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Fagc j 1

CHAPTER ONE

HYGIENE

Flygiene is the study and practice of cleanliness; it has three aspects namely Personal, Home and
Con:munity Hirgiene.

HF-AUH

Heaith is a state of complete physical, mental and s:r:cial well being not just the mere absence of
disease.

PEESQNAL I-IYGJENE

It 's ihe r:clividual's Dr;:t;.":e of cleanliness.

TiPS ON GOOD PERSONAL HYGIENE

. Have a daily bath

'. Keep and maintain clean sfiort hair.
Keep and naintain shori, ciean finger and toe nails.
. \,rVasi. your hancls before anci after eating and visiting the toilet.
. Wear clean rnended clothes.
. Cover or bandage any wounds and cuts.
. Cover youir mouth when coughlng or sneezing.
o Brush teeth every morning, evening and after every meal.

ii0t"1E HYGIEilE

is iheSractice of cleanliness in and around home

\
TIPS ON CbQO HOME HYGIENE

. \
Sweep and.ctean houses and the yard ever-yday.
n Use and clean the toilet everyday and whenr:ver necessary.
. Dig and use a i-ubbish pit.
. Burn dry refuse and bury wet refuse.
. Maintain shoft grass"
. Do not throw littei"everywhere.
. Wash kitchen utensils and Cry i:henr on a pct rack.
. Cover food and drinkirrE we*er.

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COMMUNITY HYGIENE
]

Is the practice of cleanliness within the community.

Page | 2
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TIPS ON GOOD COMMUNITY HYGIENE '*
. Avoid throwing litter everywhere.
. Clean communal toilets and halls.
. Clean and maintain safe water points,
. Prune bushes around homes.
. Fill potholes around homes.
, Burry empty tins and old tyres around homes.

GUIDE TO GOOD HEALTH

. Eat a well balanced diet.

. Drink clean water.
. Exercise in open air.
. Bath daily.
. Brush teeth daily.
. Wear clean mended clothes.
. Have a reguiar medical check up.
. Have enough time to rest.
 T

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CHAPTER TWO

SANITATION

Sanitation is the collection and final disposal of hurnan and other solid wastes. Poor Sanitation
caLises illness hence the need for good sanitation practices at both household and Community I'}age | 3
levels.

METHODS OF SANITATION IN ZIMBABWE

a) Blair ventilated latrines

b) Water closet toilets
c) Pit latrines
d) Mobile toilets
e) Bush toilet
0 Bucket system

ADVA.NTAGES OF USING LATRINES

. When everyone uses latrines the environment is clean and free from germs.
* Proper use of latrines helps to keep water sources clean.

. u:iffi i:iiiffi: 3i:Y:ti: 3;?tff:?,,,nesses

TIPS ON LATRINE SITING

The latrine should be at least 30 meters away from a well or spring from
which people get their drinking water. ga
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rI?s-AN LATRINE MAINTANANCE

A good latrine is one that keeps urine and faeces away from people, food, underground and
surface water. It must be easy to clean since a dirty latrine is a source of infection.

. Each person who uses the latrine should leave it clean.

. If any stoois or urine falls on the floor they should be washed off, into the hole.
. No rubbish, stones or tins should be thrown into the latrine.
'. Always Pr-ovide paper in the latrine.
Thoroughly clean the toilet as and when necessary.
. Always use the latrine to relieve one self.
. Always wash hands after using the latrine.
"n Avoid use of disinfectants which will slow the decomposition of matter.
Train children to use the latrine as well.
 CHAPTER THREE

WATER SUPPLiES

Water is a tasteless, odourless and colourless liquid which is essential for life.
Pase I 4
Water is essential for life. It is also an excellent breeding ground for germs to multiply.

USES OF WATER

a) Drinking
b) Cooking
c) Washing and cleaning
d) Watering Plants ' -
e) Building houses

GENERAL SOURCES OF WATER

a) Dams
b) Rivers
c) Lakes
d) Shallow wells
e) Deep wells
f) Rain Harvesters
g) Springs
h) Boreholes

SOURCES OF SAFE DRINKING WATER

a) Boreholes
b) Protected wells
c) Protected springs
d) Tapes

WAYS OF MAKING WATER SAFE FOR DR]NKING AND HOUSEHOLD USE

Water from unclean sources can be made clean and safe for drinking and household use, The
following are the ways of purifying the water.

l) Boiling
j) Adding chemicals eg Water purification tablets and chlorine
k) Protection of shallow and deep wells

TIPS ON A GOOD WELL

i) A good well is one which is at least 30 meters away from a latrine, refuse dump and animal
pen,
li) it should be at least 3 meters deep.
iii) It should be lined with bricks and cement.
iv) It should have a wall of at least half a meter above the ground'
v) It should have preferably a pump to draw water. If this is not possible the rope and bucket
should be clean and well protected.
vi) It should be covered
 -T

t]HAPTER I-OUR

MALARIA

Malaria is a parasitic disease rrihich is caused by a fr:male Anopheles mosquitoes. I'his disease is
curable and preventable. Mosquitoes breed rrery well in stagnant water and bushy areas. *:it
ir,: t'

SIGN' AND SYTUPTOMS CF MALARiA rrl

\r i
. Fever
. General bcdy wea<ness
. Loss of appetile
, Vomiting
. LJnc,;ngciousness
" Headacire
'. Dizzine,cs
Nausea
. Abdonrrnal pains

U;WIAN-EE DONE TO PREVENT MALARIA

il TO FIGHT Ti-,[ MOSQ|,]ITO

i Avt rl rccumulation tl stagnant ,"vater.

'rz Ooeir drains to carry away rainwater.
Clean the ground around the home and :lear vegetation and bushes.
i Destroy all litter which may become breeding areas.
/ lise inserticides to kill mosquitoes

.; ; TC [,RCTE[- ]NIE5ELF fRCL'l MOSQUITO BTTES

/ [rul, r'nosquito proof scre*ns on all v.rindo'vs and dcrrs.

? Use mosquito nr:ts
F \,Ye*r iorrg clcrthes to protect legs and ar.ns at night

" Use mosquito repc!len Intions.

3) C Rt OF THE SICr(
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, Take all infected persons foi'medical treatment immediatel;,.
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+) TAKE ?REVENTIVE MEDICINE
plrople visitinq m*laria prone area shoulcl take malaria drugs two weeks
before visiting the area

CHAPI"ER FIVF
 I

CHOLERA

It is the most deadly diarrhoeal disease caused 1ly a bacteria called vibro- cholerae,

W
Page | 6
-Drinking contaminated water.
"Eating contaminated food.
-Flies.
-Handling or eating food by contaminated hands;.

SIGNSAND JYTV]ETQIVIS OF CHOLERA

-Sudden, severe, painless and rice water like dia rrhoea.

-Feeling of wanting to vomit.
-Occasional rromiti ng.
-Wasting due to loss of body fluids.
-Severe body weakness.
-Dehydration.

HaIAL@
-Drink oniy water from a safe source or disinfecied water i.e boiied or chlorinated" l

-Store water in clean well covered containers.

"Eat food while still hot. .

Wash hands with soap or ash under safe running water after using the ioiiii and before preparing;,
handling and eating food.
-Promptly and safely dispose human excreta inc;uding that of children.
-Waslr fruits and vegetables with safe running urater before eating.
-Prevent fly breeding by disposing refuse in pits and covering it r,'ell.

MANAGEMENT OF CHOLERA

-Give sait sugar solution to the patient to rehydrate the body.

.Ensure guod hygiene practices.
-Seek medical assistance immediately.
.Ciothes contaminated with stools or vomits fror;r the paiienl ,:nust be disintected wit[', apprcpriate
disrnfectant or by boiling,
-Deaths due to cholera must be reported to heaith workers who shall put trr place measures tc
preve,rt the spread of the disease.
 CHAPTER SIX

TUBERCULOS]S

Tuberculosis (TB) is an infectious disease caused by a germ called "Mycobacterium Tuberculosis". The
disease may affect several body organs which include lungs, lymph glands, bones, brain and spine. pag: i 7
HOW TB SPREA.pS

It ls spread through very smali sputum droplets containing the Tuberculosis germ. When a
Tuherculosis patieirt who is not on treatment coughs, sneezes or speaks these droplets can be expelled
and anr:ther person can breathe them in,

:IGIISAND SYMPTOIV1S

-Persistent cough with sputum for three weeks or rrlore. Sometimes the sputum may be blood stained.
-Chest pains.
-Difi-iculty in breathing. t.
-sweating a lot, especially at night. 't
. i,,.. -
-Loss of energy, ..

-Lr:ss of weight. ,;...

iBFTUMEI\il"

Tuberculosis is a curable disease, it is curable even if one is HIV positive, There are five treatment
drugs for Tubercr"tlosis namely,'
a) Rifampicin
b) Pyrazinamicie
c) ,.on,uz!iJ
d) Ethambutol,.n
e) Streptomyciin (Injection)

l-he treatment takes 6-8 months and even if one is feeling better, it is important to complete the
treatment course.

Pqffi
Scrnetimes Tuberculosis medicines cause side effects'which include the follo,ving,
-rrngling or loss of feeling in the feet or hands.
- Loss of appetire.
-Fee;ing weak and sick.
-Eyes tu.irning yellow or poor eye sight as compared to the period before treatment.
-Poor hearing as compared to the per"iod before treatment.

lf a Tuberculosis patient on treatment feels any of the above effects, report to the nearest health
centre or health worker immediately.

NB.

L'-

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I
(a) Sometimes rifampicin tablets make urine, sweat and tears reddish in colour, This is not harmful,
the patient should continue taking the tablets.
(b) Rifampicin reduces the effectiveness of family planning tablets hence it is important to use an
alternative family planning method as soon as one starts Tuberculosis treatment with rifampicin,

.Pa6:e i B

WHAT TO DO WHILE ON TB TREATMENT

a) Eat a well balanced diet.

b) Spit on a handkerchief or tissue paper.
c) Stay in a well ventilated area.
d) Practice good personal hygiene.
e) Avoid dusty places.
f) Avoid overcrowded places
g) Do not smoke or take alcohol.

_l
CHAPTER SEVEN

FOOD PRODUCTION

Th* food we eat comes from various sources.

Pagc j r.
SOURCES OF FOOD

. Soil
. Water
. Plants
. Animals

In order to maintain our sources of food it ls important to plant some trees and vegetables and
keep scme livestock.

T]PS ON FQQL PRODUCTIONI

a) Gardening - There is need for each household to have a nutrition

garden to grow vegetables for household use and for
sale to others.

h) Cropping - Various crops can be grown during various seasons.

Crops ar;e a major staple food in Zimbabwe e.g maize, rapoko.

c) Orcharcjs - These provide fruits, a major source of vitamins. Fruit trees can be grown
even at home e.g oranges, bananas, mangoes, guavas eic.

ci) Animal Husbandry -This is the keepingof livestock. Animals provide meat and milk which are
good sources of protein, fats and vitamins. Cattle, goats, pigs, sheep, hare
and rabbits are some of the livestock that can be reared at home.

e) PnL:ltry - Is the keeping of chicken at home. Chicken provide meat and eggs which
are a good sources of proteln.

Farnilics engaged in the above mentioned food prcduction activities have access to nutritrous food
all times even in times when they do not have money.
CFIAPTER EIGHT

FOOD PREPARATION

Food preparation is the process of making food ready for people to eat.
In most cases this process involves cooking. page I ..

REASONS FOR COOKING FOOD

1. To make it more palatable.

2. To make it easy to digest.
3, To kill any germs.
4. To make it more appetizing.

METHODS OF COOKING FOOD

1. Boiling - Food is boiled in water for sometime but, if food is boiled for a long time it can lose
taste as well as vitamins.

2. Stewlng - Cooking food slowly in a small amount of water. It makes

tough meat tender. It ls a good method to use when cooking for old people and
babies.

3, Steaming - Cooking food by steam given off bv fast bciling vvater'

4. Frying - Cooking food in hot oil.

5. Baking - Cooking food by dry heat in an oven.

6, Roast - Cooking fcod by direct heat.

Food should be handled well to avold contamination before and after preparation.

TIPS ON FOOD HANDLING

a) A Food handler should.

', Cover cuts and wounds.

', Wash hands thoroughly in clean running water before handling food'

(a) Working surfaces should be cleaned thoroughly before food is brought. These include
tables and cutting boards. Cracks and joints on preparation tables can habour bacteria.
(b) Utensils used for serving food should be thoroughly washed before serving food, these
include plates, cups, forks, knives and spoons.
IIJAPTIB TINE
:AOD STf,PSGE

i;i.rci Storage l: puf;ing away excess food in a safe place so that itcan be used in future. During
the:tci-age ar,d all other times food should'b'e prevented from contamination, exposure to dust, ;,-,._..
r': Ir r
,

flies and unclean handling.

RTASCNS FOR STORII\G FOOD

a) To avoid foocl vrastage.

b) To avoid food shortage

c) Sc that rhe fooel should not spcil or go bad.

.j) To get certain foods during the scarce season.

\^IAYS OF STORIi\JG FOOD

.i Refrigeraticn.
ii Sr:tokinc;,
3. Dr''iing - removing molsture.
4. Salfing adding salt.
';,. Pii:klirtg - adding vinegar
5, Canning - putting food !n presst:rized tins/ can
1 -€r#r"5
,'lr.r FOOD

a) Grarns, ciried vegei;bies, n"leai rniJ fis!" etc shoulci lre stored in a dry airy place v;here rats anJ
insecl's have nu access.
o) Gi'ounC grains. sugar, lea, bi'eaC and por.nrCered milk etc should be kepl in dry, tlghtiy, closecj
tins,

LIQUIir F0ill

a) Fresn rn!:r st.oulo he lrorted and kept in a ciean tlghtly closed jar or L:ottle.
c) Cther juir:es shoull qlEo be kepl in clean tig:rtly clcsed jars or bottles.
c) i:ats sucrias bul-fer ap"l p3rgarine should be kept in clean tightly closed holvl placeo in a
refrigerator ;rr coolest part r;f the kltchen or dining

re {&iH.EL_E-LL=r

f inrrec iocc1, iurces, packeri riyJal a;rd fish, mealle- n'real and other 1'pes of focd have expiry rlat's
sno i.iiis ..'hauld ':e considered before buyinq, using cr storing the food.
 CHAPTER TEN

NUTRITION

Nutrition is the study of different kinds of food and their effects in our
bodies. )'agc 1:
l

Nutrient is a source of nourishment which can be metabolized by a living

organism to give energy and build bcdy tissues,

CLASSES OF FOOD AND THEIR SOURCES

I FOOD CLASS FUNCTION I souRCES

a High energy giving Butter
a Provides warmth Fatty rr,eai
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Mineral salts . Strengthens bones a Salt I

a Water
. Body building Eggs
". Boost the immunity Chicken
Repa!rs worn-out Meat
tissues Fish
Bearrs
i
Peas
Carbohydrates . Energy giving r Rice
Maize
I

lvlillei
Sugar
Bread
Potat<les

Protection againsr a
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infec:;on t veaetab,les
r.4ilk
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a Liver

BALANCED DIET

Isadietthatccnsistsofall food:lasses.Thehodyreetdsprotection,growthr,,id
energy hence the importance of eating a balanced ciiet so that the bcdy's
requirements are met"

DIET is a controlled regimen of food and drink as to gain or lose truelght

FOOD DEFICiENCY DISEASES

A foocl deficienry disease is an illness tha:t resuits trom iac!'of panrcul;rr fbod
nutrients.
 ( --

i
FOOD DEFICIENCY DISEASES Pau,: i?

Kwashiorkor - caused by dietary insufficient of protein in combination with high carbohydrate

diet
Rickets - a disorder in infants caused by deficiency of vitamin D causing soft bones
Marusmus - caused by malnutrition or the ability to digest protein
Scurvy - caused by insufficient intake of rritamin C leading to formation of livid spots on the
skin
Beriberi - caused by a deficient of thiamine(vitamin 81 ) Ieading to lethargy and organ
compllcation
Pellagra - a disease with skin lesions and mental confusion primarily caused by a niacin
deficiency (niacin is a component of vitamin B complex found in meat, yeast, milk)
Goitre - enlargement of the front of the neck caused by inflammation of the thyroid gland
Anemla - a condition in which the capacity of the blood to transport oxygen to the tissues ls
reduced

GENERAL LOOK OF A WELL NOURIS;ED PERSON

-Clear, smooth and soft skin.

-Bright eyes.
-Red moist tongue.
;P,ink finger nails
-Smooth lips without cracks
-Strong firm muscles.
-Well formed and clean teeth
-Well developed arms and legs which are not large at joints.
-Actir,,e and alert look.

REASONS FOR MALNUTRiTION

Family members may not get enough food because of,

. Poverty
. Drought
. Ignorance
. Negligence
. Cultural/religious taboos on certain food
. Mother not breast feeding.

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CHAPTER ELEVEN

Itis the essential health care programme which places emphasis and involvement of the
community at all levels.
Fage | 1.1

It is the essential health care which is acceptable, accessible, appropriate and affordable to the
community and it involves the active parLicipation of the community at all stages of planning,
implementation and monitoring.

COMPONENTS OF PRIMARY HEALTH CARE

* Water and sanitation

.i. HIV and AIDS
* Nutrition
.i. Counselling
* STIs
* First aid
* Hygiene

l
 CHAPTER ONE

HOME NURSING

Home Nursing is the homely art of caring for a sick person. Sick people are not kept in hospital
wards until they fully recovery, they are rather discharged for Home Based Care where relatives
care for them as they contlnue to take their medication. Terminally ill people also spend most of
. their time under Home Based Care and only visit thr hospital for doctor's review.

NI ]RSING

Nursing is the humanistic science dedicated to com'rassion and caring for the sick aiding recovery,

AIMS OF NURSI\IG

To allcviate pain
To enhance drugs taken by patient
To prolong iit-e
'lo prol'ide nlaximum possible comfortable to the sick
'Io alleviarie psychological and ernotiorial stress
+ "fo pror.ide basir, hocly exercise

}1ON4F BASED CARE

Itome Based Care is the health care extended from rospital wards to the Outpatients Department,
Clinics and to the home so that care can continue in the home environment.

ADVANTAGES OF HOME BASED CARE

! * It is cheap, no admission or hospital visit co:;ts for relatives.

. A var-iety of food can be served as per patiert's request.
* it brinrls the pratient and reiai;ves closer.
iL- . rraditional neeris are :'ne+ in n rnore relaxed environment.

."
Psychological needs are met,
r .
lrJo st rrct vrsiting times

iL .
One can die in the hands of tl-re beloveC onr's.
Farnily members take re:,ponsibility in their r:wn environment.

I
I
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L
Is the one whc looks after the sick. In home h;rsed care relatives are primary nurses whilst health
I
I
wcrkers are secondary nurses. Other volur"rteer: from the community asslst as care facilitators.
I
{-)rxtlideriiuliry - rs a substantive i";le rn say thal l"e information in a patient reveals to a health
I iare prrrvider must obtain p:rmiss.rn from thl patir"nt to mllre such a disclosure.
I
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i
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QUALITIES OF A GOOD NURSE

1. -
Sympathetic Kind and understanding.
2. Observant- Notice changes in the patient's condition.
3. Cheerful - Bears a smiling face.
4. Gentle - Has quite movements and handles the patients with care. Page I it
5. Patient - Controls temper.
6. Punctual - Does things in good time.
7. Reliable - Honest and trustworthy.
B. Discreet - Keeps secrets.
9. Knowledgeable

. A good nurse should practice good hygiene, provide total nursing care to the patient, take
health workers advice and give a full and true report on the patient's condition"

DUTIES OF A NURSE

Spread the bed

Help the patient in doing oral care
Feeding the patient
Help the patient in doing bed bath
Cleaning and dressing the wounds
Cleaning the sickioom
Giving bed pan and urinal

LIIVIITA]IONS OF A NURSE AiDE

To give drugs
To give injections
To give prescriptions
To admit a patient
To discharge the patient

PATIENT is a sick/injured person who has been attended by the medical expefts

AIDS FOR THE PATIENT'S COMFORT

1, Bed cradle - To lift the weight of top bed clothes.

2. Back rest - To support the patient to sit up.

3. Bed pan - For male and female patients to pass stools and females to
pass urine as well'
 4. Urina! bott.ie For male patients to pass urine.

5 Spr:tirn-r mug To collect sputum.

o. I- 'ed' :g Cuc To leerj helpless patient.

7. Comnroce fo sit patier;i whilst passing stool.

B. Air- ring To prevent [:erlsores.

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9 l-rot water bottie - warm the patients.

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CHAPTER TWO

THE SICKROOM
. Pagei
- li
A sick room is where slck people are kept for total nursing care. In hospitals patients are admltted
into wards.

CHOICE OF A SICK ROOM

Very often there is no choice and the nurse has to nurse her patient in a room which is unsuitable, but
if the nurse herself is familiar with the qualities of an ideal sickroom, she will then be better able to
make the best of whatever accommodation is avaiiable. The following should be considered when
choosing a sickroom,

Quietness - A quite room is best for sickroom.

Ventilation - The room must have good ventilation. An inlet for fresh air must be
provided whilst a draught must be avoided.

Heating -The room should be warm. Blankets may also help to keep the patient warm, To
prevent the room becoming too hot in summer the windows should be kept ooen.

Lightirrg The room should have adequate IiEht. Positioning the bed helps to provide natural liqht
in the room. Avoid making any form of light to shine fully on the patients tace.
Floor -The room floor should not be slippery to avoid falls of both the nurse and the patients.

REQUIREMENTS OF A SICKROOM

. Bed with a comfortable mattress, preferab!y an iron single bed.

. Small table
. Chair
. Stool
. Flowers
, Locker
' Cool clean drinking water.

CI.EAI\ING A SiCKROOM

The sickroom should be cleaned everyday and every time as may be necessary.
Remove snrall mats and clean them outside"
Remove and thoroughly clean under the bed.
DusL all the furniture with a damp cloth.
Dust walls and windows with a damp cloth, sweep floors.
 --------..--..-

CHAPTER THREE

BED MAKING

Since many patients are confined to bed it is important lor the nurse to acquire the art of bed making.
The comfort of the patient is the most important factor, a badly made bed is uncomfortable.
page I i 9
Bed making is a technique of preparing different types of beds in making a patient comfortable for a
pafticular condition.

Bed making is the removal of soiled linen and replacing with clean linen,

Bedding is the materials that are used to spread the bed

REQU]REMENTS FOR BEDMAKING

1. Bed with a comfortable mattress.

2. Bottom blanket
3. Bottom sheet
4. Draw mackintosh
5" Draw sheet
6. Top sheet
7. Top blanket.
B. Counter pan.
9. Pillow
10. Bucket for collecting soiled linen.
11. Two chairs.

PREPARING THE PATIENTS BED

1 ' Two nurses are required for this process, this is more satisfactory and economical in
ir- both time and energy.
'. Ensure that all the required linen is collected before you stad.
Place the bottom sheet on the mattress and tuck the ends first.
I . Tuck the corners presenting a neai envelope corner.
L ' Place a mackintosh preferably stretching from the level of the patients shoulders to
the thighs and tuck it in firmly.
I . Lay the top sheet and tuck it up to the shoulder level on one side and up to half on
the other side.
L . Tuck corners the envelope fashion
. Lay and tuck the top blanket like the top sheet and tuck corners the envelope
I
IL .
fashion.
Fold the top bed cloths at shoulder level such that the top sheet is on top.
. At the top middle of the bed widthwise, fold the top bed clothes to form a triangle
I 1ryith one end of the triangle being the site where you tucked the clothes up to half
I
L .
level.
Place the pillow.
Cover the bed with a counter pan,
I
L CHANGING BoTToM SHEET WITH HELPLESS PATIENT oN BED

I . Ensure that a bucket is made available to put the soiled sheet.

L . Prepare a clean sheet by rolling it tightly lengthwise for a little more than half its width.
. Loosen bed clothes and leave the patient with one pillow.

I
I
. Gently turn the patient on one of his sides, to the other half of the bed with head comfortably
supported.

' The other nurse on the opposite side of the bed rolls up the soiled sheet, mackintosh and draw
sheet close to the patient's back.

. The nurse then places the clean under sheet in position with the roll close to the soiled linen, Pagc 2('
tucking it firmly at the top, bottom and side. She/ he replaces the old draw rolling them the same
way as the sheet.

. Gently roll the patient, first on his/ her back and then over the double roll of sheets on to his/ her
other side on the clean linen.

. Comfortably support the patient.

. Remove the soiled linen and put into a bucket.

. Straighten the bottom sheet, mackintosh and draw sheet and tuck in avoiding creases.

RULES OF BEDMAKING

, Always check condition of bed.

'. Have required material before you start.
Soiled linen must never be placed on the floor.
. Firmly tuck in bottom.bed clothes to avoid creases.
. Top bed clothes must be loose.
'. Use bed cradle to hold heavy bed clothes.
Always do neat envelope corners.
. Ensure the patient's privacy.
. Work quickly and methodically.
. Handle the patient with firm gentleness,
'. Do not talk across the patient.
Always talk to the patient.
. Avoid shaking of the bed clothes.
. Observe the patient's condition as you make the bed.
 CHAPTEBJ:qUR

BED BATH

AiMS OF BED BATH

?agi: i i i
1.) To clean the skin from sweat and bed smell.

2.) To refresh the patients body.

3") To promote sleep.

4^l To observe the patients condition.

5.) T-o promote blood circulation,

REQU]REMENTS FOR BED BATH

1 Dish
2 Soap
') Two bath
J tor,vels
4 Two face cloths
q
Two jugs or buckets one witlr warm and other with cold water.
6 One empty jug or bucket for receiving dirty water.
7 Lotion
8 Razor blade.

PROCEDURE
1) Firstly check the patient's condition.
2) Inform the patient of the procedure to be done.
3) Offer the patient bed pan and or urinal.
4i Close windows and draw curtaining.
5) Loosen top bed clothes.
6) Remove counter pan and blankets leaving the patient covered with top sheet.
7) Help undress the patient.
B) Put on latex gloves.
9) Mix warm and cold water in a dish
10) Feel the temperature and comfort of the water using your elbow.
r 1i) Place a towel under-neath the patient,

- 12) Clean the patient with a soapy wet cloth and rinse.
13) Start with the face, neck, ears and dry.
I 14) Uncover and clean the chest and arm one at a time, Iet the patient dabble hands in warm water
I and dry. Cover these parts afterwards.
15) Change water, uncover clean, rinse and dry the lower chest, belly and the sides. Cover these
parts.
16 Uncover gently clean and rinse the back and cover.
L 17 Clean, rinse and dry the legs and foot.
18 Change water and cloth.

i 19
20
2t
Help the patient clean the private parts.
Trim finger nails.
Comb the hair.
22 Apply lotion.
23 Help the patient into clean clothes.
L 24 Replace bed clothes and clear material used.

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7

CHAPTER FIVE

BED SORES

These are sores that occur on bed confined patients, Bed sores usually occur on those body pats with pagel2).
bone prominence, these parts are sometimes called pressure parts.

CAUSES OF BEDSORES

1) Moisture
2) Creases
3) Crumbs
4) Pressure

PRESSURE PARTS

1) Knees
2) Back of head
3) Ankles
4) Wrist
5) Pelvis
6) Shoulders
7) Buttocks "
B) Elbows

PREVENTION OF BED SORES

1) Timeous change of soiled linen.

2) Change the patient's position frequently.
3) Avoid bed creases
4) Avoid crumbs on the bed
5) Always keep the patient's body clean.

1. NB, Massaging of pressure parts is no longer recommended

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 CHAPTER SIX

MOUTHWASH

Great care must De taken to ensure the cleanliness of the patients mouth, hence the need to do regular
mouth wash ie every morning, evening and after meals. i'irg; i r-3

REASONS FOR MOUTHWASH

1. To prevent bad smell.

2. To prevent tooth decay.
3. To arouse appetite
4. To prevent gum infection.
5. To prevent stomach infection

MOUTHWASH

If the patient is not severe a toothbrush and suitable clentifrice should be used followed by a mouth
wash. In case of severe illness, the following procedure must be done.

REQUIREMENTS

- 1) Cnp of water.
2) Receiver
3) Bowl
4) Cotton wool swabs or clean pieces of linen.
5) Two forceps or small blunt pieces of wood.
6) Mouthwash or sodium blcarbonate solution
7) Bath towel
B) Vaseline

PROCEDURE

r Put towel around the patient's neck to protect clothes.

'/ Ask the patient to clench teeth together.
'r Soak cotton wool swab or piece of cloth in mouth wash solution.
, Using forceps, piece of wood or guarded fingers, hold the swab and clean the teeth starting
with front, left and finally right side. Use one swab for stroke

F Ask the patient to open nrouth.

/ Help the patient rinse the mouth thoroughly.

'. Great care must be taken to avoid causing bleeding from the gums.
. The tongue should be cleaned from side to side not backwards and forwards to avoid vomiting.
- Remove towel.
; Apply Vaseline on lips"

. Clear material.
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CHAPTER SEVEN

MONITORING EXCRETA

Page ).
T:5 3331i?'3",1fi:lt'[".Hlf?::3"'i'.T#:li::[E
I

,?;,,;'3,:"1!:ilf:T#::"J?:
the excreta is very imPortant.

1. URINE OBSERVATION

a) ',COLOUR
Normal colour of urine is clear amber. The colour might be lighter or darker
in colour as a result of more and less output respectively, this is normal'
', Pale straw coloured urine occurs in diabetes.

of bile.

of normal menstruation in female patients'

b) QUANTITY

quantity in children. Slight variations might occur due to weather' A marked

decrease in urine output may be a result of kidney disease. Inability to pass
urine may temporarily result from shock as after a surgical operation, however,
if this takes considerable time resulting in the patient's extreme discomfort,
medical advice should be sought immediately.

C) FREeUENCY urine may be passed in small amounts of frequent intervals due

-
to bladder inflammation or nervousness but if it persists medical advice should be
sought immediatelY.

N/B. Any abnormalities in the urine output In colour, frequency, quantity as well as
abnormal contents should be reported to the medical Personnel immediately'

2, STOOLS

a) FREeUENCY - normally the bowels should be openeci once in twenty four hours.
three
Frequent watery and loose stools may be a result of diarrhoea whilst two or
days may lapse without opening the bowels due to constipation'

are found in
b) COLOUR - normal color of stools is pale brown . Clay coloured stools of typhoid
cases of jaundice whilst chocolate coloured stools may occur in cases
fever.

c) CONSISTENCy -
normal stools are soft. In cases of diarrhoea the stools may be
loose and watery whilst in constipation they may be hard and dry'

Abnormal contents in the stools may consist of bright or dark blood, mucus, undigested
food and worms. These stools should be saved for the doctor to see.
 - Draw curtains to
ensure privacv.
F Warm the

; iJlXf?:ff:J?,ffi"'."li,i:,:^"q*o
- -:" L'vLilEs dno turn
w*h a c,oth
them back hut do
Remove iil cloth and lid covering not- expose the patient.
- with the ot? bedpan.
the
L - til i.j;:T :T.1,: ;i;i'..:H j:gr. l:Uir
sr is h
- nrt",.Lu;fin:ff:"J"t':*:S31! tle o"j srip
e o*r e r r
the parient's butocks
Pal"- I rS
r5,',f['r::iflTh
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: 1:XT..l?I17E:i:3:f,:ilr iffi :ffi il:*Til b u,,.cks
; ;ffiH:"#:?:il:;. rei.nove ir rrom
rhe room

t
URINAL

A urinal can usuallV

bt
extreme helplessness:P:d"d to the patients and renroved
tne nurse must give after without trouble, but
the necessary urrirtun.X]u in cases of
HOW TO CLEAN
tsEDPANS AND
URINALS

urinals should be
emptied.immediarery
i:i:ilff'd unress the E

use. mop to clean. water

. ,,.u,9n',lot;lnrlino
Soak in a jug of
anticonrir n^r,.r:-
Weak anliseptic
solution for ahout
Rinse the utensirs thirty minutes.
Leave to d4,-.
CHAPTER EIGHT

TEMPERATURE, PULSE AND RESPIRATION

TEMPERATURE
Pirge l)t

Is the hotness or coldness of the body. The normal body temperature is 36 to 37 Degrees. A clinical
thermometer is used to take temperature.

PULSE

Is the wave of pressure that passes along arteries indicating the pumoing of the hear-t. Norrral puise
rate is 60 - B0 beats per minute.

RESPiRATION

Ts the inhaling and exhaling of oxygen and carbon dioxide respectiveiy. The noi-mal respiration rate is
72 - 20 breaths per minute.

REQUIREMENTS FOR CHECKiNG TEMPERATURE, PULSE AND RESPIRATION (TPR)

- Two sterile cloths

. Red and blue pens.

PROCEDURE

'p Irrform the patient of the proceCure to Oe Oone{

i
'P Collect requirements 1i
'p Ensure that the thermofteter is below 35 degrees celcious if not shake it.

'/ Remove the thermometer, check and record reading.

'. Wipe the thermometer and put it into the jar with disinfectant.
 AENAEI,IALIIIES

- Any abnormalities in TPR shcuid be referred to Medical experts.

. The abnormalities include the lollowing.

'l']ai:l
] i 7

t './eni' low or Iigh temperature.

, Fast, irregular, r,veak or slow pulse.

t Fast, shallow, Wheezy Stridor and sighing respiration.

These are aiso knoivn t he parameters of the sick

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CHAPTER NINE

DIET AND FEEDING OF A PATIENT

Page I ll
Diet is a controlled regimen of food'and drink as to gain or lose weight,

Food is essential to life. The work of the body cannot be carried on without food. In ill health food is
necessary so that full recovery is assured. In preparing food the following should be considered.

l. Nutrition Value - Food with high nutrition Value should be served i.e.
food containing all food nutrients which are proteins,
Carbohydrates, fats, vitamins and minerals salts.

2. Illness or disease - Other illnesses have special diet hence the illness
should be considered e.g. diabetic patients need
sugar free food.

3. Condition of the patient Very ill patients may find it difficult to chew or swallow
food hence a fluid diet is appropriate.

4. Religion -Different religions have different types of diet. some

do not eat pork whilst others are vegetarians hence
religion should be confirmed before serving food.

HINTS ON HOW TO SERVE FOOD

a) The food must be punctual and regularly served. If patients are kept waiting
for food their desire for food is upset.
b) Food must be served appetizingly - badly served food will soon destroy the
Iittle appetite of the Patient
c) Food must be served with the right temperature, cold food must be served
really cold and hot food really hot.
d) Food must be served in small helpings. The sight of too much lood is
nauseating hence it is wise to give the patient less than he eats. However be
prepared to immediately serve more if required'
e) Ensure that the patient is comfortable before you start serving food. If he
can be able to sit up he should be comfortably propped up in bed.
0 Always remember to offer bed pan or urinal before serving meals, but these
should be removed before serving food'

FEEDING A HELPLESS PATIENT

1. Inform and consult the patient prior to feeding.

2. Set the food tray attractivelY.
3. Ensure good hygiene.
4. Ensure [he patient is comfortable; put a towel around the patient's neck to prevent clothes from
dirt.
5. Use either spoon or feeding cup, depending on the patient's condition and type of food.
6. Give small amounts at a time.
7. Allow the patient to chew and swallow.
B. Clear the utensils after feeCing.
 EHAP]ER TEN

{NFECTIOUS DISEASES

Many diseases are due to the invasion of the body by micro-organisms and those that can be spread
easily fi'om one person to another are cailed infectiou: diseases. 1t)
l)-,',.
' : l-

INFECTION
Is the invasion of the body by harmful micro-organisrns or germs.

DISEASE rs the cieparture tiom normal health

HOW iNFECTION 1S TRANSMITTFD

a) Inhalation, the qerms may be taken into the lungs through breathing e.g tuberculosis,
n) Ingestion, lhe germs may be sr,vallrwed in by eating contaminated food or drinking contaminated
fluids"
Penetration of ihe skin, the germs may enter through wounds or insect bites.
d) Contact with body fluids e.g HIV

NURS1NC AN iNFECTIOUS PATIENT/ASPECTS OF INFECTION CONTROL

.l Isolate the patient untii the risk of infection is over.

'l The room chosen fr:r a sick room should prefcrably be far away from other living rcoms.
* The sick room should be light, sunny and well ventilated.
* If possible remove unnecessary furniture and carpets. '_i-
1.;

* All utensils used by the patieni must be separated and be disinfected after e.,,ery use.
* ,1ll food left should be burnt immediately.
+ All excreta shouid br ntixed',vitlr a disinfectanr before disposal into the toilet.
* Dirty lintn shor"i'J be sr-r,:rlecJ in Cisinfr:ctant sc'lution before'"nuashing.
ri- Beclpans, urinels anc sputum mugs must all he soaked in a disinfectant solution.
';' All dai'nrr dusting in lhe room sf,ould be done with a da;np duster soaked !n a disinfectant
solrrtioir. 'i

'l The nurse should ln;ear proteciirre clothi:ig ea:h time he/ she is in thesickroom.
* The nurse should wash i;anr-js r"norcrghlr bef-rre ancl after entering the sicK,oom.
* After the isclation period the r:atient :;hould be disinfected by means of a soapy hot bath.
+ Aftei' ihe isolation period th-^ room must also lisinfected by damp dusting all the uralls wrr,dov.,s
lnii fu.'nrtui"i:.
* all ihe iinen and blankels shcLrld be soaked ir, disinfectant solution, thoror:ghly washed a,:d
iroried.

Sodium \"n:-chlaride.solLir-icr,iiousehold bea:h fiik) diluted 1 :10 with water is a very effe*rve
rlirinfec',lnt solution.
1_
'/ Pienty of soap and lrct ivater may also sub:titute the above solution in cases of lack cf
feqor I i :e5^
L AD\.I\I!]AGEJ OF INFECI-ICI{ CONITRNL IN A HOSPITAL SETUP

If r'"r-iircer iabr,ur
:
l r ,{ ..
I1 .' jri ;a.ls thr. r i,sersc:
[i; gillicgg C9.15
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It ledr:ces the dea!'ii rate 1

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 AGENTS OF INFECTION

Protozoa
Fungi
Bacteria
Virus
Ilagc i 3{

CHAPTER ELEVEN

M EDICIN E

Giving medicine form an important and, in many cases, a difficuit part of the nurse's work' Many drugs
are poisonous unless they are given in appropriate quantities ordered by the doctor,

WAYS OF GIVING MEDICINE

a) Swallowing-by mouth.
b) Injection
c) Inhalation
d) Absorption
e) Insertion

coLDEN RULE oF GIViNG MEDICINE

Xf
Giving the right amount of the right medicine to the right patient at the right time through the "ight
route.

HINTS ON HOW TO GIVE MEDICINE

a) Inform the patient of the procedure.

b) Thoroughly wash your hands
c) Take the medicine container and carefully read instructions cn lhe label.
d) Shake the bottle if medicine is a liquid one'
e) Avoid oblination of the medicine label by medicine drips'
0 Pour or take out the ordered quantity of the medicine.
g) Read the instructions again before giving to the patient.
h) Talk to the patient to ensure the medicine has been swallowed'

TIME OF GIVING MEDICINE

a) Medicine to be given before meals should be given 15 - 20 minutes before food.

b) -
Me;licine to be given after food should be given 15 20 minutes after food.
.j Unless otherwiie stated, medicines are usually taken after food i.e after breakfast, lunch, and
supper.
d) Medicines given four hourly are usually given at 10 o'clock,2 o'clock and 6 o'clock thrrrughout the
day.
 The foilowing lisi of ccmmon abbre',',ations used in giving medicines maybe useful for reference. These
are usually ,,vri'iten on the patient's hospital card against each medicine.

t ac before meals Pag,: ! 3 i

n pc - aftei' foods
r mane - rn the morning
r nocte - at night
' tds - three times a day
bd - twice a day I a^fn cf fuchnres
" eoutt 'iohins
' qid - four times a day

CARE OF MEDICINE AT HOME

g"o& -
a) All medicine must be kept in locked cupboards. v€ed,'tT
b+@?P
b) All medicines must be clearly labeled. r*) --3
Qaral)
c) All medicine must be kept in cooi dry place. 5*d" bkd
d) Ail nreclicine rrrust be kept out uf reach of children.

e) Medicine nrust not be fept in food containers e.g. soft drink bcttles.

f) Medicrnes of internal use shouid be separated from those of external use.

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CHAPTER TWELVE

LIVING POSITIVELY WITH HIV .!,age 3:

Living positively with HIV means doing practices that promote good health and living as normal a life as
possible. This starts when one receives HIV positive results and accepts his / her status"

TIPS ON HOW TO IMPROVE YOUR LIFEQUALI'TI

-Living with hooe.

Hope lifts one's spirit and also gives strength to fai:e any life situatio;;.

-Reduce stress.
Find ways of coping with stress, such as seeking counseling, talking to other people and joining support
groups in your area.

-Avoid further infection.

Do not expose yourself to further infection by prar:ticing safer sex or abstaining completely from sex,

-Seek early treatment for other infections.

HIV reduces your body's ability to fight infection hence the need to go to tlre clinlc or hospital as soon
as you feel that you are not well in order to get medical treatment.

-Healthy eating.
Eating a well balanced diet will enhance your body's ability to figirt infection and recover lost weight

-Body exercise.
Exercises are very important in order to keep you fit, however you should avoid sti'essing'7our bodv'

-Avoid smoking and taking alcohol.

Smoking can cause lung infection hence it is advised to gradually stop smoking. Alcohol and si:me
other drugs suppress the immune system and should be avoided.

H]V AND FOOD

A well balanced diet strengthens the immune systr:m and slovu's down progression to AIDS'

-Prr:vides energy.
-Supports the immune system in the fight against ;nfection.
-G!,.,e medicine the best chance to work well,
-Helps the oigestive systern to cope and or recover'from ciiarrhoea.
-Minimize weight loss.
FOOD TO BE AVOIDED BY HiV POSITIVE PEOPLE

-Refined foods.
When foods are refined they loose some nutrients and fibre which is important for constipation
prevention. page 33
|

-Preserved foods,
These foods contain preservatives, artificial flavours and colourants which can interfere with digestion
and stress the immune system.

-Canned foods
Canned foods also contain preservatives. Canning also involves heating food at high temperatures
resulting in the food loosing some of its nutrients.

GERIATRICS

Is a branch of medicine coverinE old age and the disorders arising from it.
It is the study of the old aged

PHYSICAL SIGNS OF AG]NG

Hair looses its colour, becomes thin or disappears (hair loss)

Wrinkled skin
Muscle tone is lost and movement becomes slower
The person becomes stoops and becomes shorter
The sense of hearing and sight is affected
Menopause in female

PSYCHOLOGICAL SIGNS OF AGING

The mental power slows down

New ideas are not accepted
The memory of recent events are poor
They can be easily annoyed
They become sensitive and emotional

PREVENT]ON OF ILLNESS

Provide a well balanced diet

Regular medical check ups
Encourage hobbies
Control room temperature
Basic body exercise
Good communication
Good monitoring
Preventing them from smoking and drinking
 PREVENTION OF ACCIDENTS

Repair floors with cracks

Do not over polish floors
Avoid lose mats Page I 34
Provide adquete light
Avoid naked wires
Enc ourage to wear properly fiting shoes

COMMON DISEASES IN ELDERLY PEOPLE

I

BP \
Diabetes
Amnesia
Alzheimer"s diseases
Cancer
Arthritis
Card iovascu lar d iseases

-\
LAST OFFICE

Is the care given to the d'teing patient/ person

SIGNS OF APPROACHING DEATH

Unconsciousness
Loss of breathe
Mouth remains sagged
Swailowing of the tongue
Hickups
C. I,t,^"*,rpinched nose
Dryness of lips
Sunken eyes

SIGNS OF DEATH

Respiratory arrest
Cardiac arrest
Rigormotis
Pale skin
Cold hands and feets
Incontinence

PROCEDURE OF SHROUDING

Inform the doctor or sister in charge

Inform the church leaders to arrange for prayers
Provide bed bath
Screen the bed
 Wait for the doctor to certify death
Clc;e all the openings using cotton rrvooi
Place name tags on ankles, waist and shoulders
Apply a shrouding gown or use a sheet
List the belongings of the person
Allow the relatives to view the body before transfering to the mortuary
Fage j :ili

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CHAPTER ONE

SCOPE OF FIRST AID Page I 3t

FIRST AID

First Aid is the approved method of assisting those suddenly taken ill or injured before a medical expert
takes over or an ambulance arrives,

AIMS OF FiRST A]D

a) To save life
b) To prevent the condition from worsening
c) To promote recovery

FIRST A IDER

A First Aider is a person who has received training and a certificate from an authorized training body
approving him/ her to render first aid

I"ASKS OF A FIRST A]DER

In an emergency the firstaider should do the followiirg:-

1) Assess the Situation

t Check and ensure safety of the casualty, bystanders and first aider him/ herself.
{. Establish the number of casualties
.i. Identify available facilities e.g shelter, telephone
2) Identify the casualty's Condition

a) This can be done through primary and secondary surveys.

b) Get the IIISTORY - the story of what happened.
c) check the signs - what the first aider can see e.g. bleeding swelling.
d) Establish symptoms - what the casualty feels or complains of e.g pain.

3) Give immediate and appropriate help.

4) Re-assure the casualty and the bystanders.(No monotonus questions)

5) Arrange for the casualty to be taken either home or hospital.

PRIMARY SURVEY

A primary survey is the initial examination of the casualty. This is aimed at identifying any life
threatening conditions. In this survey the first aider should follow the ABC rule of first aid,
 ABC Rule of first aid

A - Airways. Open and maintain a clear arrway i.e month, nose and the windpipe.

B. - Breathing. Check whether the casualty is breathing. Look, listen and feel for breathing. If
breathing has stopped, apply artificial respiration immediately. pagei3T
- Normal breathing rate is 12 - 20 breaths per minute.
C - Circulation of blood. Check rr,,hether there is blood circulation by feeling the casualty's pulse.
- Pulse is the wave of pressure that passes along arteries indicating the pumping of the heart.
- Normal pulse rate is 60 - B0 beats per minute.
NB If Ootfr breathing and blood circulation has stopped quickly do cardio pulmonary resuscitation.

SECCNDARY SURVEY

A secondary survey is the head to toe exanrination of'a casuaity, this is the survey that identifies other
injuries. This survey can crly b.^ done after a primary survey. In this survey the casualty's facial
expressicns may help the first aider to identify injuries

BODY PART WHAT TO CHECK FOR

Lacerations
Bleeding
Contusion

Deformity
Svuelling
Bleedi
Ears and nose Blood or fluids
Swelling
Bruises
I Mouth Bleeding
I
Frothing
i
Foreign bodies
I

I Unusual oudors or smell

L-
I Fve
Swelli
Bleeding
Diseolouration
Pupil dilation
Swelli
I lvecl:- Cervical deformity
I

I
Swelling
Bruises wounds
--"1
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l

I
Bleeding
I Pain
I Chest Penetrating wounds
I Tenderness
I

I Deformity
Sweliing
Bleeding i

Pain I

iouo;,*u; Swelling I
I I
I Bleeding
__l
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Brui wounds

S\

I
 Protruding bowels
Pain
Pelvis Bruises/ wounds
Deformity
Bleeding
Pain
Spine Deformity Page- l 3l
Bleeding
Bruises/ wounds
Swelling
Pain
Lower llmbs Deformity
Swelling
Bruises/ wounds
Bleeding
Pain
 CHAFfER Trl'IC

BANDAGES

Bandages are a iength of cot[on material used to wrap injuries, I r!1 ; - I

TYPES OF BANDAGES

+ Triangular bandages
.i. Roller bandages (gauze or crepe)
* Adhesive bandages
L'SES Oi: BAiIDAGES
.l To hold rlressings in place
* 1'o apply pi-essure in stopping bleeding.
* To immobilize fractured Nimbs
* To cover wounds against infectiorr
+ To support rn;ure$ joints.
"l To prevent swerling.

I"RIANGULAR BANDAGES

+ Triangular in shape
* Easy to improvise.
* Can be used as a pad.
.l Can be used as ari open sling to secure dressing.
{. Can be folded into broadfold banclage to immobilize fractured limbs.
,:, Can be folded into narrow fold bardages.

"-7',

/-

*-/ \
Er:C
--/ End
 MAKING A BROAD FOLD BANDAGE

Fold a triangular bandage horizontally with the point touching the base.

Page | 4C

2) Fold the bandage in half again. This compietes the bandage.

MAKING A NARROW FOLD BANDAGE

1) Fold a triangu.lar bandage into broad fold bandage (as aoove).

2) Fold the broadfold bandage in half again.
This cornpletes the bandages.

GENERAL RULES FOR BANDAG]NG

a) Explain to the casualty what you are going to do.

b) Ensure that the casualty is comfortably seated or lying down.
c) Support the injured part.
d) Always work from the injured side or infront of the casualty.
e) Apply bandages firmly. A tight bandage can stop blood circulation whilst a loose bandage is
useless.
f) If possible expose fingers and tges of bandaged limbs so that blood circulation can be easily
checked.
g) If you are to bandage limbs together ensure that there is enough padding in between, especially
around joints.
h) When using a knot to secure a bandage alv,rays use a reef knot.
 REEF KNOT

A reef knot can be used to secure a bandage. A safety pin, adhesive tape or a bandage clip can also be

WHY USE A REEF KNOT

' a) It does not slip

b) It is comfortable for the casualty
c) It is neat.
d) It is easy to untie.
METHOD

1) Take one end of the bandage in each hand. Carry the left end over the right, and under.
2) Bring the ends up again. Carry the right end over the left and under.
3) Pull the knot tight
4) Neatly tuck the ends in.
CHAPTER THREE

BREATHING
Page 4'
why do we breathe?
AII parts of the body need oxygen for life and energy. During the breathing process another gas carbon
dioxide is produced as a waste gas and as such; it should be removed from the body,

ASPHYXIA

Is the lack of oxygen in the blood and body tissues.

CAUSES oF ASPHYXI a f u1ry;o

fiqvl-^i'3
a) Sm"othering - this is a condition whereby air cannot even get into the body through the nrouth
and nose e.g buried a life.
b) Choking - this is the internal blockage of the windpipe e.g. if food goes dourn the windpipe.
c) Strangling - this is the compression of the windpipe by a tight band around the neck.
d) Compression or injury of chest/ lungs.
E) Suffocatiol - to suffer from severly reduced oxygen intake to the body.
a €tearu'Ao
SIGNS AND SYMPTOMS

1) Difficulty in breathing.
2) Noisy breathing.
3) Shallow breathing.
4) Inability to talk.
5) Froathing.
6) Blueness of lips, face and fingernails.(Cyanosis)
7) Unconsciousness.
B) may stop.
[,"$Eif,
MANAGEMENT OF ASPHYXIA
^t
* Ensure safety
,.o (v*l
'l- 'j -^cN*"ag9\
t Remove cause from rra,r-rih, nr
- casuality +ha r=cr,:ri*.
or the frnm fha
casuality, from the rrr
cause.C ^dfv4'11)
"l. Open and maintain a clear airway.
n If breathing; place in the recovery position.
* if not breathing apply cardio pulmonary resuscitation immediately'
.i. Check breathing and bltiod circulation at 10 minutes intervals.
.:. Re-assure the casualty
* Prevent shock by providing warmth,
.l Get medical help.

')
(,/- I ,'
r--
,-}
r)\
t:
I
Y'll b
' il
L
I
,11 5
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!

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JJ
 CARDt,\C ARRES'I

is the sudclen stcppage r,f the heart to llimJ) hloo:1.

(or)
i":' {ite t:c,t.tcttian o/ thc' heari to {unctiott.

Pag,: | 43
CAUSES OF CARDiAC ARREST'

fi,'ctricit.r I ete&
ic 4'(tr-
{Dl'Lrqs srlqrcl#
et'tV *<e tadkafl< *'* "* o4 Pu+'*
lj6ssil ,*r',- -*) 'v
i'u':;-q q{^ v''t'z'rr
-* qnb'* *'*5
cor*$l+aor
floirui, -- rl ;v0,3* w c<:tro+t\t
CARDIO PI] LMCII\',\RY tTtiSUS C I.TATION

If the casualty has no pulse and breething quickly start cardio pulmonary resuscitation as
follows,
1. Check for safeQ' of yoursell, by-standers and the casualty.
2. Clear and maintain an c,ren airway,
3. /\ppl:,/ 5 full blows.
4. Give 30 chest compressions foiiowed by 2 blows. Apply the same for five times.
5. Check for breathing and circuiation after errery two cycles.
6. Confinue the process until the casualty recovers or the ambulance arrives.
7. If the casualty recoVers continue with the secondary survey.

CHOCKiI'-G

Is the internal blockage of the winclpipe. It can be either partial or complete chocking.

SIGT'iS AND SYMPTOMS OF CHCCKING

Breathing nray stop

Red walery eyes
Cyanosis
Gasping for air
Unconsciousness
Restlessness
Confusion

MANAGEMENT OF CHOCKING

.! Ensure safety"
* Encourage the casualty to cough.
* If the obstruction dislodges you may be able to remove it by your fingers.
* Ifit fails apply back slaps.
l. Continue lryith ahdonririal thrust that is if back slaps failed.
* Re-assure the cirsualty.
.l Prevent shock.
.:. Get medical help. \

t_
CHAPTER FCUR

WOUNDS AND BLEEDING

WOUNDS
Faga | 4(
A wound is an abnormal break in the skin which allow blood to escape and germs to enter.

DANGERS OF WOUNDS

* Bleeding
* Shock
* Infection

ryPES OF WOUNDS

TYPE DESCRIPTION

1. Incised v,,ound A clean cut

Caused by sharp instruments e.g razor
blade. knife
2. Lacerated wound
l

3. Punctured wound A stab

Caused by sharp pointed oi.:jects e.g.
nails,
Internal injury where top skin layer
may not be damaged.
Caused by a blow from a blunt object
e.o knobkerrv.
Grazed wound of the superficial layer of the
skin.
by friction against rough
L__
i 6. Gunshot
I
L___ )- Caused by a bullet ___ i

MANAGEMET.]T OF WOUNDS

* Fnsure safety
.;. Thoroughly w'ash your hands and, or wear gloves.
.i. Control bleeding if any.
i Remove clothing from the injured part if necessary.
.i. A',oid spreading germs to the rvound and the equipment to be used.
* Do not remove any foreign objects stuck on the wound. This may lead to further bleeding and
infection"
.:. Clean around and away of the wound using a clean or sterile dressing soaked in clean cold,
soapy water. L.lse a fresh dressing for each stroke.
* Place a sterile dressing over the wound; apply cotton wool and cover with a clean bandage.
.l Prevent shock by providing warmth.
* Re-assure the casuall-:,.
"i Get medical hetp.
 CHAPTER FIVE

BLOOD CIRCULATiON

Blood is pumped from the heart through arteries to all parts of the body and returns to the heart
veins. An adult needs about six Iitres of blood to survive.
Page 4{
FUNCTIONS OF BLOOD

a Distribution of oxygen to all body tissues.

* Distribution of nourishment to all body tissues.
t Distribution of warmth.
* Taking away carbon-dioxide.

BLEEDING

Bleeding is blood flowing out of the circulation system. This can be either internal or external.

ryPES OF BLEEDING

TYPE CHARACTERISTICS

Arterial I Bleeding from afteries.

T Blood is bright red in colour.
I Blood iets out with Pressure
Venous a Bleeding from the veins
a Blood is darkish red in colour
a Blood flows out smoothlv.
Capillary Bleeding . Bleeding from capillaries
. Blood oozes slowly.
o Blood is either bright or darkish red in
colour.

WAYS OF STOPPING BLEEDING

a) Direct Pressure

* Apply pressure on the wound/ injury using a sterile pad and bandage firmly.

b) Indirect Pressure

* Apply pressure away from the injury.

* For arterial bleeding apply pressure at the side of the heart and venous bleeding'

c) Elevation

* Slightly raise the injury above the level of the heart.

ie;"E
^{ e;nE
l--f
lt'ff*,
a,oi:'
[i*n ood
'i*9
L"eark
1.1earY
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f
t
I *-,^l
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'-
ffir
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Cg?'llar'es I
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.Fi;dbTe Fr *t\ y''ln w^t;1;****
'toz* o-
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r-le,r-up-
Sa .,..
Au'F ?"4 us *-3 t/P "1uflr,H, 611- '9rra
1&^ |
 .I

MANAGEMENT OF NOSE BLEEDII\.IG

.i. Ensure safety* ilage | 47

{. Sit the casualty in an open air with the head s:!ghtly bent forv;ard.
* Loosen any tight clothing around the neck.
* Ask the casualty to firmiy pinch the soft part of the nose.
* Advise the casualty to breathe through the mouth.
.:. Apply cold compress on the casualty's foreheaC.
* Release pressure at ten minutes intervals.
{. If bleeding does not stop after 30 minutes quickly refer for medical help.
* Prevent shock by providing warmth.
* Re-assure the casualty.
* If bleeding stops advise the casualty not to blow or pock the nose for the next few hours.

BL"EEDING FROM THE EAR

Ensure safety
Sit the casualty with the head slightly inclined towards the bleeding ear to allow blood to come
out.
* Cover the ear with a clean pad.
,'; Secure the pad iightly with a bandage.
.:. Do not plug the ear.
* Prevent shock
.l Re-assure the casualty.
* Get Medical help.

Y
&
16
/
vl/) P
v 1.1*
g
T
o/

o
CHAPTER SIX
Face | 4
SHOCK

It is a condition whereby there is inadequate blood supply to sustain the body's normal activities.

CAUSES OF SHOCK

t Severe bleeding
.! Loss of body fluids
* Severe vomiting
* Severe diarrhoea
* Large wounds
t Fractures
.i. Heart failure
* Good or bad news
* Poisoning
* Burns
SIGNS & SYMPTOMS

.i. Pale skin

{. Cold and clammy skin
n Fast and weak pulse
.1. Fast and shallow breathing
* Blurred vision
* Thirst
.l. Body weakness
.i. Sweating
I4ANAGEMENT OF SHOCK

n Ensure safety
.i. Lay the casualty down
.:. Open and maintain a clear airway
* Loosen tight clothing
.1. Quickly do the secondary survey
* Elevate lower limbs
* Provide warmth but do not overheat.
n Manage the identified cause
* Re-assure the casualty
* Frequently check the pulse.
* Get medical help.
* Do not give anything by mouth.
n Do not elevate lower limbs if you suspect head, spinal injurries; fractures or snake bites.
 -

CHAPTER SEVTN

UNCONSCIOUSNESS

Is the interruption of the normal brain functions. This may result in the casualty not aware of his/ her pase
| 4,.,
surrcundings.

Nr:lItVOUS SYSTEN{
it is the system which keeps us aware of our surroundings.

t.trgans Involved
l,rrin
iytrtrt! c,trd
,\lt;t'ior'tlerl:et
..: {:',q Ol.l llef1.)e,\

6
CAUSES OF UNCONSCIOU}ESS

.:. Fainting
t Infa ntile Convulsions
* Shcck
* Heart attrck
* Stroke
t Hea d injuries
* ^sphyxia
.1 Pitsoning
+ I ti,lepsy
.:. , )i--.httes
"II:iEq IN PROGRI.SSION TO UNCONSCIOUSNESS

I
sl-AC.E Ntur"t BER -*-----r wnr'tr CONDITiON

I une Full consciousness Fully aware and normall)

I
tc ouestrons,
] IWC Drowsy Falls asleep now and then.
l
s vaguely to questions.
Can only respond to painfl:l
stimuli.
No se at all but stili alive

S]G['.IS & SYMPi"OMS OF UNCONSCIOUSNESS

* These can be derived frorn specific causes.

.] r c,.^/ levels of responsrveness
* Dizzines:
.l R.estlessne::'
.i t-rnf usion

; , r; Ari[ |{ENT Of UNCONSCIOUSNESS

.l Ensure s,:fety.
,l Ope;r and maintain a clear airway.
 7

.i. Loosen tight clothing

* Manage any identified injuries
.:. Control any bleeding
.:. Place the casualty into the recovery position.
.i. Prevent shock.
.i. Re-assure the casualty
* Do not give anything by mouth. , Page | 50
* Do not leave the casualty unattended.
Get medical aiC.

RECOVERY POSiTION

This is the most comfortable position for breathing unconscious casualties whose hearts are still beating.

REASONS FOR THE RECOVERY

* To rest properly.
* To avoid falling back of the tongue.
n To wake up easily.
* To allow vomiting without choking
* To maintain an open airway.

-@ i-Y'Sq
#
"r-
t^'
6arrs a''d ScaldS

Ga'P ^Pa.!
o *-,As
ac "-4'"q
YYtrnS

@ rl,t 'l/
V
fitid
; )** t ctg oF
gwcL
-'r" *1 oda4el
-1o rej{qce

d?
P,6un
C.- speq.
]S
>-?:- l- N'€
f*iT,A Pu\
tr - { +e), -5. *',tl,.rd,
qzro'd'

E
o _#*ttr
 uuaP IEe Ej=Gxr

tsUF\IS AND SIJALDS

Burns ;i'e iniuries caused bi dry heat whilst scalds arr: caused by moist heat.

DANGERS C.I= BUR.IJS AND JCALDS

* Loss cf hody fluids

* Shrck
.: Infeclic;n

, SIGNS AND S.f';''iP"!-i)MS OF BURNS AND SCALDS

'i. Blistr:rs
I l Swelling
.3 pa .t
i.-- , R.',-jness :f rxin
":* Numbness
* Skin 1 e:ling oir.
.r{\
-:/

2'rd tJeg,'ee inlermed.are it

=l-tects
the epidermis ar':d dermis layer (€arr'a'
3'd degree - frrii ihickness rf affects the 3 la1'ers of the skin

CAL.I.JLA I1J. J,.]F'\REA BURI,-

e
1.
V,/e USe the 'a{irlce,S :-Ule Cf nine.r
it ..:ate ihal ared urnt is iltca., ,ied i[i '7o
The pi':m rs .'.rsi:,.! ra, n 3asure area ;urnt
The u hole bod', ,. :qual to 10002r
T tt r !'li rs eqrlal to lozi
- ,; ,riidd is equa! :c i,r,zo
'f ,i iS e,j,,ai to v'-}ic
iie ctr
l; 11 ,'.9J11 trunk ' ; er.iual i8o/o
i ;,; Jtjg ar-e equai to 18%
i"lAl'.iAll FM ElvT CF Sr.J (l''iS/ SCALDS

.:" Ensure safety

* {ipen and n'iaintai;- a clear airwa".
-3 Apnly cr,id co;rip.re,,;9 ..r'put the burnT scald unler clean, cold running water.
+ f$'ve r tl,- i;rj r5r y',i[h a iight r,vet <-i*th cr band;rge.
. t itlaintain body iurnpt:ratr"ire ln prevent shock,
* Re-assure :'le c;sualfy

:
II
I
 * Refer for rnedical help.
* Do not prick blisters
* Do not apply lotions, eggs butter, urine etc.
* Do not apply sticking bandages.
Do not remove stuck clothing.

fage |5

CHAPTER NINE

SKELETON

Is a bony framework of the body. It consists of 20ll - 206 bones of'different shape': an(r siz":s

FUNCTIONS OF THE SKELETON

-It shapes the body

-It protects vital organs
-it allows grace movernent-
-rl sirpports the rnuscles
-rt rnakes the body fi,.,n

FRACTURES

A fracture ls a break or crack of a bone.

CAU

a)

b) of impact

l
.l\ gy'fectbn - A bone may become brittle and fracture dLre to infection.

1'LASSIFICAIION

a) Closed fracture/simple fracture This is whereby a bore breaks bul- cl,les rct ;rfect the
overlying skin.
:l) Open fractut es/compound fracture - Tnis is whereuy e i:or:c bieeks ancj proli-udes therehy
Carnaging Lhe top layer of the skin.
 -T

^ d,,,kl'*r'
t*'E1d't' '''
ryPES OF FF'A TL|PES ' ''-".,Hi
a) Green stick ta'""e (u'o'W*l
b) ComPlicated - i"w 5^"o9^ef
e) impacted 5ti}q
d) Pathological Pag; i 5:
e),ior*e-tW
Multiole
,\ l4tr€
W{ +o

:#
S]GNS AND SYMPTOMS
,,?^nf m.:dZ a'a
* Pain
* Inability to move the limb P"-Mft
,i. Deformity
.:" Swelling
* Numbness
* Bleeding
t Tenderness
* Crepitus

MANAGEMENT OF FRACTURES

* Ensuie safe!
.4. Stop bteecliirg if any
* Cover open wounds
* Gentlyr immobilizethe injured part using splints and adequate padding.
* Maintain body temperature to prevent shock.
+ Re-assure the casualty
.:. Get Medical help.

)
 :ti,Je.[. 6 u rn 111 ]-:p_l5alts
I

': WV':$:Wp a'$ ,ex*- Pr b'*B' ,21

'i If the casualty dilute the poison by giving the casualty water to drinkl9
is conscious
'i if ceaseieus iMsce vo{niting by tor-rching the baek-of hisJh+eat.X
* If unconscious do not give anything by mouth. @ L',rt,-:
* If contarner is available, follow first aid tips on the label. (5)
i

t Put the casualty in the recovery position on left siOe 6 v

* Prevent shock @
* Continue giving drinking water p @
.:. Re-assure
* Quickiy refer for medical help and if possible take the poison container with the casualty@
i, Burning poisons

g :rftrEl?ri,'#f, .onr.io,, @
sive sips of water to drink
-Do not induce vomiting @
-If unconscious do not give anything by mouth
-If the poison container is available follow first aid tips on the label @
-Put the casualty in the recovery position on the left side
-Prevent shock \_ f-z)
&l
Reassure the casualty / Y/
-Continue giving small sips of water. @
Quiciliy refer for medical help and if possible take the poison container with the casualty @

-lt"r.:led oorscns
-err6,efrFJx",r9es (R- *k Fl'6 er^ecL Pr ve*r$ &
6tr.eEd.,",a6,Oot-wn tn fresh a* @
l:eclr fc' breathing @
-OL-en and marntain clear
6)
ailways@
Ii the casualty is unconscious place him/her in the recovery position G)
-l"revent shock @
H.e-assure the casualty @
Quickly refer for nredical help @

3" Contact Poisons

G
F:*f,-ffFhg;B-
Remcve clothes and jewellery if nect ssary @
-Rinse the porsoned part wrth pirntv cold water@
-pievent shc,k --? G)
" Re-assure the casualtyJ
-If the poison container is available follow first aid tips on the rabel (?
label @
Quickly get medir-al heip and if possible take the poison container with the casualq@

CPO(
cte&-
the casualty. This will slow do,,ryn pcison circulaticn in the bod,,@

@
 -If the poison container is available follow first aid tips on the lanei. @ (Q
-euickly get merlical help and if possible take the poison container with the casualtyv

SIGNS AND SYMPTOMS OF SNAKEBITE

Pain Page | -'ir

Fang marks
Bleeding may occur
.gV{.X- Cslt"u' 4 A'*^^'$

BITES f
MANAGEMENT OF SNAKE
ef o,.Jt)@
I* Effi ifl",#ri$o*,ffif. J56',4o
@
"
Flash the wound with warm soaPY water.
.l Cover the wound with a bandage. @';
\\-/
.l Prevent shock. @
* Re-assure the casualry. @
* Do not suck the wound. @
* Do not elevate the injury. @^
* Immobilize the bitten limb. [/
.i. Get Medical helP.
@

MANAGEMENT OF STING BITE A

L *'o @u"n
;{fr' ?*'w4 @
E:'#':"Tfi'r"'..,,.,,rt'
Remove the sting by anything sharp like credit card @
Ice the area @
r-over the area with a bandage @
Elevate the limb @
Prevent shock @
Reassure the caiualty @
Get medical helP if necessary

,(r'l,'cle
C 5onr ,c.,8
{C

-c(

\
€taU'aP
 CilnPTiR ELT''EN
"]OJNT IN]URIES

IOINI
:j1
A joint is u'here bone-r rrreet. The' bnnes are neld togeiher by eiastic like cuffs called liganterits, together
those ligaments form a fr,v4;isg capsule that surrcunds the joint. The adjacenl bone surfaces are
covered witir a gristle callc"l carlil:g.e which is smooth hence allows bones to move easily,

SpRAIN y'!,:.. ,i 1,-.;.i, t

This is a tv;ist :vhich stretches or te.rrs liqaments at tl"e joint. ,' '

MANAGEMENT (JF { SPRAII\j / ' 'i r':

"t'
^€
*"'n
* Ensure safetv. {\',rr'!zrne*
{. Rest the jnint irr the most comfortable positio't.
t Apply cold compress for about ten minutes.
t Apply support around the joint with a thick lairer of cotton wool.
.i" Apply firm rr4!-r'ow banilage,
i Elevate the !inb.
.. [-:'evenl .;hoc]
,Y Re-at,;rtre
.t Quict<ly refer ior medicai help.
DiSL I]CATINN

i-iii: s a I'lrl:- oi sp'i)ri a wren.,h which ,:iisplaces boner, at a rJtnt.

SIGNS AND SYIVIPTOMS

.
.€. Uri
,*,n
'i' lnahillty r-o r,lov,.i the 'tmb.
.l Deformity
* I'lurrh,less
":. Swel!ino

I,i,\NAGEMEI,'JI' OF A L-)ISLOCATION

r1,' P-:st the;ornt in the rnost ccmfortable position.

1 5upport ihe jr;int us,no enouEh padding.
ri Anply ,: firm oandage.
"t+ Do nct try to reolace bones.
,: Prcveirt shoc<
* Re-assure lhe ca*ralty
* Quickly rer:-r fi)r nredicai help"

alw F'ft'
l+e**J8.e t'Y'nenit
cr@slteltY'no
ff" * +'L'* ":d--
l_

I
CHAPTER TWELVE

MISCALLEN EOUS CONDITIONS

FAINTiNG l.aseis,
Fainting is temporary lack of oxygenated blood to rhe brain.

CAUSES OF FAINTING

Hunger
Good or bad news
High temperatures
ulvcrr exercices
Siaqd in sun for a long time

1&S OF FAINTING

Sweating
Dizziness
Unconsciousness
Weak pulse
.:hallorry breathing
Bcdy vreakness

MAI.IAGEME}IT OF FAINTING

* Ensurc safety
* Lay down tlte casualty in open air
* Open and marntain a clear airway.
* Loosen trght clnthing
-'. illevate lower linibs.
.l Prcr':Ce fresi; a:i' in the form of fanning
{. f'ra:ntain body tetnperature.
.:. Do not give anything by mouth.

EPlLEPSY

F,rileprsy is a temporal interruption of the brains.

.AUSES OF EP]LEPSY

Inheritant
iiead injury
infection

I-ACTORS \I/HICH TRIGERS EF]LEPSY

Watei
trii-e
t
reights
 CilnPT[R Etf"EN
.IOJNT I,N]URIES

IOINI
.jl

A jcint is \i.,rrere hone: nreet. The: bones are neld togeiher by elastic like cuffs called ligamerrts, together
those ligaments form a rr,r,ering capsule tliat surrounds the joint. The adjacent bone surfaces are
covered witt-r a grrstle calltril cadilag_e which is smooth hence allows bones to move easily.

SPRAII\ 7t '' ,, 11;','i" t

I
This is a tvrist ,vhich stretcnes or tears llgur"nts at tt e joint. ,' '

MANAGEMENT UF q SPRA]I\ / :.'Tt;"II { g"'

.i. Ensure s;ifrfv. ,{rr,*f**
.l Rest the jnint lri tfie most comfortable positiorr.
"l Apply cold compress for about ten minutes.
{. Apply support around the Soint with a thick layer of cotton wool.
":. Apply firm n?!'row banCage.
:. Elevate the ii;rb.
". [-:-event lhoci
{. Re-a":;r tre
* Quici<ly refer ior medicii help.
DiSI.C..CATINN

i iri:' . a turi-: oi sp":r,' wre n-.h which displaces bonel at a ;:int.

SIGi\S AND SYIVIPTOMS

* Pain
':. InaLilit,v ro ri'rov'.i the 'imb.
.i. Deformity
* Nun \tess
.:. Sureil,ng

I,,IANAGEM EI,,IT OF A t,!ISLCCATiON

.r.' P:st tlre;ornt in the most ccrnfortable position.

fr 5upport lhe joint usino enouEh padding.
{" Anply,.: firm i:andage.
;t+ Do not t;'r, to reolace bones,
,:' Prevelt shoc<
.:. Re-assure the ca:ualty
* Quickly rer:i'f,fr nredicai help,

6 r'"'"gJ€
al'Pa f''*'
l+er*+e{e ''f'*N
6*"^ . ,.L ,.rJ- a{s*dt*a
-
4S'{ 11'stu"
-P,e
l_
 Emotions
SexLrai excitementt

SIGNS AND SYMPTOMS OF EPILEPSY

t
Aura .rru.- lt:L *J
L Unconsciousness
t(i'lt'i;'t'\ o1g$.'i'lPPrigc j5g
Biting of the tongue cir"-itirr: *d
Incontinence - 1,1 .rl"'' li{j ri{- tri r-\ cr{ +t.€ r:v5;'rrrl
frothing

MANAGEMENT OF EPILEPSY

A person having a major epileptic fit loses consciousness and falls to the ground. Violent jerking of the
*H+l "gpf;;.overy normally happens by itself.

* Keep calm and note time. t

* Move any objects which may be harmful. :
* Li:os€n tight clothing'5
,.'" Place a cushion under the head. I
.:. Do not move the casualty unless in danger. "1

* Do not restrict.movements.
* Do not put anything between the teeth.
* Place the casualty in the reeovery position after the fits,
L {. Re-assure the casualty afterwards.
* Refer for medical help if the casualty had some injuries or the fits are prolonged.

.. (1ci\ Itii/'tc'i
-!
-_ \.(r('),
(-i(;r<*'rz --'
;;, teldJ ay'*u'1-]'sa
..----"---- -!1

fltr;k;l-
c.I-rr
!

n
ql

;,.;r *hg '(ilt

.-t' i\\
'-\1
.st ,\'- ,TL
t. '-t--'h.\e
^i( , : i\'z
,-i!il)t -/
*\cn"-
4i-/'l' ]
rv ,,x
.\ r(
c'
,i ;1
, f,, - A1u'
\\
CHAPTER THIRTEEN

HIV/ AIDS
Fage (-.t

DEFIN]TIONS

HIV - Human Immuno - Deficiency Virus

AIDS - Acquired Immuno Deficiency Syndrome

HIV is the virus that causes AIDS.

MODE OF TRANSMISSION

* Unprotected sexual intercourse with an infected paftner.

.l Blood to blood contact through sharing skin piercing objects with the infected
.! Blood to blood contact with the infected through unprotected First Aid practices'
.i. Infected mother to her child during pregnancy or birth
* Breastfeeding from an infected mother

PREVENTION

1) Abstinence
2) Having one faithful HIV free sexual partner.
3) Correct and consistent use of condoms.
4) Protective First Aid practices.
5) Avoid sharing skin piercing objects.

PROTECTIVE FIRST AID PRACTICES

BAS]C HYGIENE MEASURES IN FIRST AID

*.Wash your hands with soap and water before and immediately after giving First Aid.
* Avoid contact with bodY fluids
t Prevent injury when using, handling, clean!ng or disposing off sharp instruments.
.l Cover cuts or any other skin breaks with a dry clean dressing,

AREAS OF CONCERN

a) Givin@
* Ifpossible make use of face shields or masks.
* Use a ctean cloth to wipe any blood before applying artificial resuscitation'

b) Dealino with someone who is bleedinq

.:. If possible instruct the casualty to apply direct pressure him/ herself'
.:. If the casualty can not stop bleeding himself/ herself use gloves; thick clean cloth or bandage
to avoid direct contact with blood.
.i. If you have gloves make use of them throughout the procedures'
c) Belngjn{o_ntact with the iniweElPersons Blood

* If ycur hands are contaminated with hrlood thoroughly wash with soap water.
+ lf any part of your body is splashed with any blood wash or flash it r,vith soap and
water.
.:. If your skin is cut by a blood contarninated instrument, wash the wound thoroughly paEe j i I
with soap and vvater and apply a dry clean dressing.

d) Cleaninq uo Blood Soiils

.l Wear general purpose utility gloves.

.:. Wash the contaminated area with a disinfectant.

e) Cleaninq Materials {antamineteilwith Blood

* \ffear generai purpose utllity gloves.

+ When washing contaminated cloths use a detergent anC hot water.
* To soak cloths for at least 25 minutes.
CHAPTER FOURTEEN

FIRST AID KIT CONTENTS

ALL MEDICiNES DRUGS MAY BE HARMFI.,}L IF PRECUATIONS ARE NOT TAKEN WHEN --
Pa5rt 6
ADMINISTERIT\G THEM

1) INTRODUCTION

Medicines and drugs have been in history from long e.g. in the form of roots, herbs etc' When
using any form of medicines, the following factors are to be considered.

t Generic name of the drug i.e the original name of the drug e.g Acertyl salicylic Acid is a
generic name of Asprin. May you also need to know the various trade names used for the
same drug e.g Paracetamol is the same as Panadol, Antalgic etc.
* Indications i.e when the drug or medicine may be used e.g it is for heart problems etc.
* Contra indications i.e when the drug should not be used e.g people suffering from gastric
ulcers may not use asprin. It causes bleeding of the gut.
* Dosage i.e how much medicine to give (quantity) is it two tablets of panadols at once? Is it
10mli of cough mixture? The dosage is usually determined by the following factors on a
patient.
o Age
o Weight/ height
c Severity of illness.

ROUTE OF ADMINISTRATION OF THE MEDICINE i.e the medicine taken orally, tropically, intra-
muscularly (injection) per rectum, per vagina etc. Also need to take note of how the medicine is
taken e.g before or after meals, with plenty of water etc.
.:. ANTEDOIE i,e the drug given to neutralize the medicine which could make the patient react
(allergy).

7) SOME OF THE ABBREVIATIONS USED IN GIVING DRUGS

b.d twice a day

i.m Intra-m uscu la rly ( injection)
t.d.s. 3 times a day.
Nocte at night
i.v intravenously (inject into vein)
mane in the morning
ung ointment
stat at once, single dose
p.r.n when necessary
qd once a day.
qid 4 times a day
A,C before meals
mist mixture
t-
I
J) GENERAL SIDE EFFECTS

fhii !s how a person can react after taking some form of medicine.

-hausea
-Vomiting Ilirg.: i {,j
-Dizziness and giddiness
-
-Vertiga ringing in ears.
-Headacnes
-Rash (goose pirnples)
- itchiness
-Shock/ Fainting
- Coma
-Rapid pulse
-Loss of appetite.
L -Dermatitis (skin problem, pilling of skin, sores etc)
-Change of colour of stool, urine, etc

4) THI FIRST AID CONTENTS

1- .Adhesive dressing
2. Unrnedicated stei'ile dressing (call sizes)
3. Triangular bandages
1. Gauze bandages (all sizes)
5 Crepe bandages (all sizes)
o. Plastic gioves (disposable)
7. l-atex gloves
8. Resusci-aids
9. Eye pads
i0" Safety pins
11. Splints
12. Elastoplasts
13. Paraffin gauze
14. Spatula
15. Scissors
16. Cotton wool
17. Cotton pads

I
l-
I
L
CHAPTER FIFTEEN

ACCIDENT PREVENTION

ACCIDENT Page 6)
Is an unplanned event that can cause damage to property, damage to health or death.

CAUSES OF ACCIDENTS

1) Unsafe acts (these are committed by people)

-Lack of knowledge
-Lack of skills
-Negative attitudes
-Negligence

2) Unsafe conditions

-Poor state of machinery or equipment

-Poor materials used.
-Hazardous environment.

COMMON ACCIDENTS AND THEIR PREVENNON

1) Burns and scalds.

a) When cooking turn away pot handles so that they do not get knocked off.
b) Cords of electric gadgets should not hang down in a loop to avoid pulling by children.
c) Keep matches out of reach of small children'
d) Keep flammables e.g fuel away from kitchen'
.; Ur" proper ash trays or make sure cigarettes are completely out before throwing them
away,
f) Test the temperature of bathing water before getting or putting a child or patient into
the dish.
q) Do not smoke whilst in bed,
h) Dry off meat or vegetables before putting them ln hot fat or oil.
i) Fat and cooking oit wtrictr catches a light can only be put off by correring the pot with a
lid. Do not pour water or try to carry the pot outside,
j) Do not serve extremely hot food
k) Do not sleep around a fire,

2) Road traffic accidents.

a) Do not drink alcohol and drive.
b) Car seat belts should always be worn.
c) Young children should always travel in the back seat of a car'
O) peopte walking along roads at night should wear white or reflective clothes so that
drivers can easily see them,
e) pedestrians should always walk on the side of the road and should face the oncoming
traffic.
 T

f) Pedestrians should stop, listen and look for traffic from both sides of the road before
crossing a road.
g) Build humps at both sides of pedestrian crossings.

3) Drowning.
a) Never attempt crossing a flooded river. Page | 65
b) Do not leave children near or in water alone"
c) Keep swimming pools fenced and gated.
d) Protect shallow wells.
e) Do not drink alcohol and swim.
f) People learning to swim should only do so in shallow pools with the assistance of a
competent swimmer.

€,n"@
qH
,,7 *,
"?'
irq
4rf
l"-

,t/
CHAPTER SIXTEEN

TRiAGE AND EVACUATION OF CASUALTIES

TRIAGE
Page I (rr
Triage is the sorting of mass casualties according to severerity of their injuries so that those requiring
urgent medical attention can be given first priority in transportation and management.

COLOUR CODES
Casualties are usually put into four categories and colour coded for easy identification, The following

#RED
This colour is used for casualties who need first priority, Casualties in this category are those with life
threatening injuries e.g asphyxia, respiratory failure, complicated fractures, severe bleeding and
extensive burns and wounds.

#YELLOW
This colour is used for casualties with moderate injuries eg moderate wounds, large fractures and
moderate burns and wounds .These casualties should be given second priority in transportation and
management.

#GREEN
This colour is used for those casualties with minor wounds like bruises, sprains and mir:or bleecling,
fhese casualties should be given third priority.

#BLACK
This colour is used for those considered dead. These are given the last priority.
l, i' .+
# i.. ..i ..,' t-l't u'j1' {r l.,f ,,.r,',','",' ,- l.
i i. ! ?

'':r
MOVEMENT AND TRANSPORTATION OEIASUAL LIES
The golden rule in casualty transportation is "Do not move a casualty unless it is absoh-rtelv
necesiary" .However if professional rescue transport is ndt available, the casualty may have to be
ir nmobilised and transported.

INDiCATIONS FOR IMMEDIATE MOVEMENT

-Danger of fire or explosion
-Lack of oxygen due to gasses and fumes ,P &rlu1"
-Risk of drowning
-Possibility of collapsing walls or buildings
-Danger of electrocution
-Traffic hazards
-Dangers from machinery
jl keF -+r'''€@* .
abx,/-til\Jn,3thc/\
,
) a-rnVl')lS
I\4ETHODS *)*^^d oF Fis+ ^'dn9
"rc6us

CRADDLE
casualties. s) 63M & ciAthase)
-This can be used for light-weight -.c 9,L
O lt,,1''L
-Pass one of your arms well beneath the casualty's two knees.
or
.Pass tl^re other arm around the casualty's back and lift and carryY
 PIT*-K-A-BACK

The ct,,suaity mtrrt be conscious and able to hold on.

i r.Il"a.t-lE\ CHAIR
t'. - '

l-hrs rnetirud may Le used to cai-ry a conscious casua!,y along passages, down or upstairs.
-i-lrlar ihe way of obstr-'.:ctinns
:iL ti'e casualty orj the chalr
-t;rr rii tile frr.rt aidei. should be cerr;nd tne cnair sup:orting its hack and the patient
ire .:tlirr frrst aider sh:uld be at the f:oni facing the casualty and holding the chair by its front legs.
--iire r:hair rs lifteo siightly back, lifted and carried this way.

11U,'.]A!\ CLufCH

Tlr!s inelhoc can be used for casuaii,e; with r;roderate injuries to the lo',ver extremities
-Stanrt on tlre injured side of the ca:,i;liy. ',.- -
Place your arm around the casu,alty's uraist and grasp clothes on the uninjured side
-Pass the casua[ty's dr"fl'r Bir"lun0 ],cui'ner:k and Srasp ,.i1s wrist or hand of that arm with your free hand
-Inst"rrct ttie rasuaily to use y.1ur b$(i'y' as a clutch.

THE I-IAND SFATS

This rr,ethod rr':i b* useo t, cairy a r:nnscious casuilty over a short distance and it requires two first
^rf ^ !,.
alOei
--

-The seai. may be formed using either a hook lock, v,rrist lock, two handed seat, three handed seat cr
t,''ui- har:deci seat
li-rsU"ucr the casualty" to sit on the irand seat.
!?rse up gently ar;l set off together.

II iH:: DR.AG M5l Hr',D

I -f a stretcher is not availahle a blanket r - rag m;;y be used to drag a casualty. This method is
aporopriate for short distances over sn:coth srrfaces,

5l RETCTiER METHOD

This rs the mcst comfortable nethoct uf carry:;,g a casualty. The method requires four firs:. bearers.

Loading a stretcher
-Four beareis kneel on thelr left kriees.
-The frrst Lrearer is Dy the carllrlr'o/'s .rght hrp support '-he hips u.,hilst the other three are oil the Ieft sid,r
-The second Dearer shor,;d support the r;sualty's !r:,,ver limbs, the third supports the hips '^/hilst the.
for.rrth supports ther head and shouldei's
-At tl'. first beai'er's crder the casualty is gently lifred and placed on the knees of the othei three
Dearer5,
-vVhilsi the casualty rs cn tne other three bearers the first bearer places the stretcher under the
casu.:1b,,
-'i-hc iirc, bearer th*n resumes hislher pr,:ition anc, at his order the casualty is slightly raised frcr the
i<ri,res anC then carefuliy and Eently lo,r,,ered on to the stretcher.
-r'r€, ,i,:;;ualty is then covered with a bianket.
Carrying a stretcher

-A stretcher should normally be carried by four bearers with instructions from one of them.ST
*Going downhill or downstairs when the casualty's legs are injured
*Loading an ambulance
*Bringing the casualty alongside a bed. Pasc (r).
 ANNEXl

Primary survey
Secondary survey Page | 6e
Artificial respiration
Use of triangular bandages
Cardiac Pulmonary Resuscitation
Recovery position
Fractures -lower jaw
-Lower arm
-Lower leg
-Hand and finger
-Collar bone
-Ribs
-Upper arm
-Thigh
Foot
-Spine
-Skull
-Pelvis
-Knee
Bandages-Head cover
-Foot cover
-Large arm sling
-Triangular sling
-Cut along palm
-Cut across the palm
-Elbow bandage
-Shoulder bandage
-Hip bandage
-Chest cover
-Knde cover
-Abdominal bandage
-Abdominai bandage with protruding guts
Methods of casualty transportation
Management of shock and fainting
Management of wounds
Management of burns and scalds

r
 CHAPTER ONE

MENSTRUATION Pase 7t;

When an ovum is not fertilized, the uterus walls shade off resulting in a menstrual flow consisting of
& blood from broken down capillaries and unfertilized ovum. This is an event that occurs every 26-30
days throughout a woman's bearing age unless pregnanry occurs.

g Mernach is period in which girls start to go for menstrual cycle

w Menopouse is ending period of menstruation in woman

SIGNS AND SYMPTOMS

-Emotional upset.
'Discomfort.
-Feeling of wanting to vomit.
'Growing pimples.
-Loss of appetite.
-Backache. .r-ili , n\
- 'tlla* . . I r' tLr' t tr'

HYGIENIC PRACT]CES DURING MENSTRUATION

-Cleanliness is highly required in order to avoid unpleasant body smell.

-pads, cotton wdol,'tampons or cloths should be used to absorb the discharge and these should be
changed frequently.
-Used pads, tampons, cotton wool or cloths should be disposed properly.
If cloths are to be used, they should be thoroughly washed and ironed to kill germs'
-Avoid using cloths that are not completely dry as this causes irritation and bad smell.
-Always wear fitting pants to avoid embarrassment'
-If much pain is felt during this period quickly get medical advice'
-Ensure a balanced diet.
-Drink lots of water,
-Avoid using tissue papers and news papers to avoid cancer.
-1i'bleeding continues for 7-70 days quickly get medical help.
JQ.e
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6arrJ',fr3
tl u,a '
tt-LY'aj

a+ i "'P'lAs
61 fr-od
?*'f'ff)- ts Jhe 6leteioP'nc)
o{ Lg^e t ol 6 +"e ',&rnb

Pruy".*
-- n^CrP*n
'ro af a*Peehnl
#4e cae cji*en
C*.rn"l
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 CHAPTER TWO

PREGNANCY
F.rSe i 7l
INTRODUCTION

lf the ovum and the sperm come together to form a single cell, the woman becomes Pregnant.
-fhis
celi grows rnto a baby in period of 9 months i.e 36 - 40 weeks. The period in which the
woman is carrying the baby in her womb is called Pregnancy whilst the woman herself is called
an expectant mother

SiGNS AND SYMPTOMS OF PREGNANCY

o Ceasing of monthly periods.

o Enlargements of breast
,, Darkening of nipples.
., Enlargement of the lower abdomen
o Morning sickness
o Changing of skin complexion.
c Loss of appetite

fhe expectant mother must visit the antenatal clinic, preferably with her husband so that they both get
health education.

REASONS FOR ANTE NATAL CLINIC

a) To check mothers health

tr) To check the position of the baby.
c) To check for Sexually Transmitted Infections which includes syphilis, gonorrhoea, chancroid,
genital watts and herps.
d) To get health education on motherhood.
e) To prepare the mother for breastfeeding

HEALTH I\IEEDS OF AN EXPECIANT MOTHER

-
1) Body exerctse - Exercise is important so that all the functions of the body shoulC
be kept in good working order.
Ni B The expectant mother should only do light exercises e.g walking, house work, games.

2) Rest and sleep - A sufficient amount of rest and sleep is very important. If
possible a rest in the afternoon with slightly elevated feet should
be taken for 30-60 minutes every afternoon.

3; Diet - A well balanced diet is required preferably three good meals a

day however it is important to avoid over eating and eating
those foods that cause constipation. Weak tea and coffe should

4) water be taken sparingly.

?:":i^:'r:lli #il;'ir":i,',:,x','ill1i'[:: Xi"J :i::"",'"1i',L

and reduction of waste products through the excretory organs.
5) Clothing - the expectant mother shoukl y/ear non constricting, light, warm
and clean ciothes,
6) Oral care - the expectant mother should always ensure a clean
mouth and teeth. A dirty mouth and teeth promote
indigestion.
7) An expectant mother should not do the following:- page 7
|
* Carry heavy loads.
.l Wear tight clothing.
.:. Wear high healed shoes.
{. Take alcohol
* Smoke
* Take unprescribed medicines.

COMMON ILLNESS OF AN EXPECTANT MOTHER

* Cramp
t High blood pressure
* Constipation
* Backache
.i. Swelling of legs
{. Headache.

PREPARATIONS FOR THE BIRTH OF A BABY

Preparation for the birth of a baby starts after the expectant has confirmed her pregnancy with the
Ante Natal clinic staff. Preparation to be done well in advance includes procurement of the baby's
clothes, mother's toiletries and clothes. During the last month of pregnanry preparations to be made
include a room, linen and other toiletries.

REQUIREMENTS FOR A BABY

1) 10 napkins
2) safety pins
3) 1 face towel
4) 2 baby towels
5) 4 Flannel dresses
6) 4 cotton vests
7) 2 flannel wrapper
B) plastic comb.
9) dish
10) soap
11) Vaseline
12) 4 cotton jackets

PREPARING A LABOUR ROOM

n The room should have adequate ventilation.

* Thoroughly clean the room and remove all the dust and unnecessary equipment'
{. Put a comfortable mattress.
.... Make the bed with both mackintosh and draw sheet.
..'. Provide adequate pad.
 CHAPTER FOUR

BIRTH OF A BABY

INTRODUCTiON Page | 73

In the great majority of cases, child oirth proceeds as a normal, nattiral process - not as an emergency
situation. Understanding the birth process and the stages of labour will help you know what to do what
not to do if your assistance has been requested.
r?1 ;=!ttr-'rr:1
1) Contracting of uterus (Labour pains) at 10-20 minutes intervals ;i-
.,9(l r-it'r'
;i{i.,,tv
I -**
May last up to 16 hours. rlu r'i
When labour pains are 3 minutes apart birth is normal. (ti i\.,+'l P'j
Lower backache.
Bleetling may occur.
i,'*'"crtcii'{
Breaking of the waters.

POSITIONING THE I.4OTHER

.:. Comfortable lying on her baci.r.

* Propped up with knees bent.
.i. Raised head and upper hack.
* Knees drawn up apart.

. Reiax and help the mother.

'. Re-assure the mother
Maintain a calm atmosphere
. Request all unnecessary people out and remain with one female relative and if possible the mothers
husband.
. Remove any clothing that will be in the delivery way.

.'
Keep the mother warm with Lrlankets and sheets.
Place clean folded sheets, blankets or towels under her buttocks.
. Provide sanitary pads or other clean dressings to absorb secretions and blood.
'. Provide a clean towel or blanket to wrap in the baby.
Be prepared to cut the umbilical cord i.e boil a pair of scissors or a razor blade for 10 minutes,
. Boil three ties or strings for ten minutes and soak them in methylated spirit,
o Wash your hands and forearms thoroughly with running water.
n Wear latex gloves and face mask if available.
n Never allow persons with cols, sore throat or respiratory infection in the room.

2)DELIVERY

Normally the baby comes with the head first.

Once the head emerges instruct the mother tc stop pushing.
Support the baby's head with one hand.
Do Rot pull or twist the head allow it to emerge slowly and gently.
Support the baby's body as it emerges.
Catch the baby's body orr a clean towel and place it on the mothers'abdomen .

Avoid pulling the code.

I
 TYPES OF DILiVERY

Normal delivery
Surgical delivery
._1" Induced delivery
(Es{an an Cerseria I d el ivery
Vacuum delivery Page 7'

CUTIING THE CORD

{. After the after birth/ placenta has been delivered you can wait for about 10 minutes before
cutting the cord.
* Using a sterile string or tie, tie the cord tightly about 1Ocm from the baby's abdomen.
n Tie another cord about 15 cm from the baby's abdomen,
* Use a sterile scissors or razor blade to cut the cord in between the two ties.
t Put a sterile dressing over the cut end at tlte baby's side.
* After 10 minutes you can apply a third tie about 7 cm from the baby's abdomen.
.1. When you are certain that there is no bleeding put a sterile dressing over the cord end and
secure it with a nappy or clean cloth wrapped around the baby.

4)DELIVERY OF THE PLACENTA

Normally tlte placenta comes out few minutes after the baby has been delivered

CARE OF NEW BORN

1) Immediately open the baby's mouth and wipe out any fluids.
2) Normally breathing starts spontaneously and the baby will be crying.
3) If the baby is not crying you can stimulate it by flicking your finger on its feet sole but do not
slap it.
4) Ensure the baby is warm.
5) Hand over the baby to the mother for breastfeeding.

* Arrange for the mother and the new born to visit post natal clinic for examination, health education
and immunisation,
* Any complication before, during after delivery should be referred to the hospital immediately, these
include.
.! Miscarriage
.:. Protruding umbilicus before birth occurs.
.:. Massive bleeding
.i. Breech delivery - a baby coming with feet first.
.:. Undelivered placenta.
t Prolonged labour pains - more than 24 hours,
CHAPTER I-IVE

IMI,IUNIZATTON PaF:) I 7s

Is the introductir:n of a rraccine intt lhe body to stimu,ate natural immunity hence preventing diseases.

i l,r ivl t-.r lJ;>AT Io;'l i Ar LL

VACCINATlONS PREVENTICN OF
BCG Tuberculosis
6 Weeks PENTAVALENT 1 -Diphtheria, Tetanus, Pertusis,
D
Hepatitis B Haemophilias
R PNEUY]CCOCCAI 1 Influenza
I -Pneumonia
M ROTAV]RUS 1 -Diarrhoeal disease(rotavirus A)
A
R, ORAL POLIO VA(-CINE - Poliomyelitis

-Diphtheria, Tetanus, Pertusis,

Hepatitis B Haemophilias:
C PNEUMOCOCCAL 2 Influenza
-Pneumcnia
U ROTAVIRUS 2 -Diarrhoea I d isease(rotavirus
R -Poliomvelitis
c
I ORrr' POI-IC VA(-CINE
i: [prrurnv r.L rrlri .D'phrthe,ia, feta n uffirtusis,
Hepatitis B Haemophilias
FN!EIJMCCOCCAL 3 Influenza
-Pneumonia
ORAL POLIO VACJCINE

I9
'-_-,!
I,,Ionths MEASLES -Measles
t--
i I ionti is I DPT -Dphther'ra, Peitusis, feta n us
I
:

_t_uP_v | -Poliomr, elitis

i

bc,l\t (9t?t1e+e

vtn&ff!_asuLPltlIi&lAuoNSr
.-.\
jeEDU 15, e .tre,nee
Firsl Dose to be giverr at 6 trionths ancl thereafter Dose is at 6 Months up to the Age of 5 years
DISEASES TARGET AGE INCUBATION SIGNS & SYMPTOMS
GROUP PERIOD

Measles 8 months - 5 7 - t4 days Severe cold gelTt

years Red watery eyes
Fever
-
Running nose red
mouth
Sneezing
Bodyrashfor3-4days
Loud brass coughs.

Diphtheria 1-5yrs 2-4days

Poliomyelitis 7 - 14 days

Whooping 3 - 18 months 7 - L4 days

Cough

Tetanus 3 months - 5days-3

5years weeks

- Asphyxia Rigidity of
muscles especially
abdomen. face and neck.
Hepatitis B 3 months and Few months to Yellow eyes
above years Dark urine
Loss of appetite
Loss of weight
I Abdominal pains
Tuberculosis Any ) Persistant coughing
! Loss of weight
 ---_-_-----

CHAPTER SIX
Page I 7'i

CHiI"D NUTRITION

Breastfeeding

Is the feeding of baby with milk from the mother.

BREAST FEED]NG HYGIENE

. Mother must wash hands thoroughly.

. Mother must clean breast nipples with a clean cloth.
. Sit down comfortably.
. Talk to the baby before and during feeding.

ADVANTAGES OF BREAST FEEDING

/ Breast milk contains all food nutrients requireci by the baby.

/ It is free from germs
, Ii cost nothing
/ it has the right temperature.
'r It is easy to digest.
- Requires no mixing.
/ It is always fresh.
ARTIFICIAL FEEDiNG

is feeding the baby with cows, goat , powered miik or any recommended feeding option.

REASONS FOR ARTIFICIAL FEEDING

. Doctor's advise
n To help the baby if the mother is dead.
rl
. To help the baby if the mother is sick.

DANGERS OF ARTIFICIAL FEEDING

1) If the bottle and the teat are not well kept it may cause diarrhoea.
2) if the rnother does not give the correct measurement of feed it causes Kwashiorkor.
3) If the hole of the teat is small the baby_gets tired of sucklng.
4) If the hole of the teat is big the baby sw=allows fast resultin[ in choking or vomiting.
WEANING
Page 7:
Weaning is the gradual introduction of semi-solid food to the baby whilst breastfeeding.

STAGE 1

Most babies do well on breast milk up to the age of six months. After this age, the demand is greater
than the mother can supply, this is the time when the first stage of weaning starts. The supplementary
foods are introduced in small amounts first, and as the child becomes accustomed to each type of food,
the quantity should be increased gradually. Liquid food such as soups/ water and juices are gi'ren at
this stage"

STAGE 2

After stage one, mothers should add to the baby's diet thin maize porridge and other pastas that the
child is able to digest, A number of nutritious foods can be added to malze porridge to make it rich.
-These
additions include goat/ cow's milkand peanut butter. It should be noted, atthe same
breastfeeding continues.

STAGE J

As the child gets accustomed to various types of porridge and pastes otlier thick and aduit foods can be
introduced. These include thick porridge, potatoes, bananas, meat and other fruits.

FINAL STAGE

This is the complete removal of the baby from breast milk after the age of two'

MALNUTRITION
Mainutrition is lack of lood and otirer body nutrients. There are two types ol malnutrition namely; Wet and Dry
r.lalnutrition. Wet rnalnutrition is lack of cerlain food ti.rtrients whilst dry tnalnutrition is lack of food in general

A child is said to be malnourished if;

a) The clrild's weight falls for three consecutive trrotrths.
b) The child's rveight remains the satne for three corrsecutive niorrths.
c) The child's shou's signs of body rvasting.

Signs of Wet malnutrition ( Kwashior-kor)

*,rt?
Thin, pale and soft hair. * gr"k
Mild anemia. Or'A
( @uz'{'*ffi) +"ft-<v;'Yl
Thin upper amr.
Oder-r-ra. -4^.9 1.s u-t'<41 e<6 ff-y%r6
J91€r'\
Loss of appetite.
Flaking rash.
Under lveight.

Signs ol dry malnutritiou (Marusmus)

. "l,ittle old man".

 . Nonlal trrair.

'. Hungry look.

Gross muscle rvasting.
. Very t1.rin r-rpper arm.
. Grossly underweight.

Cari:es ol' nra lnrrtrition Page i 79

. Poor leeding practices.

o por.erty.
o Drought.
e Abrupt weaning.
. Poor food intake during illness.
r lnfbction eg Tuberculosis, HIV/AIDS.
o Religior"rs or traditional beliefs aboui certain foods

CHAPTER SEVEN

BABY BATHING

All babies like any other human"being need a bath as a daily hygiene routine. Bathing clean the skin
pores of any dirt and by so doing it promotes normal functions of the skin. It is therpfore important for
the nursing mother to acquire the art of bathing a batry.

REQUIREMENTS FOR BABY BATH

. Basin/ dish
. Soap
, Face towel
. Wrapping-tolel
. Hot water
". Cold water
Vaseline
'. Cornb/ brush
Changinq clothes

BATHING A BABY

c Wash hands
o Collect all the requirements
c-, Choose a corner of the house free from draughts preferably to the side of fire.
o Wash the baby's basin/ dish.
o Pour hot water first into the dish.
o Cool the water.
o Feel the comfort/ temperature of the water using your elbow.
c Take and undress the baby whilst talking to him/ her.
o Use a damp hand to clean the face.
. Thoroughly clean behind the ears.
o Dry the head.
c Use soapy water to clean and wash the whole body.
,:, Thoroughly wash the folded parts, groins and in between the fingers and toes.
o Dry the baby
o Wrap the bodY.
o If the babY is warm aPPIY Vaseline,
o Put his or her clothes
o Clear the equiPment.

Page | 8(
SKIN INFECTIONS IN CHILDREN
rash. These conditions should
The co,rmon skin infections in children include scabies, ringwonn and nappy
changing of clothes is very important in prevention and
be lefered for rnedical treatment. Frequent bathing and
towels should be avoided when one chiid is infected'
treatment of these inf'ections. Sharing oi clothes or

NAPPY RASH

o spared from the rash'

The rash affects the skin in contact with the nappy.The skin creases are
o thighs'
There may be little spots spreading on to the lower abdomen and upper
o Expose the affected pafi and keep it dry'
. has occur:red hence medical
When the skin creases become reddish it shows that candida infection
treatment should be sought.

RINGWORMS

than any body parts' The tlpical appealance

These are due to a fungal infection. The scalp is commortly affected
may be thicker at the outside of the round' The
is one or more slowly growing round scaly patches. The scaling
ofinfectio. are all the folded parts like armpits'
rash appears as numerol,S ,u,ilt it.hy bumps Common sites
toes. This infection should be referred to the nearest health centre
wrists, genital area, between fingers and
imtnediately.

CHAPTER SEVEN

DEHYDRATION IN CHILDREN
to, it can be fatal' Diarrhoea and vomiting are
Dehydration is a common problem in children and if not attended
the major causes of dehydration.

Signs ol moderate dehYdration

o Four to ten liquid stools Per daY.

o Some vomiting.
o Greater thirst than notmal.
r Smal1 alnount of dark urine.
r No tears.
o Sunken frontanelle.
 _-

. Fast breathing.
. Some weight loss compared to r.r.eight on the child health card.
. A pinch of the skin going back slowly.

Signs of severe dehydration

. More than ten liquid stools per day. page

t Frequent vonriting.
I B1

' VerY drir and sunken eyes.

'. The child becomes very weak and floppy.
Cold hancls, feet and legs.
. Very srinken fiontanelle.
. Small amount of urine passed after a long time.
r Much weight loss compared with the weight on the child card.
. A pinch of the skin goes back very slolvly.

Management of dehydratron

Quickiy give salt and sugar solution whilst you arrange refer:ral to the nearest health centre.

How to make the Salt and Sugar Solution (SSS)

.l Use a llitre bottle with a lid.

':. Wash the bottle well with clean soapy water and rinse thoroughly.
t Put six level teaspoons ofsugar into the bottle.
* Put half level teaspoon of salt into the bottle.
* Fill the bottle with ciean (Qoiled) drinking water.
* Mix well and al1ow it to cooi down.
.l Taste the solution; it should not taste saltier than tears.

NB

,/ Give frequent smali amounts.

'/ Keep giving the SSS even if the child vomits.
./ Continue feeding the child.

CHAPTER NINE
:

FAMILY PLANNING
-
Family planning is a responsible decision made by a couple on the following:-

- a) When to have the first child and when to have the last child.
b) To space each pregnancy by at least three years.
c) To have a manageable family size.

REASONS FOR FAMILY PLANNING

a) Mother needs to rest in between pregnancies.

b) Parents need money to provide for their family needs.

t_
 c) Parents need time to spend with their children.
d) Children need proper care, love and attention from both parents.
e) Children need shelter, a comfortable and secure home.
f) Children need good education.
g) Children need adequate clothing.
h) Children need good and well balanced food.
Page | 8ll
. MOTHER iS LIKELY TO STAY IN GOOD HEALTH IF :

a) She spaces pregnancies by three years or more.

b) She avoids getting pregnant before the age of 18"
c) She avoids getting pregnant after the age of 35.
d) She avoids getting pregnant after the fourth child.

ADVANTAGES OF FAMILY PLANNING

if people have small, manageable family sizes, there is likely to be:-

. Better health for all

. Enough land to plough
Enough grazing land
. More jobs
. Enough health and education facilities.
. Enough recreational facilities'
. Adequate water supply.
* Better sanitation.
. Adequate transport.
. More houses and adequate space.

METHOD OF FAMILY PLANNING

Permanent methods

Vasectomy
Tubal ligation

Long term methods

Depo provera
Loop
No plant
injection
Jq&)t?'
Short term methods

Condoms
Contraceptive pills
Withdrawal

When you decide to plan for a better life for you and your family through family planning visit.

ft-
 , Your nearesi health Centre, Clinic or Doctor.
r \ our local Community Based Distributor (CBD)
r Your nearest Zimbabwe National Family Planning Council (ZNFPS) centre.

"PLAN [,IOW FOR A BETTER FUTURE"

Pugc | 83

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