IVC Course Code : 619

MULTI PURPOSE HEALTH WORKER

(MPHW)(F)
First Year
(w.e.f. 2018-19)

Intermediate Vocational Course

Paper I : Community Health Nursing

Paper II : Health Promotion
Paper III : Primary Health Care Nursing

STATE INSTITUTE OF VOCATIONAL EDUCATION, A.P.

BOARD OF INTERMEDIATE EDUCATION, A.P.

Smt. B. UDAYA LAKSHMI, I.A.S.
Commissioner & Secretary
Intermediate Education
ANDHRA PRADESH
GUNTUR.
S.I.V.E Co - Ordinating Committee

Sri P. Yerraiah, M,Sc., B.Ed.

Professor
State Institute of Vocational Education
Commissioner of Intermediate Education, Guntur

Sri P. Muralidhar, M,Sc., M.Phil..

Joint Secretary (Vocational)
Board of Intermediate Education,Guntur

Sri P. Seshu Narayana, M,Sc., B.Ed.

Reader
State Institute of Vocational Education
Commissioner of Intermediate Education, Guntur

Sri Dr. G.V.S.R. Murthy, M,Sc., Ph.D.

Lecturer
State Institute of Vocational Education
Commissioner of Intermediate Education, Guntur

DTP
Katari Ravi Kumar B.Com, MCITP.
Text Book Development Committee

Paper - I Community Health Nursing

AUTHOR
Mrs. B. Suhasini, M.Sc (N)
Junior Lecturer in MPHW (F)
Government Vocational Junior College,
Guntur

Paper - II Health Promotion

AUTHOR
Smt. B. Padma M.Sc (Nursing)
Lecturer, Govt.College of Nursing,
Machilipatnam

Paper -III Primary Health Care Nursing

AUTHOR
Dr. K. Suganthi, M.Sc, (Nursing), Ph.D
Faculty, Govt. College of Nursing, Guntur

EDITOR
Dr. R. Padmavathi, M.Sc. (Nursing), Ph.D
Lecturer, Govt. College of Nursing, Guntur
 MPHW [Female]
Course

ANNUAL SCHEME OF INSTRUCTION AND EXAMINATION

FOR IST YEAR MPHW (F) COURSE

Theory Practical Total

Part-A
Periods Marks Periods Marks Periods Marks
General
1 Foundation 150 50 - - 150 50
2 English 150 50 - - 150 50

Part-B
3 Paper-I 135 50 135 50 270 100
Community
Health Nursing
4 Paper-II 135 50 135 50 270 100
Health
promotion
5 Paper-III 135 50 135 50 270 100
Primary Health
Care Nursing
6 OJT - - 365 100 365 100
otal T 705 250 770 250 1475 500

On the Job Training from 1st November to 31st December

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 EVALUATION OF ON THE JOB TRAINING:

The “On the Job Training” shall carry 100 marks for each year and pass marks is 50. During on
the job training the candidate shall put in a minimum of 90 % of attendance.

The evaluation shall be done in the last week of January.

Marks allotted for evaluation:

S.No Name of the activity Max. Marks allotted for each activity

1 Attendance and punctuality 30

2 Familiarity with technical terms 05

3 Familiarity with tools and material 05

4 Manual skills 05
5 Application of knowledge 10
6 Problem solving skills 10

7 Comprehension and observation 10

8 Human relations 05
9 Ability to communicate 10
10 Maintainance of diary 10
Total 100

NOTE: The On the Job Training mentioned is tentative. The spirit of On the Job training is to be
maintained. The colleges are at liberty to conduct on the job training according to their local
feasibility of institutions & industries. They may conduct the entire on the job training periods
of I year and (450) II year either by conducting classes in morning session and send the
students for OJT in afternoon session or two days in week or weekly or monthly or by any
mode which is feasible for both the college and the institution. However, the total assigned
periods for on the job training should be completed. The institutions are at liberty to conduct
On the Job training during summer also, however there will not be any financial commitment
to the department.
 MULTI PURPOSE HEALTH WORKER
Paper - I
COMMUNITY HEALTH NURSING
INDEX
Unit - 1 Concept of Health 1
Unit - 2 Structure And Organization Of Community 8
Unit - 3 Community Based Assessment 18
Unit - 4 Home Visit 24
Unit - 5 Health Problems And Policies 27
Unit - 6 Communication And Health Education 46
Unit - 7 Concept of Disease 55
Unit - 8 Infection 58
Unit - 9 Immunity 63
Unit - 10 Immunization 68
Unit - 11 Environmental Sanitation 75
Unit - 12 Safe Water 81
Unit - 13 Disposal Of Excreta And Waste 89
Unit - 14 Introduction To Communicable Diseases 98
Unit - 15 Occupational Health 142
Unit - 16 Disaster Management 148
PAPER I COMMUNITY HEALTH NURSING

PART A
UNIT-I - CONCEPT OF HEALTH

STRUCTURE

Introduction
Dimensions of Health
Determinants of Health
Primary Health Care
Levels of Prevention

Introduction

Health is a fundamental human right. It is an essence of productive life. Health

is common theme in most cultures. Health is an issue of social justice, but not an
issue of “Doctors, Social Services and Hospitals”. Health is central to the concept of
quality life.

Definitions of Health

1. The oldest definition of Health is “the absence of disease”

2. According to the Oxford English Dictionary, “Soundness of body and mind”. The
body functions are effectively discharged.

3. According to World Health Organization (WHO) 1948, “Health is a state of

complete physical, mental and social wellbeing and not merely the absence of
disease or infirmity”.

Concepts of Health

Health is viewed differently by different professionals like Biomedical, Social

Science Specialists, Health Administrators, Ecologists e.t.c. as follows.

I. Biomedical Concept: It was based on “Germ Theory Disease”. According to

the theory, it is an absence of disease or free from disease. The Medical
Professionals viewed as “Human Body is like a machine; disease is occurred
mainly by the breakdown of machine.

II. Ecological Concept: Health is viewed as dynamic equilibrium between man

and his environment.

III. Psychological Concept: Health is influenced by social, psychological, cultural,

economic and political factors of the people around.

IV. Holistic Concept: It is a synthesis of all above concepts. It is wellbeing of

whole person.

DIMENSIONS OF HEALTH

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PAPER I COMMUNITY HEALTH NURSING

Health is multidimensional (many dimensions). According to WHO, it is

specified as follows.

a) Physical Dimension:

It includes perfect functioning of the body. Physical health includes a great

physique, clean skin, bright eyes, lustrous hair, with a body well clothed, sound
sleep, regular passing of urine and stools and smooth easy coordinated body
movements. All the body parts and organs should be with normal size and function.

All the special senses are intact and vital signs are within the normal range.

b) Mental Dimension

It is the balance between the man and his environment. The harmony
between oneself and other. Characters of a mentally health person are

1) He is well adjusted
2) He searches for identity
3) He knows himself, his goals, needs and problems
4) He has a strong sense of well being
5) He has good self-control and emotional balance
6) He faces problems and tries to solve them
7) He is free from internal conflict

c) Social Dimension

It is the balance within the individual, between individuals and members of the
society. Social dimension includes the level of social skills possess by each
individual as a member of society.

d) Spiritual Dimension

It refers to the part of the individual which strives for meaning and purpose of
life. It is mainly principles, ethics and purpose of life.

e) Emotional Dimension

It is related to feeling of an individual to his environment.

f) Vocational Dimension

It plays an important role in promoting both physical and mental health.

Other dimensions include,

❖ Philosophical dimension

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PAPER I COMMUNITY HEALTH NURSING

❖ Cultural dimension
❖ Socio economic dimension
❖ Environmental dimension
❖ Educational dimension
❖ Curative dimension
❖ Preventive dimension

DETERMINANTS OF HEALTH OR FACTORS INFLUENCING HEALTH

Health of an individual is influenced by so many factors. These factors lie both

within the individual and externally in the society.

Mainly two factors i.e., (i) Genetic factors and (ii) Environmental factors, are
responsible for the occurrence of diseases.

The following other factors influences health are

I. Biological Determinants
II. Behavioural and socio cultural conditions
III. Environmental factors
IV. Socio and economic conditions
V. Health services
VI. Aging of the populations
VII. Gender
VIII. Other factors

I. BIOLOGICAL DETERMINANTS

It is mainly by genes at the movements of conception. Every human being

physical and mental characteristics are determined by genes. The genetic makeup
cannot be altered after conception. A number of diseases are now known to be of
genetic origin e.g., chromosomal anomalies, mental retardation and some types of
diabetes.

II. BEHAVIOURAL AND SOCIO CULTURAL CONDITIONS

Behavioural and socio cultural conditions also influence the health of an

individual. Life style activities like smoking and alcoholism, socio-cultural values,
attitudes, customs and habits also directly and indirectly influence health status of an
individual. To maintain optimum health receives adoption of healthy life styles.
III. ENVIRONMENTAL FACTORS

It is classified as Internal and External.

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 PAPER I COMMUNITY HEALTH NURSING

❖ Internal Environment is within the human body consists of tissues, organs

and systems.
❖ External Environment is outside the human body i.e., physical,
psychological and biological components.
Environmental factors include housing, water supply, psychological stress and
family structure.
IV. SOCIO AND ECONOMIC CONDITIONS

Socio and Economic Conditions which includes,

❖ Economic Status: It includes purchasing power, standard of living, quality
of life, family size etc
❖ Education: Literate and Illiterate
❖ Occupation: It is type of work whether an individual is employee and
unemployee.
❖ Political System: It can also influence the health status of country. Political
system helps n the resource allocation of manpower using technology and
availability of health services.
❖ Health Services: Availability of health services like health and family
welfare services, helps for prevention of illness, promotion of health and
treatment of diseases. Health Services are also important for social and
economic development.
❖ Aging of population: Because of the increased health services, the
population of the aged above 60 years and over and more than two third of
the living in developing countries. Increased prevalence of chronic
diseases and disability more and special attention of resources.
❖ Gender: The global communication on women’s health developed an
agenda to improve the health status of women which includes nutrition,
reproductive health, violence effect, ageing, life style related condition and
on occupational health.
❖ Other factors: Other factors like health related factors, eg food and
agriculture, education, industry, social welfare and rural development. To
improve the standard of living, new policies in the economic and social
fields like employment, increased salaries and family support scheme.

HEALTH FOR ALL

It was movement decided by World Health Assembly in 1977.

It means an equal health status for all people and countries by the year 2000.
Definition

Health for All is defined as “Attainment of a level of health that will enable
every individual to lead a socially and economically productive life”.

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PAPER I COMMUNITY HEALTH NURSING

This was achieved by following some indicators and by providing primary

health are in rural areas and urban slums.
CONCEPT OF HEALTH CARE

Health care is defined as various services provided to individuals, families and

communities by the agents of health.
Purpose of Health Care

Promoting, Maintaining and Restoring health, there are 3 concepts of health

care.
1) Comprehensive Health Care: It was defined by Bhore Committee in 1946. It is
providing adequate preventive, curative and promotive health services.
2) Basic Health Services: This term was used by UNICEF/WHO. It is a network
of coordinated services under a selected group of functions by professionals
and auxiliary personnel.
3) Primary Health Care: It was a new approach of health care came into
existence in 1978. Alam-Ata declared Primary Health Care as “First Contact
Care”, “Easily Accessible Care”.
Primary Health Care is essential health care made universally accessible to
individuals and acceptable to them through their full participation and at a cost, the
community and country can afford.
Principles of Primary Health Care

There are mainly four principles of Primary Health Care. They are
1) Equitable distribution

It is the first key principle. Health services must be distributed equally to all
sectors of people irrespective of their ability to pay, rich or
➢ Easily accessible (reachable) to all.
➢ Should not be imbalance of health services in towns and cities.

2) Community Participation

Involvement of individuals, families, communities in the health services to

improve their health status.
➢ It should be a meaningful involvement.
➢ Involvement of people at planning, implementation and maintenance of
primary health services
➢ Using of local resources, money, land, man power etc.
3) Inter Sectoral Coordination

It is not possible for health sector alone to provide health services to people.

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PAPER I COMMUNITY HEALTH NURSING

➢ Involvement of other sectors like agriculture, animal husbandry, food

industry, education, public housing, communication and other
resources.
➢ It helps to avoid duplication of activities.
4) Appropriate Technology

Using of technology provides health services must be

➢ Scientifically sound, adoptable to local needs acceptable for application
to whom it is used and maintained by the people themselves.

➢ Using of cheaper, scientifically sound procedures instead of using

costly equipment and procedures and methods, for example Oral
rehydration therapy.

Elements of Primary Health Care

a) Education about prevailing (existing) health problems and methods of

preventing and controlling them.

b) Promotion of food supply and proper nutrition.

c) An adequate supply of safe water and basic sanitation.

d) Maternal and child health care including family planning.

e) Immunization against infectious diseases.

f) Appropriate treatment of common diseases and injuries.

g) Provision of essential drugs.

Levels of prevention

Prevention is better than cure which used frequently known proverb.

Prevention of illness or disease occurs at four levels.

1) Primordial Prevention:

• It is mainly used to prevent chronic diseases.

• It is adopted by discourage children to adopt harmful life styles.
• It is mainly protecting high risk group people from many adult health
problems (e.g. obesity)
• It is mainly achieved by individual and mass education.

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PAPER I COMMUNITY HEALTH NURSING

2) Primary Prevention:

• It is achieved mainly by taking certain measures like promote general

health and wellbeing and maintenance of quality of people and using
specific protective measures.
• It is defined as action taken prior to the occurrence of a disease or in
prepathogenic phase.
• It is mainly using prevent the occurrence of chronic disease like heart
problems.
3) Secondary Prevention:

• It is defined as action taken to stop the progress of a disease at its

early stage and prevent further damage. Mainly it is achieved by early
diagnosis and correct treatment.
4) Territory Prevention:
• It is mainly achieved by takin measures to limit impairments and
disabilities and to minimize suffering caused by disabilities. For
example, Providing rehabilitation. It includes medical, psychological,
social and vocational rehabilitation.
CONCLUSION

Health is fundamental human right. Every society should have productive life.
Social and political systems play an important role to provide health services.
Primary Health Care approach is very essential to provide health services equally,
easily acceptable to the people. Preventary measures should be taken at every level
of health problem.
SHORT ANSWER TYPE QUESTIONS

1) Define Health?
2) List the elements of Primary Health Care?

LONG ANSWER TYPE QUESTIONS

1) Explain about determinants of health?

2) Write about levels of prevention?

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PAPER I COMMUNITY HEALTH NURSING

UNIT-II - STRUCTURE AND ORGANIZATION OF COMMUNITY

Introduction
Meaning/Definitions of Community
Rural community, characteristics and problems
Urban community characteristics and problems
Structure and functions of Panchayat Raj
Role of Panchayat Raj in health
Social Organization-Groups
The Family

Introduction

Man is a social animal. All human beings are part of a group or community.
Community is a collection of independent people with residential ties to a particular
locality.

Meaning

It is derived from two latin words, namely “com, which means together” and
“munis, means to serve together”. Thus Community means to serve together.

Definition

1. Community is a group of people who live together, who belong together. So

that they share.

2. According to WHO Expert Committee, community is a social group

determined by geographical boundaries and common values and interests.

Functions of Community

The basic functions are

➢ It determines the use of space for living and other purpose.

➢ To protect and conserve the health, life, resources and property of
individuals.
➢ Production and distribution of necessary goods and services.
➢ It works like a vehicle to educate newcomers i.e., children and immigrants.

➢ It transmits information, ideas and beliefs.

➢ It helps for interactions between individuals and groups
➢

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PAPER I COMMUNITY HEALTH NURSING

TYPES OF COMMUNITIES

Communities can be classified based on the size of the population extent,

wealth and populous ness, the specialized functions of the community with in the
whole society.

1) Rural Community
2) Urban Community
3) Urban Slums

RURAL COMMUNITY

In India, 75% of people are living in rural communities or areas. India is a land
of villages. For every 1000 population, a village is formed.

Characteristics of Rural Community

➢ The rural area people are primarily depend upon agriculture.

➢ They have fertile lands, water and good climate.
➢ Attracted more people.
➢ Village community is more prosperous.
➢ Rural communities are small, less dense and homogenous.
➢ In rural areas both external and internal peace.
➢ Family customs are not disturbed.
➢ The family circle must supply the greater part of economic and social needs.
➢ Rural people lives in simple way.
➢ People less adjust to the stimulation.
➢ Primary relations are more in rural community.
➢ We feeling and Dependency felling is present.
➢ People follow cultural practices, beliefs, customs and prejudices.
➢ Give importance to the marriage system.
➢ Caste system is very rigid.
➢ They share love and affection.
➢ Problems will be solved within a group.

Rural Community problems

The main rural problem is unemployment. Young men leave the village for
urban areas in search for jobs. Migration to a distant place for a contractor building,
mining and other works.

Health problems

• Health problems are common in rural areas.

• The most common problem is malnutrition among under 5 year children.
• Communicable and infectious diseases are prevalent.
• Maternal deaths and child deaths may also occur.
• Home accidents are common, e.g.: burns and scalds

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PAPER I COMMUNITY HEALTH NURSING

Other problems

1. Education: The problem of school dropouts, illiteracy, child labour, few

teachers, lack of equipment, building is too small or need repairs etc.

2. Transport and communication: Lack of good roads in rainy season causes

taking sick to hospitals and marketing.

3. Agricultural problems:

a. Insufficient water supply,

b. Power cut and repair of pump sets
c. Delay in getting supplies of seeds and fertilizers
d. Old methods of ploughing, non-availability of tractors

4. Labour problems: Not available, demand is high.

Environmental Sanitation Problems

1) Disposal of human

a. 80% of people use open field defecation. It is considered harmless

by rural people.
b. They are ignorant that faces infections and pollutes social and
water and promotes fly breeding.

2) Disposal of waste

a. People in rural areas are not aware of proper disposal of waste.

b. The solid waste is thrown in front of houses and it permits
accumulation and decompose.
c. This decomposed material is used as manure.
d. People collect cow dung to prepare manure. In this process,
mosquitoes and flies breed causes so many diseases.
e. Waste water is also permitted to flow in the streets. It causes
mosquito breeding, causing malaria, filarial and other vector borne
diseases.

3) Water supply

a. Sources of water supply in villages are wells, ponds and tanks.

b. These are used for drinking, bathing near the wells, washing
clothes, washing animals and for their drinking. These practices
cause pollution of water. Water pollution in turn leads to diarrhoea,
cholera and gastroenteritis etc.

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PAPER I COMMUNITY HEALTH NURSING

4) Housing

Houses are built with mud. These are katcha houses and without proper
ventilation. No separate rooms for cooking, latrine, bathroom and drainage. Houses
are regularly white washed and the houses are poor lighted.

URBAN COMMUNITY

Towns and cities comprises the urban communities.

Characteristics of Urban Community

➢ Relatively large, dense ad permanent settlements of people.

➢ They depend less on agriculture.
➢ People do different kinds of jobs.
➢ The social life is impersonal and less intimate.
➢ Urban community have different races and culture.
➢ Traditional patterns of belief and behaviour to be broken down.
➢ More dominance of secondary relationships in the urban community.
➢ Individualism is seen urban communities.
➢ Social relationships are selective.
➢ Less dependency, role feelings are affective.

Urban Community problems

The main problems in Urban community are overcrowding, pollution of air

accidents. In urban community, individual and social problems are common when
individual problems effect a large number of people they become social problems.
For example, alcoholism, juvenile delinquency, prostitution etc .

1) Prostitution

It is a social problem. The causes of social problem are:

a. Broken families
b. Parent quarrels
c. Want of affection, easy money, low IQ, low moral standards and
poverty.

2) Delinquency

It is an abnormal behaviour. It is committing an offense. For example, theft,

murder etc. it is mainly due to poverty, disturbed homes and drug addiction. It occurs
mainly in the age group below 13 years. social problem. The causes of social
problem are:

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PAPER I COMMUNITY HEALTH NURSING

3) Dowry System

It is also a social problem. It is a symbol of love from parents to their daughter

on the event of marriage.

4) Drug addiction

It is also more common in urban communities. Using of Narcotics, Tobacco,

Gutkha and Cocaine. Causes are lack of love and affection, depression and to
overcome situation, people get addicted by drugs.
5) Alcoholism

It is also social problem and it is consumption of more alcohol. It

causes crime, murder, neglect of families, malnutrition, disease of liver, road
accidents and causes psychological and social problems.

6) Unmarried mothers

Due to urbanization and industrialization, overcrowding and unemployment,

this problem is prevailing. This problem leads to abortion, infections and maternal
mortality.

7) Handicapped

It is also social and medical problem.

Urban Slums

Urban slums are present in towns and cities. These looks like rural
communities.

STRUCTURE AND FUNCTIONS OF PANCHAYAT RAJ

The Panchayat Raj is a 3 tire structure of rural local self-government in India.

It ties villages to districts.

The three tire institutions of Panchayat Raj system are

➢ Panchayat - At the Village level

➢ Panchayat Samithi - At the Block level
➢ Zilla Parishad - At the District level
These are public welfare agencies.

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PAPER I COMMUNITY HEALTH NURSING

At the village level Panchayat Raj consists of

1. Gram Sabha

It is the assembly of all adults of the village. They meet twice in a year. They
discuss annual programme, prepare proposals for taxation and elects the members
of the Gram Sabha.

2. Gram Panchayat

Population covered by Gram Panchayat varies from 5,000 to 15,000 and

members 15 to 30. They hold office for a period of 3 to 4 years.

Functions of Gram Panchayat are

a. Civil Administration: i.e., Sanitation and Public Health

b. Social and Economic Development

3. Nyaya Panchayat:

It is a judicial organ of the Gram Sabha. It tries civil cases and minor criminal
offences. They impose fine up to Rs. 100/-.

4. At the Block level

It consists of 100 villages and a population of about 80,000 to 1,20,000. It

consists of all Sarpanches, MLAs, MPs residing in the block area, Representative of
women, Scheduled Castes and Tribes and Cooperative Societies.

5. At the District Level

Zilla Parishad is the local self-government. Its members include heads of

Panchayat Samitis, MPs, MLAs of the district, Representatives of women,
Scheduled Castes and Tribes and persons having experience in administration,
public life or rural development. The Collector of the district is non voting
member.

ROLE OF PANCHAYAT RAJ IN HEALTH

✓ Maintenance of sanitation of the village.

✓ Provision of street light services.
✓ Disposal of waste and refuse.
✓ Collection of tax.
✓ It helps in economic and social development.
✓ Propagation of health programmes and provide health services.
✓ Conduct health camps with the help of Medical Department.

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PAPER I COMMUNITY HEALTH NURSING

SOCIAL GROUPS-ORGANIZATIONS

Society is a group of persons together by common bond and work together for
the achievements of common goals.

Structure of the Society is based on caste, income and occupation. Other

related factors include cultural practices and habits.

Social group is defined as to which individual belongs e.g., family, kindship,

caste, religion, village or town.

Other social groups like Panchayat, the club and various associations. These
are based on social groups.

Based on the time, social group is decided into temporary and permanent.

Types of Social Groups

1) Family

It is a most powerful group. It is the basic unit of all societies.

2) Religion and Caste Group

Each Caste group is following some rules and regulations. It transmits

customs, beliefs, taboos and ritual purity. Each caste group is give certain
standardized services.

3) Temporary Social Groups

It includes,

a) The Crowd: It is a temporary collection of group and is of short

period. It is motivated by common interest or curiosity.

b) The Moti: It is an essential crowd. It has a leader. Group is

represented by a flag or slogan. It is more emotional than crowd.

4) Permanent Social Group

a) The Band: It is the most elementary social group. Group is

organized itself and follows a pattern of life.

b) The Village: It Is a small collection of people permanently settle

down in a locally with their homes and cultures.

c) The Town and Cities: Large group, denser and permanent

settlement, heterogeneous individuals.

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PAPER I COMMUNITY HEALTH NURSING

d) The State: It is an ecological social group. It is based on territory,

heterogeneous.

e) Government and Political Organization: These are like Panchayats,

the club and various associations.

THE FAMILY

It is a primary and basic unit in all societies. It is also a unit for the provision of
primary health care and social services.

Definition

It is defined as a group of biologically related individuals living together and

eating from a common kitchen.

Types of Families

Mainly, there are 3 types of families.

1) Nuclear Family

It is also called Elementary Family. It consists of married couple and their

children.

Characteristics of Nuclear Family.

• In this family, husband plays a dominant role.

• Absence of grandparents, uncles, aunties and near relatives.
• More responsibility for child rearing.
• Husband and wife relationship is more intimate.

2) Joint Family

It is also called Extended Family. This family is common in agricultural areas

of India. It consists of parents, their children and parents, uncles, aunties, kins and
widows.

Characteristics of Joint Family.

• It consists of number of married couple and their children.

• All the men are related by blood and women of the household are their wives,
unmarried girls and widows of the family.
• All the property is held in common family purse is same to all and income
goes to the same purse.
• Family responsibility held in the senior male member.
• The family relations enjoy primarily over marital relations.

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PAPER I COMMUNITY HEALTH NURSING

Merits of Joint Family

• Practical sharing of responsibilities in all matters.

• Greater economic and social security provided.

3) Three Generation Family

It is defined as there are representatives of three generations. Young couples

are continuing to live with their parents and have their own children.

Functions of Three Generation Family.

• It provides clean and decent one to its members.

• There is division of roles and responsibilities of each member in the family.
• The male had the role to earn a living and support the family.
• The female had the total responsibility for the day to day care of children.
• Reproduction and bringing up of children.
• It transfers civilization the cultural patterns relating to eating cleanliness,
dress, speech, language, behaviour and attitudes are all transmitted through
the family.
• The family implies economic partnership.
• Social Care: It provides social status in the society. It protects its members
from all sorts of insult.
• It regulates its members from political religious and general social activities.
• It regulates sex relation through incest taboos.
• Community resources are needed to meet the vast health needs of the
community.

Community Resources

For effective health care services and assessment of the available resources,
their allocation and efficient utilization are important.

The basic resources for providing health care are

1) Health Man Power: It includes Doctors, Nurses and Auxiliary workers who
are needed to provide the health care.

2) Money and Material: It is also an important resource for providing health

services. Material also received in meeting the needs of the people.

3) Time: It is more than money. As someone said it is also important dimension

of health care services.

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CONCLUSION

Community is group of people with a residential tie in a particular area. As a

Multipurpose Health Worker (F) has to know the structure of community to
understand the behaviour of people in different communities and to identify the
problems of different communities, to assess and plan correctly according to their
needs.

SUMMARY

People are living in different rural, urban communities and urban slums. They
are facing different problems. Family is a basic unit of community and the families
are different types like Nuclear and Joint Families.

SHORT ANSWER TYPE QUESTIONS

1) Define Community?
2) Mention the characteristics of Rural Community?
3) Define Family?
4) Mention the characteristics of Joint Family?

LONG ANSWER TYPE QUESTIONS

1) Explain in detail about different types of Communities?

2) Write in detail about social health problems of Urban Community?

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PAPER I COMMUNITY HEALTH NURSING

UNIT-III - COMMUNITY BASED ASSESSMENT

STRUCTURE

Scope and methods of community based assessment

Health assessment
Health assessment and history taking
Care of sick and referral system

Introduction

Community based assessment is to identify the needs and problems of

families and individuals.

Definition

It is the process of identifying the needs of community and to determine

potential services.

SCOPE AND METHODS OF COMMUNITY BASED ASSESSMENT

Community based assessment is very useful in all areas of health services.

They are

1. Nutritional services
2. Environment, MCH and Family Planning
3. Mental health services

Methods of community assessment

1. Community Survey of Baseline survey

It is one of the method of data collection. The data must be collected by

conducting door to door visit.

Survey consists of 3 parts. They are

a) Questionnaire: It contains 30 to 35 questions.

b) All are open ended questions. For example, instead of asking YES or NO, ask
which method of family planning method they are using.

c) A demographic page.

Principles of Survey

• Questions should be accurate and complete.

• Questionnaire should pretrailed.
• Make sure all areas are covered.
• Use simple statements.
• Avoid duplication.

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• Demographic data is placed at the end of survey.

• Answers should be written in the correct words.

2. Interview method

It is method of collecting information face to face. It requires two persons, (i)

Interviewer and (ii) Interviewee.

Interviewer is a person who conducts the interview and Interviewee is a

person who gives information.

Principles of interview

• Interview should be pre-planned.

• Should be organized in a systematic way.
• Ask only open ended questions.
• Should maintain eye to eye contact.
• Interviewer should sit comfortably.
• Ask one question at a time.
• Give sufficient time to answer.
• Listen carefully.
• End the interview in a cheerful way.
• Should not reveal interview information.

3. Focus Group Discussion

It is method of discussion with particular group. E.g., Youth, women or

Adolescents. It is also a method of data collection. The discussion should be only for
2 hours.

• Set date and time

• See that all the group should be participated.
• One leader should lead the group.
• Note the discussed issues.
• Conduct discussion by asking questions.
• After collecting information end the discussion.
• Categorize all the answers.

4. Case Study

Study a case or a diseased patient for a period of time and get the
information. It gives the sufficient information about case, signs and symptoms and
occurrence of case.

Data should be collected by scrutinizing the records of sub centre and primary
health care.

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Methods of community assessment

1. Planning and organization

• Plan the community assessment with other staff members.

• Assess the needs and objectives based on the population.

2. Data collection and summarization

It should be done by conducting survey.

3. Summarizing the data

• On the basis of importance of needs.

• Needs should be according to priority.

4. Data Analysis

After analysing the data, action plan should be conducted in terms of

meaningful specified goals and objectives.

In the final stage, report should be written.

HEALTH ASSESSMENT AND HISTORY TAKING

Health assessment is important to identify the health problems of an

individuals. Health assessment procedure is varying from person to person and from
age to age.

Health assessment consists of history taking and physical examination.

History taking

History taking includes,

1. Socio economic data: This includes the name, age, date of birth, religion,
marital status, occupation, family income, educational qualifications.

2. Family History: Information about all members, grandparents, brothers and

sisters. History of any diseases in the family.

3. Past history: List the diseases occurred like allergies, rheumatic fever, heart
diseases etc.

4. Surgical history: Any operations, blood transfusions and accidents are

included.

5. Obstetrical history: It includes menstrual cycle history of pregnancies and

deliveries.

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PAPER I COMMUNITY HEALTH NURSING

6. Present medical history: It includes present illness, its onset, signs and
symptoms and duration of treatment.

Physical Examination

It is a detailed study of the entire body. It helps to determine the general,

physical and mental conditions of the patient.

Purpose

a) To understand the physical and mental wellbeing of the patient.

b) To identify diseases.
c) To find the cause and severity of disease.
d) To understand any changes in the conditions of diseases.

Methods of examination

1. Inspection: It is visual examination or examination of the body with an eye. It

helps to detect the defects the structure and functions of the body.
2. Palpation: Palpation of the body or a part with the hands to find the size and
position of organs.
3. Head and face: Size and shape of the head and circumference
4. Scalp: Condition of hair, dandruff, pedicure and any infections.
5. Face: Pale, puffiness, fatigue, pain, fear, anxiety, enlargements of any glands
e.t.c.
6. Eye

• Eyebrows - Normal or absent

• Eyelashes - Infections
• Eyelids - Oedema, lesions, ectropion, entropios
• Eyeballs - Sunken or protrude
• Conjunctival - Pale, red, purulent
• Sclera - Yellowish discoloration
• Cornea and Irish - Irregularities and abrasion
• Pupils - dilated, Constricted, reactions to light
• Lens - Opaque or transparent or thick
• Fundus - Congestion, haemorrhagic spots
• Eye muscle - Stabismus
• Vision - Normal, short sight or long sight
7. Ears: Any discharges, lesions, infections, obstructing the ear passage,
deafness etc.

8. Percussion: It is tapping with the finger on the body to know the condition of
the internal organs.

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PAPER I COMMUNITY HEALTH NURSING

9. Auscultation: It is listening to sound within the body.

General examination or Head to foot examination

• General appearance
• Nourishment: Well-nourished or undernourished
• Body built: Thin or obese or moderately built
• Healthy: Healthy or unhealthy or sick

Nose: External nares, Crusts or discharges

Nostrils: Inflammation, septal deviation
Mouth and Pharynx
Lips: Redness, Swelling, Crusts, Cyanosin, Angular Stomatitis, Odour and foul
smelling
Teeth: Discolouration and dental care
Tongue: Pale, Decy, Lesions,
Throat and Pharynx: Enlarges tonsils, redness and ply
Neck: Enlargement of Lymph nodes and thyroid gland

Chest

Throat: Shape, Symmetry, breath sounds

Heart: Size and location
Breasts: Lymph nodes and inverted nipples
Abdomen: Skin rashes, Scar, Hernia, Ascisicitis, pregnancy etc.
Back: Spina bifida
Genitals and Rectum: Inguinal Lymph glands, enlarges palpable, Patency of urinary
meatus rectum, descent of the testis in infants
Vaginal discharge: Presence of sexually transmitted disease, haemorrhoid
Mental Status: Conscious/Unconscious, delicum, Styper
Neurological examination: Like test for sensation, reflexes, Coordination, function of
cranial nerves
Weight: Should be checked, height, chest circumference.

Care of the sick, referral, health education of individual and family

Care of the sick at home is the response of MPHW(F). she should provide are
according to the needs and problems.

If it is not treatable at home, she should refer patient to the PHC, CHC and
district hospitals. It saves the patient’s life and get treatment as early possible.

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PAPER I COMMUNITY HEALTH NURSING

Health education should be given based on the disease condition and health
status of the patient that should be given individually and to the family.

1) Personal hygiene
2) Isolation
3) Proper treatment/nutrition
4) Safe disposal of execution

SUMMARY

Community based assessment is done by using different methods to assess

the needs and problems of the community. Care f the sick at home is an important
responsibility of the MPHW(F). She should perform need based care.

SHORT ANSWER TYPE QUESTIONS

1) Define community based assessment?

2) What is interview method?
3) Define referral?

LONG ANSWER TYPE QUESTIONS

1) Explain in detail about physical examination?

2) Describe about methods of community based assessment?

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PAPER I COMMUNITY HEALTH NURSING

UNIT-IV - HOME VISIT

INTRODUCTION

Concept, Importance, Principles and Planning

Bag Technique-Equipment, usage of bag at home
Disinfection of equipment

CONCEPT, IMPORTANCE, PRINCIPLES AND

PLANNING Introduction

70% of the Indian people lives in rural area. Rural health services provided by
MPHW (F) or Asha workers. To provide health services, they need to identify health
problems and needs of community and family through home visit. So it is a back
bone and important function of community health.

Community health

Definition

Home Visit is defined as “Providing health services at door level”.

Purpose or Importance of Home Visit

• To identify the health needs and problems of family.

• To provide simple nursing care.
• Promotion of health of the family members.
• To prevent diseases by giving health education.

Principles of Home Visit

1. It should be made based on the health needs and problems of the people.
2. Home visit should be part of a planned visiting programme.
3. Collect base lines information about the family e.g., size, number, occupation,
income, religion, resources, customs and culture.
4. Establish communication and identify the health needs of the family.
5. Provide nursing care by following scientific principles.
6. Give health education according to the health needs.
7. Develop confidence among the family members.

Planning of Home Visit

Before Home Visit, MPHW(F) should plan priory to achieve the purpose of
home visit.

The following steps should be followed in planning of home visit.

• First, make a survey of that particular area.

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• Prepare a map with details e.g., the location of the village or area, boarder
and important land marks.
• Collect the baseline information.
• Prepare family folders of each family.
• Identify the individuals or families in need of home visiting. E.g., any sick or
diseased persons, pregnant mothers or postnatal mothers.
• Maintain diary and enter the family particulars on the day of home visit.
• On the first visit, remove her chappals, enter the house and greet the family
members.
• MPHW (F) should introduce herself to the family and explain the purpose of
home visiting.
• Give sufficient time to family members to express their doubts.
• Encourage the family members to participate in the communication.
• Provide simple nursing care, if needed.
• Give health education based on the observation of environmental sanitation
and other activities. E.g. person hygiene
• Provide sufficient information regarding health.
• Establish good interpersonal relationship and end the home visiting.
• Follow up: It is required now and then, to check whether the instructions given
are followed or not. Give encouragement to follow the instructions.
BAG TECHNIQUE

• The community bag should be made of canvas or card board or with light
material.
• The bag should be made easy to carry.
• The bag should contain 2 partitions. Outside and inner side. The Outside
partition contains space for keeping, newspapers, diary, towel, soap dish, hair
brush.

Bag technique or usage of bag

• Keep the bag neat and clean. Some bag may be used in several houses.
• First select the elevated place to keep the bag.
• Spread newspaper in a clean and elevate area and place the bag on it.
• Bag should be kept away from children and pet animals.
• Open the outer packet of the bag and take out soap dish, towel and brush.
• Wash hands before opening the inner part of the bag.
• Remove things which are needed to provide simple nursing care.
• Carry out nursing procedure.
• After completion, wash, boil the equipment after completion of nursing care.
• Wash hands and replace equipment in the bag.
• Collect the soiled cotton balls and dressings in a paper bag and burn it.
• Fold the upper part of newspaper inside and keep it in the outer packet.

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PAPER I COMMUNITY HEALTH NURSING

Equipment of Bag

• Soap, brush and towel in polythene or plastic bag.

• Clinical Thermometer.
• Rectal Thermometer.
• Scissors, Artery forceps.
• Kidney tray, bag of sterile dressing, measuring tape, bag of cotton swabs,
mucus sucker, test tubes, spirit lamp, clinical Thermometer.
• Simple drugs like fab, paracetamol, iron and folic acid, B-complex.
• Solutions like Spirit, Dettol or Savlon, benedict solution, iodine etc.
CARE OF EQUIPMENT OR DISINFECTION OF EQUIPMENT

• It is important to prevent infection.

• To use equipment for longer time.
• To maintain equipment in best working condition.
1. Bag: Cover should be washed with soap and water. If contamination is more
boiled, the cover of the bag or dry under sun light.
2. Rubber goods: Rubber goods should be washed with soap and water and
rinsed. Rubber goods may be boiled for 10 minutes.
3. Clinical Thermometer and Scissor: Keep the Thermometer in 5% Dettol
solution for 15 minutes and rinse with tap water.
4. Enamel ware: These are boiled for 20 minutes, dry with clean towel. E.g.,
Kidney tray.
5. Instruments: They should be washed well with cold water and boiled for 20
minutes and dry with clean towel.
6. Sputum Cups: Before use 1/4th should be fill with sand or lime water. It
prevents sticking of the sputum.
CONCLUSION

MPHW (F) should aware of doing Home Visit by following principles to identify
health needs and problems to render nursing care.
SUMMARY

Home Visiting is back bone to Community Health Nursing. It should render

through planning. To render simple nursing care, MPHW (F) should use community
bag. So, she should know the bag technique, care of equipment.
SHORT ANSWER QUESTIONS

1. Define Home Visit?

2. Write the purpose of Home Visit?

LONG ANSWER QUESTIONS

1. Explain principles of Home Visit?
2. Describe about planning of Home Visit?

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PAPER I COMMUNITY HEALTH NURSING

UNIT-V - HEALTH PROBLEMS AND POLICIES

Overview of health problems in India

Trends and developments in National Health Policies
National Population Policy & Five years’ plans
National health Programmes

Introduction

An assessment of the health status and health problems is first requisite for
any planned effort to develop health care service.

Health problems of India

1. Communicable disease problems

2. Non communicable disease problems
3. Nutritional Problems
4. Environmental Sanitation problems
5. Medical Care problems
6. Population problems

1. Communicable disease problems:

This is a common and major problem in India. Communicable diseases like

ex. Malaria, Tuberculosis diseases, Acute respiratory tract infection leprosy, Filaria,
AIDs and others. These are major public health problems and causes mortality
morbidity rates. All these Communicable diseases are due to poor environmental
Sanitation.

2. Non communicable diseases

Which include Diabetes, Cancer, Cardiovascular stroke, lung disease are

major public health problems these diseases are due to aging of population and
changes in behavior.

3. Nutritional problems

India’s like deal society consisting of a small group of well lied and very large
group of under house shed. The Specific Nutritional problems are,

(a) Protein energy mal nutrition: it occurs mainly during infancy. It is mainly
due to insufficient food. (On inadequate food. It is mild and moderate
cases. Nutritional marasmus is more common in children.

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PAPER I COMMUNITY HEALTH NURSING

(b) Nutritional Anaemia: Nutritional anaemia is more common in women and

children. 60 to 80 percent of pregnant women are anaemia. The main
cause of anaemia is iron deficiency and B12 deficiency is less common.

(c) Low birth weight: This problem occurs due to malnutrition and anaemia
during pregnancy. It is a mayor public health problem in India. Children
born less than normal birth weight (2.5kg)

(d) Xeropthalmia (nutritional blindness): This problem is usually occurring in 1-

3 year of age children. It is due to vitamin ‘A’ deficiency and diet is with
inadequate Vitamin ‘A’ food.

(e) Iodine deficiency disorders: It is an endemic disease. This is due to the

iodine deficiency and it causes goitre in adolescent girls.

4. Environmental Sanitation

Man is always associated with his environment. Environment plays an

important role in the occurrence of diseases. Poor environmental conditions are
Source of so many communicable diseases like Malaria, Filaria, Chicken Gunya, and
Dengue fever and other water born and food borne diseases. This problem is
acceding due to the overcrowding over population and industrialization and unsafe
disposal of extra.

5. Medical Care Problems

The mayor medical Care problems in India is due to inappropriate distribution

of health services between urban and rural areas. In appropriate ration of population
and health professional.

6. Population Problem

For all health problems in India all due to growing population indirectly. Day by
day the population is increasing. It is feared that the county’s population may reach 1
billion it causes indirect consonances like, pollution, housing and other problems.

Trends and developments in National & Health policy

• A policy is important to assess the current situation.

• A National Health Policy sets goals for improving health situation. It gives
direction for providing health services.
• Health Policy was developed world wide adoption of the goal of HFA by 2000
A.D. Alma-Ata declaration calling on all government to develop and implement
primary health care strategies.
• The first national health policy was evolved by the government of india in
1983, After that a new health policy was developed in 2002.

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PAPER I COMMUNITY HEALTH NURSING

• The main objective of this policy is to achieve an acceptable standard of good

health and concentrated on diseases such as Tuberculosis, blindness and
HIV/AIDS. So many goals were formed by Natural health Policy. e.g. Reduced
mortality rate by 50% on account of TB, Malaria and other vector born
disease.
• Infant mortality rate to 30/1000
• Maternal mortality rate to 100/1Lack by 20/0

National Population Policy

In 1976 India formed first its national population policy. Notational Population
policy 2000 is the latest in its services.

The National Socio-demographic goals

1. Address the unmet needs of mother and child health service.

2. Make school education upto age 14 years free and Compulsory.
3. Reduced infant mortality rate to below 30/1000 live birth.
4. Reduced maternal mortality ratio to below 100 per 1,00,000 live births.
5. 80% institutional or hospital deliveries.
6. Promote delayed most age for given not earlier than age is and perfectly after
20 years of age.
7. 100% registration of birth, death, marriage and pregnancy.
8. Prevent and contact of communicable diseases.
9. Integration of AYUSH in the provision of RCH services.
10. Promote vigorously small frankly norm.

Five-year Plan

The economic planning of country lives caused through the Five year plans
developed, executed and monitored by the planning commission.

The First five year plan was one of the important because it hard a great role
in the lounge of Indian development after the independent. It was started in the year
1951.

12th Five Year Plan (2012-2017) of the Government of India has been decided
to achieve a growth rate of 8.2% but the National Development Council on 27
December 2012 approved a growth rate of 8% for the 12th Five Year plan.

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PAPER I COMMUNITY HEALTH NURSING

National Health Programmes in India

After independence, several measures have been undertaken by the national

government to improve the health of the people.

Prominent among these measures, all the “National Health Programs” which
have been launched by the Central Government for the Control/Eradicate
Communicable diseases, improvement of environmental Sanitation, nursing the
standards of nutrition, control of population and improving rural health.

National Health Programmes are as follows

1. National vector borne disease Control Programme,

(a). National malaria Control Programme
(b). Elimination of lymphatic Filariasis
(c). Control of Kala-Azar
(d). Control of Japanees Encephalitis
(e). Control of dengue fever
(f). Control of Chicken gunya fever

2. National Leprosy “Eradication” Programme.

3. Revised National Tuberculosis Control Programme.
4. National Program for control of blindness
5. National AIDS Control Programme
6. Iodine Deficiency Disorder Programme (IDD)
7. Universal Immunization Programme
8. Guinea Worm Eradication Programme
9. National YAWS Eradication Programme
10. National Cancer Control Programme
11. National Mental Health Programme
12. National Programme for Prevention and Control of Diabetes, Cardio vascular
diseases
13. National Programme for Control and treatment of occupational diseases.
14. National Family Welfare Programme
15. National Water Supply and Sanitation Programme
16. National Nutrition Programme
17. National Rural Health Mission and Urban Health Mission

1. National Vector borne disease control Programme : - is implemented in India

for prevention and control of vector borne diseases namely malaria, filarial,
kala-azar, JE, dengue and Chicken gunya.

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PAPER I COMMUNITY HEALTH NURSING

1) National malaria Control Programme

• It was started in 1953, during the First Five-year Plan Goals during 2007-
12
• At least 50% reduction in mortality due to malaria by the year 2010.
• 80% malaria cases get Correct, affordable and appropriate treatment
within 24 hours.
• Provide preventive measures at least 80% of high risk malarial cases Such
as insect dual treatment and indoor residual spreading.

Main components of strengthened under the project include: -

1. Early Case detection and prompt treatment distributing chloroquine

tablets.
2. Vector control and personal protection methods, include insecticide
treated, mosquito nets supplying of bed nets at free of cost.
Use of Larvivorus Fish: is being promoted in natural water sources in
urban and rural areas.
3. Identification of cases depending upon demographic area. i.e. epidemic
planning.
4. IEC activities for generating awareness about malaria.
5. Anti-malaria month Campaign Programme before the onset of monsoon
i.e. month of June every year.
6. Elimination of lymphatic Filariasis :-
It is an endemic disease in some districts and union territories. It was
launched since 1955. This programme was utilization of avail resources
since 1978.

Objectives of the programme are

1. Anti-larval operation
2. Source reduction
3. Detection and treatment of micro lateral carriers.
4. Sickness management and IEC

Elimination of Filaria

Annual Single mass drug therapy with DEC (Di Ethyl Cardomazitine). Home based
management of lymphedema cases.

Kala Azar: It is now endemic present in Bihar, Jharkhand, West Bengal and Utter
Pradesh.

Activities to eradicate Kala Azar

1. Early identification of case and complete treatment.

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PAPER I COMMUNITY HEALTH NURSING

2. Vector Control.
3. Communication for behavioural changes.
4. Monitoring, suppression and evolution of cases.
5. Follow research guideline to prevent & control of Kala Azar.

Japanese encephalitis

It is with high mortality rate and who survive also will live with neurological
problems.

Action for Control and prevention

• Early diagnosis and prompt treatment

• Vector Control, particularly personal protector and use of larvivorus fishes.
• IEC activities to change behavior.

Dengue Fever:

During 1996 the outbreak of dengue was reported in Delhi.

Control and prevention of Dengue fever:

• Early identification of cases or outbreak.

• Containment of outbreak.
• Case management with early admission in the hospital and taking correct
treatment.
• Vector Control.
• IEC activities about DO’s and Don’ts for prevention of Dengue.
• Monitoring and reporting System.

2) National Leprosy Eradication Programme

The National Leprosy Control Programme has been in operation Since 1955,
it is centrally aided programme.
The Component of the programme are

• Leprosy Services are incorporated with general health care.

• Strengthening of leprosy services
• IEC activities.
• Prevention of disability and rehabilitation of Cases
• Monitoring and Supervision.

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PAPER I COMMUNITY HEALTH NURSING

Major Activities include

• More focus in identification of new cases full course of complete treatment

should be taken by the patients.
• More emphasis disability limitation and rehabilitation.
• Asha workers have been involved in bringing new suspected Cases from
their villages for early diagnosis.
• She should see that the patient should take complete Course of treatment.
• For this Asha worker will amount of Rs.100/- on confirmed diagnosis of case,
Rs.200/- and MD Leprosy case Rs. 400/-.
• Facilities provided like settled colonies to reside, free medical facilities like
care of illness, self-care training, counselling and MCR footwear.

3) Revised National Tuberculosis Control Programme (RNTCP)

This Programme has been in operation since 1962. After that, because of
some problems in the programme in 1993. It was renamed as Revised National
Tuberculosis Control Programme by adopting DOTS.
Objectives of RNTCP

• At least 85% of cure rate of infectious cases.

• At least 70% of cases must be diagnosed through quality Sputum Microscopic
examination.

Revised objectives of RNTCP

• Organizational support, central and state level

• Use of sputum examination for diagnosis.
• Follow standard treatment regimen.
• Regular supply of drugs.
• Emphasis on training, IEC, research and NGO
• Increased budget.

Directly Observed Treatment Short Course (DOTS)

It is a treatment for TB control
Components of DOTS
1) Financial support by political system
2) Case detection by Sputum examination
3) Regular supply of drugs
4) Directly observed treatment
5) Systematic monitoring

DOTS regimen is recommended by WHO. In this, patients are divided into 4

categories.

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PAPER I COMMUNITY HEALTH NURSING

➢ Category I : New case of sputum smear positive

➢ Category II : Irregularly treated or default less
➢ Category III: New case of sputum smear positive
➢ Category IV: Chronic cases who remained sputum smear positive

Daily Regimen RNTCP adult

Revised RNTCP 2017

Changes taken place

I Change

99 DOTS:

• 99% of the benefits are enrolled in the regime.

• Introduction of fixed dose drug combination.
• Both drugs are combined.
• It is used in the R. I, E, P
1st – 4 4JC Intensive phase: Isodized, Refampicen, Ethambutol, Pyrazinamed. 1st
lane drugs combined together and formed tablets.

Dose: I: 75 mg, R:150 mg, E:275 mg, P: 400 mg

This is for one day, one single dose.

2nd, 3FJC: I,R,E dosage is same. It is used in the continuation.

II Change

Previously the regimen was 3 days in a week. But now it is daily treatment.

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PAPER I COMMUNITY HEALTH NURSING

III Change

Use of Information Technology, mainly for monitoring and implementation with

Aadhar Number.

Treatment: Patients are categorized into 2

Category I: All new cases Sputum Senear Positive or Negative

Rx is divided into intensive phase - 1st 4 FDC
First line agents for 8 weeks or 2 months

In continuation phase – (IRE drugs) 3 FDC –give for a period of 16 weeks or 4 moths
Total duration is 6 months

CNS, TB or Skeletal +B – Continuation phase - 12 week extended to 24 weeks to the

continuation phase

Category II: Previously treated or Defaulters or relapse

Intensive phase: 4 FDC+Inj. Streptomycin 5 weeks-12 weeks or 3 months

Continuation phase:3 FDC – 20 weeks or 5 months
Total 8 months

4) National Programme for Control of Blindness

It was launched in the year 1976. It was centrally sponsored Programme.

Goal: to reduce the prevalence of blindness.

Objectives

• To perform cataract operations, school eye screening Programmes and

distribution of spectacles.
• Identification and treatment of curable blind.
• “Eye Health for All” and prevention of visual impairment, by strengthening of
NPCB.
• Community awareness Programme on eye care.
• Increase research activities.
• To secure and participation of voluntary organizations.

Newer initiatives:

• Vision 2020 – The right to sight.

• Universal eye health: a global action plan (2014-2019). It involves provision of
effective and accessible eye care services is to key to control measures.

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Other New National control Programmes

which includes are

• Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A)

Strategy – 2013.
• National Programme for health care of the elderly.

5) National AIDS Control Programme (NACP)

This Programme was launched in India in the year 1987. The Ministry of
Health & Family Welfare has set up National Aids Control Programme. It is a
separate wing to implement and closely monitor the various components of the
programme.
• The aim of this programme is to prevent further transmission of HIV.
• To decrease morbidity and mortality associated with HIV infection and to
maintain socio economic impact resulting from HIV infection.
• In 1992, National Aids Control Programme-I is launched to slowdown the
spread of infection. National Aids Control Organization was setup.
• 1999-NACP-II begins, focusing on behavior change, increased
decentralization and NGO involvement. State Aids Control Society
established.
• 2002-National Aids Control Policy adopted.
• 2004-Antereteo Viral treatment adopted.
• 2007-NACP-III launched for 5 years (2007-2012)
• 2014-NACP-IV launched for 5 years (2012-2017)

Components of National Strategy

• Establishment of surveillance centers.
• Identification of high risk groups and their screening.
• Issuing specific guidelines for managements of detected cases and their
follow up.
• Formulating guidelines for blood bank.
• IEC activities by involving mass media.

Package of services under NACP-IV

• Target intervention for high risk groups. (Eg: female sex workers,
homosexuals, men who have sex with men, hizars, injecting drug users)
• Prevention of interventions for migrant population.
• Prevention and control of sexually transmitted infections.
• Blood safety.
• HIV counseling and testing services.
• Prevention of parent to child transmission.
• Information, education and communication activity.
• Youth intervention programmes and adolescent education programmes.
6) Iodine Deficiency Disorder Programme (IDD)

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PAPER I COMMUNITY HEALTH NURSING

India started a goiter control programme in 1962, based on iodized salt. The
manifestations of iodine deficiency are not limited to endemic goiter and cretinism
but to a wider spectrum of disability including deaf mutism, mental retardation and
various degrees of impairments of intellectuals and motar function.

The essential components of the programme are

• Use of iodized salt in place of common salt.

• Monitoring and surveillance.
• Man power training and mass communication.

7) Universal Immunization Programme

In 1974, the WHO launched its expanded programme on immunization

against 6 most common, preventable childhood diseases.

The Government of India has launched its EPI in 1978, with the objectives of
(a) Reducing mortality and morbidity resulting from vaccine preventable
diseases of childhood.
(b) To achieve self-sufficiency in the production of vaccines.

Universal Immunization Programme was started in India in 1985. The

components of this programme are

a) Immunization of pregnant women against Tetanus

b) Immunization of children in the 1st year of life.

The main aim of this programme was to achieve 100% coverage of infants
with 3 doses each of DPT, OPV and dose of BCG and one dose of Measles and 2
doses of Tetanus toxoid to pregnant women by 1990. The immunization services are
being provided through the existing health care delivery system i.e., MCH Centers,
Primary Health Centers, Sub Centers, Hospitals, Dispensaries and ICD Unit.

Newer achievements

• Pulse Polio Immunization Programme was launched in the country in

the year 1995.
• Additional oral polio drops are given to 0-5 years of age children. This
programme dates are 27th January and 11th March of 2018
• Introduction of Measles vaccine.
• Introduction of Hepatitis-B Vaccine.
• Introduction of Pentavalent Vaccine, it contains (DPT+Hep.B+HiB).
Five antigens i.e., Hepatitis B, Diptheria, Pertussis, Tetanus and
Homophiles Influenza vaccine.
• Introduction of Japanese Encephalitis vaccine.
• Introduction of Rotavirus vaccine and Rubella vaccine.

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Mission INDRADHANUSH

• The Ministry of Health and Family Welfare has launched “Mission

Indradhanush”.
• It depicts 7 colors of rainbow.
• It was started in December 2014.
• It is against for seven life threatening vaccines preventable diseases
which include Diphtheria, Whooping cough, Tetanus, Polio,
Tuberculosis, Measles and Hepatitis B.

8) National Guinea Worm Eradication Programme

India launched this Programme in 1984 with technical assistance of WHO.

The recommendations given by the International Commission are as follows.

• Health education to school children and women in rural areas.

• Rumour registration and rumour investigation.
• Maintenance of Guinea worm disease on list of notifiable disease and
continuation of surveillance in previously infected area.
• Careful supervision of the functioning hand pumps and sources of safe
drinking water and provision of additional units.

9) National Yaws Eradication Programme

This disease was found in the tribal areas living in hilly forests and difficult to
reach areas in 49 districts and 10 states. This programme is implemented by the
State Health Directorate of Yaws Endemic states, utilizing existing health care
delivery system with the coordination and collaboration of the Department of Tribal
Welfare and other related institutions.
10) National Cancer Control Programme
It is a public health problem in India with nearly a lakh new cases occurring
every year in the country. This programme was launched in 1975-76 and this
programme was revised in 1985-86 and in December 2004.
The main objectives of the Programme are
• Primary prevention of cancers by health education.
• Secondary prevention i.e., early detection and diagnosis of common
cancer such as cancer of Cervix, mouth, breast and tobacco related
cancer by screening, self-examination method.
• Tertiary prevention i.e., strengthening of the existing institutions of
comprehensive therapy including palliative care.
The schemes under the revised programme are
(a) Regional Cancer Centre Scheme
(b) Oncology Wing Development Scheme
(c) Decentralized NGO Scheme
(d) IEC activities at Central level

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(e) Research and training

11) National Mental Health Programme

This programme was launched during 1982 with a view to ensure availability
mental health care services for all, especially the community side and under
privileged sections of the populations.
Aims of the National Mental Health Programme
• Prevention and treatment of mental and neurological disorder.
• Using of appropriate technology to improve general health services.
• Application of mental health principles in total national development to
improve quality of life.
Objectives of the programme
• To ensure availability and accessibility of minimum mental health care.
• Application of mental health knowledge in general health care.
• To promote community participation in the mental health services.

12) National Programme for prevention and control of diabetes and

Cardiovascular diseases

India is experiencing with a rising burden of chronic-non communicable

especially cardio vascular diseases, diabetes mellitus, cancer, stroke and chronic
lung disease due to stress, overcrowding and air pollution.

Components of the Programme

• Health promotion for the general population.

• Diseases prevention for the high risk groups i.e., early diagnosis and
appropriate management for reducing morbidity and mortality.
• Assessment of prevalence of risk factors.

13) National Programme for control and treatment of occupational

diseases.

Government of India launched a scheme called “National Programme for

control and treatment of occupational diseases” in 1988-1999.

The following research projects have been proposed by the government.

• Prevention, control and treatment of silicosis and silico tuberculosis in

industry.
• Occupational health problems and tobacco harvesters and their
prevention.
• Capacity building to research, education, training at National Institute of
Occupational Diseases.
• Health risk assessment and development of intervention programme in
cottage industries, cloth and high risk of silicosis.

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• Prevention and control of occupational health hazards among salt

workers in the remote desert areas of Gujarat and Western Rajasthan.

14) National Family Welfare Programme

• India launched its nationwide Family Planning Programme in 1952,

making it the first country in the world.
• In the beginning it was established a few clinics and distribution of
educational material, training and research.
• During the 3rd 5th Year Plan, Family Planning Programme was declared
as “the very center for planned development”
• The emphasis was shifted from the purely “Clinic approach” to the
vigorous “extension education approach” for motivating the people.
Acceptance of the “Small Family Norm”.

In 1970, an all India hospital postpartum Programme and in 1972, the medical
termination of Pregnancy Act were introduced the National Health Policy (1982) laid
down the long term demographes goals of NRR-1 by the year 2000 which implies 92
child family norm – through the attainment of birth rate of 21 and a death rate of
9/1000 population and Complete protection rate of 60% by the year 2000.

The Government of India evolved a more detailed and Comprehensive

Population Policy 2000 to promote Family Welfare. All the other relative Programmes
were integrated with a Family Welfare Programme like UIP, MCH Programme,
CSSM Programme and RCH Programme.

15) National Water Supply and Sanitation Programme

The National Water Supply and Sanitation Programme was launched in 1954
with the objective of providing safe water supply and adequate drainage facilities for
the entire urban and rural population of country. In 1972, accelerated Rural Water
Supply Programme was started as a supplement to the National Water Supply and
Sanitation Programme.

New initiatives

Swajal Dhara

Launched on 25 December 2002. It is a community led participatory

programme

AIM: Providing safe drinking water in rural areas better hygienic practices and
encouraging water Conservation. Practices along with rainwater harvesting.

Bharat Nirmaan

It was launched by the Government of India in 2005 as a program to build

rural infrastructure.

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Rural Sanitation Programme

Nirmal Bharat Abhiyan (NBA)
Total sanitation programme was shifted into launching the Nirmal Bharat Abhiyan, in
the 12th Five-year plan (in 2012)
Objective: To attain sustainable behavioral changes with provision of sanitary
facilities in entire communities in a phased manner.

Swachh Bharat Mission

It is a national campaign by the Government of India to clean streets, roads

and infrastructure of the country. It was launched by the Hon’ble Prime Minister of
India on 2nd October 2014 at Rajghat, New Delhi.

AIM: to eradicate open filed defecation by year 2019 and construct 12 million toilets
in rural India.

It has 2 Submissions, (1) Swachh Bharat Mission Urban and (2) Swachh Bharat
Mission Gramin.

1) Swachh Bharath Mission Urban

Objectives

• Elimination of open defecation

• Eradication of manual Scavenging
• Modern and Scientifica Minicipal Solid waste management
• To effect behavioral change regarding healthy sanitation practices.
• Awareness about sanitation.

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Components

• Household toilets, including Conversion of insanitary latrines into pour flash

latrines.
• Community toilets.
• Public toilets
• Solid waste management
• IEC and public awareness.

2) Swatcch Bharat Mission Gramin

Improving the level of cleanness in rural areas through solid and liquid waste
management.

Objectives

• Improving of quality of life in the rural areas by promoting cleanliness, hygiene

and eliminating open filed defecation.
• To achieve the vision of Swachh Bharath by 2nd October 2019.
• Motivation of communities to adopt Sanitation practices and facilities through
awareness creation and health education.
• Encourage effective and appropriate technologies.
• Scientific Solid and liquid waste management systems for overall cleanliness
in the rural areas.

16) National Nutrition Programme

The India announced the National Nutritional Policy 1993. Nutrition is multi
sectorial issue; it needs to be tackled at various levels.
Interventions includes,

• Specially to vulnerable groups like pregnant and post-natal mother and

children under 5 year adolescents.
• Improving growth monitoring between age group 0 to 3 year, with the closer
involvement of the mother.
• To prevent birth of 10 weight babies by convening pregnant women.
• Fortification of essential foods.
• Popularization of low cost nutritious food.
• Control of Vitamin deficiencies among vulnerable groups.
• Food Security.
• Improvement of dietary pattern.
• Improving purchasing power.
• Land reforms.
• Health and Family Welfare.
• Basic Health and nutrition knowledge.

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• Prevention of food adulteration.

• Nutrition Surveillance.
• Monitoring of Nutritional Programme.
• Equal Remuneration for women
• Communication.

17) National Rural Health Mission (NRHM) and National Urban Health
Mission Programmes

National Rural health mission was launched by the Government of India on 5th
April 2005 for a period of 7 years, i.e., 2005-2012.
The main aim is to provide

• Accessible, affordable, accountable, effective and reliable primary health

cared.
• Bridging the gap in rural health care through creation of accredited social
health activist.
• Goal achieved by NRHM.
• Infant mortality rate reduced to 30/1000 live births.
• Maternal mortality rate reduced to 100/100000
• Total infertility rate reduced to 2%
• Kala-azar mortality reduction- 100% by 2010 and elimination by 2012.
• Filarial and micro filarial rate reduction 70% by 2010.
• Dengue mortality rate reduction 50% by 2010.
• Japanese encephalitis mortality rate reduction 50% by 2010.
• Tuberculosis DOTS services maintains 85% cure rate through certremission
paid.

Major initiatives of NRHM

• Selection of ASHA workers.

• Rogi Kalyan Samithi (Patient Welfare Committee/Hospital Management
Society)
• The untide grants to sub centers.
• The village level sanitation and Nutrition Committee.
• Janani Suraksha Yojana Committee.
• Janani Suraksha karyaakrammam.
• National Mobile Medical Units.
• National Ambulances Services.
• Web enabled mother and child tracking system.
New Initiatives:

• Home delivery of Contraceptives i.e., condoms, oral pills.

• Conducting district household survey.

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• Promotion of menstrual hygiene.

• Allocation of united funds and Rogi Kalyan Samithi grants.
• Involving ASHA in home based new born care.
• Rashtriya Baala Swasthya Karyakramam (RBSK): This initiative was launched
in February 2018 and provides for child health screening and early
intervention services through early detection and management of 4 diseases
namely defects of blood diseases, deficiencies, developmental delays
including disability.
• Rashtriya Kishore Swasthya Karyaakram (RKSK):- This is launched in
January 2014 to reach out 253 million adolescents in the country in their own
spaces and introduces peer-led intervention at the community level. This is
mainly adolescent health Programme beyond reproductive and sexual health
and brings in focus on life skills, nutrition, injuries, violence non communicable
disease, mental health and substance in is use.
• Mother and child health wings: 100/50/30 bedded maternal and child health
wings have been sanctioned in public health facilities.
• Free deugand free diagnostic services.
• National iront initiat a new launch in 2013.
• Reproductive, Maternal, New born, Child and adolescent health services.
• Delivery points.
• Universal health coverage.
• Comprehensive primary health care.

NRHM Programme is now renamed as National Urban Health Mission

• It is mainly seeks to improve the health status of the urban population

particularly slum peoples and other sections of the people.
• To improve the access to quality health care.

Main Focus

• Urban poor population.

• All other population such as homeless, rag pickers and lime kiln workers, sex
workers and other temporary migrants.
• Public health Services like Sanitation, clean drinking water, vector control.
• Strengthening publish public health capacity of urban local bodies.

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Functions of ASHA Workers

Selection of ASHA

• ASHA full form is Accredited Social Health Activist.

• She must be resident of the village.
• Preferable age is 25 to 45 years with formal education up to 8th class.
• Having communication skills and leadership qualities.
• One ASHA is for 1000 population.

Functions

• She creates awareness and provides information to the community on

nutrition, basic sanitation and hygienic practices.
• She will council women on birth preparedness, importance of safe delivery,
breast feeding, immigration and family planning.
• She will mobilize the Community to the health center for immunization,
antenatal checkup post-natal checkup.
• She will provide primary medical care for minor elements such as diarrhea,
fevers and furst and for minor injuries.
• She will be a providers of DOTS Programme.
• She will act as depot holder for iron and folic acids tablets, oral pills, and
chloramine tablets.
• She will inform about births and deaths in her area.
• She will promote construction of household toilets under total sanitation
programme.

CONCLUSION
National health programmes were launched to control and prevent the health
problems which were existing in India. Every decade, the Government is launching
new programmes, with scenario ofthe health problems. So it is important that to
know the health problems and their prevention and control.
SHORT ANSWER TYPE QUESTIONS
1. Name the health problems in India?
2. What is NUHM?
3. What is DOT?
4. Name the Drugs in MDT?

LONG ANSWER TYPE QUESTIONS

1. List out National health programmes and write any one of the programme?
2. Explain in detail about NRHM?
3. List the functions of ASHA Workers?

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UNIT-VI - COMMUNICATION AND HEALTH EDUCATION

Principles, Methods and process of Communication.

Inter personal relationships and communication with different groups and
health team members.
Health Education- Definition, uses, principles, scope, approaches
Use of AV Aids, role of mass media.
BCC, IEC, Role and responsibilities of MPHW (F) in IEC

Introduction

Communication is also known as sharing. It is essential to all human

association without communication. Human being cannot associate with other
persons. All of us are engaged in most of the time in receiving and sending
information. Good communication is the essence of good leadership.

Definition

Communication is a process by which two or more persons exchange or

share ideas, facts, feelings or impressions.

Purposes

• To educate the public.

• To change attitude and behaviour.
• To promote the health and welfare of community.

It is embodied in 3 words.

1. Information
2. Propagation
3. Entertainment

Principles of Communication

• The information should clear.

• To whom the information is to be given.
• When to give and where
• What method should use.
• Use local language.
• Communication should be easily understanding.
• Feedback should be there.
• Use correct channel of communication.

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Methods of Communication

The methods of communication are as follows.

1. One Way Communication

In this communication, information is send by the sender to the audience or

receiver. E.g. Lecture method or classroom teaching.

Disadvantages or Drawbacks

• Knowledge is imposed.
• Learning is authoritative.
• Audience participation is less.
• No feed back
• It does not influence human behaviour.

2. One Way Communication

In this, process of communication is very active because the sender and

receiver or audience equally take part in the process of communication. Audience
may raise questions, add information, ideas and opinions to the information.

3. Verbal Communication

It is by using words by mouth or a talk. It is oldest method, regularly and

commonly used method.

4. Non Verbal Communication

It is a communication without words. It is mainly by signs, signals, postures,

gestures, facial expressions. E.g. Smile, raised eyebrows, crying etc. it can speak
more than words. It is a silent communication.

5. Formal and Informal Communication

It is a sort of instructions, commands etc follows informal network (eg:gossips)

6. Visual Communication

It comprises of charts, graphs, pictograms, tables, maps, posters etc.

7. Telecommunication

This communication is by using of electronic instrument like TV, Radio and

Internet, Telegraph, Telex etc. These are mass communication media. These
systems are close to interpersonal communication.

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Process of Communication

It is a complex process. In this process, 5 components are present.

1) Message

• It is the information. It is in the form of words, pictures or signals. A

good message must be meaningful, accurate and sufficient.
• It may be on felt needs.
• Clear and understandable.
• It should be timely and comprehensive
• Using of local language.
• Interesting

2) Sender

Sender is one who sends the message or information.

3) Receiver

Receiver is one who receives the information. Eg: A group of people or

students.

4) Channels of communication

To pass the information, sender should use different channels of

communication like face to face communication. Mass media communication like TV,
Radio, Folk media like folk dance, singing, drama, burra katha, hari katha etc.

5) Feed Back

It is the reaction or opinion feelings of the audience. It is obtained by asking

questions, opinion polls and interviews.

INTER PERSONAL COMMUNICATION OR

RELATIONSHIP Inter personal Relationship (IPR)

It is the face to face relationship. It is most common type. It is more verbal

communication.

Uses
• It helps to clarify the doubts.
• It helps to give clear, compete and accurate information.
• It is important skill need to possess in day to day activities of
MPHW(F).
• It is also helpful to better understand patient and family needs.

She has to develop interpersonal relationship with different groups like

Programme Officers with Health Assistant (Male), Pharmacist, Lab Technician and
with subordinates like ASHA Workers, Village Guides, Anganwadi Workers, Trained
Das and other NGO organizations.

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In order to provide individual and family health services, she needs to

maintain interpersonal relationship with all the above groups members.

HEALTH EDUCATION

The main objective of the Health Education is “To win friends and influence
people “.

Definition

1) Health Education is a process which effects changes in the health practices of

people and in the knowledge and attitudes related to such changes.

2) Health Education is a process that informs, motivates and helps the people to
adopt and maintain healthy practices and life styles.

Uses of Health Education

• To inform about the value of health.

• To help the people with skills, knowledge and attitudes to enable them to
solve their health problems by their own activities.
• To promote the development and proper use of health services.

Principles of Health Education

Health is based on some fundamental principles. They are,

1) Credibility: Health Education is based on facts and also with local culture,
educational and social goals. Credibility means receiver should receive trust
worthy (trust) information.

2) Interest: Health Education must create interest among the people. So, it
should be based on felt needs of the people.

3) Comprehensive: As a Health Educator, she must know the level of

understanding, education and literacy of the people.

4) Participation: Active and personal involvement of the people is necessary.

5) Communication: It should be clear, accurate and simple words should be

used.

6) Motivation: It is stimulation of desires. Health education try to motivate

individuals and groups to accept. New ideas and new techniques.

7) Reinforcement: Repetition of education at intervals is necessary.

8) Learning by doing: Always health education is done with the help of

demonstration. Then only the people will not forget about teaching. Eg:
Demonstration of homemade ORS preparation.

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9) Good human relations: It is very important to develop confidence among the

people. The health educator must be kind and generous.

Scope of health education

Health education is used in all the branches of community health.

1) Human biology: It is educating the illiterate people about the structure and
function of the body. The contents include,

• To maintain physical fitness.

• Rest and sleep.
• Reproductive biology.

2) Nutrition: Nutrition education is important to maintain optimal nutritional status

and to fight against with malnutrition. It includes nutritive value of food,
storage of food, cooking, serving and eating of food, good dietary habits.

3) Hygiene: It includes personal and domestic hygiene. E.g., Bathing, Clothing,

washing hands and lighting, ventilation, control of rats and mice.

4) MCH and family planning: Topics included are care of pregnant mother and
care of child. E.g.: Diet, rest of the pregnant mother, weaning immunization,
infant feeding and family planning of the couple.

5) Prevention of communicable diseases: It is mainly by giving information about

mode of spread of common communicable diseases (e.g. polio, diphtheria,
typhoid) and protection by immunization against these diseases.

6) Use of health services: It is for to make the best use of health services by all
sectors of the people. E.g., MCH services, medical care. Ambulance services.

7) Mental health: It includes to use defence mechanism to cop up with situation

to prevent the occurrence of abnormal behaviour like drug addiction,
alcoholism, crime, violence etc.

Approaches in health education

Health education is carried out either by using one approach or in combination

of approaches. Mainly 3 approaches which are present and they are

1) Individual approach
2) Group approach
3) Mass approach

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Individual approach Group approach Mass approach

a) Personal contact a) Lectures a) Television

b) Home visits b) Demonstration b) Radio
c) Personal letters c) Discussion c) News paper
methods-Group d) Printed material
discussion e) Direct mailing
d) Panel discussion f) Posters
e) Symposium g) Health museums
f) Workshop and exhibitions
g) Conference h) Folk methods
h) Role play i) internet

AV AIDS

These are educational materials designed to provide new concept and

knowledge. It facilitates interpersonal and group discussion.

Types of AV Aids

Auditory Aids Visual Aids Combined Aids

Eg: Radio Chalk boards Television

Tape Recorder Leaflets Sound Films
Microphones Posters Computer
Amplifiers Charts Internet
Ear Phones Exhibits
Models
Specimen

1. Auditory Aids: Only listening of information or topic

2. Visual Aids: Listening and seeing occurs by using these types of AV Aids. It is
not required programme.
3. Combined AV Aids: These are in combination of audio and visual Aids. They
receive some projection.

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Uses of AV Aids

• They simplify the teaching and learning process.

• Easy understand by the audience.
• Make use of all senses effectively.
• They avoid monotony of lecture method.
• Creates interest.
• Memory is long lasting
• It provides new knowledge
• Feedback is possible.
• It creates enthusiasm

Role of mass media

Mass media means use of different channels to reach the information

relatively large group of people at a time.
printed material, TV, radio and propagation.

Advantages

• Information reaches to all the people.

• It develops enthusiasm.
• Creates interest to enquire about information.
• Easily understand by illiterates.
• It helps to promote knowledge.
• All types of organizations are using to promote and develop organizations.
E.g: Shopping malls, colleges
• It is widely used media in all the sectors. E.g.: Education and Entertainment

BEHAVIOURAL CHANGE COMMUNICATION (BCC)

• This type of communication is used to change the behaviour and attitude of

the people.
• This communication removes beliefs, taboos, customs and practices.
• It helps to promote health.

INFORMATION EDUCATION AND COMMUNICATION (IEC)

It is a type of communication. It changes attitudes, lifestyles of people through

information, education and communication.
1. Information

It is awareness of a topic, event or an issue. It provides scientific knowledge.

It helps in maintaining and promoting health. E.g. Pulse Polio Programme and
Antenatal care.

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Uses

• It eliminates ignorance, false beliefs of people about health matters.

• It helps to meet the health needs of people.

Providing information is the responsibility of government health professionals

and mass media people.

2. Education

Education regarding health. It can change the behaviour, life styles and risk
factors of disease. Simple health education can prevent the occurrence of many
communicable diseases.

3. Communication

It is sharing of ideas, habits, opinions and customs, it is either one way or two-
way communication. The process of communication is done by using different
channels like mass media, folk media and by interpersonal relationships.

Role of MPHW (F) in IEC activities.

• She should give correct, factful information to the public.

• Information should be specific.
• Inform about date, time, place and resource of information.
• Prior information is given to involve the public.
• Health education and IEC activities should be based on the health needs.
• She must use correct AV Aids to simplify health education.
• She should use two-way communication in sending the information.
• Should use of all channels of communication.

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SUMMARY

Communication is a process of exchange of ideas. MPHW (F) should use

communication skills in interpersonal communication. Health education is important
to prevent the occurrence of many communicable diseases.

AV Aids is important educational material used to create interest while giving

health education among the public.

SHORT ANSWER TYPE QUESTIONS

1. Define communication?
2. What is IPR?
3. Define Health education?
4. Expand BCC?

LONG ANSWER TYPE QUESTIONS

1. Explain the principles of health education?

2. List out different types of Aids? Explain one of it?

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PART B
UNIT VII - CONCEPT OF DISEASE

Identification of illness.
Disease causation
Classification of diseases

Introduction

So many theories were given definitions of disease. A Disease is defined as

deviation of health from normal situation. Diseases are classified in many forms like
infections, hereditary, congenital and communicable diseases.

IDENTIFICATION OF

ILLNESS Illness

It is one’s own feeling about health. It is a higher personal state in which the
physical, emotional, intellectual, social and spiritual development of a person is
diminished.

Illness is defined as any deviation from the function.

Definition of disease

It is an alteration in body function resulting in a shortening of normal life span.

CAUSATION OF DISEASE

Causation of disease or causes or factors responsible for disease is same.

The causative factors of diseases are many and they are

1. Agent factors
2. Host factors
3. Environmental factors

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AGENT FACTORS

HOST FACTORS ENVIRONMENTAL FACTORS

1. Agent Factors

• Agent is living or non-living factor.

• It is biological (bacteria, viruses, fungus)
• Physical: These are heat, cold, pressure and radiation.
• Nutrient: These are proteins, carbohydrates, fats and vitamins etc.
• Mechanical: It is either by trauma or fractures.

2. Host Factors

It includes age, sex, nutritional status, occupation, customs and habits (eg:
smoking and alcoholism).

3. Environmental factors

• Physical environment like poor housing, lack of safe drinking water and poor
environmental sanitation.
• Biological environment includes cultural factors, hereditary and congenital in
nature.

CLASSIFICATION OF DISEASES

Diseases are mainly classified into two types.

1. Acute diseases and

2. Chronic diseases
1. Acute Diseases

• Onset of disease is sudden.

• Duration (time) is very short.
• Symptoms appear abruptly and severe. They subside quickly.
• Sometimes it may reverse treatment or not.

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2. Chronic Diseases

• Slow onset.
• Symptoms appear for some time and disappear.
• These diseases present usually 6 months or longer.

Other classification of diseases

1. Communicable diseases: Diseases spread from person to person, directly or

indirectly from source of infection.
Eg: Malaria, Diphtheria

2. Congenital diseases: It occurs by birth.

Eg: Congenital disease and Congenital heart disease

3. Functional diseases: It occurs by failure of function of an organ.

Eg: Kidney failure or heart failure

4. Malignant diseases: It is caused by extra growth of cell.

Eg: Cancer tongue, lungs etc

5. Psychosomatic Diseases: Physical disease causes psychological illness. Eg:

Peptic ulcer

6. Idiopathic diseases: Causative factors are unknown.

7. Degenerative diseases: It occurs due to the degeneration of tissue or bone.

SUMMARY

Disease is known as alteration in the body function. Multi factors are

responsible for disease. MPHW (F) should know the causes of disease.

SHORT ANSWER TYPE QUESTIONS

1. What is mean by illness?

2. Define disease?

LONG ANSWER TYPE QUESTIONS

1. Explain the causative factors of disease?

2. Describe about classification of disease?

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UNIT-VIII - INFECTION

Meaning and types of Infection and causes of infection

Classification and characteristics of microorganisms, pathogenic and non-
Pathogenic.
Incubation period and spread of infection-transmission
Factors affecting growth and destruction of microbes

Introduction

Infection is caused by entry of microorganisms into the body. Infections will

spread from one person to another person.

MEANING OF INFECTION

1. When pathogenic microorganisms enter and multiply in or on the bodies of

human beings may produce a reaction on the part of the host is called
Infection.

2. Infections is the entry and development or multiplication of a disease

producing agent in the body of man or animal.

Types of Infection

1. Primary Infection: The first attack of a pathogen on a host is Primary Infection.

2. Secondary Infection: It is when in a host immunity is lowered by pre-existing

infection. Another new organism may set up an infection is called Secondary
Infection.

3. Focal Infection: If an infection is localized in certain places is called Focal

Infection. Eg : Appendix, Tonsels

4. Cross Infection: Infection transmits from person to person or crossing over of

pathogens between two infectious persons is called Cross Infection.

5. Re Infection: Infection occurs again and again with same organisms, same
person is called Re Infection.

6. Nosocomial Infection: It is hospital acquired infection. Eg: Hepatitis B and

Urinary Tract Infections.

7. Iatrogenic Infection: It is due to instruments and diagnostic procedures used in

the hospital.

8. Congenital Infection: This infection occurs by birth from the mother to the new
born baby. Eg: Syphilis, HIV

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9. Auto Infection: Infection in two places of the same host is called Auto
Infection.

10. Mixed Infection: Infection occurs by two or more pathogenic organisms.

11. Acute infection: It is sudden and lasts for short period. It is usually from few
days to two to three weeks.

12. Chronic Infection: Infection remains for months to years.

13. Subclinical Infection: In this infection, signs and symptoms are not appeared.

14. Opportunistic Infection: Chance of getting infection in the same host due to its
different infection.

15. Zoonoses: Infection transmits from animals to persons. Eg: Plague and
Anthrox.
Causes of Infection

1. Man
2. Animals
3. Insects
4. Soil
5. Water and
6. Food

1) Man: Man himself is a common cause of infection from a patient or a carrier.

a) Carrier: It is who harbours the pathogens in his body but look like a healthy
person.

b) Convalescent: He is carrier who has recovered from the illness but still
harbours the pathogens and causes infection to the other person.

2) Animals: Some diseases are transmitted from animals to man. Eg: Bacteria,
fungal, Protozoa, Helminths and Ricketistical

3) Insects: Diseases or infections also transmitted by mosquitoes, flies etc. Eg:

Food poison

4) Soil: Through soil also infection occurs by roundworm and hookworm.

5) Water: Infection occurs through contaminated water.

6) Food: Contaminated food also is one source of infection.

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CLASSIFICATION AND CHARACTERISTICS OF MICROORGANISMS,

PATHOGENIC AND NON-PATHOGENIC

Micro Organisms are tiny living things. There are so many microorganisms in
the world. There are 5 types of microorganisms.

1) Bacteria
2) Virus
3) Algae
4) Fungi
5) Protozoa

1) Bacteria

• It is unicellular organisms with a body size of 3-5 micrometre.

• This cells contains Cytoplasm, It has a cell wall formed with protein called
mucopeptide.
• Some bacteria cause infections in human beings.
• Bacteria can be classified based on their cell wall, structure stains in two
types. i.e., (1) Gram Positive and (2) Gram Negative.
• Bacteria can be further divided based on their response to oxygen are (a)
Aerobic and (b) Anaerobic.

2) Viruses

• These are non-cellular organisms.

• It contains nucleic acid core DNA or RNA.
• They surrounded by a protein coat.
• Viruses are classified as Microorganisms.
• They cause viral infections in human beings.
3) Algae

• These are called blue green algae.

• They are unicellular or multicellular.
• They live in water, damp soil and rocks.
• They produce oxygen and carbohydrates.
4) Fungi (Mushroom, Molds and Yeasts)

• They contain true nucleus

• They are multi cellular
• Their cell wall is composed of chitin.
• Fungi reproduced by releasing spores.
5) Protozoa

• These are unicellular aerobic organisms.

• They have nucleus.
• Cell wall is made up of Cellulose.
• They are divided based on their mobility like flagellates, Ciliates,
Amoeboid and Sporozomes.

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Except congenital diseases, all other diseases are caused by certain

microorganisms. These organisms are called as Pathogens. They effect some body
system or specific tissues or organs. Some human disease caused by Pathogens,
are Polio, Cholera, Mumps, Rabies and Malaria.
Microorganisms are smallest organism on earth. Microorganisms means
“Microscopic Organisms”. They are seen under microscope.
INCUBATION PERIOD AND SPREAD OF INFECTION-TRANSMISSION

Incubation Period

It is the time interval between the entry of the disease causing agent into body
and the appearance of signs and symptoms.
Spread of Infection

• It occurs by direct contact, physically and indirect contact by Fomites (Patient

used articles)
• Ingestion (drinking and eating) of contaminated water, milk or food.
• By inhalation of bacteria, viruses and fungi present in the atmosphere.
• By inoculation (injecting) the pathogens deep into the tissues. Eg: Rabies
through dog bite, malaria through insect bite, by mother to foetus.
Transmission of Infection

Infection transmits from patients to other healthy persons in the following

ways.
1. Direct transmission
a) Direct contact: It is by physical contact with the patient through to
touch, handshake and hug.
b) Droplet infection: Through cough, snooze, common cold etc
c) Contact soil: Play in the mud and consumption of food and water
without hand washing. Eg: worm infestations
d) Inoculation into the skin: Biting of the mosquitoes causes malaria, dog
bite causes rabies.
e) Trans placental transmission: From mother to foetus. Eg: Syphylus,
HIV.
2. Indirect transmission
Other than direct contact.
a) Vehicle and Vector Borne: Eg: Malaria, Water and Air
b) Mechanical transmission: Through insects like flies
c) Dust: Through dust, infection occurs
3. Airborne
It occurs due to polluted air through droplet, nuclei and dust. Eg:
Respiratory infection

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4. Fomiteborne

Through the articles used by the patients. Eg: Towels, Plates, glasses
5. Unclean hands and fingers of infected person. Eg: Hepatitis

FACTORS AFFECTING GROWTH AND DESTRUCTION OF MICROBES

1) Presence of Oxygen: Some organisms receives Oxygen (O2) for growth. If

Oxygen is not available, they will die.
2) Temperature: Some of the patho organisms received temperature to grow. In
over heat, they will die.
3) Hydrogen Ion Concentration: Some organisms grow in acidic, alkaline and in
neutral phase.
4) Moisture: Helps for the growth of microorganisms.
5) Nutrition: Helps in the growth of microorganisms.

SUMMARY

Infection is a state where pathogenic organisms enter into the body and alters
the normal health status of the body. Different types of infections are present. This
infection is caused by different types of microorganisms that they may enter the body
in different ways.

CONCLUSION

As a MPHW(F), she should know the meaning, types, transmission and

spread of infection and control and prevention of infection.

SHORT ANSWER TYPE QUESTIONS

1) Define infection?
2) Name the different types of microorganisms?
3) What is incubation period?

LONG ANSWER TYPE QUESTIONS

1) Explain the mode of transmission of infection?

2) Describe about different types of microorganisms?

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PAPER I COMMUNITY HEALTH NURSING

UNIT-IX - IMMUNITY

Body defence mechanism, Immunity concept

Hypersensitivity, antigen and antibody reaction
Classification or types of immunity
Types of vaccines
Storage and cold chain system

Introduction

Human body is equipped with defence mechanisms against disease causing

agent. This is known as Immunity. This defence mechanism is produce antibodies
against toxins released by antibodies.

The term Immunity refers to the resistance exhibited by the host towards
injury caused by microorganisms and their products.

MEANING OF IMMUNITY

3. It is defined as the ability of the body to fight against bacteria, viruses.

4. It is also defined as the ability of the body to recognize, destroy and eliminate
antigenic material.

The Immunity mechanism has two components.

1) Humoral Immunity and 2) Cellular Immunity

1) Humoral Immunity: It is based on the production of antibodies. They are

specific.

2) Cellular Immunity: It is more complex. It is based on a type of white cells

known as ‘T’ Cells. These T Cells are active against some pathogens.

Hyper Sensitivity (Allergy)

It refers to the reaction occurs when a foreign body introduced into out body.
The allergic reaction occurs within a few seconds. This is due to circulating
antibodies. Hypersensitivity reactions are immediate and delayed.

Immediate Hypersensitivity

It is either anaphylactic shock or Atopy.

Signs and symptoms of Immediate Hypersensitivity reaction

• Itching of the scalp and tongue.

• Flushing of skin all over the body.

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• Difficulty in breathing.
• Fall of B.P.
• Loss of conscious and patient finally in anaphylactistic

Atopy is a most commonly naturally occurring hypersensitivity. Signs and

symptoms are fever and asthma. It occurs due to inhalation of pollen or house dust,
ingestion of egg or milk.

Delayed hypersensitivity

It is very late type of hypersensitivity.

Treatment:

• Keep the patient in head low position.

• Check vital signs B.P., Pulse and respiration.
• Give injection to Adrenaline 0.5 ml Subcutaneous/Intramuscular for
adults and 0.25 ml for children.
• Start I.V. infusion.
• Start O2 inhalations at a rate of 4-6L/ml

Classification of Immunity

Immunity

Innate/Natural Acquired

Species Racial Individual Active Passive

Artificial Natural Artificial Natural

7. Natural immunity: This immunity possesses by an individual by birth though

genes. By this reason, some diseases will occur in human and do not occur in
animals.

8. Acquired immunity: This immunity occurred by an individual during his life

time. This is of two types. (a) Active immunity and (b) Passive immunity.

a) Active immunity: Which a person develops immunity as a result of

infection by pathogenic organisms or their toxic products.
• Body produces its own antibodies to fight like infection.

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• It is occurred due to an attack of disease. Eg: Chickenpox,

measles.

b) Passive immunity: It is opposite to active immunity. Body does not

produce its own antibodies. It is developed by transferring from one
person to another person. It is short lived and declines in a few weeks.
• It is occurred by antisera injection like Diphtheria Antitoxin.
• Injection Gamma Globulin obtained from an immune person
(measles, hepatitis).
• Maternal antibodies transferred to foetus across the placenta
or by giving milk.

TYPES OF VACCINES

These are immunizing agents.

Vaccine

It is a preparation of toxic product or disease agent administered to

stimulate antibody formation. Vaccine produces active immunity.

Vaccines are prepared from

a) Live attenuated organisms. Eg: Polio vaccine

b) Killed organisms. Eg: Cholera and Typhoid vaccine
c) Toxoids. Eg: Diphtheria and Tetanus vaccines

Types of vaccines

a) Live attenuated vaccines. Eg: Oral polio, measles

b) Killed vaccines. Eg: Typhoid, whooping cough, rabies and influenza
c) Toxoids. Diphtheria, Tetanus

THE COLD CHAIN SYSTEM

It is a system used maintain the temperature of vaccines and storage.

It is defined as “Storage and maintenance of vaccines at a correct

temperature in order to be effective.”

It helps to maintain the potency of vaccines at a correct temperature.

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Equipment used for Cold Chain System

The equipment used for cold chain system are

1) Walk in coolers
2) Walk in freezers
3) Cold boxes
4) Vaccine Carriers
5) Day Carriers

1. Walk in Cold rooms:

• In this, vaccines are stored for 3 months and transported to 4 to

5 districts.
• These are at regional levels.

2. Deep freezers (300 Ltrs)

• Ice lined refrigerators.

• These are used to store vaccines.
• These will be supplied to all district and the WIC to store
vaccines.
• It is also used for making ice packs and store OPV and measles
vaccine.

3. Small deep freezers and ice lined refrigerators

• These are supplied to all PHCs, family planning centres and

postpartum centres.
• Deep freezers are used to prepare frozen ice packs.
• It contains a dial thermometer, should be kept in the ILR and
temperature recorded twice a day. Vaccines like DPT, TT, DT
are kept in the basket of ILR.

4. Cold Boxes

• These are supplied to all peripheral areas.

• These are used to transport vaccines.
• Fully frozen ice packs are placed at the bottom and sides.
• The vaccines are kept in the polythene bags.
• DPT, TT, DT vaccines should not be placed directly with the
contact frozen ice packs.

5. Vaccine Carriers

• These are used to carry small quantities of vaccines specially at

Sub Centre.
• 4 fully frozen ice packs are used in the vaccine carriers.
• Vaccine carriers are closed tightly.

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6. Day Carriers

• These are used to carry small quantities of vaccines for small

sessions only.
• Two fully frozen ice packs are used.
• It is used only for few hours.

7. Ice Packs

• The ice packs contain water filled upto level marked on the
outside.

SUMMARY

Immunity is body’s defence mechanism helps to maintain health and to

protect from diseases. Immunity is mainly of 2 types, (1) Active immunity and (2)
Passive immunity. Vaccines are used to protect the children from 7 target killer
diseases.

CONCLUSION

As a MPHW(F), should know about immunity, types of immunity and cold

chain system

SHORT ANSWER TYPE QUESTIONS

1) Define immunity?
2) What is Vaccine?

LONG ANSWER TYPE QUESTIONS

1) Explain about different types of immunity?

2) Describe in detail about Cold Chain System?

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UNIT X- IMMUNIZATION

Immunization against different infections

Revised immunization schedule

Injection safety, methods of administering vaccine

Sterilization of syringes and needles

Immunization in the community

Immunization hazards, precautions while giving vaccines

Special immunization drives and programmes, records and reports

Introduction

Immunization takes place a vital role in the prevention of occurrence of

infectious or communicable diseases.

Immunizations against different infections

• Immunizations produce passive immunity against some bacterial and viral

infections.

• Immunization protects the health of the individuals and community

• These immunizations start early in the infancy, mainly given to 0 to 5 years

• Some are given as booster doses; some are as special driven.

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National Immunization Schedule

VACCINE WHEN TO GIVE DOSE ROUTE SITE

For infants
BCG At birth or as early as 0.1ml Intra-dermal Left Upper Arm
possible till one year of (0.05ml until
age 1 month age)
Hepatitis B - At birth or as early as 0.5 ml Intra-muscular Antero-lateral
Birth dose possible within 24 hours. side of mid-
1st dose: 6 weeks thigh
2nd& dose: 10 weeks 3rd
dose 14 weeks
OPV-0 At birth or as early as 2 drops Oral Oral (Mouth)
possible within the first
15 days
OPV 1, 2 & 3 At 6 weeks, 10 weeks & 2 drops Oral Oral (Mouth)
14 weeks
(OPV can be given till 5
years of age)
DPT 1, 2 & 3 At 6 weeks, 10 weeks & 0.5 ml Intra muscular Antero-lateral
14 weeks side of mid-
(DPT can be given till 5 thigh
years of age)
Measles /MR 1st 9 completed months-12 0.5 ml Sub-cutaneous Right upper Arm
Dose$ months.
(can be given till 5 years
of age)
Vitamin A At 9 completed months 1 ml Oral Oral (Mouth)
(1st dose) with measles-Rubella ( 1 lakh IU)
For Children
DPT booster-1 16-24 months 0.5 ml Intra-muscular Antero-lateral
side of mid-
thigh
Measles/ MR 16-24 months 0.5 ml Sub-cutaneous Right upper Arm
2nd dose $
OPV Booster 16-24 months 2 drops Oral Oral
Vitamin A*** 16-18 months. Then one 2 ml Oral Oral
(2nd to 9th dose every 6 months up (2 lakh IU)
dose) to the age of 5 years.
DPT Booster-2 5-6 years 0.5 ml. Intra-muscular Upper Arm
TT 10 years & 16 years 0.5 ml Intra-muscular Upper Arm

For Pregnant women

TT 1 and TT 2

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REVISED IMMUNIZATION SCHEDULE

This revised (latest) immunization schedule (2018) is recommended by IAP

(Indian Academy of Paediatrics).

Interval Interval Interval Interval

Minimum
S. between between between between
Vaccine Prevents age for Route of admn
No. Dose1 & Dose2 & Dose3 & Dose4 &
Dose1 Dose2 Dose 3 Dose4 Dose5
TB &
Intradermal
1 BCG Bladder Birth
(ID)
Cancer
8
2 HepB Hepatitis B Birth 4 weeks weeks
Polio 4 Intramuscular
3 Polio Birth 4 weeks
virus weeks (IM)
Diphtheria, 6 months 3 years
6 4 Intramuscular
4 DPT Tetanus &
weeks
4 weeks
weeks
(Booster- (Booster-
(IM)
Pertussis 1) 2)
Infections 6 months
6 4
5 Hib caused by
weeks
4 weeks
weeks
(Booster-
bacteria 1)
6 months
6 4
6 PCV Pneumonia
weeks
4 weeks
weeks
(Booster- Oral
1)
Severe
6
7 RV diarrheal
weeks
4 weeks
disease
15
Typhoid
9 months
8 Typhoid fever,
weeks (Booster-
Diarrhoea 1)
Measles,
9
9 MMR Mumps &
weeks
6 months SC
Rubella
10 Varicella Chickenpox 1 year 3 months SC
Liver
11 HepA disease 1 year 6 months
Diptheria,
12 Tdap Tetanus & 7 years
Pertussis
For child
aged 9-
14 years: For
6 child
Some
months. aged
13 HPV Cancers & 9 years
15 or
Warts For child more: 5
aged 15 months
or more:
1 month

INJECTION SAFETY
• The site of injection should be well cleaned with spirit and cotton.

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• A sterile disposable syringe and needle should be used for each injection.
• Prevent infection by following standard sterile technique.
• Place child in correct position.
Safe disposal of injection equipment
• Safety box is made to collect used disposal syringes, needles, and other
contaminated sharps.
• Collect used day material like empty vials, cotton pad, compression
dressing material, IV bags, extensive tubes, used gloves, plastic waster
material in dry bin.
• After giving, injection placed into the safety box to avoid needle prick
injuries.
• Burn or incinerate after collection.
Methods of administration vaccines
Steps to follow the administer vaccines.
1. Screening
• Check immunization card for either it is new or it is old for due date.
• Check the vial for expiry date label.
• Check for expiry date.
• Make sure that vaccine is clear or not.
2. Reconstitution of BCG and Measles Vaccine
• BCG and Measles vaccines are freeze and dried.
• Diluent for BCG in normal saline.
• Diluent for Measles in sterile water.
• Take 5 ml syringe and needle to dilute not for injection.
• Do not freeze diluents.
• To mix the vaccine and diluent, do not shake it but roll between palms
of hands.
• Use reconstituted vaccine for one session preferably within 3 hours.
3. Locate the site for injection
• Place the baby in comfortable position.
• Clean the site with cotton and spirit.
4. Site for different vaccines
• BCG is given on left upper arm.
• DPT is given. Muscle of the outer part of the middle thigh site.
• Hepatitis B injection is outer part of the middle thigh.
• DPT and Hepatitis B should not be given to the same limb.
• Measles vaccine is subcutaneous injection to the right upper arm.
• Administration of polio, orally.
5. Appropriate technique of administering vaccine
• Load syringe with correct vaccine and dose.
• Expel a drop or two of vaccine through the needle to make sure the
needle is not blocked.

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• Hold your hand side under the left arm and your thumb on the one side
finger on the other of the arm and stretch the skin.
• Hold the syringe in your right hand with the level and scar point up
towards.
• Insert the tip of the needle into skin and adjust the level and a little but
more.
• Do not push too far and do not point downwards or the needle with go
under the skin.
• Now put your left thumb over the needle end of the syringe to hold it in
position.
• Hold the plunger to end of the syringe between the index and middle
fingers of your hand.
• Inject the medicine into the site and withdraw.
• Fix the needle firmly to avid leakage of medicine.
• Avoid occurring swelling, bleeding at the site of injection.
• For intradermal injection, give it to the muscle and needle should be
3/4th entered into the muscle.
• For subcutaneous injection, 1/4th of the intra muscular needle should
go into the subcutaneous tissue.
• In case of oral polio vaccine, remove metal dropper on the vial, 2 drops
are put under the tongue.
• So it is mix with saliva and swallowed by the child.

STERILIZATION OF SYRINGES AND NEEDLES

Now days, we are using disposable syringes and needles for safety of the
patients and the health care professionals. It minimizes transmission of infection
from person to person. Previously sterilization of syringes and needles (glass
syringes and metal needles) are done by boiling method.
1. Boiling
Boiling at 1000C for one hour, but it is not safest method. It won’t kill the
spores properly.
2. Autoclave
It is also called as hot air method. In this method, under 160 0C temperature
and with some pressure for one hour syringes and needles are sterilized.

IMMUNIZATION IN THE COOMMUNITY

• Special days are used to give immunization in the community.
• It is given in the morning session only between 9 AM to 12 Noon.
• It is conduct at one place either in the school or community hall or
Anganwadi.
• The day before immunization, inform people or mothers time to time
and place of immunization.
• Encourage mothers to bring their children.
• Arrange properly in one room.
• Room should be with sufficient light and ventilation.
• Arrange tables, chairs and stools.

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• Give vaccine according to the age of child or to pregnant mothers.

• Maintain records and reports.
• The main aim of immunization is to achieve 100% coverage of all
eligible children.

IMMUNIZATION HAZARDS
The common immunization hazards are,
• Local systematic reactions like pain, local swelling, fever and pruritus.
• Sepsis due to lack of care in vaccination.
• Hyper sensitivity reactions.
• Rarely convulsions and encephalopathy.
• Live attenuated vaccines are hazards for the immunosuppressive
people as they cause fatal.
Precautions while giving vaccines
• Check the label on the vial or ampoule.
• Check whether it is correct vaccine or right vaccine.
• Check for expiry date.
• Make sure that vaccine is clear or not.
• Frozen vaccines should not be given.
• Shake test is used to identify the frozen of vaccine.
• The freezing can damage DPT, DT, Tetanus and Hepatitis B.
• Reconstitute the BCG and Measles vaccine.
• Do not freeze diluents because the ampoule will break.
• Use sterile syringes for mixing.
• Use A.D. Syringes for vaccination.
• DPT and Hepatitis B vaccine should not give the same limb.

SPECIAL IMMUNIZATION PROGRAMME

Pulse Polio Immunization Programme
• It is a largest single day public health immunization programme.
• It was started on 09.12.1995 and 26.01.1996.
• It consists of two immunization days with 6 weeks’ interval i.e. on 9th
December and on 26th January, every year.
• Regardless of previous immunization it is given.
• It is given in two rounds. It is almost reachable to all 0-5 years children.
• Polio drops are given at Bus stops, Railway stations, Airports, Markets,
Schools, Anganwadis, Chowrasthas, in business areas apart from Sub
centres, Primary Health Centres and Government Hospitals.
• Second day, the conduct door to door immunization for missing
children.
• 3rd days also do the same.
• The main objective is to cover 100% immunization of 0-5 year children.
• Polio occurs rapidly in the months from June to September.
• Recently Pulse Polio Immunization Schedule is changed i.e., on 27th
January, 2018 and 11th March, 2018.

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• After immunization each child is marked with brown ink to identify

whether immunized or not.
• It is important to maintain the correct temperature of vaccine.
• Recently, in India, MMR Vaccine Programme and JE Vaccine
Programme were conducted.
Records and Reports
• After vaccination, immunization records are maintained.
• In this record all vaccines according to the age wise are recorded.
• Each child is given Immunization Card or Road to Health Chart.
• In this card, child data and immunizations given and to be given are
recorded with due date.
• Mother is informed about the due date.
• If any untoward reactions are occurring during the immunizations, it is
bringing to the notice of Medical Officers or District Immunization
Officer.
SUMMARY
Immunization helps the child to develop resistant power against 7 target killer
diseases. These play an important role in the prevention of communicable diseases.
Always use sterile syringes and needles to prevent adverse reactions.

CONCLUSION

As a MPHW(F) student, should know about the 7 target killer diseases and
about the Immunization Schedule.

SHORT ANSWER TYPE QUESTIONS

1) What are 7 Target Killer Diseases?
2) Name the precautions while giving the vaccines?

LONG ANSWER TYPE QUESTIONS

1) Explain Immunization Schedule?

2) Write about hazards of Immunization Schedule?

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PAPER I COMMUNITY HEALTH NURSING

PART C
UNIT-XI - ENVIRONMENTAL SANITATION

Environment and ecology of healthy living basic sanitary needs

Air, Sunlight and ventilation
Home Environment-Smoke animals, drains and toilets

Introduction

Environment is in which man lives. It implies both living and non-living area
which is surrounding man. Environmental Sanitation means clean and safe
environment which influences the health of an individual.

Definition

According to WHO, Environmental Sanitation is defined as control of all those

factors in physical environment which may exercise a deleterious effect on human
physical development, health and survival.

The term environment includes all living and non-living material which is so
surrounds human being. It includes water, air, social and environmental conditions.

Components of Environment

1. Physical Component: It includes water, soil, housing wastes and radiation.

2. Biological Component: It includes plants, animals including bacteria, viruses,

insects, rodents, flies having life.

3. Social Component: It includes customs, culture, habits, income, occupation

and hygiene.

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Ecology of healthy living

• It is very important component of community healthy.

• It prevents the occurring of diseases.
• To provide safe water drinking, avoid to drink contaminated water.
• Wash hands after defecation. Follow good habits.
• Wash hands before preparation and eating of food.
• Proper disposal of refuse and human waste.

BASIC SANITARY NEEDS

AIR

Major part of the human’s environment is Air. It supplies oxygen and also it
serves many other functions like our body is cool down with its contact. It stimulates
the special senses like hearing and smell. Diseases agents are also carried by air.

Air composition

Air composes mixes of gases like Nitrogen (N2) 78.084% and Oxygen (O2)
20.947% and remaining other gases like Argon, Carbon dioxide, Neon and others. It
also contains water vapour, traces of ammonia and dust, spore and bacteria.

Factors maintain Air composition

1. Wind: By its constant movements, it dilutes and sweep away impurities.

2. Sun light: It kills the bacteria.

3. Rain: It washes away the impurities.

4. Plant life: Use Carbon dioxide and produces oxygen

Air pollution

It is mainly due to the chemicals, biological waste, releases in the

environment. Air pollution in other ways, it is the imbalance of gases present in the
natural environment.

Eg: More Nitrogen or Carbon dioxide levels

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PAPER I COMMUNITY HEALTH NURSING

Sources

Causes of Air Pollution

Natural Source Man Made

• Volcanic eruption (SO2, H2S, CO)  Industrialization

• Vegetarian decays (Eg: dead bodies  Deforestation
of human, animals and other living)  Automatic emissions
• Sand and dust storm  Automobile emissions
• Pollen grains and flowers.  Domestic combustion
 Advanced agricultural
techniques
 Over population
 Nuclear energy

Effects of Air pollution

1. Immediate Effect: On the respiratory system, on lungs, acute bronchitis and

sometimes death due to suffocation.

2. Delayed effect: Lung cancer, asthma, chronic bronchitis.

Prevention and control of air pollution

1. Containment: Controlling of air pollution by increasing ventilation, air cleaning

and providing arrestors.

2. Replacements: Coal is replaced by gas, use of electricity, decreasing use of

petrol.

3. Dilution: Growing more plants, trees, gardens in industrial areas and

residential areas.

4. Follow strict rules and regulations to prevent air pollution. Eg: Prohibition of
smoking in external environment like markets, offices and other working areas
punishes fine up to Rs. 500/-

5. Disinfection of air by mechanical ventilation through air filters providing UV

rays, dust control by providing AC.

6. Using pollution controlling equipment: Such as setting chambers, cyclone

filters, electro static precipitations, wet collectors etc.

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LIGHTING

Good and sufficient lighting is essential for proper vision. Otherwise our eyes
are put to strain and causes fatigue and loss of efficiency.

Requirements of good lighting

• Sufficient and enough good light is essential to carry out work without any eye
strain.
• Height should be evenly distributed in whole area or total place.
• Absence of sharp light is essential to prevent confusion. Eg: glare
• Lighting should be constant, should not be flickering of light. It causes
accidents.
• Should not use any colourful lights.

Types of lighting

1. Natural Lighting

a) It is mainly from sky.

b) It depends upon time of day, season, weather and even clouds.
c) It occurs mainly by building schools, colleges, laboratories, facing north
and south for uniform lighting.
d) Removal of obstructions near to buildings.
e) Windows should be planned with regards to their shape and size.
f) Unnecessary use of curtains and screens
g) White washing of the buildings.

2. Artificial Lighting

a) Sometimes, we need artificial lighting.

b) It is manly derived from two sources. (1) Electric bulb (2) Tube lights
(3) Luminous efficiency lights
c) We can’t completely depend on natural light, so we need artificial
lighting during nights and in early mornings.

VENTILATION

Ventilation is defined as exchange of air between outdoors and indoors. By

this process, stagnated air is replaced by fresh air.

Types of ventilation

1. Natural Ventilation

Wind is great force in nature which brings about natural ventilation by its
movements from one place to another place when wind blows. It sweeps the
impurities.

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a) Diffusion: Diffusion is also one method or process helps air to enter

even though the small openings.

b) Temperature: Temperature is different between indoors and

outdoors. This causes movement of air from hotter regions moving
towards cooler regions. In India, we depend much on natural
ventilation.

2. Artificial Ventilation

a) Exhaust ventilation: In this, air is exhausted by special fans. These

fans are installed in places of over growing such as cinema halls,
assembly halls, operation theatres, industries and kitchens.

b) Venum ventilation: This is the opposite of exhaust ventilation. It is

seen in industries. In this system, air is forces into the room.

c) Balanced ventilation: This is the combination of exhaust and

plenum system of ventilation. Eg: Air-conditioning

HOME ENVIRONMENT

• Housing includes physical structure providing shelter and also

immediate surroundings and the related community services and
facilities.
• Healthy house provides physical protection and shelter.
• Must have environment, air, light, ventilation, recreation, exercises and
rest facilities.
• Psychological needs, cleanliness, privacy are essential to promote
mental health.

SMOKE

It causes pollution of air. Smoke causes due to coal and firewood burning,
vehicle emissions, factories and industries.

Prevention

• By increasing ventilation, air cleaning and providing air arrestors.

• Growing more plants and trees in reduction of air pollution.
• Dust control providing air or application of oil in floors.
• Reducing of pollution discharge by the dilution of source of equipment.

ANIMALS

• Control of all animals or anthropods such as mosquitoes, house flies,

sandity, fleas, ticks, itchmitic, rodents (rats) etc.
• Control from all pet animals such as dogs, cats, birds such as pigeons
and parrots.
• These are produces communicable diseases.

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DRAINS

There should be drain to carry out waste water to a soakage pit or public
drain. such spilled or waste water is carried well beyond the cone of filtration of the
well.

TOILETS

Toilets should be adequate privacy, safe water supply, bathroom for bathing
and washing with privacy at least one toilet for house.

SUMMARY

Basic sanitary needs like air, sun light, ventilation are important aspects in the
maintenance of environment of human beings. Good environmental sanitation plays
vital role in the prevention and control of communicable diseases to promote the
health of individuals and communities.

SHORT ANSWER TYPE QUESTIONS

1) What is meant by Environmental Sanitation?

2) Define Ventilation?

LONG ANSWER TYPE QUESTIONS

1) Write about prevention and control of air pollution?

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UNIT XII - SAFE WATER

Introduction
Sources and characteristics of safe water.
Sources of contamination and prevention.
Purification of water for Drinking-Methods Small and Large Scale
Disinfection of well-Tube well, Tank and Pond in a village
Water borne diseases

Introduction

Water is one of the basic need of human being, we can use water for
domestic, public, agricultural and industrial purposes without water. It is difficult to
survive.
Sources of water

Rain Water Surface Water Ground Water

a) Artificial lakes Eg: Shallow wells
b) Rivers, streams and deep wells
c) Ponds and tanks

1. Rain Water

It is purest water in nature. It is clear, bright, sparkling soft and contains traces
of dissolved soils. Rain water is free from harmful pathogenic organisms.

2. Surface Water

When rain water reaches the surface, it is called surface water. Main Indian
towns and cities depend upon surface water sources. These are artificial lakes,
rivers and tanks.

a) Artificial Lakes: These are constructed in upland areas for the storage
of rain water. These are also impending reservoirs. The area changing
into a reservoir is called Catchment area.

b) Rivers: Rivers are good source of water supply. Cities such as Delhi,
Kolkata and Allahabad get their water supply from rivers. It is polluted
by washing, cleaning, sewage and industrial and trade waste drainage
from industrial areas.

c) Tanks: These are storages of surface water. These are sources of

water supply in villages.

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3. Ground water: When rain water sinks into the ground, it becomes ground
water. This water is purified by percolation method.
Eg: Wells. These wells are of two types.

a) Shallow wells: It is 10 feet or 30 to 50 feet deep. It is one which taps

the subsoil water. These are contaminated by drains, latrines and
soakage pits. So, these shallow wells are health hazard community, if
they are not properly disinfected.

b) Deep wells: In which it is penetrates the first, impervious layer and

taps the water lying beneath the impervious layer. They supply pure
water. Deep wells are opened, poorly constructed and not protected
against contamination.

Differences between Deep wells and Shallow wells

Shallow Wells Deep Wells

Taps the water from above the first Taps the water from below the first
impervious layer. impervious layer.
Chemically moderately hard Chemically much harder
Contaminated by bacteria Pure water
Becomes dry in summer Constant supply of water in all
seasons

Characteristics of Safe Water

Safe water and wholesome water is defined as water that is free from
pathogenic agent’s harmful chemical substances.

1) Water must be free from pathogenic agents.

2) Water must be free from harmful chemical substances.
3) Pleasant to taste i.e., free from colour and odour.
4) Used for domestic purposes

Uses of water

Water requirement is varying from quantity to quality.

1) Domestic use: Water is useful for domestic use that is for drinking, cooking,
washing and bathing etc.

2) Public use: Water is used for street washing, firefighting, maintenance of

public gardens.

3) Industrial use: Some industries like paper industry needs enormous qualities
of water.

4) Agricultural use: With water, the fold and raw material can be produced.

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Sources of contamination of water

1) Sewage: Sometimes due to leakage of sewage pipes causes water pollution

which contains decomposable organic matter and pathogenic agents.

2) Industrial and trade wastes: which contains toxic agents ranging from metal
salts to complex synthetic organic chemicals.

3) Agricultural pollutants: Comprises fertilizers and pesticides.

4) Physical pollutants: Heat and radioactive substances

Causes of contamination of water

• People defecate on the banks of rivers and tanks.

• People take bath, wash clothes, vessels and animals in or near water
resources.
• Bird dropping and leaves falling into the water.
• Well water is contaminated by soakage pits etc.
• Dirty containers used to collect water.
• Containers are uncovered and drinking water is exposed to dust, flies,
rats and dust.

Methods of water purification

Purification

It is a process of removing dust, dirty particles and bacteria, viruses or

pathogenic organisms.

Water purification is done in two methods.

1) Small scale and

2) Large scale

1. Small Scale purification: It is also called “Household method of purification”. It

is by using 3 methods. They are

a) Boiling

•Boiling water for 5 to 10 minutes, kills all bacteria, spores, cysts

and intestinal parasites
• Hard water becomes soft by boiling
• It is a satisfactory method of purifying water for household.
• It is a good practice to boil water in the same container in which
it is stored.
b) Chemical disinfection or by adding chemicals
• It is done by adding bleaching powder

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• To disinfect 1000 litres of water, 2.5 gms of bleaching powder is

required.
• To disinfect 10000 litres of water, 25 gms of bleaching powder is
required.
• To disinfect 100000 litres of water, 250 gms of bleaching powder
is required.

Chlorine tablets
• Chlorine tablets are good for disinfecting small quantity of water.
• One pot of water requires 2 chlorine tablets.
• It will act as a germicide, kills bacteria and viruses.
• It is a very easy method.
• It is a very cheapest method. It is useful for household drinking.

Potassium Permanganate
• It is not recommended for water disinfection.

Alum
• It removes only turbidity. It is not for disinfection.

c) Using domestic filters

• These filters consist central enlarged tube known as the filter

candle.
• It is made up by infusorial earth and has back the impurities
including bacteria.
• The filter candle must be clean from time to time at least once in
a week by scrubbing with a hard brush under running water.

2. Large Scale purification: Large scale purification comprises of (a) Storage and
(b) Filtration and disinfection.

a) Storage

• Water is drawn from the source and impounded in natural and

artificial reservoirs.
• It prevents further pollution.
• It is natural method of purification.
• By this method, impurities settle down in 24 hours by gravity.
• The water becomes clearer.
• Chemical changes take place during storage.
• The aerobic bacteria oxidize the organic matter present in the
water.
• Ammonia levels are reduced and rise in nitrates occurs.
• Bacterial count is dropped due to storage. The pathogenic
organisms dies.

b) Filtration
• It is second stage.98 to 99% of bacteria will be removed.

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There are two types of filter commonly used.

1) Slow sand or biological filters

2) Rapid sand or mechanical filters

Slow sand or Biological filters

• Water is next stored again for 1-2 days

• Natural purification takes place.
• 90% of the impurities are settle down by gravity.
• The water becomes much clear.
• This water is allowed into slow sand filter.
• Filter bed consists of 1.4 meters of standing water, 1.2 meters
of graded sand and 0.4 meters of graded gravel.
• Sand is the filtering medium.
• At the bottom of the bed, perforated pies are collected the
filtered water.

• The following steps are involved in this process.

(i) Mechanical staining

(ii) Sedimentation
(iii) Absorption
(iv) Oxidation of impurities and
(v) Bacterial action

Rapid sand or Mechanical filters

There are two types of Rapid sand filters.

1) Gravity type
2) Pressure type, Eg: Candys filter

The following steps are involved in this process.

(a) Coagulation
(b) Mixing
(c) Flocculation
(d) Sedimentation
(e) Filtration

(a) Coagulation: The raw water treated with chemical coagulant alum. The dose
varies from 5-40mg/litre or more. It removes the turbidity of water.

(b) Rapid mixing: then the water is subjected to violent again in mixing chamber
for a few months. This allows a quick dissemination of alum, throughout the
bulk of water.

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(c) Flocculation: Keep slow and gentle stirring of the treated water in a
flocculation chamber for 30 minutes. This stirring results in the formation of a
thick copiers when flocculate precipitate or Aluminium Hydroxide.

(d) Sedimentation: Now, the water is now led into sedimentation tanks where it is
detained for periods varying from two to six hours. At least, 95% of the
flocculent precipitate needs to be removed before this water is admitted into
the rapid sand filters. The precipitate settled at the bottom is removed from
time to time without disturbing the operation of the tank. For proper
maintenance of the tank, tank should be cleaned regularly from time to time.
Otherwise, they may become a breeding ground for molluses and sponges.

(e) Filtration: The partly clarified water is now subjected to rapid sand filtration.

Advantages

• Rapid sand filters can deal directly with raw water.

• Filter bed occupies less space.
• Filtration is rapid 40 to 50 times that of a slow sand filter.
• The washing of the filter is easy. There is more flexibility in operation.

DISINFECTION

It is the process of killing of pathogenic bacteria in water. It is necessary to kill

minute microorganisms.

There are various methods such as

1) Chlorination
2) Ozonisation
3) UV radiation
1) Chlorination

• It is done mainly by chlorination of water.

• Bacteria are killed and water is reduced for safe drinking
purposes.
• It controls algae and minute organisms and aids coagulation.
• Chlorine is available in the form of gas, chlorine tablets,
bleaching powder for 60 mls is needed to kill all bacteria and
viruses.

2) Ozonisation

It is powerful oxidizing agent.

Advantages

• It inactivates virus in few minutes.

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• it eliminates undereviable odour and taste.

• It removes organic compounds including chlorine.

3) UV rays radiation

It kills bacteria including viruses. Water should be free from turbidity and
suspensions.

Advantages

• Exposure for short period is enough.

Disinfection of wells

These are main sources of water supply in the rural areas. The best method is
by adding bleaching powder during epidemics of cholera and any other gastro
intestinal problems.

Steps

(i) Measurement of dimeter of well by a rope or a tape.

(ii) Amount of water in the well it includes the depth of the water in meters, the
diameter of well in meters.
(iii) Amount of bleaching powder added is for 1000 litres of water, 2.5 gms
bleaching powder is needed.
(iv) Mixing of bleaching powder is taken in buckets and made into thin paste
by using little water.
(v) Then add more water and stir well and allow to sediment 5 to 10 minutes.
It allows the lime is settled down at the bottom and chlorine suspension.
(vi) One hour is enough to kill the bacteria and viruses.
(vii) After one hour, orthotolidin test is done to detect the free residual chlorine.

Water borne diseases

1) Biological: it is caused by infective agent.

2) Viral: Viral hepatitis, Poliomyelitis, Diarrhoea
3) Bacterial: Typhoid, Paratyphoid, Bacillary Dysentery
4) Protozoal: Amoebiasis, Giardiasis
5) Helmenthic: Roundworm, Threadworm, Hydatid
6) Leptospirosis: Weils diseases

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SUMMARY

Safe water is free from pathogenic agents and harmful chemicals. Purification
is needed to prevent the occurrence of water borne diseases.

SHORT ANSWER TYPE QUESTIONS

1) What are the sources of water?

2) List the characteristics of safe water?

LONG ANSWER TYPE QUESTIONS

1) Explain the purification of water on large scale or small scale method?

2) Write about prevention and control of water borne diseases?

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UNIT-XIII - DISPOSAL OF EXCRETA AND WASTE

Methods of excreta disposal

Types of Latrines
Handling of animal excreta
Methods of waste disposal
Hazards due to waste
Maintenance of village drains, ponds and wells

Introduction

Disposal of excreta and waste is an important function of human beings.

Disposal is very proper and safe. If disposal is improper and unsafe, it causes air
pollution, soil pollution, water pollution and causes infectious diseases.

Excreta

Excreta means night soil or faces. It is collected from toilets and latrines by
human agencies.

Methods of excreta disposal

There are several methods of excreta disposal.

1) Unswered areas and rural areas

(a) Service type conservancy system

• Pail or bucket type of latrines
• Disposal by burning or composting

(b) Non service type (Sanitary latrines)

• Borehole latrines
• Dug well or pit latrines
• Water seal type of latrine
• PRAT type-SULABH Sowchalay
• Septic tank
• Aqua privy

(c) Latrines suitable for camps and temporary are

(i) Shallow trench latrine (ii) Deep trench latrine (iii) Pit latrine and
(iv) Borehole latrine

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2) Swered areas

Water carriage system and sewage treatment.

a) Primary treatment: Screening removal of grit plan sedimentation

b) Secondary treatment: Tricking filters activated gludge process

3) Other methods

(i) Sea Outfall (ii) River outfall (iii) Sewage outfall and (iv) oxidation
outfall.

Service Type

• This type is still prevalent.

• Night soil is collected from pails or buckets by sweeper and later disposed
by burying or compositing.
• It is exposed to flies.
• There is soil and water pollution possibility.
• The buckets are pans are get spoiled easily and replacement frequently
needed.
• Emptying of the bucket is not always satisfactory.
• More workers are needed.

Non service type (Latrines)

• It is a type of sanitary latrine.

• Excreta will not come outside.
• It is not polluting the air or soil.
• Faces should not be exposed to flies and rodents and animals namely
pigs.
• It will not create nuisance due to smell or appearance.

Borehole latrines

• It consists of a hole about 30 to 40 cm in diameter and depth of 20 feet.

• It dug vertically.
• A concrete slab with a control opening and foot rest is placed over the
hole.
• Surrounding area is enclosed to provide privacy.
• It is useful for a family for one year.
• It is completely filled, it is closed and another borehole is digged.

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Dug well latrines

• It is better than borehole latrine.

• It is modified borehole latrines
• It is easier to construct.
• It‘s diameter is 30 inches larger, depth is 10-12 feet or more.
• It is longer life usage. It serves for a period of 5 year for a small family.

Water seal latrines

• Also known as hand flushed latrines.

• These are more suitable for rural areas.
• It is widely used in the country.
• It should be located within a range of 15 meters from a water supply
source to prevent water contamination.
• It should not be built in area which flood during rainy season.
• Squatting plate is made up of cement concreter.
• It is a three feet square with two inches’ thickness with foot rest on it.
• Pan should be smooth to prevent any thing sticking onto its side.
• Connecting pipe is three feet long and two inches in diameter.
• It connects the latrine to pot. Pit is 30 inches in diameter and 10 to 12 feet
deep.
• Night soil is purified by anaerobic bacteria in the pit.
• When the pit fills up another is dig.
• Connected pipe is directed towards the other side.

Septic Tank

• This type of a tank is built by the mason with bricks and cement and is
water tight.
• Capacity will depend on the number of users.
• Tank capacity is 20 to 30 gallons.
• Length is more than its breadth in the proportion of 2:1
• Depth is 5 to 7 feet but liquid depth is only 1 to 2 mtrs
• Minimum of one foot air space is necessary.
• It has an inlet and outlet.
• Cover is placed with a manhole on top.
• Septic tank is designed to allow a retention period of 24 hours.

Working of a Septic Tank

• Night soil settles down at the bottom of the tank.

• Purification occurs by anaerobic digestion.
• Accumulation of solids takes place sludge effluent.
• It is the liquid which comes out of the outlet and contains a lot of bacteria
over, cysts and other fine suspension.
• It is organic matter gets attached by anaerobic bacteria.

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Maintenance

• Use of soap water and disinfectants should not be used much as it

destroys the bacterial flora in the septic tank.
• Too much of sludge collection disturbs the working of the tank and hence
needs to be cleared periodically.

SULABH SHOUCHALAY

• It is an improved type of the RCA type of latrine.

• It has specially designed pan and a water seal trap.
• It is connected to a pit three feet square and deep.
• Excreta is converted to a compost by bacterial action.

Aqua privy

• It functions like a septic tank.

• It consists of a water tight chamber filled with water.
• A drop pipe, short in length from the latrine floor dips into the water.
• Capacity of 1 cubic meter is adequate for a small family.
• Night soil is purified by bacterial action.
• There is vent provided in the gases to escape.

Shallow trench latrine

• It is a 30 cm wide and 90 to 150 cms deep

• A there meter (10 feet) long trench is adequate for the use of 100 people.
• Faces should be covered with earth and compacted.
• It is necessary, a new trench can be dug.

Deep trench latrine

• It is 6-8 feet deep, 30 cm wide and 10 feet long. This type of latrines are
used for camps of longer duration.

Water Carriage System

• It consists of a whole network of underground pipes which carried excreta.

• It is useful in more population areas.

There are two types of water carriage system

1. Combined types
2. Separate types

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In Combined Types, it carries sewage and surface water but in separate no

surface water is allowed.

a) Household sanitary fittings

• It is either Indian squatting type and commode system.

• It is for urinal and a wash basin.

b) House Drain

• House drain is laid in the country and below ground level about
15 cms on a bed of cement concreter with sufficient gradient
towards the main drain.
• This empties into the main server.

c) Public sewer/Trunk sewer

• Not less than 9 inches or 22.5 cms in diameter

• The bigger ones are 8-10 feet in diameter.
• They are laid on a bed of cement concrete about 10 feet below
ground level with sufficient gradient to ensure self clearing
velocity.

Handling of animal excreta

• Animal excreta should be collected in a proper way to avoid

environment and air pollution.
• Separate vessels are used to collect animal excreta specially for pet
animals like buffaloes, cows, oxes etc.
• Other pet animals like dogs, cats are needed some training to pat
excreta.
• Proper disposal of excreta is important.
• Choose one place like manure pit, for composting and to use as
fertilizers.
• Proper handwashing is important after handling animal excreta.

Hazards due to improper excreta disposal

• Soil pollution, air pollution

• Breeding of mosquitoes, flies
• Contamination of food and water,
• Diseases occurring are typhoid, paratyphoid fever, diarrhoea and
dysentery
• Intestinal worms such as round worm and hook worm
• Cholera, poliomyelitis, viral hepatitis etc

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Waste

Waste is defined as unwanted material and useless material produced by

human and animal excreta. This waste is of different types.

a) Solid Waste: which includes both garbage (food waste)

b) Rubbish waste: which is from broken materials of glasses and bricks etc
c) Other discarded material like sludge, manure, dead animals etc

Refuse: Solid waste or discarded waste material is called Refuse. It is also termed
as Litter. It includes waste from houses, streets, sweeping, commercial industries
and agricultural operation.

Sources of Refuse

1) Street Refuse: Animal dropping

2) Market Refuse: Industrial Refuse
3) Staple Refuse: Domestic Refuse

Methods of waste disposal

It is very important process to dispose waste in proper way whether in urban

and rural area.

Disposal of refuse in urban areas

It depends upon proper storage and collection of refuse.

a) Storage of refuse
b) Collection of refuse
c) Disposal of refuse

a) Storage of refuse

• At homes, it is stored in plastic buckets, steel bins, plastic bags and

paper bags.
• It is stored in bins or PVC containers. These bins are left open as they
are not linked to be touched by human beings.
• These bins are emptied by municipality workers and collected in
tractors.
• Industries will construct dumping yards or stored in large containers.

b) Collection of refuse

• House to house collection by municipality people daily or alternate

days.

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• They collect waste i.e., solid days’ waste in separate bin, wet waste in
separate bins. After collection, they are transported to dumping or
compost yard by tractors or lorries.

c) Methods of disposal of waste or refuse

It is done in the following ways or methods.

1) Dumping
2) Incineration
3) Controlled tipping
4) Composting by Banglore method
5) Manure Pits
6) Burning

1) Dumping:

• This is done by depositing the refuse in low lying area in orders to level
the ground.
• It is unhygienic method. It is not good method.
• It creates nuisance to the public.
• It acts as a breeding place for lees, flies and mosquitoes.

2) Burning or incineration

• It is the best method and hygienically good method.

• It is suitable method of disposal for hospital waste.
• It is very costly method.
• If the waste contains glass, tin, sand and dust which creates problem
during burning.
• They need to be sorted out.
• It is having drawback; it is not utilized as manure pit for community.

3) Controlled tipping

•
Waste is buried in pits. These pits are 3 feet depth.
•
It is useful for 3 to 6 months.
•
During this period, the refuse is broken into simple chemical
substances.
• Then it is converted into manure.
• After 6 months, the manure is brought to the surface.
• Again these pits are refused.
• Advantage: These pits are reused.
4) Composting

• In this method, refuse and night soil or sludge together disposed.

Organic matter naturally breakdown under bacterial action.
• Intense heat is produced by this within this pits.
• Because of heat, all the pathogenic and other organisms are killed.

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• After that the pit is cool down.

• At the end of 4 to 6 months, the decomposition is complete.
• The resulting product is manure which is very useful for agricultural
process.

a) Banglore method (Anaerobic method)

b) Mechanical composting (Aerobic method)
• In this method, compost yard is selected two miles away from town
area or residential areas.
• The pit is 3 feet depth and 8 feet broad.
• It is ideal pit for composition.
• In this 6 refuse is laid over 2 layers of night soil.
• Like this the pit is filled up to one foot above the ground level.
• The top of the earth is covered with excavated earth.
• Within a week, heat is produced and bacterial action takes place.
• Heat present over 2 to 3 weeks. Decompose not only capable of
decomposing the refuse.
• This is suitable for smaller municipality.
• Now it is most suitable method of practicing.

Mechanical Composting

• This method is followed in developed countries.

• It is now practicing in metropolitan cities.
• In this method, rubbish material is separated like glass, metals, stones
etc to prevent late in grinding process.
• It is then pulverized in a pulverizing equipment in order to reduce the
particle to less than two inches.
• The pulverized refuse is subsequently mixed with night soil or sludge in
a rotating mixed.
• Then this material is incubated in incubator to have pit.
• This process of composting is complete in a period of 4 to 6 weeks

Screening

Pulverizing equipment

Rotating Mixer Incubator Compost is prepared after 4-6 weeks

5) Manure Pits

• It is most commonly used in rural areas. In rural areas, no proper

method of collecting and disposal of refuse.
• This problem is solved by digging manure pits by individual house
holder.
• The garbage, cattle dung, leaves, grass should be dumped into the
manure pits and covered with carch after each days dumping.

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• These manure pits are dig far away from houses.

• Two pits are dig when one is in sue and the other will be closed.
• It takes 5 to 6 months’ time to convert into manure.
• Then it is used as fertilizers.
• It is simple and effective method in rural communities.
• These are located at higher places.
• It is protected against contamination of source such as latrines.
• There should be proper facilities for cleaning and washing.
• Wells should be disinfected properly.
• In the ponds, animals should not be cleaned, clothes should not be
washed.

SUMMARY

Human and animal excreta is source of infection. If it is not disposed in a

sanitary way, gives chance to spread diseases. It causes soil, water and air pollution
which are base for infectious diseases.

SHORT ANSWER TYPE QUESTIONS

1) What is meant by excreta?

2) List the types of latrines?
3) What are hazards due to waste?

LONG ANSWER TYPE QUESTIONS

1) Explain methods of excreta disposal in rural areas?

2) Describe the methods of waste disposal?
3) How will you maintain drainage system in the villages?

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PART D

UNIT XIV- INTRODUCTION TO COMMUNICABLE DISEASES

Introduction
Childhood Seven Target killer diseases
Other communicable diseases

Communicable Diseases

Diseases are defined as the diseases are transmitted from person to person
(or) from animals to human beings, directly through bacteria, viruses and their
poisonous substances, indirectly through contaminated articles and flies.

1) Diphtheria

It is a bacterial and air borne diseases occurs among small children (0-5yrs).
It is an epidemic and endemic diseases in our country.
Causative Organism
It is caused by corini bacteria diphtheria. These bacteria release exotoxics.
Host factors
It occurs mainly in small children and school children.
Environmental Factors

• Diptheria is more common in between August to January months.

• It is also common in overcrowded, poor environmental sanitation condition.
Transmission of Diseases

(a) Through droplets

(b) Droplet nuclei
(c) Dust contained bacteria
(d) Contaminated articles & milk
(e) Person to person
Incubation period
2 to 5 Days
Period of communicability
2 to 4 weeks after appearance of signs and symptoms.
Signs and Symptoms

• Formation of white false membrane and surrounded area is red in color.

• Swelling (or) Oedema of the neck.

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• This diphtheria layer is appeared in Larynx, Pharynx, Nose, and throat.

• Cold, cough, fever.
• Difficulty in swallowing and swelling of lymph glands.
• Difficulty in taking respiration.
• Sometimes (toxaemia) releasing of toxins.
Diagnosis

By shick test, it is an intradermal injection of 0.2ml shick toxin in to the skin.

Treatment

• Antibiotics like Penicillin (or) Erythromycin for 10 days helps to eliminate

infection.
• Bed rest to prevent heart failure.

Specific treatment

Diphtheria antitoxin which must be given immediately in doses ranging

from10,000 to 80,000 units.

Control Measures

The control measures include,

• Early identification of diseases based on signs and symptoms.

• Prompt treatment of cases
• Isolation of cases
• Proper disinfection of all articles and clothes soiled by the patient
• Children who have been exposed to infection and notification of the disease
and inform to medical officer
• Give immunization to 0-5yrs children with DPT vaccine.
• Identification of carriers (who carries the disease from one person to another
person)
• Do the surveillance of more cases in that area give health education on
spread of disease, vaccination, isolatim of child and articles, disinfection of the
articles, care of child.

2) Pertussis

• It is also called as whooping cough. It is a severe respiratory tract infection. In

this child will suffer from cough which is preceded by a sound.
• In this disease prolonged inspiration is present which is called whoop. It is
very serious condition.
• In India it is endemic diseases often it occurs as epidemic disease.

Causative organism

• Causative Organism is Bordutella Pertussis.

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• The structure and arrangement of bacteria is on rods shape. Sometimes

these are like egg shape.

Host factors

More commonly occurs in children 0-5 years. It is more prevalent in

malnourished children.

Environmental factors

It occurs in all seasons. It occurs more probably in the month of March and
April.

Spread of Disease

• Bacterial transmission from infected children to non-infected children.

• It is droplet infection. It is also spreads from freshly contaminated articles.

Incubation period

7 to 14 days.

Period of communicability

One week before appearance of the signs and symptoms to 3 weeks more
communicability during the 1st week.

Signs and Symptoms

• In initial state cold, fever present after that cough starts.

• More cough during 2nd week followed by deep inspiration and sound during
cough.
• Vomiting, inability to take respiration
• Swelling of eyeball, redness in the eyes.
• Bleeding from the nose.
• Cough present for 2-4 weeks.

Complications

Bronchitis, Broncho pneumonia, etc

Prevention and Control measures: -

• Early identification of disease based on signs and symptoms.

• Early diagnosis by laboratory test.
• Immediate treatment with antibiotics.
• Notify the diseases.

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• Isolation of the patient and used articles.

• Disinfection of the articles.
• Immunization with DPT (triple antigen) in 3 doses starting from 1 ½ month (or)
4 to 6 weeks with an interval of 1 month.
• Booster doses should be given in 2nd & 5th year.
• Given health education to parents on.
• Care of children.
• Immunization.
• Isolation of child.
• Disinfection of articles.
• Spread of infection etc.

3) Tetanus

In India more deaths are occurred due to tetanus. Neonatal tetanus is

occurred in rural India.80% of the children were died with neonatal tetanus.

Causative Organism

• Causative Organism is Clostridium tetani, It is a gram positive anaerobic,

spire bearing organism. it produces toxins.
• Organism is present in red soil, intestines of human and animals. Present
in animal dung.
• From animal dung it reaches to the dust of street, houses, and hospitals.
• It is developed in acid less environment. It is developed as spores under
good environmental condition.
• It is acute disease affects mainly voluntarily muscles.

Causative Factors

It occurs from 5yr to 40yr of age. High incident rates are present in males and
agriculture workers, but females are more exposed to the risk factors.
The disease is mainly present in rural area compared to urban areas.

Social factors

• such as unhygienic customs, and habits eg.(application of dust (or) animal

dung to wounder) unhygienic delivery practices.
• Using unsterilized instruments for cutting the umbilical card.
• Ignorance of infection, and lack of primary health care services.

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Mode of transmission

• It is occurred by contamination of wounds with tetanus spores.

• The range of injuries and accidents which may lead to tetanus.
• Comprise a trivial pin prick, skin abrasion puncture wounds, burns, human
bites, animal bites and stings, unsterile surgery, intrauterine death, bowel
surgery, dental extractions, injections, unsterile cutting of umbilical card,
compound fractures, otitis media, chrenie skin ulcers, eye infections and
gangrenous limbs.
Incubation period

• Usually 6 to 10 days.
• Neo Natal Tetanus is a major cause of infant death in India. It is prevented by
giving tetanus toxoid injection for every pregnant woman.
• Many mothers die after delivery because of tetanus caused by unsafe delivery
practices. This can be prevented by six cleans.

Prevention

• Active Immunization with injection tetanus toxoid 0.5ml, 2 doses with an

interval of 6 weeks.
• Passive Immunization is a temporary protecting a person with wound can be
prevented by an injection of human tetanus immunoglobulin.
• Human immunoglobulin is the best prophylactic. The dose for all ages is 250
to 500 IU. It gives a longer passive protection up to 30 days.
• ATS: - Anti Tetanus Serum is a dose 1500 IU, injected subcutaneous, with
suitable precautions. It gives passive protection for about 7 days to 10 days.
• The purpose of anti-toxin is for immediate temporary protection, and the
purpose of toxoid is of long lasting protection.
• Antibiotics: - If Tetanus toxoid is not available immediately after an injury,
patient may be given antibiotics.

Signs and Symptoms of Tetanus

• Muscular rigidity.
• Painful spasms of the voluntary muscles, especially the jaw muscles, (frismus
(or) lock jaw)
• The facial muscle, the muscles of the back and neck and lower limbs and
abdomen.
• It also affects the nervous system.

4) Polio myelitis

It is an acute viral infect disease of the human alimentary tract, but may affect
the brain, spinal cord and nerves resulting in paralysis.

Incidence

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• It is present in all countries of the world.

• India is the only country reporting polio cases during 2009 as a total of 741
cases of polio were reported in India.

Causative Factors

Agent factors: Causative organism is poliovirus is a RNA type virus. It lives for long
times in the external environment in a cold weather, it can live in water for 4 months
and in faces of patient for 6months. Man is the only reservoir of the infection. Most
infections are meld, subclinical infections and plays a dominant role in the spread of
infection.

Infectious material

It is found in mouth and pharyngeal secretums and in the faces of an infected

person.

Period of communicability

• Affected persons are more infectious 7 to 10 days before and after onset of
symptoms.
• In the faces the virus is excreted commonly for 2 to 3 weeks.
• It affects all ages, but children are usually more suspectance than adults
because of the immunity power.

Risk factors

Risk factors includes fatigue, trauma, intramuscular injections, operative

procedures such as tonsillectomy etc.

Immunity

The disease can affect non immune persons. Infants born of immune mothers
are protected up to 6months of age because of maternal antibodies.

Environmental factors

• Polio occurs during rainy season. It occurs mainly during June to September.
• The environmental sources of infections are contaminated water, food, flies,
virus survive for a long time in a cold environment.
• Overcrowding and poor sanitation provide opportunities for exposure to
infections
• Modes of transmission mainly by routes
(a) Faeco-oral route: - It is the main route of spread the infection may spread
directly through contaminated water, milk, foods, flies and articles of daily use.
(b) Droplet infection: - Occurs in acute phase of disease when the virus occurs
in the throat. Close personal contact with an infected person facilities droplet
spread.
(c) Incubation period: - Usually 7 to 14days range of 3 to 35 days.

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Signs and Symptoms:

• Fever, headache, diarrhoea, vomiting, and drowsiness.

• The warning signals are pain, weakness, stiffness, of the neck and back.
• Paralysis of the affected limb.

Diagnosis

By serological test for polio viral anti bodies.

Prevention

• Polio can be prevented by active immunization of all infants, and children.

• The vaccine is oral polio vaccine.
• It is a Sabine type of vaccine.
• It is given orally in 3doses at monthly intervals starting when the child is
6weeks of age.
• It can be administered soon after birth.
• One booster dose is given at the age of 16-24 months.
• Vaccine is stored at sub-zero temperature in a deep freeze to prevent in
activation.
• In case a deep freeze is not available, the vaccine may be stored for periods
in the freezing chamber of the refrigerator.

While giving OPV the following points will be followed

• The dose is 2drops instilled in the month by using dropper supplied with the
via
• Till the child’s back, and gently squeeze the cheeks, (or) pinch the nose to
make the mouth open.
• Let the drops full from the dropper on the child’s tongue.
• Repeat the process if the child spits out the vaccine.
• In case of diarrhoea, also OPV given.
• Hot milk and fluids should not be given at least half an hour after the
administration vaccine.
• Breast milk can be given whenever the child is hungry.
Pulse polio programme

• It is largest single day public health event occur

• The government of India conducted the fast round of pulse polio immunization
consisting of 2 immunization days about 6weeks on 9th December 1995 and
20th January 1996
• The age group of children initially are0-3yr after that WHO decided to increase
the age group of 0-5yr.
• The dose of OPV during PPI are extradoses which supplement and do not
replace the doses received during the routine immunization services.
• Since 1999 four rounds of PPIS will be conducted every year. Each round will
last for 3days, The first day of each round will be post based activity as done

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during the previous PPIS, at the end of the 3rd day house to house search will
be made for missed children.
• Gentian violet solution will be used to make the children vaccinated at the
fixed posts on the first day.
• This is program is conducted at railway stations inside long distance trains,
major bustops, market places, religious congregations throughout the country.

Health education:- The community should be protected by improving environmental

safe.
(provison of safe and adequate water supply and sanitary disposal of solid waters)
Health education in matters of personal hygiene such as hand washing with soap
and water after defecation and before handling food.
Measles:-
It occurs in human beings.
It is an acute highly infectious upper respiratory tract disease.
Incidence:- It has a world distribution in India measles is a major cause of sickness
and death among children.
Causative factors:-
• It is caused by rubeola virus. It is a RNA virus.
• Source of infection is a case of measles.
• Infective material is secretion of nose, throat.
Communicability:- It is approximately 4days after the appearance of rash.
Isolation of the patient for a week from the onset of rash morethan covers the period
of communicability.
It affects infants and children between 6months and 3 years of age, equally it affects
male and female children.
One attack of measles generally confer life long immunity second attack are rare.
Infants are protected by maternal antibodies upto 6months of age.
It is vey severe in the malnourished children.
The virus can spread in any season. In a temperature climates,measles is a winter
disease, because people together indoors. Epidemics of measles are common in
India during winter and early springs.
Transmission:- Occurs directly from person to person mainly by droplet infection
and droplet neuclei, from 4days before onset of rash until 4days there after.
The portal of entry is a respiratory tract.Infection period is common 10days from
exposure to onset of fever and 14days to appearance of rash.
Signs and Symptoms:- Characterized in 3 stages:
(a) Pre eruptive stage:- It begins 10days after infection and lasts until day 14, it
is characterized, by fever, caryza, with sneezing and secretions cough,
redness of the eyes, watery eyes and often fear to light. There may be
vomiting (or) nausea. Small bluish-white spots known as occur on the inner
surface of the cheek.
(b) Eruptive phase:- It is characterized by a typical, dresky-red, macular(or)
macula popular raw which begins behind the ears and spread rapidly in a few
hours over the face and neck and extends down the body taking 2 to 3 days
to progress to the lower extrimities.
It lasts for about 5 to 6 days and gradually fades leaving an dark,
pigmentation of the skin.

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Post measles stage:- The child will remain weak for a number of days. There may
be growth retardation diarrhoea, cancer, pyogenic infection candidiasis, reactivation
of pulmonary tuberculosis.
Prevention of measles:
(a) Measles vaccine: - A live measles vaccine is available. The child should be
immunized according to the national immunization schedule at the age of 9 to
12 months.
One dose of the vaccine appears to give 95% protection lasting for atleast
15year.
Measles vaccine can be combined with other live attenuated. Vaccine such as
measles, mums, rubella.
Immunoglobulin:- Administration of human measles immunoglobulin in dose
ranging from 250 to 750mg can modify (on prevent measles if given within 3days of
contact.
Control measures:-
1. Isolation of the child as soon as signs of measles appear.
2. Protection of the child eyes from light.
3. Disinfection of the nose and throat secretions.
4. Immunization of susceptible children.
Tuberculosis:- It is a specific infectious disease, primarily affects the lungs.
It can also affect intestine, meninger, bones and joints, lymph glands,
skin and other tissues of the body.
The disease also affects animals such as cattle. This is known as
bovine tuberculosis.
Incidence:- It is a world wide public health problems above 5.1 million were new
sputum smear positive cases. Were reported to WHO during the year 2005 of these
notifications,4.9 million were DOTS areas.
India:- Is the highest T.B burden in the world and accounts for nearly 20% of the
global burden of tuberculosis, of which about 0.8million are new smear positive
highly infectious cases.
Causative factors:
Agent:- The causative organism of T.B is mycobacterium tuberculin, a human
strain the “bovine” strain affects the cattle and other animals.
Source of infection is the patient whose sputum is positive for tuberculi bacilli
Bovine source is usually infected milk and milk products. It is more common in the
older age group (35 years and above) than in the younger age group. The disease is
more prevalent in males than females.
Hereditary: - Tuberculosis is not a hereditary disease malnutrition is a predisposing
cause to tuberculosis.
Immunity: - It is acquired as a result of natural infection (or) B.C.G vaccination.
This disease occurs equally in urban and rural areas.
Social factors: - Tuberculosis is more likely to occur in malnourished people.
• Overcrowded areas.
• Poor hygienic areas.
Period of infectivity: - It is infectious as long as the bacilli ate excreted in the
sputum by the human host.
This may be from 7months to a few years. If the case is not adequately treated.
Mode of transmission:-

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(1) Droplet infection:- Tuberculosis spread mainly by droplet infection- coughing

generates the largest number of droplets.
(2) Incubation period:- This may be weeks (or) months depending up on the
host parasite relationship and the dose of infection.
Signs and Symptoms:- are
(a) Chronic cough more than 3weeks
(b) Continous low grade fever
(c) Chest pain
(d) Harmoptisis
(e) Loss of weight

Diagnosis: - Tuberculin testing:-

The tuberculin Monteux test was developed in 1907. This test identifies
that persons who are positive& negative to TB
The tuberculin test is carried out by injecting introdermally one
tuberculin unit of purified protein derivative of tuberculine (ppn)into the fore arm. The
result is read on the third 72 hours.
If there is swelling of atleast 10mm in diameter at the site of infection is known
positive to TB
A positive test indicates that person is indicated by tuberculo bacilli
Reactions under 5mm are considered negative those between 6 and 9mm are
considered doubt full.
Control of Tuberculosis
The basic principles of tuberculosis control are
(a) Early diagnosis(identification)
(b) Treatment
(c) Using the drugs
(d) Immunization with BCG vaccine
(e) Health education
(f) Patient teaching
(g) Early diagnosis
(h) Identification.
Early diagnosis by 1. Sputum examination 2.Chest Xray 3.Tuberculin test.
1. Sputum examination:- By dirext microscopy is now considered the method
of choice for early detection of case.
Three sputum smears are collected for microscopic examinations.
1st sample is collected initially when a person contacts medical people for the
first time.
2nd sample is collected on the next day, should collect early morning sample.
3rd sample is collected on the ‘spot’ on the second day. Early morning sputum
sample is more likely to contain tuberculosis bacilli than later in the day
Sputum examination can conducted on any person presenting one of the
more following symptoms
(a) Cough lasting more than 2weeks
(b) Continous fever(or) chest pain
(c) Coughing of the blood

Sputum examination is cheapest, reliability is more, and easy.

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Treatment or Drugs

2. Chest X ray is also important routine examination to know TB.

3. Tuberculin test (or) mantouxtest:- It is also important test in the diagnosis of
TB.
Treatment (or) drugs:- A person who diagnosed as TB positive is treated with
multi drug therapy.
• These drugs are available very easily.
• Free of charge given to ever patient detected.
• These drugs are called anti tuberculosis drugs.
These are effective, free from side effects, easy to administer and
reassembly cheap.

These drugs are 2 types

1. Bacteriocidal drugs:- These drugskills the mycobacterium bacilli eg.
rifamycin, INH, streptomycin and pyrazenamide.
2. Bacterio static drugs:- These drugs complete controls and multiplication
and growth of bacteria and lead to their destruction by the immune
mechanicsm of the host eg. ethanbutol, thioacetazone,kananycin and
amikacin ,cycloseris, ethionamide

Cause of treatment:- there are two causes of treatment

1. Lung course treatment:- The treatment is given for 18months. It is classified
again (a). daily regimen (b). biweekly(or) intermittent regimen- 2 times in a
week the anti tuberculosis drugs are to be given to the diagnosed patients.

In this treatment INH isonized given along with one (or) two bacterio static
drugs
2. Short course chemotherapy:- This course of treatment is only for 6months.
This treatment is very effective low toxicity and well tolerated by the patients.
In this course during the initial intensive phase patient is given 4days like
INH,rifamycin and pycazynamide supplemented by either streptomycin(or)
ethambutol for a period of 2months,followed by 2days in the continuous phase
given daily(or) inter monthly.
This course should be given to the patient under supervision and monitoring
by bacterial examination.
Directly observed treatment short course
• It is a community based tuberculosis treatment.
• It is supervised treatment and community care
• In the year 1993 WHO address the importance of global tuberculosis control
programme as DOTS.
In this programme a health worker (or) ASHA worker (or) village health guide
watches as the patient taking the drugs in his presence.
During continuation phase, the patient is issued medicines for one week is a
multiblister combipack of which the first dose is swallowed by the patient in the
presence of health worker.
After completion of treatment the patient should return the empty multiblister combi
pack, when the patient comes to collect medicine for the next week.
The drugs are provided in the patient wise boxes with sufficient shelf life.

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• In this programme alternate day treatment is based. Immunization with BCG

vaccine:- BCG full form is bacilli calamittee Guerin. It is a live vaccine.
• It is prepared from bovine strain of tubercle bacilli .
• The dose of vaccine is 0.1ml.
• For below 1month babies the dose is 0.05ml.
• BCG is vaccine is given intradermal using a tuberculin (or) BCG syringes.
• It should be given to deltoid muscle of the left upper arm.
• This vaccine is given soon after for birth with in 4weeks.
BCG is also given when the infant is 6weeks patient teaching (or) health
education. It is very important to clear doubts of patients regarding drugs,
nutrition, disposal of sputum and follow up services.
Eg. Teach the patient that taking of refamycin give red coloured urine.
Domiciliary care (home care) of tuberculosis patient:-
(a) Isolation:- The patient should isolated(or) kept Separated from the other people
specially children should keep away from the patient until his sputum is negative
to TB bacilli.
(b) Good ventilation:- the room should be well ventilated and the room should get
sufficient sunlight.
(c) Disinfection of sputum and other articles:- Sputum must be collected in a
closed container.
Bottom of the container should be filled with water to avoid sticking of the
sputum. other articles should be disinfected to prevent cross infection.
(d) Prevention of cross infection:- the patient should avoid direcr contact with
other family members specially children
• While talking, sleeping, laughing(or) sneezing, coughing, should cover his
mouth with a handkerchief (or) towel(or) piece of cloth.
• Avoid spitting of sputum here and here.
Nutrition:- The patient should take high protein and high calorie diet to maintain
optimum nutritional status.
Course of treatment:- Regular taking drugs without fail till the complete course
of treatment.
Health education regarding:
• Regular treatment
• High protein diet
• Personal hygiene
• Proper collection and disposal of sputum
• Prevention of cross infection
• Stopping of smoking
• Follow up services
Chicken pox
It is an acute infectious diseases characterized by highly vesicular rash, fever
and weakness.
Causative factors:
Causative organism is varicella-zoster.
Source of infection:- virus is present in the secretions of mouth, pharynx, and
lesions of skin and mucosa. Infectivity it is 1 to 2 days before the appearance of
rash, and 4to 5 days there after.

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It is highly communicable disease.90% secondary attack rate in house hold contacts.

It occurs mainly under 10years of age. It is also serve in normal adults.
Immunity:- the attack of chicken pox will give immunity to the child. Second attacks
are rare.
Environmental factors:- It occurs mainly during the first 6months of the year. It
occurs mainly January to june.
• It is a seasonal disease.
Transmission:- It is mainly by droplet infection and face to face contact. The
organism enters the body is by respiratory tract.
Incubation is usually 14 to 16days and sometime 10 to 21 days.
Signs and Symptoms are 2 stages
1. Presumptive stage:- Very short stage, lasting about 24hours occurs
suddenly. The signs and symptoms are
• Mild to moderate fever
• Pain in the back
• Shivering and weakness
2. Eruptive stage:- Appearance of rash is seen on the trunk, face, arms, and
legs.
• The rash is advances quickly through the stages of macule, papule,
vesicles, and scars.
Fever:- does not run high temperature.
Complications:- bleedings, pneumonia, encephalitis, acute cerebral
ataxia.
Laboratory diagnosis:- By examination vesicle fluid under electromicroscope.
Control measures: are
• Early notification of cases.
• Isolation of cases for about 6days after the appearance of rash.
• Proper disinfection of articles.
• Drugs used are acyclovir, famicyclovir.
Preventive measures:-
1. Varicella zoster immunoglobulin is given within 72hours of exposure.
2. Vaccine:- varicella vaccine is a live attenuated vaccine is safe and
recommended for children between 1-1 ½ years age(12 to 18months).
High risk adolescents and adults should be immunized.
High risk group includes health care worker, household, contacts of immune
suppressed individuals, teacher in day care centre’s, non pregnant women of
child bearing age, college students, international travelers.
Mums:-
It is caused by RNA virus. Infection is common in winter. It is caused by
paramixovirus. Cases of peope with mums (or) subclinical cases are source of
infection.
Period of infectivity:- Four to six days before the onset signs and symptoms until
the swelling of parotid glands.
Age is common in the age group of children 5 to 9yrs.
Immunity:- one attack of mums gives lifelong immunity.
Environmental factors:- like over crowding, it is an endemic disease.
Mode of transmission is by droplet infection and direct contact with infected persons.
Incubation period from 2 to 3weeks usually 18days.

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Signs and Symptoms:- Pain and swelling of the parotid glands sublingual and
submandibular glands
• Pain in the ear
• Pain and stiffness on opening of the mouth.
• It also affects the testes in male children, pancreas ovaries in girl child etc.

Complications include, orchitis, ovaritis, thyroiditis, meningo encephalitis, pruritis,

and myocarditis.
Prevention:-
Vaccination:- Live attenuated vaccine is available. A single dose of 0.5ml of
intramuscular in children. It is given along with other same vaccine.
Immunoglobulin:- specific immunoglobulin is available.
Control:- By isolation of cases.
Disinfection of articles.
Rubella:-
It is also called german measles. It is viral infection. It is caused by toga
virus. Source of infection is infected children. Infective material is secretions of nose
and throat.
Period of Communicability:- A week before symptoms to about a week after rash
appears.
Age:- Commonly in the age group of 3 to 10years immunity one attack results in
lifelong immunity.
Environmental factors:- Occurs in winter, and spring in temperature zone areas.
Mode of transmission:- Direct transmission by droplets from nose and throat and
droplet neuclei.
Incubation period:- 2 to 3 weeks average 18 days.
Signs and Symptoms:- common cold, sore throat low grade fever, enlargement of
lymphnodes appears as early as 7 days.
Rash appears on the face, within 24 hours rash is very small, pinkish and macular
rash.
Diagnosis:- By serological test throat swab culture.
Congenital rubella:- Refers to infants born with rubella. It occurs if the mother suffer
with rubella during the first trimester of pregnancy.
Prevention:- Is by giving rubella vaccine it is single dose vaccine of 0.5ml
subcutaneously.
Enteric fever (or) Typhoid fever:-
It is an acute communicable disease. It is also called as typhoid fever.
In India it is widely present. This is due to poor sanitation, poor standards of drinking
water facility.
Causative factors:
Causative organism is salmonella typhi, it is responsible for 90% of cases.
Salmonella paratyphi ‘A’ is responsible for about 5% of cases.
Source of infection:- Patients and carriers.
Infective material:- Is urine and faeces(stools) of infected persons.
Environmental and social factors:-
It occurs during July, September months. The bacilli is found in water,
ice, food, milk .
Social factors:- such as
• Polluted water
• Open air defacation and urination.

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• Low standards of food and personal hygiene.

• Ignorance.
Incubation period:- 10 to 14days.
Mode of transmission:- mainly by the faeco oral route(or) urine-oral route.
Direct infection occurs cooled hands contaminated with faces (or) urine, cases of
carriers.
Indirect transmission occur through drinking contaminated water, milk, food.
Signs/Symptoms:- Sudden onset of fever with chills
• High grade fever
• Weakness, headache, cough and sore throat.
• Abdominal pain and constipation
• Fever occurs in zig-zag manner
Diagnosis:- By bloodtest.
Control measures:- it includes
• Contrl of reservoir
• Environmental sanitation
• Immunization.
1. Control of reservoir:- Cases identification isolation of cases, treatment and
disinfection.
Identification of cases: By early diagnosis with the help of blood and stool
culture.
Treatment:- the drug of choice is chloramphenacol.
Disinfection:- All soiled clothes , and articles used by the patients are
disinfected with 5% cresol for 2hours.
Specially the soiled cloths should be soaked in a solution of 2% chlorine and
steam sterilized.
2. Environmental sanitation:- Portable water supply
• Improvement of basic sanitations
• Promotion of food hygiene
Immunization:- with anti typhoid vaccine. It is given subcutaneously two doses of
0.5ml each for adults at an interval of 4 to 6weeks. Children under the age of 1
year are not usually immunized. Children are given small doses.
Boosters doses of 0.5ml are recommended at interval of 3years.
Follow up:- The patient should be continuous contact with medical person after
discharge at 3 to 4 months and again after 12 months. Carriers must be identified
and treated with ampicilline. 4 -6g/day together with probenecid 2g/day for
6weeks.
Hepatitis:-
It is a viral infection of the liver. It includes different forms of hepatitis “ A,B,C,D,E
and G”. It is also called water borne and food borne disease.
Hepatitis: ’A’
An infectious hepatitis caused by hepatitis ‘A’ .It is an enterovirus.
Source of infection :- infected persons are source of infection.
Infective material:- mainly mans faces, blood is infective for a short period during
the stage. When the virus is present in the blood.
Age:- The disease is most common among children and adults.

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Both sex are equally affected. It is an endemic diseases. Immunity occurs through
the subclinical infection.
Environmental factors:- It occurs during the periods of heavy rainfall.
• Poor sanitation and overcrowding are spreads the disease more.
Mode of transmission:-
1. Faeco-oral route:- Through contaminated food and water.
2. Direct contact:- Person to person contact via contaminated hands(or)
objects.
3. Hepatitis ‘A’ is rarely transmitted by blood products.
4. Incubation period:- 10 to 50days.

Signs/symptoms:-
Nausea, vomiting
• Anorexia and mild fever.
• Diagnosis: liver function test.

Prevention and control:

Isolation of infected persons common infective person.
• Proper disposal and disinfection of faeces and articles.
• Provide good hygiene and sanitary conditions. Eg. Portable water supply,
safe disposal of human excreta, promoting food hygiene
• Enforcing sanitary measures at hostels and fast foods and other eating
places.
• Proper sterilization and disposal of needles and syringes.
• Administration of human normal immunoglobulins to all contacts before with
in a week of exposure.
Hepatitis B:- It is also known as serum hepatitis. It is acute systematic infection with
major infection in the liver.
It is a blood borne infection.
Causative factors:
• Causative organism is hepatitis ‘B’ virus.
• Source of infection:- patients and carriers. The carrier state can persist
many years.
• Infective materials:- blood, saliva, and semen are infective material.
• Period of communicability:- is present usually several months.
Usually occurs in adulthood.
High risk groups includes dental doctors,nurses,bold bank technician and
other hospital and laboratory, workers, drug addicts, prostitutes.
Modes of transmission:- The disease is spread.
1. Parental routing:- It is transmitted by blood and blood products.
Through transfusion, dialysis, contaminated syrenges, needles, handling of
infected blood. occur during surgical and dental procedures, immunizations,
ear piercing, nose piercing, hatooing, circumersion, acupuncture etc.
Perinatal transmission:- From infected mother to fetus sexual transmission.
Other routes includes from child to child transmission occurs when children
play together(or) share the same bed.

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Incubation period is 30 to 180 days.

Prevention and control:- Since there is no specific treatment for hepatitis B, the
only way of managing hepatitis, ‘B’ is prevention.
Hepatitis ‘B’ vaccine is now available like 1. Plasma derived vaccine. 2.
Recombination HBV vaccine.
The vaccine is given in 3doses of 1ml each . the first 2doses at an interval of one
month and the third dose 6months after the first dose.
Other measures:- includes all blood donors should be screened for HBV infection.
Accurate & proper sterilization of instruments. Practicing simple hygienic measure.
Carriers should not share rayors(or) tooth brush. Carriers should not donate blood.
Used to avoid sexual transmission use barriers methods of contraceptives.
Hepatitis ‘C’:-
It is parentally transmitted hepatitis recognized in the year 1989.
High risk population groups are harmodialysis patients, blood transfusion patient
.high prevalence of cases has been identified in patients with chronic liver failure.
Delta hepatitis:- It occurs always in association with hepatitis B.
Hepatitis E:- It is caused by hepatitis ‘E’ virus, identified in 1990, is usually a water
borne discard. The incubation period is 2-9weeks.
Rabies:- It is a zoonotic disease also known as hydrophobia(fear of water) it is
transmitted by the bite (or) licks of animals like dogs, cats, jackals, wolves,etc.
Causes:- It is called lysa virus type. Source of infection is the saliva of rabid animals.
All warm blooded animals including men are susceptible to rabies.
Rabies in man is a dead-end- infection occur death.
Modes of transmission:-
1. Animal bite:- due to dog bite.
2. Licks:- licks is abraded skin and mucosa can transmit the disease.
3. Person to person:- man to man transmission is late.
Signs and Symptoms:-
• Head ache, slight fever.
• Weakness and twichings.
• Pain and numbness at the site of bite.
• Classical signs of rabies are
• Intolerance to bright light and noise.
• Difficulty in swallowing
• Fear of water.
• Intenspain on swallowing food (or) fluids.
• Deaths occur due to respiratory paralysis.

Rabies in dogs:- May be identified

change in behavior:- A tendency to attack and bite without provocation, biting unual
objects like stics, straws, plastic materials.
• Run away from home and wonder
• Change of voice occurs.
• Difficulty to take respiration at final stage
• The dog dies within 10 days.
Prevention:-
• Bite site should be washed immediately with soap and water for several
minutes and then treated with spirit (or) tincture of iodine.

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• To kill the virus.

• T.T should be given
• Cover the wound with sterile deers.

Observe dog for 10days. If the dog dies within 10 days after bite, anti rabies
treatment should be started immediately.
Indications for antirabies treatment:-
• If the dog shows signs of rabies within 10 days after bite.
• If the biting animal cannot be traced out (or) identified.
• All bites from wild animal.
Anti rabies treatment:-
Vaccine is prepared from brain tissue of infected animals. The
vaccine is given subcutaneously (or) intramuscularly. The dosage is 1ml. the vaccine
is given at 0,3,7,14 and 30 days. A booster dose on day 90 is optional.

Malaria
It is protozoal disease caused by infection with parasite of the genus.
Plasmodium. It is transmitted to man by certain species of infected female anaphalus
mosquito.

Incidence: - In 2008, there were estimated 243 million cases malaria world wise.
Causative factors: Malaria in man is caused by four distinct species of the malaria
parasite.
1. Plasmodium vivax
2. Pl.falcifarym
3. P.malaria
4. Pl. ovale.

Life cycle of mosquito

1. A sexual human cycle:- It begins when an infected mosquito bites a person

and injects sporozite. In this human cycle three phases are present.
(a) Hepatitis phase:- The sporozites disappear within 60minutes from the
peripheral circulation. Many of them are destroued by phagocytes but
some reach the liver cells, after 1-2weeks of development. They become
hepatic schizonts which eventually divide releasing a number of merozites.
The number of merozites produced from a single sporozites considerably
with the infecting species. They began to glow and undergo crythrocyte
schizogony, thus liberating merozites into the blood stream causing
relapses of these infection.
(b) Erythrocytic phase:- Many of the merozites are quickly destroyed but a
significant number attach to specific receptor sites on the R.B.C. The
merozoites then penetrates the RBC and pass through stages of
trophoblast and schizoint. The hour of the crythrocytic phase is 48hours
for p.facifarum, p.vivax, p.ovale, and 72hours for p.malaria.
(c) Gametogany:- In all species of malaria some crythrocytic forms do not
divide but become male and female gametocytes. These are the sexual
forms of the parasite which are infective to mosquito.
(d) Sexual cycle:- The mosquito cycle begins when gameto cytes are injected
by the vector mosquito when feeding on an infected person.

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In the stomach of mosquito is exflagellation of the male

gametocyte 4-8 thread like filamentous called “microgames” are
developed.
The female gametocyte undergoes a process of maturation and
becomes a female gamete (or) macrogamete.
By a process of “chemotaxis” male gametes are attached towards the
female gametes,and it causes fertilization of the female gamete.
• It forms zygote, a motion less body, but within 18-24 hours.
• It becomes motile.
• This is ookinete which penetrates the stomach wall of the mosquito and
develops an cyst on the outer surface of the stomach.
• It grows rapidly and develops within it numerous sporozites and liberates into
the body cavity of mosquito. These sporozites reach to the salivary glands of
the mosquito and the mosquito now becomes infective to man. The period of
time received for the development of the parasite from the gametocyte to
sporozite stage in the body of the mosquito is about (0to 20days) depending
upon the favourable conditions of atmospheric temperature and humidity. This
period is called extrinsic incubation period.
Host factors:-
Age:- malaria affects all ages.
Sex:- males are more exposed.
Race:- who are having harmoglobin sickle cell type.
Pregnancy increases the risk of malaria in women.
Social economic development: - Incidence of malaria is more in developing
countries.
House:- The ill ventilated and ill tighted houses provided ideal indoor resting places
for mosquito.
Occupation:- It is a rural disease and is closely related to agriculture work.
Habits:- Sleeping outdoors, not using protective measures like nets, spraying of
walls etx.
Immunity:- It is acquired only after repeated exposure over several years.
Environmental factors:-
(a) Season:- It is a seasonal disease. It occurs mainly in the months from July to
November.
(b) Temperature:- The optimum temperature for the development of parasite in
insect vector is between 200c to 300c.
(c) Humidity:- 60% is considered necessary to mosquito.
(d) Rainfall:- It provides opportunity for the breeding of mosquitoes give rise to
epidemics of malaria.
(e) Manmade malaria:- garden pools, irrigation channels and engineering
projects like construction of hydroelectric bridges, have led to the breeding of
mosquitoes and an increase in malaria.
Mode of transmission:-
1. Vector transmission: It is transmitted by female anopheles mosquito.
2. Direct transmission:- Intramuscular (or) intravenous injections of blood (or)
plasma.
eg. Blood transfusion, drug addiction.
3. Congenital malaria:- It occurs in new born cases with infected mother.

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Incubation period usually not less than 10 days.

Clinical features:- the onset is fever, headache, nausea, vomiting and chilly
sensation. followed in an hour(or) so by regions.
The temperature rises rapidly to 39-410c. headache is severe and commonly
there is vomiting, skin feels cold, later it becomes hot flushes are present
parasites are appear in the blood.
The pulse is rapid and may be week. This stage is last for ¼-1hour.
Hot stage:- The patient feels burning and casts off his clothes. The skin is hot
and dry to touch. Headache is intense but nausea commonly diminishes. The
pulse is full and respiration is rapid. This stage lasts for 2 to 6hours.
Sweating stage:- Fever comes down with profuse sweating.
The temperature drops rapidly to normal and skin is cool and moist the pulse
becomes slower.

Diagnosis

Malaria will be diagnosed by

1. Microscopic test
2. Serological Test
3. Rapid Diagnostic Test

Treatment: Tab. Chloroquine is full therapeutic dose of 25 ml/kg divided over 3

days.

Measures against Malaria

• Early identification of fever cases

• Administration of Tab. Chloroquine for all fever cases
• Collection of blood smears
• Administration of radical treatment to all positive cases of malaria

Mosquito control measures

1) Anti-adult measures: Like insecticide spraying. Eg: DDT, Malathion

2) Anti-larval measures: By larvicidal agents, Eg: Temphos, pouring of kerosene

in mosquito breeding places, using gamboozian fish to kill the larvas as a
biological control.

3) Protection against mosquito bites by using nets, repellents, creams and jellies

Community Measures

• Source reduction measures like elimination of breeding places

• Environmental sanitation, proper drainage system
• Used coconuts should be disordered properly.

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• Health education of community regarding the importance of taking treatment

and spraying houses.
• Proper drying of plant pots, removing of water from air collers.

Life history of malaria parasite: - The malaria parasite undergoes 2 cycles of

development.
1. The human cycle( a sexual cycle)
2. The mosquito cycle(sexual cycle)

Man is the intermediate host and the mosquito the definite host.

Dengue fever facts

• Dengue fever is a disease caused by a family of viruses that are

transmitted by mosquitoes.
• Symptoms such as headache, fever, exhaustion, severe joint and
muscle pain, swollen glands (lymphadenopathy), and rash. The
presence (the “dengue triad”) of fever, rash, and headache, (and
other pains) is particularly characteristic of dengue fever.
• Dengue is prevalent throughout the tropics and subtropics.
Outbreaks have occurred recently in the Caribbean, including
Puerto Rico, the U.S Virgin Islands, Cuba, and in Paraguay in
South America, and Costa Rica in Central America.
• Because dengue fever is caused by a virus, there is no specific
medicine or antibiotic to treat it. For typical dengue fever, the
treatment is purely concerned with relief of the symptoms.
• The acute phase of the illness with fever and myalgias lasts about
one to two weeks.
• Dengue haemorrhagic fever(DHF) is a specific syndrome that tends
to affect children under 10years of age. It causes abdominal pain,
haemorrhage (bleeding), and circulatory collapse(shock).
• The prevention of dengue fever requires control or eradication of
the mosquitoes carrying the virus that causes dengue.
• There is currently no vaccine available for dengue fever.
Causes, incidence, and risk factors
Dengue fever is caused by one of four different but related viruses. It is
spread by the bite of mosquitoes, most commonly the mosquito Aedes aegypti,
which is found in tropic and subtropic regions. This includes parts of:

Dengue fever is being seen more often in world travellers.

Dengue fever should not be confused with Dengue hemorrhagic fever, which is a
separate disease that is caused by the same type of virus but has much more severe
symptoms.
Symptoms
Dengue fever begins with a sudden high fever, often as high as 104-105 degrees
Fahrenheit, 4 to 7 days after the infection.

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A flat, red rash may appear over most of the body 2-5 days after the fever starts.
A second rash, which looks like the measles, appears later in the disease. Infected
people may have increased skin sensitivity and are very uncomfortable.
Other symptoms include
• Fatigue
• Headache (especially behind the eyes)
• Joint aches
• Muscle aches
• Nausea
• Swollen lymph nodes
• Vomiting
Signs and tests
Test that may be done to diagnose this condition include:
• Antibody titer for dengue virus types
• Complete blood count(CBC)
• Polymerase chain reaction(PCR) test for dengue virus types
Treatment
There is no specific treatment for dengue fever. You will need fluids if there are
signs of dehydration. Acetaminophen (Tylenol) is used to treat a high fever. Avoid
taking aspirin.
Expectations (prognosis)
The condition generally lasts a week or more. Although uncomfortable, dengue
fever is not deadly. People with the condition should fully recover.
Complications
• Febrile convulsions
• Severe dehydration
Prevention
Clothing, mosquito repellent, and netting can help reduce exposure to
mosquitoes. Traveling during periods of minimal mosquito activity can also be
helpful.
Mosquito abatement programs may reduce the risk of infection.
Filaria
Filaria is caused by the parasite known as Wuchereria bancrofti in most parts of
India. The infection is common in both urban and rural areas in India. Culex
mosquito is the vector that transmits the disease from one person to other. The adult
parasite produces small, immature larvae known as microfilariae and one adult
parasite can produce millions of microfilariae in it’s life period of 4-6years. The
microfilariae circulate in the peripheral blood usually in the night. The disease is
transmitted by bite of an infected Culex mosquito.
When the culex mosquito bites an infected person the microfilariae enter the
body of a mosquito. In the mosquito microfilariae takes about 7-21 days to develop.
After this when the mosquito bites a healthy person it transmits the disease.
Filariasis develops usually after many mosquito bites iver several months to
year. The risk of infection is higher in people living for a long time in areas where
filariasis is common. The risk of infection in short-term tourists to filarial endemic
areas is very low.
Kala-Azar

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• Kala-azar is a slow progressing indigenous disease caused by a protozoan

parasite of genus Leishmania
• In India Leishmania donovani is the only parasite causing this disease
• The parasite primarily infects reticuloendothelial system and may be found in
abundance in bone marrow, spleen and liver.
• Post Kala-azar Dermal Leinshmaniasis(PKDL) is a condition when
Leishmania donovani invades skin cells, resides and develops there and
manifests as dermal leisions. Some of the kala-azar cases manifests PKDL
after a few years of treatment. Recently it is believed that PKDL may appear
without passing through visceral stage. However, adequate data is yet to be
generated on course of PKDL manifestation.
Signs & Symptoms of Kala-Azar
• Recurrent fever intermittent or remittent with often double rise
• Loss of appetite, pallor and weight loss with progressive emaciation
• Weakness
• Splenomegaly –spleen enlarges rapidly to massive enlargement, usually soft
and nontender
• Liver- enlargement not to the extent of spleen, soft, smooth surface, sharp
edge
• Lymphadenopathy- not very common in India
• Skin-dry, thin and scaly and hair may be lost. Light coloured persons show
grayish discolouration of the skin of hands, feet, abdomen and face which
gives the Indian name Kala-azar meaning “black fever”
• Anaemia- develops rapidly
Anaemia with emaciation and gross splenomegaly produces a typical
appearance of the patients
Transmission
• Kala-azar is a vector borne disease
• Sandfly of genus Phlebotomus argentipes are the only known vectors of kala-
azar in India
• Indian Kala-azar has a unique epidemiological feature of being
Anthropometric; human is the only known reservoir of infection.
• Female snadflies pick up parasite(Amastigote or LD bodies) while feeding on
an infected human host.
• Parasite undergo morphological change to become flagellate (Promastigote
or Leptomonad),development and multiplication in the gut of sandflies and
move to mouthparts
• Healthy human hosts get infection when an infective sandfly vector bites them
Kala-azar vector in India
• There is only one sandfly vector of kala-azar in India Phlebotomus
aregentipes
• Sandflies are small insects, about one fourth of a mosquito. The length of a
snadfly body ranges from 1.5 to 3.5mm.

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• Adult is a small fuzzy, delicately proportionate fly with erect large wings. The
entire body including wings is heavily clothed with long hairs.
• Life cycle consists of egg, four instars of larvae, pupa and adult. The whole
cycle takes more than a month, however, duration depents on temperature
and other ecological conditions
• They prefer high relative humidity, warm temperature, high subsoil water and
abundance of vegetation
• Sandflies breed in favourable micro-climatic conditions in places with high
organic matter that serve as food for larvae
• These are ecologically sensitive insects, fragile and cannot withstand
desiccation
Diagnosis
Clinical
A case of fever of more than 2weeks duration not duration not responding to
antimalarials and antibiotics. Clinical laboratory findings may include anaemia,
progressive leucopenia thrombocytopenia and hypergammaglobulinemia
Laboratory
Serology tests: variety of tests are available for diagnosis of kala-azar. The most
commonly used tests based on relative sensitivity; specificity and operationally
feasibility include Direct Agglutination Test(DAT), rk39 dipstick and ELISA. However
all these tests detedt IgG antibodies that are relatively long lasting. Aldehyde test in
commonly used but it is a non-specific test.IgM detecting tests are under
development tests are under development and not a available for field use.
Parasite demonstration in bone marrow/spleen/lymphnnode aspiration or in culture
medium is the confirmatory diagnosis. However, sensitivity varies with the organ
selected for aspiration. Though spleenb aspiration has the highest sensitivity and
specificity(considered gold standard) but a skilled professional with appropriate
precautions can perform it only at a good hospital facility.
Differential Diagnosis:
• Typhoid
• Military tuberculosis
• Malaria
• Brucellosis
• Amoebic liver abscess
• Infectious mononucleosis
• Lymphoma, Leukemia
• Tropical splenomegaly
• Portal hypertension
Treatment of Kala-azar
Kala-azar drugs available in India
• Sodium stibogluconate(indigenous manufacture,registered for use & sale)
• Pentamidine Isethionate:(imported, registered for use)
• Amphotericin B: (indigenous manufacture & import, registered for use and
sale)
• Miltefosine(imported/registered for use& sale)

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Trachoma
Causes, incidence, and risk factors
Trachoma is caused by infection with the bacteria Chlamydia trachomatis.
The condition occurs worldwide, mostly in rural settings in developing
countries. It frequently affects children, although the effects of scarring may not be
seen until later in life. While trachoma is rare in the United States, certain
populations marked by poverty, crowded living conditions, or poor hygiene are at
higher risk for this illness.
Trachoma is spread through direct contact with infected eye, nose, or
throat secretions or by contact with contaminated objects, such as towels or clothes.
Certain flies can also spread the bacteria.
symptoms
symptoms begin 5 to 12 days after being exposed to the bacteria. The
condition begins slowly as inflammation of the tissue lining the eyelids (conjunctivitis,
or “pink eye”), which if untreated may lead to scarring.
Symptoms may include:
• Cloudy cornea
• Discharge from the eye
• Swelling of lymph nodes just in front of the ears
• Swollen eyelids
• Turned in eyelashes
Signs and tests
An eye exam may reveal scarring on the inside of the upper eye lid, redness
of the white part of the eyes, and new blood vessel growth into the cornea.
Laboratory tests are needed to accurately identify and detect the bacteria and
diagnos trachoma.
Treatment
Antibiotics can prevents long-term complications if used early in the
infection antibiotics include erythromycin and doxycycline .in certain cases eyelid
surgery may be needed to prevent long –term scarring which can lead to blindness if
not corrected.
Expectations(prognosis)
Early treatment before the development of scarring and lid deformities has an
excellent prognosis.
Complication
If the eyelids are severely irritated the eyelashes may turn in and rub
against the cornea this can cause eye ulcers, additional scars vision loss and
possibly, blindness.
Prevention
Improved sanitation and not sharing items such as towels are important
measures for limiting the spread of trachoma.
Conjunctivitis
Conjunctivitis is swelling (inflammation) or infection of the membrane lining
the eyelids(conjunctiva).
Causes, incidence, and risk factors
The conjunctiva is exposed to bacteria and other irritants. Tears help protect
the conjunctiva by washing away bacteria. Tears also contain enzymes and
antibodies that kill bacteria.

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There are many causes of conjunctivitis. Viruses are the most common
cause. Other causes include:
• Allergies(allergic conjunctivitis)
• Bacteria
• Certain diseases
• Chemical exposure
• Chlamydia
• Fungi
• Parasites(rarely)
• Use of contact lenses(especially extended-wear lenses)
“pink eye” refers to a viral infection of the conjunctiva. These infections are
especially contagious among children.
Newborns can be infected by bacterial in the birth canal. This condition is
called ophthalmia neonatorum, and it must be treated immediately to preserve
eyesight.
Symptoms
• Blurred vision
• Crusts that form on the eyelid overnight
• Eye pain
• Gritty feeling in the eyes
• Increased tearing
• Itching of the eye
• Redness in the eyes
• Sensitivity to light
Signs and tests
• Examination of the eyes
• Swab of conjunctiva for analysis
Treatment
Treatment of conjunctivitis depends on the cause.
Allergic conjunctivitis may respond to allergy treatment. It may disappear on its
own when the allergen that caused it is removed. Cool compresses may help soothe
allergic conjunctivitis.
Antibiotic medication, usually eye drops, is effective for bacterial conjunctivitis.
Viral conjunctivitis will disappear on its own. Many doctors give a mild antibiotic eye
drop for pink eye to prevent bacterial conjunctivitis.
You can soothe the discomfort of viral or bacterial conjunctivitis by applying
warm compresses(clean cloths soaked in warm water) to your closed eyes.
Expectations(prognosis)
The outcome is usually good with treatment.
Complications
Reinfection within a household or school may occur if you don’t follow preventive
measures.
Calling your health care provider
Call for an appointment with your health care provider if your symptoms
last longer than 3 or 4 days.
Prevention

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Good hygiene can help prevent the spread of conjunctivitis:

• Change pillowcases frequently.
• Do not share eye cosmetics.
• Do not share towels or handkerchiefs
• Handle and clean contact lenses properly.
• Keep hands away from the eye.
• Replace eye cosmetics regularly.
• Wash your hands often.
Scabies
Sarcoptes scabiei
Scabies is an easily spread skin disease caused by a very small species of
mite.
Causes, incidence and risk factors
Scabies is found worldwide among people of all groups and ages. It is spread by
direct contact with infected people, and less often by sharing clothing or bedding.
Sometimes whole families are affected.
Outbreaks of scabies are more common in nursing homes, nursing facilities,
and child care centers.
The mites that cause scabies burrow into the skin and deposit their eggs,
forming a burrow that looks like a pencil mark. Eggs mature in 21 days. The itchy
rash is an allergic response to the mite.
Scabies is spread by skin-to skin contact with another person who has scabies.
Pets and animals cannot spread human scabies. It is also not very likely for scabies
to be spread by:
• A swimming pool
• Contact with the towels, bedding, and clothing of someone who has scabies,
unless the person has what is called “crusted scabies”
Symptoms
• Itching, especially at night
• Rashes, especially between the fingers
• Sores(abrasions) on the skin from scratching and digging
• Thin, pencil-mark lines on the skin
Mites may be more widespread on a baby’s skin, causing pimples over the trunk, or
small blisters over the palms and soles.
• In young children, the head, neck, shoulders, palms, and soles are involved.
• In older children and adults, the hands, wrists, genitals, and abdomen are
involved.
Signs and tests
Examination of the skin shows signs of scabies. Tests include an
examination under the microscope of skin scrapings taken from a burrow to look for
the mites. A skin biopsy can also be done.
Treatment
Prescription medicated creams are commonly used to treat scabies infections.
The most commonly used cream is permethrin 5%. Other creams include benzyl
benzoate, sulfur in petrolatum, and crotamiton. Lindane is rarely used because of its
side effects.

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Creams are applied all over the body. The whole family or sexual partners
of infected people should be treated, even if they do not have symptoms. Creams
are applied as a one-time treatment or they may be repeated in 1 week.
Wash underwear, towels, and sleepwear in hot water. Vacuum the carpets and
upholstered furniture.
For difficult cases, some health care providers may also prescribe medication taken
by mouth to kill the scabies mites. Ivermectin is a pill that may be used.
Itching may continue for 2 weeks or more after treatment begins, but it will
disappear if you follow your health care provider’s treatment plan. you can reduce
itching with cool soaks and calamine lotion. Your doctor may also recommend an
oral anthistamine.
Expectations(prognosis)
Most cases of scabies can be cured without any long-term problems. A severe case
with a lot of scaling or crusting may be a sign that the person has a disease such as
HIV.
Complications
Intense scratching can cause a secondary skin infection, such as impetigo
Prevention
Avoid contact with infected persons. While there have been great strides in the
prevention of HIV transmission and care of HIV infection and AIDS since AIDS was
first recognized in 1981, many people still have questions about HIV and AIDS. The
information below is designed to answer some of these questions based on the best
available science.
Other communicable Diseases
Sexually Transmitted Diseases
The sexually transmitted disease are a group of communicable disease that are
transmitted predominantly by sexual, viral, protozoal agents and ectoparasites.
Causative Organism
A. Bacterial agents:
Neisseria gonorrhea
Clamydia trachomatis and other
Treponeam palidum
B. Viral agents:
Herpes virus 1 or 2 (herpes simplex virus)
Hepatitis B
Human papilloma virus
Human immunodeficiency virus
C. Protozoal agents:
Entamoeba histolytica
Giardia Lamblia
Trichomonas vaginalls
D. Fungal agents
Candida albicans
E. Ecto parasites
Sarcoptis scabiei.
Preventive care
Case Detection
Case detection is a prime part of any control programme. The usual
methods of early detection of STD control programme are

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1. Screening(or) testing
Screening is the testing of apparently healthy volunteers from the general
population for the early detection of disease. High priority is given to
screening of special groups like pregnant women, blood donors, industrial
workers, army, police, prostitutes, convicts etc.

2. Identification of contacts
Identification of contacts by which the sexual partners of diagnosed
patient are identified, located, investigated and treated. It helps in controlling
the spread of infection.

3. Group testing
Here the patients are asked to name other persons of either sex,
who move in the same socio-sexual environment.
Eg: blood testing
4. Treatment
Adequate treatment of patients and their contacts is very
important in STD control programme.
5. Contact treatment
Contact treatment has become a keystone of control of the administration of
full therapeutic dose of treatment of persons.
6. Personal protectors
Using of condoms and diaphragms for personal prophylaxis against
STD’s
7. Health education
Health education is an integral part any control programmes. The aim
of educational intervention is to help individual’s alter their behavior to avoid
STD’s and to minimize disease and transmission. And using of
contraceptives maintain a partner’s while inter course. Be faithfull with the
partner. Avoid pregnancy to prevent infection. The blood doners always test
before donating a blood.
The razers and towels brushes should not use of the others.
The vaccine should take without breaking the booster doses.
AIDS and HIV
AIDS, the acquired immune-deficiency syndrome is a fatal ill ness caused by a retro
virus.
HIV- Human Immuno-deficiency virus.
HIV-which the disease breaks down the body’s immuno system leaving the victim
vulnerable to a host of life threatening
Incubation period
Incubation period is few months 10years.
Mode of Transmission
(a) Sexual transmission
AIDS is first and foremost a sexually transmitted disease. Any vaginal, anal or
oral sex can spread AIDS. The cases were in homosexual or bisexual men.
Every single act of unprotected inter course with HIV infected person exposes
the unprotected partner to the risk of infection. Anal inter course carries a
higher risk of transmitted than vaginal inter course because it is more likely to
inquire tissues of the receptive partner 1 sexual inter course.

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(b) Blood contact

AIDS is also transmitted by contaminated blood transfusion of whole blood
cells; platecets and factors VIII and IX derived from human plasma. HIV or
AIDS transmission through blood depends on the getting infection through
contaminated needle, syringe or any other skin piercing instrument, infected
person blood transfusion to a healthy person(2) transfusion of blood and
products.
(c) Maternal-Foetal Transmission
Mother to child transmission.HIV may pass from an infected mother to
her foetus, through the placenta or to her infant during delivery or by breast
feeding. There is no evidence HIV is transmitted through mosquitoes or any
other insects or contact with infected persons food or water, razors etc tissue
and organ transplantation.
Clinical Manifestations
The clinical features of HIV infection have classified into four broad categories.
(a) Initial infection with the virus and development of antibodies. Within a few
weeks of infection with virus. Mild illness, fever, sore throat and malaise,
headache, lymphadenopathy, rashes and arthropathy.
(b) Asymptomatic Infection
All the patients infected with HIV whether they experience of acute
infections or not pass through a phase of symptom less infection lasting for
symptoms several months to years.
In some the infection may not progress any further while in others.
(c) Persistent Generalized
There is presence of enlarged lymphnodes, atleast 1cm in diameter that
persists for at least 3months in the absence of any current illness. This by
itself begin.
(d) AIDS Related complex
A person with AIDS has illness caused by damage to the immune
system. Clinical signs-unexplained diarrhea lasting longer than a month,
fatigue, malaise, loss or more than 10 percent body weight, fever, night
sweats, or other milder infections such as oral thrush, generalized
lymphadenopathy or enlarged spleem, tuberculosis, herpes zoster,
malignancies.
(e) AIDS
This is the end stage disease leading to irreversible break down of immune
defense mechanisms chronic tuberculosis, pneumonia, encephalopathy,
candida esophagitis.
Laboratory Diagnosis
1. ELISA- Enzymed Link Immuno Sarabitcate Assay
2. Western bilt
Prevention and Treatment of HIV/AIDS
Prevention of AIDS at present depends upon health education, identification
of source and eliminate of high risk activities.
1. These include practice safe by use of condoms, stoppage of drug abuse of
disposable syringes and needles, testify the blood and blood products, prior
sterilization of instruments used for surgery.

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a. Womens suffering from AIDS and high risk of infection should avoid
becoming pregnant.
b. Educationg the people about AIDS about its causes and its nature of
transmission and prevention.
c. Educating about use of contraceptive with safety to minimize the
disease of transmission.
For Treatment of a patient with AIDS
1. HIV refers to antiretroviral drug treatment started within hours following
accidental exposure to the virus.
2. Treatment and prophyloxis of infections.
3. Immuno restrictive measures and
4. Specific anti HIV drugs.
5. General management of patients.
6. A large number of antiviral retro drugs have been treatment tried in AIDS
patients. Only one drug zidovudine 200mg(AZT azidothymidine) has been
licensed for used in AIDS.
Japanese Encephalitis
Encephalitis or Japanese encephalitis(JE) is a mosquito caused by a group B
arbovirus(flavi virus) and transmitted by culicine mosquitoes It is a zoonotic disease
i.e: infecting mainly animals and incidentally man.
Epidemiological Features
Unlike the dengue virus, JE virus infects several extra human hosts eg:
animals and birds. Available evidence indicates that the basic cycles of transmission.
(a) Pig-Mosquito-Pig.
(b) The Ardeid bird- Mosquito Ardeid bird.
The disease is transmitted to may by the bite of infected mosquitoes. Man
is an incidental “ dead end host”. Man to man transmission has not so far
been recorded.
Signs and Symptoms
The course of the disease in may may be divided into three stages.
(a) Prodomal stage
The onset of illness is acute and is heralded by fever, headache, and malaise.
The duration is 1-6 days.
(b) Acute Enmcephalitis Stage
Fever usually high 380 to 400c etc.
(c) The prominent Feature
Fever, nunchal rizidity, focal signs, loss of coordination and altered
sensitivity. Acute. Paralysis, disorientation
Diagnosis: Laboratory tests, Antigen Antibody detection.
Treatment: Antiviral medicines
-Fluid and electrolyte balance
-control of convulsion
Prevention and control : Early diagnosis & proper casemanagement
-integrated vector contrl
-personal protection, IEC activities, vaccination

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Leptospirosis
Leptospirosis is essentially animal infection by several secotypes of leptospira
and transmitted to man under certain environment condition.
Incubation period
Usually 10 days with arrange of 4-20 days.
Causative Organism
Leptospira are thin light motile spirochetes. 0.1-0.2 cm wide and 5-15 cm long with
hooked ends.
Mode of transmission
(a) Direct contact
Leptospira can enter the body through skin abrasions or through infact
mucous membrane by direct contact with urine or tissue of infected animal.
(b) Indirect contact
Through the contact of the broken skin with soil water etc contaminated by
urine of infected animals.
(c) Droplet infection
Infection may also occur through inhalation as when milking infected cows
or goats by breathing air polluted with droplet of urine.
Signs and Symptoms
The disease manifestations are varied ranging in severity from a mild febrile
illness to severe and sometimes fatal diseases with liver and kidney.
Prevention and control
(a) Antibiotics
Penicillin is the drug of choice but other antibiotics(tetracycline or
doxycycline) are also effective. The dosage of penicillin is 6 million units daily
I.V.
(b) Environmental measures
This includes preventing exposure to potentially contaminated water,
reducing contamination by rodent control and protection of workers in
hazardous occupation. Measures should be taken to control proper disposal
of waste and health education etc.

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Vaccination
Immunization of formers and pets, prevents diseases. In some countries
for example, Italy, USSR, China where certain occupation carry a high risk of
infection vaccines are available. It is important that they should incorporate strains of
the serotypes that predominate in the particular area since immunity to one type of
leptospira may not protect against infection by another.
Acute Respiratory Infections
Pneumonia
An inflammation of the alveolar spaces of the dung, resulting in consolidation of
lung tissues the alveoli fill with exudates.
Causitive agent:
Pneumonia aureua, E. coll and infuenzae.
Signs and Symptoms
1. Cough with greenish to rust colored sputum, production rapid shallow
respirations and nasal flaring.
2. High pitched bronchial breath sounds, rares or crackles progressing to cause.
3. Fever chills, chest pain, weakness, generalized malaise.
4. Rachy cardia, cyanosis profuse perspiration.
Nursing responsibilities
1. Administer oxygen.
2. Provide adequate ventilation.
3. Place the client in semi fowler’s position.
4. Administer analgesies as ordered to relieve pain while breathing.
5. Monitor airway breathing gavage.
6. Facilitate removal of sections (general hydration , deep thing and coughing,
chest physiotherapy)
7. Administer antibodies as ordered.
8. Avoid of vistors to prevent infection.
9. Maintain pleasant environment.
10. Provide adequate rest and relief control and pain observe color,
characteristics of sputum and report anychanges.
11. Encourage the oral hygiene to prevent halitosis.
Bronchitis
It is defined as an infection of the major bronchi that may be treated and
bronchitis.
Viral Infections:
Signs and Symptoms:
1. Fever, productive cough, cold i.e worse in night and becomes productive in 2
and 3 days.
2. Loss of appetite, chillb , running nose, difficulty in breathing.
Mode of Transmission
By oral and direct to direct contact while coughing, sneezing etx.
1. Monitor for respiratoy diseases
2. Provide cool humidified air.
3. Monitor for signs such as sunken eyes, poor skin, decreased and
concentrated urinary output

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4. Increased fluid is taken.

5. Administer nebulizer as ordered by physician.
6. Provide semifowler position.
7. Administer nebulizer as ordered by physician.
8. Removal of secretion by deep breathing coughing chest therapy.
Asphyxia
It is defined a deficiency of oxygen in the blood and an increase of carbon dioxide
in the blood and tissues. It occurs due to an interruption in the normal exchange of
Oxygen and CO2 between the lungs and outside air.
Causes
1. Drowsing
2. Electric shock
3. Foreign body in the air passage.
4. Inhalation of smoke and poisonous gases
5. Suffocation of breath
6. Hanging strangulation by tight rope.
Signs and Symptoms
- Rate of breathing rises
- Breath gets shorter
- Veins of the neck becomes swollen
- Clients suffering with peripheral as well central cyanosis
- Pulse gets faster and feable
- Unconscious
- Froth may appear
- Fit may occur
Nursing Management
1. Remove the cause if possible.
2. Very quickly, make sure that air passage is not obstructed.
3. Loose his collar.
4. Remove false teeth and foreign bodies.
5. Pull tongue forward.
6. If the heart is beating, carotid pulse can be felt on the neck.
7. Place the individual on his back with his support at the gap of neck. This will
extend the head on the neck and lift the tongue to clear of the airway.
8. Apply artificial respiration to ensure prompt ventilation of the lungs and if
necessary to external cardiac massage.
9. During artificial respiration rhythmically and without interruption until natural
breathing resumed.
10. During artificial respiration also help in calling doctor and ambulance.
11. After breathing is restored keep the victim at rest and arrange for medical
care.
Diarrhoea Diseases
Diarrhoea is defined as the passage of loose liquid or watery stools. These
liquid stools are usually passed more than three times a day.

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Hence inconsistency and character of stools rather than the number of stools that is
more important.
Causative Organism
1. Virus - Rotavirus
2. Bacteria - Vibrio cholera, Escherichia coli
3. Others – Giardia intestinalis, intestinal worms
Diarrhea is most common in children especially those between 6 to
12 years. Incidence is highest in the age due to lack of active immunity the
enteric pathogens from contaminated food and direct contact with human and
animals faeces and contaminated. And cow’s milk or infant feeding formulas
is due malnutrition leads to infection due to premature gastric acidity
immunodeficiency, lack of personal and domestic hygiene or incorrect
feeding.
Mode of Transmission
Most of the pathogenic organisms that cause diarrhoea and all the pathogens
that are known to be major causes of diarrhoea in many ways to transmitted by
primary or exclusively by the faecal oral route.
Faeco Oral transmission may be water-borne, food borne or direct transmission
which implies an entry of other than faeco oral routes such as via fingers, fomites, or
dirt which may be ingested by young children.
Contaminated hands and flies. After preparation, cooked food may be
improper covering or vegetables or fruits washed with contaminated water.
Public drinking water contaminated by environment or contaminated fingers,
handling excreta or vomit by patients.
Signs and Symptoms
1. Loose watery stools associated with mucous discharge.
2. Sunken eyes.
3. Dry lips.
4. Dehydration, pale skin
5. Weakness fatigue.
6. If bloody stools present that conditions is called dysentery.
7. Cramps in legs.
8. Restlessness
9. Intense of thirst
10. Anuria.
Laboratory Tests
1. Collection of stool should be done by culture test.
Prevention and Control Measures
The diarrhoeal diseases control programme of WHO has since 1980 given
several intervention.
1. Maintenance of personal hygiene while handling of food and cooking and
water storage.
2. Maintenance of environmental sanitation mainly in rainy and winter season by
disposing of waste in proper methods.
3. Educating about the communication disease and its infections cases.
4. Immunization importance and advantages.
5. Educating proper isolation then a person has suffering from infection

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6. Educating about ORS preparation and it uses of taking.

7. Educating the mothers about hygiene before and after feeding.
Control
1. Short term
(a) Appropriate clinical management
2. Long term
(a) Better MCH care practices
(b) Preventive measures
(c) Preventing diarrhoeal epidemic
Appropriate Clinical Management
1. Oral Rehydration Therapy
The oral rehydration treatment can be safely and successfully used in treating
acute diarrhoea.
ORS is a therapy that glucose gives orally and intestinal absorption of salt
and water and is capable of correcting electrolyte and deficit.
The composition of oral dehydration fluids.
Sodium chloride 3.5 gm
Sodium bicarbonate 2.5 gm
Potassium chloride 1.5 gm
Glucose (destric) 20.0 g
Potable water 1 litre
Packets of ORS mixture is now freely available at the primary health centres,
subcentres. The one litre of drinking water. The solution should made fresh
daily and used within 24 hours. The water should be boiled or sterilized.
The simple mixture a table spoon of salt(5) gm and sugar 20 gm
dissolved in a litre of water may be safely dissolved and used.
Appropriate Feeding
Medical profession has related or rendered that is important to “ rest the gut”
during diarrhea. The current view is that during episodes of diarrhea, normal food
intake should promoted as soon as children are is able to eat. This is especially
relevant to the exclusively breast feeding to infants all the nutrients must supply to
protect from infection.
Chemo Therapy
Antibiotics should be considered where in cause of diarrhea has been clearly
identified as shigella, typhoid or cholera.
Better MCH care practices
(a) Maternal nutrition
Appropriate diet during pregnancy will reduce the low birth weight
babies antenatal and postnatal nutrition will improve the quality of life of child.
(b) Child nutrition
Is improved by breast feeding appropriate weaning practices,
supplementary feeding, vitamin A supplementation.
(c) Preventive measures includes
1. Improved sanitation, water supply, improved execute disposal and
improved domestic and food hygiene practices.
Simple measureless like, land washing with soap, preparing food, before
eating, before feeding achid, after defecting, after cleaning a child and
after disposing off a child’s stool.

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- Lavatory facilities should be there

2. Health education about environmental sanitation measures require
education support, people use and maintenance of facilities.
3. Immunization: Against measles is a potential intervention for diarrhoeal
control.
Immunization with rotavirus vaccine.
4. Fly control: Human and animal faces should be controlled, to prevent
breeding of flies.
Assessment Dehydration
Dehydration is a sign of severe diarrhoea. Dehydration is mild and severe.
Mild Dehydration
Signs and Symptoms
Thirsty, restless, pulse normal, B.P. normal, normal skin elasticity, tongue is
moist, urine output normal.
Severe Dehydration: It is drowsy, cold, clammy skin, rapid, feeble pulse, B.P less
than 80mm of Hg, skin elasticity loose, tongue is very dry, urine output is less(or)
more.
Mild hydration is corrected by oral dehydration solution severe dehydration is by
intrarenuces fluids administration I.V fluids like ringer’s lactate solution should be
administered.
After initial fluids and electrolyte deficit has been corrected, oral fluids should be
used for maintenance therapy.
Worm Infestation
Hook worm infection is defined as any infection caused by ancyclostoma
duodenal. They may occur as single or mixed infections.
Incubation period
5 weeks to 9 months.
The adults womens live in small intestine and jejunum. Eggs passes in
the faced enter into the human beings. The larva rapidly develops in warm, moist soil
and develops egg in for 2 days. It can enters through by skin and by mouth,
intestines lungs, blood stream etc. They break down into alvcoli, bronchi and trachea
are coughed up swallow to teach the small intestine.
Clinical Features
1. Hook worm infection causes chronic blood loss in body by deplection of iron
deficiency anaemia.
2. Child health is retarted physical and mental growth and development.
3. For pregnant mother gives to low birth babies, abortion, still births and
impaired lactation.
4. Loss of appetite,dysentery, constipation and abdominal pain, puffiness of
face, loss of weight.
Mode of Transmission
Hook worm enter the body, usually feet by penetrating skin. Direct ingestion
of oral route by contaminated water, fruits and vegetables.
Transmission through blood by contaminated doner.
Prevention and Control
The primary prevention are the most effective in interrupting transmission.
They should follow sanitary disposal of human excreta to prevent faccal

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contamination. Health education about personal hygiene, sanitary latrines and safe
drinking water changing behabiural patterns.
Secondary Prevention
The effective drug is tetrachloroethylene or albendazole 400 mg children orally
alternative 3 days.
Ferrous sulphate 20 mg to 50 mg for children till anaemia corrects to 12
gm/dl.
Amoebiasis
The term amoebiasis has been defined by WHO condition of harboring the
protozoan parasite. Entameba histolytica.
Incubation period
About 2 to 4 weeks or longer.
Clinical Manifestations
The symptomatic disease has been further subdivided into intestinal and extra
intestinal amoebiasis.
The Intestinal infection
Mild discomfort in abdominal, diarrhea, to acute fulminating dysentery, loss of
weight loss of appetite.
Extra Intestinal amoebiasis
Involvement of liver, lungs, brain, spleen, skin, etc.
Mode of Transmission
1. Faeco- oral route
This may readily take place through intake of contaminated water or
food. Infection occur heavy in contaminated drinking water supply vegetable,
especially those eaten raw from fields and irrigated with sewage polluted
water cysts have been found in the hands and finger nails.
2. Sexual transmission
By oral rectal contact.
3. Vector
Such as flies, cockroaches and rodents of carrying cysts and contaminate the
food and drink.
Diagnosis
1. Stool examination-containing of red cells.
2. Serological test- Indirect haemorrhagic agglutination.
Prevention and Control
1. Prevention measures- preventing by contamination of water, food, vegetables
and fruits with human faces.
(a) Sanitation- Safe disposal of human excreta coupled with elimentary
sanitary practice of washing hands after the defection and before eating.
(b) Water supply- The protection of water supply from faecal contamination
amoebic cyst. The cysts are killed by chlorine in water and by sand filters
are quite effective in removing cysts.
(c) Food hygiene- Environmental measures include the protection of food and
drink against faecal contamination. Uncooked vegetables and fruits can be
disinfected with acetic acid.
Treatment
Symptomatic- Metronidazole orally 30mg/kg after meals. Tindazole
orally 30mg duration of 8-10 days.

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Asymptomatic- Diloxanide furoate 500mg orally 10 days.

Ferrous sulphate 50mg daily 3 months till anemia corrects.
Ascariasis
An infection of the intestinakk tract caused in the adult by ascaris lumbricoides.
Incubation period
About 2 months.
Ascaris lumbricoides eggs enters lumen of small intestine. They become mature into
adults starts its growth in favorable condition. The lay eggs that will develop in
conditions like low temperature moisture oxygen pressure and ultra violet radiation
from the sunlight.
Clinical features
Nausea, abdominal pain, cough, vomiting and intestinal obstruction and worms are
passed in stools, fever. Loss of appetite, anaemia, diarrhea.
Mode of Transmission
By the facal-oral route i.e: by ingestion of infective eggs with food or drink.
Foods such as vegetable salads readily convey the infection, and so is polluted
water.
Other means of spread by finger’s contaminated with soil or by ingestion of
contaminated soil. While children playing with soil.
Prevention and Control
Prevention
Primary prevention are the most effective in interrupting transmission. These are
sanitary disposal of human excreta to prevent or reduce faeal contamination of the
soil, provision of safe drinking water by food hygiene habits and health education
built sanitary latrines and changing behavioured patters.
Secondary prevention
Effective drugs are available for the treatment of the human reservoir.
These are piperazine citrate syrup and tablets by orally 75mg/kg for 2 days.
Mebendazole
The dose is 100mg twice daily 3 days single dose orally.
Ferrous sulphate 50 to 150 mg is given orally for 3 months to anemia.
Dracunculiosis
Dracunculiosis or guinea worm disease is a vector borne parasitic disease mainly of
the subcutaneous tissues. It is caused by drancunculus medinensis.
Incubation period
About 2 months.
The larvae enters by subcutaneous tissue mainly of the legs and other parts
of body including head and neck. The larvae may remain active in water for 3-6days.
They are picked up by small fresh water crustaceans called Cyclops the larvae
require period of about 15 days for development in Cyclops. The incidence for peak
transmission in dry season march to may. Wells are the source of water supply after
rains June to September transfer to ponds larval temperature to develop 250 to
3000c.
Mode of Transmission
The disease is transmitted through consumption of water containing Cyclops.
Clinical features
Dermatitis, puffiness of face loss appetite, vomitus, diarrhea, abdominal loss of
weight, bister appears and redness nervousness.
Prevention and Control

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1. Primary prevention: provision of safe drinking water.(eg: piped water,

installation of hand pumps.)
2. Control of Cyclops by adding disinfect agents like bleaching powder, chlorine
tablets.
3. Using the filters to purify the water and boiling etc.
4. Educating to follow sanitary methods of sanitary latrines and environment
sanitation.
5. Personal hygiene protection and contamination to prevent.
Secondary prevention
The effective drugs to take albendazole 400mg alternatively 3 days orally.
Mebendazole 500mg orally 2 days.
Leprosy
Leprosy(hansen’s disease) is a chronic disease. There is no racial immunity against
it, but it is more frequently in those persons who are exposed to the disease in early
life.
It is mainly affects the peripherak nerves, it also affects the skin, muscles, the
eye, bones testis and internal organs.
Incidence
Causative Organism
It is known as leprosy bacillus or microbaterium leparae. Varieties of leprosy it
is divided into two main types.
Types of leprosy
(a) Infective leprosy
It is known as lepromatos leprosy in which organisms are shed out
from the nose, throat and skin of the patient. It is also known as multibacillacy
leprosy.
(b) Non infective leprosy:
It is also known as neural or non-lepromatous leprosy. Which is again divided
into two types.
1. Leprosy with patches on the skin.
2. Leprosy without patches on the skin paucibacilly leprosy.
Incubation period
This period is not yet determine but it is long incubation period, and average
of 3 to 5 years or more for lepromatous cases.
Causative factors
1. Agent or Causative Organisms
It is caused by “microbacterium leprosy”. The organism is now grown in the
foot pads of mice and in the anteater.
2. Source of infection
Cases are only the source of infection.
3. Infective material
Nose, throat section and skin discharges. Articles used by the infectious
patients.
4. Age
It affects all age group people.
5. Sex
More common in men than women.
6. Social factors

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Poverty, ignorance, illiteracy poor feeding, poor hygiene, and poor sanitation.
7. Genetic factors
Genes transmit the disease from generation to another generation.
Signs and Symtpoms
1. Onset of disease is gradual and the patient may have malaise, headache,
chilliness, mental depression and numbness of the body, where disease later
makes its appearance.
2. Lesions patched are see on the skin, which are present in the form of
macules, papules, and nodules.
3. These involve peripheral nerves with consequate anesthesia.
4. Muscles become weak and paralysis occur, patients suffers from trophic
changes in the skin, muscles and bones.
5. In lepromatous leprosy, the membranes of the upper respiratory that are also
usually involved.
Mode of Transmission
The mode of transmission of leprosy has not been established with certainty
the following theories are frequently.
(a) Droplet infection- The respiratory tract as the portal of entry.
(b) Contact transmission- Leprosy is transmitted from person to person by close
contact between an infectious and healthy person.
(c) Other routes like through broken skin or tattooing needles, insect, vectors.
Test for detecting
Testing for loss of sensation for heat, cold pain, and touch in the skin patches by
with needle. It cannot be emphasized that not all the hypopigmented patches show
sensory impairment.
Paresis or paralysis of the muscles of the hands and feet leading to the disabilities or
deformities.
Lepromin Test
The test is performed by injecting intra dermally 0.1ml of lepromin into the inner
aspect of the forearm is read in 48 hours and 21 days. An inflammatory response
within 24 to 48 hours tends to disappear after 3 to 4days. If is evidenced by redness
and induration at the site of inoculation if the diameter of red area is more than
10mm at the end of 48 hours the test is positive.
Treatment for adult multibacellary case of leprosy is multi drug therapy
1. Rifampicin- 600mg, once in a month given under.
2. Dapsone- 100mg. daily - self administer.
3. Clofazimine- 300mg. once in a month, and 50 mg daily self administered.
This treatment should be for 12 months.
Paccibacillary leprosy
Treatment Rifampicin-600 mg once in a month for 6months supervised.
Dapsone – 100mg of body weight daily for 6 months , self administer.
vaccination the value of B.C.G vaccination is not known.
Specific Treatment
1. Patient may be treated with oil of choulmogra hydrocarpate of sodium and
morphate sodium.
2. Penicillin and streptomycin are useful in controlling secondary infections.
3. Isonizide and other drugs are under evaluation 100 mg/orally.

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4. New group of sulphone drugs such as dapsone 100 mg-orally.

Rifampicin 600mg.
Domiciliary care of leprosy patient
- Teach the patient and family about the nature of disease, isolation of the
patient and need for regular treatment of the patient.
- Instruction should be given about keeping the eating and drinking utensils of
the patient separate.
- Follow up of patients during and after completion of chemotherapy.
- Finding of more cases in the family and in the community during home visit.
- Demonstration of nursing care.
- Advice the family on general sanitation, prevention of over crowding and
family planning.
Educate the patient about
- Leprosy is a curable disease.
- Leprosy is a preventable disease.
- Leprosy is a disease like other disease.
- Leprosy in not the result of devine curse.
- Patients need sympathy and understanding.
- Help the patient to take regular treatment.
Prevention and Control measures
1. Provision of domiciliary multi drug treatment [ MDT course].
2. Children must be separated from the infected person.
3. In endemic areas, infants should be separated from leprous parents at birth.
4. Marriages of leprosy cases may be postponed until the case to be non
infectious.
5. In religious places, fairs, big cities etc. discoverage giving aims to the lepers,
because it will encourage lepers for begging and also spreading infection.
Only organized charity meant for the benefit of leprosy should be allowed.
6. Lepers should not be allowed to roam about the streets to handle food or
keep shop or wander about in the cities or villages as peddlers, mendicants or
beggars because it will spread infection.
7. Facilities should be made available for diagnosing surveying and treating
leprosy.
8. Educate people about the dangers of this disease direct them for check up
and try to remove of false beliefs, about the disease, to enable them to take
treatment of this disease in time.
9. Socio- economic rehabilitation of the suffers.
10. Educating the people to identify the leprosy signs and symptoms to early
detection.
Control Measures
1. Report about the patient to health, authorities at once.
2. All those patients who are infectious must be admitted in the hospitals or
colonies for isolation and treatment until they become non infectious.

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3. If hospitalization is not possible for long period then they must be treated until
their clear heads and then allowed to go home and continue isolation at
home. But their parents must be checked periodically(at least every 6 month).
4. The care givers should we covered with masks and gloves before dressings
procedures.
5. Infants must be separated from leperous patient at birth.
6. Surrounding of the patient msut be kept clean.
7. Discharges from lesions should be collected and disinfect before destroying
them. Articles contaminated with discharges like bleeding and secretions,
through cleaning and disinfection of the living premises of the patient must be
done as terminal disinfection.
8. All using instruments must be kept in sunlight.
9. All the waste material discarded and incinerated.
10. Though the long and uncertain incubation period do not helping discovering
the source of infection but efforts should be made to find out the source of
infection and contacts. Periodically examination of contact will help in finding
out secondary cases- Investigation should be under taken in cases.
11. Institutional treatment, diagnosis, check up facilities should be available in the
endemic areas.
12. Government should exercise international right to refuse entry to immigrants
who are found to have leprosy in their country.
Rehabilitation of patients physically, mentally and socially.
- Establishment of colonies for people.
- Provide occupatemed therapy.
Health education to patient, family and community regular treatment,
protection of children.
- Family planning.

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SUMMARY

Lakhs of people are suffering from one or other communicable diseases in India.
They spread easily form person to person through different ways. If received correct
treatment and isolation measures to prevent and control communicable diseases.
Simple health educational measures helps to prevent the occurrence of
communicable diseases.

Knowledge about communicable diseases is very essential to MPHW(F) to prevent

the occurance of different communicable diseases in her area.

SHORT ANSWER TYPE QUESTIONS

1. Define communicable diseases?

2. Name the diseases spread by mosquitoes?
3. Name the causative organism of ‘Tetanus’?
4. List out the agent, host and environmental factors of diphtheria?
5. What is the vaccine to be given to Rabies?
6. What is meant by Diarrhea?
7. Expand O.R.S.?

LONG ANSWER TYPE QUESTIONS

1. Describe about malarial diseases?

2. Write about signs and symptoms and care of T.B patients?
3. Explain about preventive and control measures of HIV/Aids?
4. Write in detail about poliomyelitis?
5. Write about prevention and control of diarrhoea?

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UNIT XV- OCCUPATIONAL HEALTH

Definition
List the occupational diseases
Prevention of occupational hazards
Role & responsibilities of MPHW(F) in prevention of occupational diseases

Introduction

In new modern societies, focussing on occupational health is very important.

Industrial workers constitute only a segment of the general population and the
factors that influence the health of the population also apply equally to industrial
workers. The factors influencing are housing, water, sewage, waste disposal,
nutrition and education.

Definition

It is defined as Occupational Health should aim at the promotion and

maintenance of the highest degree of physical, mental, social wellbeing of workers in
all occupations.

List the occupational diseases

Diseases occur in the course of occupation or employment or work.

1) Diseases due to physical agents

a) Heat: Heat hyperpyrexia, heat exhaustion, heat syncope, heat cramps,

burns and local effects

b) Cold: Frost bite, chil blains and trench foot.

c) Light: Occupational cataract, miners nystagenus

d) Pressure: Air embolism, blast

e) Noise: Occupational deafness

f) Radiation: Cancer, Leukaemia, Aplastic Anaemia

g) Mechanical factors: Injuries, accidents

h) Electricity: Burns, shock

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2) Diseases due to chemical agents

a) Gases: CO2 (Carbon dioxide), CO (Carbon monoxide), HCN, CS2, NH2,

N2, H2S, Hcl, SO2. These causes gas poisoning.

b) Dusts:

(i) Coal dust: Anthracosis

(ii) Silica: Silicosis
(iii) Asbestors: Asbestosis, Cancer lung
(iv) Iron: Siderosis
(v) Canc fibre: Bagassosis
(vi) Cotton dust: Byssinosis
(vii)Tobacco: Tobacosis
(viii) Hay or grain dust: Farmers lung
(ix) Metals and their compounds: Lead, Mercury, Manganese
causes toxic hazard
(x) Chemicals: Acids, Alkalis and Pesticides

3) Diseases due to biological agents

Brucellosis, Leptospirosis, Anthrax, Actinonycosis, Hydatidosis, Psittacosis,

Tetanus, Encephalitis, Fungal infections

4) Occupational Cancers

Cancer of skin, lungs, bladder

5) Occupational Dermatosis

Dermatitis, Eczema

6) Diseases of psychological origin

Industrial neurosis, Hypertension, Peptic ulcer

Prevention of occupational hazards

Industrial or factory workers are exposed to 5 types of hazards based on their

occupation.

a) Physical hazards
b) Chemical hazards
c) Biological hazards
d) Psychological hazards

a) Physical Hazards: Produced by excess heat and cold, light, noise,

vibration, ultraviolet radiation, ionizing radiation.

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b) Chemical hazards: Dermatitis, allergic reactions, cancer.

c) Biological hazards: Brucellosis, Leptospirosis, Anthrax, Hydatidosis,

Tetanus etc. these are same as occupational diseases.

d) Psychological hazards: Fatigue, Frustration, lack of job satisfaction,

insecurity, poor human relationships, emotional tensions.

Occupational hazards of agricultural workers

It is a new concept. It includes,

a) Zoonotic diseases: Due to close contact of the animals or their products,

increases, causes Brucellosis, Anthrax, Leptospirosis, Tetanus,
Tuberculosis.

b) Accidents: Because of use of agricultural machinery causes accidents are

more common.

c) Toxic hazards: Use of fertilizers, insecticides or pesticides causes toxic

effects. Other hazards include malnutrition, parasitic infestation, poisoning
etc.

d) Physical hazards: Inadequate ventilation, uncomfortable positions for long

periods of time.

Accidents in industries

Workers may prone to get accidents, due to the following conditions.

1) Human factors: which includes,

a) Physical factors: Inadequate qualification, lack of proper vision.

b) Physiological factors: includes women will get more accidents.

Age: Younger age persons prone to get more accidents.
Experience: Inadequate or insufficient experience causes more accidents.

c) Psychological factors include carelessness, inattentiveness, over

confidence, slow celebratory ignorance, inexperience, emotional stress
and accident proneness.

2) Environmental factors: Humidity, Poor illumination, temperature causes

accidents.

Prevention of accidents

• Adequate preparation
• Adequate job training

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• Continuing education
• Ensuring safe working environment
• Establishing safety department
• Periodic examination
• Careful reporting

Prevention of occupational hazards

1) Provide health promotional measures

2) Ensure specific protection
3) Protecting patients undergoing X-ray
4) Provide gloves, goggles, mask, different diseases.
5) Early diagnosis and treatment
6) Rehabilitation services
7) Replacement of job

Apart from this, prevention of occupational diseases.

a) Medical measures: Replacement of examination of worker before joining into

the duty. It involves conducting some tests. Eg: Chest X-ray, Electro Cardio
Gram (ECG), vision testing, urine and blood examination.

b) Periodic examination: The frequent examination is needed.

c) Medical and health care services: Provide diagnostic and treatment facilities.
Immunization and first aid services.

d) Notification: It is to provide measures for prevention and protection services.

e) Supervision of working environment: Such as temperature, lighting,

ventilation, humidity, noise, cubic space, air pollution and sanitation.

f) Maintenance of records: Proper records should be maintained. The workers’

health record should be maintained. It is also helpful to prevent disability
conditions.

g) Health education and counselling:

• It should be start before the worker enters the factory.

• Measures for personal protection
• Correct use of protective devices.
• Simple rules of hygiene like Hand washing, Caring of the nails, bodily
cleanliness, cleanliness of clothes, should be impressed upon him.
• Frequently reminded dangerous in industry.
• Use health education media like charts, posters and hand bills.
• Health education helps the worker helps to adjust the working, home and
community environment.
• The design of the building i.e., the type floor, walls heights, ceiling, roof, doors
and windows, cubic space all are in such a that to prevent the occupational
diseases.

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PAPER I COMMUNITY HEALTH NURSING

• Good housekeeping is necessary i.e., general cleanliness, ventilation. Lighting,

washing, food arrangement to prevent occupational hazards.
• Good general ventilation, efficient exhaust ventilation is needed to decrease
the airborne diseases.
• Machines are in such a way that prevents the accidents and hazards.
• Instead of using harmful substances, use harmless substances.
• Dust can be controlled by water sprays use of dust free resources.
• Enclosing the harmful materials and processes will prevent the escape of dust
and fumes.
• Isolation of offensive process in a separate building.
• Use of protective devices like ear plugs, ear muffs, helmets, safety shoes,
aprons, gloves, gumboots, barrier cream, screens and goggles.
• Employees should provide benefits like

a) Medical benefit
b) Sickness benefit
c) Maternity benefit
d) Disablement benefit
e) Dependent benefit
f) Funeral expenses
g) Rehabilitation allowances

Role & responsibility of MPHW(F) in prevention of occupational diseases

• Pre-employment examination is done by MPHW(F) as an occupational health
nurse. Eg: checking of height and weight, vision test, HB examination, urine
examination and general physical examination.
• She should do periodical examination for every 6 months.
• She should provide first aid and immunization services.
• She should provide Crèche services.
• Maintain health record of each individual worker.
• She should provide health education and counselling services.
• She should educate the importance of use of protective devices.
• She should provide good environmental condition.
• She should explain the use of employee benefits.

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SUMMARY

Occupational health is an important in the life of the workers. Workers of

different fields will expose to different occupational hazards and diseases. MPHW(F)
who is working in industries should mainly concentrate in prevention of occupational
hazards.

SHORT ANSWER TYPE QUESTIONS

1) Define occupational health?

2) List out the occupational diseases?

LONG ANSWER TYPE QUESTIONS

1) Explain role and responsibility of MPHW(F) in the prevention of occupational
hazards?

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UNIT XVI- DISASTER MANAGEMENT

Concept & Definition

Types and Management of disasters
Role and responsibilities of MPHW (F) in disaster management

Introduction

Emergencies and disasters do not only affect health and wellbeing of people.
Large number of people are displaced, injured and killed. Disasters occur anywhere
in the world and at any time.

Definition

It is defined as any occurrence that causes, damage, ecological disruption,

loss of human life or deterioration of health.

Types of disasters

Many types of disasters are there. They are

1) Earthquakes
2) Cyclones, floods, tided waves
3) Land sliders, volcanic eruptions
4) Tornadoes, fires, hurricanes, snow storms
5) Severe air pollution (smog), heat waves
6) Famines, epidemics, building collapses
7) Toxicological collapse, nuclear accidents warefare

Management of disasters

Mainly 3 basis aspects of disaster management.

a) Disaster response
b) Disaster preparedness
c) Disaster mitigation

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These three stages are called as Disaster Cycle

Disaster impact and response

• Due to sudden disaster, more number of injuries occurred.

• They need immediate medical treatment and emergency care of mass
casualties.
• This includes search and rescue, first aid, triage and stabilization of victim’s
hospital treatment and redistribution of patients to other hospitals.
• Relief phase: This starts from when help from outside starts to reach the
diseases.

Rehabilitation

• It is restoration of pre disaster conditions.

• It starts from the first movement of disaster.
• It includes water supply, food safety, basic sanitation and personal hygiene,
vector control.

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Disaster preparedness

• It is to ensure that appropriate systems, procedures and resources are in

place to provide prompt effective help to disaster victims.

Disaster mitigation

• It prevents hazards from causing emergency or to lessen effects of

emergencies. It includes food mitigation works, appropriate land use,
planning, improved building codes and protection of vulnerable population.

Personal protection in different types of emergencies

• Do not use the telephone, only to call for help.

• Listen to the messages by various media.
• Carry out the official instructions.
• Keep family emergency kit.

Roles and responsibilities of MPHW (F) in disaster management

Floods

During Floods

• Turn off the electricity

• Protect people and property
• Be aware of water contamination.
• Evacuate danger zones as ordered by the local authorities.

After floods

• Wait until the water declared safe before the drinking

• Clean and disinfect any room that has been flooded.
• Wash thoroughly all kitchen utensils.
• Thrown away all canned foods and foods kept in refrigerators.
• Keep aside all consumables (drinks, medicines, cosmetics etc)

Earth quakes

During earth quakes

• Keep calm, do not panic.

• Keep away from the stairs
• People who are indoors should stay there but move to the central part of the
building.
• People who are in outside should stay there.
• Keep away from buildings to avoid collapsing walls and away from electric
bulbs.
• If a person is in a vehicle, stop driving, keep vehicle away.

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After earth quakes

• Listen and follow instructions

• Do not enter into the damaged building
• Give first aid to the injured people.
• Keep emergency packages.
• Make sure that water is safe to drink and food stored at home is fit to eat.

SUMMARY

Disasters occur suddenly and it causes damage to the health and wealth.
Disasters, sometimes are manmade. Disasters are different types. It should be
managed by using different actions.

SHORT ANSWER TYPE QUESTIONS

1) Define disaster?
2) List the types of disasters?

LONG ANSWER TYPE QUESTIONS

1) Explain about disaster management?

2) Describe role of MPHW (F) during and after floods?

----------------------------------------------------------------------------------

BIBLIOGRAPHY

1) Park’s Text Book of Preventive and Social Medicine by K. Park, 24th Edition.

2) Multipurpose Health Worker (F) Text Book by Smt B. Suhasini, M.Sc. (N)
published by State Institute of Vocational Education, A.P., and Board of
Intermediate Education, 2012.

3) Essentials of Community Health Nursing by K. Park, 5th Edition

4) Text Book of Communicable Diseases by Dr. K. Raghava Prasad, M.D., and

Dr. Y. Srihari Rao, M.D., Telugu Academy, 2000

5) www.google.com

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Paper - II
HEALTH PROMOTION
INDEX

Unit - 1 Essential Nutrients 157

Unit - 2 Nutritional Problems 166
Unit - 3 Nutritional Assessments 177
Unit - 4 Promotion Of Nutrition 181
Unit - 5 The Human Body 188
Unit - 6 Mental Health 221
Unit - 7 Mal Adjustment 236
Unit - 8 Mental Illness 239
Unit - 9 Geriatric Nursing 247
Unit - 10 Counselling And Guidance 253
PAPER-II HEALTH PROMOTION

MULTIPURPOSE HEALTH WORKER (V) I YEAR SYLLABUS

THEORY PAPER-II
HEALTH PROMOTION

A.NUTRITION

1. ESSENTIAL NUTRIENTS 6-13

1. Introduction, 2. History of Nutrition, 3. Concepts of Nutrition,4. Keywords, 5. Essential

Nutrients, 6. Importance of Nutrition in Health & Sickness, 7., Essential Nutrients by
Functions, Sources & Requirements for Different Age Groups, 8. Classification of Foods &
Their Nutritive Value Balanced Diet for Different Age Groups, 9. General Dietary
Guidelines.

2. NUTRITIONAL PROBLEMS 14-23

1.Nutritional deficiencies,2. correction, treatment and referral anemia, in women 3.The role
of MPHW[F] in planning supplementary foods 4. Special diets of individuals for different
age group,

3. NUTRITIONAL ASSESSMENT 24-27

1.Methods of nutritional assessment of individual and family mother and child ,2. food fads,
taboos customs and their influences on health

4. PROMOTION OF NUTRITION 28-35

1.Life style and food habits ,2. Planning diets and special diets for a family -3. methods of
using locally- 4. available foods for special diets -5. principles and methods of cooking 6.
Promotion of kitchen garden -7. Food hygiene and safe preparation storage and preservation
–8. Food adulteration precautions during festivals and Melas

B.PHYSICAL AND MENTAL HEALTH

5.THE HUMAN BODY 36-71

1.Structure and functions of the human body 2. Body systems and their functions-Digestive
system,3. Respiratory system,4. Genito urinary system,5. Cardio vascular system,6. Nervous
system.7. Musculoskeletal skeleton system, 8.Endocrine system,9.Special sensory organs

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6.MENTAL HEALTH 72-88

1.Concept of mental health-Body mind relationship-factors influencing mental health

2.Characteristics of a mentally healthy person,3.Developmental tasks of different age groups,
4.Mental health services 5.Different defense mechanisms-Emotions 6.motivation7.Learning
8.Memory9.Thinking

7.MAL ADJUSTMENT: 89-91

1.Features of a mal adjusted individual-Common causes for mal adjustment,2.Relevance of

Adjustment to Nursing

8.MENTAL ILLNESS 92-100

1.Definition,2. Mis-conceptions about mental illness,3. Symptoms of poor mental health,4.

Causes of Mental illness,5. Classification of Mental Illness:6. Types of Mental Disorders,7.
Treatment of the Mentally ill:8. Abnormal Behaviour,9. Psychiatric Emergencies.

9.GERIATRIC NURSING 101-107

1.Definition,2. Aging process and changes,3. Healthassessment of Elderly,4. National policy

on Elderly,5. Nurses Responsibilities.

10.COUNSELLING AND GUIDANCE 108-110

1. Definition of Guidance,2. Characteristics,3. Types of Guidance,4. Counselling,5. Goals of

Counselling:6. Principles,7. Process of Counselling:8. Counselling skills,9. Characteristics of
Counsellor,10Types of Counselling,11Role of Nurse in Counselling.

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PAPER-II HEALTH PROMOTION

MULTI PURPOSE HEALTH WORKER(F)

I YEAR
THEORY PAPER-II
HEALTH PROMOTION
Allotted Hours-135
Learning Objectives
1. To know the definitions & terms involved in understanding the science of nutrition
2. Explain importance of nutrition in health & sickness
3. Promote nutrition of an individual,family, community.
4. Describe the importance cognitive aspects of the individual
5. Describe the balanced diet in promotion of health.
6. Apply this knowledge in providing Therapeutic diet in care of the sick
7. Domestic skills in selection, preparation & preservation of food
8. To highlight the importance of food faddism & faulty food habits.
9. To through light on the nutritional problems in India.
10. Describe the structure & function of the body.
11. Promote Mental health of family & community

A.NUTRITION
Introduction:
In ancient time, even before the dawn of civilization, human beings believed in live to eat or
eat to live notion because probably, these were the first & fundamental lessons they could
learn from the experience of existence & survival. According to Maharshi Charaka, the sage
& physician of ancient times, emphatically observed- The body is the outcome of the food",
the distinction between ease & disease arising, totally or Partially, due to faulty food or diet

History of Nutrition:
The science of nutrition is relatively a youngster in the scientific community & Isrecognized:
as a distinct discipline only in 1934. It emerged only after the development of the other
branch of science like chemistry, biology, etc.
The history of nutrition is divided into four eras:

• Naturalistic era (400 BC to 1750 AD)

• Chemical-analytical era (1750 to 1900)
• Biological era (1900 to 1955)
• Cellular or molecular era (1955 to present).
Human has evolved as omnivorous hunter-gatherer over the past 25Q,000 years. The diet of
early modern humans varied significantly depending on location & climate. The diet in the
tropics tended to depend more heavily on plant foods, while the diet at higher latitudes tended

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more toward animal products. Agriculture developed about 10,000 years ago in multiple
locations throughout the world, providing grains, farming also provided milk & dairy
products, sharply increased the availability of meats & diversity of vegetables.

Concepts of Nutrition
• We eat food to live, to grow, to keep healthy & well & to get energy for work & play.
• when-nutrient mixed with other nutrients they do their best for individual.
• Every nutrient has its specific role in body to perform.

Keywords:
Nutrient: A substance essential for the growth, maintenance, function & reproduction of a
cell or of an organism.
Nutrition: The science of food & its relationship to health.
Micro Nutrients: Required in small amounts but play an important role in the regulation of
metabolic activities, e.g., vitamins & minerals.
Macronutrients: Required in large quantity & form the bulk of our food e.g., proteins, fats
&carbohydrates.
Malnutrition: Impairment of health resulting from a deficiency, excess or imbalance of
nutrients
Lipid: A small water insoluble biomolecule generally containing fatty acids, sterols or
isoprenoid compounds.
Carbohydrates: Polyhydroxy aldehydes or polyhydroxy ketones or substance that yield such
compound or hydrolysis
Proteins: A macromolecule composed of one or more polypeptide chain, each with a
characteristic sequence of'' amino acids like peptide bonds.
Vitamins: An organic substance required in small quantities in the diet of some species,
generally functions as a component of a coenzyme.
Energy: Capacity to do work.
Food taboos: Religion based food habits like vegetarianism in Hindu society & prohibition of
pork in Muslim society.
Fluorosis: Fluoride toxicity.
Lathyrism: Paralyzing disease of human & animals by consuming "Khesari Dal"
Protein energy malnutrition (PEM): A wasting condition resulting from a diet inadequate in
either protein or energy or both.
Obesity: The generalized accumulation of excess adipose tissue in the body
Balance diet: A diet containing all essential (macro & micro) nutrients in optimum quantities
& in appropriate proportions that meet the requirements

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Calorie: Unit used to indicate the energy value of foods. Quantitative requirements are
expressed in terms of energy i.e. kilo calories (Kcals) unit for energy in K joules.
Basal metabolic rate (BMR): It is the rate of metabolism when an individual is at complete
rest in a worm environment& is in post absorptive state (12 hours after taking a meal.
Digestion: Digestion Is the mechanical & chemical process of breaking down food into its
smaller molecules, which can then be absorbed into the blood stream.

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UNIT-1
ESSENTIAL NUTRIENTS
Importance of nutrition in health & sickness
Essential nutrients
Essential Nutrients by Functions, Sources & requirements for different age groups
Classification of foods & their nutritive value
Balanced Diet for different age groups
General Dietary Guidelines

Importance of nutrition in health & sickness

1.1.1 Role of food:

• Promotes health & prevent diseases.

• Treats & control disease condition.
Food in the Prevention of Disease:
If a person takes balanced diet, i.e. the right kind of foods in the required amounts, he or
she will maintain good health provided no other factors intervene. Contrary to this, poor
eating habits or eating too much or too little will result in poor health. Malnutrition is like two
sides of the same coin.

• Reduced intake of food for specific nutrients leads to nutritional deficiency disorder
such as PEM, vitamin A deficiency or anemia.
• It may lead to degenerative diseases. Fibers have a valuable role to play in the
prevention of disease.
Food as Therapy
Food as a whole & nutrients alone in medicinal form (oils, syrups, capsules & tablets) are
used to treat disease. Diet is an important part of treatment for patients with metabolic
disorders such as diabetes. Special dietary modification is often necessary to maintain the
lives of patient who have chronic kidney disease, heart, liver & gastrointestinal disorders.
Similarly, dietary modifications are also essential in other situations such as burns, bone
fracture & in surgical conditions. Deficiency of a single nutrient is rare. If it does exist, it can
be corrected by adding the specific nutrient through the diet or supplementation.
Diseases that are not directly related to food & nutrients, for example chicken pox, measles,
malaria, infectious diseases, etc. Similarly, high intake of fats, especially saturated fats &
cholesterol is believed to be a cause of deposition of fats in arteries which leads to narrow of
the vessels also known as atherosclerosis, a leading cause of cardiovascular diseases. In such
diseases diet cannot cure the disease but can prevent the progression & prevent associated

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complications. Thus, diet therapy helps patient lead a quality life, without which the disease
can become uncontrolled. Mild conditions can be controlled by diet alone.
Role of nutrition in maintaining health

• Good rich in nutrient values provides individual strong immunity to fight against
various dreadful diseases like tuberculosis
• Good nutrition is important for optimal growth & development of Child
• There are so many diseases which are directly or indirectly related to food & nutrition
of individual such as diabetes, mellitus, coronary heart diseases, renal diseases, etc.
• There are so many deficiency diseases caused by poor nutrition called nutritional
deficiency diseases protein-energy malnutrition, goiter, anemia, blindness
• our lifestyle with proper nutrition, health habits & exercise program will affect our
health & will reduce medical care expenditures.

Essential nutrients
There are 6 essential Nutrients

• Carbohydrates
• Proteins
• Fats
• Vitamins
• Minerals
• Water
Essential Nutrients by Functions, Sources & requirements for different age
groups

Table 1.1 Essential Nutrients their functions, sources & their requirements

S. Essential Nutrients Functions Sources Requirements

No
1. Carbohydrates • Chief source of starches, 300-400gms per day
energy Sugars
2. Proteins • Developing of Milk, Milk 1.5-2 gm/kg body
new tissues. Products, weight in case of
• Repair & Dry fruits, children & lactating
maintenance of Eggs, meat, women.
body tissues Fish
• Synthesize
hemoglobin
enzymes
3. Fats • Increase flavor Ghee, 10-20gms /day
& taste of food Butter, Fish, Young Children need
• Absorption of oils, 25%extra amount of
fats & soluble Coconut oil fat
vitamins(ADKE)
• Provide support
for internal vital

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organs
• Prevent heat loss
from the body

Table 1.2 Essential Nutrients (Vitamins fat soluble) their functions, sources & their
requirements

Vitamin Functions Sources Requirements

Fat
Soluble:
Vitamin A Vitamin A(Retinol): Helps in vision Vitamin: Carrot, papaya, Adult:750µg
Milk& eggs. Infants 300-
400µ g
Children 400-
600µ g
Pregnancy
750+400µ g
Lactation
750+400µ g
Vitamin D Vitamin(Cholecalciferol): Vitamin D: Fish& cod Infants &
Increasesintestinalabsorbtion, liver oil. children 10µg
Mineralization of Bones & teeth. Adults 7.50µg
Pregnancy&lac
tation 15µg

Vitamin E Vitamin E (Anti sterility Vitamin): Vitamin: Oils, Eggs, Meat 10mg
Prevent& delay aging process
Vitamin K Vitamin K (Antihaemorrhage) Vitamin K: Green leafy 30mg
vitamin): Helps in clotting vegetables, Cereals Fruits

Table 1.3 Essential Nutrients (Vitamins Water soluble) their functions, sources & their
requirements
Vitamin Functions Sources Requirements
water
Soluble:
VitaminB1 VitaminB1(Thiamine):Maintenanc Meat,Eggs, cereals, nuts. Children: 0.5-
e of good appetite& digestion. 1.0mg
VitaminB2 VitaminB2(Riboflavin):Helps in Green leafy 2mg
protein,fat,carbohydrate vegetables,liver.
metabolism
VitaminB4: VitaminB4(Niacin):Helps in Yeast,Germinating seeds 10-15mg
Normal functioning of skin &
nervous system.
VitaminB6 VitaminB6(Pyridoxine):Helps in Wheat,legume. 1.5mg
metabolism of amino acids.
VitaminB12 VitaminB12(Cyanocobalamin):Nec Liver,Meat. Children-0.2-
essary for DNA synthesis & RBC 1.0µg
production. Adults,

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Pregnancy &
laction:1.0µg
Vitamin C Vitamin C:Wound Healing,anti- Citrus Fruits Infants :20mg
Oxidant Children:40mg
Adults:40mg
Pregnancy &
laction:80mg
Table 1.4 Essential Nutrients (Minerals)their functions, sources & their requirements
Type of Functions Sources Requirements
Mineral
Calcium • Formation&maintenance of Fish, Milk,Dry Fruits Children &
bones & teeth adult-400-500
• Coagulation of blood mg.
Pregnant &
lactation:1000
mg
Phosphorus • Helps in regulation of Ph of Meats, poultry, fish Adults:2.5-5
blood & urine. mg
• Gives rigidity to bones & Children:5-
teeth 6mg
Sodium • Maintenance of body fluids Common salt Min-1-2 gm
• Smooth functioning of Average: 8-
nerve muscles, & body cells 10gm
Potassium • It Constitute an important Goa, Citrus fruits 2-5 gm
cation of the body
Iron • Helps in oxygen transport & Liver,Meat,Fish Children &
cellular respiration adult-20mg,25-
30mg,
Infants-
1mg.Pregnancy
& lactation-40
mg
Iodine • For synthesis of thyroid Sea foods,sea Fish 0.12-0.15 mg
hormone T4& T3
Fluorine Essential for normal mineralization Drinking water,Sea fish 0.5-0.8mg per
of bones & formation of dental liter in water
cement
Water It acts as a carrier of nutritive River water, Lakes, Four-Five liters
elements to tissues & removes Canals. Rain water per day
waste material from tissues

Classification of foods& their nutritive value

Classification of foods is mainly four types
1. By its origin
2. By chemical composition
3. By Predominate functions

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4. By Nutritive value

By its origin two types

Food of animal origin
1. milk & milk products
2. animal foods -meat,fish,& eggs
3. fats & oils

Food of Plant Origin

1. Cereals & Millets
2. Pulses
3. Nut &Oil Seeds
4. Vegetables
5. Fruits
6. Sugar & Jaggery
7. Condiments & Spices
8. Miscellaneous Food Beverages
By its chemical composition
1. Carbohydrates
2. Proteins
3. Fats
4. Minerals
5. Vitamins
6. Dietary fibers
7. Water
By its predominant functions
1. Energy yielding foods :Rich in carbohydrates, Fats eg:Cerials,Sugars,oils
2. Body building foods: Rich in proteins Eg: Milk& milk products, Pulses& meat
3. Protective foods: Rich in vitamins & minerals Eg: Milk, egg, green leafy vegetables,
Fruits

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By Nutritive valve
Table 1.5 Classification of foods & their examples
S. No Foods Examples
1. Cereals Millets Rice,Wheat,Maize,Ragi
2. Pulses Peas,Beans
3. Nuts & Oil Seeds Groundnut,Coconut,Cashewnut
4. Vegetables Green Leafy Vegetables
5. Fruits Apple,Banana
6. Milk & Milk Products Butter,Ghee,Cheese
7. Animal Foods Meat,Fish,Egg
8. Fats & Oils Fish liver Oil
9. Sugar & Jaggery Sugar & Jaggery
10. Condiments & Spices Pepper, Clove, Turmeric
11. Miscellaneous Coffee, Tea,Soft Drinks

Balanced Diet for different age groups

A healthy diet is one that helps to maintain or improve overall health. A healthy diet provides
the body with essential nutrition: fluid, adequate amino acids from protein, essential fatty
acids, vitamins, minerals, fiber & adequate calories.

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Figure 1.1 Balanced Diet for different age groups

Fig 1.2: Food pyramid designed by ICMR

General Dietary Guidelines:
The following general dietary guidelines are suggested by ICMR to plan balanced diets.

• Eat variety of foods to ensure a balanced diet.

• Ensure provision of extra food & healthcare to pregnant & lactating women.
• Promote exclusive breastfeeding for six months
• Feed home based semi solid foods to the infant after six months.
• Ensure adequate & appropriate diets for children, adolescents
• Eat plenty of vegetables & fruits.
• Ensure moderate use of edible oils & animal foods & limit use of ghee/butter
• Avoid overeating to prevent overweight & obesity
• Exercise regularly & be physically active to maintain ideal weight
• Ensure the use of safe & clean foods

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• Adopt right pre-cooking processes & appropriate cooking methods.

• Drink plenty of water & take beverages in moderation.
• Minimize the use of processed foods rich in salt, sugar & fat.

Review questions:
1.What is the importance of nutrition in Health and sickness?
2.Explain about the role of Nutrition in maintaining health.
3. Explain about the essential nutrients of the body.

4. Explain about various classifications of foods and their nutritive values.

5.Explain briefly about Balanced diet for different age-group

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UNIT-2
NUTRITIONAL PROBLEMS
Nutritional Deficiencies in India
Anemia
Role of MPHW in nutritional education
Special diets of individuals for different age groups

Nutritional Deficiencies in India

Nutritional Deficiencies

Protein energy Micro nutrient Eating disorders

Chronic diseases
malnutrition deficiency

Protein Energy Malnutrition (PEM)

• It refers to a form ofmalnutrition where there is inadequate protein & calorie

intake
• It is considered as the primary nutritional problem in India
• PEM is due to the "food gap" between the intake & requirement
• Causes childhood morbidity & mortality

Kwashiorkor
PEM

Marasmus
Marasmic -
kwashiorkor

Causes & risk factors:

• Inadequate intake of food

• Diarrhea
• Respiratory infections

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• Measles
• Intestinal worms
• Infants &preschoolers

Contributory factors

• Poor environmental conditions

• Large family size
• Poor maternal health
• Failure of lactation
• Premature termination of breast feeding
• Use of over diluted cow’s milk.
KWASHIORKOR
Kwashiorkor is the most common & widespread nutritional disorder in developing countries.
It is a form of malnutrition caused by not getting enough protein in the diet

Fig:1.3 kwashiorkor baby

MARASMUS

• Marasmus is a severe form of malnutrition that consists of the chronic wasting

away of fat, muscle, & other tissues in the body.
• Malnutrition occurs when the body does not get enough protein & calories.
• This lack of nutrition can range from a shortage of certain vitamins to complete
starvation.
• Marasmus is one of the most serious forms of protein-energy malnutrition
(PEM) in the world.

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Fig :1.4 Marasmus baby

MARASMIC KWASHIORKOR

• A malnutrition disease, primarily of children, resulting from the deficiency of

both calories & protein.
• The condition is characterized by severe tissue wasting, dehydration, loss of
subcutaneous fat, lethargy, & growth retardation

Fig:1.5 MiasmicKwashiorkor
Table 1.6 kwashiorkor & marasmus comparative
chart
S.n Kwashiork Marasmus
o or
1 Acute Severe
illness/infect prolonged
ions, starvation.
chronic/recu chronic/recu
rring rring
infections infections
measles,
AGE,
trauma,
sepsis are
some causes
2 protein are Calories &
principal protein are
nutrients principal
nutrients
3 18 months 6 months to
to 3 years 2 years
4 Rapid. acute Chronic,
onset slow onset
disease

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condition
5 Some Severe
weight loss weight loss
6 Mortality Low
mortality
unless
related to
underlying

Prevention

• Oral rehydration therapy helps to prevent dehydration caused by diarrhea

• Exclusive breast feeding for 6 months thereafter supplementary foods may be
introduced along with breast feeds
• Immunization for infants & children
• Nutritional supplements
• Early diagnosis & treatment
• Promotion & correction of feeding practices
• Family planning & spacing of birth
• Periodic surveillance
• Nutritional rehabilitation
Low birth weight (LBW)
An LBW newborn is any newborn with a birth weight of
less than 2.5 kg (including 2.499 kg) regardless of gestational age.

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Fig:1.6 Low birth weight

Risk factors
Maternal malnutrition
Anemia
Causes
1. Illness & infections
2.Short maternal stature
3.Very young age
4.High parity
5.Close birth intervals
6.IUGR
7. Hard physical labor during pregnancy

8.Smoking
Prevention
• Identification of mothers at risk – malnutrition, heavy work load, infections, disease
& high BP
• Increasing food intake of mother, supplementary feeding, distribution of iron & folic
acid tablets.
• Avoiding if smoking
• Improved sanitation methods
• Improving health & nutrition of young girls
• Early detection & treatment of medical disorders – DM HTN
• Controlling infections – UTI, rubella, malaria.
Vitamin A deficiency:
Xerophthalmia
Xerophthalmia i.e., dry eyes refer to all the ocular manifestation of vitamin A deficiency in
man.
It is the most widespread & serious nutritional disorder leading to blindness.
Risk factors Clinical features
1. Faulty feeding practices 1. Corneal ulcers
2.Weaning 2. Softening of cornea
3.PEM 3. Keratomalacia

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4.Infections 4. Bitot spot

5.1-3 years
Prevention &
control

• Administering large doses of Vitamin,An orally on a periodic basis

• Regular & adequate intake of Vitamin A
• Fortification of certain food with vitamin A – sugar, salt, tea, & skimmed milk.

Fig:1.8 Bigot spot Fig:1.9 Xerophthalmia

Anemia
Anemia is a condition where the hemoglobin content of blood is lower than normal as a
result of a deficiency of one or more essential nutrients, regardless of the cause of such
deficiency.

Table 1.7 Age Groups and their Hemoglobin percentage

Age groups Normal Hemoglobin %
Adult male 13.8 to 17.2 gm/dL
Adult female 12.1 to 15.1 gm/dL
Pregnant woman 11 to 12 g/dL
Children 11 to 16 g/dL

Risk factors Causes

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• Infants & children 1.Inadequate diet

• Pregnant women 2.Insufficient intake of iron
• Pre-menopausal women 3.Iron malabsorption
• Adolescent girls 4.Pregnancy
• Older adults 5.Excessive menstural bleeding
• Alcoholism 6.Hook worm infestation
• Chronic / critically ill. 7.Malaria
• Excessive exercise 8.Close birth intervals
Clinical Manifestations:

• Lethargy
• Fatigue
• Anorexia
• Intolerance to cold
• Weakness
• Shortness of breath
• Pallor
• Insomnia
• Headache
Effects of Anemia during Pregnancy
• Increases risk of maternal & fetal morbidity & mortality
• Abortions, premature births, PPH, low birth weight are associated with anemia during
pregnancy.
Prevention

• Estimation of Hb to assess degree of anemia

• Blood transfusion in severe cases of anemia (<8g/dL)
• Iron & folic acid supplements
• Food fortification with iron
• Changing dietary habits
• Control of parasites
• Nutritional education & awareness.
Obesity (Over weight):
Obesity is an epidemic disease, which consists of body weight that is in excess of that
appropriate for a person’s height & age to account for differences, leading to an increased
risk to health-related problems.
Over-weight & obesity are defined as abnormal or excessive fat accumulation that presents a
risk to health. A crude population measure of obesity is the body mass index (BMI), a
person’s weight (in kilograms) divided by the square of his or her height (in meters). A
person with a BMI of 30 or more is generally considered obese.

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Causes

• Family lifestyle
• Smoking
• Unhealthy diets
• Age
• Pregnancy
• Certain medical problems & medications
• Genes
Diseases caused by Obesity

• Liver disease
• Type 2 diabetes
• Mood disorders
• Hypertension
• Reproductive disorders
• Heart diseases
• Cancer risks
• Dyslipidemia
Role of MPHW in nutritional education:
• Nutrition education is a major intervention for the prevention of malnutrition,
promotion of health & improving the quality of life
• Nurse has many opportunities of influencing people & helping them towards better
eating habits
• A Nurse can guide people to choose optimum & balanced diets, remove prejudices &
promote good dietary habits
• In hospital areas the nurse should teach patients regarding therapeutic diets.
Special diets of individuals for different age groups:
Diet for Infants:
Breast milk is the natural food for infant. Colostrum, the first few days secretion from
mammary gl&s contain interferon like substance possessing antiviral activity. It is rich in
protein & vitamin A.
Breast milk alone is not able to provide sufficient amounts of all the nutrients needed to
maintain growth after the first 6 months. If the baby is to maintain the expected rate of
growth & remain healthy & well-nourished, supplementary feeding has to be restored to
around sixth month of life.
Weaning begins the moment supplementary food is started & continues till the child is taken
off the breast completely.

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Table1.8: Guidelines for Weaning process

Age Supplementary foods Frequency of supplements
(breastmilk continued)
4-6 months Fruit juices, mashed banana Start with 1 feed/day,
with milk, cow’s milk (if gradually increase the
Liquids tolerated), porridge from frequency to 3 feeds/day by
wheat flour, ground rice, ragi, 6th month of age
ground millet, cod liver oil.
6-9 months Mashed banana, mango, 4-5 times/day
chickoo ripe, boiled egg yolk
Semisolids with milk, mashed rice with
dal, mashed vegetables,
chapati softened with milk,
green leafy vegetables can be
added to dal.
9-12 months Fruits, cut finely or slewed. 4-5 times/day
Khichdi, idli, upma, curd
Solids rice, chapati,Varietyof
vegetables, egg, minced meat
, fish.

Points to be considered in introducing weaning foods:

1. Introduce only one food at a time
2. Allow the infant to become familiar with the food before trying to give another
3. Give very small amounts of any new food at the beginning, for example, one teaspoonful
or less.
4.Use very thin consistency when starting solid foods. Gradually the consistency is made
more solid as the infant learns to propel the food back with the help of tongue.
5.Food should be only slightly seasoned.
6.At first strained fruits, vegetables & cereals are given.
Diet for Pre-school children:
In the succeeding period of 1-2 years, the same diet may be continued with slightly increased
quantities. Food from all food groups are to be included to provide a balanced diet for the
child.
Special dietary guidelines:

• Pre-school child should have 2 small servings of protein-rich foods eg: chapatis, puris
can be made into shapes or can be served in attractive plates.
• Foods should be slightly seasoned
• Child should never be hurried while taking food
• Foods like tea, coffee should be restricted as they overstimulate the system

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Diet for school children:

School lunch programprovides about 300kcal. With right guidance & nutrition education
children learn to prefer healthy foods such as carrots, raisins & low-fat dishes.
Diet for Adolescents:
It is during this period that the final growth spurt occurs.
Diet in adolescents is very significant because it influences the future nutritional status.

• Adequate well balanced nutritious foods should be taken to prevent obesity or

undernutrition
• An adolescent girl should take enough calcium rich foods in her diet to increase bone
density which delays the onset of osteoporosis.
• Iron rich food may be included in the diet to prevent anemia.
• Include fruits & vegetables.
Diet for expectant mothers:
Diet during pregnancy should contain larger amounts of ‘tissue building’ & ‘protective foods’
without any greater increase in the ‘energy-yielding’ foods.
Diet during Lactation:
In a mother’s life, this is the stage in which she requires maximum nutrients.

• Number of meals can be increased

• Diet can include lactose which stimulate the production of milk. Garlic, almonds,
milk, meat, fish, mutton increase the secretion of breast milk. Special foods like sonth
laddu, gond laddu etc. are given during lactation.
Diet during Old age
Thin foods (other than pure water taken alone in small sips) may need to be avoided.
Thickening agents in foods can be used.
Elders usually should not prefer sweets, salty foods or fried foods.
Certain whole pulses may produce flatulence in the elderly age. Hence such pulses should be
avoided in diet. Sulphur containing vegetables are avoided if they produce gas & discomfort.

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Modification of diet during Old age:

• Foods rich fiber should be given.

• Foods rich in calcium like milk should be given
• Green leafy vegetables can be given liberally.
• Clear soup at the beginning of the meal.
• Small & frequent meals instead of three heavy ones
• A glass of hot milk just before going to sleep
• Plenty of fluid.

Review Questions:
1.Explain about different Nutritional deficiencies and their prevention/treatment.
2.Explain the role of MPHW in planning supplementary foods.
3. Briefly discuss about the special diets for different age groups.

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UNIT-3
NUTRITIONAL ASSESSMENTS
Methods of Nutritional Assessments:
Food fads, taboos customs & their influences on health

Methods of Nutritional Assessments:

The methods employed include:
1. Clinical examination
2. Anthropometric measurement
3. Laboratory & biochemical examination
4. Dietary examination
5. Study of vital statistics
6. Assessment of ecological factors
1. Clinical examination:

The goal is to assess the levels of health of individuals or by population groups in relation to
the food they consume. It is a head to foot examination
2. Anthropometric measurements:

Anthropometric measurements such as weight, height, median circumference, head

circumference & skinfold thickness are valuable indicators of nutritional status.
Mid-arm circumference:

• It is measured at the midpoint of the left upper arm

• Midpoint is marked by making central point of the distance between the olecranon of
the ulna & the acromion of the scapula, when the arm is at the elbow.
• The left arm will be hanging on the side. With a steel tape, the circumference of the
arm is measured by passing it around the arm applying firmly.
3. Laboratory & biochemical examination:

Laboratory tests:
Hemoglobin: The estimation of hemoglobin plays a vital role in health in nutritional
surveys, as it acts as a major index for overall nutrition state.
Stool & urine: Stool examination would detect any intestinal parasites present. Urine can be
examined for albumin and sugar.

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Biochemical tests:
Biochemical tests ate time consuming & expensive & hence they cannot be applied in large
scale. Most of the biochemical tests would give information about the current nutritional
status.
4. Dietary examination:

1.Weighing of raw foods.

2.Weighing of cooked foods
3.Oral questionnaire methods are analyzed.
5. Study of vital statistics:

Vital statistics here involve mortality & morbidity data in a community.

6. Assessment of Ecological factors:

In any nutritional survey, it is necessary to collect certain background information of the

given community in order to make the assessment complete.

• Conditioning influence: Bacterial, viral & parasitic agents (amebiasis, ascariasis, etc.)
• Cultural influence: Food habits & practices. Cooking beliefs & taboos, child-rearing
practices, feeding of pregnant or lactating mothers
• Socioeconomic factors: Family size, occupation., education, income, housing,
expenditure on food.
• Food production: Customs related to the methods of cultivation (of food, storage &
distribution
• Health & educational services: The number of hospitals & health personnel,
preventive & curative services, mass media & communication.
Food fads, taboos customs & their influences on health:
Economic factors
1. Caste system: Data from the National Family Health Survey-III (2005-2006) documents -
mug, wasting, underweight & anemia in children are higher among lower castes: Postnatal,
infant, child & under five statistics clearly show a higher mortality ng the SCs & STs.
Problems in accessing health care is higher among the lower castes. Caste is linked to socio-
economic status India.
2. Economic status: Families belonging to higher economic status usually have good food
better access for health care. Awareness of nutritional facts & governmental schemes is better
in this category.
People belonging to poverty have problem with respect to food at all levels—availability,
affordability & access.
3. Education: Usually educated families have less faddism & superstition. Those who are
minimally educated have less technical skills & unable to secure employment to earn a
satisfactory living wage.

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4. Time spent on the family: The working mother may not have enough time for shopping &
for preparing meals. Children being neglected applies not only in families of low socio-
economic status but also in higher socio-economic status.
Cultural influences:

• People choose poor diets when good ones are available because of cultural influences.
These vary from country to country & region to region.
• Family plays an important role in shaping the food habits. These habits are passed
from one generation to another. Rice eaters may not be happy to include other cereals
in their diets.
• Customs & beliefs apply most often to vulnerable groups—infants, toddlers,
expectant mothers.-. & lactating women. Papaya is avoided during pregnancy because
it is believed to cause abortion. In some communities, fresh fruits & vegetables are
avoided during certain period There is wide spread belief that if a pregnant woman
eats more, her baby will be big & delivery would be difficult. Some families avoid
certain combination of foods due superstitious beliefs.
• Religion & caste have a powerful influence on the food habits of the people. Hindus
not eat beef & Muslims pork. Some orthodox Hindus & Jains do not eat meat, fish,
egg. & certain foods like onion & garlic. These are known as food taboos which
prevent people from consuming nutritious food, even though they can afford. Fasting
may affect families who belong to low socio-economic status.
• Food faddisms, that is, irrational views & prejudices about food are not confined only
to developing countries. Food myths, fads & fallacies are held tenaciously in all
communities. In some communities, men eat first & women eat last & left overs.
When resources are limited, women are neglected.
Life style & food habits:

• Families are changing their life style & they lead sedentary lives & eat junk food.
Children who spend over three hours a day watching television are at a higher risk of
life le diseases. After people started using computers, vehicles, cell phones, grinders
& washing chines, the physical activity levels decreased. Even in some schools, too
much importance given to class-room learning & physical activity is neglected.
• Eating balanced diet is becoming difficult as more & more junk foods outlets are
opened. Foods rich in salt (chips), sugar (sweets) & fats (cakes) come under the
category of junk s. Foods made of maida like noodles are not nutritious. Rich people
imitate western & fiddle class imitate rich in following food habits. Sweetened drinks
are expensive & do not give any nutrients other than calories. Children can also be
malnourished in families who are economically well off. There is need to change
present life-style pattern to prevent obesity, hypertension, diabetes, joint pains & even
psychological problems.
Production & Distribution:
Uneven distribution between the countries & within the countries occurs. Uneven food
distribution can take place even at household level.

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Health Condition:
Pathological changes that occur in disease condition affects food consumption. Gastro-
intestinal disorders like oral cancer, tumors or strictures in throat or esophagus& cancer of the
stomach & intestine can affect food intake. The disease & the treatment cause nausea,
vomiting & loss of appetite. Symptoms like anorexia & diarrhoea can affect the food
consumption. Infections can also affect the food consumption pattern.
Man eats what his forefathers ate. & what his environment offers, A young child does not
form fixed food habits but is patterned by adults, who eat certain foods & not others. The
environment, the physical, psychological & social setting which relate to the culture of a
group & health condition of an individual determine the food patterns & nutritional status.
Review Questions:
1. What are the different methods of Nutritional assesments

2. Explain about food fads, taboos customs and their influences on health

3.Discuss about local foods and their importance

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UNIT-4
PROMOTION OF NUTRITION
Life style and food habits:
Planning Diets and Special Diets for a Family:
Methods of using locally available foods for special diets
Promotion of Kitchen Garden:
Methods of Cooking:
Food hygiene- Importance & safety:
Storage and preservation of Food:
Food adulteration:
Food hygiene during festivals and Melas:

Life style and food habits:

Families are changing their life style and they lead sedentary lives and eat junk food.
Children who spend over three hours a day watching television are at a higher risk of life le
diseases. After people started using computers, vehicles, cell phones, grinders and washing
chines, the physical activity levels decreased. Even in some schools, too much importance
given to class-room learning and physical activity is neglected.
Eating balanced diet is becoming difficult as more and more junk foods outlets are opened.
Foods rich in salt (chips), sugar (sweets) and fats (cakes) come under the category of junk s.
Foods made of maida like noodles are not nutritious. Rich people imitate western and fiddle
class imitate rich in following food habits. Sweetened drinks are expensive and do not give
any nutrients other than calories. Children can also be malnourished in families who are
economically well off. There is need to change present life-style pattern to prevent obesity,
hypertension, diabetes, joint pains and even psychological problems.
Production and Distribution:
Uneven distribution between the countries and within the countries occurs. Uneven food
distribution can take place even at household level.
Health Condition:
Pathological changes that occur in disease condition affects food consumption. Gastro-
intestinal disorders like oral cancer, tumors or strictures in throat or esophagus and cancer of
the stomach and intestine can affect food intake. The disease and the treatment cause nausea,
vomiting and loss of appetite. Symptoms like anorexia and diarrhea can affect the food
consumption. Infections can also affect the food consumption pattern.
Man eats what his forefathers ate. and what his environment offers, A young child does not
form fixed food habits but is patterned by adults, who eat certain foods and not others. The
environment, the physical, psychological and social setting which relate to the culture of a
group and health condition of an individual determine the food patterns and nutritional status.

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Planning Diets and Special Diets for a Family:

Break Fast:
You can skip your lunch or dinner but never mess with breakfast. According to a balanced
Indian healthy food diet plan, take a cup of tea with two slices of toast. You can also choose
to eat milk and cereal or two Idlis or an Uthapam.

A Mid-day Snack:
If you have your breakfast at 8 a.m., have a small snack around 10 a.m. To maintain Indian
diet plan, you may eat a small bowl of yogurt. Seasonal fruits serve as wonderful mid-day
snacks. Have a cucumber or an orange or any other fruit you like.

Lunch Time:
Don't stuff yourself heavy with a lot of food. Keep it simple and the portions must be small.
Two roti’s or a small bowl of rice with a bowl of vegetable and dal is ideal within the Indian
healthy diet plan for vegetarians. You can also have a piece of fish or 2-4 pieces of chicken.
Having a bowl of salad is must in Indian diet plan.
Munch On Something:
If you feel hungry, then have a snack at 4-4.30 p.m. Have some almonds or walnuts. You
may choose popcorn as an evening snack but don't use butter with it.

Dinner Time:
Indians almost never have dinner before 10 p.m. Try to avoid this habit to be happy and
satisfied with your food. 8-9 p.m. is good time to have your dinner. The food gets enough
time to be digested during the night. You can have the same food as lunch but try to avoid
rice.

Sum up with Something More :

Around 10-10.30 P.M, have a glass of milk or any seasonal fruit before going to bed. A cup
of watermelon or an apple is good to have at this time. Never forget to have plenty water
throughout the day. Hopefully this Indian diet plan can keep you happy as it helps to maintain
weight and can satisfy your cravings at the same time.. You may make changes to the diet
plan as and when required. For instance, you may choose to use olive oil instead of sunflower
oil. Along with this diet plan, follow aregular workout routine to see the best results.

Methods of using locally available foods for special diets

Vegetarian Diets:
A vegetarian diet is one which excludes meat. Vegetarians also avoid food containing by-
products of animal slaughter, such as animal-derived rennet and gelatin.[2]

• Fruitarian diet: A diet which predominantly consists of raw fruit.[3]

• Lacto vegetarianism: A vegetarian diet that includes certain types of dairy, but
excludes eggs and foods which contain animal rennet.[4] A common diet among

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followers of several religions, including Hinduism, Sikhism and Jainism, based on the
principle of Ahimsa (non-harming).[5]
• Ovo vegetarianism: A vegetarian diet that includes eggs, but excludes dairy.
• Ovo-lacto vegetarianism: A vegetarian diet that includes eggs and dairy.[4]
• Vegan diet: In addition to the abstentions of a vegetarian diet, vegans do not use any
product produced by animals, such as eggs, dairy products, or honey.[2] The vegan
philosophy and lifestyle is broader than just the diet and also includes abstaining from
using any products tested on animals and often campaigning for animal rights.

Semi Vegetarian Diet:

Semi-vegetarianism: A predominantly vegetarian diet, in which meat is occasionally

consumed.

• Pescatarian diet: A diet which includes fish but no other meats.

• Plant-based diet: A broad term to describe diets in which animal products do not form
a large proportion of the diet. Under some definitions a plant-based diet is fully
vegetarian; under others it is possible to follow a plant-based diet whilst occasionally
consuming meat.[8]
• Proletarian: someone who eats chicken or other poultry, but not meat from mammals,
often for environmental, health or food justice reasons.
• Pollo-pescatarian: someone who eats both poultry and fish/seafood, though no meat
from mammals.

Low Calorie Diets:

• Intermittent fasting: Cycling between non-fasting and fasting as a method of calorie

restriction.
• Body for Life: A calorie-control diet, promoted as part of the 12-week Body for
Life program.
• Cookie diet: A calorie control diet in which low-fat cookies are eaten to quell hunger,
often in place of a meal.
• The Hacker's Diet: A calorie-control diet from The Hacker's Diet by John Walker.
The book suggests that the key to reaching and maintaining the desired weight is
understanding and carefully monitoring calories consumed and used.
• Nutrisystem’s Diet: The dietary element of the weight-loss plan from Nutrisystem,
Inc. Nutrisystem distributes low-calorie meals, with specific ratios of fats, proteins
and carbohydrates.
• Weight Watchers diet: Foods are assigned point values; dieters can eat any food with
a point value provided they stay within their daily point limit.
Promotion of Kitchen Garden:
• Department of horticulture and social forestry should encourage production of green
leafy vegetables , fruits and vegetables which are rich in micronutrients like vitamin
A, iron and vitamin C.
• Identifying less familiar local fruits and vegetables
• Promoting production and consumption of non-conventional foods

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• Krishi Vigyan Kendra’s to emphasize on the production and consumption of fruits

and vegetables, through demonstration, vocational training, in-service training and on-
farm research.
• School gardens and kitchen gardens to be encouraged.
• Strengthening linkages between the infrastructure of agriculture (Horticulture),
Nutrition (ICDS,FNB) and Maternal Child Health (MCH) with a view to ensure
nutrition oriented horticulture activities at village level.
Purpose of cooking:
Cooking is an art. It is linked with the habits and cultural pattern of the people. Food
preparation requires creativity in blending of flavor, texture as well as color.
Aims and objectives of cooking food:
• Cooking makes food attractive in appearance
• Cooking makes food soft, making it easily chewable.
• Cooking partly sterilizes food.
• Cooking also improves storage quality of food. Boiling sterilizes milk, which can then
be stored for a longer time.
• Cooking helps to make food more digestible.
• Cooking helps to provide a balanced diet.
Methods of Cooking:
Heat can be transferred to food by conduction, convection, radiation or microwave energy.
Conduction:
In conduction, heat flows from source to food. For efficient conduction from one hot surface
to another, the area of contact has to be as large as possible. Hence the bottom of pans should
be flat and thick, e.g. Steaming, poaching.
Convection:
When a liquid or air is heated, the parts nearest to the heat becomes warm and less dense.
Roasting is mainly by convection, e.g. baking.
Radiation:
When heat radiations reach foods, only the surface is heated by them. They do not penetrate
the food. The rest of the food is cooked by conduction and to a less extent by convection, e.g.
boiling or toasting of bread.
Cooking media:
• Cooking in Air: Grilling, roasting and baking take place in air. The term roasting is
used to cook meat and baking is used for breads, buns, cakes, biscuits etc. Food is
cooked partially in dry heat and partially in moist heat.
• Cooking in Water: Boiling or simmering involves cooking in water. Some of the
different methods of cooking include roasting, baking, frying, boiling, poaching,

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steaming, stewing, braising, broiling and grilling.

• Roasting:Roasting includes the following types:
1. Split roasting: Is done only with good quality meat. The food is brought in contact
with direct flame in front of a bright fire.
2. Oven roasting:This is done in a closed oven.Meat, poultry and vegetables are put
into a fairly hot oven for 5-10 minutes and temperature is lowered to allow the joint to
be cooked.
3. Pot roasting: This is for cooking small joint and birds when no oven is available.

• Baking: Bread, cakes, pastries, puddings, potatoes and vegetables are cooked by
baking. The food is surrounded by hot air in a closed oven.
• Frying: Two types of frying are shallow fat frying and deep fat frying.
Shallow fat frying: This method is applied to precooked food unless the food takes
very little time to cook (omelet, liver etc.).
Deep fat frying: Sweets and savories can be cooked by this method. Food cooked by
deep fat frying has a better look than that cooked by shallow frying, as food is evenly
browned.
• Boiling: Food is cooked by surrounding it by boiling or simmering liquid (stock or
water). Only sufficient amount of liquid should be used just to cover the items to be
cooked.
• Poaching: Poaching is cooking slowly in a minimum amount of liquid, which is not
allowed to boil, but kept below boiling point. Fish, eggs and fruits are poached.
• Steaming: Steaming is a slow process of cooking and used for easily cooked food.

Advantages: Steaming advantages are as follows:

1. All nourishment and flavors are preserved in the food.
2. food by this method is easily digested.
3. Food cannot be overcooked.
• Stewing: Stewing is a very gentle method of cooking in a cold pan with only a small
quantity of liquid. Meat and vegetables may be cooked.
• Grilling/Boiling: In boiling, food is cooked uncovered on a hot metal grill or a frying
pan. the pan or grill is oiled slightly to prevent sticking.
• Microwave cooking: Microwaves penetrate the food and are absorbed. The heating is
very fast. Foods placed in the microwave oven are heated by microwaves from all
directions. This helps in cooking very easily.
• Pressure cooking: Steam cooking are 3 types - steam cooking, waterless cooking and
pressure cooking. In steaming, food is cooked by steam from added water. In
waterless cooking, the steam originates from food itself. Pressure cooking is a device

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to reduce the cooking time by increasing the pressure so that the boiling point is
quickly reached. e.g. rice, dal, puttu etc.
Cooking Principles:
• Should be washed just before they are cooked
• Wash before paring and cutting
• Cook until tender, do not over cook
• Use a large sharp knife in chopping vegetables
• Paring vegetables as thinly as possible.
Food hygiene- Importance & safety:
Proper food hygiene is very important when it comes to food preparation. Without washing
hands and kitchen tools, diseases may easily spread. One thing you can do for preventing
cross-contamination is, keep separate chopping boards for raw and cooked foods.
Safe steps in food handling, cooking and storage are essential to prevent foodborne illness.
You can't see, smell or taste harmful bacteria that may cause illness. In every step of
foodpreparation, follow the four steps of food safe families campaign to keep food safe:
Clean - Wash hands and surfaces often.
Storage and preservation of Food:
Below are some of the most common methods of food preserving:
• Freezing- Meat, vegetables.
• Sugaring - Dates, Amla
• Salting - Pickles, dry fish
• Drying -All grains
• Smoking- Meat, Fish
• Vacuum sealing - Chips
• Pickling - Vegetables
Food adulteration:
Food adulteration is the process in which the quality of food is lowered either by the addition
of inferior quality material or by extraction of valuable ingredient. A food item is said to be
adulterated if: A substance which is added is injurious for human consumption.
Types of Adulterants:
• Cream is adulterated with gelatin.
• Butter with a product of beef fat.
• Chilli powder with brick powder.
• Turmeric with Colored chalk powder.

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• Ghee with Vanaspati or daldha.

• Coffee powder with tamarind seed powder.
• Milk with water.
• Pepper with papaya seeds.
• Rice with stones.
• Honey with sugar syrup.
• Vegetable oils with cheaper oils.
Food hygiene during festivals and Melas:
• Wash hands often before and after food intake.
• Food preparation procedures followed by the vendors.
• Hot food should be served
• Do not eat food that looks like it has been sitting at room temperature for a long time.
• Foods should be covered by some type of guard or cover.
• Plates and cutlery should be clean and dry.
• Not being reheated adequately.
Review Questions:

1.Explain few methods of using locally available foods for diet.

2.Expalin the principles and different methods of cooking

3.Brielfy discuss about the concept of Kitchen Garden

4.Discuss about the food hygiene precautions to be taken during festivals and Melas

5.Explain the concept of Food adulteration and different types of food adulterants.

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B. PHYSICAL AND MENTAL HEALTH

UNIT-5
THE HUMAN BODY
Structure and function of Human Body.

Body systems and their functions:

Digestive system:

Respiratory system

Genito Urinary System

Cardiovascular System

Nervous System:

Musculo-Skeletal System

Endocrine system

Structure and function of Human Body.

The Human body is the entire structure of a human being. It is composed of many different
types of cells that together create tissues and subsequently organ systems. They ensure
homeostasis and viability of the human body. Physiology focuses on the systems and organs
of the human body and their functions.

5.1.1 Functions of Human Body: Our body consists of number of biological systems that
carryout specific functions necessary for everyday living. The job of the circulatory system is
to move blood, nutrients, oxygen, carbon dioxide and hormones around the body. It consists
of heart, blood, blood vessels, arteries and veins.

A tissue is a specialized group of cells and their products that function together. The four
tissue types in the human body are as follows: epithelial, muscle, nervous and connective
tissue. Epithelial tissue is great for building structures with walls and passageways and
compartments.

Body systems and their functions:

The 11 organ systems of the body are the integumentary, muscular, skeletal, nervous,
circulatory, lymphatic, respiratory, endocrine, urinary/excretory, reproductive and digestive.
Although each of our 11 organ systems have a unique function, each organ system also
depends directly or indirectly on all others.

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1. Integumentary System

• It constitutes of skin, hair, nails.

Functions:

Skin is a major sensory organ responsible for:

• Protection of body

• Regulation of body temperature

• Elimination of wastes.

2. Skeletal system

It constitutes of Bones, joints and associated cartilages.

Functions:

• Provides support and protection to body.

• Helps in body movements

3. Muscular system
It constitutes of skeletal muscle, smooth muscles and cardiac muscles.

Functions:

• Skeletal muscles help in body movements

• Maintenance of posture

• Production of heat

4. Nervous system
It constitutes of Brain, spinal cord, nerves, and special sense organs like eyes, ears.

Functions:

• Regulation of body activities and body's internal and external environment by nerves
impulses.

5. Endocrine system
It constitutes of Hypothalamus, Pituitary gland, thyroid gland, pineal gland, parathyroid
gland, pancreas, ovaries/testes, adrenal glands.

Functions:

• Regulation of body activities by releasing hormones.

6.Urinary system

It constitutes of kidneys ureters, urinary bladder, urethra.

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Functions:

• Production, storage and elimination of urine.

• Regulation of volume and chemical composition of blood.

• Maintenance of acid-base of the body

7.Cardiovascular system
It constitutes of heart, blood vessels - arteries and veins, blood.

Functions:

• Heart pumps the blood through blood vessels.

• Blood carries oxygen and nutrients to the cells and takes away the waste and carbon
dioxide from cells.

8.Lymphatic system
It constitutes of Spleen, thymus, tonsils, lymph nodes and lymphatic vessels.

Functions:

• Return proteins and fluids to the blood.

• Removes bacteria, toxins and other foreign bodies from tissue

• Lymph serves as an important route for intestinal fat absorption

• Sites of maturation and proliferation of B and T cells

9.Respiratory system

It consists of pharynx, larynx, bronchial tubes, trachea, lungs,

Functions:

• Transfer of oxygen from inhaled air to blood and carbon dioxide from blood to
exhaled air.

• Regulation of acid-base balance of body fluids.

10. Digestive system

It consists of mouth, pharynx, esophagus, stomach, small and large intestines, salivary glands,
liver and gallbladder, pancreas.

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Functions:

• Digestion of food

• Absorption of nutrients

• Elimination of wastes

11.Reproductive system

a.Female Reproductive system:

It constitutes of ovaries, uterine tubes, uterus, vagina, mammary glands.

Functions:

• Production of gametes

• Release of hormones that regulate reproduction and help in development of secondary

sexual characteristics

• Mammary glands are for lactation

b. Male Reproductive system:

It constitutes of testes, ductus deferens, seminal vesicles, prostate gland, penis

Functions:

• Production of gametes

• Release of hormones that regulate reproduction and help in development of secondary

sexual characteristics

• Penis is the main copulatory organ

Digestive system:

The purpose of digestion is to change the foodstuffs by mechanical and chemical action to
simple forms, which can be easily absorbed into blood and utilized by various tissues in the
body. It is also involved in maintaining the water and electrolyte balance of the body. The
gastrointestinal tract consists of an alimentary canal of 8 - 10 meters length, extending from
the mouth to the anus, salivary glands, liver and exocrine part of pancreas.

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Figure 5.1 Process of Digestion

Gastrointestinal (GI) tract is formed by two types of organs:

• Primary digestive organs

• Accessory digestive organs

Primary Digestive Organs:

Primary digestive organs are the organs where actual digestion takes place. These organs are:

- Mouth

- Pharynx

- Esophagus

- Stomach

- Small intestine

- Large intestine

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Accessory Digestive Organs:

Accessory digestive organs are the organs which help the primary digestive organs in the
process of digestion. These organs are:

- Teeth

- Tongue

- Salivary glands

- Exocrine part of pancreas

- Liver

- Gallbladder

Process of Digestion:

The process of digestion takes place in the alimentary canal and is assisted by some accessory
organs like salivary glands, liver and pancreas.

Food is processed within the body in 4 steps:

Ingestion

Digestion

Absorption

Excretion

Ingestion:

Ingestion or taking in of food and mastication (chewing) are functions performed by mouth
and teeth, aided by tongue, pharynx and esophagus are concerned with swallowing.
Digestion:
Digestion occurs in the stomach and upper part of small intestine.

Absorption:

Absorption can occur from any part of alimentary canal (mainly by small intestine)

Excretion:

Large intestine absorbs major quantity of water and the residue is excreted in the form of
feces.

Parts of Digestive system

1.Oral cavity or Mouth: The mouth or oral cavity is the first part of the digestive tube.

2.Lips: Lips (labia) are fleshy folds lined externally by skin and internally by mucous

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membrane.

3. Cheeks: Cheeks (buccal) are fleshy flaps, forming a large part of each side of the face.

4. Gums: Gums are the soft tissues which cover the alveolarprocesses of the upper and lower
jaws and surround the necks of the teeth.

5. Teeth: A tooth consists of a crown which is exposed to oral cavity and single or multiple
roots, lying in socket of jaw bones.

• Enamel: It is the hardest tissue in human body, covering the crown of the tooth.

• Dentin: It is less calcified, more resilient, vital, hard tissue forming the main bulk of
the tooth.

• Cementum: It is less mineralized tissue, covering the radicular portion of the tooth.

• Pulp: It is the soft, connective tissue in the central part of tooth enclosed by dentin.

• Periodontium: The tissues (periodontalligament, cementum, alveolar bone) which

support the teeth in jaws are collectively termed as periodontium.

Figure 5.2 Parts of Mouth

Functions of teeth:

• Help in mastication

• Helps in speech

• Give a shape and beauty to face

• For self-protection

• Blood supply to teeth - Branches of maxillary artery

• Nerve supply to teeth is through Maxillary nerve

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• Palate: It forms the arched roof of the oral cavity and the floor of the nasal
cavities. It divides into 2 regions, Hard pallet and soft pallet.

• Tongue: The tongue is highly mobile muscular organ. It is situated partly in mouth
and partly in oropharynx.

Functions:

• Mastication

• Taste

• Swallowing

• Speech

• Oral cleansing

The lingual arteries supply blood to the tongue. Lymph from the tongue drains into the
superior and inferior deep cervical lymph nodes. There are small barrel-shaped structures
called taste buds.

Pharynx: It is a wide muscular tube, situated behind the nose, mouth and larynx. It is about
13 cm long.

It is divided into 3 parts

• Naso pharynx

• Oro pharynx

• Laryngo pharynx

Functions:

• Air way

• Middle ear ventilation

• Speech

• Taste

Salivary glands: The secretions of these glands help to keep the mouth moist and provide a
protective and lubricant coat of mucous.

Salivary glands are 2 types:

• Major salivary glands - These are also called duct glands. These are 3 types

1. Parotid glands

2. Sub-maxillary glands

3. Sub-lingual glands

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• Minor salivary glands - These open directly in oral cavity. These are 3 types.
1.Buccal glands

2. Lingual glands

3.Palatine glands

Saliva: Total amount of saliva secreted is 1500ml per day. It contains 99% water and 1% of
solids like sodium, calcium, potassium, enzymes and mucus.

Functions:

• Lubrication and speech

• Digestion

• Line of defense

• Taste and excretion

Esophagus: It is a narrow part of the elementary canal. Its length is 25cm and diameter
1.5cm. Its main function is transportation of food from mouth to stomach. It is having 2
sphincters.

• Upper Esophagealsphincter - It is about 3 to 5 cm long and functions during the act of

swallowing. It is closed at rest and protects respiratory passage from regurgitation of
esophageal contents.

• Lower Esophagealsphincter - It is situated at lower portion of esophagus. It opens in

response to primary peristalsis and vomiting and allows air to escape from the
stomach.

Stomach: It is the most dilated part of the alimentary tract. Upper end continues with
esophagus, while lower end continues with duodenum. It is J-shaped. The holding capacity of
the stomach is 30ml of milk in new born and 2 to 3 liters of food in adults.

It is divided into

• Cardiac part

• Fundus

• Body of the stomach

• Pyloric region

Functions:

• Reservoir of food

• Converts food into chyme

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• Destroy microorganisms present in food

• Digestion of proteins

• Absorption of vitamin B12

• Excretes toxic alkaloids and metals

Small intestine: It extends from the pylorus to the ileo-cecal junction. It is about 6 meters
long. It is divided into

a. Fixed upper part called duodenum, approximately 25 cm long

b. The lower mobile part, which is again divided into jejunum and ileum.

Functions:

• Maintenance of water balance

• Hemopoietic function
• Mechanical function
• Digestive function

Figure 5.3 Small intestine

Large intestine: It extends from the ileocecal junction to anus. It is about 1.5 meters long. The
large intestine has caecum, the ascending colon, transverse colon, descending colon, sigmoid
colon, rectum and anal canal. In the angle between sacrum and terminal ileum, there is a
narrow diverticulum called the vermiform appendix. The rectum and anal canal are situated
in the pelvis, the remaining parts are in the abdomen.

Functions:

• Secretion of mucus

• Absorption of water and electrolytes

• Excretion of heavy metals like mercury.

• Synthesis of vitamin K, B12 and folic acid by colonic flora

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• Storage of feces.

Figure 5.4 Large Intestine

Accessory organs of digestion:

The liver, biliary system and pancreas are the accessory organs of digestion.

Liver: It is the largest gland in the body. It is reddish brown in color, highly vascular and
weighs about 1.5 kg. It occupies right hypo-chondrium region.

Functions:

• Destruction of old RBC

• Metabolism of proteins, fats and carbohydrates

• Storage of glycogen, amino acids and vitamins B12, A and E

• Secretion of bile.

• Excretion of cholesterol and bile pigments

• Defense of body

Gall bladder: It is a pear-shaped reservoir of bile. It is situated at the right lobe of the liver.
It is about 7 - 10 cm in length and 3 cm broad.

Functions:

• Storage of bile

• Secretion of mucus

• Maintenance of pressure in biliary system

Pancreas: It is a gland that is partly exocrine and partly endocrine. It is situated behind the
stomach. Normally about 1500 ml of pancreatic juice is produced every day.

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It is divided into numerous lobules. Each lobule is made up of a number of serous acini. The
tail of pancreas contain beta, alpha and Delta cells.

• Alpha cells secrete glucagon

• Beta cells secrets insulin
• Delta cells secrete somatostatin

Respiratory system
The organs of respiratory system are

• Nose
• Pharynx
• Larynx
• Trachea
• Bronchi
• Bronchioles
• Lungs

Figure 5.5 Respiratory system

1. Nose: It is a pyramidal projection in the middle of the face. It presents with the following
features

1. Tip - It is the lower free end of the nose.

2. Root- Upper narrow part attached to the forehead.
3. Dorsum of the nose - It is formed by rounded border between the tip and route of the
nose.
4. Nostrils - These are 2 perform shaped apertures present at the broad lower part of the
nose.

The nasal cavity is divided into right and left halves by a median septum.

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Functions:

• Warms and humidifies the inhaled air

• Adds resonance to the voice

• Mucus traps the dust particles

• Reduces the weight of the skull

• Respiration and sense of smell.

2.Pharynx: It is a wide muscular tube, situated behind the nose, mouth and larynx. It is about
13 cm long.

It is divided into 3 parts

• Naso pharynx

• Oro pharynx

• Laryngo pharynx

Functions:

• Air way

• Middle ear ventilation

• Speech

• Taste

3.Larynx: The Larynx is the organ for thermojunction of voice and air passage. It lies in the
anterior midline of the neck. Length is 4.3 cm, diameter is 3.6 cm. Male larynx is larger than
the female.

There are 2 wedge-shaped vocal cords present at the angle of the thyroid cartilage. In males,
the average length of vocal cords would be 23mm and in females, 17 mm.

4.Trachea: The Trachea or windpipe is a wide, fibro-cartilaginous tube about 11 - 12 cm

long. Its upper half is situated in the neck and lower part in the thorax.

5.Bronchi: The main airway - 'Trachea’ - branches into 2 bronchi, namely, right and left
bronchi. Each bronchi is divided into segmental or tertiary bronchi. The tertiary bronchi are
divided into smaller bronchi and bronchioles within the parenchyma of lung. It is totally
called as Tracheo-Bronchial tree.

6.Bronchioles: The bronchioles present within the parenchyma of lung. It is having number
of alveolus.

7.Lungs: It is the most essential organs of respiration. Their main function is to oxygenate
blood. They are present in the thoracic cavity. In healthy people who live in a clean

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environment, the lungs are light pink in color, but in people living in pollutedareas, lungs are
dark in color due to the accumulation of dust or carbon particles.

Each lung is conical in shape and covered by double layer serous membrane called as pleura.

Right lung has 3 lobes while left has 2 lobes.

Functions:

• Exchange of gases.

• Defense function

Pleura: The pleura is a serous membrane lined by a single layer of squamous cells.

Pleural cavity: It is the potential space between the 2 pleura, which contains a thin layer of
lubricating serous fluid. It prevents collapse of lung.

Physiology of Respiration:

Respiration: It is the process of exchange of gases in the lung where there is uptake of
oxygen in exchange for carbon dioxide. This is called external respiration. The exchange of
oxygen and carbon dioxide at tissue level is called internal respiration.

At rest, human being breaths about 12 - 15 times per minute. 500 ml of air is taken in each
breath which equals 6 to 8 liters of air in 1 minute.

Composition of air: The inspired air is composed of oxygen 21%, carbon dioxide 0.03%,
Nitrogen 78%, other inert gases about 1%.

On breathing out (expiration), the air has 16% oxygen, 4% carbon dioxide.

Respiratory movements: It consists of 2 phases.

Inspiration: It is an active process. There is expansion of intra thoracic volume resulting in

expansion of lungs. This creates a negative air pressure in the airway allowing the air to flow
if.In normal conditions, inspiration lasts for 2 seconds.

Expiration: It is a massive process in normal breathing. It occurs due to recoil of lungs at the
end of inspiration. This pushes out air from lungs.

Pulmonary function tests: These tests are useful in assessingthe functional status of the
respiratory system. These tests involve measurement of lung volumes and lung capacities.

Lung volume tests:

1. Tidal volume test

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2. Inspiratory reserve volume

3.Expiratory reserve volume

4.Resedual volume

Lung capacity tests:

1.Vital capacity tests

2.Total lung capacity test

3.Inspiratory capacity test

4.Functional residual capacity test

5.Timed vital capacity test

Genito Urinary

System The

urinary system

consists of 1 Two

kidneys

2 Two ureters

3 Urinarybladder

4 Urethra

Figure 5.6 Urinary System

The kidneys remove waste products of metabolism, excess water and salts from blood and
maintain the pH. The ureters convey urine from the kidneys to the urinary bladder. The
urinary bladder is the muscular reservoir of urine and the urethra is the channel in the
exterior.

Functions of Urinary System:

The kidneys maintain a stable internal environment by regulating the volume and
composition of body fluids as well as by excreting the waste products and excess water for
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maintaining homeostasis.

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• Regulation of acid-base balance

• Regulation of arterial blood pressure

• Regulation of body fluid volume

• Regulation of concentration of electrolytes

• Excretion of metabolic waste products and chemicals like urea, uric acid, creatinine
and many drugs

• Secretion and production of some hormones

• Metabolism of hormones

Kidneys: Urinary system consists of 2 kidneys, left and right. Left kidney is slightly in
higher level than the right kidney. Kidneys are bean shaped and measures 7.5 to 10 cm in
length, 5cm in width and 2.5 cm thick and weigh 150 gm. Nephron is the functional unit of
kidney.

Functions of Kidney:

• Maintenance of water balance

• Maintenance of electrolyte and acid-base balance

• Secretion of erythro-poietin

• Excretion of waste products

Glomerular filtration rate: GFR is defined as the amount of filtrate formed in all the
nephrons of both kidneys in 1 minute. Normal GFR is about 125 ml/minute or 180 L/day.
The number of functioning nephrons decreases as the age advances. Hence the GFR
decreases in old age.

Tubular Re-absorption: As filtered fluid flows through the renal tubules, the tubules
reabsorb 99% of water and solutes. This is called tubular reabsorption. About 180 liters of
GFR is formed per day. Only 1% of this volume is lost as urine. More than 99% water,
electrolytes and other substances are re-absorbed by the tubular epithelial cells.

Sites of Absorption: The reabsorption of the substances occurs in almost all the segments of
tubular portion of nephron.

Urine:

Properties of Urine:

Volume - 1000 to 1500 ml per day.

Reaction - slightly acidic

pH - 4.5 to 6

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Specific gravity - 1.010 to 1.025

Color - Straw color

Odor- Fresh urine has light aromatic odor

Ureters:

The ureters are tubular structures which serve to conduct urine from kidneys to the urinary
bladder. They are approximately 25 cm in length, 0.6 cm in diameter.

Urinary bladder: The urinary bladder is a hallow muscular organ which functions as a
reservoir for the urine. received from the kidneys and to discharge it out periodically.

Urethra: The Urethra is a tubular passage extending from the neck of the bladder to the
external urethral meatus or orifice.

Female Urethra: It is 3.75 to 4 cm long, extends downward and forward, closely related to
the anterior wall of vagina.

Male Urethra: It is 18 to 20 cm long. In the flaccid state of penis, the urethra is S-shaped.
When penis is erect it becomes J-shaped.

Sphincters: There are 2 spinsters in relation to the urethra, namely, Internal and external.

Micturition: It is the process by which the urinary bladder empties when it becomes filled
with urine. The urinary bladder fills progressively until the pressure inside rises above a
particular threshold level. Then it initiates the micturition reflex as follows:

Several stretch receptors are present in the bladder wall which gets stimulated when it is
filled with urine. They send signals to the 'Micturationcenter' in the spinal cord via the pelvic
nerves and micturation contractions are initiated in the bladder. This lasts for about few
seconds to 1 minute. As the bladder becomes more and more filled, micturation reflexes
occur more frequently and more powerfully and urge to urination occur.

Cardiovascular System

Cardiovascular system consists of

1.Heart- The heart is a hallow muscular organ, that pumps blood throughout the circulatory
system It is situated in the middle mediastinum.

Layers of the heart wall: Heart is made up of 3 layers of tissues.

1. Outer pericardium

2. Middle myocardium

3. Inner endocardium

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Figure 5.7 Normal Heart

Interior of the Heart:

The interior of heart is divided into right and left side by the septum, which does not allow
mixing of blood of the 2 sides. It has 4 valves, 2 of the valves are in between the atria and the
ventricles called atrio-ventricular valves. The other 2 are the semi-lunar valves.

Important features of chambers of the heart:

1. Right Atrium: It is the right upper chamber of the heart. It receives venous blood from the
whole body and pumps it to the right ventricle through the right atrio-ventricular or tricuspid
orifice.

2. Right ventricle: It is a triangular chamber. It receives de-oxygenated blood from the right
atrium and pumps it to the lung through the pulmonary arteries.

3. Left Atrium: It is a quadrangular chamber receiving oxygenated blood from the lungs
through 4 pulmonary veins and pumps it to the left ventricle through the left atrio-ventricular
or bi-cuspid or mitral orifice.

4. Left ventricle: The left ventricle receives oxygenated blood from the left atrium and pumps
it into the aorta.

Cardiac Cycle: The cardiac cycle refers to a series of electrical and mechanical events that
occur cyclically from the beginning of one heartbeat to the beginning of the next.

This also includes changes in pressure, blood flow and volume in the heart chambers.

Electro Cardiogram (ECG): ECG is defined as the graphical recording of the electrical
activities of heart. The electrical changes occuring with each heartbeat are conducted all over
the body and can be recorded as ECG by placing electrodes on the surface of the body. The

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recording is done on a moving strip of especially graphic paper.

Waves of ECG: The normal ECG has the P, Q, R, S and T waves.

Cardiac output: It is the quantity of blood pumped by each ventricle into the aorta per
minute. In adults, the resting cardiac output is 5 L/min.

Normal Heart rate: 72/min in adults

Factors effecting Heart rate:

• Age

• Gender

• Emotions

• Temperature

• Activity etc.

Blood Pressure: It is measured using Sphygmomanometer. The normal Bp is 120/80

MM/Hg.

Nervous System:

The nervous system integrates and coordinatesvarious activities of other organ systems. It
controls muscle contraction, secretion of hormones from glands, rate and depth of respiration,
cardiac activities and gastro-intestinal activities. It also involves in modulating and regulating
a multitude of other physiological processes.

Figure 5.8 Nervous System

It may be divided into

1. Central nervous system (CNS)- Brain and spinal cord

2. Peripheral nervous system (PNS) - Peripheral nerves
3. Autonomic nervous system (ANS) - Sympathetic and para-sympathetic

The brain consists of cerebrum, cerebellum, mid-brain, pons and medulla oblongeta.

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Peripheral nerves attached to the brain are called cranial nerves and those attached to the
spinal cord are called spinal nerves.

Neurons: Neuron is defined as the structural and functional unit of the nervous system. It is
otherwise called nerve cell.

Large axons and peripheral nerves are surrounded by a myelin sheath.

Conductivity: It is the ability of nerve fibers to transmit the impulse from the area of
stimulation to the other areas. The action potential is transmitted to the nerve fiber as nerve
impulse. The action potential is transmitted through the nerve fiber in only one direction.

Degeneration of nerve fibers: When a nerve fiber is injured, various changes occur in the
nerve fiber and nerve cell body called the degenerative changes. The injury occurs due to the
obstruction of blood flow, local injection of toxic substances, crushing of nerve fiber.

Regeneration of nerve fibers: The term regeneration refers to re-growth of lost or destroyed
part of a tissue. The injured and degenerated nerve fiber can re-generate.

Synapse: It is the junction between 2 neurons.

Central nervous system: It consists of brain and spinal cord.

Meninges: The brain and spinal cord are enclosed by 3 membranous coverings. These are

• Dura mater

• Arachnoid mater

• Pia mater

Ventricles of the brain: Brain contains 4 ventricles.

1. Right and left lateral ventricles

2. Third ventricle

3. Fourth ventricle

Lateral ventricles: The lateral ventricles are 2 cavities situated within the
cerebralhemisphere. Each ventricle is C-Shaped.

Third ventricle: It is slit-like median cavity situated between the right and left thalami.

Fourth ventricle: It is a diamond-shaped space situated between pons and cerebellum. These
ventricles are filled with CSF (cerebro spinal fluid) fluid. The CSF is secreted by choroid
plexuses.

Cerebro Spinal fluid (CSF): The fluid present in brain and spinal cord is called CSF.

Characteristics of CSF:

• Total volume is 130 - 150 ml

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• Daily rate of production - 600 - 700 ml

• Rate of CSF formation per minute - 0.3 ml/min

Functions of CSF:

• It provides fluid-cushion which protects the brain from injury

• It helps to carry nutrition to the brain

• It removes waste products

Brain: The brain is that part of CNS which lies within the cavity of the skull.

Figure 5.9 Brain

Cerebrum: It is the largest part of the brain. It consists of right and left cerebral hemispheres.
There are 4 lobes namely,

1. Frontal

2.Parietal

3.Oxypetal

4.Temporal

Functions:

• Receives all sensory stimuli and conveys them to consciousness

• Co-relates and retains all impulses

• Controls other parts of nervous system

• Seat of intelligence

• Initiates all voluntary movements

Thalamus: It is a large egg-shaped mass of grey matter, situated one on either side of the
lateral wall of the third ventricle.

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Functions:

• Relay center for impulses

• It processes the sensory information

• Centre for reflex activity

Hypo-thalamus:

It is a part of the diencephalon. It lies in the floor and lateral wall of the third ventricle.

Functions:

• Regulation of autonomic nervous system

• Regulation of heart rate, temperature and blood pressure

• Regulation of hunger and food intake

• Regulation of sleep and wakefulness

• Regulation of water balance

Brain stem: It consists of 3 parts

1. Mid brain

2. Pons

3. Medulla oblongata

Mid-Brain - It is the shortest segment of the brain stem, connecting the pons and cerebellum
with the fore-brain.

Pons: The pons lies between the mid-brain and Medulla Oblongata.

Medulla Oblongata: It is a part of the brain stem, about 3 cm in length and continues above
with the pons and below with the spinal cord.

Cerebellum: It is the largest part of the hind-brain. It is situated in the posterior-cranial fossa.

Functions:

• Controls all voluntary motor activities

• Maintenance of muscle tone

• Maintenance of body posture, equilibrium and movements of eye balls

Spinal cord: It is a part of the CNS which lies within the vertebral canal. It is approximately
45 cm in length.

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Cranial nerves:

Cranial nerves attached to the brain are bundles of processes of neurons that innervate
muscles or glands or carry impulses from sensory areas. There are 12 pairs of cranial nerves

1. All factory nerve

2. Optic nerve

3. Oculomotor nerve

4. Trochlear nerve

5. Trigeminal nerve

6. Abducent nerve

7. Facial nerve

8. Vestibulocochlear nerve

9. Glossopharyngeal nerve

10. Vagus nerve

11. Accessory nerve

12. Hypoglossal nerve

Musculo-Skeletal System

Muscles:

Muscle tissue is composed of cells that are specialized to shorten in length by contraction.
This contraction result in movement.

Muscle is a responsible for most of our functions like locomotion, posture, speech,
respiration, pumping of blood, movement of food, expulsion of wastes, storage of energy etc.

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Figure 5.10 Musculo-Skeletal System

Classification of muscles: There are 3 types of muscles.

1. Skeletal muscle

2. Cardiac muscle

3. Smooth muscle

Skeletal Muscle: It is present mainly in the limbs and in relation to the body wall. Because of
its close relationship to the bony skeleton, it is called skeletal muscle. It is also otherwise
called as striated muscle and voluntary muscle.

Functions:

• Contraction

• Elasticity

• Maintenance of posture

Cardiac muscle: It is present exclusively in the heart. It is involuntary muscle.

Smooth muscle: It is present mainly in relation to viscera. It is also involuntary muscle.

Neuro - Muscular junction: The junction between a motor nerve and a skeletal muscle fiber
is called Neuro-Muscular junction.

Neuro - Muscular transmission: It is defined as the transfer of information from motor

nerve ending to the muscle fiber through Neuro - Muscular junction. It is the mechanism by
which the motor nerve impulses initiate muscle contraction. A series of events takes place in
the neuro-muscular junction during this process.

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Muscles of the head:

• Cranio facial muscle

• Masticatory muscle

Muscles of the Neck:

• Platysma

• Trapezius

• Sternocleidomastoid

Inter-costal muscles:

• External

• Internal

• Inner most inter-costal muscles

These muscles are elevators of ribs and help in respiration.

Muscles of the abdomen:

• Internal and external oblique

• Transverses abdominis

• Rectus abdominis

Functions:

• Movement of the trunk

• Protection of the abdominal viscera

Muscles of Shoulder girdle and upper limb:

• Rhomboideus Major and Rhomboideus minor

• Trapezius

• Deltoid

• Subscapularis

• Pectoralis major and minor

Muscles of the lower limb:

• Muscles of gluteal region

• Muscles of the thigh

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• Muscles of the leg and foot

Bones:

Bones are specialized,highly vascular, constantly changing and mineralized connective tissue.
They are hard, resilient and have enormous generative capacity.

Figure 5.11 Bones

Classification of bones:

Based on histology:
1. Compact bones

2. Spongy bones

Based on maturity:

1. Mature bone

2. Immature bone

Based on manner of development:

1. Cartilage bone

2. Membrane bone

Based on shape

1. Long bone Eg: Radius, Ulna, Tibia, Fibula, Humorous, Femur

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2. Short bone Eg: Carpal bones, Tarsal bones

3. Flat bone Eg: Partial bones, frontal bones, ribs, sternum. scapula

4. Irregular bone Eg: Vertebra, hip bone, sphenoid, maxilla

5. Pneumatic bone Eg: Maxilla, sphenoid, Ethmoid

Functions of bones:

• Gives shape and form to the body

• Form the central as is of body

• Transmit weight of the body

• Give attachments to muscles and ligaments

• Protect major organs

• Storage of calcium

• Hemopoietic function

Skeleton: It forms the structural framework of the body. Skeleton includes bones, cartilage
and joints. It is bilaterally symmetrical. It is 2 types:

1. Axial skeleton - It includes bones of head (Skull), vertebral column, ribs and sternum

Skull: It is made up of 22 bones and 6 ear ossicles.

Vertebral column: It is made up of 33 vertebrae, namely 7 cervical, 12 thoracic, 5 lumbar, 5

sacral and 4 coccygeal vertebrae.

Thoracic cage: It consists of 12 thoracicvertebrae, 12 pairs of ribs with their postal

cartilages, sternum and xiphoid process.

2. Appendicular skeleton - It consists of bones of upper and lower limbs along with
shoulder girdle and pelvic girdle

Upper limb:

Clavicle: It is a long bone. It is a part of the pectoral girdle or shoulder girdle which server to
attach the upper limb to the trunk.

Scapula: It is a large, flat, triangular bone

Humorous: This is the long bone of the arm, it has upper end, lower end and shaft.

Radius: Radius is the lateral bone of forearm.

Ulna: It is the medial bone of the fore arm. It corresponds to the fibula of the lower limb. It
resembles the shape of a pipe wrench.

Bones of the palm: It consists of 8 carpal bones, 5 meta carpal bones and 14 phalanges.

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Pelvic girdle and lower limb:

Hip bone: It is a large irregular bone made up of 3 parts.

1.Ilium

2.Pubis

3.Ischium

The 3 parts are fused at a depressed area called the acetabulum.

Femur bone: It is the longest and strongest bone of the body. It is the bone of the thigh.

Patella: It is the largest sesamoid bone ossified in the tendon of quadriceps femorus. It lies in
front of the knee joint. It is also called as the knee cap.

Tibia: It lies medial itFibula. The Tibia is more massive. It articulates with the Femur to form
the knee joint and helps in the transmission of body weight.

Fibula: It lies lateral to the Tibia. It provides attachment for most of the muscles of leg.

Bones of the foot: It is divided into 3 groups. 7 tarsal bones, 5 meta tarsals, 14 phalanges.

Pelvic Girdle: Pelvis means basin. It is formed by 2 hip bones, Sacrum and Coccyx.

Types of Pelvis: There are 4 types

1. Gynecoid: Normal female pelvis

2. Android: Normal male pelvis

3. Anthropoid: Ape like pelvis

4. Platypelvic:Flat, bowl pelvis

The Gynecoid pelvis is the most spacious and most common variety of pelvis. A woman with
this type of pelvis can have a normal, vaginal delivery, if other conditions are favorable.

Joints:

A joint is formed where 2 or more bones come together. they may or may not be movement
between them. There are 3 types of joints

1. Fibrous joint - In this type, the articulating surfaces of bones are connected by fibrous
tissue.

2. Cartilaginous joint - Bones are united either by Hyaline cartilage or fibro cartilage.

3. Synovial joints - These are the most common and important joints in the body. They
normally provide free movement.

Types of Synovial joints:

1. Ball and socket joints. Eg. Shoulder joint

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2. Hinge joint. Eg: Elbow joint

3. Pivot joint. Eg: Radio ulnar joint

4.Condyloid joint. Eg: Wrist joint

5. Saddle joint. Eg: Carpo- meta carpal joint of the thumb

6. Plane joint. Eg: Joints between the articular processes of the thoracic vertebrae.

Movements of the Synovial joint:

1. Gliding

2. Angular movements (Flexion and extension)

3. Abduction and Adduction

4. Rotation

5. Circumduction

Joints of the upper limb:

1. Sterno clavicular joint

2. Acromion clavicular joint

Figure 5.12 Joints of the upper limb

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Elbow joints:
1. Humuro ulnar joint

2. Humuro radial joint

Wrist joints:

1. Radio carpal joint

Joints of hands and fingers:

1. Carpo meta carpal joints - It is a saddle variety of Synovial joint. It has a separate joint
cavity from other carpo meta-carpal joint.

2. Meta Carpo Phalangeal joints - These are condylar variety of Synovial joints

Joints of the lower limb:

Figure 5.13 Joints of the lower limb

1. Hip joint - It is a synovial joint, ball and socket type.

The movements of hip joint are flexion, extension, abduction, adduction, medial and lateral
rotations and circumduction.

2. Knee joint: It is a modified hing joint. It is the largest and most complex joint of the body.
It is called a compound joint because it incorporates 2 condylar joints between the condyles
of the femur and tibia and one saddle joint between the femur and patella.

3. Ankle joint: The Ankle joint is a uni-axial , hing joint. The main movements of this joint
are dorsi flexion and plantar flexion.

4. Subtalar joint: It is formed between the lower surface of the body of the talus and upper
surface of the middle third of the calcaneus. The Subtalar joint has a major role in the
movements of inversion and aversion of the foot.

Endocrine system
The endocrine glands are ductless glands whose secretions are called hormones. Major
endocrine glands are:

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1. Pituitary gland

2. Thyroid gland

3. Para-thyroid glands

4. Adrenal or supra-renal glands

Figure 5.14 Endocrine System

Groups of endocrine cells may be present in organs that have other functions.

1. The Islets of Langerhans in pancreas

2. Interstitial cells testis

3. Follicle and carpus-luteum of ovary

4. Harmons secreted by placenta

Functions of Endocrine glands:

• Growth and development of body

• Help in digestion and absorption of food

• Help in reproductive function

• Regulation of body fluid volume

Pituitary gland: It is situated in the floor of the third ventricle of brain. The pituitary gland is
one of the most important endocrine gland. It produces several hormones.

Harmons secreted by the Pituitary: Growth hormone, Prolactin, ACTH, TSH, FSH, LH,

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ICSH, ADH, oxytocin.

Thyroid gland: It is the largest endocrine gland in our body. It occupies the anterior and
lateral surfaces of the pharynx, larynx, esophagus and trachea like a shield. It is yellowish-
brown in color and highly vascular.

Harmons secreted by the Thyroid gland: Thyroxine, T4, T3, Calcitonin

Functions:

• Increases basal metabolic rate

• Increases protein catabolism

• Decreases circulatory cholesterol

• Regulates body growth and development

• Regulates brain development

• Increase heart rate

Para-thyroid glands: These are 4 in number situated in thyroid gland.

Harmons secreted by Para-Thyroid glands: Para-tharmone

Supra-renal or Adrenal glands: It is situated in the upper pole of the kidney.

Harmons secreted by Supra-renal or Adrenal glands: Mineralocorticoids, glucocorticoids,

sex-steroids, adrenalin, nor adrenalin, dopamine.

5.10 Special sensory organs

Special sense organs are

1. Eyes

2. Ears

3. Tongue

4. Nose

EYE: The eye or the organ of sight is situated in the orbital cavity of the skull and it is well
protected by its bony walls. Each eye ball is like a camera. It has a lens which produces
images of objects that we look at. The images fall on a light sensitive membrane called the
Retina. Cells of the retina convert light images into nerve impulses which pass through the
optic nerve and other parts of the visual pathway to reach the visual areas of the cerebral
cortex.

EAR: Ear is the peripheral sense organ concerned with hearing and equilibrium. It is made
up of 3 main parts called external ear, middle ear and internal ear. The external and middle
ears are concerned exclusively with hearing. The internal ear has a cochlear part concerned
with hearing and a vestibular part which provides information to the brain regarding the
position and movement of the head.

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TONGUE: The true sense of taste is localized in the tongue. There are 5 basic tastes, bitter,
sweet, sour, salty, and umami (pleasantsavory taste). The tongue is covered by a mucus
membrane. There are numerous elevations called papillae on the tongue. The end organs for
the sense of taste are called taste buds. They are situated most densely at the tips, sides and
base of the tongue.

NOSE: The mechanism of smell depends on all factory receptor cells, all factory nerves, all
factory bulb and all factory tract which convey the impulses to brain.

Review Questions:

1.Explain the structure and function of the Human Body

2.Explain briefly about the body systems and their functions

3.Explain in brief about the Digestive system

4.Explain in brief about Respiratory system

5.Explain in brief about Cardiovascular system

6.Explain in brief about the Nervous system

7.Explain in brief about the Endocrine system

8. Explain in brief about the Muscular-Skeletal system

9. Explain in brief about the special sensory organs of the Human body

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UNIT-VI
MENTAL HEALTH
Mental Health

Concepts of Mental
Health

Body - Mind
relationship

Relevance of the mind-body relationship to Nursing

Factors influencing mental health

Characteristics of a mentally healthy person.

Developmental tasks of different age groups

Defense Mechanism

Motivation
Learning
Memory
Thinking

Mental Health

Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity. Hence mental health is an integral and essential component of
health. It is the foundation for individual well-being and the effective functioning in a
community. It is also related to promotion of mental well-being, prevention of mental
disorders and treatment, rehabilitation of people affected by mental disorders.

It is a state of balance between the individual and surrounding world, a state of

harmonybetween oneself and others, a co-existence between the realities of the self and that
of other people and the environment.

Definition

According to WHO, Mental Health as a state of well-being in which an individual realizes his
or her own abilities, can cope with the normal stresses of life, can work productively and is
able to make a contribution to his or her community.

Concepts of Mental Health

Any time during the life of individual the psychiatric disorder plays an important role. In
ancient days it was believed that psychiatric disorders are due to evil spirits and devils. Even
some of the patients were burnt alive in Europe in the 16th century.
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Duccg and Simon 1970 Millen therapy is established. According to this therapy the
psychiatric disorders were treated by psychiatric nurses by kindness, music and dance. Even
earlier roughly 1400BC our ancient Hindu writing contained in the ayurvedic, mental illness
classified and set down functions and qualifications for psychiatric nurses. These are cool
headed,pleasant, kind spoken, strong and pay attention to the needs of the sick and follow the
physician's order (Krunpliz 1977).

Many studies reported that the genetic predisposition, anatomic and functional alterations and
biochemical process of the brain as the major component of mental illness.

Case management is a role component that enables nurses in various clinical settings to
support and facilitate the client's level of function. Crisis intervention, problem solving,
education and collaboration with various mental health professionals and community
resources are the major aspects of psychiatric nursing (ANA 1994).

Psychiatric nurses will provide various types of care. i.e. primary mental health care, it
includes continuous and comprehensive services necessary for the promotion of optimal
mental health, prevention of mental illness, health maintenance, management and referral of
mental and physical health problems, the diagnosis and treatment of mental and behavioral
disorders and sequels and rehabilitation.

Today in many countries psychiatric nurses are the only mental health professionals to have
24hr responsibility for patients in the in-patients or institutional settings and therefore the
prime care givers and monitors of patient progress. They take active participation in primary,
secondary and tertiaryprevention.

Looking into the future, psychiatric nurses will focus on concepts of healthy living based on
"Humanistic - Holistic caring", as the central core of all their nursing practices. Psychiatric
nursing will continue to grow and evolve in the years ahead. Health care reform, patient,
family and community needs, scientific developments, economic realities and societal
relations will mold and shape the role and functions pf psychiatric nurses.

Body - Mind relationship

The Mind

The mind is regarded as a function of the body. It does not exist apart from the e body. The
mind is the sum-total of various mental processes such as observing,knowing, thinking,
reasoning,feeling,wishing,imagining, remembering and judging. Our mind grows just as our
body grows. It becomes more complex with advancing years. In other words, our mental
processes become richer and more complex day by day. For example, there is a difference
between the thinking and reasoning of an adult and that of a child of three years.

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The conscious, Preconscious and Unconscious

There are three levels at which the mind functions

• Conscious
• Observing, thinking, reasoning, judging, imagining.
• Preconscious or Subconscious

Lies below the margin of consciousness. It includes matter which can be recollected. It does
not allow flow of material from the unconscious to the conscious.

Unconscious (Popularized by Freud)

Includes the processes of which we are totally unaware. It can cause dreams, slips of tongue
and even abnormal behavior.

Body - Mind relationship

Philosophers and psychologists have tried to understand the body-mind relationship. Ancient
systems of healing had shown that there is a connection between the mind and body in
healing. Mental functions and physical states affects each other. Our nervous system and
glands (which are an important part of our body) are responsible to a great extent for our
ways of thinking, feeling and wishing.

A. Affect of the body on Mental Functioning

A few examples of bodily conditions affecting mental functioning in a normal healthy person.

1. An increase in blood pressure leads to mental over-activity.

2. Fatigue of the body makes concentration difficult and reduces the individual's sense of
proportion.

3. Constipation can cause irritability and depression.

4. Excessive thyroid activity leads to mental restlessness and over-excitability, whereas

under-secretion of the same glands leads to dullness and lethargy of themind and body.
Overactive adrenal glands may produce aggressivebehavior, intense feelings, while
interactiveadrenal gland may produce depression, nervousness or negativity.

5. Septic tonsils and adenoids often weaken concentration and the power of understanding.

6. Lack of sleep can disturb our cognitive functioning.

B:Effect of the mind on bodily functions.

Our mind affects our bodily functions or physical states.

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1. The mind motivates all physical and motor activities.

2. Our emotions and strong feelings (mental states) affect the body inwardly and outwardly.
Unpleasant emotions such as fear, anger and worry cause headaches, insomnia, indigestion
etc. Emotional conflicts are responsible for various neurotic illness such as hysteria,
neurasthenic as well as gastrointestinal troubles like peptic ulcer, ulcerative colitis or
flatulence.

3. Suppressing emotions uses up a lot of energy that is needed for vital functions.
Denied,suppressed or repressed feelings affect functioning in indirect ways contributing to
the nervousness, anxiety, depression and physical disease processes.

4. Deep thinking and concentration can cause physical fatigue.

The mind nor the mental processes are always found connected to a body, but they are more
intimately connected with brain or cortical processes.

If our brain is injured or diseased, our mental processes suffer. Many brain-damaged persons
cannot think logically or perceive accurately.

Our nerves carry the impulse of the bodily changes to the brain. A pin-prick, our nerves carry
the message to the brain and the mental experience of pain is felt.

A psychosomatic disorder is mainly used to refer to a physical disease that is thought to be

caused or made worse by mental factors.

The importance of the mind in the treatment of illness can be traced back to more than 2000
years, to the healing approaches used in Ayurveda and in traditional Chinese medicine. Mind-
body interventions can be effective in the treatment of coronary artery diseases. These
therapies (e.g yoga, meditation,imagery, hypnosis, relaxation) when used before surgery, may
reduce recovery time and pain following surgical procedures.

Relevance of the mind-body relationship to Nursing

Nurses have to understand the intimate relationship between the mind and the body, since
effective nursing care adopts a holistic approach to treatment. A nurse has to attend the
physical needs of the patient by giving due consideration to the patient's feelings and needs. It
becomes important to know that some of the patient's behavior can operate from a deeper
unconscious level. A nurse has to understand that some of her own fears or dislikes with
specific reference activities are based on unexplained fears and insecurities from her own
unconscious.

Knowing how patients behave in altered states of consciousness is also important when
nurses deal with drug addicts or accident victims, who may be experiencing abnormal states
of consciousness. The fact that sleep deprivation can also bring alterations in the state of
consciousness will help the nurse understand the importance of having adequate sleep to
carry out her duties efficiently

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Summary

The mind is a function of the body, it does not exist apart from the body.

✓ The mind grows, in the sense that mental processes become richer and more complex
as we grow older.
✓ Our mind works at three levels - the conscious level (deals with our immediate
awareness), preconscious (includes what we can recollect) and unconscious (includes
our repressed desires, our fears and immoral urges).
✓ An altered state of consciousness is any condition which is significantly different
from a normal waking state. It can be caused by many conditions like sensory
changes,oxygen, and sleep deprivation,drugs, infections, hypnosis and medication.
✓ The mind and body interact with each other. Various bodily conditions affect our
mental functioning.Similarly, our feelings or our emotions can cause bodily illness.
✓ Psychosomatic disorders emphasis the intimate relationship between the mind and the
body.
✓ Mind-Body interventions have been found to be useful in the cases of coronary heart
diseases, cancer and in pain management.

Factors influencing mental health

Many factors are responsible for the causation of mental illness. These factors may
predispose an individual to mental illness, precipitate or perpetuate the mental illness.

Predisposing factors

These factors determine an individual's susceptibility to mental illness. They interact with
precipitating factors in mental illness. They are

1. Genetic make up

2. Physical damage of the central nervous system.

3. Adverse psychosocial influence.

Precipitating Factors

These are events that occur shortly before the onset of a disorder and appear to have induced
it. They are

1. Physical stress

2. Psychosocial stress

Perpetuating Factors

These factors are responsible for aggravating or prolonging the diseases already existing in an
individual. Psychosocial stress is an example. Thus, etiological factors of mental illness can
be

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1. Biological factors

2. Physiological changes

3. Psychological factors

4. Social factors

Biological Factors

1. Heredity

Studies have shown that three-fourths of mental defectives and one-third of psychotic
individuals owe their condition mainly to unfavorable heredity.

2. Biochemical Factors

Biochemical abnormalities in the brain are considered to be the cause of some psychological
disorders. Disturbance in neurotransmitters in the brain is found to play an important role in
the etiology of certain psychiatric disorders.

3. Brain damage

Any damage to the structure and functioning of the brain can give rise to mental illness.
Damage to the structure of the brain may be due to

Infection: Example - syphilis,encephalitis, HIV infection etc.

Injury: Loss of brain tissue due to head injury.

Intoxication: Damage to brain tissue due to toxins such as alcohol, barbiturates, lead etc.

Vascular: Poor blood supply, bleeding (intracranial hemorrhage, subarachnoid hemorrhage,

subdural hemorrhage)

Alteration in brain function: Changes in blood chemistry that interfere with brain
functioning such as disturbance in blood glucose levels, hypoxia, anoxia and fluid and
electrolyte imbalance.

Tumors: Brain tumors

Vitamin deficiency and malnutrition, in particular deficiency of vitamin B complex.

Degenerative diseases: Dementia

Endocrine disturbances: Hypothyroidism, thyrotoxicosis etc.

Physical defects and physical illness: Acute physical illness as well as chronic illness with
all their handicapping conditions may result in loss of mental capacities.

4.Physiological changes

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It has been observed that mental disorders are most likely to occur at certain certain critical
periods of life namely - puberty, menstruation, pregnancy,delivery, puerperium and
climacteric. These periods are marked not only by physiological (endocrine) changes, but
also by psychological issues that diminish the adaptive capacity of the individual. Thus, the
individual becomes more susceptible to mental illness during this period.

Psychological Factors

• It is observed that some specific personality types are more prone to develop certain
psychological disorders. For example, those who are unsocial and reserved (schizoid)
are vulnerable to schizophrenia when they face adverse situations and psychological
stresses.
• Strained interpersonal relationships at home, place of work, school, or college,
bereavement, loss of prestige, loss of job etc.
• Childhood insecurities due to parents with pathological personalities, faulty attitude of
parents (over-strictness, over leniency), abnormal parent-child relationship (over
protection, rejection, unhealthy comparisons), deprivation of child's essential
psychological and social needs etc.
• Social and recreational deprivations resulting in boredom, isolation and alienation.
• Marriage problems like forced bachelorhood, disharmony due to physical, emotional,
social, educational or financial incompatibility, childlessness, too many children etc.
• Sexual difficulties arising out of improper sex education, unhealthy attitudes towards
sexual functionalities, guilt feelings about masturbation, pre- and extra-marital sex
relations, worries about sexual perversions.
• Stress, frustration and seasonal variations are sometimes noted in the occurrence of
mental diseases.

Social Factors

• Poverty, unemployment, injustice, insecurity, migration, urbanization, family

instability.
• Gambling, alcoholism, prostitution, broken homes, divorce, very big family, religion,
traditions, political upheavals and another social crisis.
• These factors may influence mental health.

Characteristics of a mentally healthy person.

• He has an ability to make adjustments.

• He has a sense of personal worth, feels worthwhile and important.
• He solves his problems largely by his own effort and makes his own decisions
• He has a sense of personal security and feels secure in a group, shows understanding
of other people's problems and motives.
• He has a sense of responsibility
• He can give and accept love
• He lives in a world of reality rather than fantasy

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• He shows emotional maturity in his behavior and develops a capacity to tolerate

frustration and disappointments in his daily life.
• He has developed a philosophy of life that gives meaning and purpose to his daily
activities
• He has a variety of interests and generally lives a well-balanced life of work, rest and
recreation.

Developmental tasks of different age groups

Freud’s stages of personality development:

Freud described formation of personality through 5 stages of psychosexual development.

Table 6.1: Freud’s stage of personality development

Theory of Psychosocial Development:

Erik Erikson (1902-1994) was a German-psychoanalyst who extended Freud’s work on

personality development across life span while focusing on social and psychological
development in the life stages. In his view, psychosocial growth occurs in sequential phases,
and each stage is dependent on completion of previous stage and life task. For eg: in the
infant stage, the infant must learn to develop basic trust (positive outcome) such as that he or
she will be fed and taken care of. The formation of trust is essential: mistrust, the negative
outcome of this stage, will impair the person’s development throughout his or her life.

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Table 6.2: Erikson’s eight stages of psychosocial development

Fig 6.1 schematic Representation of Maslow’s Hierarchy of needs

Defense Mechanism:

Defense mechanisms are reactions which protect an individual from psychological distress
and protect his feelings of self-worth and are generally unconscious.

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Types of Defense mechanism:

1.) Compensation: Over achievement in one area to make up for deficiency in another.

Example: An economically poor student may work hard and may show his abilities in
dramatics

2.) Rationalization: Justifying one’s ideas or behavior.

Example: If we cannot do a job well or successfully, we could satisfy ourselves by saying "It
does not pay to work hard on this job"

There are 2 types of Rationalization:

1. The sour-grapes mechanism:

Example: A student who has failed in an examination twice or thrice may argue "only
crammers can pass such an examination".

2. The sweet-lemon mechanism:

Example: A person who lives in a small house because of financial resources may extoled
the virtues of small houses and may say that they are much more comfortable.

3.Projection: Attributing one’s own undesirable thoughts, impulses or feelings to others.

Example: A student who has cheated in an examination may satisfy himself by saying
"Others too have cheated"

4.Displacement: Releasing one's pent-up feelings on a less threatening object.

Example:Man, who gets angry at his boss, but cannot express his anger to him for fear of
being fired. He instead comes home and kicks the dog or starts an argument with his wife.

5.Identification: Increasing one's feelings of oath by identifying or modelling oneself on

people who are respected or influential.

Example: Boys often identify themselves with their father and girls with their mothers.

6.Sublimation: Channeling of unacceptable impulses, desires and behaviors into socially

acceptable behaviors.

Example: A woman who is unable to have children may engage herself in working with
children.

7.Repression: Unconscious forgetting of painful ideas, events and conflicts.

Example: Unpleasant and painful ideas to be thrown into unconsciousness.

8.Regression: Reverting to an earlier level of development.

Example: A 5-year-old child may regress when a sibling is born and feel neglected, unloved
and repressed.

9. Fantacy or day dreaming: Withdrawing to a make-believe world through day dreaming.

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Example: Day dreaming is pleasant because it may help us escape from the disagreeableness
of everyday life.

10. Denial: Refusal to accept the reality of a threatening situation in spite of real evidence.

Example: Drug edicts or alcoholics often deny that they have a problem.

11.Withdrawl: Removing oneself from situations that are embracing or painful.

Example: A student who is afraid of achieving success may withdraw from the race.

12. Reaction formation: Behaving in a way that is the very opposite of one’s real feelings or
motives.

Example: A homo-sexual may join a gay-hate group

13. Intellectualisation: Using logical explanations without feelings.

Example: When a person is told that he has cancer, he asks for details on the probability of
survival and the success rates of various drugs, using the word carcinoma instead of cancer.

14. Negativism: Becoming in-cooperative and doing the opposite of what should be done.

Example: Some individuals react to frustrating situations by becoming negative.

Motivation:
Motivation is some sort of encouragement by others. Human behavior is stimulated by
motivation.

Definition: According to Rosen, Fox and Gregory (1972), Motivation can be defined as a
readiness or disposition to respond in some ways and not others to a variety of situations.

Characteristics of Motivation:

• It is an internal condition which arises from the need of an individual

• It is goal-directed activity.
• If goal changes, our motive also changes.

Types of motivation:
There are 2 types of motivations based on needs.

1. Intrinsic motivation or Primary motivation

2. Extrinsic motivation or Secondary motivation.

intrinsic motivation: It is also called primary motive or physiological motive because they
are based on biological needs.

They are 4 types:

1. Hunger: Hypothalamus regulate the Hunger. If it is damaged, variations occur in hunger.

Eg: Brain tumors, head injuries.

2. Thirst: For maintenance of food and electrolyte balance water is very essential. It is

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regulated by ADH (Anti-diuretic hormone). During the dehydrated conditions, the water is
lost from the cells and reduction of blood volume. This behavior stimulates the individual to
drink water and bring back the blood volume to its normal level.

3. Sex: It is more influenced by hormones and physiological response. It is not necessary to

maintain a life of individual but necessary for survival of species. Hypothalamus regulates the
release of sex hormones.

4. Maternal:Harmons play an important role in activating the maternal drive. Progesterone is

important to maintain pregnancy.

Extrinsic motivation: It is not as essential as primary motive but for the psychological
development and social need satisfaction, this kind of motives are important.

Social motives are 4 types:

1. Achievement motivation: This can be seen in many areas.

Examples: Job, games etc.

2. Power motivation: It is the ability or capacity of a person to produce intended effects on

the behavior or emotions of another person.

Examples: Control, lead etc.

3. Affiliation motivation: It is influenced by many factors such as biological attachments,

reduction of fear, self-evaluation.

4. Aggression motivation: Aggression can be defined as a tendency to harm or hurt others

either physically or psychologically.

Example: Child abuse, assaults, forcible rapes etc.

Learning:The term learning is very commonly used in our day to day life
especially in the field of education. It is the key process to mold an individual's
personality. It is continuous process from birth to death.

Definition: According to Gardner Murphy (1968), the term learning covers every
modification in behavior to meet environmental requirement.

Nature of learning:

✓ Learning is a process and not a product.

✓ Learning involves experience.
✓ Learning is not only acquiring new behavior but also unlearning.
✓ Learning is the process of adoption.
✓ Learning is a universal and continuous process.
✓ Learning will not cover any modifications in behavior.

Types of Learning:

✓ Verbal learning: It is learning a language to communicate either orally or in written.

✓ Motor learning: It is learning of motor skill. Eg: Bike riding, Car driving.

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✓ Concept learning: It is a form of mental image. Eg: When we think of a house, the
image we have in our mind is acquired through previous experiences or perception.
✓ Problem solving learning: This requires cognitive abilities. Eg: Reasoning, thinking.
✓ Serial learning: Learning in a sequential order. Eg: Child learns alphabets,
multiplication, tables, names of months etc.
✓ Paired- associated Learning: It is learning by reason. Eg: A place name may be
remembered by associating with the same familiarity, for instance, Dam of Krishna
Raja Sagar may be remembered by associating it with Lord Krishna.

Memory: The term memory derives from Latin word 'Memoria' which means
historical account or remembrance.

Definition: According to Baddeley (1996), Memory is an active system that receives

information from the senses, organizes and alters it as it stores it away and then retrieves the
information from storage.

Process of Memory: It includes 3 steps:

✓ Learning: The first step in the memory process is to get information

✓ Retention: Learning process will be encoded as memory trace known as 'Engram'.
Encoding is the mental operation that converts sensory impulses into neural
impression, which enables the information to store in the brain system.
✓ Recall and Recognition: The next step is to retrieve the information to consciousness
and make use of it. This process is known as recall. The other inter-related process is
recognition which helps in identifying the proper information that we need to recall in
a specific time andrequirement.

Types of Memory: There are several types depending upon time duration.

✓ Sensory memory or Immediate memory: The retention time is extremely brief from
a fraction of second to several seconds, generally one information at a time.
✓ Short-term Memory or Temporary Memory: In this memory the information is
stored for a short term. The retention time lasts for 30 seconds. The span of STM is 5
to 9 items.
✓ Long-term Memory or Permanent Memory: It is long-lasting nature., stored
information is no decay. The memory capacity seems to be unlimited. E.g. Birth
place, date of birth etc.
✓ Episodic Memory: It includes the sequence of events that we experience in our day
to day life or life experience. At the time of recall these memory traces are reproduced
in the same sequence in which the information was stored or registered.
✓ Semantic Memory: It is collection of relationships between events or association of
ideas. E.g. The ability to make use of learn formula for solving the problem in
mathematics.
✓ Photographic Memory: In this the individual recall or reproduce the information
very precisely related to their image,shape, position. E.g. Playing games like chess.
✓ Para-normal Memory: This is a distinctive and unusual type of memory popularly

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known as Re-incarnation. it consists of unusual memory traces concerning one's

previous life. It is mostly connected with the phenomenon of rebirth.

Techniques of Memory:
✓ The method of Loci: The term Loci means location or place.Eg.: Remembering by
location or place.
✓ The Peg-Word method: Eg. A stand for Apple, B stands for Ball.
✓ The Narrative-Chaining Method: This method consists of making stories to remember
the information.
✓ Initial letter strategy: The initial letters are the focus for remembering and associating.

Eg. I - Identify the problem

D - Define the problem

E - Explore the possible strategies.

A - Acting on the strategies

L - Looking back

Thinking:
It is one of the most advanced cognitive process. We cannot stop thinking.

Definition: Glimer (1970) stated that, Thinking is a problem-solving process in which we use
ideas or symbols in place of over activity.

Characteristics:
✓ It is cognitive activity.
✓ Problem solving behavior.
✓ It involves fine muscle movement in throat and laryngeal region.
✓ It is not observable by others
✓ It is a mental exploration of solution to the problems.
✓ It is a symbolic activity.
✓ Thinking can shift over a span of time and space.

Elements of Thinking:

✓ Image: It is a mental representation of any objects or events that we experience.

✓ Concepts: These are ideas that represent a class or category of objects, events or
activities.
✓ Symbols and Signs: Traffic lights or traffic signs.
✓ Language: It is not only a medium of communication but also acts as a tool of
thinking.
✓ Muscle activities: A positive co-relation between thinking and muscular activities of
an individual.
✓ Brain function: Our brain is the major apparatus that carries the process of thinking.

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Types of Thinking:

It is majorly 3 types:

1. Concrete thinking: It involves the use of simple memory images andsensory images that
are stored in the memory process.

2.Abstract thinking: It is more advanced form of thinking which is not restricted to the
concrete phenomenon observed in the external world or in the environment.

3.Non-directed or Associated thinking: This type of thinking does not have any goal or
purpose

Abnormal thinking: Deviation from normal thinking is called Abnormal thinking. These are
2 types.

1. Autistic thinking: It refers to the thinking pre-occupied with inner thoughts, day dreams,
fantasies, lack of logic and reality. It is one of the developmental disorder. Very young
children have this type of thinking. They are completely in the world of fantasy. In adults, it
may lead to Schizophrenia.

2. Over-inclusive thinking: This type of thinking reflects a break-down of the logic. is seen
in Schizophrenia patients.

Review Questions:

1.Briefly explain the concept of Mental health and body-mind relationship.

2.Explain the factors influencing mental health.

3.What are the characteristics if a mentally healthy person?

4.Explain about the developmental tasks of different age groups.

5.Explain briefly about different defense mechanisms

6.Briefly explain the concept of Motivation

7.Briefly explain the concept of Learning

8.Briefly explain the concept of Memory

9.Briefly explain the concept of Thinking.

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UNIT-VII
MAL ADJUSTMENT
Adjustment:

Maladjus
tment:

Signs and symptoms of Maladjustment in children:

Some of the signs and symptoms of maladjustment to adults are

Causes of Maladjustment:
Social and Personal Adjustment:

Relevance of Adjustment to Nursing:

The term adjustment refers to the harmonious relationships between a person and his
environment. When we say that an individual is well adjusted, we mean that he has learnt to
satisfy his needs and cope with his life situations.

Adjustment:
Definition: Adjustment is the process through which we cope with the challenges of life and
maintain a harmonious relationship with the environment.

There are 3 ways of evaluating adjustment as a process:

✓ The negative approach in terms of symptoms.

✓ The positive approach which will look at the way one is striving and coping.
✓ The statistical approach which is to compare one’s adjustment with some norms.

Maladjustment:

Definition: It is the ability to adjust to the demands of interpersonal relationships and stresses
of daily living.

A failure to meet the demands of society or an inability to cope with problems can lead to
maladjustment and is usually reflected in emotional and behavioral problems.

Signs and symptoms of Maladjustment in children:

✓ Nervousness shown by nail biting, Lip biting, stammering, blushing, restlessness,

frequent urination.
✓ Extremely distressed about failure.
✓ Absent-minded
✓ Day dreaming
✓ Evading responsibilities.
✓ Concentration difficulties.
✓ Teasing or bullying others.
✓ Acting funny to attract attention
✓ Anti-social behavior
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✓ Refusal to go to school
✓ Unexplained fears.
✓ Lack of interest in school work
✓ Psychosomatic disturbances

Some of the signs and symptoms of maladjustment to adults are

o Substance abuse
o Social withdrawal
o Absenteeism from work
o Procrastination
o Not engaging in hobbies or interests which the person had earlier
o Fatigue
o Sleep problems
o Loss of weight or over-eating
o Aches and pains.
o Digestion problems
o Psychosomatic problems
When the problems causing Maladjustment are not solved, it can result in mental illness,
emotional instability, emotional disorders, personality disorders or behavior disorders.

Causes of Maladjustment:

• Family can contribute to Maladjustment, due to divorce, death, desertion, separation

etc.
• Low socio-economic status can sometimes create many frustrating situations leading
to maladjustment. If parents are over-possessive, highly authoritative, abusive or hold
unrealistic expectations, it can lead to situation where the psychological needs are not
met. Children or adolescents in such a family environment can develop problems,
phobias, anxiety, nail biting or lack of self-confidence.
• Individuals with physical or mental handicap can develop feelings of inferiority, they
may withdraw from others, schools with teachers and peers can also contribute to
maladjustment.
• In case of adults, Maladjustment can be seen when the work environment is too
demanding, when It does not match one’s financial or psychological expectations,
role conflict in the case of women worker’s or due to interpersonal relationship
problems. In the family, factors like lack of compatibility between spouses, clash of
values and interference by in-laws can lead to maladjustment. Failing health and
diminished importance that an individual may get in the family can lead to
maladjustment in old age.

Social and Personal Adjustment:

It can be defined as the adjustment of the person to social environment. Adjustment may take
place by adapting the self to environment or by changing the environment. (Campbell, 1996)
Social adjustment frequently involves coping with new standards and values. It means an
appropriate performance of one’s role in life – as a parent, a spouse, an employee and so on.

Personal adjustment deals with emotional security, feeling of personal adequacy, extent of
being successful, accepting one’s limitations and being able to delay gratifications, whenever
necessary.

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Relevance of Adjustment to Nursing:

• Effective nursing requires successful and professional adjustments on the part of nurse
herself.
• It is important to know her own strengths and use them and to know her own weaknesses
and where they can be improved through work and study and where they cannot be
improved.
• Adjusting to one’s profession: The successful nurse must also adjust well to her
profession.
• The nurse must be able to establish and maintain good interpersonal relationships.
• She also needs skills in team-work.
• Her conduct both on and off duty, reflects on the profession as a whole
• A code of ethics has been formulated and accepted by the ICN (International Council of
Nurses)
• This code has been accepted by many national associations in many parts of the world.

Review Questions:

1.Briefly explain Mal adjustment and features of Mal adjusted individual.

2.Explain the common causes for Mal adjustment and their treatment

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UNIT-VIII
MENTAL ILLNESS
Definition:

Mis-conceptions about mental illness:

Symptoms of poor mental health:

Causes of Mental illness:

Classification of Mental Illness:

Types of Mental Disorders:

Treatment of the Mentally ill:

Abnormal Behavior:
Psychiatric Emergencies:

Mental illness is a maladjusted way of behavior, which produces disharmony in the person’s
ability to meet human needs comfortably or effectively and function within a culture. The
mental illness can be defined by WHO (2001) as mental and behavioral disorders are
understood as clinically significant conditions characterized by alteration in thinking, mood
or behavior associated with personal distress. Thus, mental illness is a broad term including
almost all the disorders of behavior, which are caused by faulty perception, emotion, thinking
and attitude. Such individuals have problems in making adjustment with others in the society.

Definition:

It is a condition characterized by impairment of an individual’s cognitive, emotional or

behavioral functioning caused by social, psychological, bio-chemical, genetic or other
factors.

Mis-conceptions about mental illness:

There is lot of misunderstanding and fear surrounding mental illness. Myths about mental
illness have in turn let to stigma and discrimination of the mentally ill. Some of such myths
are

✓ Mentally ill persons are dangerous

✓ Mental illness in incurable
✓ Mental illness is a disgrace
✓ Mental illness does not affect children and adolescents
✓ Mental illness is determined by heredity

Symptoms of poor mental health:

✓ Disorganized daily life routine

✓ Short-tempered and irritating behavior
✓ Anger and aggressive behavior

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✓ Restlessness
✓ Increased or poor appetite and indigestion
✓ Irregular sleeping pattern such as insomnia, disturbed sleep or narcolepsy (excess
sleep)
✓ Poor interpersonal relationships
✓ Anxiety and worry
✓ Negative attitude towards self and others
✓ Withdrawing from relationships
✓ Irregular and abnormal psychological conditions (Eg: Blood pressure, pulse rate etc.)
✓ Excessive use of drugs (Eg: Alcohol)
✓ Cigarette smoking and use of tobacco in other forms

Such behaviors or remains in a particular stage for a long period is more likely develop
various kings of mental disorders.

Causes of Mental illness:

Heredity: It is often regarded is a causative factor. Studies have shown that about 3/4th of
mental defectives and a third of psychotic individuals owe their condition mainly to heredity.

Organic causes: The principle organic causes, according to Holman are,

1. Loss of brain tissue: Brain tissue can be lost through local injuries such as brain syphilis,
encephalitis and atherosclerosis in old people.

2. Damage to brain tissue by toxins: Addiction to alcohol, drugs like bromides, barbituric
acid derivatives, sulpha drugs, morphine, cocaine and lead.

3. Interference with brain tissue by changes in blood chemistry: Disturbances of blood

chemistry may be a disturbance of the blood-sugar level, disturbances of acid-alkali ratio,
insufficiency of oxygen and disturbance of water balance.

4. Endocrine disturbances: These disturbances may lead to changes in general efficiency of

bodily functions with resulting feelings of frustration or insecurity.

Other biological causes:

✓ Vitamin deficiencies and malnutrition

✓ Physical defects and physical illnesses
✓ Fatigue
✓ Surgical operations and trauma
✓ Pregnancy and puerperium

Psychological or Psychogenic factors in Mental illness:

✓ Low or very high mental ability

✓ Early interpersonal relationships
✓ Faulty child rearing methods
✓ Parents may have frequent quarrels
✓ Early loss of parents or significant others can be traumic for young children

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✓ Most vital psychogenic factors in the causation of mental illness is the problem of
mental conflicts.

Socio-Cultural and Socio-Economic factors:

✓ Socio-cultural factors include, social codes, religious beliefs and attitudes
✓ Socio-economic factors include, unemployment, poverty, sudden financial losses,
strain of uncongenial jobs.

Classification of Mental Illness:

Mental illness classification based on International Classification of Diseases (ICD-10)

WHO's classification for all the diseases and related health problems.

The main categories of ICD-10

F00 - F09 - Organic, including symptomatic, mental disorders

F10 - F19 - Mental and behavior disorders due to psychoactive substance use

F20 - F29 - Schizophrenia, schizotypal and delusional disorders

F30 - F39 - Mood (affective) disorders

F40 - F49 - Neurotic, stress-related and somatoform disorders

F50 - F59 - Behavioral syndromes associated with psychological disturbances and physical
factors

F60 - F69 - Disorders of adult personality and behavior

F70 - F79 - Mental retardation

F80 - F89 - Disorders of psychological development

F90 - F98 Behavioral and emotional disorders with onset usually occurring in childhood and
adolescence

F99 - Unspecified mental disorder

Types of Mental Disorders:

Psychoneuroses (also called neuroses): In neuroses, only a part of the
personality is affected,although normal and healthy adjustment is not possible.
Patients suffering from neurosis are not in so serious state as to require
institutionalization.

Symptoms: Vague fatigue, irritational fears, doubts and anxiety, craving for attention, undue
attachment to a member of the family, preoccupation with himself, emotional turmoil,
fantasy, tendencies to self-pity and self-blame and obsessions.

Anxiety disorders: An anxiety disorder is characterized by excessive

worrying, uneasiness, apprehension and fear about future.

A. Generalized anxiety disorder (GAD): it is characterized by exaggerated anxiety and

worry about everyday life events.
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Symptoms: Excessive ongoing worry and tension, an unrealistic view of problems, muscle
tension, headaches, sweating, tiredness, trembling and nausea.

B.Phobias: This is an anxiety disorder marked by an irritational fear and avoidance of a

specific object or situation. There are different types of specific phobias.

• Animal phobias which include fear of dogs, snakes or mice.

• Situational phobias involve a fear of specific situations, such as flying, riding in a car or
in public transportation.

• Natural environment phobias like fear of storms, heights or water.

• Social phobias cause people to avoid contact with others or to avoid speaking when they
are in a social gathering

• Acrophobia is a condition where a person has a fear of crowds, public places and
travelling alone from home.

Obsessive-Compulsive Disorder (OCD): This anxiety disorder is characterized by

unwanted repetitive thoughts (obsessions) and/or actions (compulsions).

For example, one may need to recheck a locked door over and over again. Other compulsions
include eating food in a specified order, repeatedly washing hands or refusing to shake hands.

Deposit-traumatic stress disorder (PTSD): This is once called shell shock or battle fatigue
syndrome. It is a serious condition that can develop after a person has experienced or
witnessed a traumatic event in which physical harm occurred or was threatened. Most people
who experience a traumatic event will have reactions that may include shock, anger,
nervousness, fear and even guilt.

Somatoform disorders:

• Conversion disorder: For example, a soldier wants to run away from the battlefield
• Hypochondriasis: Excessive fear. For example, A severe headache as an indicator of
brain tumor
• Body dysmorphic disorder: Preoccupation with an imagined or exaggerated defect in
appearance. Patients with body dysmorphic disorder frequently have histories of
seeking or obtaining plastic surgery or other procedures to repair or retreat the
supposed defect.

Schizophrenia: It is a psychotic disorder characterized by general withdrawal

from contact with the environment and disturbance in thought processes
leading to social or occupational dysfunction.

Symptoms:

1. Disordered thinking

2.Defusional thinking

3.llucinations

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4. Disorganised speech

5. Absense of insight or critical evaluation

6.Emotional apathy

Types of Schizophrenia:

1. Simple type of Schizophrenia

2.Hebephrenic type of Schizophrenia

3.Catatonic type of Schizophrenia

4.Paranoid type of Schizophrenia

Mood Disorders: This refers to a category of mental illness that includes

depression and bipolar disorder, also called affective disorders.

a. Major depressive disorder

involutional melancholia

8.5.6. Personality disorders: These are the mental disorders which cause enduring patterns
of thought and behavior that deviate from society's expectations, causing serious problems in
almost all aspects of life.

1.Anti-social personality disorders

2.Paranoid personality disorders

3.Schizoid personality disorders

4.Borderline personality disorders

5.Dependant personality disorders

Treatment of the Mentally ill:

Treatment of the mentally ill requires teamwork. The physician, the psychiatrist, the
psychoanalyst, the clinical psychologist and the social worker generally work together in the
process of therapy. a psychiatrist can look after the patient, both from the physical and
psychological angles. A psychoanalyst employs methods such as free association, dream
analysis and re-education. The clinical psychologist generally helps in the process of
diagnosis. He interviews patients and uses testing techniques. The social worker is a very
important member of the team. She takes the history of the patient and works closely with the
parents and their relatives. Apart from these four persons, we have the nurse and the
occupational therapist, who can help the patient in his or her recovery.

1. Physical treatment: It includes use of tranquillizing drugs or sedatives. Generally,

sedatives are given when the behavior of the patient is characterized by hyperactivity and
over-excitability.

a. Macro analysis: Here the patient is given drugs such as sodium amytal or sodium
phenobarbital and when he is under their influence, he is made to talk and express himself.

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Shock therapy: It is also a kind of physical treatment. There are 3 chief types of shocks:

1.Insulin shock

2. Metrazol shock

3.Electro shock

2.Psychological treatment: It is a form of treatment which aims at personality growth and

seeks insight into one's problems.

Abnormal Behavior:

Recurrent changes in one's thinking, feeling, memory, perceptions and judgement resulting in
abnormalities in talk and behavior.

Behavior is everything that an organism does from conception to death. This involves
knowing (cognition), feeling (affection) and doing (conation), knowing consists of primary
mental functions such as thinking, recalling, recognition, judgement etc. These functions help
one to be aware of and understand the self and the environment. Feeling consists of the
emotional component of an individual and includes happiness, sorrow, fear, anger etc. Doing
consists of psychomotor activities of the organism.

Traits of a person with "Abnormal" behavior

1. Deviation from Statically norms

2.Deviation from social norms

3.Maladjustment

4.Personal distress

5.Personal immaturity

Organic Factors: Organic causes are chromosomal abnormality (Down's syndrome) mutant
genes (psychoses) brain infection (encephalitis, etc.) injury (head injury), malnutrition (serve
anemic), fatigue (hypoglycemia) and hormonal imbalance (hyperthyroidism).

Psychological Factors: Various factors such as early maternal deprivation, pathogenic

family patterns, paternal rejection, over protection, over indulgence, rigid and unrealistic
moral standards, sibling rivalry, faulty parental models, marital discord, broken homes,
pathological interaction in the family, inadequate preparation for adolescence and old age,
lack of physical, social and intellectual competencies all can lead to abnormal behavior.

Sociological Factors: These are social, regional, language and cultural discrimination, wars,
changes in the structure of the family and other social institutions.

Nurses needs to cultivate qualities of courage, alertness, sympathy and patience in dealing
with the mentally ill. They should understand a patient's personality, his likes and dislikes, his
interests, the emotional strain he has suffered and his frustrations and conflicts. In
understanding and a sincere desire to help him that will help rehabilitate the mentally ill.

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Psychiatric Emergencies:

Psychiatric Emergency is a stress induced pathologic response that physically endangers the
effected individual or others or that significantly disrupts the functional equilibrium of the
individual or his environment and calls for immediate attention.

Objectives:
1. To safeguard the life of patient

2. To bring down the anxiety of family members

Types of Psychiatric emergencies:

• Suicide

• Violence

• Stupor

• Alcohol or drug overdose

• Delirium

• Epilepsy

• Severe depression

• Side effects of psychotropic drugs

• Maniac

Assessment:

✓ Immediate assessment of the patient behavior

✓ Mental status of the patient needs to be examined

✓ History and chief compliance of the patient

✓ Physical Examination

✓ Laboratory tests

Management: Guidelinesfor Psychiatric emergency management

✓ Provide calm and quite environment

✓ Safeguarding against injury

✓ Keep separated from other patients

✓ Proper referral system

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Review Questions:

1. Explain the concepts of Mental illness and its types.

2. What are the causes for Mental illness?

3. Explain the classification of Mental illness based on WHO.

4.Explain in brief about the treatment of Mentally ill

5.Write short note on the concept of Abnormal behavior.

6.Write short note on the concept of Psychiatric emergencies.

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UNIT-IX
GERIATRIC NURSING
Definition:
Aging process and changes:

Health assessment of Elderly:

National policy on Elderly:

Nurses Responsibilities:

Many people are able to age in good health and remain active participants in society in
society throughout their lives. But others experience physical and cognitive limitations and
may lose the ability to live independently. Population aging is a phenomenon that occurs
when the median age of a country or region rises due to rising life expectancy and/or
declining birth rates.

Definition: The aging process is a biological reality, which has its own dynamic,
largely beyond human control. Roughly, 150,000 people who die each day
across the globe, about two thirds - 100,000 per day die of age-related causes.

Indian Aging Population: India is facing an elderly population, according to a united nations
report, which revealed its number of old people will triple by 2050.

Divisions are sometimes made between:

✓ The young old (65 - 74)

✓ The middle old (75- 84)
✓ The oldest old (85+)

Aging process and changes:

There is growing appreciation that everyone does not age in the same way or at the same rate.
Many of the changes that occur from aging result from a gradual loss. These losses often
begin in early adulthood, but due to the ability of our organs to adjust and maintain health,
the actual loss is not experienced until it is fairly extensive. Most organs seem to lose
function at about 1% a year, beginning around age 30, but majority of these changes are not
seen until after age 70. The biggest changes in the rate of aging and organ efficiency lies in
the presence of disease and/or ability of the body to adapt to excess stress.

Changes that occur with aging fall into 3 categories: Physical, Psychological and Social. As
changes begin to happen in one area of a person lie most likely the other two will be affected
as well. There is a wide variation among individuals in the rate of aging and within the same
person. different organ systems age at different rates. Aging also depends on our diet,
exercise, personal habits and psychological factors.

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Physical changes:
Muscle strength and flexibility decrease with age. A major reason muscles tend to become
weaker is that there is less lean muscle mass and they shrink from lack of use. It happens
whether a person is young or old. As muscle are not used they do not work as we.

Decline in efficiency of body organs:

Examples:

The heart becomes a less efficient pump. It requires more oxygen to do the same work it used
to with less oxygen. As the age increases, the thickness and hardening of the arteries occurs
causing blood pressure rise slightly.

Lungs become less elastic and do not expand well, thus less oxygen. It is worst in case of
smokers.

Kidneys take longer time to get rid of waste products during old age. The toxic substances
tend to remain in the body for a longer period of time.

Skin, Hair, Nails:

✓ Loss of subcutaneous fat
✓ Thinning of skin
✓ Decreased collagen
✓ Nails brittle and flake
✓ Hair pigment decreases
✓ Hair thins
✓ Less sweat glands
✓ Temperature regulation difficult

Eyes and vision:

✓ Eyelids baggy and wrinkled
✓ Eyes deeper in sockets
✓ Conjunctiva thinner and yellow
✓ Iris fades
✓ Pupils smaller. let in less light
✓ Lens enlarges
✓ Lens become less transparent
✓ Results in cataracts
✓ Can actually become clouded
✓ Quantity of tears decreases
✓ Increased pressure on eye
✓ Ultimately results in blindness

Ears and hearing loss:

✓ Irreversible, sensorineural loss with age

✓ Men more affected than women
✓ Loss occur in higher range of sound
✓ By 60 years, most adults have trouble hearing above 4000 Hz
✓ Normal speech 500 - 2000 Hz

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Respiratory System:
✓ Lungs become more rigid
✓ Pulmonary function decreases
✓ Number and size of alveoli decreases
✓ Vital capacity declines
✓ Reduction in respiratory fluid
✓ Bony changes in chest activity

Cardiovascular system:

✓ Heart smaller and less elastic with age

✓ Heart valves become sclerotic
✓ Gastrointestinal system:
✓ Reduced GI secretions and motility
✓ Decreased weight of liver
✓ Liver metabolizes less efficiently

Renal system:
✓ After 40, renal function decreases by 90, lose 50% of its functioning
✓ Size and number of nephrons decreases
✓ Bladder muscles weaken

Reproductive System:

Male:
✓ Reduced testosterone level
✓ Testes atrophy and soften
✓ Erections take more time

Female:
✓ Declining estrogen and progesterone levels
✓ Ovulation ceases
✓ Vagina atrophies - shorter and drier
✓ Uterus shrinks
✓ Breasts pendulous and lose elasticity

Neurological system:
✓ Nerve transmission slows
✓ Reduced REM sleep, decreased deep sleep

Musculoskeletal system:
✓ Lean body mass decreases
✓ Bone mineral content diminished
✓ Less resilient connective tissue

Immune system:
✓ Decline in immune function

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✓ Decrease in antibody response

✓ Fatty marrow replaces red marrow

Endocrine system:

✓ Estrogen levels decreases in women

✓ Decreases ability to tolerate stress - best seen in glucose metabolism
✓ Psychological changes:

Mental changes occur due to decreased activity of sensory organs

✓ Dementia
✓ Paranoia
✓ Agitation
✓ Insomnia
✓ Depression

Sociological changes:
There is reduction in income, authority, power respect and importance due to retirement from
job. Elders suffer isolation due to loss of friends, spouse, colleagues and associates.

Spiritual changes:
The religious belief tends to increase, through attendance decrease with increasing age as
shortage of money, lack of companion, functional disabilities etc. triggers with age.

Morbidity in old age:

Mostly old people have one or more chronic diseases and 40% of them have one or more
disability. Common health problems are, hypertension, cataract, diabetes, dyspepsia,
ischemic heart disease, osteoarthritis, COPD and constipation

Mortality in old age:

The common causes of death of elderly in India are ischemic heart disease, stroke, lung
cancer, tuberculosis etc.

Health assessment of Elderly:

Assessment team: Comprehensive Geriatric Assessment (CGA) relies on a core team
consisting of a physician, nurse and social worker and when appropriate, draws upon an
extended team of physical and occupational therapists, nutrition’s, pharmacists, psychiatrists,
psychologists, dentists, audiologists, opticians etc.

Conducting the Assessment: GA involves several processes of care that are

shared over several providers in the assessment team. The overall care
rendered by teams can be divided into 6 steps:

1. Data gathering
2. Discussion among the team
3. Development of a treatment plan
4. Implementing of the treatment plan
5. Monitoring response to the treatment plan

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6. Revising the treatment plan

Assessment tools:

A pre-visit questionnaire is given to the patient or caregiver prior to the initial assessment.
These questionnaires can be used to gather information about general history (eg past medical
history, medications, social history, review of systems) as well as gather information specific
to geriatric assessment such as,

Ability to perform functional tasks and need for assistance

✓ Fall history
✓ Depressive symptoms
✓ Vision or hearing difficulties
✓ Major Components:
✓ Functional capacity
✓ Fall risk
✓ Cognition
✓ Mood
✓ Polypharmacy
✓ Social support
✓ Financial concerns
✓ Additional components may also include evaluation of the following:
✓ Nutrition/weight change
✓ Sexual function
✓ Urinary continence
✓ Vision/hearing
✓ Detention
✓ Living situation
✓ Spirituality

Geriatric Care: Following are the areas where Elderly needs extra-attention

• Need for nutritious diet: A good diet with moderate carbohydrate, high protein and
low-fat help to maintain an optimal weight.
• Exercise: Regular physical activity
• Economic security
• Need of socialization
• Continuation of respect
• Dignified death

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National policy on Elderly:

The national policy on older persons was announced by the government of India in the year
1999. Various policies and plans were established by both central and state governments. Eg:
Old age pensions, travelling concessions etc.

Areas of Intervention:

Income security in old age:

➢ Indira Gandhi National old age pension scheme - 1000/Month is being paid for
senior citizens below poverty line.
➢ Income tax - Taxation policies
➢ Micro finance - Loans for reasonable rates of interest to start small business

Health care:
✓ Health care needs of senior citizens will be given high priority.
✓ The basic structure of public health care would be through primary health care
✓ Safety and security
✓ Elderly are well respected in the society

Housing: Indira Awas Yojana help the elderly in Rural and Urban areas to get a house of
their own

Nurses Responsibilities:
The nurse should have fairness, respect, equality, dignity and autonomy while giving nursing
care to the elderly people. The nurse provides direct care to the Elderly. She uses every
opportunity to educate and train the care giver of the Elderly at home. She provides health
education regarding personal hygiene and nutrition. She also maintains correct, precise and
compliance record of the elderly as follow-up care.

Review Questions

1. Explain the process of aging in an individual.

2. What are the major changes observed in aging in different systems?

3.Explain the concepts of Health assessment of Elderly

4.What are the roles and responsibilities of Nurses in Elderly care?

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UNIT-X
COUNSELLING AND GUIDANCE
Definition of Guidance:
Counselling:

Role of Nurse in Counselling:

Definition of Guidance: Jones (1963) defines Guidance as, 'The help given
by one person to another in making choices and adjustments and involving
problems'

Characteristics:
➢ It is an assistance given to individuals in the process of development
➢ It is a service meant for all
➢ It is an integral part of education
➢ It is positive and preventive rather than curative
➢ It is fundamental responsibility of parents at home and teachers at school

Types of Guidance:
➢ Educational guidance
➢ Vocational guidance
➢ Personal guidance

Counselling:

Definition: It is a relationship in which one person endeavors to help another to understand

and solve his adjustment problems.

Goals of Counselling:
➢ To change behavior, beliefs and level of emotional distress
➢ Counselling enhances an individual’s ability to cope with life situations

Principles:
➢ Counselling is a helping relationship between client and counsellor
➢ It is directed to self-realization and self-direction
➢ Confidentiality
➢ Independent decisions must be encouraged
➢ A counsellor does not have the right to impose his values on the client

Process of Counselling:
➢ Identification of the problem
➢ In-depth exploration
➢ Selecting goals and action plans
➢ Implementing and evaluating the action plan

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Counselling skills:

➢ Rapport building
➢ Attending and listening
➢ It is important to maintain positive eye-contact
➢ A good counsellor will listen 90% of the time and talk only 10% of the time
➢ Empathy
➢ Genuinely

Characteristics of Counsellor:

➢ Counsellor should have an interest in helping others

➢ Should be able to build good inter-personal relationships
➢ Continue self-examination
➢ Fairly well adjusted
➢ Tolerance
➢ Flexibility

Types of Counselling:

➢ Individual counselling
➢ Group counselling
➢ Online counselling

Role of Nurse in Counselling:

1. In the case of patients with dementia, nurses should support the care-givers by
listening
2. In the case of illness like AIDS, Nurses must be able to communicate effectively in
relation to the patient's emotions and feelings
3. in the case of hospitalized patients, nurses can relieve some of the insecurities of
patients and encourage them to become as independent
4. Nurses working in rehabilitation as in cardiac rehabilitation have a strong role to play
in counselling and health promotion.

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Review Questions:

1.Explain the concept and techniques of counselling

2.Explain the concept and techniques of guidance

3. What is the role of a counsellor in counselling and guidance?

4.What is the role of MPHW in counselling and guidance?

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Paper - III
PRIMARY HEALTH CARE NURSING
INDEX
Unit - 1 Hospital 256
Unit - 2 Preparation Of Patient Unit 267
Unit - 3 Optical Functioning Of Hygiene 277
Unit - 4 Collection Of Specimen 304
Unit - 5 Disinfection And Sterlization 316
Unit - 6 Biomedical Waste Management 326
Unit - 7 Medical Condition 333
Unit - 8 Operation Theatre Nursing 390
Unit - 9 Care Of Physically And Mentally Challenged 403
Unit - 10 Types And Administration Of Drugs 409
Unit - 11 Emergency Drugs In O.T. And Other Areas 424
Unit - 12 First Aid And Referral 431
Unit - 13 Minor Injuries And Ailments 442
Unit - 14 Fracture 454
Unit - 15 Life Threatening Conditions 462
PAPER III PRIMERY HEALTH CARE

PART-A

UNIT-1 HOSPITAL
Structure
1.0-Introduction
1.1-Definition
1.2-Functions
1.3-Classification
1.4-Admission and discharge procedure
1.5-Nursing as profession

Objectives
After reading this unit the student is able to –
- Identify the classification of hospital
- Enumerate the functions of the hospitals
- Describe the admission and discharge procedure of the hospital
- Learn about importance of nursing profession.

Introduction:

Hospital is one of the social organization which grew out of necessity of health care
needs of the people were to be met.

Definition

The word hospital is derived from Latin word “hospes”, Hospital means, an institution or
place offering residential care, investigatory care and treatment to the sick, injured and also
health people.

A modern hospital is an institution which provides accommodation to patient and renders

curative, restorative and preventive services to the needy people.
Hospital is a place for the diagnosis and treatment of human illness and restoration of health
and well-beings of those temporarily deprived of these. Professionally and technically skilled
people apply their knowledge and skill with the help of advanced equipment and appliances
to provide quality care for the patient.
Functions:

The primary function of a hospital is providing care to the patients, who are hospitalized for
the purpose of preventive, curative and restorative.
The functions of the hospitals are
- Clinical function.
- Health promotion and education.
- Administrative functions.
Clinical Function

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- The hospital provides quality health and medical services to the people out patient as
well as in patient.
- The hospital gives diagnostic care screening of patient for identifying the disease at an
early stage. (e.g.) Mammogram, X-ray, CT scan and MRI, Blood test, Urine test,
CSE analysis etc.
- Emergencies care services provide in the casualty department of the hospital. (e.g.)
Accident, trauma and acute life threatening conditions like heart attack.
- All major and minor ailments are treated in the hospital. (e.g.) minor ailments like
cold & cough, fever, etc.; major ailments like cardiac problem, neurological problems,
cancer, fracture etc.
- The rehabilitative services provide in the hospital.
o Physical rehabilitation – (e.g.) artificial limb after ambulation, physiotherapy
for neurological deficit.
o Mental rehabilitation – Counseling for individual as well as group.
o Social rehabilitation – Economical support in form of Government health
scheme services, (e.g.) Arogyasree, EHS.
- The hospital provides well planned and organized health services adopted to ensure
complete treatment to the patient at regular time.
- It gives report to the patient regarding summary of diagnosis, treatment, procedures
and services extended to the patient for further referral.
- Monteux test for early diagnosis of TB. Mammogram for early diagnosis of breast
cancer. CT scan for early diagnosis of cerebral hemorrhage after accident.

Health Promotion and Education:

1) The hospital renders preventive services in form of vaccination (e.g.) Hepatitis ‘B’,
Meningitis, rabies vaccine for dog bite, and immunization to the child from six killer
diseases (TB, Polio, Diphtheria, pertusis, Tetanus).
2) The health team members provides health education to the patient as well as family
members regarding care of patient with disease and prevention of disease.
3) The hospital team conducts medical camps for identification and intervention of
different communicable and non-communicable diseases (e.g.) eye camps, blood
donation camp, medical camps, family planning camps.
4) Rehabilitation and training to the physically and mentally challenged.
5) The hospital gives huge learning experiences to the medical, nursing and
physiotherapy students.
6) The hospital gives chance to the medical and nursing students to conduct research
work for further improving of health care services.

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Administrative Function:

- Recruitment and selection of employees.

- Promotion to the employees.
- Employees’ welfare and benefits.
- Manpower planning to the different shifts of duty.
- Procurement of medicals, equipment and supplies for patient care.
- Budget and financial plan for patient care, hospital program, projects and hospital
development.
- Prepares statement of account on service and bill rendered to the patient.
- Maintenance of financial transactions and relevant report on expenditure.
- Monitoring and regular verification of inventory, drugs and supplies.

Departments in the Hospital

1. Medical Department
The medical department has within it the various clinical services. They are: medicine,
surgery, gynaecology, obstetrics, paediatrics, eye, ENT, dental, orthopaedics, neurology,
urology, cardiology, psychiatry, skin, -plastic surgery, nuclear medicine, etc. Medical
Director is a Doctor who has control over all the medical department.
2. Nursing Department
The nursing department consists of nursing service and nursing education. The primary
purpose of the nursing service is to provide comprehensive, safe, effective and well organized
nursing care through the personnel of the department. The primary purpose of nursing
education is to raise the standard of nursing service by providing in service education to
nursing service personnel in the hospital.
3. Paramedical Departments They include:
I Laboratory
Pathology department-The pathology department is one of the largest departments and has
the responsibility for making tests and studies on blood, sputum, faeces, body fluids and
tissues. The different laboratories in the hospital are Bacteriology lab, Biochemistry lab,
Haematology lab, Parasitological lab, Serology lab and Histopathology lab
Blood bank: It has the responsibility for collecting and processing all blood used in the
hospital for transfusions.
II Pharmacy Department
The pharmacy department has the responsibility for selecting, purchasing, compounding,
storing and dispensing all drugs and in nursing medications for in-patients and out-patients.
The pharmacy should be under the supervision of registered pharmacist.
III: Physical medicine and rehabilitation Department
This department treats patients who have functional disabilities resulting from disease
conditions or injuries. It has several specialties such as: Physical therapy, occupational
therapy, speech therapy and vocational training.
IV: Radiology Department
This department functions under the control of radiologist and qualified technical staff. It has
the following diagnostic and therapeutic services for in-patients and out-patients. e.g.

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Radiographic examination and ‘X’ Ray, Radium, Radio Active Cobalt and other Radio
Active therapy.
V Dietary Department
In most hospital, this department is under the direction of a trained dietician. The department
is charged with:
1. Ordering and preparation of food.
2. Tray service.
3. Diet teaching.
The dietician is a member of the health team and works closely with nursing service
personnel in meeting the patient's nutritional needs and in teaching.
VI Outpatient department
This is a combination of several departments. It is a miniature of the hospital except that the
patients are ambulatory. Specialities provide services. Individual may attend this department
for the purpose of receiving treatment, or to enable a physician to assess their progress
following discharge from hospital.
VII Emergency Department
People who are classified as “emergency admission" are admitted to this department to
receive life-saving services immediately needed after thorough examination by the
responsible physician.
VIII Operating Theatre (O.T.)
It is a room in a hospital equipped for the performance of surgical Operations; "great care
should be taken to keep the operating rooms aseptic.

Non –Professional Health Service Departments

1. Admitting Department
This department has the responsibility for admitting the patient to the hospital. It should
maintain good public relations. The patient, family and friends must be treated with utmost
respect, courtesy and tact.
2. Personnel Department
The functions of this department are as follow
a. Recruitment of personnel. f. Safety.
b. Interviewing. g. Health programs.
c. Promotion and transfer. h. Recreation.
d. Termination of employment. I. Remuneration and Incentive
e. In-Service training.
3. Purchasing Department: This department has the responsibility for purchasing all
supplies and equipment for the hospital.

Classification

Hospitals can be classified in many ways.

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According to ownership

I. Public hospitals: Central/State Government Hospitals, District Hospitals, Area

Hospitals, Primary health Centers, Community health centers. It provides treatment
for common diseases where as specialized hospital provides treatment for specific
diseases (e.g.) ENT, TB hospital, Cancer Hospital.
II. Charitable hospitals: A Board of Trustees usually manages such hospitals. (e.g.)
Christian Mission Hospitals.
III. Private Hospitals: It is owned by individual or group of people and run on a
commercial basis.
IV. Corporate Hospitals: It is run by limited companies, formed under the Companies Act.

According to clinical specialties

In these hospitals, patients are treated for those diseases for which that hospital has been set
up such as tuberculosis, cancer and cardiac disease etc.
According to length of stay
Acute Care Hospital: Short -stay hospitals: These are hospitals where over 90% of all patients
admitted stay less than 30 days.
Chronic Care Hospital/ long stay hospitals: These are hospitals where over 90% of all
patients admitted stay 30 days or more, i.e. cancer hospital mental hospital
According to teaching & non-teaching
A hospital with medical college is known as Teaching hospital, without medical
college is known as Non-Teaching hospital.

Admission and Discharge procedure of the Hospital

Admission

It is the term used to describe event of entering a hospital and all the procedures
related to this event.Patient admitted into the hospital in two ways i.e. from an outpatient
department, emergency care department.

Admission Procedure

(1) Reception – patient is new to the hospital environment. The patient should feel
comfortable and someone to look in to his needs. Reception office refers the patient
to the concerned O.P.D., ward/department.
(2) Recording – After receiving the patient in the ward, the patient record of admission
should be checked for completeness.
- Check the diagnosis of the patient, immediate care and treatment to be given.
- The details required for completion of ward admission registers and patient record.
- Name of the patient
- Name of the father/guardian
- Address and contact number
- Occupation and income
- Religion

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- Aadhar card No. for Arogyasree scheme treatment/procedure

- White ration card for economical status of patient.
- Date, time of admission - Time of receiving in to the ward.
(3) Orientation - The patient should also be introduced to the staff in ward i.e. nurses, the
orderlies and other professionals. Orient the location of the necessities in the ward
like the patient – toilets, switches of fans and lights.
Orient about ward routines: i.e. time of doctors rounds, visiting hours, medication and
care of belongings, diet.

Care on Admission

a) Immediate Care – The nurse should carry out these investigations and treatment on
emergency basis even if there is delay in completing the formalities of admission.
b) Routine care on admission:
- Check vital sign
- Check weight
- Assess general condition of the patient
- Send message to the appropriate doctor.
c) Patient unit: It is essential to ensure that there is a clean bed, locker and made
comfortable.
d) Keep ready, the articles required for detailed physical examination.
e) Make the relatives feel useful in the ward.

Nursing care during hospital stay

This includes the following:

1) Hygienic care of the patient.

2) Daily assessment and reporting to the concerned doctor.
3) Accurate charting.
4) Assisting in investigations and treatment.
1) Hygienic care:
The nurse duty is to ensure –
a) Daily patient cleanliness – bath.
b) Change of linen of patient as required.
c) Specific hygienic care for bedridden patients and those susceptible to infection.
The nurse should make sure that the patient and relatives understand the
importance of hygiene, specially when ill in hospital. Invasive procedures make
the patient susceptible to infection. Relatives and patients may be taught to
provide self care.
2) Daily Assessments and reporting
As a routine the nurse should take over the patients as soon as she comes on duty and
assess their general condition. As the closest to the patient she will be able to observe
even minor changes in the condition. Note types of patients and categories into those

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who require more intensive care, those who require intermediate care and those who
are ambulatory on a day to day basis and plan her work.
3) Accurate charting
The nurse should be accurate with
a) Temperature, pulse, respiration, blood pressure assessment and recording.
b) Intake and output.
c) Drugs administered.
d) Specific charts if any.

4) Assisting in investigations and treatment of patient:

As a routine it is the nurses duty to assist in carrying out investigations e.g. –
collecting and sending samples to different labs, preparing and sending patient for
investigations.
She should remember to –
a) Check the investigations to be done.
b) Collect correct sample.
c) Do accurate labeling.
d) Enter into dispatch register.
e) Send the sample to the correct lab.
f) Ensure that the report is received back.
g) Paste properly in the case sheet.

The nurse should assist in carrying out treatment procedures.

a) Ensuring indenting and stock of required drugs and treatment material.

b) Administering the prescribed drugs according to orders.
c) Getting the required equipment, trays etc. for carrying out treatment.
d) Assisting in carrying out the therapeutic procedures.

Discharge Procedure

Discharge care is the planned nursing care and teaching carried out before a patient is
transferred from hospital to home or from one ward to another.

Aims of Discharge Care

1) To prepare with the patient and family physically and psychologically for transfer of
the patient to the home.
2) To promote the highest possible level of independence for the patient by encouraging
self care activities.
3) To provide continuity of care between the hospital and home by effective
communication and adequate teaching.

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Discharge process involves the patient, relative, friends, and the hospital and community
health care teams. An individualized assessment and planning for future care is a continuous
process which begins on admission.

Discharge care is an integral part of continuity of nursing care for patients throughout
their hospital stay. Patients are often discharged before they are completely self reliant.
Patient and relatives have to cope with unmet needs and follow treatment after they go home.
An effective communication process is vital if the patient’s home nursing care is to begin
without delay.

Inadequate communication and interpersonal cooperation resulting problems in meeting

needs of the patient and inappropriate assistance being engaged by family. The days
following discharge can be a period of great vulnerability and anxiety. Poor discharge
planning and is consequences may result in physiological and psychological problems.

The decision to discharge a patient from hospital depends on many factors other than medical
considerations.
a) The doctor may consider the treatment completed.
b) Hospital beds may be required for more critical patients.
c) The doctor may feel treatment can be carried out in the home.
Collaboration between hospital and community health care professionals is important for
continuity in patient care.
Role of nurse during discharge care

The nurse must plan and spend time with patient and family to:

➢ Prepare the patient and the family feels ready to go home.

➢ Teach about care at the home. i.e. Treatment to be continued at home; Diet to be
taken; Exercises and rest.
➢ Demonstrate skills required.
➢ Give necessary information for follow up.

Nursing as a Profession

The Nursing is the word derived from Latin word Nutrix – it means “to Nourish”

“The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful death)
that he would perform unaided if he had the necessary strength, will or knowledge and to do
this in such a way as to help his gain independence as rapidly as possible”

Virgenea Hender Son 1966

Nursing begin as an art in the home, but a science while in practice, by using
scientific principles in doing procedures while doing patient care.

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A profession should be intellectual, scientific requiring higher education & provide essential
services. Nursing is recognized as a profession based on the following criteria.

- It has a well defined body of unique knowledge.

- Strong service orientation and recognized authority by a professional group.
- Code of ethics
- Professional organizations that set standards
- Ongoing research
- Autonomy.

Role of Nurses:

Nurses play several roles. The primary role is to provide care to patients, to enable
them to meet their physical, emotional, intellectual, socio-cultural and spiritual needs.

- Communicator: Establishes and maintains helping relationships with patients,

family and community in all settings.
- Teacher: Assess the learning needs of patients and family and implements individual
and group teaching.
- Counselor: Helps patient to solve problem and decide on the treatments provides
necessary information and suggest referrals.
- Leader: A nurse is a team leader, who is assistive and can bring change in the
individual and group.
- Researcher: She contributes to research and conducts research to use evidence
based practice.
- Advocate: She believes in human rights, legal rights and protects patients.
- Manager: As a manager makes decision, co-ordinate the activities of others.
- Practitioner: The nurse with an advanced degree can do service as individual
practitioner in the community (with license from Registered Nursing council
concerned state or national authority)

Qualities of a Nurse:

A nurse should cultivate the following qualities.

- Pleasant appearance. - Duty mindedness
- Honest - Understanding
- Loyal - Punctuality
- Self discipline - Courteous
- Kindness - Well balanced emotion.
- Tolerance
Nursing care is an integral part of total health care of patient. Nursing care concerts to
promote health, prevent disease, disability and restore health.
Nursing personnel respect the individuality, dignity and right of every person, regardless of
race, color, creed, national, origin, social or economical status. Nursing personnel includes –
- Professional nurse
- Auxiliary nurses

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- Health visitors
- Midwives
All people need to undergo recognized course of instruction in recognized institutions.
Nursing Educational Programmes in India:
There are several nursing programmes throughout the world that prepares nurses.
One who complete the training programmes are called as nurses. In India the Indian Nursing
Council regulates nursing education.

- ANM & Multipurpose Health Workers (MPHW) - 2 years.

- General Nursing and Midwifery (GNM) - 3 years
- B.Sc. Nursing - 4 years
- Post B.Sc. Nursing - 2 years after completion of GNM
- M.Sc. Nursing - 2 years after completion of Under Graduate
- M. Phil. - 2 years
- Post Basic specialty Diploma Course - 1 year
- PhD in Nursing - 5 years.

Opportunities in Nursing:
The nurse has so many opportunities to work in the following areas as Staff Nurse,
Nursing Supervisor, Nursing superintendent, Director of Nursing and Nurse Educator.

- Hospital – District hospitals, Primary Health Centre

- Public health nurse as in community
- Industry
- Nursing schools and colleges
- Defense – Army, Navy and Air force nursing
- Railway department
- Independent Nurse Practitioner, Nurse Midwives.

Nursing Process:

The nursing process is a method for organizing nursing activities involving both
intellectual and physical activities to solve the problem.
The steps of the nursing process are
- Assessment - Implementation
- Nursing diagnosis - Evaluation
- Planning
Basic Nursing Principles
Nurse should follow the principles while performing procedures to meet the needs of
the patient.
- Individuality
- Safety
- Comfort
- Resourcefulness
- Therapeutic effectiveness
- Workmanship

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Nightingale Pledge

“I solemnly pledge myself before God and in the presence of this assembly, to pass
my life in purity and to practice my profession faithfully. I will abstain from whatever is
deleterious and mischievous, and will not take or knowingly administer any harmful drug. I
will do all in my power to maintain and elevate the standard of my profession, and will hold
in confidence all personal matters committed to my keeping, and all family affairs coming to
my knowledge in the practice of my calling. With loyalty will I Endeavour to aid the
physician in his work, and as a 'missioner of health' I will dedicate myself to devoted service
to human welfare.”

Conclusion

Hospitals are the institutions established for the services of mankind catering to the
health needs to various categories of the populations in the community. Nursing is one of the
important parts in giving care to the patient in hospital. The professional nurse is to build
qualities to maintain standard of care by using principles.

Essay Questions

1) What are functions of the hospital?

2) Describe the admission procedure?
3) What are role and functions of a nurse?
4) Describe the qualities of Nurse?

Short Answer Questions

1) Define Nursing
2) List any 5 departments in the hospital
3) What are the principles of Nursing?
4) Define hospital
5) What are nursing education programmes in India?
6) Define profession.

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UNIT – II PREPARATION OF PATIENT UNIT

Structure
– Introduction
– Definition
– Principles
– Optimum healing environment for patient
- Factors affecting safety of patient
- Patient unit
– Bed making
– Different types of Bed

OBJECTIVES
After completion of the chapter, The student is able to
- Learn the environment required for optimal health of patient
- Describe the factors affecting safety
- Learn and practice bed making
- List the different types of bed.

Introduction
The hospital environment should make the patient stay as comfortable, unthreatening,
and pleasant and stress free as possible. The nurse is able to modify and provide safe
environment to the patient during hospitalisation.
Definition
The environment is defined as the sum of the external surroundings and influences.
Environment is defined as all which is external to the individual. It may be physical
environment, biological environment and psychological environment.
A therapeutic environment is an environment which helps a patient to return to health
from illness.
– Principles of maintaining optimum therapeutic environment
- Choose proper cleaning method to prevent contamination of the atmosphere. Wet
mopping is good for fine dust removal.
- Time for cleaning to minimise disturbance cleaning procedure as well as to carryout
ward routine.
- Careful use of cleaning agent with proper concentration helps to control bacterial
growth.
- Keep environment neat, dry, order and with effect of beauty.
- Use proper method for disposal of biomedical waste and dirt.
- Do not use wet dusters on bacterial fixtures and polished furniture.
- Furniture must be moved away from walls before dusting.
- Long and firm strokes from far to near place while doing damp dusting
- Friction aids mechanical cleaning
- Simple and correct method of cleaning saves time, material and energy.
Optimum healing environment for patient

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The common ward, special ward, special room of the patient to be kept clean free from
pathogens / microorganisms, some of the environmental factors influence the healing and
maintenance of health of the patient, they are
• Temperature • Lighting
• Humidity • Noise
• Ventilation • Psycho social environment
• Purity of air
Daily care of wards
1. The ward should be well ventilated
2. The room should be well lighted. Sunlight brings warmth and cheer has great healing
powers.
3. Prevent noise and unpleasant odour.
4. Avoid loud talking, banging of windows
5. Remove bed pans, urinals and emesis basins immediately after use.
6. Keep patients and their bed clean and tidy
7. Keep furniture in the ward in order.
8. Keep food with well covered and fly proof net.
9. Wash shelves twice / once a week as per hospital policy.
10. After daily dusting put things in orders and keep air continues
covered, the labels should be visible.
11. Keep cupboard doors closed.

Care of equipment and linen

The articles / equipments used for patient are made up of the stainless steel,
aluminium, enamel and rubber good. The articles to be cleaned properly after the use, which
helps to prevent transmission of infection from one patient to another.

Enamel ware: These articles are to be cleared by using a pan of warm soaps water for
washing. Rinse in clean warm water and dry well.
Glass ware: Wash with soap and rinse with cool water; clean with dry duster.
Stainless steel: clear the articles after use under running water; use fresh disinfecting solution
to disinfect the articles e.g. Instruments like artery forceps, kidney trays.
Rubber goods: e.g. mackintosh, hot water bag, gloves, ice caps, after use the items wash
under cool running water and dry under shadows; Apply French chalk power after drying.
Store in a dark cool place.
Care of linen
Clean Linen: Keep the linen in the cupboard according to name of stock; Label the stock to
prevent confusion and loss of energy.
Soil linen: Soiled linen with urine, blood or stool should be rinsed with cold running water.
Linen of infectious patient should be disinfected first and then send to laundry.

Factors affecting safety of patient

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Ensuring safety is one of the important aspects in care of patient during hospital stay.
The internal physical facilities of the building should be based on the category of patient i.e.
aging eye disorders, fracture, children and mentally disabled person.
Environment will support the optimum health, maintenance, care and rehabilitation.
Even though it is impossible to prevent accidents completely. There are ways to control /
minimize potential for accidents that may cause injury to the patient / health care members
and unnecessary damage to the articles.
Safety measures for patient safety
1. Identify the patients at risk for injury and don’t leave alone / assist for their daily activity.
(e.g.) impaired vision and hearing of elderly people.
2. Keep side rails to prevent fall from bed.
3. Maintain dry and uncluttered floor.
4. Use restraints to prevent falling or injuries.
5. Adequate lighting at stair ways and corridors.
6. “No smoking” board near the OXYGEN administering patient.
7. Display the telephone numbers of emergency services and know the location of fire exist.

Patient unit
It referred as the area of the hospital in which the patient receives medical and nursing
care surgical treatment. Patient care unit must be safe, pleasant and orderly environment for
the patient’s physical and mental well being.
Furniture and equipment required for the patient basic unit:
Furniture: Bed
Bed side locker / cabinet
Over bed table
Chair / bench / stool
Equipment: Articles necessary for providing basic nursing care.

Components of optimum healing environment

The patient healing is based on the environmental components required in the health
organism.
i. External environment
ii. Behavioural environment
iii. Interpersonal environment
iv. Internal environment
1. External environment
The Physical space of hospital must support healing through lighting, access to nature,
ventilation, colour and architecture etc.
The surroundings of the patient environment should
• Eliminate stress among patient
• Improve efficiency in providing care to patient
• Reduce infections and fails
• To promote healing

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Health care organisations should consider chemical impact and ecological sustainability
of the health care practices. e.g. reduce the volume of drugs and chemical deposited into the
environment i.e. Radiation therapy to patient.

2. Behavioural environment
The organisations should promote and provide instruction in healthy behaviours and
lifestyle changes for patient and employees. Enhance healthy habits and life style practices.
3. Interpersonal component
The health team members need to maintain co-ordinated, healthy co-operative team
work. To establish trust among patients and families. To maintain good interpersonal
relationships with colleges, superiors, doctors and patients.
4. Internal environment
• Enhance patient awareness and belief in early recovery from disease.
• Encourage confidence in improvement of well being.
• To maintain natural immunity
• To maintain healthy life style by keeping balance between personal and work area.
• Educate self integration and self-care.
Checklist for physical environment supports optimal healing
• Build private rooms
• Provide space for females to stay overnight in patient room.
• Develop recommended noise level standards (WHO)
• Optimal lighting
• Minimise unnecessary patient transfer
• Provide wider doors in patient bathrooms
• Install optimal air infiltration system.
• Install technical devices to case patient light and transfer.
• Keep music chronic ill patient units
• Good flooring and architectural features
• Privacy
• Install clean way finding system.
a) Linen – Bed sheet – 2; Towel ; Wash clothes ; Blankets -1;
Draw sheet – 1; Apron / Gown
b) Urinal
c) Bed Pan
d) Kidney tray
e) Sputum cup if necessary
f) Water jug
g) Soap / Hand sanitizer / alcohol based hand gel dispenser
h) Wash basin
i) Electrical outlet
j) Suction and oxygen outlet
k) Calling bell to the private room
l) Side rails

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Hospital bed
Bed is the one of most important equipment for the patient comfort, safety and
position changing.
Types of bed
According to the structure
• Immovable / bed – firm iron frame cot with
• Movable bed – it consent of a firm mattress on a metal frame that can be raised and
lower the head and fool of the bed. It has wheels with locking system.
According to age
• Adult bed: The length of the bed is 6 feet +/-, iron frame cot and firm mattress with or
without side rails.
• Paediatric bed: the length of the bed is 3 feet +/-, with side railing. Iron frame cot with
firm mattress.
The features of the hospital bed
The hospital bed consists of mattress on a metal frame that can be raised or lowered
horizontally.
1. Size : 6 feet – Adult
3 feet – children
2. Height of bed : 65cm to 70 cm from the floor
3. Mattress: 6” x 3” coir firm mattress cover with racking sheet.
4. Locks on the wheel: Locks in the wheels is to prevent accidental movement during
procedure / patient.
5. Side rails: Located on both sides of cot helps to prevent patient fall and position
themselves in the bed.
6. Special head board: it is removable and .... in emergency situation lake cardio
pulmonary resuscitation.
7. Electrical controls: it is on the side of the bed. It is aiding to reese or lower sections of
bed without using man power / energy.
Now days hospital beds are operated by electrical motor to change the position of bed for
patient comfort. Some are operated manually or by hydraulic method common bed positions.

Common bed positions

1) Fowler’s position : Head of the bed raised an angle of 450 to 900

It is used for expansion of longs during
dyspnoea.
It is preferred for eating and naso gastric tube
connection

2 Semi fowler’s position : Head of the bed raised to an angle of 300 to 450
It promotes long expansion and relieves strain on
abdominal muscles.

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3. Trendlenberg position Head end of bed in down

It is useful for postural damage; facilitates
venous return.

4. Reverse trendlenbergs position Foot end of bed in down;

It is rarely used, it prevents oesophageal reflux.

5. Flat Entire bed from horizontally parallel to the floor.

It maintains spine post platen preferred position
from sleeping.

Bed making

While doing bed making, the nurse should considers the patients mobility. Over all
medical condition and risk for pressure ulcer development. Bed clothes must be made of
suitable material size. Shape for the comfort and safety of the patient according to the climate
and patients condition.

Purpose of bed making

The purpose of a well made hospital bed is
- To give neat and tidy appearance to the unit
- To provide comfort to patient
- To promote rest and sleep
- To prevent cross infection
- To establish report with patient
Principles of bed making
- Barrier nursing helps to prevent cross infection
- Keep the required equipment before starting the procedure.
- The bed should be free from crumbs, creases and dusts.
- Keep clean and comfortable bed to ensure rest and sleep
- Appropriate body mechanisms to maintain body alignment and prevent fatigue.
- Handle soil linen carefully in order to reduce dust and spread of micro organisms.
- The patients face should never be covered by sheets or blankets.
- When pillows are being shakes, the nurse should touch away from the patient.
- Always wash hands before and after bed making
- Don’t place dirty linen on the floor and torch the uniform.
- Stay on one side of the bed until it is completely made then move to the other side and
finish the bed. This saves times and steps.
Types of beds

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i. Routine beds
a. Simple unoccupied bed
b. An occupied bed
ii. Special beds
a. Cardiac bed
b. Amputation bed
c. Fracture bed
d. Post operative bed.
Preparation
The nurse makes the bed in the morning after a patient’s bath or when the patient is
out of the room for test. Any sheets that become wet or soiled should be charged properly.
Unoccupied bed: 1. Open
2. Closed
The bed which is not occupied by a patient. This is an empty bed, in which top covers
are avenged in such a very that all lines beneath the counter pane or bed spread is fully
protected from dust and but until the admission of a new patient.

Occupied bed
An occupied bed in one that is made which is occupied by a patient. The patient is
unable to move himself or herself but from the bed by their disease condition e.g.
unconscious patient.
The patient is rolled to are side where the other side of the bed is made vies versa, the
other side of bed also completed.
Cardiac Bed
This is prepared for a patient with heart disease to relieve dyspnoea and comport for
the patient.
Bed is provided with extra pillows to b e kept on head side of patient in prop up
position for better airflow. Special cardiac table provided for cardiac vascular support at night
time with proper oxygen masks and nasogastric tubes.
Fractures bed
This is a hard frame bed designed for the patient with fracture particularly of spine,
pelvis or femur. These frames are designed to support fractured parts with traction apparatus.
Fracture bed aid in immobilising the fracture and prevents unnecessary pain.
The additional articles always required for the fractures bed patient’s comforts i.e.
back rest extra pillows, air cushion, knee pillow, cardiac table and foot rest. Bed pan should
be provided near the bed or if the patient with upper extremity fracture can walk to washroom
and toilet.
Amputation bed
This is a bed that is prepared for a patient having amputated limb. Amputation is the surgical
removal of the upper or lower limb of the patient due to gangrene diabetic foot, compound
fracture and cancer bone. The amputation bed in help to keep the stem in good position and
watch the stamp for haemorrhage. e.g. for below knee amputation, low end of bed in need to
elevated

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The additional things required for amputation bed and extra set of topless, bed cradle,
two sand bags pillow water proof cover, hot water bottles -2, two or more blankets.
Post operative bed
This is the bed for receiving the patient from operation theatre after the surgery. The
top folding linen / sheet in fan folded from the head and foot of the bed toward the middle
third of the bed and then for folded to opposite side of the bed that the patient will enter.
The additional supplies required for post operative bed are kidney tray, paper bag,
Intra venous stands steel drainage bag with rubber tubing and a tray containing bowl of gauze
of pieces, forceps, tongue depressor, air way, small towel and small protective sheet, bed
blocks, arm board, IV fluids and BP apparatus.
The post operative bed will protect bed linen from vomiting, bleeding drainage and
discharges, provide warmth and comfort to the patient to present stock. Nurse should provide
the bell or cordless phone to family and patients to call medical staff for any emergency need.

Bed making procedure of unoccupied bed

1. The procedure below should be followed
2. Place the laundry hamper or basket in a convenient position accessible to all in the
ward.
3. Obtain the necessary linen.
4. Place chair or stool at the foot end of the bed or on the side. Place pillows, flat on the
chair and put linen across pillows in the order i.e. Bedspread
Towels
Pillow with pillow case
Blanket
o bottom - top sheet
o to - Mackintosh
o Top - Bottom sheet and Mattress cover
Damp dust the bed and brush the mattress
5. Place the mattress straight on the bed. Push the mattress to the head end as far as
possible
6. Put the mattress cover on from the foot of the bed, adjusting it smoothly at the
corners, and tie it on.
7. Place the bottom sheet right side up on the mattress. The lower edge of the sheet
should be in line with the lower edge of the mattress.
8. Tuck the sheet under the mattress at the head end of the bed. Beginning at the centre,
make a right-angle corner at the side, and tuck it under the mattress at the side.
9. Place the rubber sheet, 18 inches from the head of the bed, and tuck in the side.Put on
the draw sheet so that it extends above and below the rubber sheet
10. Place the top sheet on the bed, ensuring that the centre fold is at the centre of the bed
and that the wrong side of the sheet is turned up, wide hem, at the top. The top of the
sheet should be in line with the top of the mattress. Tuck the lower end of the sheet.
Under the foot of the mattress, make a right angle corner and tuck under the mattress
along one half of the side.

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11. Likewise, place the blanket 10 inches from the head of the bed. Tuck the blanker
under the foot of the mattress and make a right angle corner. Fold the sheet over the
blanket.
12. Go to the opposite side of the bed and complete the foundation, making it smooth and
tight without wrinkles.
13. Place the bedspread so that the top is in line with head of the mattress. Make an
oblique corner and let the sides hang.
14. Put on the pillow case and fix the corners of the pillow to one side of the pillow case
and place the open ends away from the door.

Occupied Bed

To make a bed with a patient in it,with full change of linen

Purpose:The pupose is two-fold:
• To porivde ta clean and comfortable bed for the patient
• to provide for the neat appearance of the ward.
• Equipment
• The followingg requirement is needed:
• larger sheets,rubber draw sheet,draw sheet,blanker, when weather requires it, spread,
if available, pillow casw
Procedure
1. Place the laundry hamper or basket in a convenient position in the ward.
2. Obtain the necessary linen.Place it on the bedside chair, or hang over th foot of the
bed in the order of use.
3. Screen the bed, place chair conveninently for holding the bedlcothes. Loose the
bedclothes on all sides. If the spread is to be used again, fold it carefully to prevent
unnecessary creasing and hang over chair.
4. Fan down the blanket, cover the patient with a top sheet. Tuck in well at shoulders.
5. Remove pillows, unless the patient is too uncomfortable in this position. change
pillow case.
6. The patient turn with back to the nurse, lying well over on the opposite side of the
bed. caution again falling. Have the patient hold on to the side of the bed. If the
patient is helpless, another nurse can help.
7. Fan the draw sheet in smooth folds againt the back, tucking well under the body; fan
the bottom sheet likewise
8. Pull the mattress cover;keep it tight to prevent wrinkles
9. Place the fresh bottom sheet along the length of the bed with a fold in the centre.Tuck
in well at the top,do the mitered corner and tuck in the side, when the sheet is long
enough . similarly, do the mitred corner at the bottom as well.
10. Pull the rubber draw sheet out and tuck in at the side,over the sheet.
11. Place the fresh draw sheet over the rubber and tuck under, fanning the other half
neatly to the centre.

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12. Have the patient turn or move to the clean side of the bed.remove soiled linen and
place on the chair. draw out the bottom sheet and continue as for a closed bed,
drawing sheets tightlty to make a smooth,tight bed
13. Have the patient return to the centre of the bed and replace the pillow under the head
with a fold under the shoulders
14. Ask the patient to draw up his/her knees while th upper bed clothes are placed to
allow room for toes.place the sheet in position, allowing a cuff of about 12inches
15. Remove the bath blanket from the top, with a drawing under sheet.tuck sheet in at the
foot, mitered the corner and tuck under the bed.Put on the blanket and spread in the
same manner, Enveloping each piece separately.Finish the otehr side
16. Remove used linen.Place the patient in a comfortable position and leave the unit in
order.

Conclusion
The safe and healthy environment always helps to enhance early recovery of the
patient. During hospitalization, Patient received comfort from proper bed making and
facilities in the environment.

Short answer questions:

1. What are the principles of maintaining therapeutic environment
2. List the safety measures for the patient safety
3. What is amputation bed
4. What are the positions maintained in the bed
5. What is the purpose of bed making?

Essay Questions

1. Describe the preparation unoccupied bed

2. How do you provide optional healing environment to the patient in the ward?

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UNIT –III OPTIMAL FUNCTIONING OF HYGIENE

Structure
- Introduction
-Definition; Personal hygiene
-Care of mouth
-Care of skin
-Care of hair and nails
-Care of eye
-Care of ear
-Care of bowel and bladder
- sexual hygiene
- Comfort, needs of sick
- Care of pressure points
- Positioning
- Hand washing
- Basic human needs
- Rest and sleep
- Activity exercises and posture
- Habits; food, eating and drinking
- Participation in social activities
- Self actualization and spiritual needs
- Interpersonal and human relations
- Life style and healthy habits

Objectives
After reading this chapter, the students are able to
➢ Learn the importance of personal hygiene
➢ Describe the comfort needs of the sick person in the home
➢ Enumerate the basic needs of the human being
➢ Explain the spiritual needs and self actualization of the individual
➢ Describe about life and healthy habits
Introduction
Every individual is healthy in life when they maintain personal hygiene in their day to day
activity. Care of self is an art, which keeps the person happy and confident and make them to
be self esteemed. When the basic needs are fulfilled, the person is satisfied and is able to
achieve their goals. If a person is physically healthy, they are mentally and socially also
healthy and they able to maintain optimal body function.
Definition
Personal hygiene
The word hygiene refers to sanitary practice to health and prevention of disease.
Personal hygiene is the activity of self care, including bathing and grooming. It
includes care of skin, hair, nails, mouth, teeth, eyes, ears, nasal cavities and personal and

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genital areas. The personal hygiene is influenced by culture socio economic status and
personal environment of the individual at different ages.
Purpose of Personal Hygiene
To promote sense of well being.
To relieve fatigue & induce sleep.
To promote individuals safety.
To promote active and passive exercises.
Care Of Mouth
It means to keep the mouth clean and free from bad odor (halitosis) by brushing and
flossing. The oral hygiene helps to prevent carries (tooth decay) and periodontal disease.
Purpose of mouth care
To clean the teeth gums and mouth.
To remove offensive odor and food debris.
To ensure good taste sense.
To promote feeling of well being.
To give self confidence.
To protect the teeth from decay & other infections.
The common Mouth problems are
Gingivitis: Inflammation of the gums
Glossitis: Inflammation of the tongue.
Stomatitis: Inflammation of the mucous membrane of mouth.
Periodontitis: Inflammation of the mucous membrane of mouth.
Halitosis: Bad breath.
Oral hygiene should be done before breakfast and at bed time (twice a day).Oral
hygiene is necessary in the following conditions by family members or healthcare providers.
i.e. Unconscious patient (coma). Patient with O2 therapy, Naso-gastric feeding and NPO (Nil
Per Oral).

Brushing
A soft bristled brush should be chosen for brushing the teeth. The shape of brush
suits to the ones mouth and allows reaching all the teeth easily.
Tooth paste will help to prevent tooth decay. It is made of fluoride or chloride
combination. The other agent used for cleaning teeth/mouth is salt, sodium bicarbonate, and
chlorhexidine.
Hold the tooth brush with 450 degree angle against gums, and brush back and front in
short movements, and brush inner, outer surface of the teeth. Brushing the tongue will help
to remove bacteria that can cause bad breath. There should be regular habit of flossing is
important for removal of plague that is caught between the teeth.
When flossing, use a generous length of floss (18 inches). Wrap one end of floss
securely around one of the middle finger hook other end around the same finger on the
opposite hand. Holding the floss tightly between the thumb and forefingers, pull the floss
gently between each tooth.

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Plague is the main cause of tooth decay or cavities and gum diseases, when people eat
especially foods containing starches and sugars. If the persons do not brush their teeth tight
away, the plague bacteria in their mouth, produces acids. These acids then attack the enamel
on the teeth will lead to tooth decay.
Inflammation of the gum (gingivitis) can weaken the bone around the teeth and lead
to falling of teeth. A visit to the dentist can remedy almost any dental ailments. Visiting the
dentist every six months can help prevent future dental ailments. Getting regular checkups
including diagnostic ‘X’ rays will help prevent the development of serious dental problems
such as gum diseases or abscesses.
Care of the Skin
Skin is the covering layer and largest organ of the body. It has two layers i.e.
epidermis and dermis. The epidermis is the thin outer layer is made up of dead skin cells that
are constantly shed and replaced by new cells. The thick inner layer is made up of blood
vessels, nerves and hair follicles which contain glands. These glands in the hair follicles
produce oily substances, called sebum. The sebum keeps the skin and hair from drying out.
Daily washing will keep the skin on the face and other areas of the body clean by
removing the dust, oil and dead cells before they can accumulate.
Purpose of Cleaning the Skin
It stimulates circulation.
Reduces body odor by removing secretions perspiration (sweat) and bacteria from the
skin.
In hospital bed bath helps the nurse to know about the patient and able to interact
therapeutically.
The patient bath in the hospital may be classified as complete bed bath, partial bed
bath, tub bath, shower and therapeutic batch. The type of cleaning bath a nurse provides
depends on the patient’s physical capabilities and degree of hygiene required.
Acne
The common skin problem during adolescent period is acne. The hormonal changes
trigger the oil glands in the hair follicles to release more sebum and clog the small opening in
the skin eventually. The pores are unable to clear the new sebum due to clogging of sebum in
the hair fascicles.
If sebum and dead cells collect in the hair follicles, white colored plug will form in
the pore. With the pore plugged, the hair follicles begin to swell and create a white head. If
the pore remains open the surface of the pore may darken from a chemical process that occurs
in the pores thus creating a black head.
Care of the Hair
Hair appearance reflects the state of individual health and person’s feelings of well
being. Endocrine changes can affect the pattern of hair growth and color changes may reflect
aging. The older person’s hair also tends to be drier and scanter in contrast to the eyebrows
which become bristly and coarse.
Each person has a particular way of caring their hair. Some wash their hair daily,
others shampoo once a week or even less often. Oil prevents the hair from breaking and
scalp from drying. A wide toothed comb is casually used, because fines combs pull and

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break the hair. Some people brush their hair vigorously before retiring to bed, others comb
their hair frequently.
Hair on the Head:
Hair comes in a variety of types. Whether hair is curly, wavy or straight depends
upon the shape of the hair follicle.
Flat fascicle - Wavy hair
Round fascicle- straight hair
Oval fascicle - curly hair
Whatever kind of hair a person has, it is important to keep it clean and free from odor
to prevent the scalp problems.
The common hair problems
Dandruff: It is a swelling of the upper layer of skin on the scalp and greasy of dry scaling
of the scalp. It causes itching and more often come in the cold weather. Medicated shampoo
may useful to treat dandruff.
Pediculosis: These are tiny grayish whole parasitic insects that infest mammals. It is found
on the scalp attached to hair and the egg look like oval particles. Bites of pustules may be
seen behind the ears and at the hairlines. These are difficult to remove. It is treated by
medicated shampoo for eliminating lice and repeating after 24 hours.
Alopecia: Bald patches appear at the periphery of the hairline. The hair becomes brittle
and broken. It causes uneven hair and loss of appearance. Consult a specialist and stop all
other hair care.
The purpose of Hair care
Make the patient comfortable.
Observe the condition of scalp.
Give an appearance and affecting of well being.
Body Hair
The growth of body hair takes place at puberty in girls and boys. Hair will appear in
the public area and hair on the arms, under arms, legs, and face for boys will often grow
thicker. Where body hair does protect the skin and body, it is not necessary to a person’s
well being.
Facial Hair
As facial hair continuous to grow, many boys will opt to shave. Shaving depends on
person’s choice using either a treatment or disposable razor and shaving cream. Girls can
shave their legs, under arms and bikini area. Electric razors are also effective, although many
electric razors do not provide a very close shave. A new blade is used every shave in the
barber shop/commercial shaving areas to prevent transmission of infection. The other way of
hair removal from the hands and legs are waxing, sugaring, and electrolysis and laser
treatment.
Care of Nail
Nails are epithelial tissues that grow from the root of the nail bed located in the skin at
the nail grove. A normal healthy nail is transparent smooth and convex. The color of nail is
pink with translucent white tips. Pigment deposits or bands were common in the nail beds of

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patients with dark skin. The nail bed angle should measure 160 0 degrees. The nail
surrounded by a cuticle, which slowly grow over the nail must be regularly pushed back.
The problems of the nail
Paronychia: An infection around the edge of a finger nail or toe nail. It begins from a break
in the skin due to hang nail vigorous manicuring or chronic imitation from rubbing on
picking.
Onychomycosis: Fungal infection of the nail can be contracted by walking bare foot in
public places or in conjunction with development of athlete’s foot.
Nail ring worm: The newest formed part of the nail is infected by fingers and the nail
grooves thick and deformed. This treated with antifungal drugs.
Nail problems often results from
Abuse or poor care of feet and hands
Biting nails
Exposure to harsh chemicals
Weaving all fitting shoes.
Nails should be kept clean and neatly trimmed or filed. Special care of nail helps to prevent
infection, odor and injury to soft tissues.Long nails may have more dirt and look ugly than
short nail, which causes less infection.
Eye Care
Eye is the sensory organ of vision. Eye care begins immediately after birth of a baby.
o Clean the secretions from the eye where it is infected.
o Eye cleaning is to be done from inner canthus to outer canthus of the eye.
o Separate cotton swab is to be used for each eye cleaning.
o Wear protective goggles while exposure to radiation and chance of infections spillage
while doing procedure.
o Wear sun glasses while going out during sun light.
o Wash eye with cool water in the morning.
o Treat any infection to eye and surrounding areas, and until eye drops as per doctor
prescription.
Care of Ear
Ear is the sensory organ for the auditory function (hearing). It consists of three parts.
Outer ear - Pinna, ear canal and ear drum.
Middle ear - bone – Maleus, incus and stapes
Inner ear - Vestibular and cochlea
The ear canal is self cleaning by secretion of cerumen. The glands in the ear canal
secretes brown color creasy fluid adhere the other particles in the air such as dust and dirt
forms the wax in the ear.
Clean ear after the bath by ear swabs and remove the moisture in and around the skin
of ear.
• Don’t use ear buds to clean the ear wax because sometimes it is pushed toward ear
drum.
If wax is hard, consult the ENT specialist for removal of wax.

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Ear irrigation will be done in case of excessive wax, which affect hearing and person
feel uncomfortable.
Blunt instrument with loop may used for removal of wax. This is another method but
carefully insert the instrument in the ear canal for removal of wax.
Ear plugs should be used while swimming otherwise the children may develop
itching, pain, swelling and redness in the ear.
Healthy hearing habits are essential for good hearing. Avoid excessive use of cell
phone for communication.
Certain type of noises, which heard nearby an ear, causes loss of hearing or damage to
the ear. (e.g.) gun fire, explosion of fire crackers, continuous exposure to vacuum
cleaner sound, factory machine sounds, etc. hearing loud music.
Observe the children while playing for the chance of parting foreign body in the ear.
Care of Bladder and Bowel
The bladder and bowel is the important structure which helps in elimination of waste
from our body. The bladder is the collecting bay of urine. When the bladder is full, the
person develop urge to pass urine. The voiding of urine is known as micturation.
If a person is not drunk adequate water, it will decrease the urine out. It is
experienced during summer, by excessive sweat, the urine output is diminished.
Drink 1.5 to 2 liters of water 1 day.
Avoid caffeine based drinks such as coffee and cola variety of soft drinks.
The urine output is essential recording to assess the renal function after surgery,
hemorrhage, shock and fluid loss. (e.g.) vomiting, diarrhea, excessive sweat.
The common problems of bladder are retention of urine and Incontinence of urine due
to neurological disorder or obstruction.
Bowel is long tubular structure where digestion, absorption and excretion of waste (stool)
take place. Every one regularly empties the bowel as per their habit either morning or
evening. Regular habit of bowel function prevents the digestive problems and minimizes the
re-absorption of toxin into the circulation.
The stool contains a small amount of undigested roughage, sloughed dead bacteria
and epithelial cells, fat protein and dried constituents of digestive juices (bile pigments) and
inorganic matter (calcium and Phosphate).The common bowel problems are diarrhea and
constipation.

Characteristics of abnormal stool

S.No Conditions Color of Stool

1. Upper Gastro intestinal bleeding Tarry black color
2. Lower Gastro Intestinal bleeding Bright and dark red
3. Rectal and anal bleeding Streaking of blood in the stool
4. Use of iron tablet and charcoal Black stool
5. Jaundice Clay color stool
6. Mal absorption disorder Yellow, gravy and fowl smelling stool

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Diarrhea: If loose consistency and more frequency of defecation with or without odor.
Steatorrhea: Bulky, greasy foamy and gray color stool.
Cholera: Rice watery stool.
Constipation: A dry hard, stony, difficult defecation or passage of no stool for a period of
time.
Defecation is the expulsion of feces from the anus and the rectum. The frequency of
defecation is highly individual, varying from several times per day to two or three times per
week. The amount of defecation can differ from person to person. The sensory nerves are
stimulated and peristaltic waves more the feed matter from the sigmoid colon and the rectum,
the undelivered experiences the need to defecate.
The bowel elimination is affected by the following factors.
Age and development
Daily patterns of defecation
Life style
Diet
Intake of fluid
Activity and exercise
Medication
Physiological factor like anxiety and fear
Surgery and anesthesia.
Care
Practice regular habit of bowel elimination.
Take more fiber rich food.
Drink plenty of fluid
Develop habit to do exercise/walking
• Don’t use medicine for defecation
Eat plantain daily at bed time.
Perineal Care
Care of external genitalia is essential to prevent transmission of ascending infection to
the pelvic organ from urethra and vagina. The cleaning of vulva and perineum with sterile
technique/clean technique is known as perineal care.
Purpose
To prevent infection of genital tract.
To give comfort to the person after urination and defecation.
To help in heading when there are stitches on the perineum.

Sexual Hygiene

Sex is a natural part of life and it happens with or without sex education. Sex is a
fundamental part of being human; but less than half of our states require sex and HIV
education, and most of what is taught is sub-par. Just because we refuse to talk about sex
doesn’t mean it's just going to go away.

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Menstrual Hygiene Management: Menstruation is a normal biological process and a key

sign of reproductive health. But in many cultures it is treated as something negative, shameful
or dirty.
Menstruation is a woman's monthly bleeding. Menstrual blood flows from the uterus through
the small opening in the cervix and passes out of the body through the vagina. Most
menstrual periods last from 3 to 5 days.
Menstrual hygiene management is defined as: 'Women and adolescent girls using a clean
menstrual management material to absorb or collect blood that can be changed in privacy as
often as necessary for the duration of the menstruation period, using soap and water for
washing the body as required

Menstrual Hygiene
1. Change your sanitary napkin every 4-6 hours
It is the cardinal rule to establish vaginal hygiene. Menstrual blood, when released from the
body attracts various organisms from our bodies, which multiply in the warmth of the blood,
and cause irritation, rashes or urinary tract infections. Changing your sanitary napkin or
tampon regularly curbs the growth of these organisms and prevents infections.
2. Wash yourself properly
Washing your vagina regularly is extremely important, because the organisms cling to your
body after you have removed your sanitary napkin. Most people wash themselves regularly.
3. Don't use soaps or vagina hygiene products Vagina have their own cleaning mechanism
which comes into play during menstrual cycles, and these artificial hygiene products can
hamper the natural process leading to infections and growth of bacteria.
4. Discard the sanitary napkin properly
Disposing off your sanitary napkins properly is an important step. Wrap them properly before
you throw them away, so the bacteria and infections do not spread. Make sure you don't
flush them, since that will block the toilet causing the water to back up, spreading the
bacteria all over it. Washing your hands properly is of utmost importance after you have
wrapped and discarded the used sanitary napkins.
5. Stick to one method of sanitation-Women tend to use tampons and sanitary napkins, or
two sanitary napkins simultaneously during heavy flow which is an efficient technique. It
may cause infection

Comfort, needs of sick

Comfort means a pleasant feeling of being relaxed and free from pain
Sickness weakens the body. To gain strength and get well quickly, special care is needed.
Sick person requires care frequently is the most important part of his treatment.
Medicines are often not necessary. But good care is always important. The following are the
basis of good care.
The quality of care a sick person receives during recovery from an illness is one of the most
important steps to getting better. Family member who is suffering from a bad cold, an illness,
or an infection. She may be instructed to stay at home, rest up, and get better by doctor.
Caring actions ensure that he or she undergoes a speedy recovery. A sick person needs love
and constant encouragement.

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1. Make sure they rests in a quiet, comfortable spot with access to fresh air. The sick
person may have a high temperature and can feel chilled in a room that is too cold or
uncomfortable in a room that is too hot. As well, loud noises and a stuffy room can make the
sick person feel worse, rather than better. To make the person to feel more comfortable
access to warm blankets and lots of pillows, especially if they have a cold or a flu.
2. Give liquids, like water and herbal tea to the sick person. Most ill people suffer from
dehydration due to symptoms like diarrhoea or fever. Make sure they stay well hydrated by
giving those glasses of water and cups of warm, comforting herbal tea. The average adult
needs to drink eight 8 ounce glasses of water or more every day and should urinate at least
three to four times a day.
3. Prepare the person’s comfort food. Most people will have a go to comfort foods for a
sick person as they are warm, filling, and easy to digest. Nourishing foods like soup,
porridge, oatmeal, and fruits are all good meal options for a person who is feeling ill and
weak.
4. Help the sick person stay clean. Depending on how severe the person’s sickness is, she
may have a difficult time bathing herself or maintaining a level of cleanliness. The sick
person feel better by assisting with the changing of bedding every day and helping to change
the positions in bed.
5. Play a game or watch a favourite movie or show. Another simple way to cheer up a sick
person is to distract her from her illness by suggesting play a favourite game or watch a
favourite movie or show together.
6. Express sympathy and desire to make her feel better while visiting the sick person
7. Be willing to listen- Most sick people tend to feel better when they have someone is
willing to listen them and talk with empathy and understanding. Often, the sick person
experiences boring and lonely.

Care of pressure points

Definition
Decubitus ulcers, also known as pressure sores or decubiti, are ulcerated or sloughed area of
tissue subjected to pressure from lying on mattress or sitting on a chair for prolonged period
of time resulting in the slowing of circulation and finally death of tissues.

Pressure points
Pressure points are those that bear weight, so that the skin over them is subject to pressure.
The pressure points in the supine position are back of the head (occiput), scapula,
sacral region, elbow and heels.
In a prone position, the pressure points are ears, cheek, acromian process, breasts (in
the female), genitalia (in the males), knee and toes.

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Purposes
To promote relaxation and comforts.
To relieve muscular tension.
To stimulate circulation.

Clients susceptible to Bed Sores

1. Elderly bedridden clients.
2. Obese clients.
3. Very thin and emaciated clients
4. Paralysed clients with spinal cord injuries.
5. Malnourished clients
6. Agitated clients in restraints.

Signs and Symptoms of Pressure Sores

The early symptoms of pressure sore are redness, tenderness, discomfort and smarting. The
area becomes cold to touch and insensitive. There is local oedema. Later the area becomes
blue, purple. Due to continued pressure, the circulation is cut off, the gangrene develops and
the affected area is sloughed off.

Prevention of Pressure Sores:

1. Identification of clients who are particularly prone to the development of Pressure Sores.
2. Daily examination of client’s pressure areas for redness, discoloration or blisters on the
skin and they should be reported and treated immediately.
3. Keep the clients clean and dry.
4. Change the positions of the clients every 2 hours so that another body surface bears weight.
5. Keep the clients skin well lubricated to prevent cracking by using powder.
6. Protect the damaged skin. Damaged skin can be further irritated and macerated by urine,
faeces, sweat etc.
7. Provide the client with adequate fluids and with a nourishing diet that is high in protein and
vitamins.

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8. Attend and massage the pressure points as often as necessary to stimulate circulation.
9. Call assistance and lift the clients before giving and taking bedpans.
10. Whenever possible, placing the client on pillows or foam cushions or changes the position
of the client.
11. A cleaning agent is used to clean the ulcerated area for preventing infection. e.g. Normal
saline.
12. Apply the possible measures for the healing of the wound. If slough is present, clean the
area thoroughly twice a day with hydrogen peroxide diluted with distilled water.

Positioning
Positioning a patient in bed is important for maintaining alignment and for preventing bed
sores , foot drop, and contractures Proper positioning is also vital for providing comfort for
patients who are bedridden or have decreased mobility related to a medical condition or
treatment.
When positioning a patient in bed, supportive devices such as pillows, rolls, and blankets,
along with repositioning, can aid in providing comfort and safety

Patient Positions in Bed

Positioning a patient in bed is a common procedure in the hospital. There are various
positions possible for patients in bed, which may be determined by their condition,
preference, or treatment related to an illness

Supine position-Patient lies flat on back. Additional supportive devices may be added
for comfort.
Prone position-Patient lies on stomach with head turned to the side.
Lateral position-Patient lies on the side of the body with the top leg over the -bottom
leg. This position helps relieve pressure on the coccyx.
Sims position-Patient lies between supine and prone with legs flexed in front of the
patient. Arms should be comfortably placed beside the patient, not underneath.
Fowler’s position-Patient’s head of bed is placed at a 45-degree angle. Hips may or
may not be flexed. This is a common position to provide patient comfort and care.
Semi-Fowler’s position-Patient’s head of bed is placed at a 30-degree angle. This
position is used for patients who have cardiac or respiratory conditions, and for
patients with a naso gastric tube.
Trendelenburg position- Place the head of the bed lower than the feet. This position
is used in situations such as hypotension and medical emergencies. It helps promote
venous return to major organs such as the head and heart.

Changing of patient position

Prior to ambulating, repositioning, or transferring a patient from one surface to another e.g., a
stretcher to a bed), it may be necessary to move the patient to the side of the bed to avoid
straining or excessive reaching by the health care provider. Positioning the patient to the side

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of the bed also allows the health care provider to have the patient as close as possible to the
health care provider’s centre of gravity for optimal balance during patient handling.
Steps of procedure Rationale
The procedure works best with two or more
1. Make sure you have as many additional
health care providers, depending on the size of
health care providers as needed to help
the patient and the size of the health care
with the move.
professional.
2. Explain to the patient what will happen This provides the patient with an opportunity to
and how the patient can help. ask questions and help with the positioning.
Principles of proper body mechanics help
3. Raise bed to safe working height and
prevent MSI.
ensure that brakes are applied. Lay patient
Safe working height is at waist level for the
supine.
shortest health care provider.
This step keeps the heaviest part of the patient
closest to the centre of gravity of the health care
4. Stand on the side of the bed the patient is providers.
moving toward.
One person stands at the shoulder area and
the other person stands near the hip area,
with feet shoulder width apart.
Keep heaviest part of the patient closest to your
center of gravity
5. Fan-fold the draw sheet toward the
Fold sheet with fingers facing upward
patient with palms facing up.
This prevents injury to patient.

6. Have the health care provider at the head

of the bed grasp the pillow with one hand
and the draw sheet with the other hand. Grasp the
pillow with one hand and the draw sheet with
the other
This step prevents injury to patient.

7. Have patient place arms across chest.

Chin tucked in and arms across chest

8. Tighten your gluteal and abdominal Use of proper body mechanics helps prevent
muscles, bend your knees, and keep back injury when handling patients.
straight and neutral. Place one foot in front
of the other. The weight will shift from the

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front foot to the back during the move.

9. On the count of three by the lead person,

with arms tight and shoulders down, shift Start move with weight on front foot
your weight from the front foot to the back
foot. Use your large leg muscles to move
the patient. Do not lift, but gently slide the
patient. Shift weight to back foot.If the patient is
bariatric, the move should be repeated to
correctly position the patient, or use a
mechanical lift.
10. Once patient is positioned toward the This step promotes comfort and prevents harm
side of the bed, ensure pillow is to patient.
comfortable under the head, and straighten
sheets. Complete all other procedures
related to safe patient handling. Raise side rails
Placing bed and side rails in safe positions
reduces the likelihood of injury to patient.
11. Lower bed, raise side rails as required,
Bed in lowest position, side rail up, call bell
and ensure call bell is within reach.
within reach
Perform hand hygiene.
Hand hygiene reduces the spread of
microorganisms.

–Hand washing
Hand Wash:
The most important and basic technique in preventing and controlling transmission of
pathogens is by hand washing.
Hand Washing Steps

Hand washing is the single most important procedure for preventing nasocomial infection as
hand have been shown to be an important route of transmission of infection

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Procedure

Wet hands with clean and warm running water.

Apply a small amount of soap.
Rub your palms together, away from the water.
Rub your fingers and thumbs and the skin in between them.
Scour your palms with your nails.
Rub the back of each hand.
Rinse with clean running water.
Dry with a clean towel or paper towel.

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Make a habit to wash your hands

before and after eating

after playing outdoors
after using toilets
after sneezing or coughing
Before and after being around with someone who is ill.

Basic human needs

Maslow's theory of basic human needs was used to understand the motivational factors, and a
qualitative methodology was used applying quantitative techniques. The theory indicates that
the basic needs of the nursing care compromised, especially safety and physiological needs,
which are the most primary.
Characteristics of Basic Human Needs
1. Needs are universal.
2. Needs may be met in different ways
3. Needs may be stimulated by external and internal factor
4. Priorities may be deferred
5. Needs are interrelated
Definition
Each individual has unique characteristics, but certain needs are common to all
people.
A need is something that is desirable, useful or necessary. Human needs are
physiologic and psychological conditions that an individual must meet to achieve a
state of health or well-being.
Physiologic
1. Oxygen
2. Fluids
3. Nutrition
4. Body temperature
5. Elimination
6. Rest and sleep
7. Sex
Safety and Security
1. Physical safety
2. Psychological safety
3. The need for shelter and freedom from harm and danger
Love and belonging
1. The need to love and be loved
2. The need to care and to be cared for.
3. The need for affection: to associate or to belong
4. The need to establish fruitful and meaningful relationships with people, institution, or
organization

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Self-Esteem Needs
1. Self-worth
2. Self-identity
3. Self-respect
4. Body image
Self-Actualization Needs
1. The need to learn, create and understand or comprehend
2. The need for harmonious relationships
3. The need for beauty or aesthetics
4. The need for spiritual fulfillment

Maslow’s hierarchy of needs

Rest and sleep

Rest: when we give our body a period for relaxation. We relaxes our muscles, sometimes
close our eyes for comfort. But, our brain can running its functions actively during resting
phase too. We have our full consciousness about the surrounding during resting time.
Sleep: In this condition our brain does not work actively. We don't have our full
consciousness about the surroundings. Our brain here takes rest as well as our body muscles
do.
Sleep is one thing that is universal to people. It is a human need and in fact, humans spend a
one third of their lives sleeping. It is vital for optimal psychological and physiological
functioning. Sleep is essential to conserve energy, prevent fatigue, and to restore the mind
and the body.

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Sleep cycle

The sleep cycle consists of both non REM sleep and REM sleep.
Non REM sleep is sleep that is not accompanied with rapid eye movements (REM).
Non REM sleep has four phases which include 1.the stage of very light sleep, 2. The stage of
very light sleep with the non movement of the eyes,3. the stage of deep sleep with delta
waves and 4.deep sleep and increased delta brain waves.
Sleep problems
Insomnia, simply defined, is the absence of sleep. The two basic types of insomnia are
inducement insomnia and maintenance insomnia. Insomnia causes day time sleepiness,
irritability and decreased levels of mental concentration.
Narcolepsy is defined as excessive day time sleepiness that a person can be affected with
secondary to the opacity of hypo cretin within the area of the central nervous system that
controls sleep.
Hypersomnia is defined as the client's failure to stay awake during day time hours even
when they have had enough sleep the night before .e.g. hypothyroidism, central nervous
system dysfunction
Parasomnia is defined as a sleep disorder that interferes with sleep. e.g. sleep walking, sleep
talking
Sleep apnoea is absence of breathing that occurs during sleep. CNS disorder and obstruction
of respiratory tract
Nocturnal Enuresis: Nocturnal enuresis can be treated with a bed wetting alarm, positive
reinforcement and medications such as imipramine and desmopressin.
The amount of sleep that is needed also varies among the age groups. Below are some
guidelines that you can use to determine whether or not a client is getting enough sleep and
rest for physiological and psychological health.
Stage of growth Hours of sleep /day
Neonates through 3 months 14 to 17 hours
Infants from 4 months of age to 11 months 12 to 15 hours
toddlers up to 3 years 11 to 14 hours
Preschool children from 3 to 5 years of age 10 to 13 hours
School age children from 6 to 12 years of age 9 to 11 hours
Adolescents from 13 to 17 years of age 8 to 10 hours
Young adults and middle aged adults 7 to 9 hours
Older adults over 65 years of age 7 to 8 hours

Adolescents from 13 to 17 years of age should sleep about 8 to 10 hours of sleep

Young adults and middle aged adults need about 7 to 9 hours of sleep
Older adults over 65 years of age tend to require slightly less sleep than the middle
age adults and only 7 to 8 hours of sleep per night

Factors that impact on sleep

Illnesses
Medications
Environment
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Emotional and Psychological Distress and Stress

Lifestyle Choices: Consumption patterns such as cigarette smoking and alcohol use
interfere with sleep and other life style choices such as those related to exercise also
impact on sleep.
Work Schedules: Long work hours and working night time hours interfere with sleep.
Interventions for promotion of Sleep

Establishing and adhering to a regular sleep time and wake time for the client based
on their patterns and needs
Limiting the duration and frequency of day time naps
The promotion of daily exercise
The avoidance of alcohol, caffeine, heavy meals and exercise at least a couple of
hours before bedtime
The promotion of comfort using techniques such as white noise, dim lighting, pain
management, stress reduction techniques, massage and the elimination of
environmental noise
Activity and exercises and posture
Activity
Mobility is defined as ability to the joints and body part in all direction freely and
purposefully. The activity of an individual indicates optimal functioning of the body and
makes the person to feel sense of independence.
The body requires motion and Regular exercise for keeping physical fitness. Whereas
immobility has a negative effect .The adverse effect of immobility are venous stasis,
thrombus and embolism formation, ortho static hypotension, pneumonia, muscle atrophy and
contracture.
Purpose of exercise for the person
To improve muscle strength and maintain joint mobility
To enhance digestion
To improve circulation
To minimise cardiac risk problems
To gain diversion and promote physical and mental well being
To increase tolerance for more activity
Types of exercise
Active exercise- These exercise are performed by the patient without assistance. e.g. Deep
breathing exercise, coughing exercise, foot exercise, Range of motion exercise and pelvic
floor exercise
Passive exercise- These exercise are performed by the patient with assistance. The
nurse/physiotherapist assists for doing exercise in the bed.
Resistive exercise-The active movement performed by the patient is by pulling or pushing
against an opposing force.
Isometric exercise-The patient performs the exercise by contracting and relaxing the
muscles, while keeping part in affixed position.
Body mechanic the proper use of correct muscle to complete a task safely, without causing
strain to the muscle and joints

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Gaits
All natural gaits are designed to propel a person forward, but can also be adapted for lateral
movement.( The walk, jog, skip, run, and sprint). As natural gaits all have the same purpose,
they are mostly distinguished by when the leg muscles are used during the gait cycle.
Abnormal gaits
Abnormal gait is a result of one or more of these tracts being disturbed. This can happen
developmentally as the result of neuro degeneration. Some of this is associated with
decreased muscle tone (hypotonia), and neuro degeneration is Parkinson’s. some of the
abnormal gaits are below
✓ Antalgic gait ✓ High stepping gait
✓ Charlie Chaplin gait ✓ Scissor gait
✓ Circumduction gait ✓ Stiff hip gait
✓ Waddling gait: ✓ Trendelenburg gait
Posture
Posture is the position in which you hold your body upright against gravity while standing,
sitting or lying down. Good posture involves training the body to stand, walk, sit and lie in
positions where the least strain is placed on supporting muscles and ligaments during
movement or weight-bearing activities. Proper posture:

• Keeps bones and joints in the correct alignment so that muscles are being used
properly.
• Helps decrease the abnormal wearing of joint surfaces that could result in arthritis.
• Decreases the stress on the ligaments holding the joints of the spine together.
• Prevents the spine from becoming fixed in abnormal positions.
• Prevents fatigue because muscles are being used more efficiently, allowing the body
to use less energy.
• Prevents strain or overuse problems.
• Prevents backache and muscular pain.
• Contributes to a good appearance.

Proper posture requirements

Correct sitting position

• Sit up with back straight and shoulders back; buttocks should touch the back of chair.
• All 3 normal back curves should be present while sitting. A small, rolled-up towel or
a lumbar roll can be used to help you maintain the normal curves in your back.

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oSit at the end of your chair and slouch completely.

o Draw yourself up and accentuate the curve of your back as far as possible.
Hold for a few seconds.
o Release the position slightly (about 10 degrees). This is a good sitting posture.
• Distribute body weight evenly on both hips.
• Bend your knees at a right angle. Keep your knees even with or slightly higher than
your hips. (Use a foot rest or stool if necessary).
• Keep your feet flat on the floor.
• Try to avoid sitting in the same position for more than 30 minutes.
• At work, adjust chair height , so that you can sit up close to your work and tilt it up at
you. Rest your elbows and arms on your chair or desk, keeping your shoulders
relaxed.
• When sitting in a chair that rolls and pivots, don't twist at the waist while sitting.
Instead, turn your whole body.
• When standing up from the sitting position, move to the front of the seat of your chair.
Stand up by straightening your legs. Avoid bending forward at your waist.
Examples of different faulty postures
• Lordotic posture.
• Sway back posture.
• Flat back posture.
• Round back (increased kyphosis) with forward head.
• Flat upper back and neck posture.
• Scoliosis(postural)

Principles of good body mechanism

1. Maintain a stable centre of gravity
2. Maintain wide base of support
3. Maintain line of gravity
4. Maintain proper body alignment
5. Face the direction of movement
6. Use large muscle groups of the legs, arms and shoulders
7. Push, pull, slide or roll a heavy object on surface to avoid unnecessary lifting

Habits: food, eating and drinking

Good habit: A behaviour that is beneficial to one's physical or mental health, often linked to
a high level of discipline and self-control. Examples good habits Regular exercise, balanced
diet, and monogamy, etc.
Food is the basic need of an individual and essential for life. is a substance consumed to
provide nutritional support to the body. It is usually of plant or animal origin and contains
essential nutrients, such as carbohydrates, fats, proteins, vitamins or minerals.
The main function of food is
To build /repair the tissue
To regulate metabolic process

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To provide energy
A balanced diet is essential for maintenance of good health. The essential nutrients are
carbohydrates, protein and fat. The food consumption and habits are affected by many
factors. They are
o Customs and belief
o Religious belief
o Food likes and dislikes
o Food related superstitious belief
o Socioeconomic factor
o Cooking practices

Along with the right type of food, everyone must also learn how to eat it right way. General
idea of do's and don’ts as a part of healthy food habits.

1. Observe daily diet for having too many calories in diet and don't have enough time to burn
them. Consider eat something with less fat and easy to digest.

2. Make sure to add green leafy vegetables in the diet. They are a rich source of proteins,
iron, calcium and fiber. Green leafy vegetables are easy to prepare and quite appetizing too.

3. Drinking plenty of water helps detoxify the body as well as gives you a glowing skin.
Although, we should avoid drinking water during meals as it slows down the digestion
process. It is advisable to have water 30 minutes before or after having your food.

4. Proteins are vital for the body and should definitely be included in the diet. Broccoli,
soybeans, lentils, asparagus and spinach are some commonly found protein rich foods. Low-
fat dairy products are also a rich source of proteins. Insure that your body receives the
required amount of proteins daily.

5. One of the easiest and obvious ways to digest food is to chew it. Most people often eat
their food in a hurry and tend to skip chewing their food properly.

6. Keep away from fast-food and soft-drinks

Carbonated soft drinks have a high sugar content which may lead to obesity, diabetes and
dental caries. Instead of these harmful drinks, choose to refresh yourself with a glass of
buttermilk or lemonade.

7. Cook at home-Instead of ordering pizza from the joint around the corner, use your kitchen
and make that dish you've been planning on having.

9. Never skip your breakfast-Make sure you eat a wholesome and rich breakfast before you
step out of the house.

10. Digest your food better-it always helps if you can boost the process of digestion.

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A good food habit helps shape your personality. And this is why ancient sages always
preferred consuming sathvic food. So choose wisely and eat better.
Developing healthy eating habits isn't as confusing or as restrictive as many people imagine.
The essential steps are to eat mostly foods derived from plants—vegetables, fruits, whole
grains and legumes (beans, peas, lentils)—and limit highly processed foods.
Drinking

Water plays an important role in our life. Water is not only thirst-quenching but has many
health benefits for our body and vital organs. They are:

• Prevents dehydration
• Regulates body temperature
• Carries nutrients and oxygen to the cells
• Provides moisture to the skin and other tissues
• Helps prevent constipation
• Cushions joints
• Helps strengthen muscle

Water requirement per day

An average healthy adult needs to consume at least 8 glasses of water on a daily basis and
this quantity should be increased during the summer and when exercising.

Tips for drinking more water

• Drink a glass of water as soon as you get up every day.

• Add slices of lemon, lime or orange to your water for a hint of flavor if you do not
like to drink plain water.
• Enjoy water breaks at work.
• Replace other drinks with water at meal times.
• Take water bottles with you to work or college.
• Always have cold water on hand ready to drink.
• Keep a cup of water on your desk to sip on while you work.
• Drink water before, during and after physical activity.
• Do not wait until you are thirsty to drink water; stay hydrated all day long.
Drinking is tolerated in many cultures around the world. It is accepted as a legitimate way to
celebrate special occasions or just to relax after a hard day at work. Drinking alcohol in
moderation tends to be viewed as a harmless activity.
Lot of people the words ‘social drinker’ just means not exhibiting the classic signs of
alcoholism.

A definition could be based on the amount the individual drinks or their relationship to
alcohol. One way to describe a social drinker would be to say that these are individuals who:

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*Only drink occasionally.

* Do not feel the need to drink alcohol in order to have a good time.
* Never get into trouble because of alcohol.
* Don’t do or say things they regret while drinking.
* Do not spend a lot of time thinking about alcohol.
–Participation in social activities
Social participation is engagement in variety of role with others. Social roles include
domestic roles of home maintainer and care giver, inter personal roles of friend and family
members. Participating in social activity and inter acting with others people in a friendly,
supportive environment contributes positively to an individual’s sense of wellbeing. It helps
to build social networks and contributes to a sense of belonging.

Maintain and build new relationships

The human brain requires social stimulation on a regular basis, and wants interact with the
same people every day. Social activities stimulate the brain and keep those neurons firing,
whether it is joining a book or chatting with a friend. As we age, it is important to meet new
people, build new relationships, and enjoy the benefits of a wide-ranging social network.

Types of social activity

Participation in family ,friend and cultural events
Participation in sports
Participation in needs of others
•
Benefits of social participation
Acquire new skills
Socially engaging activities are a great way for seniors to learn new skills and sharpen
existing talents. It can be studying a new language, learning how to use an iPod, painting,
picking up Tai Chi, or taking exercise classes. No matter the biological age, there is always
an opportunity to learn something new.
Stimulate the mind
All social activities, such as taking up gardening or playing cards with friends, provide some
degree of mental stimulation. Each activity keeps the brain and body actively engaged. social
activities are not only enjoyable, but they also keep the minds of seniors sharp and healthy.
Improve health & well-being
Individuals who engaged in regular social activities reported higher self-perception and
lower levels of loneliness and life dissatisfaction. The health benefits including the reduced
risk of cardiovascular problems, arthritis, Alzheimer’s disease, and mental health issues such
as depression when they are socially active.
Increase motivation
Encouragement from fellow seniors and staff make the people to learn a new skill or craft
and remaining socially active. With increased motivation, seniors will feel more inspired to
experience new things and enhance their mental stimulation and self-confidence.
Retain integrity

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People don’t want to feel old and nor do they have to. With active socialization and
participation in various activities as opposed to sitting in front of the television, they’ll feel
more energized. They’re able to maintain their integrity, self-assurance, and independence
while interacting with other seniors who are also energized and active, making for a more
wholesome and healthier life.

–Self actualization and spiritual needs

Self actualization is defined as the full use and exploitation of talents, capacities and
potentialities.
It is the ongoing process in which the person abilities are completely utilized. Most
commonly self actualised people see life clearly, less emotional, more objective, less likely to
allow hopes, fears or ego defences to distort their observations.
The characteristics of self actualising people are Creativity, spontaneity, courage and hard
work; more efficient perception and comfortable relationship with others.

Spiritual needs

Nurses need to consider psychological, emotional, social, cultural and spiritual aspects of
care to help patients understand the meaning of their experience. In practice spiritual needs
should be given equal and sometimes greater precedence than physical needs.
Spirituality refers that the person seeks meaningfulness through inter and transpersonal
connection. Spirituality generally involves a belief in a relationship with some higher power,
creative force, divine being or immeasurable source of energy. Spirituality includes-meaning,
value, transcendence, connecting and becoming (know about him what he is).
The expression person’s spiritual energy to others is manifested in loving relationships with
and service to others, joy and laughter, participation religious activities. The spiritual belief
person shows compassion, empathy, forgiveness and hope in their life.
Nurses should follow some guideline while giving care to the patient in relation to spiritual
need i.e.
➢ Understand the patient belief, resources and preferences in spiritual need
➢ Give spiritual care according to the patient wish
➢ Don’t force to follow/adopt certain spiritual belief
➢ The spiritual care on par with belief of an individual

Spiritual care attends to a person's spiritual or religious needs as he or she copes with illness,
loss, grief or pain and can help him or her heal emotionally as well as physically, rebuild
relationships and regain a sense of spiritual wellbeing.
Interpersonal and human relations

Interpersonal relationship is social associations between two or more people. They vary in
differing levels of intimacy and sharing, implying the discovery or establishment of common
goal, and may be something shared in common.

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A therapeutic nurse-patient relationship is defined as a helping relationship that's based on

mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others,
and assisting with the gratification of your patient's physical, emotional, and spiritual needs
through your knowledge and skill.

➢ The nurse-patient relationship enables nurses to spend more time, to connect, to

interact with their patients as well as to understand their patient’s needs.
➢ It assists nurses to establish a unique perspective regarding the meaning of the
patient’s illness, beliefs, and preferences of patients/families.
➢ Thus, the patients/families feel that they are being cared for and they feel more
motivated to open up to the nurses as well as working together to achieve better
outcomes/satisfaction
There are five components to the nurse-client relationship:
Trust
Respect
Professional intimacy
Empathy
Power.
Regardless of the context, length of interaction and whether a nurse is the primary or
secondary care provider, these components are always present.

Life style and healthy habits

Health is multi-factorial and complex. It is influenced by a number of things including

our age, family history of illness, employment, education and living conditions. A variety of
lifestyle or health related habits (behavioural factors) can have a major impact on a person’s
health. Behavioural and social issues that impact on health include smoking, alcohol, poor
diet leading to obesity or malnutrition, lack of physical exercise, sexual behaviour and
problems resulting from drug taking.

Lifestyle that influences on health. They are as follows:

1. Diet and Body Mass Index (BMI): Diet is the greatest factor in lifestyle and has a
direct and positive relation with health. Poor diet and its consequences like obesity is
the common healthy problem in urban societies. Unhealthy lifestyle can be measured
by BMI. Urban lifestyle leads to the nutrition problems like using fast foods and poor
foods, increasing problems like cardiovascular disorder.
2. Exercise: The regular and continuous doing of exercise along with a healthy diet
increases the health.
3. Sleep:. Adequate sleep is necessary to prevent several social, psychological,
economical and health problems and its consequences. Lifestyle may effect on sleep
and sleep has a clear influence on mental and physical health.
4. Sexual behavior: Normal sex relation is necessary in healthy life. Dysfunction of sex
relation is the problem of most of societies and it has a significant effect on mental

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and physical health. It can be said that dysfunctional sex relation may result in various
family problems or sex related illnesses like; AIDS
5. Substance abuse: Addiction is considered as an unhealthy life style. Smoking and
using other substance may result in various problems; cardiovascular disease, asthma,
cancer, brain injury.
6. Medication abuse: Unhealthy behaviors in using medication are as followed: self-
treatment, sharing medication, using medications without prescription, prescribing too
many drugs, disregard to harmful effects of drugs, not explaining the effects of drugs.
7. Sleep early and wake up early
8. Application of modern technologies: Advanced technology facilitates the life of
human beings. Misuse of technology may result in unpleasant consequences. For
example, using of computer and other devices up to midnight, may effect on the
pattern of sleep and it may disturb sleep. Addiction to use mobile phone is related to
depression symptoms.
9. Recreation: Leisure pass time is a sub factor of life style. Neglecting leisure can
bring negative consequences. With disorganized planning and unhealthy leisure,
people endanger their health.
10. Study: Study is the exercise of soul. Placing study as a factor in lifestyle may lead to
more physical and mental health. For example, prevalence of dementia, such as
Alzheimer's disease is lower in educated people. Study could slow process of dementia.

Lifestyle modification involves altering long-term habits, typically of eating or physical

activity, and maintaining the new behaviour for months or years. Lifestyle modification can
be used to treat a range of diseases, including obesity.
Conclusion
Personal care and hygiene make one to maintain their physical and mental health and
wellbeing. eating and drinking habits helps for growth and repair of body. The lifestyle plays
major role in standards of individual life
Essay questions
1. Describe the procedure of changing position
2. What is the health related habits /life style influence on health
3. What is the importance of self actualization and spiritual needs?
4. Describe about the personal hygiene
5. Write the pressure points and preventive measures of pressure ulcer
Short answer questions
1. List the steps of hand washing technique
2. List the different positions used for patient
3. What is rest?
4. What are the types of sleep cycles?
5. What is MASLOW’S HIERACHY of need?
6. List the types of exercises
7. What is comfort?
8. What are five components of nurse patient relationship?
9. What are the principles of body mechanism?

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10. What is gait?

11. What are the purposes of personal hygiene?
12. What is the purpose of exercise?
13. What are the factors affecting sleep?

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UNIT-IV COLLECTION OF SPECIMEN

Structure
4.0-Introduction
4.1-Definition and Principles of collection of specimen
4.2-Methods of collection and handling body discharges
4.3-Collection of specimen of blood
4.4-Collection of specimen of sputum
4.5-Collection of specimen of urine
4.6-Collection of specimen of stool
4.7-Labelling of specimen
4.8- Collection of other specimen
Objectives
➢ After completion of this chapter, the students are able to
➢ List the types of specimen collection
➢ Describe the procedure of specimen collection
➢ Enhance knowledge and skill in handling body discharges
➢ Role of nurse in Collection of specimen and transportation of specimen
4.0 Introduction
The physical assessment is done through observation of body structure and parts,
where as physiological, nutritional and metabolic state is assessed through the body
secretions like blood, urine, vomiting, sputum and stool in the laboratory. Observation of the
secretion is also included in the route health assessment to diagnose the disease of a patient.
The body secretions investigated in the lab for confirmation of the diagnosis of the disease
e.g. Typhoid fever. Universal precautions are to be followed while handling the body
secretions for preventing transmission of infections or disease. It is one of the major
responsibilities of the nurse to collect the specimen and transport the specimen to the
laboratory for getting the accurate and reliable result.
Definition and Principles of collection of specimen
Definition
A specimen is small sample or part taken to show the nature of the whole, as a small
quantity of body secretions or a small piece of tissue for microscopic study.
Specimen collection is the process of obtaining tissue or fluids for laboratory analysis
or near-patient testing. It is often a first step in determining diagnosis and treatment
(Dougherty and Lister, 2004).
Purpose
The purpose of collection of specimen is
➢ The know the normal functions of the body
➢ To make diagnosis and prescribe treatment
➢ To assess the progress of the disease
➢ To identify the specific organism for the effective drug treatment
➢ The cytology test is to identify the origin ,structure ,function and pathology of cells

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Principles of collection of specimen

1. Preparation of Patient
Give adequate explanations regarding the collection of specimens. Explain to the client.
When to collect, what to collect. How to collect and the quantity to be collected. e.g. Ask the
client to wash the external genital area with soap and water and then rinse with water alone
before collecting urine specimens.
2. Patient identification
Label each specimen as soon as it is received with the necessary data such as
-Name of the client -Name of Specimen
-Age -Nature of test to be done
-Bed No -Date of Collection
-Ward
-Send the specimens with the requisition form duly filled and signed.
-Specimens are not to be misplaced. Send them to the proper place.
-Record the reports immediately and correctly on the client’s charts.
3. Precaution while collection of specimen
Specimen to be collected at right time. E.g. fasting blood is collected for blood sugar ,
cholesterol and blood proteins before breakfastetc.
Specimens serve as a media for transmission of disease producing organisms to the personnel
who handle them carelessly.
4. Minimize contamination during collection of specimen
If a culture specimen is required – use sterile containers, get midstream specimen or
catheterized specimen in case of urine specimen. Avoid collecting specimen during
menstruation.
The inside of the container should not be contaminated with the fingers of the nurses or
clients before or after collecting the specimens.
The lid of the container should be removed and placed in such a way that the inner surface
should not be contaminated.
Open the container just before collecting the specimen and close it immediately after
collecting the specimen.
5. Precaution during collection of specimen
Insist the client and the personnel to wash hands thoroughly after handling the
specimen bottles. Containers of the proper sizes are used according to the nature of specimen.
E.g. a large jar is used when collecting 24 hours of urine specimen.
The containers once used are cleaned and autoclaved before they are reused. All specimens
should be considered as potentially infectious and wear the gloves and masks while collecting
the specimen
6. Appropriate storage and transport of specimen collection
Contaminated and improperly collected specimens will produce false results which will
adversely affect in the diagnosis and treatment of clients.
Specimens allowed to stand at the room temperature for a long time will give a false result
due to destruction of pathogenic bacteria.

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Specimens should be always fresh for the laboratory examination. Send the specimens to the
laboratory as soon as they are collected. if not possible to test immediately keep the
specimen in the refrigerator, because cold temperature inhibits the growth of bacteria.
The accuracy and reliability of findings depend upon the correct method of collection,
transportation of the specimens to the laboratory and recording of reports. Inaccurate results
may mislead the physician in the diagnosis and treatment of clients.

Methods of collection and handling body discharges

The disposal of potentiality infectious fluid is obviously of significant one, which
requires a multi-disciplinary team approach.The fluids consisting of blood or potentially
infectious material are placed in properly sealed containers.
At the end of the lab procedure all containers with body fluids are placed in soiled-case carts
which are then sent for decontamination sub division of sterile processing department
Staff should wear all types of personnel protection and efficiently dispose the fluids using a
state of art drainage system. And it is later safely dispose with the municipal system
Standard safety precaution will minimize the risk of infectious exposure from splashing,
spattering, spraying or aerosalization ultimately
The content of all vessels that contain more than a few mm of blood remaining after
laboratory procedure, suction fluids or milk blood can either be inactivated in accordance
with state approved treatment techniques.
Many blood borne pathogens particularly viruses are not stable in the environment for longer
periods of time.
The Following ways will inactivate the blood borne pathogens in the disposal process, i.e.
a) Dilution of the discharge materials with water
b) Inactivation of pathogens resulting from exposure to cleaning chemicals,
disinfectants and other chemicals in raw sewage

Collection of specimen of blood

Blood samples are collected for measurement of complete blood picture, blood lipids,
glucose and electrolyte levels

specimen Type of examination

lipid profile,
serum electrolytes
Hormone test
plasma Plasma glucose
Total Count, Differential count, Erythrocyte
Sedimentation Rate, Haemoglobin,
whole blood Grouping,
blood glucose,
culture and sensitivity

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Preparation of patient
Explain the procedure to ease his/her anxiety and promote cooperation.
All blood samples should be drawn in a sitting position. Patient has to wait for 15 minutes
before withdrawing the blood, it will allow equilibration of the concentrations of blood
components.
Blood should not be collected from the arm that is used for blood pressure measurement, i.e.
blood should usually be drawn from the left arm.
Preparation for Blood Collection
1. When using multi-draw vacutainer system, draw tubes in the following order:
1. All draws required to be sterile (i.e. blood cultures)
2. Citrate containing tubes (blue top)
3. Plain non-additive tubes (plain red top, SST red top, plain royal blue)
4. Heparin containing tubes (green top)
5. EDTA containing tubes (lavender top, EDTA royal blue top)
6. Oxalate/fluoride containing tubes (gray top)
2. Tubes with powdered anticoagulants should be tapped near the stopper to dislodge any
anticoagulant that may be lodged between the stopper and the wall of the tube.
3. To ensure proper ratio of anticoagulant to blood.
4. All tubes with anticoagulant should be mixed thoroughly by gentle inversion 5-10 times.
DO NOT SHAKE.
5. EDTA capillary tubes should be filled to 250 mg.
6. Blue tubes MUST be as full as the vacuum allows. An uncomplicated direct veni
puncture may be performed using only a needle and vacuum collection tube to obtain a
single specimen for coagulation. (a serum tube without additives may be drawn first
instead of a waste tube).
7. Collection of coagulation specimens through intravenous lines that have been flushed
with heparin should be avoided. If coagulation specimens must be drawn through
indwelling catheters, the line should be flushed with 5 ml of saline, and the first 5 ml of
blood drawn from the indwelling catheter should be discarded before drawing coagulation
specimens.
Preparation of articles
A tray containing the following articles according to the specimen to be collected

• Needles (preferably vacutainer needles), size 20G to 22G

• Tubes
• Vacutainer holder
• Tourniquet
• Disinfection swabs
• Micropore tape
• Adhesive dressing
• Rubber gloves
• Pillow or other support
• Separate stoppers for opened vacuum tubes and non-vacuum tubes
• Needle disposal box

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NOTE: Always use the appropriate personal protective equipment when collecting patient
specimens.
Site of blood withdrawal for specimen
• antecubital area of the arm
• Back of hand or side of wrist
• Back of hand or side of wrist below a lock
• Antecubital area of arm above a lock
• Back of hand or side of wrist below an I.V. line. I.V. must be turned off by
physician/nurse for a minimum of three minutes prior to collection.
• Foot or ankle only with written permission of physician/nurse.

Procedure of collection of blood specimen (Venipuncture)

1. Properly identify and reassure the patient.

2. Assemble all materials and equipment necessary for venipuncture.
3. Apply tourniquet around the 3-4 inches above the venipuncture site. Ask patient to form
a tight fist and select vein for venipuncture.
4. Cleanse vein puncture site with 70% alcohol. Allow area to dry to prevent burning
sensation or hemolysis. Do not touch the area with anything that is not sterile.
5. Do not allow the tourniquet to remain tied for more than one minute. If the cleansing and
vein search takes longer, remove the tourniquet and reapply as needed.

6. Anchor the vein firmly, both above and below the puncture site with thumb and index
finger. Ensure that the arm is in a downward position so that blood cannot flow back
from the tube.
7. Perform venipuncture with needle at 15-degree angle, bevel of the needle up, and
following the vein with the needle.

8. When good blood flow is established and collection is nearly complete, ask patient to
relax hand and release tourniquet. Do not allow patient to pump their hand. The
tourniquet should be released after no more that one minute tied on the arm. Longer
application may result in localized stasis, hemo concentration, or hematoma.
9. When collection is complete, withdraw needle and apply cotton/gauze to puncture site
with pressure to stop bleeding. Bandage over the cotton/gauze.
10. Gently invert specimen 5-10 times to mix thoroughly.
11. Check the patient’s condition and that the bleeding is under control.
12. Label specimens clearly with the patient’s name, the specimen collection date and time,
and the initials of the phlebotomist (person performing the blood collection.)
13. Dispose of contaminated material appropriately.

Serum and serum separator

1. A serum separator tube contains a silicone barrier gel with a specific gravity intermediate
to serum and cell clot. After drawing, gently invert the tube 5-10 times to assure adequate
distribution of the glass powder, which activates the clotting mechanism. This tube is
inappropriate for some tests and a plain red top tube should be used when indicated.

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2. Allow the sample to clot in a vertical position for 20-30 minutes or until a firm clot is
established to prevent fibrin formation.
3. Centrifuge within one hour for 10-15 minutes or until good separation of serum from cells
is obtained. Separate the serum into a plastic transport vial as soon as possible.
4. Label specimens clearly with the patient’s name, registration number, the specimen
collection date and time, and the initials of the phlebotomist (person performing the blood
collection.)
5. Store serum at designated temperature for transport to the laboratory.
(If it is plasma specimen - Gently mix the blood collection tube by inverting six to ten times
immediately after collection. Label the transport tube as “PLASMA”. and Store specimen at
designated temperature for transport to the laboratory.)

Blood Smear Preparation

When requested, properly prepared and submitted smears are essential to accurately assess
the patient’s status. EDTA anti coagulated blood may be used if the smear is made within
one hour of collection.

1. Put a small drop of blood on one end of slide.

2. Draw spreader slide toward the drop at a 30-degree angle until it touches the drop of
blood. The blood will spread behind the spreader slide by capillary action and should be
allowed to spread the full width of the spreader slide.
3. Push spreader slide smoothly and quickly down the slide producing a feathered edge.
4. Allow the slide to air dry. With a lead pencil, label the slides with patient’s name on the
thick end of smear (opposite the feathered edge).

Collection of specimen of sputum

Mucus membranes line the respiratory tract and sputum helps protect this tract from infection
It is material from mucus lining of trachea and bronchi, which is coughed and spit out
through mouth.

specimen Type of examination

Sputum • microscopic acid fast bacilli
• culture

Preparation of patient
Explain the procedure to ease his/her anxiety and promote cooperation.
Tell the patient to collect a specimen of sputum (not saliva)
collect the specimen early in the morning, before breakfast, to obtain an overnight
accumulation of secretions.
Sputum specimens are usually collected on three consecutive mornings. Give a separate
specimen container and laboratory order requisition for each specimen the doctor has
ordered.
Preparation of articles:

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A kidney tray
A glass OF water
Sputum cup/Specimen container

Collection of sputum by expectoration (coughing)

1. Ask patient to rinse his/her mouth with water to reduce specimen contamination by
bacteria or food particles. (Avoid mouthwash or toothpaste). For a patient with dentures,
remove the dentures first.
2. Instruct the patient to sit on a chair or at the edge of the bed.
3. Ask patient to hold his/her breath a few seconds - then cough directly into the specimen
container.
4. Carefully and tightly replace the cap to prevent leakage. Check the top to ensure that it is
secure.
5. Label the specimen with the patient's name, doctor's name, specimen type, and the date and
time collected.
6. Send the specimen to the laboratory immediately.
7. Refrigerate the specimen if a delay of greater than one to two hours is anticipated.

4.5-Collection of specimen of urine

The kidney removes the waste products from the blood and it is excreted in the form of urine.
The urine specimen helps to diagnose the renal function disorders.
specimen Type of examination
Urine • Collection of mid-stream urine
• Routine microscopic culture
• 24hours urine
• pregnancy test
• double voided specimen

Collection of urine specimen

Preparation of patient
• Explain the patient and relatives the need of collection of specimens
• Explain the steps of procedure if the patient has to collect the specimen for himself or
herself
• Provide privacy if the patient is bedridden
Preparation of articles
A tray containing the following articles according to the specimen to be collected
Articles Rationale
Specimen container
A sterile test tube For culture and sensitivity
A clean container For routine examination
A big container For 24hours urine collection
A bed pan/urinal For the bed-ridden patient
Disposable gloves To protect the hands of the nurse
Spatula To lift the faeces from bed pan

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Labs forms and Label To send the specimen to the accurate place
and avoid its misplacement
A kidney tray and a paper bag To discard the waste
Wash down the tray with soapy swabs, wet To clean perineum
swabs and jug of water
Screen To provide privacy

Collection of mid-stream urine for culture and routine examination

1. Assess client’s mobility and explain the patient how and what specimen to be
collected
2. Provide privacy to the client e.g. by screen or curtain
3. Wash hands and wear gloves
4. Give a bed pan to the bed-ridden patient
5. Assist or allow the client to wash the perineum and collect specimen
• Male: Hold penis and retract the fore skin and using a circular motion clean
the penis moving from centre to peripheral with soapy and wet swab
• Female: Separate labia minora with thumb and forefinger and clean the area
from top to bottom, centre to periphery with soapy and wet swabs three times,
using separate swab each time.
6. After initiating urine stream, pass the urine to the specimen bottle and collect 30-60ml
of urine
7. Remove the specimen container before the client empties the bladder
8. Remove the bed pan and make the patient comfortable
9. Replace the cap on the specimen container and remove the gloves
10. Label it with name, age, sex, bed no. /ward no., diagnosis nature of examination.
11. Transport the specimen to the laboratory within 15minutes or immediately refrigerate
12. Record date and time of collection of specimen in the nurse’s record

Urine specimen from an indwelling catheter

The urine specimen from a patient with an indwelling catheter should be collected from the
catheter itself

Procedure
• Wear sterile gloves. Clamp catheter and disconnect the urine bag
• Wipe the end of the catheter with an antiseptic swab.
• Hold the sterile specimen container near the end of the catheter, unclamp the catheter
and let urine fall into the sterile container
• After collecting the required amount connect the catheter with the urine bag
• Label the container and despatch it to the laboratory

24- hours urine specimen

For a 24-hour specimen, all urine voided in a 24-hour period is collected

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• The collection is initiated at a specific at a specific time, which is noted and the client
is asked to empty his bladder at that time. This urine is discarded. After this all the
urine voided is collected receptacle for the next 24 hours. Usually, it is done from 6
am to 6 am of the next day
• After 24hours at the same time the client is asked to void again and is taken as the last
collection. The time of ending the collection is also noted. Preservatives are added as
per the institutional routine. A variety of preservatives used are boric acid, conc.Hcl,
formalin, chloroform, etc to prevent decomposition and multiplication of bacteria.
• The specimen is labelled with the type of specimen, time of collection and time of
ending, the amount, the name of the patient, bed no., ward no., doctor’s unit and date
• The collection container is labelled before the start of the collection

Urine for pregnancy test

Urine is collected after 14days of missed period preferable morning sample. The urine is
tested for Human Chorionic Gonodotropin(HCG)

4.6-Collection of specimen of stool

The waste product of gastrointestinal tract is excreted out through faeces /stool helps in
diagnosis of G.I tract problems and infestations

specimen Type of examination

Stool • routine microscopic and culture
• occult blood
• ova and cyst

Steps of procedure
1. Explain the procedure to the client, what specimen is requires and the reason
2. Ask the client to pass urine
3. Ask the patient to defecate into the clean bed pan
4. Do not collect the specimen from the toilet bowl
5. Wear gloves
6. With a clean wooden spatula lift up a portion of the stool 15-30ml from the centre of
the mass and place it directly into the appropriately labelled specimen container
7. If portion of the stool include visible blood, mucus or pus include these with the
specimen sent
8. The specimen is sent to the laboratory immediately

Stool for Ova and Parasites

Stool for ova & parasites is collected to detect intestinal infections caused by parasites and
their ova (eggs)

Preparation of patient
• The client should be instructed to avoid drugs as castor oil, mineral oil, or anti-
diarrhoeal compounds as it may alter the faeces.
• The client should be informed that the test usually requires 3 stool specimens, one
taken every other day or every third day

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Procedure
As per the steps for collection of stool given above
Stool Culture
• Stool cultures are performed to identify pathogenic organisms in the GI tract. If the
stool culture shows no pathogens, detection of viruses can be performed by
immunoassay or electron microscopy, which may help in the diagnosis of non-
bacterial gastro-enteritis
• If the client has been taking any antibiotics recently it has to be reported

Procedure:
Stool should be collected using sterile technique and a sterile stool container. It may be
collected for 3 consecutive days.

Stool for Occult Blood

Stool examinations for occult blood help to detect GI bleeding and early diagnosis of
colloidal cancer. The guaiac or orthotoluidene test is commonly used.
Instructions to patient
If the orthotoluidene test is used the client may be instructed to eat a high-fibre diet for 48 to
72 hours before the collection of the stool specimen. Red meat, poultry, fish, turnips and
horse radish should be avoided. This may create a false positive result. The following
medications should be withheld for 48-72 hours before the test like iron preparations,
bromides, rauwalfia derivatives’, steroids indomethacin and colchicines and vit C, which can
produce a negative results. Other tests for occult blood do not require any dietary restrictions.

Procedure
Usually, a total of 3 stool specimens over consecutive days is collected. A blue coloration
indicates a positive result.
1. Route has a different influence on drug absorption depending on the physical structure
of the tissue. Skin relatively slow in the absorption, whereas the mucus membrane and
respiratory airways allow quick drug absorption because of high vascularity of the
area
2. Oral route of administration of medicine causes slower absorption, where as I/V
injection produces most rapid absorption
3. Solutions and suspensions already in a liquid state are absorbed more rapidly than
capsules and tablets
4. After the drug is absorbed it is distributed within the body to tissues and organs and
ultimately to its specific site of action
5. When a drug reaches its site of action, it is metabolised into an inactive form that is
more easily excreted. This bio-transformation occurs under the influence of enzymes
that detoxify, degrade and remove the biological active chemicals. Most bio-
transformation occurs within the liver. Lungs, kidney, blood and intestines also
metabolise drugs
6. Excretion: After drugs are metabolised they exit the body through kidney, liver,
bowels, lungs and exocrine glands. The exocrine glands excrete liquid soluble drugs
4.8 Collection of other specimen

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Bone marrow aspiration-Bone marrow aspiration is a small incision, and then inserts a
hollow needle through the bone and into the bone marrow. Using a syringe attached to the
needle, withdraws a sample of the liquid portion of the bone marrow. Bone marrow biopsy
will determine the cause of abnormalities of blood,i.e. anaemia, bone marrow diseases,
leucopoenia, thrombocytopenia, or polycythemia, leukaemia or lymphomas and infection or
fever of unknown origin
Amniotic fluid aspiration
Amniocentesis is an invasive, diagnostic antenatal test. It involves taking a sample of
amniotic fluid in order to examine foetal cells found in this fluid
Pap smear
A Pap smear is a screening test for cervical cancer. The test itself involves collection of a
sample of cells from a woman's cervix.
Throat swab
The sterile Hydra Flock flocked swab to swab the posterior nasopharynx and the tonsillar
arches. Insert swab into sterile liquid amines transport system vial. Break the swab handle at
scored breakpoint line.
A throat culture or strep test is performed by using a throat swab to detect the presence of
group A streptococcus bacteria, the most common cause of strep throat. These bacteria also
can cause other infections, including scarlet fever, abscesses, and pneumonia.
Nasal swab- This test identifies disease-causing organisms that live in the secretions at the
back of your nose and throat. And it is collected from the nose.
Wound swab-Obtain a wound culture when clinical signs and symptoms of infection are
present.

Technique
1. Use sterile cotton-tipped swab and culture medium in a pre-packaged collection and
transport system.
2. Community nurses should not allow transport medium to freeze or become overheated in
the car before using it.
3. Thoroughly rinse wound with normal saline.
4. Do not swab pus, exudates, hard Eschar or necrotic tissue.
5. Rotate the swab tip in a 1cm 2 area of clean granulation tissue for a period of 5 seconds,
using enough pressure to release tissue exudates. This may be painful so warn the patient of
the possibility of pain and pre-medicate with analgesia if possible.
6. Remove protective cap from culture medium and insert cotton-tipped applicator into the
culture medium without contaminating the applicator.
7. Transport to the laboratory at room temperature within 24 hours.

Role of MPHW in collection of specimens

1. Preparation of Client
2. Working knowledge of diagnostic test
3. Nurse need to explain the test with clarity and compassion.
4. Nurse need to explain the purpose of the test.
5. While assisting the physician with a test, talk to the client throughout the test, to comfort
and encourage patient.

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6. After test is over, observe the client for any untoward reactions of complications and be
prepared to implement appropriate care.
7. On the previous day, explain the procedure to the client. Explain what specimen to collect,
when to collect, how to collect and the amount to be collected.
8. Provide an appropriate container and demonstrate to the client how to use it.
9. Instruct the client not to contaminate the outside of the bottle.
Conclusion
Specimen collection is essential for diagnosis and treatment of patient during hospitalization.
The main aim of health team work is error free diagnostic report, which is based on the
proper collection of specimen and transportation to the lab at right time.
Essay question
1. Describe the principles of collection of specimen
2. How do you collect the 24 hours urine specimen.
3. Describe procedure of blood specimen
Short answer questions
1. What is the purpose of specimen collection?
2. List the site of blood specimen collection
3. List colour of test tube topper in blood specimen collection
4. What are the points to remember in collection sputum specimen?
5. What are the measures helps to prevent contamination while collecting specimen?
6. What is the instruction to be given in stool specimen collection?

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UNIT-V DISINFECTION AND STERLIZATION

5.0-Introduction
5.1-Definition
5.2-Principles
5.3-Methods of disinfection and sterilization
5.4-Methods of disinfecting different equipment
5.5-Methods of sterilizing different equipment
Objectives
After completion of this chapter, the students are able to
➢ Learn the principles used for disinfection and sterilization
➢ Describe the different methods of disinfection
➢ Explain the different types of sterilization techniques
➢ Identify the appropriate methods of sterilization of equipment

Introduction
The environment is fresh and colourful when it maintains its cleanliness. It will be polluted
and contaminated by industrial waste, house hold waste, improper drainage of sewage and sullage. It
consists of many microorganism i.e. bacteria, virus, fungi and other microbial. These micro
organisms are causative agents of different infections and diseases, which is obviously high in
hospital environment due to more human waste, infectious body discharges and air borne infections
by coughing and sneezing. These contaminated particles may deposit on the surface and contaminate
the equipment and articles while using. These micro organisms removed by using the sterilization
and disinfection techniques.

Definitions of terms related to sterilization

1. Disinfection- It is defined as destroy all pathogenic micro organisms, but it chance to produce
infection, due to the spores are not destroyed.
2. Sterilization- It is the process by which an article, surface or medium is freed of all micro
organisms either in vegetative or spore form (bacteria, virus and fungi spore form)
3. Antiseptic- It means the substance that prevents the growth or inhibit the action of micro
organism. E.g. Povidone iodine scrub solution used for cleaning the skin before surgery.
4. Sanitizer- Agent that reduce the no of bacterial contaminants to safe levels e.g. Hand wash gel
5. Detergent- It is the surface cleaning agent which acts by lowering surface tension e.g. soap
6. Bactericide - An agent that kills bacteria.
7. Bacteriostat - An agent that arrests or retards the growth of bacteria.
8. Germicides - A substance that kills disease microorganisms (i.e. pathogens / germs) but not
necessarily bacterial spores.
9. Sterility - The absence of viable organisms.
10. Viable - Live and growing bacteria (or microorganisms) + spores
Vegetative microorganisms: Growing organisms.

Purpose of sterilization
➢ To provide a safe environment and sterile equipment for the care of the patient.
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➢ To prevent cross infection.

➢ To destroy the causative microorganisms of the disease

5.2-Principles
The basic principle of sterilization is to control/alter condition of growth of infectious microbial in
the equipments /instruments. They are
1. Temperature of the environment (either hot or cold)The vital constituents of cells such as
proteins (enzymes) and nucleic acids are denatured by Dry heat/moist heat.
The radiation creates free hydrogen radicals, hydroxyl radicals and some peroxides which cause
different kinds of intracellular damage.
2. PH of the environment (acidic or alkaline) e.g. Phenol and phenolic compounds produces a variety
of effects on the microorganisms. Based on their concentration they exert various effects like
disruption of cells, precipitation of cell protein, inactivation of enzymes and leakage of amino acids
from the cells
3. Accessibility to light (Dark or well light)Well light prevent the growth of bacteria
4. Availability of nutrition (oxygen, nitrogen, cellulose, etc)The bacteria grows well in blood due
availability of nutrients and oxygen.
5. Availability of the medium (water, chemical, gas, etc) The water is the best source of bacteria (e.g.
E.coli) because it consists of moist, oxygen and nutrients
5.3-Methods of disinfection and sterilization
There are various substances used for sterilization which can be classified as
Agents Methods
Natural agents • Sun light
• Air
Physical agents 1. Dry heat
• Flaming
• Hot air oven
• Infra red
2. Moist heat
• Boiling
• Autoclave
• Pasteurization
3. Radiation
Chemical agents • Alcohol
• Aldehyde
• Dyes
• Halogens
• Phenols
• Surface Active Agents
• Heavy Metals
• Gases

Natural agents
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Sun light - Ultra violet and enormous heat is present in the Sun light. It kill the micro organism in
the atmosphere as well as in objects like mattress, furniture used by the patient.
Air- The Open air environment keep the objects dry and evaporate the moisture. It is lethal to most
bacteria

Physical agents
1. Dry heat- Dry heat is the simplest and most economical method of sterilization
Flaming: The instruments, articles, inoculating loops, spatulas, scalpel are keep in the flame of
Bunsen lamp for few minutes till they turn into red hot. This method is not applicable for all
instruments and no guarantee of destroying the spores of microbes.
Hot air oven: The articles are sterilised by dry heat with high temperature (160 degree) for one hour
exposure in the electrical oven. The hot air is distributed in the chamber by a fan. It is used for
sterilizing the following articles i.e. glass ware, forceps, scalpel, scissors, delicate and fine
instruments, glass syringes and medical products like liquid paraffin, dusting powder
Note: avoid over loading
Dry the glass ware before placing in the hot air oven
Pack the glass ware in the metal containers.
Allow the oven to cool slowly for about 2 hours before the door is opened

Conditions to achieve complete sterilization by dry heat sterilization are as follows:

Cycles recommended as per BP 1988 are:
* A minimum of 1800 C for not less than 30 minutes.
* A minimum of 1700 C for not less than 1 hour.
* A minimum of 1600 C for not less than 2 hours.
Infrared
The articles placed in a moving conveyer belt and passed through a tunnel that is heated by
infrared radiators to a temperature of 180o C and exposed for 7 minutes.
Infrared sterilizer used for fast and efficient sterilizing of inoculation loops and micro-
instruments without gas flame and directly usable in the safety cabinet without affecting their safety
function. Special focused infrared light generates an IR hot spot where objects are sterilized in 5-10
seconds at 750-1000 ° C.
2. Moist heat
Heat in the form of saturated steam under pressure is the most practical and dependable agent
for sterilization. Bacterial death by moist heat sterilization is due to denaturation and coagulation of
essential protein molecules (enzymes) and cell constituents
Boiling: This method kills the bacteria at 900-100 0 for 30 minutes .Boiling method is not
recommended for surgical procedures. Spores are killed by autoclaving at higher pressures. Hard
water should not be used for sterilization. Boiling water (1000 ) kills bacteria viruses immediately.
Some bacterial spores and entero-toxins are also heat resistant e.g. Staphylococcal entero-toxins
Autoclave
An autoclave is a steriliser which utilizes saturated steam under pressure. Steams enter the
steriliser by means of pipes. Autoclave consists of two chambers with a safety steam lock door. In
outer chamber pressure is generated and maintained and temperature is raised. This in turn heats the
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inner chamber. Pre packed load is placed in the inner chambers. Due to pressure air is forced

ward and air is forced out through an outlet at the bottom and in front of the autoclave through the
thermostat valve. The thermostat valve closes when steam hits it.

Types of auto clave

1. Laboratory autoclave (simple pressure cooker type)
2. Steam jacketed downward displacement laboratory autoclave
3. High pressure prevaccum autoclave
4. Rapid cooling steriliser
Autoclaving at a temperature of 1210 C (250○F), at 15 to 20 psi is one of the most convenient
and effective means of sterilization available. The time is measured after the temperature of the
material being sterilized reaches 1210 C (250ºF). Care must be taken to ensure that the steam can
circulate around articles in order to provide even heat distribution.
The success of the sterilization is very time-dependent in liquid media, with large volumes
requiring longer periods of time to reach the effective temperature within the media itself.
In dry loads small amounts of water should be included inside the autoclave bag to ensure sufficient
moisture content within the load to allow for heat transference and distribution.
Autoclave tape can be used for routine runs where glassware or sterile media are prepared before use
Note:
• Use fresh washed linen.
• Limit size of bundles
• Use sterilization indicators to assure sterile goods
• The optimum temperature should be 250O F and pressure 15-17 lbs (Pressure: 15 lb /
square inch (psi),Temperature: 1210 C, Time: 15 minutes)

Pasteurization
• Pasteurization is heat-treatment process that destroys pathogenic microorganisms in certain
foods and beverages.
• Pasteurization of milk, requires temperatures of about 63° C (145° F) maintained for 30
minutes or, alternatively, heating to a higher temperature, 72° C (162° F), and holding for 15
seconds (and yet higher temperatures for shorter periods of time).
• The times and temperatures are those determined to be necessary to destroy the
Mycobacterium tuberculosis and other more heat-resistant of the non-spore-forming, disease-
causing microorganisms found in milk.
• The treatment also destroys most of the microorganisms that cause spoilage and so prolongs
the storage time of food.
3. Radiation
The radiation employed for the sterilization may be ionizing or non ionizing radiation.
Gamma and X-rays, having energies more than about 10eV, are called ionizing radiations. In
hospitals, UV radiation is used to control the spread of infection during or after surgical
procedures.

Chemical agents

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The chemical disinfectants are divided into groups according to their chemical characteristics or
action. There are many chemical compounds that have a disinfectant or antiseptic action. The most
commonly used chemical disinfectant in the hospital are mentioned as follows
• Alcohol
• Aldehyde
• Dyes
• Halogens
• Phenols
• Surface Active Agents
• Heavy Metals
• Gases
Alcohol
Alcohols disrupt the cellular membranes, solubilise the lipids, and denaturise the proteins
by acting directly on S-H functional groups.
e.g. Ethyl alcohol and isopropyl alcohol (spirit)
• Bactericidal activity.
• They evaporate rapidly.
• Disinfect the body surfaces.(before giving intra muscular injection, injection site is disinfect
with spirit cotton swab). Absolute alcohol is also not very effective. They are used to clean
instruments and wipe down interior of Biological Safety Cabinets and bottles, etc. Alcohols
are generally regarded as being non-corrosive.

Aldehyde
It damages the nucleic acid by alkylation of amino acids or carboxyl group. The name of the
chemicals is formaldehyde and gluteraldehyde.40% formaldehyde is used for fumigation of the
rooms, chambers, O.T. and surface disinfection.2% gluteraldehyde is used to sterilise the
laparoscopic instruments and anaesthetic equipments.
The main drawback of the aldehyde is
✓ Irritants of eye and mucus membrane
✓ Poor penetration
✓ Leaves non-volatile residue
Dyes
Acridine dyes are bactericidal which interact with bacterial nucleic acids.
1. Aniline dyes- e.g. crystal violet, malachite green and brilliant green. Acridine dyes –e.g. acriflavin
and aminacrine.
Euflavine has effective antimicrobial properties. They are more effective against gram positive
bacteria and gram negative bacteria and are more bacteriostatic in action. It is used in 1:1000
solution for treating wounds and for irrigation of bladder
It is used for mild burns as topical antiseptics.
They are used as paint on the skin to treat bacterial skin infections.
2% Gentian violet is a dye safe for mucus membrane infection e.g. oral thrush is a fungal infection.
But it causes stain to the cloth and difficult to remove
Halogens

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The halogens are chemical elements that have ability to form salts. Chlorine and iodine are two
halogens that are useful as disinfectant
They are oxidizing agents and cause damage by oxidation of essential sulfydryl groups of enzymes.
Chlorine reacts with water to form hypochloric acid, which is microbicidal.
1. Chlorine compounds- chlorine ,bleach,
hypochlorite 2.Iodine compounds- tincture
iodine, and iodophores
Tincture of iodine (2% iodine in 70% alcohol) is an antiseptic. Iodophores are diluted in 50%
alcohol for effective hand washing. 10% Povidone Iodine is used in pre and postoperative skin
disinfection.

Purification of water is done by Chlorine gas. Household bleach (dilution of 1:10) can be used to
disinfect floors and swimming pools with high concentration. 1% sodium hypochlorite solution is
used for decontamination of in serology, virology and spillage of infectious material. The
disadvantages are the presence of organic matter inactivates the halogens rapidly. Iodine is corrosive
and staining. Bleach solution is corrosive and will corrode stainless steel surfaces.
Heavy Metals

The compounds are made of mercury and used as a disinfectant. It’s acted by precipitation of
proteins and oxidation of sulfydryl groups. They are bacteriostatic

✓ e.g. Mercuric chloride, silver nitrate, copper sulfate, organic mercury salts
mercurochrome,merthiolate
1% silver nitrate solution can be applied on eyes as treatment for ophthalmic neonatorum
✓ Copper sulphate is used for umbilical infection and fungicide.
✓ Mercurials are active against viruses and bacteria
✓ At dilution of 1:1000 to 1:5000 for instruments.
✓ At dilution of 1:500 to 1:5000 for skin.
✓ At dilution of 1:5000 to 1:10000 for eye and urethral irrigation.

Hydrogen Peroxide (H2O2)

It is the oxidising agents. It kills the microorganisms by easy release of oxygen. Hydrogen
peroxide produces hydroxyl-free radical that damages proteins and DNA.
It is used at 6% concentration to decontaminate the instruments, equipments such as ventilators.
3% Hydrogen Peroxide Solution is used for skin disinfection and deodorising wounds and ulcers.
Strong solutions kill the spores.
It loses its power when exposed to light, heat and air. It should store in dark bottle and cool place. It
is broken down by catalyse, proteinaeous organic matter drastically reduces its activity.

Surface active agents

Mode of actions: They have the property of concentrating at interfaces between lipid containing
membrane of bacterial cell and surrounding aqueous medium. These compounds have long chain
hydrocarbons that are fat soluble and charged ions that are water-soluble. Since they contain both of
these, they concentrate on the surface of membranes. They disrupt membrane resulting in leakage of
cell constituents.

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soaps or detergents.

Detergents can be anionic or cationic. Detergents containing negatively charged long chain
hydrocarbon are called anionic detergents. These include soaps and bile salts.

If the fat-soluble part is made to have a positive charge by combining with a quaternary nitrogen
atom, it is called cationic detergents. Cationic detergents are known as quaternary ammonium
compounds (or quat). Cetrimide and benzalkonium chloride act as cationic detergents.
They are active against vegetative cells, Mycobacteria and enveloped viruses. They are widely
used as disinfectants at dilution of 1-2% for domestic use and in hospitals.

Disadvantages: Their activity is reduced by hard water, anionic detergents and organic matter.
Pseudomonas can metabolise cetrimide, using them as a carbon, nitrogen and energy source.
Phenols
✓ It is commonly called as carbolic acid. It is the compound, which Joseph Lister used first for
anti septic in1865.It is awhite crystalline compound and dissolved in water. It disrupts
membranes, precipitates the proteins and enzymes are inactivated.
✓ They are bactericidal, fungicidal, mycobactericidal but are inactive against spores and most
viruses. They are not readily inactivated by organic matter.
e.g.5% phenol, 1-5% Cresol, 5% Lysol , hexachlorophene, chlorhexidine, chloroxylenol
(Dettol)
✓ 5% phenol-is useful for disinfecting sputum and faeces or any organic matter. will inhibits
action. Phenol can cause severe burns to the skinand can cause toxic effects by being
absorbed through skin
The corrosive phenolics are used for disinfection of ward floors, in discarding jars in
laboratories and disinfection of bedpans.
✓ Lysol is the derivative of phenol that is mixed up with soap. It has a greater bacteriocidal
action and is less poisonous than phenol. It is useful for articles contaminated with gram
negative and acid fast bacilli. It is caustic and to be carefully handled
✓ Chlorhexidine (isopropanol) solution used for skin disinfection, or as an aqueous solution
for wound irrigation and an antiseptic hand wash.
✓ 20% Chlorhexidine gluconate (Savlon) solution is used for pre-operative hand and skin
preparation and for general skin disinfection.
✓ Chlorhexidine gluconate is also mixed with quaternary ammonium compounds such as
cetrimide to get stronger and broader antimicrobial effects .
✓ Chloroxylenols (Dettol) are less irritant and can be used for topical purposes and are more
effective against gram positive bacteria than gram negative bacteria. Hexachlorophene is
chlorinated diphenyl and is much less irritant. It has marked effect over gram positive
bacteria but poor effect over gram negative bacteria, mycobacteria, fungi and viruses.
Disadvantages: It is toxic, corrosive and skin irritant. Chlorhexidine is inactivated by anionic
soaps. Chloroxylenol is inactivated by hard water.
Gases
Formaldehyde is a liquid and it is vaporized as gas is used for fumigating operation theatre neo
natal intensive care units, Intensive care units .These sterilants are used in hospitals and commercial
facilities where closed systems controlling temperature, humidity, and concentration are required to
achieve sterilization using these agents.280 ml of formalin for every 100 cu ft of room value .Doors

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and windows should be sealed for 48 hours. The disadvantage is highly irritants of eye and cause
burning sensation of mucus membrane
Ethylene Oxide (ETO) has wide use as an alkyl acting agent with very broad biocide activity
including spores and viruses. The oxide ring reacts with free amino, sulfhydryl and hydroxyl groups
on proteins. It is a cyclic molecule, which is a colorless liquid at room temperature. It has a sweet
ethereal odor, readily polymerizes and is flammable.
It is used to sterilize heat labile articles such as bedding, textiles, rubber, plastics, syringes,
disposable Petri dishes, and complex apparatus like heart - lung machine, respiratory and dental
equipments
ETO is highly flammable and needs an inert agent when used in a sterilizer. The disadvantage is
highly inflammable, explosive, toxic, irritating to eyes, skin and carcinogenic.
Beta-Propiolactone (Bpl)
It is an alkalising agent and acts through alkylation of carboxyl- and hydroxyl- groups. It is a
colourless liquid with pungent to slightly sweetish smell. It is a condensation product of ketone with
formaldehyde.
It is an effective sporicidal agent, and has broad-spectrum activity. 0.2% is used to sterilize
biological products. It is more efficient in fumigation that formaldehyde. It is used to sterilize
vaccines, tissue grafts, surgical instruments and enzymes.It has poor penetrating power and is a
carcinogen.
Methods of disinfecting different equipment
Disinfectants are the chemical that destroy pathogenic bacteria from inanimate surfaces and
discharges from the body.
Types of disinfection
(a) Concurrent disinfection : It is application of disinfective measures as soon as possible after the
discharge of infectious material from the body of an infected person, or after the soiling of articles
with infectious discharge It consists of usually disinfection of urine faeces, vomit, contaminated
linen, clothes, hands, dressing, apron, gloves, etc throughout the course of illness.
(b) Terminal disinfection: It is applied after the patient has been removed by death or to a hospital
or has ceased to be a source of infection . Terminal cleaning is considered adequate, along with
airing and sunning of rooms, furniture and bedding.
(c) Prophylactic disinfection: Disinfection of water by chlorine, pasteurization of milk and hand
washing may be cited as examples Prophylactic ofdisinfection.
Properties
✓ Have broad spectrum activity ✓ Non toxic
✓ Destroy microbes ✓ Good cleansing property
✓ Stable and active in any Ph ✓ Not have a strong odour(pungent)
✓ Fast acting

Articles Chemical method Time

Needles 2%Gluteraldehyde 30minutes
/cidex/10%Dettol/detergent
Blades Formalydehyde 30minutes
/10%dettol/detergent

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Catheters and tubes 2%Gluteraldehyde/cidex/10%Dettol 2hours

Operation theatre instruments 10% chlorhexidine 10minutes
Operation theatre instruments Isopropyl alcohol/detergent 10minutes
(in emergency)
Linen and Drapes 2% hypochlorus solution /savlon 30minutes
if it is infectious ,disinfect before sent to
laundry
Incubators , Cabinets Formalydehyde 1 hours
savlon1:40(carbolization)
Clinical thermometer Isoprpyl alcohol 10minutes
savlon1:40
dettol1:20
Anatomic specimens preserved Formalydehyde it is changed
every six
months
Metal instruments Gluteraldehyde /formaline containing half 30minutes
percent sodium tetraborate

Points to remember:
• The disinfectant chosen should be efficient to destroy the pathogens
• They should be used in correct strength
• The articles should be fully submerged in it Adequate time should be taken for disinfection
• clean and dry the article before keep in the antiseptic solution/disinfectant
Methods of sterilizing different equipment
S.No Methods and Articles Degree of Heat Time
Hot air oven
a ophthalmic instruments 150 O c One Hour
O
b oil, glycerol, dusting powder 150 c Two Hour
O
c Syringes 160 c One Hour
Moist heat
a Milk Holder method 63 O c 30minutes
O
Milk Flash process 72 c 15-30seconds
O
b Vaccines 60 c One Hour
O
c Serum, Body fluids 56 c One Hour
O
d Mesophillic bacteria (destroyed) 60 c 30minutes
Staphlococcus aureas (destroyed) 60 O c 30minutes
O
Bacteria, East moulds (destroyed) 80 c 10-15 minutes
O
Clostridium, botulism (destroyed) 120 c 4minutes
O
Poliomyelitis virus (destroyed) 60 c 10 Hour
e Clothing, bedding, eating utensils 70O -80 O c several minutes
f Cystoscope, specula, apparatus 75O c 10minutes
g Vegetative bacteria (destroyed) 90O -100 O c 10-30 minutes

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Steam under Pressure

a Dressing instruments 108 O c 10-30 minutes
Laboratory ware, Pharmaceutical products. 121 O c 12 minutes
Aqueous solution
Sharp instruments 108 O c -121 O c 12 minutes
Catheter and tubes 121 O c 12 minutes
Glass ware 132 O c 2 minutes
160O c 30-60 minutes
b Auto clave 121 O c 20 minutes
c Metal and Stainless Steel wave 121 O c 30-60 minutes
d Glassware, Syringes 160 O c 20 minutes
e Gloves 121 O c 12 minutes
Conclusion
Disinfection and sterilization are vital one delivery of quality health care to the patient. It prevents
the transmission of infection to the patient as well as to the health team members
Essay questions
1. What are the chemicals methods of sterilization? Describe any two in detail.
2. Describe the hot air oven and autoclave
3. Describe the principles of sterilization
Short answer questions
1. What is infra red radiation?
2. Define disinfection
3. List four products of phenol group disinfectant
4. What are the physical methods of sterilization?

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UNIT-VI BIOMEDICAL WASTE MANAGEMENT

Structure
6.0-Introduction
6.1-Definition
6.2-Categories of biomedical waste
6.3-Principles
6.4-Methods of waste disposal
6.5-Hazards of hospital waste
6.6-Dos and Don’ts of waste management in the Hospital
Objectives
After reading of this unit, the students are able to
➢ Identify and classify the biomedical waste in the hospital
➢ Describe the different methods used for disposal of biomedical waste
➢ Describe the important points to practice in hospital waste management

Introduction
In our day to day activities, home waste is produced from kitchen and by our paper
work. Likewise hospital is also one of the place to generate waste by health care activities,
that waste may be infectious or non infectious. Healthcare waste (HCW) is a by-product of
healthcare that includes sharps, non-sharps, blood, body parts, chemicals, pharmaceuticals,
medical devices and radioactive materials. Poor management of HCW exposes healthcare
workers, waste handlers and the community to infections, toxic effects and injuries. Proper
Disposal of hospital waste is vital part to protect the environmental health and management
of quality health care services

Definition
Hospital waste is “Any waste which is generated in the diagnosis, treatment or
immunization of human beings or animals or in research” in a hospital.
According to Biomedical Waste (Management and Handling) Rules, 1998 of India
“Any waste which is generated during the diagnosis, treatment or immunization of human
beings or animals or in research activities pertaining there to or in the production or testing
of biological.

• 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 cyto-toxic drugs.

WHO estimates BMW from hospital is

• 85% of hospital waste is non-hazardous

• 10% is infectious

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• 5% is non-infectious but consists of hazardous chemicals like methyl chloride and

formaldehyde

In general, there are two recommended ways to handle medical waste fluids:

1. Collect fluids in a leak proof container, and solidified for autoclave treatment.
2. Thermally (autoclave) fluids then they be disposed into the sanitary sewer system

Waste segregation means dividing waste into dry and wet. Dry waste includes wood
and related products, metals and glass. Wet waste, typically refers to organic waste usually
generated by eating establishments and are heavy in weight due to dampness
Categories of Bio Medical Waste (BMW)

Biomedical waste (management and handling ) Rule 1998 ,prescribed by the ministry of
Environment and forests ,Government of India, came into force on 28th July 1998.This rule
applies to those who generate, collect, receive store, dispose ,treat or handle biomedical waste
in any manner

OPTION WASTE CATEGORY TREATMENT &

DISPOSAL
Category no1 Human anatomical waste (tissues, organs and Incineration/Deep burial
body parts)
Category no2 Animal waste(tissues, organs and body parts Incineration/Deep burial
bleeding parts, fluids, waste generated by
veterinary hospitals)
Category no3 Microbiology and biotechnology waste( waste Local autoclaving
from laboratory cultures, stocks or specimens of
/microwaving/incineration
micro organisms, live or attenuated vaccine and
animal cell culture used in research
Category no4 waste sharps(needles ,syringes, scalpels, blades, disinfection (chemical
glass, etc. that may cause puncture and cuts treatment/ autoclaving
/microwaving and
mutilation shredding
Category no5 Discarded medicines and cytotoxic drugs (wastes Incineration, destruction and
comprising out dated, contaminated and discarded drugs disposal in secured
medicine landfills
Category no6 Solid waste (contaminated with blood and fluids Incineration/ autoclaving/
including cotton , dressings, soiled plaster cast, microwaving
linen, beddings
Category no7 Solid waste(waste generated from disposal items Disinfection by chemical
other than the waste sharps such as tubings treatment ,
catheters intravenous sets etc) autoclaving/microwaving,

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mutilation and shredding

Category no8 Liquid waste ( waste generated from laboratory Disinfection by chemical
and washing ,cleaning house keeping and treatment and discharge into
disinfecting activities) drains
Category no9 Incineration ash (ash from incineration of any Disposal in municipal
biomedical waste ) landfill

Category Chemicals used in production of biological chemical treatment and

no10 ,chemicals used in insecticides discharge into drains for
liquids and secured landfill
for solids

Disposal of Bio Medical Waste(BMW) rules 2016

Colour coding and type of container for disposal of biomedical waste

COLOR CODING TYPE OF CONTAINER WASTE CATEGORY

Yellow Plastic Bag Human waste, Animal anatomical waste,
soiled waste, expired medicines, chemical
waste, body fluids and clinical waste
(1,2,3,6)
Red Disinfected contaminated waste (recyclable like plastic
container/Plastic bag bag, pipes, bottle or container(3,6,7)
Blue/White Plastic Bag / punch proof scalpel, blades, needles, syringes
Translucent containers including sharp metals (4,7)
Black Plastic Bag Broken glass ware or metallic body
implant (5,9,10)

Different labels for bio medical waste colour coded containers and bags shall be required
for identification and safe handling of this waste .These labels needed for storage,
transportation of bio medical waste. The symbols are as follows
BIOHAZARD SYMBOL CYTO TOXIC HAZARD SYMBOL

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Note: As per guidelines of Bhabha Atomic Research Centre (BARC), Mumbai. Standard
PPE (approved by BARC) for protection against radioactive wastes. Lead containers used for
collecting radioactive wastes. The health care person should wear disposal gloves, protective
glass, masks and aprons. Cytotoxic drugs should be stored in sturdy card board boxes and
later can be incinerated.
Principles
In determining waste disposal options, national policies are to be given first priority. At each
district and each health care facility ,Identify sustainable resources for safe and practical
medical waste collection, handling, and transport. Prepare medical waste management plans
that include:

1. Minimization of waste: Reduce unnecessary injection to protect health care providers and
the public from unnecessary health risks.
2. Segregation of waste: Separate waste at its source into 1) sharps waste; 2) infectious
waste; 3) non-infectious waste.
3. Safe handling of sharps: Use puncture-proof safety boxes or needle removal for disposal
of all needles and plastic syringes. Dispose of all medical sharps safely.
4. Safe collection of medical waste: Apply waste segregation and handling procedures to all
health care delivery areas. Waste handlers must use personal protection equipment and
maintain a routine collection and transport schedule.
5. Safe final disposal: Use best available destruction option for final disposal.
a. Non-incineration destruction—
i. Disinfect (autoclave/microwave/chemical), compact (shred/melt), then landfill or recycle.
ii. Bury in protected pit (if the water table permits).
b. Incineration—where incineration is the best locally-available option, maximize safety and
acceptability:
i. Incinerate only sharps and infectious waste.
ii. Optimize incinerator performance through repair, maintenance, and proper operation.
iii. Do not incinerate materials that produce toxic emissions (PVC, batteries, thermometers,
etc.).
iv. Install only medium- or high-temperature incinerators (small or large scale).
v. Ensure funds for proper training, operation, and maintenance.
vi. Build local support. Locate incinerators away from people and crops.

Methods of waste disposal

The primary methods of treatment and disposal of medical waste are:

• Incineration.
• Autoclaves.
• Chemical Disinfection.
• Microwave.
• Irradiation.
• Vitrification.

Incineration

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• Incineration is an old technology and was widely used in the past for all sorts of waste
Incineration is high temperature oxidation process and controlled burning of waste. It
can eliminate pathogens - even hard-to-kill bacterial spores - and can reduce the
volume and mass of waste.
• Incineration can break down and render harmless hazardous organic chemicals. With
proper technology, little acid gas is released to the atmosphere.

Types of incinerators

o Double chamber pyrolytic incinerator which may be especially designed to

burn infectious health care waste
o Single chamber furnaces with static grate
o Rotary kilns operating at high temperatures ,capable of genotoxic substances
and heat resistant chemicals

Guidelines for using incinerators

➢ Chlorine-containing materials should be removed from the feed, if feasible. This
includes polyvinyl chloride (PVC) plastic. Chlorine burns to hydrochloric acid, and
although a pollution control system on the tail pipe should be able to reduce emission
to acceptable levels.
➢ Incinerators should be located in areas away from high population areas and where
food is grown.
➢ In addition to the engineering design and construction, thoughtful development of
operating procedures
➢ Temperature should be monitored at several places in the incinerator and the system
should shut down if the temperature falls too low.
Autoclave
Autoclaves are closed chambers that apply both heat and pressure, and sometimes
steam. Autoclaves have been used for a century to sterilize medical instruments for re-use.
Surgical knives and clamps, are put in autoclaves for sterilization.
For medical waste that will be disposed of, autoclaves are a heat treatment are used to
destroy microorganisms that may be present in medical waste before disposal in a traditional
landfill.

Chemical disinfection

Chemical disinfection, primarily through the use of chlorine compounds, kills

microorganisms in medical waste and can sometimes oxidize hazardous chemical
constituents. Chlorine bleach has been used for many disinfecting processes.
1% Hypochlorous solution used for sharps and instruments disinfection Ethylene oxide
treatment is used to disinfect materials and is sometimes used in treatment of medical waste.
It is the most suitable for disinfecting the liquid waste such as blood ,urine, stools or hospital
sewage
Microwave
Microwave radiation is used to treat wastewater sludge and as a heat source to treat
medical waste. The microwave treatment helps to reduce the volume of the end waste for
disposal. If the waste is dry, water is introduced and the wet waste is introduced to the
microwave chamber. The micro organisms are destroyed by the action of microwave of about
2450 MHz and a wave length of 12.24nm

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Irradiation
Irradiation attempts to sterilize waste (or anything) by exposing it to gamma rays that
are fatal to bacteria. A radioactive isotope of cobalt is employed.
Vitrification
It is rarely used for an effective treatment for medical waste. The solid waste is mixed
in, when glass is formed (vitrification means produce glass). The high temperatures kill
pathogens and some combustible material may burn, resulting in an off-gas.
Land disposal
There are two types of disposal of land –open dumps and sanitary landfills. Health care
waste should not be deposited on or around open dumps. The risk of either people or animals
coming into contact with infectious pathogenic microorganisms is high.

6.5-Hazards of hospital waste

Health risks associated with waste and by-products also include:

• radiation burns;
• sharps-inflicted injuries; A person who experiences one needle stick injury from a
needle used on an infected source patient has risks of getting Hepatitis ‘B’ Virus,
Hepatitis ‘C’ Virus and Human Immuno deficiency Virus infection.
• Poisoning and pollution through the release of pharmaceutical products, in particular,
antibiotics and cytotoxic drugs; and.
• Landfills can contaminate drinking-water
• Inadequate incineration or the incineration of unsuitable materials results in the
release of pollutants into the air

6.6 Dos and Don’ts of waste management in the Hospital

The health care personnel should keep certain points in remembrance of BMW and its
disposal for maintaining health and prevent risk of infection.

DO’S DON’TS
Segregate the waste Do not mix infectious waste with non-
infectious
collect waste in colour coded containers Do not allow unauthorised person access o
waste collection /storage areas
cover waste collection containers Do not use open container for infectious
waste
provide protective wear to the waste Do not recap needles
handlers(gloves, masks, aprons)
Immunize all waste handlers Do not incinerate plastic waste
Decontaminate all sharps and plastics by Do not throw sharps into non puncture proof
chemical containers

Conclusion
Biomedical waste management is mandatory now days due to more generation waste by use
of disposal items. Medical waste management helps to prevent risk of occupational health
hazards to the hospital employees as well as to maintain hygienic hospital environment.

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Essay questions
1. Describe the different methods of waste disposal
2. Describe the principles of biomedical waste management
3. Classify the biomedical waste categories according the colour coding

Short answer questions

1. Define biomedical waste.
2. What is the health risk for the waste handlers?
3. List four don’ts in BMW
4. Write the types of incinerators
5. What is the type of waste collected in red colour container?

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PART-B
UNIT-VII MEDICAL CONDITIONS

Structure

–
Introducti
on 7.1-
Vital
signs
7.2-Fever, Malaria, Typhoid and nursing management of patient with fever
7.3-Respiratory conditions
7.4-Gastro intestinal conditions
7.5-Urinary problems
7.6-Cardio vascular problems
7.7-Disease of the nervous system
7.8-Metabolic diseases

OBJECTIVES

After completion of this chapter, the students are able to

➢ Describe vital signs and its importance in assessing the patient
➢ List the types of fever and explain the management of fever
➢ Enlist the respiratory problems and describe the nursing management of respiratory
problems
➢ Learn about digestive problems and its management
➢ Describe the common urinary problems and its management
➢ Understand the common cardiovascular problems and its management
➢ Enumerate the disease of the nervous system and its management
➢ Describe about diabetes mellitus and its management

– Introduction

When an individual’s vital functions are normal, it indicates their physiological function and
homeostasis maintained normal according to the changes occur in the body. Health is
maintained by balanced diet, good elimination and proper environmental hygiene and good
personal hygiene. Early identification of disease is essential for timely right treatment and
early recovery. The main Objective of the medical treatment is early recovery and to prevent
recurrent of attacks of the disease. Learning some important medical conditions and its
treatment are necessary to the MPHW (F) to educate the people in the community as well as
to refer the patient to higher health care centre by proper identifying the signs and symptoms
of medical conditions.

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Vital signs

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The measurement of temperature, pulse, respiration, and blood pressure (BP) is called
as vital signs recording. Monitoring vital signs is the one of the eradicator to assess the vital
organ problem of the patient.
Vital signs are a quick way of monitoring a patient’s condition or identifying
problems and evaluating the patient’s response to intervention.
Vital signs should be assessed at the following times.
➢ At the time of admission
➢ Before and after surgery or an invasive procedure
➢ As per nursing or medical order.
Body Temperature
Definition: Body temperature reflects the balance between the heat produced by the body
and the heat lost from the body. There are two kinds of body temperature.
Core temperature:- It is the temperature of the interior body tissue below the skin and
subcutaneous tissue. It is constant one and it is measured from rectum, tympanic membrane
and oesophagus.
Surface temperature:- It refers to the body temperature at the surface that is of the
skin and subcutaneous tissue. It is elevated or decreased as per the changes in environmental
factors affecting body temperature.
Body temperature altered as these changes in heat production and heat loss.
1) Age: The temperature regulation system is not well developed until adolescence.
Elders are sensitive to extremes in the environmental temperature.
2) Diurinal variation: Body temperature varying as 1.00C between early morning and
late afternoon.
3) Exercise: Hard work or exercise can increase body temperature.
4) Hormones: Female may have more hormone fluctuations than men.
5) Stress: Stimulation of the sympathetic nervous system can increase the production of
epinephrine and nor epinephrine.
6) Environment: Extremes in environmental temperature can affect a person’s
temperature regulatory system.
Assessment of Body Temperature:
The common steps of measuring body temperature are –
➢ Oral, rectal, auxiliary, tympanic membrane and temporal artery.
Types of thermometer:

1) Clinical Thermometer – Body temperature were measured using

Mercury in glass.

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2) Electronic Thermometer – Can display the temperature in 2 to 60 seconds.

3) Chemical disposable Thermometer
4) Infrared Thermometer – sense body temperature from the infrared energy gives off by
a heat source.
5) Temporal artery Thermometer.

Infra red thermometer Chemical thermometer

Temperature Scales:
The body temperature is measured in degrees on two scales.
(1) Celsius (C), (2) Fahrenheit (F). The body temperature scales sometimes need to convert
from Celsius to Fahrenheit.
Formula
C = (F – 32) x 5/9
F = (C x 9/5) + 32
Example: 1000 F convert it to Celsius.
C = (100 – 32) x 5/9 = 68 x 5/9 = 37.80 C
Example: 400 C
F = (40 x 9/5) + 32 = 72 + 32 = 1040 F

Temperature classification:
Normal - 36.50C
Hypothermia - < 350C (95.00F)
Fever - > 37.50C - 38.30C (99.50 – 100.90F)
Hyperthermia - > 40.00 – 41.50C (104 – 106.70F)

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General points to remember while measuring body temperature

➢ The patient must be relaxed
➢ No hot or cold drink should be given 15 minutes prior to checking oral temperature
➢ Avoid checking temperature immediately after a bath
➢ Keep oral and rectal thermometer separately
➢ Use discretion and decide the frequency of temperature taking.
➢ Note contraindication for routes of checking temperature.
Pulse
The pulse is jerky movement of blood created by the contraction of the left vertical of
the heart. The pulse wave represents the stroke volume output or the amount of blood that
enters the arteries with each ventricular contraction.
Compliance: The ability of the artery to contract and expand
Cardiac output: The volume of blood pumped by the heart each minute is 5 litres.
Stroke volume x Heart rate = Cardiac output
70ml/beat x 72/min = 5040 ml
Peripheral pulse: It is located away from the heart.
Apical pulse: It is located at the apex of the heart.
The pulse rate is affected by the following factors
E.g. Age, Sex, Exercise, Fever, Medication, Haemorrhage, stress, and position
change.

Sites of taking Pulse:

- Temporal - Brachial - Posterior tibial
- Carotid - Radial - Dorsalis Pedis
- Apical - Femoral

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Sites of taking Pulse

Variation in pulse according to age

Age Pulse/minute
Newborn -140 – 160
Infants (0 – 1 year) - 120 – 140
Toddler (1 – 3 years) - 100 – 120
Preschooler (3 – 6 years) - 75 - 120
School age (6 – 12 years) - 70 – 110
Adolescent (12 – 19 years) - 60 – 90
Adult (above 20 years) - 70 – 80

Alterations in Pulse
Tachycardia - Elevated heart rate above 100 beats/min
Bradycardia – Heart rate below 60/min
Pulse deficit – Heart is inefficient to transmit the pulse were from central to periphery.
Dysrhythmia – Inadequate cardiac output causes an abnormal rhythm and missed
heart beat.
Pattern of pulse according to pulse volume
- Regular pulse - Absent pulse
- Bounding pulse - Thready pulse

Respiration

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Respiration is the act of breathing i.e. inspiration + expiration + pulse = Respiration.

Inspiration is breath in; air enter into the lungs; Expiration is breathing out; the movement of
gases from the lungs to the atmosphere;
Ventilation - refers to the movement of air in and out of lungs.

External Respiration: Exchange of oxygen and carbon dioxide between the

alveoli of the lungs and the pulmonary blood.
Internal Respiration: Exchange of oxygen and CO2 between the blood and body
tissue. It is also known as tissue respiration.
Mechanism of Respiration
Inhalation: The diaphragm contracts, the ribs move upward and outward and sternum moves
outward thus enlarging the thorax and permitting the lungs to expand.
Exhalation: The diaphragm relaxes the ribs move downward and inward and the sternum
moves inward thus decreasing the size of the thorax as the lungs are compressed.
Inspiration lasts for 1 – 1.5 seconds and expiration lasts for 2 – 3 seconds.
Respiration rate is affected by the following factors.
- Age, disease condition, pain, toxin, fever, exercise, stress, increased
environmental temperature, high altitude and medication.

Assessing respiration rate

Variations of Respiration according to age

Respiration
Age
Rate/Minute
Newborn - 40
1 year 30
1 – 3 years - 25
3 – 6 years - 19
6 – 12 years - 17
12 – 18 years 16
Above 19 years - 18

Altered Respiration
Apnoea - Absence of breathing
Dysponea - Difficulty in breathing

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Tachypnea - Regular breathing pattern but more than 24 /min

Bradypnea - Regular breathing pattern but less than 12/min

Orthopnea - Ability to breath only in upright position
Hypernea - The rate and depth of respiration increase. There is an increase
in the volume of air in the lungs. (e.g.) exercise & anxiety
Hypoventilation - The rate and depth of respiration are decreased, reducing the
volume of air in the lungs.
Stridor - A ‘gur’ high sound caused by a laryngeal spasm
Wheezing - Noisy breathing accompanied by a whistle sound due to air
passing through narrow bronchioles (eg) Asthma.
Kussmauls respiration - Increase in the rate and depth of the breath pattern. e.g.
diabetic ketoacidosis.

Blood Pressure
Blood pressure is the force of the blood exerted against the blood vessels as it flows through
the arteries.
Systolic Pressure: It is the pressure of the blood as a result of contraction of
the ventricles.
Diastolic Pressure: It is the pressure when he verticals are dilated.
Pulse Pressure: The difference between the systolic and diastolic pressure
is called as pulse pressure.
The blood pressure is affected by the following facts.
- Age - Obesity - Body build
- Exercise - Sex - Pain
- Stress - diurnal variations - Medications
- Intracranial pressure, blood volume
Variations in BP according the age
Age Mean Blood Pressure mm/Hg
Newborn - 73/55
1 year - 90/55
6 years - 95/57
10 years - 102/62
14 years - 120/80
Adult - 120/80
Device used for measuring Blood Pressure
Sphygmomanometer (B.P. apparatus)-Comprises a blood pressure cuff, air pumping bladder
and graded mercury column
Aneroid monitor: It is less expensive and easy to manage. The cuff is inflated by hard by
squeezing a rubber bulb.
Digital monitor:It is automatic; the measurement appears on a small screen.
Finger or Wrist Blood Pressure: The finger or wrist blood pressure devices are not as accurate
in measuring blood pressure as other types of monitors.

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Recording of Blood pressure

Points to Remember:
✓ Before checking the BP, ask the person to take rest for 3 to 5 minutes.
✓ Sit in a comfortable chair with proper support.
✓ Don’t apply cuff on over the injured hand and atrio-ventricular shunt arm.
✓ Rest Rest is a state of relaxation. It is one of the elements of stress management
and can decrease muscle tension, decrease the blood pressure and regulate the heart
and lung function.

Fever, Malaria, Typhoid and nursing management of patient with fever

Alteration in Body Temperatures

Pyrexia/Fever/Hyperthermia:
An evaluation of body temperature than normal body temperature (98.40F or 36.70C) is
known as pyrexia or fever.
A very high body temperature i.e. 410C (105.80F) is called as Hyperthermia.
Types of Fever:
Intermittent fever: The body temperature altered at regular intervals between periods of
fever and periods of normal or subnormal temperatures.
Remittent fever: The body temperature elevated more than 20C over the 24 hours period
cold, influenza.
Relapsing fever: The fever presents for short period an interspersed with periods of 1 or
2 days of normal fever.
Constant fever: The body temperature fluctuates minimally but always remains above
normal. e.g. Typhoid fever.
Heat exhaustion: It is a result of excessive heat and a dehydration sign of heat
exhaustion includes paleness, dizziness, nausea, vomiting feeling and moderately increased
temperature (1010F to 1020F).
Heat stroke: When a person exposed to hot weather, have a sign of warm, flushed skin and
no sweating with 1060F and person lead on sudden unconsciousness and seizures.

Signs and Symptoms of Fever

Onset: Complaints of feeling cold

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Shivering
Gooseflesh appearance of skin.
Course: Skin that feels warm
Photo sensitivity
Classy eye appearance
↑ pulse, ↑ Respiration, ↑ thirst
Mild to severe dehydration
Drowsiness, restlessness
Delirium and confusion
Herpic lesions of mouth
Loss of appetite
Malaise & aching muscles
Weakness
Defervesence (flush phase)
Skin that appears flushed & feels warm.
Sweating
Decreased shivering
Course of fever
Onset invasion: The onset in sudden or insidious.
Fastgium: fever remains constant.
Decline: Fever may subside suddenly by 40 F to 50 F and reach normal or
below normal within a few hours.
Crisis: There are two types of crisis.
True crisis – The fever come down rapidly and stays constant
False crisis – The fever comes down rapidly and again goes up.
Lysis: Fever comes down gradually and stays constant
Treatment of Hyperthermia

➢ Give tablet tynolol/paracetamol for reducing the fever.

Nursing Interventions in Clients with Fever

1. Monitor vital signs

2. Assess skin colour and temperature.
3. Monitor WBC, Hct and other pertinent laboratory records.
a. Elevated WBC levels indicate presence of infection.
b. Elevated Hct indicates dehydration.
4. Remove excess blankets when the client feels warm; provide extra warmth when the client
feels chilled.
5. Provide adequate foods and fluids to provide additional calories and to prevent
dehydration.
6. Measure Intake and Output.
7. Maintain prescribed IV fluids as ordered by the physician.
8. Promote rest to reduce body heat production.

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9. Provide good oral hygiene to prevent herpetic lesions of the mouth.

10. Provide cool, circulating air using a fan to dissipate heat by convection.
11. Provide dry clothing and bed linens to ensure comfort.
12. Provide TSB (Temperature of water 80-98°F) to enhance heat loss by
evaporation and conduction.
13. Provide cool environment
14. Apply cold compress and ice bag application
15. Give more oral fluid
16. Cold Sponging
17. Administer antipyretics as ordered. Temperature of 38.5°C and above
usually requires administration of antipyretic.
Hypothermia
It is a core body temperature below the lower limit of normal. There are 3 main
physiological actions cause for hypothermia
i) Excessive heat loss
ii) Inadequate heat production
iii) Imperial hypothermic thermo regulation
If the skin and underlying tissues are damaged by freezing cold, this results in frostbite.
Signs and symptoms of Hypothermia
Decreased body temperature, pulse and respirations
Severe shivering
Feeling of cold and chills
Pale, cold and waxy skin
Hypotension
Decrease urine output
Frostbite nose, fingers and toes
Disorientation and coma
Management
➢ Provide a warm environment
➢ Provide dry clothing
➢ Apply warm blankets
➢ Keep lambs close to body
➢ Apply woollen cap/turban to cover the head of the patient.
➢ Apply warm pads.

Respiratory conditions

Acute respiratory infections

Respiratory diseases are most common in tropical countries, in a developing country like
India, with a majority of low socioeconomic status, the atmospheric conditions favour the
growth of the pathogens.

Cold

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The inflammation of the mucosal lining of the nose, throat which is caused by 200 different
viruses’ .Among all rhinovirus is mainly caused for cold.
The increased incidence of cold during the cold season may be attributed to the fact that more
people indoor and close to each other.
Causes
o Changes in the o Systemic disease
temperature/humidity o Use of over the counter medication
o Odour o Exposure to allergens
o Infection o Medications e.g. sulfa drugs
o Age
Signs and symptoms
o Stuffy nose
o Scratchy tickly throat
o Watery eyes
o Low grade fever
o Sore throat
o Mild hacking cough
o Body pain and headache
o Mild fatigue chills
o Watery discharge from nose
Common cold is highly contagious. It is spread through airborne droplets that are
coughed or sneezed into the air by the contagious person and then inhaled by another
person. It is also spread by hand to hand or hand to infected surface contact after which a
person touches his /her faces
Medical management
The management of common cold is depend on cause
Viral Rhinitis-Tab Amantadine and Remantidine
✓ Symptomatic treatment includes fluid intake, rest, and prevention chilling and
expectorates as needed.
✓ Warm salt water gargling
✓ Antihistamines used to relieve sneezing, rhinnorea and nasal congestion.
✓ Mucinex is an expectorant used to promote removal of secretions

Sinusitis
It is the inflammation of the mucosa of one or more sinuses. It can be either acute or
chronic sinusitis.
Causes
• Unresponsive cold/rhinitis may lead to sinusitis.
• Bacterial infection
• Allergic reaction
• Damage in obstructed by a deviated nasal septum.
• Hypertrophied turbinate’s
Signs and Symptoms
➢ Purulent nasal drainage

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➢ Nasal obstruction
➢ Facial pain, pressure or sense of fullness
➢ Stiffness as well as localized diffused head ache
Management
- Antibiotics prescribed for 5 – 7 days course (Augmentin, vibramycin, penicillin)
- Intra nasal saline lavage is an effective adjuvant therapy.
- Administer decongestants spray for improving drainage of the nasal sinuses.
- Intra nasal corticosteroids used to improve acute symptoms of either bacterial or viral
rhino sinusitis.
Complications
❖ Severe orbital cellulities
❖ Sub periosteal abscess
❖ Cavernous sinus thrombosis
❖ Meningitis
❖ Encephalitis
❖ Ischemic infection

Pharyngitis
It is a sudden painful inflammation of the pharynx, the back portion of the throat that
includes the posterior third of the tongue, soft palate and tonsils.
Causes
❖ Bacteria- Beta haemolytic streptococcus
❖ virus – Epstein-barr virus, herpes simplex, adenovirus, influenza virus
Clinical manifestations
Fever Headache
Malaise Myalgia
Sore throat Nausea
Vomiting painful cervical adenopathy
Anorexia fiery red pharyngeal membrane
Urticaria swollen & flecked with white-purple exudates
Enlarged cervical lymph nodes
Management
➢ Penicillin V, Potassium given for 5 days is the regimen of choice.
➢ Erythromycin given to the patient if they are allergic to penicillin
➢ Administer analgesic to reduce pain (e.g.) acetaminophen
➢ Provide liquid or soft diet depending on the patient’s appetite and degree of
discomfort that occurs with swallowing.
➢ Apply ice collar to relieve severe sore throat
Preventive Measures
✓ Do not share eating utensils, glasses, napkins
✓ Clean the telephone after use
✓ Dispose used tissue paper appropriately
✓ Avoid exposure second hand smoking
✓ Replace the new tooth brush for brushing
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✓ Avoid to eat stored cool item from the refrigerator

Tonsillitis
The tonsils are composed of lymphatic tissue and are situated on each side of the
oropharynx. These tissues contain cells that are useful integrating against infection.
Inflammation of the tonsils is known as tonsillitis; Adenoiditis is inflammation of the
lymphoid tissue at the back of the roof of the mouth.
Causes
Bacteria – β haemolytic streptococcal bacteria, virus: adenovirus, influenza virus,
Epstein-Barr virus and herpes simplex.
Signs and Symptoms
➢ Sudden onset of sore throat
➢ Painful swallowing and fever
➢ Headache, loss of appetite, chills malaise & swollen lymph nodes in the neck and jaw
area
Adenoiditis
➢ Acute pus like nasal discharge
➢ Mouth breathing
➢ Painful swallowing
➢ Snoring, sleep disturbance
➢ Ear infections
Diagnostic test
➢ Throat swab
➢ Rhinoscopy (visualization of the nose with speculum
Treatment
Supportive measures
➢ Increased fluid intake
➢ Salt water gargling
➢ Adequate rest
➢ Analgesics for relieving pain
➢ Antibiotic therapy for 10 days – Penicillin, amoxicillin, ampicillin
Surgical Treatment
Tonsillectomy and adenoidectomy
Indication for surgery:Recurrence of tonsillitis
Hypertrophy tonsils and adenoids
Obstructive sleep apnoea
Repeated otitis media
Post operative education
• Educate the family members & patient regarding bleeding may occur up to 8 days
after surgery.
• Take regular antibiotics without missing dose or discontinuing the course (i.e. for 5
days)
• Gargle the mouth with warm saline solution/alkaline mouth wash.

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• Educate the patient about the following symptoms which may occur in the first 24
hours after surgery –Sore throat, Stiff neck, Minor ear pain
and Vomiting
• Eat soft food which is easy to swallow than hard food
• Avoid spicy hot acidic and rough foods.
• Restrict the intake of milk and milk products
• Avoid vigorous tooth brushing and gargling

Laryngitis
It is referred as inflammation of the larynx as a result of voice abuse, exposure to dust,
chemicals, smoke and other pollutions and Upper Respiratory Infections(URI).
Pneumonia
It is an inflammation of the lung parenchyma caused by various micro organisms
including bacteria, mycobacterium, fungi and viruses.
Causes
Bacteria:
➢ Streptococcus ➢ Mycoplasma
➢ Staphylococcus ➢ Haemophilas influenza
➢ Pseudomonas ➢ Fungal pneumonia
➢ Chlamydia ➢ Klebsiella pneumonia
➢ Viral
Types
➢ Bacterial pneumonia ➢ Ventilator associated
➢ Viral pneumonia pneumonia
➢ Fungal pneumonia ➢ Pneumonia in immune
➢ Parasitic pneumonia compromised host
➢ Hospital acquired ➢ Aspiration pneumonia
pneumonia
Hospital Acquired Pneumonia
It develops 48 hours or more after admission and does not appear to be incubating at
the time of admission. It may predispose patients to HAP because of impaired host defences.
Ventilator Associated Pneumonia
It occurs to the patient with ventilators care in Intensive Care units after 48 hours.
Pneumonia in Immune Compromised Host
Patient who has developed compromised immunity due to HIV, long term
corticosteroid therapy and decreased protein intake.
Aspiration Pneumonia
It refers to the pulmonary consequences resulting from entry of endogenous or
exogenous substances into the lower respiratory tract (e.g.) aspiration of stomach content into
respiratory tract.
Risk factors of Pneumonia
❖ Smoking
❖ Prolonged immobility

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❖ Depressed cough reflex due to medication

❖ Alcohol intoxication
❖ Advanced age
❖ Respiratory therapy with improperly cleaned equipment
Signs and Symptoms
❖ Fever (1010F to 1050F)
❖ Sudden onset of chills
❖ Pleuritic chest pain
❖ Tachypnea
❖ Rapid and bounding pulse
❖ Rusty blood tinged sputum – in pneumococcal
- Staphylococcal
- Klebsiella and streptococcal
❖ Viscous sputum – Klebsiella pneumonia
❖ Lobe consolidation, including increased table framitus, dullness, bronco
vesicular, sounds
❖ Egophony (change of patient’s ‘ee’ to ‘ay’ sound on auscultation
Diagnosis
➢ Physical examination
➢ Chest ‘X’ ray
➢ Blood culture & sputum examination
Management
➢ AntibioticTherapy:PencillinG,Erythromycin,Clindamycin,Cephalosporins,Trimethpri
m and sulfamethoxazole
➢ Administer oxygen
➢ Perform ABG analysis to determine the need for oxygen
➢ Endo tracheal intubation for respiratory support
➢ Place the patient on bed rest until the infection is subsided
Complications
❖ Lung abscess
❖ Emphysema
❖ Respiratory failure
❖ Septic shock
❖ Age: Elderly are at greatest risk of death with any form of pneumonia
Prevention
There are a number of steps for preventing pneumonia.

Stop smoking.
Avoid contacting with people who have infections that sometimes lead to pneumonia.
Stay away from people who have colds, the flu, or other respiratory tract infections.
Simple Hand hygiene often helps to prevent the spread of viruses and bacteria that
may cause pneumonia.
Pneumococcal Vaccinations recommended for people ages 65 and older
Children get the pneumococcal conjugate vaccine.

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Tuberculosis
Tuberculosis is an infectious disease that usually affects the lungs. Compared with other
diseases caused by a single infectious agent, globally tuberculosis is the second biggest killer
disease.
In the 18th and 19th centuries, a tuberculosis epidemic rampaged throughout Europe and
North America, before the German microbiologist Robert Koch discovered the microbial
causes of tuberculosis in 1882.
Following Koch's discovery, the development of vaccines and effective drug treatment led to
the belief that the disease was almost defeated. However, in the mid-1980s, TB cases began
to rise worldwide, so much so, that in 1993, the World Health Organization (WHO) declared
that TB was a global emergency.
Causes The Mycobacterium tuberculosis bacterium causes TB. It is spread through the air
when a person with TB (whose lungs are affected) coughs, sneezes, spits, laughs, or talks.
Risk factors
People with compromised immune systems are most at risk of developing active tuberculosis.
HIV
• Using tobacco
• diabetes
• certain cancers
• malnutrition
• kidney disease
• people who are undergoing cancer therapy,
• Travel to certain countries where TB is more common
Symptoms of tuberculosis
While latent TB is symptomless, the symptoms of active TB include the following:
• Coughing, sometimes mucus with • Fever
blood(Haemoptysis) • Loss of weight
• Productive sputum • Loss of appetite
• Chills • Night sweats
• Fatigue and malaise
• TB symptoms may be mild for many months, and people ill with TB can infect up to
10-15 other people through close contact over the course of a year
TB usually affects the lungs, although it can spread to other organs around the body.
There are two kinds of tuberculosis infection: latent and active.
Latent TB - the bacteria remain in the body in an inactive state. They cause no symptoms
and are not contagious, but they can become active.
Active TB - the bacteria do cause symptoms and can be transmitted to others.
About one-third of the world's population is believed to have latent TB. There is a 10 percent
chance of latent TB becoming active, but this risk is much higher in people who have
compromised immune systems, i.e., people living with HIV or malnutrition, or people who
smoke.
Diagnosis of tuberculosis

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Skin testing for T.B

✓ History collection: Ask about symptoms and medical history as well as assessing the
individual's risk of exposure to TB.
✓ The most common diagnostic test for TB is a skin test where a small injection of
Purified Protein Derivative (PPD) tuberculin, an extract of the TB bacterium, is
injected below the inside forearm. The injection site should be checked after 2-3 days.
If the site of skin is developing a hard, red bump has swollen up to a specific size,
then it is confirmed as TB positive. If there is no change it is considered as negative.
✓ Blood tests,
✓ Chest X-rays, and sputum tests can all be used to test for the presence of TB bacteria
and may be used alongside a skin test.
✓ MDR-TB is more difficult to diagnose than regular TB.
Treatments for tuberculosis
The majority of TB cases can be cured when the right medication is available and
administered correctly. The precise type and length of antibiotic treatment depend on a
person's age, overall health, potential resistance to drugs, whether the TB is latent or active,
and the location of infection (i.e., the lungs, brain, kidneys). The five basic or first line TB
drugs are Isoniazid (INH), Rifampicin , Pyrazinamide, Ethambutol and Streptomycin
People with latent TB may need just one kind of TB antibiotics, whereas people with active
TB (particularly MDR-TB) will often require a prescription of multiple drugs.
Antibiotics are usually required to be taken for a relatively long time. The standard length of
time for a course of TB antibiotics is about 6 months.
TB medication can be toxic to the liver, and although side effects are uncommon, when they
do occur, they can be quite serious. Potential side effects should be reported to a doctor and
include:
• Dark urine • Loss of appetite
• Fever • Nausea and vomiting
• Jaundice
It is important for any course of treatment to be completed fully, even if the TB symptoms
have gone away. Any bacteria that have survived the treatment could become resistant to the
medication that has been prescribed and could lead to developing MDR-TB in the future.
Directly observed therapy (DOT) may be recommended. This involves a healthcare worker
administering the TB medication to ensure that the course of treatment is completed.
Prevention of tuberculosis
✓ If you have active TB, Wearing face mask can help to lower the risk of the disease
spreading to other people.
✓ Avoiding other people by not going to school or work, or sleeping in the same room
as someone, will help to minimize the risk of germs from reaching anyone else.
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✓ Wearing a mask, covering the mouth, and ventilating rooms can also limit the spread
of bacteria.
✓ TB vaccination-BCG injections are given to children to vaccinate them against
tuberculosis.
Complications
If left untreated, TB can be fatal. Although it mostly affects the lungs, it can also spread
through the blood, causing complications, such as:
• Meningitis: swelling of the membranes that cover the brain.
• Spinal pain.
• Joint damage.
• Damage to the liver or kidneys or heart.

7.4-Gastro intestinal conditions

People often suffer with digestive problems when they consume food excess or
inadequate/irregular diet in the gastro intestinal system. They are constipation, indigestion,
peptic ulcer, gastro enteritis, colitis, appendicitis and hernia,

Indigestion
Indigestion is the food which consumed is not digested and emptied from the from stomach
for long duration.
Dyspepsia, it is defined as a persistent or recurrent pain or discomfort in the upper abdomen.
Causes of Indigestion
Indigestion has many causes, including
• Ulcers
• Stomach cancer
• Gastro paresis (a condition where the stomach doesn't empty properly; Stomach
infections)
• Irritable bowel syndrome
• Pregnancy
• Use of drugs like Aspirin and other painkillers, oral contraceptives, antibiotics
• Eating too much, eating too fast, eating high-fat foods, or eating during stressful
situations
• Drinking too much alcohol
• Cigarette smoking
• Stress and fatigue
Indigestion is not caused by excess stomach acid.
Swallowing excessive air when eating may increase the symptoms of belching and bloating,
which are often associated with indigestion.

Signs and symptoms

• Burning in the stomach or upper abdomen

• Abdominal pain

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• Bloating (full feeling)

• Belching and gas
• Nausea and vomiting
• Acidic taste
• Growling stomach
These symptoms may increase in times of stress.
Diagnostic evaluation
X- rays of the stomach or small intestine.
An upper endoscopy to look closely at the inside of the stomach.
Treatment
The drugs relieve the symptoms of indigestion pain include:
• Antacids
• Acid blockers - Ranitidine, Omeprazole
Other indigestion remedies to alleviate symptoms include:
• Avoid laying down flat, as this may worsen symptoms
• Drink milk or water to ease the acid in the stomach

Preventive measures of Indigestion

Most episodes of indigestion go away within hours without medical attention. If indigestion
symptoms worsen, consult the doctor.
• Do not chew with your mouth open, talk while chewing, or eat quickly. This causes
you to swallow air, which can aggravate indigestion.
• Chew food completely and eat slowly.
• Drink fluids after meals, rather than during.
• Avoid late-night eating.
• Avoid spicy, greasy foods.
• Quit smoking.
• Avoid alcoholic beverages.
• Avoid caffeine.
• Wait at least one hour after eating to exercise.
• Always take aspirin and NSAIDs with food.
• If you are lactose intolerant or allergic to a food, avoid the aggravating foods.
• Meditation may help if indigestion is caused by stress or anxiety.

Vomiting

Vomiting, or throwing up, is a forceful discharge of stomach contents. It can be a one-time

event linked to something that doesn’t settle right in the stomach. Recurrent vomiting may be
cause by underlying medical conditions. Frequent vomiting may also lead to dehydration,
which can be deadly if left untreated.

Causes of vomiting

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Vomiting is common. Eating too much food or drinking too much alcohol can make a person
throw up. This generally isn’t a cause for concern. Vomiting itself is not a condition. It’s a
symptom of other conditions. Some of these conditions include:

• food poisoning
• indigestion
• infections (associated with bacterial and viral illnesses)
• motion sickness
• pregnancy-related morning sickness
• headaches
• prescription medications
• anaesthesia
• chemotherapy
• Regional enteritis
Frequent vomiting not related to any of these causes may be a symptom of cyclic vomiting
syndrome. This condition is characterized by vomiting for up to 10 days. It is usually coupled
with nausea and extreme lack of energy. It mainly occurs during childhood.
This condition can cause vomiting episodes several times throughout the year when left
untreated. It can also have serious complications that include:
• Dehydration • Oesophagitis
• Tooth decay • A tear in the oesophagus

Vomiting emergencies
Vomiting is a common symptom but it can sometimes warrant emergency medical attention.
If a person:
vomits for more than one day
suspects food poisoning
has a severe headache accompanied by a stiff neck
has severe abdominal pain
Blood in the vomit (haematemesis)
Complications of vomiting
Dehydration is the most common complication related to vomiting. Dehydration can cause:
dry mouth, fatigue, dark urine, decreased urination, headache and confusion

Vomiting treatments
✓ Treatment for nausea and vomiting depends on the underlying cause.
✓ Drinking clear liquids is recommended. Clear liquids containing electrolytes can help
provide essential nutrients lost through vomiting.
✓ Avoid solid foods until clear liquids are tolerated to rest the stomach
✓ Antiemetic drugs for frequent vomiting. These medications help to reduce episodes
of throwing up.
✓ Alternative remedies like ingesting products that contain ginger, bergamot, and
lemongrass oil may also help.

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✓ Severe dehydration caused by vomiting may require treatment with

intravenous fluids.

Dietary changes can also help recurrent vomiting. These are especially helpful for morning
sickness. Foods that help to alleviate vomiting include:

non greasy foods

saltine crackers
ginger products like ginger ale

Preventing vomiting

Adopting better lifestyle habits can help prevent vomiting episodes. It’s difficult to entirely
avoid viruses that cause vomiting, but you can reduce your chances of getting a virus by
exercising good hygiene, like regular hand washing. Knowing how to treat recurrent vomiting
can help you avoid further complications. They are

Avoid excessive alcohol consumption

Avoid eating too much food
Avoid causative factors of migraines
Avoid exercising after eating
Avoid stress
Avoid hot or spicy foods
Avoid lack of sleep

Constipation
Constipation refers to bowel movements that are infrequent or hard to pass the stool is often
hard and dry

Causes
✓ Common causes include slow movement of stool within the colon, age, irregular
defecation habits, inappropriate diet, insufficient fluid, insufficient exercise, increased
psychological stress
✓ Underlying associated diseases include
Hypothyroidism,
Diabetes,
Celiac disease, non-celiac gluten sensitivity,
Colon cancer,
Diverticulitis and inflammatory bowel disease.
✓ Medications associated with constipation include opioids, certain antacids, calcium
channel blockers, and anticholinergics.
Symptoms
The symptoms of constipation are
Infrequent or hard to pass bowel movements

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Straining with bowel movements

Excessive time needed to pass a bowel movement
Hard stools
Pain with bowel movements secondary to straining
Abdominal pain
Abdominal bloating.
the sensation of incomplete bowel evacuation.
Treatment
A limited number of causes that require urgent medical intervention or result in severe
consequences.
The treatment of constipation should focus on the underlying cause if known.
In chronic constipation of unknown cause, the main treatment involves the increased intake
of water and fiber (either dietary or as supplements). The routine use of laxatives is
discouraged, as having bowel movements may come to be dependent upon their use.
Enemas can be used to provide a form of mechanical stimulation. Enemas are particularly
useful when there is impaction, when stool hardens in the rectum. In order to be effective, the
instructions that come with the enema must be followed. This requires full application of the
enema, appropriate positioning after the enema is instilled, and retention of the enema until
cramps are felt. Defecation usually occurs between a few minutes and one hour after the
enema is inserted.
Fiber supplements-Soluble fiber supplements such as psyllium are generally considered
first-line treatment for chronic constipation, compared to insoluble fibers such as wheat bran.
Laxatives If laxatives are used, milk of magnesia or polyethylene glycol are recommended as
first-line agents due to their low cost and safety.
Physical intervention
Constipation that resists the above measures may require physical intervention such as
manual dis-impaction (the physical removal of impacted stool using the hands.
Regular exercise can help improve chronic constipation.

Haemorrhoids
Haemorrhoids (HEM-uh-roids), also called piles, are swollen veins in anus and lower rectum,
similar to varicose veins.
Causes
Unknown. They may result from Straining during bowel movements or from the increased
pressure on these veins during pregnancy.

The veins around your anus tend to stretch under pressure and may bulge or swell. Swollen
veins (haemorrhoids) can develop from increased pressure in the lower rectum due to:
Straining during bowel movements • Obesity
Sitting for long periods of time on • Pregnancy
the toilet • Anal intercourse
Chronic diarrhoea or constipation • Low-fibre diet
Types

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• Internal haemorrhoids: These lie inside the rectum. But straining or irritation when
passing stool can damage a haemorrhoid’s surface and cause it to bleed.
External haemorrhoids. These are under the skin around your anus. When irritated,
external haemorrhoids can itch or bleed.
Thrombosed haemorrhoids: Sometimes blood may pool in an external haemorrhoid
and form a clot (thrombus) that can result in severe pain, swelling, inflammation and a
hard lump near your anus.
Symptoms
Signs and symptoms of haemorrhoids may include:
Painless bleeding during bowel movements
Itching of anal region
Pain or discomfort
Swelling around anus
A lump near anus
Complications
Complications of haemorrhoids are very rare but include: Anaemia and Strangulated
haemorrhoid. If the blood supply to an internal haemorrhoid is cut off, the haemorrhoid may
be "strangulated," which cause extreme pain.
Treatment

✓ Apply an over-the-counter haemorrhoid cream or suppository containing

hydrocortisone.
✓ Soak anal area in plain warm water 10 to 15 minutes two to three times a day. A sitz
bath fits over the toilet.
✓ Bathe (preferably) or shower daily to cleanse the skin around your anus gently with
warm water.
✓ Apply ice packs or cold compresses on your anus to relieve swelling.
✓ Use acetaminophen (Tylenol, others), aspirin or ibuprofen, temporarily to relieve
discomfort.
Minimally invasive procedures
Rubber band ligation. placing of one or two tiny rubber bands around the base of
an internal haemorrhoid to cut off its circulation.
Sclero therapy In this procedure, injects a chemical solution into the haemorrhoid
tissue to shrink it. While the injection causes little or no pain
Coagulation (infrared, laser or bipolar). Coagulation techniques use laser or
infrared light or heat.
Haemorrhoidectomy is the surgical removal of excessive tissue that causes bleeding
in the anus with a local anaesthetic combined with sedation/a spinal anaesthesia or a
general anaesthesia.
Haemorrhoid stapling: This procedure is called stapled haemorrhoidectomy and
blocks blood flow to haemorrhoidal tissue. It is typically used only for internal
haemorrhoids.
Prevention

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The best way to prevent haemorrhoids is to keep your stools soft and reduce symptoms of
haemorrhoids, follow these tips:

Eat high-fibre foods. Eat more fruits, vegetables and whole grains. Doing so softens
the stool and increases its bulk, which will help you avoid the straining that can cause
haemorrhoids.
Drink plenty of fluids.
Don't strain. Straining and holding your breath when trying to pass a stool creates
greater pressure in the veins in the lower rectum.
Go to toilet as soon as you feel the urge.
Exercise helps to prevent constipation and to reduce pressure on veins, which can
occur with long periods of standing or sitting.

Peptic ulcers
Peptic ulcers are sores that develop in the lining of the stomach, lower oesophagus, or small
intestine. They’re usually formed as a result of inflammation caused by the bacteria H. pylori,
as well as from erosion from stomach acids. Peptic ulcers are a fairly common health
problem.
There are three types of peptic ulcers:
gastric ulcers: ulcers that develop inside the stomach
oesophageal ulcers: ulcers that develop inside the oesophagus
duodenal ulcers: ulcers that develop in the upper section of the small intestines,
called the duodenum
Causes
Different factors can cause the lining of the stomach, the oesophagus, and the small intestine
to break down. These include:
Helicobacter pylori (H. pylori),
frequent use of aspirin, ibuprofen , and other anti-inflammatory drugs
smoking
drinking too much alcohol
radiation therapy
stomach cancer
Symptoms of peptic ulcers
The most common symptom of a peptic ulcer is burning abdominal pain that extends from
the navel to the chest, which can range from mild to severe.
Other common signs of a peptic ulcer include
changes in appetite • indigestion
nausea • vomiting
bloody or dark stools • chest pain
unexplained weight loss
•
Tests and exams for peptic ulcers
Two types of tests are available to diagnose a peptic ulcer. They are called upper endoscopy
and upper gastrointestinal (GI) series.

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Upper endoscopy-In this procedure, your doctor inserts a long tube with a camera down
your throat and into your stomach and small intestine to examine the area for ulcers. This
instrument also allows removing tissue samples for examination.
Upper GI- For this procedure, patient drinks a thick liquid called barium (barium swallow).
Then a technician will take an X-ray of your stomach, oesophagus, and small intestine
Treatment
Treatment will depend on the underlying cause of ulcer.
If tests show that you have an H. pylori infection, the medications include antibiotics to help
kill infections and proton pump inhibitors (PPIs) to help reduce stomach acid.
Acid blockers like ranitidine (Zantac) or famotidine can also reduce stomach acid and ulcer
pain
sucralfate which will coat stomach and reduce symptoms of peptic ulcers.
Complications of a peptic ulcer
Untreated ulcers can lead to other more serious health complications such as:
Perforation: A hole develops in the lining of the stomach or small intestine and
causes an infection.
Internal bleeding: Signs of a bleeding ulcer include light-headedness, dizziness, and
black stools.
Scar tissue: This is thick tissue that develops after an injury.

Urinary problems
The kidney is one of the vital organs which eliminate waste from our body and maintain
homeostasis and PH level of our body. If urine is not excreted it causes lot of inconvenience,
It leads to either retention or incontinence.
Urinary retention

Urinary retention is the inability to empty the bladder. With chronic urinary retention, patient
may be able to urinate, but may have trouble starting a stream or emptying the bladder
completely.

Causes of urinary retention

Urinary retention can be caused by an obstruction in the urinary tract or by nerve problems
that interfere with signals between the brain and the bladder. If the nerves aren't working
properly, the brain may not get the message that the bladder is full. A weak bladder muscle
can also cause retention. Some of the most common causes are:

✓ Urinary tract infection (UTI) may cause retention if the urethra becomes inflamed and
swells.
✓ Anaesthesia is often administered to block pain signals during Surgery and
Consequently, many patients have urinary retention after surgery.
✓ MedicationThe drugs that may cause urinary retention include:
1. Antihistamine to treat allergies Anticholinergic/antispasmodic to treat stomach
cramps, muscle spasms and urinary incontinence, e.g. hyoscyamine, propantheline
2. Tricyclic antidepressants to treat anxiety and depression as imipramine or
amitriptyline.

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✓ Bladder stone
✓ Cystocele and rectocele

A cystocele occurs when the wall between a woman's bladder and her vagina weakens and
allows the bladder to drop into the vagina. The abnormal position of the bladder may cause
urine to remain trapped.

In a rectocele, the rectum droops into the back wall of the vagina. Cystocele and rectocele are
often the results of a dropping of the pelvic support floor for the bladder. This sagging can
pull the bladder out of position and cause urinary problems such as incontinence of urinary
retention.

✓ Constipation: A hard stool in the rectum may push against the bladder and urethra,
causing the urethra to be pinched shut, especially if a rectocele is present.
✓ Urethral stricture-A stricture is a narrowing or closure of a tube. Men may have a
narrowing of the urethra, usually caused by scarring after a trauma to the penis.

Diagnostic evaluation

✓ The history of the patient is collected and the symptoms experience by the patient.
Physical examination is also performed of lower abdomen to confirm the diagnosis.
✓ Bladder scan: A bladder scan uses a portable ultrasound device that can determine
how much urine is present in bladder. Patient is asked to urinate and then bladder scan
is used to determine residual urine
✓ Cystoscopy: It is used to see inside the bladder and urethra.
✓ X-ray and Computerized tomography (CT) Scan

Treatment of urinary retention

Catheterization: With acute urinary retention, treatment begins with the insertion of a
catheter through the urethra to drain the bladder. This initial treatment relieves the immediate
distress on a full bladder and prevents permanent bladder damage. Long term treatment for
any case of urinary retention depends on the cause

Treatment to relieve prostate enlargement: The treatment for prostate enlargement range
from medication to surgery

Surgery for women with cystocele or rectocele: Women may need surgery to lift a fallen
bladder or rectum. The surgeon places sutures in the fascia to close up the defect, and then
closes the incision in the vaginal wall with more stitches, removing any excess tissue and
creating more support for the pelvic organs.

Treatment for men with urethral stricture: If a man is diagnosed with urethral stricture,
perform dilation a procedure, in which increasingly wider tubes are inserted into the urethra
to widen the stricture.

Complications of urinary retention

Urinary tract infection.

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Bladder damage
Chronic kidney disease-If urine backs up into the kidney, permanent kidney damage
can lead to reduced kidney function and chronic kidney disease.

Nursing care

1. Evaluate time interval between voiding and record the amount voided each time.
Carefully monitor the patient's vital signs and intake and output, initially saving any
urine for inspection
2. Restrict foods and juices high in potassium and sodium and make sure that the patient
maintains a balanced diet with controlled protein levels.
3. Encourage the patient to increase his fluid intake
4. Explain the importance of frequent urination
5. Record fluid intake and output weigh the patient daily
6. Provide emotional support
7. If the patient doesn't require immediate urinary catheterization, provide privacy and
suggest that a normal voiding position be assumed.
8. Teach valsalva's manoeuvre or gently perform creed's manoeuvre

10. Stimulate voiding by the following measures . For example

a. Run water in the sink

b. Pour warm water over his perineum
c. Place his hands in warm water
d. Stroke the inner thigh with light pressure
e. Apply ice to the inner thigh
f. Gentle massage on lower abdomen
g. Play tapes of aquatic sounds.
Offer a bed pan or urinal that is warm.

11. Provide enough time for voiding

12. Encourage the importance of physical activity and regular exercise

Urinary incontinence

It referred as the loss of bladder control and is a common embarrassing problem.

Causes and Risk factors

Urinary incontinence can also be a persistent condition caused by underlying physical

problems or changes, including:

Pregnancy
Childbirth
Aging cause decrease the bladder's capacity to store urine
Menopause
Hysterectomy
Enlarged prostate gland

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• Obstruction. A tumour Urinary stones — hard, stone-like masses that form in the
bladder — sometimes cause urine leakage.
Neurological disorders. Multiple sclerosis, Parkinson's disease, a stroke, a brain
tumour or a spinal injury
Overweight
Family history
Types of urinary incontinence include:

Stress incontinence. Urine leaks when exert pressure on the bladder by coughing,
sneezing, laughing, exercising or lifting something heavy.
Urge incontinence. A sudden, intense urge to urinate followed by an involuntary loss
of urine. Urge incontinence may be caused by a minor condition, such as infection, or
a more-severe condition such as a neurologic disorder or diabetes.
Overflow incontinence is frequent or constant dribbling of urine due to a bladder that
doesn't empty completely.
Functional incontinence. A physical or mental impairment keeps the person from
making it to the toilet in time.
Urinary incontinence isn't a disease, it's a symptom. It can be caused by everyday habits,
underlying medical conditions or physical problems.

Complications
Complications of chronic urinary incontinence include:

Skin problems. Rashes, skin infections and sores can develop from constantly wet
skin.
Urinary tract infections. Incontinence increases your risk of repeated urinary tract
infections.
Impacts on your personal life. Urinary incontinence can affect your social, work and
personal relationships.
Prevention
Urinary incontinence isn't always preventable. However, to help decrease your risk:

Maintain a healthy weight

Practice pelvic floor exercises
Avoid bladder irritants, such as caffeine, alcohol and acidic foods
Eat more fibre, which can prevent constipation, a cause of urinary incontinence
Don't smoke, or seek help to quit smoking

Cardiovascular problems

Anaemia
Anaemia is a condition that develops when blood has lack of red blood cells or
haemoglobin. Women, young children, and people with chronic diseases are at increased risk
of anaemia. Important factors to remember are:

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• Certain forms of anaemia are hereditary and infants may be affected from the time of
birth.
• Women in the childbearing years are particularly susceptible to iron-deficiency
anaemia because of the blood loss from menstruation and the increased blood supply
demands during pregnancy.
• Older adults also may have a greater risk of developing anaemia because of poor diet
and other medical conditions.
Causes - The types of anaemia are divided into three groups:
• Anaemia caused by blood loss
• Anaemia caused by decreased or faulty red blood cell production
• Anaemia caused by destruction of red blood cells

Anaemia Caused by Blood Loss

Red blood cells can be lost through bleeding, which often can occur slowly over a long
period of time, and can go undetected. This kind of chronic bleeding commonly results from
the following:
• Gastrointestinal conditions such as ulcers, haemorrhoids, gastritis (inflammation of
the stomach, and cancer
• Use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen,
which can cause ulcers and gastritis
• Menstruation and childbirth in women, especially if menstrual bleeding is excessive
and if there are multiple pregnancies
Anaemia Caused by Decreased or Faulty Red Blood Cell Production

With this type of anaemia, the body may produce too few blood cells or the blood cells may
not function correctly. Conditions associated with these causes of anaemia include the
following:

• Sickle cell anaemia

• Iron-deficiency anaemia
• Vitamin deficiency
• Bone marrow and stem cell problems
• Other health conditions

Sickle cell anaemia is an inherited disorder that, in the U.S. affects mainly African-
Americans and Hispanic Americans. Red blood cells become crescent-shaped because of a
genetic defect. They break down rapidly, so oxygen does not get to the body's organs,
causing anaemia. The crescent-shaped red blood cells can also get stuck in tiny blood vessels,
causing pain.
Iron-deficiency anaemia occurs because of a lack of the mineral iron in the body. Bone
marrow in the centre of the bone needs iron to make haemoglobin, the part of the red blood
cell that transports oxygen to the body's organs. Without adequate iron, the body cannot
produce enough haemoglobin for red blood cells. The result is iron-deficiency anaemia. This
type of anaemia can be caused by:

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• An iron-poor diet, especially in infants, children, teens, vegans, and vegetarians

• The metabolic demands of pregnancy and breastfeeding that deplete a woman's iron
stores
• Menstruation
• Frequent blood donation
• Endurance training
• Digestive conditions such as Cohn’s disease or surgical removal of part of the
stomach or small intestine
• Certain drugs, foods, and caffeinated drinks

Vitamin-deficiency anaemia may occur when vitamin B12 and foliate are deficient. These
two vitamins are needed to make red blood cells. Conditions leading to anaemia caused by
vitamin deficiency include:

• Megaloblastic anaemia: Vitamin B12 or folate or both are deficient

• Pernicious anaemia: Poor vitamin B12 absorption caused by conditions such
as Crohn's disease, an intestinal parasite infection, surgical removal of part of the
stomach or intestine, or infection with HIV
• Dietary deficiency: Eating little or no meat may cause a lack of vitamin B12, while
overcooking or eating too few vegetables may cause a folate deficiency.
• Other causes of vitamin deficiency: pregnancy, certain medications, alcohol abuse,
intestinal diseases
• Treatment: Anaemia treatment depends on the cause.
Iron deficiency anaemia. Treatment for this form of anaemia usually involves taking
iron supplements and making changes of your diet.
If the underlying cause of iron deficiency is loss of blood — other than from
menstruation — the source of the bleeding must be located and stopped. This may
involve surgery.
Vitamin deficiency anaemia: Treatment for folic acid and B-12 deficiency involves
dietary supplements and increasing these nutrients in diet. The patient may need to get
vitamin B-12 injection when trouble absorbing.
Anaemia of chronic disease: There's no specific treatment for this type of anaemia.
Doctors focus on treating the underlying disease. If symptoms become severe, a blood
transfusion or injections of synthetic erythropoietin.
Aplastic anaemia. Treatment for this anaemia may include blood transfusions to
boost levels of red blood cells and bone marrow transplant.
Anaemia associated with bone marrow disease. Treatment of these various diseases
can include medication, chemotherapy or bone marrow transplantation.
• Haemolytic anaemia’s. Managing haemolytic anaemia’s includes avoiding suspect
medications, treating related infections and taking drugs that suppress the immune
system, and affecting red blood cells.
Depending on the severity of anaemia, a blood transfusion or plasmapheresis may be
necessary. Plasmapheresis is a type of blood-filtering procedure. In certain cases,
removal of the spleen can be helpful.

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Sickle cell anaemia. Treatment for this anaemia may include the administration of
oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and
prevent complications. Doctors also may recommend blood transfusions, folic acid
supplements and antibiotics.
A bone marrow transplant may be an effective treatment in some circumstances. A
cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell
anaemia.
Thalassemia: This anaemia may be treated with blood transfusions, folic acid
supplements, medication, removal of the spleen (splenectomy), or a blood and bone
marrow stem cell transplant.
LEUKEMIA

There is increased number of premature white blood cells in the blood stream is called
leukaemia. It is also known as blood cancer.

Types of Leukaemia

Acute lympho cytic leukaemia

Chronic lympho cytic leukaemia
Acute myelo cytic leukaemia
Chronic myelo cytic leukaemia
Causes
Radiation – ‘X’ ray, nuclear industry
Exposure to chemicals at work (benzene)
Smoke and Genetic problem
Clinical Feature
Fever, right sweats, headache, bruising, bone or joint pain, enlarged spleen, swelling
of lymph nodes prone to get infection, feeling tired and loss of weight and appetite.

Treatment

1) Chemotherapy: Adenosine, Vincristine, L-asparaginase. These drugs kill the cancer

cells.
2) Radiation therapy:
3) Stem cell transplant:- Stem cells can rebuild the supply of normal blood cells and
boost immune system.

Hypertension

Hypertension is constant high blood pressure that results from regulatory mechanism
abnormality or disturbance. It is defined a systolic pressure above 140 mmHg and diastolic
pressure above 90mmHg at multiple recording of BP at regular interval.

Types

1) Primary Hypertension – There is no cause for the elevation of blood pressure.

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2) Secondary Hypertension – It is caused by renal, endocrine or central nervous system

disorders and from drugs.

Causes/High risk factor of high blood pressure

• Obesity
• Stress and anxiety
• Alcohol consumption
• Excessive intake of salt
• Smoking
• Medical conditions like kidney disease, renal gland disorder, pregnancy, birth
control pills, hyper parathyroidism

Signs and Symptoms

✓ Fatigue, reduced activity tolerance

✓ Dizziness, palpitation, angina and dyspnoea, decreased urine output
✓ Severe headache, changes in vision, nosebleed, cerebral haemorrhage in
severe hypertension.[

Diagnostic evaluation

- Blood pressure monitoring;

- serum BUN – evaluated
- serum creatinine elevated;
- urinalysis;
- eye examination with ophthalmoscope;
- ECG – Electro Cardio Gram.

Management

The goal of the treatment is to reduce the blood pressure, and prevent the risk of
complications.
I Medications
1) Diuretics : (eg) Lasix, spironolactone - The action of the drug is to reduce plasma
volume and cardiac output and also decrease the peripheral vascular resistance.
2) Beta adrenergic blockers (eg) Proponolol, atenolol. The action of this drugs are
- Reduce peripheral vascular resistance
- Decrease plasma resign activity and resetting of baro receptor
- Release of vasodilator prostaglandins
3) Calcium Channel blockers – (eg) Nifedipine decrease in the concentration of free
intracellular calcium cons results decreased contraction and vasodilatation.
4) Angio tensin converting enzyme inhibitors – (e.g.) enlapril, captopril

The action of drug is inhibition of circulating and tissue angiotensin converting

enzyme – Increased formation of bradykinin and vasodilatory prostaglandins.

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II Education

Educate patients about the Hypertension and its complication and involve their family
in the treatment.

- Stress that the treatment to be continued life long

- Encourage them to come to health care centre for regular measurement of blood
pressure.
- Insists them follow up visits at interval of 3 months.
- Encourage life style modification.
- Weight Reduction – It has significant affect on lowering B.P. in many people
- DASH - Dietary Approach for Stop Hypertension diet:This diet involves eating
several sewing of fish week, eating plenty of fruits and vegetables. Increase fiber
intake and drink lot of water.
- Restrict the dietary sodium intake – The adult average intake of salt is 15g/day and
the restricted intake of salt per day is less than 6 grams.
- Limit their alcohol intake, not more 2 drinks per day
- Exercise regularly at least 30 minutes of aerobic exercise a day.
- Reduce stress, try to avoid things that cause your stress we can do meditation & yoga.

Complication

When blood pressure is not well controlled it will lead to the following complications.

- Bleeding (e.g.) cerebral haemorrhage

- Chronic kidney disease
- Heart attack and heart’s failure
- Poor blood supply to the legs
- Smoke
Portal Hypertension
The blood pressure is elevated in the Portal vein and its tributaries. The features of
portal hypertension are: ascetics, peritonitis, enlargement of spleen, hepatic coma. It is
caused by cirrhosis of lever and hepatic fibrosis.
Pulmonary Hypertension:
The elevated blood pressure in the pulmonary blood vessels due to narrowing of the
lumen, which supplied to right vertical of heart. The pulmonary hypertension leads to right
heart failure.
The feature of pulmonary hypertension is shortness of breath, fatigue, dizziness and
fainting, swelling in the leg and abdomen, cyanosis. It is caused by diet drug “fen-phen”,
lever disease, lung disease, heart disease and thromboembolism.

Heart Attack
The decreased blood flow to the myocardium due to partial or complete block of one
of the coronary artery may cause myocardial ischemia. It is known as myocardial infarction
(Heart attack).

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Causes
Hereditary, post menopausal women, smoking, hypertension, elevated serum
triglycerides and cholesterol, DL, obesity excessive intake of saturated fats, sedentary life
style, aging (35 to 40 years male), stress and type A personality, use of cocaine and
amphetamine drugs.

Clinical manifestations
• Chest pain, palpitation, new onset of murmur, elevated blood pressure,
• Dyspnoea, tachyponea, pulmonary oedema, nausea and vomiting
• Decreased urinary output, cool, clammy and diaphoretic skin,
• Anxiety, restlessness and altered speech
• Fear with feeling of something wrong with him

Management

➢ Assessment of patient with chest pain in emergency room as easily as possible start
the treatment (within one hour of the onset of symptoms)
➢ Administer O2 for 2 – 3 hours for increasing oxygenation of the blood.
➢ Administer the tab nitro-glycerine sublingually; it cause vasodilatation and relieves
chest pain;
➢ Give tab Aspirin 320 mg stat on the day of acute myocardial infarction. Then 160 mg
daily to inhibit platelet aggregation.
➢ Start thrombolytic therapy within first 6 hours after onset of symptoms. (e.g.) inj.
Streptokinase, inj. Heparin
➢ The action is to dissolve and lysis the thrombus in a coronary artery and allowing
blood flow through the coronary artery again.
➢ Start beta blockers within 12 hours post acute myocardial infarction, if no
contraindication of concomitant thrombolytic. The action is to decrease myocardial
oxygen demand by reducing heart gate and reduce the size of infarction.

Surgical Management

➢ Percutaneous transluminal coronary angioplasty (PTCA)

➢ Coronary artery bypass grafting surgery
➢ Transmyocardial laser revascularization

Complications: Arrhythmias, heart failure, pericarditis, cardiogenic shock, and rupture of

atrium or ventricular septum.

Diseases of nervous system

Nervous system
Headache is the symptom of pain anywhere in the region of the head or neck. It occurs in
migraines (sharp, or throbbing pains), tension-type headaches, and cluster headaches.
Frequent headaches can affect relationships and employment.

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Primary headaches
Primary headaches are stand-alone illnesses caused directly by the over activity of, or
problems with, structures in the head that are pain-sensitive. This includes the blood vessels,
muscles, and nerves of the head and neck. They may also result from changes in chemical
activity in the brain.
Secondary headaches
Secondary headaches are symptoms that happen when another condition stimulates the pain-
sensitive nerves of the head.
Factors can cause secondary headaches. These include:
• alcohol-induced hangover • dehydration
• brain tumour • glaucoma
• blood clots • teeth-grinding at night
• bleeding in or around the brain • influenza
• "brain freeze," or ice-cream • overuse of pain medication,
headaches • panic attacks
• carbon monoxide poisoning • stroke
• concussion
Types
There are different types of headache.
Tension headaches
Tension headaches are the most common form of primary headache. Such headaches
normally begin slowly and gradually in the middle of the day. Episodic attacks are usually a
few hours in duration, but it can last for several days. The person can feel:

as if they have a tight band around the head

a constant, dull ache on both sides
pain spread to or from the neck
Migraines
A migraine headache may cause a pulsating, throbbing pain usually only on one side of the
head. There may be nausea and vomiting, and the person may feel especially sensitive to light
or noise. The aching may be accompanied by:
blurred vision
light-headedness
nausea
sensory disturbances known as auras
Rebound headaches
Rebound or medication-overuse headaches stem from an excessive use of medication to treat
headache symptoms. They are the most common cause of secondary headaches. They usually
begin early in the day and persist throughout the day. Rebound headaches can cause:

neck pain
restlessness
a feeling of nasal congestion
reduced sleep quality

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Cluster headaches
Cluster headaches usually last between 15 minutes and 3 hours, and they occur suddenly once
per day up to eight times per day for a period of weeks to months. In between clusters, there
may be no headache symptoms, and this headache-free period can last months to years.
The pain caused by cluster headaches is:
one-sided
severe
often described as sharp or burning
typically located in or around one eye
The affected area may become red and swollen, the eyelid may droop, and the nasal passage
on the affected side may become stuffy and runny.
Thunderclap headaches
A thunderclap headache is often secondary to life-threatening conditions, such as
intracerebral haemorrhage, cerebral venous thrombosis, ruptured or un ruptured aneurysms,
reversible cerebral vasoconstriction syndrome (RVS), meningitis, and pituitary apoplexy.
People need to seek medical evaluation immediately.
Diagnosis
History collection and physical examination
blood tests
X-rays
brain scans, such as CT and MRI
Treatment
The most common ways of treating headaches are rest and pain relief medication.
Generic pain relief medication is available over the counter (OTC), or doctors can prescribe
preventative medication, such as tricyclic antidepressants, serotonin receptor agonists, anti-
epileptic drugs, and beta-blockers.

Treatment may include:

Rest in a quiet, dark room

Hot or cold compresses to your head or neck
Massage and small amounts of caffeine
Over-the-counter medications such as ibuprofen (Advil, Motrin IB, others),
acetaminophen (Tylenol, others), and aspirin
Prescription medications including triptans, such as sumatriptan
Preventive medications, such as metoprolol , propranolol, amitriptyline,
Trans cranial magnetic stimulation (therapy using electrical currents to stimulate
nerve cells in the brain) for migraine with aura
It is important to follow the doctor's advice because overusing pain relief medication
can lead to rebound headaches

Alternative treatments
Several alternative forms of treatment for headaches are available, but consult a doctor before
beginning any alternative forms of treatment.

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Alternative approaches include:

acupuncture
cognitive behaviour therapy
herbal and nutritional health products
hypnosis
meditation

Acupuncture is an alternative therapy that may help relieve headaches.

Home remedies
A number of steps can be taken to reduce the risk of headaches and to ease the pain if they do
occur:
1. Apply a heat pack or ice pack to your head or neck, but avoid extreme temperatures.
2. Avoid stressors, where possible, and develop healthy coping strategies for
unavoidable stress.
3. Eat regular meals, taking care to maintain stable blood sugar.
A hot shower can help, although in one rare condition hot water exposure can trigger
headaches. Exercising regularly and getting enough rest and regular sleep contributes to
overall health and stress reduction.

Back pain

The human back is composed of a complex structure of muscles, ligaments, tendons, disks
and bones - the segments of our spine are cushioned with cartilage-like pads called disks.
Problems with any of these components can lead to back pain. In some cases of back pain, its
cause is never found.

Problems with the spine such as osteoporosis can lead to back pain.
Causes
Strain - the most common causes of back pain are: Strained muscles Strained ligaments and
muscle spasm
Things that can lead to strains or spasms include:

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Lifting something improperly

Lifting something that is too heavy
The result of an abrupt and awkward movement

Structural problems - the following structural problems may also result in back pain:

Ruptured disks - each vertebra in our spine is cushioned by disks. If the disk ruptures
there will be more pressure on a nerve, resulting in back pain.
Bulging disks - in much the same way as ruptured disks, a bulging disk can result in
more pressure on a nerve.
Sciatica - a sharp and shooting pain that travels through the buttock and down the
back of the leg, caused by a bulging or herniated disk pressing on a nerve.
Arthritis - patients with osteoarthritis commonly experience problems with the joints
in the hips, lower back, knees and hands
Abnormal curvature of the spine
Osteoporosis.
Sleep disorders
Bad mattress - if a mattress does not support specific parts of the body and keep the
spine straight, there is a greater risk of developing back pain.

High risk of developing low back pain:

A mentally stressful job

Pregnancy - pregnant women are much more likely to get back pain
A sedentary lifestyle
Age - older adults are more susceptible than young adults or children
Anxiety
Depression
Gender - back pain is more common among females than males
Obesity and overweight
Smoking
Strenuous physical exercise (especially if not done properly)
Strenuous physical work.

Signs and symptoms

The main symptom of back pain is an ache or pain anywhere on the back, and sometimes all
the way down to the buttocks and legs.

If any of the following signs or symptoms accompanies a back pain, see the doctor
immediately. i.e.
Weight loss Inflammation (swelling) on the
Elevated body temperature back

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Persistent back pain Difficulty urinating

Pain down the legs • Faecal incontinence –
A recent injury, blow or trauma to Numbness around the genitals
your back Numbness around the anus
Urinary incontinence Numbness around the buttocks

Diagnosis

X-rays can show the alignment of the bones and whether the patient has arthritis or
broken bones.
MRI or CT scans - these are good for revealing herniated disks or problems with
tissue, tendons, nerves, ligaments, blood vessels, muscles and bones.
Bone scan - a bone scan may be used for detecting bone tumors or compression
fractures caused by brittle bones (osteoporosis). Electromyography or EMG - the
electrical impulses produced by nerves in response to muscles is measured. This study
can confirm nerve compression which may occur with a herniated disk or spinal
stenosis (narrowing of the spinal canal).
Treatments
In the vast majority of cases back pain resolves itself without medical help - just with careful
attention and home treatment.

Usually back pain is categorized into two types:

Acute - back pain comes on suddenly and persists for a maximum of three months.
Chronic - the pain gradually develops over a longer period, lasts for over three
months, and causes long-term problems.
Medication - back pain that does not respond well to OTC painkillers may require a
prescription NSAID (non-steroidal anti-inflammatory drug). Codeine or hydrocodone -
narcotics - may also be prescribed for short periods; they require close monitoring by the
doctor.
Physical therapy - the application of heat, ice, ultrasound and electrical stimulation, as well
as some muscle-release techniques to the back muscles and soft tissues may help alleviate
pain. As the pain subsides the physical therapist may introduce some flexibility and strength
exercises for the back and abdominal muscles. Techniques on improving posture may also
help.
Cortisone injections - Cortisone is an anti-inflammatory drug; it helps reduce inflammation
around the nerve roots. Injections may also be used to numb areas thought to be causing the
pain.
Complementary therapies
A large number of patients opt for complementary therapies, as well as conventional
treatments. According to the NHS, chiropractic, osteopathy, shiatsu, and acupuncture may
help relieve back pain, as well as encouraging the patient to feel relaxed.
An osteopath specializes in treating the skeleton and muscles.

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A chiropractor treats joint, muscle and bone problems - the main focus being the
spine.
Shiatsu, also known as finger pressure therapy, is a type of massage where pressure is
applied along energy lines in the body. The shiatsu therapist applies pressure with
his/her fingers, thumbs and elbows.
Acupuncture, which originates from China, consists of inserting fine needles and
specific points in the body. Acupuncture can help the body release its natural
painkillers - endorphins - as well as stimulating nerve and muscle tissue.
Yoga is a practice that involves specific poses, movements, and breathing exercises.
Some forms of yoga may help strengthen the back muscles and improve posture. Care
must be taken that exercises do not make back pain worse.
TENS (Transcutaneous electrical nerve stimulation) - The TENS machine delivers
small electric pulses into the body through electrodes that are place on the skin and it
encourage the body to produce endorphins, and may possibly block pain signals
returning to the brain.
Surgery -If a patient has a herniated disk surgery may be an option, especially if there
is persistent pain and nerve compression which can lead to muscle weakness.
Examples of surgical procedures include:
Fusion - two vertebrae are joined together, with a bone graft inserted between them.
The vertebrae are splinted together with metal plates, screws or cages. There is a
significantly greater risk for arthritis to subsequently develop in the adjoining
vertebrae.
Artificial disk - an artificial disk is inserted; it replaces the cushion between two
vertebrae.
Diskectomy - a portion of a disk may be removed if it is irritating or pressing against
a nerve.
Partially removing a vertebra - a small section of a vertebra may be removed if it is
pinching the spinal cord or nerves.
Preventive measures of back pain
Regular exercise helps build strength as well as keeping your body weight down.
There are two main types of exercise that people can do to reduce the risk of back
pain: Core-strengthening exercises- exercises that work the abdominal and back
muscles, helping to strengthen muscles that protect the back.
Posture when standing - make sure you have a neutral pelvic position. Stand upright,
head facing forward, back straight, and balance your weight evenly on both feet
Posture when sitting - a good seat should have good back support and arm rests for
working to keep the spine straight.
When Lifting things keep your back as straight as you can, keeping your feet apart
with one leg slightly forward so you can maintain balance. Bend only at the knees,
hold the weight close to your body, and straighten the legs while changing the
position of your back as little as possible.
Do not lift and twist at the same time.
While moving the object, it is good for the back to push things across the floor, by
using leg strength, rather than pulling them.
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Wear flat shoes place less of a strain on the back than heels shoes.
Give proper support to the back while driving.
Use the firm mattress that keeps your spine straight, while at the same time supporting
the weight of the shoulders and buttocks.
Convulsions:

A seizure is an abnormal electrical impulse in the brain that interrupts normal function
Cause
Birth trauma, Anoxia, meningitis, encephalitis, ingestion of toxins, brain tumours, head
injury, Hypoglycaemia, Hyperparathyroidism, cardio vascular accident.
Stages of Seizures:
• Prodromal phase: Activity/signs which provide a seizures
• Aural phase: With sensory warning, preliminary symptoms of fits.
• Ictal phase: Tonic and clonic contractions of voluntary muscles – seizures presents.
• Post Ictal Phase: Period of recovery after seizures.
Clinical Manifestations
Partial Seizures: It is a seizures that involves a small region of the brain.
versive head or eye movement are of the head or eyes to one side during a partial seizure.
Generalized Seizure: A generalized seizure involves large bilateral cortical
areas. It is non-specific origin and affect the entire brain simultaneously.
Complex Partial Seizures: The person either remains motionless or moves
automatically but inappropriately for time and place or irritability, fear,
angry and elation experienced by the patient.
There may be intensive rigidity of the entire body followed by jerky alterations of
muscle relaxation and contraction.
Tongue is chewed
Incontinent of urine and stool
➢ Convulsive movement for 1 – 2 minutes
Confused and hard to arouse
Headache or sore muscles
Sleep many hours.

Post Ictal State:It is a period of somnolence and confusion that occurs after
a complex partial or generalized convulsive seizures.
Post Ictal focal neurological abnormalities are transient neurological abnormalities that occur
after focal seizures and are related to the site of seizures onset. (e.g.) Post ictal hemiperisis,
aphasia, and unilateral extensor plantar reflex.
Management:
Phenytoin, carbamazepine, phenobaibital and primidone for generalized tonic clonic
seizures and complex partial seizures.
IV fosophenytoin is an alternative to phenytoin. It is effective with a long half life
and minimal CNS depression.
IV diazepam, lorazepam for status epileptics administration of dextrose, when it is
caused by hypoglycemia.

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Administer thiamine if a chronic alcoholism or withdrawal.

Patient Education

Wear ID card while going outside alone.

The person should be advised to not operate a motor vehicle, dangerous machinery or
participate in activity where he may chance to get injury.
The person should know the dose, name and side effects of all his anticonvulsant
medications.

Cerebro vascular Accident

A sudden loss of brain function resulting from a disruption of the blood supply to a
part of the brain.
Causes
Cerebral Thrombosis – a blood clot within a blood vessel of the brain or neck
Cerebral Embolism – a blood clot or other material carried to the brain
from another part of the body.
Cerebral Ischemia – decrease of blood flow to an area of the brain
Cerebral haemorrhage - rupture of a cerebral blood vessel with bleeding into
the brain tissue or spaces surrounding the brain.

Clinical Manifestation

Stroke can cause a wide variety of neurologic deficits, depending on the location of the
lesion, the size of the area of inadequate perfusion, and the amount of the collateral blood
flow.

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Motor Loss
Hemiplegia, hemiparesis
Flaccid paralysis and loss of or decrease in the deep tendon reflexes (initial clinical
feature) followed by (after 48 hours) reappearance of deep reflexes and abnormally
increased muscle tone (spasticity)
Limb weakness (unilateral)
Speech difficulty
Ptosis
Altered level of consciousness
Hemiperisis
Aphasia
Amenesia
Ataxia
Communication Loss

Dysarthria (difficulty speaking)

Dysphasia (impaired speech) or aphasia (loss of speech)
Apraxia (inability to perform a previously learned action)
Perceptual Disturbances and Sensory Loss

Visual-perceptual dysfunctions (homonymous hemianopia [loss of half of the visual

field])
Disturbances in visual-spatial relations (perceiving the relation of two or more objects
in spatial areas), frequently seen in patients with right hemispheric damage
Sensory losses: slight impairment of touch or more severe with loss of proprioception;
difficulty in interrupting visual, tactile, and auditory stimuli
Impaired Cognitive and Psychological Effects

Frontal lobe damage: Learning capacity, memory, or other higher cortical

intellectual functions may be impaired. Such dysfunction may be reflected in a limited
attention span, difficulties in comprehension, forgetfulness, and lack of motivation.
Depression, other psychological problems: emotional stability, hostility, frustration,
resentment, and lack of cooperation.

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Bladder Dysfunction: After stroke the patient may have transient urinary incontinence due
to confusion, inability to communicate his needs and inability to use bedpan/urinal duce to
impaired motor loss.

Management:

Healthy diet
Weight control
Regular exercise
Cessation of smoking
Avoiding risk factors

Drug Therapy:

Control of Hypertension
Treating hypoglycaemia

Thrombolytic therapy - Urokinase or streptokinase within the first 3 hours

after onset of symptoms to dissolve the clot, remove occlusion and restore
blood flow, thus minimizing cerebral damage.
Anticoagulant therapy - to maintain vessel patency and prevent
further clot formation.
Anti-platelet agents -aspects to reduce risk of platelet aggregation and
subsequent clot formation
Anticonvulsant drugs – Phenytoin for prophylaxis for seizures
Administering crystalloids or colloids -IV fluids for treating
Haemorrhage type of stroke for treating hypovolemia
Manitol is given to control/decrease intracranial pressure.
Corticosteroid helps to reduce cerebral inflammation.
A patient airway and circulation to the brain are maintained.
Adequate oxygenation of blood o the brain is necessary to minimize cerebral damage.
The patient is placed in a lateral or semi prone position with the head of the bed
slightly developed elevated to lower cerebral venous pressure.
Endo tracheal intubation and mechanical ventilations are necessary for the patient
with massive stroke, because respiratory arrest is usually life threatening situation.
Monitor the patient for pulmonary complication.
Assist the patient in maintaining good body alignment and prevent compressive
neuropathies especially of the ulnar and peroneal nerves.
Wear high top sneakers. Care should be employed to prevent pressure areas on the
heels, ankles and back.
Flexor muscles are stronger than extensor muscles, it may be necessary to apply a
posterior splint at night to prevent flexion of the affected extremity.
Apply trochanter roll to prevent external rotation at the hip joint.
Change the position every second hourly.

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The affected extremities are exercised passively and put through a full range of
motion four or five times a day to maintain joint mobility, to regain motor control, to
prevent development of a contracture in the paralyzed extremity to prevent further
deterioration of the neuro muscular system.
Assist the patient to get out of bed. To develop sitting balance, the head of the bed is
raised to an upright position and the patient is instructed to hold the bed rails, with the
unaffected hand.
➢ The patient is assisted to a standing position by the nurse supporting his lower back
with her hands and positioning her knees on the outside of the patient’s knees. This
gives the patient maximum support in the standing position and prevents his knees
from backing. The patient should be reminded to lean forward when he comes from a
sitting to a standing position. The patient’s arms must be left free for balance and
support.
The patient is usually ready to walk as soon as standing balance is achieved. Parallel
bars are useful when the patient first starts for walk.
A flaccid shoulder joint may be overstretched by the use of excessive force in turning
the patient or from over strenuous arm and shoulder movement, to prevent shoulder
pain.
As soon as the patient is able to sit up, he is encouraged to assist his personal hygiene
and activities of daily living.
Encourage the patient to overcome the cognitive problems, by giving positive
feedback and conveys an attitude of confidence and hopefulness.
➢ To improve communication by – give written copy of schedule of speech exercise.
Keep surrounding the patient with familiar objects and reassure by caring the patient
Use of gestures may enhance comprehension of communication
➢ Family coping is facilitated by involving others in the patient’s care, stress
management techniques and maintenance of personal health.
The family is advised that the patient will tire easily, will become irritable and upset
by small events and is likely to show less interest in things.
Depression is a common and serious problem in the post stroke patient. Counsel the
patient and family members for overcome the depressive mood during rehabilitation
program.

Care of unconscious

Definition
Unconsciousness A State of the mind in which The individuals Not Able To respond to
express his needs. Unconsciousness is a lack of awareness of one’s environment and inability
to respond to external stimuli,
Causes of unconsciousness:-
Shock, Renal failure, Liver failure, Heat stroke, Head injury, Cerebro vascular
accident (CVA),infections e,g: meningitis, encephalitis,
Diabetes mellitus e.g.: hyperglycaemia, hypoglycaemia,
Anaesthesia, Poisons, e.g.Endosulphon, organo phosphorus, Drugs,

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Asphyxia, Alcohols, Carbon monoxide gas,

Epilepsy, Brain tumours,
Cardiovascular problems e.g. Heart attack,
Nursing Management of unconsciousness patient:-
Assess for Glasgow coma scale to Know the Patient’s the level of Consciousness, before
doing the following measures
a. Loosen Clothing at Neck, Chest and Waist.
b. If the weather is cold wrap the blankets around the patient body.
c. If breathing has stopped or about to stop, turns casual in to the required posture and start
CPR (artificial respiration).
d. Breathing may noisy or quiet, if not noisy, let the casualty lie on his back. Raise the
shoulders slightly by a pad and turn the head to one side.
e. Watch for some time. If breathing becomes difficult, or gets obstructed, change the posture
to easy breathing.
f. If breathing is noisy (i.e. the lungs are filled with secretions and the air passing through
makes a bubbling noise) turn casualty to three-quarter-prone position and support in this
position with pads, (in a stretcher case, raise the foot of stretcher so that lung secreting drains
easily).
g. See that there is a free supply of fresh air and that the air passages are free.
h. Take the casualty away from harm full gases, if any; if inside a room, open doors and
windows.
Remove false teeth.
i. Apply specific treatment for the cause of unconsciousness.
j. Watch continuously for any changes in the condition, do not leave the casualty until he
passed on to medical hands
k. No form of drinks should be given in this condition.
l. It is best to send the casualty a healthier place on a stretcher.
m. On return to consciousness, wet the lips with water
n. If there are no thoracic or abdominal injury sips of water also can be given.
Nursing care includes
Air way:-
Check for air way an adequate airway must be maintained all the time,
Clothes must be loosen to allow easy movements of abdomen and chest
Sometimes frequent suction may required for removing any secretion in the pharynx.
Position of the patient:-
Patient must nursed in the left lateral position or Sims position, or prone position
Observation and charting,
Observe airway any secretions is present if present remove secretions,
Monitor vitals e.g. Temperature, pulse, respiration will be record every off-on hour,
Monitor input and output
Urine analysis chart will be maintain for who are suffering with renal failure, Diabetic
mellitus,
Hygiene:-It includes Oral care, Bed bath, Skin care and Protect from flies and mosquitoes,
Care of pressure sore:-
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The bed linen must keep clean and dry,

Use safety devices like water bed, air bed, pillows, side rails,
Nutrition:
Maintain electrolyte balance and water balance
Give parenteral line fluids and nutrition e.g. : TPN (Total parentraeral nutrition),Or Naso
gastric tube feeding e.g. : high protein liquid diet, fruit juices, water,
Elimination:-
Monitor Foley’s catheter e.g.: urine colour and 24 hours volume,
Check for abdominal distension,
Check for urinary retention,
If the patient is constipated a glycine suppository may be ordered by the physician,
Note:-
Don not live unconsciousness patient,
Do not give food and drinks.

Diabetes Mellitus
Diabetes mellitus is heterogeneous group of disorders characterized by elevation in
the level of glucose in the blood.

In diabetes mellitus is occurred due to decrease or absence of insulin production by

the pancreas; decrease in the body’s ability to respond to insulin. The action of insulin are
promotes glucose uptake by target cells, prevents fat and glycogen breakdown; inhibits
gluconeogenesis and increases protein synthesis. The insulin is produced by the pancreatic
beta cells in the islets of Langerhans.

Types of Diabetes

The major classifications of diabetes are –

Type I:Insulin dependent diabetes mellitus (IDDM). In this type of diabetes, inadequate
amount of insulin are produced by pancreas, resulting in the need for insulin
injections to control the blood glucose.

Type II: Non Insulin Dependent Diabetes Mellitus (NIDDM). In this type of diabetes, the
insulin secretion is adequate but it is not utilized properly by the cells. The elevated
blood glucose is controlled by diet and supplemented with oral hypoglycaemic agents.

Gestational Diabetes: The elevation of blood glucose during second and third trimester of
pregnancy is known as gestational diabetes mellitus.

Causes

➢ Genetic factor – people with HLA (Human Leukocyte Antigens)

➢ Immunologic factor – auto immune antibodies against islets cells.
➢ Environmental factors – viruses or toxins may precipitate autoimmune process.
➢ Insulin resistance tends to occur with age over 65 years
➢ Obesity
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➢ Family history
➢ Ethnic group

Signs and Symptoms:

• 3 ‘P’- Polyurea, Polydepsia, Polyphagia,

Sudden weight loss, nausea, vomiting and abnormal pain in type I diabetes.
Fatigue, weaken,
Recurrent infection, recurrent vaginal itching/infection
Prolonged wound healing,
Visual changes
Tingling or numbness in hand.

Difference between Type-I diabetes and Type-II diabetes:

Type – I DM Type – II DM

Insulin dependent diabetes mellitus Non insulin dependent diabetes mellitus

Onset at young age Onset age above 40 years

Little o no endogenous insulin Decrease in endogenous insulin

Need insulin to preserve life Oral hypoglycemic agents may improve blood
glucose

Ketosis prone when insulin is absent Ketosis rare, hyperosmolar nonketotic

syndrome

Diagnostic evaluation

➢ History collection and physical examination

➢ Fasting blood glucose level
➢ Random blood glucose level
➢ Glucose tolerance test
➢ Urine analysis
➢ Fundoscopic examination
➢ HbA1c
➢ ECG & Doppler scan

Management
The main goal of the treatment in diabetes is to try to normalize insulin activity and
blood glucose levels in an attempt to reduce vascular and neuropathic complications. There
are five components of management of diabetes.
o Diet o Monitoring
o Exercise o Medication and

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o Education
Diet:
✓ In weight maintenance diet is to multiply ideal weight by 28 cal/kg for weight
reduction a 15-20 cal/kg of patient ideal weight.
✓ If a patient is obese, control weight/losing weight and recommended a dietitian or a
weight modification program to help the patient reach goal.
✓ Eat consistent, well balanced diet that is high in fiber, low in saturated fat and low in
concentrated sweets.
✓ A healthy diet also helps to beep blood sugar at a relatively even level and avoids
excessively low or high blood sugar levels which can be dangerous and even life
threatening.
Exercise:
✓ Regular exercise in any form can help to reduce the risk of developing diabetes.
✓ 20 minutes of walking three times/week.
✓ If patient has complication of diabetes (such as age, kidney or neuro problem) they
may be limited both in type of exercise and amount of exercise they can safely do
without worsening their condition.
✓ In obese persons with type-II diabetes exercise in addition to dietary management
both improves glucose metabolism and enhances loss of body fat.
✓ Persons with diabetes should be taught to exercise at the same time and in the same
amount each day.
✓ Regular daily exercise is good for controlling blood glucose.
✓ Encourage slow, gradual exercise in the length of the exercise.

Self monitoring of blood glucose:

Check blood glucose level frequent at least before meals and at bed time and record
the result in book.

The recording book should also include insulin or oral medication doses and times, when and
what the patient ate, when and for how long they exercised and any significant events of the
day such as high or low blood glucose levels and how they treated the problem.
People require SMBG: Unstable diabetes, a tendency for severe ketosis or hypoglycaemia,
abnormal renal threshold.
A glucometer could use for the one prick testing of blood glucose of the patient with
minimal injury and less blood requirement

Urine testing for glucose:

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This procedure involves applying urine to a reagent strip or tablet and matching colors
on the strip with a color chart. The results are expressed as on a scale of 1+ to 4+.

Traditional method of urine testing

Uristic Method Of Urine Testing

Medication
Insulin therapy:
Type Onset Peak Duration
Rapid acting insulin 5-15 min 45-60 min 3-4 hour

Short acting insulin regular ½-1 hour 2-3 hours 3-6 hours
humulin N

Intermediate acting insulin NPH 2-4 hours 4-10 hours 10-16 hours
humulin N

Long acting insulin 1-2 hours No pronounced 24 hours

peak

Self administration of Insulin

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Insulin syringe:
The classic injection device is an insulin syringe. The plastic, disposable syringes currently
are available in three sizes i.e. 30, 50 or 100 units of insulin. The needles are fine (up to 31
gauge) with lengths ranging from 3/16th of an inch for infants, to ½ inch or more for adults.
The insulin is injected into the subcutaneous tissue just under the skin.
Wash hands with soap and warm water and dry them with a clean towel.
Prepare the Insulin and Syringe
Remove the plastic cap from the insulin bottle.
Roll the bottle of insulin between your hands two to three times to mix the insulin. Do
not shake the bottle, as air bubbles can form and affect the amount of insulin
withdrawn.
Wipe off the rubber part on the top of the insulin bottle with an alcohol pad or cotton
ball dampened with alcohol.
Set the insulin bottle nearby on a flat surface.
Remove the cap from the needle.
Draw the required number of units of air into the syringe by pulling the plunger back.
Insert the needle into the rubber stopper of the insulin bottle. Push the plunger down
to inject air into the bottle
Turn the bottle and syringe upside-down. Be sure the insulin covers the needle.
Pull back on the plunger to the required number of units
Recheck the dose and add more insulin to the syringe if necessary.
Remove the needle from the insulin bottle. Carefully replace the cap on the needle.
Site of Insulin injection: The four main areas for injection of insulin are the abdomen, arms,
thighs and legs.

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Insulin administered to the patient subcutaneously – The technique used for holding
the skin and inserting the needle must ensure that the insulin is injected in to the
subcutaneous tissue.

Injecting insulin at room temperature.

Making sure no air bubbles remain in the syringe before injection.
Waiting until topical alcohol (if used) has evaporated completely before injection.
Keeping muscles in the injection area relaxed, not tense, when injecting.
Penetrating the skin quickly.
Not changing direction of the needle during insertion or withdrawal.
Not reusing needles.

Adverse effect of Insulin:

➢ Local allergic reaction
➢ Generalized utricaria
➢ Insulin lipodystrophy
➢ Insulin resistance
Oral hypoglycaemic agents
Sulfonylureas e.g. glipizide
➢ It stimulates release of insulin from pancreatic islets.
➢ Decrease glycogenesis and glyconeogenesis
➢ It enhance cellular sensitivity to insulin
Meglitinides e.g. repaglinide
➢ It stimulates a rapid and short level release of insulin from the pancreas.
Biguanides e.g. metformin
➢ It decrease the rate of hepatic glucose production
➢ It augments glucose uptake by tissues.
∞ Glycosidase inhibitors e.g. acarbose
➢ It delays absorption of glucose from GII tract.
Education:
It is a chronic illness requiring a lifetime of special self management behaviours.
Because diet, physical activity, physical and emotional stress can affect diabetic control.
Teach the patient during the hospitalization, may be the only opportunity, the patient
has for learning skills of self management and avoidance of diabetic complications.
Care of Foot
There are many things you can do to keep your feet healthy.
Take care of your diabetes by maintaining normal glucose level
Check your feet every day. Look at your bare feet for red spots, cuts, swelling, and
blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for
help.
Plan daily physical activity as program without getting exertion
Wash your feet every day. Dry them carefully, especially between the toes.
Keep the skin soft and smooth by rubbing a skin lotion over the tops and bottoms of
feet.

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Trim the toenails straight across and file the edges with nail file.
Never walk barefoot. Wear comfortable shoes that fit well and protect your feet.
Check inside your shoes before wearing them.
Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement.
Don't put your feet into hot water.
Enhance the blood flow to feet i.e. Put your feet up when sitting. Don't cross your legs
for long periods of time. Don't smoke.
Care of skin
Wash with a mild soap, rinse and dry thoroughly in every part of body. Use a
moisturizer, but not between your toes.
Avoid very hot baths and showers, which can dry the skin.
Extended exposure to water softens the feet and makes your skin more prone to being
pierced.
Inspect your body for red spots, blisters and sores that could lead to infection.
Treat cuts right away. Wash minor cuts with soap and water.
Keep your blood glucose levels as close to normal as possible.
Drink plenty of fluids, like water and caffeine-free, sugar-free drinks, to keep your
skin hydrated.
Eat foods rich in omega-3 fatty acids, which nourish the skin.

Complications of Diabetes Mellitus

Acute complications:
❖ Diabetic ketoacidosis
❖ Non ketotic hyperosmolar syndrome
❖ Hypoglycaemia
Chronic complications:
❖ Retinopathy
❖ Nephropathy
❖ Neuropathy

Diabetic ketoacidosis (DKA)

DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells,
and so the body starts to burn fat from the store and producing acidic ketone bodies. A high
level of ketone bodies in the blood can cause diabetic ketoacidosis.
Causes and risk factors
DKA is caused by the body having too little insulin to allow cells to take in glucose for
energy.
Risk factors for diabetic ketoacidosis
Having blood glucose levels consistently over 15 Mmol/L Missing insulin injections
Faulty insulin pen or insulin pump function
As a result of illness or infections
High or prolonged levels of stress
Excessive alcohol consumption

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Illegal drug use

Signs and Symptoms
Specific symptoms of diabetic ketoacidosis include:
Vomiting
Dehydration
Fruity smell on the breath
Deep laboured breathing ( kussmaul breathing) or hyperventilation
Rapid heartbeat
Confusion and disorientation
Coma
Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose
levels become and remain too high (hyperglycaemia).
Treatment
✓ The primary treatment of DKA is with intravenous fluids and insulin.
✓ Depending on the severity, insulin may be given intravenously or by injection under
the skin.
✓ Usually potassium is also needed to prevent the development of low blood potassium.
✓ Check the blood sugar and potassium levels till the recovery
✓ Antibiotics may be required in those with an underlying infection.

Thyroid disorders

Thyroid disorders are conditions that affect the thyroid gland, a butterfly-shaped gland in the
front of the neck. The thyroid has important roles to regulate numerous metabolic processes
throughout the body. Different types of thyroid disorders affect either its structure or
function.

There are specific kinds of thyroid disorders that includes:

• Hypothyroidism
• Hyperthyroidism
• Goiter
• Thyroid nodules
• Thyroid cancer
Hypothyroidism
Hypothyroidism results from the thyroid gland producing an insufficient amount of thyroid
hormone. It can develop from problems within the thyroid gland, pituitary gland, or
hypothalamus. Causes of hypothyroidism include: Hashimoto's thyroiditis: In this
autoimmune disorder, the body attacks thyroid tissue.
Common causes of hypothyroidism

Hashimoto's thyroiditis (an autoimmune condition that causes inflammation of the

thyroid gland)
Thyroid hormone resistance
Other types of thyroiditis (inflammation of the thyroid), such as acute thyroiditis and
postpartum thyroiditis

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Signs and symptoms

Fatigue
Poor concentration or feeling mentally "foggy"
Dry skin
Constipation
Feeling cold
Fluid retention
Muscle and joint aches
Depression
Prolonged or excessive menstrual bleeding in women

Treatment
Treatment for hypothyroidism is daily use of the synthetic thyroid hormone levothyroxine
(Thyronorm,eltroxin). This oral medication restores adequate hormone levels, reversing the
signs and symptoms of hypothyroidism.
Hyperthyroidism
Hyperthyroidism describes excessive production of thyroid hormone, a less common
condition than hypothyroidism. Graves' disease is an auto-immune condition and is the
commonest cause of an overactive thyroid gland.
Some of the most common causes of hyperthyroidism are:
Graves' disease
Toxic multi nodular goitre
Thyroid nodules that over express thyroid hormone (known as "hot" nodules)
Excessive iodine consumption

Signs and symptoms

Symptoms of hyperthyroidism usually relate to increased metabolism.
Tremor
Nervousness
Fast heart rate
Fatigue
Intolerance for heat
Increase in bowel movements
Increased sweating
Concentration problems
Unintentional weight loss
Treatment
The treatment depends on your age, physical condition, the underlying cause of the
hyperthyroidism, personal preference and the severity of the disorder:
Radioactive iodine. Taken by mouth, radioactive iodine is absorbed by thyroid gland, where
it causes the gland to shrink and symptoms to subside, usually within three to six months.
Because this treatment causes thyroid activity to slow considerably, causing the thyroid gland
to be underactive.

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Anti-thyroid medications. These medications gradually reduce symptoms of

hyperthyroidism by preventing your thyroid gland from producing excess amounts of
hormones. They include propylthiouracil and methimazole (Tapazole). Symptoms usually
begin to improve in six to 12 weeks, but treatment with anti-thyroid medications typically
continues at least a year and often longer
Beta blockers: These drugs won't reduce thyroid levels, but they can reduce a rapid heart
rate, prevent palpitations and treat high blood pressure.
Surgery: Surgical removal of thyroid gland either partially or totally is known as
thyroidectomy. The main complication of this surgery is damage to vocal cords and
parathyroid glands.
Conclusion
All people are susceptible for disease based on their immunity status, dietary pattern and
lifestyle. The common respiratory problems like flu occur in the winter season and mostly
they are seasonal diseases. If indigestion and vomiting is not treated at early, it will lead to
dehydration. Elimination problem identification is essential to prevent renal failure and
maintain the PH level of our body. Early diagnosis and correction of Anaemia helps in
preventing heart failure. Every person need to practice regular exercise good eating habits
regulate the blood pressure and also prevent bad cholesterol formation in the blood vessel as
well as heart attack. Neurological disorders are complex one, which require skill in caring
patient to recover the patient neurological deficit and provide the rehabilitation measure. The
current problem of the adult today is diabetes mellitus which should be managed by exercise,
diet, self monitoring of glucose level, drugs and patient education. Over the entire
multipurpose health worker female need to aware about disease sign and symptoms and its
management. The knowledge of managing and caring the patient with different health
problems helps to prevent complications and impart knowledge to the people by proving
health education in community
Essay questions
1. Explain about tuberculosis and its preventive measures
2. What pneumonia and write the types and management of pneumonia
3. Describe management of back ache
4. Explain causes ,management and prevention of vomiting
5. Describe in detail about hyper tension and its management
6. Explain the care of unconscious patient
7. Write the types of diabetes mellitus and explain about self administration of insulin
administration
8. What are the nursing measures help to prevent urinary retention
Short answer questions
1. What is Graves’s disease?
2. What are the sign and symptoms of diabetes mellitus?
3. What are causes of diabetic keto acidosis?
4. Enlist any four points of foot care in diabetic patient
5. List the types of head ache
6. Write the causes of back ache
7. What are the signs and symptoms of stroke?
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8. What are the types of cerebral vascular accident?

9. What is convulsion?
10. What are the stages of convulsions?
11. What are the drugs used in convulsion
12. What are the clinical features of the hypothyroidism?
13. What is urge incontinence?
14. List the types of anaemia
15. What are the causes of constipation?
16. What is sinusitis?
17. What is tonsillitis?
18. What are the complications of tonsillectomy?
19. What are the signs and symptoms of cold?
20. Define fever
21. List the types of fever
22. What are factors affecting respiration
23. List the sites checking pulse
24. Write the conversion formula of centigrade to Fahrenheit
25. List the types of thermometer

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UNIT-VIII OPERATION THEATRE NURSING

Structure
- Introduction
- Structure of O.T
- Supplies and equipment of the O.T
- Functions of scrub nurse and circulatory nurse
- Pre and post operative care of a patient posted for surgery
Objectives
After completion of the unit, the students are able to
➢ Lay out the physical structure of the operation theatre
➢ List the supplies and equipment of the operation theatre
➢ Describe the functions of the scrub nurse and circulatory nurse
➢ Explain the pre and post operative care of patient with surgery
Introduction
The hospital has different wards and departments to treat the patient ailments. The minor health
problems are treated in the outpatient department itself. The medical problems treated in the
medical wards, acute medical intensive care units depend upon the severity of patient conditions.
But some of the patient problems are not able to treat with medicine only; it requires surgery and
other kind of therapy also. The surgical procedure need to done under special zone with the team
health care members, i.e. surgeon, anesthetist, staff nurse, O.T. technician, nursing orderly and
stretcher boy. This area maintained with highly sterile by following policy of the operation
theatre
Structure of Operation theatre
Operation theatre is the place in which surgical operations and diagnostic procedures are carried
out. It consists of one, two or more operating rooms depending upon the number and type of
operation done in the hospital
I. The design of operation theatre
The design of operation theatre must provide maximum facilities, control of
infection and provide safe environment for the patient and the staff. It is advisable
to have a planning team for the theatre consisting of Hospital Superintendent,
Nursing Superintendent, Architect and Engineer. While planning for the operation
theatre following aspects should be kept in mind.
1. Scope of service to be provided and estimated work load
2. Specialties to be included
3. The theatre usually has four main zones. They are :-
❖ Entrance zone: This area includes entrance, reception, patient transfer area, staff
changing room, departmental room, waste-bin area and offices

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❖ Limited access zone: This area includes post anesthesia recovery area, staff rest rooms,
some offices, special storage room and the exit area to each operation room
❖ Restricted access zone: It is limited to the persons working in the operating room, and
includes anesthesia room, scrub room, preparation and supply room. Only those who are
working inside the theatre are allowed to be in this area.
❖ Operating zone: Minimum persons are allowed in the operating zone to decrease
infection.
Construction of the theatre walls, ceilings and floors
The walls, ceiling and floors are made up of materials which should withstand wet cleaning and
chemical treatment. It should be made up of light color, pale blue or green is suitable. There
should not be any cracks. Floors should not have any drains and gulleys. There should be no
shelves. There should be provision for fire escape.
Lighting
Normal light is providing by high level windows, black out the windows. If the main light fails
provision should be made for emergency light. Provide florescent light in general area. Provide
ceiling mounted light which should be easy to move in all directions. Dome light should be
provided with removable sterilized handle. There should be earth line to electrical points.
Ventilation
The main function of ventilation in operation theatre is as follows:
a) To control the temperature and humidity of the operating room.
b) To reduce contamination by air borne micro organism and expired anesthetic gases
c) To provide air movement within the operation room to minimize transfer of air borne
micro organism from less clean to clean area.
d) The air conditioning should be able to maintain internal temperature. The control of
adjusting of temperatures should be in the operation theatre itself.
Disposal of waste
Soiled dressing and linen is disposed in a bag. Disposal bag is sent out of theatre after
instruments are checked. Disposal of operated organ or parts is done as per the policy of the
hospital.
Post anesthesia recovery room
Immediately after surgery the patient shifted here for observation for one hour before shifting to
the intensive care unit or post operative ward, to assess the patient’s vital functions and
complications of patients with recovery /any bleeding from surgical site.
Before returning to the ward patients are sent to this room. It should be closed to reception and
transfer area. There should be two beds for each operation room. Room should contain oxygen
supply, electrical sockets, anesthesia trolley and emergency equipment. There should be space at
the head end for the anesthetist to work.

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Design operation theatre in such a way that entry is at one end and exit at other. Staff should
have access to changing area from outside. Patient enters through reception area. Lounges, stock
room and linen room are located outside the operation theatre.
Supplies and equipment of the O.T
Furniture, equipment and linen needed in the theatre
Changing room and dressing room require cupboards or racks to keep the personal belongings of
male and female staff. There should be tables and chairs to sit and relax. It is provided with bins
containing theatre gowns, caps, rubber slippers and masks.
Anesthetic room
It is provided with bed, anesthesia trolley, emergency drug trolley, suction and oxygen.
Scrub room
It contains small steam sterilizer to meet the needs of the operation room. This unit contains
refrigerator for blood and medication. Hot plate for saline is located in scrub room. Requisition
forms, stationery and records are kept here. Separate space is located in scrub room for hand
washing where hand brush, soaps and towels are provided for the scrub.
Storage room It is provided with cupboards and racks to keep equipment, linen and extra tables.
Utility room It is provided with washer, sterilizer, sinks, cupboards and all necessary aids for
cleaning.

Instruments and supply room

This room contains instruments sets, basin sets, trays and other supplies. Packing and wrapping
of equipment and linen is done in this room. The room contains cupboards in which all clean
instruments not needed for wrapping are stored. It keeps stock of supplies.
Sterile supply room
It is provided with shelves and cupboards. All sterile supplies such as gauze, gloves and dressing
material are kept here.
Recovery room
It is provided with beds, patient lockers and trolley with I.V. sets, solutions, emergency drugs,
suction apparatus, oxygen. A tracheotomy tray, CPR tray, bronchoscope tray, pace maker,
mechanical ventilators, monitors and defibrillators are also available here. One bed per operating
room is provided plus one bed for each four operating room.

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Recovery room is provided with all suction and oxygen outlets, electrical sockets and outlets for
machines, call system and telephones, refrigerator for blood, private rooms for patient on the
danger list. Office with sink and running water, cupboards, storage space utility room and air
conditioning are provided.
Operation room
It is provided with operation table stool for surgeon and anesthetist to sit. Instrument trolley,
emergency drug trolley and anesthesia trolley, I.V. stands, sterile gowns and glove table are
present. The room has table with sterile equipment, gauze, cotton, bins, B.P apparatus stand,
suction apparatus, defibrillator and ventilators.
Instruments
Content of mayo stand
Towel clips, sponges, straight and curved scissors, BP handle, skin towel, needle holder, Allis
clamps, toothed and non toothed thumb dissecting forceps, kellies clamps, curved artery forceps
and needle holder hemostat material.
Emergency Drug Trolley
Emergency drug trolley is replenished everyday and kept in important areas for use, content of
the emergency drug trolley is
o Airways
o Intubation tray- endo-tracheal tube with different size, laryngo scope,10ml syringe, ambo
bag , Oxygen connections and mask
o Suction tube, catheters and pump
o Gastric tubes
o Tongue depressors
o Defibrillators with electrodes
o Intra cath, I.V sets, I.V. fluids(5% dextrose, normal saline, Ringer lactate and
haemoceal), three way cannula.
o Monitors
o Sterile gloves
o Disposal syringes (2ml,5ml,10ml,20ml )
o Disposal needles
o Tourniquet
o Antiseptic solution
o Surgical spirit swabs
o Scalpel
o Sterile towel and small surgical drape
o Suture needles /A traumatic sterile suture material
o Sponges(4” x4”)
o Equipment required for drawing blood samples
o Adhesive tape and scissors

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Preparing basic anaesthetic equipment:

• Monitors - ensure that your monitors are working, configured correctly and with
appropriate alarms and volume limits set.
• Airway equipment - ensure you have a full
range of the required equipment including
spares. This includes:
o Bacterial filters,
connectors and
catheter mounts –
these should be
checked for patency
o Tracheal tubes and
laryngeal mask
airways
o Appropriately sized
face masks and Guedel airways
o Laryngoscopes with appropriately sized blades
o Equipment for the management of the anticipated or
unexpected difficult airway must be available and checked
regularly in accordance with departmental policies
o resuscitation equipment:
o Check that the patient’s trolley, bed or operating table can be
tilted head down rapidly
o A resuscitation trolley and defibrillator must be available in
all locations where anaesthesia is given and checked regularly
in accordance with local policies

List of operation packs

General set (It consists of BP handle, curved scissors, straight scissors, toothed dissecting
forceps, non toothed dissecting forceps, fine dissecting scissors, towel clips, Gilles’s dissecting
forceps, artery forceps -small, medium and long, sponge holder, Lanes tissue forceps, Babcock
tissue forceps, Allis tissue forceps Probe, sinus forceps, Needle holders, Morris’s retractors,
Suction cannula, Lange beck retractor)

▪ Minor set
▪ Laprotomy
▪ Appendectomy
▪ Herniorraphy
▪ Prostatectomy
▪ Mastectomy

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▪ Supra pubic cystostomy

▪ Hysterectomy
▪ Caesarean section
▪ Tonsillectomy
▪ Nasal polypectomy
▪ P.O.P and open reduction
▪ Hydrocele repair
▪ Implant fixation
▪ Thyroidectomy

Linen
▪ White sheet
▪ White draw sheet
▪ Fenestrated towel
▪ Thyroidectomy towel
▪ White drape sheet for main stock table
▪ Green towel
▪ Surgical apron
▪ O.T. gown
▪ cap and mask
▪ Sterile bin cover
▪ Shoe cover
▪ Hand wash towel
▪ Stone towel for keeping suture material
▪ Glove bags
▪ Special instrument bag
▪ Surgeons vest and pyzama

Functions of scrub nurse and

circulatory nurse Duties of nursing staff

Senior Manager
1. Maintenance of a high standard of patient care
2. Planning and ordering
3. Welfare and professional development of staff.
4. Liaison with other department, e.g. surgery, anesthesiology, nursing, administration,
personnel, pharmacy and laundry.
Theatre Sister
1. Daily management of the theatre

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2. The safety and welfare of patients.

3. Ordering stock
4. Continuing education of staff.
5. Liaison with surgeons and anesthetists regarding operation lists and equipment orders.
surgery, anesthesiology, nursing, administration, personnel, pharmacy and laundry
6. Discussion of problems with the senior theatre sister .
Senior staff nurse/Scrub nurse
After adequate training, the senior staff nurse assists and relieves the theatre sister. A scrub nurse
is a person who arranges the table and assists the surgeon throughout the procedure in the
operation room.

Scrub nurse

I. Before the operation

1. Collection of equipment and linen for the operation planned.
2. Gowning and gloving
3. Draping trolley and bowl stand with sterile drapes.
4. Collecting suture material, needles, blades, mops, gauze and cotton.
5. Draping Mayo table and preparing initially required instruments.
6. Checking patient’s identity with the name band, case paper and operation list.
7. Ensuring safe positioning of the patient.

II. At the commencement of the operation

1. Handing skin preparation agents and swabs on holder to the surgeon
2. Assisting in draping
3. Positioning Mayo table.
4. Arranging diathermy and suction.
5. Passing instruments, swabs and sutures to the surgeon
6. Keeping an accurate count of extra instruments and swabs collected during the
operation, and ensuring that they are charted by the circulator
7. Anticipating the needs of the surgeon
8. Ensuring adequate discipline and minimum disturbance within the theatre.

III. At the end of the operation

1. Confirming that all instruments, swabs and mops are accounted for
2. Removing instruments from Mayo table
3. Collecting dressing from the circulator
4. Disposing of blades and needles into appropriate containers
5. Removing drapes
6. Ensuring that the peri operative area is clean
7. Ensuring that the patients gown is clear and dry
8. Covering the patient with a clean sheet
9. Returning instruments for washing and sterilization
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10. Completing entries in the operation register

Circulatory nurse
A circulatory nurse is a person who helps the scrubbed nurse and is available throughout the
procedure in the operation room.
I. Before the operation
1. Checking that the theatre has been cleaned.
2. Confirmation that lights, suction and diathermy equipment is in working
condition.
3. Ensure and set that the temperature and humidity are correct in O.T.
4. Collecting the necessary equipment and stocks, e.g. swabs, specimen jars, sterile
water, fiber-optic light source
5. Preparing sterilized gowns and gloves
6. Tying gowns
7. Opening instrument packs, bowl packs, and other equipment for the scrub nurse
for arranging the table.
8. Assist with counts and records of patient.

II. During the operation

1. Being available in the theatre
2. Connecting diathermy and suction leads.
3. Replenishing and recording swabs and mops as requested
4. Disposing of used swabs.
5. Filling bowls with sterile water.
6. Placing swab-collecting bowls conveniently for the scrubbed assistant
7. Anticipating the requirements of the team
8. Ensuring that all the doors of the theatre remain closed.
9. Assisting with the count and records before the end of the operation
10. Preparing the wound dressing
III. After the operation
1. Assist the scrub nurse for dressing the patient.
2. Helping with the removal of the drapes
3. Helping with the preparation of the patient for shifting to the recovery ward.
4. Removing the instrument trolley and other equipment to the sluice room.
5. Ensuring that the theatre is cleaned and prepared for the next operation.
Pre and post operative care of a patient posted for
surgery Pre operative care
General Pre-operative Nursing Care
This is preparing a patient for a surgical procedure. The pre-operative period is the time
from which person is admitted in the ward and prepared for surgery to hand over the patient to

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the theatre sister. This period varies in length and depends on the patient’s condition. Surgery is
a traumatic event for most patients. The better the patient is prepared and instructed for surgical
procedure the easier in his post-operative period and the shorter his duration of convalescence.
Psychological Consideration: Surgery is viewed as a crisis in life. Emotional responses
to surgery may be manifested in various ways. Some patients may be talkative, some may be
withdrawn and some other may show non-adaptive responses. After assessing the patient
carefully, nurse should provide adequate psychological support.

A complete assessment of health status is a part of preparation for surgery:

a. The patient’s age the young and old are less able to cope with stress.
b. Nutritional, water and electrolyte status – Surgical risk is increased when the patient is
malnourished and dehydrated.
c. The presence of previous pathological condition – The nurse should observe the signs of
disease.
d. Special conditions affecting the surgical risk:
❖ Obesity: The surgical risk is higher than the patient with normal weight.
❖ Acute infection: An acute infection anywhere in the body requires a delay in surgery
in most instances to help prevent post-operative complications.
❖ Drug therapy: The drugs which have profound effect are hypoglycemic,
hypertensive, psychic, anticoagulant, steroids etc. Continued use of anticoagulants
may cause serious hemorrhage.
❖ Addiction: Post-operative pulmonary complications are more in patients who smoke.
❖ Wasting disease: In diabetes mellitus the stress accompanying surgery may increase
the need for insulin.
❖ Skin disease at the operation site should be treated prior to operation.

1. Patient Teaching

The most important part in pre-operative management is health teaching. Teaching should
include sharing information about purpose of various types of care the patient receives pre-
operatively and post-operatively.

Diaphragmatic breathing

This causes deep breathing and helps the patient ventilation. It is carried out as follows:

❖ The patient lies on low Fowler’s position, flexing knees and placing his hands
over his lower rib cage and on sides of abdomen.
❖ The patient exhales thoroughly, his ribs move downward with exhalation.
❖ Then he takes deepest breath.
❖ The patient holds the breath for 3-5 seconds after inhaling deeply.

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❖ Then he exhales through pursed lips holding in a manner as though he will whistle
taking double the time to inhale action. The patient is helped to practice this
breathing twice a day for at least 15 times in each sitting.

Coughing

❖ The patient lies in low Fowler’s position or a side-lying position.

❖ The patient’s hands are placed on the incision area to splint the surgical wound.
❖ The patient takes a deep diaphragmatic breath.
❖ After inhalation the patient is asked to make two strong coughs while keeping the mouth
open, tongue extended and hands in position.
❖ The patient then takes another deep breath and gives two more strong coughs.
❖ The patient practices coughing at least two or three times a day.

Moving in bed

❖ The patient is placed on back and is asked to flex the knees to about 45 0 to 900 and
holding this position for a few seconds, to extend the leg. This is done alternately. These
exercises are repeated four to five times every 3-4 hours.

2. Legal Considerations

❖ The patient must be told about the operative procedures, risk, possible complications and
what disfigurement can occur.
❖ He should be informed what to expect during post-operative period.
❖ Operative consent is to be taken from the patient, in the presence of witness. Parents or
guardian must sign for minor.
3. Psychological preparation of the patient and family
Most of the patients fear surgery. Common fears include fear of death, unfavorable prognosis,
disablement which may bring disruption in family life etc. There is worry about anesthesia, loss
of self control and financial and employment limitations.
❖ The nurse should have knowledge of the type of surgery the patient is to undergo
to guide for preparing the patient both psychologically and physically.
❖ The patient is to be given opportunity to discuss his fear and concern. It also
includes listening to what is being said as well as non-verbal communication.
Touch, when used appropriately conveys the message of showing an interest in
what the patient is experiencing.
❖ Each will respond emotionally to a surgical experience in his own way.

4. Preparing the patient for operation

The nurse should also prepare family members for the surgical equipment needed in the
case of the patient. She should offer emotional support to family members.

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1. Regular bath with soap or cleaning after admission.

2. Maintenance of oral and general hygiene.
3. Any infective fever should be treated.
4. Bowel should move regularly.
5. Fluid intake should be plenty. When necessary glucose drinks in large amount e.g. in
jaundice should be given.
6. Adequate diet followed by light diet in evening before operation and nothing by
mouth on the day of operation is standard protocol unless ordered specially.
7. Tranquillizer on the night before operation.
8. Infants, children and old-aged require special care. Infants and children are
susceptible to infection; they tolerate fluid and electrolyte imbalance badly and they
may have congenital disorders. The elderly are prone to have pulmonary,
cardiovascular, urinary and liver disorders which should be taken care of.

5. Preparation of the patient immediate pre-operatively

a) Prepare Skin at the site of surgery and around the areas to reduce the chance of
infection. Shaved area may be applied with sterile dressing.
b) Administration of a cleaning enema as ordered the patient may have an involuntary
bowel movement while he is being anaesthetized if the lower intestinal tract is not
emptied.
c) Checking of the vital signs is important. Any abnormality of vital signs should be
reported promptly. Surgery may need to be cancelled if abnormalities are present.
d) Removing of patient’s valuables such as rings and wrist watch should be carried out.
Remove dentures, contact lenses, artificial limbs and eyes, wigs, hair pins, clips and
colored nail polish. Branding the long hair and putting on the hospital’s clothes are
important.
e) The patient should void urine before going to operation theatre.
f) The pre-operative medication should be administered at the time ordered.
g) The patient’s record must be completed.
h) Help to move the patient on stretcher after checking the patient’s identity.
i) Accompany the patient to the operating room and handover the patient and records to
the operation room nurses.
j) Special preparations are given as ordered for some surgical conditions like
cardiothoracic surgery, uro-surgery etc.

General Post-operative Nursing Care

The post-operative period is the time from the patient is transferred from recovery room of the
theatre to received in the ward and until discharge from the post operative ward.

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• Preparation of patient’s room: Recovery room should be in the same floor as operation
theatre. The furniture should be so arranged that stretcher on which patient is transported
can be moved near the patient’s bed.
• Maintenance of pulmonary ventilation: The patient should be in a position so that he
can breathe normally with full use of all portions of his lungs; the head turn on side
position is preferred after the airway has been removed to facilitate drainage from mouth
and nose. so that he will not be aspirated..
• Maintenance of circulation and prevention of shock: As soon as the nurse is certain
that the patient’s airway is clear, she should check the blood pressure and pulse. The
blood pressure, pulse and respiration are usually taken every 15 minutes for first 2 hours
and eventually every 4 hours until further orders. The rate, volume and rhythm of the
pulse should be carefully observed and character and rate of respiration noted. A rapid
thready pulse with sudden drop of blood pressure may indicate hemorrhage or circulatory
failure. The surgeon should be notified immediately. Oxygen may be given to increase
its concentration in the available circulating blood.
• Protection from injury: Following anesthesia, side rails are usually placed on the bed
and are left until the patient is fully awake.
When infusions are given, the patient’s arm should be secured on an arm board so that
the needle is not dislodged.
The patient should be turned frequently and placed in good body alignment to prevent i)
nerve damage from pressure and ii) muscle and joint strain due to lying in the same
position for a long period of time.
• Bleeding and drainage: The nurse must check for soakage or bleeding. She should also
look for tubes of any kind and connect them to drainage system as ordered.
• Maintenance of fluid and electrolyte balance: An adult requires about 2.5 liters of
fluid. This should be maintained by I.V. infusion. There should complete and accurate
intake / output charting in the post-operative period. All fluids, medications and
treatments that the patient receives during this time must be recorded.
• Checking for consciousness: The nurse can ascertain as the return of reflexes and
consciousness of the patient by asking him his name.
• Care of bladder: Retention of urine is a usual complaint after perineal rectal or hernia
operation. An indwelling catheter is introduced pre-operatively.
• Vomiting: This may occur after general anesthesia. In additional operation presence of
Ryle’s tube and gastric suction prevent vomiting. Antiemetic may be necessary if
vomiting does not subside.
• Oral hygiene: This is important to prevent parotitis, gingivitis, bad odor etc.
• Diet: It is advised depending on abdominal or extra-abdominal operations. Fluids are
administered after return of peristaltic movements usually after six hours.

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• Bowel: No purgative is advised in abdominal operations. Suppositories in some cases

like appendicectomy and enema in selected cases e.g. cholecystectomy are advised after
4th or 5th day.
• Ambulation: Nowadays, early ambulation is advised for improving circulation. This
helps psychological, physical and physiological improvement.
• Wound care: Usually dressing is changed when a drain has been left or there is wound
infection. Otherwise it is changed during suture removal.

Conclusion
The operation theatre nursing is skillful and technical to handle the patient during and after
surgery by the nurse and other health team members. The maintenance of supplies and
equipment is always keep ready to the next surgical procedure as well as maintain the
sterilization for preventing transmission of infection.

Essay questions
1. Describe responsibilities of the scrub nurse
2. Describe the physical structure of the operation theatre
3. Explain the post operative patient care of patient with surgery

Short answer questions

1. What is pre operative period?
2. List the names of equipment in mayo stand
3. Write any four surgical set used for surgery
4. What are exercises to be taught before surgery?
5. List any four points to be carried out by the nurse before surgery

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UNIT-IX CARE OF PHYSICALLY AND MENTALLY CHALLENGED

Structure
9-0-Introduction
9-1-Types of physically challenged
9-2-Understanding of mentally challenged
9-3-Counselling for challenged
9-4-Helping family to ensure need based care
Objectives
After completion of the chapter, the students are able to
➢ Define physically challenged and mentally challenged
➢ Illustrate the different types of physically and mentally challenged
➢ Describe the importance of counselling for challenged people
➢ Explain the family responsibility to ensure need based care
9-0-Introduction
Everyone in our day to day life faces variety of stress and strain (biological, psychological
and social) and problems from time to time at various stages of life. Every phase of life
,person needs to adjust and adapt to situation what he is exposed .It causes challenges to the
people when the situation is tough and difficult .Where as physically and mentally disabled
people need extra support and care and also faces the challenges for their successful life. The
family responsibility is 100 % essential for the challenged person’s quality of life.
9-1-Types of physically challenged
Definition
A condition or function of the organ as a whole person’s behavioural function is significantly
impaired and not able to maintain the normal function as like the usual standard of an
individual is called Disability/Handicapped/physically and mentally challenged
An impairment is defined as “any loss or abnormality of psychological, physiological or
anatomical structure or function” e.g. Loss of limb, loss of organ, defects of mental function.
A disability is defined as “any restriction or lack of ability to perform an activity in a manner
or within the range considered normal for a human being.
A handicap (challenged person) is defined as a disadvantage for a given individual, resulting
from an impairment or a disability that limits or prevents the fulfilment of a role that is
normal for that individual .It reflects interaction with and adaptation to the individual’s
surroundings
TYPES
➢ Physically challenged
➢ Mentally challenged
➢ Socially challenged

1. Physically challenged
This is classified based on the structure and functional disability of an individual.
The physical impairment is caused by
• Birth defects- deaf and dumb, blindness, clubfoot
• Infections- poliomyelitis

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• Accidents-loss of limb, loss of hearing, loss of vision, spinal cord injury

Disability in mobility: The person restricted with day to day activities and depend on others
for self care skills e.g. spinal cord injury, poliomyelitis and amputation of hand or leg
Visual impairment may be congenital or accidental or infections. It may be partial or
complete loss of vision and lead to sensory functional limitation like blurring of vision,
double vision and unable to see the object. It may be caused by vitamin ‘A ‘deficiency, injury
to the eye, diabetes mellitus and cataract.
Hearing impairment
The person unable to receive the sounds through the ear is known as hearing loss or hearing
impairment.
Types
1. Conductive hearing loss – Impairment of external middle ear
2. Sensory Hearing Neural loss – Impairment of inner ear / auditory nerve
People who are partial deaf can often use hearing aids to assist the hearing; deaf people use
sign language for the way of communication
2. Mentally challenged – Mental health is defined as a state of well being in which every
individual realizes their own potential, cope with normal stresses of life, can work
productively and work for the community welfare.
4. Mental sub normality refers the delay in overall development and require special education
and systematic training for maintaining their life.
Mental retardation is the old term which has been replaced by mentally challenged/ mental
sub normality/ intellectual disability
Mentally challenged are intellectual disability may present with or without physical problem
1 It originates in developmental period – the child has impairment in adaptive behaviour in
different stage of life
2 Based on IQ level the child’s capacity of adjust and perform activities of daily living
3 Intelligent quotients is Ratio between Mental Age (MA) and Chronological Age (CA)
4 Chronological age is determined from the date of birth; Mental age is determined by IQ
test.
5 IQ = (Mental age / Chronological age ) * 100
Levels of Sub normality IQ Range Activity
Mild 50-70 Able to educate
Moderate 35-49 Able to train
Severe 20-34 Dependable
Profound below 20 Custodial care
Mental sub normality or mentally challenged condition is not curable but could be managed
with correct treatment and support of family. It is not a mental disorder because it is a
delayed developmental problem e.g. The age of child is 6 years but the child behaviour is like
2 years old
Causes of Mental Sub normality
• Genetic Condition – Down Syndrome, phenyl Ketonuria, Galacotosomia, Congenital
Hypo thyroidism etc

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• Antenatal factors – Neural tube defect, RH incompatibility, Maternal infections(

Rubella , Herpes simplex)
• Perinatal factors – Hypoxia, Birth injuries, cerebral palsy
• Post natal factors – Encephalitis, Head injuries and accidents
• Others – Maternal malnutrition, consanguineous marriage, late pregnancy.
Features of mental sub normality children
1. Flat Face
2. Short nose
3. Slanting eyes
4. Flat back of head
5. Abnormal ear
6. Special Skin Ridge Pattern
7. Decreased muscle tone
8. Small arched palate and big tongue
9. Big tooth with wide space
10. Congenital anomalies in the organ structure e.g. umbilical hernia
11. Delay in motor skills, self care, language skills
3. Socially challenged – The child unable to develop healthy personality and full unfolding
of potentialities is obstructed by certain element in his social environment is known as
socially handicapped. The elements are parental inadequacy; environment is not suitable for
learning process and emotional disturbances
9-3-Counselling for challenged
Counselling
Counselling is a talking therapy which can be life enhancing, promoting positive change to
the people who need guidance in health problems.
Emotional Disability Counselling Service offers person-centred counselling delivered by a
counsellor with a physical disability. It offers those affected by disabilities a unique
opportunity to work with a physically disabled counsellor who has the professional
knowledge and personal insight to offer a deep understanding of disability issues.
Aims of parent counselling for challenged children
• Understand the medical facts about their child’s condition
• Understand whether child’s parent/ancestors/maternal relationship of family passed
on genetic changes to the child
Learn more about what the risk is, and how to deal with it if you have more children
Plan realistically for the future
Adjust in the most positive ways to the condition
Person-centred counselling aims to achieve personal growth and change within the
individual by providing a confidential space of acceptance, genuineness,
understanding and empathy.
Preparing for counselling
Before starting of counselling session, it’s a good enough to find out as much as about
family’s medical history This might include:

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Your relation to each family member, including whether family members are adopted
or half-relatives
Any major health conditions that affect each family member and any relevant
pregnancy history such as miscarriage
Age of onset of each condition
The cause and age of death of family members (if relevant).
It’s a good idea to write down your questions before going into a session so you don’t forget
to ask.
During counselling session, The counsellor might:
Ask about family history
• Make or confirm a diagnosis, or there’s no genetic condition present
Work out the risk of other family members getting the condition
Talk about how the condition will affect your child, and how you might handle this
problem
Provide information about support agencies or other medical services available in
local area or any places.
Give verbal/ written information about the condition.
Health suggestions
Counselling helps for prevention of inborn error metabolism, congenital abnormalities and
birth defects.
Screen and identify the individual with defective gene
Counsel the antenatal mother, avoid exposure to radiation during pregnancy
• Don’t take drugs without doctor’s prescription especially first trimester of pregnancy
Regular antenatal check up
Avoid late pregnancy i.e. age above 35 years
Encourage the parents for neonatal screening for early treatment to new born
Explain the mother regarding adverse effects of smoking, alcohol and substance abuse
Avoid consanguineous marriage, encourage hetrosanguinous marriage which can be
prevented /reduce the birth defect to the child e.g. Sickle cell anaemia, micro cephaly,
mental sub normality
9-4-Helping family to ensure need based care
Most of the handicapped conditions are preventable/ manageable at initial stages .Usually
people who become physically disabled are not able to agree themselves regarding their
problems, feels inferior and may depressed in mood as well not involving in activities of
daily living .
For some people, the thought of having a disabled child is nothing more than ‘well it’s just
one of those things’. But for a lot of people, it is the beginning of a life of never ending
trauma, anxiety, depression, isolation, guilt, anger, frustration, sleep deprivation, denial,
dread, grief, overwhelming hopelessness, helplessness and ongoing stress.
These parents have to learn how to cope in a world of changing attitudes towards the child as
well as society’s attitude to disability

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Facing up to reality: Parents just the mere fact of facing up the reality, coming to terms with
the diagnosis and prognosis and accepting the term ‘disabled child’ can be too much for
them.
Parent’s knowledge and understanding helps to guide themselves and rearing their
disabled child
Positive outcomes: The parents should have will power, self-belief and encouragement the
impossible is possible. It is essential that parents who have a disabled child seek therapy in
order to explore in a therapeutic setting. The negative impact may be not only affecting the
child health but also on the health of those living within the family – i.e. siblings and other
close family members – and find positive ways forward.
Most people who get genetic counselling want information about genetic conditions in their
families, and counselling can give this before or at the same time as genetic testing.
Genetic counselling can help when:
• a condition seems to run in the family and there’s concern that you or your children
might develop it
a child in the family has a serious problem that affects growth, development or
health, possibly linked with a genetic cause
two people who are closely related are thinking of having a child together
prenatal testing has detected a foetal abnormality or a risk of a foetal abnormality
Family therapy
Family therapy, also referred to as systemic therapy, is an approach that works with families
and those who are in close relationships to foster change. These changes are viewed in terms
of the systems of interaction between each person in the family or relationship.
Essentially, by evaluating the issues and providing support, family therapy can help families
and individuals to:
Better to understand their family functions
Identify strengths and weaknesses within the family system
Set goals and devise strategies to resolve problems
Develop their communication skills
Make the entire family unit stronger.
Families who have children with behavioural issues may also find family therapy particularly
valuable.
To help a client overcome the challenged effect of physical disability a counsellor should
have a rudimentary knowledge of the behavioural manifestation of the medical condition and
be skilful at implementing counselling strategies which are compatible with the intra and
inter personal dynamics characteristics of each stage to overcome the problem with disabled
child in the family.
Conclusion
The challenged children are the gifted child of the society .They need to train them in a way
by their family members. It requires special education to the parents to cope up with child
and caring the child as per different stage of growth and development. Family and genetic
counselling helps the parents to understand state of challenged children and their needs.
Essay questions:
1. Describe about the importance of counselling to the parents regarding challenged child

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2. Write about mentally challenged children

Short answer questions
1. What is impairment?
2. What is intelligent quotient?
3. List the types of hearing loss?
4. List the features of mentally retarded children?

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UNIT-X
TYPES AND ADMINISTRATION OF DRUGS
Structure
10.0- Introduction
10.1- Different systems of medicine
10.2- Classification of drug forms
10.3- Characteristics of drugs
10.4- Abbreviations used in medication
10.5- Administration of drugs-policies and regulations as per protocol
10.6- Classification of drugs
10.7- Routes of administration
10.8- Rights of drug administration
10.9- Principles of safety measures
10.10- Role of MPHW (F) in the administration of drugs

OBJECTIVES
After completion of the chapter, the students are able to
➢ Understand about different systems of medicine
➢ Illustrate the types of drug forms and its characteristics
➢ Describe the policies and regulations of drug administration
➢ Explain the different routes of drug administration and the role of MPHW (F) in drug
administration
➢ Describe the safety measures while administering the drug administration
10.0- Introduction
In olden days the medications are called as ‘avushath’ and the name of the treatment is called
based on the origin of the place or country. e.g. Chinese medicine, ayurvedic medicine and
western medicine etc. Whatever the systems, ultimately the medicines are used to treat the
people who are suffering with disease. The drug administration is the crucial role to every
MPHW (F) personnel in the community as well as in the hospital setting. They should have
clear understanding about types of drugs and its route of administration.
10.1- Different systems of medicine
The Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy,
abbreviated as AYUSH, is a governmental body in India purposed with developing,
education and research in ayurveda (Indian traditional medicine), yoga, naturopathy, unani,
siddha, and homoeopathy,
Alternative system of medicine(ASM) use elements from the domain of traditional medicine
Ayurveda and siddha are actually originated and developed in India.

Ayurveda
The meaning of ayurveda is “Knowledge of life” .It is derived from Sanskrit word. AYU-
life ; veda-Knowledge; In AYURVEDA, the cause of disease is mainly three.
They are 1.Asatmyedryia samyoga- indiscriminate use of sense organs and their objects.
2. Prayana Parthia- error or intellect resulting in a loss of discrimination between and
unwholesome.

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3. Parinama - seasonal variations

Health is defined as the state of equilibrium of Dosha, Agni, Dhatu and Mala, patency of
stotras and a healthy state of the Agni.
Ayurveda also focus on diet, hygiene, exercise, yoga and meditation. Vajikarana and
Rasayana measures are also prescribed for removing toxins accumulated in the body,
maintaining equilibrium and preventing senility and related problems.
Unani
The word Unani / Yunani is derived from Greek word-Ionia. It means” Greek medicine” and
is widely practiced in south Asia. It is tradition of Greco-Arabic medicine, which is based on
the technology of Greek physician.
Unani medicine is based on the concept of four humours, they are
1. Phlegm (Balgham )
2. Blood (Dam )
3. Yellow bile (safra )
4. Black bile (sauda )
Any cause of disease is countered by the power of body responsible to maintain health, the
failing of which may lead to derangement of the normal equilibrium, which contribute to the
disease. Unani medicine is very close to ayurveda theory of the presence of elements, i.e. fire,
water, earth and air in the human body.
Yoga
The word Yoga is derived from Sanskrit word “YUJ”. It means to join together i.e. to join the
mind, body and spirit. The aim of yoga is to bring a balance into the body and spirit. The aim
of yoga is to bring a balance into the body physically, mentally, emotionally and spiritually.
Yoga is considered an antidote to stress and potentially powerful tool for living healthy
balanced life.
The physiological benefits of Yoga based on regular practice of traditional yoga poses
breathing exercises and meditation.
▪ Attains equilibrium in autonomic nervous system
▪ Increases cardio vascular efficiency
▪ Increases respiratory volume and vital capacity
▪ Normalises the gastro intestinal function
▪ Normalizes the endocrine function

Naturopathy
An individual is healthy when he/she is in perfect harmony with nature. The primary cause of
disease is accumulations of waste matter in the body except for the traumatic and
environmental conditions; pathogens enter and survive in the body, when a favourable
atmosphere for their growth is established in the body after the accumulation of morbid
matter. Acute diseases are self healing efforts of the body. The treatment of all diseases is
elimination of morbid matter from the body.
Allopathy
The term Allopathy was coined in1842 by C.F.S. Hahnemann to designate the system of
medical science /practice which treats disease by the use of remedies /drugs which produce

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effects different from those produced by the disease under treatment. Focused on eliminating
the disease or alleviating the symptoms
Homeopathy
Homeopathy is form of alternative medicine originated by Samuel Hahnemann (1755-1843)
based on the hypothesis that a substance that causes the symptoms of a disease in healthy
people and will cure that disease in sick people. Homeopathic remedies are prepared by serial
dilution in alcohol or distilled water, followed by forceful striking on an elastic body, called
“succession”. Each dilution followed by succession is assumed to increase the remedy‘s
potency.
10.2- Classification of drug forms
Drug
A drug is defined as any substance used for the purpose off diagnosis, prevention, relief or
cure of a disease
Pharmacology: It is the branch of science which deals with the study of drugs, their origin,
nature, properties and effects
Drug nomenclature: Drugs are identified according to their chemical name, generic name
and trade name to prevent confusion of drugs.
1. Chemical name: the name which reflects the chemical structure or composition of a
drug
2. Generic name: It is the original name that the drug is given when the drug company
applies for the approval process.
3. Brand name/ Trade name: It is the name given by the company which developed the
drug and trades the drug
4. Examples of chemical, generic and brand name of drug

Chemical name I-thyrocine, T4 Acetyl salicylic acid

Generic name Levothyroxine sodium Aspirin
Trade name Eltroxin,Synthroid, Disprin, Aspro, Wimprin,
Levothyroid, etc etc.

The drugs are prepared manufactured in different forms. They are

Solid form
Caplet: Shaped like a capsule and coated for easy swallowing
Capsule: Powdered, liquid or oily drugs enclosed in a gelatine shell
Pills: Tablets containing one or more drugs shaped into ovoid or oblong form.
Tablet: Powdered dosage compressed into hard disc.
Lozenges: Flat, round form containing drug, flavouring sugar and mucilage. It dissolves in
mouth.
Suppository: Solid dosage form mixed with gelatine for insertion in the body cavity, melts at
body temperature, releasing the drug for absorption.
Liquid form
Injections: Liquid drugs in the ampoule or vial for IM, IV, SC, ID use
Drops: Liquid drugs for instillation in eye, ear, nose

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Elixir: Clear fluid containing water or alcohol, usually has sweetener for easy swallowing
Syrup: Drug dissolved in concentrated sugar solution
Suspension: finely divided drug particles in a liquid medium
Lotion: Drug in liquid suspension used externally onto the skin
Tincture: Water or alcohol drug solution
Emulsion: Mixture of two liquids uniformly dispersed throughout each other
Semi solid form
Ointment: Preparation made for external use usually containing one or more drugs
Paste: Thick and stiff preparation absorbed through skin more slowly than ointment
Cream: A non greasy semi solid preparation used onto the skin
10.3- Characteristics of drugs
Dosage
A dose is the amount of drug administered at one time. The minimum dose is the least
quantity of the drug that will produce an effect in the body. The maximum dose is the highest
quantity of the drug that can be administered at one time without producing harm to the body.
Lethal dose is larger than the maximum dose which will have poisonous effect on the patient.
Factors influencing drug dosage:
1. Age: Infants. Children and the old require smaller dosage of a drug
2. Weight: A person of overweight requires a larger dose than the usual one. A person with
underweight requires a smaller dose.
3. Sex: Male require large dose than females.
4. Physical condition
5. Cumulative action of the drugs: The frequency and dose of a drug administration
depends upon the rate of excretion from the body .
6. Tolerance of the patient
7. Habituation to a drug, lead to physical craving and definite organic symptoms. e.g. use
of sleeping pills
8. Route of administration: drugs given by IV route have a very quick and immediate
action than oral and rectal route
Effects of drugs administration
Therapeutic effects:
It is the effect which is desired for the reason a drug is prescribed. The drugs are administered
for the following purposes:
1. To promote health: drugs are given to the individuals to increase the resistance against
disease e.g. vitamins
2. To prevent disease: e.g. vaccines, antitoxins
3. To diagnose disease: e.g. barium is used in the x-ray studies
4. To alleviate disease: certain drugs are given for the palliative effect or for the
temporary relief of distressing symptoms, but does not remove the cause or cure the
disease, e.g. analgesic
5. To treat or cure a disease:
Local and systemic effects:

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Local effects of a drug are expected when they are applied topically to the skin or mucus
membrane. A drug used for systemic effect must be absorbed into the blood stream to
produce the desired effect in the various systems and parts of the body.
Toxic effects
High levels of the drugs in the blood stream produce toxic effects. Cumulative effect occurs
when a person is unable to metabolize the previous dose of the drug. Some of the toxic
effects are fatal for the patient.
Synergistic effect
Synergistic effect occurs when a combination of medications is given. In synergistic effect,
the combined effect of two or more drugs is different from the effect of each drug when taken
alone. e.g. alcohol and barbiturates are potentially lethal
Effects on the blood dyscariasis
Aplastic anaemia: Failure Bone marrow functions .Thrombocytopenia: it is characterized by
purpura, petechiae, melena, epistaxis, haematuria Granulocytosis, leukopenia: it is
characterized by chills, fever, sore, throat, cough, malaise and lesions in the mouth.
Effects on the nervous system
1. Abnormal involuntary movements: tremor, chorea, dystonia,.
2. Stimulations of the central nervous system: these are characterized by anxiety,
nervousness, insomnia, headache, double vision and convulsions etc.
3. Depression of the central nervous system: it is characterized by dizziness, vertigo,
drowsiness, fatigue and ataxia.

Effects on the gastro-intestinal system

Irritation of the gastric mucosa: this is characterized by nausea, vomiting, anorexia. This can
be prevented to some extent by not giving the drug in an empty stomach. Give the drug with
or after the meals or it should be given along with one glass of milk or an antacid. These
drugs are contraindicated if the patient has a history of peptic ulcer.

Side effects of drug administration

The various side effects observed due to the administration of drugs, their signs and
symptoms:
Allergic reactions: A patient can react to a drug as a foreign body and thus develop symptoms
of allergic reaction. Allergic reaction can be either mild or severe. A severe allergic reaction
usually occurs immediately after the administration of the drug, it is called anaphylactic
reaction. A mild reaction has a variety of symptoms from skin rashes to diarrhoea.
1. Skin rashes : oedematous pinkish elevations (rash) with itching may occur due to the
reaction of a drug
2. Angio oedema: oedema due to increased permeability of the blood capillaries.
3. Rhinitis: excessive watery discharge from the nose
4. Lachrymal tearing: excessive tears from the eyes
5. Nausea and vomiting: due to stimulation of the centres in the brain
6. Diarrhoea: irritation of the mucosa of the intestines.
7. Shortness of breath and wheezing due to laryngeal oedema.
10.4- Abbreviations used in medication
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The MPHW (F) is able to understand the abbreviation and symbols meaning while
administering medicine to a patient
ABREVIATIONS –used for time of ABREVIATIONS –used for amount of
drug administration drug administration
Abbreviation Meaning Abbreviation Meaning

a.c. before meals c with

p.c. after meals cc cubic centimeter
a.m. before noon gr grain
p.m. afternoon gtt a drop
o.m. every morning M Minim
o.d. once a day kg Kilogram
s.o.s if there is needed O a pint
b.i.d twice a day mg milligram
t.i.d three times a day OZ Ounce
q.i.d four times a day Cm centimeter
stat immediately g gram
h hour ml milliliter
Q4H Every four hours lb Pound
Q6H Every six hours gal gallon
Q8H Every eight hours tsp teaspoon
H.S At bed time dr dram

Weight and measures

unit approximate values unit approximate values
1Dram 60 Minims 1pound 480grams
60grains 12ounces
4grams
4ml1teaspoonful
1 Ounce 30 grams 1kg 1000 grams
8teaspoonful 2.2 lbs
450 grains
25ml
1Liter 1000ml 1tsp 4-5ml
40ounzes 60drops
2pints
1 grain 60mgm 1Tablespoon 4drams
3tsp
15ml
1cc 1ml 1teacupful 6ounces
15minims 150ml
1minim 1drop 1glassful 8ounces

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200ml
1ml 15drops 1meter 100cm
1000mm
1.1yard
39.4 inches
5ml 1tsp 1cm 10mm
15ml 1tbsp 1Km 1000meter
0.6mile
1pint 16 ounces 1mile 1.6km
500ml

10.5- Administration of drugs-policies and regulations as per protocol

There are three agencies to regulate drug administration

Advisory agency –It includes drug technical advisory board (DTAB) and Drug consultative
committee. DTAB modifies rules regarding drugs
Analytical agency: It includes Central drug Laboratory (Kolkata) and drug laboratories in
respective states. These laboratories test and analyse the samples of drugs and cosmetics.
Executive agency: Authorities, which grant licence to various organizations for
manufacturing, storing, recapping, selling, importing and exporting drugs.
Indian Pharmacopeia (IP)
Manufacturing, sale, import, and export are controlled by the Government. The central drug
authority, Indian Pharmacopeia (IP) is based in Nirman Bhawan, New Delhi. The drug
authorities of state are mostly in their capitals. Central drug authorities formulate the policy
and peripheral authorities implement these policies.
Drugs are essential for health of human beings. The well qualified person with specialized
knowledge and skill required for dealing and handling the drugs. The are certain drug laws
for abiding rules and regulations.
The Opium act-1878 it deals with manufacture , possession, transport, import and export and
sale of opium.
The Poisonous act-1919 it controls the possession, import and sale of poisons.
The Dangerous drug act-1930 It is to control operations related allopathic drugs only.
The Pharmacy act-1948 It is passed for better regulation of the pharmacy profession
The medicinal and Toilet preparation act-1955 the manufacturer of spirit containing
preparations required needs special licence.
The narcotic drugs and psychotropic substance act-1985The act totally prohibits the
cultivation, manufacture, sale, purchase, use or transport of all narcotic and psychotropic
drugs.
Drug order (Price control)- 1995 Under the essential commodities act, this order was
passed so that the Government may control over the price of bulk drugs and drug
formulations.
10.6- Classification of drugs
Classification of drugs by action

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▪ Analgesic: These drugs are used to relieve pain

▪ Anaesthetics: These drugs are used to cause loss of sensation
▪ Antacids: These drugs are used to reduce gastric acidity
▪ Anti-anxiety: These drugs are used to treat anxiety disorders.
▪ Anti-emetics: These drugs are used to control vomiting
▪ Anticoagulants: These drugs are used to prevent blood clotting
▪ Anticonvulsants: Theses drugs are used to control convulsions or seizures
▪ Antidepressants: These drugs are used to treat depressive disorders.
▪ Antidiarrheals: These drugs are used to control diarrhoea
▪ Antihelmintics: These drugs are used to destroy and expel intestinal worms
▪ Antihistamines: These drugs are used to compete with histamines for its receptors site
and to overcome allergic reactions
▪ Antihypertensive: These drugs are used to control hypertension.
▪ Antimicrobial: These drugs are used to treat infections diseases
▪ Anti neoplastics: These drugs are used to interfere with cell reproduction or
replication at some point in cell cycle to reduce the production of tumour cells.
▪ Antipyretics: These drugs are used to relieve or reduce fever
▪ Antispasmodics: These drugs are used to relieve spasm of involuntary muscle.
▪ Antiseptics: These are chemicals used to destroy bacteria.
▪ Anti tussive: These drugs are used to suppress cough.
▪ Carminatives: These drugs are used to cause expulsion of gas from the stomach and
intestines.
▪ Diaphoretics: These drugs are used to induce perspiration
▪ Diuretics: these drugs are used to increase the flow and frequency of urination
▪ Expectorants: These drugs are used to increase bronchial secretions and their
expulsion
▪ Laxatives: These drugs are used to stimulate bowel movement but not accompanied
by cramping
▪ Mucolytics: Mucolytics are respiratory drugs that dissolve mucus in the respiratory
tract.
▪ Muscle relaxants: A skeletal muscle relaxant may be defined as an agent that reduces
skeletal muscle tone
▪ Mydriatics: These drugs are used to dilate the pupils of the eyes.
▪ Myotics: These drugs are used to contract the pupils of the eyes.
▪ Oxytocics: These drugs are used to stimulate uterine contractions
▪ Purgatives: These drugs are used to stimulate bowel movement but accompanied by
cramping.
▪ Sedatives: These drugs are used to lessen the body activity.
▪ Tonics: These drugs are used to increase appetite and promote digestion.
▪
10.7- Routes of administration
There are various routes through which a drug can be administered. There are two factors
determine the choice of routes of administration i.e. drug form and patient desire
Classification of routes of drug administration
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1. Enteral
2. Parenteral
3. Local
Enteral/Oral route
This route involves the oral ingestion of the drug and act as the safest route of drug
administration.
Advantages
o Safest and non-invasive consumption of medicine
o Convenient and efficient route
o Able to take medicine self
Disadvantages
o Slower onset of action
o Irritant and unpleasant drugs cannot be administered
o Certain drugs may not be absorbed effectively
o Can cause nausea and vomiting
o Gastric juice may destroy some drug e.g. Insulin
o Not used in case of uncooperative person and unconscious person
o drugs which are coated with substances e.g. Cellulose acetate are not digested by
gastric juice but break down in alkaline juice of the intestine. It helps to prevent
gastric irritation and provide maximum level of the drug in the small intestine for the
treatment.
Parenteral Route
The drugs are administered other than oral route is known as parenteral route. The drug is
administered to the muscle, mucosa, blood or skin. Sum of the parenteral route drug
administration are:
1. Injection
2. Trans Mucosal
3. Trans Dermal
4. Inhalation.
Advantages
1. Rapid and predictable action
2. It can be used for unconscious and un-cooperative patient
3. It prevents gastric irritation
4. Highly beneficial in emergencies
Disadvantages
1. It requires a septic technique for administration
2. It cause pain
3. It is expensive & inconvenient
4. It cause injury to nerves and other tissues
Injection
The medicine is given through syringe into the muscle, vein or artery are known as
injectables. It is classified as

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1. Intra muscular injection- The solution is administered into the large muscle. The
common sites of IM Injection is : Deltoid muscle, Gluteus muscle, vastus lateralise
muscle.
2. Intra Venus- The drug is injected into the vein of the body and the drug reaches the
circulation directly. It is useful for giving bolus amount of solution. The infusion
should be given very slow as per requirement.
3. Subcutaneous- The medicine is administered into the subcutaneous tissue are areola
tissue i.e; below the dermis layer. The absorption of drug is slow as well as largely
uniform which makes it long acting. E.g. Insulin Injection
4. Intra Dermal- The drug is administered into the dermis layer. The route is commonly
used for BCG vaccination and test dose for hyper sensitivity.
5. Intra Arterial – The drug is directly injected into the arteries and use in the treatment
of peripheral vascular disease and diagnostic studies like angiography
6. Intra- thecal (Intra Spinal)- The drug is administered into the sub arachnoids space of
the spinal cord for the action the central nervous system. E.g.: Spinal anaesthesia.
7. Intra Osseous – The drug is directly injected into the joint for the treatment of
arthritis.
8. Intra Peritoneal- The drug is directly injected into the peritoneum. The peritoneum has
the large surface area for absorption. It is used for peritoneal dialysis
9. Intra Medullary- The drug is injected into the bone marrow
10. Transfusion- Administration of whole blood or plasma into the vein or artery to
supply actual volume of blood or to introduce constituents as clotting factors which is
less in the patient due to loss. Transfusion is done according to the requirement of the
patient
Trans mucosal
The drug is observed through the mucus membrane. Trans mucosal administration includes
1. sublingual
2. rectal
3. nasal
Sublingual
The drug contained by a tablet is placed under the tongue. The drug is dissolved and absorbed
across the sublingual mucosa. Eg: Nitro glycerine. It can cause buckle ulceration
Advantage
1. Rapid absorption
2. Reaches circulation within minutes
3. Helps in avoiding first pass metabolism
Rectal route
Rectum has a rich blood supply. The drugs gets absorbed and produce local and systemic
effect. E.g. Indomethacin, paracetamol, Diazepam & suppositories used as laxatives.
Gastric irritation can be avoided. It is beneficial for patient with vomiting and swallowing
difficulty.
Nasal Route
The drug administration can be used for systemic as well as local effect e.g. : Decongestant
nasal drop for reducing nasal congestion.
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Trans dermal
The drugs which are high lipid soluble can be applied to the skin for slow and prolonged
absorption to achieve systemic effect. E.g. Nitro glycerine ointment in angina pectoris.
Inunctions applying Vicks or pain balms on the skin for pain relief

Adhesive unit- Trans dermal patches used for systemic effect to reduce pain or for
vasodilatation E.g. Hyosine, nitro glycerine, fentanyl, estrogens. The patches usually applied
on chest, abdomen, upper arm, back or mastoid region.
Jet Injection- It causes absorption of drug occurs the layers of skin
Implantation- Putting the solid drug under the skin to achieve the systemic effect E.g.: Nor
plant used for birth spacing .
Inhalation- The volatile liquids and gases given through the special mask or apparatus into
the nose in the form of vaporization and it causes general anaesthesia. The solution of the
drug particles and the fine droplets are inhaled in the form of aerosol. E.g. Salbutomol Drug
inhalation for wheezing.
Advantage
1. Rapid absorption
2. More effective and less harmful in case of pulmonary disease
3. hepatic first pass metabolism is avoided
4. Conveniently controlled blood level of volatile anaesthesia. As their absorption and
excretion is through the lungs are governed by the law of gases
Disadvantage
1. The irritant gas may enhance the production of pulmonary secretion
2. It requires technical skill for administration

10.8- Rights of drug administration

The rights of drug administration ensures safety while giving medicines to the patient
Right patient-Read and check the name on the patient case sheet and medicine card
Right drug- Perform a three times check of the medication’s label
✓ When retrieving the medication.
✓ When preparing the medication.
✓ Before administering medication to patient.
✓ Always check the medication label with the physician’s orders.
✓ Never administer medication prepared by another person
✓ Never administer medication that is not labelled
Right dose Check the medication sheet and the doctor’s order before medicating. Be aware
of the difference of an adult and a paediatric dose.
✓ Check label for medication concentration.
✓ Compare prepared dose with medication order.
✓ Triple all medication calculations.
✓ Check all medication calculations with another nurse.
✓ Verify that dosage is within appropriate dose range for patient and medication.

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Right time- Check the order for when it would be given and when was the last time it was
given.
✓ Verify schedule of medication with order.
✓ Date
✓ Time
✓ Specified period of time
✓ Administer medication within 30 minutes of schedule.
Right route- Verify medication route with medication order before administering. Check the
order if it’s oral, IV, SQ, IM, etc.
Right documentation- Check the order for when it would be given and when was the last
time it was given. Never document before medication is administered

Right to educate the patient: Provide enough knowledge to the patient of what drug he/she
would be taking and what are the expected therapeutic and side effects.
Right assessment- Properly assesses patient and tests to determine if medication is safe and
appropriate.
✓ If deemed unsafe or inappropriate, notify ordering physician and document
notification.
✓ Document that medication was not administered and the reason that dose was
skipped.
Right evaluation- Review any medications previously given or the diet of the patient that
can yield a bad interaction to the drug to be given. Check also the expiry date of the
medication being given.
✓ Assess patient for any adverse side effects.
✓ Assess patient for effectiveness of medication.
✓ Compare patient’s prior status with post medication status.
✓ Document patient’s response to medication
Right reason Know why the medication is being ordered. Know patient’s history and why
are he/she taking this medication?
Right to refuse- Give the client enough autonomy to refuse to the medication after
thoroughly explaining the effects.
✓ The legally responsible party (patient, parent, family member, guardian, etc.) for
patient’s care has the right to refuse any medication.
✓ Document refusal of medication and that responsible party understands consequences.

Right principle of care-All safety measures should carry out while administering the
medication.
Right prescription: Check correct drug prescribed to the patient by the physician or not.

Right nurse clinician Be sure to document your monitoring of the patient and any other
nursing interventions that are correctly carried out by the nurse at right time.

10.9- Principles of safety measures

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There are some Principles of safety measures helps the nursing personnel to protect
themselves from legal issues as well as to maintain the patient safety. They are
✓ Be vigilant when preparing medications.
✓ Check for allergies.
✓ Use two patient identifiers at all times.
✓ Assessment comes before medication administration.
✓ Be diligent in all medication calculations.
✓ Avoid reliance on memory; use checklists .
✓ Communicate with your patient before and after administration.
✓ Avoid workarounds.
✓ Ensure medication has not expired.
✓ Always clarify an order or procedure that is unclear.
✓ Use available technology to administer medications.
✓ Report all near misses, errors, and adverse reactions.
✓ Be alert to error-prone situations and high-alert medications.
✓ If a patient questions or expresses concern about a medication, stop and do not
administer it.

10.10- Role of MPHW (F) in the administration of drug

The multipurpose heath worker should follow the principles and the very much care to be
taken to prevent medication error. Some of the steps for safe medication administration as
follow.

• Plan medication administration to avoid disruption:

o Dispense medication in a quiet area.
o Avoid conversation with others.
• Prepare medications for ONE patient at a time.
• Follow the SEVEN RIGHTS of medication preparation
• Check that the medication has not expired.
• Perform hand hygiene.
• Confirm patient ID using two patient identifiers (e.g., name and date of birth)
• Check against MAR.
• Check allergy band for any allergies, and ask patient about type and severity of
reaction.
• Complete necessary focused assessments, lab values, and/or vital signs, and document
on MAR.
• Provide patient education as necessary.
• If a patient questions or expresses concern regarding a medication, stop and do not
administer.

Procedure of drug administration

1. Check Medication chart against doctor’s orders and with patient wristband. Check that
Medication chart and doctor’s . Orders are consistent

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2. Perform the SEVEN RIGHTS

o The right patient o The right time
o The right medication (drug) o The right reason
o The right dose o The right documentation
o The right route
3. The label on the medication must be checked for name, dose, and route, and compared
with the Medical Administration Record at three different times:
o When the medication is taken out of the drawer
o When the medication is being poured
o When the medication is being put away/or at bedside
If taking the drug to the bedside (e.g., eye drops), do a third check at the bedside.
4. Circle medication when poured. NEVER document that you have given a medication
until you have actually administered it.

5. Positioning:
o Position patient appropriately for medication administration.
o Ensure proper body mechanics for health care provider.
o Position patient safely and appropriately once medication is administered
6. Post-medication safety check:
o Complete post assessment and check vital signs
o Sign Medication chart; place in the appropriate chart.
o Perform hand hygiene, This step prevents the transfer of microorganisms

Conclusion

From olden days to till now illness is common among the human being, which needs to cure
by drugs. The drugs are used based on the system of medicine according to the condition of
the patient. The drugs may be administered oral, injection form or through nasal. The drug
handler should have the knowledge of use and its side effects. Using medication without
proper knowledge is harmful to the patient. So the MPHW (F) should have adequate
knowledge of drug and its route of administration. It helps the patient to feel comfort and
enhance early recovery.

Essay Question

1. Describe the different systems of medicine

2. What are the medical regulations and describe it
3. Describe about the rights of medication
4. What are the principles of safe administration of medication

Short Answer Question

1. Write abbreviation for AYUSH

2. Write the advantage of oral drug administration

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3. List the forms of drug classification

4. What is antihelmentics?
5. What is antipyretic?
6. List the types of parenteral route of drug administration

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UNIT-XI EMERGENCY DRUGS IN O.T.AND OTHER AREAS

Structure
–Introduction
–Drugs used in O.T.
–I.V fluids, injections
–Ante rabies vaccine
–Ante snake venom
OBJECTIVES
After completion of this chapter , the students are able to
➢ List the drugs used in the operation theatre
➢ Describe the I.V. fluids and its uses
➢ Learn the some emergency drugs functions and its uses
➢ Describe vaccine and ante snake venom for animal bites

Introduction
Emergency care requires the finest skills to handle the patient and save his life. From the
initial management to making the quick diagnosis, everything is done carefully to achieve the
best outcomes. However, one must know the drugs used in emergency to treat and stabilize
the patient as early as possible. Following is the list of commonly used emergency medicines
in Casualty in India.

Emergency drugs used in O.T and other critical care units.

Emergency drugs are those chemical entities used in patients during life threatening
conditions so that the symptoms can be controlled and life can be saved.
The concept of GOLDEN HOUR In emergency medicine, the golden hour (also- known as
golden time) refers to a time period lasting for one hour, or less, following traumatic injury
being sustained by a casualty or medical emergency, during which there is the highest
likelihood that prompt medical treatment will prevent death
Purpose
To provide initial treatment for broad spectrum of illness and injuries, most of which are
life threatening.
✓ To save life of patient.
✓ To control symptoms of patient.
✓ To reach the site of action as soon as possible
✓ To normalize he vital body functions.
✓ To diverge the patient from possible risk.
The drug which is used for life saving is called emergency drugs. They are
Atropine, Adrenaline, Deriphilline, Decadran, Lasix, Sodium Bi Carbonate, Potassium
Chloride, Calcium Gluconate, Nitro Glycerine, Avil, Aminophilline and 2% Xylocord.

OXYGEN: Without O2 brain death occurs within 6 minutes. O2 saturation is measured

using pulse oximeter. O2 is required in emergency condition like severe physiological stress,
Shock, Traumatic injury, Acute myocardial infarction, Cardiac arrest.

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CARDIAC ARREST: Cardiac arrest is a sudden stop in effective blood flow due to the
failure of the heart to contract effectively. Defibrillation is the most prompt treatment.

Adrenaline Dose: 1 mg i.v. bolus (1 ml of 1:1000) Adrenaline concentrates the blood around
the vital organs, specifically the brain and the heart, by peripheral vasoconstriction.
Adrenaline also strengthens cardiac contractions as it stimulates the cardiac muscle.
Amiodarone and Lidocaine are given to control arrhythmias.

ASTHMA: Asthma is chronic inflammatory disease of the airways of the lungs Status
Asthmatics is an emergency condition where asthma attack is not relieved by relievers (
Bronchodilators)

Salbutamol is beta-2 agonist and causes bronchial smooth muscle relaxation. 100 – 200
microgram/puff. Such 2 puffs are inhaled through meter dose inhaler in case of breathlessness
with the help of spacer.

Hydrocortison hemisuccinate Dose: 200 mg given i.v immediately. Steroids improve

airway, reduce asthma exacerbation. They also improve response of airway smooth muscle to
beta2 agonist and reduce refractoriness to them.

Aminophylline 250mg/10ml ampoule to be dissolved in 20 ml of 5% glucose and is given

i.v. slowly. It causes smooth muscle relaxation.

Anticonvulsants: Midazolam Injection 1 mg/ml; administered into the buccal cavity between
the gum and cheeks by syringe or intravenous for controlling the convulsions

Diazepam 5 mg intravenous bolus and repeat every 2 minutes to a maximum dose of 20 mg

for convulsions

Injection Phenytoin 15 mg/kg via intravenous infusion over 20 minutes followed by

maintenance dose for seizures.
Atropine: It is a alkaloid and antagonist of acetylcholine. It is used in pre anaesthetic
medication to inhibit the body secretions like trachea bronchial secretions. It is an antidote for
insecticide poisoning
Dose: 0.5 mg IM
Side effect: dry mouth, flushing, dry skin, constipation, difficulty in swallowing, headache

Adrenaline: This medication is used in emergencies to treat very serious allergic reactions to
insect stings/bites, foods, drugs, or other substances. Epinephrine acts quickly to improve
breathing, stimulate the heart, raise a dropping blood pressure, reverse hives, and reduce
swelling of the face, lips, and throat.
Side effect: Fast/poundingheartbeat,nervousness, sweating, nausea, vomiting, trouble
breathing, headache, dizziness, anxiety, shakiness, or pale skin may occur.

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Decadran: It is selective glucocorticoid. It is used in acute conditions like shock, adrenal

crisis, acute asthma and cerebral oedema
Dose: 4-10 mg
Side effect: Prolonged usage lead to Cushing syndrome, i.e. obesity, moon face , narrow
mouth , supra claviclular hump, fragile skin.
Deriphilline: It is the xanthenes derivative and smooth muscle relaxants and increases the
force of diaphragmatic contraction and improving asthmatic conditions and copd
Dose: 15-20 mg /kg /day
Side effects: cardia arrhythmias, anorexia, nausea, tremors and CNS excitation
Avil / Chlorphenaramine: It is an anti histamine and inhibit the enzyme activity of histidine
decarboxylase catalysing the transformation of histidine into histamine. It is commonly used
for relief of allergies a running nose and watery eyes, swelling and vaso dilation
Side effects: Drowsiness, blurred vision, constipation, dry mouth, dizziness, confusion and
difficulty in passing urine.
Xylocard 2 % Injection : It is an effective numbing medicine used before surgical
procedures. It blocks nerve signals from a specific part of the body and is categorized as a
local anaesthetic medicine. It is also used to treat arrhythmia characterized by an improper
beating of the heart.
Side effect: Flushing or redness of skin, Injection site bruising and red coloration, Nausea or
Vomiting, Cracked or scaly skin, Fast heartbeat, Difficulty in breathing, Join pain and
swelling

FUROSEMIDE
It is the loop diuretic used for acute pulmonary edema due to left ventricular dysfunction or
hypertensive crisis.The action of diuresis may start within 20 minutes
Side effects: hypotension, dehydration and electrolyte imbalances and allergic reaction
Calcium chloride: It Increases cardiac contractile state. It is used for Hypocalcemia,
hyperkalemia, and hypermagnesemia; Side effect: Syncope, cardiac arrest, dysrhythmia,
bradycardia

Calcium gluconate: It Counteracts the toxicity of hyperkalemia It is for Hyperkalemia,

hypocalcemia; Side effects: Syncope, cardiac arrest, dysarrhythmia, bradycardia
Magnesium sulphate: It reduces striated muscle contractions.It is used for Seizures of
eclampsia, torsades de pointes, hypomagnesaemia ; Side effect: Drowsiness, CNS depression,
respiratory depression
Nitro glycerine: It is the Smooth muscle relaxant, acting on vasculature, bronchial, uterine,
intestinal smooth muscle. It is used in Acute angina pectoris, ischemic chest pain; Side effect:
Headache, dizziness, weakness, reflex tachycardia
Sodium bi carbonate:It Buffers metabolic acidosis and lactic acid buildup. It is used for
metabolic acidosis during cardiac arrest, tricyclic antidepressant, aspirin; Side effect:
Hypernatremia, metabolic alkalosis, tissue sloughing and cellulites

Drugs used in operation theatre/ Anaesthetic drugs

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Halothane: It is used for general anaesthesia for doing surgery; Dose 2-4% in air,
oxygen/nitrous oxide ,maintain at 0.5-1.5%
Theopentone sodium
It is used for induction of anaesthesia and rapid control of convulsions like status epileptics
Dose: 100-150 mg for adult and 3- 7 mg/kg body weight for children.
Side effect: cardiac arrhythmias, prolonged somnolence, sneezing, coughing and laryngeal
spasm
Ketamine: It produces feeling of dissociation from ones own body and
surroundings(analgesia, immobility, amnesia with light sleep)
Dose: 2mg/kg body weight
Side effect: illusion, hallucination and nystagmus, nausea, vomiting, hypotension and
tachycardia
Pancuronium
It is a synthetic steroidal compound with little ganglionic blockade and good cardiovascular
stability. It is used for skeletal muscle relaxation in general anaesthesia.Dose: 40-10 mcg per
kg body weight
Side effect: flushing, bronco spasm and arrhythmias
Atracurium:
The main action of this drug is inactivation in plasma by spontaneous non-enzymatic
degradation; in addition to that by cholinesterase. The duration of action is 30-60 mins. It is
also the muscle relaxant used during general anaesthesia.Dose: 0.4-0.5 mg/kg body weight
Side effect: Hypersensitivity, bronco spasm, hypotension and flushing
Succinycholine: It is an ultra short acting depolarising agent. It induces rapid complete and
predictable paralysis within 1 minute and has spontaneous recovery in 5 minutes. It is also
skeletal muscle relaxants used during general anaesthesia.
Dose: 0.3-1.1 mg/ kg
Side effect: Prolonged apnoea, nausea, nervousness, respiratory depression, increased intra
cranial pressure, tachycardia hypertension, hyper kalemia

I.V fluids, injections

Injections
An injection is an infusion method of putting fluid into the body , usually with a hallow
needle and syringe, which is pierced through the skin to a sufficient depth for the material to
be forced into the body.An injection follows a parenteral route of administration that is
,administered through other than digestive tract.( see the unit 10)
fluids
The aim of infusing the fluid in the body is to correct or prevent fluid and electrolyte
imbalance and to deliver medication and blood products.
Equipments required for I.V. infusion
Intra venous catheter
I.V. set
Hanger
Adhesive tape

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Micro drip set

Infusion pump
Substances that may be infused intravenously include volume expanders, blood products
medications and nutrients. Volume expanders has mainly classified into Two types i.e.
crystalloids and colloids.
Colloids are intravenous solutions that contain large form of protein or similarly other form
of molecules. e.g. Plasma Protein Fraction , Dextran and Hestastarch.
Crystalloids solutions are the primary fluid used for pre hospital Intra venous fluid therapy. It
contains electrolytes e.g. sodium, potassium, calcium, chloride .crystalloids come in many
preparations and are classified according to their tonicity .They are Isotonic, hypotonic and
hypertonic

Isotonic fluids
Isotonic: Equal concentration of a solution
The cell has the same concentration in normal conditions the cell’s intracellular and
extracellular is both isotonic. Isotonic solutions are used to increase the extracellular fluid
volume due to blood loss, surgery and dehydration.
Isotonic fluids
0.9% Saline
5% Dextrose in 0.225% saline (D5W1/4NS)
• Lactated Ringer’s
Hypotonic fluids
Hypo Tonic: under concentration of a solution
The cell has a low amount of solute in extracellular and it wants to shift inside the cell to get
everything back to normal via osmosis. This will cause cell swelling which can cause the cell
to lyses. Hypotonic solutions are used when the cell is dehydrated and fluids need to be put
back intracellular chamber. e.g. diabetic ketoacidosis (DKA) or hyperosmolar, hyper
glycaemia.
Hypotonic fluids
0.45% Saline (1/2 NS)
0.225% Saline (1/4 NS)
0.33% saline (1/3 NS)

Hypertonic fluids
Hyper Tonic: excessive concentration of a solution
The cell has an excessive amount of solute extracellular and osmosis is causing water to rush
out of the cell i.e. intracellular to the extracellular area which will cause the cell to shrink.
3% Saline
5% Saline
10% Dextrose in Water (D10W)
5% Dextrose in 0.9% Saline
5% Dextrose in 0.45% saline
• 5% Dextrose in Lactated Ringer’s

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Ante rabies vaccine

Rabies is a serious disease caused by a virus. Rabies occurs mainly in animals, but a human
can get rabies after being bitten by an infected animal. There may be no symptoms at first,
but weeks or even months later rabies can cause pain, headaches, tiredness, irritability, fever,
hallucinations, seizures, and paralysis.
Rabies human diploid cell vaccine is used to protect people who have been bitten by animals
(post-exposure) or otherwise may be exposed to the rabies virus (pre-exposure).
This vaccine works by exposing a small dose of the virus, which causes the body to develop
immunity to the disease. Assess the following before giving Anti rabies vaccine
✓ a weak immune system
✓ any type of infection or severe illness; or
✓ an allergy to neomycin.
Vaccine-Anti rabies vaccine; Dose- 1ml; Route-Intra muscular
Pre-Exposure Prophylaxis:
Primary vaccination: 3 doses, 1 ml each, IM, on days 0(first shot), 7 days after the first,
followed by a third shot 21 or 28days (i.e. 2 or 3 weeks later).
Booster vaccination: 1 dose, 1 ml, IM
Post-Exposure:
Previously unvaccinated: 5 doses, 1 ml each, IM, on days 0, 3, 7, 14, and 28
Previously vaccinated, known antibodies: 2 doses, 1 mL each, IM, on days 0 and 3
Common side effects of vaccine:
• pain, swelling, itching, or redness where the shot was given;
• headache;
• dizziness;
• muscle pain
• nausea, stomach pain
• Serious side effects are a very high fever; vomiting, skin rash, joint pain, general ill
feeling; problems with balance or eye movement, trouble in speaking or swallowing..
Note:
✓ Do not interrupt or discontinue because of local or mild systemic reactions; these can
usually be managed with anti-inflammatory, antihistamines, and anti-pyretic drugs.
✓ In people at high risk of exposure, periodically check titres to determine the need for a
booster dose.
✓ For lab workers/vaccine makers who work with live virus, check titres every 6
months; for other high exposure patients (veterinarians, animal control, cavers, etc.)
check every 2 years.
✓ Administer post-exposure doses immediately after exposure.
✓ Rabies immune globulin may be given on day zero with the first post-exposure dose

Ante snake venom

Anti-Snake Venom
Snake ant-venom is a kind of therapeutic serum which constitutes A purified fraction of

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immunoglobulin or immunoglobulin fragments fractionated from the plasma of animals that

have been immunized against a snake venom or a snake venom mixture.
Anti snake venom acts to neutralize the poisonous venom .Thus, the receptor sites that were
previously blocked by venom are now free to interact with the acetylcholine molecule and
normal respiration resumes.
Indication As per WHO guideline ASV should be administered in the following conditions
✓ evidence of coagulopathy
✓ systemic bleeding
✓ Neuro toxicity like ptosis and opthalmoplegia
1 ml of ASV neutralises
✓ cobra-0.6mg
✓ commonkrait-0.45mg
✓ Russel viper-0.6mg
✓ saw scaled viper-0.45mg
• Initial dose of 100ml of normal saline and given over one hour;
• ASV should introduce 2ml/min rate as slow intravenous (IV) injection.
• ASV should introduce continuous 1 hour in same rate
Patient should be keep in monitoring for 2 hours after ASV injection.
• ASV should not be administered locally at the biting site.
side-effects : Rash ,Itching ,Wheezing , Rapid heart rate ,Fever , Body aches
Contraindications- Hypersensitivity

Conclusion

The MPHW (F) are required to know the names, mechanism of action, and side effects,
routes of administration, dose, and specific administration considerations for many
emergency medications and intravenous fluids. When administering certain medications
would be harmful to the patient, it is critically important they develop a solid understanding
of the information in this chapter and stay up to date on the latest pharmacologic information.
Essay questions
1. Explain about anti rabies vaccine
2. Describe about I.V. fluids
Short answer questions
1. List name of the emergency drugs
2. List the name of drugs used in operation theatre
3. What is the action of Avil?
4. What is the action of salbutamol?
5. What is action of atropine?

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PART – D
UNIT-12 FIRST AID AND REFERRAL

Structure
- Introduction
- Principles of first aid
- First aid kit and supplies
- Bandages and types
- Principles and methods of Bandaging

Objectives
All the end of this chapter reading the students are able to
➢ Follow the principles of first aid
➢ Prepare first aid kit
➢ Learn and improve skill of bandaging
➢ List the principles of Bandages
Introduction
A sudden or unexpected illness or injury is initially cased by individual is known as
firs aid. It is commonly required during accidents in the road, fire accidents and medical
problems like shock and heart attack according to the seriousness of the causality, the person
is transferred to the hospital through ambulance. (e.g. 108 services, ambulance services).
Definition
First aid is the immediate care providing to the victim by non expert of an accident or
sudden illness.
Aims of first aid
• To preserve life
• To promote recovery
• To prevent further injury / harm
Principles of first aid
The general principles of first aid are to
• Remove the causality immediately from the accident area.
• Rescue the victim of early as possible
• Without aggravating existing health situation.
• Confirmed to necessary people only
• Control bleeding immediately
• Restore respiration and circulation of causality
• Give immediate treatment to shock and prevent impending shock.
• Immovable fracture part of casualty
• Give me assurance
• Do first things first
• Don’t allow crowd around the causality
• Call ambulance to shift the victim to the referral centre / hospital.

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Symbol
It is the ISO first aid symbol It is the symbol of red cross

12.3-First aid Kit

A kit which consists of supplies and equipment for giving initial care to the victim is
called as first aid kit.
First aid kit consist of

The medicine chest or first-aid kit should be kept well stocked and should be restocked every
6 months. The following basic supplies are useful to have on hand:

Activated charcoal (call the poison control centre before using)

Adhesive tape
Antihistamine for allergic reactions
Antibiotic ointment (such as bacitracin)
Antiseptic solution or towelettes
Acetaminophen or ibuprofen
Bandage adhesive strips in various sizes and shapes
• Bandages – with all sizes
Gause pad
Sterile dressings
Sterile eye pad
Anti septic ointment, neomycin and polymyxin is
Beta dine solution
Gloves, surgical mastic, apron
Syringe with needle
Splints
Cold pack or ice bag
Compression (elastic) bandage for sprains and strains
Cotton balls and cotton-tipped swabs
Eye wash (sterile)
First-aid manual
Gauze bandages in a roll, 2 or 3 inches (5 or 7 centimetres) wide
Gauze pads in various sizes to stop bleeding and cover wounds
Gloves (latex or nitrile)
Hand sanitizer
Hydrocortisone cream for insect bites and stings
Loperamide in case of diarrhoea (call a doctor before taking)
Pen light or flashlight with extra batteries
Petroleum jelly
Plastic bags for the disposal of potentially contaminated material
Rehydration solution (call a doctor before taking)

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Sharp scissors
Soap
Thermometer
Tissues
Tweezers

General rules
When ever, we come cross the emergency situation like accidents, burns etc. We need
to
• use our common sense to save the life of victim
• know our limitations
• do not attempt to do too much
1. Assess the situation :-
As soon as enter into the incident place, make execute assessment of the situation and
decide on priorities of action.
• Assess whether causality are in any danger and any source helps in surroundings
2. Safety: The first aider must minimize the risk of danger to him against any further
causalities arising for example road accidents and petrol spillage – switch off the ignition
of the vehicles concerned.
3. Determine the priorities i.e. air way clearance breathing pattern and circulation – check
anyway is open and check pulse for circulation.
4. Getting help from others in emergency.
By standards can be extremely useful and may be able to assist with treatment. i.e.
supporting badly injured part; control traffic crowds.
5. Calling for emergency service for assistance :e.g. Ambulance ,Police and Fire brigade .
The following information to be passed by the first aider or by bystanders.
• Telephone numbers of the informer
• Location of the incident
• Type and seriousness of the
• Name of causality, sex and approximate age of casualty.
• Request for special help if the emergencies like heart attack and child birth.

Qualities of a first aider

• Good observation skill
• Able to act quickly
• Be stable (without panic)
• Self confidence
• Able to judge injuries
• Sympathy
• Good counselling skill
• Strong enough to control the situation
• Good communication skill
• Able to get help from others.

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But the first aider should keep in mind that he is not a doctor and don’t examine the wound
by opening which have already been bandaged by somebody else.
Bandages and types
Bandages are made of cotton, calico, elastic net, special paper or other materials and
are used to maintain direct pressure over a wound, that dressing in known as bandages.
Purpose:
• To control bleeding
• To hold dressing or splint in position
• To provides support for lumbar joint
• To restrict movement
• To assist in lifting and carrying patients
• To reduce swelling.
Types of bandages:
• Roller
• Triangular
• Special (e.g.) many failed bandage.
General rules in Bandage application.
• The victim should be in lying or sitting position while applying bandage.
• Give well support to the injured part.
• Use sterile or clear materials
• Cover the entire wound
• Do not bandage too tightly or too loosely
• Expose the finger / nails for checking the circulation.
• While applying the bandage, to immobilize the a limb part of the body the knots in
front of the uninjured side of the body.
• Pay special alteration to natural hallows by keeping extra padding.

Principles and methods of Bandaging Roller

Bandages
Roller bandages are made of cotton, gauze and are supplied in 5 meters roles.

Bandaging part Width

Fingers, toes - 25 cm (1 inch)
Hand, Head - 5 cm (2 inch)
Arm - 5 or 6 cm (2 or 2 ½ inch)
Leg - 7.5 – 9 cm (3 or 3 inch)
Trunk - 10 or 15 cm (4 or 6 inch)
Parts of roller bandage:
Rolled part is called head
Unrolled part is called tail
Rules for roller bandage application
• Face the patient

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• When bandaging left limb hold the head of the bandage to right hand and vice
versa.
• Apply the outer side of the bandage over the pad and wind it round the injury
twice so that it becomes firm.
• Apply bandage from the inner side to the outer side.
• Apply bandage from lower part to upwards.
• Neither the bandage is too loose or too tight
• Each layer of bandage covered 2/3 of the earlier layer.
• Fix the bandage with pain or adhesive plaster.
Patterns used in Roller bandage
1. Simple spiral: it is used on the trunk fingers and other uniform services with circular
turns.

2. Reverse spiral: It is modified spiral in which router in reversed downwards on itself

at each round. It must be used where the thickness of the part various like the leg or
fore arm.

Figure of ‘8’
The bandage is applied obliquely alternatively up and down. So that the loops appear
like the figure of 8. It is used for points like elbow knee etc.

Spica

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This is modified figure of ‘8’ and is useful for bandaging the leg, shoulder, groin and
thumb.

Head Bandaging
Vertical bandage carried twice forwards and once backwards. Continue to pass the vertical
bandage backwards and forwards, each time a little to the left and right alternately, locking it
with horizontal bandage. Finally pass horizontal bandage twice around the head and pin in
front.

Triangular bandage
(100 cm2) 1 meter calico cloth has been cutting from corner to corner, which gives two
triangular bandage. It has 3 borders. The longest is called as the base and the other the two
sides there are 3 corners the one opposite the base in called the “point” the other two are
called the “ends”.
Terminate the bandage above the joint with two circular turns, and secure the end
appropriately

Triangular Bandage to the head

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1. Turn the base (longest side) of the bandage up and center its base on center of the
forehead, letting the point(apex) fall on the back of the neck.
2. Take the ends behind the head and cross the ends over the apex.
3. Take them over the fore head and tie them.
4. Tuck the apex behind the crosses part of the bandage and/or secure it with a safety
pin, if available.
Apply a Triangular Bandage Sling
A triangular bandage sling is usually made from a muslin bandage, but any material that does
not stretch (such as fatigue shirt, trousers, poncho, blanket or shelter-half) can be used. Fold,
cut, or tear the material into a triangular shape.

1. Insert the material under the injured arm so that the arm is in the center, the apex of
the sling is beyond the elbow, and the top corner of the material is over the should of
the injured side
2. Position the forearm so that the hand is lightly higher than the elbow (about a 10
degree angle)
3. Bring the lower portion of the material over the injured arm so that the bottom cover
goes over the shoulder of the uninjured side.
4. Bring the top corner behind the casualty’s neck
5. Tie the row corners together so that the knot should slip into the “hallow” at side of
the neck of the uninjured side.
Triangular bandage to the head
1. Turn the base (longest side) of the bandage up and center its base on center of
forehead, letting the point (apex) fall on the back of the neck.
2. Take the ends behind the head and cross the ends over the apex.
3. Take them over the forehead and tie them.
4. Tuck the apex behind the crossed part of the bandage and / secure it with a safety pin,
if available.
Triangular bandage to the head

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Ear bandage
1. Lay the outer surface of the bandage on forehead and carry the bandage round head in
one circular turn, bandaging away from injured ear.
2. Turn the sound side carry the bandage round the back of the head, lowdown in nape
of the neck again, repeat these.
3. Each turn being slightly higher than the previous one as it covers the dressing, but
slightly over as it covers the hair.
4. Continue still the hole is covered and complete the bandage by one straight turn
around the forehead, pinning where all the turns cross one another.
Ear bandage

Jaw injuries and bandaging

1. Before applying a bandage to a casualty’s jaw, remove all foreign material from the
casualty’s mouth. If the casualty is unconscious, check for obstructions in the airway.
2. The dressing and bandaging procedure outlined for the jaw serves a twofold purpose.
In addition to stopping the bleeding and protecting the wound, it also immobilizes a
fractured jaw.
3. When applying the bandage, allow the jaw enough freedom to permit passage of air
and drainage from the mouth.
Bandaging
1. Place the bandage under the chin and carry its end upward. Adjust the bandage to
make one end longer than the other.
2. Take the longer end over the top of the head to meet the short end at the temple
and cross the end over.

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3. Take the longer end in opposite direction to the other side the head and tie them
over the part of the bandage that was applied first.
Jaw bandage

Securing bandage
To secure the bandage apply the following
A. Tape
B. Metal
C. Safety
D. Binders
i. Binders used to secure a dressing in the rectum and perineal areas.
ii. Abdominal binder ( sculetetus).
Ensure that there are no wrinkles creases in the binder.
Slings are used to provide support and protection for injured arms, wrists and hands or for
immobilizing an upper limb when the there are chest injuries.
Types of slings
1. Arm sling
2. Elevation sling
3. Improvised sling
1. Arm sling
This is used when there are injuries to the upper limb and for some chest injuries. This
is used in treating a fracture of the collarbone. It helps to keep the hand raised high up
giving relief from pain due to the fracture.
• It holds the forearm across the chest but it is only effective if the casualty sits or
stands.

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• When an arm sling is in the correct position the casualty’s hand will be slightly higher
than the elbow. Place the forearm across the chest with the fingers pointing towards
the opposite shoulder and the palm over the breastbone.
• The base of the bandage should lie at the root of the little finger leaving all the finger
nails exposed.
2. Elevation sling
This sling is used to support the hand and forearm in a well raised position.

• If the hand is bleeding

• There are complicated chest injuries.
• There are shoulder injuries.
A. Collar and Cuff sling
This is used to support the wrist only.
1. The elbow is bent, the forearm is placed across the chest in such a way that the
fingers touch the opposite shoulder. Now the sling is applied.

Collar and cuff sling

B. A clove-hitch is passed round the wrist and the ends tied in the hollow above the
collarbone on the injured side. Clove-hitch is made with a narrow bandage. Two loops are
made and laid one on top of the other.

1. Improvised sling

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If no triangular bandage is available slings may be improvised in several ways to provide

support.
a) Turn the free end of a coat and pin it to the clothing.
b) Pass the hand inside the buttoned coat or shirt.
c) Pin the sleeve of the injured limb to clothing
Use mufflers, scarf, belt, tie or soft cloth
Conclusion
First aid is essential for preserving the life of the victim in during emergencies
learning & practicing bandages well help to restore the life by controlling bleeding.
Conclusion
Knowing first aid is very important to every medical person and to extend the services to
needy and sufferers are the key principle of this unit.
Essay question
1. Describe the general rules of first aid
2. What are the types of bandages and write any two types in detail.
Short answer questions
1. What are the purposes of first aid?
2. What are the qualities required for first order?
3. What are the principles of roller bandages
4. What is the use of triangular bandage?

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UNIT –XIII MINOR INJURIES AND AILMENTS

Structure
- Introduction
- Cuts and wounds
- First aid for foreign bodies
- Burns and scalds
- Snake bite
- Dog bite
- Health education
Objective
➢ At the end of this chapter, the students are able to
➢ Define cuts and wounds
➢ List the type of wounds
➢ Learn the first aid for foreign body removal
➢ Understand and acquire knowledge regarding first aid measures for animal bite
➢ Describe the first and management for burns and scalds learn the principle of health
education

Introduction
The skin is the largest surface layer which covers and provides structure and shape of the body.
Intact skin protects over body from entry of infection and initial aliment of minor injuries will
prevent entry of micro organisms and promote healing. Burns has classified into superficial
burns, partial thickness burns and deep and full thickness burns. It is minor, it could be managed
at home and severe burns require hospitalization. Creating awareness in the community requires
effective health education on need basis by the multipurpose health worker
Cuts and wounds
The intact skin is cut or tear with sharp instrument/ blunt instrument unexpectedly or accidently
by force is known as wound. It may be superficial or deep wound.

Cut is just tear of skin, it involves epidermis and partial dermis. The tear is caused by blade or
knife while doing work eg: cutting vegetable

Types of wound
Abrasions- It is scraping away of superficial layer of skin

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Punctured wound-A stab from needle, nail or bullet causes tear deep small skin area is known
as punctured wound

Contused wound-A blow with blunt object which splits the skin and bruises the surrounding
tissues e.g. fall on floor, falling of objects on the body. It is closed wound with small blood
vessels are broken under the skin which forms ecchymosis

Chest wound-A wound in front or back of thoracic cavity due to blunt force, stabbing and
punctured sharp instrument. The chest injury affects the lung ventilation and sometimes heart
function also. The amount of oxygen reaching blood stream may b insufficient and asphyxia may
result

Abdominal wound-The injury to abdominal wall underlying organ due to sharp or blunt
instrument lead to bleeding and protrusion of intestinal structure from the wound is known as
abdominal wound

Signs and symptoms

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✓ Superficial scrapping of skin

✓ Wound edges irregular
✓ Bleeding is present to a varying extent
✓ Pain and swelling of the affected area
✓ Bluish discolourization of lip, tongue, nails bud, skin in chest injury due to asphyxia

Chest injury- Difficulty in breathing, blood stained liquid bubbling

Abdominal wound-Vomiting, abdominal pain, bleeding and exposure intestinal structure / organ
from the injured side

Treatment
✓ Wash the site with clean boiled cool water and soap if its abrasion
✓ Handle the injured part as gentle as possible
✓ Sit or lay down the victim and elevate the affected limb
✓ Stop bleeding by using direct pressure
✓ Always clean away from the wound , don’t clean towards the wound, remove the foreign
matter
✓ Apply a cold compress to the injured part to control bleeding and reduce swelling
✓ If the wound is small, apply antibiotic ointment and cover with a clean dry dressing

Chest injury
✓ Place the victim in half sitting position with the head and shoulder supported , turn the
body towards the affected side of injury
✓ Cover the wound with sterile dressing and sir tight seal with plastic sheet or adhesive tape
✓ Support the arm on injured side in an elevation sling and make the causality as
comfortable as possible
✓ Check the breathing rate, pulses and level of responsiveness at 10 minute interval

Abdominal wound
✓ Place the causality in their back with knee bent and orevent wound gaping
✓ Apply sterile dressing cover the abdominal wound
✓ Check respiration and pulse for every ten minutes for evidence of shock and internal
bleeding
✓ If necessary applu tourniquet
✓ Preserve the avulsed part, turn of parts should be saved and flaps of skin may be folded
back to their normal position before bandaging

Wounds that need special care

Call 108 ambulance

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1. Control any bleeding

• Use a bulky pad and apply it firmly to the bleeding area. Rise if possible

2. Recover the injured part

✓ If possible, gently place it into plastic bag. Seal the bag with a little air inside to protect
the severed part with a cushion of air
✓ Place the inflated bag into a container or bucket of cold water to which several ice cubes
have been added
✓ Ensure the severed part is transferred to hospital with the patient

Crush injury
A crush injury occurs form compensation of large muscle groups and soft tissues by heavy
weight. The most serious sites for crush injury to occur are the head , neck, chest, abdomen and
thigh

Call 108 for an ambulance

1. Remove the crushing by force
❖ Remove the crushing by force if possible because permanent tissue damage may occur
with severe crushing force
❖ If crushing force has been in place for some time, be prepared to give prompt first aid,
because removal of crushing force may cause a sudden collapse or deterioration in
patient’s condition

2. Treat the patient’s injuries

❖ Assess and treat any injuries in order of their importance
❖ Control any bleeding with a sterile pad applied firmly to injured area
❖ Assist the patient into the position of greatest comfort and use soft padding to provide
support for the injured part
❖ If a limb is involved, support and immobilize the injured area

Dust, insect, tiny air borne particle may large in the eyes unexpectedly of an individual. It
produces irritation of eyes redness, difficulty to blink, pain, watery eyes
❖ Don’t rub eyes

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❖ Retract eye lids and assess the size of foreign bodies

❖ Wash the eye with sterile water/ clean water
❖ Gently mop the eye and support the eye with napkin
❖ If foreign body is glass or wooden particle, remove with instrument under the supervision
of doctor / ophthalmologist

Burns and scalds

Definition: Burns are the tissue injury caused by contact with heat, flame, chemicals, electricity
and radiation

Scalds: Skin injury which is caused by hot liquids is known as scalds (hot food, hot water, tea,
coffee, milk.Burn categories based on the following the extent of tissue damage

1st -degree burn

A first degree burn is the least serious type, involving only the out layer of skin. It may cause :
Redness, swelling and pain. First-degree burn as a minor burn. If it involves much of the hands,
feet, face, groin, buttocks or a major joint, seek emergency medical attention.
2nd-degree burn
A second-degree. Bum is more serious. The, second-degree burn is no larger than 3inches(7.6
centimeters) in diameter, treat it as a minor burn. Of the burned area is larger or covers the
hands, feet, face, groin, buttocks or a major joint, treat it as major burn and get medical help
immediately. It may cause
· Red, white or splotchy skin · pain
· Swelling · Blisters

3rd-degree burns
The most serious burns involve all layers of the skin and underlying fat. Muscle and even bone
may be affected. Burned areas may be charred black or white. The person may experience :
Difficulty breathing, Carbon monoxide poisoning, Other toxic effects, if smoke inhalation also
occurred
First aid for minor burns
Minor burns
• while waiting for the ambulance to arrive, observe the patient closely for any change in
condition.
• Cool the burn to help soothe the pain. Hold the burned area under cool (not cold) running
water for 10 to 15 minutes or until the pain decreases. Or apply a clean towel dampened
with cool tap water.
• Remove rings or other tight items from the burned area. Try to do this quickly and gently,
before the area swells.

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• Don't break small blisters (no bigger than your little fingernail). If blisters break, gently
clean the area with mild soap and water, apply an antibiotic ointment, and cover it with a
non-stick gauze bandage.
• Apply moisturizer or aloe Vera lotion or gel, which may provide relief in some cases.
• Do not put any butter, other remedies on the burn
Note : (See your doctor if you develop large blisters. Large blisters are
best removed, as they rarely will remain intact on their own. Also seek
medical help if the bum covers a large area of the body or if you notice signs of infection, such
as oozing from the wound and increased pain, redness and swelling.)

Rule of nine for assessing the Burns area

To determine the percentage burn injury in the body i.e. total burns surface area of the body

Major Burns
Call 108 or emergency medical help for major burns. Until the ambulance unit arrives, do these
actions
❖ Immediate removal from heat source
❖ Do not allow the person to run about. This only fans the fire and makes the flames
spread.

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❖ Hold a fire, blanket, coat, in front of victim

❖ In case of open flame, the victim should help to flat on the ground and roll on the floor.
❖ Protect the burned person from further harm. Ensure, the person you're helping is not in
contact with smoldering materials or exposed to smoke or heat.
❖ Avoid pouring of water over the burnt area, once the fire has been extinguished, because
it may be dangerous and lead to hypothermia, hyponatremia, convulsions and brain
edema. The child should be wrapped in clean sheet to prevent heat loss.
❖ Check for signs of circulation. Look for breathing, coughing or movement. Begin CPR if
needed.
❖ Remove jewels, belts and other restrictive items, especially from around burned areas and
the neck. Burned areas swell rapidly.
❖ Oro-pharyngeal secretion to be removed and airways to be kept patents. The victim
should be turned to one side and respiration to be checked. If necessary mouth-to-mouth
breathing may be given.
❖ Shift patient to hospital immediately
❖ Take killed snake to hospital.

13. 2 First aid for foreign bodies

Foreign Body:
Any tiny particle that causes irritation abstraction to the body is known as foreign body. A
foreign body is an object entered into the body from outside e.g. Young children put tiny objects
in their body orifices i.e. ear, eyes, nose, and mouth. The tiny objects are: Button, coin, chalk
piece, slate chalk, peas, marbles etc.
Foreign body can be inert or irritating. If it is irritable it will cause inflammation and scaring.
They can obstruct passages either by size or by the scaring some cm be toxic.

one of the most common locations for foreign body is the alimentary tract. It
is possible for the foreign bodies enter into the tract from mouth and come
out from the rectum.
Skin
A small or big foreign body enters into the skin by force or pressure while walking falling or by
accident that penetrates into the body
e. g. wood piece, thorn of the plant, sharp iron tiny particles, glass pieces etc
• If the foreign body is superficially present rinse with cold water and wiped off easily with
swap
• If possible remove foreign body by lingers or hooks
• If the large foreign body embedded in the skin never attempt to remove it. It may be
plugging the wound therefore restricting the bleeding.
• Control bleeding by applying direct pressure
• Squeeze the edge of the wound together along the side of foreign

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• place the ring pad and build up the padding until it is high enough to prevent pressure on
object
• Secure with diagonally applied bandage
• Don't apply bandage all over the foreign body then transfer the victim to the hospital
immediately
Airways
Children commonly put peanuts, grapes, dha1, seeds, into the nose or mouth cause choking. It
causes obstruction in the airway. Heimlich Manures used for removal of food particles from the
throat which is caused for choking. Based on the site of obstructed particle, the foreign body
removal takes place at the hospital the hospital/operation theatre.

Eyes
• cover the area of the burn. use a cool, moist, bandage or a clean cloth
• Transfer to hospital to be arranged promptly.
STOP
S-Strip-hot clothes and jewelry if possible

T-Turn on cold tap-(never use ice)-Run the Burn under cool water for10-20min keep the rest of
the person warm
0-Organise-Medical assistance
rotect-Burn with cling film or clean cloth (no dressing, cloth,c reams / lotions.
• Put sterile dressing
• Shift the patient to hospital
13. 4 Snake Bite
Snakes are cold-blooded. Thus, they are unable to increase their body temperature and stay
active when it is cold outside. They are most active at25-32 C (77-90 F).
The Bite
• Poisonous snakes inject venom using modified salivary glands.
• During envenomation (the bite that injects venom or poison), the venom passes from the
venom gland through a duct into the snake's fangs, and finally into its prey.
• Not all bites lead to envenomation. Snakes can regulate whether to release venom and
how much to release."Dry Bites"(a bite where no venom is injected) occur in between
25%-50% of snake bites.
• This variation is species specific with approximately 25% of pit-viper bites being "dry"
and up to 50% of coral snake bites. Snake venom is a combination of numerous
substances with varying effects.
• In simple terms, these proteins can be divided into 4 categories
1. Cytotoxins cause local tissue damage,
2. Hemotoxins cause internal bleeding

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3. Neurotoxins affect the nervous system

4. Cardiotoxins act directly on the heart.
All snakes are not fatal. Only small quantity of venom may be fatal. Most people die from fear
and venom is not point of consideration.
Signs and symptoms
• Pain and numbness at the site of bite
• Drowsiness
• Burning pain at bite
• swelling
• Dimness of vision
• Difficulty in breath and speech
• Area become bluish purple after bite in 12 hours
• Dribbling of saliva,paralysis
• Convulsions
Diagnosis
• linear laceration with more punctures and abrasion
• local swelling for poisonous snakes bite
• respiratory symptoms
• paralysis
1. Poisonous snake bite 2.Non poisonous snake bite

Treatment

• Give him complete rest by laying down in calm

• Don't make him walk
• Apply a tourniquet immediately between bite and heart loose il for few seconds for every
10 minutes.
• Immobilize the affected limb
• Gently wash wound with normal saline
• Ice packs can be applied.
• Don't suck poison from site of wound.

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• Treat shock
• Resuscitation (if necessary)

DOG BITE
When a dog bites, the front teeth are used to grasp the victim, while the
other teeth pull at the surrounding skin as they bite. The result can be a
deep hole in the skin causing a puncture wound, made by the front teeth,
and a jagged wound or laceration (cut) with a scraped section of skin, or
abrasion.
• Causes hydrophobia
• Watch dog for 10 days
Symptoms: History of bite, open wound, Discomfort, pain and bleeding
Rabies
• Headache, nausea, vomiting
• Agitation, confusion, hallucination
• Difficulty in swallowing
• Foaming at mouth
• Respiratory paralysis
• Difficulty in drinking water
Treatment
• Wash the wound with soap and water
• Clean the wound immediately run it under warm water for a few minutes to ensure it is
thoroughly cleaned.
• Encourage bleeding from the wound : if it is not already bleeding ,gently squeeze the
wound to encourage it to bleed, which will help prevent bacteria entering the wound.

Health education
Health education is as informal way of education to an individual, family and public by the
health authorities by the local and other agencies regarding development of healthy habits and
creating awareness about the health and disease
Health education is normally considered as a changing attitude and behavioral patterns of people
towards attaining better status. Health education is a part of health care that is concerned with
promoting healthy behavior. The Alma Ata declaration (1978) emphasizes the need for
individual and community participation in the process of health education.1. It emphasize has
shifted from prevention of disease from promotion of healthy life style. 2. Modification of
individual behavior to modification of social environment. Community participation to
community involvement
Aims
• To encourage-people to adopt and sustain health promoting life style and practices.
• To promote proper use of health care services available to them

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• To create interest in gaining new knowledge and skill and change attitudes in making
rational decision to solve their own problem
• To stimulate individual and community self reliance and participation to achieve health
development at every step from identifying problems to solving them
Role of different agents in health education
Health education is provided to the society by different ways or agent, they are education
institution, press, film, radio and television
Educational Institution
Health education is indeed an inter disciplinary approach which draws content and initiatives
from physical, biological, medical and behavioral sciences. Health instruction component is
encouraged today in the curriculum of the student from primary school to higher education. Even
though health instruction is limited due to lack of awareness by the resource person in the
educational. Healthy habits to be insisted to be students from the school age onwards, so that
healthy nation could be developed
Mass Media
It may facilitate the health for all by passing information through magazines, newspaper and
poster. e. g. Family welfare activities
The press and print media have its own limitation in promoting health consciousness among
people. Once in a while reports, articles features profiles and other health centered contents
appear in the press
Films
Film is a powerful medium of communication. Feature films which focus on health management
are hardly produced in the country and it focus the attention of the audience on health, nutrition,
family welfare, environmental protection
Radio
Radio is the only mass media which is accessible to the rural and urban people in plenty. It
provides special programmes on variety of subject including health management.
Television
TV is the biggest mass media in India. The Doordarshan which is managed by the prasar
Bharathi Corporation provides information, education and communication (IEC). support to
health and family welfare through telecast during different time slots all over the country
Contents of Health Education
It covers every aspect of family and community health, the content of health education may be
divided in the following division for the sake of simplicity
1. Human Biology-structure and function of Body need for exercise and rest ; effect of alcohol
and smoking
2. Nutrition-Guide the people to maintain health by balanced diet remove Prejudices and
improve food habits ; prevention of malnutrition ; obesity in children prevention of
cardiovascular disorder; dietary plan for diabetes mellitus

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3. Hygiene-To promote standard of personal cleanliness in the setting of the condition where
people live ; education about fresh air, light, ventilation, storage of food, hygienic disposal of
waste and prevention of pest
4. Family health-Health education to improve family responsibility in childbearing, child rearing
self care and influencing their children to adopt healthy lifestyle
5. Disease Prevention and control-prevention of local endemic or communicable disease like
typhoid, malaria, TB.
6. Mental Health-The health education is for keeping the people mentally healthy and prevent
break down of mental health
7. Prevention of accidents-Educate the parents regarding accidents in children
8. Use of health services-Educate the people about the health services available in the
community
9. Occupation Health-Safety measures in the working environment. Awareness of occupational
hazards
10. Sex Education-Education about the pubertal changes, menstrual hygiene, health
communication
Ethical Issues in Health Education- Health education is a complex activity in which different
individuals and, organization play a part. They are parents, teachers, friends, physician, nurses,
health workers and various organizations, governmental and nongovernmental.
Conclusions
Wound care is essential in any form of injury like open, closed, bite of animal and burns. The
MPHW (F) may play role as first aider in the community during emergencies. In such times she
needs to care the injuries and other animal bites. She should be cleaned the injured skin properly
and seek medical help on priority basis is necessary.

Essay questions
1, How do you give first aid to the major burns victim?
2. Describe the different types of wounds?
3. Describe the first aid management of the person with snake bite?
4. Write about the management of the foreign body removal?
Short answer questions
1. Write sign and symptoms of rabies
2. List the types of burns
3. What are the aims of health education?
4. What is scald?
5. What is STOP?
6. What are the sign and symptoms of wound?

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UNIT-14 FRACTURE
Structure
–Introduction
14.1- Skeletal
system
14.2- Different types of bone fracture
14.3-causes and signs and symptoms
14.4-first aid for fracture
14.5- Methods of immobilization and transportation
Objectives
After completion of this chapter, the students are able to
➢ Review the skeletal system
➢ Describe the types of fracture
➢ Explain the first aid management of fracture
➢ Describe the care while mobilisation of victim

Introduction
Motor vehicles accidents are high today, people may suffer with fracture and internal injuries.
Fracture near vital structure is critical, because it affects vital function also e.g. skull bone
fracture. First aid management of bone injury victim requires systemic treatment followed by
accident.

Skeletal system

Human skeletal system, the internal skeleton that serves as a framework for the
body. This framework consists of many individual bones and cartilages. There also are bands
of fibrous connective tissue—the ligaments and the tendons—in intimate relationship with
the parts of the skeleton. This article is concerned primarily with the gross structure and the
function of the skeleton of the normal human adult.

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The skeletal system is the body system composed of bones and cartilage and performs
the following critical functions for the human body:

• supports the body.

• facilitates movement.
• protects internal organs.
• produces blood cells.
• stores and releases minerals and fat.

Definition
A fracture is the partial or complete breakage of bone

Different types of bone fracture

• Transverse fracture-Fractured at a right angle.

• Oblique fracture - Fractured at any angle other than 90 degrees.
• Spiral fracture -Twisted Fracture.
• Comminuted fracture - the bone is shattered into many pieces.
• Avulsion fracture-a muscle or ligament pulls on the bone, fracturing it.
• Impacted fracture-when the bone is fractured, one fragment of bone goes into another.
• Fissured fracture - Down the long axes.
• Green Stick fracture - Incomplete fracture like a GREEN STICK.
• Simple Fracture. Fracture that doesn't penetrate the skin
• Hairline fracture - a partial fracture of the bone. Sometimes this type of fracture is
harder to detect with routine ‘X’rays.

Causes and signs and symptoms

Fractures are usually caused by a fall, blow or other traumatic event. Pathological fractures
are those caused by disease that weakens the bones - they can occur with little or no trauma.

Signs and symptoms of a fracture include:

• pain
• swelling
• bruising

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• discoloured skin around the affected area

• angulations - the affected area may be bent at an unusual angle
• the patient is unable to put weight on the injured area
• the patient cannot move the affected area
• the affected bone or joint may have a grating sensation
• if it is an open fracture, there may be bleeding

First aid for fracture

First aid management of fractures victim
➢ Assessment-Check for fractures – open, closed or complicated.
➢ Ask patient to remain as still as possible
➢ Examine the injured area for swelling and / or deformities, lacerations and puncture
wounds.
➢ Gently feel along the length of the bone for tenderness, swelling and deformities.
➢ Stop any bleeding: Control any bleeding by , elevate and apply pressure to the
wound. Cover wounds by using a sterile bandage, a clean cloth, or a clean piece of
clothing.

➢ Immobilize the injured area: If you suspect they’ve broken a bone in their neck or
back, help them stay as still as possible. If you suspect they’ve broken a bone in one
of their limbs, immobilize the area using a splint or sling.
➢ Use broad bandages to prevent movement at joints above and below the fracture.
➢ Support the limb, carefully passing bandages under the natural hollows of the body.
➢ Place a padded splint along the injured limb
➢ Place padding between the splint and the natural contours of the body and secure
firmly.
➢ For leg fracture immobilise foot and ankle.
➢ Check that bandages are not too tight or too loose every 15 minutes.
➢ Don’t try to straighten or reposition the fractured limb.
➢ Splint the limb in the position you find it move the limb as little as possible while
applying and securing the splint.
➢ Ensure that splints are long enough to immobilise the joint above and below the
suspected fracture.
➢ Apply cold to the area: Wrap an ice pack or bag of ice cubes in a piece of cloth and
apply it to the injured area for up to 10 minutes at a time. It helps to limit swelling
and relieve pain.
➢ Check for a pulse and sensation below the fracture area.
➢ Treat them for shock: Help them get into a comfortable position, encourage them to
rest, and reassure them. Cover them with a blanket or clothing to keep them warm. : if
the person feels faint or is breathing in short, rapid breaths, lay the person down with
the head slightly lower then the trunk and if possible, elevate the legs.
➢ Get professional help: Call 108 for help them get to the emergency department for
professional care.

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Methods of immobilization and transportation

TRANSPORT OF ACCIDENT VICTIMS

When dealing with a wounded or unconscious person, it is crucial to examine in the same
place where he was found, without moving or transporting the victim until first aid care has
been provided since, otherwise, there is a risk of aggravating the situation and causing new
wounds.
When transporting the patient or the accident victim take into account that the body should be
moved as little as possible.

TRANSPORT WITHOUT STRETCHER

This is required when the accident victim must be moved quickly away from the place where
he is, or when it is not possible to reach the scene with a stretcher.

1. Transport of an accident victim with a single lifeguard

Creeping method. For the initial transport (unless other resources are available) turn
the victim backwards, tying his wrists together with a handkerchief or cloth. The first
aider should kneel astride the victim, and place his head under the tied wrists. He
should then creep forward, sliding the accident victim across the floor (see picture ).

Fireman method. The evacuation may also be done on the back of the life saving
person or carrying the victim on his shoulders (see pictures)

2. Transport of an accident victim with several lifeguards

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Two hand settee/ Three hand settee - When there are two or more life saving
persons, they should make a settee with two hands, carrying the victim on it. Each
lifeguard holds the accident victim with an arm under the thighs, holding each other's
wrists; the other pair of hands will provide support for the back (see picture).

Two hand settee. Three hand settee

Transport with chair A chair may be used as a stretcher in case of emergency (see picture).
The victim may also be transported in a similar position without the chair.

All these methods will be used only when there is no suspicion of a lesion in the spinal
column (unless there is a life threatening situation). In such case, immobilise as indicated in
SPINAL COLUMN IMMOBILISATION

TRANSPORT WITH STRETCHER

The ideal procedure for carrying injured patients is the stretcher. The Neil-Robertson
stretcher (OTHER MATERIAL OUTSIDE THE DRAWERS,) is the most recommended for
use onboard, since in it the subject is held in place and may be lifted, making it ideal for
vertical transport.

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Neil-Robertson stretcher.

The vacuum shaped mattress adapts itself to the patient and complete horizontal
immobilisation is guaranteed during transport.

Vacuum shaped mattress.

Improvised stretchers may be used when other resources are not available, using a door,
ironing board or a wide wooden board; a hand ladder; two paddles held together with ropes,
blankets or clothes with long sleeves, etc.

For the transport of an injured patient in a stretcher the following rules must be taken into
account:

Bridge method Carry the stretcher to the place where the accident victim is, and not vice
versa.

1. Place the injured victim with paramount care, always respecting the block head-neck-
trunk-legs:
Place the stretcher on the floor. Lift the victim as smoothly as possible until he is
placed on it. The "bridge method" may be used (see picture).

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If there is suspicion of spinal column fracture, immobilise as indicated in spinal

column immobilisation,.

Sideways placing of an immobilised spinal column

When the accident victim is conscious, lay him on his back unless there is a thorax
wound; in such case place in a semi sitting position. If unconscious, place in lateral
recumbent position, unless there is suspicion of column fracture. In this case, whether
conscious or not, if there is vomit, place sideways (see picture).

2. Cover up as required, since the cold seriously harms the shock patient just the same as
it would an injured person. Immobility, haemorrhage and trauma reduce cold
tolerance.

Stretcher transport

3. Hold to prevent him from falling. The subject must be held with straps or bands, since
any sudden movement may displace the patient out of the stretcher, whether
conscious or not, and in such case the patient's own movements may cause him to fall.
4. Lift the stretcher with care. For the transport of the patient, both carriers must kneel at
each end of the stretcher. The one situated at the feet of the patient gives the order for
both to stand up together. During the transport both carriers must alternate their step,
always keeping the stretcher horizontal (see pictures).

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Conclusion
The right time of first aid management of fractured victim is essential for saving the victim’s
life, which is compulsory for MPHW student to manage fracture patient at emergency
department.

Essay questions
Describe the first aid management of fractured victim
Explain the methods of transportation

Short answer question

1. List the signs and symptoms of fracture
2. What is compound fracture?
3. What are the causes of fracture?

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UNIT -15 LIFE THREATENING CONDITIONS

Introducti
on 15.1-
Bleeding
15.2-
Drowning
15.3-
Strangulati
on
15.4-suffocation and asphyxia
15.5-Loss of consciousness
15.6-Cardio respiratory arrest
15.7-Convulsions
15.8-Chest injuries
15.9-Shock and allergic conditions
15.10-Poisoning
15.11-Bites and stings
15.12-Stroke
15.13-Heat stroke
15.14-Burns and scalds
Objectives
After completion of this chapter, the students are able to
➢ Learn the control measures of Bleeding
➢ Describe the first aid treatment for Drowning
➢ Gain knowledge regarding Strangulation, suffocation and asphyxia
➢ Explain and acquaint information regarding Loss of consciousness, Stroke and Cardio
respiratory arrest
➢ Describe the first aid management victim with Convulsions
➢ Develop practical knowledge in first measures of Chest injuries conditions
➢ Describe the first aid management victim with Shock and allergy, Bites and stings
➢ Learn about Poisoning and its first aid measures
➢ Learn the control measures of Heat stroke
➢ Describe the first aid management victim with Severe burns

Introduction
During accident and other emergencies, individual sometimes may land on life threatening
problems. In such condition the people in the home or working place need to give primary
care to prevent severe complications arise out from the critical illness. Right decision at right
time requires in emergencies. Then the causality shift to the specialised care unit for
systematic treatment with the life saving equipment

Bleeding
The term haemorrhage refers to a large amount of bleeding in a short time.
It is mainly classified as external bleeding and internal bleeding
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1. External bleeding: The blood is coming out from the body and visible to identify the site
of injury is known as external bleeding
According to the type of blood vessel damage It can be classified into three types: 1. Artery
2. Vein 3. Capillary.

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In arterial bleeding, blood spurts and bright in colour (up to several feet) from the wound.
Arterial bleeding is the most serious type of bleeding because a large amount of blood can be
lost in a very short period of time and blood can clot only when it is flowing slowly or not at
all
In venous bleeding, blood from a vein flows steadily or gushes and dark in colour. Venous
bleeding is easier to control than arterial bleeding. Most veins collapse when cut. Bleeding
from deep veins, however, can be as massive and as hard to control as arterial bleeding.
In capillary bleeding, the most common type of bleeding, blood oozes from capillaries. It
usually is not serious and can be controlled easily.
Causes
Minor bleeding caused by small cuts, grazes, etc.
Some wounds are associated with other injuries beneath the skin – e.g. an organ injured by a
stabbing; broken bones which have pierced the skin.
Severe bleeding may be life threatening if a large vein or artery has been injured – e.g. the
jugular vein in the neck.
Symptoms and signs
• a wound with, or without, an embedded foreign object
• pain from skin surface wounds
• bruising or discolouration of the skin
• loss of normal function in the injured area
• pale, cold, sweaty skin

External bleeding management

1. Apply direct pressure to the bleeding wound

• Apply firm pressure over the wound by clean bulky pad.. Apply a bandage to keep the
dressing in place.
• Apply direct pressure to the bleeding wound
• If bleeding is severe, DO NOT waste time looking for suitable padding, but be
prepared to use the patient’s hand or your hand to hold the wound together if the
patient is unable to do this unaided.

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Apply direct pressure Raise the injured area

2. Raise the injured area
• If the wound is on a limb, raise it in a supported position to reduce blood flow to the
injured area. Apply elevation sling
Try to avoid any direct contact with the patient’s blood or other body fluids. Use disposable
gloves if possible. If gloves are not available, place your hands inside a plastic bag.
• If there has been any contact with blood or any other body fluids, wash your hands or
any blood splashed on the skin thoroughly with soap and water as soon as possible
after the incident.
3. If a foreign body is embedded in the wound
• DO NOT remove foreign object but apply padding on either side of the object and
build it up to avoid pressure on the foreign body.
• Hold the padding firmly in place with a roller bandage or folded triangular bandage
applied in a criss-cross method to avoid pressure on the object.

4. Keep the patient at total rest

• Even if the injury involves the arm or upper part of the body, the patient should rest in
a position of greatest comfort for at least 10 minutes to help control the bleeding.
5. Seek medical assistance
• If the wound appears to be minor and the patient is able to travel by car, arrange an
urgent appointment with a local doctor to assess and treat the injury.
If the injury is severe or the patient is very unwell – call 108 for an ambulance as soon
as possible.
While waiting for an ambulance to arrive, observe the patient closely for any change in
condition.

6. If blood leaks through the pressure pad and bandage

• Apply a second pad over the first. Use a tea towel or similar bulky fabric and apply
maximum pressure to the area.
• For major uncontrolled bleeding quickly remove the blood-soaked pad and bandage
and replace with a fresh bulky pad and bandage. The continuing bleeding may be due
to the pad slipping out of position when the first bandage was applied.

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Nose bleed
A blow to the nose, flying at high altitude, or diving may all cause a bleeding nose
(epitaxsis).
For a child, always check whether there is a foreign body present – e.g. a bead or coin. If this
has occurred, seek prompt medical advice If bleeding is due to a head injury – e.g. a fractured
skull – call 108 for an ambulance urgently.

Apply firm pressure, elevation and rest

• The patient needs to hold the head well forward and breathe through the mouth
• Pinching the entire soft part of the nose for 10 to 20 minutes.
• The patient must be sitting down and at total rest until the bleeding stops.
• A cold compress can be used.
• Instruct the victim ,do not blow the nose for a few hours

Internal bleeding

Internal bleeding is referred as blood from injured part is not visible and accumulated inside
of the body.
Internal bleeding occurs when blood vessels within the body are ruptured and blood
escapes out of the circulatory system. It may follow such incidents as a blow to the head,
chest, or abdomen due to a fall or being struck by a vehicle. Internal bleeding should be
suspected when blood is seen in vomit, urine, sputum or faeces.
This type of bleeding can occur without an obvious wound and can be very serious as it is
difficult to stop without surgical intervention.

Symptoms and signs – Not all may be present

• rapid and ‘gasping’ breaths

• increasing thirst
• frothy red blood coughed up from the lungs, blood-stained vomit like ‘coffee
grounds’, red or rust-coloured urine, or dark faeces like tar
• pale, cold, sweaty skin

First aid management

1. Place the patient at total rest

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• Assist the patient into the position of greatest comfort.

• Cover the patient with a blanket to maintain body heat.
• Place protective fabric underneath the patient if the surface is rough, cold or hot – e.g.
a coat if the patient is lying on a road.

Call 108 for an ambulance.

1. While waiting for the ambulance
• Manage any other injuries.
• Ensure that all restrictive clothing has been loosened, especially at the neck and waist.
• Keep any bystanders clear.
• Reassure the patient.
• DO NOT allow the patient to eat, drink or smoke.

Drowning
Drowning cause’s asphyxia by water entering the lungs (or) by causing the throat to go into
spam, so constricting the air passage (known as dry drowning).

a) Drowning is a major source of accidental death and can be a result of cold, fatigue,
injury, disorientation, intoxication etc (or) the victims own limited swimming ability.
b) The drowning victim struggles to inhale air as long as possible but eventually the
victim goes under the water where he must exhale air and inhale water.
Effects of drowning
➢ Airway obstruction
➢ Asphyxia
➢ Congestion of lungs
➢ Injury to head and neck
➢ Broken bones
➢ Soft tissue injuries
➢ Internal bleeding
➢ Hypothermia

General symptoms and signs of asphyxia is Froth around the causality’s lips, mouth,
nostrils and difficulty in breathing or noisy breathing, which may ultimately lead to cessation,
rapid pulse, high blood pressure (hypertension), cyanosis of the face.

Treatment
i) Reaching the victim
a. Pull the patient from the water using rope, branch, fishing pole, stick, towel, shirt,
lie down flat on your stomach extend your hand or leg.
b. Throw him an object that will float with live i.e. tyre, foam, cushions, logs,
boards, plastic toys.
c. Make sure that your position is safe.
d. Use boat and life jacket, if available
e. Plan to bring victim to the shore

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f. Do not –swim to the patient

ii) Stabilization of the victim in the water :-
a. Keeping the victims head and body aligned place one of young hands in the
middle of his / her back. You arm directly over the victim’s head
b. Place your other hand under the victim’s upper arm near the shoulder.
c. Slowly and carefully, rotate the victim over in the water by lifting the shoulder up
limit rotating it over.
d. Support the victim in neutral position in water short mouth to mouth ventilation.
iii)Resuscitation :
Quickly remove any obstructions such as sea – weed, mud, from nose and mouth start
artificial ventilation immediately. It is possible to begin ventilation even in water.
a. If with, in your depth use one arm to support the casualty body use the other hand
to support the head and seal nose while you perform mouth to mouth ventilation.
b. If in deeper water give the occasional breath of air while to bring the casualty a
shore.
• Turn the victim face down with head to one side and arms stretched beyond
his head.
• Use postural drainage to clear water aspiration.
CHILD: Child and infant can be held upside down for a short period. Raise the middle part of
the body with your hand round the belly. This will cause water to drain out of lungs.
ADULT: Raise the middle part of the body as in children press chest and costal margin to
press the lungs to remove water from the lungs.
• Check breathing – heart beat and continue resuscitation, if necessary.
• As soon as breathing begins. Keep causality in recovery position.
• Remove wet cloth, keep the body warm, cover with blankets, and give hot drinks,
coffee and tea.
• Do not allow him to spit up
• Shift him to hospital in recovery position.
Things to remember
➢ The chance for survival in warm water is much less than in cold water.
➢ In fresh water drowning, water passes through the lungs into the circulation and may
cause dilution of blood, this interferes with oxygen exchange.
➢ In salt water drowning, salt from the aspirated water causes the loss of large amounts
of fluid from the circulation into the lungs. This causes water accumulation in the
lungs or death.

STRANGULATION
Definition
It involves cutting off the air supply by a tight constriction around the neck.
Symptoms and signs :-
i. Symptoms and signs of asphyxia

• Difficulty and/ or noisy breathing, which may ultimately lead to cessation

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• Rapid pulse
• High blood pressure (hypertension)
• Cyanosis of the face
• Swollen veins on the head and neck
• Slowly losing consciousness

ii. Congestion of face and neck with prominent vein.

iii. Visible marks of construction around neck
iv. Body may still be suspended.
Treatment
• Remove the constriction from around the neck immediately, supporting the weight of the
body. If it is changing always cut below the knot.
• Place in recovery position casualty, if casualty is unconscious but breathing normally.
• If breathing is difficult start CPR
• Shift the causality to hospital.
15.3-Suffocation and Asphyxia
Suffocation
This occurs when
a. Air is prevented from reaching the air passages by an external obstruction such as
plastic bag, soft pillow or fall of mud.
b. A person is kept in a confined space then all the available oxygen is used up.
Signs and symptoms
- Sign & symptoms of asphyxia like difficulty in breathing, contusion, froth from
mouth etc,
- Air tight seal over the mouth and nose
- Presence of state air in a confined space.
Treatment:-
1. Immediately remove any obstruction or take the casualty to fresh air.
2. If the casualty is conscious and breathing normally, reassure and observe.
3. If he is unconscious but breathing normally place in the recovery position.
4. If breathing is difficult or stopped, begin artificial ventilation immediately.
5. Shift the casualty to hospital immediately.
Asphyxia
It is a condition in which the wings do not get sufficient supply of air for breathing.
If blockage of air ways continues for some minutes, breathing and heart action stop
and death occurs.
Causes
▪ Conditions affecting the air passage are
▪ Food going into respiratory passage
▪ Drowning
▪ Instant gases like coal gas, smoke, motor exhaust fumes getting into air passages.
▪ Foreign body, vomit, artificial teeth in air passage.
▪ Tongue falling back in unconscious patient
▪ Swelling of tissues in throat as a result of injury, infection, burns.
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▪ Neck strangulation.
▪ Chest injury
▪ Epilepsy,
▪ Electrical injury
▪ Poisoning
▪ Paralysis caused by a stroke
▪ Morphine, barbiturates
▪ Air containing insufficient oxygen
▪ Carbon monoxide poisoning
▪ Cyanide poisoning

Signs and symptoms

• Difficulty in breathing: the role & depth of breathing increases.
• Noisy breathing
• Veins of the neck become swollen
• Face, lips, nails, fingers & toes turn blue
• Pulse gets faster and feeder
• Froth may appear at mouth & nostrils
• Confusion
• Unconsciousness
• Fits may occur
• Breathing may stop.
Treatment
1. Call the ambulance emergency medical services immediately.
2. Remove the cause of asphyxia and open the airway
o Choking: Perform Heimlich Manoeuvre (which will vary in adults, children, and
pregnant women) to remove the object
o Drowning: Safely remove the victim from the water.
o Gas poisoning: Get the victim into fresh air only if it is safe to go in the place.
Evacuate anyone else in the same establishment.
o Suffocation: Remove anything blocking the airway, such as plastic bags immediately
o Strangulation: Remove the object used to strangle immediately
o Asthma attack: Assist the victim to sit upright and assist to medication.

3. The resuscitation measures for all victims of asphyxiation are,

➢ Loosen any tight clothing, especially around the neck.

➢ Check for airway, breathing and circulation
➢ If the victim is unconscious and not breathing with no pulse, perform CPR.
➢ If the victim has pulse but not breathing, give rescue breaths.
➢ Do not leave victims of asphyxia alone at all times, even if consciousness is regained.
➢ When breathing and pulse return, place the causality in recovery position.
➢ Check breathing rate, pulse & level of consciousness at 10 min intervals.

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➢ Send casualty to hospital.

Loss of consciousness
Unconsciousness
Unconsciousness is when a person suddenly becomes unable to respond to stimuli and
appears to be asleep. A person may be unconscious for a few seconds — as in fainting — or
for longer periods of time.
People who become unconscious don’t respond to loud sounds or shaking. They may even
stop breathing or their pulse may become faint. This calls for immediate emergency attention.
The sooner the person receives emergency first aid, the better their outlook will be.
Causes
Unconsciousness can be brought on by a major illness or injury, or complications from drug
use or alcohol misuse.
Common causes of unconsciousness include:
a car accident
severe blood loss
a blow to the chest or head
a drug overdose
alcohol poisoning

A person may become temporarily unconscious, or faint, when sudden changes occur within
the body. Common causes of temporary unconsciousness include:

low blood sugar

low blood pressure
syncope, or the loss of consciousness due to lack of blood flow to the brain
neurologic syncope, or the loss of consciousness caused by a seizure, stroke, or
transient ischemic attack (TIA)
dehydration
• problems with the heart’s rhythm
straining
hyperventilating

Signs
Symptoms that may indicate that unconsciousness is about to occur include:
sudden inability to respond
slurred speech
a rapid heartbeat
confusion
dizziness or light-headedness

If you see a person who has become unconscious, take these steps:
Check whether the person is breathing.

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• Check again to see if they’re breathing, coughing, or moving. These are signs of
positive circulation. If these signs are absent, perform CPR until emergency personnel
arrive.
• If they’re not breathing, have someone call 108 or your local emergency services
immediately and prepare to begin CPR.
Raise their legs at least 12 inches above the ground.
Loosen any restrictive clothing or belts.
Check their airway to make sure there is no obstruction.
• If there’s major bleeding occurring, place direct pressure on the bleeding area or apply
a tourniquet above the bleeding area until expert help arrives.

CPR

CPR is a way to treat someone when they stop breathing or their heart stops beating.
If a person stops breathing, call your local emergency services or ask someone else to. Before
beginning CPR, ask loudly, “Are you OK?” If the person doesn’t respond, begin CPR.

1. Lay the person on their back on a firm surface.

2. Kneel next to their neck and shoulders.
3. Place the heel of your hand over the center of their chest. Put your other hand directly
over the first one and interlace your fingers. Make sure that your elbows are straight
and move your shoulders up above your hands.
4. Using your upper body weight, push straight down on their chest at least 1.5 inches
for children or 2 inches for adults. Then release the pressure.
5. Repeat this procedure again up to 100 times per minute. These are called chest
compressions.

To minimize potential injuries, only those trained in CPR should perform rescue breathing. If
you haven’t been trained, perform chest compressions until medical help arrives.
If you’re trained in CPR, tilt the person’s head back and lift the chin to open up the airway.
1. Pinch the person’s nose closed and cover their mouth with yours, creating an airtight
seal.
2. Give two one-second breaths and watch for their chest to rise.
3. Continue alternating between compressions and breaths — 30 compressions and two
breaths — until help arrives or there are signs of movement.

Treatment

If unconsciousness is due to low blood pressure, a doctor will administer medication by

injection to increase blood pressure. If low blood sugar level is the cause, the unconscious
person may need something sweet to eat or a glucose injection.
Medical staff should treat any injuries that caused the person to become unconscious.
Complications: coma and brain damage.

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A person who received CPR while unconscious may have broken or fractured ribs from the
chest compressions..
Choking can also occur during unconsciousness. Food or liquid may have blocked the
airway.

Cardio respiratory arrest

Cardiac Arrest
Sudden cardiac arrest occurs when the heart stops beating suddenly commonly due to
some electrical malfunction. The victim becomes unresponsive, unconscious with no signs of
breathing or movement. Death can occur within minutes as blood stops flowing to the lungs,
brain and other organs. This can be reversed with prompt emergency intervention.
The first 60 minutes are considered the most crucial and draw the line between life and death.
it is called the Golden Hour.

1. Check for danger to the person of any kind such as safety, hazards or injury due to the
fall etc.
2. Response – Speak to them to see if they respond, if not pinch them hard on their ears.
3. If you get a response – they are alive!!
4. If there is very little response then they are not sufficiently conscious to keep their
Airway open .Put the patient in a recovery position (see image below).

Call emergency helpline number for medical help.

If there is no response you will need to:Check to see if the airway is open. Put 2 fingers under
the chin and other hand on the forehead; tilt the chin up so the tongue is not blocking the
airway.

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Now check for Breathing –Look along the body; Listen for breaths; Feel their breath on your
cheek to see if they are breathing

If you are not sure whether or not they are breathing, you will need to phone the Emergency
Services and start CPR (Cardio Pulmonary Resuscitation)

Push hard and fast on the centre of their chest – right between the nipples
Push down 5-6 cms
At a rate of 120 beats per minute
After about 30 compression
To give someone the best chance, you will need to: tilt the head and lift the chin to take the
tongue off the back of the airway then give 2 breaths – sealing your mouth around their
mouth and blowing into them like a balloon.

Do not expect them to come back to life until the paramedics are there to help.

If there is an Automatic Electronic Defibrillator machine – USE IT!

First Aid for life provides this information for guidance and it is not in any way a substitute
for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or
actions taken based on this information.
1. Check for breathing by watching the chest, nostrils and listening.
o If person is breathing, open the mouth to ensure easy breathing.
o If person is not breathing, start CPR*. CPR (Cardiopulmonary resuscitation)
should be 2 compressions per second followed by 2 breaths. Continue CPR till
person becomes responsive or breathing returns.
2. If there is a Defibrillator (AED) nearby, attach it and follow the voice instructions.
*If you don’t know CPR, please do not attempt it, wait for medical help.

Convulsions
A seizure or convulsion can occur at any age and is due to abnormal electrical activity in the
brain resulting in uncontrollable muscular activity and loss of consciousness. There are many
types of seizure, with some being relatively mild and others severe and prolonged.

A full-scale epileptic seizure involves violent jerking of the limbs, facial twitching, and
foaming at the mouth due to saliva being blown through clenched teeth. The seizure may last
for a few minutes and the patient may need several hours in which to recover.

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Symptoms and signs – Not all may be present

jerking or twitching of the face and limbs

foaming at the mouth
loss of consciousness
loss of control of bladder and/or bowel
blue/purple skin colour and blue lips
flushed and dry skin in a child having a feverish convulsion

Seizures or Convulsions first aid treatment

1. Protect the patient from injury
Check the immediate area for hazards and remove them if possible. Move furniture
away from the person, but take special care with electrical appliances or cooking
utensils to avoid a burn or scald.
If the patient is close to a wall or hard furniture, pad the area with clothing or a pillow
to avoid further injury.
• DO NOT move or try to restrain the patient’s movements because this may result in a
broken bone or soft tissue injury.
• DO NOT try to pad between the patient’s teeth because this may damage the tissues
in the mouth.
2. Manage the seizure or convulsion
Stay with the patient until the seizure ends.
If in a public place, keep bystanders clear and reassure them that the seizure will end
soon.
• If the seizure does not stop after 5 minutes – call for an ambulance.
3. After the seizure
As soon as the seizure ends, quickly roll the unconscious patient onto their side and
open and clear the airway.
Cover the patient lightly with a coat or blanket. Check that normal breathing has
resumed.
Allow the patient to sleep until fully recovered, but check for a response every few
minutes.
• If the patient does not wake up within 10 minutes, is not breathing well, or it is their
first seizure – call for an ambulance.
4. After care
Check for a identity card stating that the wearer suffers from epilepsy.
Check for any injuries and apply necessary first aid.

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Reassure the patient as full consciousness is restored.

Advise the patient not to drive. Try to arrange for someone to be with the patient until
safely home.
Advise the patient to contact their doctor to report the seizure and check that any
prescribed medication is adequate.
If the patient is known to have epilepsy, there is no need for medical aid or an
ambulance unless the seizure lasted more than 5 minutes or a second seizure followed.
If it is the first known seizure, medical advice is vital to avoid any future
complications.

Feverish Convulsions
Convulsions in infants and young children may occur following a sudden rise in body
temperature. This is commonly associated with infections. Such convulsions without
complications from the underlying illness do not cause damage or result in epilepsy.
1. Ensure the child’s safety from any hazards
2. Remove all clothing
• Cool the child slowly by uncovering them down to a nappy or pants.
Avoid giving anything to drink until the child is fully conscious.
3. Wait until the convulsion ends
• Before rolling the child or baby onto their side in a supported position.
4. Open and clear the airway
• Check that normal breathing has returned.
5. Reassure parents
If not breathing normally after the seizure – call for an ambulance.

Chest injuries
Injury to the thoracic cavity by sudden force or fall or penetration of sharp instruments is
known as chest injury. Chest injuries can be classified as open or closed.
An open chest injury occurs when the integrity of the skin has been broken and the
chest wall is penetrated by objects commonly by knife or bullet.
A closed chest wound on the other hand is a wound sustained on the chest without any
object penetrating the skin’s surface and is usually blunt in nature.
A responsive chest injury victim can be assisted to sit up or if the injury is on either
side can be positioned on the injured side down. This position normally would prevent blood
inside the chest cavity from pooling into the uninjured side and more importantly allow the
uninjured side to have enough space to expand when breathing.

Rib Fractures identifying signs

Rib fractures are basically closed chest injuries and the most common type of rib fracture are
the ones caused by a hard blow or a fall. The care for isolated rib fractures and flail chest are
the same. The signs of a rib fracture are:

1. Shallow breathing.

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2. Sharp pain especially when victim takes a deep breath, coughs and moves.
3. Victim constantly holds his/her chest in trying to alleviate pain.

Care for Rib Fractures

To care for a victim with a suspected rib fracture, do the following:

1. Assist the victim in finding the most comfortable resting position to make breathing
much more comfortable as easier.
2. Instruct the victim to stay still as possible to prevent possible puncture of rib shrapnel
to the lung cavity.
3. Stabilize the ribs by splinting the chest with a soft object against the injured area or
use bandages to hold the pillow in place.
4. Contact emergency medical services for further care and management.

Impacted Object to the Chest

Impacted chest wounds are life threatening injuries mainly because of the close proximity of
the area to the lungs and heart; two vital organs that when injured can lead to death within a
matter of minutes.
Care for an impacted object to the chest
1. Do not attempt to remove the embedded object. Removing the impacted object might
cause more damage and profuse bleeding.
2. When moving the victim, carefully assist the victim to a comfortable position slowly
without dislodging the impaled object.
3. Use bulky dressings (clean cloth sterile packs) to wrap around the object for stability.
4. Immediately call emergency medical services for further medical management.

Shock and allergy

Shock is a syndrome that results from decrease in effective circulating blood volume
(or) fluid in the body is result of injury (or) illness.
It can vary from – faintness to complete collapse.
Causes
1. Severe (or) extensive injuries 8. Bites of poisonous snakes (or)
2. Severe pain, heart attack insects
3. Loss of blood 9. Gas poisoning
4. Severe burns 10. Poison taken internally
5. Electric shock 11. Emotional stress
6. Exposures to extreme heat and cold 12. Certain illness
7. Allergic reactions

Types of shock
- Neurogenic
- Hypovolemic shock
- Psychogenic

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- Cardiac
- Septic
- Anaphylactic
Signs
Causality is anxious and restricts
Weakness, fainting (or) giddiness and disorientation
Shallow, rapid (or) gasping breathing
Nausea, vomiting (or) excessive thirst.
Skin becomes pale, cold, clammy and sweating may develop.
Symptoms
Pulse rate becomes weaker
Blood pressure falls
Pupils are dilated
Lustres eyes
Snaking and trembling of arms and legs
Unconsciousness may develop
Evidence of associated external (or) internal injury.
First aid on shock
• If you suspect a person on shock call 108 (or) your local emergency number. Then
immediately take the following steps.
• Lay the persons down and elevate the legs and feet slightly, unless you think this may
cause pain /further injury.
• Normally the lower extremities should be elevated by gravity, this will reduce the blood
in the extremities and may improve the blood supply to the heart.
If the victim has leg fractures, the leg should not be elevated unless they are well
splinted.
If the victim has any head injuries the head could be raised slightly to reduce pressure
on brain; the feet may also be elevated.
If there are breathing difficulties, the victims be more comfortable with in head and
shoulders raised i.e.in semi sitting position.
Keep the person still and don’t move him (or) her unless necessary.
• Begin CPR if person shows no signs of life such as breathing, coughing (or) movement.
• Loose tight clothing and if needed cover the parson with a blanket to prevent chilling.
• Don’t let the person eat (or) drink anything.
• If you suspect that the person is having an allergic reaction and you have access to an
epinephrine auto injector, according to its instructions.
• If the person is bleeding, hold pressure over the bleeding area, using a towel (or) sheet.
• If the person vomits (or) begins bleeding from the mouth, turn him (or) her into a side to
prevent choking.
• Check breathing rate pulse and level of consciousness.
• If breathing and heart beat stop then
• Establish an airways

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• Begin resuscitation immediately

• Keep patient in recovery position
• Shift to hospital immediately.

Allergic reactions
Allergic reactions may be triggered by foods, medications, insect stings pollen (or) other
substances. All allergic reactions aren’t serious.
Severe reactions will lead to life threatening and require immediate medical attention.
Signs and symptoms
Mild
• Itchiness
• Skin redness
• Slight swelling
• Stuffy running nose
• Sneezing
• Itchy watery eyes
• Red bumps anywhere on the body.
Severe
• Swelling as the mouth (or) tongue
• Difficulty in swallowing (or) speaking
• Wheezing (or) difficulty in breathing
• Abdominal pain, nausea, vomiting.
First aid for allergic reactions
• Immediately call local emergency number
• Maintain the person in open airway
• Place the person in recovery position
• Begin CPR to resuscitate the person if the victim with cessation of heart beat and
breathing
• Shift the patient to hospital immediately.
•
15.9-Poisoning
Poisoning
Poisons are harmful substances and when sufficient doses are taken may kill a person.
Definition: Poison is a substance that causes injury, illness (or) death if it enters the body.
Poisons may enter the body in the form of liquids, solids (or) gas and vapour fumes.
First aid management of poisoning
1. Call emergency
2. Clear the person’s airway:-
If the person swallowed a household product, a pill, (or) another substance, its
important to make sure none remains in the mouth (or) air passage.
• Wrap a clean towel around your hand
• Open the persons mouth and remove traces of substances used by him

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• If the person vomits, continue monitor the airway and keeping the mouth area
clean.
• If you are not sure what the person swallowed, keep the soiled towel to bring with
you to hospital for testing.
3. Check the person breathing and pulse:
• If you don’t feel breath (or) a pulse, administer CPR immediately.
4. Keep the person comfortable
• Poison in the system can lead to seizures, so its important to take measures to
prevent injuries.
• lie down the victim on side on a comfortable surface
• Loosen tight clothing
• Make sure the person doesn’t lie down on his / her back, if vomiting occurs this
could lead to choking.
• Continue monitoring the persons breathing and pulse, performing CPR as
necessary, until medical help arrives.
DRSABCD action plan
D – Danger Ensure the area is safe for yourself, other, and patient

R – Response Ask name and squeeze shoulders

No response - Response
Send for help make comfortable
Check for injury
S – Send for help Call 108 for an ambulance
A – Airway Open mouth if foreign material is present
Open airway – by lifting head with chin lift
B – Breathing Not normal breathing - Normal breathing
- Start CPR -Place recovery position
-Treat for shock
- Manage injury
C – CPR 30 chest compressions : 2 breaths
CARDIO PULMONARY
RESUSCITATION
D – Defibrillation Apply defibrillators if available and follow voice prompts

Take the following actions until help arrives:

• Swallowed poison- Remove anything remaining in the person's mouth. If the
suspected poison is a household cleaner or other chemical, read the container's label
and follow instructions for accidental poisoning.
• Poison on the skin- Remove any contaminated clothing using gloves. Rinse the skin
for 15 to 20 minutes in a shower or under running tap water.
• Poison in the eye- Gently flush the eye with cool or lukewarm water for 20 minutes
or until help arrives.
• Inhaled poison- Take victim into fresh air as soon as possible.

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• If the person vomits, turn his or her head to the side to prevent choking.
• Begin CPR if the person shows no signs of life, such as moving, breathing or
coughing.
• Call the ambulance service for medical services.
• Ask somebody to collect and send pill bottles, packages or containers with labels, and
any other information about the poison along with the ambulance team.

Bites and stings

Mostly insect bites and stings are mild, reactions causing little more than redness, itching,
stinging or minor swelling. Rarely, insect bites and stings, such as from a bee, a wasp, a
hornet, a fire ant or a scorpion, can result in severe reactions.
For mild reactions- To take care of an insect bite or sting that causes a mild reaction:

• Move to a safe area to avoid more bites or stings.

• If needed, remove the stinger.
• Wash the area with soap and water.
• Apply a cool compress. Use a cloth dampened with cold water or filled with ice. This
helps reduce pain and swelling. If the injury is on an arm or leg, elevate it.
• Apply a cream, gel or lotion to the injured area. Use products containing ingredients
such as hydrocortisone, pramoxine or lidocaine to help control pain. Use creams such
as calamine lotion or those containing colloidal oatmeal or baking soda to help soothe
itchy skin.
• Use over-the-counter medications. Try a pain reliever, such as acetaminophen or
ibuprofen.

Usually, the signs and symptoms of a bite or sting disappear in a day or two. If necessary, call
your doctor.

When to seek emergency careCall your local emergency number if the injured person
experiences:

• Difficulty breathing
• Swelling of the lips, eyelids or throat
• Dizziness, faintness or confusion
• Rapid heartbeat
• Hives
• Nausea, cramps or vomiting
• A scorpion sting and is a child

Take these actions immediately while waiting for medical help:

• Ask the person if he or she is carrying an epinephrine auto injector others to treat an
allergic attack.

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PAPER III PRIMERY HEALTH CARE

• If the person says he or she needs to use an auto injector, ask whether you should help
inject the medication. This is usually done by pressing the auto injector against the
person's thigh and holding it in place for several seconds.
• Loosen tight clothing and cover the person with a blanket. Don't give him or her
anything to drink.
• Turn the person on a side to prevent choking if he or she is vomiting or bleeding from
the mouth.
• Begin CPR if the person shows no signs of circulation, such as breathing, coughing or
movement.

Stroke
A stroke is a condition in which part of the brain is affected by an interruption to the normal
blood supply. This can result from a clot in a blood vessel that stops blood passing through to
brain tissue. If this condition is recognised at an early stage and hospital care is readily
available, drug treatment is able to dissolve the clot, resulting in a full recovery.

Stroke is caused by a burst blood vessel when the internal bleeding in the skull causes
pressure on brain tissue. At first, the patient may have a severe headache, but it can lead to
paralysis down one side of the body and even the loss of the ability to speak.

Causes of stroke

Symptoms and signs – Not all may be present

Signs of a stroke include:

• weakness, paralysis (inability to move) or numbness of the face or limbs, particularly
on one side of the body;
• vision suddenly becoming blurred or decreased, double vision especially in one eye;
• difficulty talking or understanding speech;
• sudden difficulty swallowing;
• an unexplained fall, dizziness or loss of balance — someone suffering from stroke
may resemble a drunk person;
• sudden severe headache or a new type of headache with no known cause; and
• Drowsiness, confusion or loss of consciousness.

1. Assess the patient’s level of consciousness

• If unconscious and breathing normally, or if not fully alert, place the patient on their
side in a supported position.
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 PAPER III PRIMERY HEALTH CARE

Call 108 for an ambulance.

It is important for the patient to be assessed as soon as possible because treatment must be
started within 1 to 2 hours if a clot is present in the brain.
2. Care for a conscious patient
• Assist a conscious patient into the position of greatest comfort
• Cover the patient to reduce heat loss.
3. Observe the patient
• While waiting for the ambulance to arrive, observe the patient closely for any change
in condition.
• If there is any deterioration in the patient’s conscious state, turn the patient on their
side in a supported position.
Although the experience of suffering a stroke is very frightening for the patient, if prompt
medical treatment is given followed by rehabilitation therapy over a period of time,
improvement is achievable for many.

Heat stroke
When a person exposed to excessive high temperatures, there will be failure of body's
temperature-regulating mechanism occurred. This condition is marked by fever and often by
unconsciousness,
Symptoms of Heat Stroke

The prime symptom of heat stroke is a core body temperature above 104 degrees Fahrenheit.
The first sign may be fainting.

Other symptoms may include

• Throbbing headache
• Dizziness and light-headedness
• Lack of sweating despite the heat
• Red, hot, and dry skin
• Muscle weakness or cramps
• Nausea and vomiting
• Rapid heartbeat, which may be either strong or weak
• Rapid, shallow breathing
• Behavioural changes such as confusion, disorientation, or staggering
• Seizures
• Unconsciousness

First Aid for Heat Stroke

If you suspect that someone has a heat stroke, immediately call ambulance for transporting
the person to a hospital. Any delay seeking medical help can be fatal. The immediate first aid
measures are

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 PAPER III PRIMERY HEALTH CARE

Move the person to an air-conditioned environment -- or at least a cool, shady area -- and
remove any unnecessary clothing.
If possible, take the person's core body temperature and initiate first aid to cool it to 101 to
102 degrees Fahrenheit. Try these cooling strategies:
• Fan air over the patient while wetting his or her skin with water from a sponge or
garden hose.
• Apply ice packs to the patient's armpits, groin, neck, and back. Because these areas
are rich with blood vessels close to the skin, cooling them may reduce body
temperature.
• Immerse the patient in a shower or tub of cool water.
• For young and healthy victim who suffered with heat stroke exertion- an ice bath may
help to cool the body.
• Do not use ice for older patients, young children, patients with chronic illness, or
anyone whose heat stroke occurred without vigorous exercise. Doing so can be
dangerous.

Burns and scalds

The second degree burns larger than the person's abdomen or the area of their hand spread
out or Full thickness burns. Full thickness burns are called third degree and at times fourth
degree. These extend into the deeper tissue and involve all layers of the skin and possibly all
the way through to the bone. Areas may appear dry, white or charred black. These may be
numb or painless because the nerves in these areas have been damaged.

First Aid for Burns (Major/severe)

1. If person is on fire get them to drop and roll to help extinguish the flames.
2. Call emergency services.
3. If the person is not breathing start the CPR process.
4. Cover the burn area with a cool, moist (if possible sterile) dressing. A sheet will do if the
area is large.
5. Remove any jewellery on or near the burn area. Do not remove jewellery if it is stuck
6. Elevate the burnt areas above the heart where possible. If injuries allow.
7. To help prevent shock lay the person down with legs elevated. This really can only be done
if it is the extremities that have been affected.
8. Continue to monitor the person's breathing and pulse until medical help arrives.
9. Call emergency services
10. If the person is not breathing start the CPR process.
11. Cover the burn area with a cool, moist (if possible sterile) dressing. A sheet will do if the
area is large. Preferably do not use a material that fluff can enter the wound and cause
infection.
NOTE: Do not run; Don’t pour cold water over the burn as this can lead to shock.

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PAPER III PRIMERY HEALTH CARE

• An Exception were you need to use flowing water is when the injury has been caused
by a Chemical. It is vital to remove the cause of the burning just like you would
remove the person from flames
• The water must not be cold but tepid (body temperature) so no noticeable change in
temperature when you put your hand in the water and definitely not hot to touch. If
possible run water over chemical burn area for 20 minutes.

5. Remove any jewellery on or near the burn area as swelling can follow shortly after a burn.
If swelling occurs jewellery can become tight and restrict circulation.
6. Elevate the burnt areas above the heart where possible. This can help to reduce possible
swelling.
7. To prevent shock- lay the person down with legs elevated. Also cover the person with a
blanket or jacket etc.
8. Continue to monitor the person's breathing and pulse until medical help arrives.
There are some Don’ts that need to be followed when giving First Aid for Burns:

• Do not removes burnt clothing that is stuck as this can damage the area further.
• Do not immerses large severe burns in cold water as this may cause shock. This is
mentioned above.
• Do not applies burn ointments as these will need to be removed by the medical team
so an assessment can be done. This can delay appropriate treatment and also cause
further damage to the area.
• Do not gives food or water to a person who has a severe burn as they may require
surgery. If surgery is needed it is best that the person not consume anything for a
minimum of 6 hours prior to having anaesthetic.
• Do not position the person where their airway may be restricted e.g. no pillow under
their head as they may have inhaled smoke and therefore may have airway burns.

Conclusion
FIRST AID at right time will help to restore the life and survival of the victim, even if he is
in critical life threatening condition. The multipurpose health worker must practice first aid
and implement in the community services.
Essay questions
1. Describe the first aid management of causality with convulsions
2. How do you give first aid management for the victim with cardiac arrest
3. How do you control internal and external bleeding
Short answer questions
1. What is asphyxia?
2. List four point of first aid care for stings with minor problem
3. Enumerate four don’ts of severe burns conditions
4. What are the causes of heat stroke?
5. What are the signs and symptoms of stroke?

484
 MPHW [Female] Course

SYLLABUS
MULTIPURPOSE HEALTH WORKER (F)
COMMUNITY HEALTH
NURSING
BLUE PRINT
I YEAR
THEORYPAPER-I
PERIODS/WEEK : 04 ALLOTTED PERIODS : 135
TIME SCHEDULE, WEIGTAGE & BLUE PRINT

S, Name of the Unit No. of Weightage Short Problem

No. allotted in marks answer questions
hours questions
1 Concept of health 10 8 1 1
Structure &
2 Organisation 05 2 1
of community
3 Community Based 05 2 1
Assessment
4 Home Visit 10 8 1 1
5 Health problems & 10 8 1 1
Policies
6 Communication and 10 8 1 1
Health Education
7 Concept of disease 05 2 1
8 Infection 05 2 1
9 Immunity and body 10 8 1 1
defence mechanisms
10. Immunization 05 8 1 1
11. Environmental 10 8 1 1
Sanitation
12. Safe water 10 8 1 1
Disposal of excreta and
13. waste 10 8 1 1

14. Introduction to 15 8 1 1
communicable diseases
15. Occupational Health 10 8 1 1

16. Disaster Management 05 8 1 1

135

Note : The question paper contains two sections i.e. A&B

Section – A contains ten (10) questions carries 2 marks each.
The student has to answer all questions.
Section – B contains eight (8) questions carries six (6)
marks each. The student has to answer any five (5)
questions

1
 MPHW [Female] Course

SYLLABUS
MULTIPURPOSE HEALTH WORKER (F)
HEALTH PROMOTION
BLUE PRINT
I YEAR
THEORY PAPER-II
PERIODS/WEEK : 04 ALLOTTED PERIODS: 135

TIME SCHEDULE, WEIGHTAGE & BLUE PRINT

S. Name of the Unit No. of Weightage Short Problem

No. allotted in marks answer questions
hours questions
1. Essential Nutrients 15 8 1 1
2. Nutritional problems 15 8 1 1
Nutritional
3. assessment 15 8 1 1
Promotion of
4. Nutrition 10 8 2 1
5. The Human body 20 16 2 2
6 Mental Health 10 8 2 1

7. Mal adjustment 10 8 1 1
8. Mental Illness 15 8 1 1
9. Geriatric Nursing 10 8 1 1
Guidance and
10. Counselling 15 8 1 1

135

Note: The question paper contains two sections i.e. A&B

Section – A contains ten (10) questions carries 2 marks each.
The student has to answer all questions.
Section – B contains eight (8) questions carries six (6)
marks each. The student has to answer any five (5)
questions

2
 MPHW [Female] Course

SYLLABUS MULTIPURPOSE
HEALTH WORKER (F) PRIMARY
HEALTH CARE NURSING BLUE PRINT
I YEAR THEORY
PAPER-III
PERIODS/WEEK : 04 ALLOTTED PERIODS : 135
TIME SCHEDULE, WEIGHTAGE & BLUE PRINT

S. Name of the Unit No. of Weightage Short Problem

No. allotted in marks answer questions
hours questions
1. The Hospital 10 8 1 1
2. Preparation of patient unit 10 2 1
Optimal functioning and
3. hygiene of the body 05 2 1

4. Collection of specimen 05 8 1 1
Disinfection and
5. sterilization 10 8 1 1
6. Bio Medical waste 10 8 1 1
Management
Medical Conditions in
7. Different Systems 25 8 1 1

8. Operation theatre nursing 10 8 1 1

Care of Physically and
9. Mentally Challenged 10 2 1
Types and Administration
10. of drugs 10 8 1 1
Emergency drugs in O.T
11. and other areas 05 2 1
12. First aid 05 8 1 1
Minor injuries and
13. ailments 05 2 1
14. Fractures 05 8 1 1
15. Life threatening conditions 10 8 1 1
135

Note : The question paper contains two sections i.e. A&B

Section – A contains ten (10) questions carries 2 marks each.
The student has to answer all questions.

3
 Section – B containM
s PeH
igW
ht[F(e8m
) aqlu
e]eC
stoiuornses carries six (6) marks
each. The student has to answer any five (5) questions

MODEL QUESTION PAPER- THEORY PAPER-I

MULTIPURPOSE HEALTH WORKER (FEMALE)- I YEAR
COMMUNITY HEALTH NURSING

Time : 3 Hours. Max.Marks 50

SECTION-A
Note:

A. Answer all questions 10 x 2 = 20

B. Each question carries 2 marks
1. Define Community?
2. Define Community Based Assessment
3. Write the Principles of Home Visit
4. Write the methods of communication
5. Define Disease
6. Define Incubation Period?
7. Write the precautions while giving Vaccines?
8. Define and Classify Disasters?
9. List out the Occuational Diseases?
10. Define Immunity?

SECTION-B

Note:
Answer five questions 5 x 6 = 30
Each question carries six marks

11. Define Health and Explain Dimensions of Health?

12. List out the National Health Programmes in India and Explain in
detail about National AIDS Control Programme.
13. Role of MPHW(F) in maintaining inter personal relation ship?
14. Write the classification and differences between Active and Passive
Immunity?
15. What are the sources of Water and explain about Large scale
purification of water?
16. Explain indetail about methods of waste disposal?
17. Write in detail about Immunization Schedule?
18. What is meant by Environmental Sanitation and write indetail about
artificial ventilation?

4
 MPHW [Female] Course

MODEL QUESTION PAPER- THEORY PAPER-II

MULTIPURPOSE HEALTH WORKER (FEMALE) -I YEAR

HEALTH PROMOTION

Time : 3 Hours. Max.Marks : 50

SECTION-A
Note:
A. Answer all questions 10 x 2 = 20
B. Each question carries 2 marks

1. Define vitamins and mentions the types of vitamins?

2. List out the parts of Respiratory System?
3. What is Anaemia?
4. Define Motivation?
5. Define Guidance and Counselling?
6. Write the functions of food?
7. Define Learning?
8. Uses of promotion of kitchen gardens?
9. Features of Mal-adjusted individual?
10. List the problems of old age?

SECTION-B
Note:

Answer five questions 5 x 6 = 30

Each question carries six marks

11. Explain physical and psychological changes during and care of old age
people at home.
12. List out the Endocrine Glands in the body and write in detail about
Pituitary Gland?
13. Write in detail about classification of foods?
14. Explain in detail about food fads, taboos, customs and their influences
onhealth?
15. Describe the components of counselling and write role of counsellor?
16. How will you assess malnutrition in an individual
17. Write the various types treatment for mental illness?
18. Draw a neat labelled diagram of Heart and write the functions of
Heart?
5
 MPHW [Female] Course

MODEL QUESTION PAPER - THEORY PAPER-III

MULTIPURPOSE HEALTH WORKER (FEMALE) -I YEAR

PRIMARY HEALTH NURSING

Time : 3 Hours. Max.Marks: 50

SECTION-A
Note:
A. Answer all questions 10 x 2 = 20
B. Each question carries 2 marks

1. Define Hospital and types of Hospitals?

2. What are the seven steps in Patient Satefy?
3. What are steps in Hand washing?
4. Basic needs of the Humans?
5. Basic principles while collecting principles?
6. Define sterilization?
7. What are the colours of the containers used in waste disposal?
8. Define Constipation?
9. Signs and syptoms of Diabetes?
10. Mention the routes of drug administration?

SECTION-B

Note:
Answer five questions 5 x 6 = 30

Each question carries six marks

11. Write about causes of convulsions and how will you manage the Heat
stoke patient?
12. What are the functions of scrub and circulatory nurse?
13. Write in detail about diabetes mellitus?
14. Describe the signs and symptoms of cardiac arrest and write about
emergency management of patient with heart attack?
15. Classify the types of headache and explain in detail?
16. Explain in detail about Tuberculosis?
17. Write about physical methods of sterilization in detail?
18. Write the procedure of urine test?