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Concept:-

• The patient with appendicitis usually prefers to lie still, often with the right leg flexed to decrease pain.
• Appendicitis is referred to as acute inflammation of the appendix. This is most common in children and young adults characterized by intense abdominal pain.
• Rebound tenderness is a clinical sign in which when pressure is applied to McBurney's Point to assess the pain and to check the location of the pain, there is no pain on applying pressure but the pain in that area when the pressure is removed back.
• Obturator sign: Pain caused by passive internal rotation of the hip when the right knee is bent. It is present when an inflamed appendix comes into contact with the obturator internalus muscle.

Important Points 

• The appendix is ​​a small, thin sac-like structure about 5 to 10 cm long, it is a gastrointestinal organ and is attached to the large intestine.
• The most common causes include- Obstruction of the appendix i.e. Faecolith which leads to secretion and deposition of mucous within the lumen of the appendix and development of infection, abdominal surgery or trauma, Inflammatory bowel disease, a parasitic infection.
• Management:- Surgery (appendectomy)
• Key nursing interventions:- Fowlers positions
• To minimize pain.

Additional Information

Sign of Appendicitis-​

• Abdominal pain
• Anorexia
• Diarrhea/ constipation
• Fever
• Nausea and Vomiting

Symptoms:

• McBurney's point i.e. rebound tenderness in the right lower quadrant.
• Rovsing's Sign i.e. Palpation of the left lower quadrant causes pain in the right lower quadrant.
• Obturator's sign i.e. pain on internal rotation of the hip

The correct answer is  'Reminiscence'.

Key Points

• Reminiscence: the act of remembering events and experiences from the past
• Example: The novel contains endless reminiscences of/about the author's youth.
• Thus, from above, the correct answer is option 4.

Additional Information

• Self-exploration is a process of discovering that there is something innate, immutable, and universal in all human beings.​
• Auxiliary percussion is percussion instruments without a pitch, used for the purpose of creating rhythm and pronunciation.
• Procrastination is the act of delaying or postponing tasks until the last minute, or they have expired.

Concept:-

• Celiac artery: also known as the celiac trunk.
• It is the first major branch of the abdominal aorta.
• It supplies oxygenated blood to the stomach, abdominal esophagus, spleen, and liver.

Origin:

• it is very short and arises from the front of the abdominal aorta at the level of the lower border of the T12 vertebra.
• It is surrounded by the celiac plexus of nerves.
• It lies behind the lesser sac of the peritoneum.

It has 3 terminal branches:

1. Left gastric artery
2. Splenic artery
3. Hepatic artery

Concept:-

• G6PD deficiency:  also called glucose-6-phosphate-dehydrogenase
• In this deficiency, red blood cells break down in response to certain medications, infections, or other stresses.
• It is an inherited disease. It is X-linked.
• This disease is characterized by hemolytic anemia caused by the inability to detoxify oxidizing agents.

Symptoms of G6PD:

• Shortness of breath
• Fever
• Rapid heart rate
• Fatigue
• Jaundice
• Dark or yellow urine

Additional Information

• Homocystinuria:  it is an inherited disorder of the metabolism of the amino acid methionine.
• Phenylketonuria: it is a genetic disorder that is characterized by an inability of the body to utilize the essential amino acid, phenylalanine.
• Celiac disease: it is an immune disorder characterized by an abnormal immune response to the protein gluten.

Concept:-

• Vivid dreaming: vivid dreams are intense dreams that linger in the mind and feel similar to real-life memories.
• They arise from the normal REM cycles.

Explanation:-

4 stages of sleep:

NREM stage 1.

• The transition period between wakefulness and sleep
• Lasts around 5 to 10 minutes

NERM stage 2.

• Body temperature drops and heart rate begins to slow
• The brain begins to produce sleep spindles
• Lasts approximately 20 minutes

NERM stage 3.

• Muscles relax
• Blood pressure and breathing rate drop
• Deepest sleep occurs

REM stage:

• The brain becomes more active
• The body becomes relaxed and immobilized
• Dreams occur
• Eyes move rapidly

Haemophilia

• Haemophilia is a group of bleeding disorders. Blood clotting factors are needed to stop bleeding.
• The most common types are:
• Hemophilia A (classic hemophilia)—caused by too little or no factor VIII (most common)
• Hemophilia B (Christmas disease)—happens in males, caused by too little or no factor IX
• Causes of this disease is a faulty gene on a certain DNA strand.
• Females carry 2 copies of the strand. If one is faulty, the other one takes over. The faulty gene can pass to their children. If so, the female child will carry the gene. If it passes to the male, they will get the disease because they carry one copy of the strand.

Additional Information 

Concept:

Mantoux test

• Mantoux test (Purified Protein Derivative) or TB skin test: A standard dose of 5 tuberculin units is injected intradermally.
• The reaction is read (48-72 hours later) by measuring the diameter of erythema (palpable raised, hardened area) 15 mm or more millimetres is considered positive.

Important Points

Erythema measurement

• Erythema measurement of  5 or more millimetres is considered positive in People living with HIV
• Erythema measurement of 10 mm or more is positive in
• Client with clinical conditions that put them at higher risk.
• Mycobacteriology lab worker.
• People who abuse drugs.
• Erythema measurement of 15 or more millimetres is considered positive in People with no known risk factors for TB
• TB Vaccination with Basil Calmette-Guerin (BCG) Vaccine.

Concept:

• Blood coagulation Process:
• It is the process of clotting blood using platelets and fibrin in the blood.
• It is required to reduce the loss of blood from the body.
• This process is called Hemostasis.
• Some steps are there in this process:
• The primary step is vasoconstriction, in the vascular wall reacts to reduce the loss of blood.
• Then platelets start covering the injured area.
• It activates fibrin clots known as secondary hemostasis.
• It follows the formation of fibrinogen, which is a soluble plasma protein.
• Platelet clots are termed as white thrombus and if the red blood cells are present, it is known as red thrombus.

Explanation:

• There are different processes in the coagulation process.
• Formation of Thromboplastin, thrombin, fibrin from thromboplastin, prothrombin, and fibrinogen respectively.
• Formation of thrombin is not the coagulation process.

Notes:

• There is a series of steps leading to the formation of fibrin protein fibre, it involves different clotting factors.
• There are about thirteen known clotting factors:
• Fibrinogen (Factor 1)
• Prothrombin (Factor 2)
• Thromboplastin (Factor 3)
• Calcium (Factor 4)
• Proaccelerin or Labile Factor (Factor 5)
• Stable Factor (Factor 6)
• Antihemophilic Factor (Factor 8)
• Christmas Factor (Factor 9)
• Stuart - Power Factor (Factor 10)
• Plasma Thrombin antecedent (Factor 11)
• Hegman Factor (Factor 12)
• Fibrin Stabilising Factor (Factor 13)

WHO Classification of Hypothermia in Newborn

Normal

• Temperature: 36.5°C to 37.4°C
• Feel: Warm trunk & warm extremities
• Action:
• Cover the baby with pre-warmed cloth
• Keep baby close to the mother
• Encourage breastfeeding
• Provide skin-to-skin contact (KMC)

Mild Hypothermia (Cold Stress)

• Temperature: 36.0°C to 36.4°C
• Feel: Warm trunk but cold extremities
• Clinical features: Cold hands/feet, bluish extremities, poor weight gain if prolonged
• Action:
• Skin-to-skin contact
• Cover adequately
• Ensure warm environment
• Provide warmth and encourage breastfeeding

Moderate Hypothermia

• Temperature: 32.0°C to 35.9°C
• Feel: Cold trunk and cold extremities
• Clinical features:
• Poor sucking, lethargy
• Weak cry
• Fast breathing or irregular breathing
• Poor perfusion
• Action:
• Cover mother and baby with warm preheated clothes
• Reassess temperature every 15 minutes
• Provide additional heat if no improvement
• Encourage breastfeeding.

Severe Hypothermia

• Temperature: < 32°C
• Feel: Very cold trunk and extremities
• Clinical features:
• Slow heart rate
• Red, hardened skin
• Edema, bleeding
• Low blood sugar
• Action:
• Rapid rewarming to 34°C, then slow rewarming
• Provide oxygen
• Give warm IV fluids (5–10% glucose)
• Administer Vitamin K
• Reassess every 15 minutes
• Provide additional heat if needed

Concept:-

• Surfactant: it is a surface-acting material or agent that is responsible for lowering the surface tension of a fluid.
• A surfactant that lines the epithelium of the alveoli in the lungs is known as a pulmonary surfactant and it decreases the surface tension on the alveolar membrane.

Source of secretion of pulmonary surfactant:

Pulmonary surfactant is secreted by two types of cells:

1. Type II alveolar epithelial cells: in the lungs, which are called surfactant secreting alveolar cells or pneumocytes.

• A characteristic feature of these cells is the presence of microvilli on their alveolar surface.

2. Clara cells: which are situated in the bronchioles.

• These cells are also called bronchiolar exocrine cells.

Significance of surfactant:

• Prevents collapse of alveoli
• Increases lung compliance
• Keeps alveoli dry
• Keeps lungs expanded
• Prevent pulmonary edema
• Allows fetal lung maturity