is not a common cause of bacterial meningitis in otherwise healthy children.

4) Streptococcal pneumonia meningitis:

• Streptococcus pneumoniae is a significant cause of bacterial meningitis across all age groups, including the 6 months to 5 years age bracket. However, the question specifically asks for the cause that has been virtually eradicated by vaccines, which points to Hib.

In summary, Haemophilus influenzae type b (Hib) was the most common cause of acute bacterial meningitis in children aged 6 months to 5 years before the effective vaccination programs virtually eradicated this disease in many areas.

Concept:-

Lithium: also known as antimanic.

• It is used for mental illnesses, including bipolar disorder, depression, and schizophrenia.
• It is classed as a mood stabilizer.
• Therapeutic range of lithium: - 0.6 – 1.2 mEq/L.

Explanation:

• The nurse should advise a female patient who takes lithium for manic episodes to maintain her hydration to avoid lithium toxicity

Other nursing advice for a patient taking lithium:

• Teach patients to take drugs as prescribed and keep medical appointments.
• She should stay in the shade when she walks.
• Advise patient that drug effect may take 1 to 2 weeks.
• Advise patient against getting pregnant because of teratogenic effects.
• She can continue her exercise because lithium toxicity is very rare.

All human activities produce waste. We all know that such waste may be dangerous and needs safe disposal. 

Bio-medical waste means “any solid and/or liquid waste including its container and any intermediate product, which is generated during the diagnosis, treatment or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps.

The bio-Medical waste consists of-

• Human anatomical waste like tissues, organs and body parts
• Animal wastes generated during research from veterinary hospitals
• Microbiology and biotechnology wastes
• Waste sharps like hypodermic needles, syringes, scalpels and broken glass
• Discarded medicines and cytotoxic drugs
• Soiled waste such as dressing, bandages, plaster casts, material contaminated with blood, tubes and catheters
• Liquid waste from any of the infected areas
• Incineration ash and other chemical wastes

The biomedical waste (BMW) management requires its categorization as a first step. The BMW Rules classify the BMW into the following categories.

Therefore option 3 is the correct answer.

Key Points

• Jaundice
• The red blood cells which are damaged or the cells which have completed their life cycle, migrate to the liver cells are destroyed and broken down to form bile pigments called bilirubin and biliverdin.
• When the liver cells are damaged due to hepatitis infection or injury, the bilirubin pigments increase in human blood.
• Hyperbilirubinemia is excessive bilirubin in the blood. This increase also results in the yellowing of the tissues which is referred to as jaundice. Hence, Option 3 is correct.
• It is caused by an obstruction in the bile duct, excessive hemolysis, or viral infection.
• It leads to the deposition of bilirubin in the mucous membrane, sclera, nail tissues, and skin so that the patient looks yellow.
• The colour of the urine is bright yellow.

Additional Information

• Jaundice Symptoms:
• Skin and sclerae colour changes to yellow.
• Urine colour also changes to yellow.
• Itching of the skin.
• Fever
• Abdominal pain
• Vomitings
• Weight loss

Concept:

• Long bones: are bones involved with large movements. They are elongated and cylindrical with enlarged, knob-like ends, called epiphyses which are mostly spongy bone covered by a thin layer of compact bone.

Explanation:

• Epiphyseal plate: It is a disc of hyaline cartilage that grows during childhood to lengthen the bone.

Growth in bone length:

• Zone of resting cartilage: cartilage attaches to the epiphysis.
• Zone of proliferation: new cartilage is produced on the epiphyseal side of the plate as the chondrocytes divide and form stacks of cells.
• Zone of hypertrophy: chondrocytes mature and enlarge.
• Zone of calcification: matrix is calcified, and chondrocytes die.
• Ossified bone: the calcified cartilage on the diaphyseal side of the plate is replaced by bone.

Additional Information

• Bone marrow:  it is the soft, fatty tissue inside your bones. Stem cells are immature cells in the bone marrow that give rise to all of your blood cells.
• Diaphysis: the central tubular part of the bone.
• Periosteum: it is a fibrous membrane covering the surface of bones.