Perforated peptic ulcer is a surgical emergency. The classic presentation is:

• Sudden, severe, generalized abdominal pain
• Board-like rigidity (involuntary guarding) — contents spill into peritoneal cavity causing chemical peritonitis
• Rebound tenderness (positive Blumberg's sign)
• Absent bowel sounds
• Tachycardia, hypotension (shock)
• Free air under diaphragm on chest X-ray (pathognomonic)

Priority nursing actions:

1. Keep patient NPO immediately
2. Insert IV lines — large-bore cannulas
3. IV fluids to maintain hemodynamic stability
4. Insert urinary catheter — monitor urine output hourly
5. IV antibiotics as ordered
6. Prepare for emergency laparotomy
7. Do NOT give analgesics until surgeon has assessed (may mask signs)

Least Count ($LC$) of a screw gauge is given by: $LC = \frac{\text{Pitch}}{\text{Number of divisions (N)}}$.

Given $LC = 5 \ \mu\text{m} = 5 \times 10^{-6} \text{ m}$ and Pitch $= 1 \text{ mm} = 10^{-3} \text{ m}$.

$N = \frac{10^{-3}}{5 \times 10^{-6}} = \frac{1000}{5} = 200$.

The Attack Rate is used during outbreaks/epidemics to measure the proportion of exposed individuals who develop the disease:

\\text{Attack Rate} = \\frac{\\text{Number of ill persons among exposed}}{\\text{Total number of exposed persons}} \\times 100

• Option 1 describes Incidence Rate
• Option 3 describes Prevalence Rate
• Option 4 describes Case Fatality Rate (CFR)

Understanding attack rates is essential during disease outbreak management — a core Head Nurse responsibility in community settings.

Neonatal Resuscitation Program (NRP) — Algorithm:

1. Initial steps (warm, dry, stimulate, position, clear airway) — 30 seconds
2. Assess: breathing, HR
3. HR \(<100\,\text{bpm}\) or apnea → Start PPV with 21% O₂ (room air) for 30 seconds
4. After 30 sec PPV: Reassess HR
   • HR \(\geq 100\): Continue PPV, wean O₂
   • HR \(60{-}99\): Ensure effective ventilation (MRSOPA), continue PPV
   • HR \(<60\) after 30 sec effective PPV → Start chest compressions + PPV
5. Chest compressions:
   • Technique: 2-thumb encircling (preferred) or 2-finger method
   • Ratio: 3 compressions : 1 ventilation (90 compressions + 30 breaths = 120 events/min)
   • Depth: \(\frac{1}{3}\) of AP chest diameter
6. After 60 sec compressions + PPV: If HR still \(<60\) → Epinephrine (IV preferred: \(0.01{-}0.03\,\text{mg/kg}\) of 1:10,000 solution)

Note: Adult CPR ratio is 30:2, but neonatal is 3:1 because neonatal arrest is usually respiratory in origin.