NURSING

Theory
VocationalEducation
HIGHERSECONDARYFIRSTYEAR
A Publication under
Government of Tamilnadu
DistributionofFreeTextbookProgramme
(Notforsale)
Untouchabilityisasin
Untouchabilityisacrime
Untouchabilityisinhuman
CollegeRoad,Chennai600006.
GovernmentofTamilnadu
FirstEdition2010
CHAIR PERSON
Dr. Mrs. P. Mangala Gowri
CollegeofNursing
MadrasMedicalCollege
Chennai600003.
Authors
Dr. Mrs.Prasanna Baby Mrs. M. Elizabeth
CollegeofNursing Government Higher Secondary School
ChengalpetMedicalCollege Ottanchantram.
Chengalpet.
Dr. Mrs.N. Jaya Prof. Kamala Subbaiyan
CollegeofNursing VenkateshwaraCollegeofNursing
MadrasMedicalCollege Chennai.
Chennai600003.
ThisbookhasbeenpreparedbytheDirectorateofSchoolEducation
onbehalfoftheGovernmentofTamilnadu
Thisbookhasbeenprintedon60GSMpaper
FOREWORD
ThedevelopmentofthetextbookNursingresultedfromthecombinedeffortsofmanytalented
professional,committedtoexcellence.Specialrecognitionanddueacknowledgementisherebymade
totheDirectorofSchoolEducationandtheJointDirectorofSchoolEducationChennai.
Nursingisamajorcomponentofthehealthcaredeveliverysystemandnursesmakeupthelargest
employmentgroupwithinthesystem.
Nursingservicesarenecessaryforeverypatientseekingcareofvarioustypesincludingprimary,
secondary,tertiaryandrestorative.Asnursingisanimportantpartofhealthcaredeliverysystem,the
nursesneedtohaveasoundknowledgeaboutnursingasaprofessionandcommonprofessionalactivi
ties.
WiththepresentintroductionofVocationalcoursessuchasnursingintheacademicstreamasone
oftheoptions,itisbelievedthatitwillcontributetowardsthebasicnursingcareofindividuals,families
andcommunityforhealthandhappiness.Itwillalsobeafoundationcourseforfuturediplomaand
degreeprogrammesinNursing.
InthiseditionanewchapteronBioMedicalWasteManagementhavebeenaddedinviewof
thefactthattheseknowledgewillbeessentialforthestudentstolearnbeforeenteringintotheprofes
sionalcourse.Thesubjectcontentshasbeendeveloped,refinedandreconstructedatseveralpointsas
perthecurrentperspectives.
Dr.Mrs.P.MangalaGowri.
III
CONTENTS
S.No Subject Periods PageNo.
1. Nurse and Nursing as a profession 20
Definitionofhealth. 1
Conceptof health. 1
Health&illnesscontinuum. 1
HistoryofNursing 2
DefinitionofNursing&Nurse. 9
QualitiesofNurse. 9
Functions of Nurse 10
Fundamentalrulesfornursing. 11
Codeofethicsinnursing. 11
FlorenceNightingalepledge. 13
Definitionofhospital. 14
Types of Hospitals 14
Function of Hospitals 15
2. Anatomy and Physiology: 50
Definitionofanatomy&physiology 19
Anatomical positions 19
Cells&Tissues 20
Musculoskeletalsystem 22
Nervous system 33
CardioVascularsystem 37
Blood 38
Digestivesystem 40
Respiratory system 46
Excretory system 49
Endocrine system 51
Senseorgan 55
Reproductive system 61
3. Introduction to Psychology 30
Definitionofpsychologyandmentalhealth 73
Characteristicsofmentallyhealthyperson 73
Importance of psychology in nursing 73
Factorsinfluencingmentalhealth 74
IV
S.No Subject Periods PageNo.
DefinitionofLearning 74
Characteristicsoflearningbyinsight 76
Observation,Attention, &Perception 77
Emotion 80
Personality 83
Defencemechanism 87
4. Principles and practice of nursing 60
DefinitionofNursingprocess 91
Steps in Nursing process 91
Admissionofapatient 92
Orientationtotheward 93
Careofbelongings 94
Dischargeofapatient 94
Bed&Bedmaking 94
Therapeuticenvironment 96
Psycho social environment 96
BodyMechanicsandPositioning 96
HygienicNeedsPersonalhygiene 98
Safety & Comfort Needs 99
Activity&Exercises 100
Moving,shifting&liftingpatients 101
OxygenNeed 102
EliminationNeeds 104
5. HealthAssessment&PhysicalExamination 30
DefinitionofphysicalExamination 108
PurposesofphysicalExamination 108
MethodsofphysicalExamination 108
PrinciplesofphysicalExamination 109
- Headtofootexamination 109
Physiological assessment 111
- Temperature 111
-Pulse 115
- Respiration 116
- Bloodpressure(BP) 117
- Pain 117
Testing&examination 118
V
S.No Subject PeriodsPageNo.
-Urine. 118
-Stool. 121
-Sputum. 122
6. Medical & surgicalAsepsis: 20
Definitionofasepsis 126
Principles of asepsis 126
Types of asepsis 126
Basicprinciplesofsurgicalasepsis 127
- Useofgloves 127
- UseofAprons 127
- UseofMasks 128
Sterilizationanddisinfection 128
- Definition 128
- Methodsofsterilization 128
Handlingofsterilearticles 133
BiomedicalWasteManagement 134
- Classificationofwaste 134
- Segregation,PackingandTransporting 135
- Categoriesofbiomedicalwaste 135
7. FirstAid: 60
DefinitionofFirstAid 140
RulesandprinciplesofFirstAid 140
FirstAidandEmergencysituations 140
- FireandBurns 140
- Fractures 142
- Drowning 142
- Haemorrhage 143
- Shock 144
- Bandagingandsplinting 145
- HeatstrokeorSunstroke 147
- Heatexhaustion 147
- Frostbite 149
- BitesandStrings 150
- Poisoning 153
- Foriegn body 159
- CarAccident 160
VI
S.No Subject PeriodsPageNo.
Cardiopulmonary resuscitation 162
Emergencykit 163
8. Hospital Housekeeping 20
Principlesofgoodhousekeeping 169
Cleanlinessandorderliness 169
Care of rubber goods 170
- Gloves 170
- Rubbertubes 170
Careofenamelwares 171
- Bedpan 171
- Urinal 171
- Kidneytray 171
- Sputumcup 171
Careofinstruments 171
- Sharpinstruments 171
- Glassware 172
- Syringeandneedle 172
- Careoflinen 172
CareofpatientsUnit 173
- Flooring 173
- Wall 174
- Sanitaryannex 174
- Bathroom 174
- Lavetory 174
VII
19
2.ANATOMYANDPHYSIOLOGY
DEFINITIONOFANATOMYANDPHYSIOLOGY
Anatomy: Itisthestudyofthestructureofthehumanbody.
Physiology:Itisthestudyofthe functionsofthehumanbody.
Thebodyasawhole:
Thebodyiswonderfullymade,likeacomplex,perfectmachine.Eachpartisspeciallyconstructed
tocarryoutitsownfunction,andtoworkasawholewiththeotherparts.
Lookatapersonstandingwitharmsatthesides,palmsturningforward,thisiscalledtheana
tomicalposition.Thebodyisseentoconsistofthehead,neck,trunk,upperlimbs(thearms)and
lowerlimbs(thelegs).
ANATOMICALPOSITION
Whenapersonstandinguprightwiththeheadfacingforward,armsbythesidesandthepalmsofthe
handsfacingforwardandfeetstogetherissaidtobeanatomicalposition
THEFOLLOWINGTERMSAREUSEDINANATOMY:
1)SUPERIOR higher
2)INFERIOR lower.
3)ANTERIOR nearerthefrontofthebody.
4)POSTERIOR nearerthebackofthebody
5)MEDIAL nearertothemidline.
6)LATERAL totheside.
7)PROXIMAL nearertotheheadorsource.
8)DISTAL distantfromtheheadorsource.
9)EXTERNAL outside,orawayfromthetrunkcentre.
10)INTERNAL inside,ornearertothetrunkcentre.
11)SUPERFICIAL nearerthebodysurface.
12)DEEP inside,awayfromthebodysurface.
Thebodyhasastrongframeworkofbonescalledthe skeleton. Theskeletoniscoveredby
musclesandothersofttissuesandbyskinontheoutside.
Cavitiesofthebodyandtheircontents:
Somebodypartsformspacescalled cavities,inwhichimportantinternalorgansareprotected.
1)The cranialcavityorskull containsthebrain.
20
1
2
3
4
5
6
2)The thoraciccavityorchest contains:
(a)Thelungs
(b)Theairpassagestracheaandbronchialtubes.
(c)Theesophagusorfoodpipe,whichliesbehindthetrachea.
(d)Theheart.
(e)Thegreatbloodvesselsandthethoracicduct(thelargestlymphaticvessel).
3)The abdominalcavity,whichisseparatedfromthethoraciccavitybyadomeshapedmuscle
calledthediaphragm.Itcontains:
(a)Thestomach (b)Thesmallintestines.
(c)Thelargeintestineorbowel (d)Theliver.
(e)Thespleen (f)Thekidneys.
(g) Theureters (i)Thepancreas.
4)The pelviccavity,whichcontains:
(a)Thereproductiveorgans
(b)Thebladderwhenempty(whenfullitrisesintotheabdominalcavity)
(c)Therectum.
CELLSANDTISSUES
Alllivingthings,includingthehumanbody,aremadeupoflivingcells.Thecellisthestructuraland
thefunctionalunitofthehumanbody.
Justasmanykindsofmaterialsmaybeusedintheconstructionofalargebuilding,inthesameway
manydifferentkindsofcellsarefoundinthebody.
StructureofaCell: Acellhasthefollowingparts:
(a)Cellmembrane,theoutercovering.
(b)Protoplasm,themainsubstanceofthecell.
(c)Nucleus,whichcontrolsactivitiesofthecell
1)Vacuole
2)Cytoplasm
3)Nucleus
4)Endoplasmicreticulum
5)Mitochondrion
6)Cellmembrane
Fig.2.1StuctureoftheCell
21
Functionsofcells: Byfunctionswemeantheactivities
(a)Digestion intakeofthenutrients.
(b)Excretion eliminationofwastes.
(c)Respiration takingandusingoxygen,andgivingoutcarbondioxide.
(d)Growthandrepair increasesthesizeofthecellandreplacementofwornoutcell.
(e)Somecellsmoveaboutz,andsomehavespecialfunctions.
(f)Reproductionisbyeachcellsimplydividingintotwo.
TISSUES
Tissuesarematerialsmadeupofgroupsofsimilarcells.Cellsareofvarioustypes,andtissuesvary
accordingtothetypesofcellsintheirstructure.Therearefourmaintypesoftissueinthehumanbody.
Fig.2.2Variouskindsofcells
1)Epithelialcells(2)Connectivetissue(3)Fattytissue(4)Cartilage
(1) Epithelial whichformscoveringsliketheskin,liningmembranesandglandsconnective,
whichhelpstosupportandbindpartstogether,holdingtheminplace.
(2) Thereareseveraltypesof connectivetissue includingbone,cartilage,ligaments,fattyand
elastictissue,alsobloodandlymph(thefluidtissues).
(3) Muscular thistissuehasthepowerofcontraction,whichcausesmovement.
(4) Nervous conductsnerveimpulses.
ORGANSANDSYSTEMS:
Tissuesarejointedinlargerunitscalled organs, suchastheheart,lungs,brain,liver.Eachorganis
madeupoftypesoftissue,whichenableittodoitsspecialwork.
Asystemisagroupoforgans,whichtogethercarryoutoneoftheessentialfunctionsofthebody.
Thereareninesystemslistedbelow.Allofthesesystemsworkharmoniouslytogetherinahealthybody.
22
S.No.SystemsofthebodyFunctions
1. SkeletalSystem Support,movementandprotection
2. MuscularSystem Movementsandproductionofheat.
3. NervousSystem Controlofbodyactivities.
4. CircularSystem Transportoffoodandoxygen,wasteproducts.etc.
5. RespiratorySystem Takinginofoxygenandgivingoffcarbondioxide.
6. DigestiveSystem Takinginfood,breakingitdownintonutrientsforuse
bybodycells.
7. ExcretorySystem Removalofwastematterfromthebody
8. Endocrine Productionofhormones,whichinfluencetheactivity
ofcells.
9. ReproductiveSystem Enablesnewindividualstobeborn.
(I)MUSCULOSKELETALSYSTEM
Theskeletonisthebonyframeworkofthebody.Thehumanskeletoniswonderfullymadeinsuch
away,thatitcansupportthebodyintheerectpositionandenablethebodytomovefreely.
StructureandFunctionsoftheSkeleton:Theskeletoniscomposedof 206separatebones inthe
adult,andthecartilagesandligaments,whichhelptounitethebonesatthejoints.
ThePartsoftheSkeletonare:
(1) Skull,madeupof29bonesinall(includingmiddleearbonesandthehyoid).
(2) SpineorVertebralcolumnmadeupof26Separatebones.
(3) ThoraxorChestmadeupof25(12pairsofribsandthebreastbone)
(4) Upperlimbs,each32bones.
(5) Lowerlimbs,each31bones.
Thetotalbonesinourbodyis206.
TypesofBones:
(1) Longbones Theseareinthearms,legsandfingers.Theyactasleverstomoveparts.
(2) Shortbones Asinthewristsandankles.
(3) Flatbones Theseincludestheribs,shoulderandbonesofthecranium.
(4) Irregularbones Suchasthebonesofthefaceandofthespine.
23
FunctionsoftheSkeleton:
1) Supportsandgivesshapetothebody. 2) Protectsinternalorgans.
3) Movementswiththehelpofmuscles. 4) Formsbloodcells.
Structureofskeletaltissue:
1) Periostium: Thisistheoutercoveringofbones.Itcarriesbloodvesselsandnerves.
2) CompactBone: Mainlycomposedofcalciumandphosphorus,isthehardouterlayerof
bonetissue.
3) Cancellous Bone: insideisaporoustypeofbonewithmanytinyspaces.Ithelpstomake
theboneslight.
(a) RedMarrow:Thisfillsthespacesincalcellousbone.Redbonemarrowproduces
redbloodcellsandsomewhitebloodcells.
Fig.2.3LongBone
Fig2.4aShortBone
1)HyalineCartilage2)Periosteum
3)MedullaryCavity
1)Fibula2)Tibia
1
2
3
Fig2.4bShortBone
1)Phalanges
2)MetatarsalBones
3)TarsalBones
2
1
3
1
2
24
(b) YellowMarrow:Thisismainlycomposedoffatcells.Yellowbonemarrowfillsthe
shaftofthelongbonemakingthemlight.
(c) Cartilage:Astrongplaintissuelikehardrubbersisattachedtosomebones.Eg.The
endofthenose,andofitsribs
4)Ligamentsaremadeofstrongfibroustissueandtheyholdbonestogetheratthejoints,
allowingsomemovement.
TheSkullconsistsoftwoparts:
1) Thecranium,whichislikeaboxinwhichthebrainiswellprotected.
2) Thebonesoftheface.
Thecraniumismadeupofeightbonesasfollows:
1) Frontalbone: Whichformstheforeheadandhelpstoprotecttheeyes.
2) Parietalbone Oneateachsideofthetopoftheskull,joinedintothemiddle.
3) TemporalbonesOneoneachsidebelowtheparietalbones.Theseprotecttheinnerpartsof
theears.
4) OneOccipitalbone:Thisformsthebackoftheheadandpartofthebaseoftheskull.Ithasa
largeopeningforthespinalcordtopassthrough.
5) OneSphenoid Ahatshapedbone,whichalsoformspartofthebaseoftheskull.Ithasa
littleseatforthepituitarygland,andsomeholesforbloodvesselsandcranialnervespass
through.
6) OneEthmoid Whichformstheroofofthenoseandinbetweentheeyes.Ithasmanysmall
holesforthenervesofsmalltopassthroughthebrain.
1
2
3
4
5
6
7
8
9
10
Fig2.5TheSkull
1)ParietalBone2)TemporalBone3)OccipitalBone4)MaxillaryBone5)MandibleBone6)
FrontalBone7)SphenoidBone8)LacrimalBone9)EthmoidBone10)MalarBone
25
TheFacehasthefollowingfourteenbones:
Two nasalbones,whichformthebridgeofthenose.
Two lacrimalbones,neartheeyes,whichcontaintherearducts.
Twocheekbones.
Two upperjawbones,withupperteeth.
Two palatebone whichjoinwiththeupperjawbonesinformingthehardpalate.
Two curledbone,oneineachsideofwallofthenose.
Two vomerbones,whichrestsonthepalateandhelpstoformthenasalseptum.
One lowerjawbone,whichconsistsofthehorizontalpartonwhicharethelowerteeth,and
twoverticalparts,whichmeetthetemporalbones.Theangleofthejawoneachsideis
important.Allthebonesoftheskullexceptthelowerjawarejoinedfirmlytogetherbyfixed
jointscalledSutures.
Sinuses.Someskullboneshavehollowspacescalledsinuseswhichconnectwiththenose
andarefilledwithair.Sinusesmaketheskulllighter,andhelpinthesoundofthevoice.
Sinusitisisinfectioninthesespaces.Themainsinusesarethefrontalonesabovetheeyes,
andlargeantrumsinuses,oneineachoftheupperjawbones.
Hyoidbones,thisisahorseshapedlittleboneintheupperpartoftheneck.Thetongue
muscleisattachedtothisbone.
TheVertebralColumn
Spineorbackboneisthecentralpartoftheskeleton.Itsupportstheheadandenclosesthespinal
cord.Itconsistsof33irregularbonescalledVertebraebutsomearefusedtogetherandsotheseare
actually26separatebonesformingthespine.
ThepartsoftheVertebralColumnareasfollows:
Cervicalvertebralcolumn intheneckregion.Thefirsttwo,calledatlasandaxisare
importantfornoddingandturningthehead.
12dorsalor thoracicvertebrae atthebackofthechest.Theribsarejoinedtothese
vertebrate.
5 lumbarvertebrae intheassistregion.Thesearebigandstrongforgivingsupport.
5 sacralvertebrae arefusedtogethertoformthesacrum,atriangularshapedbonewitha
hollowanteriorly.Thesacrumhelpstoformthepelvis.
4smallvertebraeinthetailregionarefusedtoformasmalltriangularbonecalledthe
coccyx.Itisattachedtothelowerpartofthesacrum.
IntervertebralDiscs
Betweenthebodiesofthevertebraetherearethickpadsofcartilagecalleddiscs.Theyallow
movementinthespine,andactasshockabsorbers.
Thevertebraearealsojointtogetherbyligamentsandmusclesattachedtothebackandside
processes.
26
FUNCTIONSOFTHEVERTEBRALCOLUMN
1) Movement:Forward,backward,fromsidetoside,alsonoddingandturningtheheadare
possiblebecausethespineismadeofnotonebutmanysmallbones,withdiscsofcartilagein
between.
2) Thespinesupportstheweightofthehead,andoftheabdominalorgans.
3) Protectionforthespinalcord,whichlieswithinthespinalcanal,andprotectionfrominjuryby
cushioningofthediscs.
4) Balanceintheerectpositionismadepossiblebythecurvesofthespine.
TheThorax: Thethoraxorchestisformedbythe sternum(Breastbone)andcostalcartilagesinfront,
theribsatthesides,andthetwelvedorsalvertebralbonesattheback.
Thesternumisaflatbone,shapedlikeadaggerpointingdownwards.Thetipconsistsofacarti
lageknownasthexiphisternum.Theupperpart,likethehandleisjoinedtothetwocollarbones.The
costalcartilagesarejoinedtothesidesofthesternumandtothetrueribs.
1
2
3
4
5
Fig2.6VertebralColumn
1)CervicalRegion
2)ThoracicRegion
3)LumbarRegion
4)SacralRegion
5)CoccxygealRegion
Fig2.7TheThorax
1&2)Sternum
3)TrueRibs
4)FalseRibs
5)FloatingRibs
6)Xyphisternum
7)LumbarVertebrae
27
Theribsaretwelvepairsofthelongcurvedbones.Theuppersevenpairsarecalledtrueribs.
Theseareeachattachedtothesternumbyitscostalcartilages.
Thenextfivepairsofribsarecalledfalseribsbecausetheyarejoinedbytheircartilagestothose
oftheribsaboveandnotdirectlytothesternum.Thelasttwopairsarenotconnectedtothesternumat
all,andarecalledfloatingribs.
FunctionsoftheThorax:
1) Protectionfortheheart,lungs,liver,stomachandspleen.
2) Supportforthebonesoftheshouldergirdleandforthebreast.
3) Importantinrespiration.
BonesoftheUpperLimbs:
Eachupperlimbconsistsofthirtytwobones.
One collarbone:Thesetogetherwiththoseoftheothersideformtheshoulderbone.
Shouldergirdle.
One humerus,theboneoftheupperarm.
One radius,theouterboneoftheforearm.
One ulnar,theinnerboneoftheforearm.
Eight carpalbones ofthewrist.
Fourteen phalanges ofthefingers.
1 2
3
1
2
3 4
5
Fig2.8aHumerus
1)Head2)Neck3)Shaft
Fig2.8bTheUlna&Radius
1)HeadoftheRadius2)NeckoftheRadius3)Shaftof
theRadius4)ShaftofUlna5)HeadofUlna
28
The collarbone (clavicle)oneachsideisalongbonewithtwocurves.Itsinnerendis
attachedtothesternum,andouterendwiththeshoulderblade.Thecollarboneiseasilyfeltat
thelowerandfrontpartoftheneck.Itkeepstheshoulderbladeinplace.Whenitisbroken
theshoulderdropsforwardanddownwards.
The shoulderblade (scapula)oneachsideisattheupperandouterpartofthebackofthe
thorax.Itislargeflat,triangularshapedbonewitharidgeorspineattheback.Ittakespartin
theshoulderjoint.
The humerus isalongbonewitharoundedheadattheshouldersandabroadlowerendat
theelbowjoint.
The radiusandulnarbones oftheforearmreachfromtheelbowjointtothewrist.
Thewristconsistsofeight carpalbones.Theseshortbonesarearrangedintworows,
proximalanddistal,withfourbonesineachrow.
Thepalmconsistsoffivelongbonescalled metacarpal,whicharticulatewiththedistalrow
ofcarpalbonesandwiththeproximalrowof phalanges. Thephalangesarelongbones.The
thumbhasonlytwophalangeswhilethefingershavethreeeach.
BonesoftheLowerLimbs:
Eachlowerlimbconsistsofthirtyonebones:
Oneinnominate orhipbone,
One femur,thethighbone,
One patella orkneecap,
One tibia
One fibula thelowerlegbones
One tarsalbones oftheankle
Five metatarsalbones ofthefoot
Fourteen phalanges ofthetoes
1
2
3
Fig2.9TheHand
1)CartalBones
2)MetaCartalBone
3)Phalanges
29
1)TheInnominateBones: Oneoneachside,joinwiththesacrumtoformthepelvis.Besidespro
tectingthepelvicorgans,thepelvissupportstheabdomenandprovidesthedeepsocketsforthehip
joints.
Inthefemale,thetruepelvis(lowerpart)isroundsothatthehead,ofthebabycanpassthrough
duringdelivery.Inthemalethetruepelvisislong,narrowandheartshaped.
Theinnominateboneinachildisseparatedintothreebones,whicharefusedtogetherintheadult.
Thereforethebonehasthreepartsasfollows:
1) Ilium,theupperflatpart,formsthefalsepelvis.Itsupperridgeiscalledtheiliaccrest.
2) Ischium,theheavylowerpart,whichsupportsthebodywhensitting.
3) Pubis,thefrontpart.Thepubicbonesfromthejointcalledsymphysispubis.
Thefemur(thighbone)isthelongestandstrongestboneinthebody.
Thepatella(kneecap)isasmallboneatthefrontofthekneejoint.
Thetibiaisthelongboneontheinnersideofthelowerleg.
Thefibulaisalongthinboneontheoutersideoftheleg.
Thetarsalbonesoftheankle.Thesearesevenshortbones.Thelargestistheheelbone
(calcanium).Theupperbonetakespartintheanklejoint.
Themetatarsalbonesarefivelongbonesinfrontofthefeet.Theysupportthetoes.
Thetoebones(phalanges)arefourteeninnumber.Likethefingerbones,theyaresmalllong
bones,twointhebigtoeandthreeineachoftheothertoes.
Joints: Ajoint isthepointatwhichtwoormorebonesmeet.Bonesareheldtogetheratthejointsby
otherconnectivetissuesuchasfibroustissue,cartilage,ligamentsandtendons.Musclesarethemeans
bywhichallmovementinthebodytakesplace,includingthemovementsofbonesatsomeofthejoints.
Fig2.10InnominateBone
1)Ilium2)Pubis3)Symphysispubis
4)SacroiliacJoint5)Ischium
1
2
3
4
5
30
TypesofJoints:
1)) Fibrousjoints inwhichthereisnomovement.Eg.Thesuturesoftheskull.Thebonesare
joinedtogethercloselyasthoughtheywerestitched(sutured)together
2) Cartilaginousjoints inwhichtwobonesarejoinedbyapadoffibrouscartilage,which
allowsslightmovement.Theyarefoundinthevertebralcolumnandpelvis.
3) Synovialjoints whicharefreelymovable,arefoundinthelimbsandjaw.
4) Ballandsocketjoints theroundheadofonebonefitsintothecavityofanotherbone:eg.
Shoulderandhipjoints.
5) Hingejoint theonlymovementsareflexionandextension.Eg.Elbow,knee.
6) Glidingjoint thebonesglideononeanotherandallowfairlyfreemovements.Eg.Wrist
andanklejoint.
7) Pivotjoint turningistheonlymovement.Eg.Themovementbetweentheatlasandaxisfor
turningthehead.
Muscular system
Thefunctionofamuscleistocontractandtoproductmovement.Amuscle ismadeupofbundles
offibersheldtogether.Thesearetheredfleshofthebody.Therearethreetypesofmuscles:
1) Voluntarymuscle:Theseareconnectedwiththeskeletalsystem,causingthejointstomove.
Theyarecalledvoluntarybecausetheiractioncanbecontrolledbythewill.
2) Involuntarymuscle:Workwithoutconsciouscontrolbytheindividualandarefoundinthe
internalorgans.
3) Cardiacmuscle:Aspecialtypefoundonlyintheheart.Thefibersarestripedbutthe
muscleisnotundercontrolofthewill.
Fig2.11Joints
1)Femur
2)Patella
3)Cartilage
4)Tibia
5)SynovialMembrane
6)Fibula
1
2
3
4
5
6
31
StructuresandFunctionsofVoluntaryMuscles
Avoluntarymuscleisshapedlikeaspindle,andisenclosedinaprotectivecoatcalledfascia.
Thecentreofthemuscleiscalledthebodyorbelly.thebodyinthickandbecomeshorterand
thickerwhenthemusclecontracts.
Inhealththemusclesarealwaysinastateoftheslightconstractions,readyatalltimesforaction.
Thisstateofreadinessiscalledmuscletone.
Fucntionsare1)Movement,2)Maintainingposture.3)Producingbodyheat.
MainGroupofmusclesandtheiractions
Manymusclesarearrangedinpairs,andopposeeachotherinaction.Theyareoftengrouped
accordingtofunctionasfollows.
1)Flexorscausebendingofajoint.
2)Extensorsstraightenajoint.
3)Abductorsmovetheboneawayfromthemidline
4)Adductorsmovethebonetowardsthemidline.
5)pronatorsturnthehandpalmdownwards
6)Supinatorsturnthehandpalmupwards.
7)Levatorsraiseapart.
8)Sphinctersreducethesizeofanopening.
1
2
3
4
5
6
7
Fig2.12MusclesoftheBody(Anterior)
1)Sternomastoid
2)Deltoid
3)Pectorails
4)Biceps
5)Quadriceps
6)Illiopsoas
7)Sartorius
32
Musclesoftheheadandneck: Sternomastoid,amuscleattachedtothemastoidprocessof
thetemporalboneandtothesternum.Thispairofthemuscleswhenusedtogetherflextheandhead.
Separatelytheyheldtoturntheheadtooneside.
Trapezius,alargediamondshapedmuscle,attachedtotheocciputanddorsalvertebrae.Itdraws
backtheshouldersandextendsthehead,thushelpingingoodposture.
MusclesthatmovetheupperArm: Deltoidatriangularmusclecoveringtheshoulderjoint,
andattachedtotheshoulderblade,collarboneandhumerus.Itraisestharmoutwardstoshoulderlevel
(abduction).
Pectoralisamusclecoveringthefrontofthechest,attachedthehumerus.Itadductsthearm
(drawsthearmacrossthechest).
Latissimusdorsialargemuscleoftheback,attachedtotheupperposteriorpartofthehumerus.
Itadductsthearm,drawingitdownandback.
Musclesthatmovetheforearm: Bicepsamusclewithtwoheadsfromtheshoulderblade.It
liesinfrontofthehumerusandisattachedtotheradius.Itflexestheelbowjoint.
Tricepsamusclewiththreeheadsfromtheshoulderbladeandhumerus.Itliesalongthebackof
thehumerusandisattachedtotheulna.Itextendstheelbowjoint.
Musclesthatmovethethigh: Iliopsoasmusclethatpassesfromthefrontofthelumbar
vertebraeandtheilium,tothefemur.Itflexesthehipjoint.
Glutealsmusclesofthebuttocks.Attachedtotheposteriorsurfaceoftheilium,andsacrum,and
tothefemur,theyextendthehipjoint.
1
2
3
4
5
6
Fig2.13MusclesoftheBody(Posterior)
1)Sternomastoid
2)Trapezius
3)Deltoid
4)GluteusMaximus
5)Hamstrings
6)Gastronemus
33
MusclesthatmovethelowerLeg:Quadricepsfemorisaverystronggroupoffourmuscles,which
coverthefrontofthethigh.Passingfromtheiliumandfemur,theyareattachedtothepatellaandsoby
thepatellarligamenttothetibia.Theyextendedthekneejoint.
Harmstringsfromtheischiumandfemurtothetibiaandfibula,thismuscleliesatthebackofthe
thighandflexesthekneejoint.
Sartoriusfromtheiliacspinetotheinnersideofthetibia,thislongthinmusclehelpstoabductand
flexboththehipandknee,aswhensittingcrosslegged.
Musclesoftheabdominalwall:Rectusabdominisfromthesternumandcostalcartiliagestothe
publicbone,thesearetwostraightmuscleformingthefrontwalloftheabdomen.theycauseflexionof
thespine,andhelpindefaecationandinchildbirth.
Obliquemuscles,externalandinternal.Theseformthesidewallsoftheabdomen,andhelpsin
turningthetrunk.
MusclesthatmovetheChestwall: Intercoastalssituatedbetweentheribs,thesemuscles
elevatetheribsforbreathing.
Diaphragm is a dome shaped muscle which divides the chest from the abdomen. It is
attachedtothesternumandlowerribs,andtothelumbarvertebrae.Itsmovementsareessentialfor
breathing.Itflattenswhencontractedandthusthechestisenlargedforbreathingin.Ithelpsalsoby
downwardpressureindefaecation,passingurine,andinchildbirth.
NERVOUSSYSTEM
Thisfunctionslikeatelephonesystem.Withthebrainastheheadoffice,andnerveslikethe
telephonewirescommunicationtakesplacewithallpartsofthebody.Bymeansofnumerousmessages
sentandreceived,thevarioustissuesandorgansofthebodyworkinharmony
Thenervoussystemhastwoparts:
1) Centralnervoussystemmadeupofthebrainandcranialnerves,spinalcord,andspinal
nerves.
Itcontrolsthevoluntarymusclesofthehead,trunkandlimbs.
Itreceivesmessagesfromsenseorganssuchasskin,eyesandears.
2) TheAutonomicnervoussystemthisismadeupofsympatheticandparasympathetic
nerves.Itcontrolsinvoluntary(internal)musclesandglandularsecretions.
NerveTissue: NerveTissue,ofwhichthesenervoussystemsarecomposed,issofttissuemadeupof
nervecellsandnervefibres.Thecellsmassedtogether,asinthebrain,formwhatiscalledthegray
matter.Thenervefibresformwhitematter.
Nervefibresareeachconnectedwiththeirownnervecells,formingaunitcalledaneurone.Messags
jumpacrossfromoneneuronethroughitsfirbestothenextneurone.Thefibresofsomeneuronesarevery
long(eg.thoseinthelimbs)andtheyaregroupedtogetherasvisiblewhitenervetrunks.
34
Nervesarethreetypes:
1) Sensorynerves,whichcarrymessagesfromallpartsofthebodytothebrainandspinalcord.
Theyenablethebodytoreactforitsprotection.
2) Motornerves,whichtakemessagesfromthebrainandspinalcordtomusclesandglandsinall
partsofthebody.theystimulateactivity.
3) Mixednervesconsistsofbothsensoryandmotornervefibres,sotheycarrymessagesinboth
directions.
Thebrain:
Thisisthemostimportantpartofthecentralnervoussystem.Itiswellprotectedinthecranial
cavityandhasthefollowingparts.
1) Thecerebrumorforebrain. 2)Thecerebellumorhindbrain.
3)Themidbrain. 4) Thebrainstemconsistingofponsandmedulla.
TheCerebrum: Thelargestpartofthebrain,fillsthefrontandtoppartsoftheskull.Ithastwoparts
rightandleft.Thesetwopartscontroltheoppositesidesofthebody,sothatdiseaseorinjuryoftheright
sideofthecerebrumparalysestheleftsideofthebody,andviceversa.
FunctionsofCerebrum:
1) Frontallobe:
a)Motorcenterscontrollingvoluntarymuscles.b)Speechcentre.c)Mentalpowerssuchas
memory,intelligenceandwill.
2) Parietallobe:Thesensorycentersforsensationsoftouch,pain,heat,coldandpressure.
3) Temporallobe:Forhearing.
4) Occipitallobe :Forvision(sight).
TheCerebellum: Thecerebellumissituatedunderneaththecerebrumattheback.Itissmaller
thanthecerebrum.Italsohasarightandleftsides.Itsactivitiesareunconsciousandnotundercontrol
ofthewill.
4
1
5
2
3
Fig2.14TheBrain
1)Cerebrum
2)MidBrain
3)Cerebellum
4)Ponsvaroli
5)MedullaOblongata
35
FunctionsoftheCerebellum:
1)Helpstomaintainbalance 2)Helpstomaintainmuscletone.
3)Coordinatestheworkofmuscles.
TheMidBrain: Thisconsistsoftwoshortstalksofnervetissueattachedtothelowerpartofthe
rightandleftsidesofthecerebruminthecentre.
FunctionsoftheMidBrain:
1) Actsasapathwayformessagestoandfromthecerebrum.
2) Containsreflexcentresforvisionandhearing.
3) Containscentersforcontrollingbodytemperature(hypothalamus),theemotionsandsexual
responses.
Thebrainstem: TheBrainstemlikeastalkconnectingthebrain,withthespinalcord,hasthe
followingparts.
1)ThePons:Thispart,situatedbelowtheMidBrain,islikeabridgeconnectingthetwosidesof
thecerebellumandthemidbrainwiththemedullabelow.
2)themedulla.Thisjoinstheponsabovetothespinalcordbelow.Itlookslikethespinalcordbut
isalittlethicker.Itliesjustinsidetheskull.
FunctionsoftheMedulla:
1) Connectsthebrainwiththespinalcord,andconveysmessages.Itisinthemedullathat
cerebralnervefibrescrossovertotheoppositeside.
2) Containnervescenters,whichcontrolthevitalfunctionsofcirculationandrespiration.
3) Containreflexcentersofswallowing,vomitingandcoughing.
CranialNerves:
Thereare twelvepairs ofcranialnerveswhichcomeoutfromthebrainandbrainstem.They
passthroughholesintheskulltotheeyes,ears,face,tongue,throat,etc.
Thetenthcranialnervecalled vagus,givebranchestothelarynx,lungs,andheartanddigestive
organs.Thevagusnervefunctionsaspartoftheautonomicnervoussystem.
TheSpinalCord:
Thespinalcordisacordofnervoustissue,thethicknessofalittlefingerandabout12cmlong.It
liesinsideacanalformedbythevertebrae.Itconnectsabovewiththemedullawherethebackofthe
neckjoinstheskullandextendstothelevelofthefirstlumbarvertebrae.
FunctionsoftheSpinalCord:
1)Receivesmotorimpulsesfromthefrontallobeofthecerebrum,andpassesthemontomuscles
viathespinalnerves.
2)Receivessensationsfromtheskinandothertissuesandrelaysthemessagetothebrain.
3) Reflex action. This is the quick response in the spinal cord itself. Eg. If you touch
somethinghot,themessagereceivedinthespinalcordisimmediatelyflashedtothemusclesofthearm
beforethenewsreachesthebrainyouhavetakenyourhandaway.
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Themeningesandcerebrospinalfluid(C.S.F.)
Thebrainandspinalcordarecoveredbythreemembranescalledmeninges.
1) Duramateristheouter,thickelasticcover.Itlinestheskullandspinalcord.
2) Arachnoid,athinmiddlemembrane.Itisaloosecoveringandunderisaspacecalledtheca
(subarachnoidspace)containingcerebrospinalfluid(C.S.F.)
3) Piamater isclosesttothenervetissueandcarriesbloodvessels.Whenthesemembranesget
infected,theconditionisknownasmeningitis.
CerebroSpinalFluid:(C.S.F.): Thisisaclearfluid,whichcirculatesbothinsideandoutsidethebrain
andspinalcord.Alittlecerebrospinalfluidissometimesremovedbylumbarpuncturetohelpindiag
nosingdiseaseofthenervoussystem.
FunctionsofCerebrospinalFluid:
Itactsasawatercushiontoprotectthebrainandspinalcordfromshocksandjarring.
Itnourishesandcleanses,washingawaywaterandtoxins.
TheAutonomicNervousSystems
Itisthesecondsystemofthenervesthatcontrolsthemovementsoftheinvoluntarymusclesand
thesecretionoftheglands.Wehavenocontroloverthesenervesalthoughtheyarecloselyconnected
withthecentralnervoussystem.
IntheANStherearetwosetsofnerves,whichopposeeachotherinaction.
SympatheticSystems: Thisconsistsoftwochainsofganglia(groupsofnervecells)oneoneachside
ofthevertebralcolumn.Thegangliaareattachedbyfibrestothespinalnerves.
Thesympatheticnervesarestimulatedbytheemotionssuchasfear,excitementandanger.The
results of the sympathetic nerve stimuli are: 1) dilated pupils 2) the heart beats quicker
3)breathingisquickeranddeeper4)thebloodpressureisraised5)digestionissloweddown
6)sweatingisincreasedand7) analandurethralsphincterstightenup.
4
1
2
3
Fig2.15TheMeninges
1)Piamater
2)ArachnoidMater
3)Duramater
4)Brain
37
ParasympatheticSystem: Thissystemisincontrolduringnormalquietliving.Certaincranialnerves
(thevagusespecially)havesuchactionsasthefollowing.1)pupilsoftheeyescontract.2)increasein
salivaflows3)digestionandperistalsisarestimulated.
THECARDIOVASCULARSYSTEM
Thecardiovascularsystemisthetransportsystemofthebody.Itisthemeansbywhichfood,
oxygen,waterandotherrequirementsareconveyedtothetissuecalls,andtheirwasteproductsare
carriedaway.
Theheartisimportantorganofthecirculatorysystem.Itisplacedbehindbreastboneandwithin
the thoracic cage. It is hollow muscular organ. It is enclosed in a sac known as the
pericardium.Itisaboutthesizeofapersonsclenchedfistandweighsaround300gminamanand
250gminawoman.
Thehearthasfourchambers,twoatria(upper)andtwoventricleslower.Valvesconnectthe
upper and lower chambers. The right and left sides of the heart are totally separated by a
muscularwallandthereisnocommunicationbetweenthem.
The right side of the heart receives the deoxygenated (impure) blood collected from the
differentpartsofthebodythroughsmallandbigveins,whichentersthelungs.Inthelungsthebloodis
oxygenatedandcarbondioxideandmetabolicwasteareremoved
Theleftsideoftheheartreceives(pure)bloodfromthelungsandsuppliesittotheentirebody
throughthemajorbloodvessel(aorta)anditsnumerablebranches(arteriesandcapillaries).
Theleftventriclegeneratesgreaterpressurethantherightventricletoenabletheboldtobepumped
throughoutthebody.Hencetheleftventricleismorethickerandmoremuscular.
Thecoronaryarteriesbranchout(leftandrightcoronaryarteries)fromtherootoftheaortanear
itsoriginfromtheleftventricle.Boththecoronaryarteriesbranchofintosmallervessels,whichare
distributedalloverthesurfaceoftheheart.Forefficientpumping,itisnecessaryforthehearttobeatat
areasonablerateof6090beatsperminute,whichisachievedthroughcontrolledelectricalimpulses
(conductivesystem).
1
2
3
4
5
6
7
8
9
10
Fig2.16TheHeart
1)Aorta
2)LeftAtrium
3)LeftVentricle
4)ApexoftheHeart
5)Aorta
6)SuperiorVenacava
7)RightAtrium
8)SemiLunarValves
9)RightVentricle
10)InferiorVenacava
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FunctionsofHeart:
1)Itdrawsbloodbackfromthecapillariesandveins.2)Itsendsbloodintothelungswhereitis
oxygenated.3)Itsendsbloodthroughtheaortatoallthepartsofthebody.
Thepartsofthecirculatorysystemare:
1)Blood.2)Theheart,whichisthepumpforcingbloodintothecirculation.3)Thebloodvessels
inwhichthebloodtravels.4)Thelymphaticsystemiscloselyconnected,andcanbeconsideredapart
ofthecirculatorysystem.
THEBLOOD
About6litresofbloodcontinuouslycirculatesthroughtheheart,andbloodvesselsinallpartsof
thebody.Itisastickyredfluidisslightlyalkalineinreaction.Itismadeupofaliquid(plasma)andsolids
(thebloodcells).
Plasmaisapaleyellowfluidconsistingof
Water90%
Salts,inlcudingsodiumchloride0.9%
Proteins(albumin,globulin,fibrinogen)
Nutrients,suchasglucose,fats,aminoacidsvitaminsandminerals
Wasteproductssuchasureaandcarbondioxide
Antibodiesandantioxinsforresistancetodiseasegerms,
Hormonesproducedbytheendocrineglands.
Substancesforbloodclotingandforpreventingclotingofblood.
Plasmaisimportantforthelifeofthetissuecells,conveyingtothemwaterandnourishment,and
carryingawaytheirwasteproducts.
1
2
3
4
5
6
7
Fig2.17BloodCells
1)Platelets 2)RedBloodCells 3)WhiteBloodCells 4)Monocyte5)Neutrophil
6)Esoniophil 7)Basophil
39
Bloodcells(Bloodcorpuscles)
Therearethreemaintypes
RedbloodcellsorErythrocytes
WhitebloodcellsorLeucocytes
BloodPlateletsorThrombocytes.
Redbloodcellsareformedinthebonemarrowandwearoutinaboutthreemonths,soneed
placing.Theyareverytinydiscwithnonucleus,andarefilledwithhaemoglobin,whichismadefrom
ironandprotein.Haemoglobingivestotheblooditsredcolour.Thenormalamountofhaemoglobinis
14.515gms.per100ml.ofblood.Lackofirontomakehaemoglobiniscommoncauseofanaemia.
RBCshavetheimportantfunctionofcarryingoxygenfromthelungstothetissuecells.Whenunited
withoxygeninthelungs,thehaemoglobinhasabrightredcolur.Whenthebloodreturnsaftergivingup
itsoxygen,itischangedtoadullredcolour.
WhiteBloodcells
Whitebloodcellshelptofightinfection.Therearetwomaintypes.
1) Leucocytesareproducedinthebonemarrow.Theycanchangeshapeandsqueezethroughthe
smallboodvesselwallsinordertofightgemsthathaveenteredthetissues.Manydieinthefight
andbecomepuscells.Inacuteinfectionmanymoreleucocytesareproducedtohelpinthefight
(leucocytosis)
2) Lymphocytesareproducedinthespleenandlymphglands.Theyarelessmobilebuttheyare
helptofightinfectionespeciallywhenitischronic.
BloodPlateletes
Bloodplateletesareproducedinthebonemarrow.Theyhelpintheclotingofblood.
FunctionsofBlood:
Carriesoxygentothetissuesbymeansofredbloodcells.
Carriesfoodtothetissues.
Carriesawaywasteproductsfromthetissuestotheexcretoryorgan.
Carrieshormonesfromtheglandstothetargettissues.
Fightsgerminfectionbymeansofthewhitecellsandantibodies.
Distributesheatandhelpstomaintainbodytemperature.
Helpstomaintainwaterbalanceinthebody.
TheLymphaticSystemandSpleen:
Thelymphaticsystemisaspecialtypeofcirculatorysystem.Itiscomposedof1)Thelymph.2)
Thelymphaticvessels.3)Thelymphglandsornodes.
Lymphisafluidlikeplasmaandthetissuefluidbutincasesofinfectionitmaycontainbacteria.
Lymphisreallythetissuefluid,whichfindsitwayintothelymphaticvessels.
LymphaticVessels:Lymphaticstartintissuespacesbetweenthecellsandstartliketheveins.
Insidethemarethevalveswhichhelptheflowoflymphtowardsthetwolargestlymphatic
vessels.
40
LymphGlands aresmallbeanshapedstructures,situatedalongthecourseofthelymphatic.
Theyarefoundmainlygroupedtogetherintheneck,axilla,andgroinsandinthepelvicand
abdominalcavities.Lymphoidtissueisalsofoundinthetonsils,pharynxandintestines.
FunctionsofLymph:
Lymphglandshelptoprotectthebodyfrominfectionby
1) Filteringthelymphtopreventgermsfromgettingintothebloodstream,andfightingto
overcomethem.
2) Producingnewlymphocytesfortheblood.
DIGESTIVESYSTEM
Digestionistheprocessbywhichthecomplexformsoffoodmaterialsarebrokendowninto
simplerformoffoodmaterialssuitableforabsorption.
Oncethefoodisdigested,itmustbetransferredtothebloodstreamandtheprocessbywhich
this transfer occurs is called absorption. Digestion and absorption are two chief functions of
thedigestivesystem.
TheAlimentaryCanal:
Thealimentarycanalisalongmusculardigestivetubeextendingthroughthebody.Itisabout
750cminlength.Itconsistsofthefollowingparts:
1) Themouth. 2)Oesophagus 3)Stomach 4)Smallintestine
5)Largeintestine. 6)Rectum 7)Analcanal.
1
2
3
4
5
6
7
8
9
Fig2.18DigestiveSystem
1)Mouth
2)Oesophagus
3)Stomach
4)Pancreas
5)Largeintestine
6)Smallintestine
7)Rectum
8)Liver
9)GallBladder
41
Thegastrointestinaltractconsistsatubecomposedoffourprincipallayersfromoutsideinwards:
1)Tunicaadventitiaorserouscoat
2)Tunicamediaorthemuscularcoat.
3)Tunicaintimaortheinnerliningofthebloodvessel.
FunctionsofDigestiveSystem:
1)Breakdownthefoodsubstancesintosmallparticles
2)Digestionoffoodsubstances.
3)Absorptionoffoodsubstances.
4) Excretionofundigestedfoodandtoxicsubstances.
Thealimentarycanal,whichisacontinuous,passagewaybeginningatthemouth,wherethefood
istakeninandterminatingattheanuswherethesolidproductsofdigestion,whicharenotabsorbed,are
expelledfromthebody.
Theaccessoryorganswhicharevitallynecessaryforthedigestiveprocess,donothappentobe
thepartofthealimentarycanal.
PhysiologyofDigestion:Digestiontakesplaceisthreepartsofthealimentarycanal.Theyare:
1)Mouthwiththehelpofsalivafromthreepairsofsalivaryglands, 2)Stomach withthehelpof
gastricjuicefromthestomachwalland 3)Smallintestine withthehelpofpancreaticjuicefromthe
pancreasbilejuicefromtheliverandtheintestinaljuicefromthesmallintestine.
TheMouth: Themouthisalsocalledtheoralcavity.Inthemouththereareabout32teeth.Theyare
(1)Molars12 (2)Premolars8 (3)Canines4 (4)Incisors8
Theteethhelptobreakdownthefoodsubstancesintosmallparticles.Amuscularorganprojects
intothisspaceiscalledthetongue.Ithelpsinchewingandswallowingandisoneoftheprincipalorgans
ofspeech.
Thetonguehasonitssurfaceanumberoftastebudsbymeansofwhichwecandifferentiate
sensationoftaste.(bitter,sweet,sourandsalty)
Inchewing,theteethgrindthefoodintopieceswhilethesecretionofsalivamoistensandlubri
catesthefood.
Salivaisajuicesecretedbythreepairsofsalivaryglandsinthemouth.theyare
1) Theparotid:locatedinfrontandbeloweachexternalear.
2) Thesubmaxillary:locatedbetweenthemandibleandthemuscleofthefloorofthe
mouth.
3) Thesublingualgland:locatedinfloorofthemouth.
Salivary secretion is a reflex process, both conditioned and unconditioned reflexes are
involved.Anewborninfantsalivateswhenfoodisplacedinitsmouth.Butthesightandsmelloffood
doesnotproduceanyreaction.
Laterbyassociatingthesightandsmelloffoodwithitstaste,thechildlearnsthatthefoodhas
certain qualities and these very qualities are after wards capable of eliciting salivary
secretion.
42
FunctionsofSaliva:
1) Itkeepsthemouthmoistandhelpsinspeech.
2) Ithelpsintheprocessofmasticationofthefoodstuffandinpreparingitintoabolussuitable
fordigestion.
3) Itdiluteshot,irritantsubstancesandthuspreventsinjurytothemucousmembrane.
4) Salivacontainstwoenzymes.PtyalinandMaltase,whichconvertsstarchyfoodintosugars.
5) Salivahelpsinthesensationoftaste.
6) Ithelpsheatloss.Thisismainlyfoundinanimals.Whentheybecomehot,moresalivais
secretedcausinggreaterheatloss.
7) Ithelpsintheexcretionofcertainsubstanceslikedrugscontainingmercury,leadandiodine.
Digestioninthemouth
Thefoodischewedandsalivathefirstofthedigestivejuicesactsonit,softensitsothatitcanbe
easilyswallowed.Salivacontainstwoenzymes.
(1)Ptyalin (2) Maltase.
Ptyalinsplitsstarchintomaltoseandmaltaseconvertsmaltoseintoglucose.
Oesophagus :
Theoesophagusisatubeconnectingthepharynxandthestomach.Itconveysthefoodfromthe
mouthtothestomach.
Stomach
Thestomachisanenlargedsectionofalimentarytube.Bothendsofthestomachareguardedby
valveswhichnormallypermitthepassageofsubstancesinonlyonedirection.
Theproximalendisguardedbycardiacsphincterandthedistalendofthestomachisguardedby
pyloricsphincter.
Stomachactsasapouchforholdinglargequantitiesoffoodsothatfrequentfeedingcanbe
avoided. The stomach mixes up the food thoroughly by its movements. It also destroys the
bacteriabythehighacidity.
DigestionintheStomach
The food material after being broken down by mechanical grinding and having been
convertedintoaboluswiththesalivareachesthestomach,whichpoursalargequantityofgastricjuice
everyday.
Themechanismofproductionofgastricjuiceisachemicalorhormonalinnature.Whenthe
digestedfoodisincontactwithgastricmucosa,achemicalextractisformed.Itisnamedasgastrinand
belongstothegroupofgastrointestinalhormones.Thiscausesthedischargeofgastricjuice.
Thegastricjuicecontainsmainlyhydrochloricacidandenzymes.
1) Pepsin. 2)Rennin 3)Lipase
FunctionsofHydrochloricAcid:
1)Killsbacteriapresentinthefood.
2)Softenstheconnectivetissuesofmeat.
3) Convertsinactiveformofpepsinogenintoactiveformofpepsin.
43
FunctionsofEnzymes:
1)Pepsinconvertsproteinintopeptones.
2)Renninconvertstheindigestibleproteinofmilkintoeasilydigestibleone.
3) Lipaseconvertsfatsintofattyacidsandglycerol.
Liver
Theliverisoneofthelargestandimportantorgansituatedontherightsideoftheabdomen.Bileis
secretedbytheliver.
FunctionsofLiver:
1) Theproductionofbilefromthepigmentofbrokendownredbloodcells.
2) Theremovaloftoxinsthathavebeenabsorbedfromtheintestine
3) Thestorageofsimplesugarintheformofglycogenwhichisreleasedasneededintheform
ofglucose.
4) ThestorageoffatsolublevitaminsincludingA,D,EandK.
5) Themanufactureofheparin,whichpreventsclottingofthebloodinthebloodvessels.
6) Theformationofantibodieswhichactsagainstdiseaseproducingorganisms.
7) Theproductionofcertainbloodplasmaproteinssuchasfibrinogenandalbumin.
8) Theremovalofawasteproductcalledureafromaminoacids.
BileJuice:
1)Intheabsenceofbile,fatsarenotdigestedproperlywhichresultsinfattydiarrhea.Thusbileis
essentialfordigestionthoughitdoesnotcontainanydigestiveenzymes.
2)Thebileistakenbythehepaticductandisstoredinthegallbladder,whichissituatedonthe
lowersurfaceoftheliver.Thebileisconcentratedandsenttotheduodenumthroughthecysticduct
whenchimefromthestomachenterstheduodenum.
3)Bilecontainsbilesalt,bilepigment,mucinandwater.Thetwopigmentspresentinthebileare
calledBilirubinandBiliverdin.Thesepigmentsgivecolourtothefaecesandurine.
Duetoliverdamageorobstructionofthebileduct,bilirubincollectsinexcessquantitiesinbleed
andchangesthecolouroftheskinandtheeyes.Theremaybechangesinthecolouroftheurinealso.
Thisiscalledjaundice.
FunctionsofBileJuice:
1)Itstimulatesthefunctionsoftheproteolyticenzymesandtheamylase.
2)Itdissolvesfattyacidandglycerol.
3)Itcoordinateswithlipasetoconvertthefatintofattyacidandglycerol.
4)Acidicnatureoffood.
Pancreas
Pancreasanelongatedstructurelyingacrosstheposteriorwalloftheabdomen.Itisanexocrine
aswellasanendocrinegland.Thepancreasnotonlyproducesthepancreaticjuicebutalsosecretes
hormoneseg.Insulinandglucacon.Itisreleaseddirectlyinthebloodwhichregulatesthebloodglucose
level.Thepancreaticjuicecontainsthreeenzymes.Theyare
1
44
1) Trypsin. 2)Amylaseand3)Lipase.
Besidestheseenzymespancreaticjuicecontainslargequantitiesofsodiumbicarbonatewhich
neutralizesthehydrochloricacidpresentinthegastricjuicesecretedbythestomach.
TheSpleen: Thisisadarkpurpleorgansituatedintheleftsideoftheupperabdomen,behindthe
stomach.
FunctionsoftheSpleenare:
1) Itproducesnewlymphocytesfortheblood.
2) Ithelpstofightinfection.
3) Itdestroyswornoutredbloodcellsandremovestheironfromthemtobereused.
4) ItactsasareservoirforRedBloodCells,whichitreleasesintimeofneed,suchasasudden
haemorrhage.
Small Intestine
Thesmallintestineisabout600cmlonginadultextendingfromthepyloricsphincterofthestom
achtointestine.Thefirst25cmor30cmofthesmallintestineiscalledtheduodenumfollowedbythe
jejunumandtheremainderistheileum.
DigestionintheSmallIntestine:
Thefoodinthestomachispartiallydigestedbythegastricjuice,butthesmallintestineistheorgan
inwhichthecompletionofthedigestionandabsorptionoccurs.
Intheduodenumthereisanopeningintowhichleadtwoductscarryingdigestivejuicesi.e.,
pancreaticjuiceviathepancreaticductfromthepancreasandtheother,bile,viabileductfromtheliver.
Bileisnotprimarilyadigestivejuicebecauseitcontainsnoenzymebutithelpsinthedigestionof
fats.Thebilesaltemulsifiesfatsandhelpsthepancreaticlipasetoactanddigestiteasily.Thepancreatic
juicecontainsthreepowerfulenzymes.
Theyare:
1)Pancreatin:convertscarbohydratesintosimplesugarslikeamylaseglucose,fructoseand
galactose.
2)Trypsin:convertspeptonesintopolypeptides.Inthebeginningtrypsinispresentintheformof
inactivetrypsinogen.
Thistrypsinogenisconvertedintoactivetrypsinbyactionofenterokinasewhichissecretedinthe
smallintestine.
3)Pancreatic lipase:convertsfatsintofattyacidsandglycerol.
Afterpancreaticdigestion,thefoodwhichisnowcalledchymeproceedsfurtherintheintestine.
Hereitcomesintocontactwithsuccusentericuswhichisajuiceproducedbythesmallintestine.Succus
entericuscontainsthreeenzymes.Theyare
1)Pepsin:Itconvertspolypeptidesintoaminoacids.
2) Nucleotidase :ConvertsNucleotide,intonucleoside.
3)Nucleosidase:Convertsnucleosidesintopentose,purine,andpyramidin.
45
Italsocontainsthreesugarsplittingenzymescalledlactase,maltaseandsucraseconvertingthe
respectivesugarsintosimplesugars,mostlyglucose.Italsohaslipase,whichactsonfatsandconverts
themintofattyacidsandglycerol.
Thefinalproductofdigestionofthecarbohydratesisglucosewhiletheproteinsareaminoacids
andfatsarefattyacidsandglycerol.
LargeIntestine
Thelargeintestineisasthenameimplieshasthelargerdiameterthanthesmallintestine.Itisabout
150cminlength.Thesmallintestineopensintothelargeintestine.
Thereisasmallpouchatthebeginningpartofthelargeintestine.Thispouchiscalledthecaecum.
Largeintestineconsistsofascendingcolon,transversecolonanddescendingcolon.
Rectumandanalcanal:
Thedescendingcolonoflargeintestineopensintolastpart,therectumandanalcanal.Itisabout
15cmto20cmlong.Therectumservesasatemporarystorageareafortheindigestibleandnon
absorbablesubstances.
Thenarrowportionofthedistalpartofthelargeintestineiscalledtheanalcanal,whichleadsto
theoutsidethroughanopeningcalledtheanus.
AbsorptionofFood:
Absorptionistheprocessbywhichwater,minerals,vitaminsandendproductsofdigestionare
absorbedthroughthemucosaofalimentarycanal(especiallythesmallintestines)intobloodstream
eitherdirectlyorvialymphaticvessels.
In the stomach there is little absorption. Water, alcohol, glucose and simple salts are
absorbedtocertaindegree.Themainabsorptionoccursinsmallintestinesespeciallyinthelower(ileum)
part, the upper part of the small intestine is mainly associated with the process of
digestion.
Themucousmembraneofsmallintestineiscoveredwithminutefingerlikeprojectionsknownas
villi. Eachvilluscontainsarteriole,avenule,acapillarynetworkandalacteal(lymphaticvessel).
1
2
3
Fig2.19Villus
1)Epithelialcells
2)Bloodvessels
3)Lacteal
46
Nutrientsthatdiffusethroughtheepithelialcellswhichcoversthevillusareabletopassthroughthe
capillarywallsandthelactealenterstheblood.
About90%ofallabsorptiontakesplacethroughoutthelengthofthesmallintestine.Theother
10%occursinthestomachandlargeintestine.
Both monosaccharide and amino acids are absorbed by a positive pressure gradient
betweentheintestinalcontentandthebloodaswellasbyanactiveprocessinvolvingenzymaticreactions
andtransportedinthebloodstreamtotheliverviathehepaticportalsystem.
Theexcessamountofglucoseisconvertedintoglycogenandstoredintheliver,whenneedarises
glycogenisconvertedintoglucoseandisutilizedbythebody.
VitaminKwhichissynthesizedbythebacteriainthecolonareabsorbedfromthelargeintestine.
Largequantitiesofwaterarehoweverabsorbedfromthelargeintestineandthefluidcontentofthesmall
intestineareconvertedintothepastyconsistencyandejectedthroughtheopeningcalledthe anus.
Movementsofthegastrointestinaltract:
Deglutition istheprocessbywhichthemasticatedfoodistransportedacrossthepharynxand
reachesthestomach.Duetocontractilemovementsofthestomach,thefoodiswellmixedupwith
gastricjuice.
Afterbeinginthestomachfor3or4hoursthepyloricsphincteropenspushingthefoodintothe
duodenum.Theintestineshowsthreeimportanttypesofmovements.Theyare
1)PendularMovement:thesemovementsareinducedbycontractionsofthecircularand
longitudinalmusclesoftheintestine.Thismovementcontributestothethoroughmixingofchimewiththe
digestivejuice.
2) SegmentalMovement:thismovementoccursbythecontractionofthecircularmuscles,
whichproducestransversefolds,dividingtheintestineintoshortsegment.
3) PeristalticMovement:itisthewavelikecontractionofthealimentarycanal,whichpropels
thefoodthroughthegastrointestinaltract.
RESPIRATORYSYSTEM
Respirationistheprocessofgaseousbetweenanorganismanditsenvironment.Inthehigher
animals,andmanthegaseousexchangebetweenthetissuesandenvironmentistermed asInternalor
tissuerespiration.
Theexchangeofgasesbetweenthebodyandtheenvironmenttakingplaceinthelungsistermed
as externalrespiration.Theexternalrespirationconstitutesprocessesof inspirationand expiration.
Inspirationisanactivemuscularcontractionwhileexpirationismerelyapassiveactoftherelaxation
ofrespiratorymuscles.
Structureofrespiratorysystem:
Therespiratorysystemisresponsiblefortakinginoxygenandgivingoffcarbondioxideand
water.Itisdividedintotheupperrespiratorytractandlowerrespiratorytract.
1) Theupperrespiratorytract:Nose,Mouth,thethroat,pharynx,thelarynxandnumerous
sinuscavitiesinthehead.
47
2) Thelowerrespiratorytract:Thetrachea,thebronchiandthelungs,whichcontainbronchial
tubebronchiolesandalveoliorairsac.
Thetwo lungs,whicharetheprincipalorgansoftherespiratorysystem,aresituatedintheupper
partofthethoraciccage.
Theyareinertorgans,i.e.theydonotworkbythemselves,butfunctionwiththehelpofamuscular
wallknownasthe diaphragm.
Thepharynxisatubeapproximately12cminlength,whichisacommonopeningforbothdiges
tiveandrespiratorysystem.
Itconnectstheoralcavitytotheoesophagus(foodtube)andthenasalcavitytothelarynxand
windpipe.Theopeningintothelarynxisovalinshapeandguardedbytheleaflikeepiglottis.
The epiglottis foldsdownovertheopeninglikeatrapdoorwhilefoodorliquidisbeingswal
lowed,itpreventstheentryofforeignsubstancesintotherespiratorypassageways.
Theclosureofepiglottis,whenweswallow,isareflexactionandcanbeinterferedwith,ifone
attemptstotalkandswallowatthesametime.
Ifthishappensonemaychoketodeathintheabsenceofimmediateassistance.Fromthephar
ynx,airpassesthroughthetrachea,whichis12cmlongand1.5cmindiameter.Thetract,consistsofa
largenumberofCshapedcartilagerings.Thelarynxorthe voiceboxisatthetopofthetrachea.Itis
thevocalcordsinsidethebox,whichbyitscomingtogetherandgoingawayfromoneanotherproduces
differentsounds.
Thetracheabranchesatitslowerendintotherightandleftbronchiwhichentersthelungs,within
thelungsthosepassagewaysrepeatedlydivide,formingmicroscopictubescalled bronchioles.
Eachbronchioleendswithseveralclustersofmicroscopicelasticairsacscalledalveoli,whichare
thefunctionalunitsoflungs.Thisresemblesbunchofgrapes.
Thepairedlungsliewithinthelargecavityofthechest,thethoraciccavity.Thelungsaregrayish
colourandarespongyinappearance.
Therightlungshavethreelobesupper,middleandlower,andtheleftlunghastwolobesupper
andlower.Thefloorofthethoraciccavityisformedbyadomelikemuscularstructurecalled dia
phragm. Eachlungisenclosedbytwolayersofmembranecalled pleuralmembranes.
Fig2.20Lungs
1)Larynx
2)Trachea
3)Bronchus
4)Lung
1
2
3
4
48
Thechestcavityisalsolinedwiththismembrane.Thislayerbeingknownastheparietalpleura,
whilevisceralpleuralinethelungparenchyma.
Respiration
Webreathecontinuouslyfrombirthtodeath,dayandnightinhealthanddisease.
Respirationmaybedefinedasthemechanicalprocessofbreathinginandout,afunction
whichinvolvesboththerespiratorysystemandmusclesoftherespiration.
The2phasesofbreathingare
1. Inhalationduringwhichairisdrawnintolungs
2. Exhalationwhichreferstotheexpulsionofairfromthealveoli
Inhalation
Thediaphragmwhenrelaxedisaflatteneddomeshapestructurepointingupwardstothelungs.
Duringtheprocessofinhalationitcontracts.
Itflattens,pullsdownthethorax,increasesthevolumeofthethorax,andthusdecreasesthe
atmosphericpressureinthelungs.Thiscausesairtorushinduringrespiration.
Exhalation
Duringtheprocessesofexhalation,thediaphragmrelaxes,thethoraxispushedup,thevolume
decreasesandtheatmosphericpressureincreasesandairrushesoutofthelungs.
Theinspiredair,whichcontainsoxygen,passesdownintothebillionsofminuteairchambersorair
cellsknownasalveoli,whichhaveverythinwalls.Aroundthesewallsarethecapillariesofthepulmo
narysystem.
Itisatthispointthatthefreshairgivesoffitsoxygentothebloodandtakescarbondioxidefrom
thebloodbydiffusion,whichisthenexpelledwiththeexpiredair.
PhysiologyofRespiration:
Therespiratorycenterofthebrainislocatedinthemedulla,immediatelyabovethespinalcord.
Fromthiscenternervefibersextenddownintothespinalcord.Fromtheneckpartofthecord,these
nervefiberscontinuethroughthe phrenicnerve tothediaphragm.
Thediaphragmdoesnotcontinuetoworkifitiscutofffromitsnervesupply.Ifonenerveiscut,
thediaphragmofthatsideisparalyzed.Thiscenterisgovernedbyvariationinthechemistryofthe
blood.
IfthereisanincreaseinCo2intheblood,thecellsoftherespiratorycenterarestimulatedandthey
intermsendimpulsesdownthephrenicnervetothediaphragm.
RespiratoryRate:
Inadults,therespiratoryrateis14to18timesperminute.Childrenbreathsmoresuperficiallyand
thereforehaveahigherrespiratoryrate.
Importanceofrespiration:
1) Itsuppliesoxygenandeliminatedthecarbondioxide.
2) Itexcretesvolatilesubstanceslikeammonia,ketonebodies,essentialoils,alcoholandwater
vapour,etc.,
49
3) Byadjustingtheamountofcarbondioxideelimination,ithelpstomaintaintheacidbase
balance.
4) Ithelpstomaintainthenormalbodytemperature.
5) Itisnecessaryforthemaintenanceofoptimaloxidationreductionprocessinthebody.
EXCRETORYSYSTEM
Duringthevitalactivityofthehumanandanimalbody,significantamountsoforganicdegradation
productsareproduced,aproportionofwhichisnotutilizedbycells.
These degradation products must be eliminated from the body. The end products of
metabolismwhichhavetoberemovedfromthebodyarecalled excreta,andtheorgansthatremove
themarecalled excretoryorgans.
Thelungseliminatedcarbondioxideandwatervapourintotheenvironment.Thegastrointesti
naltractexcretesasmallamountofwater,bileacids,pigments,cholesterol,certaindrugs(whenadmin
istered into t he body) salts of heavy met als (cadmium, iron, manganese) and
indigestiblefoodresidues(faeces).
Theskinperformsitsexcretoryfunctionbysweatandsebaceousglands.Sweatglandsexcrete
sweat,whichcontainswater,saltsurea,uricacid,creatinineandothercompounds.
The main excretory organs are the kidneys which eliminate in the urine most of the
metabolitesprimarilythosecontainingnitrogen.(Urea,ammonia,creatinine).
Kidneys:
Thekidneyisabeanshapedorganabout5cmlong,3cmwideand2cmthick.Theyaresituated
atbothsidesofthelumbararea.
Theweightofthekidneyisabout200250gms.Ontheinnerormedialborderthereisanotch
calledthe hilumatwhichregiontheartery,theveinandtheureterconnectwiththekidney.
Eachkidneyhasapelvis,wheretheurinecollects.Theurineisdrainedofffromthepelvisbythe
ureters.Theuretersendintheurinarybladder,whichcanholdabout800mlofurine.Theurethra
carriestheurinefromthebladderandvoidsitconvenientintervals.
Inalongitudinalsection,thekidneyisseentoconsistofoutercortexandinnermedulla.The
medulla consists of 1018 conical or pyramidal shaped structures, known as the renal
pyramids
Thebaseofarenalpyramidfacestowardsthecortex.Thepelvisthefunnelshapedupperendof
theureter.
Microscopicexaminationofmammaliankidneysrevealsthateachkidneyconsistsofaboutmillion
nephron,whicharethefunctionalunitofthekidney.
Thenumberofnephronsvariesdependingonspecies.Thenephronconsistsoftheglomerulus,
therenaltubules,thecollectingtubulesandtheassociatedbloodvessels.
50
Theglomerulusisatuftofcapillaryvessels,whichisinvaginatedintoanepithelialcupshapedlining
calledthe Bowmanscapsule.
Therenalarterydividesintoinnumerablebranchesandtheultimatedivisionsofthearteryforma
tuftofcapillariescalled glomerulus.
Thebloodpressureinsidetheglomerulusdrivesoutthefluidthroughitisopposedbytheosmotic
pressure.ThisfluidthusdrivenoutiscollectedintheBowmanscapsule.
Thefiltrateinthecapsuleconsistsofalltheconstituentsofblood,excepttheplasmaproteinsand
theformedelementsofblood.Thisprocessisknownas ultrafiltration.
Thefiltratedthenpassestothedescendingascendingportionofloop(HenlesLoop)andthento
theconvolutedtubules(proximalanddistal)andfinallyreachesthecollectingduct.
A large number of substances are reabsorbed (reabsorption) by the tubules, a few
substanceadded(secreation)tothefiltrateandthefinalurineisformed.
Forexample,water,glucose,somesaltsandasmallfractionofureaarereabsorbedfromthe
primaryurineintotheblood.Usuallyabout200litersoffiltrateisformedperdayofwhichoneandahalf
litersissentoutasurine.
Therefore, nearly 198 liters of water has to be reabsorbed every day by the kidney
tubules.About80%ofthisreabsorptiontakesplaceintheproximaltubulesandtherestisabsorbedin
thedistaltubules,andsentbacktothebloodstream.
Reabsorptioniscarriedoutwiththehelpof antidiuretichormone whichissecretedinthe
posteriorpituitarygland.
Thuseachnephronisabletocleanorfilteraverylargevolumeofbloodwithoutcausingthebody
tolosemuchofwaterorotheressentialmaterials.
Thecompositionoffinalurineradicallydiffersfromthatoftheprimaryurine.Itisdevoidofglu
cose,aminoacids,certainsalts(phosphatesandsodium)andhasaveryhighureaconcentration.
Fig2.21Kidney
1)Cortex
2)Medulla
3)Pyramid
4)Pelvix
5)Ureter
4
2
1
3
5
51
Theurinethusformedcollectsintothebladderthroughtheureterswhicharelong,slender,muscu
lartubethatextendfromthekidneytothelowerpartoftheurinarybladder.
Thebladderisamuscularbagwhichcollectstheurineandvoidsitatintervalsthroughtheurethra.
Whenthebladderisempty,themuscularwallbecomesthickandtheentireorganfeelsfirm
Theorganmayincreasefromthelengthof2or3inchesto5inchesormoreinches.
Amoderatelyfullbladderholdsabout800mlofurine.When400mlofurineiscollectedinthe
bladder,thenormaldesireformicturitionisfelt.Theprocessofexpellingurinethroughtheurethrais
called urinationormicturition.
Theactofmicturitionisareflexaction.Itiscontrolledbytheactionofcircularmuscles,continu
ouswiththoseinthewallsofthebladderandintheurethra.
Urine
Normalurineisfaintyellowincolour,clear,withacharacteristicsodour.Thespecificgravityis
1.010to1.020.NormallyurineiscomposedofWater96%Urea2%Salts2%
Thesaltsconsistsmainlyofsodiumchlorides,phosphatesandsulphates.Theaveragequantityof
urinepassedin24hoursis1.5litres.
ENDOCRINESYSTEM
Theglandsofthebodymaybedividedintothosewithandexternalsecretion(exocrineglands)
andthosewithInternalsecretion(endocrineglands).
Examplesofexocrineglandsarethesweat,lacrymalandmammaryglandswhichpasstheirsecre
tionalongtheductstotheexternalsurfaceofthebodyandtheglandsofthemouth,stomach,and
intestinewhichpasstheirsecretionsalongductsintothealimentarytract.
Theendocrineorductlessglandontheotherhandhavenoductsoropeningstotheexterior.Their
secretionarepasseddirectlyintothebloodstreamandtransmittedtothetissues.
Ahormoneisachemicalsubstanceproducedbytheendocrineglandsandtheiroverallfunctionis
toregulatetheactivitiesofvariousbodyorgansandtheirfunctions.
Themainendocrineglandsinthebodyare
1)Thyroid 2)Parathyroid 3)IsletsofLangerhans
4)Adrenalgland 5)Pituitarygland 6)Sexglands.
ThyroidGland:
Thelargestoftheendocrineglandsisthethyroidwhichislocatedintheneckregion.Thethyroid
glandweighs25gmsinahealthyadult.Ithastwoovalpartscalledthelaterallobesoneithersideofthe
trachea.Thesetwolobesareconnectedbyanarrowbandcalledisthmus.Theentireglandisenclosed
byaconnectivetissuecapsule.Thisglandproduceshormone,thyroxinrichiniodine.Thyroidgets
iodinefromthebloodstream.Itisthenfixedwiththeaminoacidsthyroxincompounds.Twomolecules
52
ofdiiodothyroxincombinetoformthyroxin.Thyroidstimulatinghormone(TSH)producedbythe
anteriorpituitarylobeincreasestheactivityofthyroidgland.Whenever,thethyroxinlevelfallsbelowa
particularlevelTSHisstimulated.
FunctionsofThyroxin:
1) Helpstoregulatetissuegrowthanddevelopment
2) IncreasestheBMRandthusraisesthebodytemperature
3) Itcontrolsthemetabolismbyregulatingtheanabolicand
4) Catabolicprocess
5) Stimulatethecellstobreakdowntheproteinsforenergy.
6) Decreasesthebreakdownoffats
7) Increasesthebreakdownofbodyglucoseandenhancestheglucoseabsorption.
8) CalciumandPhosphorousareremovedfromthebonesandexcretedinincreasedamounts.
9) HelpsintheconversionofbetacaroteneintovitA.
ParathyroidGland
Thesearetwotinyovalpair(6mmx2mm)ofglandssituatedatupperendandlowerpolesof
laterallobesofthyroidgland.Itsecretesthehormoneparathyroxin.
FunctionsofParathyroxin:
1)Increasestheconcentrationoforganicacidinthebone.
2)Increasesthecalciumandphosphorussolubility
3)Increasesthereabsorptionofcalciumfromthebones.
4)Increasesserumcalciumlevel
5)Increasesphosphateexcretionintheurine
1
2
3
Fig2.22ThyroidGland
1)Larynx
2)Thyroidgland
3)Trachea
53
6)Increasesthereabsorptionofcalciumfromtherenaltubules
7)Promotestheabsorptionofcalciumandphosphorusfromtheintestine.
8)Stimulatestheprocessoflactationinmammarygland.
IsletsofLangerhansinthepancreas:
Thepancreasisbothanexocrineglandsecretingdigestivejuicethroughaductintotheduodenum
andanendocrineglandsecretinghormoneintothebloodstream.
Itconsistsofhead,bodyandtail.Theheadfitintothecurveofduodenum.Thenbodyandtailare
directedtowardstheleft.Thepancreaticisletsrepresentstheendocrinepartofthepancreas.
Mostoftheisletsarelocatedinthetailandonlyasmallnumberintheheadofthepancreas.There
aretwodifferenttypesofcellsintheisletsofLangerhans.Thealphacellsandbetacellsarevery
important.
ThealphacellssecreteahormoneGlucagonwhereasthebetacellssecreteinsulin.
FunctionsofGlucagon:
1)Increasesthebloodglucoselevel
2)Breakdowntheliverglycogenintoglucose
3)Stimulatesthebreakdownoflipidinadiposetissue
FunctionsofInsulin:
1)Convertsglucoseintoglycogenandacceleratesthetransportofglucosefromtheblood
intothecells.
2)Decreasesthebloodsugarlevel
3)Builduptheglycogenstoreintheliver.
AdrenalGland:
Theadrenalorsuprarenalsaretwosmallglandseachonesituatedaboveakidney.Adrenal
glandsconsistsoftwodifferentpartseachofwhichactsasaseparategland.
Theinnerareaiscalledmedullawhichisbrownincolorwhiletheouterareaiscalledcortexwhich
islighterincolor
AdrenalCortex:
Itiscomposedofthreelayers.Theyare
1)Zonaglomerulosa(outerlayer)
2)ZonaFaciculate(middlelayer)
3)Zonareticularis(innerlayer)
Theadrenalcortexsecretesthreehormones.Theyare:
1. Glucocorticoids:Actsasantagoniststoinsulinandcauseincreaseinbloodsugar
2. Minerlocorticoids: Acts on sodium and potassium and help in the conversation of
sodiuminthebody
54
3. SexSteroids:Stimulatesthedevelopmentofthereproductiveorgansinthechildhood.Itis
responsiblefordevelopmentofsecondarysexcharacteristicsandreproductivefunction.
AdrenalMedulla
AdrenalMedullasecretestwohormones.Theyareadrenalineandnoradrenaline.
FunctionsofMedullaryhormones
1)Dilationofthepupilsandimprovesthevisualacuity
2)Increasesbothrateandamplitudeofcontractionofheartandraisesthecardiacoutput.
3) Increases both rate and amplitude of respiratory movements and causes dilation
ofthebronchioles
4)Raisesthebloodsugarlevelbymeansofglycogenolysis
5)Increasesthebasalmetabolicrate
6)Dilationofthewallsofintestineandtheurinarybladder
Thefunctionsofadrenalinearesimilartothatofnoradrenalineexceptinafewinstances.For
example,Adrenalinincreasestheheartratewhereasnoradrenalindecreasesheartrate.
Pituitarygland:
Thepituitaryglandisasmallglandaboutthesizeofthecherry.Itissituatedatthebaseofthebrain.
Itplaysapeculiarroleinthesystemoftheendocrineglands.
Itisreferredtoasthemasterglandofinternalsecretionbecauseitcontrolstheactivitiesofother
endocrineglands.Thepituitaryglandisdividedintotwomainparts.
1) Anteriorpituitarygland.2)Posteriorpituitarygland
Theanteriorpituitarygland:Thispartsecretesalargenumberofhormones.Manyofthemstimulate
otherglands.Itsmainhormonesare:
1) Growth hormone: it facilitates the growth of the bone and cartilage tissue. Over
activityoftheanteriorpituitarylobeinchildhoodresultsinexcessivegrowthandheight.Thiscondition
isknownasgigantism.
Adecreasedactivityoftheanteriorpituitarycausesaseveregrowthretardationleadingtodwarfism.
Excessiveproductionofgrowthhormoneinanadultleadstoexcessivedevelopmentofcertain
regionssuchasfingersandtoes,feet,hands,nose,lowerjaw,tongue,thoracicandabdominalorgans.
Thisconditionisknownasacromegaly.
2.Thyrotrophicstimulatinghormone(TSH):thishormonestimulatestheactivityofthethyroid
gland.Administrationofthishormonecausesovergrowthofthyroidtissue.
3. Adreniocorticotrophichormone(ACTH):thishormonestimulatesthecortexoftheadrenal
glandandincreasestheproductionofthehormonesoftheadrenalcortex.
4. Follicularstimulatinghormone(FSH):thishormoneinfluencesthegrowth,developmentand
maturationandoftheovarianfollicles.Inmales,thehormonestimulatestheformationofspermintestes.
55
5. Prolactinhormone:itactsonthemammaryglandandhelpsintheformationandflowofmilk
duringlactation.
6. Luteinisinghormone:itisrequiredforthegrowthoffollicleintheovaryandstimulatesovula
tion.Intheabsenceofthehormone,noovulationandproductionofthecorpusluteumcanoccur.In
malesitstimulatestheinterstitialcellsoftestestosecretetestosterone.
Theposteriorlobeofthepituitary:
Thislobeisjustbehindtheanteriorlobe.Itproducestwohormones.Oxytocinandvasopressin.
Oxytocinactsonthesmoothmusclesespeciallythatoftheuterusandproducespowerfulcontractions
oftheuterusandhelpsinparturition.
Vasopressin acts on the smooth muscle of the arterial system and increases the blood
pressure.Thishormonehelpsinthereabsorptionofwaterfromthedistalconvolutedtubule.Vaso
pressindeficiencyisthecauseofdiabetesInsipidusinwhichwaterisnotreabsorbed.Sogreatamounts
ofurineareexcretedwithnosugarinit.Suchpatientsfeelconstantlythirsty.
Thesexglands:
Thesexglandsincludingtheovariesofthefemaleandthetestisofthemaleareimportantendo
crinestructures.Thesecretionsofthisglandplayanimportantpartinthedevelopmentofthesexual
characteristics.
Themalesexglandsecreteshormonecalledtestosteroneandisresponsibleforsecondarysex
characteristics.Thefemalesexglandsecretesahormonecalledestrogenanditstimulatesthedevelop
mentandfunctioningofthefemalereproductiveorgans.
Thereisoneotherhormoneproducedbyfemalesexglandanditiscalledprogesterone.This
hormoneassistsinthenormaldevelopmentofthepregnancy.
SENSEORGANS
Theorgansofthespecialsensearespeciallyadaptedendorgansforthereceptionofcertainkinds
ofstimuli.Thesensoryimpressionswhicharesuppliedbythenervescarriedtothebrainwheresensa
tionsareinterpretedfore.g.
1)Taste 2)Smell 3)Sight4) Touch 5) Sound
Ineachcasethesensorynervesaresuppliedwithspecialnerveendingsforcollectingthestimuli
fortheparticularsensewithwhicheachorgandeals.Weapparentlytastewiththenerveendings
inthetongue, hearwiththoseintheearandsoon,butinrealityitisthebrainthatappreciate
thesesensations.
Skin
Theskinformsaprotectiveoutercoveringaroundtheentirebody.Itconsistsofanouterthinlayer
calledthe epidermis andaninnerthicklayercalledthe dermis. Numerousstructuressuchasglands,
senseorgansandappendagessuchashairnailsareembeddedintheskin.
Epidermis: Thisistheoutermostthinportionoftheskin.Nobloodvesselsarefoundinthislayer.
Itderivesitsnutritionfromlymph.Nervesarefoundinthislayer.Theepidermisconsistsoffourlayers
ofcells.
56
Theyare:
1)TheStratumCorneum 2)TheStratumLucidum
3)StratumGranulosumand 4)TheStratumMalphigi
TheStratumCorneum:Thecellsinthislayerarethin,scalelike,dead,andcornified.The
corneuslayeristhickenedinthosepartsofthebodysuchasthepalmandsoleofthefoot.Itisthinner
inthelips.Hoofs,horns,nails,feathers,thescalesofthefishesareallspecialoutgrowthsofthislayer.
TheStratumLucidum: Thisisathinmoreorlesstransparentlayer,inwhichthecellsare
indistinct.
The Stratum Granulosum: It consists of three to five layers of flattened cells,
containingdarkgranulesofirregularshape.
TheStratumMalphigi: Thislayeristhelowermostandbroadestlayeroftheepidermis.Itis
capableofactivemultiplication.Thislayerismadeupofpolyhedralcells.Theinnermostcellofthis
layercontainspigmentgranulescalled melaninwhichgivetheskinitscolour.
Dermis:
Situatedbelowtheepidermisisthethickestdermisformedmostlyofconnectivetissuewhichis
richlysuppliedwithbloodvesselsandnerves.
Theboundarylinebetweenthedermisandepidermisisneithersmoothnorstraightitisratherzig
zagbecauseoftheconicalprojectionofthedermisintotheepidermis.
Theseprojectionsarecalled dermalpapillae.Thislayeristough,flexibleandhighlyelastic.
Itcontainsthefollowing:
1)Fineelasticfibres. 2)Capillarybloodvesselsandlymphatics.
3)Sensorynerveendingsofvarioustypes. 4)Hairrootsorhairfollicles.
5)Sweatglands. 6)Sebaceousglandsand
7)Involuntarymusclefibres.Thesemusclefibre,callederrectorespilorumareattachedtothehair
follicleandwhenthesemusclescontract,thehairsbecomeverticalandgooseskinisbroughtabout.
Glands:
Therearetwosetsofglandsintheskin.Theyare
1)TheSweatglands
2)Thesebaceousglands.
Eachsweatglandconsistsofalongtube,whichatoneendopensontothesurfacethroughthe
sweatspore.Attheotherends,inthedeeperpartofthedermis,thetubeformsacoiledmasswitha
blindend.
Inthecoiledportionofthesweatglandthereandglandularcells,whichseparatewaterandsmall
quantitiesofmetabolicwasteproductsfromthebloodthatcirculatesthroughthecapillarynetwork
associatedwiththegland.
Thesweatpassesthroughthesweatporeandevaporatefromthesurfacebytakingheatfromthe
skin.Thesweatglandsarepresentinlargeamountsonthepalms,soles,foreheadandinthearmpits.
57
Thesebaceousglandsareirregularlyshapedsaclikeglandsthatopenintothehairfollicle.The
oilysecretions(sebum)oftheglandsmakethehair,waterproofandprotecttheskinfromdryingeffects
oftheatmosphereduetohightemperaturesandlowhumidity.
SensoryNerveEndings:
Numeroussensorynervesspecializedtopickupstimulithatcausesensationsoftouch,pressure,
pain,heatandcoldarescatteredintheskin.
Theyareconnectedtothebrainbynervefibres.Stimulipickedupbythesenseorgansare
transmittedtothebrainwhentheyareinterpretedtogivethecorrectinformation.
Appendages:
Hairandnailsareappendagesoftheskinformedasaresultoftheoutgrowthorthickeningofthe
epidermis.
Functionsoftheskin:
Theskinisnotmerelyanoutercoveringforthebodybutitservesavarietyoffunctions.
1)Protection:Theskinprotectstheinnerpartsofthebodyfrommechanicalinjuries.Ahealthy
skinalsoprotectsthebodyfromtheinvasionofgermscausingdiseases.Thenails,hoofs,andhornsare
alsodefensiveappendagesoftheskin.
2)Excretion:Likekidneys,theskinthroughitssweatglands,eliminatessalts,andmetabolic
wasteproductsintheformofsweat.
3)Sensoryfunction:Thenumeroussenseorgansandnerveendingshiddenintheskinmakeitan
importantsensorystructurethatpicksupdifferentstimuliandinformsthebrainofsuchchangesinthe
environment.
4)ProductionofVitaminD:Theskincontainsasubstancecalled7dehydrocholesterolwhich
isconvertedintovitaminDbyultravioletraysofthesun.
5)Regulationofthebodytemperature:Byconduction,convectionandradiationalarge
amountofheatislostfromthebody.Thesubcutaneousfatandhairsactasnonconductorsofheat.
Evaporationofsweattakesawayalargeamountofheatfromthebody.
6)Waterbalance:Formationandevaporationofsweatisanimportantfactorintheregulationof
waterbalanceofthebody.
7)Acidbalanceequilibrium:Sweatbeingacidinreactionagoodamountofacidisexcreted
throughit.Inacidosis,itbecomesmoreacidandinthiswayhelpstomaintainaconstantreactioninthe
body.
8)Secretion:Sebumwhichissecretedbythesebaceousglandshelpstokeeptheskingreasyand
preventsdrying.Sweatissecretedbysweatgland.Milkissecretedbymammarygland.Themam
maryglandsaretheskinstructures.Theyarethemodifiedsebaceousglands.
9)Storagefunction:Thesubcutaneoustissuecanstore
a.fat b.water
c.salts d.glucoseandsuchothersubstances
58
Tongue
The tongue is concerned in the special sense of taste. It is a solid muscular organ of
deglutition,taste,speechandhelpsinmasticationoffood.Itissituatedintheoralcavity.Themucous
membraneofthetongueismoistandpinkinhealth.
Tongueconsistof3parts
Root Attachedwiththehyoidbone
Body surfaces
Apex Touchestheposteriorsurfaceoflowersurfacesincisorteeth
Surfaces:Bodycontainingdorsalsurfaceandinferiorsurface.Uppersurfacehasavelvetteap
pearancecoveredbythreevarietiesofpapillae
1) Circumvallatepapillae thesepapillaearearrangedinaVshapeatthebackofthe
tongueandtastebudsarefoundnumerousinthewallsofthe
circumvallateandfungiformpapillae.
2) Fungiformpapillae aredistributedoverthelipandsidesofthetongue
3) Filiformpapillae areabundantandfoundoverthewholesurfaceofthetongue
Smell:
Noseisthespecialorganofthesmellandthenasalcavitiesarelinedbymucousmembrane.The
olfactoryorfirstcranialnervesuppliestheendorgansofsmell.Thefilamentsofthenerveariseinthe
upperpartofthenasalcavityiscalledolfactoryportionofthenoseandlinedwithhighlyspecialized
cells.
Theolfactorynervesandconnections
Theolfactorybulbisanoutlyingportionofthebrainistheslightlyenlargedportionoftheolfactory
nervetractwhichliesabovethecribriformplateoftheethmoidboneformtheolfactorybulbsensation
ispassedalongtheolfactorytractbyseveralrelayingstationsuntilitreachesthefinalreceivingareain
theolfactorycentrewhichisinthetemporallobeofthecerebralhemispherewherethesensationis
interpreted.Thesenseofsmellisstimulatedbygasesinhaledbysmallparticle.
OrgansofspecialsenseTheearandhearing:
Theearistheorganofhearing.Thenervesupplyingthisspecialsenseistheeighthcranialor
auditorynerve
Theearhasthefollowingparts
1)Externalear 2)Middleearortympaniccavity 3)Internalear.
Externalearconsistof
1)Pinnaorauriclecollectsthesoundwaves
2)Externalauditorymeatus conveysthevibrationsofsound
Middleearconsistof
1) Eardrum communicatestothemastoidprocess
2) Eustachiantube maintainingthepressureofairinthetympaniccavity
3) Auditoryossiclesare3smallbones.Theyare
59
Malleus
Incus Thischainofboneservestotransmitthe
vibrationsofsoundfromthedrumtotheinternalear
Stapes
Mastoidprocessisthepartofthetemporalbonelyingbehindtheearanairspacecommunicates
inthemiddleear
Internalear
Consistsofcavitiescalledthebonylabyrinthandmembranouslabyrinth.Bony
labyrinthconsistof3parts
Thevestibule It is the central part wit h which all the others communicate, as
doorsmayopenoutofthevestibuleofadwelling
Semicircularcanals Assistthecerebelluminthecontroloftheequilibrium
Cochlea Spiraltubetwistedresemblingasnailshell.Thefluidwithinthemembranous
labyrinthisendolymphandthefluidinthebonylabyrinthistheperilymp.The
fenestravestbuliandthefenestracochleaarewindowsdirectedtowardsthe
middleearandallowthevibrationstransmittedtoperiandendolymphtoacti
vatethenerveendingsoftheauditorynerve
Hearing: Soundwavespassalongtheexternalauditorycanalcausethetympanicmembranetovibrate.
Thevibrationstransmittedthroughmalleus,incusandstapes.Bymovementofthesebones,magnifythe
vibrations,thencommunicatedtothevestibularfenestratotheperilymphandtotheendolymphinthe
canalofthecochlea.Thisstimulireachesthenerveendingsintheorganofcorti,conveyedtothebrain
byauditorynerve.Thesensationofhearingisinterpretedbythebrainasapleasantorunpleasant
sound(noiseormusic).
Balance: Thechangeinthepositionofthefluidinthesemicircularcanalshelpsin ordertomaintain
balanceofthebodyandthiscanaldistributedbythevestibularnervewhichconveystothebrainthe
1)Pinna 2)Auditorycanal 3)Eardrum 4)Semicircularcanals
5)AuditoryNerve 6)Cochlea 7)EustachianTube
1
2 3
4
5
6
Fig2.23Ear
7
60
impulsegeneratedtherebyalterationsinthepositionofthefluidinthesecanalswhichhavetodowith
theknowledgeofthesenseofthepositionoftheheadinrelationtothebody
OrgansofspecialsenseTheeyeandsight:
Eyeballissphericalinshapesituatedintheanterior2/3oftheorbitalcavityanditisembeddedinthe
fatofthecavity.Theopticorsecondcranialnerveisthesensorynerveofthesight
Theeyeballcomposedof3layers
1) Outer Fibrousandsupportinglayer
2) Middle Vascular
3) Inner nervouslayer(Retina)
Fibrouslayer:
Sclera: Itisopaque,white,smoothandcontributestheposterior5/6
th
oftheeyeball.Itprotects
thedelicatestructureoftheeyeandhelpstomaintaintheshapeoftheeyeball
Cornea: Isatransparentfrontportion,avascularandcontinuouswiththesclera.Itconsistof
severallayersandithelpstofocusimagesontotheretina
Vascularlayer:
Choroid: Itishighlyvascularandpigmentedlayer,suppliesnutritiontotheouterlayerofretina,
absorbsthelightandpreventsreflectionoflight
Ciliiarybody: Itliesbetweenthechoroidandtheirisandhascircularmusclefibersandradiat
ingfibershelpsinmaintainingtheaccommodationoftheeye
Iris: Itisacircular,contractileandpigmenteddiaphragm.Itisthecolorcurtaininfrontofthelens
anditcontains2setsofinvoluntarymusclefibers,onesetcontractthesizeofthepupil&otherset
dilatesthepupil
Pupil: Itisthedarkcentralspotwhichisanopeningintheiristhroughwhichlightreachesthe
retina
Nervouslayer(retina): Composedofnumberoflayersoffibers,nervecells,rodsandcones.The
mostsensitivepartoftheretinaistheMaculalies,oppositetothecentreofthepupil.Atthemiddleside
ofthemaculathereisacircularpaleareawhichisinsensitivetolightcalledblindspot
1
2
3
4
5
6
7
Fig2.24Eye
1)Conjunctiva
2)Cornea
3)Iris
4)Pupil
5)Lens
6)Retina
7)OpticNerve
61
Sight
Whenanimageisperceivedtheraysoflightfromtheobjectseen,passthroughthecornea,
aqueoushumor,lensandvitreousbodytostimulatethenerveendingsintheretina.Thestimulireceived
bytheretinapassalongtheoptictractstothevisualareasofthebraintobeinterpreted.Bothareas
receivemessagesfrombotheyesthusgivingperspectiveandcontour.Onelensisprovidedinanordi
narycamera,whereasintheeyesthecrystallinelensisimportantinfocusingtheimageontheretina
REPRODUCTIVESYSTEM
Thereproductivesystemconsistsofthoseorganswhosefunctionistoproduceanewindividual.
Maleandfemalesexualreproductiveorgans:
Thesexorgansinthemaleandfemalecanbedividedas
1. Primarysexorgansi.e.thoseproductionmaleandfemalegametes.
2. Secondary(oraccessory)sexorgansi.e.thoseconcernedwithcarriageofgametes
andotherfunctions.
Primarysexorgansinmaleandfemale:
Thereareapairoftestesproducingspermatozoa(malegametes)whileinfemalesareapairof
ovariesproducingovum(femalegamete).Theseprimarysexorgansinadditiontoproducingmale
andfemalegametessecretemaleandfemalehormonesaswell.
Accessorysexorgansinthemale:
1. Epididymisgland
2. Vasdeferens
3. Seminalvesicles.
4. Prostrategland.
5. Urethra.
6. Penis.
Malereproductivesystem:
Thereisonepairoftesteslyingoneineachscrotalsac.Thescrotumisabagofskinhavingtwo
separatecompartments.
Oneforeachtestislyingattherootofthepenis.Eachtestisisovalshapedmeasures.5x3x2cm
andweighsabout15gm.
Eachtestisiscoveredwithalayeroffibroustissuecalledtunicaalbuginea.Manyseptatefromthis
layerdividethetestesintopyramidallobulesinwhichlieseminiferoustubulesandinterstitialcells.
Theseminiferoustubulesareconcernedwithprocessofspermatogenesis.Theinterstitialcells
calledLudwigcellsliebetweenthetubulesandsecretethetestosterone(malesexhormone).
Fromtheliningofthesetubulesspermatozoaareproducedbytheprocessofcelldivision.The
epididymisisaveryfineconvolutedofsurvivingformonths.
Convolutedtube,being46meterslongandjointstheposteriorpartofthetestesandvasdeferens.
Itstoresthespermatozoa.Thespermatozoaremaininactiveinepididymisandarecapableof
survivingformonths.
62
Vasdeferensisafibroelasticduct3040cminlengthandextendsfromepididymistoendin
ejaculatoryductwhichisjoinedbyseminalductandopensinprostaticurethra.
TheSeminalVesiclesarelittlesacsoneoneachsideoftheurethranearthebaseofthebladder.
Theyreceiveandstorethespermsbroughtbythevasdeferens.Theyalsoaddafluidtothesemen.
Theirductspassthroughtheprostateglandtotheurethra.
The prostrate gland lies at the base of the urinary bladder and is covered with fibrous
capsulewhichbyanumberofseptadividesintomanyfollicles.Theprostrateaddsanotherfluidtothe
semen,whichmakesthespermsmoreactiveinswimmingtoreachtheovum.Inmiddleandoldage
prostatemayenlargeandcausemicturitiontroubles.
The ejaculatory ducts lead from the seminal vesicle through the prostrate gland to the
urethra.Inmalestheurethraisabout2022cminlengthandservesthepurposeofurinationaswellas
ejaculationofsemen.
ThePenisistheexternalorganofboththeurinaryandreproductivesystemsinthemale.Itconsists
ofspongytissuewithspacesforbloodtorushintomakethepenishardanderect.Theendofthepenis
iscalledtheglanspenis.Itisnormallycoveredwithaloosedoublefoldofskin(Theforeskin),whichcan
bedrawnback.Theforeskincanberemovedbycircumcision.
Theurethrapassesthroughthepenisandopensattheglanspenis.
Functionsoftestis:
1) Theyproduceandmaturethemalereproductivecellscalledspermatozoa.
2) Secreteseminalfluid.
3) Secretehormonetestosteronedirectlyintotheblood.
Functionsofhormone:
1) Androgens:Maintainsspermatogenesisandsexualactivity.
2) Testosterone:stimulatesthedevelopmentofthesecondarysexualcharacteristicsofthemale
suchasthegrowthofbeard,thedeepeningofthevoice,thegrowthandthedistributionof
haironthebody,thegrowthanddevelopmentoftheaccessorysexorgans.Stimulatethe
productionofspermsatpuberty.
1
2
3
4
5
Fig2.25MaleReproductivesystem
1)SpermDuct
2)Bladder
3)Prostrategland
4)Penis
5)Testis
63
FEMALEREPRODUCTIVEORGANS
Thesearedividedintoexternalorgansandinternalorgans.
TheExternalOrgans:TheVulva
Theexternalorganstogetherformthevulva.Theyareasfollows.
MonsvenerisorpubicMont:itliesoverthesymphysispubis,andiscoveredwithhairafter
puberty.
Labiamajoraortheouterlips,formthesidesofthevulva.
Labiaminora,orsmallerlips,arewithinthelabiamajora.Theyaremoistbyglandsecretions.
Clitoris asmallsensitiveorganwitherectiletissuesimilartothemalepenis.
Vestibule: atriangularpartbetweenhelabiaminora.Theurethralopeningisinthevestibulein
frontofthevaginalopening.
Vagina: Itisamusculartubelinedwithmembranecomprisedofspecialtypeofstratifiedepithe
lium,wellsuppliedwithbloodvesselsandnerves.Itextendsfromthevestibuletotheuterus.
Perineum: Thisistheareaoftheskinfromthevaginalopeningbacktotheanus.Itcoverstheperineal
body,whichisawedgeshapedstructurebetweenthevaginaandlowerpartoftherectum.Themuscle
oftheperinealbodyformsthemainmuscleofthepelvicfloor.Itflattensduringthesecondstageof
labourandquiteoftengetstorn.
Femalereproductiveinternalorgans:
Theinternalorgans,whicharesituatedinthepelvis,areasfollows:
1) Fallopiantubes 2)Uterus
3) Vagina 4)Ovaries
Fallopiuantubes: thefallopiantubesaretwothintubesconnectedtothesidesoftheuterus,justbelow
thefundus.eachtubeisabout10cmlong,curvesbackwardsbehindtheuterusandaroundtheovary
likeanarch.theouterendwidensandopensintotheperitonealcavity.Thisopeningissurroundedby
fingerlikeprocessescalledfimbriae,oneofwhichisconnectedtotheovary.Thefallopiantubeshave
wallsofmuscleandarelinedwithciliatdepitheliumandcoveredwithperitoneum.
Fig2.26FemaleExternalOrgans
1)Clitoris 2)Urethra 3)Vagina 4)Anus5)LabiaMajora 6)LabiaMinora
5
6
1
2
3
4
64
Functions:
Thesetubesactasductsforthefemalegametesalthoughtheyarenotconnectedtotheovaries.
Thefunctionofthetubeistocollecttheovumdischargedfromovaryandpassitalongthetube.Itissent
along partly by peristaltic act ion of t he muscles and partly by waving
movementsofthecilia.Fertilizationofthemaleandfemalegametesnormallyoccursinthetubesatthe
ampullaryportion.
Uterus: Uterusisapearshapedmuscularorgan.Thisinsideofwhichishollow.Itmeasuresabout7.5
x5x2.5cmandweighsabout60gm.consistsofanupperportioncalledthebodyandthelowerportion
calledthecervix.Theuterusislinedbyamucusmembraneknownastheendometrium.Theuterushas
threeparts:
1)Fundus,theupperpartbetweeenthetwofallopiantubes.
2)Body,themiddlepart,whichhasatriangularshapedcavity.
3)Cervix,thelowernarrowpart,whichprojectsintothevaginabelow.Thecervixisabout2.5cm
long,andhasacentralcanalwithtwocircularopenings:theinternaloswhereitjoinswiththebodyofthe
uterus,andtheexternalos,whichopensintothevagina.
Thewalloftheuterusisinthreelayers:
1)Perimetrium,theouterserouslayer.
2)Myometrium,themuscularlayer,whichisthickandstrong.
3)Endometrium,theinnerliningofspecialepithelialtissue.Thenarrowcavityoftheuterushas
threeopenings:oneintoeachfallopiantube,andonethroughtheexternalosofthecervixintothevagina.
Functions
1)Menstruationthethickenedendometriumcomesawaycausingbleedingoftornvessels,and
theresultingmenstrualflowisdischargedthroughthevagina.
Fig2.27TheUterus
1)Fallopiantube 2)Fundus 3)DevelopingEgg 4)Myometrium
5)BodyoftheUterus 6)Ovary 7)Cervicalcanal 8)Vaginalcanal
6
1
2
3
4
5
7
8
65
2)Pregnancytheuterusreceivesthefertilisedovumandnourishesthedevelopingfoetus.
3)Labourcontractionsofthemuscularwallcausethefoetusandplacentatobeexpelled.
4)Involutionthegradualreturntonormalsizeoftheuterusfollowingdelivery.
Ovary:
Thegonadsofthefemalesarecalledovariesandthecellsthattheyproduceareknownasovaor
eggcells,eachfemalehasapairofovalshapedstructureaboutthesizeofaalmond.
Eachovarymeasures3.5x2.5x11.5cmandweighs810gms.
Theyaresituatedatthebackoftheabdominalcavityatthehiplevel.Anovaryconsistsofthe
following
1)Thegerminalepithelium:itistheouterpartoftheovaryfromwhichtheprimitivegraffian
folliclesdevelop.
2)Tunicaalbuginea:thisismadeupofconnectivetissuefoundunderthegerminalepithelium.
3)Stroma: itistheconnectivetissuenetworkcontinuouswithtunicaalbugineaandcontaining
involuntarymusclefibres.Itsupportstheovariantissuesandcarriesbloodvessels,lymphaticandnerves.
4)Graffianfollicles:thesearesmallislandsofcellsfoundattheperipheralpartoftheovary.The
femalegametescalledovaareproducedinthegraffianfollicle.
Whentheovummatures,thefollicleinwhichitdevelopsbursts.Thefollicleusuallytakes1014
daystorupture.Thisprocessofruptureofgraffianfollicleiscalledtheovulation.
5)Corpusluteum:whenthefolliclerupturescorpusluteumdevelops.Intheabsenceofpreg
nancyitpersistsupto27
th
dayanddegeneratesonthe28
th
day.Ifpregnancyoccursitpersiststoabout
45months.Itsecretesprogesteronewhichisessentialforthemaintenanceofpregnancy.
6)Interstitialcells:therearepolyhedralcellsfoundinbetweenthefollicles.Thesecellssecrete
oestrogen.
Functions:
1) Produceovaandexpeloneatapproximately28daysintervalduringthereproductivelife.
2) Secreteshormones(oestrogen&progesterone).Oestrogeninfluencesecondarysex
characteristicsandisresponsibleforthechangesintheaccessoryorgansofreproduction.
Theprogesteronepreparestheuterusforthereceptionofthefertilizedovum,
implantation,thedevelopmentoftheplacenta,developmentofthemammaryglands,and
inducingmultiplicationoftheuterinemusclefibres.
TheBreasts(Mammaryglands)
Theseareaccessorytothereproductivesystem.Theyarepresentinan,undevelopedforminthe
femalebeforepuberty,andalsointhemale.Theyaresituatedatthefrontofthethorax.
Thefullydevelopedfemalebreastiscircularinoutlineandcurvesoutwards.Inthecentreisthe
nipple,whichprojectsoutwardsandispinkinthevirgin,butpigmentedafterthefirstpregnency.It
becomeserectwhenstimulatedandagoodteatforthebaby.
66
Theglandisdividedintolobesbypartitionsoffibroustissue.Ductsfromtheglandulartissue
convergetowardsthenippleandopenonitssurface.
Duringpregnancyhormonesfromthepituitaryandovariescausethebreaststoincreaseinsize
andtosecreteasmallamountoffluid,whichcanbeexpressedfromthenipples.Thisisinpreparation
forthefunctionoflactation(milkproduction).
MenstrualCycle
This means the cycle of changes that regularly take place in the lining of the uterus
(endometrium)undertheinfluenceofhormoneswiththeoutwardsignofmenstruationormonthlyperiod
offemales.
Menstruationisafunctionoftheuterusthatstartsduringpubertyattheaverageageof13.It
occursontheaverageevery28days,untilitstopsat45to50years(themenopause).
Thepurposeofthemenstrualcycleistopreparetheendometriumtoreceivethefertilizedovum.It
becomesthicker,issoftandrichinbloodsupply.Whennofertilisedovumarrivesintheuterus,the
endometriumbreaksdownandresultsinthemenstrualflow.Theendometriumbleedsfor3to5days.
Thebloodcontainsepithelialcellsandmucus,anddoesnotclot.Theamountoffluidisnormallyfrom30
to180ml.inall.
Aftermenstruation,thereisaperiodofrepairfortheendometrium,followedbyarestingperiod
andslowgrowth.Duringthemiddleofthisrestingperiodanewovumisdischargedfromtheovary
(ovulation)
Themenstrualcyclecontainsthefollowingphases.
Premenstrualperiod,withcongestionintheuterus7days.
Menstruation 5days
Periodofrepair 6days
Restingperiodwithovulation 10days
Total 28days
Ovulationusuallytakesplacemidwaybetweenthebeginningoftwomenstrualperiods.Thisis
timewhenthewomanisfertileandpregnancymayoccur.
Menstruationstopsduringpregnancyandthisiscalledamenorrhoea.Themenstrualperiodsusu
allydonotstartagainuntilbreastfeedingisstopped.
Hormonesandthereproductivesystem
Hormonesaremostimportantintheworkingofthereproductiveorgans.Atpuberty,hormones
fromtheanteriorpituitaryglandstimulatesthesexglands(ovaryinthefemale,testesinthemale)to
producetheirsexhormones.
Themalehormonestestosteronepromotesthedevelopmentofmalecharacteristics.
Inthefemale,oestrogen,promotesdevelopmentofthefemalesexorgansandtissuegrowthfor
thedevelopmentoffemininefeatures.
67
Theanteriorpituitareyhormonesandadrenalcortexhormonesalsohaveeffectonthedevelpment
ofsexualcharacteristicsbothinthemaleandinthefemale.
Ovulation
TheFollicleStimulatingHormone(FSH)fromtheAnteriorpituitarycausesdevelopmentofa
Graafianfollicleintheovaryonceamonth.Thisislikeacystorsacoffluidprotectingtheovum.Atthe
timeofovulation,theovumissetfreeasthefollicleruptures.
Immediatelyafterovulation,theLuteinisingHormone(LH)fromtheanteriorpituitaryglandcause
therupturedfollicletochangeintotheCorpusLuteum(YellowBody)whichappearsontheovary
followingovulation.Iftheovumisnotfertilized,itdiesandpassedoutofthebodyinthemenstrualflow.
Thecorpusluteumalsodisappearswiththenextmenstrualperiod.
Summary:
Thebodyismadelikeacomplexperfectmachine.
Eachpartisspeciallyconstructedtocarryoutitsownfunction.
Thebodyconsistsofthehead,neck,trunk,upperlimbs,andlowerlimbs.
Thebodyhasastrongframeworkofbonescalledtheskeleton.
Therearespacescalledcavitiesinwhichimportantorgansareprotected.E.g.thecranial
cavitycontainsthebrain.
Thehumanbodyismadeupoflivingcells.
Eachcellhascellmembrane,protoplasmandnucleus.
Thefunctionsofthecellsaredigestion,excretion,respiration,growthandrepairand
reproduction.
Tissuesaremadeupofgroupsofsimilarcells.
Tissuesarejoinedintolargerunitscalledorgans.
Asystemisagroupoforgans.
Skeletalsystem,muscularsystem,nervoussystem,circulatorysystem,digestivesystem,
respiratorysystem,excretorysystem,endocrinesystem,andreproductivesystemarethe
systemsofourbody.
Nervoussystemhastwoparts:centralnervoussystemaneautonomicnervoussystem.The
centralnervoussystemismadeupofthebrainandcranialnerves,spinalcordandspinal
nerves.
Themainfunctionofcirculatorysystemistransportationofoxygen,nutrientstotissuesand
carriesmetabolicwasteproductstotheexcretoryorgans.
Thelymphglandshelptoprotectthebodyfrominfection.
Thefunctionsofdigestivesystemaredigestion,absorptionofnutrientsandexcretionof
undigestedfood.
Respirationistheprocessofgaseousexchangebetweenanorganismanditsenvironment.
68
Thelungs,kidneyandskinaretheimportantexcretoryorgansinourbody.
Themainendocrineglandsinthebodyarethyroid,parathyroid,adrenalandpituitary
glands.
Theendocrineglandsproduceachemicalsubstance,hormone,whichregulatestheactivities
ofvariousorgansandtheirfunctions.
QUESTIONS
PARTAWRITEINONEORTWOWORDS:(Onemark)
1) Whichistheimportantpartofthenervoussystem?
2) Whatistheendproductofdigestion?
3) Writethetwophasesofrespiration?
4) Whatarethelayersofskin?
5) Listdownthelayersofepidermis?
6) Whataretheglandsintheskin?
7) Whatarethehormonessecretedbyadrenalcortex?
8) Whataretheaccessorysexorgansinfemale?
9) Defineanatomy?
10) Howmanybonesarethereinthebody?
11) Whataretrueribs?
12) Whatarefalseribs?
13) Whatarethepartsofnervoussystem?
14) Whatconstitutethecentralnervoussystem?
15) Howmanycranialnervesarethereinthebrain?
16) Whatarethethreemembranesofthebrainandspinalcord?
17) Whatarethetwoenzymespresentinsaliva?
18) Whatarethepigmentspresentinbile?
19) Whataretheenzymespresentinthepancreaticjuice?
20) Whatarethetwochieffunctionsofdigestivesystem?
21) Whatarethetypesofnerves?
22) Whatarethetypesofbloodvessels?
23) Howmanylobesarepresentinrightlung?
24) Howmanybonesarepresentincranialcavity?
25) Mentionthepartsoftheinnominatebone?
69
PARTBMULTIPLECHOICEQUESTIONS:(Onemark)
1) Theimportantpartofthecentralnervoussystemis
a)Brianb)spinalcordc)nervesd)alloftheabove.
2) Thebiggerpartofthebrainis
a)Cerebrumb)cerebellumc)ponsd)medullaoblongata
3) Brainandspinalcordiscoveredby
a)Meningesb)pleurac)peritoneumd)periosteum.
4) Functionofthefrontallobeofthebrain
a)motorcentreb)speechcenterc)mentalpowersd)alloftheabove.
5) Theendproductsofproteindigestionare
a)glucoseb)aminoacidsc)fattyacidsd)alloftheabove.
6) Bileisstoredandconcentratedin
a)liverb)pancreasc)stomachd)intestine
7) The process by which the masticated food is transported across the pharynx to
reachthestomachis
a)peristalsisb)deglutitionc)mastication.D)micturituion.
8) Theopeningofthelarynxisguideby
a)glottisb)epiglottisc)cartilaged)noneoftheabove.
9) Thenervethatcontrolsthediaphragmis
a)vagusnerveb)sciaticnervec)phrenicnerved)alloftheabove.
10) Thetoughtofcapillaryvesselspresentinthebowmanscapsuleis
a)cortexb)medullac)pyramidd)glomerulus
11) Processbywhichcomplexformoffoodisconvertedintosimplenutrient
a)digestionb)absorptionc)assimilationd)noneoftheabove.
12) Thefingerlikeprojectionsfoundinthemucusmembraneoftheintestineis
a)villib)esophagusc)liverd)gallbladder
13) Thechemicalpresentinmostofthedigestivejuicesis
a)pepsinb)renninc)hydrochloricacidd)trypsin.
14) Theconditioninwhichtheskin,nails,andeyesbecomesyellowis
a)anemiab)jaundicec)dwarfismd)gigantism.
15) Theprocessofgaseousexchangebetweenanorganismanditsenvironmentis
a)inspirationb)internalrespirationc)externalrespirationd)expiration.
70
16) Theprincipalexcretoryorgansofthebodyare
a)lungsb)kidneyc)skind)alloftheabove
17) Theouterthinlayeroftheskinis
a)dermisb)epidermisc)subcutaneoustissued)alloftheabove
18) Thepigmentgranulewhichgivestheskinitscolouris
a)sebumb)melaninc)rennind)alloftheabove
19) Thenervouslayerofeyeis
a)corneab)sclerac)irisd)retina.
20) Thesecretionsofsebaceousglandisknownas
a)sebumb)melaninc)rennind)alloftheabove
21) Thetermsuperficialrefersto
a)Awayfromthebody b)nearertothehead
c)nearertothebodysurface. d)noneoftheabove.
22) Theyellowmarrowismainlycomposedof
a)fatcellsb)whitebloodcellsc)redbloodcellsd)noneoftheabove
23) Thefaceconsistsofthefollowingnumberofbones
a)22 b)12 c)18 d)14.
24) Theeighthcranialnerveis
a)facialb)vagusc)accessoryd)vestibulecochlear
25) ThefunctionofOccipitallobeofcerebrumis
a)speechb)memoryc)redbloodcellsd)noneoftheabove
26) Thegroupofnervecellsarecalledas
a)Gangliab)neuronsc)fibersd)sciatica
27) Thecoronaryarteriesbranchoutfromthe
a)Archofaortab)ascendingaortac)Rootofaortad)descendingaorta
28) Thedistalendofthestomachisguardedby
a)cardiacsphincter b)internalsphincter
c)pyloricsphincter d)noneoftheabove
29)Thefollowingorganisthevoicebox
a)pharynx b)trachea c)larynxd)glottis
30) Thelargestoftheendocrineglandis
a)parathyroidb)thyroidc)adrenalsd)pituitary
71
PARTCWriteShortNoteson:(5marks)
1) Enumeratethefunctionsoftheblood?
2) Whatarethefunctionsoftheheart?
3) Whatarethefunctionsoftheliver?
4) Whatarethetypesofthebloodvessels?
5) Whataretheimportanceofrespiration?
6) Enumeratethefunctionsofparathyroidgland?
7) Fallopiantube.
8) Tongue.
9) Ovary.
10) Anteriorpituitarygland.
11) Whatarethesystemsfoundinthebody?
12) whatarethefunctionsofcell?
13) Howwillyouclassifyjoints?
14) Namethetypeoftissueswithexample?
15) Statethefacebones?
16) Whatarethefunctionsofskeleton?
17) Namethebonesofupperlimb?
18) Writeaboutinnominatebone?
19) Statethenamesofanteriormusclesofthebody?
20) Namesoftheposteriormusclesofthebody?
21) Whatarethefunctionsofspinalcord?
22) Whatarethefunctionsofbrain?
23) Listdownthefunctionsofspleen?
24) Drawthediagramofbrain?
25) Drawthediagramoftestes?
26) Writethefunctionsofmedullaryhormones?
27) Drawthediagramofkidney?
28) Whatarethefunctionsofsaliva?
29) Drawthestructureoftooth?
30) Whatarethepartsofcirculatorysystem?
72
PARTD WRITEINDETAIL: (10marks)
1) Drawthestructureofalimentarycanal?
2) Writeindetailsaboutendocrineglands?
3) Definejoints.Explainthevarioustypesofjointsinourbody?
4) Writeindetailaboutheart.?
5) Structureandfunctionsofkidney?
6) Structureandfunctionsofskin?
7) Definerespirationandexplainthephysiologyofrespiration?
8) Structureandfunctionsofeye?
9) Structureandfunctionsear?
10) Writedownthecaviesinourbody?
11) Statethetypeofboneswithexample?
12) Explainthefunctionsofblood?
13) Drawthediagramofgastrointestinaltract?
14) Discussthestructureofskeletaltissue?
15) Writeaboutthyroidglandwithexample?
PARTE WRITEESSAY: (20marks)
1) Whatisdigestionexplainaboutphysiologyofdigestion?
2) Drawthediagramofrespiratorysystemandexplainthephasesofbreathing?
3) Explainaboutpituitaryglandwithaneatdiagram?
4) Describethestructureofheartandbloodcirculation?
5) Describethestructureoffemalereproductivesystem?

73
3.INTRODUCTIONTOPSYCHOLOGY
DEFINITIONOFPSYCHOLOGYANDMENTALHEALTH
Psychologyisabranchofsciencedealingwithknowledgeofmindandsoul.Itplaysavitalrole
intakingcareofthepatientsinnursing.
Theknowledgeofbasicprinciplesofpsychologyissignificantintakingcareofnurseherselfand
alsoinherinteractionwiththepatient.
Thenursesshouldunderstandthatthefulfillmentofbasicneedsasgivenbelowisimperativein
achievingonesownselfactualization.
Mentalhealthastheadjustmentofhumanbeingstotheworldandtoeachotherwithmaximum
ofeffectivenessandhappiness Meninger
Mentalhealthisanabilitytomaintain
1) Aneventemper
2) Analertintelligence
3) Asociallyconsideratebehaviorand
4) Ahappydisposition
CHARACTERISTICSOFMENTALLYHEALTHYPERSON
1) Heisfreefrominternalconflict
2) Heiswelladjusted
3) Hesearchesforanidentify
4) Hehasastrongsenseofselfesteem
5) Heknowshisneeds,problemsandgoals
6) Hehasgoodcontroloverhisbehavior
7) Heisproductive
8) Hefaceandsolvestheproblems
IMPORTANCEOFPSYCHOLOGYINNURSING
Thestudyofhumanbehaviorisofgreatvaluetoanursingprofessionalinanumberofways
1) Itwillhelphertounderstandherself
2) Itwillhelphertounderstandotherpeople
3) Itwillhelphertoimprovesituationsbyhelpingothertosolvetheirproblems
4) Itwillhelptounderstandthecloserelationshipofbody,mindandspirit
74
FACTORSINFLUENCINGMENTALHEALTH
1)Personalfactors
Age Growthanddevelopment
Geneticsandbiology Physicalhealthandhealthpractice
Responsetodrugs Selfefficacy
Hardness(abilitytoresistillness) Commitment,controlandchallenge
Resourcefulness Spirituality
Resilience(healthresponsetostressfulcircumstances)
2)Interpersonalfactors:
Senseofbelonging Socialnetworkandsocialsupport
Familysupport
3)Culturalfactor:
Culture Race
Gender Sexualorientation
Socialclass Economicsituation
LEARNING
Oneofthemostimportantcharacteristicsofhumanbeingisthecapacitytolearn.Learningis
centraltoallourbehavior.Ourattitude&emotionalexpressionsarealsolearnedbehavior
Learningisdefinedasthementalactivitybymeansofwhichknowledge,skill,attitude,apprecia
tionsandideasareacquired,resultinginmodificationsofbehaviors
Factorsinfluencinglearning:
Itisdependsuponthefollowingfactors
1) Natureofthelearner
2) Natureofthelearningmaterial
3) Natureofthelearningsituations
Natureofthelearner:
Perception Senseorgansarethegatewaystoacquireknowledge.Processofperception
shouldbeperfect
Organicdefects Visualdefects,hearingimpairmentandinfections
Fatigue Strain,loneliness,lackoffreshair,sunlightandcompulsivelearningcauses
fatigue.
Timeoftheday Thereisnovariationinefficiencyoflearning.Itdependsonlywithlearners
willpower
Age&learning Thecapacityoflearningimprovesupto23years&declinesafter40years
Natureoflearning:
Meaningfullearningeasierthanlearningwithoutknowingthemeaningofthelearningmethod
75
1) Definitegoal:Withacleargoalinmindthestudentworkstowardsadefinitepurpose.It
enhancesmotivation,intentiontolearnbetterlearning.
2) Knowledgeofresultsorpsychologicalfeedback.Regularandfrequentreviewofthe
amountofprogressbeingmadetowardsthegoalpromoteseffectiveleaning
3) Distributionofpracticeboard:Shorterpracticeperiodaremoreeffectivethanlonger
periodsthiswillreducesthementalfatigue
4) Wholeversuspartmethod:Wholemethodshouldbeadoptedwitheasyunitanddifficult
materialcanbelearnedinsmallunits
5) Logicallearning:Logicallearningcallsforanarrangementandalsoassimilationwithideas
inminds.Studentsshouldtrytograspthemeaningoftext
6) Rest: Takerestinbetweenstudiespreventsmentalfatigue
7) Levelsofanxiety:Avoidsundueworry,anxiety&nervousnesstopromotebetterlearning.
Otherwiseitwillhaveaninhibitingandinterferingeffect
8) Overlearning/repetitionsatregularintervals helpstoretainthematerialoveralonger
periodoftime
Theoriesoflearning
1) Trailanderror
2) Theoryofconditionedreflexes
A)Classicalconditioning B)Operantconditioning
3) Cognitivelearning
A)Insightlearning B)Signlearning
Trialanderror: EdwardLeeThorndikeAmericanPsychologistconsideredasthefatherofeduca
tional,psychologyconductedseriesofexperimentsontrialanderrormethodoflearningbyanimalsand
foundoutthatalllearningistrial&errorandhehasdevelopedcertainlawsoflearning.Theyare
Lawofeffect:Theresponsefollowedbyarewardwillbestrengthened
LawofExercise:Thereisadirectrelationshipbetweenrepetitionandthestrengthofthestimulus
response.AnytaskthatisrepeatedshowsatendencyforthestrengtheningofthebondEg:
Reading,writing,typing,singing,dancing,drawinglearnedbyconstantpractice
Lawofreadiness:Learningtakesplacebestwhenapersonisreadytolearn
Theoryofconditionedreflexes
Classicalconditioning: IvanPavlovaRussianphysiologist,aresearcherexperimentedonadog.A
capsuleattachedtoadogssalivaryglandtomeasurethesalivaryflow.Abellwasrungeverytimeand
meatpowderwasgiventothedog.Thiswasrepeatedseveraltimes.LaterPavlovobservedthatthe
dogsalivatedatthemeresoundofthebellwithoutgivingmeatpowder.Thusthedoghasbeenconditioned
torespond.Pavlovshowed,howtheinternalprocesssuchaslearningcanbestudiedobjectively.
Principlesofclassicalconditioningusedinthefollowingareasforlearning
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1) Developinggoodhabits
2) Breakingofbadhabitsandeliminationoffear
3) Trainingofanimals
4) Useinpsychotherapy
5) Usefulindevelopingfavorableattitude
Operantconditioning: Skinnerexperimentedonaratwhichwasplacedinsideaglassboxcontaining
aleverandfoodtray.Theratwasfreetoexplorethebox.Whenevertheleverintheboxwaspressed
automaticallyapelletoffoodwasdroppedonthetray.Thenumberoftimes,theratpressedonthelever
wasrecorded.Pressingtheleverwastheresponsetobelearned(theoperantresponse)andthefood
wasthestimulusconsequences(reinforcement).Thustherateofpressesincreasedwithrewardingof
theratwithfood
Cognitivelearning
Learningbyinsight:Gestaltpsychologistconcludedthattheindividuallearnsbyhisabilityknownas
insight&notbytrial&errormethod.TheyexperimentonaChimpanzeecalledsultan.Somebananas
wereplacedinsidethecageofhungrysultan,whowasthengiven2sticks.Hungrysultantriedtogetthe
bananasbyextendinghishands.Thenhetookuponeofthesticks&triedtopullthebananas.Theeffort
spentforonehour,gottiredandstartedtoplaywiththeSticks.Meanwhileoneendofonestickgot
incidentallyfastenedintotheringfixedontheendoftheotherstick,withtheresultthatboththesticks
werejoinedtogether.Nowsultanusedthisjoinedsticktopullinthebananas&succeeded.Gestalt
psychologistconcludedthat,sultanssuddenlearningwasduetoinsightdevelopedfromhisperception
ofthetotalsituationconsistingofthecage,sticks&bananasasawhole
CHARACTERISTICSOFLEARNINGBYINSIGHT
1) Insightissudden
2) Insightisduetounderstanding
3) Insightaltersperception
4) Oldobjectsappearinnewpatternsandorganizationduetoinsight
5) Higherspeciesofanimalsincludingmanhasmoreinsightthanmembersoflowerspecies
6) Insightdevelopsusuallyaftersometrialanderror
Tolmanstheoryofsignlearning: AccordingtoTolamns(1930)learningisatotalprocess.Ittakes
placebycognitionwhichincludesconceptslikeknowledge,thinking,planning,inferenceandpurpose.
Thelearnerthroughhisexperiencerecognizessomecuesorsignsandthenrelationshipswithgoals.
Learningconsistsintherecognitionofsignsandtheirmeaningsinrelationtogoalsinsignlearning,a
comparisonwasmadebetweentwogroupofhungryratsinamaze.Inonegroup,eachsubjectreceived
foodeachtimeitranthemazeandsteadyimprovementwasnoticed.Intheother,eachsubjectwas
givenaccesstothemazewithoutfindingafoodrewardandlittleimprovementoccurredintimeorerror
scores.
However,whenfoodwasintroducedatthetenthtrial,performancesoonapproximatedthatof
thegroupwhichhadbeenrewardedcontinually.Suchsuddenimprovementsuggeststhattheanimals
hadacquiredinformationaboutthemazewhichtheydidnotutilizeuntil,afterthetenthdayitbecame
advantageousforthemtodoso.Theratshaddevelopedacognitivemapofthemaze
77
Bandurassocialcognitivetheory:JustasTolmanbelievedthatratsgatherinformationandform
cognitivemapsabouttheirenvironmentsthroughexploring,Bandurabelievesthathumansgatherinfor
mationabouttheirenvironmentsandbehaviorofotherthroughobservations
Socialcognitivelearningresultsfromwatching,imitatingandmodelinganddoesnotrequirethe
observertoperformanyobservablebehaviororreceiveanyobservablerewardBandurabelievesthat
fourprocessattention,memory,imitationandmotivationoperateduringsocialcognitivelearning
Theoriesoftransferoflearning: AsperThorndike,thetransferoflearningfromonesituationto
anotherispossiblebecauseofidenticalcommonelements.Forexample,inlearningcyclinganddriving
acare,thetransfertakesplacebecauseofthecommonelementslikestearingmovements,knowledge
oftherulesoftheroadandlookingahead.Inlearningtypewritingandpianothetransfertakesplaceon
accountofthepresenceofcommonelementsliketheuseofbothhandsrequiredforpressingthekeys
andeyehandcoordination
OBSERVATION: ATTENTIONANDPERCEPTION
Definition: An expression of an opinion or judgment upon what one has observed a remark.
Observationinvolvestomentalactivitiesattentionandperception
Toimproveobservation
1) Fullattentiontoeachtask 2)Avoiddistraction
3) Observeaccurately&quickly 4)Showinterest
5) Haveactivemotivation 6)Avoidpersonalbiasorprejudice
7) Cultivatethehabitofobservingaccurately
ATTENTION
Attentionisthefocusingofconsciousnessonaparticularobjectorideaataparticulartimetothe
exclusionofotherobjectsorideas
Typesofattention: Attentioncanbeclassifiedintotwo
1) Involuntary 2)Voluntaryorhabitual
Involuntaryattention: Itdoesnotrequireanyconsciousefforttoattendanobject.Ex
Attentiontoloudsounds Brightlights
Strongpenetratingodours
Factorsincreasingattentionbyexternalfactors:
1) Natureofthestimulus:Moreattractivestimuluscatchesmaximumattention(Picture)
2) Locationofthestimulus:Stimulusinfrontoftheeyeattractsourattraction
3) Intensity:Loudsound,brightcolors
4) Changeintheintensityofthestimulus:Tickingofaclockinourroommaynotattractour
attentionbutwhenitstopsourattentionisattracted
5) Movement:Afastmovingelectricsignattractsourattention
6) Size:Biggersizeattractsmoreattention
7) Contracts:Asinglemanamongthemanywoman,aspotonacleanwhitedressattractsour
attention
8) Novelty:Anewfashiondressattractsourattention
9) Repetition:Repeatedcry,repeatedringingofacallbellattractsourattention
78
Factorsincreasingattentionbyinternalfactors:
1)Interest:Whenwearemotivatedtoagoal
2)Motives:Whenachildishungryhelooksforafeedingbottleratherthanatoy
3)Experience:Weattendtoobjectwithwhichwearefamiliar
4)Mentalset:Whileexceptingafriend,weperceiveanyknockingsoundasthatoffriends
footstep
5) Emotionalstage: Understressfulconditionswefailtoperceiveoursurroundingsfully
Voluntaryorhabitual: Thereisnoconsciouseffortofsensation.Weattendtothembecauseofour
attitudes,habits,orinterest.Ex:Theattentionthatateachergivestoherstudents
Spanofattention:Themaximumamountofmaterialthatcanbeattendtoinoneperiodofattention
iscalledspanofattention
Distractionofattention: Referstoshiftingofattentionfromonestimulustoanother.
Externaldistraction: Noisepollution
Internaldistraction: Painheadache
Divisionofattention: Referstotheprocessofdividingourattentionequallyandsimultaneously
betweentwoormoreobjects.Ex:Whilestudentsreadingabookmayhearhisfavoritesong
Perception: Perceptionistheprocessbywhichwediscriminateamongstimuliandinterprettheir
meaningsandappreciatetheirsignificance.ExWhenwehearasound,weareabletoidentifyitasbeing
producedbyanaeroplane
Perceptionsaredividedinto
1)Visualperception 2)Auditoryperception
Factorsinfluencingperception:
Functioningofthesenseorgans Functioningofthebrain
Previousexperience Frequencyofexposure
Psychologicalstateoftheindividual Interest
Motivation Behavioroftheorganism
Theoriesoflawsofperceptualorganization:
1) Figuregroundrelationship: Themostfundamentalprocessinformperceptionisthe
recognitionofafiguresstandingoutfromabackground.Coloralsohelps,e.g.Ablackpanther
canbeseeneasilyagainstawhitegroundofsnowbutnotapolarbear.Thisisbecausethepolar
beariswhiteincolor
79
Intheabovefigureyouseethelightportionasafigure,youwillseeawaterglassorcandleholder,ifyou
seethedarkportionasafigure,youwillseetwofaces.Eitheroneisafigureagainstbackground
Groupingofstimuliinperceptualorganization: Stimuliaregroupedintothesmallest possible
patternthathasmeaning.Importantprinciplesofgroupingareproximity,similarity,symmetry,closureand
continuation
Proximity: Whenobjectsareclosetoeachother,thetendencyistoperceivethantogether
ratherthanseparately.Weseethreesetsoftwolineseachandnotsixseparatelylines
Proximity
Similarity: Itemsthatmostcloselyresembleeachotherorperceivedasunits
Inabovefigurethecirclesandtrianglesareseenastwoverticalrowsoftrianglesandonerowof
circlesandnotthreehorizontalrowsoftrianglesandcircles
Symmetry: Itemsthatformsymmetricalunitsaregroupedtogether
Weseethreesetsofbrackets.Wedonotseesixunconnectedlines
Closure: Itemsareperceivedascompleteunitseventhoughtheymaybeinterruptedbygaps
Continuation: Anythingwhichextendsitselfintospaceinthesameshape,sizeandcolorwith
outabreakinperceivedasawholefigure.
80
Infigureweseeacurvedlineandastraightline.Wedonotseeastraightlinewithsmallsemi
circlesaboveandbelowit
Perceptualconstancies: Perceptualconstanciesreferstoourtendencytoperceiveobjectsas
relativelystableandunchangingdespitechanginginformation.Perceptualconstancies
1)Spaceconstancy 2)Sexconstancy
3)Brightnessandcolorconstancy 4)Perceptionofspacebinoculardepthcues
5)Visualmonocularclues
Typesofperceptualconstancies:
1)Observercharacteristics: Dependsgreatlyonpastexperienceandlearning
2)Depthperception: Istheabilitytoperceivespaceanddistanceaccurately
3)Binocularcues: Helpsintheperceptionofdepthbyintegratingandsynchronizingthe images
ofboththeeyes.
4)Monocularcues: Helpsinperceptionofdepthanddistancewiththeimageofsingleeye
EMOTION
ThepsychologistKulpedefinesemotionasafusionoffeelingandorganicsensations.Thepsychologist
Hoffdingdefinesitasapleasurepaininassociationwiththeideaofitscause.Accordingtopsychologist
Ward,itisthecompletepsychosisinvolvingcognition,pleasurepainandconation.Ingeneralemotion
isacomplex,notasimpleelementary,mentalstate.
Thedifferencebetweenmotivesandemotionsareasfollows:
Emotionsareusuallyarousedbyexternalstimuliandthatemotionalexpressionisdirectedtoward
thestimuliintheenvironmentthatarousesit.
Motivesontheotherhand,aremoreoftenarousedbyinternalstimuliandnaturallydirected
towardscertainobjectsintheenvironment.(e.g.food,water).
Mostofthemotivatedbehaviourhassomeaffectiveoremotionalaccompanimentalthoughwe
maybetoopreoccupiedinourstrivingtowardsgoal.
Motivationisfocusedonthegoaldirectedactivity.Emotionisfocusedonthesubjective,affective
experiencesthataccompanybehaviour.
Emotionsareexpressedbylanguage,facialexpressionsandgestures.
Theemotionalstateischaracterizedby:
1) Amoreorlesspronouncedaffectivetone.Pleasureunpleasuresexperiencedinconnectionwith
someobjectiveorsituation.
2) Adiffusestimulationoftheorganicprocess,involvingpulse,respiration,glandularsecretions
whichisusuallycalledtheorganicresonanceoftheemotionbutaccordingtotheoryofthe
psychologistJamesLange,itisidentifiedwithemotionitself.
3) Anarrowingandspecializingofconsciousness,bothonthecognitiveandonthecurativeside,the
consequenceofwhatwemaycallemotionaldisassociation.
4) Animpulsiveforce.
81
Physiologicalchangesinemotions:
1) Allemotionalstatesaffecttheactivitiesofthesalivaryglands.Thebodilyeffectsofpain,hunger,
fearandragehavealltheemotionsofcharacteristically,negativepolarity.Insuchcasesthe
secretionofsalivaisdiminishedorinhibited.
2) Thereisafairpresumptionthatemotionsofanoppositeorpositive,polaritywillproducethe
oppositeeffectbutpracticallynoexperimentalevidence.
3) Theemotionaldisturbancesofanegativepolarity(thatisdisagreeable)involvedisturbanceofthe
digestivefunctionsinallitsaspects.
4) Theflowofsalivaisdiminishedoraltogetherinhibited,anditschemicalcompositionaltered.The
flowofgastricjuicesissimilarlydimishedorinhibitedandalteredchemically.Thenegative
momentsthentendtocease.
5) ThisfactsuggestedtopsychologistCannon,thepossiblythatemotionalexcitementmightinvolve
anincreasedsecretionofadeninesandthatthisadenineinthebloodmighthavetheeffectof
prolongingtheinhibitionoftheactivityofthedigestiveglandsaftertheemotionalexcitementitself
haddisappeared.
6) Bytestingbloodforadenineafteraperiodoftimeofthequantityofadenineintheblood,itis
greatlyincreasedasaresultofstrongemotion.
Thesympatheticsystemisresponsibleforthefollowingchanges:
1) Bloodpressureandheartrateincreases.
2) Respirationsbecomemorerapid.
3) Thepupilsoftheeyedilate.
4) Electricalresistanceoftheskindecreases.
5) Bloodsugarlevelincreaserstoprovidemoreenergy.
6) Thebloodbeginstoclotmorequicklyinthecaseofwounds.
7) Themobilityofthegastrointestinaltractdecreasesorstopsentirely.Bloodisdivertedfromthe
stomachandintestinesandaresenttotherbrainandskeletalmuscles.
8) HairsontheskinerectcausingGoosepimples.Inemotionthesympatheticsystemalsocauses
epinephrineandnorepinephrine.Nerveimpulseswithsympatheticsystem,whichreachadrenal
glandslocatedonthetopofthekidneys,triggerthesecretionofhormones.Theythengetintothe
bloodandcirculatearoundthebody.
Theoriesofemotion:
Jamestheoryoremotionproposesthefollowingsequencesofeventsinemotionalstate.
Firstweperceivethesituationthatwillproduceemotion.Secondwereacttothisemotion.Thirdwe
noticeouraction.Theperceptionofthereactionisthebasisoftheemotionaswefeelandexperienceit.
ThemajorobjectiontoJamesLangtheorycamefromCannonwhopointedout
1) Thatchangesdonotseemtodifferverymuchfromoneemotionalstatetoanother.
2) Theinternalorgansarerelativelyintensivestructuresnotwellsuppliedwithnervesandinternal
changesoccurtooslowlytobeasourceofemotionalfeelings.
82
3) Artificiallyinducingthebodilychangesassociatedwithanemotioninjectingapersonwithadrenaline
doesnotproducetheexperienceofthetrueemotion.
JamesLangesTheory
Canontheory
Emotionwhensufficientlyintensecanseriouslyimpairtheprocessthatcontrolorganizedbehavior.
Emotionalbehaviorstudiesininfancyandearlychildhoodbymeansofdirectobservation.Motion
picturesandrecordingofchildrenscriesindicatethattheinfantsresponsetostimulidesignatedto
arouseemotionareverydiffuseandlackinginorganization.
Emotionalshocksandhurtssufferedbyindividualsatanearlyagecanhandicapthemaslongas
theylive.Childrensoonerorlateracquirethecapacityforexperiencingnegativeemotionssuchasanger,
fear,andalsosorroworgrieftoanintensedegree.
Thiscapacitydevelops,beforethechildismatureenoughtouselanguage,toformulatehis
experienceinwords.
Foratime,theinfantsexpressionofrageispoorlyrecognized.Laterhisangerbecomesmore
indefinitelydirectedatsomethingorsomebody.Changescanlikewisebenotedinachildsexpression
offearandhisreactionstopain.
Theseimprovementsintheyoungchildsabilitytorespondinspecificwaystosituationsthat
arousehim,parallelthedevelopmentofhismentalandmotorabilities.
Asthechildsintellectualandmotorcapacitymatures,heacquireslargevarietyofmeansand
formsofexpressionsuchasovertanddirecttomoregradedcovertandindirect.
Thehabitofconcealingemotionmaybecomespeciallyburdensomeundertwoconditions.Ifa
personmaymaskintensefeelingofangertatoccurswhensomeonehuntshisprideverysharplyandthen
stillharboringhisangermayexplodeonanotheroccasionsbecauseofaverytrivialaffront.
Perceptionof
emotion
producing
stimulus
Stimulusprocessedby
Thalamus,which
simultaneouslysend
messagestothe
cortexandotherparts
ofthebody
Messagestocortex
produceexperience
ofemotion
Messagesfrom
thalamusactivates
visceralandskeletal
responses
Perceptionof
emotion
producing
stimulus
Activationof
Visceraland
skeletal
responses
Feedbacktobrain
frombodily
responsesproduce
experienceof
emotion
83
Againsuppressionofanyshowofemotionmayharmfulinanindividualforonereasonoranother
hasputalidonanyimpulsetoshowaffectionanditsawkwardandevenrude,whenhehappenstofeel
veryaffectionatetowardsomeoneandwishesthathecouldsomehowshowitinaspontaneousway.
Themostimportantfactorsinachildsemotionaldevelopmentandtheaffectionthathereceives
fromhisparents,peergroupandsociety.Thisgivesopportunitytodevelopwholesomeaffectionforhis
fellowcreatures.
Themoregenuinetheparentsloveforthechild,the,morethechildtendstofeelfreetoloveother
people.Moreoverheislikelytoexpressallhisemotionsatease.
Allphysiologicalhealthynursesarelikelytofeelsomeaffectionforpatientsintheirchargeorwith
whomtheyhaveachancetoassociateeventhoughthechildrenarenottheirown.
Affectionismoreimportantforanindividualsemotionalwelfarepromotingsecurity.Theirun
lovedpersonmaysufferinconnectionwiththedevelopmentofpositiveattitudesandconceptsconcern
inghisownworth.
PERSONALITY
ThewordpersonalityhasbeenderivedfromtheLatinwordpersonawhichwasthemaskwhich
Greekactorworkwhileacting.Thishoweverisnotthemeaningtakeninthemodernwordpersonality.
Thispersonalityisnotfixedstatebutdynamictotality,whichiscontinuouslychangingdueto
interactionwiththeenvironment.
Personalityisknownbytheconduct,behavior,activities,andmovements.Itisthewayofre
spondingtotheenvironment.Thewayinwhichtheindividualadjustswiththeexternalenvironmentis
personality.
Definitionofpersonality:
Inthewordsof Munn,itischaracteristicintegrationofanindividualsstructure.Modesofbe
havior,interests,attitudes,capacities,abilitiesandattitudes.Behaviorrequiresintegration.
Inthewordsof GordenAllport,personalityisthedynamicorganizationwithintheindividualof
thosepsychophysicalsystems,thatdeterminehisuniqueadjustmenttohisenvironment
Thepersonalityistheorganizationoftheinternalandexternalactivities.Itisnotacollectionof
traitsbutaparticularorganizationo0fthem.
Personalityisthetotalqualityofbehavior,attitudes,interests,capacities,aptitudesandbehavior
patterns,whicharemanifestedinhisrelationwiththeenvironment.
Anintegratedpersonalityleadstoorganizedcharacter.Disintegratedpersonalityleadstodisor
ganizedcharacter.
Abnormalitiesinpersonalityhamper,theorganizationofcharacter.Inmentalpatient,bothchar
acterandpersonalityareindisorder.
Thebasicsourcesofpersonalitydevelopmentarehereditaryandenvironment.Howeverasa
persongeneticinheritanceinteractswithandisshapedbyenvironmentalfactors,theemergesaself
structurethatbecomesanimportantinfluenceinshapijgnfurtherdevelopmentandbehavior.
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Traitandtypeapproachesofpersonality:
Thetraitapproachestopersonalityattemptstolistanumberofbasicpersonalitytraitsandthe
personalityofanindividualcanbedescribedbyitspositionanascaleofunitsineachofthesetraits.
Atraitisanenduringandconsistentcharacteristicofapersonthatisobservedinawidevarietyof
situations.Thetraitsareintelligence,emotionalsensitivityascendance,submission,irritable,warmetc.
InfactAllportandOdberthavelisted17,593wordsinEnglish,whichareadjectivesstandingfor
personalitytraits.Hedistinguishedbetweensurfacetraitsandsourcetraits.
Normanlisted5termsextroversion,agreeableness,consciousness,andemotionalstabilityand
culture.
H.J.Evsenckspeaksofthreebasiccategoriesofpersonality.
Extroversionintroversion.
Neuroticismstability.
Psychotismnormality.
Thishasbeenultimatelyreducedtostable,unstableandintroversionandextroversion.
1) Extrovertsaredescribedasoutgoing,uninhibitedfondofactivities,whichbringthemintocontact
withotherpeople.Introvertshavetheoppositetraits.
2) NeuroticismstabilityinEvsenchksmodelrangesfromstabilitytohighanxiety.Insituationsof
worry,panicking,stressandoveremotionalityahighlevelactivitycouldaffectperformanceadversely
inacademicworkofpupils,resultinginlearningdisabilities.
Thetypepersonality:
Itisolderthanthetraitapproach,whichdependsuponmodernstatisticalprocedures.Hippocrates
andGalenhaveassociatedpersonalitieswithcertainkindsofbodyfluidscalledhumours.
Galenhasspokenoffourkindsofhumantemperaments
Choleric. Melancholic.
Phlegmatic. Sanguine.
Krrichmerreferstofollowingtypesofhumanpersonalitybasedonbodilyfluid.Theseare:
Asthenic(thin,long)whoareshyandsensitive,withdrawn.
Pyknic(short,fat)whoarejovialoutgoingwithfluctuatingmoods.
Athletic(strongandsturdy).
Theathleticandasthenictypeofbodybuild,gowithwhatisknownasschizothymepersonality
andthepyknicbodygoeswithcyclothymicpersonality.Theformerisbasicallyinterestedinhimonly
andthelatterextroverted.
Sheldonspeaksofthreetypesofbodybuild.
1) Endomorphic(round,fatandmuscular)individualshavethetypeofpersonalitycalledviscerotonia
whichimpliesloveofleisure,desireforfoodandsleep.
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2) Mesomorphic(hardmuscular)havesoamtotomicpersonalities.Whoexhibitpersistencein
behaviordesirefroadventure,courageandinvolvementinactions.
3) Ectomorphic(delicateandlean)havecerebrotoniawhichimpliesdisciplinedbehavior,ready
responsetostimulation,lackofinterestinsocialinteraction,hypersensitivitytopainetc.
Psychologicaltheoryofpersonality:
Personalitytheoriesaregroupedunderthreemajorheads
1) Psychodynamictheories.
2) Sociallearningtheories.
3) Phenomenologicaltheories.
Psychodynamictheoriesofpersonality:
Psychoanalytictheoriesofpersonalityarereferredtoaspsychodynamictheory.Thistheoryat
temptstounderstandpersonalityintermsofmentalfunctionsmayberational,irrational,consciousor
unconscious.
Freudstheoryofpsychoanalysisemphasizesmanasdynamicsystemofenergiesandmainstore
houseofsuchenergiesinunconscious.Thecontentsoftheunconsciousinvariablyexhibitconflicts.To
Freud,thestructureofanindividualspersonalityconsistsofthreeseparateagencies.
1) Idistheinbornreservoirsofprimitivepsychicenergycalledlibido,unconsciousdemanding
immediatesatisfactiononthebasisofpleasureprincipleregardlessofexternalwhichegoand
superegodevelopsanditconsistsofenergythingthatisinherited.
2) Allenergyofhumanbehaviorisprovidedbytwoinbornidinstinctsnamelysexandaggression,
whichhespokeofEroslifeinstinctsandthantoes,deathinstincts.
3) Egoembodiesarationalcognitivecapacitythatdemandsofsuperego.
4) Idseekspleasureegotestrealityandsuperegostrivesforperfection.Fromanxiety,defense
mechanismorunconsciousattemptstoreduceanxietybydenyingordestroyingrealty,.
ThetechniqueofEricBernestransactionalreferstowholesometransactionfromchildhoodto
adulthood.Freudalsoemphasistheearlyexperiencesinpersonalitydevelopment.Hespeaksofpsy
chosexualdevelopmentoftheindividual.
1)Theoralstage,duringinfancy.
2)Theanalstagebetweentheage2and3.
3)Thephallicstagebetween3to5.
4)From5uptoearlyadolescencethestageofOedipuscomplex/Electracomplex.Thenfrom5
uptoearlyadolescencesexualforceissubordinatedwhichmarksthelatency,periodandfinallythe
genitalstageofheterosexuality.
5)Psychosexualmaturityisreachedbyanindividualastheendresultofsuccessfulpassage
throughthefullsequenceofstages.
CarlJungdiffersfromFreudintakingamorepositiveandoptimisticattitudetowardshuman
naturebelievingthatpeoplenotonlytrytogratifytheirinstinctsbutalsotrytodeveloptheirpotential.
JungagreeingwithFreudianviewofunconsciousness,whichrepresentstheaccumulatedexperi
ences,andcultureofthehumanspeciesthroughoutitsevolutionarydevelopmentfromprimitivetimes.,
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AlfredAdlerspersonalitytheorystresstheuniquenessofonespersonalitylooksuponaggres
sionismoresignificantthansexasamotiveofbehavior.Hepointstotheinnatestrivingforsuperiority.
ToErickson,personalityistheresultantfrominteractionbetweentheneedsofapersonandthe
demandsofasocietyataparticularstageofdevelopment.
Herefersto8psychosocialstagesofdevelopment.Aparticulartypeofcrisischaracterizeseach
stage.Egoidentifycrisisduringadolescenceandnowanindividualresolvessuchcrisisdetermines
personalitycharacteristics.
H.S.Svilanhasstressedtheinterpersonalnatureofpersonalityandhaslaidontheacquisitionof
languageasameansofnormalpersonalitydevelopment.
Sociallearningtheoriesofpersonality:
Thesetheoriessaythatconsistencyofbehavior,resultsnotonlyfromrigidpersonalitytraitsbut
alsofromotherfactorslikeenvironmentalstability.
SkinnerandHullslearningtheoriesarebasedontheabovefactors.DollardandMiller
pointedfear,asanimportantfactorinpersonalitydevelopmentasitactsasapowerfulmotiveordrive
inthepromotionoflearning.
TheroletheoryofG.HMeadspeaksofdifferentrolesoneplaysinlife(ason,pupil,leader,
friendetc.)andgraduallyinternalizestheassociatedtraitstoformhispersonality.
Apersonsbehaviordependsuponthespecificnatureofthesituation,howthesituationis
appraisedbyhimaswellaspastreinforcementofbehaviourinsimilarsituations.
Behavioriststheoriesofpersonality:
Behavouristsissuchaskinneremphasizethatconditioningaloneisnotadequatetoexplainhuman
characterandpersonality.
Phenomenologicaltheoriesofpersonality:
Thisincludeshumanisticconceptionsofpersonality.Thesetheoriesemphasizetheexistenceof
positivegrowthpromotingforcesinpersonalitybeyondmoreconflictresolutionortensionreduction
andalsostressespresentratherthanpastexperiences.
Maslowstheoryemphasizesinherentpotentialitiestoseekselfactualization.MaslowandCarl
Rogerbothdealtonhumanisticandpsychoanalytictheoriesongrowthandselfactualization.
Rogersclientcenteredonnondirectivecounselingispopular.Themostimportantconceptis
self.Anindividualwithastrongpositiveselfconceptseekgrowthandhavepleasantproductive
relationwithothers.
G.Kellyscognitivetheoryofpersonalityconsistsofpersonalconstructsthatisthewaysaperson
hasofevaluatinghimselfandhiscircumstances.
Defensemechanism:Anothermodeofreactingtodifficultiesisthatofmentalmechanismordefense
orientedreactionstostressaimschieflyatprotectingtheselffromhurtanddisorganization.
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EGODEFENSEMECHANISMS
Summary:
Psychologyisabranchofsciencedealingwithknowledgeofmindandsoul.Itplaysavitalrole
intakingcareofthepatientsinnursing.
Factorsinfluencingmentalhealtharepersonalfactors,interpersonalfactors,andculturalfactors
Learningisdefinedasthementalactivitybymeansofwhichknowledge,skill,attitude,
appreciationsandideasareacquired,resultinginmodificationsofbehaviors
Factorsinfluencinglearningarenatureoflearner,natureoflearningsituation,natureofthelearning
material
TheoriesoflearningareTrailanderror,Theoryofconditionedreflexes,Cognitivelearning
Sl.No Expression Modeofreactions
1 Withdrawal Protectingselffromunpleasant,realitybyrefusalto
perceiveorfaceit.
2 Fantasy Gratifyingfrustrateddesiresbyimaginaryachievements
3 Repression Preventingpainfulordangerousthoughtsfromentering
consciousness.
4 Rationalism Attemptingtoproveonesbehaviorrationalandjustifiable
andthusprojectworthyofitselfandsocialapproval.
5 Projection Placingblamefordifficultiesuponotherorattributing
onesownunethicaldesirestoothers.
6 Displacement Dischargingpentupfeelingusuallyofhostilityorobjects
lessdangerousthanthose,whichinitiallyarousedthe
emotions.
7 Emotional
insulation
Reducingegoinvolvementandwithdrawingintopassivity
toprotectselffromhurt.
8 Intellectualization
(isolation)
Cuttingofaffectivechargefromharmfulsituationsof
separatingincompatibleattitudesbylogictight
compartment.
9 Undoing Counteractingimmoraldesiresoracts.
10 Regression Retreatingtoearlierdevelopmentslevelsinvolvingless
matureresponsesandusuallyalowerlevelofaspiration
11 Identification Increasingfeelingsofworthbyidentifyingoneselfwith
personorinstitution.
12 Introjections Incorporatingexternalvaluesandstandardsintoego
structuresothattheindividualisnotattheirmercyas
externalthreats.
13 Compensation Coveringupweaknessbyemphasizingdesirabletraitor
makingupforfrustrationinoneorbyoverqualifyingin
another.
14 Actingout Reducingtheanxietyarousedbyforbiddenordangerous
desiresbypermittingtheirexpression.
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An expression of an opinionor judgment upon what one has observed isobservation
Attentionisthefocusingofconsciousnessonaparticularobjectorideaataparticulartimetothe
exclusionofotherobjectsorideas
Attentioncanbeclassifiedintotwotypesvoluntaryandinvoluntary.
Factorsinfluencingattentionincludesexternalandinternal.
Perceptionistheprocessbywhichwediscriminateamongstimuliandinterprettheirmeanings
andappreciatetheirsignificance
Perceptionareoftwotypesauditoryandvisualperception.
Emotionisthecompletepsychosisinvolvingcognition,pleasurepainandconation.
Mostofthephysiologicalchangesoccursduringintenseemotion.
ThetheoriesofemotionareJamestheoryandCannontheory.
Personalityisthedynamicorganizationwithintheindividualofthosepsychophysicalsystems,that
determinehisuniqueadjustmenttohisenvironment.
Atraitisanenduringandconsistentcharacteristicofapersonthatisobservedinawidevarietyof
situations.Thetraitsareintelligence,emotionalsensitivityascendance,submission,irritable,warm
etc.
Normanlisted5termsextroversion,agreeableness,consciousness,andemotionalstabilityand
culture.
H.J.Evsenckspeaksofthreebasiccategoriesofpersonality.
1) Extroversionintroversion.
2) Neuroticismstability.
3) Psychotismnormality
Galenhasspokenoffourkindsofhumantemperaments
1) Choleric.
2) Melancholic.
3) Phlegmatic.
4) Sanguine
Sheldonspeaksofthreetypesofbodybuild.Endomorphic,Mesomorphic,.Ectomorphic.
Personalitytheoriesaregroupedunderthreemajorheads
1) Psychodynamictheories.
2) Sociallearningtheories.
3) Phenomenologicaltheories
Defensemechanismoperateonrelativelyautomaticandhabituallevelsandtheytypicallyinvolve
somemeasureofselfdeceptionandrealitydistortion
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QUESTIONS
PartA ANSWERINONEORTWOWORDS: (Onemark)
1) Mentionthetypesofattention.
2) Whatarethetwotypesofmentalactivitiesinvolvedinobservation.
3) Whatarethetwotypesoftheoriesofemotion.
4) Writethebasicsourcesofpersonalitydevelopment.
5) Namethethreebasiccategoriesofpersonality.
6) Namethepsychologicaltheoriesofpersonality.
PartB MULTIPLECHOICEQUESTIONS: (Onemark)
1) Psychosexualtheorywasgivenby
a)Freudb)CarlJungc)Ericksond)Skinner.
2)Psychoanalysistheorywasemphasized
a)Freudb)CarlJungc)Ericksond)Skinner
3)Fearasanimportantfactorforpersonalitydevelopment waspointedoutby
a)Freudb)CarlJungc)Ericksond)Dollard.
4)Classicalconditioningwasgivenby
a)IvanPavlovb)Skinnerc)Dollardd)Freud.
5)Gratifyingfrustrateddesiresbyimaginaryachievementsis
a)Fantasyb)Repressionc)regressiond)submission.
6) Thefatherofeducationalpsychologyis
a)Gestaltb)EdwardLeec)Parlord)Skinner
7) Fourkindsofhumantemperamentswasspokenby
a)Sheldonb)Krichmerc)Galond)Hippocrates
8) Thephallicstageisbetween
a)23yrs b)35yrs c)12yrs d)5yrstoadolescence
9) Theextroversionintroversioncategoryofpersonalityspokenby
a)Evsenckb)Rogerc)Kellyd)Galen
10)Preventingpainfulordangerousthoughtsfromenteringconsciousnessisknownas
a)Projectionb)Displacementc)Regressiond)Repression
11) AccordingtoErickson,thestagesofpsychologicaldevelopmentis
a)8 b)9 c)7 d)10
12)Thelawdescribedtheresponsefollowedbyarewardwillbestrengthenedisthe,
a)Lawofexerciseb)Lawofreadinessc)Lawofeffectd)allofthisabove
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13)Operantconditioningwasgivenby
a)IvanPavloub)Skinnerc)Dollardd)Freud
14)Theitemsareperceivedincompleteunitseventhoughtheymaybeinterruptedbygaps
isseenin
a)Continuationb)Closurec)Similarityd)Proximity
15)Thebasicsourcesofpersonalitydevelopmentarte
a)Hereditaryb)Environmentc)Educationd)Lifestyle
PartC WRITESHORTNOTESON: (5marks)
1) Statethestepsoflearningprocess.
2) Whatarethecharacteristicsoflearningbyinsight.
3) Howwillyouclassifythetheoriesoflearning.
4) Wherearetheareas,theprinciplesofclassicallearningcanbeused.
5) Whatarethekindsofmotivation.Giveexample.
6) StatethebodybuildaccordingtonSheldon.
PartD WRITEINDETAIL:(10marks)
1) Listthefactorsinfluencingperception.
2) Learningbyinsighttheorydiscuss.
PartE WRITEESSAY: (20marks)
1)Explainfactorsinfluencinglearning.
2)Describethefactorsincreasingattention.
3)Discussthephysiologicalchangesthatoccursduringemotion.
4)List down the defense mechanism and write the mode of reaction for any two
expression.
5)Freudstheoryofpsychoanalysis

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4.PRINCIPLESANDPRACTICEOFNURSING
INTRODUCTION
Nursingisamajorcomponentofthehealthcaredeliverysystemandnursesmakeupthelargestem
ploymentgroupwithinthesystem.
Nursingservicesarenecessaryforeverypatientseekingcareofvarioustypesincludingprimary,
secondary,tertiaryandrestorative.Asnursingisanimportantpartofhealthcaredeliverysystem,the
nursesneedtounderstandthesystemtoeffectivelydeliverqualitycarewithinit.
Nursing: Nursingistheprocessofrecognizing,understandingandmeetingthehealthneedsofany
personorsocietyandisbasedonaconstantlychangingbodyofscientificknowledge.
DEFINITIONOFNURSINGPROCESS
Thedefinitionofthenursingprocessisaprofessionalnursesapproachtoidentifydiagnose,andtreat
humanresponsestohealthandillness(Americannursesassociation2003)
Itisadeliberateintellectualactivitywherebythepracticeofnursingisapproachedinanorderly,
systematicmannerofpatientcare,inadynamic,continuousmethodtoassistthepatienttoachieveand
maintainhealth.
Thenursingprocessisanorderlysystematicmannerofdeterminingthepatientsproblems,mak
ingplanstosolvethem,initiatingtheplanorassigningotherstoimplementitandevaluatingtheextentto
whichtheplanwaseffectiveinresolvingtheproblemsidentified.
Thenursingprocessisasystematicmethodforassessinghealthstatus,diagnosinghealthcare
needs,formulatingaplanofcare,initiatingplanandevaluatingtheeffectivenessofplan.
STEPSINNURSINGPROCESS
(1) Assessment(2)Diagnosis
(3)Planning(4)Implementation(5)Evaluation
Assesscollectinformationabout
Patientcondition
Evaluate Diagnose,identify
Nursingprocess thePatientproblems
Implementation Planandsetgoalsfor
Performthenursing Careidentityapproachto
actions Nursingactions
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Assessment: Thisreferstoasystematiccollectionofdata,toassistinidentifyingneedsandproblems.
Dataarecollectedinasystematicfashion,utilizingtheinterviewornursinghistory,physicalexamina
tions,laboratoryresultsandotherresources.
Diagnosis: Nursingdiagnosisisaclinicaljudgmentaboutindividualfamilyorcommunityresponsesto
actualandpotentialhealthproblemsandlifeprocesses.Duringthisphase,thedatacollectedduring
assessmentarecriticallyanalysedandinterpreted.Conclusionsaredrawnregardingthepatientsneeds,
problems,concernsandhumanresponses.
Planning: Planningisasystematicapproachindevelopingaplanofactionbasedonacarefulassess
ment.Strategiesaredevelopedtoprevent,minimizeorconnecttheproblemsidentifiedinthenursing
diagnosis.
Itconsistsofseveralstepsincludingestablishingpriorities,settingobjectives,writinginterven
tions,recordingoutcomesofnursinginterventionsinanorganizedfashiontocompletethenursingcare
plan.
Implementation: Itreferstocarryoutaplanthatisbasedoncarefulassessmentofneed.Itisthe
initiationandcompletionofactionnecessarytoachievetheoutcomesorobjectives.
Evaluation: Itisanongoingprocessthatdeterminestheextenttowhichthegoalhasbeenachieved.
Thenursesassesstheprogressofthepatient,institutecorrectivemeasuresifrequired,andrevisethe
nursingcareplan.
ADMISSIONOFTHEPATIENT
Theentranceofapatientintoahealthcareagencysuchasahospitaloraprivateclinicistermedas
admission.Apatiententersthehospitalbyhimselforhemaybebroughttothehospitalbyhisrelatives,
friends,neighboursorothers.
Mentallyillpatients,persons,whohavetriedtocommitsuicideandaccidentpatientsareadmit
tedthroughalegalprocess.
Evaluation
Planning
Diagnosis
Assessment
Implementation
Knowledge
Attitude
Standards Experience
NursingProcess
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Allillpersonentersthehospitaltogethisdisordercuredwhenahealthyindividualgetsadmitted
intoahospitalforadayorforinvestigationsandobservationsandinordertofindwhetherheissuffering
fromanyillnesswhichhasnotbeenmanifestedbyanyexternalsignsandsymptoms.
Patientswhohavebecomeseriouslyillsuddenly,comethehospitalwithouthavinghadanytimeto
settletheirfamilyworkaffairs.
Hence,theyarenotonlyworriedandanxiousabouttheillness,butalsoareupsetaboutvarious
otherproblemsaffecttheirfamily.Nursesmustunderstandtheirphysicalandmentalproblemsandbe
verykindandunderstanding.
Needforgoodreceptionofthepatient: Anursehasanimportantroletoplayinthereceptionthe
patienttothehospital.Thefollowingarethepurposesofthisprocedure:(1)Preparethepatientboth
physicallyandmentallyforhisstayinthehospital.(2)Tohelpthepatienttobecomfortableandto
providehimwithacleanandsafeenvironment.(3)Togiveagoodimpressionofthehospitalandits
servicesothatthepatientwillfullycooperatewiththetreatmentandnursingcare.
A patient may be coming to hospital for the first time. He leaves his familiar home
surroundingandhislovedonesandcomestoanunknownplaceandtounknownpeople.Anychangein
humanlifeisanxietyproducingandisviewedwithfear.
Addedtothis,hisphysicalconditiongiveshimfearandanxiety.Hence,itisthenursesdutyto
receivethepatient,kindlysympatheticallyandwithanunderstandingofhisillness.Ifheisadmitted,he
isgivenadietsheetandsenttotheward.Ifheistooillandneedsimmediateattentionheisgiven
emergencytreatmentandthentransportedtotheward.
Assoonasthepatientcomestotheward,receivehim,hisrelativesandhisfriendsasifyouare
receivingyourguestsintoyourhome.Askthemtobeseatedwhileyoupreparethebedreadyforthe
patient.
Ifthepatientisinaseriouscondition,thewardnurseisinformedinadvanceaboutthearrivalof
thepatient,sothatthepatientdoesnothavetowaittillthebedismadeready.
Need for orientation to place and people: Inform the patient and his relatives about the
hospitalroutine,thehospitalrules,thegeneralsetupofthewardandthepersonnelworkingintheward.
Informthepatientsrelativesaboutthetimeofvisitinghoursandsupplythemwithvisitingpasses.
Ifthepatientisseriouslyillgivetherelativeaspecialpasssothathewillbeabletostaywiththe
patientinthehospital.
Needforadmissionassessment: Doagoodassessmentofhisphysicalconditioninordertoplanhis
care.Ifhisphysicalstateneedsimmediatetreatmentreporttophysicianandprepareyourpatientfor
physicalexaminationandcarryoutthetreatment,whichthephysicianprescribesafterthephysical
examination.
ORIENTATIONTOTHEWARD
Thepatientwhoisnotveryill,areallowedtomoveaboutcanbetakenroundtheward.Introducethe
otherpatientstohimandviceversa,andalsowiththenursingpersonnelworkingintheward.Orientthe
patienttothewholeward,dutyroom,toiletrooms,andtheunitpreparedforhim.Aftermakingthe
patienttobeseatedcomfortablyexplainedthehospitalpolicies,procedures,androutinestothepatients
andhisrelatives.Tellhimwhatisexpectedfromhim.Explaintohimthetimeformealsserving,the
doctorsvisit,visitingtimetheprayerservice,ifanyandotherhospitalsroutines.
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CAREOFBELONGINGS
Itisalwaysgoodpolicytodiscouragepatientstokeep/valuablethingsandmoneywiththem.Sendthe
valuablestohomethroughrelatives.Ifhedoesnothaveanyonewithhim,enterthedescriptionofitems
intheregisterandsendthevaluablestotheofficeforsafecustody.Getthepatientssignatureorthumb
impressionintheregister.However,informthepatientthathewillgetbackhisvaluablesondischarge.
Itisimportantthatyoutakecareofthepatientsclothing,shouldseethattheclothingarecleaned
andstoredawaywithproperlabelorsendthemhomeforafreshsetofcleanclothes.
However,encourage,patientstousehospitalclothing.IfaPatientissufferingfrominfectious
disease,seethattheclothingaredisinfectedandcleanedbeforetheyaresenthomeorstoredaway.
DISCHARGINGOFTHEPATIENT
Dischargeisapreparationofapatientanddischargerecordstoleavethehospital.
Purpose:(1) Toensurecontinuityofcaretothepatientafterdischarge.(2)Toassistthepatientin
dischargeprocess
Guidelines: Thepatientsaredischargefromthehospitalinoneofthefollowingways.
Dischargetohome:Thedischargetohomeoranotherhospitaloranotherunitwithinthehospitalis
initiatedbythedoctorwhoadvisesthepatientthatheiswellenoughtoleavethehospitalorrequires
treatmentinanotherunitwithinthehospitalorinananotherhospital.
Dischargetoanotherhospitaloranotherunitwithinthehospital (referral).Whenapatientor
familyisnotsatisfiedwiththetreatmentorcaregivenandwantstoleavethehospitalagainstthemedical
adviceinsuchcasesthepatientortherelativeisaskedtosignastatementthatheisgoingortakingthe
patientonhisownwillandresponsibility.
Dischargeagainstmedicaladvice(AMA): Patientleavesthehospitalagainstthemedicalofficers
advice,whenapatientescapesfromthehospitalwithouttheknowledgeofthehospitalstaffandwithout
signingthesaidstatementheistreatedasabscondedintherecords.
NursesResponsibility: Informthepatientandtherelativesadayortwobeforethedischarge.Get
thedischargeslippreparedaftercheckingthevitalsignsandexaminingthepatient.Thenurseshouldsee
thatthepatientspersonnelhygieneismaintained,heisdressedinhomeclothesandhastakenmeals.
Handoverthepatientsbelongingandanyvaluable,whichhavebeenkeptsafety,tothepatientorthe
relativeunderproperreceipt.Completetheunitadmissionanddischargeregisteredcasesheetand
otherrecords.Handoverthecasesheetandotherrecordsmedicalrecorddepartmentunderproper
receipt.Informthehospitalauthoritiesaboutthedischargeifthepatientismedicolegal.Handoverthe
dischargesliptothepatientorrelativeandexplainaboutthetreatmentandthediettobetakenathome,
followupvisitandinformtobringthedischargesliponeveryvisits,anyspecialadvicespertainingto
condition.Seethatthepatientreceivesallthemedicinesasperdischargeslip.Checkthehospitalthings
beforethepatientleavestheward.Placethepatientinthewheelchairorstretcheraccordingtothe
patientsconditionuntilheleavesthehospital.Immediatelyafterthepatientleaves,reorganisethepa
tientunit.
BEDANDBEDMAKING
Bedmakingisanart.Skillfulbedmakingcontributesmateriallytothepatientscomfort.Cleanand
comfortablebedincludesthepatientsunitinthehospital.
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Purpose:(1) Toprovidecleanandcomfortablebedtothepatient.(2)Toobserveandpreventpatients
complications.(3)Tosavetime,effortandmaterial.(4)Toprovideaneatappearanceoftheward/unit.
(5)Toadapttheneedsofthepatient
Typesofbed: Thebedsareoftwotypes,ordinaryandspecialbeds.
Open(simple)bed:Thisispreparedforanambulatorypatient
Indication:(1)Provideacleansmoothcomfortablebedtothepatient.
Closed(unoccupied)bed:Thisisanemptybedinwhichthetopcoversarearrangedinsuchawaythat
alllinenbeneaththecounterpaneorbedspreadisfull)protectedfromdustanddirtuntiltheadmissionof
newpatient.Onarrivalofthepatient,thisbedisconvertedintoopenbed.
Indication: Keepthebedreadyforreceivingthenewpatient.
Occupiedbed :Thisbedispreparedforbedriddenpatient,lyinginthebed.
Indication: Provideacleanandcomfortablebedwiththeleastdisturbanceofthepatientinit.
SpecialBeds
Admissionbed: Thisispreparedforthenewlyadmittedpatient.
Indications:(1) Provideminimumdisturbancetothepatientduringadmissionbathandphysical
examination.(2)Protectbedlinenduringadmissionbathandleaveafreshbedimmediatelyreadyfor
theuse
Postoperativebed:Thisispreparedforthepatientwhohasundergonesurgery
Indication:(1)Protectbedlinenfromvomiting,bleeding,drainageanddischarges.(2)Providewarmth
andcomforttothepatienttopreventshock.
Fracturebed: Thisisahardfirmbeddesignedforthepatientwithfractureparticularlyofspine,pelvis
orfemur.
Indication:(1)Aidinimmobilizingthefracture,(2)Preventunnecessarypain,(3)Providewarmthand
comforttothepatient(4)Preventunduesaggingofthemattress.
Plasterbeds:Thisisahardbeddesignedforthepatientwithplaster.
Indications:(1) Aidinimmobilizingthepartuntiltheplasterdries,(2)Aidindryingtheplasterincorrect
positionandshape,(3)Providewarmthtodrytheplasterandkeepthepatientcomfortable.
Amputationorstumpbed:Inthistypeofbedthetopbedclothesaredividedorsplit.Thisisknown
asamputationorstumpbedwhenitisusedforthepatientwithamputationoflegs.
Indications:(1) Avoiddisturbancetothepatientduringconstantobservation,repeatedapplicationsor
treatmentsarenecessaryforabdomenorlowerlimbs,(2)Taketheweightoftheclothesoffthesideof
theamputatedlimborstump,(3)Keepthestumpingoodposition,(4)Watchstumpforhaemorrhage
constantlyandapplyatourniquetinstantlyifnecessary
Cardiacbed:Thisispreparedforapatientwithheartdisease.
Indication:(1) Relievedyspnoea.(2)Assistinrecoveryofthepatient(3)Providecomforttothe
patient(4)Preventcomplications
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Rheumatismorrenalbed:Thisispreparedtoprovideextrawarmthtothepatient.
Indications:(1) Provideextrawarmthtothebodyincaseofgeneraldebilityandshock,(2)Provide
comforttotheachingjointsinpatientswithacuterheumatism.(3)Improveperspirationforexcretionof
wasteproductsincaseofnephritis
Burnsbed: Thisispreparedforapatientwithburns.
Indications:(1) Preventinfectiontotheburntarea,(2)Helpinhealingoftheburntarea,(3)Provide
comforttothepatient,(4)Preventthepatientfromstickingtothesheetasaresultofexudatesoozing
fromtheburntarea.
Thebedsmustbeversatileandadaptabletodifferentneedsofthepatientswithfollowingar
rangements
Siderails:Theseareusedtopreventthepatientfromfallingoutofbed,protecttherestlesspatient,
providethepatientsupporttograspandholdwhenmovingabout.
Handcranks :Thesearelocatedatthefootofbedandusedtoadjusttheheightofbed,raiseorlower
thehead,footorkneesectionsinordertomaintainvariousbedpositionsfortreatmentorcomfort.
Specialattachmentstheattachmentsofvariouspoles,framesandequipmentfortractionareused
tomodifythebedstomeetvariousneedsofthepatientfortreatmentandcomfort.
THERAPEUTICENVIRONMENT
(1)Maintainingandcreatingtrustfulsupportingrelationshipincareofpatients.
(2)Itisclearlyandgenuinelycommunicatingandperformingcareactivity.
(3)Allowingthesupportivegroupincareofpatients.
(4)Acceptanceofpatientsfeelingsandvaluesandworthyaswhole.
(5)Assistthepatientandfamilyinidentifyingsupportivegroups.Maintainingasafeandsecuredenvi
ronment.
(6)Reinforceprogressinbehaviourorselfcareactivitiesorterminatingtherelationship.
(7)Encourageevaluationofprogressbetweennurseand thepatient.
PSYCHOSOCIALENVIRONMENT
Mentalcomfortisprovidedforthepatientbyeliminatinghisfear,anxietyandworry.Heshould
receivesympathyandconsiderationfromthenursingandmedicalstaff.Hisrelativesshouldavoidun
pleasantnewstohimwhileheisinthehospital.Meetinghisspiritualneedsmayhelptogivehimmental
peaceandcomfortagain..
BODYMECHANICSANDPOSITIONING
Definition: Bodymechanicsmeansthecoorienteduseofthebodypartstoproducemotionand
maintainequilibriuminrelationtobothinternalandexternalforces.Postureistherelationshipofthe
variouspartsofthebodyinactivityoratrest.Positioninpatientincorrectedbodyalignmentmeansto
givepropersupporttothebodyinordertomaintainmuscletoneandeliminatestrain.
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Purposeofgoodbodymechanicsandposture: (1) Toprovidemaximumcomfortandrelaxation.(2)
To aid in normal body function (3) To prevent cont ract ures and neuromuscular
deformities and complications (4) To conserve maximum possible energy by preventing
unnecessarystrain
Standingposition: Incorrectstandingpositiontheheadishelderect,backiskeptstraightasmuchas
possible,chestisputforward,shouldersarekeptback,elbowsareslightlyflexed,wristsareextended,
fingersareslightlyflexed,abdomenisdrawninwardandkeptflat,kneesareslightlyflexed,andare
pointingaheadandparalleltoeachotherabout3inchesapart.
Knowledge of correct standing position is necessary because all other positions are
modificationsofstandingposition.Whenanursehelpsthepatienttositorliedowninbed,shefollows
theprinciplesofcorrectstandingpositionandkeepspatientsbodyingoodalignment.
Sittingposition: Insittingposition,theweightofthebodyisbalancedbyischialtuberositiesthe
buttocksandthethighs.
Elbowsareflexedandsupported,hipsareflexedatrightanglestothetrunk,kneesareflexedat
rightanglestothethighs,andanglesareflexedtorightanglestothelegsandareflatonfloor.Backis
helderectandthebackandbuttocksaresupportedbythebackofthechair.
POSITIONSUSEDFORPATIENTS
Dorsalposition:Patientisflatonthebedwithlegsextendedandarmsatthesidesofthebody.Thisis
notacomfortableposition,asthecurvesofthebodyarenotsupported.
Dorsalrecumbentposition:Thisiscalledbacklyingposition.Thisisamodificationofstandingposi
tion.Theonlydifferencebeing,thepatientisinhorizontalpositioninsteadofvertical.
Patientliesflatonhisbackwithapillowunderhishead.Asmallpadisplacedinthehollowofthe
back,andthekneesareslightlyflexed.Asoftpillowisarrangedundertheknees.Afootboardispro
videdtopreventfootdrop.Armsarekeptatthesidesofthebody.Mostofthepatientsarenursedinthis
position.
LateralPosition:Patientliesonhissidewithspinestraight.Thekneesareflexedtheupperkneesare
moreflexedthanthelowerone.Pillowsmaybeprovidedforthehead,inbetweenthelegs,andto
supportbackandabdomen.Thelowerarmiskeptabovetheheadandtheupperarmisplacedona
pillowinfront.Thearmsandlegsdonotbeartheweightofthebody.Thispositionisusedforgeneral
comfort,restandrelaxation.Duringbackcare,patientisplacedinlateralposition.
Leftlateralposition isusedforvaginal,perinealandrectalexaminations,andthepostoperative
patientsarekeptinlateralpositioninordertomaintainaclearairway.
Jackknifeposition:Patientsliesonhisbackwithhisshouldersslightlyelevated.Thehipsandknees
areflexedandbroughtuptotheabdomenandchest.Thepositionisusefultoperformalumbarpunc
ture.
KneeChestPosition:Thepatientkneesonthebedandthenlowershishead,shouldersandchestand
reststhemonthebed.Headisturnedtooneside,andkeptonapillow.Thethighsarekeptvertical.
Armsarecrossedabovethehead.Thispositionisusefulforperformingvaginalandrectalexaminations
andforcorrectingdisplaceduterusorotherorgans.
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LithotomyPosition:Thepatientiskeptonhisback.Headandshouldersrestonasmallsoftpillow.
Kneesareflexedwellandbuttocksarebroughtovertotheedgeofthebed.Ifitisusedforalong
period,thelegsaresupportedbystirrups,attachedtothetable.Thepositionisusedforexaminationor
operationsonrectumandgenitalorgans.
PronePosition:Patientliesflatonhisabdomenwithheadkeptonapillowandturnedtooneside.
Pillowsarekeptunderthewaistandunderthelowerlegs.Thearmsareflexedattheelbowandkept
abovethehead.Thispositionisusedwhenthereisbedsoreorburnsoraninjuryatthebackandasa
changeofpositionforpatientswhichfracturedspine.
Simspositionorsemiproneposition:Thisisamodifiedleftlateralposition.Thepatientliesontheleft
side.Head,shouldersandchestareturnedforwardsothatherchestrestsonthepillow.Therightknee
iswellflexedandrestsonthebedinfront.Theleftkneeisslightlyflexedandispositionedbehindthe
rightknee.Thispositionisusefulforperformingvaginalexaminationsandforrestsandrelaxation.
FlowersPosition:Patientisinapartiallysittingposition.Thebackofthebediselevatedto45degrees
withtheaidofabackrestandpilloworbyadjustmentofthecot.Patientsbackshoulderandheadare
supportedwell.Thekneesareflexedandsupportedwithapilloworbycotadjustment.Afootrestis
providedtopreventfootdrop.Patientsarenotkeptinthispositionforlongtime,sincethereisalways
thedangerofthrombusformation.Thispositionisusedforpatientswithdyspnoea(difficultyinbreathing),
distendedabdomen,abdominalsurgery,cardiothoracicdisordersandascites.Thepositionisalso
usefulwhilepassingRylestubeandwhileperformingtappingofascitesfluid.
Trendelenburgposition:Thepatientliesonthisbackwiththefootatthebedelevatedonwooden
blocks.Patientsheadandtrunkarelowerthanthelegs.
ReverseTrendelenburgPosition:Theheadandshouldersareatahigherlevelthanthehips,legsand
feet.Thispositionisusedforreducingintracranialpressureandforothertreatmentmeasure.
BasicNursingCare: Patientandhisenvironmentincludingthebedcomprisesofpatientsunit,which
needstobemaintainedfacilitatinghygieneenvironmenthelpingthecureprocess.
HYGIENICNEEDSPERSONALHYGIENE
Definition: Thewordhygienereferstothescienceofhealthanditsmaintenance,thepreventionof
disease,andsanitarypractices.PersonalHygieneistheactivityofselfcare,includingbathingand
grooming.Careoftheskin,hair,nails,mouth,teeth,eyes,ears,nasalcavities,andperinealandgenital
areas.
Factorsinfluencingpersonalhygienepractices
1) Developmentlevel:Childrenlearnmostoftheirhygienepracticesathomeandintheirpersonal
environment.Theymodifytheirbehaviourwithotherfamilymembers.Manyofthesebehavioursstick
withthemthroughoutlife.Theadvancingage,hormonallevelsandchangesintheintegumentarysystem
oftenrequirehygienicpractices.
2) Culturalbackground:Normsrelatedtohygienepracticesdifferfromculturetoculture.Forexample,
NorthAmericancultureplacesahighvalueonpersonalcleanlinessandpeoplehaveahabitofbathing
dailywhereaspeoplefromotherculturemayormaynotconsiderbathingasadailypractice.
3) Socioeconomicstatus:Financialstatusoftenaffectsapersonsabilitytopurchasehygieneproducts.
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4) Religion: Somereligionsobservespecificrulesrelatedtopersonalhygiene.
5) HealthStatus:Personswhoareillareoftenunabletoattendtopersonalhygieneactivities,either
becausetheyhavealowenergysupplyoraspecificphysicaldeficit.
SAFETYANDCOMFORTNEEDS
Theenvironmentinwhichthepatientisplacedshouldbecomfortableandsafeanditshouldcontribute
tohiswellbeingsandshouldnotretardhisrecovery.
Safetymeansprotectionfrompossibleinjury.Manyfactorscontributetowardsthesafetyof
patientsinthehospital.Thehospitalbuildingsshouldbestructurallysoundforensuringsafetyforpatients
withphysicallimitationssuchas,blind,agedorhandicapped.
Thenursingpersonnelmustbesafetyconsciousandtheyshouldtakealleffortstopreventaccidents
inthehospital.sheshouldreportallaccidentspromptlyandtakemeasurestopreventthemfromhappening.
Comfort: Comfortisasenseofmentalandphysicalwellbeing.Physicalcomfortgetsaffectedduetoa
dirtyandwetbedandlackofbodyalignment.Hightemperatureandhumidity,poorventilationtoomuch
noise,unpleasantodoursandglaringlightingmakethepatientuncomfortable.Topromotecomfortfor
thepatients,certainmechanicaldevicescanbeused.Pillowscanbeusedforgivingsupportforthe
variouspartofthebody.Sometimespatientfeelscomfortableinaproppedupposition.Inahospital,
abackrestisprovidedforthepatienttokeephiminasittingposition.
Forrelaxationofabdominalmuscles,whenpatientsareinpainorafteranabdominaloperation,
kneescanbekeptflexedbymeansofakneerest.
Apilloworablanketorsheetrolledasapillowcanbeimprovisedasakneerest.Patientsshould
notbekeptwithflexedkneesforalongperiod.Hiscirculationmaygetaffected.Hencehispositionis
changedfrequently.
Forsupportingfeetandforpreventingfootdrop,footrestsareused.Thisdevicekeepsthefeet
atrightanglestothelegandpreventsdeformities.Footrestcanbeimprovisedwithsandbags.
Otherdevicesusedascomfortmeasuresareairringsorcottonringsandaircushionsairmattress,
watermattressaretopreventpressureulcer.
Mentalcomfortisprovidedforthepatientbyeliminatinghisfear,anxietyandworry.Heshould
receivesympathyandconsiderationfromthenursingandmedicalstaff.Hisrelativesshouldavoid
unpleasantnewstohimwhileheisinthehospital.Meetinghisspiritualneedsmayhelptogivehimmental
peaceandcomfortagain.
MechanicalDevicesforcomfortmeasures: Tohospitalsusemanymechanicaldevicesforensuring
safety/patients.
Bedbars(siderails): areusedtopreventpatientsfromfallingoutofbed.Patientswhorequirethis
safetymeasurearepostoperativepatients,unconscious,semiconsciousmentallydisturbed,sedated,
blindorchildrenorveryoldpatients.
Backrest:Theseareusuallymadeofmetals.Theseareusedtosupportthebackofthepatientin
uprightposition.
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Overbedtable: Thetablesuchasthecardiactableisplacedinfrontofthepatientandthetopofthe
tableisadjustedtothedesiredheight.Aspillowisarrangedonthetopofthetablesothatthepatientcan
leanforwardonitforsupport.Whenhewantstotakefood,readorwrite.
Footboards:(Footrests):ThesearemadeofwoodandareLshaped,sothatoneendcanbe
slippedunderthemattresstoholdtheotherendinafirmuprightposition.Thepatientisplacedinsupine
positiontorestthebottomsofthefeetflatagainstthesurfaceofthefootboard(coveredwithsheet).
Theseareusedtopreventfootdropbymaintaininggoodalignment.
Sandbags: Thesearecanvas,rubberorplasticbagsfilledwithsandandare1,5and10lbsinweight.
Theseareusedtoimmobilizethebodypart,placingthemsnuglynexttothepart.eg.Oneithersideof
thefeettomaintainthepositionofthefeetonthefootboard,immobilizethefracturedlimb.
Blocks(shockblocks): Thesearemadeofwood,maybehighorlow.Theseareplacedunderthe
footofthebedforvariousreasons.Eg.Surgicalshock,tractionandposturaldrainage.Thismaybe
placedundertheheadofbedtopromotedrainageandimprovecerebralcirculation.
Handrolls:Thesearemadeofcloththatisrolledintoacylinderabout45incheslongand23inches
indiameterandstuffedfirmly.Theseareusedtokeepthefingersformbeingheldinatightfistleadingto
flexioncontractureinpatientswhoareunabletomovethehandsduetoparalysis,injuryordisease.
Thighrolls:Thesearemadebyfoldingasheettoadesiredlengthof23feetandthenrolledintoatight
cylinder.Theseareusedtosupportthehipsandthighs,preventingthemoutwardrotationandkeeping
thefeetingoodalignment,incaseofparalysis,fractureofthefemurorhipsurgery.Tousetheroll,place
theloseend(flap)underthepatientshipsandthighswiththeroleundertheflapendandthentucking
snuglyalongthehipandthigh.
Cradle: Thesearemostlysemicircularinshape,madeofwoodormetal.Theseareusedtopreventthe
weightoftopbedclothesonpatientsfeetandtoes.Tousethecradle,Placeitoverthebottombedclothes
andthetopbedclothesarethenbroughtoverthecradle.Theseareusedforpatientsaffectedbyburns.
Restraints aredevicesusedtopreventagitatedpatients,personswhogetoutofbedatnightintheir
sleepandsmallchildren,fromfallingoutofbed.
Wiremesh forwindowsanddoorsarefixedtopreventinsects.
SafetyMeasures: Patientsshouldbesafeguardedfromfireaccidentsandfromcarelessapplication
ofheat.Fireaccidentsoccurmainlyduetoallowingpatientstosmokeinbed.Useoffaultyelectric
appliancesandcarelessuseofoxygencylinders.Patientmaygetinjuredfromcarelessapplicationofhot
waterbags,electricpadsandapplicationofmedicationsontheskin.Poisonousdrugsshouldbekept
underlockandkeywithspecificredlabel.
Patientsmaycometoharmthroughbacteriologicalsources,insectsandrodents.Foodandwater
shouldbemadesafeforconsumption.Insectsandrodentsshouldbeeliminated.
ACTIVITYANDEXERCISES
Activityandexercisearenecessaryforhealthyliving.Activitiesusuallyperformedinandaylikeeating,
dressing,grooming,bathing,brushingetcarecalledactivitiesofdailyliving.
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Activitiesofdailyliving: Itisessentialformeetingthedaytodayneeds.Whenapersonisnotmeet
theseactivities,itisthecaregiverresponsibilitiestomeettheirneeds.Accordingtotheirhealthstatusthe
degreeofassistancerequiredwillvarythosewhoarerecordingsickneedstotalassistanceinorderto
meettheirdailyneeds.Exerciseistheperformanceofphysicalexertionforimprovementofhealthorthe
correctionofphysicaldeformity.
Benefitsofexercise:(1) Exercisestrengthsmuscles(2)Helpstopreventconstipation(3)Increases
appetite(4)Improvessleep(5)Stimulatesbloodcirculation(6)Improveslungventilation(7)Prevents
obesity(8)Promotesphysicalandmentalwellbeing.(9)Promoteurinaryfunction(10)Itregulates
bodytemperature
Typesofexercise: Therearetwotypesofexercises.Theyare
Activeexercise: Activeexerciseisatypeofphysicalactivityaccomplishedbythepatientwithout
assistance.theseexercisehelpthepatienttoattainthenormalphysiologicalfunctionofthebody.
(1) Deepbreathingandcoughingexerciseforcompletelungexpansionusuallydonebypostoperative
patient.
(2) Exerciseofthelimbsthroughfullrangeofmotionwhichincludeflexion,extension,adduction,abduction
androtation
(3) Movinginbedtochangetheposition
(4) Footexercisetopreventfootdropandtoedeformities.
(5) Abdominalandglutealcontractionexercise
Passiveexercise: Inpassiveexercisethemovementsoractivityiscarriedoutbyanotherpersonand
thepatientmakesnovoluntaryefforttoassistorresisttheaction.Thepassiveexercisesareusually
carriedoutbythephysiotherapistorthenurse.Theperformanceofcertainnursingproceduressuchas
bathingthepatient,givingbackcareandchangingthepositionetc.,providessomepassiveexercisefor
the patient. Passive exercise is useful for patient with restricted movements, deformities and
unconsciousness.
MOVING,SHIFTINGANDLIFTINGPATIENT
Asnursesyoumayberequiredtomoveandliftpatients.Animportantpointyouhavetobearinmind
whilemovingpatientsisthatyoumustobservecorrectbodymechanicforyourpatientsaswellasfor
yourself.
Whileliftingheavyobjects,itiswisetostandwithyourfeetwhileapartandfirmlyonthefloor.
Theweightshouldbeliftedclosetothebody.Flexyourkneessothatyourstrongmusclesofthelegs
beartheweightoftheobject.
Purposes:(1) Toperformthetaskefficiently.(2)Toavoidthepatientfromunnecessaryeffort(3)The
preventnursesfromstrainandbackinjuries(4)Topromotecirculationandmusculartone
Movingupwardordownward:Twonursesarerequiredtodothis.Onenurseplacesheronehand
underthepatientsshoulderandtheotherhandunderthelumbarregion.
Theothernursestandsontheothersideofthebedanddoesthesameasthefirstnurse.The
patient,ifheisable,isaskedtoflexthekneeandpushagainstthematterswithheels.Bothnurses
togetherbringthepatientup.
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Movingfromonesideofbedtoanother:Movepillowstowardsthesideofthebed.Placeyourone
armundertheshouldersandtheotherunderthelumbarregion.
Moveupperpartofthebodytothesideofthebed.Thenkeeponearmunderthelumbarregion
andtheotherunderthethighsandmovethemiddlepartofthebodyofthesideofthebed.Lastlyplace
onearmunderthethingsandtheotherundertheanklesandmovethelowerpartofthebodytotheside
ofthebed.Seewhetherthewholebodyisstraightandingoodalignment.
Turningonside:Beforeturningmovethepatientalittleawayfromthecentre.Ifheistobeturnedon
theleftside,youstandathisleft.Keephisrightarmcrossedonthechestandrightlegcrossedoverthe
leftleg.Flextherightkneeslightlykeeponehandonthepatientsrightshoulderandtheotheronhisright
hipandgentlyrollhimtoleftlateralposition.
Movingpatientsfromstretchertobed:Keeptheheadofthestretcheratrightanglestothefootof
thebed.Threenursesareneeded.
Allstandonthesamesideofthestretcheronenurseplacesherarmsunderthepatientsheadand
shoulders,anotherkeepsheranusunderthehips,thethirdhasherarmsunderthethingsandlegs.
Alltogetherlifethepatient,turnandplacehimonthebed.Theliftersobservebodymechanicsfor
themselves.Theykeeptheirbacksstraight,flextheirkneesandplacetheironefootforwardwhile
transferringthepatient.
OXYGENNEEDS
Oxygenisadministeredwheneverthereisdeficiencyinthebloodisshownbycyanosis.Patientswith
respiratorydysfunctionaretreatedwithoxygentherapytorelieveanoxaemiaorHypoxemia.Thenormal
amountofoxygeninthebloodmustbeintherangeof80to100mm.Hg.Ifitfallsbelow60mmofHg
irreversiblephysiologicaleffectmaytakeplace.Thebraincellsreceive20percentofthebodysoxygen
supplyandcanliveonlyfor3to5minutesiftheiroxygensupplycutoff.
Purpose:(1) Tosupplyoxygeninconditionswhenthereisinterferencewiththenormaloxygenationof
theblood.
IndicationsforOxygenInhalation :(1)Breathlessnessduetoasthma,pulmonaryembolism,
emphysema,cardiacinsufficienciesetc,(2)Obstructedairwayduetogrowth,enlargedthyroid,
(3) Cyanosis (4) Shock and circulatory failure (5) After severe haemorrhage (6) Anaemia.
(7) Patients under anaesthesia. (8) Asphyxia due to any reason e.g. drowning, inhalation of
poisonousgases,hangingetc.(9)Poisoningwithchemicalsthatalterthetissuesabilitytoutilize
oxygen e.g. cyanide poisoning. (10) Carbon monoxide poisoning. (11) Postoperative chest
surgeryandthyroidectomies.(12)Insufficientoxygeninatmosphere.(13)Airhunger
MethodsofOxygenAdministration: Administrationofoxygendependsupontheconditionofthe
patient,theconcentrationdesired,thefacilityavailableandthepreferenceofthedoctor.Itcanbegiven
byfollowingways:
Oxygenbynasalcatheter: Thisistheusualmethodofadministeringoxygentothepatientsinthe
ward.Thenasalcatheterisinsertedintothenostrilreachinguptotheuvula.Thecatheteristapedonthe
foreheadtokeepitinplace.Thenasalcatheterpermitsfreemovementforthepatientandnursingcare
maybegivenwithmuchmoreease.
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OxygenbyB.L.B.Mask: Whenoxygenconcentrationofover25%isneededorwhenoxygenis
givenunderpressurethemaskisused.Ifthemaskdoesnotfitsnuglyovertheface,oxygenwillbelost
fromthemask.Itisusefulforthepatientswhoareunabletobreathethroughthenose.Flowof8to12
litresoxygenwillbesufficienttomaintaintheconcentrationofoxygento25to60%.
B.L.B.[Boothby,LovelaceandBulbalian]isarubbermask.Itismadetofitoverthenoseor
noseandmouth.Thereservoirbagisattachedtoit.
OxygenbyTent: Itconsistsofacanopyoverthepatientswhichmaycoverthepatientpartiallyor
totally.Itisconnectedtoasupplyofoxygen.Thecanopiesaretransparent,sothatthenursecan
observethepatient.Thelowerportionofthecanopyistuckedunderthebedtopreventtheescapeof
oxygen.
O
2
cylindersandaccessories: Oxygenissuppliedincylindersortanks.Itisstoredunderapressure
of2200lbs1000kgpersq.inch.Pipedinoxygenisstoredunderoxygencylinderarelowpressure
about50to60lbspersq.inch.Theoxygencylindersarepaintedblackwithwhiteneck.
TheWolfsbottlehastwoholedrubbercorkinwhichtwoglasstubesareinsertedoneshortand
onelong.Thelongtubeisattachedbyrubbertubingtooxygencylinder.Theshorttubeisattachedby
rubbertubingandglassconnectiontoanasalcatheter.Thelargevalveofthecylinderisopenedwith
keys.Thereisaregulatortoregulatetheflow.
Careofoxygencylinders:
1) Handlethecylinderwithcare.
2) Oxygenstandshouldbeusedtopreventfallingandcausinginjurytosomeoneortotheequipment.
3) Itshouldbealwaysplacedattheheadofthebed.
4) Oxygendoesnotcausefirebutitsupportscombustion.Soavoidanysourceoffirefromthe
cylinderforfearoffire.
5) Visitorsandotherpatientsmayneedtobereminded.HangNosmokingboardtotheoxygen
cylinder.
6) OxygencylindersshouldbestoredinacoolTemperature,becausehightemperaturecancause
expansionofthegaswithconsequentlossofgasthroughthesafetyvalve.
7) Donotuseelectricappliancesclosetooxygen.
8) Oilorgreaseshouldnotbeusedontheregulator,becauseinthepresenceofhighoxygenconcen
tration,oilislikelytocatchthefireandthecylindermayexplore.
9) Markemptycylinder,replaceprotectioncap,andsetasidefromfullcylinders.
10) Inspecttheapparatusatfrequentintervalsandmakesurethatitisinworkingcondition.Thenurse
shouldlearntheworkingofcylinders,itsregulatorsetc.beforehandlingtheapparatus.
Precautions:
1) Givingoxygenisanemergencyprocedure,soitshouldbereadyfor24hours.
2) Thenurseshouldseethatthecylindersarefullandalltheapparatusisinworkingcondition,thekey
isattachedwiththecylinderinabag.
3) Thereshouldnotbeanyleakageinrubbertubing.
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4) ThereshouldbewrittenorderforO2inhalationandspecificdoesmustbeprescribedtoavoid
oxygentoxicity.
5) Useregulartoreducethepressureoftheoxygeninthecylindertoasaferlevel.
6) Measuretheflowinlitresperminute.Adjusttheflowofoxygen2to4litresperminuteforadults
whenthenasalcatheterisused.
7) Usesterileordisposablenasalcatheterstoavoidinfection.
8) Thecathetershouldbechangedatleastevery8hourlytoavoidblockageofcatheter.
9) Thecathetermaybetapedtotheforeheadforthecomfortofthepatientandtokeepitinplace.
10) Patientsnostrilsshouldbelubricatedwithpetroleumjelly,ifthereisanysignofirritation.
11) Oxygenadministrationmustneverbestoppeduntilthecauseofhypoxiaisreversed.
12) Ifnurseisleavingthepatientforshortperiod,leaveacallbellnearthepatient
13) Theprematurebabiesshouldbegivenoxygeninhalationonlyforashorttimeandataverylow
concentrationtoavoidretrolentalfibroplasia.
14) Observethepatient,receivingoxygeninhalationcontinuouslytodetectearlysignsofoxygentoxicity.
15) Sinceoxygenhelpsincombustion,fireprecautionsaretobetakenwhentheoxygenisonflow.
ELIMINATIONNEEDS
Definition:Elimination istheprocessbywhichwasteproductsareremovedfromtheboweland
bladderbymeansoffaecesandurine.
Factorsaffectingbowelandbladderelimination: Age,dietaryintake,fluidintake,physicalactivity,
psychologicalfactors,positionduringdefecation,pain,pregnancy,surgery,anaesthesiaanddiagnostic
test.
Commonboweleliminationproblems:Constipation,impaction,diarrhoea,incontinence,flatulence,
haemorrhoidsandboweldiversion.
Commonbladdereliminationproblems:Incontinence,Urinaryretention.
SUMMARY
(1) Nursingistheprocessofrecognizing,understandingandmeetingthehealthneedsofanypersonor
societyandisbasedonaconstantlychangingbodyofscientificknowledge
(2) Therearefivestepsinnursingprocess.Theyareassessment,diagnosis,planning,implementation,
evaluation.
(3) Applicationofnursingprocess
(4) Theentranceofapatientintoahealthcareagencyistermedasadmission.
(5) NursesresponsibilitiesareInformthepatientandtherelativesadayortwobeforethedischarge
(a)Getthedischargeslippreparedaftercheckingthevitalsignsandexaminingthepatient(b)The
nurseshouldseethatthepatientspersonnelhygieneismaintained,heisdressedinhomeclothes
andhastakenmeals.(c)Handoverthepatientsbelongingandanyvaluable,whichhavebeen
keptsafety,tothepatientortherelativeunderproperreceipt
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(6) Skilfulbedmakingcontributesmateriallytothepatientscomfort
(7) Bedsareoftwotypesordinary,andspecialbeds
(8) Bodymechanicsmeansthecoorienteduseofthebodypartstoproducemotionandmaintain
equilibriuminrelationtobothinternalandexternalforces.
(9) Thehygienereferstothescienceofhealthanditsmaintenancethepreventionofdisease,and
sanitarypractices.
(10)Comfortisasenseofmentalandphysicalwellbeing
(11)Restraintsareusedtopreventagitatedpatientswhogetoutofbedatnightintheirsleepandsmall
children,whenfallingoutofbed
(12)Whileliftingheavyobjectsflexyourkneessothatyourstrongmusclesofthelegsbeartheweight
oftheobject.
(13)Patientswithrespiratorydysfunctionaretreatedwithoxygentherapytorelieveanoxaemiaor
Hypoxemia.Thenormalamountofoxygeninthebloodmustbeintherangeof80to100mm
(14)Oxygencanbeadministeredbythewaysofnasalcatheter,B.L.B.mask,andanoxygentent
(15)Eliminationistheprocessbywhichwasteproductsareremovedfromthebowelandbladderby
meansoffaecesandurine.
(16)Exerciseistheperformanceofphysicalexertionforimprovementofhealthorthecorrectionof
physicaldeformity.
QUESTIONS
PartA ONEWORDANSWERS: (Onemark)
a)Nursing b)PersonalHygiene c)Dyspnoea
d)Position e)Hypoxemia f)Cyanosis
g)Anoxia h)Elimination i)Comfort
PartB MULTIPLECHOICEQUESTIONS: (Onemark)
1) Therelationshipofthevariouspartsofthebodyinactivity(or)rest.
1) Posture2)Exercises 3)comfort
2) Aclinicaljudgementtoactualhealthproblems
1) Assessment 2)Implementation 3)Diagnosis
3) Abedpreparedforbedriddenpatient.
1) Occupiedbed 2)Closedbed 3)Openbed
4) Patientisinapartiallysittingposition
1) Semiproneposition 2)Trendlenburgsposition 3)Fowlersposition
5) Senseofmentalandphysicalwellbeing
1) Comfort 2)Position 3)Rest
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6) Themechanicaldeviceusedforthepatienttopreventfallingfromthebed
1)Backrest 2)Footboard 3)BedBares
7) Shapeofthefootboards
1)LShape 2)IShape 3)TShape
8) Thedeviceusedtoimprovecirculationandpromotedrainage
1)SandBags 2)Blocks 3)Overbedtable
9) Colouroftheoxygencylinder
1)Bluewithwhiteneck2)Blackwithwhiteneck 3)Whitewithblackneck
10) Flowofoxygenforanadultperminutes
1)24litresperminutes 2)46litresperminutes3)12litresperminutes
11) Amountofoxygensaturationintheblood
1)80to100mmofHg2)60to70mmofHg 3)50to60mmofHg
12) Thesystematicdatacollectioninidentifyingneedsandproblemsisknownas
1)assessment2)diagnosis3)implementation4)evaluation
13) Thepatientleavesthehospitalagainstthemedicalofficersadviceisknownas
1)Discharge2)referral3)AMA4)abscond
14) Thetypeofbedispreparedtoprovideextrawarmthtothepatient
1)Fracture2)Amputation3)cardiac4)Rheumatism
15) Modifiedleftlateralpositionisknownas
1)Simsposition 2)Fowlersposition
3)Jackknifeposition 4)Trendelenburgposition
16) Thedevicesusedtopreventagitatedpatientsfromfallingoutofthebed.
1)Handrolls2)Backrest3)blocks4)restraints
17) Theindicationsforoxygenadministrationare
1)Breathlessness2)Asphyxia3)carbonmonoxidepoisoning4)alloftheabove
18) Thenormalamountofoxygeninthebloodis
1)6070mmHg2)5070mmHg3)80100mmHg4)7090mmHG
19) Deepbreathingandcoughingexercisesfallsunder
1)Activeexercise2)passiveexercise3)stretchingexercise4)relaxingexercise
20) Thecommonbladdereliminationproblemis
1)Impaction2)incontinence3)flatulence4)diversionofbowel
21) Thepositionusedforreducingintracranialpressureis
1)Trendelenburg2)ReverseTrendelenburg3)Prone4)Fowlersposition
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PartC WRITESHORTANSWERS: (5marks)
a)Typesofexercises
b)Therapeuticenvironment
c)Stepsinnursingprocess
d)Purposesofgoodbodymechanism
e)Factorsaffectingbowelandbladderelimination
PartD WRITEINDETAIL: (10marks)
a) Nursesresponsibilitiesindischargeprocedure
b) Purposesofbedmaking
c) Benefitsofexercises
d) Careofoxygencylinder.
PartEWRITEESSAY: (20marks)
a)Mechanicaldevicesforcomfortmeasure
b)Typesofpositioning.
c)Admissionprocedure.
d)Typesofbedmakingandindications

108
5.Healthassessmentandphysicalexamination
DEFINITIONOFPHYSICALEXAMINATION
Itisdefinedasacompleteassessmentofapatientsphysicalandmentalstatus.
PURPOSESOFPHYSICALEXAMINATION
(1)Togatherbaselinedataabouttheclientshealth.(2)Tosupplementconfirmorreputedataobtained
inthenursinghistory.(3)Toconfirmandidentifynursingdiagnoses.(4)Tomakeclinicaljudgmentabout
aclients.(5)Changinghealthstatusandmanagement.(6)Toevaluateandphysiologicaloutcomesof
care.(7)Itoffersanopportunityforhealthteaching(breastandtesticularselfexamination)
IndicationsofPhysicalExamination: Isdoneinhospitalsandduringhomevisits,onadmission,
beforeandafterdiagnostic&therapeuticprocedure,ondischarge,onfollowup,healthcampus.
METHODSOFPHYSICALEXAMINATION
Observationofthepatient: Webstersdictionarydefinesobservationastheactorpowerofnotic
ing.Nursesarewiththepatientsthroughoutdayandnight.Yourreportofobservationisveryvaluable
inhelpingthephysiciantoarriveatproperdiagnosisandtreatment.Theessenceofgoodnursingde
pendslargelyonintelligentobservation.Itisthroughobservationyounoticeyourpatientsdeviations
fromnormalcondition.
Yourobservationandpromptactionsmayhelppatientsfromgettingintoseriouscomplications
suchashaemorrhageandothersimilarproblems.Yourplanofnursingcarealsodependsupongood
observation.
Goodobservationdependsonyourintelligenceandknowledge.Skillinobservationisacquired
throughcarefultraininginusingyoursensesnamely,seeing,hearing,touchingandsmelling.
Itisthroughthesenseofseeingyouobservewhetherthepatientiswalkingwithdifficulty,whether
heisinpainandwhetherhehasanyothervisibleproblems.
Fromhearingthesoundofhisbreathingyouwillabletounderstandwhetherthepatientishaving
difficultyinbreathing.Touchingthepatientrevealswhetherhisbodytemperatureisraisedabovenormal
orwhethertheskinisofnormaltextureornot.Yoursenseofsmelltellsyouthenatureofdischargefrom
woundsandbodycavities.
Observationisacontinuousprocessasapatientsconditionisneverstatic.Itchangescontinu
ously.Thesechangesarenoticedthroughcarefulobservation.Anursesobservationincludesnotonly
thephysicalconditionofthepatient,butalsohispsychologicalaspects.
Yourobservationbecomesmeaningfulwhenitisaccompaniedbyquestioning.Tocometoclear
interpretationsofyourobservations,youhavetoquestionyoupatientsothatyouwillbeabletofindout
theproblemsexperiencedbythepatient.
Throughobservationyouidentifytheobjectivesymptomsofyourpatient.Changesincolourof
theskin,pulse,respiration,dischargesfrombodycavitiesandchangesinspeecharesomeoftheex
amplesofobjectivesymptoms.
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Painnausea,fear,anxiety,dizzinessanditchingareidentifiedbyquestioningthepatient.Theseare
examplesofsubjectivesymptoms.
Certainsymptomscannotbeidentifiedbyobservationorquestioning.Forexample,somespecial
techniquesareneededtonotechangesintemperature,pulse,respirationandbloodpressureXrays
andlaboratorytestsareusedforfindingoutchangesinstructureandfunctionsofvarioussystemsofthe
humanbody.
Physiciansusemethodssuchasinspection,palpation,percussionandauscultationforobservation
ofpatientscondition.
Inspectionisobservingwitheye.
Palpationistheartoffeelingwiththehand.
Percussionandauscultationdependontheproductionofsound.
Percussion istappinganareatoproducesounds.
Auscultationislisteningtosoundswithinthebodywith
astethoscope.Itistheartofhearingtheheartsound,bowelmovementetc.
Olfaction:Senseofsmell,(odour)
PRINCIPLESOFPHYSICALEXAMINATION
Headtofootexamination: Whenapatientcomestothehospitalorclinic,doanoverallobservation
ofthepatient,notedownhisproblems,reporttotheseniornurseandwriteyourobservationsinthe
nursesrecordsheet.
Usethefollowingasaguideforyourobservationandforestimationofyourpatientscondition.
1)Thegeneralstructureofthebody:Whetherheisobese,malnourished,acutelyillor
chronicallyill.Whetherheisweakandunabletowalkorwalkswithaidwhetherheisinpain.Notethe
colouroftheskinpale,jaundiced.
2)Mentalstatusandlevelofconsciousness:Whetherthepatientischeerfulordepressed,anxious
andworried,irritate,afraidorsad.Whetherorientedtoplace,personandtime.Whetherfullyconscious,
drowsyorcomatose.
3)Hairandscalp:Whetherthehairisclean,thick,thin,matted,dirtyorcoarse.Whetherthereisany
lesion,dandruff,pediculiornitsonthescalp.
4)Eyes:Whethertheeyesareprotruding,sunkenorcrossed.WhetherthecolourisabnormalReddish
oryellow.Whetherthereisswelling,discharge,abnormalwatering,pain,burning,itching,photophobia
orheadache.Whetherthevisionisnormalorpoor.Whetherthepatientusesglasses.
5)Face: Whetherthefaceispale,flushedorjaundiced.Whetherthereisswelling,ulcers,rashesor
injuries.Whetherhiseyesareswollenorsunken.
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6)Mouth: Whetherhisbreathsmellsofdrugsoralcoholorhasabadsmell.Whetherthegumis
inflamed,swollen,bleedingorulcerated.Whetherthelipsarecyanotic,dryswollen,crackedorulcerated.
Whethertheteethareloose,broken,artificialorirregularlyarranged.Whetherhehasanytoothache.
Whetherthetasteisimpaired,ordisturbed.Whetherthetongueisdry,cracked,coated,inflamed,
ulcerated,blistered,fissuredorswollen.
7)Throat: Whetherthepatienthasanyulcer,inflammationorpain.Whetherhehasanydifficultyin
swallowing..
8)Speech: Whetherthespeechisabsent.Whetherhehasanydifficultyinspeechstammeringor
incoherent.Whetherthevoiceishoarseorweak.
9)Nose: Whetherthereisanydeformity,swellingordischargeofmucous,bloodorpus.Whetherthe
senseofsmellispresentorabsent.
10)Ears: Whetherheisabletohearornot.Whetherthereiscollectionofwaxintheear.Whetherthe
patientexperiencesanyringingorbuzzingsounds,dizziness,itchingorpricking.
11)Neck: Whetherthepatienthaspainanddifficultyinmovingtheneck.Whetherthereisanyswelling
ordistendedvein.
12)Chest: Whetherthepatientsuffersfromcough.Whetherthesputumisofabnormalcolouror
quantity.Whetherthebreathingislabouredornormal.
13)Breast: Whetherthereareanyabnormalitiesintheshapeandsize.Whetherthereareanylumpsor
dischargefromthenipples.
14)Abdomen: Whetheritissoft,tender,distended,hard,swollen,flabbyorprotruding.Whetherhe
hasanynausea,vomitingorpain.Whetherhisappetiteisnormalornot.
15)Back:Anyswellinglumporanysore/ulcerattheback.
16)UpperExtremities:Whetherthenailsarebrokenorbrittle.Whetherthereisclubbingoffingertips,
tremorsofhands,swellingofextremities,paininthejointsoranyotherabnormality,allrangeofmotions
present
17)Lowerextremities:Normalinshapeandsize,anydeformity,allrangeofmotionspresent.
18)Skin: Whetherthereareanysores,wounds,rashesorscales.Whethertheskinisdry.moist,hot.
coldorclammy.
19)Excretionsanddischarges: Whetherthecolour,consistency,amount,odour,andcharacteristics
ofstools,urine,sputum,perspiration,vomitusandvaginaldischargearenormalorabnormal.Whether
patientgetsanypainoranyotherdiscomfortduringexcretion.
Charting: Thenursesarerequiredtoreportandrecordtheirobservations.Shereportsherfindingsto
theprofessionalnurseandtothephysician.
Recordingoftheobservationsiscalledcharting.Thenursesshouldcharttheirobservationscor
rectly.Allchartingsshouldbebrief,concise,accountandcomplete.
111
Chartinghelpsphysicians,nursesandotherstounderstandtheconditionandprogressofthe
patient.Thechartisalsousedforlegalproceduresandresearch.
Apatientschartincludesrecordsmaintainedbyphysiciansandnurses.Anurseshouldbeableto
maintainrecordsrelatedtonursingandsheshouldbeabletounderstandthenotesmadebyphysicians
andothers.
PHYSIOLOGICAL ASSESSMENT
Vitalsigns: Temperature,pulserespiratoryrateandoxygensaturation,bloodpressure,painarecalled
vitalsignsasindicatorsofhealthstatus.Thesemeasuresindicateeffectivenessofcirculation,respiratory,
neuralandendocrinefunctionbecauseoftheirimportancetheyarereferredtoasvitalsigns.
Temperature: Degreeofheatmaintainedbythebody.Itisthebalancebetweentheheatsproduced
andheatlost.
Oraltemperature :98.6F(37C)
Rectaltemperature/Tympanic :99.6F(37.5C)
Axillarytemperature :97.6F(36.4C)
Fever: Itoccursbecauseofheatloss.Mechanismsareunabletokeeppacewithexcessheatproduc
tion,resultinginanabnormalraiseinbodytemperature
Thermometer: (clinicalthermometer): Itisusedformeasuringbodytemperature
Thermometerintotwotypes:(1)Basingonthematerials.(2)Basingontheroute
Basingonmaterials (a)Electronicthermometer(b)Disposablethermometer(c)Glassthermometer
(d)Temperaturesensitivestrip
Basingontheroute: (a)oraltemperature(b)rectaltemperature(c)tympanicthermometer
TheCommonSitesforTakingBodyTemperature:Togetaccuratemeasurementofthebody
temperaturethebulbofthethermometermustbeplacedwhereitcanbecompletelysurroundedby
bodytissueandwheretherearebloodvesselssituatednearthesurface.Thetemperaturemayvaryifthe
bulbofthethermometercomesincontactwithclothing,air.Moistureetc.thecommonsitesforraking
bodytemperaturearemouth,groin,rectum,axilla.
EachdevicemeasurestemperatureusingtheCelsiusorFahrenheitscale.Followingformulasare
usedinconvertingvalues
ToconvertFahrenheitintoCelsius
C=(F32)5/9
E.gconvert104FintoCelsius
C=104325/9
C=725/9=40C
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ToconvertCelsiustoFahrenheit
F=C9/5+32
E.gconvert37CtoFahrenheit
=(379/5)+32
=66.6+32=98.6F
Contraindicationforrectalmethod
1)Thepatientswhohadrectalsurgeryorinflammationoftherectum
2)Thepatientswhoarehavingdiarrhoea
3)Whentherectumispackedwithfaecalmatter
4)Patientwhoarehavingsomekindoftreatments(eg)bowelwashenemaect
Contraindicationsfortheoralmethod: Patientswhoare
1)Extremelynervous
2)Delirious
3)Unconscious
4)HystericalandMentallyconfused
5)Patienthavingconvulsionmouthbreathe
6)Patientswhohaveinjuries
7)Inflammationofoperationinthemouth
8)Childrenundertheageof6years
9)Extremelyweakpatient
Typesoffever
Termsusedtodescribethetypesandphasesoffever
Onset: Onsetorinvasionoffeveristheperiodwhenthebodytemperatureisrisinganditmaybea
suddenorgradualprocess
Fastigiumorstadium: Fastigiumorstadiumoffeveristheperiodwhenthebodytemperaturehas
reacheditsreturningtonormal.Thefevermaysubsidesuddenly(declinebycrisisorgradually(decline
bylysis)
Crisis: Crisisissuddenreturntonormaltemperaturefromaveryhightemperaturewithinafewhoursof
days
Truecrisis:Thetemperaturefallssuddenlywithinfewhoursandtouchesnormal,accompaniedbya
markedimprovementinthepatentscondition
Subnormaltemperature:Whenthebodytemperaturefallsbelownormalitiscalledsubnormal
temperature.Thetemperaturemayvarybetween95to98For35to36.7c
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Hyperthermia: Whenthebodytemperatureisraisedto105Foraboveitiscalledhyperthermia
Hypothermia: Ifthetemperaturefallsbelow95For35C,theconditioniscalledhypothermia
Falsecrisis:Asuddenfallintemperaturenotaccompaniedbyanimprovementinthegeneralcondition
iscalledfalsecrisis.Itmaybedangersignalandnotasignofimprovement
Lysis: Thetemperaturefallsinazigzagmannerfortwoofthreedaysofaweekbeforereachingnormal
duringwhichtime,theothersymptomsalsograduallydisappear
ConstantfeverorContinuousfeverConstantfeverorContinuousfeverisoneinwhichthetemperature
variesnotmorethentwodegreesbetweenmorningandeveninganditdoesnorreachnormalfora
periodofdaysofweeks
Remittentfever:Remittentfeverisafevercharacterizedbyvariationsofmorethantwodegrees
betweenmorningandeveningbutdoesnotreachnormallevel
Intermittentorquotidianfever:Thetemperatureisraisesfromnormalorsubnormaltohighfeverand
backatregularintervals.Theintervalmayvaryfromfewhourstothreedays.Usuallythetemperatureis
higherintheeveningthanthemorning
Inversefever: Inthistypethehighestrangeoftemperatureisrecordedinthemorninghoursandthe
lowestintheeveningwhichiscontrarytothatfoundinthenormalcourseoffever
Hecticfever:Whenthedifferencebetweenthehighandlowpointisverygreat,thefeveriscalled
hecticorswingingfever.
Relapsingfever:Relapsingfeverisoneinwhichtherearebrieffebrileperiodfollowedbyoneormore
daysofnormaltemperature
Irregularfever: Whenthefeverisentirelyirregularinitscourse,itcannotbeclassifiedunderanyone
ofthefeversdescribedaboveanditiscalledirregularfever
Rigor: Rigorissuddensevereattackofshiveringinwhichthebodytemperaturerisesrapidlytoastage
ofhyperpyrexiaasseeninmalaria
Lowpyrexia:Inlowpyrexiathefeverdoesnotriseabove99to100For37.2to37.8C
Moderatepyrexia:Thebodytemperatureremainsbetween100to103For37.8to39.4C
Highpyrexia:Thetemperatureremainsbetween103to105For39.4to40.6C
Hyperpyrexia:Thetemperaturegoesabove105F
Frequencyoftakingtemperatureinthehospital:Frequencyoftakingtemperatureisdeterminedby
theconditionofthepatient.Forpatientswhoarenotseriouslyill,itneedstobetakeninthemorningand
evening.Thetemperatureistobecheckedevery4hoursofevenmorefrequentlyforthosewhoare
actuallyill,whoarehavinghighfever,andpostoperativepatients.Ifthetemperatureistakenbyrectum
oraxillaitshouldbespecifiedinthechart
Fever(PYREXA): Feverorpyrexiaisdefinedastheriseinbodytemperatureabove99F(37.2C).
thecauseoffeverareinfections,diseasesofthenervoussystem,certainmalignantneoplasms,blood
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diseasessuchasleukemia,embolismandthrombosis,heatstrokefromexposuretohotenvironment,
dehydration,surgicaltraumaandcrushinginjuries,skinabnormalitiesthatinterferewithheatloss,allergic
reactionstoforeignproteinsandpyrogensetc.
Infever,allthesystemsofthebodyareaffected.Itmayvarywiththenatureofthediseases
Respiratorysystem:Shallowandrapidbreathing
CirculatorysystemIncreasedpulserateandpalpitation
Alimentarysystem:Drymouth,coatedtongue,lossofappetite,nausea,vomiting,constipation,
ordiarrhea
Urinarysystem:Diminishedurinaryoutput,burningmicturition,highcoloredurine
Nervoussystem:Headache,reslessness,irritability,insomnia,convulsions,delirium
Musculoskeletalsystem:Heavysweating,hotflushes,gooseflush,shiveringorrigors.
Integumentrysystem:Heavysweating,hotflushes,gooseflush,shiveringorrigors
Feverisnotadiseasebutitisasign.feverisaprotectivefunctionofthebody,becausetherise
intemperaturepreventsthegrowthoforganismscausingthedisease.Feverifnottoohighhastensthe
destructionofbacteriabyincreasingphagocytes,andbyproducingimmunebodies.Atemperatureof
104to105Fforseveralhourswilldestroytheorganismsofsyphilisandgonorrhoea.Therangeinthe
bodytemperaturewithinwhichthecellscanfunctionefficientlyisbetween34to41C(94to106F).
thecentralnervoussystemisextremelysensitivetothetemperaturevariations.Irreversiblechangesmay
occurinthenervoussystemifthebodytemperaturegoesabove41Corbelow34C
CareinFevers
1)Regulationofthebodytemperature: Careofthepatientsinfeversfocusesonreducingthe
elevatedbodytemperature.Whenthepatientstemperatureismoderatelyelevated,variousmethodsof
reducingthetemperaturebestarted.Theroomtemperatureshouldbemaintainedatacomfortable
temperature.Theroomshouldbewellventilated.Theblanketsandexcessclothingshouldberemoved
butpreventthepatientfromgettingdraughts.Thevariousmethodusedforcoolingthebodyare:
1) Exposuretocoolairanelectricfan.Administrationofcooldrinks
2) Applicationofcoldcompressandicebags
3) Coldspongingandcoldpacks
4) Coldbath
5) Icecoldlavagesandenemas
6) Useofhypothermicblanketsofmattresses
Whensurfacecoolingisusedtreatmentisdirectedatnotonlycoolingthebodybutalsoprevent
ingshivering.Shiveringmustbepreventedbecauseitincreasesmetabolicactivity,producesheat,in
creasestheoxygenusagemarkedly,increasescirculation,maycausehyperventilationandrespiratory
alkalosis.Ittakeslongertimetoreducebodytemperatureinashiveringpatient
2)Meetingthenutritionalneed:Thecellularmetabolismisgreatlyincreasedduringfever.The
oxygenconsumptioninthebodytissuesapproximately13percentforeachcentigradedegreeofrisein
115
temperatureof7percentforeachFahrenheitdegree,Thereforeahighcaloricdietisindicatedinfevers.
Sincerethedigestiveprocessissloweddownthedietshouldbeeasilydigestibleandpalatable.Mostof
thepatientspreferfluiddiet.
Unlessitiscontraindicated,thefluidintakeisincreasedto3000mlin24hourstopreventdehy
drationandtoeliminatethewasteproducts
Careinrigor: Rigorischaracterizedbythreestages:
1)Thefirststageorcoldstages:thepatientshiversuncontrollably.Theskiniscold,faceis
pinchedandpale,thepulseisfeebleandrapid.Thetemperaturerisesrapidlyto103F(39.4C)or
above.Inthisstage,coverthepatientwithblanketsandapplywarmthwithhotwaterbags.Givewarm
drinks.Protectthepatientfromfalling.
2)Thesecondstageorhotstage: theskinfeelshotanddryandpatientfeelsverythirsty.The
shiveringstops.Thepatientmayberestless.Thetemperaturemaycontinuetorise
Duringthesecondstage,removealltheblanketsandhotappliances.Coverhimonlywithathin
blanket.Givehimcooldrinks.Coldcompressesareappliedtotheheadtorelievecongestionand
headache.Thetemperatureiscarefullyrecordedevery10to15minutes.Watchpulseandrespirations
carefully.Ifthetemperaturegoesveryhigh(105F)(40.5C)coldspongingmaybestarted.Watchfor
theearlysignsofsweating.
3)Thethirdstageorstagesweating: thepatientsweatsprofusely.Thetemperaturefalls.The
pulseimproves.Acutediscomfortsarediminished.Thepatientmaygointostateofshockandcollapse
ifnotcaredproperly
PULSE
Definitionofpulse:Thepulseisthepalpableboundingofbloodflownotedatvariouspartsonthe
body.Pulseisrhythmicfluctuationoffluidpressureagainstthearterialwallcreatedbythepumping
actionoftheheartmusclebyplacingfingersoveranarteryparticularlyatthelocationwhereitcrossthe
bond
Sitesforcheckingpulse:
1)Temporalartery 2)Carotidartery
3)Brachialartery 4)Radialartery
5)Femoralartery 6)Poplitealartery
7)Dorsalispedis 8)Posteriortibialartery
ApicalpulseAuscultatedinadult
Apicalpulseispalpatedtocountpulserateininfants
Characteristicsofpulse
1)Rate: Itisnumberofpulsebeatsinaminute.Normalrateinadultis80to100perminute
2)Rhythm:Itreferstoregularityofthebeats,beatsarespacedatregularintervalstheyaresaidtobe
regular.Intervalvariesbetweenthebeatsitiscalledirregular
116
3)Strength: Thestrength/amplitudeofapulsereflectsthevolumeofbloodejectedagainstthearterial
wall
4)Volume:Itreferstothefullnessofthearteryitistheforceofthebloodfeltateachbeat
5)Tension: Itisthedegreeofcompressibility
6)Equality:Itreferstoassessbothradialpulsesandcomparethecharacteristicsofboth
7)Principles:Exercise,emotionandanxietywillcauseincreasedpulserate,fingertipssensitiveto
touchwillfellthepulsation.Moderatepressureallowonetofeelsuperficialradicalarterycharacteristics
ofthepulsevarywithindividuals
Factorsinvolvedinpulse
1)Age: Theheartrhythmininfantsandchildrenoftenvariesmarkedlywithrespiration
2)Autonomicnervoussystem:Stimulationoftheparesympatheticnervoussystemresultsindecreas
inginthepulserate.Stimulationofsympatheticnervoussystemresultsinanincreasedpulserate
3)Medications: Certaincardiacmedicationsuchasdigoxindecreasesheartrate
RESPIRATION
Meaningofrespiration: Respirationisthemechanismofbodyusestoexchangegasesbetweenthe
atmosphereandbloodandthecells
Rate: Rateisthenumberoffullrespirationinaminute,normalrateis1620breaths/minute
Depthofrespiration: Normalaveragemanatrestinspiresandexhalesabout500ccofairwitheach
respiration.Ifmorethanthisquantityofairpassesoutinandoutofthelungstherespirationissaidtobe
deep
Rhythm: Innormalrespirationrhythmisnormal
Varioussitesofrespiration
1)Chest 2)Abdomen
Factorsinvolvedinrespiration:
1)Age:Normalgrowthfrominfancytoadulthoodresultsinalargerlungcapacityaslungcapacity
increasestherespiratoryratedecreases.Medicationsnarcoticdecreasesrespiratoryrateanddepth
2)Stress: Stressincreasestherateanddepthofrespiration
3)Exercise: Itincreasesrateanddepthoftheairdecreasestomeetthebodysneedforadditional
oxygen
4)Altitude: Theoxygencontentoftheairdecreasesasthealtitudeincreases
5)Gender: Mennormallyhavelargerlungcapacitythanwoman
6)Bodyposition Astraighterectpositionpromotesfullchestexpansion.Asloppedasslumpedposition
impairsventilatormovement
7)Fever: Duringfevertherespiratoryrateincreasedbecauseheatcanbelostfromlungs
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BLOODPRESSURE
Definition: Bloodpressureisthepressureexertedbybloodonthewallofabloodvessel.Thenormal
rangeofbloodpressureis120/80mmofHginadult.
WhentheventriclesarecontractionthepressureisatitshighestthisisknownastheSystolic
Pressure
DiastolicPressureiswhentheventriclesarerelaxingandthebloodpressureisatitslowest
Hypertension:whenthesystolicpressureisabovethenormallevel
Hypotension: whenthesystolicpressureisbelowthenormalrange
Purposes:(1) Toacquireabaseline.(2)Monitorforfluctuation(3)Todiagnosedisease(4)Toassess
thecardiovascularsystem(5)Tomonitortheeffectsofmedication
Typesofequipmentrequired:
1)MercurySphygmomanometer:thisisthesimplestandmostaccurateandeconomicaldevicefor
measuringbloodpressureaslongasitisusedcorrectly
2)AneroidSphygmomanometer:thereregisterpressurethroughabellowsandleversystem,whichis
moreindicatethanthemercuryreservoirandcolumn
3)Automatic digital sphygmomanometer: there remove some of the human error from BP
measurement,butobservertrainingisstillnecessary.
PAIN
Definition: Whateverthepersonsaysitisexistingwhenevertheexistingpersonsaysitdoes.(MC
Caffery1999).
Painisthefifthvitalsign.
Characteristicsofpain:
1)Severity :Rangesfromnopaintoexcruciatingpain
2)Timing :durationandonsetofpain
3)Location: bodyareainvolved.
4)Quality :whatthepatientfeelsthepainis
5)Personalmeaning:howaffectsthepersonsdailylife.
Factorsincreasinganddecreasingpain:age,gender,activity,rest,sleep,diet,culture,homerem
edies,drugs,alcohol,diversionalactivitieslikelisteningtomusic,watchingT.V.,yoga,meditation,etc.
PainAssessment: Painintensityscale
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FacesPainScaleRevised:Thisinstrumenthas6facesdepictingexpressionsthatrangefromcon
tentedtoobviousdistress.Thepatientisaskedtopointtothefacethatmostcloselyresemblesthe
intensityofhisorherpain.
TESTINGANDEXAMINATION
URINE
Characteristicsofurine:
1)Color:Normalurinerangesfrompale,strawcolorsamber,dependingonitsconcentration.
Bleedingfromthekidneysorureterscausesurinetobecomedarkred,bleedingfromthebladder
orurethracausesbrightredurine.
Darkamberurinemaybearesultofhighconcentrationsofbilirubincausedbyliverdysfunction.
2)Clarity:thenormalurineappearstransparentatvoiding.Urinethatstandsseveral,minutesina
containerbecomescloudyrenaldiseasemanyappearcloudyorfoamybecauseofhighproteinconcen
trations.
3)Odour:Urinehasacharacteristicsodour.Themoreconcentratedtheurine.Thestrongertheodour
SimpleDescriptivePainIntensityScale
010NumericPainIntensityScale
Nopain Mildpain Moderate
pain
Severe
pain
Very
Severe
pain
Worst
0 12345678910
VisualAnalogScale
Nopain painasbadasitcouldbepossible
orunbarrablepain
119
CharacteristicsofNormalUrine:
1)Volume:Onetotwolitresin24hoursbutvaries
2)Color:Yelloworamberbutvaries.
3)Turbidity:Transparentwhenfreshlyvoidedbutbecomesturbid(cloudy)uponstanding.
4)Odour:Urinehasacharacteristicodour.Themoreconcentrationtheurinethestongertheodour
5)pH: 4.6and8.0average6.0varies.
6)Specificgravity:1.001to1.035.
CommonUrineTests:
UrineTesting:Thenurseoftencollectsurinespecimensforlaboratorytesting.Thetypeoftestdeter
minesthemethodofcollection
Specimencollection:Thenursecollectsrandom.Cleanvoidedormidstream,sterile,andtimed
specimens.
Urinalysis: Thelaboratoryperformsaurinalysisonaspecimenobtainedbyanyofthepreviously
describedmethods.Thespecimenshouldbeexaminedassoonaspossible,preferablywithin2hours.
Specificgravity: Thespecificgravityistheweightordegreeofconcentrationofasubstancecom
paredwithanequalvolumeofwater
Urineculture:Aurineculturerequiresasterileorcleanvoidedsampleofurine.Ittakesapproximately
24to48hoursbeforethelaboratorycanreportfindingsofbacterialgrowth.
Urinetest
PurposesofSugartest:Testingtheurineforthepersonsandtheamountofsugarprovidesthe
doctorswithinformationabouttheamountofinsulinneededbythepatient.
PurposeofAcetonetest:Acetoneisanabnormalfindingthatindicatesthatthebodyhasbegunto
breakdownstoredfatstouseforenergy,sinceitisnotabletousethesugar.
PurposeofAlbumintest:Highalbuminexcretionisaprognosticofrenalfailureandcomplications
suchasmyocardialinfarction.
Indicationsfor Sugar,AcetoneandAlbumin
Sugarintheurineindicatesdiabetesmellitus.Inpregnancywhentherenalthresholdislowered.
Thesugarisfoundintheurine.
Acetoneisfoundintheurineofpeopleloosingweightorinstarvation.
Albuminuriaispresentlythemostreliableearlyindicatorofadverserenalandcardiovascular
eventsindiabeticpatients.Theconsensusisthatscreeningandinterventionforalbuminuriaareworthwhile
inpatientswithinsulindependentdiabetes,moreoftenintypeIdiabetesmellitusthantypeII.Increased
albuminexcretionsuggeststheonsetofdiabeticnephropathy.
120
Testingtheurineforglucoseandacetoneisgenerallydonefourtimesaday.Themostaccurate
methodistoobtainadoublevoidedurinespecimeninwhichthefirstvoidedissetasideandthepatient
isaskedtovoidashorttimelater.Thissecondvoidingconsistsofthemostrecentlyproducedurinefrom
thekidneyandisthebestindicatoroftheamountofsugarbeingexcretedatthatmomentnotofurine
thatmayhavebeeninthebladderforhours.IfthepatienthasaFoleyscathetertheurinespecimen
shouldbetakenfromthetubing,whichcontainsthelatestformedurinenotfromthedrainagebag.
Analbumintestingusuallyrequiresa24hourspecimenwithoutpreservatives.Somelaboratories
willacceptarandomspecimen.
Preparationofthepatient:
1) Onthepreviousdayexplaintheproceduretothepatient.
2) Explaintothepatientwhentheurinetocollecthowtocollectandtheamounttobecol
lected.
3) Provideanappropriatecontaineranddemonstratetohimhowtouseit
4) Instructhimnottocontaminatetheoutsideofthebottle.
5) Askthepatienttowashtheinternalgenitaliawithsoapandwaterandrinseitwithwater.
6) Ifthepatientisunabletodohimselfthenurseassistshim.
Preparationofarticles
Correctcollectionandpreparationofurinaryspecimensfordiagnostictestingcontributestoac
curatetestresults.Bedsidetestsforurineglucoseandacetonemustbedonepreciselyaccordingtothe
directiontoobtainaccurateresults.Timingofthereadingiscrucialandtheresultmaybeincorrectifthe
readingistakentooearlyortoolate.
Patientfamilyteaching:
1)Encouragereportingforroutineurinalysisandfollowupexamination
2)Adviceavoidanceofanymedicineunlessspecificallyprescribed
3)Teachthepatientandfamilytheimportanceoffluidintake
4)Teachthepatientandfamilyhowtoperformthetest
Patientcondition:
Presenceofsugarintheurineabout140180mgm/100mlofbloodisglycosuria
Presenceofketoneintheurineisketonuria.
121
Characteristics NormalFindings SpecialClassification
Volume Variable The diet high is roughage
produces more faeces than a
soft,blanddiet.
Consistency large diarrhoeal
stools suggest a disorder in the
small bowel , small and
frequent stools urgency to bed
pan suggest a disorder of the
colon'or'rectum
Colour Infant:Yellow
Adult:Brown
The brown colourof the stool
is due to stercobilin, a bile
pigmentderivative
The rapid rate of peristalisis
intheinfantcausesthestoolto
beyellow.
The colour of the stool is
influenced by diet. For
example, the stool will be
almost black if the person eats
red meat & dark green
vegetables, such as spinach.
Thestoolwillbe lightbrownif
the diet ishigh in milk & milk
productsandlowinmeat.
The absence of bile may
cause the stool to appear
whiterorclaycoloured
Certain drugs influence the
colour of the stool. For
example, iron salts cause the
stool to be black. Antacids
causeittobewhitish.
Bleeding high in the
intestinaltractcausesastoolto
beblackowingtothedigestion
oftheblood.
Bleeding in lower intestinal
tract will result in fresh blood
inthestool.
Odour Aromatic, may be
affected by foods
ingested
Excessive putrefaction
causes a strong odour.
The presence of blood in the
stoolcausesauniqueodour.
Consistency Soft, SemiSolid, &
formed
The consistency of the stool is
influenced by fluid & food
STOOL
122
SampleoftheLabel
NameofthePatient:________________________Ward/BedNo.______
Age:________Sex:_____________OP/IP._________________________
NameofSpecimen:_____________________________________________
NatureofTesttobeDone:_______________________________________
DateofCollection:______________________________________________
AbnormalityofStool
BloodinstoolDifferentformsare
1)Haematochezia: Passageofbrightredbloodperrectummixedwithorwithoutstool,ex:
haemorrhoids,analfissure&fistula,trauma,ischemiccolitis,diverticulitis,polyps,malignancyetc.
2)Melena: Characteristicsareblacktarry(sticky)stool(usetoproductionofacidhaematin).
Offensive(acidhaematinisalteredbybacteria).Semisolidinconsistency.Redcolouredfluidcomesout
fromtheUsuallyassociatedwithvertigo,dizzinessorsyncopalattackduringdefecation.Causesare
(1)Duodenalulcer(2)Carcinomaofthestomach
3) OccultBloodCausesare:IntakeofNSAID,hookworminfestation&colorectalcanceretc.
SPUTUM
Sputumisthemucoussecretionfromthelungs,bronchi,andtrachea.Itisimportanttodifferen
tiateitfromsaliva,theclearliquidsecretedbythesalivaryglandsinthemouth,sometimesreferredto
spit.30ouncesofmucusproduced/day.
HealthyIndividualsdonotproducesputum.
Clientsneedtocoughtobringsputumupfromthelungs,bronchi,andtracheaintothemouthin
ordertoexpectorateatintoacollectingcontainer.
Documentamountofsputumcollected,color,odourconsistency(thick,tenacious,watery)and
presenceofhaemoptysis.
Characteristicsofsputum
Charact eri st i cs Normal Abnormal orDi sease Condi t i on
Amount No sput um of ver y
l i t t l ei s expect orat ed
Amount may var y accordi ng t o
t he di sease. Eg. Ast hma,
Bronchi t i s.
Col our It i s col our l ess &
t ransl ucent
Yel l owi sh col our i ndi cat es
bact eri al i nfect i on
Bl aki sh col our i ndi cat es carbon
pi gment Eg. Smoki ng
Bri ght red/ Dark red, t arr y
col ouri ndi cat es bl ood
Greeni sh col our i ndi cat es
bronchi ect asi s
Brown col our i ndi cat es
gangrenous condi t i on of l ung.
Odour Odourl ess Unpl easant odour i ndi cat es l ung
abscess, l ung cancer, l ung
gangrene
Consi st ency Fort hy wat ery t enaci oi us and
t hi ck dependi ng on t ype of
condi t i on
123
Sputumproduction: Sputumproductionwithcoughingisnotnormal.Questiontheclientabout
sputumcolor(clear,yellow,green,rusty,bloody)andodor.
Quality: Watery,stingy,frothy,thick.
Quantity: teaspoon,tablespoon,cup.Documentinclientsmedicalrecordanychangesincolor,
odorquality,orquantity.Assertionwhethersputumisproducedonlyoftenthelyinginacertainposition.
Theamountofsputumproducedisincreasedseveraldisorder,forinstance.Clientswithbronchi
tismayexpectorateseveralcupsofsputumdaily.
Summary:
1) Physicalexaminationisdefinedascompleteassessmentofapatientsphysicalandmental
status
2) ThemethodsofPhysicalexaminationareinspectionpalpation,percussion,auscultation,
andolfaction.
3) Therecordingoftheobservationsiscalledcharting.
4) Temperatureisdegreeofheatmaintainedbythebody.Itisthebalancebetweentheheats
producedandheatlost.
5) Thecommonsitesfortakingbodytemperaturearemouth,groin,rectum,axilla
6) Feverorpyrexiaisdefinedastheriseinbodytemperatureabove99F(37.2C).
7) Crisisissuddenreturntonormaltemperaturefromaveryhightemperaturewithinafew
hoursofdays
8) Rigorissuddensevereattackofshiveringinwhichthebodytemperaturerisesrapidlytoa
stageofhyperpyrexiaasseeninmalaria
9) Pulseisrhythmicfluctuationoffluidpressureagainstthearterialwallcreatedbythepump
ingactionoftheheartmusclebyplacingfingersoveranarteryparticularlyatthelocation
whereitcrossthebond
10) Respirationisthemechanismofbodyusestoexchangegasesbetweentheatmosphere
andbloodandthecells
11) Bloodpressureisthepressureexertedbybloodonthewallofabloodvessel.
12) Hypertension:whenthesystolicpressureisabovethenormallevel
13) Hypotension:whenthesystolicpressureisbelowthenormalrange
14) Bleedingfromthekidneysorureterscausesurinetobecomedarkred,bleedingfromthe
bladderorurethracausesabrightredurine.
15) Absenceofbilemaycausethestooltoappearwhiterorclaycolour.
16) Theamountofsputumproducedisincreasedseveraldisorder,forinstance.Clientswith
bronchitismayexpectorateseveralcupsofsputumdaily
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QUESTIONS
PARTA ONE WORDANSWERS: (Onemark)
a)Physicalexamination b)Olfaction c)Percussion
d)Temperature e)Fever f)Fastigium
g)Rigor h)Pyrexia I)Haemoptysis
j)Melena
PARTB MULTIPLECHOICEQUESTIONS:(Onemark)
1)Artoffeelingwiththehand
1)Palpation 2)Inspection 3)Percussion
2)Recordingtheobservationiscalled
1)Monitoring 2)Charting 3)Documenting
3)Degreeoftheheatmaintainedbythebody
1)Saturation 2)Temperature 3)Bloodpressure
4)Normalrectaltemperature
1)98.6degreeF 2)99.6degreeF 3)97.6degreeF
5) Suddenreturnedtonormal temperaturefromaveryhightemperature withina
fewhoursofaday.
1)Lysis 2)Crisis 3)Fastigium
6)Thebodytemperatureisraisedto105degreeFiscalled
1)Hypothermia2)Hyperthermia 3)HecticFever
7)Temperaturefallsinazigzagmanner
1)Lysis 2)Hypothermia3)Hyperthermia
8)Exchangeofgasbetweenatmosphereandblood
1)Pulse 2)Respiration 3)Bloodpressure
9)Thenormalrangeofbloodpressureforanadult
1)120/80mmofHg 2)110/70mmofHg 3)120/90mmofHg
10)Browncoloursputumindicates
1)Bronchitis 2)Bacterialinfection 3)Gangrenousoflung
11)Coughingoutofbloodwithsputum
1)Haemoptysis2)Haematemesis 3)Epistaxis
12)Themethodtoproducesoundbytappinganareaisknownas
1)Percussion2)Auscultation3)palpation4)noneoftheabove
13) TheformulatoconvertFahrenheitintoCelsiusis
a)C=(F+32))5/9b)C=(F+32))9/5c)C=(F32))5/9d)C=(F32))9/5
125
14) Whenthedifferencebetweenthehightemperatureandlowtemperatureisgreat,
thefeveris
a)Inversefeverb)Hecticfeverc)Raisecrisisd)Rigor
15) Thesecondstageofrigoris
a)Coldstageb)nSweatingstagec)Hotstaged)Warmstage
16) Thedegreeofcompressibilityofpulseisknownas
a)Strengthb)Tensionc)Equalityd)Volume
17) Thespecificgravityofurineis
a)1.000tto1.035b)1.010to1.035c)1.031to1.035d)1.010to1.031
18) Blacktarrystoolis
a)Haematocheziab)Malaenac)Occultbloodd)Haematemsis
19) Greenishcoloursputumindicates
a)Bacterialinjectionb)Bronchiectasisc)gangrenousconditiond)Asthma
20) Thepressurewhentheventriclesarerelaxingandthebloodpressureatitslowestis
a)Systolicb)Diastolicc)Pulsepressured)meanpressure
PARTC WRITESHORTANSWERS: (5marks)
a)Careofpatientwithfever
b)Characteristicsofpain.
c)Purposesofphysicalexamination
d)Methodsofphysicalexamination
e)WhataretheContraindicationfororaltemperature?
f)Whatarethemethodsusedforcoolingthebody?
PARTD WRITEINDETAIL: (10marks)
a)Describesitesandcharacteristicsofpulse?
b)Painscale
c)Characteristicsofurine
d)Explaincommonsitefortakingtemperature?
e)Abnormalitiesofstool
PARTE WRITEESSAY: (20marks)
1)Explainheadtofootexaminationofpatient?
2)Explainurinetesting?
3)ManagementofRigor
4)Characteristicsofstool
126
6.MEDICALANDSURGICALASEPSIS
Theconceptofasepsis(freedomfromorganisms)isimportantforallhealthcareworkerswho
havedirectorindirectpatientcontact.Nursesarethepersonswhohavefrequentcontactwiththe
patientstoprovidecarefor24hours.Itistheresponsibilityofthenursetobeawareofthepatientsat
riskofdevelopinginfectiousandalsoadutytoprotectthemwithaseptictechniques.
DEFINITIONOFASEPSIS
Asepsisisthepracticetoreduceoreliminatecontaminants(suchasbacteria,viruses,fungiand
parasites)fromenteringtheoperativefieldissurgeryormedicinetopreventinfection.
Definitionofaseptictechniques: Aseptictechniqueistheefforttokeepaclientasfreefrom
hospitalmicroorganismsaspossible.
PRINCIPLESOFASEPSIS
Threethingsthatareextremelyimportantisachievingasepsisarethereductionoftime,trauma
andtrash.
(1)Time: Thetimetakenforanymedicalorsurgicalprocedureisanimportantfactor.Longer
thetimetaken,havethepossibilityofgreaterexposuretocontamination.
(2)Trauma: Traumaoccurredduetoroughhandling,excessivedeadspace,foreignbodieswill
contributetoinfection.
(3)Trash: Itreferstocontaminationbybacteriaorforeignmatter.
Essentialcomponentsofmaintainingasepsisinahospitalinclude:
(1) Hand washing, (2) Utilizing gloves, gown and mask as indicated, (3) Cleaning
equipment.(4)Handlinglinensiswaysthatpreventgermsfromspreading.
TYPESOFASEPSIS
Thetwotypesofaseptictechniquesthenursepracticesaremedicalandsurgicalasepsis.
Medicalasepsis: Itisacleantechniquewhichincludesprocedureusedtoreducethemicro
organismsandpreventtheirspread.(e.g.)changingpatientsbedlinendaily,handwashing.
Surgicalasepsis: Itisasteriletechniquewhichincludesproceduresusedtoeliminatethemicro
organisms.Steriletechniqueisusedwheresterileinstrumentsareused(e.g.)inoperationtheatre.
Medicalasepsis:Medicalasepsisiscommonlyreferredascleantechnique.Thegoalisto
reducethenumberofpathogensorpreventthetransmissionofpathogensfromonepersontoanother.
Techniquesusedshouldbeappropriatetointerruptthespreadoftheknownpathogen.
Guidelinesformaintainingmedicalasepsis:
(1)Thoroughhandwashingisbasictechniqueforinfectiouscontrol.(2)Knowaboutpatients
susceptibilitytoinfection(e.g.)Age,Nutritionalstatus,Stressetc.,(3)Neveruseaseptictechnique
haphazardly.(4)Protecthealthworkersfromexposuretoinfectiousagents.(5)Awareofthebodysites
wherenosocomialinfectiouscanoccur. (6) Properusageofprotectivedeviceslikegowns,gloves,
masksandprotectiveeyewear. (7) Proceduresshouldfollowtheprinciplesoftechniques,soasto
interrupt.Thetransmissionofmicroorganisms.
127
Surgicalasepsis: Surgicalasepsisisasteriletechniquetoeliminateallmicroorganismsincluding
sporesandpathogens,fromanobjectandtoprotectanareafrommicroorganisms.Surgicalasepsisis
used in operat ing room, delivery room, certain diagnostic test ing areas,
certain procedures like insertion of urinary catheter, sterile dressing changes, preparing an
injectablemedicationetc.Whenfollowingsurgicalasepsis,areasareconsideredcontaminatedifthey
aretouchedbyanyobjectthatisnotalsosterile.Whiledoingtheprocedure,itisnecessarytoexplain
theproceduretothepatientstofacilitatetheircooperation.Informthepatientwhichobjectsandareas
maynotbetouchedanddirectthepatienttoavoidsuddenmovementsthatmightcontaminatethe
equipment.Thishelpsthepatientassistinmaintainingthesterilityofprocedure.
BASICPRINCIPLESOFSURGICALASEPSIS
(1)Sterileobjectremainssterilewhentouchedonlybyanothersterileobject.
(2)Onlysterileobjectsmaybeplacedonasterilefield.
(3)Anobjectheldbelowapersonswaistiscontaminated.Nursesneverturntheirbacksona
steriletray.
(4)Asterileobjectbecomescontaminatedbyprolongedexposuretoair.
(5)Avoidtalking,coughing,sneezingoversterilefieldorobject.
(6)Whenasterilesurfacecomesincontactwithawetcontaminatedsurface,thesterileobject
becomescontaminatedbycapillaryaction.
(7)Theedgesofsterilefieldorcontainerareconsideredtobecontaminated.
(8)Usedry,sterileforcepswhennecessary.Forcepssoakedindisinfectantarenotconsidered
sterile.
Useofgloves: Gloves,notsubstituteforgoodhandhygiene.Itshouldwornonlyonceand
discardedappropriately.Itismoreimportanttoperformgoodhandhygienebeforeandafterusing
gloves.Glovesprovideabarrierbutarenotimpenetrable.
Glovesareusedforthefollowingsituations:
(1)Highrisksettinglikeoperatingroom,labourroom.
(2)Handlingthesterilesurgicalinstruments.
(3)Whiledoingtheasepticprocedureslikecatheterization,suctioning,bowelirrigation,dressing
thewoundetc.
(4)WhiledoingsomeofthediagnosticprocedureslikeThoracentesis,liverbiopsy,renalbiopsy,
lumbarpunctureetc.
(5)Whilecaringthepatientswithinfectiousdiseases.
(6)Whilehandlingthebloodandbloodproducts.
Useofaprons: Apronsareusuallyworntopreventsoilingofthenursesclothingbythepatients
bloodandbodyfluids.Theyprovidebarrierprotectionandarewornbeforeenteringthepatientsroom.
Gowniswornonlyonceandisthendiscardedappropriately.Gownispreparedbyclothorwaterproof
materials.Ifagownbecomesheavilysoiledormoistenedwithbloodorbodyfluidswhencaringfora
patient,removeit,performthroughhandhygieneandputonacleangown.
128
Useofmasks: Maskshelppreventthewearerfrominhalinglargeparticleaerosols,whichusually
travelshortdistancesandsmallparticledropletnuclei,whichcanremainsuspendedintheairandtravel
longerdistances.Maskspreventthenursestotoucheyes,noseandmouth,thuslimitingthecontactof
organismswithmucousmembranes
Maskspracticesareusedinvarioussituationslikesometimesthepatientsvisitorsalsohavetobe
usedwhentheyarewithpatientswhohaverespiratoryinfections.Sometime,thepatientswithimmuno
suppressivedrugneedtowearmaskforspecificprecautionswhentransportedoutsidetheroom.
Amaskiswornonlyonceandneverloweredaroundtheneckandthenbroughtbackoverthe
mouthandnoseforreuse.Itshouldcertainlybechangedbeforeitbecomesdampfromthewearers
exhalations.
STERILIZATIONSANDDISINFECTION
Definition:
Disinfectionisthedestructionusuallybychemicalsofpathogenicorganismsnotincluding
bacterialspores.
Guidelinestobeconsidered:
Someorganismsarecarriestodestroythanothers.
Thegreaterthenumberoforganisms,thelongerittakestodestroythem.
Thetypeofequipmenttobedisinfectedorsterilizesmakesadifference.
Itemsusedforcertainproceduresmustbesterile.
Methodsofsterilization:
1) Heat :Itisrapidandreliablemethodtodestroythesmalland
heatresistantobjects.
2) Chemicals: Itisslow,corrosiveandusedforheatsensitiveobjectsforlarge
surfaces.
3) Filtration: Itrequiresmembranefiltrationapparatusandonlyusedfor
liquids.
4) Irradiation: Ionizingirradiationisreliablebutexpensiveanditisusedto
sterilizetherooms.
A)Tyndallisation:Repeatedsteamingat100degreecentigradeofculture
mediaoneachofthreesuccessivedays,allowingsporesto
germinateandtobesubsequentlykilled.
B)Boiling Thismethodissuitableforenamel.Metal,glassandrubberwares.Bowlsterilizersareused
forlargearticles,instrumentsterilizersforsmallerarticles.
Pointstoremember:
1)Seethatarticlesarequiteclean,andcompletelyimmersedinthewater,whichalsomustbe
clean.
2)Onlyafterthewatercomestotheboilstarttiming.Ifmorearticlesareadded,thesterilizing
timemustbeginagain.
129
3)Boilvigorouslyfor5minutes.boilingwillnotkillspores.
4)Removearticleswithsterilecheatleorotherliftingforceps.Ontoasterilesurface.
C)Autoclaving: Thisisareliablemethodandmaybeusedformostarticles.Theautoclaveisametal
chamberwithanouterjacketandalidordoor,whichcanbefirmlyclamped.Steamisgeneratedby
heatingwaterinaboilerorintheouterjacket.Airisevacuatedfromthechambereitherbydisplacement
withsteam,orbyavacuumattachment.Thenthesteamisallowedtobuilduppressure,usually15or20
lbspersquareinch,andiskeptatthatpressure,usuallyfro15to30minutes.Thentheheatisturnedoff,
thesteamevacuated,andthecontentstheautoclave.
Pointstoremember:
1)Allarticlesshouldbecleananddrybeforepacking.Anyorganicmattersuchasbloodorpus
preventspenetrationofsteam.
2)Theholesindrumsmustbeopenwhenplacingintotheautoclave,andclosedimmediatelyon
takingthemout.
3)Bundlesshouldbenottoolargeandnottightlypacked.Steamshouldbeabletopenetrateto
thecentre.
4)Rubberglovescannotstandhightemperatureandlongsterilizing.Autoclavethemseparatelyat
15lbspressurefor15minutes.
5)Toautoclavebottlesoffluid,loosenthescrewcaps.Evacuatethesteamslowly.
Generalinstruction:
1)Thearticlesbeingsterlizedshouldwithstandhightemperature.
2)Thewrapperandthecontainershouldallowpenetrationofthesteamintothearticle.
3)Theinnerchambermustnotbetoofullnorthecontentsarrangedtoocompactly.Bundlesand
drumsmustbepackedloose.Cansorjarsmustbeopenedandturnedontheirsidessothatsteam
caneasilypenetratethecontents.
4) The temperature and pressure of the steam should be high enough to kill all the
microorganismsincludingspores.Theusualtemperatureis121degreecelsiusandthepressureis1.05
kg/cm
2
.
5)Thedesructionofabacteriadependsuponthelengthoftimethearticlesareexposedtosteam
underpressure.Theminimumtimeis30minutes.Ifthepressureisincreasedtheexposuretimecan
bereduced.
6)Inoperatinganautoclave,itisimportanttorememberthatalltheairintheinnerchambermust
bedrivenoutandentirelyreplacedbysteam.Otherwisealthoughthegaugemayshowapressureof
15 lbs, this pressure would be caused by a mixture of steam and air and t he
temperaturewouldbelowerthanthatofthesteamalone.
7)Thearticlesshouldbeleftintheautoclaveforashorttimeaftertheprocedureisovertodrythe
materials.
130
Workingoftheautoclave:
Autoclave is the name given to a sterlizer that utilises saturated steam under pressure
(saturatedmeansthesteamexertsmaximumpressureforwateratthegiventime)
Thesteamisusedintheautoclavefortworeasons:
1)Whensteamisheldinaclosedcontainer,itiscompressedandthetemperaturerisesfarabove
thatoftheboilingpointofwater.
2)Steamisabletopenetrateporousmaterialsveryrapidly,providedthat,itisnotimpeded
byunsuitablewrappersorbyairtrappedwithinfabricsorhollowinstruments.
Anautoclaveconsistsofanouterchamberandaninnerchamber,whichcanbetightlyclosedby
asafetylock.Thesteamisintrroducedfirstintotheoutercahmberuntilthedesiredtemperatureis
reached.Atthispoint,thesteamisturnedintotheinnerchamberwhichispackedwitharticlesthatare
tobesterlized.
Asthesteamenterstheinnerchamber,theairisforcedoutthroughthevalves.Thesteamiskept
flowingintotheinner chamberuntilthedesiredtemperatureisreached.Itisveryimportanttonotethe
temperatureaswellasthepressureoftheinnerchamber.Whenthedesiredlevelsarereached,itshould
bemaintainedtothedesiredlengthoftime(Temp:121degreecelsius,Pressure:1.05kg/cm2andthe
exposuretimeis30minutes.)
Theremovalofairfromanauotclave,duringthesterlizationprocessisimpotantfortworeasons:
1)Airleftinthecenterofapackorinthecannulaofacatheterwillpreventthesteamfrom
comingintodirectcontactwiththecenterofthepackortothelumenofthecatheter.Failureto
contactmeansfailuretosterlize.
2)Airmixedwithsteamreducesthetemperatureofthesteam.
Attheendoftheperiod,thesteamsupplyisshutoff,butthedoorisnotopeneduntilthepressure
gaugeisatzeroandthetemperaturehasfallento100degreecelsius.Thisallowtheliquidstocooltoa
pointwhentheywillnotescapefromtheircontainerswiththereductionofpressureanditalsohelpsto
drythepackagedgoods.
D)Dryheat: Sterilizingofglasswareincludingsyringesisoftendoneinahotairoven,at160degree
centigradeforonehour.Sporesaswellasorganismsarekilled.Rubberwillnotstanduptothisheat.
Thismethodisefficientifheatpenetratesthroughdressings,towelsandgown.
Twomethodsareused
1) Incineration :Usedfordisposalofdressings,laboratorymediaandhumantissuesandusedoil.
Hospitalincineratormaycauseunacceptableenvironmentalpollution.
2) Hotairoven :Itisusedforobjectswhichcannottoleratemoisture.Mostlyusedforglassware,
oils,powders.
Methodsofdisinfection:
Destructionoforganismsbychemicalisusedinthefollowingcircumstances:
131
Environmental :Disinfectionofexcreta,floors,furniture,linenandfabrics.
Instruments/Equipments:Sterilizationofheatsensitiveobjectsincontactwithpatient.
Skinandwounds:Removalofpathogens.
Foodmedication:Preservationinpreventionofspoilage.
Water: Removalofpathogens.
Vaccines:Destructionoforganismsordenaturationoftoxins.
Chemicalsterilization: Itisthemethodusedforeyeinstrumentsandotherdelicateinstruments.
Pointstoremember:
1)Thearticlesmustbecleanandfreefrompus,bloodoroil.
2)Themustbecompletelyimmersedinthedisinfectant.
3)Thedisinfectantshouldbeofacertainstrengthandthearticlesmustbeincontactwithitfora
certainlengthoftime.
4)Aftersterilization,articlesmustbewellrinsedinsterilewaterbeforeuse.
Fumigationorgassterilization:
Totalsurfaceexposuretoformaldehydegasunderconditionsofcontrolledhumidity,temperature
andtimeexposurewilldestroyallvegetativeformsofbacteria,virusesandmostofthespores.Thebest
resultscanbecbtainedwithhighconcentrationsofgas,humidityabove60%andtempratureofnotless
than18degreecelcius.Theexposuretimevariesonetosixteenhours.Theagentsthatarecommonly
usedforthefumigationareformalintablets,ethyleneoxideliquidsetc.
Thedisadvantagesofthegassterlizationarethatithasapungentsmell,isirritanttotheeyes,skin
andmucusmembrane.
Ultravioletlightsterilization:
Ultravioletsterilizationiseffectivefordisinfectingworkingsurfacesandairinsidetherooms.
Disadvantages:
1)Lighttravelsinstraightlinesanddoesnotpenetrate.Onlythesurfaceofanobjectindirectline
withultravioletsourceisirradiated.Anybacteriainshadowsareunaffected.Allsurfacesshouldbe
exposedtotherays.Ultravioletraysdoesnotpenetratetheliquids.
2)Prolongedexposuretotheultravioletrayscausesconjunctivaldamage.Topreventthis,dark
glassesshouldbeworn.
3)Itisalsoinjurioustotheskinandtissues.
4)Itisexpensive.Thecheapestformofultravioletradiationisobtainedfreefromsun.Gamarays
havethegreatestpowerofpenetrationandisusedforthesterilizationofplasticitemssuchasdisposable
syringesandcatheterswhichwillnotwithstandheatsterilizationandsharpinstrumentssuchashypodermic
needles,andscalpelblades.Thegreatestadvantageofthismethodisthatthearticlescanbepacked
beforesterilizationinindividualsealedplasticpacksoraluminiumfoilswhichavoidsanyhandlingand
possiblerecontaminationaftersterilization.
132
Principlesofdisinfection:
Onlyobjectswhichcannotbeheattreated.
Itisimportanttoremovegreaseandproteinsbeforeuse.
Dilutionofconcentrationshouldbeaccuratelymeasured.
Dilutionsshouldbemadeaseptically.
Disinfectantsshouldbeappropriatelychosenfortheirpurpose,costantimicrobialrange,
toxicityandcorrosiveness.
Disinfectantsforgeneralcleaningareawasteofmoney.
Typesofchemicals:
A) Alkylatingagents:
Theyarecapableofkillingbacteria,sporesandviruses.Theyaretheacceptablechemical
alternativetousualheattreatment.
Theyinclude:
1) Formaldehyde :usedforinstrumentsandmachinessterilization.
2) Gluteraldehyde :usedforinstrumentsterilization.
3) Ethyleneoxide :usedforrubberandplasticsarticlessterilization.
4) Propiolactone :Usedforgaseoussterilization.
B)Phenols:
Itincludesacidsandsemisyntheticcompoundsinsoapsolution.Itissomewhattoxicwitha
unpleasantsmell.Itisusedforgeneralpurposedisinfectantsforcontaminatedsurfaces.Ithasnoactivity
onspores.
Advantagesofdisinfection: Thisisthemethodusedtosterlizethearticlesthataredestroyedbyhead
andthemetalicobjectspronetocorosion.Thisisthemosteasymethodofdisinfectingarticles.
Disadvantages: Thismethoddoesnotensuresterlisation,becausethedisinfectantsdoesnotdestroy
thespores.Somedisinfectantsareinjurioustotheskinandarticles.
Importantpointstoremember:
1)Thedisinfectantchosenshouldbeefficienttodestroypathogens.
2)Theyshouldbeusedincorrectstrength.
3)Thearticlesshouldbefullysubmergedinit.
4)Theyareplacedforasufficientlengthoftime.
5)Theyshouldnotbeinjurioustotheskinandarticles.
6)Thearticleshouldbethoroughlycleansedtoremovetheorganicmaterialwhichwillprotect
thebacteriaagainsttheactionofdisinfectants.
7)Thedisinfectantshouldbeinexpensive.
8)Instrumentssoakedingermicidesmustbeadequatelyrinsedwithsterliewaterbeforebeing
used.
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HANDLINGOFSTERILEARTICLES:
1)Alwayswearamaskwhenhandlingsterilearticles.
2)Sterilizedarticlesmustbekeptincontainersoronsteriletowels,andkeptcoveredtillused.
Neverallowcontactofunsterilewithsterilearticles.
3)Makesurethereisnodampness.Asthiscouldmakethethingsunsterile.
4)Neverallowanyunsterilearticleincludingthearmsandhands,topassoverasterilefield.
5)Nevertouchtheinsideofapackageorcontainerwithyourfingers.Usethecheatleforceps.
6)Topullacorkfromabottleofsterilefield,takecarenottocontaminatetheinsidepartofthe
corknorinsidetherimoftheinnersideup,andthenreplaceitwithoutdelay.
7)Whenliftingacoverfromasterilecontainer,layitdownwiththeinnersideup,thenreplaceit
withoutdelay.
8)Tocarryasterileasterilebowlorothercontainer,holditwithyourhandsunderneath,anddo
nottouchtherim.
Rulesforuseofcheatleforceps:
1)Thesterilejarholdingtheforcepsmustbecleaned,resterilizedandfilledwithfreshantiseptic
lotiondaily.Thecheatleforcepsshouldbecleanedandautoclavedorboiled.
2)Wheninuse,keeptheforcepsatelbowlevelandpointeddownwards,becauseifyouliftit
upwardsthesolutionmayrunontoyourhandandthenbacktotheforceps,makingitunsterile.
3)Puttheforcepsbackintothejarimmediatelyafteruse.Replacecarefullywithouttouchingthe
rimofthejar.Iftheforcepsbecomescontaminatedinanyway,itmustberesterilizedbeforebeingput
backintothejar.
Preparingarticlesforsterilization:
Aconvenientmethodoftenusedtobepreparedwithsetsoftheinstruments,swabs,sponges,
dressings,towelsandsuturesneededformeachtypeofoperationorsterileprocedure.Thesesetsare
packedintodrums,bundles,orontrays,labeledandkeptreadyforsterilization.Thearticlesshouldbe
carefullyarrangedsothatthoseneededfirstareontop.Theymustbelooselypackedforsteamto
penetrate.Drumsmusthavetheperforationsopened.Bundlesshouldhaveadoublewrapperorclose
wovenclothorofpaper.
Dressings,swabsandspongesareusuallymadeofseveralthicknessesofsurgicalgauze.Raw
edgesmustbefoldedin.swabsanddressingsareagainfoldedtothedesiredsize.Spongesusedfor
abdominalsurgeryneedtobelarge,stitchedaroundtheedgesandapieceoftapesewedtoonecorner.
Whenanarteryforcepsisclippedtotheendofthetape,thereisnoriskofthespongebeingleftinside
theabdomen.
Packinggauzeismadeinvarioussizes.Usegauzefourtimesthewidthofthedesiredpacking.
Foldtheedgessothattheymeetinthemiddle,andagainfolddownthecentre,androll.
Cottonwoolispreparedinvariousways.Cottonballsofvarioussizesarepreparedbyrolling
betweenthepalms.Somemaybeneededforinternalsurgery,andforthisthecottonballmustbe
coveredwithgauzeandtied.Thistypeofswabisgraspedwithalonghandledforceps.Cottonsquares
ofvarioussizesaretobecutforuseindressingwounds.Somemayrequiretobecoveredwithgauze.
134
Instruments: Surgical instruments should be washed first in cold water, then in warm
waterwithadetergentafteruse.Useabrushtocleanwellespeciallybetweentheteethofarteryforceps
and clamps. To be properly sterilized, there should be no trace of dried blood or
discharge.Rinseincleanwater,thenboilfor5minutesanddrywell.
Sharpinstruments,knivesandneedlesshouldbedealtwithseparately,takingcaretoavoidcuts
andpuncturewounds.
Syringesandneedles:Assoonaspossibleafteruse,drawupsomewaterintothesyringeand
pushenoughthrougheachneedletomakesuretheyarenotblocked.Infectedsyringes(usedfor
withdrawingbloodorpus)shouldbewashedimmediatelyinacolddisinfectantsolution.Nextwashthe
syringesandneedlesinwarmsoapywater,usingabottlebrushforthebarrel.Rinseincleanwater.Take
carenottogetbarrelsandplungersmixed.Butkeepthemalwayspairedtogether.
Needlesshouldbeexaminedcarefullyforsharpness.Thetipsmayberubbedcarefullyona
sharpeningstone.Takecarenottoprickyourfingerasinfectionmaybetransmittedinthisway.
Rubbertubingafteruseshouldbecleanedwithcoldwater,thenwithhotsoapywater.Then
rinsed.Theinsidemustbethoroughlyclean.Thenitisboiled,andhungoverarailtodrain.Putaway
looselycoiled,toavoidkinking.Rubbercathetersshouldbecleanedbyrunningcoldwater,boilfor5
minutes,thendry,withatowelorbyhangingup.
BIOMEDICALWASTEMANAGEMENT
Biomedicalwasteisthewaste,whichisgeneratedbyhospital,nursinghomes,Clinic,dispensaries,
veterinaryinstitution,animalhouse.Pathologicallaboratoryandbloodbankandisnotdegradable.
Classificationofwaste:
1) Generalwaste:
a)Generalsweeping. b)Kitchenwaste
c)Packingmaterial. d)Paperpieces.
e)Wastefromlaundry,kitchen,wardsandlaboratory.
2) Infectiouswaste:
a)Humananatomicalwaste(humantissue,organandbodyparts).
b) Microbiologyandmicrotechnologywaste(wastefromLaboratorycultures,stocksor
specimens of micro organisms lie or attenuated vaccines, human and animal cell
culture used in research and industrial laboratories , waste from production of
biological,toxins,dishes,anddevicesusedfortransferofcultures.
c)Solidwaste(itemscontaminatedwithbloodandbodyfluidsincludingcotton,ressing,soiled
plastercasts,linen,beddings,othermaterialscontaminated).
3) Sharps:
a)Hypodermicneedles,stitchingneedles,needlesattachedwithtubing.
b)Scalpelblades,razors,nailsetc.
c)Brokenglassmaterials,syringes,bloodvials,edgesofslidesandcoverslipsincontactwith
infectiousagents.
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Segregation,packing,transporting:
1)Biomedicalwasteshallnotbemixedwithotherwastes.
2)Biomedicalwasteshallbesegregateintocontainers/bagsatthepointofgenerationpriorto
it s storage, transportation, treatment and disposal. The containers shall be
labeled.
3)Notwithstandinganythingcontainedinthemotorvehiclesact,1988,orrulesthereunder,
untreatedbiomedicalwasteshallbetransportedonlyinsuchvehicleasmaybeauthorized
forthepurposebythecompetentauthorityasspecifiedbythegovernment.
4)Nountreatedbiomedicalwasteshallbekeptstoredbeyondaperiodof48hours:provides
thatifforanyreasonitbecomesnecessarytostorethewastebeyondsuchperiod,the
authorizedpersonmusttakepermissionoftheprescribingauthorityandtakemeasuresto
ensurethatthewastedoesnotadverselyaffecthumanhealthandtheenvironment.
Measurestominimizehealthriskduetomedialwaste:
1)Useappropriateprotectingclothinglikeapron,thicklayergloves,longbootwiththicksole,
facemasks,eyeglasseswhenrequired,witharrangementofdisinfectionanddisposal
arrangementforstaffhandlinghospitalwaste.
2)Popularizeuseofcolorandemblemcodeoncontainerbags.
3)Introducemonitoringandsurveillanceforproblemareasorhighriskareas.
4)ConstituteaHospitalAcquiredInfectioncontrolcommittee.
5)Incinerator.
6)Conformstopollutioncontrolboardnorms.
7)Builtinsafety.
8)Easytooperateandmaintain.
9)Minimumsitework.
10)Shredderforplasticmaterials(plastic,bottles,syringes,IVsetsetc)cutsplasticwasteinto
small pieces of 1 cm size chips thus ensuring that syringes, and other plastic
materialarerenderednonrecyclable.
11)SegregationofwastefromHospitalkitchen,canteenandhousesinsidethehospitalpremises
iscollectedfromhousetohouseandtransportedtovermicompostingsite.
Categoriesofbiomedicalwaste:
CategoryNo.I Humananatomicalwaste
Waste Humantissue
Humanorgans
Humanbodyparts,
Treatment&disposal Incineration/DeepBurial.
Colourcoding Yellow.
Container Plasticbag.
136
CategoryNo.II Animalwaste
Waste Animaltissuers,orghans,bodypartscarcassesbleeding
parts,fluidblood,experimentalusedinResearch,waste
generatedbyverterinary,hospitalscolleges,Discharge
fromhospitals,Animalhouse.
Treatment&disposal Incineration/DeepBurial.
ColourcodingYellow.
ContainerPlasticBag
CategoryNo.III Microbiology&Biotechnology
Waste Waste from labouratory culture, stocks or specimens of
microorganisms, live or attenuated vaccines human and
animalcellcultureusedinresearchandinfectiousagentsfrom
researchandindustriallaboratories,wastefromproductionof
biological,toxins,dishesanddevicesusedfortransferofcultures.
Treatment&disposal LocalAutoclaving/Microwaving/Incineration
Colourcoding Yellow/Red
Container PlasticBag/Disinfectedcontainer
CategoryNo.IV WasteSharps
Waste Needles,syringers,scalpels,blades,glass,etcthatmaycause
punctureandcuts.Thisincludebothusedandunusedsharps.
Treatment&disposal Disinfection Chemical treatment with 1% hypochlorite
solution/localautoclaving/shredding.
Colourcoding Blue/Whitetranslucent
Container PlasticBag/Punctureproofcontainer
CategoryNo.V DiscardedMedicinesandCytotoxicDrugs
Waste Waste comprising of outdated contaminated and discarded
Medicines.
Treatment&disposal Incineration/ destruction and drugs disposal in secured
landfills
Colourcoding Black
Container PlasticBag
CategoryNo.VI SolidWaste
Waste Itemscontaminatedwithbloodandbodyfluidsincludingcotton,
dressings,soiledplastercasts,linen,beddings,othermaterial
contaminatedwithblood.
Treatment&disposal Incinerationautoclaving/microwaving
Colourcoding Yellow/Red
Container PlasticBag/Disinfectedcontainer
137
CategoryNo.VII SolidWaste
Waste Wastegeneratedfromdisposableitemsotherthanthewastesharps
suchastubings,catheters,intravenoussetsetc.
Treatment&disposal Disinfectionbychemicaltreatmentwith1%hypochloritesolution
autoclaving/microwavingandmultilation/shredding.
Colourcoding Red
Container PlasticBag/Disinfectedcontainer
CategoryNo.VIII LiquidWaste
Waste Waste generated from laboratory and washing cleaning,
housekeepinganddisinfectingactivities.
Treatment&disposal Disinfectionbychemicaltreatmentwith1%hypochloritesolution
anddischargeintodrains.
CategoryNo.IX IncinerationAsh
Waste Ashfromincinerationofanybiomedicalwaste
Treatment&disposal Disposalinmunicipallandfill
ColorCoding Black
Container PlasticBag
CategoryNo.X ChemicalWaste
Waste Chemicalusedinproductioninbiologicals,chemicalsusedin
disinfection,asinsecticides,etc.
Treatment&disposal Chemicaltreatmentwith1%hypochloritesolutionanddischarge
intodrainsforliquidsandsecuredlandfillforsolids.
ColorCoding Blackforsolids
Container PlasticBag
Summary:
Nursesarethepersonswhohavefrequentcontactwiththepatientstoprovidecarefor24hours.
Itistheresponsibilityofthenursetobeawareofthepatientsatriskofdevelopinginfectiousandalsoa
dutytoprotectthemwithaseptictechniques.
Asepsisisthepracticetoreduceoreliminatecontaminants(suchasbacteria,viruses,fungi
andparasites)fromenteringtheoperativefieldissurgeryormedicinetopreventinfection.
Threethingsthatareextremelyimportantisachievingasepsisarethereductionoftime,
traumaandtrash.
Thetwotypesofaseptictechniquesthenursepracticesaremedicalandsurgicalasepsis.
Medicalasepsisisacleantechniquewhichincludesprocedureusedtoreducethe
microorganismsandpreventtheirspread.(e.g.)changingpatientsbedlinendaily,hand
washing.
138
Itisasteriletechniquewhichproceduresusedtoeliminatethemicroorganisms.Sterile
techniqueisusedwheresterileinstrumentsareused(e.g.)inoperationtheatre.
Disinfectionisthedestructionusuallybychemicalsofpathogenicorganismsnotincluding
bacterialspores.
Thethreemainmethodsofsterilizationareheat,chemicals,irradiation,andfiltration.
Themethodsofdisinfectionareenvironmental,equipments,skinandwound,food
medication,water,andvaccine.
Thetypesofchemicalsusedfordisinfectionarealkylatingagentsandphenol.
Questions
PartAANSWERINONEORTWOWORDS:(Onemark)
1) Whatisthesteriletechniqueusedtoeliminatemicroorganism?
2) Whatisusedforgaseoussterilization?
3) Whichmethodisusedtosterilizeinstrumentandmachines?
4) Whichmethodisusedtodisposedressings,laboratorymediaandhumantissues?
5) Whatisthepressuremaintainedintheautoclave?
PARTBMULTIPLECHOICEQUESTIONS:(Onemark)
1) The technique which includes procedures used to reduce the microorganisms and
preventtheirspreadis
a)medicalasepsisb)surgicalasepsisc)sterilizationd)disinfection
2)Thebasictechniqueforinfectioncontrolis
a)Wearingmaskb)wearingglovesc)wearinggownsd)handwashing.
3) To prevent soiling of the nurses clothing by the pat ient s blood
andbodyfluidsbywearing
a)maskb)glovesc)gownd)alloftheabove.
4)Thedestructionofmicroorganismbychemicalsis
a)medicalasepsisb)surgicalasepsisc)sterilizationd)disinfection
5)Exposureofheatresistantmaterialstosteamunderincreasedpressureis
a)autoclavingb)filtrationc)steamingd)dryheat
6) Asteriletechniqueiseliminatethemicroorganismsinoperationtheatresisknownas
a)Medicalasepsisb)surgicalasepsisc)disinfectiond)noneoftheabove
7) Frominhalinglargeparticlesaerosolspreventsby
a)Gownb)Maskc)Apronsd)Gloves
139
8) Enamelandclearwaresaresterilizedbythemethodof
a)Tyndallisationb)chemicalsc)boilingd)radiation
9) Thedesiredtemperatureforautoclavingis
a)121cb)112cc)100cd)125c
10)The effective sterilization for disinfecting working surfaces and air
insidetheroom
a)Chemicalb)Ultravioletlightc)Incinerationd)noneoftheabove
11)Theinstrumentsandmachinesforsterilizationthechemicalsused
a)Gluteraldehydeb)Propiolactonec)Ethyleneoxided)Formaldehyde
12)Whichisnotthegeneralwasteinthefollowingitems.
a)packingmaterialb)kitchenwastec)solidwasted)properpieces
13)Thecolourcodingfordisposingsharpsandglassesis
a)yellowb)redc)blued)black
14)Thetypesofchemicalsusedfordisinfectionare
a)alkalizingagentsb)Phenolc)bothd)noneoftheabove
15)Thetubings,catheter&IVsetscanbedisposedinthefollowingcolourcontainers
a)yellowb)blackc)redd)blue
PARTC WRITESHORTNOTESON: (5Marks)
1)Principlesofasepsis.
2)Principlesofsurgicalasepsis.
3)Principlesofdisinfection.
4)Useofgloves
5)Guidelinesformaintainingmedicalasepsis.
PARTD WRITEINDETAIL: (10Marks)
1)Explainaboutdisinfection?
2)Describeaboutmedicalasepsis?
PARTE WRITEESSAY: (20Marks)
1)Sterilizationanddisinfection.
2)Medicalandsurgicalasepsis.

140
7.FIRSTAID
DEFINITIONOFFIRSTAID
FirstAidistheinitialassistanceortreatmentgiventosomeonewhoisinjuredorsuddenlytakenill.
Aimsoffirstaid: Firstaidtreatmentisgiventoacasualty:(1)Topreservelife.(2)Topreventworsen
ingofthecondition(3)Topromoterecovery
RULESANDPRINCIPLESOFFIRSTAID
(1) Gettothescenequickly,tohelpinsavinglife.(2)Ifthecauseoftheaccidentisstillthere,remove
itorthecasualtyfromdanger.(3)Becalm,Methodicalandquickbutgentleinhandlingthecasualty.(4)
Asfaraspossiblekeepthecasualtywhereheisuntileverythingisreadyfortransportinghim,(5)Look
forthefollowingandtreatthisfirst(a)FailureofBreathing.(b)Bleeding.(c)Unconsciousness.(6)Reas
surethecasualtyandotherspresenttoreduceshock,(7)Seethatthecasualtyisinbestpositiontoaid
recovery,(8)Clearthecloudtactfully.Thecasualtyneedsfreshair.Anyotherfirstaiderpresentmay
helpyou.Gethelpalsotocallthepolice,directtrafficetcasneeded.(9)Diagnoseinjuriesandgivefirst
aidthatisessential.Makeuseofavailablefirstaidequipments.Ifthereisnone,improvisethematerialat
hand.(10)Arrangeformedicalaidassoonaspossible,forcarefultransport,andforinformingrelatives.
(11)Staywiththecasualty,continuingtoobserveandgivecareuntilhandingovertothedoctor.(12)Do
notattempttoomuch:dotheminimumfirstaidsothattheconditionsdoesnotbecomeworseandlife
canbesaved.(13)Donotremoveclothingunnecessarily,asthismayaddtoshock.(14)Donotgive
anythingbymouthtoacasualtywhoisunconscious,whomayhaveaninternalinjuryorwhomaysoon
begivenananaesthesia.
FIRSTAIDINEMERGENCYSITUATIONS
FIRE
Rapidandclearthinkingatafireisvital.Firespreadsveryquicklysoyourfirstpriorityistowarnany
peopleatrisk.Ifinabuilding,activatethenearestfirealarm.Youshouldalsoalerttheemergency
servicesatonce.Panicspreadsfastamongpeopletrappedinfire.Encouragethepeopletoevacuatethe
area.Donotdelayorreenteraburningbuildingtocollectpersonalpossessions.Ignition(anelectric
sparkornakedflame)asourceoffuel/petrol,woodorfabric)andoxygen(air)
ClothingonFire: Alwaysfollowthisprocedure:(1)Stop,dropandRoll(2)Stopthecasualitypanick
ing,runningaroundorgoingoutside.(3)Ifpossible,wrapthecasualitytightlyinacoat,curtain,blanket
orheavyfabric.(4)Rollthecasualityalongthegrounduntiltheflameshavebeensmothered.(5)Ifwater
isavailablecooltheburnwiththeliquid.
BURNS
Skinplayskeyrolesinprotectingthebodyfrominjury,infectionandinmaintainingbodytemperature.
Theskinconsistsoftwolayers.Theouterlayer(epidermis)andtheinnerlayer (dermis)andfattytis
sue(Subcutaneousfat)theepidermisisprotectedbyanoilysubstancecalledsebumsecretedfrom
sebaceousglandswhichkeepstheskinsuppleandwaterproof.
Thedermiscontainsthebloodvessels,nerves,musclessebaceousglands,sweatglands,hair
folliclesEndsofthesensorynerves(sensationslikeheat,cold,touch,pain)Bloodvesselssupplynutri
entsandregulatesthebodytemperature.
141
Depthofburns:Burnsareclassifiedaccordingtothedepthoftheskindamage.Thereare3depths.
Superficial :Onlyepidermis(eg)Sunburn
Partialthickness :Destroysepidermis,Pain,Blisterformation
Fullthickness :Nopainsensation,skinscared.Needurgentmedicalattention.
AssessingaBurn
Assessfor: Pain,difficultyinbreathing,signsofshock
Aims: (1)Tostoptheburningandrelievepain(2)Tomaintainanopenairway(3)Tominimizetheriskof
infection(4)Toarrangeurgentremovaltohospital(5)Principlestobefollowedstop,dropandroll(6)
Helpthecausalitytoliedown(7)Continuecoolingtheaffectedarea(8)Covertheinjuredareawith
sterile/cleanclothtoprotectfrominfection.(9)Monitorthevitalsignslevelofresponse.(10)Donot
breaktheblisters.(11)Donotapplyointmentsleadstoinfection.(12)Whilewaitingforhelptoarrive,
reassurethecasualtyandseeforshock.
ElectricalBurn: Bumsmayoccurwhenelectricitypassesthroughthebody.Burnsmaybecausedby
alightningstrikebyhighlowvoltageelectriccurrent.Anelectricshockcanalsocausecardiacarrest.If
thecausaltyisunconscious,makesurethatthecasualtyisinsafearea,openthecausaltysairwayand
checkforbreathinganddoC.P.R.Donotapproachthecausaltyofhighvoltageelectricityuntilthe
currenthasbeenswitchedoffandisolated.
ChemicalBurns:Mostcorrosive,strongchemicalsareinindustry.Chemicalburnsarealwaysserious
andcasualityneedsurgenthospitaltreatment.Neverattempttoneutraliseacidoralkaliburnsunless
trainedtodo.Chemicalburntotheeye,firstaideristowashouttheeyesothatthechemicalisdiluted
anddispersed.Donotallowthecasualirytotouchtheinjuredeyeorforciblyremovethecontactlens.
Sunburn: Causedbyoverexposuretosun.Reddenedskin,painandblistering.Ifthereisextensive
blisteringseekmedicaladvice.
HeatExhaustion:CausedbyJossofsaltandwaterfromthebodythroughexcessivesweating.
Complaintsofheadache,dizziness,confusionlossofappetiteandnausea,sweatingwithpaleandclammy
skin,crampsinthearm,legsandabdomen,Rapidpulseandbreathing.Helpthecasualitytoacool
place.Givehimplentyofwater,weaksaltsolution.Monitorthevitalsigns.BepreparedtogiveCPRif
necessary.Transferthecasualityifnecessary.
HeatStroke: Thisconditioniscausedbyfailureofbodytemperatureregulationinthebrain.Usually
duetohighfeverorprolongedexposuretoheat.Headache,dizziness,discomfort,restlessness,Hot&
flushed,dryskin,boundingpulse,hightemperatureabove104
0
F(40
0
C).
TypesofBurn Causesoftheburn
Dryburn Flames,contactwithhotobjects
Scald Steam,Hotliquids
ElectricalBurn High Voltage currents over head
cableslightingstrikesFrostbite
Coldinjury Frostbite
Chemicalburn Industrial chemicals, inhaled fumes
andcorrosivegases,chemicalagents
Radiationburns Sun burn, over exposure to ultra
violet rays, Expose to radio active
sources.
142
Management:(1) Quicklyremovethecasualtytoacoolplacewarpthecasualtyinacold,wetsheet
untilthetemperaturecomesdownto100
0
Forgivecoldsponge.(2)Monitorandrecordthevitalsigns.
(3)IfthecasualtybecomesunconsciouspreparedtogiveCPR.Ifthecasualtyisbreathingnormally
placehiminarecoveryposition.
FRACTURES
Afractureisabreakincontinuityofabone,thismayvaryfromacracktoaCompletebreak.
CausesofFractures:DirectForce: Abonecanbefracturedatthepointwheretheforceofablow
isapplied. Indirectforce: Thebonebreaksawayfromthespotofapplicationofforce(eg.)fractureof
theclaviclewithoutastretchedhandwhilefallingopenandclosedfractures.
Inanopenfracture,oneofthebrokenboneendsmaypiercetheskinsurfaceortheremaybea
woundatthefracturesite.Anopenfracturecarriesahighriskofinfection.Inclosedfracture,theskin
abovethefractureinintact.Howeverbonesmaybedisplacedcausesdamagetotheinternalorgans.
Maycausebleeding(internal)andsuffershock.
TypesofFractures:
Greenstickfractures:Closedfracturemostlyitoccursinchildren..
Complicatedfractures:Theyoccurwhenthejaggedendsofthebonefragmentsdamagebloodves
sels,nervesorajoint,brokenbonesinthechestmaypenetratethelung,heartorliver.Infracturesofthe
skullthebrainisusuallydamaged.
Depressedfractures:Theseoccurintheskullwhenthebrokenendsofthebonesarepressedin
wards.
CommunatedFractures:Inthesecases,theboneisbrokenintoseveralfragments.Thisisserious
becausetherewillbemuscledamagewithmorebleedingatthefracturesite.
ImpactedFractures: Afteraheavyfall,thefracturemaybeimpactedbytheforce,(eg.)Spinalinjury
fallingfromtree.
PathologicalFractures: Theseoccurwhentheboneisweakenedbylossofcalcium,infectionor
cancer.Minimalcauseabreakinsuchcases.Inoldagethebonesaremorebrittle,andmaybreak
spontaneouslyduetocalciumlosswhichispartoftheageingprocess.
StressFractures:Stresscausedbyrepeatedminortraumaasinathletictraining.Involvedinstrenuous
training,suchasjoggingormarathonrunning.
Management:(1) Advisethecasualtytokeepstill.(2)Supporttheinjuredpartforimmobilization.
Splintscanbeusedforthesupportofthearea.(3)DressingtobedoneanddoBandagingtotheinjured
part.(4)Arrangetotransportthecasualtytohospitalasnecessary.Treatforshock.(5)Monitorthevital
signs.
DROWNING
Drowningisaconditionofsuffocationwhichmayleadtodeath,duetoairwayspasmorwaterentering
intotheairwayduringswimmingorwheninwater.
143
Drowningisasilentkiller.Peoplewhoaredrownedmaynotbeabletocallforhelpbecausethey
expendalltheirenergytobreatheortokeeptheheadoverwater.Bealertforsignsthatsomeonemay
beintrouble.Aswimmerflailinghisorherarms.Displayingunevenswimmingmotions.Lyingfacedown
inwater.Onlythehead,showingabovewaterwithmouthopen.
Thedrowningsequence: Beginswithpanicorstrugglefollowedbysubmersionwithbreathholding,
thenwaterswallowingbeforepassingout,within3minutesofbeingunderwater,lossofconsciousness,
within5minutes,brainsuffersdamage,thentheheartgoesintoirregularrhythmbeforeitstopsbreath
ing.
Signs: Abdominaldistensionandvomiting.Bluishorpaleskinofthefaceandlips.Coughwithclearor
frothypinksputum.Decreasedconsciousnessorunconsciousness.Labouredornobreathing.Weakor
noheartbeat.
FirstAid:(1)Reachingthevictim.(2)Reachfromashore.(3)Ifyoucannotreachaperson,wade
closer.(4)Throwanobjectthatfloatswithalinetothevictim(throwandtow).(5)Useaboatifoneis
available.(6)Ifnotusemustswimtotheperson,useatowel/boardforhimtohold.(7)Stabilizethe
victiminwater.(8)Keepthevictimsheadandbodyaligned,placeonehandinthemiddleofhisback.(9)
Yourarmdirectlyoverthevictimshead.(10)Placeyourotherhandunderthevictimsupperarm,near
theshoulder.(11)Slowlyandcarefullyrotatethevictimoverinthewater,byliftingtheshoulderand
rotatingitover.(12)Supportthevictiminneutralpositioninwaterandstartmouthtomouthventilation.
(13)Ifindeepwater,givetheoccasionalbreatheofairwhiletowingthecasualtyashore.
AdditionalCareMeasures:(1) Whenyoucanplacehimonafirmsurface,checkbreathingand
pulseandcontinueresuscitationifnecessary(2)Assoonasthecasualtybeginsbreathing,placein
recoveryposition.(3)Keepthecasualtywarm.(4)Ifpossible,removewetclothinganddryhimoff.(5)
Coverwithspareclothesand/ortowels.(6)Ifneededtreatforhypothermia.(7)Arrangeremovaltothe
hospital.(8)Transportinastretchercase,maintainingthetreatmentposition.
HAEMORRHAGE
Haemorrhageorbleeding:isaflowofbloodfromanartery,veinorcapillary.
Typesofhemorrhage
ArterialBleeding: Bloodisbrightredincolour.Itspurtsateachcontraction.
VenousBleeding: Bloodindarkredincolour.Itdoesnotspurt.Steadyflow.
CapillaryBleeding:Bloodisredincolour.Itdoesnotspurt.Slowinflow.
Effectsofhemorrhage:Thelossofredbloodcellscausesalackofoxygentothetissuesofthe
body.Adecreaseinbloodvolumecausesdecreaseinbloodpressure.Theheartspumpingratein
creasestocompensateforreducedbloodpressure.Theforceoftheheartbeatisreducedsincethereis
lessbloodtopump.
Howtorecognizeexternalbleeding:Evidenceofmajorexternalbloodloss.Symptomsandsignsof
shock.Casualitycomplainsofthirst.Blurringvision,fainting,giddiness.Faceandlipsbecomepale.Skin
feelscoldandclammy.Pulsefasterandweaker.Restlessness.Breathingshallow(airhunger).Uncon
sciousnessmayoccur.
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InternalBleeding: Woundsthathavepenetratedskull.Woundthathavepenetratedthecheston
abdomen.Signsandsymptomsofshock.Bloodmayappearfromoneofthebodyorificeslikenose,ear,
mouthrectum,urethra,vagina.
Management:Controlbleedingassoonaspossible.Keepthewoundcleananddressittominimize
bloodlossandpreventinfection.Quicklytransferthecasualitytohospital.
HowtoControlBleeding.
Directpressure:Placeyourhanddirectlyoverthewoundandapplypressure,firmandsteadyuntilthe
bleedingstops.Tieabondagefirmlyenoughtocontrolbleedingbutnotsotighttocutoffthecirculation.
Immobilizetheinjuredpart.Neverreplaceanydressingonceitisapplied.Ifthedressingissoaked,
placeanotherdressingandholdbothinplacewithfirmpressure.
Elevation: Elevatethebleedingpartofthebodyabovetheleveloftheheartsothattheflowofblood
willslowdowninthatpartandbloodclothingtakeplace.
PressurePoints:Applyingpressureoverthepressurepointspressingovertheunderlyingbonepres
surepointsonthearms(brachialpressurepoint)onthegroin(femoralpressurepoint).
Applyingatourniquet:Astandardtourniquetisapieceofwebbeltingabout36"longwithabuckle
devicetoholdittightlyinplacewhenapplied.Thisisusedtosopbleeding.Caretobetakennottocut
offthecirculation.
Management: Applydirectpressureoverthewoundwithyourfingersandpalms,withcleanpad/cloth
youcanaskthecasualitytoapplydirectpressureherself.Elevateandsupporttheinjuredpartabovethe
levelofthecasualtyshearttoreducebloodloss.Ifyoususpectthecasualityisgoingintoshock,raise
andsupportherlegssothattheyareabovethelevelofherheart.Securethedressingwithbandage.Tie
itwithpressurenottootightlytocutoffthecirculation.Furtherbleedingstilloccurs,putontheanother
bandageoverthepreviousone.Monitorthevitalsigns.Watchforthesignsforshock.Dialforan
ambulanceandtransportthecasualitytohospitaltillthenthefirstaidershouldnotleavethecasualityuntil
takenoverbydoctorornurse.
BleedingfromtheNose(Epistaxis): Bleedingoccursfromthebloodvesselsinsidethenostrils.
BleedingcomingfromNoseisalsoasignoffracturedskull.Makethecasualitytositwiththeheadbent
forward,loosenthetightclothingaroundtheneck.Allowthebloodtodrainfromthenostrils.Askthe
casualitytobreathethroughhermouthandtopinchthesoftpartofthenostrilforI0mts.Ifthebleeding
restartstellthecasualitytoreapplypressure.Ifbleedingfollowsaheadinjury,thebloodmayappearthin
andwatery.Itisaserioussignbecauseitindicatesskullfracture.Tellthecasualtytopinchhernose.
Advisehernottospeak,swallow,coughspitbecauseshemaydisturbthebloodclotsthathaveformed
inthenose.Givehercleanclothtowipeoffthedribbling.Advisethecasualtytorestquietlyforfew
hours.Avoidexertion,blowingofnoseatleastfourhourssoastonottodisturbtheclot.Ifafter30mts
alsobleedingpersistsorrecurs,seekmedicalaid.
SHOCK
Shockoccurswitheveryaccidentorsuddenillness.Thenervoussystemisaffectedandlaterifthe
conditionofshockcontinues,thecirculationofbloodgraduallyfailsandthepatientdies.Promptfirstaid
treatmentisneededtopreventshockincreasing,andtohelpthepatienttorecoverfromtheprimary
shock.
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Signs,SymptomsandTreatmentofShock:Ashockedpersonmayonlyfeelalittlefaint,weakand
cold.Andlookpale,orhemaycollapsewithsignsandsymptomsasfollows:(1)Hefeelsfaint,weak
andgiddy.(2)Theskinfeelscoldanddampthereissweatingevenincoldweather.(3)Colourispaled
andcyanosed(4)Hewillusuallyvomit.(5)Thepulseisweakandbecomerapid.(6)Hemaybe
restless,mentallyconfused,andbecomeunconsciousinlaterstages
Treatment:
1)Reassurethecausalityifheisconscious
2)Layhimonhisbackwiththeheadlow.Ifshockissevere,raisethelowerpartofthebody
unlessisinjurytotheheadnorchest
3)Loosenstightclothing,butdonotremoveclothing
4)Ifhefeelscold,coverhimwiththeblanket,butdonottrytowarmhimbyanymeans
5)Offerhimawarmsweatdrink,e.g.teaorcoffee,unlessthereisinternalinjuryorheisnotfully
conscious.
6)Keephimquiet,andundisturbed,givingonlyessentialfirstaidtreatmentforinjuries.Avoid
causingpain
7)Iftherearesevereinjuries,orshockincreases,getthecausalitytothehealthcenterorhospital
withoutdelay.heurgentlyneedsI.V.fluids
ElectricalShock:Ifanelectricalcurrentorlightingflashpassesthroughapersonsbody.Theeffects
maybemildorsosevereastocauseimmediatedeath.Theremaybefailureofrespirationwhilethe
heartcontinuestobeat.Theremaybeburnswherethebodywasincontactwithalivewire.
Aimsoffirstaidtreatment:
1)Havethesourceofelectricityswitchedoff
2)Checkbreathing,andgiveartificialrespirationimmediatelyifheisnotbreathing.
3)Treatanyburns
BANDAGINGANDSPLINTING
Purposes:(1) Tosecuredressinginposition.,(2)Toformslingsforsupport.(3)Tosecurepads
RollerBandages: Thesebandagesaremadeofcotton,gauzecrepe,elasticfabricorlinenarewrapped
aroundtheinjuredinspiralturns,figureofeight.Toimprovise,materialmaybetornintostripsofthe
requiredlengthandwidth.
Widthrequired Forfinger2.5cm
Forheadandarm6cm
Fortheleg,about9cm
Forthebody15cm
Thebandagesshouldbetightlyandevenlyrolled.
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RulesforApplyingRollerBandages: Facethecasualty,exceptforbandagestheheadorbackof
theneck.Whenbandagingtheleftlimb,holdtherollofbandageintherighthandandviceversa.Apply
theoutersideofthebandagetothepart,andunrollnomorethan5cmatatime.Tobandagealimb,
workfrombelowupwards,andfrominsidetowardstheoutsideoverthefrontofthelimb.Seethatthe
bandageisneithertootightnortooloose.Eachlayershouldcovertwothirdsofthepreviouslayerof
bandage.Finishinfront,notoverthewound,andfixtheendwithasafetypin,stickingplaster,stitching,
orbytearingtheendintotwotailsandtying.Thecompletedbandageshouldbecomfortable,lookneat
andfulfilitspurposewithnorestrictionofcirculation.
PatternsUsedinBandaging
Circularturns,asusedforheadandtrunk.
Simplespiral, forpartsofuniformthickness,e.g.fingers,wrist.
Reversespiral,usedonlimbswherethethicknessofthepartvariouse.g.forearm,leg
FigureofEight: Thismaybeusedonlimbsinsteadofthereversespiral,alsoforthehandand
foot.
Spica, usedfortheshoulder,hipandthumb
Divergentspica,foraflexedjoint,e.g.elbow,knee,heel
Recurrent, tocovertipsoffingersorastump
Specialbandagessuch ascapeline forthehead,eyebandage,earandbreastbandages.
ChoosingtheCorrectSize:Beforeapplyingarollerbandage,checksuitablewidthforthe
injuredarea
ApplyingaRollerBandage: Keeptherollerpartofthebandage(Head)uppermostasyour
work(theunrolledpart)iscalledthetail.Standinfrontofthecasualtyexceptincapeline(Head
bandagingandeyebandageareappliedstandingbehindtheclient).Supportthepartwhilebandaging
.Learntousebothhandsequally,changingthebandagehandtohand.Workfrombelowtoupwards.
Finishoffsecurelywitheitherreefknot,safetypin,bandageclip,adhesivetap.Tuckingintheend.
Splinting:Splintscanbemadeoutofwood,cardboard,ironrodsusedtosupportthefractured
partandforimmoblization.
TraingularBandages: havevarioususeinfirstaid.Tomaketwobandages,takea1metre
squarepieceofstrongcottoncloth,cutinacrossfromcorner,andhemtheedges.Thelongsideiscalled
thebase,andthecorneroppositetoitthepoint,Thebandagesmaybeappliedopenedoutoritcan
befoldedintoabroadornarrowbandages.Areefknotisusedtotietheendsofthebandage,
becauseitisflatandwillnotslip.Therulefortyingareefknotisrightoverleft,thenleftoverright.If
youkeepthisruleyoucannotgowrong.
Slings areusedtosupportorlimitmovementoftheupperlimb,incasesofinjuryorinflammation.
Threetypesofslingsareused:
LargeArmsling:Thisisusedincasesofsimpleribfractureandforfractureoftheforearm.
Whenapplied,onlythefingertipsshouldshow,thewholearmbeingwellsupported.
CollarandCuffSling :Thissupportsthewristonly.Withthecasualtysforearmflexedand
fingerstouchingtheoppositeshoulder,aclovehitch,madefromanarrowbandage,isplacedroundhis
wrist.Theendsofthebandagesaretakenaroundtheneckandtiedinthehollowjustabovethecollar
bone,ontheinjuredside.
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TriangularSling:Thissupportsthearmwiththehandwellraised.Itgivesrelieffrompainwhen
usedinfractureofthecollarbone.Firstplacetheopenbandageacrossthechestwiththepointbeyond
theelbowandoneendoverthehand.Tuckthebasecomfortablyundertheforearm.Taketheend
behindtheelbowacrossthebackandtietothefirstendwiththeknotjustinfrontoftheshoulder,onthe
uninjuredside.Foldinthepointandfixthebandagewiththesafetypin.
ImprovisedSlings: Theloweredgeofthecasualtyscoatorshirtmaybeturnedupandpinned
tosupportthearm,orthehandmaybepassedinsideabuttonedupcoat.Amuffler,tieorothersuitable
clothmaybeusedtosupportthearm.
BandagefortheScalp :Placetheopenbandageontheheadwiththepointattheback.Folda
narrowhematthebase,placeitjustabovetheeyebrows,thentakethetwoendsbackwards,cross
thembelowtheocciputwiththepointunderneath,thenbacktotheforeheadwheretheyaretied.Draw
thepointdownandthenupwards,andfixitwithasafetypin.
EFFECTSOFEXTREMEHEAT
Peoplecanbeidentifiedashighriskinrelationtoheatandheatrelatedillness.Thereare3types
ofheatrelatedillness
1)Heatstroke
2) HeatExhaustion
3)Heatcramps
HEATSTROKEORSUNSTROKE
Thisconditioniscausedbyfailureofbodytemperatureregulationinthebrain.Usuallyduetohigh
feverorprolongedexposuretoheat.Heatstrokemaybecausedbyhightemperatureinfactoriesor
furnaces.
SignsandSymptoms: Headache,dizziness,discomfort,restlessness,Hot&flushed,dryskin,bounding
pulse,hightemperatureabove104
0
F(40
0
C),rapidunconsciousness
Firstaid:
1) Removethepatienttodryandshadyplace,looseninghiscollar,andothertightclothings.
2)Risetheheadandupperpartofthebody
3)Sprinklecoolwateronhisbodyorwraphiminawetsheetandfanhim.
4)Keepontakingbodytemperatureevery10minutes.
5) Afterthebodytemperaturefallento102Fwraphiminadrysheetandkeepfanhim.
6) Ifthepatientisconscious,coolwatermixedwithsaltandglucosefordrinking.
7) Removetothehospital
HEATEXHAUSTION
Itiscausedbytoohightemperatureintheatmospheredirectlybythesun,orduetohardwork
andconfinementinaclose,hotatmospherelikefactoriesetc.
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Signs&Symptoms:
1)Headache,dizziness,nausea,vomiting,andsometimesabdominalcramps,orcrampsinthe
limbs.
2)Faceinpalewithcoldsweat
3)Pulseisweak
4)Shallowbreathing
5)Temperatureisnormalorslightlyraised
6)Sometimesthereisunconsciousness
7)Theremaybeashock
8)Lossofappetite
Firstaid:
1)Removethepatienttoacoolplace
2)Placehimflatonhisback
3)Loosenhisclothing
4)Givehimplentyofsaltedwater(1/4litreeveryhourly)
5)Observethepatient
HEATCRAMPS
Theseareintermittent,painfulcontractionsofskeletonmuscles.Thesecrampsoccursthefluidlost
insweatbydrinkingwaterbutdontreplacesodium.Sodiumdepletionisresponsibleforthecramps.
Heatcrampsusuallyoccurinmusclesthathavebeeninvolvedinastrenuousactivity.Bodytemperature
isnormalandtheserumsodiummaybenormalorlow.
Firstaid:
1)Replacethesodiumwithsalttabletsoranelectrolytesolution
2)Addingsaltinthedietwillpreventheatcramps
Pointstopreventheatinjury:
1)Limitingthestrenuousactivitiesinthehotweather
2)Stayindoorsandwearaminimumofclothingsduringheatwaves.
3)Whentemperaturesareunusuallyhighoutdooractivitiesshouldbecancelled.
4)Wearclothesthatareloosefitting,lightincolourandcoverthebodyasmuchaspossible
whenoutdoors
5)Looseweightifyouareobese
6)Avoidheavyexercise
7)Usemeasurestoimproveventilationandreduceheatbyshades
8)Cookingshouldbedoneinearlymorningorlateeveningtoavoidheatingupthehouseduring
thehotpartoftheday
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9)Fansandventsoverstovesandovensshouldbeusedtohelpremoveheatfromthehouse.
10)Eatingmoresalts,butmustbeaccompaniedbyanincreasedamountoffluids.
11)Drinklotofwater,eventhepersonwithcardiovasculardiseasewhomightotherwisebe
limitingfluids.
Effectsofextremecold: Effectsofextremecoldarecommoninpersonwholiveorworkinaclimate
wheretemperaturefallsbelow32Forareinhighaltitudes.
FROSTBITE
Frostbitesoccurswhenthebodyisexposedtoextremecoldtemperature.(i.e.)icecrystalsform
inginsidethecellcanresultinpermanentcirculatoryandtissuedamage.Bodyareassusceptibletofrost
bitearetheearlobes,tipofthenose,fingersandtoes.
Signsandsymptoms:
1)Theexposedpartbecomescold,painfulandultimatelynumb
2)Colourfirstisred,thenbecomewhitewhichmaylaterleadtogangrene
3) Injuredareaiswhite,waxyandfirmtotough.Patientusessensationintheaffectedarea.
Nursingaction: Gradualwarmingmeasures,analgesia,andprotectionoftheinjuredarea.
Firstaid:
1) Removeallwetortightclothingsfromthefrostbittenarea
2) Carrythepatienttoaclosedroomwithoutafireandundresshimcarefully.
3) Removetightgloves,boots,shocks,ringsetcfromthebody
4) Donotrubthefrozenpartwithsnoworanythingelse
5) Puthimtobedandcoverhimsnuglywithadrycloth.
6) Givehimwarmdrinks
7) Iffaceorearisaffected,coverthefrozenpatchwithaglovedhanduntilnormalcolourand
sensationreturn.
8) Sentforaphysicianimmediately
Importantpointstopreventcoldinjury:
1) Planactivitiescarefullytominimizeexposure
2) Dressfortheweather
3) Avoidvigorouswashingoftheface
4) Savingthebearduntilafterthedaysouting
5) Applyprotectivecreamtothefacepriortoexposure
6) Wearseverallayersofloosewarmclothing
7) Usehandprotection.Mittensaregenerallymoreeffectivethangloves
8) Avoidalcoholandcigarettes
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9) Avoidbecomingundulyfatigue
10) Donotusesnow,icecoldwater
11) Iffreezingoccurs,avoidthawingthepartuntilrefreezingiseliminatedasathreat.
BITESANDSTINGS
Bitesfromsharp,pointedteethcausedeeppuncture,woundsthatcarrygermsintothetissues.
SnakeBite:Commonlytwotypesofsnakesarefoundinourcountry.
1) Colubrine 2)Viper
Allsnakesarenotpoisonous.Identificationofthesnakeisimportanttoenabletogiveappropriate
treatmenttobegiven.Ifthesnakehasbeenkilleditshouldbetakenwiththecausalitytothehospital
mostofthepeoplediefromfear.
SignsandSymptoms
1) Apairofpuncturemarks.
2) Severepain,redness,swellingatthesiteofthebite.
3) Drowsiness.
4) Dimnessofvision.
5) Breathingdifficulty.
6)Unabletospeak.
7) Increasedsalivation.
8) Convulsions
9)Shock.
10)Weaknessofhandsandlegs,lossofsensation,wateringofmouth,slowrespirationandweak
pulse.
Firstaid:
1) Helpthecausalitytoliedown.Reassureher.
2) Washthewound.
3) Slashthewoundwithknife.
4) Immobilizetheaffectedpart.
5) Treatforshock.
6) Resuscitation,ifdifficultyinbreathing.
7) Shiftthecausalitytohospitalimmediately.
8) Takethekilledsnake,ifavailable,forpropermanagement.
Scorpionbites: Generallyscorpioncanbeseeninthemoistdarkplacesandinrainyseason.Though
thescorpionsarenotseriouslypoisonousbutsometimespersonscanbecomeunconscious
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Signs&Symptoms:
1) Severeburning
2) Intolerableincreasingpaininthebittenarea
3) Giddiness
4) Vomiting
5) Unconsciousness
Firstaid:
1) Patientshouldmaketoliecomfortablyandsoothingcreamapplied.
2) Ifthepatientisunconsciousness,sendhimtodoctororhospital
3)Ifabigblisterisseenafter612hoursanditburstbyitself,dothedressingwithantibiotic
cream
DogBite: Arabidanimalisaggressive,droolingsaliva,mustbeapproachedwithcare.Themost
seriousinfectionriskisrabies,apotentiallyfatalviralinfectionofthenervoussystem.Thevirusiscarried
inthesalivaoftheinfectedanimal.Tetanusisalsoapotentialriskfollowinganyanimalbite.Thedog
shouldbewatchedfor10days.Ifthedogishealthyafterthisperiodthenthereisnodangerofrabies.
Symptoms:
1) Headache,nausea,vomiting,fever.
2) Restlessness,confusion.
3) Difficultyinswallowing.
4) Foulsmellingofthemouth.
5) HydrophobiaDifficultyindrinkingwater.
6) Aerophobia
7) Respiratoryparalysis.
Firstaid:
1)Thoroughwashingofthebittenareaandwashthewoundwithsoapandwater(Detergent
solution)for510minutes.
2) Dressthewoundwithcleansterilegauzeorcloth.Applyantibioticcream
3) Shiftthecausalityimmediatelytothehospital
4)Thedogshouldbekeptunderobservationfor10days
Catbite: Catskeeproamingaroundthehousesbutiftheyaredisturbedandtouchedtheybecome
violentandcanattack.Itcausestwotypesofwounds
1.Onbitingwithteeth 2.Scratchesbythenails
Firstaid: Washthewoundandapplythedressingproperly.
Ratbite: Ratsareharmtothehumanbeingindifferentways.
1)Thefleafoundontheirbodyspreadadangerousdiseasecalledplague.
2) Sometimestheyscrapthepalmofthehandorfootofsleepingperson
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Signsandsymptoms: Fever
Firstaid:
1) Woundshouldbewashedanddressedproperly
2) Patientshouldbesenttothehospital
BeesandWaspbite:
InsectsuchasBeeandWaspthebiteispainfulratherthandangerous.
Startingpainwillbetherelatermildswellingandrednessappears.
Signs&Symptoms:
1) Localpain,itchingandsevereswelling
2)Lowbloodpressure
3) Unconsciousness
Firstaid
1) Torelievethepaintrytoremovethestingwithtweezer.
2) Treatmentofthelocalarea.
3) BeeVenomisacidneutralizewithammonia,sodawaspvenomisalkalineneutralizewithvinegar.
4) Torelievepainandswellingapplycoldcompress.
5) Sentthepatienttothehospital
TicksandMitesbites:
Tickisasmallinsectlikebedbug.Itisabouthalforonecentimeterlong.Ithasaterriblecapacity
tosticktothebodyandkeepsuckingthebloodduringthisperioditspreadsgermsofcertaindiseases
inthebodybywhichtuloramie,rockymountainspottedfever.
Signs&Symptoms: TyphusFever
Firstaid:
1) Thetickormitehasbittenanditisstickedshouldbeimmediatelyremoved.
2) Shouldbepulledforcefully
3) Applyburningcigarettesonthedorsalsurface.
4) Applyoilturpentineorkerosenetoremovethetickormite.
5)Thewoundshouldbewashedwithsoapandwater
6) Applyantibioticcream
7) Applybandage
Spiderbite:
Thereare2typesofspider.1.Blackspider2.Tarantula
Blackspiderismorepoisonous.Tarantulaisbig,hairyandlesspoisonous.
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SignsandSymptoms:
1)Redness
2)Severepain
3) Localswelling
4) Stomachcramps
5) Musclehardness
6)Theface,legsandhandslooksswollen
7)Breathlessnessandshock
Firstaid:
1) Patientshouldbemaketolieinacomfortableposition
2)Shouldbecoveredwithblanketorbedsheet
3) Aclothorropeshouldbetightatadistancefromthebittenarea.So,thebloodisnotabsorbed
inotherpartsofthebody.
4) Ifthepatientisconscious,givecoffeeorteatodrink.
5)Bittenareashouldbecleanandbandage
6) Senthimtothehospital.
Leechbite:
Leechisgenerallyfoundintanks,rivers,moistandmuddyplaces.Itsucksquitealargeamountof
blood.
Firstaid:
1) Applyaburningstickorcigaretteonthedorsalsurface.
2) Washthewoundandapplybandage.
Fishstings:
Twobreedsofthornyfishvizstingrayfishandjellyfishandgenerallyharmtothehumansby
stinging.
Signs&Symptoms: Severepain
Firstaid:
1) Thestingshouldbetakeitoutbyscratchingtheskin.
2) Washthewoundanddothedressing
3) Applycoldbandagesofammoniaandwatertogetrelievefromtheburningsensation
4)Ifthepainissevere,getthemedicalaid.
POISONING
Poisonisasubstancewhichistakenintothebodyinsufficientquantitymaycausetemporaryor
permanentdamage.Theymaybeconsumed,accidentally(bymistake,byIgnorance),forsuicidalpurpose,
intentionallyforkillingenemies
154
RoutesofTakingPoisons:(1) Eatingordrinkingpoisonoussubstancebymouth.(2)Byinhaling
gases,fumes,chemicalvapours.(3)Byinjectionintotheskinasresultofbites(eg.)snakebites,
hypodermicinjection.(4)Absorptionthroughskin(eg.)poisonoussprays.
Anothercommontypeofselfpoisoningistermedparasuicide.Ayoungpersonwhoisemotionally
distributedmaytakesuchaspainkillerorsleepingtablets.Theobjectistoobtainattentionandtotry
andsolvetheemotionalproblem,ratherthantotaketheirlife.
Recognition:(1)Dependsonthepoison.(2)Vomiting,sometimesbloodstained.(3)Impaired
consciousness.(4)Painorburningsensation.(5)Emptycontainersinthearea(6)Historyofingestion/
Exposure
HOUSEHOLDPOISONING
Almosteveryhouseholdcontainspoisonoussubstances,suchasbleach,paintstripper,glue,
paraffin,insecticides,pesticides,alcohol,petroleumproducts,acids,alkalis,sedativesetc.
Diluteorweakenthepoisonoussubstances.
Excesswatershouldbegiventoweakenedtheirconcentratedstateexceptacidpoisoning.
Takingoutpoisonoussubstancesbyincludingvomiting:
Thepoisonoudsubstancescanbetakenoutofthebodybyinducingvomiting.Mixingtwo
tablespoonsofsaltinoneglassofwaterortwoteaspoonsofsodabicarbinaglassofwater
orbymixingoneteaspoonofmustardwaterpowderinlukewarmwater.Iftheabove
substancesarenotavailablethenlukewarmwateraloneisalsouseful.
Inallcasesofpoisoningseekthemedicalhelpofcallthedoctorimmediately.
Hypnotics:
Heroinesandbadbituratescanleadtosleep,deepcomabywhichtherespirationisslowed
down.
Takeoutthepoisonousmedicinesbyinducingvomitingorweakenthosesubstancesbygiving
morewatertodrink.
Keepthepersonawakenedwhoissleepingwiththeeffectofsleepingpills.
GASPOISONING: Itarisewithinhalationofpoisonousgasessuchcarbonmonoxide,carbondi
oxide,inflammablegases,steamofammoniaetc.
Theeffectsofthesepoisonousgases
1) Reducetheamountofoxygeninhaledair.
2) Affectstheoxygencaringcapacityofblood
3) Damagethemucousmembraneoftherespiratorytract,notallowingtheoxygenabsorbedin
thebloodfromthelungs
Signs&Symptoms:
1) dizziness
2) tighteningofchest
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3) lossofconsciousness
4) meiosis
5) respiratoryfailure
6) fallinginbloodpressureandpulse
7) twitchingandconvulsion
8) asphyxia
9) cyanosis
10)circulatorycollapse
Firstaid:
1) Bringthepatientintheopenair
2)Keepthepatientwarmunderblanketorbedsheet
3) Iftherespiratoryprocessisstop,startgivingartificialrespiration
4) Thereisnoquickimprovement,makeanarrangementtosendhimtohospital.
FOODPOISONING:
Foodpoisoningoccursduetocontaminatedwater,foodsubstances,unboiledanduncleaned
vegetables,contaminatedkulfi,milkandcreamproductscontainsbacterias,itproducestoxins.
Signs&Symptoms:
1) nasueaandvomiting
2) crampingabdominalpains
3) diahorrea
4)headache
5) fever
6) featuresofshock
7) collapse
Firstaid:Themainaimoffirstaidistoeliminatethepoison,giveblandfluidssuchaswater,dilutedfruit
juiceorweaktea.Thepoisonouseffectcanbeweakenedbyinducingvomiting.Butwithconstant
vomitinganddiarrhoea,thewaterandelectrolytebalanceofthebodygetsdisturbedwhichresultsinto
theweaknessandconditionofshockarises,thepatientshouldbesentthedoctorandhospitalimmedi
ately.
Alcoholpoisoning: Alcohol(ethanol)isadrugthatdepressestheactivityofthecentralnervoussys
tem.Smallquantitiesgenerallyproduceonlyaslightchangeofmood.
Dangersofalcoholpoisoning:
Anunconsciouscasualtyisindangerofinhalingandchokingonvomit.
Hypothermiacanoccurwhenexposedtocold.
Misdiagnosed.
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Signsandsymptoms:
Astrongsmellofalcohol
Unconsciousness.
Aflushedandmoistface
Deep,noisybreathing
Afull,boundingpulse.
FirstAid: Ifapersonisintoxicationofliquorthenheshouldbemadetositandvomit.Afterthisgivehim
strongteaorcoffee.Ifthepatientisunconsciousandthesymptomsofheadinjuryareseen,thenarrange
tosendhimtothehospitalimmediately.
Dhaturapoisoning: Thispoisoningisduetoconsumptionofseedsoftreedhaturawhichmaybe
eatenunknowinglyoraccidentallyormaybeduetoconsumptionofbelladonnaalkaloidscontaining
medicine.
Firstaid:
Keepthepatientincool,darkandsilentroomandcontroltheseveremovementspatiently.
Vomitingshouldnotbeinducedinconditionsofunconsciousnessandcramps.
Coldbandagesshouldbeapplied.
Artificialrespirationcanbegivenifnecessary.
Protectivemeasures
Medicinebottlesandpacketsshouldbeclearlylabeledandunlabelledbottlesshouldnotbe
usedanddestroyed.
Toxicmedicinesshouldbelabeledpoisonandkeepitinlockedalmirah.
Thelabelonthebottleshouldbereadbeforetakingthemedicine,duringmeasuringthedose
andwhilekeepingthebottlebacktotheplace.
Cleaningagentsshouldbelabeled.
Toavoidfoodpoisoningfoodshouldbepreparedwithcleanlinessandkeptcovered.
adequatecookingandboilingtobedone.
Leadpoisoning:Moreindustrialworkersareexposedtolead,asitismostcommonlyusedmetalin
industries.Mostcasesofindustrialleadpoisoningisduetoinhalationoffumesanddustofleadorits
compounds.
Symptoms:
Insomnia,headache,mentalconfusion,metallictaste,stomachburning,constipationfollowedby
diarrhea,convulsions,muscularweakness,skin,coldandcyanotic.
Firstaid:
Keepthepersonquiet.
Gastric lavage with magnesium or sodium sulfate and analgesics for pain. maintain
fluidandelectrolytebalance.
Diazepamforconvulsions.
Calciumethylenediaminotetraaceticacidisthespecificantidote.
Adequateurineflow.
Reduceoreliminateexposuretolead.
157
Mercurypoisoning: Itoccursintheoccupationsrelatedtocrushing,roastingandcondensationof
mercuryfromore,manufactureofpaints,chlorine,causticsoda,paperandpulp.
Symptoms: Tremor,gingivitis,disturbedsleep,burningsensationinmouth,throat.Abdominalpain,
nausea and vomiting. Diarrhea and bloody stools. Weak rapid pulse, slow shallow
respiration,coldandclammyskin.
Firstaid:
Eggwhite,milkorflourbymouth.
Lavagewithactivatedcharcoal.
DimercaprolI.M.pencillamine.
Demulcentsandanalgesics.
Treatforshock/acuterenalfailure.
Cyanidepoisoning: Cyanidesareamongthemostcommonandmostdeadlypoisonsknown.
Symptoms: Utteracry,unconscious,rapidrespiration,laterslowandgasping.Deathusuallywithin5
minutes.
Smallerdosesacridtaste,choking,anxiety,dizziness,headacheandconvulsionswithfrothiness.
Firstaid:
Immediateemesisandgastriclavagenodelay.Inhaleamylnitrateimmediately1530seconds
every23minutes.
I.Vsodiumnitrite.3gin10mlofwateratrateof2.5ml5mlthisisbeingdonesimultaneously.
2550mlofsodiumthiosulphate50%tobeadministered.
Artificialrespiration.
Recumbentposition.
Turpentinepoisoning: Itisderivedfromvariousconiferous,pinetrees,whichyieldsavolatileoil,as
oilturpentinewhichisusedinthepreparationofpaints,varnishesandinmedicine.Turpentinepoisoning
usuallyoccursbyinhalation.
Symptoms: Warmorburningsensationinthegulletandstomach,followedbycramping,vomitingand
diarrhea.weakrespirationandpulse.IrritationofurinarytractandCNS.
Firstaid:
Gastriclavage.
Soothingdrinksandstimulants.
Increasefluidintake.
Radiationhazards: Manyindustriesuseradiumandotherradioactivesubstancesandtheseexposures
willleadtovarioushazards.
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Effectsofradiation: Acuteburns,dermatitis,blooddyscariasis,malignancies,,geneticeffects,lung
cancer,affectstheeyes,intenseconjunctivitis,keratitis
Prevention:
Avoiddirectcontact.
Wearxraythickshieldduringexposure.
Monitorfilmbadgeorpocketelectrometerfrequentlyforevery6months.
Adequateventilationinworkingarea.
Replacementandperiodicexaminationofworkersforevery2months.
Pregnantwomanshouldavoidexposure.
Noiseinducedhearingloss: Everyoneinindustryisconcernedaboutindustrialnoiseanditseffecton
thehearinginworkers.Butnoiseproblemisgenerallyaneglectedsubject.
Hearingconservationprogramme: TheprinciplesinvolvedinHCPareoutlinedbelow:
Noisesurvey
Audiometry
Hazardevaluation
Noisereduction
Hearingprotectivedevices.
Firstaidinestablishment:
Employersshoulddevelopappropriatefirstaidarrangementintheirundertakings.Regulation
andtheirassociatedcodeofpracticesbeevolvedwhichshouldapplytovirtuallyallpeopleatworkand
coverfirstaidregulation.
EmployersshouldprepareawrittenstatementofpolicyonfirstAID,coveringemployeesand
bringittothenoticeofallconcerned.
Firstaidroom.
GuidanceontherequirementofFirstAIDroomsiscontainedintheFactoriesAct1948.Thisisto
providetreatmentforminorinjuries,ambulanceshouldbethereandwellequippedfirstAIDboxtobe
there.
Controlmeasurestoavoidriskofoccupationaldiseases:
Preemploymentmedicalexamination
Periodicalmedicalexamination
Changeofjobassignment
Education
Useofpersonalprotectiveapplianceswhererequired
Substitution
Enclosure
Employment
159
Monitoringofworkenvironment
Adoptingengineeringcontrolmeasures
Goodhousekeepingandgoodventilation.
FOREIGNBODIES
Foreignbodiesintheskin: Smallforeignbodies(woodsplinters,shardsofglass)usuallycauseminor
puncturewoundswithlittleornobleeding.Ifforeignbodiesdeeplyembeddedinawoundisnotbe
removedbyafirstaided,itmaycausefurtherinjury.
Splinters: Smallsplintersofwood,metalorglassintheskinparticularlyofthehands,feetandknees
arecommoninjuries.Itshouldbedrawnoutbyusingtweezers.
Firstaid:
Cleanareaaroundthesplinterwithsoapandwater
Sterilizeapairortweezersbypassingthemthroughaflame
Graspthesplinterasclosetotheskinaspossible
Squeezethewoundtoencouragealittlebleeding
Applyanadhesivedressingplaster
Foreignbodiesintheeye:
Sandparticles,dust,smallpiecesofglass,coal,emerystone,metal,usuallyentertheeyeas
foreignbodies.Theseparticlesgetsituatedundertheeyelidsoreyeballs.
Signs&Symptoms:
1) Painandirritation
2) Wateryeyes
3) Photophobia
Firstaid:
1) Trytotakeoutonlythoseforeignbodieswhicharelyingonlyonthesurfaceareaoftheeyes.
2) Inanemergencycondition,itbecomesnecessarytotakeoutforeignbodiesthenthehand
shouldbewashedproperlyandcottonpieceorsofthandkerchiefshouldbemadewetwith
acornermadepointedandthentheforeignbodyshouldbetakenoutwithahelpofpointer
end.
3) Iftheforeignbodyinthemiddleportiondonottrytotakeitoutbecausethiscanleadtogreat
harm.Theeyesshouldbeclosed,paddedandthenpatientshouldbesenttothehospital.
4) Theforeignbodysometimescomesoutwhenthehairsofthelowereyelidgetrubbedwith
theupperunderpartoftheeye.
5) Donotrubtheeyesvigorously
6) Examinetheeyescarefullywithsofthands
Foreignbodiesintheear: Thecasesofforeignbodiesintheearoccurgenerallyinchildrenlikepeas,
buttons,seeds,flies,mosquitoesorbedbugs.
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Firstaid:
1) Neverusepinorpieceofwiretotakeoutforeignbodiesfromtheear.
2) Mosquitoes,bedbugsorfliesdiebyputtingoliveoilorsodabicarbinlukewarmwaterinto
theears.
3) Sentthepersontohospital.
Foreignbodiesinthenose: Certainforeignbodieslikepiecesofbetelnuts,grainsorpeasandother
seedsenterthenose.
Firstaid:
1) Puttingoliveoilorweatheroilinthenoseeithertheforeignbodycomesoutorirritationofthe
nosesubsides
2) Donotsneezeforcefully
3) Sentthepersontohospital.
Foreignbodiesinthethroat: Generallyinthethroatorupperpartoftherespiratorytract,some
piecesoffood,smallbonesoffish,coinsorartificialteethorotherthingscanenter.
Firstaid:
1) Generallytheforeignbodynotseeninthethroatandevenifitisseenthendonottrytotake
itoutbyfingerorothermeasures.
2) Bendthepersondownandbypattingontheshoulderthethingscomesout
3) Artificialrespiration
4) Sendthepatienttothehospital.
ForeignbodiesintheStomach: Theintroductionofforeignbodiesintothestomacharegenerally
foundinthechildrenlikebuttons,seedsoffruits,coins,safetypins
Firstaid:
1) Noimmediaterisk
2) Geteliminatedduringevacuation
3) Noneedtogivelaxatives.
CARACCIDENT
Thesituations
lookofvictims
inspectthevictimsforbleeding,asphyxiaorburningcar
Preventfurtheraccident.
putoutfirewitharug,soilorsand
turnoffcarlightsandswitchofftheigniter
applythebrakesorblocksthewheelswithabulkyobject
161
setwarningsaredreflectortriangleandawhitescarfornewspaperalongtheroadupto200
yardseithersideoftheaccident
atnightwearboldlywhite
Thepatient:Patientshouldbeprotectedbysupportingneckandjawwithacollarmadefroma
newspaperthicklyfoldedtoformarigedbutpliablesupportabout3by12inchesandinsertedintoa
stocking.
Extractingthepatientfromabuckledcarespeciallyifthedoorsarejammedandiftheinjuries
includefracturedspineandlimbs.Leaveittotheexpectsofpolice,ambulance,firebrigade,rescue
doctors.
Thecarfirstaidkit:
Kitshouldbekeptinawellclosedbuteasilyopened,clearlylabeled,metalorplasticbox
Triangularbandages
Womendiscardedstockings
Whitegauze
Gamgeetissue(inlargepieces12inchesby18inches)
Cottonelasticorcrepebandages
Adhesivetape
Scissorsandarescueblanket
Whenbreaksdontworkwhattodo
pumpthebreakpedal
parkmeanstheparkingbreakuseitbutdontjamit.Itcancauseaspin
shiftintoalowergear
sideswipesomethingaguardrailorcurb,somebushes,evenparkedcar.
Sixthingstodobeforehelparrives:
avoidasecondcollision.Dontpackbehindthewreck,orontheoppositesideoftheroad
Reducethechanceoffirebyturningofftheignition
Assisttheinjured
Getthevictimsoutofdanger
Gethelp.Callthepoliceorambulance
Searchtheareaforvictimswhomighthavebeenthrownfromthecarsinvolved.
162
CARDIOPULMONARYRESUSCITATION(CPR)
Resuscitationincludesallmeasuresthatareappliedtorevivepatientswhohavestoppedbreathing
suddenlyandunexpectedlyduetoeitherrespiratoryorcardiacfailure.Cardiacarrestisoneofthe
commoncausesforcardiorespiratoryfailure.
Whenapersonstopsbreathingspontaneously,hisheartalsostopsbeating.Clinicaldearthoccurs.
Within4to6minutes,thecellsofthebrain.Whicharesensitivitytothepaucityofoxygenbeginto
deteriorate.Iftheoxygensupplyisnotrestored,thepatientsufferirreversiblebraindamageandsbiological
deathoccurs.
Cardiorespiratoryfailure:
Therespiratoryandcardiovascularsystemsareinterdependent.Theheartconsumedmoreoxy
genperminutethananyotherorganinthebody,becauseitisconstantlybeating.Consequently,when
thelungsstopsworking,theheartfailoccurs.Conversely.,theventilationofhelungsfailsoonafterthe
heartstops.Thisisbecausetherespiratorycentreinthemedullaoblongatacannotfunctionwithoutthe
continuoussupplythatisnormallytransportedtoitbythecardiovascularsystem.
Sequenceofcardiopulmonaryresuscitation:
AAirway. BBreathing. CCirculation
Generalinstruction:
1) CPRtechniquesareusedinpersonswhoserespirationsandcirculationofbloodhave
suddenlyandunexpectedlystopped.
2) Theimmediateresponsibilitiesoftheresuscitatorare:
Torecognizethesignsofcardiacarrest.
Toprotectthepatientsbrainfromanoxia.
Tocallforhelp.
3) TheCPRmustbeinitiatedwithin3to4minutesinordertopreventpermanentbraindamage.
4) TheCPRtechniquesshouldnotbediscontinuedformorethan5secondsbeforenormal
circulationandventilationoflungsareestablished.
5) BeforeCPRisattemptedinapatient,makesurethattheairwayisclear.
6) Cardiaccompressionshelptostimulatethecirculation.
7) Theartificialbreathingandthecardiacmassageshouldcorrespondtothenormalrespiration
andpulserate.Theratioofcardiaccompressiontoventilationrateis5:1i.e5cardiac
compressiontooneventilation.Cardiaccompressiongivenattherateof60perminute.
Ventilationsaregivenattherateof12perminute.
8) Whentherearetworescuers,bothpositionthemselvesoneithersidesofthevictimsi.eone
rescuerdoesartificialventilationwhileheotherdoesexternalcardiaccompressions.Theratio
ofcardiaccompressiontoventilationrateis15:2
9) Thecirculationofbloodisinitiatedwiththeexternalcardiacmassagebecause,thepressure
exertedonthepliablesternumsqueezestheheartagainstthespineforcingbloodoutofthe
heartintoaorta.
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10) Watchforcomplicationsthatmayoccurduringthecardiopulmonaryresuscitation.
11) Discontinuetheprocedureonlywhenyouaresurethattherespirationsandcirculationrere
established.
12) Patientsviralsignsarewatchedconstantlyoveraperiodof24to48hoursafterthecardiac
arrest,becauseofthedangerofrecurringanothercardiacarrestatanytime.
13) Anasogastricincubationandaspirationofgastriccontentsarenecessaryforapatientwith
fullstomachtopreventvomitingandaspirationofvomitusintothelungs.
Complications:
1) Damagetothecervicalspineduetohyperextensionoftheneck.
2) Fractureoftheribandxiphoidprocess.
3) Hemopericardium.
4) Pneumothorax.
5) Intraabdominalhemorrhage.
6) Gastricdistentionofair.
7) Aspirationofthevomitusintothelungs.
EMERGENCYKIT
Anemergencybagorkitwillhelpyoutoprovideemergencycareandtreatmentinanefficient
way.Thecontentsofanemergencybagwillvaryconsiderablyaccordingtoplkaceofpractice,proxim
ityofaprimaryhealthcentre,medicalclinicorhospital,yourindividualpreferenceforpracticeina
specialityareaonlyandstandingordersforadministrationofmedicines,injections,oranyothertreat
mentinanemergency.Somenursesmaywishtoaddordeleteitemsfromthelistofsuggesteditems
giveninthefollowingsection.
Theemergencybagshouldbeaportableone,withcompartmentsandpocketswithflaps.Re
placementofeachitemassoonaspossibleafteruseisimperativetoavoidwastingtimelookingfor
itemsinanemergency.Checkthebagregularlyreplenishwhennecessaryandkeepitemsinthesame
place.
EmergencyBagContents
ItemsandDesriptionQuantity
For Flashlight,(Medicaluse) 1
Assessment Tonguespatula 1
Thermometer 1
Aneroidsphygmomanometer 1
Stethoscope 1
Gloves,rubber 1pair
Smallwritingpad 1
Pen 1
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ItemsandDesriptionQuantity
ForEmergency Bandages,assortedsizes 6
CareTreatment Bandagetriangular 2
Gauzepads,individuallypacked,sterile 6
Adhesivedressingstrips(bandaid) 1packet
Cottontippedapplicators 6
Cottonwool,smallpacket 1
Adhesivetape 1roll
Safetypins,assortedsizes 1dozen
Eyepads 2
Splints,lightwood,plywood 2
Bottles,screwtopped,widemouthed(forspecimen) 2
Catheters,plasticorrubber,urethral 2
Gastriclavagetube,rubber,mediumsize 1
Tourniquetorrubbertubingstrip 1
Intravenousdripset,disposabletypewithneedle 1set
Hypodermicsyringe2ml. 1
Hypodermicsyringe5ml. 1
HypodermicneedlesNo.26,24,22sizes 4
Fileforcuttingampoules 1
Pocketknife 1
Scalpel 1
Scissorsblunttipped 1
Scissorssharppointed 1
Forceps,arteryclamps 2
Forceps,dissecting 1
DextranorDextrosesolution(asintravenousdrip
starterinnonbreakableflaskorbag) 500ml.
OralRehydrationpower 2packets
TetanusToxoid5ml.vial 1vial
InjectionAdrenalin1:10001ml. 2ampoules
InjectionPethedine100mgin2ml. 1ampoules
InjectionMorphineSulphate30mgin2ml. 1ampoules
InjectionAtropineSulphate1mgin1ml. 1ampoules
CombinedInjectionMorphineSulphateand
AtropineSulphate 1ampoules
OralMedications
Antihistamineseg. TabletAvil,Phenergan,Benadryl.
Antispasmodicseg. TabletSpasmindon,Belladonna
Antimeticseg. TabletSiquil,Stemetil,
Analgesicseg. TabletAspirin,Dispirin,Crocin,Paracetamol,
Novalgin
Antiasthmaticseg. TabletAminophylline,Ephedrine
Antacideg. TabletAludrox,Gelusil
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TopicalMedicationsforExternalApplication
RectifiedSpirit30ml. 1bottle.
Tincturebenzoin30ml. 1bottle.
TinctureIodine,weak 1bottle.
LotionCalamine30ml. 1bottle
Lignocaine/Xylocaineointment9% 1tube.
EyeOinment
TetracyclineEyeOintment1% 1tube
Summary:
1)FirstAidistheinitialassistanceortreatmentgiventosomeonewhoisinjuredorsuddenlytakenill.
2)Donotdelayorreenteraburningbuildingtopersonalpossessions
3)Burnsareaccordingtothedepthsaresuperficial,partialthickness,fullthickness.
4)Chemicalburntotheeye,firstaideristowashouttheeyesothatthechemicalisdilutedand
dispersed
5)Afractureisabreakincontinuityofabone,thismayvaryfromacracktoaCompletebreak.
6)Poisonisasubstancewhichistakenintothebodyinsufficientquantitymaycausetemporaryor
permanentdamage.
7)Drowningisaconditionofsuffocationwhichmayleadtodeath,duetoairwayspasmorwater
enteringintotheairwayduringswimmingorwheninwater.
8)Haemorrhageorbleedingisaflowofbloodfromanartey,veinorcapillary.
9)Bandagesaremadeofcotton,gauzecrepe,elasticfabricorlinenarewrappedaroundthe
injuredinspiralturns,figureofeight.
10)Frostbitesoccurwhenthebodyisexposedtoextremecoldtemperature.
11)SunburnisCausedbyoverexposuretosun.
12)Heatstrokeiscausedbyfailureofbodytemperatudeinthebrain
QUESTIONS
PARTA MEANINGOFTHEFOLLOWINGTERMS: (Onemark)
1. Coldinjury. 2.Greenstickfracture. 3.Rabies
4. Epistaxis 5.Shoulderspica
PARTB MULTIPLECHOICEQUESTIONS: (Onemark)
1)Firstaidtreatmentisgiventoacasualtyto
a)Preservelife b)Promotehealth c)Preventillness
2)Scaldiscausedby
a)Hotobjects b)Steam c)Flames
166
3)Sunburnisatypeof
a)Superficial b)Partialthickness c)Fullthickness
4)Lossofsaltandwaterfromthebodythroughexcessivesweatingcauses
a)Heatexhaustion b)Thirst c)Frostbite.
5)Theboneisbrokenintoseveralfragments.
a)Commnutatedfracture b)Impactedfracture c)Stressfracture
6)Electricshockcancause
a)Cardiacarrest b)Respiratoryarrest c)Hypoxia
7)Chemicalburntotheeyes
a)Washouttheeyes b)Applyeyedrops c)Dontdoanything
8)Temperatureofheatstrokeis
a)Above104degree b)Below100degree c)102to104degree
9)Firstaidforfracture
a)Supporttheinjuredpartforimmobilization
b)Monitorthevitalsigns
c)Aboveall
10)TreatmentforScorpionbite
a)ApplycoldcompressandwashwithKMNo4
b)ApplyhotcompressandwashwithKMNO4
c)Dontapplyanything
11) Thefollowingarethesignsandsymptomsofheatstrokeareexcept
a) temperaturerisesupto104degreeForhigher
b) faceispalewithcoldsweat.
c) Restlessnessandconfusion.
d) Rapidunconsciousness.
12) Thefollowingarethefirstaidforthefrostbiteexcept
a) Gradualwarmingbybodyheat.
b) Givewarmdrinksandcoverpatientbydrycloth.
c) Takethepatienttotheclosedroom.
d) Rubthefrozenpartwithsnow.
167
13) Themainaimoffirstaidinfoodpoisoningisto
a) Eliminatethepoison.
b) Avoidtheirabsorption.
c) Makethemlessharmful.
d) Alloftheabove.
14) Thevomitingshouldnotbeinducedinthefollowingpoisoning
a) Acetylsalicylicacidb)Arsenicc)concentratedacidd)Atropine.
15) Ifthebrakesofthecardoesnotworktheorderoftechniquestobeusedis
a) Pump,park,shift,swipe.
b) Park,shift,swipe,pump.
c) Shift,swipe,pump,park.
d) Swipe,pump,park,shift.
16) Thefirstaidfortheforeignbodyintheeararethefollowingexcept
a) usepinorwiretoremove
b) useoliveoil
c) outsodabicarbinlukewarmH2O&pourintotheear
d) Refertheclienttothedoctor
17) Thespecificantidotefortheleadpoisoning
a) magnesiumsulphateb)diazepamc)Sodiumsulphated)calciumEDTacid
18) Thecommonfeaturesofgingivitis,tremorswithsleepdisturbanceareseenin
a)Mercurypoisoning b)Leadpoisoning
c)turpentinepoisoning d)cyanidepoisoning
19) Thesigns&symptomsofturpentinepoisoningare
a)Burningsensationsinthestomach
b)Diarrhea&vomiting
c)Weakpulse&shallowrespiration
d)alltheabove
20) Employeesworkinginradiationshouldbemonitoredforexposureofintervalsof
a)9month b)3month c)6month d)4months
168
PARTC ANSWER THEFOLLOWING: (5marks)
1)DefinefirstAidandwriteaimsoffirstaid.
2)Whatarethetypesofhaemorrhage?
3)Typesofinsectsbite?
4)Writesignsandsymptomsofsnakebite.
5)Whatarethepatternsusedinbandages?
PARTD WRITEINDETAIL: (10marks)
1)Typesofburns 2)Typesoffracture
3)Drowningmanagement 4)Rulesforapplyingrollerbandage
5)Typesofsling
PARTE WRITEESSAY: (20marks)
1)Rulesandprinciplesoffirstaid
2)Burnsmanagement
3)Firstaidmanagementforpoisoning
4)Managementofbleeding
5)Managementofinsectbite

169
8.HOSPITALHOUSEKEEPING
Awellmanagedhousekeepingdepartmentcanreducethecostofhospitaloperationconsiderably.
Ifthehospitalhousekeepingisofpoorquality,nursingcaresuffers,nursingeducationisadversely
affected,efficiencyisloweredandthemoraleisimpaired.
PRINCIPLESOFGOODHOUSEKEEPING
1) Thedustingcanbedonebestbyadampdusterorbyanoiledcloth.Adrydusterscattersthe
dust.
2) Dustingisdoneaftersweepingandnotbefore
3) Soapandwaterareusedforcleaning.
4) Frictionaidsinmechanicalcleaning.Usebrushwhencleaningagroovedsurface..
5) Abrasivesareharmfultothepaintedandpolishedsurface.
6) Albuminousmaterials(e.g.,bodydischarges)arecoagulatedbytheheat.So,itshouldbe
removedwithcoldwater.
7) Bacteriagrowindark,moistanduncleanplaces
8) Exposuretosunlightdestroyssomebacteria
9) Disinfectionbychemicalsdependsuponthecleanlinessofthearticle,thestrengthofthedisinfectant
andthelengthofexposure.
10) Effectivesterilizationdependsuponthecleanlinessofthearticles,thedegreeofheatandthe
lengthofexposure
11) Heat,chemicals,abrasivesandsolventsareharmfultosomematerials.
12) Choosingthecorrectandthesimplestmethodofcleaning,savestime,materialandenergy
13) Equipmentsuitableforthepurposeforwhichitisusedandingoodcondition,conveniently
locatedandarranged,savestimematerialandenergy.
14) Thecleaningarticlesarestoredinaneatandtidyalways.
CLEANLINESSANDORDERLINESS:
Cleanlinessandorderlinessgohandinhand.Nursesareheldresponsibleforthecleanlinessof
thewards.
Purposeincleaning:
1) Toleaveacleanpolishedsurfacewherepossible,sothatdirtmaynotbeaccumulated.
2) Toremovealldust,dirtandbreedingplacesofmicroorganismswiththeleastdisturbanceto
thepatient.
3) Toprolongthelifeofthearticles.
4) Tokeepthearticlesinsuchaconditionthattheyarereadyforuseatanytime.
5. Tomaintaintheaestheticfactors.
170
CAREOFRUBBERGOODS:
Therubbergoodsincommonusearemackintosh,hotwaterbottles,icecaps,icecollars,rubber
tubes,catheters,glovesandrubberbeds.
Naturalandsyntheticrubberdeterioratewithage,exposuretoheat,light,moisturesandbychemi
cals.Rubbergoodshouldneverbedriedbyartificialheat,norbycontactwiththeradiatororstove.It
shouldbefreefromGreeceandacids.
Ifautoclavingisused,shortperiodsofexposurearerecommended(1015minutes).
Cleaningofrubbermackintosh:
1) Spreadthemackintoshonthetableoraflatsurfaceandwetwithcoldwater
2) Rubtheuppersurfacewithsoapandwater
3) Turntheothersiderubwithsoapandwater
4) Ifstrainsarepresenttoberemoved.
5) Fordisinfectionuselyzolordettol1:40
6) Hangthemonahorizontalcylindricalpole
7) Bothsurfacesabsolutelydrypowderthem.
8) Storethemflatorrolled,neverfolded.
9) Storetheminadarkcoolplace.
CareofRubberGloves:
1) Itisdesiredthattheweareroftheglovesshouldwashontheirhandsjustbeforetheyare
removed.
2) Afterremovingfromthehands,theyarewashedwithsoapandcoldwater,firstontheoutside
theninvertandrepeatontheinside.
3) Rinsewellwithwaterbothinsideandoutside
4) Holesandtearsarediscoveredbysubmergingtheglovefilledwithairinthewater.Ifthere
holes,separatethegloves.
5) Hangthemtodry.
6) Turninsideoutanddry
7) Whenbothsidesaredry,powderedinsideandoutsideandpackedinpairsofthesamesize.
8) Steamunderpressureisthebestmethodofsterilizinggloves.
CareofRubberTubes:
Cathetersvaryinsizeandqualityaccordingtothespecialneeds.
Cleaningofrubbertubes:
1) Afteruse,washthemunderrunningwater
2) Asmallquantityoforganicmattermaybelodgedattheeyeend.Removethemusingaswap
stick
3) Cleanthemwiththesoapandwater
171
4) Washthemagainunderrunningwater
5) Boiledtubesfor5minutesbyputtingthemintheboiledwater.
6) Dryitbyhanging
7) Whendried,powderedandstoretheminairtightcontainer
8) Reboilorautoclavethembeforeuse.
CAREOFENAMELWARE
Thearticlescommonlyusedarebedpans,urinals,kidneytrays,sputumcups,feedingcupsand
trays.
Careofthebedpans:
1) Beforeemptyingthebedpans,inspectthecontents.Iftherearecottonspongesorsanitarypads
shouldberemovedbyusingaforceps.
2) Emptythebedpantoalavatorypan
3) Rinsethebedpanwithcoldwaterunderforce
4) Washwithsoapandwarmwaterusingabrush
5) Todisinfectantthebedpans,soaktheminLysol1:40
6) Bedpansmaybeplacedindirectsunlightforfewhours
7) Keepthemdryforthenextuseonthebedpantrack
Careoftheurinals:
Theurinalshouldnotbeleftstandingforalongtimewithurine.Itshouldbecleansedanddisin
fectedbyusingLysolsolution1:40
Careofthekidneytrays:
1) Beforeemptyingthekidneytray,inspectthecontents.Iftherearecottonspongesorsanitary
padsshouldberemovedbyusingaforceps.
2) Emptythekidneytraytoalavatorypan
3) Rinsethekidneytraywithcoldwaterunderforce
4) Washwithsoapandwarmwaterusingabrush
5) Todisinfectantthekidneytray,soaktheminLysol1:40
6) Kidneytraymaybeplacedindirectsunlightforfewhours
7) Keepthemdryforthenextuseonthekidneytraytrack
Careofthesputumcups:
NoninfectioussputummaybeemptiedLavatorypan.
Infectioussputumshouldberenderedbyboilingordisinfectionbychemicalsordisposedbyburning.
CAREOFINSTRUMENTS
Careofsharpinstruments: Theknifesandscissorsarethemostcommonlyusedsharpinstruments.
Sharpinstrumentsaresterilizedbyhotairsterilizerexposingintoatemperatureof160cforanhour.
Chemicaldisinfectionscanbedonebysubmergingthemfullyunderpuredettolorotherdisinfectants.
172
Careofotherinstruments: Operationtheatreinstrumentsshoulddropintoabasinorbucket.Rinse
theinstrumentsthoroughlywithcoldwatertoremovethebloodorotherorganicmatter.
Cleantheinstrumentswithsodiumcarbonate(2%)andhotwater.
Careofglassware: Cleaningoftheglasswareshouldhaveahardsmoothsurfacegroundglasssusceptible
toerosionbywaterorsteam.Itshouldbesterilizedwithdryheat.Glasswaresusedfortheparenteral
therapyshouldberinsedwithfreshlydistilledwater.Whentheglassgoodsaresentforautoclavingor
boiling,shouldbeadequatelypaddedtopreventbrakingbyrubbingwithhardsurfaces.
Careofsyringesandneedles: Syringesareexpensiveandcommonitemoftheglasswareusedin
thehospital.Rinsingimmediatelyafterusetopreventthepistonsstickingtothebarrels,thusprolonging
thelifeofsyringes.
Stucksyringesplacedin25%ofaqueoussolutionsofglycerineandboiledfor10minutes.
Whencleaningandsterilizingthesyringesofthesamenumbershouldbekepttogether.Steriliza
tionbyhotairisthebestmethodofsterilizationofglasssyringes.
Theimportantpointstoremember
1) Afterusecoldwaterisforcedthroughtheneedlewiththesyringes
2) Againwashitwithwarmwater
3) Iftheneedlesareblockedwirestillestareusedtoremove
4) Needlesaresterilizedby1020minutes.
Careofthestainlessgood:
Stainlesssteelutensilsaresuitableforalmosteveryotherpurposebecausetheyareeasilycleaned,
heatresistantandunbreakable.
CAREOFLINEN
Careoflinenisimportantandexpensiveiteminthehospital.
Rules:
1) Thelinencupboardshouldbekeptinperfectorder.
2) Thecupboardsshouldbelockedwhennotinuse.
3) Careshouldbetakentoavoidlinenbeingtakenhomebythepatients
4) Stockshouldbecheckedatregularintervals.
5) Allitemsshouldbeusedforthepurposesforwhichtheyweremade.
6) Tornlinenshouldnotbeusedonthebedbutsentformending
7) Soiledlinenshouldnotbeplacedonthefloor
8) Damplinenshouldbedriedimmediately.
9) Ifsoiledwithurineormotion,theseshouldberinsedwithcoldwater
10) Removethestrainwherestrainingisunavoidableoldlinenshouldbeused.
173
11) Theinfectedlinensshouldbedisinfectedfirst.
12) Usemackintoshwhereveritisnecessarytoeconomizetheuseoflinen.
Generalinstructionsforremovalofstrainsfromthelinens:
1) Trywhetherthestrainscanberemovedwithcoldwater.
2) Thestrainswhichcontainsproteinssuchasblood,excreta,milk,pusfromthewoundare
coagulatedbytheapplicationofheat
3) Ifthestrainscontainedfattymaterial,hotwaterandsoakshouldbeused.
4) Whenthestrainsdonotresponsetothesimplemethods,bleachingagentsmaybeusedsuchas
lemonjuice,hydrogenperoxideandbleachingpowder.
5) Useequalpartsofhydrogenperoxideanddiluteammoniaandmoisturethestrainuntildisappears.
Bloodstains: Soakimmediatelyincoldwater.whenthestainsdisappear,washtheminwarmsoapy
water.Ifitisoldstain,soaktheminamixtureofhydrogenperoxideandammonia.
Forthethickbloodstainsonthemattress,applyathickpasteofstarchandwaterandallowto
standinthesun.Whenthepasteisdryanddiscoloured,brushoffthestain.
Teacoffee,coco: Linenwhenitisstainedwithtea,coffee,andcoco,removeitbypouringmilkoverit.
Washingthemincoldwaterorhotwater.Sodiumcarbonatewillremovethestains.
Rustmarks: Applysaltandlimejuiceandexposedtosunlight
Inkstrain: Sprinklesaltandlimejuiceandlayinthesuntobleachthestrain
Careofblankets: Theseareexpensivearticlesanddonotstandwashingorsteamdisinfectionswithout
shrinkage.Blanketsshouldbeprotectedbysheetsbyunderandoverit.
Blanketsarecleanedbydrycleaningtodisinfectthembyexposingthemtosunlight.Whenstoring
blanketsshouldbecarefullyprotectedfrommothusingnaphthaleneballs.
Careofmattressandpillows:
Mattressshouldbebrushedatregularandfrequentintervalstopreventcollectionofdustand
alongtheseams.Topreventrustingofthemattressfromthewiresorsprings,usecanvassbetweenthe
mattressandbedsheett.Whenthepatientdischarged,mattressshouldbethoroughlybrushedand
examineforstrainsandtears.Itshouldbetreatedatonce.Disinfectedbyexposingthemtosunlight.
Pillowsshouldbeprotectedfromwetwithbloodandbodilydischarges.Theyshouldbeprotectedwith
mackintosheswhentheyareusedforthepatientswithbleeding,vomitingetc.
CAREOFPATIENTSUNIT
Careoftheflooring: Floorsaremoppedwithmopsofgoodquality.Vacuumcleanersmaybeused.
Mostofthefloorswashedwithsoapandwater.
Woodenfloorsarekeptwellpolished.Theyaremoppeddaily.Watershouldbewipedofimmediately.
Cementfloorscanbecleanedwithhotwaterandweaksolutionofsodiumcarbonate.
Mosaicfloorscleanedwithmildalkalinesolutionsuchassoda,sodabicarbetc.
174
Careofthewalls: Cementandmarblewallscanbecleanedinthesamewayasthefloors.
Paintedwalls: Neverusecleaningsolutionsthatcontainsastrongalkaline.Paintedsurfaceshould
alwaysbecarefullyrinsedanddried.
Dailycleaning: Thepatientsunitissweptandmoppedtwiceorthriceadaytokeepitclean.The
furnitureshouldbemovedtocollectthedustpresentunderthem.Aftersweeping,allthearticlesare
dustedwithdampduster,dampenedwithdisinfectant.
Weeklycleaning: Theroofandwallsofthewallshouldbeswepteachweektoremovethecobwebs.
Theceilingfansaredustedwiththedampduster.Allthefurnituresshouldbescrubbed,washedand
carbolized.
Careofthesanitaryannex: Sanitaryannexattachedtothewardsconsistofbathingrooms,lavatories,
handwashingplaces,placeforwashingandstoringofbedpans,urinalsetc.
Bathingroom: Thefloorshouldbescrubbed,washeddailytopreventslipping.Nowatershould
stagnateinthebathingroom
Lavatories: Lavatoriespansshouldbecleanedwithvimorsanefresh,usingabrushifstrainsare
present,smearasmallamountofacidandwashitoff.Thepatientsandtherelativesshouldbetaught
regardingproperuseoflatrine.
Handwashingplace: Thedrainsmaybecomeblockedbytherefusethrownintothesinksbythe
patients.Theyshouldbetoldnottothrowintothesink.
Summary
Wellmanagedhousekeepingdepartmentcanreducethecostofhospitaloperation.
Effectivesterilizationdependsuponthecleanlinessofthearticles,thedegreeofheatand
thelengthofexposure.
Rubbergoodshouldneverbedriedbyartificialheatorbycontactwiththeradiatoror
stove.
Fordisinfectionofrubbermackintoshuselysolordettol1:40dilution.
Holesandtearsarediscoveredbysubmergingtheglovefilledwithairorwater.
Steamunderpressureisthebestmethodofsterilizinggloves.
Cleaningofrubbertubesareboiledfor5minutesbyputtingthemintheboiledwater.
Sterilizationbyhotairisthebestmethodofsterilizationofglasssyringes.
Needlesaresterilizedby1020minutes.
Removalofstrainsfromthelinensbyusingequalpartsofhydrogenperoxideanddilute
ammoniaandmoisturethestrainuntildisappears.
Mosaicfloorscleanedwithmildalkalinesolutionsuchassoda,sodabicarbetc.
175
QUESTIONS
PARTA ANSWERINONEORTWOWORDS:(Onemark)
1) Statesomerubbergoodsusedinhospitals?
2) Timeperiodrecommendedforautoclavingofrubbergoods?
3) Whatistheratiousedfordisinfectionofrubbergoodsbydettol?
4) Whichisthebestmethodofsterilizinggloves?
5) Howtodisinfectbedpan?
6) Whichoneisthebestmethodofsterilizingglasssyringes?
7) WhatIthetimedurationtosterilizetheneedles?
8) Howtoremovethestainsfromthelinen?
9) Whatisusedtocleancementfloor?
10) Howtoremoverustmarks?
PARTB MULTIPLECHOICEQUESTIONS:(Onemark)
1) Dustingcanbedonebestby
a)WetDuster b)DryDuster c)Alloftheabove d)Noneoftheabove
2) Bacteriagrowin
a)CleanPlacesb)DryPlaces
c)Dark,Moistanduncleanedareas
d)Areasexposedtosunlight
3) Howtoidentifytheholesandtearsinthegloves?
a)VisualInspection b)VisualInspectionwithgoodlight
c)Submergetheglovefilledwithairinthewater
d)Whilewearing
4) Sharpinstrumentsaresterilizedbyhotairsterilizerexposingintotemperatureat
a)Temperatureof160deg.celciusperhour
b)Temperatureof180deg.celciusperhour
c)Temperatureof200deg.celciusperhour
d)Temperatureof220deg.celciusperhour
5) Toremovebloodstain(thick)fromthemattressbymeans
a)Applyathickpasteofstarchandwater
b)Applylemonjuice
c)Washwithsoapandwater
d)Washwithhotwater
176
6) Blanketsshouldbecarefullystoredtoprotectfrommothbyusing
a)UsingNaptheleneballs b)Usinginsecticides
c)Usingcamphor d)UsingSandal
7) Mosaicfloorsshouldbecleanedwith
a)Alkalinesolution b)AcidicSolution
c)Water d)Sodiumbicarbonate
8) Dustingisdoneby
a)BeforeSweeping b)AfterSweeping
c)DuringSweeping d)AfterMopping
9) Exposuretosunlightdestroy
a)Bacteria b)Virus c)Fungi d)Spirochete
10) Rubbergoodsshouldneverbedriedby
a)ArtificialHeat b)NaturalHeat
c)Air d)Dusting
PARTC WRITESHORTANSWERS:(5marks)
1) Explainpurposeofcleaning?
2) Describecleaningofrubbermackintosh?
3) Enumertate4thestepsincareofrubbergloves?
4) Howtocaresharpinstruments?
5) Howtocleansyringesandneedles?
PARTD WRITEINDETAIL: (10marks)
1) Elicitthegoodprinciplesofhousekeeping?
2) Explainthecareofgoodinstruments?
3) Explaintherulesincareoflinen?
4) Enumerategeneralinstructionsforremovalofstainsfromlinens?
5) Explainthecareofpatientunit?
PARTE WRITEESSAY:(20marks)
1) Explainhospitalhouse keeping?
2) Explainthecareofrubbergoods?

NURSING
PracticalI&II
VocationalEducation
HIGHERSECONDARYFIRSTYEAR
A Publication under
Government of Tamilnadu
DistributionofFreeTextbookProgramme
(Notforsale)
Untouchabilityisasin
Untouchabilityisacrime
Untouchabilityisinhuman
CollegeRoad,Chennai600006.
GovernmentofTamilnadu
FirstEdition2010
CHAIR PERSON
Dr. Mrs. P. Mangala Gowri
CollegeofNursing
MadrasMedicalCollege
Chennai600003.
Authors
Dr. Mrs.Prasanna Baby Mrs. M. Elizabeth
CollegeofNursing Government Higher Secondary School
ChengalpetMedicalCollege Ottanchantram.
Chengalpet.
Dr. Mrs.N. Jaya Prof. Kamala Subbaiyan
CollegeofNursing VenkateshwaraCollegeofNursing
MadrasMedicalCollege Chennai.
Chennai600003.
ThisbookhasbeenpreparedbytheDirectorateofSchoolEducation
onbehalfoftheGovernmentofTamilnadu
Thisbookhasbeenprintedon60GSMpaper
FOREWORD
The development of the text book Nursing resulted from the combined efforts many
talentedprofessional,committedtoexcellence.Specialrecognitionanddueacknowledgeishereby
madetotheDirectorofSchoolEducationandtheJointDirectorofSchoolEducationChennai.
Nursingisapracticalorientedprofession.Thenursehasmultifacetedroleinhospitalsettingsasa
careprovidetoclients,administrator,superviosor,etc.Butthemainroleplayedinthehospitalisthe
careprovider.Thenurseshouldbewelltrainedtomanageallpracticalsituationindifferentareasof
treatment.Sheshouldbeabletoassesstheclientofvariousconditions.Sheshouldbeskilledinprovid
ingcareaspertheassessmentfindings.
Thisbookiswrittenforthehighersecondarystudentswhoneedtogainthepracticalbefore
joiningtheprofessionalcourseinNursing.
Inthiseditionvariousbasicnursingprocedureshavebeendescribed.Thiswillbeaguid
anceforthestudentstogaintheskilltopracticenursing.Thiswillpavethewayfortheprofes
sionalcareerinfuture.
Dr.Mrs.P.MangalaGowri.
III
VOCATIONALNURSING
HIGHERSECONDARY
FIRSTYEAR
PRACTICALSI
IV
Sl. Procedure Date Signature
No. Ward Classroom
I. Bedmaking.
Unoccupied bed.
Occupied bed.
II. Basiccare
Mouthcare.
Backcare.
Sponging.
Nailcare.
Haircare.
Foot care
III. Recordingofvitalsigns.
Temperature.
Pulse.
Respiration.
Blood pressure.
PRACTICALSI
V
Sl. Procedure Date Signature
No. Ward Classroom
IV. Positioningofpatients.
Supine Position
Prone Position
LateralPosition
Fowlers Position
Dorsal Recumbent
Dorsal(Supine)Position
SittingPosition
Lithotomy Position
Kneechest Position
Sims Position
PRACTICALSI
VI
CONTENTS
NursingLaboratoryhours200periods
Clinicalhours 80periods
S.No Subject PageNo.
I. Bedmaking. 1
A.Unoccupiedbed. 2
B.Occupiedbed. 3
II. Basiccare 4
Mouthcare. 4
Backcare. 6
Sponging. 10
CareofFootandNails. 12
CareofHair. 14
III. Recordingofvitalsigns. 20
Temperature. 20
Pulse. 20
Respiration. 20
Blood pressure. 24
IV. Positioningofpatients. 26
VII
1
BED MAKING
BEDMAKING(Proceduretokeepbedcleanandcomfortable)
1) BED/COT:Metalrods/spring,Wood/plasticwire
Length :78inch.
Breadth :38inch.
Height :28inch
2) MATTRESS: Firm, thick smooth, with washable covers that are bigger than the
mattressmadeofcotton,coir,dunlop,air,water.
Length :190cms.
Breadth :90cms.
3) BEDSPREAD/TOPSHEET
Length :3mts.
Breadth :2mts.
4) DRAWMACKINTOSH:Shouldertobelowtheknees(rubberorplastic)
5) DRAWSHEET:drawnfromsidetoside
Length :150cms.
Breadth :110cms.
6) FOOTSHEET/BOTTOMSHEET
Length :108inch.
Breadth :76inch.
7) PILLOWS:Cotton/firmwithpillowcase
Length :60cms.
Breadth :45cms.
Thickness :10cms.
8) SPACEBETWEENCOTS:3to3.5feet.
Purposes
1) Toreceivethepatientcomfortably.
2) Togivetheunitorwardaneatappearance.
3) Toprovideasafebedtothepatient.
Guidelines
1) Worksystematically
2) Planthework
3) Collectequipmentintheorderthattheyaretobeused.
4) Arrangetheenvironmentconveniently.
5) Accomplishataskwitheachmovement.
2
6) Avoidtornlinen
7) Preventlinenawayfromyou.
8) Foldlinenandpreventtouchingthefloor.
9) Avoidplacingdirtylinenonthefloor.
10) Shakegently,donotflap.
11) Facedirectionofwork.
12) Workfromheadtofoot,fromneartofarandfromcleantounclean.
13) Makethebedsmooth,unwrinkledandflat
14) Tucklinenforenoughunderthematressandkeepitfixed,tightandsmooth.
15) Donotaltertheshapeofthemattress
16) Maintainbodymechanics
17) Ensuretheclientscomfortandsafety.
18) Ensureyourownpersonalsafety.
UNOCCUPIEDBED
Equipmentsrequired:
1)Carbolizationarticles,hamber,bucket,mattresswithcover.
2)Pillow,Pillowcase,Blanket,topsheet,drawsheet,DrawMackintosh,Bottomsheet,longmack
intosh.
Stepsforbedmaking:
1)Washhandsthoroughly.
2)Arrangethoroughlyinordertouseonastoolatthefootendofbed.
3)Carbolizethemattressandcot.
4)Turnthemattressandpullthecoveron.
5)Placebottomsheetwiththecreaseinthemiddleandrestinupperrightquadrantofmattress.
6)Unfoldandspreadstraight.
7)Tuck1218inchesunderthemattressonrightheadendwithhandsstraightandpalmsdown.
8) Makeamitredcornersandtuck.
9) Tuckatfootend.
10) Pulltightandtuckthesheetalongtherightside
11) Placedrawmackintosh15inch.fromthetopandtuckitalongtherightside
12) Placedrawsheetoverthemackintoshabout3.5inch.abovethemackintoshandtuckit
alongtherightside.
13) Gotooppositesideleftandtuckineachlinenasdoneontherightsidebutfanfoldandtuck
thedrawsheetontheleftside.
3
14) Cometotherightsideandplacethetopsheetwiththecreaseinthemiddleandrestofthe
sheetinrightlowerquadrant.
15) Unfoldthetoplayersandtuckatthefootendandmakemitredcornerontherightside.
16) Spreadtheotherendoverthemattressabout15inch.fromtheheadend.
17) Tuckalongtherightside
18) Gototheleftsideandtuckasdoneontherightside.
19) Ifablanketisusedthenspreadandtuckitlikeafootsheet.
20) Placethepillowwiththecoverattheheadend(openendawayfromtheentrance)
21)Coverbedwithcounterpan.
22) Straightentheunit,inorder
23) Cleanandreplacethearticles
24) Washhands.
OCCUPIEDBED: Makingabedwiththepatientinit(usuallydonebytwopersons)
ArticlesRequired: Likeforanunoccupiedbedandaircushion,BedCradle/Backrest/footrest,
serveralpillows.
PROCEDURE
1) Untucksheet,allaround,rollitontherightside.
2) Turncoveredpatienttotheleftsideandsupportwithpillows.
3) Carbolizerightside.
4) Rolltopsheetlengthwiseandplaceontherightside
5) Rolldrawmackintoshandplaceontherightside.
6) Gentlyturnthepatienttotherightsideandsupportwithpillows.
7) Secondnurseremovessoiledsheetsandcarbolizetheleftside,thenpulls.
8) Thepatientliesinthesupineposition.
9) Bothnurses,shouldtightenandtuck,thesheetsontheirrespectivesidesandmakemitred
corners(fanfolddrawsheetontheleftside)
10) Liftpatientslegs(secondnurse)
11) Placethefootsheet(firstnurse)atthefootend.
12) Spreadthesheettooppositeside
13) Tucktoplayerandmakemitredcorneratfootend.(rightside)
14) Firstnurseliftspatientslegssecondnursetuckattheleftside
15) Pullotherendofthetopsheetoverpatientslegandcoverhim.
16) Ifpatientcanbeliftedbutnotturndobedfromheadendtothefootend.
4
BASIC CARE
MOUTHCARE: Themouthcavityislinedwithmucousmembranecontinuouswiththeskin.The
mucousmembraneisanepithelialtissuethatlinesandprotectsorgans,secretesmucoustokeeppas
sagewaysofdigestivesystemmoistandlubricated,andabsorbsnutrition.
PurposesofMouthCare
1) OralHygienehelpsmaintainthehealthystateofthemouth,teeth,gumsandlips.
2) Brushingcleansestheteethfromfoodarticles,plaqueandbacteria.
3) Brushingmassagesthegums.
4) Brushingrelievesdiscomfortresultingfromunpleasantodours.
5) Flossinghelpsremoveplaqueandtartarfrombetweenteethtoreducetheguminflammation
andinfection.
6) Oralhygienegivesasenseofwellbeing.
7) ProperOralhygienestimulatedappetite.
8) Toimprovetaste.
ProperMouthCare
1) Goodoralhygieneinvolvescleanliness,comfortandthemoisturizingthemouthstructures.
Propercarepreventsoraldiseaseandtoothdestruction.
2) Brushing,flossingandirrigationarenecessaryforpropercleansing.
3) Topreventtoothdecay,reducestheintakeofcarbohydrates,especiallysweetsnacksbe
tweenmeals.
4) Brushingoftheteethatleastfourtimesadayisabasictoaneffectiveoralhygiene(after
mealsandatbedtime).
5) Toothbrushesshouldbereplacedeverythreemonths.
6) Afterbrushing,throughrinsingisimportanttoremovedislodgedfoodparticles.
RiskfactorsforOralproblems:
1) Patientswhoareparalyzedorseriouslyill.
2) Unconsciouspatients.
3) Diabeticpatients.
4) Patientsundergoingradiationtherapy.
5) Patientsreceivingchemotherapy.
6) Patientshavingoralsurgery,trauma.
7) Patientswithimmunosuppressantdrugeg.HIVpatients.
CommonOralproblems: ThetwomajortypesofOralproblemsaredentalcaries(cavities)and
periodontaldisease(Pyorrhoea)
Dentalcaries isthemostcommonoralproblemofyoungerpeople.Thedevelopmentofthe
cavitiesinvolvesthedestructionoftoothenamelthroughdecalcification.Decalcificationisaresultofan
accumulationofmucin,carbohydratesandlacticacidbacilliinthesalivanormallyfoundinthemouth,
whichformsacoatingontheteethcalledplaque.
5
Periodontaldisease isthediseaseofthetissuearoundthetooth.Itisaninflammationofthe
periodontalmembrane.Itisthemostcommonproblemofpeopleover35yearsofage.
Thecalculusdepositonteethatthegumline.Thealveolarboneisdestroyedandtheteethloosen.
Halitosis(Badbreath)isacommonproblemoftheoralcavity.
Causes: (1)Poororalhygiene.
(2)Infectionoftheoralcavity
(3)Liverdisease
(4)Diabetes
Cheilosis isthedisorderinvolvescrackingofthelipsespeciallyattheankleofthemouth.
Causes: (1)Riboflavindeficiency
(2)Mouthbreathing
(3)Excesssalivation
Stomatitis isaninflammativeconditionofthemouth
Causes: (1)Vitamindeficiency
(2)Infectionbybacteria,virusesorfungi
(3)UseofChemotherapeuticdrugs
Glossitis isaninflammationofthetongueresultingfromaninfectiousdiseaseorinjurysuchasburnor
bite.
Gingivitis isaninflammationofthegumsusuallyresultingfromPoororalhygiene.
Oralmalignancies: Themostcommonsiteisatthebaseofthetongue.
Causes: (1)Pipesmoking
(2)TobaccoChewing
Equipments
Atraycontaining
1) Cottonswaborcleanpiecesinabowl
2) Forceps(arteryanddissectingforceps)
3) Gallicups2nos.(OneforGlycerineboraxanotherforsaltsolution)
4) Feedingcupwithsaltsolution
5) Kidneytrays2
6) Swabssticks
7) Rubbersheet
8) Towel
9) Washtowel
Procedure:
1) Placeallthearticlesatconvenientlyonthebedsidetable.
2) Explaintheproceduretothepatient.
3) Puttherubbersheet(mackintosh)withtowelandkidneytrayunderthechin.
4) Havethepatientrinsedhismouthwithsaltsolutionfromthefeedingcup.
6
5) Turnthepatientsheadtooneside.
6) Takethearteryforceps,wrapapieceoflinenaroundthetipoftheforceps.
7) Dipitinsidethesalinewaterandcleantheteethwithupanddownmovements.
8) Payspecialattentiontoinsidethemouth,gums,insidethecheeks,tongueandtheroofofthe
mouth.
9) Changelinenpiecesasoftenasnecessary.
10) Discardusedcottonintheotherkidneytray
11) Allowthepatienttogargleasmuchasnecessary.
12) Diptheswapstickinglycerineborax,swabgums,rootandsidesofthemouth.
AftercareofEquipments:
1) Cleankidneytraysandfeedingcupswithsoapandwater.
2) Boilforcepsandgallicupsaftercleaning.
3) Placeallarticlesintheirplacesaftercleaningandboiling.
CareofDentures:
Ifthepatienthasdentures,careshouldbetakentokeepthedenturesclean.Ifthepatientisunable
todoso,thenursehastoremovethedenturesbygraspingitwithgauzepieces,placetheminatumbler
orcupcontainingwater.Denturesarewashedcarefullybyusingbrush,toothpasteandcoolwater.
Water,whichistoohot,mayinjurethecompositionofdentures.Ifthepatientistodobyhimself,he
maybeassisted.Removedenturesofpatientswhoareunconscious,mentallyillandwhohavevomiting
orcoughspasm.
BACKCARE
Careofpressurepointsandpreventionofdecubitusulcer
Preventionofdecubitusulcerintheirpatientswhoarebedriddenisamajorresponsibilityofnurses
workinginahospital.Whenwewalkorstandonourtwofeet,theweightofourbodyisbornebyour
feet.Butwhenanindividualisconfinedtobed,theweightofhisbodyhastobebornebyhisbackor
sides.Theskinofthesolesofourfeetisverytoughandthickanditdoesnotbreakeasilyinspiteofthe
entireweightofthebodybeingsupportedbyit.Thenaturehasdesignedthesoleoftheskinforweight
bearingwhereastheskinoverthebackofthebodyisnot.Whenthereispressureontheskinofthe
backbecauseoftheweightofthebody,theskinbreaksandanulcerdevelops.
DefinitionofDecubitusUlcer: Adecubitusulcerisapressuresoreresultingfromprolonged
confinementinbed.
Areaswhicharelikelytobeaffected.
Whenapatientliesinsupineposition,thefollowingareasarevulnerabletopressuresores.
1) Backofthehead 2)Shoulderblades 3)Elbows
4) BaseoftheSpine 5)Buttocks 6)Heels
Whenapatientisinlateralpositionthefollowingareaswillbeaffected.
1) Edgeofear 2)Shoulders 3)Knees4)Ankles
7
Alloranyoftheprotuberantpartsofabedriddenpatientmaybecomeliabletopressuresores.
Thesevariouspicturesareillustratingdifferentbodypositionsandthepressureareas
Heels
(Calcaneus)
Sacrum
Elbows
(OlecranonProcess)
Scapulae
Backofhead
(Occipitalbone)
Malleolus
(medial
and
lateral)
Knee
(medial
andlateral
condyles)
Greater
trochanter
Llium
Shoulder
(acromial
process)
Sideofhead
(parietaland
temporalbones)
Ear
C.PronePosition
Toes
(phalanges)
Knees
(patellas)
Genitalia
(men)
Breasts
(women)
Shoulder
(acromial
process)
Cheekandear
(zygomatic
bone)
8
CausesofDecubitusUlcer:
Localcauses:(a)Pressure: Whenanybodyprominencepressesuponthebed,thetissueslying
betweenthemgetreducedbloodsupply.Ifthisconditionprolongs,thesuperficialtissuesnecroses,
skinbreaksdownandformationofanulcertakesplace.
Thefollowingconditioncausesprolongedpressure:
1) Leavingapatientinonepositionforalongtime.
2) Leavingapatientonabedpanforalongwhile.
3) Hardandlumpymattress.
4) Pressureexertedbysplintsandplastercasts.
(b)Friction:
1) Frictionfrombedclothesoranyothercauseirritatestheskinleadingtoinflammation.
2) Ifyoulieonabedsheet,whichhasaroughseaminthemiddleofit,forawhile,youwillnotice
theimpressionoftheseamonyourback.
3) Youwillalsoexperienceburningsensationandthepartwillberedcolour.
Thefollowingfactorscausefrictioninapatient:
1) Carelesspullingofpatientandhislinen.
2) Givingandremovingbedpancarelessly.
3) Leavingbroadcrumbs,orangeseedsandfoodparticlesonthebed.
4) Creasesinthebottomsheet.
5) Generalrestlessnessofpatient.
6) Rubbingtwoskinsurfacestogether.
(c)Moisture: Moisturemakestheskinswollen,unhealthyandeasilybreakable.
1)Thefollowingreasonsresultinmoistureoverthepressureareas:
1) Incontinenceoffaecesandurine
2) Severeperspiration
3) Leavingapatientinwetlinen.
4) Heat:Leavingapatientinonepositionforalongtime,thepartgetsheated.
5) Lackofcleanlinessandirritatingsubstancesontheskin.Eg.Perspiration,faeces,urineand
vaginaldischarge.
D.Fowlersposition.
Heels
(calcaneus)
Pelvis
(ischial
tuberosity)
Sacrum
Vertebrae
(spinalprocesses)
30

9
2)Predisposingfactorfordecubitusulcer:
1) Unconscious,helplessoracutelyillpatients.Thesepatientsareunabletoappreciatetheweight
ofpressureandchangetheirposition
2) Paralysedpatients(Paraplegicandquadriplegicpatients).Theyhavelostmotorandsensory
functions.
3) Patientswithincontinence(Spinalinjuries)
4) Agedpersons
5) Veryemaciatedandmalnourishedpeople
6) Patientswithdehydrationoroedema.
7) Veryfatpeople
8) Patientswithdiseaseaffectingcirculation.eg.Heartdiseasesandanaemia
9) Patientswithdebilitatingdiseasessuchascancerandtuberculosis.
10) Patientswithmetabolicdisorders.eg.Diabetes
Preventionofdecubitusulcers:
A)PreventPressure:
1) Establishaturningscheduleforbedriddenpatientsturnhourly.
2) Haveafirmcotandfoammattressforbedriddenpatientsuseextrapillows,padsandairringsto
reducepressure.
B)PreventFriction:
1) Whenchangingpositionofyourpatientlifthimanddonotdraghimontobed.
2) Keepsheetswithoutwrinklesandseams.
3) Keepbedcleanandfreefromcrumbs.
4) Ifpatientisrestless,protectpressurepointswithsoftpads.
C)PreventMoisture:
1) Keepdressingsandbeddryandclean.
2) Cleananddrytheincontinentpatientspromptly.
D)PreventPredisposingcauses:
1) Improvepatientshealthbymeansofgoodfood,ventilation,sunlightandexercises.
2) Encouragecirculationthroughmassage.
3) Havepatienttoambulateearly.
E)Observeearlysignsandsymptomsofdecubitusulcers:
1) Redness
2) Darkdiscoloration
3) Bruising
4) Tendernessofthearea
5) Burningsensation
10
F)Givegoodcaretopressurepoints:
Carefulcleaningandmassageshouldbecarriedout3or4timesadayforallbedriddenpatients.
Forsomepatients,itisnecessarytogivecareasoftenaseverytwohours.
Equipment
1) Abowlofwarmwater
2) Spongecloth
3) Soap
4) Towel
5) Dustingpowder
6) Spirit
Procedure:
1) ExplainproceduretopatientArrangearticlesatthebedside.
2) Screenthebed
3) Wetthepartwithsoapyhandmassagetheareaincircularmovementsothatthetissuesunder
theskingetsincreasedcirculation.
4) Removesoapbywashing.
5) Drytheareas
6) Applyspiritovertheareamassagewell.Spirithelpstohardentheskin.
7) Applylightlydustingpowdertokeepthepartthoroughlydry.
8) Dothistreatmenttoallpressurepoints.
9) Ifthepatientisincontinent,applyzinccreaminsteadofspiritandpowder.Thisprotectstheskin
frommoisture.
10) Leavethepatientcomfortableaftertheprocedure.
Treatmentofdecubitusulcer:
1) CleanulcerswithasepticprecautionsUseantisepticssuchaseusole(or)hydrogenperoxide.
2) Applymedicationorderedbythedoctor,eg.Antibioticointment,sharkliveroil,zincoxide,(or)
anyothertopicalapplications.
3) Coverwithsteriledressingsandbandage.
4) Surgicalformentation,ultravioletrays(or)heatlamparehelpfulinhealing.
5) Providegoodnutrition.
6) Preventsecondaryinfections.
SPONGING
Definition:Bathingthepatientwhileheisinbed.
Purpose:
1) Tocleansetheskinandthusincreaseeliminationthroughit.
2) Tostimulatecirculationthroughslightlyactive(or)entirelypassiveexercise.
3) Torefreshthepatientbyrelievingfatigueanddiscomfort
11
GeneralInstructions:
1) Thetemperatureofthewatershouldbe105
o
F107
o
F(40
o
C44
o
C).
2) Thewatershouldbechangedwhenitiscoolorsoapy.
3) Besuretoremoveallthesoapasitisirritatingtotheskin.
4) Donotexposethepatientunnecessarily.
5) Observethepatientsskinwhilebathing.Particularlyifitisthefirstbathafteradmission.It
offersanopportunityforthenursetoobserveanyrashesorpressuresores.
Equipment
1) Mackintosh(long)andtwobedsheets.
2) Soapinasoaptray
3) Twospongingpads
4) Towelone
5) Linentochange(Gown)
6) Twojugscontaininghotandcoldwater
7) Basin
8) Bucket
9) Screen
10) Urinalandbedpan
Procedure:
1) Closethewindowordoorandscreenthebedtopreventdraughtandtoavoidexposure.
2) Tocollecttheequipmentnexttothepatientsbed.
3) Andarrangetheitemsconvenientlyatthebedside.
4) Explaintheproceduretothepatientandgethiscooperation
5) Protectthebedwithmackintoshandsheet.
6) Removethepatientslinenandcoverthepatient
7) Takewaterinthebasinandfeelwiththebackofyourhand.Thetemperatureshouldbecomfortably
hot.
8) Withwetspongepad,moistenthepatientsfacefirst.
9) Applysoap.Carefullywashpatientsface,ears,andfrontoftheneck.Drywiththetowel
10) Washthelefthandfirstandtherighthand.Supportpatientsarmbyholdingthewrist.Washwell
betweenfingersifdesired.Thepatientmayplacehandsinbasin.
11) Removethesheetuptothewaist,askthepatientstokeepthearmsabovehishead.Itwillbeeasy
tocleantheaxillaeinthisposition.
12) Cleanchestandabdomen
13) Changewaterandturnthepatienttothesideandspongehisback.Givelongfirmstrokesfrom
backofnecktothebuttocks
14) Watchforanyrednessoverthepressureareas.
12
15) Dotheleftlegfirstandthentheright.Havethepatientskneeflexedsotofacilitatewashing.Give
thebedpanandaskthepatienttocleanthegenitals.Ifthepatientisunabletodohelptodoitfor
him.Patientshouldbegivenprivacyduringthisprocedure .
16) Thebackcareisdonebyapplyingalcohol,massageback,anduselongfirmstrokesstartingfrom
backoftheneckoutovertheshouldersanddowntothebuttocks.Usealsorotatormotionto
increasethebloodcirculation.Extraattentiontobegiventothepressureareas.
17) Applypowderifindicated.Thisdependsupontheconditionoftheskin.Iftheskiniswrinkledthe
applicationofpowderisnotadvisable.
18) Ifthepatientishavingdribblingofurine,zinccreamisapplied
19) Roleupthemackintoshandsheetwhenthepatientisontheside.Thenremoveitfromtheother
side.Putthesoiledlineninthereceptacle.
20) Dressupthepatientandremovethetopsheet.
21) Thebedismadetidy.
22) Thepatientisgivenawarmdrink.
23) Removethearticlesfromthebedside.
24) Cleanandreplaceinrespectiveplaces.
25) Sendsoiledlinenforwash.
TypeofTherapeuticBaths
1) Hotwatertubbath:Immersioninhotwaterhelpsrelievemusclesorenessandspasm.Water
temperatureshouldbe45
o
Cto46
o
C.
2) Warmwatertubbath: Bathinginwarmwaterrelievesmuscletension.Watertemperature
shouldbe43
o
C.
3) Coolwaterbath:Bathingintepidwaterhelpstolowerbodytemperaturewhenthebody
temperatureisover40
o
C(104
o
F).Watertemperatureshouldbe37
o
C.
4) SitzBath: Cleansesandreducesinflammationoftheperinealandanalareasofapatientwho
hasundergonerectalorperinealsurgeryorinhaemorrhoidsorfissures.Watertemperature
shouldbe43
o
Cto45
o
C.
5) Coldsitzbath: Coldsitzbathismoreeffectiveinrelievingpaininthepostoperativeperiod.
6) Backruborbackmassage promotesrelaxation,relieves,musculartensionandstimulates
skincirculation.Aneffectivebackrubtakes35minutes.
CAREOFTHEFOOTANDNAILS: Thefeetandnailsrequirespecialattentiontoprevent
infection,odours,andinjurytotissue.Peopleareunawareoffootornailproblemsuntilpainor
discomfortoccurs.Problemsmayresultfrompoorcareofthefeetandnailssuchasbitingnailsor
trimmingthemimproperly,exposuretochemicalsandwearingpoorlyfittedshoes.
Purposesofcareofthenails
1) Tokeepnailsharmless
2) Topreventaccumulationofdirtunderthenailsandreduceoccurrenceofinfection.
Characteristicsofahealthynails:Anormalhealthynailistransparent,smoothandconvexwith
pinknailbedsandtranslucentwhitetips.
13
Careofnailandfoot:
1) Inspectthefeetdailyincludingthetopsandsolesofthefeetandtheareabetweenthetoes.
2) WashandsoakthefeetdailyusingLukewarm(37
o
C).
3) Ifthefeetperspire,applyablandfootpowder.
4) Ifdrynessisnotedalongthefeet,applysoftoilandrubgentlyintotheskin.
5) Filethetoenailsstraightacrossandsquare.
6) Avoidwearingelasticstockings.
7) Wearproperlytoimprovecirculationtothelowerextremities.
8)Immediatelywashminorcutsanddrythemthoroughly.Mildantisepticsmaybeappliedtothe
skin.
Riskfactorsforfootandnailailments:
1) Patientwithperipheralvasculardiseaseeg.Diabetesmellitus.
2) Patientswithneuropathy(degenerationofperipheralnervescharacterizedbylossofsensation)
3) Poorillfittingfootwear
4) Poorknowledgeoffootandnailcare.
Commonfootandnailproblems
1) Callus: Isathickenedportionofepidermiscausedbylocalfrictionorpressure.
2) Corns:Iscausedbyfrictionandpressurefromshoes.Itisseenmainlyontoes,overbonyprominence.
3) Plantarwarts:Arefungatinglesions,appearingonsoleoffootandiscausedbyPapillomavirus.
4) Athletesfoot:(Tineapedis) isthefungalinfectionoffootmainlyinducedbywearingofconstricting
footwear.
5) Ingrownnails: Toenailsorfingernailsgrowinwardintosofttissuearoundnailresultingfrom
impropernailtrimming.
6) Paronychia: Istheinflammationoftissuesurroundingnailsfollowinganinjury.Itiscommon
amongdiabeticpatients.
7) Footodour:Areresultofexcessiveperspirationpromotingmicroorganismgrowth.
Equipment:
Atraycontaining
1) Apairofscissorsoranailclipper.
2) Wetswabsinasmallbowl.
3) Ajugwithwaterforwashinghands.
4) Akidneytraywithdettol1in40solution.
5) Softnailbrush.
6) Apaperbag.
7) Atowel.
14
Procedure:
1) Assemblearticlesatthebedsideofthepatient.
2) Explaintheproceduretothepatientandgethiscooperation.
3) Placetowelunderthehands.
4) Washhandsofpatientwithsoapandwater.Usebrushifthenailsareverydirty,soaknailsin
watertocutthemeasily.
5) Cutfingernailstotheshapeofthenails.Cuttoenailsstraightacrosstopreventingrowingtoe
nails.Takecarenottoinjuretheflesh.
6) Receivesoiledwipersinthepaperbag.
7) Washhandsanddry.
8) Cleanandsterilizenailclipper/scissorsandreplaceintheirproperplace.
9) Disposeofsoiledwiperswiththepaperbag.
CAREOFTHEHAIR: Careofthehairisapartofdailyhygiene.Apersonsappearanceanda
feelingofwellbeingdependonthewaythehairlooksandfeelshairgrowth,distributionandpattern
canbeindicatorsofgeneralhealthstatus.
Properhaircare:
1) Frequentbrushinghelpskeephaircleananddistributesoilevenlyalonghairshafts.
2) Shorttoothcombsareadequateforshorthairs.
3) Largetoothcombsarepreferableforcurlyhair.
4) Avoidusingcombswithsharpandirregularteeth
Factorsthataffectthecharacterofhair
1) Hormonalchanges
2) Emotionalandphysicalstress
3) Ageing
4) Infection
5) Certaindiseaseslikecancer
6) Certaindrugslikechemotherapy.
Commonhairandscalpproblems:
1) Dandruff: Dandruffisthescalingofscalpaccompaniedbyitching.Inseverecases,dandruffis
foundoneyebrows.
2) Pediculosis(lice): Tinygrayishwhiteparasiteinsectsinfesthumanbeings.
a) Pediculosiscapitis(headlice): Parasiteisfoundonscalpattachedtohairstrands.
b) Pediculosiscorporis(bodylice): Parasiteclingstoclothingandsucksblood.
c) Pediculosispubis(crablice): Parasitesarefoundinpubichair.
3) Hairloss(alopecia)
15
Purposes:
1) Tomaintaincleanliness
2) Topreventmatting.
3) Topromotecomfort
4) Toremovedirtanddandruffbycombingandbrushing
5) Togiveexercisestoscalp
6) Togetanopportunitytoexaminethescalpandthehairofpatientswhoareacutelyill.
7) Tosoothenthepatientandtohelpinducesleep.
Equipment
Atraycontainingthefollowingarticlestobetakentothebedside.
1) Brushandcomb
2) Alittleoilinasmallbottle
3) Kidneytraywith1in40dettolsolution
4) Cottonswabs(wet)
5) Ribbon
6) Towel
Procedure
1) Arrangearticlesattherightsideofthepatient.
2) Explaintheproceduretothepatientandgethercooperation
3) Getthepatienttositupifherconditionpermits
4) Placeatowelaroundtheshoulderstopreventsoilingherbedclothes.
5) Smearyourfingerwithoilandapplyonthescalpandhair.
6) Massagescalpinacircularmovementtopromotegoodcirculation
7) Brushandcombhairfreefromtangles.Takeafewstrandsofhairatatime.Holditwithyour
lefthandtightlyattherootofthehairtopreventpullingofhairandcombitfromtoptodownwards.
Wipethecombwithwetswabsandexamineforpediculi.Disposeofsoiledswabsinapaper
bag.
8) Braidthehairandtiewithribbon.
9) Keeppatientcomfortableandcleanandarrangetheequipment.
ATTENDINGHAIRCAREWASHING
Purpose
1) Tokeepthehaircleanandhealthy.
2) Topreventitching,infection,infestation
3) Toprovideasenseofwellbeing
4) Todestroypediculi
16
Supplies:
1) Combinghairoil,combandpaperbag.
2) Washing
A)Atraycontaining
a) Hotandcoldwaterinjugs.
b) Abasinandamug
c) Protectivesheetstwo,onelargeandonesmall.
d) Apieceofbandage.
e) Soap/Shampoo
f) Littlecottoninbowl
g) Washcloth
h) Bathtowel
i) Hotwaterbottlewithcover.
B)Bucketone
(N.B.Makeatroughoflargeprotectivesheetwithapieceofbandagerolledinit.)
Fortreatingpediculosis
A)Pediculosiscapits(Headlouse)
Agownforthenurse
Atraycontaining
a) Finetoothcomb
b) Parasiticide
c) Antisepticlotioninakidneytrayandpaperbag.
d) Suppliesforwashinghairinbed(asabove)incasepatientisbedridden.
B)Pediculosiscorporisorvestimenti(Bodylouse)ReferAntisepticBathinprocedureApplyingHot
Applications.Forcepstopickuplicefromeyebrowsandeyelashes.
C)Pediculosispubis(Crablouse)
Atraycontaining
a) Protectivesheetandtowel
b) Bowlofwarmwater
c) Razorandblade
d) Soapandbrush
e) Antisepticlotioninakidneytrayandpaperbag.
Guidelines
1) Combing:Hairarecombedandarrangedinthestylethepatientprefersatleasttwiceaday.
2) Whenwashingthehair,followasunder
17
a) Thepatientsaregivenhairwashatleastonceaweekandbedriddenpatientsaregiven
hairwashinbed.
b) Avoidhairwashforthepatientwhohasjusttakenmealsatleastforanhour.
c) Avoidexposureandchillingby
Keepingthepatientcoveredwithtopclothes.
Closingthewindowsanddoorsoftheroom
Keepingtheroomwarm
Finishingthehairwashquickly
d) Ifthepatientisverysick,notepulsebeforeandafterthehairwash.
e) Donotletthepatientexert.Trytoavoidexertiontothepatientasfaraspossible.
3)Whentreatingpediculosis,nursemusthavefollowinginformation.
a) Thepediculiaresmall,greycoloured,bloodsuckingparasiteswhichliveforseveral
daysinthehair.Thefemalelaysabout50eggs/nitswhicharegreyorwhiteincolour,
clingtohair.
b) Thesymptomsofpediculiare
A)Itching
a) Scalp,neckandbehindearsinheadlouse.
b) Alloverthebodyinbodylouse.
c) Onandaroundthepartaffectedincrablouse.
B) Rash
a) Neckandbehindearsinheadlouse
b) Alloverthebodyinbodylouse
c) Onandaroundthepartaffectedincrablouse.
C)Sores
a) Scalpinheadlouse
b) Bodyinbodylouse
c) Onthepartaffectedincrablouse
Thecommonparasiticidesusedare:a) Mediker.b)Cyban
NursingActivity
a) Washyourhandsandputongown
b) Takesuppliestothebedside
c) Maintainprivacybyusingscreen
d) Explaintheproceduretothepatient
e) Givehaircare
18
1)Combing
a) Loosenthehair
b) Applyoiltohairifnecessary
c) Coombandarrangethehairinthestylethepatientprefers.
d) Ifhairarebraided,securetheendofbraid.
e) Replacethesupplies
2)Washing
1) Positionthepatientbringingheadontheedgeofbedandshouldersraisedonapillow
sothatheadisslightlydown.
2) Placetheprotectivesheetandbathtowelunderthehead.
3) Placethetroughinthepatientsneckanddirectitintothebucket.
4) Placecottoninpatientearsandwashclothovereyes.
5) Loosenthehairandremovehairpins
6) Mixhotandcoldwaterandcheckthetemperatureofwateratthebackofhand.
7) Wetthehair,applysoapandshampooandworkupthelather.
8) Startcleaningatthehairlineandworktowardsthebackoftheheadandthentothe
frontofheadsymmetrically.Massagethescalpfirstandthenthehairwiththefinger
tips.Addwaterasnecessarytoworkupthelather.
9) Rinsethoroughly.Squeezeoffwaterfromthehair.
10) Wrapbathtowelaroundthehair.
11) Removethetroughandslipthepillowundertheheadbyraisingheadandshoulder.
Placepatientsheadonprotectivesheetoverthepillowandrubtheheadgentlywith
towel.Spreadthehairoutonbathtowelwithhotwaterbottleunderneathtodryin
winter.
12) Whenitisdryapplyoil,combitarrangeinthestylethepatientprefers.
13) Remove,clean,dry,andreplacethesupplies.
1)Treatingpediculosis
I) Prediculosiscapits(Headlouse)
1) Putongownandfollowfirstfivestepsofwashing
2) Wetthehair,pourmedikeronhair,massagethescalpfirstandthenthehair
withfingertipsworkingfromthehairlinetowardsthebackandthenthefrontof
theheadsymmetrically.Addwaterasnecessarytoworkupthelather.Leave
thehairinlatherforfiveminutesandrinse.
3) Followtheprocedurementionedabove.
4) Repeatthetreatmentwithinfewdays
5) Removethesupplies,washandboilthesupplies,soakgown,clothesandlinen
incarbolicsolution1:20forfourhoursbeforesendingtolaundary.
19
II) Pediculosiscorporis/vestimenti(Bodylouse)
1) Giveadisinfectantbath
2) Applyantisepticointmenttohealanyinjuriesproducedbyscratching
3) Followsteps4and5asabove
III)Pediculosispubes(Crablouse)
1) Thehairofaffectedareas(PubesorAxillae)shavedandburnt.
2) Applydisinfectantintotheareasandaftersomehourspatientgivenbath.
3) Incaseeyebrowsandeyelashesareaffected,pickuplicewithforcepsand
applytwopercentofyellowoxideofmercury.
4) Followstep5asabove
5) Washyourhandsthoroughly
Recording
Recordinthenursesnotesasunder
1. Combing: anydandruff,pediculosisoranyotherabnormalconditionregardinghairorscalp.
2. Washing: timeofgivinghairwash,soap,shampooused,patientsreaction.
3. Treatingpediculosis: Thetime,parasiticideusedandtheeffectoftreatment.
QUESTIONS
PARTA ONEWORDANSWERS:(Onemark)
(a)Meaningofthefollowingterms:
1.Cheilosis 2.Halitosis 3.Gingivitis
4.Callus 5.Decubitusulcer 6.Paronychia
7.Allopecia
PARTB MULTIPLECHOICEQUESTIONS: (Onemark)
1)ThetermPyorrhoeameans
(a)Pusfromthegums (b)Bleedingfromthegums c)Badbreath
2)Oralhygienehelpsto
(a)MaintainHealthystateofthemouth
(b)Stimulateappetite
(c)Alltheabove
3)Coatingoftheteethiscalled
a)Plaque b)Mucin c)Gingivae
4)Cheilosisiscausedby
a)Thiaminedeficiency b)Riboflavindeficiencyc)Irondeficiency
5)Commonsitesfordecubitusulcerinsupineposition
a)Heels,sacrum,backofthehead.
b)Knee,Ileum,sideofthehead.
c)Toes,knee,cheekandears.
20
6)Signsofdecubitusulcer
a)Rednessanddiscolouration
b)Burningsensationandheadache
c)Noneoftheabove
7)Theantisepticsolutionusedtocleandecubitusulcer
a)Dettol
b)EusolandHydrogenperoxide
c)Savlon
8)Watertemperatureforsponging
a)105degreeto107degree
b)100degreeto104degree
c)99degreeto100degree
9)Sitzbathgivenfor
a)Perinealsurgery b)Abdominalsurgery c)Abdominalpain
10)PediculosisCapitis
a)Headlice b)Bodylice c)Crablice
PARTC WRITETHESHORTANSWERS:(5Marks)
1)Whatarethetypesoftherapeuticbaths?
2)Mentionthepurposesofhaircare?
3)Listoutthecommonfootandnailproblems?
4)Writethesymptomsofpediculosis?
5).MentiontheRiskfactorsfororalproblems?
6)Whatarethefactorsaffectingthecharactersofhair?
PARTD WRITEINDETAIL: (10Marks)
1)Listoutthepurposesofmouthcare?
2)Whatarethefactorsaffectingthecharactersofhair?
3)Mentionthecommonoralproblems?
4)Explainthecausesforthedecubitusulcer?
5)Explainthepredisposingfactorsofdecubitusulcer?
PARTEWRITEESSAY:(20Marks)
1)Describethenursesresponsibilitiesinhaircare?
2)Explaintheprocedureofmouthcare?
3)Describethestepsinprocedureofbedbath?
4)Mentionthecareofpressurepoints?
5)Describethecareofnailandfoot?
RECORDINGOFVITALSIGNS.
TEMPERATURE,PULSEANDRESPIRATION
ArticlesRequired:
Cleantraycontainingthree/fourthermometerinabottlecontainingdettol
lotion1:40withsomecottonatthebottomofthebottle
Kidneytray/paperbag
21
Bottlecontainingplainwaterwithsomecottonatthebottomofthebottle
Cottonswabs,soapyswabs,wetswabsanddryswabsPen,chart,watch
withsecondhandpulsemeter
YourresponsibilityfortakingTPR(temperature,pulse,respiration)
Identifythepatient
Checkthediagnosis
Abilitytoretainthermometer
PreviousmeasurementandrangeofTPR
Procedure
Washthehandbeforeandaftertheprocedure
Thermometeraredisinfectedinaproperdisinfectanttopreventcross
infectionfortherequiredtome
Beforeproceedingdeterminetherouteoftakingtemperature
Beforetakingoraltemperaturecheckwhetherthepatienthadanyhotor
colddrinks,chewinggum/betelleaves.Waitforatleast15minutes
Beforeplacingthethermometerinthemouthrinsethethermometerincold
watertoremovealldisinfectants
Donotusehotwaterforwashingthermometer
Beforeplacingthermometerinpositionwipeitfromthebulbtostemto
keepthebulbclean
Aftertakingthethermometerwipeitfromstemtobulbtoavoid
contaminatingthefingersofthecaregiverwithsalivaandfaeces.
Bringdownthelevelofmercurytoobtainaccuratereading
Iforaltemperatureistakeninstructthepatientnottobiteonit
Neverleavethepatientalongwiththermometerinposition
Readthethermometerateyelevelagainstlight
Neverholdthermometeratthebulb
Useseparatethermometerforpatientssufferingfrominfectiousdiseases
Storethermometerproperly
RecordTPRimmediatelyandaccurately
Nevermakethepatientconsciousthatyouarecountinghisrespiration
Counttheinspirationonlynotethecharacteristicsofrespiration
Nevercounttherespirationwhenthepatientisinthestateoftension
Explaintheproceduretothepatient
Tellthepatientnottodrink,eatorchewbetelleaves15minutespriorto
thetakingoforaltemperature
Placethepatientincomfortableposition
Keepthehandoverthechestreadyfortakingthepulse
Keepthethermometertrayatthebedsidewithnecessary
22
Aftercareofthepatientsandarticles:
Makethepatientcomfortable
Tidyuptheunit
Discardthecottonswabs
Afterinfectingthethermometeritshouldbewashed,dried,andputinother
containersandstorethemintheirproperplace
Washandrefillthebottleswithcleanlotionssothattheyarereadyforthe
nextuse
Ifanythermometerisbrokenitshouldbereplacedimmediately
Seethatalltheequipmentareinorder
Washhands
Ifanychangesinvitalsignsinformthedoctor
Ifthetemperatureisveryhighcoldtherapymaybestarted.
TEMPERATUREBYAXILARYMETHOD
1) Beforeplacingthethermometer,drytheaxilla
2) Placethebulbofthethermometerintheaxillasothatthebulbisintouchwiththeskinfolds
ofaxilla.
3) Keepthethermometerinpositionbyplacingthearmoverthechest
4) Donotallowclothingtocomeincontactwiththebulbofthethermometer
5) Havethethermometerinplacefor2minutes.Inauxiliarymethodleavethethermometerin
positionfor5minutes
6) Countthepulseandrespirationswhilethethermometerisstillinplace
7) Placethepatientshandoverhischestwiththewristextendedandthepalmdownwards.
Placethefingertipsoverthepulsepoint
8) Holdingthewatchinthelefthand,starttocountthepulseratewithzerothen1,2etc.
9) Ifthepulseisregular,countthenumberofpulsationsforhalfminuteandmultiplyitbytwo.If
thepulseisnotregular,counttherateforonefullminute
10)Continuepalpationofthepulsetoassesstherhythm,volume,tensionandirregularity
11) Withtherighthandstillonthepulsecountrespirationbywatchingtheriseofthechest,with
outtheknowledgeofthepatient
12) Iftherespirationsarenormalcountthenumberofrespirationsinthe30secondsandmultiply
by2.Iftherespirationsareabnormal,counttherateforfulloneminuteandnotethepattern
ofbreathing
13) Removethethermometersafter2minutes(after5minutesincaseofauxillarymethod).Wipe
thethermometerfromthestemtothebulbwithacleancottonswab,usingrotating
movements.Discardtheswab
23
14) Readthelevelofmercury
15) Returnthethermometertothebottleno:2shakingitdownagain
16) Washhands
17) Recordthetemperature,pulseandrespirationsimmediatelybeforeproceedingtotake
anotherpatientstemperature
RECORDINGOFRECTALTEMPERATURE
1) Washhands
2) Drawcurtainaroundbedorcloseroomdoor.Assistclienttosimspositionwithproperleg
fixed.Moveasidebedlinentoexposeonlyanalarea.Keepclientsupperbodyandlower
extremitiescoveredwithsheetorblanket
3) Applydisposablegloves
4) Holdendofglassthermometerwithfingertips
5) Readmercurylevelwhilegentlyrotatingthermometerateyelevel.Ifmercuryisabove
desiredlevel,grasptipofthermometersecurely,standawayfromsoiledobjectsandsharply
flickwristdownward.Continueshakinguntilreadingisbelow35.5celciusor95.9farenheit
6) Insertthermometerintoplasticsleevecover
7) Squeezeliberalamountoflubricantontissues.Dipthermometerbluntendintolubricant
covering2.5to3.5cmforadults
8) Withnondominanthandseparateclientsbuttocksintoexposeanus.Asktheclienttodeep
breathslowlyandrelax
9) Gentlyinsertthermometerintoanusinthedirectionofumbilicus3.2cmforadults.Dont
forcethethermometer
10) Ifresistanceisfeltduringinserting,withdrawthethermometerimmediately.Neverforcethe
thermometer
11) Holdthermometerinplacefor2secondsoraccordingtoagencypolicy
12) Carefullyremovethermometer,discardplasticsleevecoverinappropriatecontainer,and
wipeoffanyremainingsecretionswithcleantissue.Wipeinrotatingfashionfromfingers
towardbulb.Disposeoftissuesinappropriatecontainer
13) Readthermometerattheeyelevel.Gentlyrotateuntilscaleappears
14) Wipeclientsanalareawithsofttissuetoremovelubricantorfecesanddiscardtissue.Assist
clientinassumingacomfortableposition
15) Removeanddisposeofglovesinappropriatecontainer
16) Washhands
24
BLOODPRESSURE
Articlesandequipmentsrequired
Sphygmomanometer:Tomeasurearterialpressure
Bladderandcuff:Toexertequalpressurearoundthearterybeingauscultated
Stethoscope:Auscultatesarterialpressurewaves
Pen,pencilandflowchart:Fortimelydocumentationoffindings
25
Procedure:
Washhands
Supporttheclientsforearmatheartlevelwithpalmturnedup
Exposeupperarmfullybyremovinganyconstrictingclothing
Palpatebrachialartery.Positioncuff2.5cmabovesiteofbrachialpulsation
Withcufffullydeflated,wrapthecuffevenlyaroundtheupperarm
Palpatethebrachialarteryorradialarterywithfingertipsofonehandwhileinflatingcuffrapidly
topressure30mmofHgabovepointatwhichpulsedisappears.Slowlydeflatethecuffand
notepointwhenpulsedisappears.
Deflatecufffullyandwaitfor30seconds
Placethestethoscopeearpiecesinearandbesuresoundsareclear,not
muffled
Relocatebrachialarteryandplacebellordiaphragmoveritwithouttouchingtheclients
clothing
Closevalueofpressurebulbclockwiseuntiltight
Inflatecuffto30mmHgabovepalpatedsystolicpressure
Slowlyreleasevalueandallowmercurytofallatrateof23mmHg/sec
Notepointonmanometerwhenfirstclearsoundisheard
Continuetodeflatecuffgradually,notingpointatwhichmuffledordampenedsoundappears
Continuecuffdeflation,notingpointonmanometeratwhichsounddisappears
Removethecufffrompatientsarmafterdeflating
Washhands
Skillsequenceforbloodpressurerecording:
Recordthebloodpressureontheobservationchart
Documentanyabnormalitiesorirregularitiesandreportthemtothemedicalteam
Theexpectedoutcomeisthatthebloodpressureiswithinthenormalaveragerangewhenthe
cardiovascularstatusisnormal
Theunexpectedoutcomeisthatthebloodpressureisaboveofbelowtheexpectedrangefor
clientsage
Whenmeasuredbeforeadministrationofanyantihypertensive.Someinstitutionsrecommended
recordingpressureonmedicationchart.
QUESTIONS
PARTA ONEWORDANSWER:(Onemark)
1)Temperature
2)Pyrexia.
3)Bloodpressure.
4)WhatistheformulaforconvertingFahrenheitintoCelsius.
26
PARTB WRITETHESHORTANSWER:(5marks)
1)Whatarethetypesofpulse.
2)Mentionthetypesofthermometer.
3)Partsofstethescope
4)Whatarethecontraindicationsfororaltemperature.
5)Whataretheadvantagesofaxillatemperature.
6)Whatarethearticlesneededfortemperature.
PARTC WRITEINDETAIL:(10marks)
1)Explaintheprocedureoftakingtemperature
2)Explainthestepsinprocedureofbloodpressure.
POSITIONINGOFTHEPATIENT
Supineposition
Thispositionmaybeemployedtoadvantagemanytimeswhenthenecessityfordrainagedoesnot
requirethefowlerposition.Itisbelievedthatwhenthepatientisflatinbed,respirationoftenismorefree
andturningiseasier,advantagesthatareimportantinthepreventionofrespiratorycomplications.
1)Theheadisinlinewiththespine,bothlaterallyandanteroposteriorly.
2)Thetrunkispositionedsothatflextionofthehipsisminimzied.
3)Thearmsareflexedattheelbowwiththehandsrestingagainstthelateralabdomen.
4)Thelegsareextendedwiththesmall,firmsupportunderthepoplitealarea.
5)Thehealsaresuspendedinaspacebetweenthemattressandthefootboard.
6)Thetoesarepointedstraightup.
7)Thetochantertollsareplacedunderthegreatertocahantersinthehipjointareas.
PronePosition:
Intheproneposition,theclientliesontheabdomenwiththeheadturnedtooneside.Thehipsare
notflexed.Bothchildrenandadultsoftensleepinthisposition,sometimeswithoneorbotharmsflexed
overtheirheads(Figure3416).Thispositionhasseveraladvantages.Itistheonlybedpositionthat
allowsfullextensionofthehipandkneejoints.Whenusedperiodically,thepronepositionhelpsto
preventflexioncontracturesofthehipsandknees,therebycounteractingaproblemcausedbyallother
bedpositions.Thepronepositionalsopromotesdrainagefromthemouthandisespeciallyusefulfor
unconsciousclientsorthoseclientsrecoveringfromsurgeryofthemouthorthroat.
27
LateralPosition
Lateralpositionwithpillowsinplacetuckbackpillowbehindclientsback.(Makebyfolding
pillowlengthwise.smoothareaisslightlytuckedunderclientsback.)Placepillowundersemiflexed
upperleglevelathipfromgrointofoot.
FowlersPosition:
Offallthepositionsprescribedforapatient,perhapsthemostcommon,aswellasthemost
difficulttomaintainistheFowlersposition.Thepatientstrunkisraisedtoformanangleoffrom60to
70degreeswiththehorizontalplane.Thisisacomfortablesittingposition.Thepatientswithabdominal
drainageusuallyareputinFowlerspositionassoonastheyhaverecoveredconciousness,butgreat
cautionmustbeobservedinraisingthebed.
28
CommonlyusedBedPositions:
POSITION DESCRIPTION INDICATIONFORUSE
Clientsleepingandavarietyofbed
positionssuchasbacklying,side
lyingandprone(facedown)To
maintain spinal alignment for clients,
With spinal injuries
Toassistpatientstomoveandturnin
bedbynurseConvenientforeating,
reading,visiting,watchingTV
Relieffromlyingpositions
Topromotelungexpansionforclient
withrespiratoryproblem
Toassistaclienttosittingposition
ontheedgeofthebed,Relieffrom
lyingposition,Topromotelung
expansion
Topromotevenouscirculationin
certainpatients
Toprovideposturaldrainageofbasal
lung lobes
Topromotestomachemptyingand
preventesophagealreflex inclients
with hiatal hernia
Mattressiscompletely
horizontal
Semi sittingposition in
whichheadofbedisraised
toangleofatleast45
degrees.Kneesmaybe
flexedorhorizontal
Headofbedraisedonlyto
30degreeangle
Headofthebedlowered
andthefootraisedina
straight incline
Headofbedraisedandthe
footlowered
Straighttiltindirection
oppositeto
Trendelenburgs position
29
Backlying position with
kneesflexed andhips
externally rotated small
pillowsunderthehead
Backlying position with
legs extended small
pillowunderthehead
Backlying position
withoutapillow
Aseatedposition,back
unsupportedandlegs
hanging freely
Backlying position with
feetsupportedinstirrups
thehipsshouldbeinline
withtheedgeofthetable
Headandneck,axillae,
anteriorthorax,lungs,
breasts,heart,abdomen,
extremities, peripheral
pulses,vital signsand
vagina
Head,neck,axillae,anterior
thorax,lungs,breasts,heart,
extremities, peripheral
pulses
Asforhorizontalrecumbent
Head,neck,posteriorand
anteriorthorax,lungs,
breasts,axillae,heart,vital
signs,upperandlower
extremities, reflexes
Females genitals, rectum
andfemalereproductive
tract
POSITIONSANDBODYAREAEXAMINED
POSITION DESCRIPTION AREAEXAMINED
SittingPosition
Lithotomy
Dorsal(Supine)
Horizontal
recumbent
Dorsal
recumbent
30
Kneeling position with
torsoata90
0
angletohips
Sidelying position with
lowermostarmbehindthe
bodyanduppermostleg
flexed
Facelying position, with
ofwithoutasmallpillow
Rectum
Rectum,vagina
Posteriorthorax,hip
movement
POSITION DESCRIPTION AREAEXAMINED
QUESTIONS
PARTA ONEWORDANSWERS:(Onemark)
Meaningofthefollowing
1.Proneposition 2.Lateralposition 3.Fowlersposition
4.Trendelenburgposition 5.Lithotomyposition
PARTBWRITEINDETAIL:(10marks )
1.Explaintheindicationsforusingbedpositions
Genupectoral
(kneechest)
Sims
Prone
31
VOCATIONALNURSING
HIGHERSECONDARY
FIRSTYEAR
PRACTICALSII
32
PRACTICALSII
I Demonstration
Handwashingandscrubbing
technique
Wearingof
Gloves
Masks
Apron
II. Transfering,Lifting&shifting
ofpatients
III. Givingandremovingof
Bedpan&Urinal
IV. Applicationofbandages
Spiralbandage
Reversedspiralbandages
Figureofeight
Divergentspica
Elbowbandage
Caplinebandage
Largearmsling
Cuff&Collarsling
Triangularbandage
Improvisedsling
V Rangeofmotionexercises
VI Enema
VII. Cardiopulmonary
resusititation
S.No. Procedure
Date
Ward Classroom
Signature
33
CONTENTS
NursingLaboratoryhours200periods
Clinicalhours 80periods
S.No Subject PageNo.
I Demonstration
Handwashingandscrubbingtechnique 34
Wearingof
Gloves 37
Masks 37
Apron 37
II. Transfering,Lifting&shiftingofpatients 40
III. GivingandremovingofBedpan&Urinal 45
IV. Applicationofbandages 48
SimpleSpiralbandage 50
Reversedspiralbandages 50
Figureofeight 50
Divergentspica 50
Elbowbandage 51
Largearmsling 51
Caplinebandage 52
TriangularSling 53
Cuff&Collarsling 53
V Rangeofmotionexercises 54
VI Enema 56
VII. Cardiopulmonaryresusitation 58
34
HAND WASHINGAND SCRUBBING TECHNIQUE
Handwashing
Definition:Atechniqueofcleaninghandsdevelopedtopreventtransmissionofmicroorganisms.
Handwashingisavigorous,briefrubbingtogetherofallsurfacesofhandslatheredinsoap,
followedbyrinsingunderastreamofwater.Thepurposeistoremovesoilandtransientorganismsfrom
thehandstoreducetomicrobialcountsovertime.
Purposes: 1) Cleanliness2)Aesthetic3)Removesoilandtransientorganism.
4)Reducethetotalmicrobialcountsovertime.5)Topreventcrossinfection.
Indication: 1) Attheendofeachtask.
2)Beforegoingintocleanareasorhandlingcleanarticles.
3)Beforesurgicalprocedure,delivery.
4)Beforeservingoreatingfood.
5)Atanytimewhennecessary.
Situationforhandwashing:Garnerand Favero recommendthatnurseswashhandsinthefollowing
situations.
1) Beforecontactwithclientswhoaresusceptibletoinfection.
ex.Newborninfants,clientswithleukemia,clientswhoareHIVpositive
2) Aftercaringforaninfectedclient.
3) Aftertouchingorganicmaterial.
4) Beforeperforminginvasiveproceduresuchasadministrationofinjections,catheterizationand
suctioning.
5) Beforeandafterhandlingdressingsortouchingopenwounds.
6) Afterhandlingcontaminatedequipment.
7) Betweencontactswithclientsinhighriskunits.
8) Afterremovalofsterileandnonsterilegloves.
Stepsofeffectivehandwashing:
Step1: Washpalmsandfingers.
Step2: Washbackofhands
Step3: Washfingersandknuckles.
Step4 Washthumbs.
Step5:Washfingertips.
Step6:Interlockingofhands.
Step7:Washwrists.
35
GuidelinesforMaintainingHandWashing:
1) Cutnailshortstopreventaccumulationofdirt.
2) Removejewellerytoensurethoroughcleaning.
3) Removethewristwatchandpushlonguniformsleevesabovewrists.
4) Inspectthesurfaceofthehandsandfingersforbreaksorcutsinskinandcuticles.
MedicalHandWashing
Equipments:
1) Easytoreachsinkwithwarmrunningwater
2) Antimicrobialsoap/Regularsoap.
3) Cleantowel.
Procedure:
1) Removewristwatchandpushlonguniformsleevesabovewrists.
2) Avoidwearingrings
3) Besurefingernailsareshortandfiled.
4) Standinfrontofsink,keepinghandsanduniformawayfromsinkssurface.(ifhandstouch
sinkduringhandwashingrepeatit.)
5) Opentapandwetelbowhand(holdhandsbelowlevel).
6) Avoidsplashingwateragainstuniform.
7) Regulateflowofwatersothattemperatureiswarm.
8) Wethandsandlowerarmsthoroughlyunderrunningwater.Keephandsandforearmslower
thanelbowsduringwashing.
9) Apply1mlofregularor3mlofantisepticliquidsoapstohandslatheringthoroughly.
10) Washhandsusingplentyoflatherandfrictionforatleast10to15seconds.
11) Interlockfingersandrubpalmsandbackofhandswithcircularmotionatleast5timeseach.
12) Areasundernailsareoftensoiledcleanthemwithnailsofotherhandorcleanstick.
13) Rinsehandsandwristthoroughlykeepinghandsdownandelbowup.
14) Dryhandsthoroughlyfromfingerstowristandforearmswithtowel
15) Discardtowelinsoiledbin.
16) Turnoffwater
SURGICALHANDWASHING/SCRUB: Aseptictechniqueisdesignedtoeliminateallmicro
organisms,includingsporesandpathogens,fromanobjectandtoprotectanareafrommicro
organisms.
ARTICLES: 1)Soap/antisepticdetergent.2)Runningwarmwatertorinsesoapand
thoroughhandwash.3)Nailbrushinantisepticlotion.4)Maskandcap.
36
PRINCIPLES:
1) Asterileobjectremainssterilewhentouchedonlybyanothersterileobject.
2) Onlysterileobjectsmaybeplacedonasterilefield.
3) Anobjectheldbelowapersonswaistiscontaminated.
4) Asterileobjectbecomescontaminatedbyprolongedexposuretoair.
5) Whenasterilesurfacecomesincontactwithawetcontaminatedsurfacesterileobject.
STEPSTOPROCEDURE:
1) Ensurethatnailsareshort.
2) Inspecthandsforabrasionsandcuts.
3) Aftermedicalhandwash,wearcapandmask.
4) Turnonwater.
5) Wethandsandarmsunderrunninglukewarmwaterandlatherwithsoqpto5cmabovethe
elbows.
6) Handshouldbeheldaboveelbows.Usecircularmovementstowashpalms,backofhands,
wrists,forearmsandinterdigitalspacesfor2025Seconds.
7) Rinsehandsandarmsthoroughlyunderrunningwater.
8) Cleanundernailsofbothhands.
9) Scrubnailsofeachhandwith15strokesusingmicrobialagent.
10) Holdingthebrushperpendicularscrubpalm,eachsideofthumbandfingersandposterior
sideofhandwith10strokeseach.
11) Scrubfromwristto5cmaboveeachelbow.
12) Entirescrubshouldlastfor5to10minutes.
13) Discardbrushtosoiledbin.
14) Takecarenottotouchthetaporsidesofthesinkduringtheprocedure.
15) Useasteriletoweltodryonehandmovingfromfingerstoelbow.
16) Repeatdryingoftheotherhandusingadifferenttowel/Useonesidetodryonehand
reversesideforotherhand,ifonlyonetowelisavailable.
17) Discardtoweltothesoiledbin.
18) Oneassistpersontostaywhilesurgicalhandwashing
AFTERCARE:
1) Turnoffwater.
2) Towelshouldbesenttolaundaryforwashing.
3) Washednailbrushtobekeptindisinfectantsolutiontray.
4) Soaptobekeptinsoapbox,andantisepticsolutiontokeptincupboard.
37
QUESTIONS
PARTA WRITETHESHORTANSWERS: (5marks)
1) Definehandwashing.
2) Whatarethepurposesofhandwashing?
3) Whataretheindicationsforhandwashing?
4) Definesurgicalhandwashing?
PARTB WRITEINDETAIL:(10marks)
1) Stepsofeffectivehandwashing.
2) Guidelinesformaintaininghandwashing.
3) Principlesofsurgicalhandwashing.
PARTCWRITEESSAY:(20marks)
1) Writeindetailaboutmedicalhandwashing?
2) Writeindetailaboutsurgicalhandwashing?
WEARINGOFGOWN,GLOVE,ANDMASK
GOWNING: Cleanordisposablegownsorplasticapronsarewornduringprocedureswhenthe
nursesuniformislikelytobecomesoiled.
INDICATION:
1) Whenthenurseschangesthedressingsofaclientwithextensivewounds,burns.
2) Duringdeliveryprocedureandsurgicalprocedure.
3) Clientwithmoresucceptabletoinfection.
4) ForstrictasepticdiagnosticprocedureslikeFNAC,lumbarpuncture,bonemarrowbiopsy
etc.
PURPOSE:
1) Topreventsoilingofclothingduringcontactwiththepatient.
2) Toprotecthealthcarepersonnelfromcomingincontactwithinfectedmaterials.
STEPSTOPROCEDURE
1) Pickupasterilegownandallowittounfoldkeepinginsideofthegowntowardsthebody
withoutallowingtheoutsideofthegowntotouchanyarea.
2) Withhandsatshoulderlevel,slipbotharmsintoarmholessimultaneously.Asktheassisting
nursetobringthegownovershoulders
3) Theassistingnursefastensthetiesattheneck.Overlapthegownatthebackasmuchas
possibleandfastenthewaist,tiesorbelt.
4) Preventthegownfrombecomingwet
5) Whileremovingavoidtouchingsoiledpartsontheoutsideofthegown.Rollupthegownwith
soiledpartinsideanddiscardintheappropriatecontainer.
38
GLOVING: Glovingisdefinedastheputtingonofapairofsterileglovestoprotectonesownhand
frompathogenicmicroorganismsandtoavoidcontaminationofasterileareabyhand.
PURPOSE:
1) Toprotectthenursefromthepathogenicmicrtoorganisms.
2) Tosafelyuseherhandstohandlewithoutcontaminatinganyobjects.
INDICATION:
1) Contactwithopenwound
2) Forstrictasepticdiagnosticprocedures.
3) Handlewithinfectedmaterialslikeblood,urine,faecesetc.
4) Nurseorhealthpersonnelwithanycutinjuryinhandsorfingers.
5) Forsurgicalprocedureanddeliveryprocedure
TYPES:
1) Closedmethod.
2) Openmethod
3) Plungemethod.
USES:
1) Itreducethelikelihoodofthenursestransmittingtheirownendogenousmicroorganismsto
individualsreceivingcare.
2) Ithelptopreventcrossinfection.
3) Ithelptomaintaintheinfectioncontrol.
STEPSTOPROCEDURE:
1) Whentheglovepacketiscollectedfromtheautoclavedbinandplacedflatonthesterile
towel.
2) Thepacketofpowderisremovedfromtheglovepackandthehandsarepowdered.
3) Identifyrightandlefthand.
4) Pickuptheleftglovewiththerighthand,bytheinsideturneddowncuff.
5) Carefullypushthefingersofthelefthandintothegloveuntilitreachesthecuff.
6) Pickuptherightglovebyputtingtheglovedhandunderthecuff.
7) Carefullypushthefingersoftherighthandintotheglovedhandintothegloveandpullthe
glovecuffoverthecuffofthegown.
8) Nowpullthecuffontheleftglovecompletelyoverthegowncufftothelefthands.
9) Adjustthegloves.
39
WEARINGMASK: Maskareworntoreducetheriskfortransmissionoforganismsbythe
dropletcontact,airborneroutes,andsplattersofbodysubstances.
PURPOSE:
1) Themaskshouldbewornbypersonnelwhoworkclosetotheclientiftheinfectionis
transmittedbylargeparticleaerosols.eg.Measles,mumps,acuterespiratorydiseasesin
children.
2) Themaskshouldbewornbyallpersonnelenteringtheroomiftheinfectionistransmittedby
smallparticleaerosols(dropletnuclei)eg.pulmonarytuberculosis.
STEPSTOPROCEDURE:
1) Findtopedgeofmask(usuallyhasthin,metalstripalongedge)
2) Holdthemaskbytoptwostrings.Tietwotoptiesatthetopofthebackoftheheadwithties
aboveears.
3) Tietwolowertiessnuglyaroundtheneckwiththemaskwellunderthechin.
4) Ensurethatthemaskcoversthemouthandthenoseadequately.
5) Ifglassesareworn,fittheupperedgeofthemaskundertheglasses
40
6) Avoidunnecessarytalkingand,ifpossible,sneezingorcoughing.
7) Whenremovingamaskwithstrings,firstuntiethelowerstringsofthemask.
8) Discardadisposablemaskinthewastecontainer.
9) Washthehandsiftheyhavebecomecontaminatedbyaccidentallytouchingthesoiledpartof
themask.
QUESTIONS
PARTAWRITETHESHORTANSWERS:(5marks)
1) Whatarethepurposesofgowning?
2) Definegloving?
3) Whatarethepurposesofwearingmasks?
4) Whatarethetypesofgloving?
PARTBWRITEINDETAIL:(10marks)
1) Indicationsofgowning.
2) Usesofgloving.
3) Indicationsofgloving.
1) Writeindetailaboutgloving?
LIFTINGANDTRANSFERINGTHEPATIENTSFROM
BEDTOSTRETCHER&STRETCHERTOBED
ArticlesRequired
1) Hospitalbed
2) Wheelchair(lockthebrakes)
3) Transferbelt(optional)
4) Siderails
5) Nonslipfootwear
6) Sheetforlifting
7) Stretcher(lockthebrakes)
Principlestobefollowedinlifting/transferringofpatient
Broadenthebaseofsupportbyplacingthefeetfartherapart
Bendthekneestolowerthebodytotheobject(patient)
Keepthebodyclosetotheobjectaspossible
Tightentheabdomenandbuttockmuscleandbreathnormally
Shiftthepositionoffeet,ratherthantwistingtheback
41
Requirementsintransferring
Transfersurfacesmustbefirmratherthansoft(becauseofenergyistransferred)
Stabilizethesurfacesbyapplyingbrakes/lockingthewheels
Siderailsoneonwhenlyingandhalforoffwhenturningpositiongettingout
respectively
Patientcanusetrapezebarsifupperarmhasstrength
Preliminaryassessmentofpatient
1.Assessthepatientsforfollowing:
Musclestrength
Jointmobilityandcontractureformation(arthritis)
Paralysisorparesis
Orthostatichypotension(riskoffainting)
Activitytolerance
Levelofcomfort(pain)
Vitalsigns
2.Assessthepatientssensorystatus
Adequacyofcentralandperipheralvision
Adequacyofhearing
Lossofperipheralsensation
Cognitivestatus
3.Assessforanycontraindicationstoliftortransfer
Checkforthedoctorsorder
Assesspatientslevelofmotivation
Patientseagerness
Whetherpatientavoidsactivity
Assesspreviousmodeoftransfer
Assesspatientsspecificriskforfallingwhentransferred
Assessspecialequipmentsneededtotransfer
Assessforsafetyhazards
Performhandhygiene
Explainproceduretopatient
Transferthepatient
Aftercare:
Followingeachtransferassessthepatientsbodyalignment,tolerance,fatigue,comfort
Ifthepatientistransferredtobedaftertransfer,siderailsareraised
42
Ifthepatientistransferredtowheelchairthebrakesarereleasedbeforemovingthe
patient
Recordtheprocedureaccurately.Thepatientsperformanceisalsorecorded
Anydifficultyofdisruptionoccurredduringthetransferisalsorecordedwithdate
andtime
Thepatientscomfort,vitalsignsareallrecorded
Procedure:
Transferringapatientfromabedtostretcher
Animmobilizedpatientwhomustbetransferredfromabedtoastretcherrequiresa
threepersoncarryortwopersoncarry
Anothermethodisusingasheettolift
Transferringapatientfromabedtostretcher:
Threeofyoushouldstandsidebysidefacingofpatientsbed
Eachpersonassumesresponsibilityforoneofthreeareas
a)HeadandShoulders
b)Hipsandthighs
c)Ankles
Performthreepersoncarryfrombedtostretcher(BedatStretcherlevel)
Threepersonsstandsidebysidefacingsideofpatientsbed
1. Eachpersonassumesresponsibilityforoneofthreeareas:headandshoulders,hips
andthighs,andankles
2. Eachpersonassumeswidebaseofsupportwithfootclosertostretcherinfrontand
kneesslightlyflexed
3. Armsofliftersareplacedunderclientsheadandshoulders,hipsandthighs,and
ankleswithfingerssecurelyaroundothersideofclientsbody(seeillustration)
4. Eachpersonshouldassumeswidebaseofsupportwithfootclosertostretchinfront
andkneesslightlyflexed
Armsofliftersareplacedunderpatient
Headandshoulders,hipsandthighs,ankleswithfingerssecurityandothersideofpatients
body
Liftersshouldrollpatienttowardstheirchestsoncountofthreepatientislifterandholded
againstthreepersons
Onsecondcountthreeofyoushouldbackandpivottowardsstretchermovingforwardif
needed
Gentlylowerthepatientontocenterofstretcherbyflexingknees,hipsuntilelbowsasa
levelwithedgeofstretcher
Assessthepatientsalignment,placesafetystrapsacrossbodyraisesiderails
43
TRANSFERPATIENTFROMBEDTOWHELLCHAIR
demonstratethetransferringthepatientfrombedtowheelchair
Transferringapatientfrombedtowheelchair:
Assistthepatienttosittingpositiononsideofbed.Havethewheelchair(lockthebrakesatits
45angletobed
Applytransferbelt(ifpresent)
Ensurethatthepatienthasstablenonskidshoes.Weightbearingorstronglegisplaced
forwardweakfootback
Spreadfeetapart
Flexhipsandkneesaligningkneeswithpatientsknees
Grasptransferbeltfromunderneath
Rockpatientuptostandingpositiononcountofthreewhilestraighteninghipandlegsand
keepingkneesslightlyflexed
Maintainstabilityofpatientsweakorparalyticlegwithknee
Pivotonfootfartherfromchair
Instructthepatienttousearmrestonwheelchairforsupportandeaseintochair
Assessthepatientforproperalignmentforsittingposition
Providesupportforparalysedextremities
Praisethepatientprogress,effortorperformance
44
QUESTIONS
PARTAWRITESHORTNOTES:(5marks)
1Writeaboutliftingandtransferringofpatients?
2.Mentionthepreliminaryassessmentofpatientbeforeprocedure?
3.Whatistheaftercareofpatienttransferredfrombedtostretcher?
PARTBWRITEINDETAIL:(10marks)
1. Explaintheprocedureoftransferringthefrombedtostretcher?
2. Explaintheprocedureoftransferringthefrombedtowheelchair?
45
GIVINGANDREMOVINGOFBEDPAN&URINAL
OFFERINGURINAL
Definition:
Bedrestorimmobilitycaninterferewithmicturition(actofpassingurine)itdoesnotallowthe
patienttohavethenormalpositionforemptyingthebladder.
Thenursingbedsideassistantassiststhebedriddenwomentouseabedpanforvoiding.For
amanwhohasnotbeenabletoreachthetoiletfacilitieshemaystandatthebedsideandvoidintoa
plasticofmetalreceptacleforurine.Ifheisunconsciousorunabletostandatbedsidetheassistant
needstoassisthimtousetheurinal.
Purpose:
Provideacontainerforcollectionofurine
Tomeasuretheurineoutput
Forobservationofcolorandconsistencyofurine
Indications:
Forpatientwithimpairmobilityduetosurgery,fracture,injury
Elderlyman(agingimpairsmicturation)mayrequireurinalmorefrequentlytoavoidurinary
incontinence
Formobilepersonwhoisabletogotobathroom,doesnotrequireurinal.Encouragethepatient
togotobathroom.
OFFERINGBEDPAN
Objectives: attheendofthislessonyoushallbeableto
recognizetypeofbedpan
purposesofbedpanoffering
indicationsforbedpan
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Typesofbedpan:
Regularbedpan
Madeofmetalorhardplastichasacurved,smoothupperendandataperedlowerend.Thepan
isapproximately5cmdeep
Fracturepan
Designedforpatientswithbodyorlegcasts,theshallowupperendapproximately13cmdeep
thatslipseasilyunderthepatient
Offeringbedpan
Abedpanforpatientsconfinedtobedprovidesameanstocollectstool
Femalebedpantopassurineandfeces,Formalebedpansonlyfordefecation
Sittingonabedpancanbeextremelyuncomfortable.Thecaregivershouldhelpthepatientassumea
positionsimilartothenaturalsquattingposition.
Purposes
Thenursingassistancepacesandremovesthebedpantobedtobedriddenpatients
Forboweleliminationwhenthepatientisnotpermittedtogooutofbed
Obtainastoolspecimen
Duringboweltraining,itfacilitatesbowelincontinence
Indication:
Forthepatientsrestrictedtobedmustusebedpanfordefecation.Patientswithfractureorinjuryuse
bedpans.
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QUESTIONS
PARTA WRITESHORTANSWERS: (5marks)
1.Whatarethetypesofurinals?
2.Whataretheequipmentsneededforofferingurinal?
3.Whatarethetypesofbedpan?
4.Whataretheequipmentsneededforofferingbedpan?
5.Whatistheindicationforofferingbedpan?
PARTBWRITEINDETAIL:(10marks)
1.Explaintheprocedureofofferingbedpan?
2.Listoutthecharacteristicsofstool?
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APPLICATIONOFBANDAGES
PreparatoryPhase:APreliminaryAssessment
Checkthedoctorsordertoseethespecificprecautionsifanyregardingthepositioningand
movement.
Assessthepatientsneedforapplicationofbandage.
Monitorvitalsigns
Assessthepatientsmentalstatus
Assesstheneedforpainmedication
Assurethepatient,thepatientsfamily.
Assesstheadequacyofcirculationbynotingsurfacetemperature,skincolor,and sensation
ofbodypartstobewrapped.
Fortyingthebandageareefknotmustbealwaysused.Tomakeareefknottaketheends
ofthebandageoneineachhandcrosstheendintherighthandunderandthenovertheendin
thelefthandthusmakingaturn.Thencrosstheendnowintherighthandoverandthenunder
theendinthelefthandthusmakingasecondturn.
Theusualgrannyknotshouldnotbeusedasitislikelytocomeloose.
Theknotshouldbemadewhereitdoesnothurttheskinorcausediscomfort.
Tuckthelooseendsofthebandageoutofsight.
Notinusethetriangularbandageshouldbefoldednarrow.Bringthetwoendstothecentreand
foldagain.Itbecomesapacketwhichmeasures16x9cmhandytocarry.
WrinkledBandagesareuncomfortable.
Neverignoreanycomplaintsofpainexperiencedbythepatient.ThisshouldbeInvestigated
andthecauseisremovedimmediately.
Donotuseextraturnsinordertouseallthebandages.
Whencompleted,fixthebandagewithacircularturnandsecureitwithasafetypinorother
suitablematerialssuchasadhesivestrapping.
PreparationofthePatient
Explainthesequenceoftheproceduretothepatientandexplainhowthepatientcanassistyou.
Placethearticlesneededconvenientlyinthebedsidetable.
Bringthepatienttotheedgeofthebed.
Closethewindowsandswitchoffthefan.
Provideprivacy
Helpthepatienttoassumecomfortableandcorrectposition.
Performhandhygiene.
RulesForApplicationOfRollerBandage
Facethepatient
Whenbandagingleftlimb,holdtheheadofthebandageintherighthandandviceversa.
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Applytheoutersideofthebandageoverthepadandwinditaroundtheinjurytwicesothatit
isfirm.
Bandagefrombelowupwardsoverthelimb.Alsomakeitarolltoapplybandagefromtheinner
sidetotheouterside.
Seethatthebandageisneithertooloosenortootight.
Rollbandagesothateachlayercoverstwothirdsoftheearlierlayer.Fixthebandageby
pinningituporusingadhesiveplaster.Theusualpracticeoftearingthefinalendintotwolong
tailsandtyingthemupisquitesatisfactory.
PERFORMANCEPHASE(PROCEDUREFORAPPLICATIONOFBANDAGE)
BANDAGING
Objectives: Attheendofthisexerciseyoushallbeableto
demonstratebandageapplication
ARTICLESANDEQUIPMENTSREQUIRED
1) Correctwidthandnumberofbandages
2) Disposablegloves(ifnecessary)
3) Safetypins
4) Scissor
5) Adhesivetapes
6) Rubbersheet(ifnecessary)
Applybandagefromdistalpointtowardproximalboundaryusingvarietytoturnstocover
variousshapesofbodyparts.
Unrollandveryslightlystretchbandage
Overlapturnsbyonehalftotwothirdswidthofbandagerolls.
Securefirstbandagewithcliportapebeforeapplyingadditionrolls
Applyadditionalrollswithoutleavinganyuncoveredskinsurface.Securelastbandageapplied.
Removeglovesifwornandperformhandhygiene
Assessdistalcirculationwhenbandageapplicationiscompleteandatleasttwiceduring8hours
period
ObserveTheBandageSite
FiveP
Pain
Pallor
Pulselessness
Palpateskinforwarmth
Paralysis
Itcomesinvariouswidthslengthsandtypesofmaterial.Forbestresults,usedifferentwidthsfor
differentbodyareas.
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Fore.g Fingers1inch
Hand&arm2to2.5inches
Leg3to3.5inches
Trunk4to6inches
(a) SimplespiralBandage
Thisisusedonfingersorotheruniformsurfaces.Thisbandageisjustroundinspirals.
(b) ReversedspiralBandage
Thispatterniselegantandwillfitashapedlimb,butisunstableandwillonlyremaininplaceifthe
limbisatrest,itmightbeusedforaforearmkeptinasling,ifnopressurewasrequired.Withtheback
ofthepatientshandtowardsyou,takeafixingturnroundthewristandcarrythenextturnupwardsat
anangleof45,turnthebandageovertocrossitselfatarightangle,andbringitroundthelimbreadyfor
thenextturn.Thereversemustbemadewithouttensionandthepatternkeptupthecentreofthe
pronatedforearm.
FigureofEight
Thisismuchthemostusefulpattern.Itcanbeusedtoapplypressureoveranextendedjointorto
bandagealeg,foot,handorarmifmovementisallowed.Touseitontheleg,takeafixingturn,then
carrythebandageupwardsacrossthefrontofthelimbat45roundbehinditatthesameleveland
downwardsoverthefronttocrossthefirstturnatarightangle.Repeattheturnsuntilthelimbhasbeen
sufficientlycovered.
DivergentSpica
Thispatternenclosesaflexedjoint(or)projection(e.g)knee,heelorelbow.Itmerelycoversthe
dressingandexertsnopressure.
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Toapplyit,passthefirstandsecondturnsoverthecentreofthejoint.Succeedingturnspass
alternatelyaboveandbelowtheseturns,formingapatternateachsideofthejoint.
Elbowbandage
Rollerbandagescanbeusedatthesejointstoholddressingsinplace,ortosupportsofttissue
injuriessuchasstrains(or)sprains.Alwaysmakesurethatyourbandagingextendssufficientlyfaron
eithersidetoexertevenpressure.Themethodbelow,forbandaginganelbow,canalsobeusedfora
knee.
Largearmsling(usedtosupporttheforearm)
Standinfrontofthecasualty.Spreadthebandageoverthechest,withoneendgoingoverthe
shoulderontheuninjuredside,andtheotherhangingovertheabdomenthepointshouldbebeneaththe
elbow.Placetheforearmslightlyraisedoverthemiddleoftheslingbringthelowerendupandtieon
theinjuredshouldertotheotherendwithareefknot.Tuckintheends.Bringthepointroundtothefront
oftheelbow,foldinneatlyandpin.
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Caplinebandage
Placetheopenbandageontheheadwiththepointattheback.Foldanarrowthenatthebase,
placeitjustabovetheeyebrows,thentakethetwoendsbackwards,crossthembelowtheocciputwith
thepointunderneath,thenbacktotheforeheadwheretheyaretied.Drawthepointdownandthen
upwards,andfixitwithasafetypin.
a) one end being continued
roundthescalpandother
goingoverit
b)scalpturnsecuredby
horizontalturn
c) capline bandage
completed
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TriangularBandage
Atriangularbandageismadebycuttingapieceofcalico100cmsquarefromcornertocornerso
astogivetwobandages.Ithasthreeborders.Thelongestiscalledbaseandtheothertwoofthesides.
Therearethreecorners,theoneoppositethebaseiscalledthepoint.Theothertwoarecalledtheends
Cuffand Collar Sling
Thissupportsthewristonly,withthecasualtysforearmflexedandfingerstouchingtheopposite
shoulder,aclovehitch,madefromanarrowbandage,isplacedroundhiswrist.Theendsofthebandage
aretakenaroundtheneckandtiedinthehollowjustabovethecollarbone,ontheinjuredside.
AdhesiveTapeAndStrips
Itcomesinrollsandinvarietyofwidth.Itisoftenusedtosecurerollerbandageandsmalldress
ingsinplace.
Forthoseallergictoadhesivetape,usepapertapeorspecialdermatologictape.
Adhesivestripsareusedforsmallcutsandabrasionandareacombinationofadressingand
bandage.
TheSpica
Thisisamodifiedfigureofeight,andisusefulforbandagingthehip,shouldergroinandthumb.
AClovehitch
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TBANDAGE
Itisusedforperinealdressingsonemeterlengthand10cmwidthbandageforthewaistband.One
meterof15cmbandagefortheperinealdressings.
MATERIALSUSEDFORBANDAGE
Flannel: Strong,warmandgivessupport,itissemielastic,butheavyandmaybetoohot.
Openwovecotton:Lightandexpensivebutdoesnotgivemuchsupport.Itisunwashablebutthe
edgesfray.
Calico:Harshandinelasticbutfirmusefulforslingsandforapplyingsplints.
Crepe: Comfortableandgivesgoodsupport,elasticandeasytoapplyexpensiveandwashable.
QUESTIONS
PARTAWRITESHORTNOTES:(5marks)
1.Whatisspica?
2.Materialsusedforbandages.
3.Mentionthearticlesusedforbandaging?
4.Whatarethe5ps?
5.Writethedifferentwidthsofmaterialusedforbodyarea?
PARTBWRITEINDETAIL:(10marks)
1.Explainabouttypesofbandages?
RANGEOFMOTIONEXERCISES
Definition:exerciseistheexertionofthebodyformaintenanceofitshealth.
Types of exercises:
1) Activeexercises:activeexercisesarethemotionorfreemovementsperformedbytheindividual
withouthelp.
2) Passiveexercises:passiveexercisesarethemotionormovementsperformedbyanother
personforthepatient.
3) Activeassistanceexercise:activeassistanceexercisesiswhichthepatientperformsasmuch
ofthemotionaspossiblewiththehelpofanotherpersonasneeded.
4) Aerobicexercises:aerobicexercisesareactivitiesthatstimulateheartandlungssignificantly
increaseoxygenuptakeandisdeliverytothebodytissues.
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5) Isotonicexercises:isotonicexercisesarethenormaltypeofexerciseswhichthemotionofa
parttakeplaceinvolvingshorteningofthemusclesandmusclecontraction.
6) Isometricexercises:isometricexercisesinvolvesactivecontractionandrelaxationofthemuscle
withoutmovementofthejointthatisnormallymobilizedbythesemuscles.
7) Rangeofmotion:rangeofmotionexercisearethoseinwhichajointismovedthroughitsfull
rangeofmotione.g.thefullextenttowhichitiscapableofbeingmoved.
Purposesofexercise:
1) Topromotehealth.
2) Toretainmovementinthejoints.
3) Torestorenormaltoneinthemuscle.
4) Todecreasecholesterollevel.
5) Todecreasebodyweight.
6) Todelaydegenerationchanges.
7) Topreparepatientforambulationinorthopedicconditionsandpostoperatively.
8) Topreventdeformity.
9) Topromotephysicalmobility.
10) Toimprovegaitincrutchwalking.
11) Toimprovebloodsupplyinvasculardisorders.
12) Topreventconstipation.
13) Toreducestress.
Movementsofvariousjoints:
1) Abduction:movementsawayfromthemidlineofthebody.
2) Adduction:movementstowardsfromthemidlineofthebody.
3) Flexion: bendingofajointsothattheangleofthejointdiminishes.
4) Extension:thereturnmovementfromflexionaroundjointangleisincreased.
5) Rotation: turningormovementofapartarounditsaxis.
6) Pronation: rotationoftheforearmsothatthepalmofthehandisdown.
7) Supination: rotationoftheforearmsothatthepalmofthehandisup.
8) Opposition: touchingthumbtoeachfingertiponthesamehand.
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RANGEOFMOTIONEXEERCISES:
QUESTIONS
PARTAWRITESHORTNOTES:(5marks)
1) Writethetypesofexercises.
2) Whatarethepurposesofexercise.
3) Whatarethetypesofmovementofvariousjoints.
ENEMA
Enema:Enemaisaninjectionoffluidintothelowerbowelthoughtherectumforthepurposeofcleaning
ortoprovidemedicationornourishment.
Indication:
1)Stimulatethebowelmovementandcleaningthelargeboweleg.Soapandwaterenema.
2)Stimulateperistalsiseg.Asafoetida
3)Relievingflatulanceordistensioneg.Carminativeenema
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4)Soothingirritatedmucosaofthecoloneg.starch.
5)Tocheckdiarrheaeg.starch
6)Tosupplyfluidsandnutrientseg.GlucoseandSaline
7)Tostimulatepatienteg.Coffee
8)Toreducetemperaturecoldenema
9)Toquietpatientbyintroducingsedatives
10)Tomakediagnosiseg.BariumEnema.
Procedure: ForSoapandWaterEnema
Equipmentrequired.
1)EnemaCan
2)TubingandClamp
3)Appropriatesizerectaltubeinasterilecontainer/wrapAdult2230Frenchgauge,Child1218
Frenchgauge
4)Correctvolumeofsolutionwarmedto105109deg.Fforadultsand98.6deg.Fforchild
5)Baththermameter
6)Lubricatingjelly
7)Mackintosh
8)Bathblanket
9)BedpanoraCommode
10)DisposableGloves
11)TowelandBasin
12)IVPole
13)Screen
Procedure
1)AssessStatusofpatientslastbowelmovementmobilityetc.
2)ReviewPhysiciansorder
3)Explainproceduretothepatient
4)Assembleequipmentnearbedside
5)ProvidePrivacy
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6)Placemackintoshunderpatientship.
7)Positionpatientinleftlateralwithrightkneeflexed
8)Coverpatientwithbothblanketexpressingrectum
9)Placebedpanorcommodeineasilyaccessibleposition
10)Assembleenemacan,tubingandtheclampandrectaltube.
11)Add30ml.ofsoapsolutionwith500mlofwarmwater,checktempofsolutionandpour
solutionintocan.
12)Raisecontainer3045cm.abovetheanus.
13)Washhandsandweargloves
14)Lubricatesidesoftherectaltubewithvaseline
15)Gentlyseperatebuttockslocaterectumandinsertrectaltube7.510cmtoadultbyinstruct
ingthepatienttotakedeepbreath.
16)Holdtubinginplace.
17)Openregulatingclampandallowsolutiontoenterslowly.
18)Explainthefeelingofdistensionisnormal
19)Advicepatientretainsolutionfor510min
20)Discardenemacanandtubinginproperreceptacleafterthoroughwashing.
Questions
PARTAWRITESHORTNOTES:(5mark)
1)Defineenemaandindicationforenema?
2)Explaintheprocedureofsoapandwaterenema?
CARDIOPULMONARYRESUSCITATION
DEFINITION: Resuscitationisamethodwhichincludesallmeasuresthatareappliedtorevive
patientswhohavestoppedbreathingsuddenlyandunexpectedlyduetoeitherrespiratoryorcardiac
failure.
PURPOSE:
1) Tomaintainanopenandclearairway(A).
2) Tomaintainbreathingbyartificialventilation(B).
3) Tomaintainbloodcirculationbyexternalcardiacmassage(C).
4) Tosavelifeofthepatient.
5) Toprovidebasiclifesupport.
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INDICATIONS:
CARDIACARREST:
1) Ventricularfibrillation(VF).
2) Ventriculartachycardia(VT).
3) Asystole.
4) Pulselesselectricalactivity.
RESPIRATORYARREST:
1) Drowning. 2)Stroke. 3)Foreignbodyinthroat.
4) Smokeinhalation. 5)Drugoverdose. 6)Electrocutionorinjurybylighting.
7) Suffocation 8)Accident,injury. 9)Coma.
10) Epiglottisparalysis.
PRINCIPLESOFCPR
1) Torestoreeffectivecirculationandventilation.
2) Topreventirreversiblecerebraldamageduetoanoxia.
GENERALINSTRUCTIONSFOREFFECTIVECPR:
1) CPRtechniquesareusedinpersonswhoserespirationsandcirculationofbloodhavesud
denlystopped.
2) TheCPRmustbeinitiatedwithinthreetofourminutes.
3) TheCPRtechniquesshouldnotbediscontinuedformorethanfivesecondsbeforenormal
circulationandventilationoflungsareestablished.
4) BeforeCPRisattemptedinapatient,makesurethattheairwayisclear.
SIGNSOFEFFECTIVECPR:
1) Movementandstruggling.
2) Distinctcarotidpulsationswitheachcardiaccompression.
3) Decreasedcyanosis.
4) Breathingthatbeginsspontaneously.
5) Blinkinguponstimulationoftheeyelid.
6) Constrictionofpupils.
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INEFFECTIVE RESUSCITATION:
WhenCPReffortsarenoteffective,itisusuallybecauseofoneormoreoftheseproblems.
1) Thepatientisnotlyingonahardsurface.
2) Thepatientsheadisnotplacedintheproperheadtiltpositionforventilations.
3) Thepatientsmouthisnotopened.
4) Therescuesshandsareincorrectlyplaced.
5) Thechestisnotsufficientlycompressed.
6) Thecompressionratioistoorapidortooslow.
COMPLICATIONS:
1) Pneumothoraxasaresultofribsfracturedduringcardiacmassage.
2) Haemorrhagefromrupturedliver.
3) Braindamageasaresultofcerebralhypoxia.
4) Seizure.
SIGHT FOR CARDIAC COMPRESSION
1) Firstofalltracethelastribandfollowtheribtothenotch.
2) Thenplacetheheeloftheotherhandonthelowerpartofthesternumabout11inch
abovethepalpatinghand.
3) Thenplacedonthetopofthehand,whichisrestingonthesternum.
4) Bothhandshouldbeparallel.
5) Keepfingersoffthechestorinterlocked.
6) Iffingersarerestingonthechest,forcewillbedissipated.
7) Theartificialbreathingandcardiacmassageshouldcorrespondtothenormalrespirationand
pulserate.
8) Ventilationsaregivenbetweencardiaccompression.
9) Theratioofcardiaccompressiontoventilationis5:1(ie)5cardiaccompressionstoone
ventilation.Cardiaccompressionisgiveattherateof60perminute.
PROCEDURE:
PREPARATION OF THE PATIENT:
1) Notimeislostinexplainingtheproceduretothepatientorhisrelatives.
2) Canexplaininsimplelanguagetotherelatives.
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3) Patientmaybeshiftedtoahardsurface.
4) Removeorpushasidetheclothingwhichcoveredthepatientschesttoobserveforcardiac
beatsandrespirations.
5) Place the patient back on his back without any pillows. This position helps in
maintainingairwaysandgivingexternalcardiaccompressions.
6) Tightclothingaroundtheneckandchestshouldberemoved.
7) Ensurefreshairintheroombyopeningwindowsanddoors.
8) Externalcardiacmassagemustbestartedwithin4to6minutes.
PREPARATIONOFARTICLES:
EQUIPMENTS:
Atraycontainingthef ollowingarticles:
1) Endotrachealtubesofvarioussizes(7,7.5,8).
2) Anambubagwithmask.
3) Stillet(inaplasticcover)
4) Megalsforceps(inaplasticcover).
5) Asuctiontubeorcatheter.
6) Laryngoscopewithdifferentsizesofblades.
7) Nasalairway.
8) Oralairway
9) Abowlwithgausepieces.
10) Lubricatingjelly.
11) Adhesivetapewithscissors.
12) Localanaesthetic(drug)spray.
13) Glovesincover.
14) Akidneytray.
15) Apaperbag.
16) Masksofvarioussizes.
17) Localanaestheticdrugs(xylocaine2%and4%)
18) Disposablesyringeswithneedles.
19) AnintravenousIVsetandacutdownset.
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OTHERS:
1) Oxygeninhalation(centralsupply)
2) Suctionpoint(centralsupply).
3) Defibrillator.
ATRAYCONTAININGEMERGENCYDRUGS:
1) Inj.Adrenaline.
2) Inj.Atropine.
3) Inj.Digoxin.
4) Inj.SodiumBicorbonate.
5) Inj.Dopamine.
6) Inj.Efcorlin.
7) Inj.Decadron.
8) Inj.Avil.
9) Inj.Calciumgluconate.
10) Inj.Aminophylline.
11) Inj.Calmpose.
12) Inj.20%Dextrose.
13) Inj.Deriphyllyin.
Syringeswithneedlescannulaoncottonpadandglovesincover.
STEPSTOPROCEDURE:
ONERESCUER:
1) Determineunresponsivesness.
2) Placevictiminasupineposition.
3) Opentheairwaywiththeheadtiltchin.
4) Placeearonmouthandnoseandfeelforrespiration.
5) Ifthepersonisbreathingbutunconsciousplacehimintherescueposition.
6) Ifthevictimisnotbreathingobtainbarrierdevice.
7) Placemaskovermouthandnoseanddeliver10to12breaths/minutes.
8) Checkforpulseatcarotidarteryfor5to10seconds.
63
9) Ifnopulse,beginchestcompressions.
10) Placeheelofonehandoverlowerhalfofsternum,andplaceotherhandontop.
11) Straightenarmsandsockelbows.Keepshouldersdirectlyoverhands.
12) Compresschest1to2inches.Perform15chestcompressionsatarateof80to100/
minute.
13) Afterthe15compressions,delivertwoslowrescuebreaths.
14) Afterfourcycles,reassess.
15) IfthepersonispulselessandapneiccontinueCPR.
16) Ifpulsehasreturnedbeginrescuebreathing.
17) Ifeffectivebreathingandpulsehavereturnedplacethevictimintherecoveryposition.
TWORESCUERS:
1) TworescuerCPRispreferable.
2) Onerescuerperformschestcompressionswhiletheotherperformsrescuebreathing.
3) Thecompressionventilationcycleis5:1.Afterfivechestcompressionsonebreathisdelivered.
4) Whentherescuerperformingchestcompressionbecomesfatigued,therescuersshouldchange
positions.
POSTRESUSCITATIONCARE:
1) Providingcardiorespiratorysupporttooptimizetissueperfusion,especiallytothebrain.
2) Transportthepatienttothehospitalemergencydepartment.
3) Attempttoidentifytheprecipitatingcausestothearrest.
4) InstitutemeasuressuchasAntiArrhythmictherapytopreventrecurrence.
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Questions
PARTA WRITESHORTNOTE:(5 marks)
1)DefineCPRandpurposeofCPR?
2)WhatarealltheindicationofCPR?
3)WritethesightsforCardiaccompression?
PARTBWRITEINDETAIL:(10marks)
1)WritetheprocedureofCPR?