12th - General Nursing - EM

GOVERNMENT OF TAMIL NADU
HIGHER SECONDARY SECOND YEAR
GENERAL NURSING
Theory and Practical
A publication under Free Textbook Programme of Government of Tamil Nadu
Department of School Education

Untouchability is Inhuman and a Crime
12th_Nursing_General_ Front_Page_1-4.indd 1 12/14/2021 5:46:39 PM

Government of Tamil Nadu
First Edition - 2019
Revised Edition - 2020, 2022
(Published under New Education Syllabus)
NOT FOR SALE
Content Creation
The wise
possess all
State Council of Educational

Research and Training
© SCERT 2019
Printing & Publishing
Tamil NaduTextbook and Educational

Services Corporation
www.textbooksonline.tn.nic.in
II

How to use the book?
Student would be motivated and focus attention to

Introduction the subject matter.
Learning List out all the major topics and provide students
objectives: with a clear purpose to focus their learning efforts.
Life experiences and indepth understanding of the

Case study concept given.
Do you Gives additional related information for broader

know? understanding.
Given to elicit critical thinking , creative thinking

Activity : and application in day to day activities.
Enhance long term memory through Audio Visual

QR Code learning.
References to the relevant website for enhanced

ICT Corner information.
An outline map of the entire information given in

Summary gist.
Glossary Detailed meaning in English and Tamil for new terms.
References/ Website Basic raw materials used for the birth and development
links of the text.
III

Contents
GENERAL NURSING
Contents
Chapter Topic Page No Month

1. Human Anatomy and Physiology 1 June
2. Medical Surgical and Nursing Management 42 June
of Human Diseases
3. Applied Psychology 88 June
4. Applied Sociology 102 July
5. Applied Nutrition 109 July
6. Introduction to Sex Education 142 July
7. Midwifery Nursing 148 August
8. Child Health Nursing 178 August
9. Community Health Nursing 198 August
10. Mental Health Nursing Principles and 218 October
Practices
11. Communicable Diseases 244 October
12. Nursing Education and Management 270 November
13. Introduction to Nursing Research 287 December
Practicals 294
E-book Assessment
IV

HUMAN
1 ANATOMY AND
PHYSIOLOGY
ந�ோய்நாடி ந�ோய்முதல் நாடி அதுதணிக்கும்

வாய்நாடி வாய்ப்பச் செயல்.
Let the physician enquire into the (nature of the) disease, its cause and its method of cure
and treat it faithfully according to (medical rule).
Learning Objectives
At the end of the chapter students will be able to;

➢➢ understand the anatomy and physiology of various organs
➢➢ gain knowledge about sense organs and their function
➢➢ understand the skeletal and muscular system
➢➢ follow the health and hygiene of reproductive system
of damages such as loss of water or damages

Introduction
from outside.
Anatomy and physiology are the
branches of biology. Many of the concepts The skin is the largest
in physiology, also incorporate other basic organ that covers the entire
sciences including chemistry and physics. body.
Anatomy is the study of the structure of
living organisms. The form of an organism is
the structure of its body and body parts. he integumentary system
T
consists of the
Physiology is the study of the function of
living organism. The function of the body and • Skin
its parts determines how an organism carries • Hair
out its daily activities. • Finger and toe nails
• Sebaceous glands
1.1 Integumentary System • Sweat glands
It comprises the skin and its appendages

which protects the body from various kinds
Unit_1_Human_physiology_Gen_Nur.indd 1 12/10/2021 9:37:32 PM

Skin
The human skin is the outer covering
of the body and is the largest organ of the
integumentary system. The main functions are
protection, regulation and sensation.
Hair
Sensory Nerve Ending Sebaceous Gland
Epidermis
Nerve
Dermis
Muscle Schematic view of hair follicle and
Subcutaneous
sebaceous gland
tissue
Sweat Gland
Fat, Collagen, Fibroblasts
Eye lashes protect the eyes
Arteriole
from foreign debris getting into
Cross-section of all skin layers. the eye.
The skin has the following layers from

exterior to the inner layer. Sebaceous Glands
• The epidermis Sebaceous glands are exocrine glands.
• The dermis It lubricate and moisturize the skin with an
• The hypodermis (subcutaneous layer) oily secretion which is called as sebum and
maintains thermoregulation.
The epidermis is a vascular (without
blood vessels); the skin contains keratin which
protects and prevents the skin from becoming There are no sebaceous
water logged. glands in the palms and sole of
The dermis, the middle layer of the skin, the feet.
contains blood vessels, gives the skin its elasticity
to stretch. Nail
The hypodermis, the subcutaneous layer,
The finger and toe nails
stores fat that are ready for use when energy
are made of keratin. Nails
is needed. This layer of skin fat also maintains
protect the tips of our fingers
body temperature by serving as an insulator.
and toes from injury.
Hair Three parts of the nail are:
• Nail bed
Hair keeps the body warm. Hair covers
the majority of the body surface; thick hair • Nail matrix
• Nail plate. Nail
is found on the head and face and fine hair
is found on other parts of the body such as
the pubic area. Hair has a follicle below the Sweat Glands
skin, and a shaft above the skin. Hair contains Sweat glands are exocrine and apocrine
keratin. glands that secretes sweat to the surface of

the skin. They are found under the arms in nutrients and hormones. Blood circulation
the axillary area and perform little function controls the body temperature, the PH or acid
in humans. Sweat glands, are exocrine glands base balance of the body. Circulation fights
secrete a substance that cools the body off against infection, helps in clotting of blood
with perspiration and eliminate wastes. during injury and eliminates waste products
such as carbon dioxide.
Position
The heart lies in the thoracic cavity at the
mediastinum [the space between the lungs].
It lies obliquely a little more to the left than
the right. The apex is about 9cm to the left of
the midline at the level of the 5th intercostal
space and the base extends to the level of the
2nd rib.
Sweat gland
Disease related to Integumentary system Organs associated with the heart

• Acne • Rash Inferiorly- The apex rest on the central
tendon of the diaphragm .
• Athlete’s foot • Pressure ulcers
Superiorly- The great vessels in the aorta,
• Sunburn • Skin cancer
superior venacava, pulmonary artery and
• Albinism • Herpes pulmonary veins.
• Impetigo • Psoriasis Posteriorly- Oesophagus ,trachea, left
• Rosacea and right bronchus, decending aorta, inferior
venacava, and thoracic vertebrae.
Functions of Integumentary System
Lateraly- The left lung overlaps the left side
• Protects the body against the external
of the heart.
environment as the first line of defence
from germs and infections. Anteriorly- The sternum, rib, and
intercostal muscles.
• The skin, its thickness and sweat glands,
maintain the body temperature Structure
• Vitamin D production The heart wall is composed of three layers
• Protection against UV rays of tissues. Namely
• Perspiration. • Pericardium
• Dehydration • Myocardium
• Reception of tactile sensory messages such • Endocardium.
as heat, cold, and pain sensations.
Pericardium
The pericardium is the outmost layer and
1.2 The Cardiovascular System
is made up of two sacs. The outer sac and inner
Heart is the master of the cardiovascular side
system. It pumps out blood all over the body 1. Fibrous pericardium –consists of fibrous
to circulate and supply oxygen, electrolytes, tissue.

2. Serous pericardium- double layer of serous
membrane.
The Fibrous Pericardium continues with the

tunica adventitia of the great blood vessels
above and is adherent to the diaphragm. It
consists of two layers.
• The outer layer of the serous pericardium
is the parietal pericardium
• The inner layer is visceral pericardium
adherent to the heart muscles. Heart
It secretes serous fluid called pericardial
• The pulmonary circulation
fluid. Pericardial fluid present in the space
between the visceral and parietal layer, which • The systemic circulation
allow smooth movement of the heart. • The coronary circulation.
Myocardium Pulmonary Circulation

The myocardium is composed of The portion of the circulatory system
specialized cardiac muscles found only in which carries deoxygenated blood away from
the heart. The Muscle arrangement of the the right ventricle of the heart, to the lungs
myocardium enable the atria and ventricles to and returns oxygenated blood to the left
contract in a coordinated and efficient manner. atrium and ventricle of the heart.
It is also important for electrical activity of the
Systemic Circulation
heart.
Systemic circulation carries oxygenated
Endocardium blood from the left ventricle, through the
It lines chambers and valves of the heart. It arteries to the capillaries in the tissues of
is a thin, smooth membrane to ensure smooth the body. From the tissue capillaries the
flow of blood through the heart. It consists of deoxygenated blood returns through a system
flattened epithelial cells, and it is continuous of veins to the right atrium of the heart.
with the endothelium lining of blood vessels.
Coronary Circulation
The cardiovascular [cardio-heart,
Coronary Circulation is the circulation
vascular-blood vessels] system is divided for
of blood in the blood vessels that supplies the
descriptive purpose into two main parts.
heart muscles.
1. The heart pumping action ensures constant
The cardiovascular system ensures a
circulation of the blood.
continuous flow of blood to all body cells. Heart
2. The blood vessels which form a lengthy
plays a major role in continual physiological
network through which the blood flows.
adjustment to maintain an adequate blood
The lymphatic system is closely connected supply.
by both structurally and functionally with a
Interior of the heart
cardiovascular system.
The heart is divided into a right and
The heart pumps blood in to three
left side by the septum, partition consisting
anatomically separate systems of blood
vessels.

of myocardium covered by endocardium. It • Pulmonary artery is divided in to left and
subdivided into 4 chambers they are right carries either side of the lungs.
• Left atrium. • In lungs exchange of gases takes place.
• Right atrium • Oxygenated blood passes through
• Left ventricle pulmonary veins to the left atrium.
• Right ventricle. • In left atrium blood passes through left
atrioventricular valve to the left ventricles
Right Atrium carries blood from left ventricles through
Right atrial chamber is located in the upper aortic valves.
portion of the right side of the heart which • Arteries-Oxygenated blood passes through
receives blood from all parts of the body by all parts of the body.
superior and inferior venacava. They are thin
less muscular walls and smaller than ventricles. Valves
These are the fibrous flaps of tissues that are
Left Atrium present in cardiac chamber, between the arteries
Left atrium receives oxygenated blood chambers and veins. They ensure unidirectional
from the lungs and pumps it down into the left flow and prevent backflow of blood.
ventricle. They are
The lower portion of the heart left side of is Arterioventricular Valve
left ventricle.
It is present in every ventricle and atrium.
Right Ventricle
Tricuspid Valve
Deoxygenated blood flows in the right
The valve lies between the right ventricle
atrium, passes through the tricuspid valve
and right atrium.
and in to the right ventricle, which pumps the
blood up to the lungs by pulmonary artery, Mitral Valve
through the pulmonary valve. It is present between left atrium and left
Left Ventricle [bicuspid valve] ventricle.
It is larger and more muscular chamber. Semilunar Valve

It pumps and delivers the blood to all parts of It is present between arteries and
the body by a larger artery [aorta] for systemic ventricles.
circulation.
Aortic Valve
Flow Of Blood Through The Heart
An aortic valve is present between the aorta
• The right atrium receives deoxygenated and left ventricle.
blood from all over the body by superior
and inferior venacava. Pulmonary Valve
• Deoxygenated blood from right atrium Pulmonary valve exists between the
passes through right atrioventricular valve pulmonary artery and right ventricle.
to right ventricle.
Functions of heart
• Pulmonary artery collects deoxygenated
blood from right ventricle to lungs through The structure of the heart is primarily
pulmonary valve or semilunarvalve. responsible for transportation of blood and

to supply nutrients to all parts of the body. In the fig - 1.6 shows Red color indicates
This continuous activity uplifts the role of the oxygenated blood carried in arteries. Blue
heart as a vital organ. indicates deoxygenated blood carried in
Blood pumping cycle of the heart is called veins.
as cardiac cycle, which ensure that the blood is
The relationship between the heart and
distributed throughout the body. The oxygen
different types of blood vessels.
distribution process begins when oxygen –free
blood (impure) enters in to the heart through Heart
the right atrium goes in to the right ventricle,
• Aorta
enters the lungs for oxygenation and release
• Arteries
of carbondi-oxide and transfers in to left atrial
• Arterioles
chambers, ready for re-distribution. About 5-6
• Capillaries
liters of blood circulates in the body and cardiac
• Venules
cycles are completed per minute.
• Veins
• Venacava
A healthy heart beats 70 to 75
• Heart
times per minute, each cardiac
cycle, or heartbeat, takes about Arteries
0.8 seconds to complete the cycle. Arteries are the blood vessels that carries
oxygenated blood through out the body. Arteries
Oxygen reloading process occur in two consists of several layers and smooth muscles
phase. The systole is a short period that occurs, that enable them to pump blood throughout the
when the tricuspid and mitral valve close. body after it leaves the heart.
The diastole is a relatively longer period ARTERIES - It has three layers
when the aortic and pulmonary valve close. • Tunica adventica
The systole –disastole relationship is the mean • Tunica media
blood pressure. Other ways of physically • Tunica intima
determining the regular functioning of the
heart is through examining the pulse rate. Arterioles
Blood valve that receives blood from the
Circulatory System
arteries. Those are present next to the arteries
and before the capillaries. Arterioles also have
smooth muscles.
VEINS ARTERIES
VENULES
Capillaries
CAPILLARIES
These are the smallest structure of the
HEART ARTERIOLES
circulatory system. The point at which the
exchange of oxygen and corbon di-oxide
occurs through the thin walls of the capillaries.
Venules
Blood vessels that receive blood from the
capillaries and transport deoxygenated blood
Circulatory system to the veins.

Veins Platelets
Veins are blood vessels that carry blood Platelets or thrombocytes(do not have
towards the heart. Blood vessels receive blood a nucleus) maintain haemostasis (clotting).
from the venules and transport blood back to Haemostasis is enabled by the coagulation or
the heart. Like arteries, veins, have three layers. thickening of blood by production of fibrin
from the clotting factors found within the
Blood Components platelets to prevent blood loss, when a blood
Blood is a body fluid that consists of: vessel has been broken due to injury.
• Plasma
Lymphatic system
• Red Blood Cells
The lymphatic subsystem, a part of the
• White Blood Cells
circulatory system, is closely aligned with
• Platelets the body’s immune system and removes
excessive fluid from the body. The lymphatic
Plasma
vessels contain lymph including lymphocytes.
Plasma in blood is over 50% of the volume
Lymphatic system also consists of lymph nodes
of blood and over 90% of plasma is water. The
and lymphatic organs. These organs include
main component of plasma is plasma albumin
the thymus gland, spleen, bone marrow
which is a protein that enables and controls
and tonsils. Nodes are found throughout
the osmotic pressure of the blood.
the lymphatic system and they serve to filter
Red Blood Cells (RBC) the blood as it travels throughout the body.
Swollen lymph nodes are a signal of a disease
Red blood cells or erythrocytes are disc
or an infection. Many lymph nodes are found
like in shape. RBCs are enucleated, do not
in the neck area, under the arms and in the
contain a nucleus. The red blood cells contain
groin area, although there are hundreds of
iron laden haemoglobin which carries oxygen
them throughout the body.
to the cells. Red blood cells also contain
glycoproteins which determine the blood Spleen
group of an individual. The blood types are
Spleen is an organ present in the upper
type A, type B, type AB and type O.
left part of the abdomen and to the left side
White Blood Cells of the stomach. The spleen plays multiple
supporting roles in the body. It acts as a filter
White blood cells or leukocytes are part
for blood as part of the immune system. Old
of the immune system which fights against
red blood cells are recycled in the spleen,
infections from pathogens. When the white
platelets and white bloods are stored.
blood cell count rises, it is a sign of infection.
All leukocytes have a distinct nucleus. Diseases related to blood and blood vessels
The various types of white blood cells are: • Phlebitis
• Eosinophils • Deep Vein Thrombosis (DVT)
• Basophils • Anaemia, including pernicious anaemia
and sickle cell anaemia
• Neutrophils
• Leukaemia
• Lymphocytes
• Lymphoma
• Monocytes
• Thrombocytopenia.

A Blood bank is a place, 1.3 Musculo skeletal system
for carrying out all or any of
It consists of
the operations for collection,
aphaeresis’, storage, processing and • Bones
distribution of blood drawn from donors and/ • Muscles
or for preparation, storage and distribution of • Cartilage
blood components. By an organization. One • Tendons
of the earliest blood bank was established by
• Ligaments
Frederic Durán-Jordà during the Spanish Civil
War in 1936. A blood collection program was • Joints
initiated in the US in 1940. • Facia
Someone needs blood every two seconds.
About 1 in 7 people entering a hospital need Bones
blood. Healthy adults who are at least 17 Bone tissue is a hard tissue, a type of dense
years old, and at least 110 pounds may donate connective tissue. Bone tissue is made up of
about a pint of blood—the most common different type of bone cells.
form of donation—every 56 days, or every
two months. Females receive 53 percent of Bone cells
blood transfusions; males receive 47 percent. Osteocytes are the building blocks of the
Dr. Karl Landsteiner first identified bone and form the inner matrix of bone tissue
the major human blood groups – A, B, AB that gives strength to bones.
and O – in 1901. One unit of blood can be Osteoclasts maintain the integrity and
separated into several components: red blood strength of the bones.
cells, plasma, platelets and cryoprecipitate. Osteoblasts build new bones by producing
Red blood cells live about 120 days in the collagen and minerals so that the osteocyte
circulatory system. Healthy bone marrow can remain in good functioning condition.
makes a constant supply of red cells, plasma
Stem cells form in the inner surface of
and platelets. Donated red blood cells can be
the bone will later transform into osteoblasts.
stored for 42 days.
Donated platelets can be stored for five Lining cells protect the bones and they
days. Frozen plasma can be stored for one also release calcium into the blood when the
year. According to the Central Drug Standard blood calcium levels are low.
Control Organisation (CDSCO), India has Types of the bones
2,760 licensed blood banks. Maharashtra
1. Long bones: Present in the arms and legs.
(308) had the highest number of blood
They act as levers to move parts
banks followed by Tamil Nadu (265), Uttar
Pradesh (248), Karnataka (185), Kerala (166), 2. Flat bones: These includes the ribs, scapulae,
Telangana (153), Gujarat (134), Madhya sternum, and bones of the cranium
Pradesh (133), Andhra Pradesh (125), West 3. Irregular bones: These bones are seen in
Bengal (115) and Rajasthan (102). face and spine bones.
4. Short bones: These bones are seen in wrist
One Blood Donaon can and ankle bones.
Save upto three lives
Be a “HERO”

Human Skeleton
Diagram of the front view of the Diagram of the rear view of the
human skeleton. human skeleton.
BONES OF THE BODY 206
THORAX OR CHEST BONE (25)

Sternum (breast bone)
Ribs - 24
CRANIUM (8) FACE BONES (14) SPINE UPPER LIMB (64) LOWER LIMB (31)
1 - Frontal bone Lacrimal bone - 2 (Vertebral Column) Clavicle - 1 Hipbone - 1
(Collarbone) Femur -1
2 - Temporal bone Nasal bone - 2 Cervical Vertebrae - 7
Scapula - 1
2 - Parietal bone Cheek bone - 2 Thoracic vertebrae - 12 (Shoulder bone) Patella -1
1 - Occipital bone Curled bone - 2 Lumbar vertebrae - 5 Humerus - 1 Tibia -1
1 - Ethomoid Palate - 2 Sacral Vertebrae - 5 Radius - 1 Fibula -1
1 - Sphenoid Upper Jaw bone - 2 Coccyx - 4 Ulna -1 Tarsals - 7
Lower jaw bone - 1 Carpals - 8 Metatarsals - 5
Vomer - 1 Metacarpals - 5 Phalanges - 14
Phalanges - 14

5. Cortical bone: the stronger bone that is structures, form the nasal cavity, enclose the
needed for support and movement. eyeballs, and support the teeth of the upper
6. Axial bones: Found in the skull, the ribs and lower jaws. The rounded brain cases
and the spinal column surrounds and protects the brain and house
the middle and inner ear structures.
7. Appendicular bones: found in the
arms,legs, shoulders and the pelvis. In the adult, the skull consists of 22
individual bones, 21 of which are immobile
8. Cancellous bone or spongy bone: not as
and united into a single unit. The 22nd bone
strong as cortical bone.
is the mandible (lower jaw), which is the only
9. Seasmaoid bones: embedded in tendons moveable bone of the skull.
eg. Patella.
The Cranium is made up of eight bones as
The skeleton is compossed of 206 separate follows:
bones in an adult. The cartilages and ligaments Frontal Two frontal bones, which
helps to unite the bones at the joint bone: forms the forehead and helps to
protect eyes
Skull
Parietal One at each side of the top of
The skull is a body structure that forms the
bone: the skull joined into the middle
head. It supports the structure of the face and
Temporal One on each side below the
provides a protective cavity of the face.
bone: parietal bones. These protect
Skull bones the inner parts of the ears and
The skull consists of two parts brains
• The cranium, which is like a box in which Occipital This forms the back of the head
the brain is well protected bone and part of the base of the skull
• The bones of the face One A Butterfly or bat shaped bone,
sphenoid which also forms part of the
base of the skull
Ethmoid Which forms the roof of the
nose and in between the eyes
• e only movable joint in

Th
the skulls is mandible.
• Human beings are the only living
organisms which sleep on their back.
Skull bone
The Cranium The face has the following 14 bones

The cranium (skull) is the skeletal Facial Bones
structure of the head that supports the face Two nasal bones which form the
and protects the brain. It is subdivided into bridge of the nose
the facial bones and the brain case, or cranial Two lacrimal bones Near the eyes it is very
vault. The facial bones underlie the facial thin and small
10

Two cheek bones – forms the check the coccyx. It is attached to the lower part
Zypomatic bone – of sacrum.
Two zygomatic bones
Upper limbs.
Two upper jaw bones Forms upper jaw.
Upper limb is divided into three regions.
Two Maxilla bones
Its consists of,
Two palatine bones which join with the
• Arm - located between the shoulder and
upper jaw bones
elbow joint.
forming the hard
palate • Fore arm - between the elbow and wrist
joints
Two Nasal concha one in each side of
wall of the nose • Hand - which is located distal to the wrist.
One Vomer bone which rests on the Chest (thorax)
palate and helps to
The rib cage forms the thorax portion of
form the nasal septum
the body. It consists of 12 pairs of ribs with
One Mandible bone It forms the lower their costal cartilage and the sternum. The ribs
jaw and horse shoe are anchored posteriorly to the 12 thoracic
shaped vertebrae. It protects the heart and lungs.
The vertebral column Lower limbs

The vertebral coloum, also known as the Lower limb includes foot, thigh, hip and
back bone or spine, is part of the axial skeleton. gluteal region.
It separated by intervertebral disc.
Spine or Vertebral column is the central Ear bones (MIS)
part of the skeleton. It supports the head Following are the 3 ear bones
and encloses the spinal cord. It consists of 33 M-Malleus
irregular bones called “vertebrae” I-Incus
The parts of the vertebral column are as S-Stapes
follows:
Together they form a short chain that
• 7 Cervical vertebral column in the neck crosses the middle ear and transmit vibrations
region. The first two bones called atlas caused by sound waves from the eardrum to
and axis are important for nodding and the liquid of the inner ear.
turning the head.
Throat bone (Hyoid bone): is a horseshoe
• 12 dorsal or thoracic vertebrae at the back shaped bone situated in the anterior midline
of the chest. The ribs are joined to these of the neck between the chin and the thyroid
vertebrae cartilage.
• 5 lumbar vertebrae in the waist region
• 5 sacral vertebrae are fused together to 1.4 Muscular system
form the sacrum, a triangular shaped bone
with a hollow anteriorly. The sacrum helps A brand or bundle of fibrous tissue in a
to form the pelvis. human body that has the ability to contract,
• 4 small vertebrae in the tail region are producing movement in or maintaining the
fused to form a small triangular bone called position of parts of the body.
11

The muscular system has three different types
of muscles
• Cardiac muscle
• Skeletal muscle
• Smooth muscle
Cardiac muscles are striated muscles

only found in the heart. Cardiac muscles
works involuntarily without the control of
a person.The cells found in cardiac muscle
are the myocardiocytes which contract the
myocardium.
Skeletal muscle is striated and voluntary,
that enables the skeletal structures to move.
These muscles are also controlled by the
nervous system and the majority of skeletal
muscles are attached to the bones of the body
with tendons to enable body movement. The Movements of Muscles
Smooth muscles are non striated and Hyperextension: Extension of a joint is beyond
involuntary muscles. Muscles that control the what it normally should do, for example, can
movements and actions of the internal organs occur with a traumatic car crash when the head
and systems of the body like peristalsis. is forced backwards, or extended, beyond what
it normally should do.
Role of muscular system
Rotation: Circular movement of a joint or
• Voluntary movement with the skeletal
muscle that allows the body part to move in a
muscles
circular manner.
• Involuntary actions with the smooth
External rotation: Muscular and joint
muscles
movement that entails both circular movement
• Involuntary contractions and relaxation and also movement away from the center of the
of the heart with the cardiac muscles body.
Abduction: Movement away from the centre of
the body.
Adduction: Movement towards the middle of
the body
Flexion: Bending movement of a joint or
muscle
Hyperflexion: The flexion of a joint that is
beyond what it normally should do, for example, Rotating the arm closer to the body is
can occur with a traumatic car crash when the internal rotation
head is forced to the chest, or flexed, beyond Internal rotation: Muscular and joint
what it normally should do. movement that entails both circular movement
Extension: Normal straightening movement of and also movement towards the center of the
a joint or muscle. body.
12

• Circumduction: The muscular and joint • Pivot joint, e.g. atlantoaxial joint between
movement that entails complete 3600 the atlas and axis – neck
movement • Gliding joint (“Condyloid” joint), e.g.
• Inversion: The turning of a joint inward between radius, scaphoid and lunate
• Eversion: The turning of a joint outward bones – wrist.
• Plantar flexion: Movement of the foot Structural and functional
downward Structural (binding tissue)
• Dorsiflexion: Movement of the foot • Fibrous joint - joint by connective tissue.
upward • Cartilage joint - joint by cartilage
Cartilage • Synovial joint - not directly joined.
Cartilage is an important structural • Facet joint - between two vertebrae.
component of the body. It is less hard than Functional (movement)
bones and more flexible than bones and helps • Synarthrosis means no mobility (skull)
in articulations It protects the ends of the • Amphiarthrosis means slight mobility
bone. It is found in elbows , knees and ankle. (vertebrae)
• Diarthrosis means freely movable (knee)
Cartilage does not have
a blood supply, nerves and Fascia
marrow. A fascia is a band or sheet of connective
tissue, primarily collagen, beneath the skin
that attaches, stabilize, enclose and separates
Tendons
muscles and other internal organs.
A tendon is a tough band of fibrous
connective tissue that usually connects It is classified as
muscle to bone and is capable of withstanding • Superficial fascia
tension. It is made up of collagen.
• Deep fascial fascia
Ligaments • Visceral fascia
A ligament is a short band of tough, • Parietal fascia.
flexible fibrous tissues, tissues that connects
Diseases related to the bone
bones to bone to form a joint. It also maintain
position of the organs. • Arthritis
• Rheumatoid arthritis
Joints
• Osteoporosis
Joint or articulation is the connection
• Osteoarthritis
made between bones in the body which link
• Osteomyelitis
the skeletal system into a functional whole.
• Fractures
Types of Moveable Joints
Functions of musculo skeletal system
• Hinge joint, e.g. interphalangeal joints –
fingers and toes. The human skeleton and the skeletal system
perform several functions.
• Ball and socket joint, e.g. hip and shoulder
joints 1. The protection of the vital organs of the body
13

2. The support of the human body which gives The parts of the central nervous system are
it its form and stability the
3. Body movement • Brain
4. Control of metabolic functions like the • Spinal cord

calcium and calcium storage as well as iron
The Brain
metabolism and iron storage in the bone
marrow The brain is placed inside a skull or
cranium which protects it. The brain consists of
5. Hematopoiesis, the production of red blood
three major parts, two hemispheres (right and
cells in the bone marrow of bones.
left hemisphere) and meninges, the protective
membrane.
1.5 Nervous System The meninges have three layers (PAD)
The nervous system is the most complex P-Pia mater (inner)
of all the systems which coordinates controls A-Arachnoid (middle)
and enables all body functions like movement, D-Dura mater (outer).
thinking, autonomic, or automatic, reflexes The spinal cord is covered with meninges.
and sensory perception. The nervous system The subarachnoid space (space between the
sends messages to all parts of the body and arachnoid layer and the pia mater) contains the
receives it. For example, when a person cerebrospinal fluid.
touches fire, the message is sent to the brain
which interprets and sends a message to the Cerebrospinal fluid (CSF)
person’s finger to suddenly remove it. CSF fluid is a clear, colorless body fluid
found in the brain and spinal cord. It is about
The Parts of the Nervous System
125ml of CSF at any one time and about 500ml
• The central nervous system is generated everyday.
• The peripheral nervous system CSF acts as a cushion or buffer for
the brain, providing basic mechanical and
immunological protection to the brain inside
the skull.
Note: Both the brain and the spinal

cord are comprised of gray matter and white
matter. Gray matter plays a higher role in
the central nervous system's functioning
than the white matter. The white matter
consists of lesser cells than the gray matter.
The brain is also divided into three major

areas
• Cerebrum
• Cerebellum
• Brain stem
Nervous System
14

Cerebrum
The cerebrum is the largest part of the
brain and its lobes coordinate and enable body
movement, sensory perception, learning,
olfactory sense, gustatory sense, optic sense,
auditory sense, memory, thinking, judgment
and communication abilities.
Cerebellum
Brain stem
The brain stem lies at the base of the skull
and between the right and left hemispheres of
the brain.
The brain stem has three sections

• Midbrain
• Pons
• Medulla oblongata
Cerebrum
The midbrain controls messages sent from
The cerebrum has four major lobes which, other higher areas of the brain to the pons and
as shown in the picture above, are: medulla below it and it also controls posture.
• The frontal lobe The pons connects the midbrain and
• The temporal lobe the medulla. The pons controls the rhythm of
• The parietal lobe respirations.
• The occipital lobe The medulla oblongata connects the pons
The frontal lobe is responsible for and the spinal cord through a hole in the base
thinking, movement, judging and writing. of the skull called the foramen magnum. The
medulla is the center of control for breathing and
The temporal lobe plays a role in terms of
cardiac functioning and manages swallowing,
memory and hearing.
vomiting, cough, and sneeze reflexes.
The parietal lobe helps in sensory
perception. The Spinal Cord
The occipital lobe facilitates understanding The spinal cord connects the brain to the
written language and vision. peripheral nervous system throughout the body.
The spinal cord is protected with the meninges
Cerebellum and the spinal column.
The cerebellum, referred as the little The spinal cord is divided into different parts,
brain or hind brain is much smaller than the which are:
cerebrum and lies behind the other parts of
• Cervical region
the brain. The cerebellum controls motor
nerves, balance, equilibrium, fine motor • Thoracic region
coordination and gross motor coordination. • Lumbar region
15

• Sacral region The peripheral nervous system is divided
• Coccyx, or tail bone, region into two:
• Autonomic nervous system
• Somatic nervous system
Autonomic nervous system

The autonomic nervous system controls
automatic and involuntary physiological
functions of the body that are out of our control
like the movements of smooth, involuntary
muscles. For example, the constriction of the
eye’s pupil when it is exposed to bright light.
The autonomic nervous system’s functions
can be further divided into:
Sympathetic nervous system

Sympathetic nervous system is
responsible for the fight and flight syndrome
Spinal Cord that results from stress. These responses
include an increased heart rate, pupil dilation
and decreased peristalsis.
Parasympathetic nervous system

The parasympathetic nervous system
manages the functions related to rest. For
example, the parasympathetic nervous
system manages involuntary control of tears,
digestion and the production of saliva.
Somatic nervous system

The somatic nervous system controls
Spinal Cord C.S voluntary muscular movement with the
The spinal cord has 31 nerve clusters skeletal muscles of the body. The somatic
which sends and receives motor and sensory nervous system has efferent and afferent
messages to and from the rest of the body and nerves which send and receive motor function
it coordinates reflex action. related nerve signals.
Reflexes
The Peripheral Nervous System
A reflex is a muscle reaction that
The Parts of the Peripheral Nervous
automatically occurs in response to a stimulus.
System
Peripheral nervous system consists of There are two types of reflexes.
all the parts of the nervous system other than Infant reflexes
the brain and the spinal cord. The peripheral Reflexes present at the time of birth, but
nervous system is not protected with bones. disappear shortly thereafter.
16

Other reflexes The neuron is the primary type of nerve
Reflexes present at the time of birth cell in the nervous system. Glial cells forms
and remain active throughout life time. myelin sheath over the neuron for protection.
For example, the pupil reflex, sneeze reflex, Neurons communicate with other
blinking reflex, cough reflex and yawn reflex. neurons by sending impulses at the synapse,
Twelve Cranial Nerves a point of junction between any two neurons.
There are two types of neurons which are
Remember the mnemonic: One Old Owl
sensory neurons and motor neurons. Sensory
Turned Top, A Fat Aunt Go Viewed Some Hop
neurons sense and transmit information such
• Olfactory: smell as taste, touch and sight. Motor neurons send
• Optic: vision and transmit messages that involve muscle
• Oculomotor: eye movements. movement.
• Trochlear: eye movements. Glial Cells
• Trigeminal: chewing and sensory to face Glial cells are non-neuronal cell that
• Abducens: eye abduction. provide support and nutrition, maintain
• Facial: facial expressions, the tongue and homeostasis, form myelin and patricipate in
the salivary glands. signal transmission in the nervous system.
• Acoustic/Auditory: hearing Types of nerves
• Glossopharyngeal: taste impulses and the Sensory or afferent nervesWhen action
secretion of saliva from the parotid gland. potentials are generated by sensory receptors
• Vagus: respiratory and the digestive systems on the dendrites of these neurons, they
such as the pharynx and swallowing. are transmitted to the spinal cord by the
• Spinal accessory: movement of shoulder. sensory nerve fibres. The impulses may then
• Hypoglossal: Tongue movement. pass to the brain or to connector neurons of
reflex arcs in the spinal cord motor or efferent
Functional Units of Nervous System nerves.
The nervous system is comprised of Motor nerves originate in the brain,
millions of neurons and glial cells. spinal cord and autonomic ganglia. They
transmit impulses to the effectors organs
Types of nerves muscles and gland. There are two types:
• Sensory or afferent nerves Somatic Nerves – involved in voluntary
• Motor or efferent nerves and reflex skeletal muscle contraction.
• Mixed nerves Autonomic Nerves (sympathetic and
Neuron parasympathetic) – involved in cardiac and
smooth muscle contraction and glandular
secretion.
Mixed Nerves: In the spinal cord,
sensory and motor nerves are arranged in
separate groups or tracks. Outside the spinal
cord, when sensory and motor nerves are
enclosed with the same sheath of connective
tissue they are called mixed nerves.
Neuron
17

Disease related to nervous system digestive enzymes, respectively through the
• Seizures common bile duct to the duodenum of the
• Stroke small intestine.
• Epilepsy Mouth
• Meningitis The cheeks,tongue and palate frame the
• Paralysis mouth, which is also called oral cavity .its
• Multiple sclerosis boundaries are defined by the lips, cheeks,
• Parkinson’s diseases soft palate and epiglottis. It is divided in to
two sections.
• Alzheimer’s disease
They are
• Bell’s palsy.
• The vestibule- the area between the cheeks
1.6 Gastro Intestinal System and the teeth.
• The oral cavity- filled by the tongue
Introduction
The mouth is the opening through which
The alimentary canal, is a continuous the person ingests food and fluids. Incisors,
hollow tube from the mouth to the rectum. canines, premolar and molars are the types of
The alimentary canal along with the associated teeth helps in mastication
organs like the salivary glands, liver, pancreas
and the gallbladder is called the digestive or Tongue
gastrointestinal system. The primary role of Tongue is one among the five sensory
the digestive system is to supply blood stream organ. It is a muscular structure used for
with nutrients that can be used by the body moving food in the mouth and to swallow
for its fuel, energy and fluid needs. fluid and food. Taste buds are found on the
upper surface of the tongue and the salivary
glands.
Salivary glands
Salivary glands produce saliva which
contains the digestive enzyme amylase.
Amylase digests and breaks down starch into
glucose and maltose.
Pharynx
The pharynx receives air from the nares
or the mouth and it also receives food from
the mouth. When people say that their food
has gone down the wrong pipe, they are
experiencing an abnormal small amount of
Parts of digestive system food moving from the pharynx to the trachea.
The organs that contribute to digestion
Epiglottis
are the tongue, salivary glands, the liver, the
The epiglottis is the flap like projection
gallbladder, and the pancreas. The gallbladder
in the back of the mouth attached to the
and the pancreas secrete and deposit bile and
18

larynx. It goes up during breathing to allow Small Intestine
the air to enter into the trachea and it moves The chyme from the stomach is mostly
down during the swallowing of food and absorbed in the small intestine as usable
drinking fluids to allow the food to enter the minerals and nutrients. The small intestine
oesophagus. also receives bile and the pancreatic enzymes
from the bile ducts. These pancreatic enzymes
Oesophagus
break down carbohydrates, fats and proteins
The oesophagus is a long straight hollow for absorption. The small intestine is also a
structure that starts at the pharynx and ends hollow abdominal tube that connects to the
at the stomach. The upper portion of the stomach at its upper end and to the large
oesophagus has skeletal muscles and the lower intestine at its lower end which sphincter
portion has smooth muscles. Oesophagus has prevents back flow.
a sphincter at the top of pharynx end and it
has a sphincter at the bottom of the stomach The three parts of the small intestine are
which prevent food from flowing back into the the duodenum, jejunum and ileum
pharynx from oesophagus and backing up from Iron is absorbed in the duodenum, jejunum
the stomach into the oesophagus. The primary absorbs all of the products of digestion and the
role of the oesophagus is peristalsis, wave like ileum absorbs any remaining nutrients that has
movements that move and propel food and left behind.
fluids along the digestive tract with the help of
muscles. Large Intestine
The large intestine is involved in the
Stomach absorption of water and the removal of by
The stomach is a hollow organ on the left products of digestion through defecation. The
side of the abdomen that collects and processes two major parts of the large intestine are the
food and fluids. The stomach has the fundus, cecum and sigmoid colon.
body and antrum. The stomach secretes digestive The caecum is connected to the
enzymes, such as pepsin, hydrochloric acid and appendix which has an unknown role and the
gastric acid to facilitate the digestive process. colon absorbs water and propels waste to the
As the food and fluids are processed in the rectum.
stomach, a partially digested chyme is formed.
Pepsin digests proteins; and hydrochloric acid Rectum
provides the pH of acidity that is necessary for The rectum is a part of the lower gastro
digestion. Minimal absorption of water soluble intestinal tract. It is a continuation of a
vitamins and some medications such as aspirin sigmoid colon and connects to the anus. The
takes places at stomach. key role of the rectum is to act as a storehouse
for feces.
Liver
The liver is an abdominal organ and Anus
gland on the right side of the abdominal The anus is the last part of the
cavity and near the center of the body. The digestive tract. The lining of the upper anus
liver produces bile which is then transported is specialized to detect rectal contents. It
to the gallbladder through the common bile knows whether the contents are liquid, gas or
duct and then to the small intestine. Bile is solid.
used for the breakdown and digestion of fats.
19

The stages of digestion are: • Colitis
Mastication • Irritable Bowel Syndrome (IBS)
Digestion of the food starts by the action • Cancer
of mastication(chewing) aided by teeth, a form
of mechanical digestion. 1.7 Urinary system
Saliva secreted by the salivary glands which
contains the following: Introduction
Salivary Amylase - Starts the digestion of Urinary system also known as the
starch renal system consist of the kidneys, ureters,
Mucus - Lubricates the food bladder, and urethra. The purpose of the
urinary system is to eliminate the excess
Hydrogen carbonate - Maintains the ideal
water from the body, regulate blood volume
condition of PH (Alkaline) for Amylase to work
and blood pressure, control and regulate the
Digestion level of electrolytes and blood PH.
Digestion is the breakdown of large
insoluble food molecules into small water- The parts of the urinary system
soluble food molecules. So that they can • Kidneys • Ureters
be absorbed into the watery blood plasma. • Bladder • Urethra
Digestion is a form of catabolism that is
divided into mechanical and chemical Kidneys
digestion. The term mechanical digestion The kidneys are bean shaped bilateral
refers to the stepwise physical breakdown urinary organs that lie in the upper abdominal
of large pieces of food into smaller pieces. area in close proximity to the stomach and
In chemical digestion, enzymes break down liver. The two main layers of the kidney are the
food into the small molecules the body can medulla and the renal cortex. The medulla is the
use. inside portion of the kidney and the cortex is
Absorption the outer layer of the kidney. The kidneys are
made up of millions of nephrons, the primary
95% of absorption of nutrients occurs
functional unit of the kidney.
in the small intestine. Water and minerals are
reabsorbed by the colon .
Diseases related to digestive system

• Poisonings
• Diarrhea
• Constipation
• Diverticulitis
• Gastric Eosophageal Reflux Disorder
(GERD)
• Peptic ulcers Kidney
• Cholelithiasis
Ureters
• Cirrhosis of liver
The bilateral ureters connect the pelvis of
• Hepatitis
each kidney to the bladder. The ureters consist
20

of smooth involuntary muscle which serves
as the conduit of urine from the kidneys into
the bladder.
Ureters Urinary System

Bladder
Filtration
The bladder is the muscular organ that
Filtration occurs when the circulating
serves as the collection and retention vessel
blood passes through the kidney where
which temporarily holds and retains urine
the removal of proteins and other cellular
prior to urination. A normal urinary bladder
particles. The ultra filtrate becomes urine
can hold up to 800 milliliters of urine.
after reabsorption and secretion.
Urethra
Re absorption
Urethra transports urine from the
bladder to the outside of the body. This image Reabsorption occurs after filtration,
shows (a) a female urethra and (b) a male entails the re-entry of some particles and
urethra. molecules from the ultrafiltrate back into the
blood for future use.
The urethra is the opening through which
the urine passes out.
The male gender has two urethral NOTE: Anti Diuretic Hormone controls
sphincters to control both the passage of urine the amount of water in the body and
and sperm and the female gender has only one the blood. Excessive water in the blood
urethral sphincter to control the flow of urine causes high blood pressure and fluid
only. overload, and a low amount of water in
the blood causes low blood pressure and
Physiology Of Urinary System dehydration. Anti diuretic hormone also
The functional unit of the urinary system decreases the amount of aldosterone in
is the nephron. The actual filters are tiny the body.
structures called nephron and each kidney is
made up of one million nephrons. A nephron Secretion
is made up of two parts, a cluster of capillaries
Secretion is the opposite of reabsorption
called glomerulus, and a long fine tube. The
which entails the movement of wastes and
nephrons are doing the following functions.
21

other molecules into the urine from the blood Disease related to urinary system
after it is processed by the kidney. • Urinary tract infection
The process of urine production • Urolithiasis
The entry of blood into the kidneys → • Nephrolithiasis

filtration of blood → ultra filtration → Re • Renal failure
absorption → Secretion → Excretion of urine • Renal cysts
Kidney physiologically prompts the • Glomerulonephritis
secretion of Antidiuretic hormone and • Cancers of the urinary tract
Aldosterone and production of enzymes like • Dialysis
Renin and Angiotensin II
NOTE: A normal adult human void from 1.8 Respiratory system

800 to 2,000 ml of urine per day. Urinary
Introduction
output less than 800 mLs per day and
Respiratory system provides the body
less than 30 mLs per hour are considered
with oxygen required to sustain life and to
oliguria; urinary output in excess of
eliminate carbon dioxide. The respiratory
2,000 ml per day is considered polyuria;
system works in association with the heart
and the absence of all urine production is
and lungs.
referred to as anuria.
Air is breathed in through the nose or
Functions of the urinary system the mouth. In nasal cavity, a layer of mucus
• Eliminates wastes from the body membrane acts as a filter and traps pollutants
and other harmful substances found in the air.
• Manages and controls the homeostasis of
Next air moves in to the pharynx, a passage
the body in terms of its pH or acid-base
that contains the intersection between the
balance
oesophagus and the larynx. The opening
• Manages and controls the homeostasis of of the larynx has a special flap of cortilage
the body in terms of its electrolytes and the epiglottis that opens to allow air to pass
electrolyte balance through but closes to prevent food from
• Manages and controls the blood pressure moving in to the airway.
• Stores urine until voiding is prompted
Upper respiratory tract
• Enables the process of urination Alveoli
Nasal Cavity Broncheole
• Remove wastes like urea and ammonia Artery
Pharynx
from the blood
Larynx Vein
• Manage and control the fluids and fluid Lower respiratory tract
Left Lung
balance in the body by holding or retaining Trachea
water and releasing and removing water Primary Bronchi
from the blood stream Lungs
• Serve with endocrine functions such as the

production of erythropoietin and calcitriol
which are needed for the production of
red blood cells and the reabsorption of
Respiratory System
calcium, respectively.
22

From the larynx air moves in to the trachea. It received inspired air from the
trachea and down to the intersection that pharynx and passes it to the trachea.
branches to form the right and left primary
bronchi, each of these bronchi, branch in to Trachea
secondary bronchi that branch into tertiary
bronchi that branch in to smaller airways
called bronchioles that eventually connect
with tiny specialized structure called alveoli
that function in gas exchange.
The respiratory system is divided into
the upper and lower respiratory system.
Upper Respiratory Lower Respiratory

Tract Tract
Nostril Trachea
Pharynx Bronchi
Larynx Bronchioles Trachea
Epiglottis Alveoli Trachea called as windpipe, is a
cartilaginous tube that connects the pharynx
Nostrils and larynx to the lungs allowing the passage of
A nostril is one of the two channels of the air.
nose from the point where they bifurcate to the Lungs
external opening. The lungs are the primary organs of the
respiratory system. Human lungs are conical
Pharynx
in shape and spongy organ. Right and left
Pharynx is the part of the throat. It is lung are situated in the thoracic cavity, either
situated at behind the nasal cavity, besides the side of the heart, and above the diapharam.
larynx, and above the oesophagus. It has three
The lungs are protected by ribcage and
part, they are nasopharynx, oropharynx and
the spine. The right lung is larger than left
laryngopharynx.
lung. The left lung has two lobes, upper and
Epiglotis lower lobes. The right lung has three lobes
upper, middle and the lower lobe.
Epiglotis is a flap in the throat. It is
present between the pharynx and larynx. It Bronchus
helps to prevent the food from entering the
The bronchus is passage of airway in the
windpipe [trachea] and the lungs. It is made
respiratory system. They conducts air in to the
up of elastic cartilage covered with a mucus
lungs. It is divided in to primary, secondary,
membrane attached to the entrance of the
and tertiary bronchi.
larynx.
Bronchioles
Larynx
They are bronchus of the bronchi. The
Adam’s apple or the voice box. Larynx bronchioles further divided in to smaller
connects the lower part of the pharynx and terminal bronchioles.
23

Alveoli Disease of the respiratory tract
The alveoli are located in the respiratory • Pneumonia
zone of the lungs. It is the smallest units in the • Emphysema
respiratory tract. Human lungs contain about
• Bronchitis
480 million alveoli.
• Asthma
• Chronic Obstructive Pulmonary Disease
(COPD)
• Influenza or the “flu”
• Tuberculosis
• Laryngitis
• Pharyngitis
• Lung Cancers
• Dyspnea
• Respiratory arrest
Alveoli
1.9 Endocrine System
Each alveolus is surrounded by numerous
capillaries and is the site of gas exchange by The endocrine system provides the body
diffusion. with the hormones that are needed to sustain
life and create life. Hypo and hyper secretion
NOTE: Diaphragm is the major breathing of the endocrine glands leads to physiological
muscle of the body. problems.
NOTE: Endocrine glands are different

Respiratory cycle from exocrine glands. Endocrine glands
The respiratory cycle includes two secrete hormones to an internal part of
phases, inspiration or inhaltion of oxygen the body; and exocrine glands secrete
and expiration or exhalation of carbon substances to the exterior or near the
dioxide. surface of the body. Salivary glands secrete
saliva into the mouth and sebaceous glands
secrete an oily substance on the skin.
NOTE: Each inspiration plus one
expiration is one breath. Normally, Physiology
adults breathe 16 to 20 times per minute Endocrine system
or 960 to 1,200 times per hour. is a control system of
ductless glands that secrete
hormones within specific
The lungs expand with inspiration and
organs. Hormones acts as
deflate and relax during expiration. Both the
“messengers” and are carried by the blood
expansion and contraction of the lungs are
stream to different cells in the body, which
aided by the muscular diaphragm and the
interpret these messages and act on them.
intercostal muscles.
It provides an electrochemical connection
24

from the hypothalamus of the brain to all several other glands included in the endocrine
the organs that control the body metabolism, system.
growth and development, reproduction and
also maintain homeostasis. Pineal Gland
The endocrine system regulates its The pineal gland is a small endocrine
hormones through negative feedback. gland that lies close to the hypothalamus,
Increases in hormones activity decrease the performs the coordination of circadian
production of that hormone rhythm (sleep - wake cycle).
Thyroid Gland
The endocrine system consists
of these glands The Thyroid gland shaped like angel
wings on each side of the throat just above the
• Hypothalamus • Pituitary gland trachea, are connected to each other with a
• Pineal gland • Thyroid thin connecting area called the Isthmus.
• Parathyroid • Adrenal glands The Thyroid gland regulates the body’s
• Pancreas • Ovaries metabolism, basal metabolic rate, cardiac
• Testes system’s function, physical growth and sexual
functioning.
NOTE: The Thymus is the only
endocrine gland that does not secrete any
hormones
The Thymus is considered as an
endocrine gland because it plays a role in
the immune system of the body.
Endocrine System Thyroid System
Hypothalamus Parathyroid Glands (“para” means around

and “thyroid” is thyroid gland).
The hypothalamus lies within the
cranium which regulates the homeostasis. The parathyroid glands are two pairs
The hypothalamus regulates the release or of glands found bilaterally on both sides of
slow down and stop the release of hormones the neck just behind the Thyroid gland. The
from other endocrine glands based on the body has four parathyroid glands which is
blood levels of these hormones. unique when compared to the other glands of
the endocrine system. The role of the glands
Pituitary Gland is to control the circulating amount of two
Located at the base of the brain, is the electrolytes, calcium and phosphorous with
master gland which controls the secretion of the secretion of parathyroid hormone.
25

Adrenal Glands Follicle Stimulating Hormone (FSH)
The adrenal glands, which are in the in females and in males it inhibits the
abdominal area, are located bilaterally just development of sperm and androstenedione
above each kidney and the diaphragm. The (androgen that is weaker than testosterone).
adrenal glands consist of two layers, the cortex The testes produce androgens, testosterone
(outer layer) and the medulla (inner core). and sperms.
The cortex secretes:

• Androgen - male hormone
• Aldosterone - controls blood pressure and
fluid balance
• Cortisol - regulates and coordinates
metabolism
The medulla secretes stress reaction hormones

such as:
• Adrenaline • Noradrenaline
• Catecholamine
The Pancreas
The pancreas is located behind the
stomach. The islets of Langerhans secrete
glucagon, insulin, pancreatic polypeptide
and somatostatin. The pancreas produces
and releases digestive enzymes and juices
that break down foods as they enter the small Testes and Ovaries
intestine.
Diseases related to endocrine system
NOTE: Pancreas is called as a mixed • Diabetes insipidus
gland since it serves both as an endocrine • Acromegaly
gland and as a digestive organ and • Gigantism
exocrine body.
• Syndrome of Inappropriate Antidiuretic
Hormone Secretion (SIADH)
Testes and Ovaries • Hyperthyroidism
Ovaries and Testes are the endocrine • Hypothyroidism
glands and gonads, which is called as a sex • Cushing’s syndrome
and reproduction glandular structure.
• Addison’s disease
The ovaries produce progesterone,
estrogen, inhibin and androstenedione.
Progesterone regulates menstrual cycle 1.10 Reproductive System
and the preparation of the uterus for the
The role of the male and female
implantation of the egg. Estrogen regulates
reproductive system is to procreate and to
the development of breasts. Inhibin inhibits
provide sexual gratification to the person.
26

Labia minora
The labia minora lies just inside the labia
majora and surround the openings to the vagina
and urethra.
The Clitoris
The clitoris lies above the vagina is covered
with a protective cover or hood.
Vestibule
It is a small space or cavity at the beginning
Female Reproductive System of a vaginal canal.
Female reproductive system Internal Organs

The female reproductive system is made
Vagina
up of the internal and external sex organs that
function in reproduction of new offspring. The Vagina is an elastic, muscular canal
The female reproductive system is immature that extends from the vulva to the cervix. The
at birth and develops to maturity at puberty vaginal canal travels upwards and backwards
and able to produce gametes, and to carry a between the urethra at the front and the
foetus to full term. rectum at the back.
The outer vaginal opening is normally
Parts of Female Reproductive System. partly covered by a membrane called the
External Organs Internal Organs hymen. It joins the internal and external female
• Vulva • Vagina reproductive organs and protects against
• Mons pubis • Cervix infection by a moist secretion.
• labia majora • Uterus
Cervix
• Labia minora • Fallopian tubes
• clitoris • Ovaries The cervix is the lower part of the uterus.
• Vestibule The lower narrow portion where it joins with
the upper part of the vagina. The cervix is
External Organs usually 2-3 cm long and roughly cylindrical
in shape which changes during pregnancy. As
Vulva
labour progresses, the cervix becomes softer
The vulva is the external part of the female and shorter, beings to dilate and facilitate
genitalia. It protects the woman’s sexual organs normal labour.
urethra, vestibule, and vagina.
Uterus
Mons Pubis
The uterus is a pear shaped muscular
The mons pubis is a pad of fat lying in organ and the major female reproductive
front of the symphysis pubis where pubic hair organ. It provides mechanical protection,
develops with puberty. nutritional support, and removal of the waste
for developing embryo and fetus.
Labia majora
• It has three layers, they are perimetrium,
The labia majora are two thick folds
myometrium and endometrium.
which form the sides of the vulva.
27

• Major functions are to accept a fertilized The external organs
ovum which becomes implanted into the • Penis
endometrium, and menstruation. • Scrotum
The fallopian tube The Penis
The fallopian tubes are two tubes leading The tip of the penis is protected with
from the ovaries in to the uterus. They enable foreskin. The penis enlarges and becomes
the passage of ovum from the ovaries to the erect with sexual excitation because there is a
uterus. Different segments are interstitial, rich supply of blood.
isthmus, ampulla, infundibulum and fimbriae.
Fertilization takes place in the ampulla of the The Scrotum
fallopian tube. The scrotum lies bilaterally behind the
penis. The scrotal sac holds and protects the
Ovaries
testes.
The ovaries are considered as the
female gonade. Each ovary is whitish in NOTE: The scrotum moves upward and
colour and located alongside the lateral downward when it is exposed to cold
wall of the uterus. It secretes estrogen, and warm environmental temperatures,
testosterone, Inhibin and progesterone. respectively.
These hormones are responsible to maintain
menstrual cycle, pregnancy and development The internal organs are the
of breast. • Testes • Epididymis
Functions of the female reproductive system • Vas deferens • Seminal vesicles
• To produce ovum. • Ejaculatory ducts • Prostate gland
• To protect and nourish fertilized egg until • Urethra
it is fully developed.
Testes
• To give birth.
The testicles, or testes, lie bilaterally
• Menstruation. to the penis in the scrotum. The testes are
• To have sexual intercourse. endocrine glands and gonads.
Diseases related female reproductive system

• Breast cancer
• Cervical cancer
• Ovarian cancer
• Poly cystic ovarian disorder
• Menorrhagia
• Fibroids
Male Reproductive System

The male reproductive system consists of
internal and external organs.
Male Reproductive System
28

Epididymis Disease related to reproductive system
The epididymis is the connecting tube • Prostate cancer • Testicular cancer
between the testes and the vas deferens which • Gynecomastia • Erectile dysfunction
stores, transports and matures the sperm • Varicocele • Hydrocele.
from the testes. The epididymis has three
parts such as, the head, body and tail. Sensory system
It is an organ of the body which response
Vas Deferens
to external stimuli by conveying impulses
The vas deferens moves the through the sensory neuron to the appropriate
mature sperm from the epididymis to the places within the sensory nervous system.
ejaculatory ducts and then to the urethra for
There are five sense organs in the human body.
ejaculation.
It includes,
Seminal Vesicles • Skin • Eye • Ear
The seminal vesicles are the pair of • Tongue • Nose
glands which attach to the vas deferens near
and under the bladder. It produces a fructose Skin
substance that provides the sperm with the The human skin is the outer covering
energy it needs to locomote and move through of the body and is the largest organ of the
the male reproductive tract. integumentary system. The main functions
are protection, regulation and sensation.
Prostate
The prostate is an exocrine gland which Anatomy of the Eye
secretes an alkaline fluid that preserves the
The eye is a sensory organ. It absorbs light
life of the sperm when it hits the acidic female
rays from our environment and transforms
vagina.
them in such a way that the information in
Ejaculatory Ducts the brain can be processeced further.
The pair of ejaculatory ducts forms the
union of the vas deferens and the seminal
vesicles. Sperm enters the ejaculatory ducts
from the vas deferens.
Urethra
The urethra is an organ common for both
reproductive system and urinary system.
The primary male reproductive hormones are

Follicle stimulating hormone which
produces sperm (spermatogenesis). Anatomy of Eye
Luteinizing hormone which produces
• The eye has many parts work together to
testosterone.
produce clear vision.
Testosterone which leads to the
• The sclera or white part of the eye protects
development of primary and secondary
the eyeball.
sexual characteristics during puberty.
29

• The pupil or black dot at the center of the
eye is a hole through which light can enter ABOUT EYE BANK
the eye. In India, we have an
• The iris or coloured part, surrounding the estimated 4.6 million people
pupil. It controls how much light enters the with corneal blindness that is curable
eye by changing the size of the pupil. through corneal transplantation made
• The cornea, a clear window at the front of possible by eye donation. The cornea is the
the eye covers the iris and pupil. transparent outer portion of the eyeball
• A clear lens, located behind the pupil, acts that transmits light to the retina. It is a
like a camera lens by focusing light in to 1/2-inch wide film of tissue that forms a
the retina at the back of the eye. protective covering on the front of the eye.
• The retina is a light sensitive inner lining at Corneal blindness can be cured in many
the back of the eye. Ten different layers of cases through the transplant of a donated
cells work together in the retina to detect cornea. In 1905 Eduard Konrad Zirm,
light and turn it into electrical impulses. MD, performed the first successful corneal
• The retina has special cells called cones transplant. In 1944 Paton established the
and rods are located in the retina. These world’s first eye bank, the Eye-Bank for
all are known as photoreceptors and help Sight Restoration, in New York. Certified
absorb light. Eye Bank Technicians are re-certified
• Cones cone cells help us see colour and every 3 years. Anyone can be an eye
detail. donor! Cornea donation is not dependent
• Rods rod cells allow us to see in poor on age, eye colour, blood type or even
lighting and give us our night vision. eye sight quality. The eyes have to be
removed within six hours of death. Cornea
Functions [Physiology] of the transplant is usually performed within
Eye 4 days after donation, depending upon
1. Light reflects of the object we are looking at the method of cornea preservation. Eye
2. Light rays enter the eye through the cornea donation gives sight to two blind persons.
at the front of the eye. One blind person is given one eye. Almost
3. The light passes through a watery fluid and anyone between the ages of 2 and 75 can
enters the pupil to reach the lens. be an eye donor, regardless of poor vision,
4. The lens can change in thickness to bend the diabetes, or cancer. In fact, only under
light, which will focus it on to the retina at the following conditions can eye donation
the back of the eye. definitely not occur: HIV or AIDS,
5. On the way to the retina, light passes through Active Hepatitis, Active Syphilis, Rabies,
a thick, clear fluid called a vitreous humour. Viral Encephalitis, Leukemia, Active
The vitreous humor fills the eyeball and Lymphoma, or Active Meningitis. It is
helps maintain its round shape. illegal to buy and sell human eyes, organs
6. The light then reaches the back of the eyes and tissues. Any cost associated with eye
and hits the retina. The retina translates the procurement are absorbed by the eye bank.
light into electrical impulses which are then MAKE EYE DONATION A FAMILY
carried to the brain by the optic nerve. TRADITION
Finally, the visual cortex of the brain Your eyes after death need not perish.
interprets these impulses at what we see. Help blinds to see, donate eyes after death.
30

Ears Eustacian tube
A tube that connects the middle ear to
the back of the nose. It equalizes the pressure
between the middle ear and the air outside.
The inner ear

It has two main parts.
Cochlea
This is a spiral that is covered in a stiff
membrane. It contains thousands of hair cells
Ear attached to the end of the organ of the auditory
The ear is the organ for hearing. It is nerve called organ of corti. These tiny hairs
divided into three parts. bend because of the vibrations caused by the
• Outer ear-pinna /auricle, auditory canal sound waves.
• Middle ear-ear drum, ossicles, Eustachian The auditory nerve
tube The vibration from the hairs stimulated
• Inner ear- cochlea, vestibule and tiny nerve cells. The nerve cells then send
semicircular canal. signals along the auditory nerve to the brain.
The outer ear Functions of Ear

Pinna: receives sound waves that travel the
Any source of sound sends vibrations or
auditory canal or ear canal.
sound waves in to the air. These funnel through
The curved formation on the outside [the
the ear opening, down the ear canal and strike
pinna] helps funnel sound down the ear canal
eardrum acquiring in to vibrate. The vibrations
to the ear drum.
become nerve impulses and transported to the
Auditory canal brain, which interprets the impulses sound
Acts as a funnel and leads to the ear drum. [music, voice, etc.]
which protects the eardrum from shock and
intrusion by external objects. Tongue
Tongue is a muscular organ situated in
Ear drum
the floor of the mouth. It is associated with
• It is a cone shaped piece of skin. the function of taste, speech, mastication,
• It is very sensitive, even the slightest degurtition.
pressure variation will cause it to vibrate.
• It is also separates the outer ear from the Parts of the tongue
middle ear. • Root
• Tip
The middle ear
• Body – it consists of two
It transfer the energy of a sound wave by
vibrating the three bones found there. • Dorsum – oral part
Ossicles:- smallest bone of the body. Ear • Pharyngeal part
bones are malleus, incus and stapes. • Posterior part
• Inferior – inferior surface.
31

Functions of the nose
• Respiration
• Olfaction
1. Nose is the first part of the upper respiratory
tract.
2. Warming and moistening of the inhaled air.
3. Filter the air by removing particulates.
Tongue
There are two groups of muscles of the
tongue.
1. Four intrinsic - alter the shape of the tongue
and not attached to the bone.
2. Four paired extrinsic muscles- change the Nose
position of the tongue and are anchored to
Olfaction
the bone.
It has olfactory receptor neuron and it is
The tongue upper surface is covered responsible for sense of smell.
by taste buds housed in numerous lingual
papillae. It is responsible for taste. Speech
The normal speech is produced with
Nose pressure from the lungs, this can be modified
The organ of smell is located in the middle using airflow through the nose in a process
of the face. The internal part of the nose lies called nasalization.
above the roof of the mouth.
The nose consists of external nose and
nasal cavity both are divided by the septum into
right and left.
SUMMARY
Integumentary system comprises the skin. Appendages protect the body from various
kinds of damage. Such as loss of water or damages from outside.
It consists of the skin, hair, finger nails, toe nails and other structures including glands.
Heart is the master of cardiovascular system. It pumps out blood to supply oxygen,
electrolytes, nutrients and hormones through out the body.
Blood circulation controls the body temperature, the PH or acid base balance of the body.
Blood pumping cycle of the heart is called cardiac cycle. The heart consists of four chambers,
valve, and three layers of covering.
Heart has three types of circulation like coronary, systemic and pulmonary circulation. It is
considered as a one of the vital organ of the body.
32

SUMMARY (CONTD)
The musculo skeletal system is made up of the body’s bones, muscles, cartilage, tendons,
ligaments, joints, and other connective tissue that supports and bind tissues and organs
together.
The primary functions of the system is forming and supporting the body, allowing motion,
and protecting vital organs.
The nervous system is the most complex of all the systems which coordinates controls and
enables all body functions like movement, thinking, autonomic, or automatic, reflexes and
sensory perception.
The nervous system sends messages to all parts of the body and receives it.
The alimentary canal, with the other organs of digestion, is a continuous hollow tube from
the mouth to the rectum.
The alimentary canal along with the associated organs like the salivary glands, liver, pancreas
and the gallbladder is called the digestive or gastrointestinal system.
The stages of digestion are mastication, digestion, and the absorption.
Urinary system also known as the renal system, consist of kidneys, ureters, bladder, and
the urethra.
The purpose of the urinary system is to eliminate the excess water from the body, regulate blood
volume and blood pressure, control and regulate the level of electrolytes and blood PH.
The physiology of urinary system are filtration, reabsorption and secretion.
Respiratory system provides required oxygen to the body, to sustain life and to eliminate
carbon dioxide. The respiratory systems’ work is associated with the heart and lungs. It is
divided into upper and lower respiratory tract.
Air is breathed in through the nose or the mouth. Alveoli plays major role in process of
diffusion .
The endocrine system provides the body with the hormones that are needed to sustain life
and create life. Hypo and hyper secretion of the endocrine glands leads to physiological
problems.
The purpose of reproductive system is to procreate, and to provide sexual gratification to
the person.
Sensory organ responses to external stimuli by conveying impulses through the sensory
neuron to the appropriate places within the sensory nervous system.
The skin is the outer covering of the body and is the largest organ of the integumentary
system. The main functions are protection, regulation and sensation.
The eye is a sensory organ. It absorbs light rays from our environment and transforms them
in such a way that the information in the brain can be processed further.
The ear is the organ for hearing. The ear can be divided into outer and inner ear. Inner ear
plays major role in conduction of sound waves.
Tongue is a muscular organ situated in the floor of the mouth. It is associated with the
function of taste, speech, mastication, and deglutination.
Nose is the organ of smell located in middle of the face. The internal part of the nose lies
above the roof of the mouth.
33

GLOSSARY
Bradycardia - A pulse rate of less than 60 per minute

Tachycardia - A pulse rate of more than 100 per minute
Systole - The phase of the cardiac cycle when the heart gets contract
Diastole - The phase of the cardiac cycle when the heart is at rest
Pericardium - The sac that encloses the heart; the heart’s outermost layer
Purkinje fibers - Bundles of nerve tissues that allows the heart to conduct nerve
impulses
Pulse - The rate of the heart this is documented as the number of heart
beats per minute
Sinoatrial (SA) node - The natural heart pacemaker that controls the rate of the heart
Atrioventricular - This node sends an electrical impulse to the bundle of His
(AV)node
Bundle of His - sends electrical impulse to Purkinje fibers
Cardiac arrhythmia, - Abnormal and irregular heart beats
or dysrhythmia
Electrocardiogram - CG, records the electrical activity of the heart and the heart’s
E
rhythm
Hypertension - High blood pressure
Hypotension - Low blood pressure
Angina or angina - Chest pain that results from the lack of adequate oxygen to the
pectoris heart muscle. The lack of oxygen to the heart muscle is referred to
as ischemia.
Myocardial - Heart attack
infarction
Mastication - Chewing
Digestion - The breaking down of food particles into smaller particles and
molecules
Taste buds - Taste sensors found on the upper surface of tongue
Parotid salivary - One of the salivary glands
gland
Amylase - The digestive enzyme that is produced by the salivary glands in
the saliva.
Peristalsis - Wave like involuntary muscular movements that move and propel
food and fluids along the digestive tract
Chyme - Partially digested food in the stomach
Diarrhea - Loose and often difficult to control fecal evacuation
Constipation - The lack of a bowel movement and fecal evacuation
Fecal Impaction - The drying of stool in the intestines that cannot be evacuated
34

Diverticulitis - The inflammation or infection of the intestine affected with
diverticulosis
Gastric acid reflux - The movement of acids and contents from the duodenum of the
small intestine back into the esophagus
Cholelithiasis - Gall bladder stones
Cholecystitis - An inflammation or infection of the gall bladder
Cirrhosis - Damage to the liver and its hepatic tissues
Hepatitis - A type of liver infection by hepatitis virus
Colitis - An acute or chronic inflammation of the colon
Crohn’s disease - inflammation of the gastrointestinal tract
Irritable bowel - A disorder of the large intestine that can lead to abdominal pain,
syndrome diarrhea and other gastrointestinal system disorders
Hemorrhoids - Enlarged veins in the lower rectum and/or anus
Hormones - Chemical substances that control manage and coordinate several
body functions
Gland - An organ that secretes and releases a substance.
Circadian rhythm - The normal human being's 24 hour cycle of sleep and
wakefulness.
Diurnal beings - Day time active and nighttime sleep beings
Nocturnal beings - Nighttime active and daytime sleep beings
Progesterone - The hormone secreted by the ovaries and plays a role in the
menstrual cycle and the preparation of the uterus for the
implantation of the fertilized egg or ovum
The testes - The endocrine system gland that produces testosterone
Diabetes insipidus - A pituitary gland disorder, lack of insulin production
Acromegaly - A pituitary gland disorder, swelling or overgrowth of extremities
including head
Gigantism - A pituitary gland disorder, over growth of the entire body
including tallness
Hyperthyroidism - An overactive thyroid gland
Hypothyroidism - An underactive thyroid gland
Cushing’s syndrome - Over production of cortisol by the adrenal glands
Addison’s disease - Under production of cortisol by the adrenal glands
Skin - The largest organ of the body that covers the entire body
Thermoregulation - The regulation of the bodily temperature
Tactile sense - sense of touch
Lunula - The half-moon (luna) white area at the base of the nail.
Acne - Clogging of skin pores with dead skin and skin oils
Rash - An often itchy irregular reddened area on the skin that can occur
from a number of different causes
35

Athlete’s foot - Also referred to as tinea pedis (foot), it is a fungal infection of the
feet
Sunburn - Burning of the skin as the result of exposure to the sun
Albinism - Defective melanin that causes an abnormal coloration of the skin and
hair
Herpes - A viral infection
Impetigo - A contagious skin condition that appears as a rash on the skin
Psoriasis - Thick skin surface as the result of an abnormal buildup of cells on
the skin surface
Rosacea - A skin disorder that causes redness and skin break outs
Ligaments - Connective tissue with collagen at the point of articulation
Tendons - Connective tissue with collagen that allow joint movement
Fascia - Connective tissue that connects muscles to other muscles
Fractures - The breakage of a bone
Greenstick fracture - A fracture that occurs when only one side of the bone is fractured
Dislocation - The joints are completely separated and are no longer articulated
and connected with each other
Arthritis - One of the many types of skeletal disorders that is characterized
with the inflammation of one or more skeletal joints in the body
Rheumatoid arthritis - A type of arthritis that affects the younger population, auto
immune disorder
Osteomyelitis - An infection of bone tissue
Glial cells - A type of nervous system cell, other than a neuron, that forms
myelin which is the covering or sheath over parts of the neuron
Synapse - The point at which neurons gently touch each other to send or
receive a nerve impulse or message.
Meninges - The protective membrane that covers the brain and the spinal
cord
Brain - The major organ of the body that controls and manages virtually
all physiological and emotion bodily responses
Pons - The mid-section of the part of brain stem that connects to the midbrain
above and the medulla below and the part that controls the rhythm of
respirations
Reflex - A muscle reaction that automatically occurs in response to a
certain type of stimulus, or stimulation
Seizures - Abnormal nervous system nerve activity in the brain that can lead
to a wide variety of signs and symptoms including uncontrolled
body movement and jerking or a short lapse of consciousness
Stroke - An episode of bleeding or a clot in the brain that causes
symptoms and damage to the brain and its functioning
Epilepsy - A group of disorders that lead to seizures
36

Paralysis - The neurological loss of function to one or more parts of the body
Parkinson’s disease - A chronic and progressive disorder of the nervous system that
can lead to disability
Alzheimer’s disease - A progressive degenerative form of dementia
Bell’s palsy - A disorder of the facial nerve that adversely affects the face and
the muscular movements of the face
Neuralgia - Pain originating from a nerve or group of nerves
Procreate - To give life to a new person
Salpinges - An alternative name for the fallopian tubes
Fimbria - The hair like fringes of the fallopian tubes nearest to the ovaries
Vaginitis - Infection of the vagina and vaginal vault
Cystocele - The collapse of the urinary bladder into the vagina
Rectocele - The pushing of the rectum and part of the large intestine against
the vaginal wall
Nares - The nostrils of the nose
Pneumonia - An inflammation and infection of the lungs
Emphysema - A disorder characterized with an inability to expel air from the alveoli
Bronchitis - An inflammation and infection of the bronchi
Asthma - A lung inflammation that makes the work of breathing more difficult
Chronic obstructive - A chronic lung disorder that consists of chronic bronchitis and/or
pulmonary disease emphysema
(COPD)
Influenza or the “flu” - n acute inflammation and infection that can adversely affect the
A
lungs and respiratory functioning
Tuberculosis - A serious lung infection that is contracted with a bacillus
pathogen
Laryngitis - An inflammation and infection of the larynx
Pharyngitis - An inflammation and infection of the pharynx
Dyspnea - Difficulty breathing
Erythropoietin - The substance that is needed for the production of red blood cells
Vasopressin - An alternative name for antidiuretic hormone
Micturition - The synonym for urination or voiding
Urolithiasis - A kidney stone or calculi
Renal cysts - Infections in the kidney
Glomerulonephritis - Inflammation of the glomeruli of the kidneys
37

Evaluation
I. Choose the best answer. 9. The point at which the exchange of oxygen
1. The largest organ of human body is and carbon dioxide occurs
a. skin b. liver a. lungs b. arteries

c. heart d. lungs c. veins d. capillaries
2. Sweat glands are a part of 10. The red colour of blood is due to the
presence of
a. skeletal system
b. integumentary system a. hemoglobin b. erythrocin
c. urinogenital system c. xanthophyll d. rhodopsin
d. circulatory system 11. Thymus gland is a part of
3. _______ protect the eyes from foreign a. muscles b. lymphatic system
debris getting into the eye c. skin d. inner ear
a. eye brows 12. 90% of plasma consists of
b. eye lids a. protein b. sugar
c. eye lashes c. water d. salt
d. fore head
13. Red blood Cells contains
4. The finger and toe nails a. a prominent nucleus
are made of b. a dormant nucleus
a. chitin b. protein c. a pronucleus
c. insulin d. keratin d. no nucleus
5. There are no sebaceous glands in 14. Hemostasis is aided by
a. palms and sole of the feet a. thrombocytes b. leucocytes
b. palms alone c. erythrocytes d. granulocytes
c. sole of the feet alone
15. Adult human has
d. all are wrong
a. 206 bones b. 216 bones
6. Sweat glands are c. 226 bones d. 236 bones
a. endocrine glands
b. eccrine and apocrine glands 16. Malleus Incus and Stapes are
c. eccrine glands a. bones b. ear ossicles
d. apocrine glands c. tarsus d. carpals
7. _______ is the master of circulatory system 17. Sternum is a _____
a. brain b. kidney a. leg bone b. hand bone
c. heart d. liver c. breast bone d. hip bone
8. The blood vessels that carry oxygenated 18. The building blocks of bones are called
blood throughout the body are a. osteocytes
a. veins alone b. melanocytes
b. both arteries and veins c. thrombocytes
c. arteries alone d. leucocytes
d. all are correct
38

19. Haematopoiesis is 29. Spinal cord has ___ nerve clusters
a. production of WBCs a. 11 b. 21
b. production of RBCs c. 31 d. 41
c. production of haemoglobin 30. Abducens is a
d. production of insulin
a. muscle tissue b. cranial nerve
20. Cartilage does not have c. exocrine gland d. protein derivative
a. blood supply b. nerves 31. Digestion starts from
c. marrow d. all of the above
a. small intestine b. large intestine
21. Ligaments are connective tissue made up of c. tongue d. stomach
a. chitin b. carbohydrates 32. The salivary amylase is called
c. collagen d. fatty acids
a. ptyalin b. pepsin
22. Rheumatoid arthritis is c. insulin d. renin
a. dystrophy 33. Bile is produced in
b. Alzheimer’s disease
a. lungs b. liver
c. auto immune disorder
c. stomach d. kidney
d. anemia
34. Stomach secretes
23. The basic units of nerves are called
a. oxalic acid b. citric acid
a. neurons b. nephrons
c. nitric acid d.hydrochloric acid
c. transposons d. exons
35. The point of fertilization is
24. A point of junction between any two
neurons is called a. fallopian tube b. vagina
c. uterus d. endometrium
a. collapse b. synapse
c. prolapse c. relapse 36. The male hormone is called
25. The brain is protected by the a. estrogen b. Androgen
c. thyroid d. progesterone
a. pericardium b. diaphragm
c. cranium d. osphradium 37. The sugar present in semen is
26. CNS consists of a. glucose b. galactose
c. fructose d. mannose
a. heart and skin
b. liver and bones 38. __________ is the master gland
c. skin and nails a. thyroid b. adrenal
d. brain and spinal cord c. prostate d. pituitary
27. ________ is the largest part of brain 39. Diabetes is caused due to the lack of
a. cerebrum production of
b. cerebellum a. glucagon b. insulin
c. medulla oblongata c. thrombin d. keratin
d. spinal cord
40. The major breathing muscle is
28. The respiratory rhythm is controlled by a. trachea b. bronchus
a. gyri b. sulci c. diaphragm d. meniscus
c. pons d. glial cells
39

41. Larynx in males are also called as Answer The Following Questions
a. Eve’s apple 1. Illustrate the structure of sebaceous glands
b. Guyton’s apple and label the parts
c. Newton’s apple 2. Briefly write about the layers present in the
d. Adam’s apple skin
42. Alveoli are the 3. Write short notes on lymphatic system
a. air sacs b. water sacs 4. What are the types of leucocytes?
c. water bags d. hairs in lungs 5. What are the functions of platelets?
43. Adults breathe ____ times in a minute 6. Briefly write about the structure of bone
a. 20-24 b. 16-20 7. Other than bones, what are the other tissues
c. 12-16 d. 18-22 and structure of musculo skeletal system?
8. Illustrate and briefly write about the
44. COLD is expanded as structure of a neuron
a. child of limited dystrophy 9. Write about peripheral nervous system
b. city old lantern dialling 10. What are the functions of small intestine?
c. chronic obstructive lung disease
11. What are the internal organs of male
d. children of lifetime diseases
reproductive system?
45. Human urine majorly consists of 12. Substantiate kidney as an organ
a. uric acid b. ammonia 13. Illustrate the structure of larynx
c. nitrogen d. urea 14. What is respiratory cycle?
46. Kidneys are _______ shaped 15. Draw and explain the structure of nephron
a. pearl b. bean
Write In Detail
c. triangle d. spherical
1. Explain the arrangement of integumentary
47. The inner layer of kidney is called the
system and in its functions
a. lamella b. cortex
2. Illustrate and explain the structure and
c. medulla d. glabella
function of human heart
48. _______ is performed in case of kidney 3. Classify human bones
failure
4. Illustrate and explain the structure of
a. paralysis b. haemolysis human brain
c. plamolysis d. dialysis
5. What are the different stages of digestion?
49. Antidiuretic hormone controls the amount 6. Illustrate and explain the structure of
of water in human ovaries
a. blood b. urine 7. List down the endocrine glands and the
c. sweat d. tears corresponding hormones secreted by it.
50. Polyuria is 8. Explain the structure and function of
a. frequent urination Thyroid gland
b. excess urination 9. Illustrate and explain the structure of
c. less urination human lungs
d. blood in urine 10. Explain the structure and function of
kidneys
40

REFERENCE BOOKS 5. Yalayyaswamy,” Human Anatomy &
physiology for Nursing Courses and Allied
1. Roger Watson.” Anatomy & physiology for Health sciences, 1st Ed, CBS publication,
Nurses”, 13th Edn, Jaypee Publication, New New Delhi.
Delhi.
2. Inderbeer singh.” Anatomy & physiology INTERNET LINKS
for Nurses”, 2nd Edition, Jaypee Publication,
New Delhi. 1. https://www.youtube.com/
3. Mahendra Kumar Anandkumar & Meena watch?v=vii3YLGouv0
Verma,” Anatomy & physiology for Nurses,” 2. https://www.youtube.com/
2nd Edn, Jaypee Publication, New Delhi. watch?v=dYYHaPkKqIA
4. Indi Khurana & Arushi,” Anatomy & 3. https://www.youtube.com/
physiology for Nurses, 1st Edn, CBS watch?v=eXQgPCsd83c
publication, New Delhi.
HUMAN ANATOMY
ICT CORNER
Through this activity you will
be able to learn the structure
of human
Steps
• Step 1: Type the URL link given below in the browser or scan the QR code.
• Step 2: Click on the name of the organ system you want to learn. A new page with
a diagram on the right side and list of parts on the left side will open.
• Step 3: You can further explore detailed information of a particular part by clicking
either the part on the diagram or part name fom the list given.
• Step 4: Y
ou can browse back to the previous page or to the home page and learn
more about the other systems.
Step1 Step2 Step3 Step4
URL : https://www.innerbody.com/htm/body.html
*Pictures are indicative only

*Allow flash player.
41

CHAPTER
2
CHAPTER Medical Surgical and
APPLIED
3
Nursing Management
PSYCHOLOGY
of Human Diseases
மருந்தென வேண்டாவாம் யாக்கைக்கு அருந்தியது

அற்றது ப�ோற்றி உணின்
No medicine is necessary for him who eats after assuring (himself)

that what he has (already) eaten has been digested.
Learning Objectives
At the end of this chapter, the students will be able to:

➢➢ gain knowledge about the conditions related to Nursing Or Medical and Surgical
➢➢ know about definition of the disease condition
➢➢ observe the causes of the specific diseases
➢➢ understand the signs and symptoms of the diseases
➢➢ acquire knowledge about the methods of the diagnostic evaluations
➢➢ learn about the management of the specific disease conditions
➢➢ list out the complications of the diseases
➢➢ demonstrate the skills in Nursing management
➢➢ know about the prevention and promotion of the health condition
beneficiaries of health care in India have been

Introduction
adult clients. The special knowledge required
Medical and Surgical Nursing is a in medical surgical aspect for nurses is to
specialized and skilled branch of nursing. provide quality care. Medical and surgical
It can be considered to be the foundation nursing went unrecognized for several years.
of nursing because it has served as a launch But now it has been developed by experts
pad to the several interdisciplinary advanced serve as guide to the nursing practice.
specializations in several vital areas of Medical-Surgical Nursing provides
nursing, such as cardiology, neurology, etc the student with opportunities to apply the
Medical-Surgical nursing is a specialized nursing knowledge in the care of individuals
branch of nursing that involves the nursing and families experiencing alterations in
care of adult patients, whose conditions system stability related to the acute and
or disorders are treated pharmacologically chronic conditions
and with surgical procedures. The major
42
Unit_2_Medical_Surgery_Gen_Nur.indd 42 12/10/2021 9:38:30 PM

on the surface of the host and includes mites,
2.1 Infection and Infestation
ticks, head lice and bed bugs.
An internal (or endoparasitic)
Infection infestation is a condition in which organisms
In Integumentary system, skin, hair, and live within the host and includes those
nails are prone to different types of infections involving worms
and infestations which needs to be diagnosed
Worm Infestation
early and treated promptly to prevent spread.
Worm infestations are long-term
Definition: Infection is defined as the
diseases that produce few symptoms in their
invasion and multiplication of microorganisms
early stages and sometimes serious effects at
such as bacteria, viruses and parasites that are
well developed stages or may be quite fatal
not normally present within the body.
at times.
Different types of skin infections
Worms are generally classified as
according to the causative organism:
1. Round Worms: is also known as “Ascaris”
1. B
acterial skin infections - Bacterial
skin infections often begin as small, red 2. Pin worms: Is also known as “threadworm”
bumps that slowly increase in size. Some 3. Hook worms
bacterial infections are mild and easily 4. Flat Worms: tape worm (teniasis)
treated with topical antibiotics, some
infections require an oral antibiotic and Clinical manifestation of worm infestation:
good personal hygiene. Bacterial skin Abdominal pain, nausea, loss of
infections includes Cellulitis, Impetigo, appetite, sleeplessness, irritability, anemia
Boils and Leprosy. and diarrhea
2. V
iral skin infections - Skin infection are Diagnosis
caused by a virus are called Viral skin
History collection: history of passage of
infection.
worms
Common Viral Skin infection include:
Stool examination: It is done to detect which
Herpes Zoster (Akki). Chickenpox, Warts,
type of worm is present
Measles and Molluscum contagiousum.
Blood examination
3. Fungal skin infections - Skin infections
which are caused by fungus, are mostly to Management
develop in damp areas of the body, such as
Anthelmintic
the groin, nail and armpit. Common fungal
Albendazole (15mg/kg) or Mebandazole
infections are Athelete's foot, Fungal Nail,
(100mg) twice Daily for 3 days irrespective of
Oral thrush and Diaper rash.
patients age.
Correction of anemia should be done with
Infestation
iron therapy
Infestations can be classified as either Complications - Intestinal obstruction,
external or internal with regards to the Perforation, Jaundice, Appendicitis,
parasites' location in relation to the host. Pancreatitis, Ascaris encephalopathy,
External or ectoparasitic infestation is a Liver abscess, Peritonitis and Protein loss
condition in which organisms live primarily (kwashiorkar)
43

Preventive Measures • skin contact with affected person (physical
For Round Worm contact)
• Prevention of round worm infestation can • Direct contact with skin, clothing and
be done by interrupting its transmission furniture containing infected mites.
• Sanitary disposal of human excreta Signs and Symptoms
• Reduction of feacal contamination of the • ITCHING: Itching is a common symptom,
soil often worse at night and can be severe and
• Provision of safe drinking water, intense.
food hygiene, good personal hygiene, • RASH: When the mite burrows into the
improving habits of hand wash before and skin it forms rashes.
after defecation, avoidance of open field
• SORES: These occur in infested areas
defecation
where a person has scratched at the skin.
Pin Worm Prevention • THICK CRUSTS: Crusted scabies, is a
The preventive measures include form of severe scabies.
maintenance of personal hygiene, careful hand
The most common site of infection
washing with soap and water after defecation
and before meal, treatment of all infected • In between the finger webs
family members • Around finger nails
• Armpits
Hook Worm Prevention
• Waist lines
• avoiding contact of contaminated soil by
• Inner parts of the wrists
using foot wear
• Inner elbow
• use of sanitary latrine for the sanitary
disposal of feces to prevent soil pollution • Soles of the feet
• change in farming practice, that is not • Breasts
to use raw feces or untreated sewage as • Genitalia
fertilizer Diagnosis based on
• Onset of generalized pruritis (itching) and
Tapeworm Prevention
the characteristic eruptions
Treatment of infected person, meat
• Itchy burrows and vesicles
inspection, consumption of meat with proper
cooking, adequate sewage treatment and • Microscope examination
disposal creating awareness about preventive • Dermatoscopy
aspects by health education • Digital Photography
Scabies Management
Definition Medical management: Tropical application
Scabies is an infestation caused by itch • Permethrin 5 % Cream/lotion
mite due to poor personal hygiene. • Benzyl Benzoate 10 – 25% lotion
• Crotamition 10% ointment
Causes
• Lindane 1% lotion/cream
• Infestation by the itch mite otherwise
• Oral medication according to the severity.
called as Sarcoptes Scabiei”
44

Nursing management Definition
• Maintenance of personal hygiene Psoriasis is an inflammatory and
• Isolation - separate clothing and proliferative immune mediates disease of the
toiletries. skin that results in a rapid turnover of the
• Necessary care to be given to the family skin cells.
members
Types
• Topical treatment must be applied to the
entire skin surface. • Plaque type Psoriasis
• After completion of treatment patients • Guttate Psoriasis, Pustular Psoriasis
should use fresh, clean bedding and • Inverse Psoriasis
clothing. • Erythrodermic Psoriasis
• Other family members and Close • Nail Psoriasis
personal contacts should be treated at • Psoriasis of the Scalp
the same time. • Palmar-Plantar Psoriasis
• Teach them to wash all linens, towels, and • Psoriatic Arthritis
clothing used by the patient during the 2 • Systemic diseases in Psoriasis
days before treatment in hot water and dry
them in sunlight. Causes
The exact cause of psoriasis is not fully
Psoriasis undestood.
Immune system: Autoimmune
conditions are the result of the body cell
reacting against its own cells.
Genetics: Approximately 35 to 50 percent
of people genetically inherit the condition.
Triggers
Food: Whole milk, citrus fruits, gluten and
fatty foods.
Psoriasis is one of the commonest skin Drugs: Lithium, Non Steroidal Anti-
disorders. Psoriasis is a chronic autoimmune Inflammatory Drugs (NSAIDs), malaria drugs,
skin disease. In auto immune disease immune beta-blockers, tetracycline etc.
system of our body attacks our own tissues, Weather: Excess sun exposure, Cold, dry
which leads to the rapid build-up of skin weather
cells and causes scaling on the skin’s surface.
Psoriasis may begin at any age, but most Infections
diagnoses occur in adulthood. The average Others: Alcohol, Smoking, Stress, Obesity,
age of onset is between 15 to 35 years old. Scratches, bites and Skin injury.
According to the World Health Organization
(WHO) some studies estimate that about 75 Risk Factors
percent of psoriasis cases are diagnosed • Family history
before age 46. • Viral and bacterial infection
45

• Stress • Encourage patient to follow up.
• Obesity • Encourage patient to try to identify
• Smoking triggers.
• Teach patient to avoid direct sun
Signs and Symptoms exposure.
• Advice patient to use good lubricants to
• Red, raised, inflamed patches of skin
prevent drying and cracking of skin.
• Whitish-silver scales or plaques on the red
patches Complications
• Dry skin that may crack and bleed • Psoriatic arthritis
• Soreness around patches
• Obesity
• Itching and burning sensations around
patches • Type 2 Diabetes
• Thickened, pitted nails • Hyper tension
• Painful, swollen and stiff joints • Cardio Vascular disease
• Parkinson’ Disease
Diagnosis
• Nose specific blood test or diagnostic
2.2 Myocardial Infarction (MI)
procedures
• Physical Examination A heart attack is a life-threatening
• Skin Biopsy or scraping condition that occurs when blood flow to
the heart muscle is abruptly cut off, causing
Management tissue damage. This is usually the result of
a blockage in one or more of the coronary
Psoriasis has no cure. Treatments aim is
arteries. It occurs as a result of sustained
• to reduce inflammation and scales
ischemia, causing irreversible myocardial
• to slow the growth of skin cells cell death (necrosis). 80% to 90% of all acute
• to remove plaques. Myocardial Infarctions (MIs) are secondary
Topical treatments: Creams and to thrombus formation. Acute myocardial
ointments applied directly to the skin can infarction is the medical name for a heart
be helpful for reducing mild to moderate attack.
psoriasis.
Definition
• Steroid creams
• Vitamin D3 creams Myocardial infraction refers to a
• Phototherapy (ultra violet light). dynamic process by which one or more
• Immune system suppressing medications. regions of the heart experience a severe
• Photo chemotherapy (PUEA). and prolonged decrease in oxygen supply
because of insufficient coronary blood
Nursing Management
flow, subsequently necrosis or death to the
• Assist patient with daily tub bath to soften myocardial tissue occurs.
scales and plaques.
• Apply topical preparation after bath and Types
scale removal. 1. Non-ST segment elevation myocardial
• Advise patient to wear goggles during infarction or heart attack (NSTEMI)
phototherapy.
46

2. ST segment elevation myocardial infarction • Hypotension (or) Hypertension
or heart attack (STEMI). • Disorientation
• Sweating
Causes And Risk Factors • Anxiety
• Bad cholesterol, Saturated fats, Trans fat - • Tachycardia
intake • Nausea and Vomiting
• Obesity - cause of 20% cases
Diagnosis
• Genetics
• ECG (Electro Cardio Gram)
• High Blood Pressure (hypertension)
• X-ray Chest.
• High Triglyceride level
• Serum Cardiac Markers Blood tests such
• Diabetes and high blood sugar level
as Troponin and Creatine KinaseMB (CK-
• Smoking causes above 36% cases MB).
• Lack of exercise linked 7 to 12% cases • Angiogram with coronary catheterization
• The use of certain illegal drugs including to look for areas of blockage in the arteries.
cocaine and amphetamines • Echocardiography
• A history of preeclampsia or high Blood • Coagulation Studies
pressure during pregnancy
• Nuclear imaging
Signs and Symptoms
Medical Management
The classic symptoms of a heart attack
• Made the patient in a comfortable bed and
are chest pain and shortness of breath, the
provide complete bed rest
symptoms can be quite varied.
• Administration of oxygen
• Starting IV line
• Monitoring ECG
• Administration of analgesics (opiates)
• Oral antianginal drug.
• Thrombolytic therapy.
• Anti-coagulants.
• B-adrenergic receptor antagonist.
• Anti-arrhythmic.
• Antiplatelet.
The most common symptoms of a heart Surgical Management

attack include: • Percutaneous Transluminal Coronary
• Prolonged cardiac pain (severe, sharp Angioplasty (PTCA)
stabbing, radiating to neck, shoulders and • Coronary Artery Bypass Grafting (CABG)
back)
• Breathlessness Nursing Management
• Collapse / Syncope / Fainting • Vital Signs
• Pallor • Provide comfortable bed.
47

• Oxygen administration Left-sided heart failure
• Start Intra Venous (IV) line • Systolic heart failure occurs when the left
• Intake and output chart ventricle fails to contract normally.
• Diastolic failure, or diastolic dysfunction,
Complications happens when the muscle in the left
• Thromboembolism ventricle becomes stiff.
• Dysrhythmias Right-sided CHF occurs when the right
ventricle has difficulty pumping blood to
• Heart failure
the lungs. Blood backs up in the blood
• Cardiogenic shock
vessels, which causes fluid retention in the
• Papillary muscle dysfunction leads to lower extremities, abdomen, and other vital
mitral regurgitation organs.
• Ventricular Aneurysm
Causes
• Pericarditis
• Acute Circulatory failure • Cardiac muscle disorder
• Coronary atherosclerosis
2.3 Congestive Cardiac failure • Systemic or pulmonary hypertension
• Systemic factors
Heart failure, sometimes known as
• Degenerative diseases of the myocardium
congestive heart failure, occurs when the
• Stenosis of a semilunar valve.
heart muscle doesn't pump blood. In certain
conditions, such as narrowed arteries in the • Hemorrhage
heart (coronary artery disease) or high blood • Anemia
pressure, gradually the heart become too
weak and failed to pump efficiently. Risk factors
• Hypertension and diabetes
Definition • Alcohol and smoking
Congestive Cardiac Failure (CCF) • Use of cardio toxic
Cardiac failure often referred to as congestive • Cocaine abuse drugs
heart failure is the inability of the heart to pump
sufficient blood to meet the need of the tissues Signs and Symptoms
for oxygen and nutrients. • Pulmonary edema
The term congestive heart failure is most • Dyspnea
commonly used when reopening to left sided
• Cough
and right sided failure.
• Shortness of breath
Common types • Congested lungs
Left-sided CHF is the most common type • Sodium and Fluid retention
of CHF. It occurs when the left ventricle doesn’t • Low perfusion
properly pump blood out to the body. • Dizziness
There are two kinds of left-sided heart • Fatigue and weakness
failure:
• Rapid or irregular heart beats
48

• Oliguria Complications
• Nacturia • Intractable heart failure
NORMAL HEART ENLARGED HEART • Cardiac arrhythmias
• Myocardial failure
• Cardiac arrest
• Pulmonary infraction
• Pneumonia
Prevention
Lifestyle changes can help to prevent
The difference between the normal and heart failure include:
enlarged heart • No smoking
• Controlling certain conditions, such as
Diagnosis
high blood pressure and diabetes
• Echocardiography.
• Staying physically active
• ECG
• Eating healthy foods
• X-ray chest
• Maintaining a healthy weight
• Blood test
• Reducing and managing stress
• Cardiac catheterization
• Arterial Blood Gas analysis (ABG)
2.4 Fracture
Management
Bone fracture is
• Pharmacologic therapies include the
a medical condition
use of diuretics, vasodilators, inotropic
where the continuity
agents, anticoagulants, beta-blockers.
of the bone is
• Invasive therapies for heart failure broken. A significant
include electro physiologic intervention percentage of bone
• Cardiac resynchronization therapy fractures occur
(CRT) because of high force
• Pacemakers impact or stress. A
• Implantable cardioverter-defibrillators fracture caused by
(ICDs); revascularization procedures medical conditions which weakens the bone
(e.g Osteoprosis) is known as a pathological
Nursing management
fracture. A crack (not only a break) in the
• Provide comfortable bed bone is also known as a fracture. Fractures
• Oxygen administration can occur in any bone in the body.
• Start Intra Venous (IV) line
• Vital signs Definition
Diet therapy A fracture is a breakage in the continuity

of bone and is defined according to type and
• Restricted sodium
extended.
• Restricted fluids
49

Types • Crushing force
1. Complete fracture involves the break • Sudden twisting motion.
across the entire cross section of the bone
Signs and symptoms
and is frequently displaced.
2. Incomplete Fracture: The break occurs • Pain, swelling, bruising, discoloration of
only through part of the cross section of the the skin
bone. • Angulation
3. Open fracture: The skin may be pierced by • False motion
the bone or by a blow that breaks the skin • deformity
at the time of the fracture. The bone may or
• Shortening and Crepitus
may not be visible in the wound.
4. Closed Fracture: Does not produce a break • Tenderness
in the skin. • The patient is unable to put weight on the
5. Pathologic fracture: A pathologic fracture injured area
(also called insufficiency fracture) is a • The patient cannot move the affected
bone fracture caused by disease that led to area
weakness of the bone structure. • Pale and clammy skin
• Dizziness
Pattern of fracture
• Transverse fracture: This type of fracture Diagnosis
has a horizontal fracture line.
1. History of incident whether fall, accident,
• Oblique fracture: This type of fracture has
trauma should be asked to patient or
an angled pattern.
witnesses.
• Comminuted fracture: In this type of 2. Physical examination, identify signs and
fracture, the bone shatters into three or symptoms, and make a diagnosis.
more pieces.
3. X-ray, CT scans, MRI done as required.
• Other types: Avulsion fracture,
Compression (crush) fracture, Greenstick The treatment of fractures
fracture, Hairline fracture, Impacted Goals of fracture treatment
fracture, Intra articular fracture, • Restore fracture fragments to their normal
Longitudinal fracture, Spiral fracture, anatomic position (Reduction)
Stress fracture, Torus (buckle) fracture. • Maintain reduction in place until heating
Causes occurs (Immobilization)
• Promote regaining of normal function
Most fractures are caused by and strength of the affected part
• Fall (rehabilitation)
• Automobile accident.
Methods for obtaining fracture reduction
• Osteoporosis, infection
• Closed reduction
• Tumor
• Traction
• Direct violence
• Open reduction
• Bending forces
50

Methods for maintaining immobilization • Arthroplasty
External Devices • Joint replacement
• Splint • Brace • Amputation
• Case • External fixator
• Bandage 2.5 Osteoporosis
Internal devices
Osteoporosis is a disease where increased
• Nails • Plates bone weakness increases the risk of breakage
• Screws • Wires of bone. Osteoporosis literally leads to
• Rods abnormally porous bone that is compressible,
Maintaining and Restoring function like a sponge. It is the most common reason
• Maintain reduction and immobilization for a broken bone among the elderly. The
most common site include the vertebrae in
• Elevate to minimize swelling
the spine, the bones of the forearm, and the
• Control anxiety and pain hip.
• Isometric and muscle setting exercise
Definition
Complications of fractures
Osteoporosis is a condition characterized
• Fat embolism by a decrease in the density of bone, decreasing
• Infection its strength and resulting in fragile bones.
• Hypovolemic or traumatic shock
• Delayed healing Causes
• Nerve or blood vessel damage 1. Genetic factor

• Arthritis 2. Vitamin D and Deficiency factor
• Unequal leg length 3. Post Menopausal women but may also
• Mal union or non union occur in men
4. Chronic illness e.g. Malabsorption
Nursing Management of fractures syndromes and Renal failures
• Bed rest 5. Chemotherapy such as Cortico steroids
• Vital signs 6. Cigarette smoking, alcohol consumption
• Skin care 7. Lack of exercise
• Prevent infection 8. Body type- small frame / short stature, low
• Intake and output chart body fat.
• Encouraging mobility
Signs and Symptoms
• Providing adequate nutrition.
1. Asymptomatic until later stages
Surgical Management 2. Fracture after minor trauma may be first
• Open reduction indications
3. Most frequent fractures associated with
• Closed reduction
Osteoporosis include fractures of the
• Internal fixation
distilled radius, spinal vertebrae, humorous
• Bone graft pelvis
51

4. May have vague complaints related to aging It’s often called “the silent killer” because it
process (Stiffness pain, weakness) can be asymptomatic for many years, and
5. Estrogen deficiency may be noted. people suffering of this problem can have a
sudden fatal heart attack
Diagnosis
1. X-ray Definition
2. Scan to measure Bone Mineral Density Hypertension(High Blood Pressure (BP))
(BMD). is a disease of vascular regulation in which the
3. Bone density scanning uses a type of X-ray mechanisms that control arterial pressure with
technology known as Dual-Energy-X- in the normal range are altered. (The systolic
ray Absorptiometry (DEXA) and bone pressure is above 140 mm Hg and the diastolic
densitometry. pressure is above 90 mm Hg).
4. Serum Calcium phosphate Classification of Blood pressure for adults
5. Serum bone matrix Glaprotein is elevated. Blood pressure
6. Bone biopsy shows thin porous. SBP* DBP*
classification
(mm of hg) (mm of hg)
(BP)
Nursing Management Normal <120 <80
• Adequate intake of calcium and Vitamin D. Prehypertension 120-139 80-89
• Major food sources are dairy products egg Stage 1-
140-159 90-99
yolks, fish and liver. hypertension
• Weight bearing exercise Stage 2-
≥160 ≥100
• Hormone Replacement Therapy (HRT) hypertension
• Prevention of falls. DBP: Diastolic blood pressure
• Encourage exercise for all age groups. SBP: Systolic blood pressure
• Provide dietary education for daily intake
of calcium and Vitamin D. Causes
• Encourage young woman at risk to • Increased Cardiac output
maximize bone mass through nutrition • Excessive dietary sodium intake
and exercise.
• Endocrine disturbances
Complications • Medications like Antidepressant steroids.
• Fractures • Stroke
• Kyphosis, loss of height
Risk factors
• Chronic back pain
• Age between 30-70
2.6 Hypertension • Diabetes Mellitus
• Metabolic syndrome
Worldwide prevalence is projected to
• Over weight
increase from approximately 1.0 billion in
• Family history
2000 to 1.5 billion by 2025. It is a major,
independent risk factor for cardiovascular • Smoking and alcohol
disease (CVD), and the chief risk factor for • Sedentary lifestyle.
stroke (accounted for about 62% of strokes).
52

Signs and Symptoms • Advice low fat and low cholesterol diet
• Usually asymptomatic • Vital signs.
• Head ache and dizziness, Blurred vision • Advice life style modification
• high BP • Regular follow up
• Confusion Complications
• Shortness of breath • Myocardial infarction (MI)
• Nose bleeds
• Heart failure
• Chest pain
• Renal failure
• Irregular heart beat
• Stroke, hemorrhage
Diagnosis • Retinopathy
• BP measurements.
• ECG 2.7 Stroke (Cerebrovascular
• Chest X-ray Accident)
• BUN (Blood urea nitrogen) test and
Stroke occurs when there is an ischemia
creatinine levels
(inadequate blood flow) to a part of the brain
• Proteinuria
or hemorrhage into the brain that results
• Urine (24-hours) for catecholamine’s in death of brain cells. Functions such as
• Renal scan to detect renal vascular movement, sensation, or emotions that were
diseases controlled by the affected area of the brain are
lost or impaired. The severity of the loss of
Management
function varies according to the location and
• Lose weight extent of the brain involved. Following the
• Avoid alcohol onset of a stroke, immediate medical attention
• Regular aerobic exercise is crucial to reduce disability and death.
• Lower sodium intake (2.4 gram or less per
day) Definition
• Stop smoking Stroke or Cardiovascular Accident (CVA)
• Reduce cholesterol and trans fat diet is the onset and persistence of neurologic
Drug therapy dysfunction lasting longer than 24 hours and
• Diuretics resulting from disruption of blood supply to the
brain.
• Beta-adrenergic blockers
• Alpha-receptor blockers Types and Causes
• Central alpha agonists
Ischemic Stroke : About 80 percent of
• Peripheral adrenergic agents
strokes are ischemic strokes. A stroke may be
• Angiotensin converting enzyme (ACE)
caused by a blocked artery (ischemic stroke)
inhibitors
• Thrombotic stroke: A thrombotic stroke
Nursing management occurs when a blood clot (thrombus) forms
in one of the arteries that supply blood to
• Provide comfortable bed
brain. A clot may be caused by fatty deposits
• Measuring monitoring and charting BP.
(plaque) that build up in arteries and cause
53

reduced blood flow (atherosclerosis) or Risk Factors
other artery conditions. Lifestyle risk factors : Being overweight or
• An Embolic Stroke: Occurs when a blood obese, Physical inactivity, Alcohol consumption,
clot or other debris forms away from the Use of illicit drugs such as cocaine and
brain commonly in the heart and is swept methamphetamines
through bloodstream to lodge in narrower Medical risk factors: Blood pressure
brain arteries. This type of blood clot is readings higher than 140/90 millimeters of
called an embolus. mercury, Cigarette smoking or exposure to
secondhand smoke, High cholesterol, Diabetes,
Haemorrhagic stroke
Obstructive sleep apnea, Cardiovascular
Haemorrhagic stroke occurs when a disease, including heart failure, heart defects,
blood vessel in the brain leaks or ruptures. heart infection or abnormal heart rhythm,
Brain haemorrhages can result from many Personal or family history of stroke, heart attack
conditions that affect the blood vessels. These or transient ischemic attack.
include:
Other factors associated with a higher risk of
• Uncontrolled high blood pressure
stroke include
(hypertension)
• Over treatment with anticoagulants (blood • Age - People age 55 or older, race, sex, men
thinners) have a higher risk of stroke than women,
Hormones- use of birth control pills or
• Weak spots in the blood vessel walls
hormone therapies that include estrogen,
(aneurysms)
as well as increased estrogen levels from
Types of haemorrhagic stroke pregnancy and childbirth.
include
Signs and Symptoms:
• Intracerebral hemorrhage. In an
intracerebral hemorrhage, a blood vessel • Sudden weakness, paralysis or numbness
in the brain bursts and spills into the of the face, arm or leg especially on one
surrounding brain tissue, damaging brain side of the body.
cells. • Sudden dimness or loss of vision in one or
• Subarachnoid hemorrhage. In a both eyes.
subarachnoid hemorrhage, an artery on • Sudden loss of speech, confusion, or
or near the surface of the brain bursts difficulty speaking or understanding
and spills into the space between the speech.
surface of your brain and the skull. This • Unexplained sudden dizziness,
bleeding is often signaled by a sudden, unsteadiness, loss of balance or
severe headache. coordination.
• Sudden severe headache.
ransient ischemic attack
T
(TIA) Diagnosis
A transient ischemic attack (TIA) - • Blood tests: blood sugar levels, platelet
sometimes known as a ministroke - is a levels, Bleeding time and clotting time
temporary period of symptoms similar to • Magnetic Resonance Imaging (MRI) scan
stroke.
• Computerized Tomography (CT) scan.
54

• Electro cardio gram (ECG) • Hemycraniaetomy
• Cerebral angiography
Prevention
• Carotid ultrasound
• Healthy diet
• Echocardiogram
• Controlling high blood pressure
• Glasgow Coma Scale (GCS) (Hypertension)
• VSH/Doppler study of carotid arteries • Quitting tobacco use
Management • Controlling diabetes

• Maintaining a healthy weight
• Anti-platelet drugs Anti-platelet drugs
make these cells less sticky and less likely • Exercising regularly
to clot. • Routine health assessment
• Anticoagulants Reduce blood clotting Complications
• Physical therapy such as walking, eating • Aspiration pneumonia
and dressing.
• Dysphagia (Difficulty in swallowing)
• Speech Therapy
• Spasticity, Contractness
Nursing Management • Brain stem herniation
• Vital Signs • Deep vein thrombosis, pulmonary
• Maintain neurologic flow sheet (Stroke embolism
scale) • Post stroke depression.
• Assess for voluntary or involuntary
movement. 2.8 Head Injury
• Monitor bowel and bladder function
• Assess the skin care A head injury is any sort of injury to brain,
• Personal hygiene skull, or scalp.
• Support of vital function- Maintain air Common head injuries include
way. Breathing oxygenation circulation concussions, skull fractures, and scalp
• Assess the stroke scale wounds. The consequences and treatments
• Intra venous fluids at maintenance until vary greatly, depending on what caused your
able to tolerate oral diet head injury and how severe it is.
• Maintain Blood Pressure Head Injury
• Acces the level of conciousness by usingn
Head injury can include fractures to the
(GCS)
skull and face, direct injuries to the brain
• Thrombolytic therapy - ischemic stroke (as from a bullet) and indirect injuries to
• Maintain normal body temperature the brain (such as concussion, contusion or
• Antispasmodic agents can be used for intracranial Haemorrhage).
spastic paralysis Head injuries commonly occur from
Surgical Treatment motor vehicle accidents, assaults or falls.
• Carotid Endarterectomy to treat carotid Key terms
artery disease
Concussion: A temporary loss of consciousness
• Thrombectomy
55

Contusion: A bruising of the brain tissue. • Complete blood counts
Intracranial Haemorrhage: Significant • Coagulation studies
bleeding into a space or a potential space • Arterial Blood Gas (ABG)
between the skull and the brain. • X-rays
Haematomas: Collections of blood that • CT Scans
develop within the cranial vault are the most • MRI (Magnetic Resonance Imaging)
serious results of brain injury. • Glasgow Coma Scale (GCS)
• Increased Intra Cranial Pressure (ICP)
Head injuries causes by a blow to the head are
usually associated with: Management
• Motor vehicle accidents
• Maintenance of Airway: Oral suction
• Falls
• Administer high-flow oxygen.
• Physical assaults
• Control Bleeding.
• Sports-Related Accidents
• Intravenous fluid (IVF) – to prevent
pecific Problems after Head
S hypovolemic shock.
Injury Includes • Maintain normothermia
Concussion Skull fracture, Lacerations to Pharmacotherapy

the scalp and resulting haemorrhage of the skin, • Anticonvulsants – to control seizures
Traumatic subdural haematoma, Traumatic
• Diuritics – to reduce cerebral edema.
extradural, or epidural haematoma, Traumatic
• Antibiotics – to prevent infection
subarachnoid haemorrhage, Cerebral contusion,
• Antipyretics – to control hyperthermia
(a bruise of the brain), a loss of motor sensory
an reflex function due to trauma, a severe injury • Cortico steroid - to reduce intracranial
may lead to a coma or death. pressure
• In severe condition of brain injury, the
Signs and Symptoms anti-seizure medication is very essential,
because the patient is at risk for seizures.
• Vertigo
• Diuretics may be given if injury has caused
• Pain
pressure buildup in brain. Diuretics cause
• Changes in vital signs
to excrete more fluids. This can help relieve
• Immobility
some of the pressure.
• Visual and hearing impairment
• Bleeding Surgery
• Nausea and Vomiting • Surgical decompression
• Loss of consciousness • Craniotomy: Surgical incision into the
• Seizures cranium (may be necessary to evacuate a
• Leaking of clear CSF fluid from the ear or hematoma or evacuate contents)
the nose • Ventriculostomy: insertion of a drain into
the ventricles.
Diagnosis
Nursing Management
• History
• Assess the neurologic and respiratory
• Physical Examination
status.
56

• Monitor and record vital sign and intake Causes
and output.
The etiology may be unknown or due to one of
• Check cough and gag reflex to prevent the following:
aspiration.
• Trauma to head or brain resulting in scar
• Administer IV fluids to maintain
tissue or cerebral atrophy
hydration.
• Tumor in the brain
• Providing Suctioning to maintain airway
• Cranial surgery
• Provide eye, skin and mouth care to prevent
tissue damage. • Metabolic disorders (hypocalcemia,
hypoglycemia)
2.9 Epilepsy/Seizure Disorders • Drug toxicity, such as theophylline,

lidocaine, penicillin
Definition: Seizures (also known as • CNS infection
epileptic seizures and, if recurrent, epilepsy) • Circulatory disorders
are defined as a sudden alteration in normal
• Drug withdrawal states (alcohol,
brain activity that causes distinct changes
barbiturates)
in behavior and body function. Seizures are
thought to result from disturbances in the • Congenital neuro degenerative disorders.
cells of the brain that cause cells to give off • Non epileptogenic behaviors, which can
abnormal, recurrent, uncontrolled electrical emulate seizures but have a psychogenic,
discharges. rather than an organic, origin
Classification Signs and Symptoms
The International League Against Manifestations are related to the area of

Epilepsy developed an international the brain involved in the seizure activity and
classification of epileptic seizures that divides may range from single abnormal sensations,
seizures into two major classes: partial-onset aberrant motor activity, altered consciousness
seizures and generalized-onset seizures. or personality to loss of consciousness and
1. Simple-partial seizures can have motor, convulsive movements.
somato sensory, psychic, or autonomic 1. Impaired consciousness
symptoms without impairment of 2. Disturbed muscle tone or movement
consciousness. 3. Disturbances of behavior, mood, sensation,
2. Complex-partial seizures have an or perception
impairment (but not a loss) of consciousness 4. Disturbances of autonomic functions.
with simple-partial features, automatisms,
or impairment of consciousness only. Diagnostic Evaluation
3. Generalized seizures have a loss of • EEG (Electroencephalography) – locates
consciousness with convulsive or non epileptic focus, spread, intensity, and
convulsive behaviors. duration; helps classify seizure type
4. Simple-partial seizures can progress to • MRI, CT scan–to identify lesion that may
complex-partial seizures, and complex- be cause of seizure
partial seizures can secondarily become
• Neuropsychological studies–to evaluate
generalized.
for behavioral disturbances
57

• Serum laboratory studies or lumbar • Support patient in discussion about
puncture–to evaluate for infectious, seizures with employer, school, and so
hormonal, or metabolic etiology. forth.
Management Complications
• Pharmacotherapy - Anti-Epileptic Drugs • Difficulty learning.
selected according to seizure type. • Aspiration pneumonia
• Surgery–operations (temporal lobectomy, • Injuries from falls, bumps, and self-
extratemporal resection, corpus inflicted bites.
callosotomy, hemispherectomy)
Self-care at home for epilepsy
• Vagal nerve stimulation anterior thalamic
stimulation • Loosen any tight neckwear.
• A ketogenic diet • Turn the person on his or her side.
• Do not hold the person down or restrain
Nursing Management the person.
• Establish airway • Do not place anything in the mouth or
• Maintain blood pressure (BP). try to pry the teeth apart. The person is
not in danger of swallowing his or her
• Monitor vital and neurologic signs on a
tongue.
continuous basis.
• Observe seizure characteristics – length,
• Administer oxygen–there is some
type of movements, and direction of
respiratory depression associated with
head or eye turning. These characteristics
each seizure,
may help the doctor diagnose the type of
• Establish I.V. lines, and keep open for
seizure.
blood sampling, drug administration, and
infusion of fluids.
• Administer I.V. anticonvulsant slowly to 2.10 Gastric Ulcer
ensure effective brain tissue and serum
concentrations.
• Monitor the patient continuously;
depression of respiration and BP induced
by drug therapy .
• Determine (from family member) if there
is a history of epilepsy, alcohol/drug use,
trauma, recent infection.
• Counsel patients with uncontrolled
seizures about driving or operating
dangerous equipment. Gastric ulcers are open sores within the
• Assess home environment for safety lining of the stomach. Stomach ulcers (gastric
hazards in case the patient falls, such as ulcers) are a type of peptic ulcer, meaning
crowded furniture arrangement, sharp having to do with acid. Because of the amount
edges on tables, glass. Soft flooring and of acid present in the stomach and the damage
furniture and padded surfaces may be that can occur, they are often extremely
necessary. painful. Although gastric ulcers can occur
58

in any portion of the stomach, they are most • Anemia (symptoms can include tiredness,
commonly found on the lesser curvature close shortness of breath, or paler skin)
to the antral junction. • Dark, tarry stools
• Vomit that’s bloody or looks like coffee
Definition grounds
Gastric ulcer that develop inside the

stomach.
Gastric ulcer occurs in the lesser curvature
of the stomach to acid secreting parietal cell
mass.
Causes
The most common cause of stomach ulcers is
• Helicobacter pylori, or H. pylori infection.
• Ulcers may also be caused by overuse of
painkillers, such as aspirin (Bayer), and
other nonsteroidal anti-inflammatories Diagnosis
(NSAIDs) • Barium Meal Study
Risk Factors • Routine blood test
• Alcohol • Oesophago Gastro Duodenoscopy (OGD)
• Burns Ulcer appear with or without slough or
• Cigarette Smoking bleeding in their typical locations.
• Drug induced NSAID • Gastric secretary Studies.
• Emotion / Stress • Serology to test for H.pylori.
• Family history • Breath test to detect H.pylori.
• Gastritis
• Hyperchlorohydria General Measures
• Injection of toxins • Avoid use of NSAID drugs.
Signs and Symptoms • Avoid cigarette smoking.

• Well balanced diet with meals at regular
• Dull pain in the stomach
intervals.
• Weight loss
• Not wanting to eat because of pain /
Drug Therapy
Anorexia
• Multiple drug regimens are used to treat
• Nausea or vomiting
H.Pylori.
• Bloating
• Feeling easily full Surgical Treatment: May perform in advanced
• Burping or acid reflux disease condition
• Heartburn (burning sensation in the
• Billroth I Partial Gastrectomy with
chest)
removal of antrum and pylorus of
• Pain that may improve when you eat, drink,
stomach.
or take antacids
59

• Billroth II Gastrectomy: Here the • Other factors such as smoking, stress and
gastrectomy is done below the ulcer and drinking heavily may possibly increase
remant of the stomach is unastomosed to the risk of having a duodenal ulcer.
a jejunal loop. • Genetic causes family history of duodenal
ulcer.
Nursing Management
• Hyper secretion of stomach acid
• Take vital signs and BP.
• Promote healthy life style. Risk Factors
• Blood group ‘O’
Complications
• Alcohol
• Gastric Perforation, haematemesis,
• Smoking stress
melaena
• Gastric Outlet Obstruction (GOO) Signs and Symptoms
• GI haemorrhage • Pain in the upper tummy (abdomen) just
below the breastbone (sternum) is the
2.11 Duodenal Ulcer common symptom food intake may releive
the pain
Duodenal ulcers account for about 80% of • Pain may flare at night
all peptic ulcers. Approximately 10% of men
• Weight gain
and 5% of women at some time in their lives
will experience a duodenal ulcer. Duodenal • Vomiting
ulcers may occur at any age, but the incidence • Hemorrhage
is especially high between 35 and 45 years of • Haematemesis
age. Duodenal ulcers can develop in anyone,
regardless of occupation or socioeconomic Diagnosis
group. Although many factors are associated as same as gastric ulser
with the development of duodenal ulcers, H.
Pylori has been identified as playing a key Management
role. H. Pylori is found in approximately 90%
• Change in Lifestyle
to 96% of patients with duodenal ulcers.
• Lose weight.
Definition • Avoid any trigger foods.
Duodenal ulcer: A crater (ulcer) in the • Eat smaller meals and eat your evening
lining of the beginning of the small intestine meal 3-4 hours before going to bed.
(duodenum). • Stop smoking.
• Stop alcohol consumption.
Causes
• Acid-suppressing medication
• Infection with Helicobacter pylori (H. • A Proton Pump Inhibitor (PPI) -90-95% of
pylori) healing within 2-4 weeks.
• Anti-inflammatory medicines are • H2 receptor blockers for 6 weeks.
sometimes called non-steroidal anti
• Triple drug rigimens are used to treat
inflammatory drugs (NSAIDs).
H.pylori infection.
60

Surgical treatment • Obese people
• Highly Selective Vagotomy (HSV) • People undergoing sudden weight loss
• Pyloroplasty. • Those with a positive family history of
gallstones
• Individuals with health issues such as
2.12 Gall Bladder Stone
diabetes and certain intestinal and liver
The gall bladder is a storage place for diseases
digestive (bile) juice. It is tucked below the • Patient with Cirrhosis, hemolysis and
liver, in the right upper side of the abdomen. infections of the biliary tree.
When you consume fatty foods, the gall • Warning signs of a serious problem are
bladder pushes bile juice into the intestine fever, jaundice, and persistent pain.
through the bile duct, to aid digestion.
Any changes in the bile juice can result Signs and Symptoms
in formation of small pebble like stones in the • Asymptomatic even for years
gallbladder, commonly called as gallstones or • Fullness
gallbladder stones. • Abdominal distension
Gallstones can either be as big as golf • vague pain in the right upper quadrant of
ball or as small as a pebble. Also, there can the abdomen.
be one large stone or many small stones or a
• Reffered Pain and Billary Colic
combination of both.
• Jaundice
Definition • Vitamin Deficiency- A, D, E and K
Gallstones (Cholelithiasis) usually form
Diagnosis
in the gallbladder from the solid constituents
of bile and vary greatly in size shape and • Abdominal X-ray
composition. • Ultrasonography
• Cholescintography
Types
• Cholecystography
The two main kinds are • Percutaneous Transhepatic
• Cholesterol stones. These are usually cholangiography (PTC)
yellow-green in color. They're the most • Serum bilirubin and phosphatase
common kind, accounting for 80% of
gallstones. Nursing management
• Pigment stones. These stones are smaller
• Dissolving Gallstones by infusion of a
and darker. They're made up of bilirubin,
solvent into the gall bladder.
which comes from bile, a fluid your liver
• Two types of non-surgical or noninvasive
makes and your gallbladder stores.
treatment options can be used to dissolve
Risks Factors cholesterol gallstones:
• In laparoscopic cholecystectomy, the gall
• Pregnant women and those who are on
bladder is removed through a tiny slit in
birth control pills
the abdomen with the help of a tiny video
• People of age >40 years
61

camera. The recovery is faster and patient • Fluid in the abdomen, or ascites
can be discharged on the next day. • Abdominal surgery
• Open cholecystectomy is performed • Obesity
when laparoscopic cholecystectomy is not
possible. Open surgery causes more pain Types
and recovery time in hospital is around a
Inguinal hernia: Intestines push through
week.
the inguinal canal.
• Extra Corporeal Shock-Wave Lithotripsy
Incisional hernia: Resulting from an
(ECSW)
operated site.incision
Supportive Management Hiatal hernia: Part of the stomach
• Intravenous fluids administration protrudes up through the diaphragm into the
chest cavity.
• Nasogastric tube suction
Umbilical hernia: A part of the
• Pain management
bowel protrude through the belly button
• Antibiotics (umbilicus).
Complication Congenital diaphragmatic hernias is
• Cholangitis a birth defect in which there is an abnormal
opening in the diaphragm.
• Necrosis
Sports hernia is a tear or strain of any
• Gallstoneileus leads to intestinal
tissue in the lower abdomen or groin due to
obstruction
gym activity.
2.13 Hernia Signs and Symptoms
A hernia occurs when an organ pushes • Swelling in the abdomen or in the groin
through an opening in the muscle or tissue that which disappears when lying down.
holds it in place. • Pain on palpation
• Vomiting
Definition • Feeling of weight in the abdomen.
Hernia is a localized bulge in the abdomen • Constipation
that occurs when there is a weakness in the • Discomfort in the abdomen or groin when
muscular wall. coughing, lifting a weight or bending over.
• Fever
Causes • Upper abdominal pain
• Congenital - failure of the abdominal wall • Chest pain
to close.
Diagnosis
• Age – after 60 years
• History collection
• Chronic cough
• Physical examination
• Pregnancy - which puts pressure on the • Abdominal X-rays
abdomen • Complete blood count, electrolytes.
• Constipation • Ultrasonography of the abdomen
• Lifting heavy weight • CT abdomen
62

Management Causes
Non Medical: Abdominal binder • Straining during bowel movements
• Sitting for long periods of time on the
Surgical management:
toilet
• Herniorrhaphy
• Chronic diarrhoea or constipation
• Hernioplasty
• Obesity
Nursing management • Pregnancy
• Provide trendelenburg’s position
• Administer stool softners Types
• Internal haemorrhoids - inside the
Inguinal hernias are the rectum.
most common type of hernia • External haemorrhoids - around the anus.
Symptoms
Prevention
• Painless bleeding during bowel
• Stop smoking movements
• Avoid developing a persistent cough
• Itching or irritation in anal region
• Maintain appropriate body weight for the
• Pain or discomfort
age.
• Avoid straining during bowel movements • Swelling around the anus
• Lift objects with knee flexion and not with
Diagnosis
hip flexion.
• Heavy lifting should be avoided for 4 to 6 • Digital rectal examination - to detect
weeks after treatment. the unusual growths.
• Inspection - examine the lower portion of
Complication
the colon and rectum with proctoscope
• Strangulation: reduced blood supply to a • Colonoscopy to examine the entire colon
herniated organ.
• Obstruction: the bowel contents may no Management
longer be able to pass through the herniated • Home remedies
area, leading to cramps, the absence of • Eat high-fibre foods (fruits, vegetables and
defecation and vomiting. whole grains.)
• Recurrence hernia • Increase fluid intake
• Use topical ointment
2.14 Haemorrhoids (Piles)
• Sitz bath for 10 to 15 minutes, two to three
Haemorrhoids, also known as piles are times a day.
swelling containing enlarged blood vessels • Keep the anal area clean.
found inside or around the rectum and anus. • Apply ice packs or cold compresses on anus
to relieve swelling and pain
Definition
Medical management
An abnormal mass of dilated and
engorged blood vessels either internally in • Lidocaine that can relieve pain and
the anal canal or externally around the anus itching
63

• Sclerotherapy - injecting a chemical Types
solution into the haemorrhoid to shrink
Acute real failure(ARF)
it.
• Sudden onset
Surgical management • Rapid reduction in urine output-usually
• Rubber band ligation. placing one or irreversible
two tiny rubber bands around the base of Chronic renal failure(CRF)
haemorrhoid to cut off its circulation. • Progressive
• Haemorrhoidectomy • Not reversible
• Haemorrhoids stapling - Surgical staples
block the blood flow to haemorrhoids Acute Renal Failure
Definition
Nursing management
Acute Renal Failure –is a sudden and
• Educate to take plenty of water. almost complete loss of kidney function
• Care of drainage tubes caused by failure of the renal circulation or by
glomerular or tubular dysfunction
Complications
• Anemia. Causes of ARF
• Strangulated hemorrhoid. • Pre-renal (60-70 % )
• Infection • Volume Depletion
• Anal fistula • Hemorrhage
• Renal losses
Prevention
• Sepsis
• Eat high fibre foods. • Cardiac failure
• Drink plenty of fluids. • Anaphylaxis
• Don't strain when trying to pass a stool
• Defecate as soon as the feeling of urge Intra renal (5-10%)
occurs • Pigment Nephropathy
• Exercise. • Myoglobinuria
• Avoid long periods of sitting Obesity • Hemoglobinuria
• Nephrotoxic agents
Nearly three out of four Post-renal (20-40% cases)
adults will have hemorrhoids
• Urinary tract obstruction
• Calculi
2.15 Renal Failure • Tumors in lower urinary tract
Kidneys are two bean-shaped organs People in risk

located in lower back. It excretes wastes and • Being hospitalized especially for a serious
extra fluids from the body and producing and condition that requires intensive care
balancing chemicals that are necessary for • Advanced age
body to function
64

• Blockages in the blood vessels in arms or -sodium restriction
legs -Calorie intake 30 to 35 kcal/day/kg body
• Diabetes weight
• High blood pressure -Dialysis
• Heart failure
Chronic Renal Failure (ESRD-
• Kidney diseases
End stage Renal Disease)
• Liver disease
Definition
Signs and Symptoms of ARF Chronic or irreversible renal failure is
• Oliguria - Urine output less than 400ml/ a progressive reduction of functioning renal
day tissue or loss of renal function in which the
body’s ability to maintain metabolic and fluid
• Anuria - Urine output less than 100ml/day
electrolyte balance fails, resulting in uremia
• Increased BUN creatinine or azotemia over a period of months or years.
• Hyper Kalemia
• Metabolic acidosis Causes
• Edema • Diabetic Nephropathy
• Mental changes • Hypertension
• Heart failure • Glomerulonephritis
• Nausea, vomiting • Pyelonephritis.
• Pruritus • HIV nephropathy

• Reflux nephropathy in children
Diagnosis • Polycystic kidney disease
• History of underlying cause • Kidney infections and obstructions
• Blood- Increased potassium, BUN, • Chronic pyelonephritis
Creatinine • Head, Cadmium, mercury and chromium
• Urine: decreased volume and specific
gravity is fixed or increased Clinical manifestation
• Renal ultrasound, renal scan, renal biopsy, • Amenorrhea
CT scan or MRI, KUB X-ray, Retrograde • Testicular atrophy
pyelogram. • Malaise and Fatigue
• Pitting edema
Management • Periorbital edema
• Removal of the underlying cause • Engorged neck veins
• CHF
• Diuretics
• Anorexia
• Fluid restriction (600 ml plus previous day
• Nausea
output) Calcium supplements or phosphate
• Vomiting
binding agents
• Seizure
• Nutritional therapy • Constipation
-Protein intake 0.6/kg/day • Peptic ulceration
-Potassium restriction • Diverticulosis
65

• Anemia • Fluid allowances per day is 500 ml to 600
• Pruritus ml plus previous day urine output
• Jaundice
Surgical management
• Hypertension
• Pericarditis • Renal transplantation
• Peripheral neuropathy, dialysis dementia
Nursing management
Diagnosis 1. Assessing fluid status and ideentifying
• History collection potential source of imbalance
• Physical examination 2. Implementing a dietery program to ensure
• Identification of reversible renal disease proper nutrional intake
• Renal ultrasound 3. Promoting positive feelings by encouraging
• CT scan / Doppler increased self-care and greater
• Renal biopsy independence
• Blood-BUN, creatinine, electrolytes, Hb 4. Provide explanations and information
level to the patient and family concerning
• Urine analysis ESRD, treatment options and potential
• Renal biopsy complications.
Management 5. Provide emotional support to the patient
and family
Medical
6. Health education on diet and fluids.
• Calcium and phosphorous binders and
phosphate binders Complications
• Anti hypertensive drugs-to control BP • Hyperkalemia
• Hypoglycemic agents-to reduce and
• Pericarditis
maintain blood sugar level
• Pericardial effusion
• Fluid restriction-600 ml plus previous day
output) • Pericardial tamponade
• Diuretics-to increase the output • Hypertention
• Erythropoien-to maintain RBC count • Anaemia
• Dialysis • Increased incidence of fracture
1. Peritoneal
2. Hemodialysis
2.16 R
enal Stone/Renal Calculi /
Urolithiasis
75% of kidney function can
be lost before it is noticeable A stone is a hard, solid mass that
can form in the gallbladder, bladder, and
kidneys. Kidney stones usually originate in
Diet
kidneys.
• Low protein - 0.8 gm protein/kg/day with
normal carbohydrate Definition
• Low potassium (avoid bananas, dry
Urolithiasis refers to the presence of
fruits, fruit juices), low phosphorus (soak
stone (Calculi) in the urinary tract.
vegetables 24 hr prior to cooking).
66

Incidence Signs and Symptoms
It is associated with urinary tract infection. • Severe pain and is called renal colic.
Commonly seen between the age of 20 and 55yrs.
• Flank pain
Types of kidney stones • Haematuria
• Calcium stones: Are the most common • Obstruction

type made of calcium and oxalate.35-40% • Infection
• Cystine stones: Are very rare 1-2% • Edema
• Uric acid stones: Formed when urine is • Pyuria
too acidic.5-8% • Nausea and vomiting
• Struvite stones: Can happen when there is • Fever with chills
urinary tract infections.10-15% • Frequent urination
• Upper urinary tract stones: That involve • Urinating small amounts of urine
the renal pelvis and extend into at least 2
• Increased urge to urinate
calyces are classified as staghorn calculi
Diagnosis
• Health history
• Physical examination.
• 24 hour urine test
• Urography.
• Blood tests for calcium, phosphorus, uric
acid, electrolytes, urea and nitrogen
• Urinalysis to check for crystals, bacteria,
blood, and white cells
• Examination of passed stones to determine
Causes
the type
• Genetic factors-- family history of kidney
• KUB X-rays
stones
• Intravenous Pyelogram (IVP)
• Previous history of kidney stone.
• Ultrasound of the kidney
• Certain medications
• MRI of the abdomen and kidneys
• Infection
• Abdominal CT scan
• Urinary stasis
• Hyper Calcemia Management
• Hypercalcuria Medical management
• Diets that are high in protein and sodium • Antispasmodic drug-relieves colic pain
but low in calcium • Antibiotics-prevents infection
• Sedentary lifestyle, obesity, pressure, • Narcotics-relieves pain
immobility
Surgical management
• Dehydration
• Cystoscopy: Scopic removal of stones
• Warm climate
67

• Lithotripsy-Extracorporeal shock wave • Preservatives added to some foods and
lithotripsy (ESWL) uses sound waves to beverages, including shrimp, dried fruits,
break up large stones into smaller pieces processed potatoes, beer and wine
and they pass through the ureters in to the • Gastro esophageal reflux disease (GERD), a
bladder. condition in which stomach acids back up
• Nephrectomy into the throat
• Ureterolithotomy • Drugs/food allergies.
Nursing Management Signs and Symptoms

• Increase the fluid intake of 3000 ml/day • Shortness of breath
• Encourage Urination at frequent intervals • Chest tightness or pain
• Avoid stone-forming foods like • Trouble sleeping caused by shortness of
Beets, chocolate, spinach and colas breath
• coughing
North Indians are prone for • wheezing
renal calculiand so North India is • Difficult in breathing(dyspnea)
called as stone belt region
• A whistling or wheezing sound when
exhaling (wheezing is a common sign of
asthma in children)
2.17 Bronchial Asthma • Coughing or wheezing attacks
Asthma is a chronic disease involving the Types

airways in the lungs. These airways, or bronchial • Exercise-induced asthma
tubes, allow air to come in and out of the lungs. • Occupational asthma
• Allergy-induced asthma
Definition
• Extrinsic Asthma
Asthma is a chronic inflammation of the • Intrinsic Asthma
airways characterized by reversible air flow
obstruction. This can make breathing difficult Asthma triggers
and trigger coughing, wheezing and shortness
of breath.
Pets Exercising Pollen
Causes
• Airborne substances, such as pollen, dust
mites, mold spores, pet dander or particles Stress Bugs
of cockroach waste
• Respiratory infections, like common cold
• Physical activity Anger Cool Air
• Air pollutants and irritants, such as

smoke
• Medications, like aspirin, ibubrufen Pollu on Smoking Dust
• Strong emotions and stress
68

Diagnosis
The more ozone you breathe,
Tests to measure lung function
the greater the likelihood of
• Spirometry. This test estimates the developing asthma.
narrowing of your bronchial tubes
• Peak flow. A peak flow meter is a simple device
that measures how hard you can breathe out. 2.18 Chronic Obstructive
• Skin testing to identify causative allergens Pulmonary Disease (COPD)
• X-ray chest
Chronic Obstructive Pulmonary
Medical management Disease (COPD) is an umbrella term used to
• Antibiotics describe progressive lung diseases including
• Immunotherapy emphysema and chronic bronchitis.
• Corticosteroids. Definition
• Bronchodialators COPD is a obstructive lung
Nursing management disease characterized by long-term breathing
problems and poor airflow.
• Assess the airway of the patient
• Assess the skin turgor for dehydration Causes
• Patient room should be free of respiratory • Cigarette smoking
irritants
• Indoor air pollution
• Exposure to fumes from burning wood
Lifestyle and home remedies
• Chronic respiratory infections
Avoid triggers
• Allergy autoimmunity
• Maintain optimal humidity. • Occupational exposure
• Reduce pet dander. • Hereditary and genetic factors
• Change the bed linen once in a week. • Alpha-antitrypsin deficiency
• Cover the nose and mouth during cold season.
Signs and Symptoms
Stay healthy
• Dyspnea Shortness of breath,
• Exercise regularly.
• Chronic coughing,
• Maintain a healthy weight.
• Wheezing,
• Control heartburn and Gastro Esophageal
• Chest tightness
Reflux disease (GERD).
• Production of thick, gelatinus sputum
Alternative medicine
• Acute or chronic reparatory failure,
• Breathing exercises.
• Weight loss,
• Herbal and natural remedies includes black
• Respiratory insufficiency,
cumin seeds.
• Tachypnea,Fatigue,Peripheral edema
Prevention
• Get vaccinated for influenza and 2.18.4 Diagnosis
pneumonia. • Lung (pulmonary) function tests
• Avoid asthma triggers • Spirometry
69

• Chest X-ray
• CT scan Incidence of COPD is
9/1000 per year globally with a
• Arterial blood gas analysis
higher incidence in males and
Medical Management in smokers.
• Inhaled Bronchodilators
• Anticololinergic 2.19 Diabetes Mellitus
• Antibiotics
• Corticosteroids nebulization Diabetes mellitus is a chronic disease
caused by inherited and /or acquired deficiency
• Methylxanthines
in production of insulin by the pancreas, or
• Digitalis – to treat LVF, if present
by the increased insulin resistance such a
• Mucolytics eg: potassium iodide,
deficiency results in increased concentrations
guaifenesin
of glucose in the blood, which in turn damage
• Immunization many of the body's systems, in particular the
• Oxygen therapy blood vessels and nerves.
• Chest physiotherapy
Definition
Surgical management
The term Diabetic mellitus describes
• Lung volume reduction surgery a metabolic disorder of multiple etiologies
• Lung transplantation characterized by chronic hyperglycemia with
disturbance of carbohydrate fat and protein
Prevention metabolism resulting from defects of insulin
• Avoid cigarette smoking and other inhaler secretion, insulin action or both.
irritants.
Types
• Control of environmental temperature and
humidity • Type 1
• Proper nutrition and adequate hydration • Type 2
• Pneumococcal vaccination • Prediabetes
• Gestational diabetes
Nursing management:
• Eliminate pulmonary irritants like cigarette Type 1 diabetes/Insulin dependent/ Diabetes
smoking mellitus (IDDM)
• Train and monitor patients inhaler using Type 1 diabetes is also referred to as
techniques Juvenile diabetes Mellitus. It results from
• Restrict sodium destruction of pancreatic β cells which
• Encourage relaxation exercises produce insulin leading to absolute insulin
deficiency.
Complications
• Respiratory infection. Etiology
• Respiratory failure • Viral
• Right side heart failure
• Autoimmune
• Pneumonia.
• Environmental factors.
• Depression
70

Type 2 diabetes/Non-Insulin dependent Diagnosis
diabetes mellitus(NIDDM)
Urine analysis
Most common form of diabetes. Body • Glucose
produces insulin, but do not use it properly,
• Ketone
glucose doesn’t move into cells, they pile up
• Microalbuminuria
in the bloodstream.
Blood chemistry
Risk factors • Blood glucose estimation, fasting and
• Genetic random blood sugar
• Autoimmune • Oral Glucose tolerance test (OGTT)
• Stress •
C heck HbA1c (GLYCOSYLATED
• Environmental factors HAEMOGLOBIN LEVEL)
• Obesity Management
Prediabetes Type 1
Slight elevation of blood glucose levels, • Maintain and control sugar level
regarded as indication that the person is at • Insulin therapy
risk of progressing to Type 2 diabetes. • Healthy life style – exercise and diet.
Gestational Diabetes Mellitus (GDM) • Islet transplantation
is defined as carbohydrate intolerance • Oral Antidiabetic agents

during pregnancy. • Lipid control
• DIET
Risk factors
• Meal plan for Caloric restriction
• Polycystic ovary syndrome
• Weight reduction
• women under age 25
• EXERCISE: Regularly scheduled,
• Hydraminos moderate exercise performed 30 to 60
minutes/day.
Causes
• Islet transplation
• Family history of diabetes
• Overweight prior to pregnancy Type 2
• Maintain a healthy lifestyle
Signs and Symptoms • Oral hypoglycemic agent and injection
• Hyperglycemia - Polyuria, Polydipsia, insulin if needed
Polyphagia • Dietary management and exercise
• Weight loss Gestational diabetes
• Fatigue • Insulin
• Blurred vision • Physical activity
• Poor wound healing • Diet
• Recurrent infection • Plan Increase fiber intake
71

Nursing management the neck, below the larynx (the voice box).
The main hormone secreted by the thyroid is
• Monitoring blood glucose.
Thyroxin, (T4) and Triiodothyronine (T3).
• Administering antidiabetics/insulin.
• Foot care. Definition
• Monitoring for hyper/hypoglycemia.
Inadequate secretion for thyroid hormone
• Offering snacks at bedtime if permitted. during fetal and neonatal development,
• Lifestyle management resulting in retardation of growth and mental
Prevention development in children and adults.
Causes of hypothyroidism
• Iodine deficiency
• Lithium therapy
• Autoimmune disease
• Surgical removal of the thyroid
Complications of uncontrolled • Radiation treatment
diabetes • Overdose of anti-thyroid drugs
Signs and Symptoms

• Body's functions to slow down, leading
to dry skin, fatigue, loss of energy, and
memory problems.
• Thinly hair
• menorrhagia.
Diagnosis
Blood test for Thyroid-Stimulating
Hormone (TSH) T3 and T4.
• Elevated TSH level
• elevation of cholesterol level
• Hypoglycemia • Electro cardio gram (ECG)
• Macroangiopathy
• Peripheral Neuropathy Management Medical
• Micro angiopathy • Replacement of thyroid hormone
• Autonomic Neuropathy
Side effects of thyroid harmone
• Diabetic Keto acidosis (DKA)
• Headache.
• Shaking and trembling of arms and feet.
2.20 Hypothyroidism
• Nausea and Vomiting.
The thyroid is a butterfly-shaped • Diarrhea.
endocrine gland located in the lower front of
• Abdominal cramps.
72

• Nervousness and irritability. functional activity and produces excess
• Sleeplessness. thyroid hormone
• Excessive sweating.
Causes
Foods to be avoided • Diffuse hyperfunction of the thyroid
Foods that contain gluten: Bread, pasta, gland.
cereals, beer, etc. • Grave’s disease.
• Soya and it’s products Tofu and soya milk.
• Cruciferous vegetables: Broccoli, kale, Signs and Symptoms
spinach, cabbage, etc. THYROID DYSFUNCTION
• Certain fruits: Peaches, pears and HYPO-THYROIDISM HYPER-THYROIDISM
strawberries. DRY HAIR
PUFFY FACE
HAIR LOSS
BULGING EYES
SLOW HEARTBEAT SWEATING
WEIGHT GAIN RAPID HEARTBEAT
Effects of exercise CONSPIRATION
BRITTLE NAILS
WEIGHT LOSS
REGULAR GAS
ARTHRITIS SOFT NAILS
• Maintain a healthy weight. COLD SLEEPING DIFFICULTIES
HEAT INTOLERANCE
DEPRESSION
DRY SKIN INFERTILITY
• Decrease joint pain. FATIGUE IRRITABILITY
MEMORY LOSS MUSCLE WEAKNESS
• Relieve depression. HEAVY MENSTRUAL
PERIODS
NERVOUSNESS
SCANT MENSTRUAL
MUSCLE ACHES PERIODS
• Boost energy.
• Increase muscle mass. Diagnosis
Prevention Blood test

• Taking iodized salt and iodine • Elevated T3 and T4
supplements • Low TSH
• Presence of TSI antibodies
Complications
• Goiter. Management
• Heart problems. Medical
• Peripheral neuropathy. • Antithyroid medications to suppress the
• Myxedema. production of thyroid hormones.
• Infertility and Birth defects. • Radioactive iodine therapy
• Hypotension • Glucocorticoids
• Bradycaudia Surgical
• Convulsions Thyroidectomy : Removal of the part or
• Hypothermia entire thyroid gland
2.21 Hyperthyrodism Nursing management

• Promote adequate rest (back rubs, hot
milk)
Definition
• Encourage short walk, rest between
Hyperthyroidism is a condition in activity
which thyroid glands performs excessive
• Promote good eye care (dark glass)
73

• Facilitate improved coping. nearly every tissue in the body. The growth
• Enhance client knowledge about of new capillaries into the inert material
hyperthyrodism (exudates or thrombus), the migration
of macrophages and the proliferation of
Dietary management fibroblasts resulting in fibrosis.
• Iodized salt.
Definition
• Vitamins or supplements that contain
iodine Pathological accumulation of
extracellular matrix (ECM) proteins resulting
• Milk or other dairy products including ice
in fibrosis or scarring and thickening of the
cream, cheese, yogurt and butter.
affected tissue.
• Seafood including fish, shellfish.
• Herbal supplements. Causes
• Unknown
Foods to be included
• Radiation
• Non-iodized salt. • Cigarette smoke
• Coffee or tea (without milk or dairy- or • Chemicals
soy-based creamers) • Chronic alcoholism
• Egg whites. • Occupational hazards (silicosis,
• Fresh or canned fruit. asbestosis)
• Unsalted nuts and nut butters. • Chronic infection
• Breads made without salt, dairy, and • Fatty liver disease
eggs. • Hepatitis B or hepatitis C.
• Popcorn with non-iodized salt. Types
• Oats.
• Lung fibrosis or pulmonary
fibrosis - occurs as a result of long
Women are 4-7 times more standing infections such as tuberculosis
likely to have THYROID disorders or pneumonia.
than men • Cirrhosis of liver refers to the scar tissue
and nodules that replace liver tissue that
Complication disrupt liver function.
• Arrhythmia • Heart fibrosis - areas of the heart that

have become damaged due to myocardial
• Congestive heart failure.
infarction.
• Hypertension.
• Mediastinal fibrosis - calcified fibrosis
• Sudden cardiac arrest. of the lymph nodes, which can block
respiratory channels and blood vessels.
2.22 Fibrosis • Retroperitoneal cavity fibrosis - fibrosis
of the soft tissue in the retro-peritoneum
Fibrosis, or scarring, is a condition
• Myelofibrosis - scarring of the bone marrow
where the wound healing is exaggerated. It
that prevents the normal production of
is progressive in nature eventually leading to
blood cells.
organ malfunction and death. Fibrosis affects
74

• Keloid-fibrosis on the skin in response to • Intramural fibroids
injury • Subserosal fibroids
• Scleroderma or systemic sclerosis - an
autoimmune disease of the connective Signs and Symptoms
tissue that primarily affects the skin but • Abnormal uterine bleeding
can also involve other organs such as the
• Spotting between menses
kidneys, heart and lungs.
• Iron deficiency anemia
Diagnosis • Mild or severe, localized pain in lower
• Tissue biopsy abdomen or back during / after sexual
contact
Management • Pelvic pain, including pain during sexual
• Stem Cell therapy contact
Complication • Pressure on the bladder

• Obstructed urination
• Joints - stiffness and pain
• Painful or difficult defecation
• Tendons – contracture, deformity
• Shoulder capsule - adhesive capsulitis and Diagnosis
frozen shoulder • Pelvic exam
• Fibrosis of the soft tissue in the penis • Ultrasound.
• Hystero Salpingo Graphy (HSG)
2.23 Fibroid Uterus • MRI, CT Scan
Uterine fibroids are noncancerous Management
growths of the uterus that often appear
Management in general
during childbearing years. It is also called
leiomyomas or myomas. • Preventive
• Conservative
SUBSEROSAL INTRAMURAL
FIBROID FIBROID
Medical
• Hormonal Therapy
FALLOPIAN • Low dose of oral contraceptives
TUBE
OVARY • Analgesics for pain
SUBMUCOSAL
UTERUS
FIBROID
CERVIX Surgical
• Hysterectomy,
VAGINA
• Myomectomy
Definition • Cryosurgery
The benign tumors that originate in the Preventive

uterus. • Effective antenatal care
Classification • Adequate intranatal care
• Submucosal (submucous) fibroids • Adequate postnatal care
75

Conservative Menorrhagia - abnormally heavy and
• Assurance prolonged menstrual period.
• Improvement of nutritional status Metrorrhagia - bleeding at irregular times,
• Pelvic floor exercises. Menometrorrhagia (meno = prolonged,
metro = uterine, rrhagia = excessive flow/
Nursing management discharge) prolonged or excessive uterine
bleeding occurs irregularly and frequently.
• Assess the blood loss
• Assist and teach the pain relieving Dysmenorrhea - cramps or painful
techniques menstruation
• Educate about hormonal therapy Causes
• Advice calcium rich diet to prevent
• Uterine abnormalitites (Fibroids)
osteoporosis
• Sexually transmitted diseases (gonorrhea)
• Advice to consult doctor in case of bleeding
per vagina during Hormonal therapy • Steroid consumption
• Advice to do yoga and meditations • Chronic pelvic diseases

• Immaturity of the hypothalamic-pituitary
axis
Increased risk of pregnancy
• Polycystic ovarian disease
complications in the presence of
fibroids, such as first trimester Psychological factors
bleeding, breech presentation, placental
• Anxiety
abruption, and problems during labor.
• Stress
Fibroids have also been associated with an
increased risk of cesarean delivery • Emotional trauma;
• Drugs
• Drug addiction
2.24 Menstrual Disorders • Steroid administration
Menstrual cycles often bring about • Metabolic or endocrine diseases
a variety of uncomfortable symptoms. • Nutritional deficiency
Menstruation can be either too heavy or too
light, or complete absence of a cycle. Peripheral causes:
• Ovarian cyst,
Disorders of cycle length • Pelvic tumors
Oligomenorrhea –Infrequent menstruation
Diagnosis
Polymenorrhea - cycles with intervals of 21
days or fewer. • General examination
Amenorrhea -absence of a menstrual period • Abdominal and pelvic examination
in a woman of reproductive age. • Transvaginal ultrasound
• Dilatation and Curettage
Disorders of Flow
• Hysteroscopy
Hypomenorrhea - light or scantly menstrual
blood flow.
76

Management Second degree: The cervix drops to the
level just inside the opening of the vagina.
General Management
Third degree: The cervix is outside the
• Encourage to eat a healthy diet that includes
vagina.
plenty of whole grains, fruits, vegetables,
protein and calcium. Fourth degree: The entire uterus is
outside the vagina. This condition is also called
• Exercise regularly
procidentia. This is caused by weakness of the
• Adequate sleep supporting muscles.
• Use absorbent tampon
Risk factors
• Avoid caffeine.
• Excess weight lifting
• Eat smaller, and frequent meals
• multiple deliveries
• Vitamin or mineral supplements
• Avoid alcohol, Causes
• Avoid self medications • Pregnancy/childbirths with normal or
complicated delivery through the vagina
Medical Management
• Advancing age with weak pelvic muscles
• Hormonal therapy
• Weakening and loss of tissue tone after
• Iron supplementation to prevent menopause and loss of natural estrogen
anaemia.
• increased pressure in the abdomen such
as chronic cough
Normal menstrual cycle is
• Major surgery in the pelvic area leading to
28 days + 7 days
loss of external support
• Smoking
2.25 Uterine Prolapse
Signs and Symptoms
Uterus (or womb) is normally held in
• Pelvic heaviness or pulling
place inside pelvis with various muscles,
tissue, and ligaments. Because of pregnancy, • Vaginal bleeding or an increase in vaginal
childbirth or difficult labor and delivery, in discharge
some women these muscles weaken. Also, • Difficulties with sexual intercourse
as a woman ages and with a natural loss of • Urinary leakage, retention or bladder
the hormone estrogen, the uterus can drop infections
into the vaginal canal, causing the condition • Bowel movement difficulties, such
known as a prolapsed uterus as constipation
• Lower back pain
Definition
• Uterine protrusion from the vaginal
Descend of uterus from its normal position opening
in the pelvis further down into the vagina. • Sensations of sitting on a ball or feeling of
something is falling out of the vagina
Types
• Weak vaginal tissue
First degree: The cervix drops into the
vagina.
77

Diagnosis • Anaemia due to heavy bleeding
Diagnose uterine prolapse with • Uterine cancer
• A medical history and physical examination Vaginal pessary: It is a removable device
of the pelvis. placed into the vagina.
• Intra Venous Pyelogram (IVP) Surgery: Hysterectomy
• Renal sonography.
Nursing management
• X-rays.
Teach and insist to practice Kegel exercise
• Ultrasound.
during pregnancy and post natal period
• Vaginal examination
• Rectal examination. Exercise
Mild uterine prolapse can be treated with
High post – pregnancy Kegel exercises
BMI raises pelvic organ • Tighten the pelvic floor muscles, as you are
prolapsed risk attempting to stop urinating and hold for
Research suggests that having a high 5 seconds
BMI after pregnancy increases the risk of • Take a 5-second break and repeat for three
a prolapse to 10 times per day.
• Avoid more child birth.
Management Prevention
Prolapse up to the third degree may • Maintain optimal weight.
spontaneously resolve. • Avoid constipation by eating a high-fiber
diet.
Complications
• Perform Kegel exercises to strengthen the
• Infertility pelvic muscles.
• Abortion • Avoid heavy lifting or straining. Preventing
• Preterm labour and treating constipation
• Risk of operative delivery • Avoid chronic cough
Types
Vaginal Prolapse Uterine Prolapse
Anterior wall Prolapse Posterior wall prolapse Utero vaginal Congential
Cystocele Urethrocele Cysto-Urethrocele Relaxed Perineum Vault prolapse
78

• Dribbling or leaking during urination after
2.26 Benign Prostatic
urination
Hyperplasia (BPH)
Diagnosis
Prostrate is a gland about the size of a
walnut and is present only in males. It lies • History collection
below the urinary bladder and surrounds • Physical examination -digital rectal
the urethra. The prostate secrete a fluid that exam to check the size and shape of the
helps to nourish sperm as part of the semen prostate.
(ejaculatory fluid). It is a noncancerous • Urine culture and sensitivity to rule out
enlargement or hypertrophy of the prostate. infection
• Uroflowmetry: Urine flow test to measure
Definition the urine stream.
A benign (not cancer) condition in which • Measurement of post voidal residual
an over growth of prostane tissue pushes volume
against the urethra and bladder, blocking the • PSA (Prostate-Specific Antigen) blood test.
flow of urine. High PSA levels are a sign of a large
prostate.
Risk factors
• Ultra Sonogram
• Aging occurs after 50- 80 years. • Biopsy to rule out cancer.
• Family history • Cystocopy as part of treatment.
• Obesity
• Diabetes Management
• Heart diseases. Medical
• Diabetes and heart diseases and use of beta • Alpha blockers- relax the muscles of the
blockers prostate and neck of the bladder.
• Obesity • 5-Alpha Reductase Inhibitors (5-ARIs)-
• Ethnicity Black men may get symptoms at shrinks the prostate and prevents additional
a younger age. growth.
• Phosphodiesterase 5 Inhibitors (PDE5
Causes
inhibitors) - relieves the symptoms and
• Hormonal changes androgen/estrogen increases the flow rate of urine
imbalance
• Neoplastic theory is of all the elements of Surgical
prostoke • Transvesical suprapubic Prostatectomy
• Frequency • Transurethral resection of the prostate
(TURP)
Signs and Symptoms • Retropubic prostatectomy.
• Hesitancy, urgency, weak stream and
Nursing
straining to pass urine
• Ensure patient voids at regular intervals
• Nocturia
• Acute retention of urine • Provide warm environment as cold worsens
the symptoms
• Chronic retention of urine
79

Lifestyle changes: Risk factors
Exercise to strengthen the pelvic floor • Injury or inflammation of the scrotum
muscles
• Reduce the intake of fluids in the night Causes
before going to bed • Excessive production of fluid within the
• Avoid caffeine and alcohol sac
• Defective absorption of fluid
Complications
• Defective lymphatic drainage of scrotal
• Urinary tract infection(UTI) structures as in case of elephantiasis
• Renal stone • by connection with a hernia of the
• Bladder outlet obstruction peritoneal cavity in the congenital variety,
• Renal failure. which presents as hydrocele of the cord
BPH is not cancer, and Symptoms

it does not raise the risk for • Soft, Cystic, Not reducible, Scrotal swelling
prostate cancer
• Scrotal pain
• Redness of the scrotum
2.27 Hydrocele • Heaviness
• Fullness
The testes, or testicles, are the two male
reproductive glands that produce sperm • Fluid accumulation with translumination
and the male hormone testosterone. They • Dragging sensation
are located in the scrotum, which is a pouch • Fever
located behind the penis. Hydroceles can • Chills
occur on either side of the scrotum or, in • Nausea
rarer cases, on both sides. • Vomiting
Definition Diagnosis
Hydrocele is a collection of excessive fluid • History.
in the tunica vaginal sac. • Physical examination
• Ultrasound.
Types
• Blood and urine tests to check for
1. Vaginal Hydroceleoccurs when underlying infection.
hydrocele sac in patient only in the scrotum.
2. Infantile Hydrocele The sac from the Management
scrotum in patient upto the deep ingunial
• Lord/s Plication is indicated in small
rings
hydrocoeles. The sac is opened and the
3. True congenital Hydrocele The scrotal sac cut edge of the sac is plicated to tunica
communicates with peritoneal cavity. albuginea.
4. Hydrocele of canal of Nuck: It presents • Partical excision and eversion of the sac:
as a smelling in the inguinal region in Jaboula’s operation
female. • Aspiration-is a temporary method.
80

Nursing management
Though hydroceles are
• Teach about the hydrocele bandage
associated with males, it can
• Teach coping techniques
occur in females too. It is termed
Complications as Hydrocele of canal of nuck. Most cases
of hydrocele, which are present from the
• Infection
birth, resolve within the first year.
• Inguinal hernia.
• Haematocoele
• Pyocoele
GLOSSARY
Dyspnoea (மூச்சுத்திணறல்) Difficulty in breathing.
Expectrant சளி (expulsion of mucus)
Dyspnoea மூச்சு திணறல் (difficulty in breathing)
a gland surrounding the neck of the bladder in
Prostate விந்துப்பை male mammals and releasing a fluid component
of semen.
Hyperplasia மிகைப்பெருக்கத்தில் the enlargement of an organ or tissue
Pee சிறுநீர் urine.
Kidney Stone சிறுநீரக கல் a hard mass formed in the kidneys
a swollen vein or group of veins in the region of
Hemarrhoid மூலநோய்
the anus.
a blood clot formed in situ within the vascular
Thrombus இரத்த உறைவு
system of the body and impeding blood flow.
a slipping forward or down of a part or organ of
Prolapse இறக்கம்
the body.
a compact mass of a substance, especially one
Lump கட்டி
without a definite or regular shape.
Topical மேற்பூச்சு applied directly to a part of the body.
the surgical procedure of tying a ligature tightly
Ligation கட்டுக்கட்டுதலுக்கு around a blood vessel or other duct or tube in the
body.
prevent circulation of the blood supply through
Strangulated நெரித்து (a part of the body, especially a hernia) by
constriction.
81

a condition in which part of an organ is displaced
and protrudes through the wall of the cavity
Hernia குடலிறக்கம்
containing it (often involving the intestine at a
weak point in the abdominal wall).
the organ in the lower body of a woman or female
Womb கருவில் mammal where offspring are conceived and in
which they gestate before birth; the uterus.
Congenital பிறவிக் குறைபாடு physical abnormality present from birth
மலச்சிக்கல் a condition in which there is difficulty in
Constipation emptying the bowels, usually associated with
hardened faeces.
பரிசபரிசோதனை an examination of something, usually an organ or

Palpation part of the body, by touching it with the fingers or
hands
Renal Stone சிறுநீரக கல் A stone formed in the kidney
சிறுநீரக வலி A sharp pain in the lower back that radiates in to
Renal Colic
the groin
சிறுநீர்ப்பையின்
Examination of the inside of urethra with a
Cystoscopy உட்புறத்தை
Cystoscope
ஆய்வதற்கான கருவி
Anaemia இரத்த சோகை (decreased rbc level in the blood)
ஆக்ஸிஜன் (harmful effects of breathing high molecular
Oxygen Toxicity
நச்சுத்தன்மை oxygen)
Renal Failure சிறுநீரக செயலிழப்பு Malfunction of the kidney
Acute Renal கடும் சிறுநீரகக் Sudden and often temporary loss of kidney
Failure குலைவு function
Chronic Renal நாட்பட்ட சிறுநீரகச்
Permanent loss of kidney function
Failure செயலிழப்பு
இரத்தத்தில் யூரியா
Azotemia A higher-than-normal blood level of urea
மிகைமை
Oliguria சிறுநீர்க்குறைவு Not enough urine
Anovulation அண்டம் விடுபடாமை Absence of ovulation
பால்கொடுத்தல் / A women who is breast feeding the child
Lactation
பாலூட்டல்
Menopause மாதவிடாய் நிற்றல் Absence of menstruation
பசியிழப்புந�ோய் is an eating disorder characterized by low weight,
Anorexia
fear of gaining weight, and a strong desire to be
Nervosa
thin, resulting in food restriction
மாதவிலக்கு சீரின்மை, if the menstrual cycle is frequent and excessive
Epimenorrhoea
குருங்கால மாதவிடாய் bleeding
Myometrium கருப்பத் திசுச்சுவர் Middle layer of the uterine cavity
82

Endometrium கருப்பையகம் Inner layer of the uterus
மலட்டுத்தன்மை/ Inability of the women to become pregnant
Infertility கருவுறா விகிதம் even after 1 year of on protected sexual
intercourses
தன்தடுப்பாற்றுந�ோய் any disease in which the body's immune system,
Autoimmune
designed to protect the body from viruses and
Disease
bacteria attacks a normal (healthy) part of the body.
நாளமில்லாச் சுரப்பி glands that produces and releases hormones
Endocrine Gland directly into the blood; for example, the thyroid,
pituitary, adrenals, and pancreas
சுரப்பி an organ or tissue that makes and sends out a

Gland
hormone or other substance
உட்சுரப்புநீர்; இயக்கு substance, made by an organ or tissue, that affects
Hormone
நீர் the function of one or more other organs
கூடுதல் தைராய்டு an overactive thyroid
Hyperthyroidism
சுரப்பிச் செயலாக்கம்
தைராய்டு சுரப்புக் an underactive thyroid
Hypothyroidism
குறை
Immune System நோய் எதிர்ப்பு அமைப்பு the body's way of protecting itself from invaders
like bacteria and virus
இரத்தச் சர்க்கரை high blood sugar that is a sign that diabetes is out
அதிகரிப்பு of control. It occurs when the body does not have
Hyperglycemia
enough insulin or can not use the insulin it does
have.
இன்சுலின் a hormone that helps the body use glucose for
Insulin energy. The beta cells of the pancreas make
insulin.
வளர்சிதை மாற்றம் all of the physical and chemical processes in the
Metabolism body which occur when food is broken down,
energy is created, and wastes are produced.
கணையம் an organ behind the lower part of the stomach
Pancreas that is about the size of a hand. It makes insulin so
the body can use glucose (sugar) for energy.
ந�ோய் (PVD) / புற any abnormal condition that affects the blood
Peripheral இரத்த நாளம் vessels outside the heart and lymphatic vessels.
Vascular Disease Often occurs as decreased blood flow to the hands
(Pvd) and feet. People who have had diabetes for a long
time may develop PVD.
வெகுதாகம் / வெகு நீர் excessive thirst that lasts for long periods of time;
Polydipsia
வேட்கை may be a sign of diabetes.
Polyphagia அளப்பரிய பசி excessive hunger and eating.
83

Evaluation
I. Choose the correct answer 9. Symptom of Hernia is

1. The common characteristic feature of a) Coughing
persistent asthma is a) Sneezing
a) Family history b) Swelling
b) Airway inflammation 10. Prevention of Hernia is
c) Oral steroids a) Eating more food
d) Nocturnal wheeze. b) Drinking alcohol
2. Simple instrument to roughly determine c) Not smoking
lung function is a 11. Complication of hernia is
a) Barometer a) Strangulation
b) Manometer b) Incision
c) Peak flow meter c) Vomiting
d) Sphygmomanometer
12. The bluish discoloration of the skin and nail
3. What is the most common cause of chronic beds is called?
obstructive pulmonary disease (COPD)? a) Cyanosis b) Anameia
a) Bronchiectasis c) Hemorrhage d) Dyspnea
b) Chronic bronchitis
13. The device fits snugly over the mouth and
c) Cigarette smoking
nose and is secured in place with a strap is?
d) Emphysema
a) BP Apparatus
4. What is BPH b) Nasal cannula
a) Benign Prostate Hyperplasia c) O2 tent
b) Blood Pressure High d) face mask
c) Big Painful Headache
14. Which of the following best describes
5. What is Prostatitis chronic renal failure?
a) Inflammation of the urethra a) Rapid decreases in urinary output with
b) Inflammation of the prostate azotemia
c) Inflammation of the bladder b) Progressive irreversible destruction of
6. What is PSA both kidney
a) Public Service Announcement c) Creatinine clearance increases as
b) Psoriatic Arthritis urinary output decreases
c) Prostate-Specific Antigen 15. What are the alert signs and symptoms of
7. Common abdominal Hernia is oliguric phase of acute renal failure?
a) Inguinal Hernia a) Urine with high specific gravity and

b) Sports Hernia low sodium concentration
c) Hiatal Hernia b) Hypotension and fluid volume deficit
c) Fluid volume excess and hypertension
8. Cause of Hernia is d) Kussmaul's respiration and increased
a) Over eating appetite
b) Obesity
c) Snoring
84

16. One of the symptoms of hypothyroidism is 25. The risk factors for type 1diabetes include
a) Intolerance to cold all of the following except
b) Hair loss a) Diet b) Genetic
c) All of the above c) Autoimmune d) Environmental
17. A person with untreated hypothyroidism 26. Prediabetes is associated with all of the
may also suffer from_________ following except
a) High cholesterol a) Increased risk of developing type 2
b) Low blood pressure diabetes
c) Low blood sugar b) Impaired glucose tolerance
d) None of the above c) Risk of heart disease and stroke
18. How is hypothyroidism treated? 27. Risk factors for type 2 diabetes include all of
a) With radiation the following except
b) With surgery a) Advanced age b) Obesity
c) With a synthetic hormone c) Smoking d) P h y s i c a l
d) The condition can't be treated inactivity
19. Where is the thyroid gland located? 28. Untreated diabetes may result in all of the
a) At the base of the spine following except
b) Neck a) Blindness
c) Abdomen b) Cardiovascular disease
d) Back c) Kidney disease
20. Thyroxine is contains the following. d) Tinnitus
a) Tyrosine b) Selenium 29. Blood sugar is well controlled when

c) Iodine d) a and c Hemoglobin A1C is
21. Menstrual bleeding that is scanty and last a) Below 7%

for less than 2 days. b) Between 12%-15%
c) Less than 180 mg/dL
a) Oligomenorhea b) Hypomenorrhea
d) Between 90 and 130 mg/dl
c) Metrorhagia d) Menorrhagia
22. Absence of menarche until the age of 16 II. A
nswer the following questions
years in one or two lines
a) Amenorrhea 1. Define asthma.

b) Primary Amenorrhea 2. Define Dyspnoea?
c) Secondary Amenorrhea 3. Define COPD?
d) Dysmenorrhea
4. What is the main cause of COPD?
23. Benign tumours that originate in the uterus 5. What is haemorrhoids?
a) Fibroids uterus b) Prolapse 6. Name any two types of haemorrhoids?
c) Rectocele d) Cystocele
7. What is thrombosed haemorrhoids?
24. Expansion of HSG 8. What is the use of digital examination?
a) Hystero salpinjography 9. What is hernia?
b) Ultrasonography
10. Name any 2 types of hernia?
c) Hydro sonography
d) Hystoscopy
85

III. Short notes REFERENCE BOOKS
1. List down Triggering factors for Bronchial 1. Text book of Medical Surgical Nursing SN
Asthma. CHUGH Text book of Medical Surgical
2. Explain briefly about nursing management Nursing P.M. Prathiba. TNAI, Medical
of Bronchial asthma. surgical Nursing: A Nursing process approach,
2. Smeitzer, Suzanne C, et al 2009.Brunner and
3. Explain about stages of COPD?
Suddaarth’s Textbook of Medical Surgical
4. Draw the grades of the internal Nursing 11 th edition, Volume I .Philadelphia:
haemorrhoids? Lippincott Williams and Wilkins.
5. List out the symptoms of the haemorrhoids? 3. Joyce, M Black and Esther Jacobs.1993.
Luckmann and Surensen’s Medical Surgical
6. Write the home remedy for haemorrhoids?
Nursing,4th edition Philadelphia: W.B.
7. Discuss the preventive measures of saunders, company
haemorrhoids?
4. Bower P, Pareek G. History of Laser
8. Write the risk factors of hernia? Lithotripsy. InThe History of Technologic
Advancements in Urology 2018 (pp. 87-
9. Write the symptoms of hernia?
96). Springer, Cham. TAI, Medical surgical
10. List out the causes of hernia Nursing: A Nursing process approach,vol
1,page no;1228-1244
IV. Long essay 5. Smeitzer, SuzanneC, et al 2009. Brunner and
1. Mrs. Padma 68years old lady got admitted Suddaarth’s Textbook of Medical Surgical
in the medical ward with the complaints Nursing 11 th edition, Volume I .Philadelphia:
of cough, wheezing, and dyspnoea. So it is Lippincott Williams and Wilkins.
diagnosed as bronchial asthma. Write in 6. 3.Joyce,M Black and Esther Jacobs.1993.
detail about it. Luckmann and Surensen’s Medical Surgical
2. Explain in detail about the management Nursing, 4th edition
and preventive aspects of COPD?
3. Write about the minimal invasive
INTERNET LINKS
procedures?
4. Discuss the management for Haemorrhoids? 1. Philadelphia:W.B.saunders,company
2. https://en.wikipedia.org/wiki/Asthma
5. Discuss about the Benign Prostate
3. https://www.medicinenet.com/asthma_
Hypertrophy(BPH)? overview/article.htm
6. Describe about the Hernia in detail? 4. https://w w w.ncbi.n lm.ni h.gov/pmc/
7. What is Renal stone? Write the causes, signs articles/PMC2696883
& symptoms, diagnostic management of 5. https://www.mayoclinic.org/diseases-
Renal stones? conditions/asthma/symptoms.../syc-
20369653
8. Write about management prevention of
6. https://www.racgp.org.au › AFP › 2015 ›
Renal stones?
August
9. Explain in detail about the procedure of 7. https://www.copdfoundation.org
oxygen administration? 8. Www.lung.org › Lung Health and Diseases ›
10. Describe about the renal failure in detail? Lung Disease
9. https://www.healthline.com/health/copd
86

10. https://www.mayoclinic.org/diseases.../ 16. https://www.webmd.com › Digestive
benign-prostatic-hyperplasia/.../syc- Disorders › Reference
20370087 17. https://w w w.he a lt h line.com/he a lt h/
11. https://en.wikipedia.org/wiki/Benign_ hemorrhoids
prostatic_hyperplasia 18. https://www.healthline.com/health/hernia
12. https://www.webmd.com › Men's Health › 19. https://www.webmd.com › Digestive
Prostate Enlargement/BPH Disorders › Reference
13. https://www.mayoclinic.org/diseases- 20. https://en.wikipedia.org/wiki/Hernia
conditions/hemorrhoids/...causes/syc- 21. https://www.rxlist.com/hernia/drugs-
20360268 condition.htm
14. https://www.mayoclinic.org/diseases- 22. https://www.respiratorytherapyzone.com/
conditions/hemorrhoids/diagnosis.../drc- oxygen-therapy-test-bank/
2036028.
15. http s : / / w w w. e m e d i c i n e h e a lt h . c om /
hemorrhoids/article_em.htm
ICT CORNER MEDICAL SURGERY

Through this activity you will be able to associate
symptoms with conditions and learn to differentiate
the common and serious conditions. anatomy
Steps
• Step 2: Fill the mandatory fields such as ‘Age, Gender and Region’.
• Step 3: Input some symptoms in the search tab and click the search button.
• Step 4: A list of possible conditions are displayed on the right side of the activity
window. Serious complications are marked with red flag icon.
URL : https://symptomchecker.isabelhealthcare.com/suggest_diagnoses_advanced/
landing_page
87

CHAPTER
3
APPLIED
PSYCHOLOGY
தன்நெஞ் சறிவது ப�ொய்யற்க ப�ொய்த்தபின்

தன்நெஞ்சே தன்னைச் சுடும்.
“Utter not a word which the conscience tells is false, lest your own conscience should smite
you”. Even to entertain the very thought of stealing is an evil to be avoided
Learning Objectives

➢➢ define the term Psychology
➢➢ explain the importance of psychology in Nursing
➢➢ describe Maslow’s theory of motivation
➢➢ understand the concept of individual differences
➢➢ describe attitude
➢➢ explain emotional adjustment
➢➢ describe the personality development and its disorders.
➢➢ understand conflict and frustration
➢➢ explain regarding crisis intervention
to give us better understanding and control

Introduction
of the behavior of the organism as a whole. In
The word “Psychology” has originated from simple terms, it is a science of human behavior.
two Greek words-“psyche” and “logos”. The word A human being is best understood through
logos stand for a rational discourse or a study. his behavior. The following quote by Johann
The word psyche is interpreted in different ways Wolfgang Von Goethe reveals the importance
by psychologists at various periods. Initially of study of human behavior.
the word psyche was interpreted as ‘soul’, then “Behavior is a mirror in which everyone
‘mind’ and at later stage as ‘consciousness’. Now displays his image.”
psychology is viewed as a science which aims
88
Unit_3_Applied_psycology_Gen_Nur.indd 88 12/10/2021 10:21:51 PM

as well as counseling services whenever they
3.1 Definition of Psychology
need it.
Psychology is the science of mental life, iv. provide quality nursing care
both of its phenomena and their conditions. The Any individual is the combination of the
phenomena are such things as we call feelings, body and mind. If something goes wrong with
desires, cognitions, reasoning decisions and the the body, it affects the mind and vice versa.
like. (William Jamel 1890). Individuals get admitted to the hospital for
“Psychology is the scientific study of the their problems in the body or mind. The study
activities of the individual in relation to his of psychology helps nurses to understand
environment” Woodworth and Marquis, (1948). the importance of body mind relationship
According to N.L. Munn, “Psychology and apply the principles of psychology in
today concerns itself with the scientific the care of the patients. The knowledge on
investigation of behavior”. psychology gives a nurse awareness about the
attitude, conflicts, positive thinking, crisis
intervention which in turn helps to provide
3.2 I mportance of psychology in
quality nursing care.
Nursing
v. adjust to the professional environment
Nursing is a team work and has to work
Psychology helps the nurses to
together with other health care team members
i. understand and help the patient
including her colleagues. She should understand
Nurses must understand the patients to the psychology of people around her to
provide quality nursing care. The study of work effectively. She is expected to work in
psychology helps nurses to understand the collaboration with other health team members
individual differences found in behavior and and face the challenges in the professional
personality traits of the patients and the meaning environment. The knowledge on psychology
of their behavior at different circumstances. helps nurses to overcome these challenges in
ii. understand and help the relatives their profession.
Nurses in the process of providing holistic vi. understand oneself
care, they encourage the relatives and well The nurse must understand them that is
wishers to participate in the patient care. It’s her attitude, way of thinking, coping abilities,
a challenging task for the nurses to get their mental mechanisms, overall strength and
cooperation and make them understand why weakness. Understanding self helps to adjust to
certain actions are performed for the patients. the personal and professional life and to lead a
The study of psychology helps nurses to well balanced life.
understand the genuine demand of the relatives
and concern for the patient.
3.3 Maslow’s theory of Motivation
iii. provide needed advice, guidance and
support to the patient Maslow’s hierarchy of needs is a theory in
Nurses by studying psychology they psychology proposed by Abraham Maslow in
understand the principles of guidance and 1943. This theory is often portrayed in the shape
counselling and its techniques. Understanding of a pyramid with the largest, most fundamental
the techniques of guidance and counseling helps needs at the bottom and the need for self
nurses to provide individual or group guidance actualization at the top. From the bottom, the
89

first four levels of the pyramid contains in the absence of physical safety – due to war,
“deficiency needs” such as physiological, safety, natural disaster etc. – people may experience
love/belonging and esteem needs. The basic stress and tension. Safety and Security needs
needs must be met before the individual will include personal security, emotional security,
strongly desire for the next level needs. For financial security, health and well being and
example, an individual will not expect safety safety needs against accidents/illness and their
needs until unless his physiological needs are adverse impacts.
met. He will not desire for love and belonging
Love/Belonging
before the safety needs are met. Maslow also
coined the term ‘meta motivation’ to describe The third level of human needs is
the motivation of people who go beyond the interpersonal and involves feelings of
scope of the basic needs and strive for constant belongingness. Social Belonging needs include
betterment. If these “deficiency needs” are not friendships, family and intimacy. Human beings
met, the individual will feel anxious and tense. need to feel a sense of belonging and acceptance
among social groups, regardless whether these
Maslow’s Hierarchy of Needs groups are large or small. The example for
Self actualisation large social groups may include clubs, religious
(Achieving individual groups, sports teams, gangs, etc and some small
potential)
social connections include family members,
Esteem (self) - esteem intimate partners, mentors, colleagues, etc.
and esteem from others Human beings need to love and be loved – both
sexually and non-sexually – by others.
Belonging (love, aftection
being a part of groups) Self esteem
Self Esteem is a belief about one’s own worth
Safety (shelter, removel based on an overall self evaluation. Esteem needs
from danger)
are ego needs or status needs which are related
Physiological (health, food, sleep,
to getting recognition, status, importance, and
shelter) respect from others in the society. All humans
have a need to feel respected; this includes the
Physiological needs need to have self esteem and self-respect. These
activities give the person a sense of contribution
Physiological needs are the physical
or value. Deficiency in this level leads to low self
requirements for human survival. If these
esteem.
requirements are not met, the human body
cannot function properly and will ultimately
fail. Physiological needs are the first and basic How people with low and high self esteem
need in the hierarchy. Without them, the other view themselves?
needs cannot follow up. Physiological needs Those with low self esteem tend to view
include breathing, water, food, sleep, clothing, themselves in negative terms. They do not
shelter and sex. feel good about them, tend to have trouble
in dealing effectively with others and are
Safety needs hampered by self doubts. High self esteem
Once a person’s physiological needs are individuals, in contrast, see themselves as
relatively satisfied, their safety needs take worthwhile, capable and acceptable.
precedence and dominate behavior. For example
90

Self-actualization • Emotional differences
Self actualization refers to an individual’s • Personality differences
need to develop his or her potentialities: in
Causes of individual
other words, to do what he or she is capable of
differences
doing. It means a person’s motivation to reach
his or her full potential. • Heredity
• Influence of caste, race and nation
• Sex differences
Who are Self actualizers?
• Age an intelligence
Self-actualizers are people who make the
• Temperament and emotional stability
fullest use of their capabilities.
• Economic condition and education
• Environment
3.4 Individual differences
Implications for Nursing
We all know that whatever lies around us • Nurses must understand that it is quite
in the form of non-living or living beings differ, natural for their patients and people under
from each other in so many respects. Humans, their care to differ in respect of their likes
though we are a common species, differ in sizes, and dislikes, levels of IQ and understanding,
shapes, appearances, colour, personality and tolerance for the pain, adjustment to the
behaviour. There are individual variations and new situations and environment, social
differences found in ourselves. and emotional adjustment etc. She must
plan her nursing actions considering these
Definition of individual
differences in her mind.
differencesy
• The knowledge on individual differences
It is defined as the differences among helps nurses to learn and provide care
individuals, that distinguish or separate them which is unique for each individual.
from one another and make one as a unique
• Nurses can make their patients and relatives
individual in oneself.
realize that all are not same and there is no
Types of individual differences point in comparing their treatment with
that of others. They cannot simply copy
1. Physical or physiological differences
the treatment of others and all cannot be
2. Psychological differences benefitted in the same way.
In total the differences may be found in • Nurses can understand and guide or protect
the following respects. They are differences the patients with inferiority or superiority
related to feelings under their care.
• Physical differences
• Differences in intelligence 3.5 Attitude
• Differences in attitudes
• Differences in achievement The main aim of education is
• Differences in motor ability modification of one’s behavior according
• Differences on accout of sex to the expectations of the society. One’s
• Racial differences behaviour to a larger extent, depends upon
• Differences due to nationality one’s attitude towards the things,idea, person,
• Differences due to economic status. or object in his environment. The entire
91

personality and development of an individual Factors within the individual
is influenced by his attitude. Physical growth and development: Poor
physical health and growth are responsible
Definition
for poor emotional and social adjustment.
An attitude has been defined as a The colour of the skin, weight of the body, or
predisposition or tendency toward a particular biochemical changes in the body tissues and
congnitive, behavional or emotional reaction to fluids. for example, sex hormones have a vital
objects or people. effect on the development of attitude through
their connection with social adjustment.
Meaning of Attitude
Intellectual development: Intelligence
An attitude is a readiness to respond in
influences the attitude formation. The
such a way that behavior is given a certain
components of intelligence like memory,
direction-Travers, 1973.
understanding, thinking etc play a significant
An attitude is a predisposition or readiness role in formation of attitude.
to respond in a pre-determined manner to
Emotional Development: Emotions play
relevant stimuli. –Whittaker, 1970.
a dominant role in overt or covert (hidden)
Nature of Attitude behavior manifestation and behaviour is related
to attitude.
• Attitude is concerned with the relation of
Social development: Social interaction and
an individual with the specific persons,
group processes is the key to attitude formation
groups, values or norms related to his
at any stage of human development. Children
environment.
having poor social adjustment are more likely
• Attitude are learnt and acquired.
to have antisocial attitude.
• They are not innate and inherent in an
individual. Ethical and moral development: Each
• It is the state of readiness to respond to a individual develops certain ideals, values and
certain stimuli. concept of the self in which he takes pride. For
• Attitude have definite motivational enhancing his feelings of self esteem, one tries
characteristics. to develop those attitudes that suit his values
• It ranges from strongly positive to strongly and ideals.
negative attitude.
Factors within the individual’s environment
Factors influencing the Home and Family: A healthy family
development of Attitude environment and positive attitude of the parents
and other members bring desirable impact on
Attitudes are learnt and acquired. Heredity
the children in picking up desirable attitudes.
does not play any role in the development of
Many antisocial attitude are said to be the
attitudes. Environment plays an important role
product of the faulty upbringing and unpleasant
in the development of attitude. An attitude
environment at home.
at any stage is essentially a product of the
interaction of one’s self with one’s environment. Social environment: Contact with the
So the factors can be classified as people in neighbourhood, school, community,
society and norms, traditions etc influences
• Factors within the individual himself attitude formation and its reshaping. For
• Factors within the individual’s environment example, in schools factors like teachers and
92

their behaviours, class mates or school mates Emotions are the outward expressions of the
and their behaviours, teaching methods and feelings. They are usually aroused by external
discipline all contribute towards attitude stimuli and emotional expression is directed
formation. towards the stimuli in the environment that
arouses it.
Attitudinal changes
Meaning of emotion
Attitude can be changed. It is not fixed one.
They can be changed through the acquisition Emotions are agitated states of our mind
of new experiences. The following are the ways and body leading us to perform some or other
and means of attitudinal changes:- types of behavioural acts.
• Providing proper education It is a subjective response that is usually
• Making use of the propaganda machinery accompanied by a physiological change and is
(eg, family planning, sanitation, road associated with a change in behavior.
safety)
Types of emotions
• Using fear inducing mechanism (eg.
Rules and legal laws against dowry, child Emotions are categorized as positive
marriage, child abuses) emotions and negative emotions.
• Using modeling technique (eg. Imitating
Positive emotions
the behaviours of the heroes and
The Positive emotions are pleasant
heroines)
emotions like amusement, love, curiosity, joy
• Direct personal experience ( eg. Lack of
and happiness which are helpful and essential
exercise leading to obesity and diabetes in
for the development of an individual.
a person will develop favourable attitude
towards exercises). Negative emotions
• Using cognitive dissonance mechanism Negative emotions are the unpleasant
(eg, In smoking, making a person to think emotions like fear, anger, jealousy which are
rationally instead of criticizing his negative harmful to the well being and development of
attitude towards smoking). an individual.
• Bringing desired changes in beliefs and
At the same time, too much of everything
values.
is bad. Emotions with too much intensity and
Implications for Nursing frequency whether positive or negative bring
harmful effects.
• Nurses can help patients to develop positive
and desirable attitude towards the things Components of emotion there
and persons are three basic components:
• She can help patients and their relatives to
• Congnitive:- Physiological and
bring about attitudinal changes.
behavioural
• She can use the techniques of attitudinal
• Cognitive component:- Includes the
change whenever and wherever applicable.
thoughts, values and expectations that help
in determining the intensity and type of
3.6 Emotions emotions.
• Physiological component:- It is also
Human beings are emotional beings and
known as a arousal. This is an internal
emotions add colour and spice to our life.
93

physical changes that occur in the bodies Characteristics of an
when one experiences an emotion. emotionally adjusted person
• Behavioural or Expressive component:-
• All emotions are easily recognized in him
Action done as a result of cognitive and
• He/She expresses emotions in a socially
physiology. Ex. Emotional expression is
desirable way
a form of communication. A baby’s smile
• He exercises control over his emotions
can create bonding.
• He is not a day dreamer.
Bodily changes accompanying • He will not run away from realities
emotions • He is guided more by his intellect than his
emotions
There are bodily changes happening during • He never puts the responsibility of his own
positive as well as negative emotions. mistakes on others
Internal bodily changes: It includes • He possess adequate self concept and self
changes in respect
• Functioning of heart • He thinks for others
• Blood circulation • He never engages in antisocial behavior
• Functioning of digestive system • He maintains social relationships
• Sugar level • He has emotional stability
• Red Blood cells Emotions in Health and illness
• Temperature
• All emotions are basically useful to our
• Secretions of ducts and ductless glands
survival.
• Sweating and perspiration
• Emotions are capable of exercising a
• Tone of the muscles leading role in the health and happiness
• Functioning of the brain of the individual.
External bodily changes: These are • An emotionally adjusted person is found
observed in to possess a good health, free from illness
• Face as facial expressions or diseases.
• Body postures • An emotionally maladjusted individual
is characterized with a poor health and
• Voice as vocal expressions
ailing personality.
Emotional Adjustments • The person with positive emotions enjoys
good physical health
Emotional adjustment is the realization • Many of our chronic physical conditions
of one’s emotions and feelings and controlling and illnesses are linked with emotional
feelings when making relationship with maladjustment.
others. • Emotional maladjustments increases the
It is the capability of adjusting to his individual’s susceptibility to many physical
self and environment in relation to the use and mental ailments.
and expression of his own emotions. An
emotionally adjusted person has an ability
3.7 Personality disorders
to express all types of emotions, positive
or negative, in an appropriate degree with Personality of an individual is all that
reasonable control at the appropriate time. possessed by him in terms of his physique,
94

intellect and behavioural traits determining rejection and are uncomfortable in
his unique adjustment to the self and the social situations.
environment. 9. Dependent Personality disorder: They
Personality is the totality of emotional and are dependent on others, allow others
behavioural characteristics that are peculiar to to decide for them, submissive, and also
a specific person and that remain somewhat tolerate mistreatment by others.
stable and predictable over time. 10. Obsessive-Compulsive personality
disorder: They are very serious, formal
Types of personality disorder and have difficulty expressing emotions.
1. Paranoid personality disorder: They are overly disciplined, perfectionist
Individuals with this condition suffer and preoccupied with rules.
from distrust and suspiciousness of others. 11. Passive-Aggressive personality
They are oversensitive and trust no one. disorder: They feel cheated and
2. Schizoid personality disorder: These unappreciated. They believe that life has
individuals display social withdrawal, been unkind to them, and they express
have discomfort with human interaction, envy and resentment over the easy life
and are unsocial. that they perceive others having.
3. Schizotypal personality disorder:
Causes of Personality disorders
Individuals have magical thinking,
illusions, hallucination etc. • Hereditary
4. Antisocial personality disorder: These • Parental antagonism and harassment
individuals have a general disregard for • Neurochemical dysfunction
law, socially irresponsible behaviours and • Poverty and poor socio economic
violate the rights of others. conditions
5. Borderline personality disorder: These • Faulty parenting styles
people will have fluctuating attitude, • Excessive disciplining
impulsive, self destructive behavior, and
• Parental rejection
form chaotic relationships.
• Parental attitude and behaviours
6. Histrionic personality disorder: These
people will have dramatic and extroverted
Treatment Modalities
behavior and are excitable, emotional
people. They have a tendency to be self Psychotherapy: It is given by the trained
dramatizing, attention seeking, overly psychotherapist to establish therapist-client
gregarious and seductive. relationships.
7. Narcissistic personality disorder: They Milieu or Group therapy: It is given by
are overly self centered and exploiting taking support and feedback from peers which
others to fulfill their own desires. They is more effective than one to one interaction
view themselves as superior and they with a therapist.
believe that they deserve to receive a Cognitive Behaviour therapy:
special rights and privileges. Behavioural strategies offer reinforcement
8. Avoidant personality disorder: They for positive change. Social skills training and
have extreme shyness and fear or assertiveness training teach alternative ways to
deal with frustration.
95

Psychopharmacology: Medications Sources of Conflict
such as anxiolytics, antidepressants, and
The conflict arises from the home, school,
antipsychotics are available to manage the
occupational social and cultural environment.
patients with personality disorders
The faulty upbringing at home, unhealthy
relationships, over protection is the sources of
3.8 Conflicts and frustration conflict from home environment. Unpleasant
school or college environment, role of teachers,
All individuals at one or other time in our faulty method of teaching, denial of opportunities
day to day life have conflicts and frustration. for self expression and classmates are some of
Continuous feeling of chronic conflict and the sources of conflict in youngsters. Improper
frustration will have a negative impact on our working environment, dissatisfaction with the
well being. Frustration and unresolved needs working conditions, unsatisfactory relationships
and desires cause great emotional unhappiness. and poor salary or wages is the sources of conflict
in occupational environment. The taboos,
Meaning of conflict
inhibitions and the negative attitude towards sex
Douglas and Holland defines conflict as are the causes of many sex conflicts in the minds
a painful emotional state which results from a of youth and adults.
tension between opposed and contradictory
wishes. Conflict resolution
Barney and Lehner defines conflict is a • Negotiation is an important part of conflict
state of tension brought by the presence in the resolution
individual of two or more opposing desires. • First of all, accept each desire as it arrives
without judgment or resistance
Types of conflict • Remove any barrier or resistance in
• Approach-Approach conflict: This choosing among conflicting desires
arises when an individual is faced with • Think the goals of life and which one of the
the problem of making a choice between desires will be helpful to achieve the life’s
two or more positive goals almost equally goal
motivating and important. For example, • Choose one desire and follow it with full
a child may have to choose between enthusiasm
watching a movie in TV or going out to
Meaning of Frustration
play games.
Frustration means emotional tension
• Avoidance-Avoidance conflict: In this, an resulting from the blocking of a desire or need
individual is forced to choose between two (Good, 1959)
negative courses of action. For example, a child According to Barney and Lehner (1953),
who does not want to study and at the same frustration refers to failure to satisfy a basic need
time does not want to displease the parents because of either condition in the individual or
by failing in the examination may experience external obstacles.
such conflict.
• Approach-Avoidance conflict: In this, Causes of Frustration
an individual is faced with a problem of External factors
choice between approaching and avoiding Physical factors: Natural calamities, floods,
tendencies at the same time. droughts, earthquakes, fire and accidents cause
frustration in an individual.
96

Social and societal factors: Societal crisis. Crisis result in a disequilibrium from
norms and values impose certain obstacle in which many individuals require assistance to
meeting the individual needs which leads to recover.
frustration
Meaning of crisis
Economic and financial factors:
Unemployment and lack of money causes A sudden event in one’s life that disturbs
frustration in an individual. homeostasis, during which usual coping
mechanisms cannot resolve the problem
Internal factors
(Lagerquist, 2001)
Physical abnormality or defects: Too
small or too big a stature, very heavy or thin Characteristics of a crisis
body, an ugly face or dark complexion etc causes
frustration. Crisis occurs in all individuals at one time or
Conflicting desires or aims: When a another
person has conflicting desires, he develops • They are precipitated by specific identifiable
frustration. For example, a nurse wants to work events.
in abroad and does not want to leave her family • Crises are personal by nature. What may be
in home country causes frustration. considered as crisis by one individual may
Individual’s morality and high ideals: An not be so for another.
individual’s moral standards, code of ethics and • Crisis are acute, not chronic and will be
high ideals may become a source of frustration resolved in one way or another within a
to him. brief period.
Level of aspirations: One may aspire very
• A crisis situation contains the potential
high in spite of one’s incapabilities or human
harm for psychological growth or
limitations which may lead to frustration
deterioration.
Lack of persistence and sincerity in efforts:
Frustration may result in one’s own weakness in Causes of crises
putting continuous and persistent efforts with
courage, enthusiasm and will power. Crisis may arise as a result of
• Stress or from the environment
Reaction to frustration • Life transitions
It can be classified as simple reactions and • Traumatic experience in life like death of
violent reactions loved one, accidents,
Simple reactions: It includes • Life threatening illnesses
• Increasing trials or improving efforts • Stress out of promotions.
• Compromising with what is available • Existing psychiatric problems
• Withdrawal from the situation
• Submissiveness Crisis Intervention
Violent reactions: It includes aggression
Individuals experiencing crisis have
an urgent need for assistance. In crisis
3.9 Crisis intervention intervention the therapist, or other intervener
becomes a part of the individual’s life situation.
Stressful situations are a part of everyday’s
Because of the individual’s emotional state, he
life. Any stressful situation can precipitate a
or she is unable to solve a problem, so requires
97

guidance and support from another to help coping strategies, growth and learning from
mobilize the resources needed to resolve the the crisis and plan of action for dealing with
crisis. stressors similar to the one that precipitated
the crisis. At the end of this phase, decision is
Goal of crisis intervention
made regarding follow up therapy; if needed,
• Resolution of immediate crisis the nurse provides referral information.
• Restoration of the individual to his pre-
crisis level of functioning Activity 1
Phases of crisis intervention Study the individual differences among
Phase 1: Assessment: It includes gathering your classmates on any five aspects such
of information regarding the precipitating as height, weight, BMI, colour of skin, IQ,
stressor and resulting crisis that prompted academic achievement etc and submit a
individual to seek professional help. It includes report.
assessment of physical and mental status, coping Recall the various emotions experienced
methods, support systems, individual’s personal in the past one week, state the reason and
strengths and limitations. classify and submit the report.
Phase 2: Planning: In these phase, goals
are established and appropriate activities
are planned to meet the goals based on the Sigmund Freud is known
individual’s needs and strengths. as Father of Psychology.
Phase 3: Intervention: This is the actual National Mental Health Programme
phase of implementation in which the person was launched in year 1982 by Govt of
suffering from crisis is helped to overcome/ India.
manage the crisis. It includes guidance services World mental Health day is observed
and utilizing the support systems in favour of on 10th October every year.
the individual. Institute of Mental Health, Kilpauk
Phase 4: Evaluation of crisis resolution: It was founded in 1794 by British.
includes reassessment to determine if the stated Child Helpline- No: 1098, to call for
objective was achieved. It includes reassessment help when any child is in distress.
for positive behavioural changes, adaptive
SUMMARY
Psychology is the scientific study of the activities of the individual in relation to his environment.
Maslow’s hierarchy of needs is a theory in psychology proposed by Abraham Maslow in 1943.
This theory is often portrayed in the shape of a pyramid with the largest, most fundamental
needs at the bottom and the need for self actualization at the top.
Individual difference is defined as the differences among individuals that distinguish or separate
them from one another and make one as a unique individual in oneself. The differences in
individual are due to heredity or environment or both.
An attitude is a readiness to respond in such a way that behavior is given a certain direction.
98

Emotions are agitated states of our mind and body leading us to perform some or other types
of behavioural acts. Emotions are categorized as positive emotions and negative emotions. The
components of emotions are knowing, feeling and doing.
Emotions are capable of exercising a leading role in the health and happiness of the individual.
An emotionally adjusted person is found to possess a good health, free from illness or diseases.
Personality is the totality of emotional and behavioural characteristics that are peculiar to a
specific person and that remain somewhat stable and predictable over time.
Frustration refers to failure to satisfy a basic need because of either condition in the individual
or external obstacles.
Conflict is a state of tension brought by the presence in the individual of two or more opposing
desires. The conflict arises from the home environment, school environment, occupational
environment and social and cultural environment.
Stressful situations are a part of everyday’s life. Any stressful situation can precipitate a crisis.
Crises result in a disequilibrium from which many individuals require assistance to recover.
Individuals experiencing crises have an urgent need for assistance. In crisis intervention the
therapist, or other intervener becomes a part of the individual’s life situation.
The goal of crisis intervention is the resolution of immediate crisis and restoration of the
individual to his pre-crisis level of functioning
GLOSSARY
Aggression - feelings of anger resulting in hostile or violent behaviour

Anxiolytics - drug used to relieve anxiety
Antidepressants - drug used to reduce feelings of sadness and worry
Antipsychotics - drug used to manage psychiatric disorders
Stress - A state of mental or emotional strain
Evaluation
I. Choose the correct answer 3. Which one of the following is the self
1. The theory of hierarchy esteem need?
of need is proposed by a) Physiological need
a) Abraham Maslow b) Status need
b) Abraham Marlow c) Safety need
c) Abraham Mundro d) Security need
d) Abraham Muller 4. Which one of the following is not the ways
2. Which one of the following is not a of attitudinal changes?
physiological need according to hierarchy a) Providing proper education
of needs theory? b) Using modeling technique
a) Breathing b) Water c) Direct personal experience
c) Food d) Belongingness d) Avoiding /neglecting
99

5. The example for positive emotion is 19. Characteristics of emotionally adjusted
a) Fear b) Anger persons
c) Joy d) jealousy 20. Cause of frustration and reaction to
6. Which one of the following is not the frustration
component of emotions? 21. Types and sources of conflict and its
a) Knowing b) Enjoying resolution
c) Feeling d) Doing
IV. Detailed answers
7. Which one of the following is Not the
22. Explain in detail Maslow’s hierarchy of
treatment modality of people with
needs
personality disorder?
23. Individual differences
a) Psychotherapy
b) Milieu therapy 24. Explain the personality disorders and
c) Cognitive Behaviour therapy development
d) Hydrotherapy 25. Describe crisis and crisis intervention
II. Short answers

REFERENCE BOOKS
8. Define the following terms
1. Anthikad J (2004) Psychology for Graduate
a) Psychology Nurses 3rd edn, Jaypee Brothers Medical
b) Individual differences Publishers (P) Ltd.
c) Attitude 2. Gorman LM & Sultan DF (2009) Psychosocial
d) Personality Nursing for General Patient care 3rd edn,
e) emotion Jaypee Brothers Medical Publishers (P) Ltd.
f) Conflict 3. Khan M A (2004) Psychology for Nurses
g) Frustration Academia Publishers
h) Emotional adjustment 4. Mangal SK (2012) Psychology for Nurses 1st
i) Crisis intervention edn, Avichal Publishing Company Newdelhi
9. List any four individual differences 5. Sreenavni R (2010) A guide to Mental health
10. List the nature of attitude and Psychiatric Nursing 3rd edn, Jaypee
11. Explain types of emotions Brothers Medical Publishers (P) Ltd.
12. List any four bodily changes accompanying 6. Stephen Babu, (2018) Psychology for Nurses,
emotions 2nd edn, Elseviers Publication
7. Sreenavni R (2013) Psychology for nurses,
13. Enlist any four causes of personality
2nd edn, Jaypee Brothers Medical Publishers
disorder
(P) Ltd.
14. List any four causes of frustration
8. Townsend MC (2005) Psychiatric Mental
15. Explain the types of conflict Health Nursing 5th edn, Jaypee Brothers
Medical Publishers (P) Ltd.
III. Brief answers
16. Importance of Psychology INTERNET LINKS
17. Factors influencing the development of
1. https://www.psy.org
attitude and attitudinal changes
2. https://www.assessmentpsychology.com
18. Types and components of emotions
3. https://www.psypost.org
100

ICT CORNER APPLIED PSYCOLOGY
Through this game activity you will

be able to know the maslow hierarchy
of needs.anatomy
Steps
• Step 2: Click the START button to begin the game.
• Step 3: Drag and drop the picture icons into the rectangle given, using the mouse.
• Step 4: Continue and complete the pyramid.
URL : http://planeta42.com/psychology/maslow/

101

CHAPTER
4
Applied
Sociology
வையத்துள் வாழ்வாங்கு வாழ்பவன் வான்உறையும்

தெய்வத்துள் வைக்கப் படும்.
He who on earth has lived in the conjugal state as he should live, will be placed among the
Gods who dwell in heaven
Learning Objectives

➢➢ define sociology
➢➢ enumerate the importance and principles of sociology
➢➢ explain about family and marriage
➢➢ discuss the application of sociology in health management
Henry Fairchild: "Sociology is the study

Introduction
of man and his human environment in their
A dictionary defines sociology as the relations to each other".
systematic study of society and social interaction.
The word “sociology” is derived from the Latin
Health
word socius (companion) and the Greek word Science
logos (speech or reason), which means “study of Understand Eradricaon

those forces & of Social
society”. Father of sociology is Auguste Comete Pressures Problems
a French philosopher.
Importance of
4.1 Definition Sociology in
Nursing
Father of sociology, defines sociology as the No use yets Comprehensive

informaon Health
science of social phenomena "subject to natural Services
and invariable laws, the discovery of which is Learn the

Techniques of
the object of investigation". Adjustment
- Auguste Comete.
102
Unit_4_Introduction_to_sociology_Gen_Nur.indd 102 12/10/2021 10:22:35 PM

Scope of Sociology
4.3 Importance of sociology in
HEALTH
EDUCATION Nursing
FAMILY / COMMUNITY PHYSICAL
INVOLVEMENT EDUCATION
Sociology plays an important role in the
area of health sciences medicine and nursing
HEALTHY PROMOTION
FOR STAFF
HEALTH
SERVICES
with the common goal of preventing illness
and restoration of health.
The study of sociology is important for
HEALTHY SCHOOL
ENVIRONMENT
NUTRITION
SERVICES
nurses due to the following reasons
COUNSELING
PSYCHOLOGICAL &
• Helps to understand those forces and
SOCIAL SERVICES pressures which affect patient adversely.
• It helps the nurses to understand the
4.2 Principles of Sociology behaviour, conflicts, Inter Personal
Relationship (IPR), hierarchy, groups and
Hirschman’s Principles of Sociology adaptation of different people working in
• Things are real because they are socially hospitals.
constructed. • Through sociology, the nurse gets
• Society is not just the aggregation of information about the socio cultural life of
discrete, pre-existing individuals. That is, the patient.
the individual is not ontologically prior to • To study the structure of family, community
the social. and society.
• The ideas we hold about the world change • To understand the characteristics of social
the world. relationship, its complexities, and its
impact on health care.
• The language we use to describe the world
• Helps in the understanding and eradication
changes the world.
of social problems.
• Society cannot be understood by looking
at individuals separately from their
interconnections and their environments 4.4 Family
(both social and physical). The family forms the basic unit of social
• The economy is not separate from the organization and it is difficult to imagine how
political or social world. human society could function without it. The
family has been seen as an universal social
Nature of Sociology
institution and it is an inevitable part of the
• It is the science of society and studies society.
organized in an organized society.
• It is a general science with all kind of social Definition
relationship. The family is a group of persons united
• It is an analytical science. by ties of marriage, blood or adoption
constituting a single household interacting
• In sociologist point of view, man is a social
with each other in their respective social
animal.
role of husband and wife, mother and father,
• It has wider scope. brother and sister creating a common culture
• It studies both conscious and unconscious -Burgess and Lock
activities of human being.
103

Family is a more or less durable association Family of Procreation: The family where
of husband and wife with or without child or of an individual sets up after his/her marriage is
a man or woman alone with children. his/her family of procreation.
-Nimkoff
Based on Marriage
Characteristics Of Family Monogamous Family: This family consists
Universality: Malinowski writes the typical of one husband and wife, including children
family a group consisting of mother, father and is based on monogamous marriages.
and their progeny is found in all communities, Polygynous Family: A family consisting of
savage, barbarians and civilized. one husband, and more than one wife, and all
Emotional basis: It is built upon sentiments the children born to all the wives or adopted by
of love, affection, sympathy, cooperation and each of them.
friendship. Polyandrous Family: A family made up of
Limited size: The family is smaller in size. one wife and more than one husband, and the
It is a smallest social unit. children, either born or adopted with each one
Formative influence: It shapes the of them.
personality and molds the character of its
Based on Residence
members.
Family of Matrilocal Residence: When
Responsibility of the members:
a couple stays in the wife’s house, the family is
The members of the family has certain
known as family of matrilocal residence.
responsibilities, duties and obligations.
Family of Patrilocal Residence: When a
Social regulation: The society takes
family stays in the house of husband, the family
precaution to safeguard this organization from
is known as family of patrilocal residence.
any possible breakdown.
Family of Changing Residence: When a
Types of The Family family stays in the husband’s house for some
time, and moves to wife’s house, stays there
Based on Birth
for a period of time, and then moves back to
Family of Orientation: The family in husband’s parents, or starts living in another
which an individual is born is his family of place, the family is called a family of changing
orientation his family of orientation. residence.
104

Based on Ancestry or Descent 4.5 Functions Of The Family
Matrilineal Family: When ancestry or
descent is traced through the female line, or
through the mother’s side, the family is called
matrilineal family.
Patrilineal Family: A family in which
the authority is carried down the male line,
and descent is traced through the male line or
the father’s side, is called a patrilineal family.
Based on Authority
Matriarchal Family: In these families, a
woman is the head of the family, and authority
is vested in her.
The matriarchal family is known as
mother centered or mother dominated family. FAMILY LIFE CYCLE
The mother or the woman is the head of the
family.
Newly married Wedding
Youthful
Patriarchal Family: In patriarchal Marriage
stage
families, the head of the family is a male, and (Ages 20-40) Early Parenthood Birth of first
Child
authority is vested with him. stage
Oldest child
Middle-Aged Later Parenthood begins
The patriarchal family is also known as Marriage adolescence
(Ages 40-60) stage
father centered or father dominated family.
Empty Nest Last child
stage Leaves home
Based on the Nature of Relations Aging Marriage
(Ages 60 ---) Rerement Rere from
Conjugal Family: A conjugal family stage
career
includes only the husband, wife and
Death of a spouse
unmarried children who are not adults. This stage
is also referred as nuclear family.
Consanguine Family: A consanguine 4.6 Needs of the Family
family consists of a parent, his or her children
and other relatives According to psychologist Abraham
Maslow, the needs of family can be divided into
Based on the size or structure: following:
Nuclear Family: A nuclear family is a • Basic needs: The most rudimentary
small group consisting of a husband, a wife human needs, associated with the survival
and children, natural or adopted. of human beings, are called basic needs.
Human beings cannot survive in the
Joint Family: A joint family consists of
absence of these things. One needs of food
three generation, living together under the
to eat, water to drink and house to live.
same roof, sharing the same kitchen and
purse or economic expenses. • Physiological needs: Physiological needs
are associated with the function of body
105

3. Marriage requires social approval. The
organ. Sex is biological needs of the youth.
relationship between men and women
After this, human being moves to safety
must have social approval without which
needs. After one's stomach is full, she/
marriage is not valid.
he needs a safe environment. Cloth and
4. Marriage establishes family. Family helps
shelter provide security from the general
in providing facilities for the procreation
environmental torments and the foes.
and upbringing of children.
• Additional needs: The secondary human 5. Marriage creates mutual obligations
needs, associated with career development between husband and wife. The couple
and better living standard, are termed fulfills their mutual obligations on the
as additional needs. He needs love, care, basis of customs or rules.
affection, respect, freedom and eventually 6. Marriage is always associated with some
self fulfillment. civil and religious ceremony. This social
and religious ceremony provides validity
4.7 Marriage to marriage. Though modern marriage
performed in courts still it requires certain
Introduction religious or customary practices.
7. Marriage regulates sex relationship
Marriage is one
according to prescribed customs and laws.
of the most ancient,
8. Marriage has certain symbols like ring,
important, universal
vermillion, special cloths, special sign
and indispensable
before the house etc.
social relationship which has been in existence
since the inception of human civilization.
Prohibition of Child
Definition of Marriage
Marriage Act states that a girl in
1. According to Encyclopedia Britannica, India should not marry before
“Marriage is a physical, legal and moral the age of 18, and a boy before 21.
union between man and woman in complete
community life for the establishment of a
family.” Functions of marriage
2. According to Malinowski, “Marriage is a 1. Regulation of sex life and inheritance or
contract for the production and maintenance procreation
of children.” 2. Marriage leads establishment of family
3. Provides economic cooperation
Characteristics of Marriage 4. Marriage contributes to emotional and
intellectual interstimulation of the partners
1. Marriage is a permanent bond between
husband and wife. It is designed to fulfill 5. Marriage aims at social solidarity
the social, psychological, biological and
Social Benefits Of Marriage
religious aims.
2. Marriage is a specific relationship between Marriage and Health
two individuals of opposite sex and • On average, husbands and wives are
based on mutual rights and obligations. healthier, happier and enjoy longer lives
Relationship is enduring. than those who are not married.
106

• Men appear to reap the most physical Marriage and Society
health benefits from marriage and suffer • The institution of marriage reliably creates
the greatest health consequences if they the social, economic and affective conditions
divorce. for effective parenting.
• Married mothers have lower rates of • Being married changes people’s lifestyles
depression than single or cohabiting and habits in ways that are personally and
mothers, probably because they are more socially beneficial. Marriage is a “seedbed”
likely to receive practical and emotional of pro-social behaviour.
support from their husband and his family. • Marriage generates social capital. The social
Marriage and Wealth bonds created through marriage yield
benefits, not only for the family, but for
• Married couples build more wealth on
others as well, including the larger society.
average than singles or cohabiting couples.
• Married men earn more money than do
4.8 Application of Sociology in
single men with similar education and job
Nursing
histories.
• Married women are economically better • Sociology is a recent addition to the
off than divorced, cohabiting or never- syllabus of medical education.
married women. • Sociology is needed in general to all the
Marriage and Children medical professions and especially nursing
because social conditions are sometimes
• Less likely to be poor or to experience
responsible for health problems.
persistent economic insecurity.
• Sociology helps to understand the
• More likely to stay in school, have fewer
relationship between disease and social
behavioural and attendance problems, and
condition.
earn four-year college degrees.
• Less vulnerable to serious emotional Importance of social environment
illness, depression and suicide attempts. • A patient with physical handicap should
• More likely to have positive attitudes be understood in the context of his social
towards marriage and greater success in milieu.
forming lasting marriages. • Psychological, social and vocational
handicaps of the disabled person and
Marriage and Crime/Domestic Violence
patients are often related with false attitute
• Married women are at lower risk for
of the people.
domestic violence than women in
• The nurse should understand the social
cohabiting or dating relationships.
environment for develop the patients
• Boys raised in single-parent homes are health conditions.
more likely to engage in criminal and
delinquent behaviours than those raised by SUMMARY
two married biological parents. Sociology is just as valuable and
• Married women are significantly less likely important to nursing as is psychology.
to be the victims of violent crime than Sociology explores the issues of genders,
single or divorced women. Married men social classes, stratification, families and
are less likely to perpetrate violent crimes economic policies which have impacts on
than unmarried men. health care and nursing.
107

GLOSSARY
Sociology – சமூகவியல் the study and classification of human societies

Universality – ப�ொதுமை the quality of being universal; existing everywhere
Procreation – இனப்பெருக்கம் the sexual activity of conceiving and bearing offspring
Materialism – ப�ொருள்முதற் a desire for wealth and material possessions with little
க�ோட்பாடு interest in ethical or spiritual matters
Evaluation
I. Multiple choice question REFERENCE BOOKS

1. Family started with patriarch belongs to 1. K.Madhavi, (2018), A
textbook of psychology
a) matriarchal
& sociology., Vijayam
b) patriarchal
publications.
c) polygamy
2. Clement. I, (2010)
2. What are key structure of societies Sociology For Nurses.,
a) marriage Pearson Education India
b) family 3. I.Clement (2015), “Sociology for Nurses”
c) a and b 2nd edition, Published by Pearson India
Education Service Pvt. Ltd., Noida, India,
II. Answer in one or two lines 4. K.P.Neeraja (2010), “Text book of Sociology
for Nursing Students” 1st edition, Jaypee
1. Define sociology
Brothers Medical Publishers Pvt. Ltd. New
2. Define family Delhi, India,
3. Define marriage 5. G.S.Purushothama (2014), “Sociology for
4. What is consanguine family? Nursing and Health Sciences” 2nd edition,
5. List out the benefits of marriage Jaypee Brothers Medical Publishers Pvt.
Ltd. New Delhi, India.
III. Short notes
1. List out the importance of sociology INTERNET LINKS
2. Explain the principles of sociology
3. Enlist the types of family 1. https://www.nursingtimes.net/roles/nurse-
4. Discuss the function of marriage educators/sociology-in-practice-1-can-
5. Enumerate the functions of family sociolog
2. https://onlinelibrary.wiley.com/doi/pdf/
IV. Write in detail about 10.1111/j.1447-0349.2008.00571.
1. Explain about the family 3. https://www.elsevier.com/books/sociology
2. Discuss about marriage - i n - nu r s i ng - an d - h e a lt h c are / c o o ke /
3. Explain the application of sociology in 978-0-443-10155-
health management
4. Describe the characteristics of family
108

CHAPTER
5 Applied
Nutrition
மாறுபாடு இல்லாத உண்டி மறுத்துண்ணின்

ஊறுபாடு இல்லை உயிர்க்கு.
There will be no disaster to one's life if one eats with moderation,

food that is not disagreeable.
Learning Objectives
At the end of the lesson students will be able to

➢➢ understand the classification of food
➢➢ understand the ICMR suggested food pyramid
➢➢ know the food source of carbohydrates, fats, and protein
➢➢ know in details about vitamins.
➢➢ apply therapeutic diets related to hypertension, peptic ulcer, chronic renal failure and
Diabetes Mellitus
➢➢ know the additives in food
nourished especially, the series of processes by

Introduction
which organism assimilates food and uses it for
To eat is a necessity, but to eat intelligently is growth and replacement of tissues”.
an art.
- La Rochefoucauld. 5.1 Terminology
Hippocrates first coined the word clinical Nutrition: It may be defined as the science
nutrition in 4th century B.C. The word diet of food and its relationship to health. It is
is derived from the Greek word "data" which concerned with the part played by nutrients in
means healthful living according to proper body growth, development and maintenance.
reflection of food. The science of nutrition is
Dietetics: Dietetics is the practical
defined as “the study of the Nutrients in food
application of the principles of nutrition. It
and the body’s handling of them”. Nutrition
includes the planning of meals for well and the
means “the process of nourishing or being
sick.
109
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Nutrients: A substance in suitable
5.3 R
ole of nutrition in maintaining
amount is essential for the growth,
maintenance, function and reproduction of a health
cell or organism is called Nutrients. Nutrients Nutrition is a basic element of health.
consist of carbohydrates, fats, proteins, Nutrition influence the health from birth to
Vitamins and Minerals. death.
Macronutrients: Proteins, carbohydrates,

and fats are called macronutrients. It supply
energy in large quantities to the body and build

tissues.
Micronutrients: Vitamins and minerals
are called micronutrients. It is needed in small

quantity but they play a crucial role to regulate
and control body processes.

Malnutrition: Malnutrition is an
impairment of health resulting from a

deficiency, excess or imbalance of nutrients. It
includes under nutrition and over nutrition.
Metabolism: Metabolism is the sum
Growth and development
total of building up reactions (anabolism) and
breakdown reactions (catabolism) going on • Good nutrition is essential for attainment
inside the body of a living organism. of normal growth and development during
fetal life and childhood. Physical growth,
intellectual development, learning and
5.2 Classification of Food behavior are affected by malnutrition.
1. Classification by origin • Adequate nutrition is needed for adult
• Foods of animal origin life maintenance for optimum health and
efficiency.
• Foods of plant origin.
• Elder people needs special nutrition due
2. Classification by chemical composition
to their physiological and chronological
• Protein changes. Pregnant and lactating mothers
• Fats require more proteins and nutrients to
• Carbohydrates prevent abortion, growth retardation
• Vitamins and low birth weight babies and provide
• Minerals adequate breast feeding for their babies.
3. Classification by predominant function
Specific deficiency diseases
• Body building foods: milk, meat,
poultry, fish, egg, pulses, peanuts • The most common deficiencies find in
etc., Indians are Protein energy malnutrition,
• Energy giving food: cereals, sugars, blindness, goiter, anemia, beriberi,
roots and tubers, fats and oils. rickets etc. There is increased incidence
• Protective foods: vegetables, fruits of abortion, prematurity, still birth and
and milk. low birth weight babies in malnourished
mothers.
110

• Hence, good nutrition is essential to • Traditional factors
prevent nutritional deficiency diseases, • Food production and distribution.
promotion of health and treatment of
deficiency diseases. Food Pyramid
Resistance to infection According to Indian Council of Medical

Research, foods are grouped as shown in
• A well balanced nutrition prevents
Pyramid according to the requirement for
infections like tuberculosis. Good nutrition
healthy life.
enhances wound healing. Improves
resistance of an individual towards
infections.
Mortality and morbidity

• Malnutrition leads to increased death
rate, infant mortality rate, still births and
premature deliveries. Prematurity is the
major cause of deaths.
• Over nutrition causes diseases like
Obesity, diabetes, hypertension,
cardiovascular and renal diseases and
causes death. Each food groups is a source of different
nutrients. Balanced diet should include all the
5.4 F
actors affecting food and food groups.
nutrition
One of the
The following factors affects food and world’s healthiest
nutrition food is lemon. One
• Basal metabolic rate lemon contains our daily dose
• Weight of vitamin C it cleanses our liver, boost our
immunity and aids in weight loss.
• Age
• Sex
5.5 Carbohydrates
• Climate and environment
• Physical activities Carbohydrates are the main source of
• Physiological state energy for daily activities. Carbohydrates
• Socio economic factors (primarily starches) are the least expensive, the
most available, easily obtainable and readily
• Cultural factors
digestible form of nutrient.
• Life style and food habits
• Food fads Composition of Carbohydrates
• Cooking practices Carbohydrates are organic compounds
• Child rearing practices of carbon, hydrogen and oxygen with the
latter elements in the ratio of 2: 1. The general
• Religion
formula is C6H12O6. Carbohydrates are widely
111

Table -1 - Food Groups Suggested by ICMR (2011)
Nutrient content of food groups Nutrients
1. Cereals, Millets and Pulses: Energy, Protein, Invisible fat, Vitamin B1,
Rice, Wheat, Ragi, Bajra, Maize, Jowar, Barley, Vitamin B2, Folic acid, Iron, Fiber.
Rice flakes, Wheat flour, Breakfast cereals.
Pulses and Legumes: Bengal gram, Black gram, Energy, Protein, Invisible fat, Vitamin
Green gram, Red gram, Lentil (Whole as well as B1, Vitamin B2, Folic acid, Calcium, Iron,
dhal), Cowpea, peas, Rajmah, Soya bean, Beans. Fiber.
2. Milk and Animal products:
Milk, Curd, Skimmed milk, Cheese, Chicken, Protein, Fat, Vitamin – B1, Vitamin B2,
Liver, Fish, Egg, Meat. Calcium, Iron
3. Vegetables and Fruits: Carotenoids, Vitamin C, Fiber, Invisible
Fruits: Mango, Guava, Tomato, papaya, Orange, fat, Vitamin B2, Folic acid, Iron.
Sweet lime, Water melon.
Green leafy vegetables: Amaranth, Spinach, Carotenoids, Vitamin B2, Folic acid,
Gogu, Drumstick leaves, Coriander leaves, Calcium, Iron, Fiber.
Fenugreek leaves.
Other vegetables: Carrots, Brinjal, Ladies finger, Carotenoids, Folic acid, Calcium, Fiber.
Beans, Capsicum, Onion, Drumstick, Cauliflower
4. Oils, Fats and Nuts:
Fats: Butter Ghee, Hydrogenated fat, Cooking Energy, Fat, Essential fatty acids.
oils like groundnut, mustard, Sunflower.
Sugar: Jaggery and cane – sugar. Energy
Almonds, walnuts and gingelly seeds Protein, ω-3 fatty acids.
distributed in plants. Foods which contain Recommended daily allowances

carbohydrates are called energy foods. Table: 2
Classification of Carbohydrates Recommended
Age Group
Carbohydrates are classified according carbohydrate/Gms/day
to the number of saccharide (sugar) Adults 50 – 70
groups present. They are broadly classified Expectant and
40 – 60
as simple carbohydrates and complex nursing mothers
carbohydrates. The simple carbohydrates Infants
40 – 50
include monosaccharides (Single sugar) and (1 – 12months)
disaccharides (Double sugars). Complex Preschool children
40 – 60
carbohydrates include starch, glycogen and (1-25years)
fibers. The classification of carbohydrates Older chidren
50 - 70
is schematically represented below: and adolescents
112

CLASSIFICATION OF CARBOHYDRATES

(Dextrose or grape sugar)
2.Fructose
(Fruit sugar)
3.Galactose

()
()

(
)

(

(

)
Dietary sources Functions

The important sources of carbohydrates in 1. Supply energy for body functions and for
the diets are cereals, millets, roots, tubers pulses, doing work. Each gram of carbohydrate
sugar and jaggery. yield 4 kcal of energy.
2. Essential for the oxidation of fats
Table: 3
3. Exert a sparing action on proteins.
Food Carbohydrate g / 100 g
4. Provide carbon skeleton for the synthesis of
Cereals and millets 63 – 79 some non – essential amino acids.
(rice, jowar)
5. Add flavor to the diet.
Pulses (Bengl gram, 50 – 60
red gram, etc)
Digestion, absorption and
Nuts and oilseeds 10 – 25 storage, metabolism of
Roots and tubers 22 – 39 carbohydrates
Arrow root flour 85 – 87 The first stage of digestion takes place in

the mouth while the food is chewed. In saliva
Cane sugar 99 the enzyme called alpha – amylase which is
Sago 87 – 89 called as ptyalin acts on starch. The enzyme
Honey 79 – 80 acts on starch splitting it into dextrin and
maltose. As soon as the food reaches the
Jaggery 94 – 95 stomach it mixes with acidic gastric juices for
Milk 4–5 digestion. The main digestion takes place in
Dried fruits 67 – 77 the intestines.
Fresh fruits 10 - 25
113

The final products of digestion of Excessive carbohydrates
carbohydrates are glucose, fructose and Excessive consumption of carbohydrates
galactose, these products are absorbed in the leads to heart disease, diabetes, and obesity.
intestines. The non – digestible carbohydrates
present in the food such as cellulose,
5.6 Fat
hemicelluloses, pentosans, galactans, fructosans
etc add bulk to the contents of large intestine The name fat may make it sound like
and are excreted in the faeces. something you shouldn't eat. But fat is an
important part of a healthy diet. Fat from
Storage, metabolism of carbohydrates
your diet gives you energy. As a bonus, fat in
Glucose, galactose and fructose absorbed food helps you feel full, so you don't eat too
in the intestines pass through the portal much.
circulation to the liver. In the liver a part of the
Some foods, including most fruits and
glucose and the entire galactose and fructose
vegetables, have almost no fat. Other foods
are converted into glycogen. A portion of
have plenty of fat. They include nuts, oils,
glucose enters into the general circulation and
butter, and meats like beef.
to the various tissues for being oxidized and
used as energy. A small portion of the glucose The lipids are a heterogeneous group of
is stored in liver and muscle as glycogen and substances found in plant and animal tissues,
some portion of the glucose is converted into which share the property of being relatively
fat and stored in adipose tissue. The oxidation insoluble in water, and soluble in organic
of glucose in the tissues occurs in two stages solvents, such as ether, chloroform and
as indicated below; benzene. Fat contain 9 kcal per gram.
1. Glycogen Glucose Pyruvic acid Functions of fats

Lactic acid 1. They are the chief energy stores of the
body, which form an important source
Oxidation
2. Pyruvic acid CO2 + H2O of energy during starvation or other
The first stage is called ‘glycolysis. The emergencies.
oxidation of pyruvic acid takes place through 2. Fats play a role in the absorption of fats soluble
a series of reactions known as tricarboxylic vitamins like vitamins A, D, E and K.
acid cycle (Krebs’s cycle). 3. Fats are the constituents of cell membrane
structure and regulate the membrane
permeability.
Drinking tea / coffee can
4. Subcutaneous fat acts as an insulator and
severely inhibit your body’s
helps in retaining body heat.
ability to absorbs vitamins and
minerals – especially Iron. 5. Fats are important as cellular metabolic
regulators (Steroid hormones and
prostaglandin).
Deficiencies
6. Fat is the main energy store in the body and
A deficiency of carbohydrates makes the most concentrated source of energy in
the body to utilize fats for energy, if it is not the diet – 1 g of fat provides 37kJ (9Kcal),
rectified it leads to ketone bodies formation more than double that provided by either
which occurs due to oxidation of fats. protein or carbohydrate (4Kcal).
114

IV. On the basis of requirement
World Food Day – October 16 Fatty acids are of 2 types:
1. Essential fatty acids: Fatty acids which are
essential to be taken in our diet because
Classification of lipids they cannot be synthesized in our body
Lipids are classified into 4 categories as are known as essential fatty acids. (eg.)
follows: Linoleic, linolenic and arachidonic acids.
2. Non-essential fatty acids: Non-essential
I. On the basis of chemical composition fatty acids are those which can be
I. On the basis of chemical composition
systhesized by the body and which need
not be supplied through the diet. Palmitic
Simple Compound Derived
acid, oleic acid and butyric acid are
examples of non-essential fatty acids.
1. Sterols
Fats and oils
2. Fatty acids
Digestion, absorption and
storage metabolism
Phospho lipids Glycolipids Lipoproteins
Fats are not digested in the stomach.
Fats delay emptying of the stomach. Fats are
II. On the basis of sources
hydrolyzed by the pancreatic and intestinal
Fats are divided into 2 types based on
lipases in the intestines into diglycerides,
their source, namely visible and invisible
monoglycerides and fatty acids. Bile is
fats.
essential for the digestion and absorption of
III. On the basis of fatty acids fats.
Fats and fatty acids
Saturated fats
Unsaturated fats
Animal fats, butter, lard
Polyunsaturated fats Monounsaturated fats
Omega – 3 fatty acids Omega – 6 fatty acids Omega – 9 fatty acids

Eicosapentanoic acid (EPA) Corn oil Olive oil
fish, shellfish Safflower oil Avocados
Docosahexaenoic acid (DHA) Sunflower oil Peanuts
fish, shellfish almonds
alpha-linolenic acid (ALA)
flaxseed, soyabean, walnut,
rapeseed oil
115

• Obesity
• Coronary heart disease
• Cancer
• High cholesterol
5.7 Proteins
Proteins are made of amino acids linked

together by peptide bonds. Amino acids can
be divided into essential amino acids and
Sources of fat non – essential amino acids. Proteins and
carbohydrates contain 4 kcal per gram.
Storage of fats
Fat is stored in the adipose tissues. In Composition
normal human beings adipose tissue constitutes Proteins are chemical compounds that
of 10 – 15% of the body weight. contain the same atoms as carbohydrate
and lipid – carbon (C), hydrogen (H) and
Fat metabolism
oxygen (O) – but proteins are different in
Fatty acids are oxidized by certain
that they also contain nitrogen (N) atoms.
enzymes in the tissues to carbon dioxide and
These nitrogen atoms gives the name ‘amino’
water. The oxidation takes place through the
(nitrogen containing) to the amino acids
tricarboxylic acid cycle.
that are the links in the chains referred to as
Deficiencies proteins.
• Dry, scaly skin • Poor growth
Classification of proteins
• Hair loss • Lower resistance to
• Low body weight infection Proteins are large molecules formed by
• Cold intolerance • Poor wound healing the combination of a number of aminoacids.
• Bruising • Loss of menstruation About 20 amino acids have been found to
occur in proteins and are important from
Over consumption the point of view of human nutrition.
• Over weight
Table 4
Classification of Proteins (Based on chemical composition)
Simple Conjugated Derived
Globular proteins Scleroproteins • Nucleoproteins Primary Secondary
• Albumins • Collagens • Glycoproteins • Coagulated • Proteoses
• Globulins • Elastins • Mucoproteins Proteins • Peptones
• Glutelins • Keratins • Lipoproteins • Proteans • Polypeptides
• Prolamines • Phoshoproteins • Metaproteins • Peptides
• Histones • Chromoproteins
• Globins • Matalioproteins
• Protamines
116

Sources of protein • Production of enzymes and hormones
• Excellent sources of protein include tuna, • Production of transport proteins and
shrimp, turkey, and cod. lipoproteins
• Very good sources of protein include • Production of antibodies
snapper, venison, halibut, salmon, • Maintenance of proper fluid balance
scallops, chicken, lamb, beef, calf ’s liver, • Maintenance of proper acid – base balance.
spinach, tofu, mustard greens, mushrooms, Protein deficiency diseases – Maras muss
soybeans, and mozzarella cheese. and kwashiorkor
• Good sources of protein include eggs,
milk, collard greens, cauliflower and Table: 6
many legumes including lentils, split peas, Recommended daily protein allowances
kidney beans, black beans, pinto beans and Protein
garbanzo beans. allowance
Group Particulars
(g/kg/ (g/
day) day)
Sedentary work
Man (60kg) Moderate work 1 60.0
Heavy work
Sedentary work
Moderate work
1 50.0
Woman Heavy work
(50kg) Pregnancy
1 +15.0
Lactation
Sources of Protein 1 +25.0
(0 go 6m)
Table 5 0 to 3 Months 2.3 (a)
Nutritional classification of amino acids 3 to 6 months 1.8 (a)
Infants
Semi- Non- 6 to 9 months 1.65 (b)
Essential
essential essential to 12 months 1.5 (b)
Histidine Arginine Glutamic acid
1 to 3 years 1.83 22.0
Lysine Tyrosine Aspartic acid
Children 4 to 6 years 1.52 30.0
Tryptophan Cystine Alanine
7 to 9 years 1.46 41
Phenylalanine Glycine Proline
Males
Methionine Serine Hydroxyproline
to 12 years 1.46 54
Threonine Cysteine
13 to 15 years 1.40 70
Leucine
Isoleucine 16 to 18 years 1.31 78
Adolescents
Valine Females
to 12 years 1.45 57
Functions of protein 13 to 15 years 1.33 65
• Production and maintenance of structural 16 to 18 years 1.21 63
proteins
117

Classification of Vitamins
5.8 Vitamins
Thirteen (13) recognized vitamins
Vitamins are essential organic, classified in two groups, based on their
compounds that are needed in small amounts solubility in fat or in water are as follows:
in the diet both to prevent deficiency diseases
and to support optimal health. The term Fat – soluble vitamins
vitamin (vital amines) was coined by Casmir
The four fat – soluble vitamins – vitamins
Funk. The term vital denoting essential for
A, D, E and K are often present in the fat portion
life and amines because these compounds
of foods, they are not easily lost from foods or
contained an amine functional group.
destroyed by exposure to water, heat, air, or
light.
Characteristics of vitamins
• Vitamins are vital, organic, dietary Vitamin A (retinol and beta –
substance that is necessary in only very carotene)
small amounts to perform a specific
Vitamin A and carotene can be obtained
metabolic function or prevent an associated
from either animal or vegetable sources.
deficiency disease.
The animal form is divided between retinol
• Vitamins are not synthesized by the body and dehydroretinol whereas the vegetable
and therefore must be supplied through carotene can be split into four very potent
food. groups– alpha– carotene, beta–carotene,
Table: 7 gamma carotene and crypto– carotene.
Fat – Soluble Water – Soluble Vitamins Function
Vitamins
Vitamin A has a variety of functions in
Vitamin A Vitamin C
the body. It is required for the synthesis of
Vitamin D B – Complex vitamins (8)
rhodopsin and other light – receptor pigments
Vitamin E Thiamine
in the eye and thus is essential for vision.
Vitamin K Riboflavin
Vitamin A is needed for normal growth and
Niacin
development to occur in the body, including
Pyridoxine
the formation of bone and cartilage.
Folate
Healthy epithelial or skin cells, which
Cyanocobalamin
line surfaces inside and outside the body,
Biotin
require vitamin A. Vitamin A plays a role
Pantothenic acid
in reproduction, metabolism, and immune
system function also.
Functions of Vitamins
Each vitamin has its specific metabolic Digestion and absorption
task. However the general functions are: Retinol esters in food are hydrolyzed by
• Function as control agents in cell pancreatic and intestinal enzymes to form
metabolism free retinol. After absorption, the retinol, is
• Components of body – tissue construction. reesterified and transported to blood.
• Prevent specific nutritional deficiency Carotenes are split in the intestines to
disease, which is considered as a result of form retinaldehyde, which is then reduced to
their primary role in cell metabolism.
118

Table 8: A summary of the fat soluble vitamins
Vitamin Functions RDA Deficiency Symptoms Toxicity
Vitamin Aids in vision, Men : 1000 Short – term: Night Toxic symptoms appear
A especially night retinol blindness, flaking skin. with chronic intake of 10
vision promotes equivalents times the RDA, usually
growth, (RE) 5000 Long term : due to supplement
development, 1µ Xerophthalmia (dry, hard abused.
reproduction, cornea); progresses to
healthy skin softening of corneas and Symptoms include lack
cells, and health blindness if untreated of appetite; dry, itch skin;
immune system loss and coarsening of
acts as an hair; liver damage; fetal
antioxidant defects and miscarriage.
Vitamin Aids in 5 – 10 µg Rickets (faulty bone Toxic symptoms appear
D absorption, formation) in children. with regular intake of 5
transport, and Osteromalacia (Softening times the RDA, usually
use of calcium of bones) in adults due to supplement abuse.
and phosphorus Symptoms include lack
of appetite, high blood
Maintains pressure, excessive
optimal blood thirst and urination,
calcium levels high blood calcium
and calcium deposits in
tissues, kidney stones,
and kidney failure can
lead to death.
Vitamin Acts as an 20 – 25 mg Damage to all Relatively nontoxic;
E antioxidant, membranes, leading to use of supplements
protecting cell destruction of red blood with 80 times or more
membranes cells (hemolyticanemi) of the RDA may cause
from oxidative Rare in humans except symptoms. Symptoms
damage. in premature infants include muscular
and those with certain weakness, fatigue, and
diseases nausea.
Vitamin Promotes Men : Poor blood clotting, Natural forms
K formation of 70 – 80 µg possibly leading to are nontoxic;
some blood – hemorrhage (Rare in excessive synthetic
clotting factors Women : humans excepts in supplementation can
60 – 65 µg newborn infants and cause toxic symptoms
people on long term in infants. Symptoms
general antibiotic include anemia and
therapy) jaundice.
119

retinol. Some carotene may be absorbed intact inactive pro-vitamin D. Both inactive vitamin
and later converted to vitamin ‘A’ in the liver D formed in the skin and vitamin D absorbed
or kidney. Bile is necessary for the absorption from dietary sources are transported through
of vitamin A and carotene. Vitamin E in the the bloodstream to the liver, where they are
intestinal tract prevents oxidation of the stored.
vitamin. Mineral oil hinders absorption since
it dissolves the vitamin but is not absorbed. Functions
• Vitamin D helps with the absorption,
Food sources transport and use of calcium.
• Vitamin D assists in bone growth and the
integrity of bone and promotes strong
teeth.
• It also helps to regulate the amount of
phosphorus in the body as well as assisting
in a healthy heart and nervous system.
Food sources
Sources of Vitamin A
Liver, milk, egg – yolk, carrots, dark green
leafy vegetables and yellow fruits are high in
vitamin A or beta – carotene.
Deficiency
A diet deficient in vitamin A for several
months may lead to night blindness and flaking
skin.
A long – term vitamin A deficiency leads Sources of Vitamin D
Xerophthalmia, major symptom of which is dry, Vitamin D is present in fatty fish like
hard cornea. If this condition is left untreated, kipper, sardines, salmon, tuna and mackerel,
damage to the cornea progresses, leading to a liver, egg yolk and butter. Smaller amounts are
softening of the cornea and eventually total also present in dark leafy vegetables.
blindness.
Vitamin A deficiency also affects the skin, Absorption
causing it to become dry and rough. Dietary vitamin D is absorbed along
If xerophthalmia and the underlying with dietary fats in the small intestines and
vitamin A deficiency are treated at an early transported to the lymph system. Bile is
stage, blindness can be prevented. essential for the absorption of this vitamin
Excess vitamin is stored in the body.
Vitamin D (Calciferol)
The human body can produce vitamin Which is the only non-
D from cholesterol present in the skin. This animal natural source of
conversion depends on exposure of the skin vitamin-D – Mushroom. The
to the ultraviolet rays in sunlight and yields best source of vittamin D is Sun.
120

Deficiency the presence of cultured milk, like yogurt, in
Vitamin D deficiency affects the the diet.
mineralization of bones and teeth.
Functions
-Rickets, osteomalacia
• The major function of vitamin K is to
Vitamin E (Tocopherol) promote coagulation of blood after injury,
thereby preventing haemorrhage.
Vitamin E is an essential, fat – soluble • Vitamin K is necessary for the synthesis
vitamin that includes eight naturally occurring of prothrombin, an inactive form of
compounds in two classes designated as thrombin.
tocopherols and tocotrienols. • It is involved in the formation of
Vitamin E is an effective chain – breaking, prothrombin.
lipid – soluble antioxidant in biological • It is also involved in bone formation and
membranes, and aids in membrane stability. repair.
Synthesis of Prothrombin with the help of vitamin k
Vitamin k
Liver Prothrombin Thrombin
Catalyzes
Fibrinogen Fibrin
Forms
Sources of Vitamin E Blood clot
Function Food Source

• Vitamin E is a powerful antioxidant.
• Antioxidant capability helps to prevent
degenerative diseases.
• Vitamin E is also useful in preventing
blood clots forming and promotes fertility.
• An increase in stamina and endurance is
also attributed to vitamin E.
• Vitamin E is also used to great effect for
skin treatments.
Deficiency of vitamin E
Deficiency of vitamin E is a not common,
and the symptoms not very clear cut, but may Sources of Vitamin K
include fatigue, inflamed varicose veins, slow
The best dietary sources of this vitamin
wound healing, premature ageing and sub –
are green leafy vegetables, cheese and liver.
fertility.
Deficiency
Vitamin K
Increased tendency to haemorrhage
Vitamin K can be produced in the defective blood clotting
intestines and this function is improved with
121

Table: 9 Water soluble vitamins
Vitamin Functions RDA
Involved in synthesis of collagen, and

norepinephrine
Vitamin C 60 – 70 mg
Promotes immune – system functioning, acts
as antioxidant
Coenzyme involved in catabolism of Men : 1.2 – 1.6 mg

Thiamine
carbohydrates to yield energy Women : 1.1 – 1.5mg
Coenzyme involved in many energy – yielding Men: 1.4 – 1.9 mg

Riboflavin
pathways Women 1.1 – 1.5mg
Coenzyme involved in nearly all / energy

Men : 16 – 12 Women
Niacin – yielding path – ways and in synthesis and
12 – 16 mg
breakdown of fats
Coenzyme involved in proteins and amino

Pyridoxine 2.0 mg
acids synthesis
Coenzyme involved in amino acid metabolism

Folate 100µµg
and synthesis of DNA
Various coenzymes involved in energy

Cyanocobalamin metabolism; work with folate in synthesizing 2 - 10µgµg
methionine
Coenzyme involved primarily in

gluconeogenesis, fatty acid synthesis, leucine
Biotine 30 – 100 µgµg
metabolism and synthesis of purine structure
carbohydrate and lipid metabolism
Coenzyme form (coenzyme A) involved in

Pantothenic acid 4 – 7 mg
carbohydrate, lipid, and protein metabolism
122

Sources Deficiency Symptoms Toxicity
Dietary, excellent sources; citrus fruits Scurvy: fatigue, bleeding gums, poor Relatively nontoxic;
and their juices, sweet red and green appetite, slow wound healing, muscle supplement abuse may
peppers, strawberries, cantaloupe, fatigue. Seen occasionally in infants fed cause diarrhea
broccoli, Brussels sprouts, papaya, only cow’s milk and in elderly people
cauliflower. Good sources: potatoes,
tomatoes, peas, kale, asparagus, cabbage.
Dietary, excellent sources: pork, Beriberi: poor coordination, Muscle Nontoxic except for high
sunflower seeds, fortified grain weakness, edema, heart diseases dose injections.
products, fresh peas. Good sources:
legumes, whole and enriched grains
Dietary, excellent sources: liver, milk Ariboflavinosis: inflammation of the Nontoxic
and milk products Good sources: mouth and tongue, cracks at the corners of
oysters, mushrooms, green vegetables the mouth and lips, anemia, dermatitis, eye
(broccoli, spinach, asparagus) – related problems
Dietary, excellent sources: tuna, Pellagra: diarrhea, dermatitis, dementia, Nicotinic acid form is toxic
chicken, liver, beef, fortified cereals. and possibly death (the four Ds) common with high dose supplements.
Good sources: Mushrooms, whole in Africa and Asia Symptoms include flushing
grains (>100 mg); liver damage,
increased levels of uric acid
and glucose in blood (>3
grams); increased use of
glycogen during exercise.
Dietary, excellent sources: liver, Convulsions, dermatitis, inflamed tongue, Toxic with long – term
potatoes, bananas, prune juice, light and anemia. Deficiency symptoms often supplement abuse (>1 gram
poultry meat, fortified grain products seen in alcoholics, the elderly, and women per day). Symptoms include
Good Sources : Sweet potatoes, water taking birth control pills nerve damage and lack of
– melon muscular control (usually
reversible)
Dietary, excellent sources: legumes, Macrocytic megaloblastic anemia, diarrhea, Nontoxic
liver spinach and turnip greens, mental confusion, depression, fatigue.
artichokes. Good sources : asparagus,
oranges, green peas, broccoli, beets,
beet greens, green beans, corn
Dietary, excellent sources: organ meats, Pernicious anemia: a macrocytic Nontoxic
shellfish, milk and milk products (found megaloblastic anemia accompanied by nerve
only in animal foods) damage. Most commonly results from poor
absorption due to lack of intrinsic factor, not
from low dietary intakes of vitamin
Dietary, excellent sources: liver, soy Poor appetite, nausea, sore tongue, Nontoxic
flour, egg yolks. Dietary, good Sources: depression, pallor, hair loss, dry skin,
cereals. Nondietary: synthesized by increased blood levels of cholesterol and
bacteria in the intestinal tract. bile Rare in humans.
Dietary, excellent sources: egg yolks, Deficiency symptoms are rare. In severely Nontoxic
liver, kidney. Dietary, good sources: malnourished individuals symptoms such
meat, legumes, whole grains as paresthesia in the toes and soles of feet,
burning sensations in the feet, fatigue,
insomnia, depression may be seen
123

Water – soluble vitamins • Ascorbic acid also promotes healthy cell
development.
Water – soluble vitamins are essential of
• Vitamin C is essential for the formation
health, and each one has its own function in
and maintenance of intercellular cement
the body and due to its solubility in water. It is
substances such as bone matrix, cartilage
normally easily lost in urine. The water soluble
dentine, collagen, connective tissue, etc.
vitamins include vitamin C and 8 B complex
• Vitamin C is needed for healthy gums and
vitamins – thiamine, riboflavin, niacin,
to protect against infection.
pyridoxine, folate, cyanocobalamin, biotin and
pantothenic acid. Most of these are unstable Food sources
and thus easily destroyed by exposure to water, Good sources of vitamin C are green
heat, air or light. leafy vegetables, berries, citrus fruits, guavas,
tomatoes, melons, papayas, etc.
Vitamin C
Many fruits and vegetables are rich in Deficiency
vitamin C, also known as ascorbic acid. To In infants and children, vitamin C
ensure optimal physiological functioning and deficiency results in defective bone formation
to prevent subclinical deficiencies, a person leading to retardation of growth.
needs to consume a good source of vitamin
C every day because the body normally stores B – complex vitamins
only small amounts of Vitamin C. The eight B – complex vitamins include
thiamine (B1), riboflavin (B2), niacin (B3),
pyridoxine (B6), cyanocobalamin (B12), folic
acid, biotin (B7), and pantothenic acid. The B
vitamins are easily lost in cooking water because
they are water soluble. With the exception of
niacin, all other B vitamins lose some activity
when exposed to heat, oxygen, light, or alkaline
conditions.
Thiamine (Vitamin B1)

Thiamine also called B1 is used in many
Sources of Vitamin C different body functions and deficiencies may
have far reaching effects on the body, yet very
Functions little of this vitamin is stored in the body and
• Vitamin C is required in the synthesis depletion of this vitamin can happen within
of collagen in connective tissue, steroid 14 days. Thiamine is integrally involved as a
hormones, carnitine, etc. coenzyme in the catabolism of carbohydrates to
• Vitamin C is required for the conversion of yield energy.
cholesterol to bile acids.
Functions
• It enhances iron bioavailability.
• Ascorbic acid is a great antioxidant • It is also required for the health of the
and helps to protect the body against nervous system.
pollutants. • It is used in the manufacture of
hydrochloric acid, and therefore plays a
part in digestion.
124

• In children it is required for good appetite also available in good quantities in green leafy
and proper growth. vegetables, fish, legumes, whole grains, and
yogurt.
Food sources
Deficiency
A dietary deficiency of riboflavin leads to
ariboflavinosis.
Niacin (B3)
Niacin also called nicotinic acid or niacin
amide and can be manufactured by body. Niacin
is derived from two compounds – nicotinic acid
and niacin amide.
Sources of Vitamin B
Functions
Sunflower seeds, peanuts, wheat bran, beet
liver, pork, seafood, egg – yolk, beans whole • Niacin functions as a coenzyme in nearly
grains and yeast contain good amounts of all the metabolic pathways yielding energy
thiamine. from carbohydrates, fats, proteins, and
alcohol.
Deficiency • Niacin also plays a role in tissue
Beriberi occurs in two forms, wet beriberi respiration.
and dry beriberi, whose prominent symptoms • It is involved in the synthesis and
differ. breakdown of fats, and helps to maintain
healthy skin.
Riboflavin – (Vitamin B2)
Riboflavin is another B – complex vitamin Food sources
involved as a coenzyme in the metabolism of Liver, lean meat, fish, nuts, cereals, legumes,
carbohydrates, as well as of fats and proteins. asparagus, milk, green leafy vegetables and fish.
The adult RDA for riboflavin has been A cup of coffee also provides 3 milligrams of
established at a minimum of 1.2 milligrams niacin.
per day.
Deficiency
Functions
A deficiency of niacin is known as
• It is required by the body to use oxygen pellagra, which means rough skin (from the
and the metabolism of amino acids, fatty Italian words pelle for skin and Agra for
acids, and carbohydrates. rough).
• It is a used for red blood cell formation,
antibody production, cell respiration, and Pyridoxine (Vitamin B6)
growth. Pyridoxine is part of the B group vitamins
• It may be helpful in the prevention and and is water – soluble and is required for both
treatment of cataracts. mental and physical health.
Food sources Functions
Organ meats, nuts, cheese, eggs, milk and • Pyridoxine is required for the balancing of
lean meat are best sources of riboflavin. It is hormonal changes in women.
125

• It is essential for the metabolism and fruit, starchy vegetables, beans, whole grains,
proteins, fats and carbohydrates. liver, kidney, egg, yeast etc.
• It assists in the maintenance of serum level
Deficiency
of sodium and potassium
A deficiency of folate can lead to
• It helps to promote red blood cell
macrocytic, megaloblastic anemia, diarrhea,
production.
fatigue, depression, and mental confusion.
• It is linked to cancer immunity and
fights the formation of the toxic chemical Cyanocobalamin (Vitamin B12)
homocysteine. Cyanocobalamin also known as cobalamin
is referred to as the energy vitamin. It is a
Food sources
very widely researched vitamin, and used in
Good sources to obtain pyridoxine are supplementation to a very large degree.
brewer’s yeast, egg, chicken, carrot, fish, liver,
kidney, pea, wheat germ and walnuts. Roots Functions
and tubers, cabbage, legumes, molasses, whole • Cobalamin is required in the metabolism
grains, etc., contain moderate amount of this of fats, proteins and carbohydrates.
vitamin. • It is needed in the manufacture of red
blood cells and the maintenance of red
Deficiency blood cells.
Irritability, nervousness, insomnia, • It stimulates appetite and Promotes
anemia, general weakness, skin changes such as growth.
dermatitis.
Food sources
Folic acid (Vitamin B9) – folic acid, folacin, Liver, organ meat, muscle meat, shellfish,
folate egg, cheese and fish are rich sources of this
Folic acid is also referred to as folacin or vitamin. It can be manufactured in the body.
folate. Its chemical name is pteroylglutamic Milk contains vitamin B12 however processing
acid. This vitamin can be produced by the of milk may destroy the vitamin.
body and be stored in the liver.
Deficiency
Functions Vitamin B12 deficiency results in
• Folic acid is required for DNA synthesis macrocytic, megaloblastic anemia (pernicious
and cell growth and is important for red anemia) similar to that occurring with folate
blood cell formation, energy production deficiency.
as well as the forming of amino acids.
Biotin (Vitamin B7)
• Folic acid is essential for synthesizing
heme, the iron containing substance in Biotin is also referred to as anti – egg white
hemoglobin, crucial for oxygen transport. injury factor.
Folic acid is very important in the Biotin present in foods in not affected by
development of the nervous system of a exposure to light. Biotin is also produced by
developing fetus. bacteria in the intestine.
Food sources Function

Fresh green vegetable such as spinach and • Biotin is involved in carbohydrate and lipid
broccoli contains folic acid. It is also found in metabolism.
126

• Biotin is also indicated for healthy hair and lack of appetite, constipation, and tingling
skin, healthy sweat glands, nerve tissue, and numbness in both the feet and hands.
and bone marrow.
• Biotin is also helps in maintaining a steady 5.9 Minerals
blood sugar level.
The essential minerals are classified
Food sources according to their recommended intake.
Biotin is widely distributed in both animal Macro minerals, also called major minerals,
and plant foods. Liver, kidney, egg, yolk, milk, are needed in amounts greater than 100
tomatoes are rich sources. milligrams per day. Micro minerals, also
called trace minerals or trace elements, are
Deficiency
needed in less than 100 milligrams per day.
Dietary deficiency of biotin is rare.
Symptoms of biotin deficiency include lack of Table: 10 Classification of essential minerals
appetite, nausea, an enlarged tongue, mental Macro minerals Micro minerals
depression, pallor, loss of hair. (> 100 mg/day)* (<100 mg/day)*
Calcium Iron
Pantothenic acid (vitamin B6)
Phosphorus Zinc
Pantothenic acid referred to as the “anti –
Magnesium Copper
stress vitamin” is part of the B group vitamins.
Sulfur Iodine
This vitamin can be produced in the body by
Sodium* Fluoride
the intestinal flora.
Potassium* Manganese
Functions Chloride* Selenium
• Pantothenic acid plays an important role Chromium
in the secretion of hormones, such as Molybdenum
cortisone because of the role it plays in *Recommended intakes are greater or lesser
supporting the adrenal gland. than 100mg per day, as indicated.
• Pantothenic acid is also used in the release
of energy as well as the metabolism of fat, Macro minerals
protein and carbohydrates. There are seven macro minerals; calcium,
• It is used in the synthesis of lipids, phosphorus, magnesium, sulfur, sodium,
neurotransmitters and haemoglobin. potassium, and chloride. As well as being
Food sources needed in amounts greater than 100 milligrams
Beef, brewer’s yeast, egg, fresh vegetables, per day, each of the macro minerals makes up
kidney, legumes, liver, mushrooms, nuts, more than 0.01% of the body’s weight.
pork, royal jelly, saltwater fish, torula yeast,
Calcium
whole rye flour, and whole wheat contain this
vitamin. Calcium is by far the most prevalent
mineral in the body. About 98% of the 1200
Deficiency grams (2.5 pounds) of calcium in the average
Symptoms of a pantothenic acid adult body is found in the bones. Small
deficiency though rare, may occur in severely amounts of calcium (1%) are also found in
malnourished individuals and include fatigue, the extracellular fluid, certain intracellular
irritability, low blood pressure upon standing, structures, and cell membranes.
127

Function Deficiency
• Calcium is one of the minerals needed for A phosphorus deficiency is characterized
the growth and strength of the bones. by weakness, lack of appetite, fatigue and
• Calcium is needed for muscle contraction muscle pain.
• Calcium ions are essential for blood
clotting. Magnesium
• Calcium is needed for the functioning of About 60% of the body’s magnesium is
neuro transmitters. contained in the bones; most of the remaining
magnesium is present in the muscles and
Food sources other tissues, with about 1% circulating
Milk and milk products are among the best extracellular fluids.
sources of calcium, other sources of calcium
includes leafy greens, firm tofu, and small fish Function
with bones, such as sardines. • The activity of hundreds of enzymes
depends on magnesium
Deficiency
• Magnesium also helps maintain calcium
A severe deficiency of calcium leads to the and potassium homeostasis.
condition hypocalcemia resulting in rickets in
children and osteomalacia in adults. Food sources
Nuts, legumes, dark green leafy vegetables,
Phosphorus
soya beans and milk are good sources.
Approximately 85% of the 700 grams of
phosphorus in the adult body is present in the Deficiency
bones. The ratio of calcium to phosphorus in Symptoms of magnesium deficiency
the bones is 2: 1. After calcium, phosphorus is include weakness, confusion, lack of appetite,
the second most common mineral in the body nausea, and lack of coordination.
by weight.
Sulfur
Function
Because sulfur is part of the essential
• Phosphorus is involved in a variety of amino acid methionine and the nonessential
chemical reactions in the body, many of amino acid cysteine, it is present in the body’s
which are related to energy metabolism. proteins. Interactions among sulfur atoms
• Mineralization of bones and teeth in cysteine helps to give proteins their three
• Facilitation of energy transaction dimensional shape.
• Absorption and transport of nutrients
The Electrolytes
• Regulation of protein activity
Three of the macrominerals – Sodium,
• Component of essential body compounds. potassium and chloride are the body’s main
electrolytes. The major function of the electrolytes
Food sources
is to maintain the proper distribution of water
In general, good sources of protein are inside and outside cells. If this water balance is
also good sources of phosphorus. Meat, not maintained, cells will shrink or swell beyond
poultry, fish and eggs are rich in phosphorus. their normal size. Sodium and chloride are
Milk and milk products, nuts, legumes, found in the extracellular fluid; potassium is
cereals and grams are good sources. found in the intracellular Fluid (ICF).
128

Sodium Food sources
Sodium is the principal cation of This mineral is widely distributed in
extracellular fluid. Human body has foods, but fruits and vegetables are generally
approximately 1.8 g of sodium per kilogram of the most nutrient – dense sources of
body weight. The body regulates the sodium potassium.
concentration in the extracellular fluid within
narrow limits. Deficiency
As with sodium, deficiencies of potassium
Function are usually caused by excessive losses, not low
In addition to its role in maintaining the intakes. Losses occur primarily via the urine;
body’s water balance, sodium functions in lesser amounts are lost in sweat. Excessive
maintaining extracellular fluid volume and in potassium losses via the kidneys may result
regulating the body’s acid – base balance. from use of potassium – depleting diuretics,
which are often prescribed to treat high blood
Food sources pressure. High levels of activity in hot, humid
The major dietary source of sodium is climates may lead to excessive potassium
sodium chloride, more commonly called table losses via perspiration. Much potassium can
salt. One teaspoon of table salt supplies 2132 also be lost through long-term vomiting or
milligrams of sodium. prolonged diarrhea.
Symptoms of a potassium deficiency
Deficiency
include weakness, loss of appetite, nausea,
Excessive sodium loss, not a low dietary
listlessness, apprehension, fatigue, irrational
intake; is the usual cause of sodium deficiency.
behavior, muscle weakness, and muscle
Trauma, long – term diarrhea, vomiting and
cramping. A severe deficiency may cause an
kidney disease may also lead to excessive
abnormal heartbeat and possibly death.
sodium losses.
A sodium deficiency, with fluid levels Chloride
remaining constant or increasing, leads The electrolyte chloride is found
to a decrease in the extracellular sodium primarily in the extracellular fluid.
concentration. As a result, water migrates
into cells, leading to water intoxication. Water Functions
intoxication causes loss of appetite, muscle • Chloride’s major functions are
twitching, mental apathy, coma, and seizures. maintaining the body’s water and
electrolyte balance.
Potassium
• Chloride is mainly a component of
The electrolyte potassium is found mainly hydrochloric acid, which is secreted in
in the intracellular fluid the stomach and helps in the digestion of
protein.
Functions
• The main function of potassium, like Food sources
sodium, is to maintain water balance. The main dietary sources of chloride is
• Potassium is required for maintaining a sodium chloride, that is, table salt. Chloride
normal heartbeat. is also found in many processed food that
contain added salt.
129

Deficiency Particularly high needs for zinc occur
As with the other two electrolytes, during growth and development.
chloride deficiency rarely results from poor
Food sources
dietary intake. Rather, chloride deficiencies
are typically caused by excessive losses due Meat, fish, eggs, milk and nuts are rich
to diarrhea or vomiting, heavy perspiration, sources.
trauma, or kidney disease.
Deficiency
Micro minerals A zinc deficiency impairs protein
synthesis, collagen formation, and energy
We require intakes of the essential trace production; it also decreases alcohol
minerals, or micro minerals, in amounts of tolerance.
less than 100 milligrams per day. The essential
trace minerals are iron, zinc, copper, iodine, Copper
manganese, fluoride, chromium, selenium, The trace mineral copper is required for
and molybdenum. proper use of iron by the body and for the
activity of certain enzymes. This trace mineral
Iron
also aids in the production of connective tissue,
About 30% of the iron in the body is stored blood vessels, phospholipids, and melanin (a
in the spleen, liver, and bone marrow. Iron is skin pigment).
a constituent of haemoglobin and myoglobin,
which are iron-binding proteins found in Food sources
red blood cells and muscle, respectively. Iron The main dietary sources of copper are
also function as a cofactor for a number of shellfish, whole grains, legumes, and nuts.
enzymes and is required for their activity.
Deficiency
Deficiency
Symptoms include decreased blood levels
Iron deficiency develops in stages; the of copper, fewer white blood cells, anemia,
last stage is iron-deficiency anemia. bone demineralization, deterioration of the
nervous system.
Zinc
Most zinc in the body is found in the bones Iodine
and muscles. This trace mineral is necessary The micro mineral iodine is a necessary
for optimal activity of many enzymes and component of two hormones produced
for various bodily processes, including the by the thyroid gland (thyroxine and
following: triiodothyronine). These thyroid hormones
• Protein metabolism, wound healing, and are critical in regulating the body’s metabolic
growth rate.
• Metabolism of DNA, the genetic material
Food sources
• Development of sexual organs and bones
The amount of iodine present in a
• Immune responses
particular food depends on the amount of
• Memory formation iodine in the environment in which that
• Alcohol metabolism food was raised. Therefore, food from the sea
lobsters, oysters, sardines etc.
130

Deficiency selenium has an effect similar to that of the
A prolonged deficiency of iodine causes antioxidant vitamin E.
enlargement of the thyroid gland, known as
Food sources
goiter.
Selenium is widely distributed in both
Fluoride animals and plant foods.
Although some scientists have doubted
that fluoride is an essential nutrient for Deficiency
humans, this trace mineral is currently Deficiency resulting from low dietary
considered essential. The main function of intake is unlikely because of its wide distribution
fluoride is to harden the bones and teeth. in animals and plant foods.
Food sources Chromium

The only good dietary sources of fluoride The trace mineral chromium is involved in
are fluoridated water, seafood, seaweed, and the normal use of glucose and blood lipids and
tea. Some natural water sources are also high in in the functioning of insulin. The active form
fluoride. of chromium in the body is called the Glucose
Tolerance Factor (GTF).
Deficiency
Deficiency of fluoride results in the Molybdenum
development of dental caries. Molybdenum is required for several
Manganese enzyme systems in the body. One of these
enzyme systems involved in the formation
The trace mineral manganese is required
of uric acid, a waste product of protein
for normal brain function. This micro
metabolism is excreted in the urine.
mineral also aids in the synthesis of collagen,
urea, fatty acids, and cholesterol. Manganese Food sources
is involved in bone growth and is required for
The molybdenum of plant foods depends
the digestion of protein.
on the type of soil in which they are grown.
Food sources (Neutral or alkaline soil).
Manganese is present in many vegetable Deficiency
foods, and our diets supply plenty to meet the
Molybdenum deficiency has not been
requirement, which is minimal.
observed in human beings or any other
Deficiency species.
For the above reason, deficiency of this
Ultra trace mineral
trace mineral has not been observed in humans,
although it can be induced in experimental Seven minerals present in foods and in
animals. human bodies have been found to be essential
nutrients for animals and may be essential for
Selenium humans, but nutritional requirements for them
The best understood role of the micro have not yet been clearly defined. This group of
mineral selenium is its involvement in an minerals sometimes called ultra-trace minerals,
enzyme system that helps to protect cell includes arsenic, boron, cobalt, nickel, silicon,
membranes against oxidative damage. Thus tin, and vanadium.
131

Table 11: Functions and dietary sources of ultra-trace minerals
Mineral Essential for Functions Good dietary sources
Arsenic Animals Aids normal growth and use of iron; needed Fruits, vegetables, fish,
possibly humans for conversion of methionine to cysteine. shellfish, grains
Boron Plants Possibly Affects use of calcium, magnesium and Noncitrus fruits, leafy
animals Possiblycopper and protein metabolism; involved greens, nuts, legumes,
humans in composition of kidney and brain; may cider, wine, beer.
be needed for membrane function; may
help prevent loss of calcium from bone in
postmenopausal women.
Cobalt Animals Is part of vitamin B12, which is necessary for Liver and red meat.
Possibly humans production of normal red blood cells.
Nickel Chickens, rats, Involved in iron absorption, use of calcium, Nuts, legumes, whole
pigs, and goats zinc, and vitamin B12, and metabolism of grains.
possibly humans genetic material (DNA)
Silicon Animals Probable required for deposition of minerals, Whole grains,
possibly humans especially calcium, in bones; needed for cereal products,
synthesis of collagen and elastin, major root vegetables (e.g.
proteins in connective tissue. potatoes, carrots)
Tin Rates Is necessary for normal growth Commercial fats
Vanadium Experimental Probably involved in iodine and glucose Whole grains and
animals metabolism and thyroid function grain products; meat,
poultry, and fish
(moderate levels)
2. The tolerance of fats varies in different

5.10 Therapeutic Diets
individuals and this nutrient should not
be forced if there is nausea and vomiting.
Modification of nutrients in therapeutic
Diets 3. In illness, there is usually an increased
demand for proteins, due to wasting
The general principles of nutrition
and this should be given in easily
related to health apply also to the treatment
digestible forms such as milk, egg,
of patients suffering from various diseases.
chicken and fish.
Diet in disease must be planned as part
of the complete care of the patient many 4. The requirements of calcium and iron
modifications may have to be made according must be maintained during illness and it is
to the disease and the condition of the patient, necessary to check.
but there are certain general principles which 5. Fat – soluble vitamins often need to be
may be used for guidance. added as concentrates if a patient has to
be on a fat – restricted diet for a long time.
Principle of Therapeutic Diets The demand for Vitamin C is greatly
1. Carbohydrates are usually well – tolerated increased in fevers, and it is especially
and are necessary to maintain the stores of necessary for the healing of wound after
liver glycogen. surgery.
132

6. Roughage: Excessive bulk hinders the 3,000 ml must be given in 24 hours with
penetration of the digestive juice, but it as much variety as possible, both in
may be necessary to include foods with appearance and in taste.
a moderately high residue content to
produce daily bowel action. Diabetes mellitus
7. Fluids are very important to prevent Diabetes mellitus is a condition in
dehydration which is common in which the secretion of insulin by the islets
conditions of fevers, diarrhea and of Langerhans in the pancreas is deficient or
vomiting. In such condition 2,500 – absent. It is characterized by hyperglycemia,
Table 12: Diabetes Mellitus Table 13: Daily menu for high blood pressure
Vegetarian Non – vegetarian Vegetarian Non – vegetarian
Morning Morning
Tea or coffee (without Tea or coffee (without Weak tea – 1 cup Weak tea – 1 cup
sugar) sugar) Breakfast
Breakfast Bread or corn flakes Bread or corn flakes
Corn flakes with milk Corn flakes with milk with skin milk or with skin milk or
Cheese Boiled egg idly – 1 serving idly – 1 serving
Toast with butter Toast with butter (with sugar and jam) (with sugar and jam)
Tea or coffee Tea or coffee (without salt) (without salt)
Mid – morning Fruits – 1 serving Fruits – 1 serving
Tea or coffee (without Tea or coffee (without Weak tea – 1 cup Weak tea – 1 cup
sugar) sugar)
Mid – morning
Lunch
Fruit juice – 1 glass Fruit juice – 1 glass
Cooked rice or Cooked rice or
Lunch
chapatti or bread chapatti or bread
Cooked rice or Cooked rice or
Cooked soup Cooked dal
chapatti – 1 serving chapatti – 1 serving
Vegetable soup Mutton or fish curry
Cooked dal – half Meat or fish curry –
Pappad Pappad
cup half
Curds Curds
Curds – 2 cups Curd – 1 cup
Roasted groundnut Roasted groundnut
Cooked vegetables Cooked vegetables
or cashewnut or cashew nut
and potato – 1 and potato – 1
Fruit (half apple or Fruit (half apple or
serving serving
one slice of papaya or one slice of papaya or
mango) mango) Fruits – 1 serving Fruits – 1 serving
Tea Skimmed milk Skimmed milk
Salt biscuits Salt biscuits pudding – 1 cup pudding – 1 cup
Roasted nuts Roasted nuts Evening
Tea or coffee (without Tea or coffee (without Biscuits – 2 Biscuits – 2
sugar) sugar Fruit juice – 1 glass Fruit juice – 1 glass
Dinner Dinner
Similar to Lunch Similar to Lunch
133

and glycosuria accompanied by polyuria, Calories – 1800 – 2000 Kcal; Fat (rich in
polydipsia, polyphagia, and if untreated for a essential fatty acids) – 60 gm; Proteins – 50 –
long time by loss of weight. 60 gm
Note: one multivitamin tablet providing
Hypertension the daily requirements of all essential vitamins
Hypertension develops due to some should be given daily.
reason, there is increased resistance to the
Table 15: Daily menu for coronary heart
normal circulation of blood. This may be
disease
temporary, as the result of exercise, pregnancy,
or menopause; it may be permanent, Vegetarian Non – vegetarian
associated with atherosclerosis, cardiac Morning
failure or chronic kidney disease. Weak tea Weak tea
Breakfast
Notes Corn flakes with Corn flakes with
1. Salt should not be added in cooking skimme milk or skimmed milk or
2. One multivitamin tablet providing the bread of idly – 1 bread or idly – 1
daily requirements of all essential vitamins serving serving
should be included along with the diet Cheese – 2 slices Cheese – 2 slice
Fruits – 1 serving Fruits – 1 serving
3. Strong coffee is not permitted.
Weak tea – 1 cup Weak tea – 1 cup
Table 14: Daily menu for Hypertension Lunch
Non – Cooked rice or Cooked rice or
Food stuffs Vegetarian chapatti – 1 serving chapatti – 1 serving
vegetarian
Milled cereals 200 200 Dal soup – 1 cup Mutton soup – 1 cup
Skin mil (fluid) 1000 1000 Cooked vegetables – Mutton or fish curry
Pulses 60 40 1 serving – 1 serving
Cheese – 2 slices Curds – 1 cup
Cheese 60 20
Curds – 2 cups Fruits – 1 serving
Meat or fish - 20
Fruits – 1 serving Skimmed milk
Leafy vegetables 100 100
Skimmed milk pudding – half cup
Other vegetables 100 100
pudding – half cup
Fruits 300 300
Tea
Vegetable oils (sesame 60 60
Biscuits – 2 Biscuits – 2
or safflower or
Fruits – 1 serving Fruits – 1 serving
sunflower seed oil)
Weak tea – 1 cup Weak tea – 1 cup
Sugar and jam 40 40
Dinner
Coronary Heart Diseases Similar to Lunch
A majority of coronary heart diseases
are due to coronary antheroma (A fatty Chronic Renal Failure
deposit in the inner lining of an artery) and Chronic Renal Failure occurs
atherosclerosis, are used to denote conditions in glomerulonephritis, and chronic
in which lipid is deposited in the intima of the pyelonephritis. In this condition, the
blood vessels. glomeruli and tubules are heavily damaged.
134

Diet Peptic Ulcer
The diet in chronic uratemia (presence of Chronic ulcer formed in the region of
abnormal of uric acid salts in the blood) should the gastrointestinal tract where the gastric
be below in protein depending on the urea juice comes in direct contact with the mucous
content of blood. The pattern of diet and the membrane is known as peptic ulcer. Such ulcers
daily menu for an adult suffering from chronic usually occur in the duodenum (duodenal
renal failure are given in Tables 16 and 17. ulcer) and in the stomach (gastric ulcer).
Duodenal ulcer is associated with hyperacidity
Table: 16 Diet for an adult suffering from
while gastric ulcer is not.
chronic renal failure
(Calories 1500 – 2000 Kcal; Proteins 15 – Diet in Peptic Ulcer
20 gm; Fat 40 – 50 gm, Carbohydrates 300 – 40 The diet is the most important factor in the
gm; Salt free) treatment of peptic ulcer. Three main types of
diets have been used in the treatment of peptic
Foodstuffs gm/caput/day
ulcer.
Cereals 200
Vegetables (potato, carrot) 100 Table 18: Types of therapeutic diet for peptic
Milk 200 ulcer
Egg 30 Name of Diet Ingredients
Butter and vegetable fats 40 – 50 Sippy’s diet and
Hourly feeds of milk, cream
Sugar 50 its modification
and olive oil with antacid
Glucose 200 by Hurst medication
Fruit juice 1000 ml Lenhartz dietFluid diet based on milk
and eggs
Table 17: Daily menu for chronic renal Meulengracht A mixed bland diet
failure diet containing milk, egg, meat
Morning Fruit juice with glucose – 1 glass and fish (Minced and
strained) given once in 2
Breakfast Bread – 2 slice
hours.
Butter – 2 teaspoons
Jam – 2 teaspoons Sippy’s diet consisting of milk and olive
Fruit juice with glucose – 1 glass oil was used widely. Since it is monotonous
Lunch Cooked rice or bread – 1 serving and not adequate to meet the calorie needs, it
Butter or ghee – 2 teaspoons has been replaced by a bland diet containing
Potato and carrot curry – 1 serving large quantities of milk.
Curds – 1cup
Fruit juice with glucose – 1 glass Table 19: Diet for adult suffering from peptic
Tea Biscuits – 3 ulcer (gm/caput/day)
Butter – 1 teaspoon
Non –
Fruit juice with glucose – 1 glass Foodstuffs Vegetarian
vegetarian
Dinner Similar to Lunch
Milled rice and
Note: Common salt should not be added during or refined wheat flour, 200 200
after cooking. One multivitamin tablet providing or bread and biscuit
the daily requirements should be taken
135

Dal (decuticled split 2 pm
50 50
legumes) Milk – 1 cup Milk – 1 cup
Milk 1800 1500 4 pm
Biscuits – 2 Biscuits – 2
Cheese 50 -
Milk (with sugar) – 1 Milk (with sugar) – 1
Eggs - 30 cup cup
Meat or lean fish - 60 6 pm
Milk (with sugar) – 2 Milk (with sugar) – 2
Fats and oils (2/3 as
cups cups
vegetable oils rich in 60 60
essential fatty acids) 8 pm (Dinner)
Same as Lunch Same as Lunch
Sugar 60 60
10 pm
Tender vegetables 50 50
Milk – 1 cup Milk – 1 cup
Potato 50 50
Fleshy fruits (banana, Table 21: Foods permitted and not permitted
100 100 in peptic ulcer
apple and mango)
Permitted Not permitted
Note: One vitamin C tablet (100mg) may 1. Milled cereals 1. Whole cereals and
be taken once daily. (milled rice, whole millets
Table 20 refined wheat 2. Legumes with husk
flour and (Bengal gram, field
Vegetarian Non – vegetarian
semolina) bean, cow gram, dried
Morning 6 am 2. Dal (decuticled pea, etc.).
Milk – 2 cups (with 2 Milk – 2 cups (with 2 split legumes) 3. Vegetables containing
teaspoon sugar) teaspoon sugar) 3. Milk fiber, raw onions,
4. Eggs garlic, etc.
Breakfast 8 am
5. Tender 4. Spices and condiments
Breads – 2 slices Breads – 2 slices
vegetables free and pickles
Butter – 2 teaspoons Butter – 2 teaspoons
from fiber 5. Meat soups and
Cheese – 2 slices Boiled egg – one
6. Meat and fish in extractives
Milk – 1 cup Milk – 1 cup
limited amounts 6. Fried foods
10 am 7. Fruits without 7. Alcohol and alcoholic
Milk – 2 cups (with Milk – 2 cups (with fiber drinks
sugar) sugar) 8. Fats and oils 8. Chewing betel leaves,
12 noon (Lunch) 9. Sugar arecanut and tobacco
Cooked rice or bread Cooked rice or bread
– 1 serving – 1 serving
5.11 Adulteration of Food Additives
Smashed dal – 1 cup Smashed dal – 1 cup
Cheese – 2 slices Cooked minced meat Food additives are defined as non-
Boiled potato – 2 – 1 serving nutritious substances which are added
Milk pudding – 1 cup Boiled potato – two intentionally to food generally in small
Milk pudding – 1 cup
136

quantity, to improve its appearance, flavor, Adulteration of Food
texture or storage properties.
Adulteration of food is
Food additives may be classified into an age – old problem. It is
two categories. Additives of the first category done through a large number
includes: of practices:
• Coloring agents, e.g. saffron, turmeric • Mixing
• Flavoring agents, e.g. vanilla essence • Substitution
• Sweeteners, e.g.saccharin • Abstraction
• Preservatives, e.g.ascorbic acid, sodium • Concealing the quality
benzoate • Putting up decomposed foods for sale
• Misbranding or
• Acidity imparting agents, e.g. citric acid,
• Giving false labels and
acetic acid, etc.
• Addition of toxicants.
These agents are generally considered Food adulteration practices vary from one
safe for human consumption. Additives part of the country to another, and from time
of the “Second category” are, strictly to time.
speaking, contaminants incidental through
The types of adulteration commonly found
packing, processing steps, farming practices
in India are as follows:
(insecticides) or other environmental
conditions. 1. Milk: Addition of water, removal of fat
and addition of starch to make the milk
Uncontrolled or indiscriminate use
thicker are the common forms of milk
of food additives may pose health hazards
adulteration.
among consumers. For example, certain
2. Ghee: This is adulterated with dalda and
preservatives such as nitrites and nitrates can
animal fats such as pig’s fat.
lead to the production of toxic substance, e.g.
3. Rice and wheat: These are mixed with stone
nitrosamines that have been implicated in
chips and mud to increase the bulk
cancer etiology.
4. Flour: Wheat flour is mixed with soap stone
powder and cheaper flours such as singhada
Food Fortification
flour.
Fortification of food is a public health 5. Pulses: Chemical substances are added to
measure aimed at reinforcing the usual dietary old stocks to improve the appearance.
intake of nutrients with additional supplies to 6. Tea and coffee: Tea leaves are adulterated
prevent / control some nutritional disorders. with old tea leaves; leather and saw dust,
WHO has defined “Food fortification” coffee is adulterated with chicory
as the process whereby nutrients are added 7. Honey: This is adulterated with sugar or
to foods (in relatively small quantities) to jaggery and boiled with empty beehives.
maintain or improve the quality of the diet of 8. Medicines: Even drugs are adulterated.
a group, a community or a population.” For
example, he prevention of Food
T
1. Foods artificially fortified with vitamin ‘D’ Adulteration Act 1954
e.g. milk, margarine, Vanaspati and infant Any food that does not confirm to the
foods. minimum standards is said to adulterated
2. Foods fortified with vitamin ‘A’ e.g. standards. Provisions have been laid down
margarine, milk, Vanaspati. under this Act for various foods.
137

In 1954, the Government of India enacted established which are revised from time to
a Central Prevention of Food Adulteration time by the “Central Committee for Food
Act. The act has been amended several times, standards”.
the latest amendment is that of 1976 and in The purpose of PFA standards is to obtain
lately in 1986 to make the Act more stringent. a minimum level of quality of foodstuffs
Although it is a Central Act, its attainable under India conditions.
implementation is largely carried out by the
local bodies and State Governments. The Agmark Standards
These standards are set by the
Food Standards Directorate of Marketing and Inspection of
FAO/WHO formulates food standards for the Government of India.
international market. Codex Alimentarius
commission which is the principal organ Bureau of India Standards
of the joint FAO/ WHO food standards The ISI mark on any article of
programme. The standards in India are based food is a guarantee of food quality in
on the standards of the Codex Alimentarius. accordance with the standards prescribed by
the Bureau of Indian Standards (BIS) for that
PFA Standards commodity.
Under the Prevention of Food
Adulteration Act, 1954 standards have been
SUMMARY
Nutrition is the science of food and its relationship to health. It is concerned with the part
played by nutrients in body growth, development and maintenance.
Good nutrition is essential for attainment of normal growth and development during fetal
life and childhood. Physical growth, intellectual development, learning and behavior are
affected by malnutrition.
Adequate nutrition is needed for adult life maintenance for optimum health and efficiency.
Carbohydrates are the main source of energy for daily activities. Carbohydrates (primarily
starches) are the least expensive, the most plentifully available, easily obtainable and readily
digested form of nutrient.
The lipids are a heterogeneous group of substances found in plant and animal tissues, which
share the property of being relatively insoluble in water, and soluble in organic solvents,
such as ether, chloroform and benzene.
Proteins are polymer chains made of amino acids linked together by peptide bonds. Amino
acids can be divided into essential amino acids and non – essential amino acids. Proteins
and carbohydrates contain 4 kcal per gram as opposed to lipids which contain 9 kcal per
gram of energy.
Vitamins are essential organic, compounds that are needed in small amounts in the diet
both to prevent deficiency diseases and to support optimal health. The term vitamin (vital
amines) was coined by Casmir Funk. The term vital denoting essential for life and amines
because these compounds contained an amine functional group.
The four fat – soluble vitamins – vitamins A, D, E and K are often present in the fat portion of
foods, they are not easily lost from foods or destroyed by exposure to water, heat, air, or light.
138

The water soluble vitamins include vitamin C and B complex vitamins – thiamine, riboflavin,
niacin, pyridoxine, folate, cyanocobalamin, biotin and pantothenic acid. Most of these are
unstable and thus easily destroyed by exposure to water, heat, air or light.
WHO has defined “Food fortification” as the process whereby nutrients are added to foods
(in relatively small quantities) to maintain or improve the quality of the diet of a group, a
community or a population.
GLOSSARY
1. Assimilates - தன்மயமாக்கு To absorb into the system / absorb

2. Organic - கரிம Derived from living matter
3. Inorganic - கனிம Not derived from living matter
4. Resistance - எதிர்ப்பு The refusal to accept
- The chemical processes that occur within a
5. Metabolism வளர்சிதை மாற்றம்
living organism in order to maintain life
6. Heteragenous - பலவகைப்பட்ட Diverse in character / content
- Type of chemical substance artificially
7. Steroid ஊக்க மருந்து
introduced to improve strength
8. Bruising - சிராய்ப்பு a brown or purple mark on your skin
Sedantary - உடல் உழைப்பு very limited amount of physical activity
9.
work தேவைப்படாத
10. Pigment - நிறமி The natural colouring matter
11. Flaking - செதில் செதிலாக To come off a surface in small, thin pieces
- க�ொஞ்சம் க�ொஞ்சமாக decline / to fall below a normal
12. Degenarating
சீரழிந்த
- proteins that speeds up the rate of a
13. enzyme ந�ொதிகள்
chemical reaction in a living oraganism
- abnormal enlargement of thyroid gland
முன்கழுத்துக் கழலை
14. Goiter result from under or over production of
ந�ோய்
hormone due to deficiency of iodine
- addition of nutrients to foods irrespective
வலுவூட்டல் /
15. Fortification of whether or not the nutrients were
ஊட்டமேற்றுதல்
orginally present in the food
- The act of making food by adding
16. Adulteration கலப்படம்
something to them
- சேர்க்கைப்
17. Additives
ப�ொருட்கள்
- In living organisms synthesis of more
18. Anabolism வளர்சிதை மாற்றம்
complex substances from simpler ones
19. Lactation - பாலூட்டும் The action of sucking of milk by an infant
- a mixture of flour, fat and water which is
20. Pastries மாவுப்பண்டம்/கேக் used as base or covering for other foods
baked
139

Evaluation
I. Choose the best answer. 10. Anti stress vitamin is ____________.

1. Proteins, Carbohydrates and fats are e.g. of a) Pantothenic acid
a) Micro Nutrients b) Biotin
b) Macro Nutrients c) Miacin
c) Protective food d) Cyanocobalamin
d) Diets II. Short Answer.
2. Pick the odd one out classification of 11. Brief on Malnutrition.
nutrients is based on
12. Define Hypertension
a) Body building b) Energy giver
13. Tabulates the food permitted and to be
c) Protective food d) Healthy food
avoided in peptic ulcer.
3. Find the water soluble vitamin 14. Give two examples of flavouring agents.
a) Vitamin A b) Vitamin B 15. What is “food fortification”?
c) Vitamin C d) Vitamin D
16. What are the functions of vitamins?
4. This Vitamin plays the role in the synthesis 17. Note on Calciferol.
of rhodopsin.
18. Note on Vitamin B1.
a) Vitamin B b) Vitamin A
19. What are the food sources rich in Vitamin
c) Vitamin D d) Vitamin K
B6?
5. Varicose vein inflamation occurs due to
deficiency of the following Vitamin III. Brief Answers.
a) Vitamin K b) Vitamin E 20. What are the factors affecting food and
c) Vitamin D d) Vitamin B nutrition?
6. Which Vitamin is responsible for nervous 21. What are the major food groups given by
system development of a fetus ICMR?
a) Folic acid b) Niacine 22. Note on functions of Carbohydrate.
c) Pyridoxine d) Cyanocobalamin 23. What is glycolysis?
7. Each gram of carbohydrates yield ______ 24. What are the functions of Riboflavin?
of energy. 25. Brief on Micro minerals.
a) 2k cals b) 4k cals 26. What are the uses of zinc in our body?
c) 6k cals d) 8k cals 27. Tabulate the functions of Boron, Cobalt,
8. Carbohydrates is stored in animals in the Nickel and Silicon.
form of
IV. Detail answer.
a) Starch b) Glycogen
c) Malt sugar d) Disaccharide 28. Give a brief note on fat and its classification.
9. 1g of fat provide __________ KJ of energy. 29. Give a menu plan for diebetes mellitus.
a) 40 b) 50 30. Write in detail on any four major mineral
c) 35 d) 37 sources.
31. Brief on adulteration.
140

REFERENCE BOOKS 5. Dr.Shrinandan Bansal (2014), “Food &
Nutrition” 2nd edition, Aitbs Medical
1. Sheila John D.Jasmine Jenifer (2015), Publishers., Delhi, India.
“Essentials of Nutrition and Dietetics for 6. Deepti Chauhan (2011), “Nutrition” 1st
Nursing” 2nd edition, Wolters Kluwer edition, Lotus Publishers., Jalandhar city,
Publications Pvt. Ltd., New Delhi, India. India.
2. B.Srilakshmi (2016), “Human Nutrition”
2nd edition, Newage International INTERNET LINKS
Publications Pvt. Ltd., New Delhi, India.
3. Queen Mary Machendar (2011), 1. seafood.ucdavis.edu/sanitation/Ch5points.
rtf
“Text Book on Food & Nutrition for
2. www.fda.gov/oc/history/historyoffda/
Nurses” 1st edition, EMMESS Medical
default.htm - 8k
Publishers., B, India.
3. www.itrcindia.org/services2.html - 13k
4. TK.Indrani (2008), “Nursing Manual 4. http://www.perstorp.se/pnet/ext/septp370.
of Nutrition & Therapeutic Diet” nsf/EnvRep/
1st edition, Jaypee Brothers Medical 5. http://people.cornellcollege.edu/cliberko/
Publishers Pvt. Ltd. New Delhi, India. OrgLabManual
ICT CORNER APPLIED NUTRITION
Through this game activity you will be able

to differentiate the food varieties based on
their nutritional classification.
Steps
• Step 1:
• Step 2: Click the START button to start the game activity.
• Step 3: A page with pictures of food varieties are arranged as a grid of picture tiles will
open.
• Step 4: Drag and drop the tiles into the buckets give below to sort. Continue the activity
as per the instructions displayed during the game and complete the game.
URL : https://www.brainpop.com/games/sortifynutrition/
141

CHAPTER
Introduction to
6 Sex Education
ஒழுக்கம் விழுப்பந் தரலான் ஒழுக்கம்

உயிரினும் ஓம்பப் படும்.
Propriety of conduct leads to eminence, it should therefore be preserved more

carefully than life.
Learning Objectives

➢➢ define sex education
➢➢ distinguish between good and bad types of touching.
➢➢ describe the basics of sexual harassment and Child protection schemes.
the human relationships and free from

Introduction
fear disgrace and guilt.
India’s National Population Policy also • Help adolescents adapt associations
reiterates the need for educating adolescents between age and maturity and views on
about the risks of unprotected sex. sexual life which would be in harmony
Unfortunately, a complete sex education drive with their own personality.
on a regular basis is still to be introduced in • Help adolescents make their own
the Indian schools. If we were to go by the data emotional and sexual choices.
published by WHO, sex education should be • Stress the importance of responsibility
imparted to children of 12 years and above. and respect of sexual relationships both
in and out marriage.
6.1 Aims of Sex Education
Lack of Sex Education
• Prepare the youngsters to adolescence creates problems such as:
and make then capable of accepting • Undesired pregnancy
the physical and functional changes
• Transmitting sexual diseases
calmly and naturally without emotional
judgments. • Sexual abuse
• Help adolescents to realize the relation • Ignorance of facing sexual problems

between sexual life, making them to love
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“Good” touch and “bad” touch are words • if that touch makes you feel scared and
most commonly used to explain to children nervous.
what is acceptable and not acceptable, and • if a person forces you to touch him or her.
how they should treat other people. Good • if a person asks you not to tell anyone.
touch or physical affection is a wonderful way
• if a person threatens to hurt you if you tell.
to bond with your child.
Head
Face
6.2 Good Touch
Mouth
Neck &
It feels good to be hugged and kissed by the Hand Shoulders
Chest
people you love. For example: Stomach Hand
Buocks & Part
between our legs
• When Mommy gives you a hug and kiss
Thighs
after you wake up. Good
May Not Like
Legs
• When Daddy gives you a good-night hug Bad
and kiss.
Teach your children the following safety
• When Grandma and Grandpa come to visit rules:
and everyone gets hugs and kisses.
It is not okay
• to touch someone else’s private body parts.
6.3 Bad Touch
• for someone to touch his or her own
Touches that make you feel uncomfortable private body parts infront of you.
are usually bad touch. • for someone to ask you to touch his or her
private body parts.
Good Touch Bad Touch
• for someone to ask you to take your clothes
+ Parents hug and kisses. = Makes you feel scared
+ Grandparents love. / nervous / ashamed. off except if they are a doctor helping to
+ Teacher pats you on the = Forced or Hurts.
= Told to keep it a SECRET see if you are hurt or sick
head “Good Job”.
= Touching or pang
+ Brief friendly hugs by
areas covered by a • for someone to take photos or videos of
family members.
SWIM SUIT. you with your clothes off.
+ Brief kiss on the = Kissing on the mouth.
cheek or forethead. = Touching the
+ Shaking hands or buocks.
giving Highs. = Hing, slapping,
+ Doesn’t scare or sping, pushing or
make you feel bad. punching.
It is a bad touch
• if it hurts you.
• if someone touches you on your body
where you don’t want to be touched.
• if the person touches you under
your clothing or tickles you under the Worldwide, around 15
clothing. million adolescent girls aged 15
to 19 have experienced forced
• if a person touches you in a way that
sex in their lifetime.
makes you feel uncomfortable.
143

• Making sexual comments about a person’s
POCSO Act (protection of clothing, anatomy, or looks
children’s from sexual offences)
• Repeatedly asking out a person who is
A special law has been passed to not interested
address the issue of sexual offences
against children. India has a strong
The Act has come into force with prevention program which goes
effect from 14th November, 2012 along hand in hand with care, support
with the rules. and treatment. We have been able to
• It is a comprehensive law to provide contain the epidemic with a prevalence of
for the protection of children just 0.31%. We have also brought about a
• From the offences of sexual assault, decline of 50% in new infections annually.
sexual harassment and pornography — Shri Gulam Nabi Azad, Hon’ble
• To safeguard the interests of the child Minister of Health and Family Welfare, 2011.
at every stage of the judicial process.
• For the proper development of the Non-Verbal
child in view of his/her protection of
• Looking a person up and down (Elevator
the right to privacy and confidentiality
eyes)
• Staring at someone
6.4 Sexual Harassment
• Blocking a person’s path
Sexual harassment is unwelcome sexual • Following the person
advances, requests for sexual favours, and/or • Giving personal gifts
other verbal, visual or physical conduct of a
sexual nature .
The Sexual Harassment
Sexual harassment includes many things of Women at Workplace
(Prevention, Prohibition and
1. Verbal
Redressal) Act, 2013
2. Non verbal
[Act No 14 of 2013]
3. Physical
An Act to provide protection against
Verbal sexual harassment of women at workplace
• Referring to an adult as a and for the prevention and redressal of
girl, hunk, doll, babe, or honey complaints of sexual harassment and for
matters connected therewith or incidental .
• Whistling at someone, cat calls
• Making sexual comments about a person’s
Physical
body
• Giving a massage around the neck or
• Making sexual comments or innuendos
shoulders
• Turning topics
• Touching the person’s clothing, hair, or
• Telling sexual jokes or stories body
• Asking personal questions about social or • Hugging, kissing, patting, or stroking
sexual life
144

I. The number of cases registered for child abuse raised from 8,904 in the year 2014
to 14,913 in the year 2015, under the POSCO Act. Sexual offences and kidnapping
account for 81% of the crimes against minors
II. Preventive measures designed to ward off strangers (installing CCTV cameras and
providing self-defence training) will be ineffective, as children do not know how to ward
off unwanted sexual offences from their known relatives, acquaintances or workplace
seniors, who they trust.
III. POSCO: State wise cases - Uttar Pradesh led the highest number of child abuse cases
(3,078) followed by Madhya Pradesh (1,687 cases), Tamil Nadu (1,544 cases), Karnataka
(1,480 cases) and Gujarat (1,416 cases).
Along with workplace cases, here are other findings of rapists being known to children:
94.8% of rape cases saw children being raped by someone they knew, not strangers. These
acquaintances include neighbors (3,149 cases) who were the biggest abusers (35.8%). 10% of
cases saw children being raped by their own direct family members and relatives.
• Touching or rubbing oneself sexually provides opportunities including non-

around another person formal education, vocational training,
• Standing close or brushing up against etc. to working children to facilitate
another person their entry / re-entry into mainstream
education.
6.5 Schemes and Programmes on • Rajiv Gandhi Scheme for Empowerment

of Adolescent Girls (RGSEAG)-SABLA
Child Protection
aims at an all-round development of
The Government has initiated various adolescent girls (AGs) of 11-18 years by
Schemes to address the problems. Some of making them self reliant by facilitating
the Schemes are outlined as follows: access to learning, health and nutrition
through various interventions such as
• Integrated Child Development Services
health, education, vocational training etc.
(ICDS) is a Centrally Sponsored Scheme
Such empowerment also addresses the
which provides a package of six services
issue of Child Marriage.
to children below 6 years and pregnant
and lactating mothers. • Indira Gandhi Matritva Sahyog Yojana
(IGMSY) is a Conditional Cash Transfer
• Integrated Child Protection Scheme
Scheme for pregnant and lactating
(ICPS) was introduced in 2009-10 with
women which was introduced in October,
the aim to the improve the well being of
2010 for improved health and nutrition
children in difficult circumstances, as
to pregnant and nursing mothers.
well as the reduction of vulnerabilities
to situations that lead to abuse, • Trafficking: “Ujjawala” – is a
neglect, exploitation, abandonment Comprehensive Scheme for Prevention of
and separation of children from their Trafficking and Rescue, Rehabilitation, Re-
families. integration and Repatriation of Victims
of Trafficking for Commercial Sexual
• Scheme for Welfare of Working
Exploitation.
Children in Need of Care and Protection
145

• The POCSO Act was passed to strengthen • he Protection of Children from Sexual
T
legal provisions for the protection of Offences Act, 2012 (POCSO Act)
children below 18 years of age from sexual • The Prohibition of Child Marriage Act
abuse and exploitation. Under this Act, if (PCMA) 2006
any girl under 18 is seeking abortion the • The Immoral Traffic (Prevention) Act, 1956,
service provider is compelled to register
• The Child Labour (Prohibition and
a complaint of sexual assault with the
Regulation) Act, 1986
police.
• he Right of Children to Free and
T
• Rehabilitation of Child Labour National
Compulsory Education (RTE) Act,
Child Labour Project (NCLP) is a Scheme
2009 etc.,Workshops, Seminars, legal
with the objective to withdraw children
awareness camps and consultation are
working in hazardous occupations and
held with the State Governments, NGOs
processes, and mainstream them into
and other stakeholders for sensitisation
formal education system. All children
and wider public awareness.
rescued/withdrawn in the age group
of 9-14 years are enrolled in the NCLP
India was the first country
Special Training Centres, where they are
in the world to establish a
provided with bridge course, vocational
government family planning
training, mid-day meal, stipend, health
program way back in 1952. According to
care, etc. before being mainstreamed into
2011 Family Welfare Programme, some
formal education system.
major achievements are as follows:
In addition to implementing the Schemes Awareness of one or more methods of
and programmes as above, the Government contraception.
has also initiated several legislative measures Increase in contraceptives use over the years.
viz
Evaluation
I. Short Answer 3. PV books, Jalandhar, page no.-225-227

4. ®Chalkey A. M., A text book for the health
1. Define Health
worker, 1st ed, 1985, N.A, I. Limited,
2. Explain good touch publishers,New Delhi, page no.- 330-340.
3. Describe bad touch 5. ®Basavanthappa BT, Community health
4. Explain harassment nursing, 1st ed, 1998, jaypee brothers, delhi,
page no.-319 -3®. Bibliography.
REFERENCES INTERNET LINKS
1. Swarnkar k. Community health nursing,
1. h t t p s : / / w w w . y o u t u b e . c o m /
2nd ed 2008, N.R. Brothers, indore, page
watch?v=1JUk3_bkHHs
no.639-642
2. https://sexedrescue.com/sex-education-
2. ®Park k., essentials of community health
videos/#sexed
nursing, 4th ed, 2004, m/s Banarasidas
3. https://www.youtube.com/watch?v=WYr_
Bhanot Publishers, Jabalpur, page no.
Bp53PcQ
225-226 Ò Kumari Neelam, essentials of
community health nursing, 1st ed , 2011.
146

ICT CORNER SEX EDUCATION
Through this activity you will be to

know the various changes happen
during the menstrual cycle
Steps
• Step 2: Click and drag the slide bar given below to start the activity.
• Step 3: The changes can be observed from the tabs given such as Temperature
change, Hormonal change, Folicular change, Uterine lining change.
• Step 4: Changes happening on any of the 28days can be observed and compared
with the help of the slide bar.
URL: http://owensborohealthse3.adam.com/content.aspx?productId=
147&isArticleLink=false&pid=17&gid=000087&Category=Interactive%20Tool
147

CHAPTER
7 Midwifery
Nursing
பெறுமவற்றுள் யாமறிவது இல்லை அறிவறிந்த

தெய்வத்துள் வைக்கப் படும்.
Among all the benefits that may be acquired, we know no greater

benefit than the acquisition of intelligent children
Learning Objectives

➢➢ define Midwifery
➢➢ discuss the physiological changes during pregnancy
➢➢ briefly discuss about the normal pregnancy
➢➢ explain the labour process
➢➢ enumerate the care during puerperium.
➢➢ brief out the reproductive health care and family planning.
measures in the absence of medical aid. She

Introduction
plays an important role in health counseling
Maternity care is professionaly of a high and education.
quality and maintains the safety of the mother
7.1 Definition
and fetus that makes the integrity of the family.
A professionaly trained person is a midwife. Midwifery is the art and science, its caring
The midwife must be able to give necessary for woman undergoing pregnancy, labour and
supervision, care and advice to women during the following child birth.
pregnancy, labour and postpartum period.
Midwife has to conduct deliveries on her own Normal Pregnancy
responsibility and to take care of the newborn and Normal pregnancy involves a continuous
the infant. process. It is divided into three trimesters.
This care includes preventive measures, • I trimester - 0-12 weeks (3 months)
detection of abnormal conditions among mother • II trimester - 13-24 weeks (4-6 months)
and newborn, the procurement of medical • III trimester - 25 to till delivery (7-10
assistance and the execution of emergency months)
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I trimester events Cervix- Softening of the cervix is evident
• Fertilization occurs at 6 weeks. It occurs due to fluid accumulation
• Fetilized egg (Zygote) develops into a inside the fibros tissue of the cervix and
hollow ball of cells called the blastocyst increased vascularity.
• The aminotic sac begins to form Normal Cervix Pregnant Cervix
• Brain and spinal cord (neural tube) begins
to develop
• The heart and major blood vessels begins
to develop
• Arms and legs begins to appear
• Bones and muscles form
• Kidneys begin to function
• Almost all organs are completely formed
II trimester events Other Organs

• Fetus sex can be identified Fallopian tube- The total length is
• Fetus moves, the mother can felt increased. The tube becomes congested.
(Quickening) Ovary- Both the ovarian and uterine
• Hair appears on the skin and head cycles of the normal menstruation remain
• Eyebrows and eyelashes are present suspended.
• Placenta fully formed
Changes In Breast
• The woman gain more weight
In early pregnancy the women feel
III trimester events fullness of breast or tingle and increase in size
• The fetus is active, often changing positions as pregnancy progresses. The areola of the
• The lungs continue to mature nipples darkens and the diameter increases. The
Montgomery’s glands (the sebaceous glands of
• The fetus head moves into position for
the areola) enlarge and tend to protrude. The
delivery
surface vessels of the breast may become visible
due to increased circulation. By the 16th week
7.2 Maternal Physiological Changes (2nd trimester) the breasts begins to produce
During Pregnancy colostrum. It is a thin, watery, yellowish
secretion which thickens as pregnancy
Physiological changes during pregnancy.
progresses. Colostrum may leak from breasts.
Genital Organs
Changes In Skin
Vulva- Vulva becomes oedematous. Labia
Skin changes occurs due to increased
minoria are pigmented and enlarged.
secretion of Melanocyte Stimulating Hormone
Vagina- Vaginal walls becomes (MSH) from pituitary.
oedematous, Because of more blood supply, the
Face- There is an extreme form of
vaginal walls mucosa looks in bluish colour.
pigmentation present around the cheeck,
Uterus- The uterus which in non-pregnant forehead and around the eyes. It is called as
state, weighs about 60 gm, during pregnancy chloasma gravidarum or pregnancy mask.
uterus increases in size upto 10-12kgs.
149

Abdomen- A brownish black pigmented Ideally the weight gain depends on pre-
line appears on the abdomen stretching from pregnancy body mass index (BMI) level. Weight
the Xiphisternum to the symphysis pubis. It will gain for a woman with normal BMI (20-26) is 11
disappear after delivery (Linea Nigra). to 16kg. An obese woman (BMI>29) should not
Striae gravidarum-It is a specific form of gain more than 7 kg. Where as an underweight
scarring of the abdominal skin area due to rapid woman (BMI<19) may be allowed to gain upto
expansion of the uterus. It looks pinkish in first 18kg.
pregnancy, in subsequent pregnancy both pinkish
Maternal weight gain 6 kg
and white striae are visible (Striae albican).
• Increase blood volume 1.3 kg
• Increase in extracellular fluid 1.2 kg
• Accumulation of fat and protein 3.5 kg
Reproductive weight gain 6 kg

• Fetus 3.3 kg
• Placenta – 0.6 kg
• Liquor (amniotic fluid)-0.8 kg
• Uterus-0.9 kg
• Breast – 0.4 kg
Systemic Changes
Respiratory System:
Because of enlargement of the uterus, there
is an elevation of the diaphragm and breathing
becomes diaphragmatic. Upper respiratory tract
mucosa becomes congested. The respiratory
rate rises to from 18 to 20 breathes per minute
to meet demand of fetus. Decreased functional
residual capacity 1.7 to 1.35 litres due to the
compression of the diaphragm by the uterus.
Cardiovascular Changes:
The heart enlarges by 70 to 80ml due to
small increase in wall thickness and venous
filling. Cardiac output increases from 4.5 - 6.0
litre/min. Heart rate increases from 70bpm
Maternal Weight Gain in non-pregnant state to 78bpm at 20 weeks
gestation and a peak around 85 bpm in late
The total weight gain during the course
pregnancy.
of a singleton pregnancy for a healthy woman
averages 11kg. 1kg in first trimester (1-3 Haematological Changes
months). 5 kg each in second (4-6 months) and
Blood volume increases by 40-50% at 30-32
third trimester (7-9 months).
weeks of pregnancy. It causes Haemodilution.
Haematocrit decreases. The number of white
150

blood cells (which fight against infection) wrist joint, leading to pain in the hands
increases slightly during pregnancy. Blood and arm called CARPAL TUNNEL
plasma volume increases to the extent of 1.25 SYNDROME may appear in late pregnancy.
litres (Non pregnant plasma volume is 2500 ml, • Nausea, vomiting, mental irritability and
increase about 3750ml during pregnancy. sleeplessness due to some psychological
background.
Urinary System
• Glomerular filtration rate (GFR) is
increased by 50% all throughout pregnancy. 7.3 Diagnosis of Pregnancy
Frequency of micturation is a common
symptom of early pregnancy. This is due First Trimester
to changes in pelvic anatomy. A degree Presumptive signs:
of hydronephrosis and hydroureter exist. • Amenorrhoea-Absence of menstruation.
These result from the loss of smooth muscle
• Morning sickness- Nausea, vomiting on
tone due to the progesterone, aggravated
rising from bed, loss of appetite.
by mechanical pressure from the ureters at
• Frequency of micturition due to congestion
the pelvic brim.
of the bladder mucosa.
• Vesicoureteric reflux is also increased.
• Breast discomfort- feeling of fullness and
These changes predispose to urinary tract
‘Pricking sensation’ is present.
infection.
• Darkening of the nipples, primary and
• Glycosuria of mild degree in 35% to 50% of
secondary areolar change.
all pregnant woman. Increased glomerular
filtration leads to more sugar reaching the • Fatigue or tiredness.
tubules that can be reabsorbed.
Probable signs
Gastrointestinal System • Breast changes: The breasts are enlarged,
• The gums become congested and spongy evident between 6 to 8 weeks.
and may bleed to touch. • Vaginal Sign- The walls become softened
• Relaxation of lower oesophageal sphincter and looks bluish in colour. Copious non
produces regurgitation and heart burn. irritating mucoid discharge appears at 6th
• Slight reduction in gastric secretion and week.
diminished gastric motility result in slow
• Osiander’s sign- There is increased
emptying and more effective pulping of
pulsation, felt through the laternal fornices
food and causes nausea.
at 8th week.
• Reduced motility of large intestine
increased time for water reabsorption • Jacquemier’s or Chadwick’s sign - a bluish
which leads to induce constipation. discoloration of the cervix, vagina and labia.
This is due to local vascular congestion.
Nervous System
• Hegar’s Sign- Upper part of the uterus is
• There may be generalised neuritis
enlarged by the growing fetus, and lower
probably due to Vitamin B 1 (Thiamine)
part of the body of the uterus is empty and
deficiency.
extremely soft.
• Compression of the median nerve
underneath the carpal ligament over the
151

PHYSIOLOGICAL CHANGES IN PREGNANCY
Nutrion
Respiratory Musculskeletal
Breasts Cardiovascular
Gastrointesnal Urinary - Renal
Vagina Uterus
Endocrine
Integumentary
Positive signs • Fetal heart sound (FHS) is elicited around

• Fetal heart sounds. 20th weeks by fetoscope with doppler by
• Fetal movements. 16th weeks.
• Fetal parts. Third Trimester (29-40 Weeks)
Diagnostic test: Symptoms
• Blood/urine test for Beta HCG (Human • Amenorrhea continues

Chorionic Gonadotropin) • Enlargement of the abdomen
• Ultrasonogram • Lightening(fetal head sink in to the pelvic
brim)
Second Trimester (13-28 Weeks) • Frequency of micturition
• Quickening(feeling of life): The perception Signs
of active fetal movement by the woman.
• Skin changes are more prominent
Usually felt during 18-20 weeks of
pregnancy. • Uterine shape is changed from cylindrical
to spherical
• Progressive enlargement of the lower
abdomen by a mass(fetus) • Fundal height up to the level of ensiform
cartilage
• chloasma-Pigmenation over the forehead
and cheek, appear at 24th week. • Braxton Hicks contraction
• Braxton-Hicks contraction: Braxton- • Fetal movement are easily felt.

Hicks contraction-Irregular, Infrequent, • Fetal parts are Palpable.
spasmodic painless uterine contraction • Fetal heart rate
without any effect on dilation of cervix.
Calculation of Expected Date of Delivery
• Ballottment of the uterus.
152

[EDD] Aims
EDD is calculated from first day of the • To achieve a healthy mother and baby.
Last Menstural Period [LMP] by using Naegle’s • To provide psychological support to the
formula. For calculation, 9 calendar months women and her family.
and 7 days are added in the LMP • To educate the women regarding health
Gestational age – It is to be calculated as care during pregnancy.
completed weeks of gestation • To monitor progress of pregnancy and the
baby.
• 9 out of 10 women • To recognize deviation from the normal
experience a change in skin and provide treatment as required.
tone during pregnancy called • To prepare women physically and
hyperpigmentation. This is because emotionally for the child birth, lactation
the increased production of melanin and care of the baby.
during pregnancy.
• To prevent congenital deformities by
• During gestation, babies develop hair educating the mother to avoid smoking,
all over their body called “lanugo”. substance abuse and self medications.
This hair is typically shed before birth.
• Uterus stretches from the size of a pear Antenatal Visits
to approximately the size of watermelon Routine prenatal visits has been followed as
over the course of pregnancy. convention and not an evidence based benefits.
• Morning sickness is very common • Initial visits at early pregnancy (when a
and typically goes away by the second women missed her first period.
trimester. Try to eat bland diet like
• Every 4 weeks until 28 weeks
bananas, rice, and toast to settle your
stomach. Avoid spicy, oily and fried • Every 2 weeks until 36 weeks
foods during night.
• Every week until delivery
Antenatal Care Antenatal visits should cover the following

Antenatal care refers to the care given to an • History collection
expectant mother from the time of conception • Examination
to the beginning of labour. It includes, • Investigation
• Maternal health check ups.
History Collection
• Evaluation of fetal health and development a) Socio economic status
• Detection of high risk pregnancies e.g Low socio-economic status increases the
GDM, PIH risk of perinatal morbidity and mortality.
• Prompt intervention to prevent b) Age

complications. Maternal age younger than 20 years
increases the risk of premature births, late
• Health education. e.g Diet, exercise and prenatal care, low birth weight, uterine
follow up dysfunction, fetal death, neonatal death.
153

Maternal age older than 35 years Examination
increases the risk of first trimester General state of health:
miscarriage, genetically abnormal fetus, • Build - obese, average, thin
medical complication (Hypertension,
• Nutritional status - good, average, poor
Diabetes, Eclampsia), multiple gestation, fetal
morbidity and mortality. • Gait - normal, with a limp,
c) Menstrual history • Postures - Kyphosis, Scoliosis, Lordosis
• Age of menarche • Personal hygiene
• Cycle : regular/irregular Height – A short stature women (<145cm)
• Amount and duration of blood flow may have a small pelvis leading to difficulty in
labour.
• LMP- date is counted from the first day of
the last menstrual period Weight - Monitor for weight gain regularly
• EDD- calculate from LMP • Inadequate weight gain may indicate low
b) Contraceptive history birth weight baby,Intra Uterine Growth
Retardation( IUGR )and poor perinatal
Use of contraceptives copper T, or oral pills.
outcome.
c) Past obstetric history
• Excessive weight gain may be due to
• Previous miscarriage
fluid retention, pre-eclampsia, multiple
• Previous viable pregnancies pregnancies, polyhydramnios.
• Still births or neonatal deaths Pallor – It is a indicative of anemia, examine
• Method of delivery conjunctiva, tongue and nails for pallor.
• Gestational age, sex and weight of infants Jaundice – Yellowish discoloration of the
• Previous antenatal or postnatal sclera, palate and skin.
complications Oedema – Examine for pitting oedema over
d) Previous medical history the legs above the medial malleolus.
• Diabetes Breast and nipple – Observe the skin changes
• Cardiac diseases over the breast, gently palpate the breast for
any tumor or nodule, look for any crack or
• Hypertension
retracted nipple.
• Renal diseases
Teeth and gums – women with dental carries,
• Infectious diseases such as HIV, Hepatitis
gingivitis or poor oral hygiene should be reported.
B or C
Varicosities – Note the presence of varicose
e) Personal history
vein and their distribution.
• Smoking
Vital signs – Record pulse, respiration,
• Alcohol temperature and blood pressure and report
• Substance abuse any abnormality.
f) Family history Abdominal Examination should be performed
• Diabetes in each visit.
• Hypertension Steps of Abdominal Examination:
• Tuberculosis • Inspection
• Twins • Palpation
• Auscultation
154

Inspection Palpation
• Abdomen • Measure symphysis pubis - fundal height
• Size • Between 18-34 weeks measurements from
• shape pubis symphysis to the top of the uterus in
• Contour – spherical, cylindrical, cm correlates well with the weeks of
pendulous, flattened anteriorly, unduly gestation
enlarged or small.
• Skin – Striaegravidarum and lineanigra
• Scar of previous operations
• Prominent veins, evidence of skin
infections
• Umbilicus - Flat and dimple
A.A.First
FirstManeuver
Maneuver B.B.Second
SecondManeuver
Maneuver C.C.Third
ThirdManeuver
Maneuver
Uterus Size
12 Weeks-at the level of symphysis pubis
16 weeks- Half way between symphysis pubis
22 weeks- at the level of umbilicus
28
weeks- between umbilicus and Xiphoid
process
32 weeks- below the xiphoid process
A. First Maneuver
A. First Maneuver B. Second Maneuver
B. Second Maneuver C.C.
Third
ThirdManeuver
Maneuver D.D.Fourth
FourthManeuver
Maneuver
38 weeks- level of the xiphoid process
48
weeks- below the xiphoid process (if Abdominal –palpation
lightening occurs). • Measuring fundal height (Leopold
maneuver).
• Fundal palpation(first maneuver)
36 • lateral palpation(second maneuver)
40 • Pelvic grip-I
32 • Pelvic grip-II(Pawlik’s grip)
Feel for presenting part
26 • Determine lie
• Determine position of the presenting part
20
• Engagement
16
12
8
155

Auscultation acid may cause megaloblastic anaemia and
Fetal heart rates can be identified by neural tube defect in fetus.
Doppler ultrasound by 12 – 24 weeks and by Life Style Modification
fetoscope at 18– 20 weeks.
• Exercise– It is not necessary for a pregnant
Investigations mother to limit her exercise but restriction
may require in Placenta previa, Cervical
• Urine test for confirmation of pregnancy,
incompetence, Pregnancy induced
albumin and sugar
hypertension, Premature labour and
• Blood test for
multiple gestation.
1. grouping
• Travel – No harmful effects have been
2. Rh-typing identified. A pregnant woman should move
3. Blood sugar around every 2 hours to prevent venous
4. Haemoglobin stasis and thrombus formation.
5. HIV Antigen. • Bowel habit in pregnancy due to
6. VDRL progesterone induced GI smooth muscle
relaxes lead to increased transit time.
7. HbsAg.
Late in pregnancy compression on
Antenatal Advice the bowel by the presenting part may
Nutrition cause constipation. Women may avoid
constipation by liberal fluid intake,
• Weight gain - the recommended weight
exercise and stool softner, bulking agents
gain in a normal pregnancy is 11.5 to 16 kg.
& mild laxatives.
Failure to weight gain may lead to IUGR,
Low birth weight babies and poor perinatal • Nausea & vomiting are common in the
outcome. Excessive weight gain may be due first and second trimesters, usually in
to fluid retention pre-eclampsia. the morning. Small frequent meals and
avoidance of strong odours.
• Calories & proteins – The pregnant women
require 300 kcal/day protein promotes • Sexual intercourse does no harm but
growth of the fetus, placenta, uterus, breast, should be avoided if there is pregnancy
red cells and production of milk. During complication such as placenta praevia,
pregnancy 1 g of protein is deposited half rupture of membrane, preterm labour.
to the fetus and half to mothers. • Smoking– women who smoke often have
• Fats – Fats are important sources of energy. smaller infants with increased perinatal
Phospholipids lower the surface tension in morbidity. Mothers are encouraged
the lungs of the newborn. to quit smoking completely during
• Iron – Recommended iron intake is 30 – pregnancy.
60 mg of elemental iron per day. During • Alcohol should not be consumed during
pregnancy iron stores are depleted, pregnancy. The fetal abnormalities associated
supplementary iron is needed for both with drinking (fetal alcoholic syndrome)
mother and fetus. include craniofacial defects, limb and CVS
• Calcium – Recommended calcium intake defects, prenatal and postnatal growth
is 1200 mg per day. restriction and mental retardation.
• Vitamins – Folic acid is required for the • Caffeine has no increase in teratogenic or
formation of heme. Deficiency of folic reproductive risk.
156

• Women who had four or more pregnancies
These are some of the
• Short Structure (height <145 cm and
beneficial pregnancy tips: -
below)
• Eat 5 to 6 meal a day
• Twins
• Take a prenatal vitamin each day as
• Aneamia
directed by the doctor
• Previous Abortion, Intra uterine death.
• Drink plenty of fluids
• Malnutrition mother.
• Take adequate rest and sleep
• Do proper exercise Placenta Praevia
• Wear comfortable clothes DEFINITION: Placenta Praevia is a
• Don’t take over the counter drugs condition where the placenta is implanted
• Wear safety belts while traveling completely or partially in the lower part of the
• Avoid exposure to smoking uterus.
Cause: Unknown
Risk factors: Multiparity, multiple gestations,
7.4 High Risk Pregnancy previous uterine surgery
Manifestations: Painless, bright red bleeding
Definition > 20th week; episodic, starts without warning,
High Risk Pregnancy is a pregnancy stops & starts again.
complicated by a disease or a disorder that Vaginal examination is contra - indicated.
may endanger the life or affect the health of
the mother, the fetus or the newborn Types of Placenta Praevia
Maternal Death Incidence • First degree (Type I): Low lying Placenta
the lower edge of the placenta reaches the
A maternal death is death of a Woman
lower uterine segment but not the internal
while pregnant or within 42 days of
cervical os.
termination of pregnancy irrespective of the
duration and the site of the pregnancy, from • Second degree (Type II): Marginal the
any course related to or aggravated by the lower edge of the placenta reaches the
pregnancy or in management but not from margin of the internal os but does not
accidental or incidental causes. - WHO cover it.
• Third degree (Type III): Incomplete or
• 20-25% deaths occur during pregnancy.
partial the placenta covers the internal os
• 40-50% deaths occur during labour and partially.
delivery.
• Fourth degree (Type IV): Total placenta
• 25-40% deaths occur after childbirth (More covers the internal os completely.
during the first seven days)
• Annually, 585,000 women die of pregnancy
related complications
Complete 40% Paral 30% Marginal Low-lying
Pelvic inlet
High risk mothers are

• Women below 18 years, over 35 years in 30%
Placenta
Fully dilated cervix
primigravida
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the membranes and decidua. (Blood is not
visible outside) Rare type.
2. Revealed - Following separation of the
placenta, the blood comes out of the
cervical canal to be visible externally
Normal Total placenta previa
(commenest type)
Risk factors
• Smoking
• Short umbilical cord
• Advanced maternal age
• HTN
Par al placenta previa Marginal placenta previa
• PIH
• Cocaine use
Management
• Trauma to or near abdomen.
Management depends upon gestational
age, amount of bleeding and fetal condition.
• Monitor Fetal Heart Rate, maternal Vital
signs
• Intra Venus Fluid administration Paral separaon Paral separaon Complete separaon
(Concealed hemorrhage) (apparent hemorrhage) (Concealed hemorrhage)
• O2 administration
• Assess intake and output, amount of Manifestations: Tenderness mild to severe
bleeding constant pain; mild to moderate bleeding
• Do complete Blood count and Rh factor depending on degree of separation.
Total placenta previa Paral placenta previa
test (CBC), Type and cross match for

Management
transfusion.
• Monitor Fetal Heart Rate, maternal Vital signs
• Ultrasound
• Intra Venous Fluid administration
• No pelvic exams
• O2 administration
• No vaginal delivery- may lead to
haemorrhage • Assess intake and output, amount of
bleeding
• Prepare for caesarean section
• Do complete Blood count and RH factor
Prognosis: depends on amount of bleeding &
test (CBC), Type and cross match for
gestational age
transfusion.
Abruptio Placenta • Ultrasound
• No pelvic exams
Abruptio Placenta: Premature
separation of normally situated placenta. • No vaginal delivery- may lead to
haemorrhage
Cause: Unknown
• Prepare for caesarean section
Types of Abruptio placenta:
1. Concealed - The blood collects behind the
separated placenta or collected in between
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Amniotic Fluid • Premature rupture of membrane
DEFINITION: Amniotic fluid is a • Fetal anomalies
clear, slightly yellowish liquids surround and • Poor placental function.
protects the fetus during pregnancy. Normal
Diagnosis
Amniotic fluid is around 800 ml
• AFI < 5-6 cm
Amniotic fluid is made up of fetal urine &
• Small uterine size.
fluid that is transported through placenta from
• Less fetal movements
maternal circulation.
• Prominent fetal parts on palpations
Polyhydramnios • Small for date uterine size.
Polyhydramnios is defined as a state where • Fetal demise.
amniotic fluid exceeds more than 2000 ml. • Ultrasonogram
Prognosis: Depends on severity of disease.
Risk factors
• Multiple pregnancy. Management
• Fetal abnormalities. • Careful assessment of mother/fetus
• Fetal skeletal malformations. • Frequent ante-partum testing
• Obstruction of GI tract- prevents normal • Determine optimal time for delivery (early)
ingestion of amniotic fluid. • Antibiotics/corticosteroids with PROM
• Rh Iso immunization (Premature Rupture Of Membranes)
• Maternal Diabetes Mellitus.
• Spinabifida; Anencephaly, Hydrocephaly. Ectopic Pregnancy
Diagnosis: Sonography-To detect Amniotic The fertilized ovum is implanted and
Fluid Index (AFI) is more than 20 cm. (Normal develops outside the normal uterine cavity
AFI is 8-18 cm). usually in fallopian tubes, rare on ovary, cervix
or abdominal cavity.
Management
• Bed rest. Incidence
• Monitor weight gain. • Leading cause of death
• Remove excess amniotic fluid every 1-2 from hemorrhage in
weeks through amniocentesis. pregnancy
• Most women with mild polyhydramnios • Reduces fertility
deliver healthy baby. • 1 in 100 pregnancies
Oligohydramnios Causes
It is a condition where the amniotic fluid is • Scarring of fallopian tubes (Chlamydia/
less than 500 ml in the amniotic sac. Gonorrhea).
• More common with infection of fallopian
Causes tubes or surgery to reverse Tubale
• Failure of fetal kidney development Ligation.
• Obstruction in urinary tract • Previous ectopic
• Intra Uterine Growth Restriction (IUGR) • Multiple induced abortions
• Post-term pregnancy
• Diethylstilbestrol (DES) exposure
159

Symptoms • Usually occurs closer to due date. Will not
• Colicky, cramping pain in lower abdomen resolve until birth.
on affected side General Signs of PRE-ECLAMPSIA
• Tubal rupture: sudden/sharp/steady pain • Rapid weight gain; swelling of arms/face
before diffusing throughout pelvic region • Headache; vision changes (blurred vision,
• Heavy bleeding causes shoulder pain, seeing double, seeing spots)
rectal pressure • Dizziness/faintness/ringing in ears/
• Dizziness/weakness - If tube ruptures, confusion; seizures
weak pulse, clammy skin, fainting. Assess • Abdominal pain, ↓ production of urine;
for s/s shock. nausea, vomiting.
• Alarming signs:
Diagnosis
U - Urinary output dimished
Estimation of Beta hCG (more than 1500 IU/L
S - Sleep disturbance
• Ultrasonogram
H - Headache
Treatment E - Epigastric pain and eye symptoms.
• Immediate surgery to remove/repair tube. Eclampsia
• If no rupture, Methotrexate - stops Seizures or coma due to hypertensive
cellular division in fetus; causes cell death. encephalopathy
Conceptus expelled with bleeding.
Incidence
Hypertension In Pregnancy • Most serious complication.
Global cause of maternal/fetal morbidity • Affects ~ 0.2% pregnancy.
& mortality. Responsible for 76,000 deaths/ • Major cause of maternal death due to
year. Normotensive patient may become intracranial hemorrhage.
hypertensive in late pregnancy, during labor, or • Maternal mortality rate is 8-36%.
24 hours postpartum.
Risk factors
Pre-Eclampsia
• < Age 20 years or > 40 years
Defined As
• Twins, triplets
Pre-Eclamsia is characterised by hyper
• Primigravida
tention protrinuria and oedema.
• Molar pregnancy
Dangers of Pregnancy Induced Hyper tention
(PIH) • Preexisting HTN, Diabetes mellitus
• BP ≥ 140/90 mmHg • Renal or vascular disease
• Systolic ↑ of 30mm Hg > pre-pregnancy. levels • Previous history of preeclampsia/eclampsia
• Diastolic ↑ of 15mm Hg > pre pregnancy. Causes: Unknown.
levels. Management: Usually only cure is termination
• Presents with HTN (Hypertension), of pregnancy. It depends upon symptoms.
proteinuria, edema of face, hands, ankles.
Mild preeclampsia
• Can occur anytime > 20th week of
pregnancy. • Bedrest
• Monitor at home or hospital.
160

• Deliver close to EDD • Results in increased circulating glucose
• Frequent Blood Pressure, 24 hours urine, • More insulin released to attempt to maintain
liver enzymes glucose homeostasis
• Fetal Heart Rate • Patient feels “hungry” due to increased insulin
• Ultrasounds. • vicious cycle of increased appetite & weight
Severe preeclampsia: BP = 160/110 gain results
mmHg, epigastric pain, 2-4+ proteinuria, ^
Diagnosis
liver enzymes, thrombocytopenia [↓ 100,000].
• Oral Glucose Challenge Test (OGCT)
Goal: prevent convulsions & control BP.
Magnesium sulphate is the drug of choice • Screen all women at 24-28 weeks.
Magnesium Toxicity based on clinical signs: • HIGHER Risk patient to be screened in
such as sharp drop in BP, respiratory paralysis 1st trimester/1st prenatal visit and at 24-28
and disappearance of patellar reflex. weeks.
• STOP infusion Determining High Risk Clients
• O2 administration • Family history DM; Previous GDM
• Calcium gluconate if magnesium sulphate • Marked obesity; Glycosuria
toxicity present
• Maternal Age > 30
Gestational Diabetes Mellitus • Previous infant > 4000g
• Member of high-risk racial/ethnic group
Glucose intolerance beginning in
• Hispanic, Native American, South or East
pregnancy.ussually present in the second
Asian, African American, Pacific Islander.
or during the third trimester. Fasting blood
sugar exceeds 90 mg/dl and post prandial • If results negative, repeat during 24-28wks.
value is greater than 120 mg/dl
Interventions
Antepartum Goal: strict glucose control.
Maternal risk Infant risk
• Provide immediate education to patient.
Hypertention Birth trauma and family members
disorders Shoulder dystocia • Standard diabetic diet [2000-2500 cal/day].
Pre term labour Hypoglycemia • Total calories – 30Kcal/Kg for normal
Polyhydramnios Hyperbilirubinemia weight women
Macrosomia (C/S Respiratory distress Distribution of calories: 40-50% carbs, 20%
rate) syndrome protein, 30-40% fat,
Thrombocytopenia Recommend: 3 meals & 3 snacks evenly
Hypocalcemia spaced to avoid swings in blood glucose. Snack
Fetal death at bedtime.1200 mg/day calcium, 30 mg/day
iron, 400 mcg/day folate.
Pathophysiology Intrapartum: monitor glucose levels and titrate
• Pregnancy hormones estrogen, HPL, with insulin
prolactin, cortisol, progesterone, blocks Postpartum: Mostly return to normal after
insulin receptors > 20 weeks pregnancy. delivery.
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• 50% patients. with GDM develop type II Causes of onset of labour
later in life. • The exact mechanisms are not known. The
• After 6 wk. PP (Postprandial) serum theories are,
glucose estimation to be done • Biological – ageing of conceptus, cell
• Children of GDM (Gestational Diabetes degeneration, hypoxia.
Mellitus) patients. ^ risk for obesity/ • Mechanical – myometrial stretch, decidual
diabetes in childhood/adolescence cell stretch.
Pre-Conception Planning: • Hormonal – prostaglandin release, oxytocin
• Begin during reproductive years stimulation, fetal cortisol production and
• Maintain normal HbA1c 3-6 months progesterone withdrawal.
before conception & during organogenesis
Characteristics of uterine contraction
(6-8weeks) –minimize risk of spontaneous
AB & congenital anomalies. • Effective uterine contraction lasts for 30 –
90 secs create 20 – 30 mmHg of intrauterine
• HbA1c level > 7: increased risk for congenital
pressure and occur every 2 – 4 minutes.
anomalies & miscarriage. (Normal HbA1c
= 4-6 %. ) • The pain of contraction is throughout
labour to be caused by one or more of the
• Multidisciplinary team: nutritionist,
following
endocrinologist, high risk OBG nurse.
• Hypoxia of the contracted myometrium.
• Educate patient.- managing diet, activity,
insulin Excercise • Compression of nerve ganglia in the cervix
and lower uterus by the tightly interlocking
• Daily food diary to assess compliance.
muscle bundles.
• Stretching of the cervix during dilatation.
7.5 Normal Labour
• Stretching of the peritoneum overlying the
Definition uterus.
Labour is the process resulting from uterine Changes in cervix
contraction leading to expulsion of products
of conception from the uterine cavity through
vagina.
Normal labour
Labour is called normal when it satisfies the
following criteria
• Spontaneous onset of labour
• Starts at 38 – 40 weeks
• Vertex presentation
• Occipito-anterior position Effacement of the cervix: it is the
shortening of the cervix. The cervix is pulled
• Labour is not unduly prolonged (average
up and become a part of the uterine segment.
12 hours)
Effacement is expressed as ranging from 0%
• No complication to the mother and (no reduction in length) to 100% palpable
baby below the fetal presenting part.
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Dilatation of cervix: cervix dilates to a • Bearing down pain with strong uterine
maximum of 10 cm to enable the head to pass contraction.
through the cervix. • Bulging of the perineum and gapping
of the anus.
Diagnosis Of Labour
• Full dilatation of the cervix.
True labour pain:
Third stage: The 3 rd stage of labour
• Starts over the back (sacrum) radiates
is the interval between the delivery of the
to lower abdomen and thigh.
fetus to delivery of the placenta, umbilical
• Intermittent colicky pain. cord and fetal membranes and lasts 15-30
• Gradually the intensity, duration and minutes. Separation of the placenta is the
frequency of contraction increases. result of continuous uterine contraction
• Pain is associated with uterine after delivery of the fetus . The contraction
contraction. reduces the area of uterine placental bed,
• Pain is not relieved by enema. with placental separation occurring in the
spongiosa layers of the decidua Vera. Blood
Dilatation of cervix: Progressive dilatation &
loss is controlled by compression of spiral
effacement of cervix
arteries by the continued contraction which
Show: Blood stained mucus discharge per
transport the placenta from fundus into the
vagina due to separation of the cervical mucus
lower uterine segment and through cervix
plug.
into the vagina.
Stages and Phases Of Labour Fourth stage: The 4th stage is the stage
First stage: The first stage of labour is the of observation for atleast one hour after the
interval between the onset of true pain and full expulsion of the placenta and membranes.
cervical dilatation. Duration is 6-12 hours. The
Mechanism Of Normal Labour
first stage is further divided into a latent and an
Definition: A Series of movements adapted by
active phase.
fetus in the birth passage during expulsion.
• Latent phase:
Mechanism of normal labour falls on: - (3 P’s)
The latent phase extends from the onset of
• Power – strength of contraction
labour till 3 – 4cm dilatation. During this phase,
uterine contraction are mild and irregular. They • Passage – pelvic dimensions and
become intense, frequent and regular as the configurations
latent phase progress. • Passenger – size of the baby
• Active phase:
Mechanism
The active phase is characterized by
a. Engagement:
increased rate of cervical dilatation.
• When the greatest diameter of the
Second stage: The duration of the 2nd stage
presenting part (biparietal diameter
averages 2 hours for primi and 30 minutes for
in vertex) has passed the plane of the
multiparaThe 2nd stage of labour is the interval
pelvic brim, the head is said to be
between full cervical dilatation to delivery of
engaged.It occurs in late pregnancy
the baby.
(primi) or at the time of labour (multi).
Diagnosis of second stage of labour:
b. Descent:
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• The Presenting part descends slowly MECHANISM OF NORMAL LABOUR
and progressively.It depends on
cephalopelvic relationship
c. Flexion:
• Good flexion aids engagement and
descent.
d. Internal rotation: 01. Head flong, before engagement 05. Complete extension
• It occurs on pelvic floor. The resistance

of the pelvic floor helps.
• The head must rotate to anterior (or
posterior) to pass ischial spines. 02. Engagement, descent, flexion 05. Restuon (external rotaon)
e. Crowning:
• After internal rotation and further
descent, vulva form a crown around
the head (i.e.) the biparietal diameter
distends the valval outlet without 03. Further descent, internal rotaon 07. Delivery of anterior
shoulder
any recession of the head even after
contraction is over.
f. Extension:
• Distension of perineum by vertex. 04. Complete rotaon,
08. Delivery of posterior shoulder
begining extension
• Occiput beyond symphysis &Head
stands out.
g. Restitution: At the moment a baby’s
born , 1/3 of their blood is still
• Untwisting of the neck, head rotates to
outside their body. If you delay
the position occupied at engagement.
cord clamping 90 seconds they get 60% more
h. External rotation:
blood cells. They get enough iron to last them
• Shoulder descends in the path similar through their first year. They get white blood
to that followed by the head and rotates cells to fight infection. They get antibodies.
anteroposteriorly. They get stem cells to help repair their body.
• Head swings.
i. Lateral flexion:
• Anterior shoulder comes under the 7.7 Normal Puerperium
symphysis pubis.
Puerperium is the period following
• Posterior shoulder sweep the perineum. childbirth during which the body tissues
j. Expulsion: especially the pelvic organs, revert approximately
• After delivery of the shoulder under to the pre-pregnant state both anatomically and
the symphysis pubis, the rest of the physiologically.
body expelled quickly. Rest of the Anatomic and physiologic changes
body expelled with lateral flexion
• Uterus involution
• Regeneration of endometrium
164

• Reduced bladder sensitivity to over • 3 weeks – rugae first appear.
distention • 6 – 10 weeks – epithelium restored to
• Increased coagulability normal.
• Fall in plasma volume • Lower vagina – suffers superficial laceration.
Pelvic Floor
Uterine Involution
Normal by 6 weeks except varying degree
• In pregnancy, uterus increases 11 times in
of musculoskeletal laceration.
size and weight.
• Rapid involution – immediately following Urinary Tract
delivery it reduces from 1000gm to 100gm • Immediate postpartum – bladder
at the end of 6 weeks. mucosabecomes edematous
• Reversal of hypertrophy due to withdrawal
• Over distension – incomplete emptying
of sex hormone causes increases
and presence of , residual urine are
collagenase, proteolytic enzyme causes
common urinary problem in puerperium
autolysis of intracellular protein.
• 1 – 2 days – mild proteinuria in 50 % of
• Decrease uterine volume due to increase
women
myometrial force and intrauterine pressure
• By 8 weeks – renal plasma flow reduces to
150 mmHg.
normal, glomerular filteration returns to
• After pains 2 – 3 days more in multiparous
normal.
and more during lactation due to increase
in oxytocin. • Creatinine clearance becomes normal by
• Uterine cavity- sterile, bactericidal effects 1st week.
of granulation tissues. Fluids And Electrolytes
Lochia • Weight loss - immediately after delivery –
Lochia is the vaginal discharge after giving 5.5 kg – fetus, placenta, amniotic fluid 4 kg
birth. – excretion of fluids and electrolytes.
Rubra– last for 3 days, contains fresh blood • Fluid loss – 2 liltres during 1st week. – 1.5
and necrotic tissue. litres – next 5 weeks.
Serosa – last for 4-9 days, contains liquefied Electrolytes
blood, leucocytes, serous, palour and reddish
• Total exchangeable sodium decreased but
brown in colour.
body water loss exceeds sodium loss.
Alba – last for 10-15 days ,contains
• Decreased plasma progesterone causes
leucocytes, mucus decidual cells, yellowish
decreased aldosterone antagonism and
white in colour.
increased sodium.
Cervix • Tissue involution – cellular breakdown,
• 1ST week – closes to 1 cm. increases potassium level.
• External os – transverse slit. Cardio Vascular Changes
• Complete healing 6 – 12 weeks. i. Blood coagulation:
Vagina • Rapid and dramatic changes in the
coagulation and fibrinolytic system
• Smooth, swollen and poor tone after
after delivery.
delivery.
165

• Extensive activation of clotting factors through 4th and 6thintercostals nerve.
together with immunity. Oxytocin is released by stimulation of
ii. Blood volume: During delivery and soon auditory and visual efferent limb.
after 1/5 of the volume is reduced due to • Maintenance: suckling and emptying of
• Blood loss in normal delivery – 400 ml duct and alveoli.
and in caesarean section – 1000 ml
Complications Of Puerperium
• Obliteration of loss – resistance
• Genital tract infection
uteroplacental circulation
• Urinary tract infection
• Maternal vascular bed decreases 10 –
15 % • Wound infection
iii. Hematopoiesis: • Mastitis
• Leukocytosis – 25000/mm3 during • Thromboembolism
labour and puerperium. • Incontinence/ urinary retention
• Bone marrow hyperactivity present • Anal sphincter dysfunction
• Iron decreases,becomes normal by 2nd • Episiotomy wound gaping
week.
Postnatal Care
Respiratory Changes Mother:
• Residual volume increase. a) Rest and sleep: Adequate rest and sleep are
• Vital capacity and inspiratory capacity vital for maternal health, lactation and baby
decrease. care.
• Post partum decreased progesterone and b) Diet: A balanced diet contains high protein,
decreased respiration increase PCO2. carbohydrate, fats, minerals and vitamins.
Additional calories are required for
Menstruation lactation. (500 calories/day)
• Non-lactating: starts at about 12 weeks. c) Ambulation: Ambulation should be
• Lactating: starts after 6 months encouraged as soon as possible, 6 hours
• 1st cycle: anovulatory or inadequate after normal delivery and 24 hours after a
caesarean delivery. This helps preventing
Lactation thrombo-embolism complications, improve
• Prolactin is an obligatory hormone which venous return and muscle tone.
increases as pregnancy advances. d) Bladder: The postnatal mother usually
• Prolactin induced secretory activity is passes urine within 6 hours. In case of any
placental sex steroid. difficulties, she should be encouraged to
• After delivery decreased sex steroid of do so, by ambulation, plenty of oral fluids,
lactation. opening the water tap while she is trying
to pass urine, pour hot and cold water over
• Milk ejection by myoepithelial cells
vulva.
contraction. Milk propelled along with the
ducts into lactiferous sinus beneath the e) Bowel: Constipation is common due to
areola. painful perineum. Plenty of fluids, green
leafy vegetables and roughage in diet will
• Neurohormonal reflex: afferent pathway to
help.
hypothalamus are stimulated by suckling
166

f) Hygiene: Bed sheet, linen and clothing Underfeeding: It is diagnosed by (1) failure to
should be clean and changed as when gain in weight.(2) dissatisfied with feeds (e.g)
required. This will prevent infection. Bath, cry, disturbed sleep, (3) constipation or frequent
body sponging, cleaning at the breast and small stool (or) scanty urine.
nipple and toileting of the perineum should Overfeeding: usually occurs at the end of first
be done. week. Diagnosed by (1) vomiting soon after
g) Exercise: pelvic floor and abdominal feeding, (2) frequent loose bulky stool with
exercise to restore muscle tone undigested curds (3) excoriation over buttock.
Clothing: Should be appropriate for climate.
7.8 Care of Newborn
7.9 Reproductive Health Care and
First 24 hours is crucial for the newborn
Family Planning
where most of the complication occur during
that period. Definition Reproductive Health Care
Vital signs: Monitor cardio, pulmonary • Ability to reproduce and regulate fertility
function and vital signs at frequent intervals.
• Safe motherhood – safe pregnancy and
Temperature: once a day, may be recorded 6 child birth with resultant safe mother and
hourly if indicated. infant
Respiration: Normally regular, smooth and • Safe sex with no fear of pregnancy and of
quite with a rate of about 30 - 60 breaths controlling diseases.
per minute. Any abnormality e.g:- grunting,
dyspnoea may be noted. Components of reproductive health
Skin: Look for cyanosis, jaundice and Adolescent girl’s health
dehydration. problem
• Pre-
Head, eyes mouth – must be inspected for any Nutrition
reproductive
abnormalities and infection. Sex education
years:
Contraception and
Umbilical cord: check daily for any
Adolescent pregnancy
inflammation, discharge, smell. Cord usually
Age at marriage (ideally girls
comes out by 6 – 7 days.
21 – 25 yrs, boys 26 – 30 yrs)
Stool: Number, color and character of
• Reproductive Family planning
stools should be noted. First stool known as
years: Legal abortion
meconium is dark, greenish viscid substance.
Infections
After Subsequent to feeding of the baby, the
Infertility
color of stool changes to brownish yellow.
Education on menopause
Urine: Usually passed during or shortly after • Post-
Screening for genital cancer
birth. Most infant pass urine within first menopausal
Prevention and cure of
24hours. Urine may stain napkin pink due to years:
genital cancer
the heavy deposits of urates. Napkins should
be changed immediately following soiling and Definition Family Planning
local parts are cleaned and kept dry. Practices that help individuals or couples
Feeding: Encourage demand feeding baby should achieve the following:
be breast fed every 3 – 4 hours. Any abnormality • Avoid unwanted pregnancy
like vomiting, distension should be noted.
167

• Achieve wanted pregnancy and child birth phase 2, the mucus is more abundant thick and
• Spacing the pregnancies clear and stretches easily.
• Determine the number of children in the Measuring basal body temperature:
family Basal body temperature should be
• Choose the age for becoming pregnant measured in the morning. A sustained rise
of temperature of 0.2 to 0.6 C indicates that
Contraception
ovulation has occurred
Measures designed to prevent pregnancy
due to coital act either temporary or Advantages Disadvantage
permanenty
• No physical side • High failure rate
Temporary Methods Of Contraception effects • No protection
I. Natural Method • Economical against sexually
Rhythm Method: • No method- transmitted diseases
The menstrual cycle is divided into three related health (STD’s) Hepatitis -
phases for purpose of assessment of likelihood risks B, HIV
of conception.
Abstinence Complete abstinence
Phase-1: relatively infertile phase last
Coitus interruptus - During sex the man
from onset of menstruation until the time of
withdraws his penis from the vagina before he
preovulation.
ejaculates
Phase-2: fertile phase. last from seven days
preovulation to 48hrs post ovulation. Lactational Amenorrhoea Method
Phase-3: absolutely infertile phase lasts
It suppresses ovulation and thickens
from 48hrs after ovulation until the onset of
cervical secretions. It is effective in women
menstrual, bleeding about 10 – 16 days.
less than 6 weeks of postpartum, who are
Methods to determine the phase of the cycle:
breastfeeding.
Emergrncy Contraception
It reduces sperm transport and changes the
endometrium thus unfavorable for fertilization.
It is effective for women who have had
unprotected intercourse within 72 hours and
for victims of sexual assault.
Advantages of natural methods
• Natural method that does not require
devices or medicine in the body.
• There are no side effects.
• No cost. Is morally and culturally
acceptable.
Testing cervical mucus: • Better than not using any birth control
During phase 1 and 3, the mucus is scanty , method
thick and breaks quickly when stretches. During
168

II. Barrier Methods The diaphragm should lie just posterior to
Condoms: symphysis pubis and deep into the cul-de-sac,
Types: -Latex (plain or treated with spermicide) so that the cervix is completely covered and
behind the centre of the membrane. Spermicide
• The spermicide will immobilize or kills
should be applied before each coital act. The
sperm providing added protection if
diaphragm should left in place for a maximum
breakage or leaks occur.
of 8 hrs after the last coital act.
Direction of use:
• The condom should be applied before Cervical Cap
vaginal penetration and should cover • It is a dome shaped cup that fits over the
the entire length of the erected penis. cervix.
Adequate lubrication should be used • I t cannot be left in the cervix for more than
and the condom should be removed 48 hours.
immediately after ejaculation and • Only women with normal pap smear can
disposed properly. use.
Advantages Disadvantages Spermicide
• Fairly effective • High failure rate 3 to They are agents that cause destruction of
in preventing 15 per 100 women. the sperm cell membrane; thereby affecting
pregnancy mobility.
• Only synthetic
• Only condom can provide • Aerosol foams
contraceptive protection against • Creams and Jellies
method that HIV and HBV’s • Vaginal suppositories
provides • If either partners has • Films & sponges
protection latex allergy, a non- All contain spermicidal agents usually
against STD’s. latex product should nontoxic.
be used.
Advantages Disadvantages
Diaphragm:
• Serves as a lubricant • High failure rate
and also provides • Effective for only
•E ffective in •• High failure rate some protection 1-2 hours
preventing •• Slight risk of against STD’s
pregnancy if used toxic shock • Reduced risk of
properly and provide syndrome. cervical neoplasia
same protection •• Increased risk of
against STD’s UTI III. Iucd- Intra Uterine CONTRACEPTIVE
••Decreased risk of •• It requires initial Devices
cervical cancer fitting. Modern Methods
They are flexible plastic device medicated
Types:
with slowly released hormones. Copper –
i) flat spring ii) Coil spring iii) Arching spring released devices interferes with the ability
of sperm to pass through the uterine cavity.
169

Progestin releasing device thicken the cervical Side effects
mucus and thin the endometrial lining thus • Cramping
prevents conception. • Abnormal menstrual bleeding
Types:
Copper Complications
• Copper - T 380 A • Uterine and pelvic infection
• Nova T • Expulsion
• Multiload 375
• Uterine perforation
Silastic
• Ectopic pregnancy
Hormone releasing
• Progestasert IV. Hormonal Contraceptives
• Levonova / Mirena
Combined oral contraceptives
Insertion:
They consist of synthetic oestrogen and
1. Bladder empty, lithotomy position.
progestin preparations, act by suppressing
2. Posterior vaginal speculum is introduced in lactation, thickening of cervical mucus and
vagina and cervix are cleansed by antiseptic alteration of endometrium.
lotion.
3. Anterior lip grasped by Allis forceps. Uterine Contraindication
sound passed through the cervical canal Absolute Relative
to normal position of uterus and length of • Breast carcinoma • Smoking
cavity. • History of DVT, • Age > 35yrs
4. Insert the device through the cervical Os Pulmonary embolism • Obesity
up to the fundus and after positioning, • Acute liver diseases • Hypertension
inserter is withdrawn keeping the plunger • Concurrent treatment • Breast feeding
in position. with rifambicin
5. Excess of nylon thread is to be cut. • Familial hyperlipidemia
• Pregnancy
Side effects
• Highly effective • Risk for pelvic • Amenorrhoea
in preventing inflammatory • Breast fullness or tenderness
pregnancy. diseases.
• Depression, severe vascular headache
• Immediately effective • Dysmenorrhoea • Hypertension
after insertion. and menorrhea
• Spoting or intermenstrual bleeding
• Long term protection within first few
is provided with months after Missed pills
copper T. insertion. • If one pill is missed, instruct the patient to
• Can be used for • IUD’s offer take two pills at the next scheduled time
emergency post coital no protection and complete the pack as usual.
contraception. against STD’s. • If two or more consecutive pills are missed,
• Do not affect breast instruct the patient to finish the package of
feeding. pills.
170

Progestron Only Pills
They cause suppression of ovulation, • Highly effective and • Requires minor
thickening of cervical mucus and alteration of acts within 24 hours surgical procedure
the endometrium. placement to insert and
Advantages Disadvantages • Long term removal.
protection (3 – 5 yrs) • Provides no
• Pill is rapidly effective • Amenorrhoea
• Immediate return of protection against
• Fertility returns • I ntermenstrual
fertility on removal. STD’s.
immediately when the pill bleeding
is discontinued •M ust be taken
• Does not affect breast everyday Advantages Disadvantages
feeding • Highly effective in • No protection
• May improve anemia preventing pregnancy. against HBV,
• Menstrual flow is decreased HIV or other
• Protection against
• Protects against STD’s.
endometrial cancer.
endometrial cancer and
• B enign breast disease, • Must be taken
pelvic inflammatory
ectopic pregnancy and every day.
diseases
iron deficiency anaemia
are also reduced.
Progestron only Injectable Contraceptives
They cause suppression of ovulation, Side effects
thickening of cervical mucus, alteration of
• Mastalgia
endometrium and change in tubal motility.
• Breast tenderness
Advantages Disadvantages • Weight gain or loss
• Irregular bleeding or spotting
• Very & rapidly • Return to fertility is
• Amenorrhoea
effective and delayed up to 5 – 7
long acting months • tHirsutism
• Hair loss
• Can be used by • Some patients
women more experience weight
Permanent Method
than 35 years. gain, irregular
bleeding, amenorrhea Surgical Sterilization
& excessive bleeding. It is appropriate to couples who desire
permanent sterilization.
Implants (Norplant) 1. FEMALE: Tubal ligation OR Tubectomy
It consists of thin, flexible capsules filled Types
with levonorgestrel that are inserted under the • Puerperal sterilization
skin of women’s arm. They cause suppression
• 2. Interval tubal ligation:
of ovulation, thickening of cervical mucosa,
• Minilaprotomy: The Pomeroy procedure
alteration of the endometrium and change in
performed using a 3 to 4 cm suprapubic
tubal motility.
incision under local anaesthesia with
sedation.
171

• Laparoscopic: Silastic rings are placed
• World population 711 crore
around loop of the tube, resulting in
necrosis and occlusion. • Indian population
1,251,695,584 (July 2015)
• Second most populous country
• Will become the first by 2022
• Occupies 17.5% of world population
and 2.4% of land area
• Population growth ratio is 1.25%
• Birth rate is 20.22
• Death rate is 7.4
SURGICAL STERLIZATION
Uterine CAUTERIZED
Fallopian tube Fundus
cavity
• Highly effective and • Permanent of uterus
no longterm side procedure

effects • No protection
• Provided in against STD’s
Ligament
outpatient basis • Risk of ectopic Ovary of Ovary Fimbriae
pregnancy
TIED AND CUT CAUTERIZED BANDED
•• Outpatient procedure •• Permanent
under local anesthesia procedure
•• Less expensive •• No protection
•• Fewer complication against STD’s
Activity 1
Calculate EDD for the women whose

LMP is 16th june 2018.
172

SUMMARY
Midwifery is the art and science of caring for woman undergoing normal pregnancy, labour
and the period following child birth.
Normal pregnancy involves a continuous process. It is divided into three trimesters. It starts
from fertilization to delivery of the fetus.
Physiological changes occur during pregnancy especially there is marked changes in
genitourinary system. Pregnancy is diagnosed by first in urine testing of beta HCG and
confirmed by ultasonogram. Expected date of delivery is calculated by last menstrual period.
Antenatal care refers to the care given to an expectant mother from the time of conception
to the beginning of labour. Importance of regular follow up should be insisted to the women.
Advise them to take regular calcium, iron and folic acid.
Identification of high risk pregnancy and provide appropriate treatment to reduce the
maternal and fetal morbidity and mortality.
Each visit should check blood pressure and weight in order to identity the early signs of
pregnancy induced hypertension which is major cause of maternal death and fetal death.
Labour is the process resulting from uterine contraction leading to expulsion of products
of conception from the uterine cavity through vagina. Labour is diagnosed by dilatation of
cervix and contraction of uterus.
A serious of movements adapted by fetus in the birth passage during expulsion is called
mechanism of normal labour. Mechanism of normal labour falls on: - (3 P’s) power, passage,
and passenger.
There are three stages of labor.
First stage: F
irst stage of labour is the interval between the onset of labour and full cervical
dilatation. Duration is 6 – 12 hours.
Second stage: It is the interval between full cervical dilatation and delivery of the fetus.
Third stage: It is the interval between the delivery of the fetus and delivery of the plancenta,
umbilical cord and fetal membranes and last 15 – 30 minutes.
Puerperium is the period following childbirth during which the body tissues especially
the pelvic organs, revert approximately to the pre-pregnant state both anatomically and
physiologically. Post natal care which includes of rest, sleep, early ambulation, diet,
hygiene, etc.
First 24 hours is crucial for the newborn where most of the complication occur during that
period. Feeding should be planned for every 2 – 4 hours intervals including demand of the
baby
Early initiation of breast feeding should be initiated within 1 hour of child birth. Educate
the mother about the exclusive breast feeding for six month and continue for 2 years along
with weaning food.
Mother has to be instructed to follow contraceptive methods. There are two types of
contraception temporary and permanent. Temporary methods divided into natural,
hormonal, intrauterine devices and barrier methods. Tubectomy and vasectomy are the
permanent methods.
173

GLOSSARY
Conception – the action of conceiving a child or of one being conceived.

Antenatal – relates to the medical care of women when they are expecting a baby.
Labour – childbirth, the process of delivering a baby and the placenta, membranes &
umbilical cord.
Puerperium – the period of about 6 weeks after childbirth during which the mother’s
reproductive organs return to their original non-pregnant condition.
Gravid – total number of confirmed pregnancies that women has had, regardless of
outcome.
Parity – the number of births that a women has had after 20 weeks.
Abortion – the deliberate termination of human pregnancy during the first 28 weeks.
Caesarean – it is the use of surgery to deliver babies.
Lactation – it is the production of milk by women during the period after they give
birth.
Ammenorrhoea – the absence of menstruation.
Expand the IVF In Vitro Fertilization

Expansions
following LMP Last Menstrual Period
AF Amniotic Fluid Pregnancy Induced
PIH
AFI Amniotic Fluid Index Hypertension
BP Blood Pressure PP Post Prandial
C/S Caesarean Section reterm Premature Rupture of
P
PPROM
Membranes
CBC Complete Blood Count
RL Ringer Lactate
CNS Central Nervous System
WHO World Health Organization
DES Diethylstilbestrol PTL Pre Term Labour
DM Diabetes Mellitus HPL Human Placental Lactogen
EDD Expected Date of Delivery
FH Fetal Heart STD Sexually Transmitted Disease
FHR Fetal Heart Rate

UTI Urinary Tract Infection
GDM Gestational Diabetes Mellitus IUD Intra Uterine Device
IM Intra Muscular
GI Gastro Intestinal
HBV Hepatitis B Vaccine
HTN Hypertension
DVT Deep Vein Thrombosis
Human Immunodeficiency
HIV
Virus
Intra Uterine Growth
IUGR
Retardation
174

Evaluation
I. Choose the correct answer 7. Puerperium is a period of ______ weeks

1. Th
e dramatic changes of uterus is influenced (six)
by hormone during pregnancy a) 6 b) 10
a) oestrogen c) 12 d) 15
b) progesterone 8. The common side effects for Intrauterine
c) oxytocin devices (hypertension)
d) prostaglandins a) Cramping
2. A
t term the weight of the pregnant mother b) Abnormal Mentural Bleeding
is increased upto (12.5 kg)? c) Amennorhea pelvic inflammatory
a) 10kg disease
b) 11.5kg d) Expulsion hypertension
c) 12.5kg 9. Emergency contraception is effective
d) 15kg within ______ Hours (72)
3. Th
e first fetal movement heard by the a) 48 b) 24
pregnant mother is called as. (quickening) c) 72 d) 6
a) Quickening 10. Sudden expulsion of normally implanted
b) Softening placenta (Abruptio placenta)
c) Soufling a) Abruptio placenta
d) Meconium b) Placenta praveia
4. The mucoid discharge and the development c) Placenta accrete
of antibacterial plug of mucous in the cervix d) Placenta percreta
(None of the above)
II. Short answers
a) Chloasma
b) Operculum 1. Define midwifery.
c) Lineanigra 2. Define labour
d) None of the above 3. Define puerperium?
5. The phase extends from onset of labour to 4. How will you diagnose pregnancy?
till 3 – 4 cm of cervix dilation(latent)Fear 5. W
rite the management for gestational
a) Latent diabetes mellitus.
b) Active 6. Define placenta praevia?
c) Maximum curve 7. Define family Planning
d) MaximumSlope
6. The untwisting of the neck in mechanism of III. Brief answers
labour is referred as (restitution) 1. W
hat are the physiological changes in
a) Crowning pregnancy?
b) Restitution 2. Explain about the mechanism of labour.
c) Desent 3. Explain physiological changes occur during
d) Engagement puerperium briefly.
175

4. What are all the postnatal care?
INTERNET LINK
5. What are the benefits of intra uterine
devices. 1. https://images.google.co.in/
6. Mention the types of intra uterine devices. imgres?imgurl=https%3A%2F%2Fimg.
7. Write the importance of combined oral webmd.com%2Fdtmcms%2Flive
pills. %2Fwebmd% 2Fconsumer_assets%2Fsite_
images%2Farticles%2Fhealth_
8. What do you mean by emergency
tools%2Fbirth_control_overview_
contraception?
slideshow%2Fgetty_rf_graphic_of_least_
9. What are all the components of reproductive effective_birth_control_methods.jpg
health?
2. https://images.google.co.in/
10. What do you mean by norplant? imgres?imgurl=https%3A%2F%2Fufh-
11. What are the two methods of permanent jax northside.sites.medinfo.ufl.
sterilization? edu%2Ffiles%2F2017%2F04%2FWeek-3.jpg
REFERENCE BOOKS imgres?imgurl=https%3A%2F%2Fstatic.
boredpanda.com%2Fblog%2Fwpcontent%2
1. Annamma Jacob,” A Comprehensive Text
Fuploads%2F2016%2F10%2F12045546_73
book of Midwifery”, 2nd edition, Jaypee
1907343602705_4896914255634650962_o-
Brothers Medical Publishers.
581180f749e66__700.jpg
2. Berish Ruth, “ Myles Textbook of Midwifery”,
13th edition, B.I Publications Pvt Ltd.
imgres?imgurl=https%3A%2F%2Fimage.
3. Dutta D.C,” Text book of Obstetrics”, 5th
slidesharecdn.com%2Fpopulatio
edition, New Central Book Company,
nexplossionandfamilyplanning-
Calcutta 2001.
160712163757%2F95%2Fpopulation-
4. Parulekar V.S,” Textbook of Midwives”, explossion-and-family-planning-2-638.
2nd edition, New Central Book Company, jpg%3Fcb%3D1468341500
Calcutta 2001.
5. Sir K. Chattopadhy and M. Narayanasamy,”
Midwifery”, 1st edition, B.I Publications Pvt
Ltd.
6. Varney Helen, “Nurse Midwifery”, 2nd
edition, Jones and Barlett Publishers, Boston
1996.
176

ICT CORNER CHILD HEALTH
Through this activity you will be to

know the various changes happen
during the menstrual cycle
Steps
• Step 2: A picture of the foetus is displayed, week numbers of the trimester is given
above and trimester timeline is given below the picture.
• Step 3: Click any week number to know the position and growth condition of the
fetus on the particular week
• Step 4: Click the picture to see it enlarged.
URL : https://www.healthlinkbc.ca/health-topics/tn10283
https://www.webmd.com/baby/interactive-pregnancy-tool-fetal-development?week=3
177

CHAPTER
8
Child Health
Nursing
குழல்இனிது யாழ்இனிது என்பதம் மக்கள்

மழலைச்சொல் கேளா தவர்.
“The pipe is sweet, the lute is sweet,” say those who have not heard the
prattle of their own children
Learning Objectives

➢➢ understand about the newborn
➢➢ explain the medical and special care of newborn
➢➢ explain the universal immunization programme
➢➢ explain the importance of exclusive breast feeding
➢➢ understand the growth and development
➢➢ describe weaning
➢➢ explain the maternal and child health services
Introduction 8.1 Definition of Newborn
“A person is a person no matter how small” A newborn is otherwise known as a

said by Dr. Seuss. Children, though small, they “neonate” is a child under 28 days of age.
are unique individual and are our most valuable
resources. They are the gift to the society and
a nation’s wealth depends on the health of its
children. They need healthy atmosphere for
their all round development and also need
special care since they are world’s most valuable
resource and among the most vulnerable in
the society. Knowledge about the needs and
problems of the children will help us to provide
healthy atmosphere there by to create a better
world for them.
178
Unit_8_Child_health_Gen_Nur.indd 178 12/10/2021 10:30:00 PM

Neonatal period • The newborn loses 10% of its body weight
during the first week. The initial weight
The period between birth to first 28 days
loss is regain by 10th day.
is known as neonatal period. Early neonatal
period is the first seven days of life after birth. • Hemoglobin is high (around 18g/dl)
Late neonatal period includes from the 8th day
to 28th day. Proper care of the newborn during A newborn usually sleeps
this period is mandatory to pave a foundation around 18 hours a day
for a healthy life.
Important Neonatal Reflexes
Characteristics of Newborn
Baby Rooting Reflex
Physical characteristics
• Birth weight of the normal term newborn
ranges from 2.5 to 4.0 kg.
• Length ranges from 47-52 cm.
• Babies head circumference ranges from 34
cm - 35 cm and chest circumference ranges
from 31 cm -32 cm
• The chest circumference is approximately
2-3 cm less than the head circumference at
Eliciting Rooting reflex
birth.
It helps the baby to locate the mother’s
• The chest is rounded and abdomen is
nipple without the mother directing the
prominent.
baby’s mouth. When the corner of the baby’s
• Newborn’s trunk is relatively larger and the
mouth is touched, the lower lip is lowered
extremities are short.
and the tongue is brought forward towards
• Newborn has flexed attitude. the contact.
Physiological characteristics Sucking and swallowing reflexes
• Temperature is 36.5°C to 37.5°C
• Heart rate is 120-160 beats per minute
• Respiratory rate is 40-60 breaths per
minute
• Baby has a vigorous cry.
• Baby has normal breathing, pink in colour,
sucking and swallowing normally
• Newborn passes its first stool within
24 hours and are dark green coloured
and thick. The first stool is known as
Eliciting sucking reflex
meconium. The colour of the stool changes
after initiation of breast feeding. Introduce a clean finger in to the mouth of
the newborn and the baby will start sucking the
• The first urine is passed during or shortly
finger.
after birth.
179

Moro reflex rapidly and successfully to an alien external
environment. The risk of death is the greatest
during the first 24-48 hours after birth.
Principles of Newborn care

• To promote adequate oxygenation
• To prevent hypothermia
• To promote early
breastfeeding
• To prevent neonatal
infections
Newborn exhibiting Moro reflex
• To identify at risk
It is elicited by raising the shoulder for newborn
45° from ground and then dropping by 30°.
• To facilitate stabilization of the newborn
There will be abduction and extension of
arms with opening of fingers. This is followed
Care of newborn
by flexion and adduction of arms.
Maintenance of normal respiration and
Palmar Grasp reflex oxygenation
The first cry of the baby after birth is
the sign of respiration. All babies should cry
immediately after birth. If the baby doesn’t
cry, it needs immediate attention of the health
care personnel. As soon as the baby is born,
the airway should be cleared of mucus and
any other secretions within the labour room.
Then continuous monitoring of respiration
and heart rate is done for every 15 minutes
Eliciting Palmar grasp for first 2 hours or till adaptation to external
environment. Positioning the baby with its head
It is elicited by touching the baby’s palm
extended may help in the drainage of secretions.
from the ulnar side with finger or any other
A gentle suction in the mouth first and nostrils
suitable object. The fingers close and grasp the
second can facilitate removal of secretions and
object.
amniotic fluid. Resuscitation is necessary for
babies who do not breathe within a minute.
8.2 M
edical and Special Care of The APGAR score is taken at 1 minute
Newborn and again at 5 minutes after birth. It requires
immediate and careful observation of the
The first week of life is the most crucial
Appearance, Pulse, Grimace, Activity and
period in the life of an infant. In India, 61.3
Respiration. Each sign is given a score of 0,
percent of all infant deaths occur within the
1 or 2. It provides an immediate estimate of
first month of life. Of these, more than half
the physical condition of the baby. A perfect
may die during first week of birth. This is
score should be 9 or 10. A score below 5 needs
because the newborn has to adapt itself
prompt action.
180

APGAR Score
Sign Score
0 1 2
Appearance Body pink Extremities Completely pink all
Blue/pale
(colour of the baby) blue over
Pulse(Heart rate) Absent Below 100 Above 100
Grimace (Reflex Facial movement only
No response Sneezes, Coughs
response) with stimulation
Lethargic and Some flexion of
Activity (Muscle tone) Active movements
extremities extended extremities
Respiration Absent Slow and irregular Regular with cry
Maintenance of Body temperature (warmth) Provide skin to skin contact to the baby if
Body heat is lost from the newborn by four possible
ways. They are as follows:- If skin-to-skin contact is NOT possible:
• Wrap the baby in a clean dry warm cloth
Convecon
Evaporaon
• Mummify the baby
Radiaon
• Cover the baby’s head with cap.
• Assess warmth every 4 hours by touching

Conducon baby’s feet
• Keep the room warm

• Convection- Leaving the baby in a draught
(Cool air) • Remove all wet cloths
• Radiation – If the baby’s head is not • Rooming in. The mother should be
covered, the body heat is able to pass into encouraged to keep the baby with her.
surrounding air.
• Conduction – Leaving the baby on a cold
How to provide skin to skin contact?
surface
In skin-to-skin contact, the baby is placed
• Evaporation – Baby not dried after birth
naked on the mother’s bare chest, between
the amniotic fluid evaporate by using by
her breasts. A blanket should be draped
body heat.
over both of them for warmth. If the
• The body temperature below 36.5°C is mother is unable to provide skin-to-skin
known as hypothermia. contact, then the father can provide.
To maintain the temperature of the newborn
one must do the following
181

Breast feeding
It should be initiated as early as possible

after birth. The first milk which is called
“colostrum” is the most suitable food for
the baby during early period because it is
rich in anti-infective factors. It contains high
concentration of protein and other nutrients
the baby needs.
Vitamin K injection: Vitamin K
Cord care injectioning is given intra muscularly to prevent
The stump is kept dry and clean. Nothing bleeding.
should be applied over stump. Bandages Care of Skin: It is advisable to postpone
the formal bath to the second week. However
should not be applied. Fold diaper below
sponge bath may be given after 24 hour of birth.
stump. If the stump is wet, wash with clean
Urine and meconium: Check for passage
water and soap, dry with clean cloth. Usually
of urine and meconium.
the stump will fall in 7-10 days time. If Immunization: Hepatitis B vaccine
umbilicus is red or draining pus or blood, the and zero doses of OPV and BCG is given
mother should be advised to see the health immediately. Thereafter, the child should be
worker. immunized on specific dates.
Harmful practices which should

not be followed for newborn
• Giving prelacteal feeds soon after birth
like sugar water or honey or donkey milk,
jaggery water.
• Discarding the colostrums (the first milk
secretion from the mother)
• Applying ashes or soot or powder or dry
cow dung on the umbilical cord of the
baby.
Eye care • Applying kajal on the baby’s face to prevent
Eyes of the babies are cleaned from bad eye
inner canthus to outer canthus using sterile • Tying black thread or bangles to the baby’s
wet gauze or cotton in the hospital and with hand or leg to prevent bad eye.
a clean cloth at home. Nothing should be • Exposing baby to a “holy” smoke
poured into the eyes of the newborn unless (Sambirani) after bath.
medically indicated. • Giving home remedies for digestion like
vasambu
• Pouring of oil into eye or ear.
• Blowing of nose and ear during bath
182

Red flag signs there is a possibility of vaccine failure. It is
expected to maintain 6 rights of supply chain.
These are danger signals to be identified
They are as follows:-
at newborn. Presence of one or more of these
sings is an indication for prompt evaluation and • Right vaccine
treatment. • Right dose
• Feeding difficulty • Right site
• Persistent vomiting • Right time
• Fast breathing (more than 60 breaths per • Right condition(temperature)
minute) • Right person
• Hypothermia (temperature less than 35.5°C
To maintain cold chain, certain equipments
• Hyperthermia or Fever,Temperature more are used in Universal Immunization Programme.
than 37.5°C They are as follows:-
• Seizures
• Walk in freezers
• Lethargy
• Walk in coolers
• Fatigue yellowish discoloration
• Deep freezer
• Ice lined refrigerator
A newborn usually In India,
the newborn death rate is 25.4 • Domestic refrigerator
in 1000 live births as per 2016 • Cold boxes
statistics • Vaccine carriers
• Ice pack
8.3 U
niversal immunization
programme
Immunization is a mass means of

protecting the greatest number of people. It
has to be planned according to the needs of
the situation and the prevailing health issues.
Deep Freezer
Every country has its own immunization Ice lined Refrigerator
schedule to suit the local needs. Under
immunization, immunizing agents such as
antisera, live vaccines and inactivated or
killed vaccines are administered.
Cold Chain and Equipments Cold box and

vaccine carrier
The vaccines should be stored at an
appropriate temperature (preferably low) and
the temperature should be maintained during
its transport from the manufacturing site to
the actual vaccination site. This system of
storage and transport is known as the “cold
chain”. If the temperature is not maintained,
Ice pack Vaccine carrier
183

Universal Immunization BCG Vaccination
Programme In addition to the above mentioned
The World Health Organization vaccines, Rota Virus vaccine & Japanese
officially launched a global immunization Encephalitis vaccine is given in selected states.
programme, known as Expanded Programme Diseases and its vaccine
on Immunization (EPI) in May 1974, to
protect all children of the world against six S. N Vaccine Protection against
1 BCG Tuberculosis
vaccine –preventable diseases. They are namely
Hepatitis B, liver
diphtheria, whooping cough, tetanus, polio, 2 Hepatitis B
infection
tuberculosis and measles. EPI was launched in
3 Oral Polio Vaccine
India in January 1978. This programme is now Polio
Inactivated Polio
called as Universal Immunization Programme 4
Vaccine
(UIP) in India. Diptheria, Pertussis,
Tetanus, Hepatitis
5 Pentavalent vaccine
National Immunization Schedule for Infants B &Haemophilus
and Children in India Influenza B
6 Measles Vaccine Measles
Diptheria, Pertussis,
7 DPT Vaccine
Tetanus
TT (Tetanus
8 Tetanus
Toxoid)
9 Rota virus Vaccine Diarrhoea
Japanese
Japanese Encephalitis
10 Encephalitis
- a brain infection
Vaccine
Vaccine When to give Dose Route Site

BCG (Bacilli galmetteGurein) At birth 0.05ml Intra dermalLeft Upper arm
Left Antero lateral
Hepatitis B birth dose At birth 0.5ml Intra muscular
side of mid thigh
OPV zero dose At birth 2 drops Oral
OPV 1, 2, &3 (Oral Polio Vaccine) At 6, 10 & 14 weeks 2 drops Oral
Right-Antero lateral
IPV (Inactivated Polio Vaccine) At 14 weeks 0.5ml Intra muscular
side of mid thigh
Pentavalent 1,2 & 3 (Diptheria,
At 6, 10 & 14 Left Antero lateral
Pertussis, Tetanus, Hepatitis B 0.5ml Intra muscular
weeks side of mid thigh
&HIB)
At 9 completed
Measles – 1st Dose 0.5 ml Subcutaneous Right Upper arm
months
Left Antero lateral
DPT Booster-1 16-24 months 0.5ml Intra muscular
side of mid thigh
Measles – 1st Booster Dose 16-24 months 0.5 ml Subcutaneous Right Upper arm
OPV Booster 16-24 months 2 drops Oral
DPT Booster-2 5-6 years 0.5ml Intra muscular Left Upper arm
10 years & 16 Intra
Tetanus Toxoid (TT) 0.5 ml Upper arm
years muscular
184

which are nutritionally adequate and safe to
8.4 Breast feeding
meet their nutritional requirements,while
Breast feeding should be initiated as continuing to breastfeed for up to two years
soon as after birth of the baby. A baby is or beyond.
usually alert immediately after birth which is
the ideal time to facilitate breast feeding. The Advantages of Breast feeding
baby will spontaneously seek the breast if it is
put on skin to skin contact with its mother’s For babies
body. Breast milk is the best milk, suited for a • It is safe, clean and hygienic
newborn. It contains all the nutrients for the • It is cheap and available in correct
normal growth and development of a baby temperature to the infant
from birth to first six months of life. • It completely meets the nutritional
requirement of infants upto 6 months
Exclusive Breast feeding
• It provides immunity to the infants
In exclusive breast feeding, the infant is
given only breast milk. Even the water is not • It protects babies from diarrhoea and
given – with the exception of oral rehydration respiratory infection
solution, or drops/syrups of vitamins, • It is easily digestible
minerals or medicines.
• It promotes bonding between the mother
and infant
• It prevents under nutrition as well as over
Healthy neonates when
nutrition
placed skin to skin on their
mother’s tummy and chest after • It reduces the risk of overweight and
birth, shows amazing behaviours. The baby obesity in children
moves, crawls, smells and licks the mothers • It increases the Intelligence Quotient of the
nipple. Finally, the baby on its own attaches babies
to the breast and feeds.
• It ensures food security for the babies
The first milk secreted from the breast
is known as colostrum, also called the baby’s
For the mother
‘first vaccine’ as well as considered as “liquid
• Breast feeding delays next pregnancy
gold” which is extremely rich in nutrients
and antibodies. • It lowers risk of breast and ovarian cancer
• It decreases mother’s work load

HO recommendations on
W
Breast feeding For the family and society
Babies should be exclusively breast fed • Breast feeding saves money
for the first 6 months of life to achieve optimal
• It promotes family planning
growth, development and health. Thereafter,
infants should be given complementary foods • It decreases the need for hospitalization
185

eflexes useful for breast
R The foremilk satisfies the thirst of the baby
feeding whereas the hindmilk which is high in fat
provides satiety.
• The following two reflexes are helpful for
the babies in breast feeding.
Techniques of breast feeding
• Rooting reflex: To find the nipple and
proper attachment to breast. Positioning
• Sucking reflex: To draw out milk from • The mother is relaxed and comfortable.
mother’s breast.
• The baby’s head and body are in a straight
Types of Breast Milk line
The breast milk secreted undergoes changes • The baby’s face is opposite the nipple and
as the days goes on to meet the demands of the the breast
baby.
• The baby’s upper lip or nose is opposite the
S. N Breast Milk Characteristics mother’s nipple
This milk is secreted • The baby is held or supported very close to
in the first week of the mothers body
1 Colostrum life.Thick and yellow.
Rich in protein and • The baby’s whole body is supported if the
antibodies mother is in a sitting position
Milk that is secreted Attachment: It is otherwise known as
between the 1st and the latching. It means attachment of nipple along
Transitional
2 2nd week. The fat and with areola in baby’s mouth and not nipple
milk
sugar content starts alone.
increasing.
Key points to good attachment
After 2 weeks, the
• The mouth is widely open
milk secreted is known
as mature milk It is • The tongue is forward in the mouth, and
3 Mature milk
thinner and watery may be seenover the bottom gum
Rich in all necessary
nutrients • The lower lip is turned outwards
• The chin is touching the breast
More areola is visible above the baby’s

mouth than below it
Burping: After feed the baby should put
on to the left shoulder of the mother with its
head supported and then with the right arm, the
Foremilk vs Hindmilk mother should gently pat on the baby’s back. It
The milk that is secreted when the baby avoids regurgitation.
initiates feeding is foremilk whereas the milk
that is secreted at the end the feed is hindmilk.
186

efinition of growth and
D
development
Growth is defined as an increase in size
of an individual. This increase in size is due
to increase in the number and diameter of the
cells.
Development denotes the functional
maturity of the child. It is the mental maturation
with acquisition of skills.
Though growth and development are not
the same, they are assessed simultaneously. They
are unique characteristics of children and any
Don’ts in Breast feeding problem in this process at any stage can result in
• Avoid prelacteal feeds deviation of growth and /or development.
• Avoid bottle feed

Stages of Growth
• Do not discard colostrum The following are the stages of growth in
• Do not give water children
S.N. Stages Growth period
Checking adequacy of breast Implantation to 8 weeks
1 Embryo
feeding of gestation
9th week of gestation to
The following indicates that baby is getting 2 Fetus
birth
adequate breast milk. 3 Newborn Birth to 28 days of life
• Baby is passing urine 6-7 times a day 4 Infant Birth to 1 year of age
• Baby is passing well formed stools 5 Toddler 1-3 years of age
6 Preschool 3-5 years of age
• Sleeping comfortably after feed for atleast
7 School age 6-12 years of age
2-3 hours
8 Adolescence 13-18 years of age
• Gaining weight adequately.
Assessment of growth
• Physical anthropometry (weight, height,

8.5 Growth and Development
circumferences of head, chest, abdomen
and pelvis)
Growth refers to an increase in size • Assessment of tissue growth (skin fold
and development refers to maturation of thickness and measurement of muscle
function. Starting from conception, growth mass)
and development is influenced by various
• Bone age (x ray of the bone)
factors both inside the uterus and external
environment. Growth and development begin • Dental age (by counting the number of
at conception and end at maturity. erupted teeth)
• Biochemical and histological means.
187

Examples of developmental tasks • Growth proceeds from general to specific
Developmental • Head grows faster than the body and
S. N. Examples extremities
areas
Sitting, walking, • Growth pattern is same for all children
1 Gross motor running, climbing • Rate of development varies from child to
& jumping etc child
Hand skills like • Boys and girls grow differently
writing, buttoning,
2 Fine motor Factors influencing growth
holding objects and
visual development Growth is influenced by interaction of both
Thinking, decision genetic and environmental factors. Children
Cognitive making, recalling, generally grow to their genetic height potential
3
development learning of maths with little outside assistance. Parents have to
etc., provide best possible environment for their
Speaking, growth to take place.
understanding Genetic factors: In general, Asians tend
Speech, to be smaller than Europeans while Afro
language, replying
Language Americans are taller than white Americans
4 and responding
and hearing Parental influence: Tall parents tend to
by verbal and
development have taller children.
non verbal
communication Gender: Boys tend to be taller and heavier
Feeding, toileting, than girls
Personal social dressing, Genetic disorders: Chromosomal
5 behavior establishing and disorders such as down syndrome, Turner
development maintaining social syndrome and genetic mutations can adversely
relationship. influence growth.
Prenatal (before delivery) growth: The
Assessment of development size at birth is primarily influenced by maternal
health and uterine environment. Maternal health
Development can be assessed under
condition affects the growth of the foetus. Certain
various categories. They are
diseases like diabetes, hypertension during
• Motor (gross and fine motor) development
pregnancy affects the growth in the uterus.
• Speech, Language and hearing development Post natal (after delivery) growth
• Cognitive development Nutrition: Lack of nutrition during first
• Personal social behavior development two years of life after birth has remarkable
influence on the growth of the child.
Principles of growth and Chronic illnesses in children: Congenital
development heart diseases, recurrent pneumonia, persistent
• Growth is a continuous process diarrhea, tuberculosis leads to growth failure.
Hormonal influences: Growth hormone
• Growth is an orderly process
and thyroxin deficiency and sex hormone
• There is period of rapid growth and slow
deficiency during puberty affects growth.
growth
Emotional factors: Emotional deprivation,
• Growth follows a sequence
anxiety may affect the child’s growth.
188

evelopmental mile stones in
D
gross motor functions
Age Mile stones
3 months Neck holding
5 months Sitting with support
8 months Sits independently without support
9 months Standing with support
10 months Walking with support
Roll over
11 months Crawling (creeping)
12 months Standing without support
13 months Walking without support
18 months Running
2 years Climbing upstairs
3 years Riding tricycle
Sitting
Crawling
Squatting
Standing with support
Walking Standing on one leg
189

Growth Chart • WHO growth chart
• ovt. of India Growth
G
chart
• ICDS growth chart
Uses of growth chart

•
To ensure normal
growth
•
To identify any
deviation in growth
• o assess the health
T
status
• o teach mother about
T
the importance of
proper care
• o motivate the mother
T
to promote normal
growth
8.6 Weaning
Weaning is giving family

foods in addition to breast
milk. Family foods are foods
that the rest of the family
normally eat, can give babies
all the nourishment they
need without any additional
cost. Weaning is a gradual
WHO growth chart process by which the infant
Growth chart is developed by Prof. becomes accustomed to the adult diet. The
David Morley. It is a visual display of child’s weaning period is the most crucial period in
growth and development. In growth chart, the child’s development. Weaning, if not done
child’ weight is recorded periodically and a properly, lead to diarrhea and malnutrition.
curve is drawn. A flat curve indicates that the
child’s growth is arrested or slowed down.
There are reference curves printed in the
growth chart. One has to compare the child’s
growth curve with the reference curve to
detect normalcy or any deviation. There are
Height for age and Weight for height chart is
available. The various types of growth chart
available in India are
190

• Inexpensive and easy to prepare
• Not too highly seasoned
Techniques of weaning
• Wash hand thoroughly with soap before
preparation of weaning foods.
• Introduce one food at a time
• Let the baby get used to one food for a few
days before introducing another.
Definition of Weaning • Start by giving one or two teaspoons and

gradually increase the quantity
Weaning is the gradual replacement of
• Give food in addition to regular breast
breastfeeding with other foods.Weaning is the
feeds.
process by which a baby slowly gets used to
eating family or adult foods and relies less and • Do not use a feeding bottle.
less on breast milk. • Slowly increase the number of meals and
the amount of food given.
Time of weaning • Feed babies using a clean cup and spoon.
It is a gradual process starting around the • Do not add water to the weaning food.
age of 6 months, because the mother’s milk • Encourage the child to hold the food
alone is not sufficient to sustain growth beyond • Encourage eating on its own
6 months.
• Avoid force feeding
Supplementary foods • Avoid ready made processed foods
By the age of eight months, most babies
During weaning, suitable foods rich in
need four ‘meals’ a day including a variety of
protein and other nutrients are given to the
foods, in addition to regular breastfeeding. At
child. These foods are called supplementary
one year old a child should be able to be given
foods. These are usually cow’s milk, fruit juice,
all types of family foods, although the food may
soft cooked rice, dhal, vegetables and egg yolk.
still need to be softened or mashed. Patience
As far as possible, locally available foods should
is needed when babies are first starting to eat
be used in weaning the child. The weaning/
family foods. There is no need to buy expensive
supplementary foods do not replace breastmilk,
commercially manufactured weaning foods.
they complement it. As the baby gets older it
needs more food to grow and stay healthy.
ules for safe preparation of
R
weaning foods
haracteristics of ideal
C
weaning foods • Wash hands before preparing food
• High in energy • Prepare weaning foods immediately before
they will be eaten
• Easy to digest
• Wash all utensils before preparing food,
• Low in bulk and viscosity
and scrub chopping boards and tables
(not too thick)
• Cook or boil food well
• Fresh and clean
• Mash foods up with a clean spoon.
191

• Use the cleanest water available for making and National Urban Health Mission (NUHM)
weaning foods and for washing uncooked as its two sub missions. The programme
foods. components include Reproductive-Maternal-
• If possible boil the water if it has not come Newborn-Child and Adolescent Health
from a clean source such as a tap or water (RMNCH+A); and control of communicable
pump. and non communicable diseases.
• Boiling water will kill the germs that cause Reproductive, Maternal,
diarrhoea. Newborn, Child and Adolescent
• Do not store weaning foods for more than Health (RMNCH+A)
two hours if possible. This programme has been launched
• Keep them stored in clean covered in 2013. It aimed to reduce the maternal
containers that keep out flies and other mortality and child mortality and addressed
insects. the delays in accessing and utilizing health
care and services. Under this programme, the
8.7 Maternal and Child Health areas of care include
services • Reproductive care
• Maternal care
Maternal and Child Health services
• Neonatal care
include the curative, preventive and social
aspects of maternity services, paediatrics, • Child care and
family welfare, nutrition, child development • Adolescent health care
and health education. The specific objectives The three goals that are relevant to
of MCH are: RMNCH+A strategic approach in 12th Five
• Reduction of morbidity and mortality rate Year Plan which has to be achieved by 2017 is
for mothers and children as follows:
• Promotion of reproductive health and • Reduction of Infant Mortality Rate (IMR)
• Promotion of the physical and psychological to 25 per 1,000 live births
development of the child within the family. • Reduction in Maternal Mortality Ratio
(MMR) to 100 per 100,000 live births
Components of MCH • Reduction in Total Fertility Rate (TFR) to
2.1
• Family planning and reproductive health
service Priority interventions in RMNCH+A
• Maternal, newborn and child health service The following are the intervention for
• Health Communication children. They are
• Health Commodities and supplies • Home-based newborn care and prompt
• Health systems strengthening referral
The Ministry of Health and Family Welfare • Facility-based care of the sick newborn
has launched National Health Mission in • Integrated management of common
May 2013. Many different health and welfare childhood illnesses (diarrhoea, pneumonia
programmes have been brought together under and malaria)
the umbrella of National Health Mission (NHM) • Child nutrition and essential
with National Rural Health Mission (NRHM) micronutrients supplementation
192

• Immunization • Free transport during referral services
• Early detection and management of defects • Free drop back from hospital to home
at birth, deficiencies, diseases and disability
in children (0–18 years) Rashtriya Bal Swasthya
Karyakram (RBSK)
Janani SurakshaYojana (JSY) It is a new initiative launched in February
It is a safe motherhood intervention under 2013. It includes provision for child health
the National Rural Health Mission (NRHM). It screening and early intervention services
was launched in 12th April 2005. The objective through early detection and management of 4
of JSY is reducing maternal and neo-natal Ds, prevalent in children. These are
mortality by promoting institutional delivery • Defects at Birth
among the poor pregnant women. A monetary • Deficiencies
benefit is given to the mother under this • Diseases of Childhood
programme for institutional delivery.
• Developmental delays and disabilities
Janani Shishu Suraksha
Integrated Management
Karyakaram (JSSK)
of Neonatal and Childhood
Government of India has launched Janani Illnesses (IMNCI)
Shishu Suraksha Karyakaram (JSSK) on 1st
It is one of the main interventions
June, 2011. This programme aimed to motivate
under the Reproductive and Child Health
the mother for institutional delivery.
programme as well as under NRHM. It has
The following are the free entitlements for two components.
pregnant women:
• Free delivery Care of Newborns and Young Infants (infants
• Free Caesarean Section under 2 months)
• Free drugs and consumables It includes
• Free diagnostics • Keeping the child warm
• Free diet in the hospital • Initiation of breastfeeding immediately
• Free provision of blood after birth
• Exemption from user charges • Counseling for exclusive breastfeeding and
• Free transport from home to hospital non-use of pre lacteal feeds
• Free transport during referral services • Cord, skin and eye care.
• Free drop back from hospital to home • Recognition of illness in newborn and
The following are the free services for sick management and/or referral
newborns till 30 days after birth.This has now • Immunization
been expanded to cover sick infants:
• Home visits in the postnatal period.
• Free treatment
Home visits are an essential part of this
• Free drugs and consumables intervention. Home visits done by health workers
• Free diagnostics help mothers and families to understand and
• Free provision of blood provide essential newborn care at home and
• Exemption from user charges detect and manage newborns with special needs
• Free Transport from Home to hospital due to low birth weight or sickness.
193

Care of Infants (2 months to 5 years) Amma Baby care kit
It includes This is launched in Tamil Nadu in the
• Management of diarrhoea, acute respiratory year 2015. Under this scheme, all the babies
infections (pneumonia) malaria, measles, born in Government institutions are given
acute ear infection, malnutrition and anemia Amma Baby Care Kit worth of Rs.1,000/-. It
• Recognition of illness in children and is distributed with the objective of improving
management/referral the hygiene of the postnatal mothers and
• Prevention and management of Iron and the newborn baby and inculcating hygienic
Vitamin A deficiency practices among the mothers for self and baby
care. The Amma Baby Care kit contains 16
• Counseling on feeding for all children
items viz. baby towel, baby dress, baby bed,
below 2 years
baby protective net, baby napkin, baby oil,
• Counseling on feeding for malnourished baby shampoo, baby soap, baby soap box, baby
children between 2 to 5 years nail clipper, baby rattle, baby toy, liquid hand
• Immunization wash, bathing soap, sowbagyasundilehiyam
and a kit bag to securely keep all the items.
Dr.Muthulakshmi Reddy
Maternity Benefit Scheme
This scheme is being implemented in
Activity 1
Tamil Nadu with a noble objective of providing
financial assistance to poor pregnant mothers to Go to nearby Primary Health centre and
meet expenses on nutritious diet, to compensate observe the Immunization process and cold
for the loss of income during motherhood and chain systems followed and write a report.
to avoid low birth weight of new born babies. In
Go to nearby ICDS centre and ask for
this scheme, Rs. 12,000 per beneficiary is given
the growth chart of the children. Study in
from 20 Feb 2017, it is increased to Rs. 18000
detail the growth chart and write a report.
for the improvement of healthy motherhood.
SUMMARY
A newborn otherwise known as a “neonate” is a child under 28 days of age.

The period between birth to first 28 days is known as neonatal period.
The APGAR score is taken at 1 minute and again at 5 minutes after birth.
It requires immediate and careful observation of the Appearance, Pulse, Grimace, Activity
and Respiration.
Heat is lost from the newborn by four ways such as convection, radiation, conduction and
evaporation.
The first milk which is called “colostrum” is the most suitable food for the baby during
early period because it is rich in anti-infective factors.
Immunization is a mass means of protecting the greatest number of people
194

vaccines should be stored at an appropriate temperature (preferably low) and the
temperature should be maintained during its transport from the manufacturing site to
the actual vaccination site.
This system of storage and transport is known as the “cold chain”. The World
The Health Organization officially launched a global immunization programme, known
as Expanded Programme on Immunization (EPI) in May 1974, to protect all children of
the world against six vaccine –preventable diseases.
Babies should be exclusively breastfed for the first 6 months of life to achieve optimal
growth, development and health.Thereafter, infants should be given complementary foods
which are nutritionally adequate and safe to meet their nutritional requirements,while
continuing to breastfeed for up to two years or beyond.
Growth is defined as an increase in size of an individual
This increase in size is due to increase in the number and diameter of the cells.
Development denotes the functional maturity of the child.
It is the mental maturation with acquisition of skills. Growth chart is developed by Prof.
David Morley.
It is a visual display of child’s growth and development. Weaning is the process by which
a baby slowly gets used to eating family or adult foods and relies less and less on breast
milk
Maternal and Child Health services include the curative, preventive and social aspects of
maternity services, paediatrics, family welfare, nutrition, child development and health
education
GLOSSARY
Rooming in - An arrangement in hospitals where newborn babies stay with their mothers
Prelacteal - Any food except mother’s milk provided to a newborn before initiating
breastfeeding.
Abduction - Movement of a limb or other part away from the midline of the body, or
from another part.
Adduction - Movement of a body part toward the body’s midline.
Mortality - Death
Morbidity - Sickness
Satiety - State of being completely satisfied
195

Evaluation
I. Choose the correct answer d) Janani Bal Swathya Yojana(JBSY)

1. The neonatal period is 9. The breast milk which is thick and yellow is
a) Birth to 28 days a) Foremilk b) Hindmilk
b) Birth to 1 year c) Mature milk d) Colostrum
c) Birth to 90 days 10. 10. The first milk which is secreted from the
d) Birth to 120 days mother immediately after delivery is known
2. The normal birth weight as
of newborn ranges from a) Colostrum b) Foremilk
a) 2-4 kg c) Hind milk d) Mature milk
b) 1.5-3 kg 11. The technique done to avoid regurgitation
c) 2.5 -4 kg. in newborn in
d) 4-6 kg
a) Latching b) Burping
3. An ideal APGAR score for newborn is c) Positioning d) Attachment
a) 6-8 b) 9-10 12. The example for fine motor activity is
c) 4-6 d) 5-6
a) Hand skills
4. The injection given to newborn to prtevent b) Maintaining social relationship
bleeding is c) Walking
a) Vitamin A b) Vitamin D d) Running
c) Vitamin K d) Vitamin C 13. The system of storage and transport of
5. Rota virus vaccine is given to protect the vaccine is known as the
child from a) Cold chain b) Hot chain
a) Pneumonia b) Polio c) Warm chain d) Ice chain
c) Tuberculosis d) Diarrhoea 14. The child from birth to one year is known
6. Exclusive breast feeding to the infant is as
recommended for upto a) Neonate b) Infant
a) 4 months b) 6 months c) Toddler d) Preschooler
c) 8 months d) 10 months 15. The child will be able to sit independently
7. The child will be able to walk independently by
by the age of a) 12 months b) 14 months
a) 12 -14 months b) 10-12 months c) 8 months d) 6 months
c) 16-18 months d) 18-20 months 16. Early detection and management of 4 Ds is
8. Free delivery & Free Caesarean Section is done in
done under a) Janani Shishu Suraksha Karyakaram
a) Rashtriya Bal Swasthya Karyakram (JSSK)
(RBSK) b) Janani Suraksha Yojana (JSY)
b) Janani Shishu Suraksha Karyakaram c) Rashtriya Bal Swasthya Karyakram
(JSSK) (RBSK)
c) Janani Suraksha Yojana (JSY) d) Janani Bal Swathya Yojana(JBSY)
196

17. RMNCH+A is launched in the year 6. Stages of growth & development
a) 2013 b) 2012 7. Gross motor mile stones
c) 2014 d) 2015 8. Factors influencing growth & development
18. The milk which satisfies the thirst of the 9. Janani Shishu Suraksha Karyakaram (JSSK)
infant is
a) Hind milk b) Mature milk IV. Detailed answers
c) Cow milk d) Foremilk 1. Write in detail about Newborn care
19. The vaccine which protects the child from 2. Write Universal Immunization Programme
Tuberculosis is 3. Explain exclusive breast feeding
a) DPT b) OPV 4. Explain in detail about the weaning
c) BCG d) MMR 5. Explain maternal child health services
20. The ideal time of starting of weaning is
a) 3 months b) 6 months Answers
c) 8 months d) 10 months 1. a 2. c 3. b 4. c
5. d 6. b 7. a 8. b
II. Short answers
9. d 10. a 11. b 12.a
1. Define newborn 13. a 14. b 15. c 16. c
2. Define cold chain 17. a 18. d 19. c 20. b
3. List any four red flag signs
4. List any four principles of newborn care
5. List the methods of Heat loss REFERENCE BOOKS
6. List any four cold chain equipments 1. Parthasarathy A(2016) IAP Text book of
7. What is colostrum? Paediatrics 6thedn, Jaypee Brothers Medical
Publishers (P) Ltd.
8. Name two reflexes useful for breast feeding?
2. Park, K (2017) Park’s Textbook of
9. Define growth and development Preventive and Social Medicine 24thedn.
10. Define weaning BanarsidasBhanot Publishers
11. Expand the Following 3. Gupte S The short Textbook of Paediatrics
� WHO � ICDS 12thednJaypee Brothers Medical Publishers
(P) Ltd.
� JSSK � JSY
4. Santhanam, I (2018), Illustrated Textbook
� RBSK � RMNCH+A
of Paediatriacs, First edn, Jaypee Brothers
� APGAR � IMNCI Medical Publishers (P) Ltd.
� NRHM � DPT
INTERNET LINKS
III. Brief answers
1. Characteristics of Newborn 1. http://www.dphpm.com
2. Neonatal Reflexes 2. http://nhm.gov.in
3. Harmful practices for the newborn 3. h t t p : / / w w w. w h o . i n t / c h i l d g r o w t h /

standards/chts_wfa_boys_z/en/
4. Diseases and protecting vaccine
5. Advantages of breast feeding
197

CHAPTER
9
Community
Health Nursing
நலம்வேண்டின் நாணுடைமை வேண்டும் குலம்வேண்டின்

வேண்டுக யார்க்கும் பணிவு.
He who desires a good name must desire modesty; and he who desires (the continuance of) a
family greatness must be submissive to all.
Learning Objectives
At the end of the lesson, students will be able to:

➢➢ explain the Health Problems.
➢➢ understand the National Health Programmes
➢➢ elaborate the National Health Policy and Planning
➢➢ analyse the Health Care delivery system in India
➢➢ understand the FIVE YEAR PLANS
➢➢ evaluate the Social Welfare Programmes
➢➢ understand the Qualities and Functions of a Public Health Nurse
➢➢ follow the principles of Home visiting
positive health. Now a days more emphasis is

Introduction
focused on the sick to the well person, from the
“Community health nursing is a synthesis individual to the community. To attain Health
of nursing practice applied in promoting For All through Primary Health Care led to
and preserving the health of the population. the restructuring of the rural health services.
Community health implies integration At present Public health nurses are called as
of curative, preventive and promotional Community health nurses who are registered
health services. The aim of community nurses (RN) trained to work in public health
diagnosis is the identification of community settings. It includes nursing services in all
health problems. Remarkable development in phase of health services which is organized for
public health was successful control of many the welfare of the community. In 1958 Indian
communicable diseases. Nursing and medical Nursing Council has integrated Community
services were strengthened to promote health into basic curriculum in nursing.
198
Unit_9_Community_health_nursing_Gen_Nur.indd 198 12/10/2021 10:30:44 PM

Community Health Nurse (Village Health Principles of Community Health Nursing
Nurse, Sector Health Nurse, and Community • It should be planned based on the needs of
Health Nurse) is responsible for her defined the community.
area of work in the provision of community • It is based on identified needs and
health services. functions.
• Integration of Health education, guidance
9.1 Community Health nursing and supervision with community health
nursing services.
Definition • Health services should be realistic in terms
• It is a synthesis of nursing and public of available resources.
health practice applied to promoting and • Community is the focus which is the unit
preserving the health of the people. of health care services.
• Public health: It is the art and science of • Professional relationship with etiquette
preventing illness, prolonging life and and dignity
promoting through organized efforts of the • Community participation is the integral
society. part of the community health services.
• Community health: It refers to the health • Individual and family members
status of the members of the community, participation in decision making.
to the problems affecting their health and • Health services must be continuous.
to the totality of the health care provided • Proper records and reports are essential.
for the community.
• Proper evaluation of health services
Aims of Community Health Nursing • Health services must be available to all
• To promote health and efficiency. without any difference.
• Prevention and control diseases and
disabilities. 9.2. Health problems in india
• Need based health care to prolong life.
Poor health is a major problem in India
Objectives of Community Health Nursing which contributes to the many health problems.
• Provide antenatal, intranatal and postnatal, Following are three causes of poor health in
care to ensure safe pregnancy and delivery. India.
• Immunization • High Birth Rate and Rapid Growth of
• Provide under five children care Population
• Health education • Malnutrition
• To improve the ability of the community to • Unsanitary Conditions and Housing
deal with their own health problems Health problems are classified in to
• To strengthen the community resources • Communicable disease
• To prevent and control communicable and • Non-communicable diseases
non-communicable diseases
• Nutritional Problems
• To provide specialized services
• Environmental Sanitation problems
• To conduct research
• Medical Care Problems
• Population Problems
199

Communicable Diseases Mycobacterium Tubercle, which mainly affects
Problem: lung. According to the Global TB report 2017
the estimated incidence of TB in India was
Communicable diseases continue to be the
approximately 28,00,000 accounting for about
major problem in India, but many of them are
a quarter of the world’s TB cases. Every year
controlled in developed countries such as USA.
about 1.2 million persons develop Tuberculosis
It is estimated that nearly 54% of deaths in India
of which 0.64 million cases are sputum positive
are due to communicable diseases.
which is highly infectious and 0.32 million
Common communicable diseases found in
people die due to TB. The emergence of HIV-
India are
TB co-infection and multidrug resistant TB has
become a challenge today.
IS S
III. Diarrheal Diseases

ULO
ERC
Diarrheal diseases constitute one of the

FILA
TUB
major causes of sickness and death specially

RIA
CHOLERA
LA RIA
MA in children below 5 years of age accounting for
COMMUNICABLE approximately 8% of all deaths among children
JAUNDICE DISEASES DIARR below 5 years worldwide in 2016. Outbreaks of
HEA
diarrheal diseases including cholera continue
AIDS to occurs due to the poor environmental
ACU PIRAT S
LEPROSY
RES ECTIO
INF
TE ORY
conditions. Diarrheal diseases are caused by

viral, bacterial and parasitic organisms.
N
IV. Acute Respiratory Infections (ARI)

I. Malaria
Acute respiratory diseases are one of the
Till today Malaria is a major health major causes of sickness and death in children
problem in India which is a big challenge to below 5 years of age. During 2011, nearly 26.3
eliminate and control. Malaria is transmitted million episodes of Acute Respiratory Infection
by the bites of infected female anopheles were reported with 2,492 deaths.
mosquito(Parasite). If not treated properly
which can become life threatening. The V. Leprosy
National Malaria Control and Eradication Leprosy is a chronic infectious disease which
Programmes launched in 1953 and 1958 is caused by Mycobacterium Leprae. It mainly
respectively. During 2016 1.09 millon cases affects the skin, the peripheral nerves, the
were reported and about 331 deaths were mucosa of the upper respiratory tract and the
registered due to malaria. Whereas the eyes. It is curable when the treatment started
scenario in 2017 was about 0.84 millon cases in the early stages prevents disability. Multidrug
were reported and about 194 deaths were therapy, made available by WHO free of cost
registered dut to malaria to all patients worldwide since 1995, provides
a simple but highly effective cure for all types
II. Tuberculosis
of leprosy. Control of leprosy has improved
Tuberculosis is a leading communicable significantly by Integration of basic leprosy
disease in India accounting for one-fifth of services into general health services to diagnose
the world incidence. Pulmonary Tuberculosis and provide treatment of the disease within easy
is contagious bacterial infection caused by reach(PHC). WHO has launched a new global
200

strategy in 2016 –2020: accelerating towards Millions of deaths due to Non Communicable
a leprosy-free world – which aims to leprosy Diseases which can be prevented by promoting
control and prevent disabilities. the public awareness and participation.
Measures to Control Non Communicable
Leprosy is recorded in ancient Disease
vedic writings and it is termed as
• Stronger anti-tobacco
"Kusht" in those days
controls - No smoking
• Promoting healthier
VI.
Acquired Immuno Deficiency diets
Syndrome(AIDS) • Promoting Physical
Since AIDS was first detected in the year activity
1986 and worldwide it stands in third place. It • Reducing/Stop the use of alcohol;
is estimated that by the end of year 2016, there • Improving people's access to essential
were about 2.1million cases of HIV positive health care.
cases and 62000 people died from AIDS related
illnesses in the country. Nutritional Problems
on Communicable Diseases
N According to WHO, "Malnutrition refers
Problem (NCD) to deficiencies, excess or imbalances in a
person's intake of energy and/or nutrients"
Malnutrition covers two broad spectrums
of under nutrition and over nutrition.
Undernutrition: Refers to lack of proper
nutrition, caused by not having enough food or
not eating enough food containing substances
necessary for growth and health.
Over nutrition: Is a form of Malnutrition
in which nutrients are oversupplied relative
to the amounts required for normal growth,
development and metabolism.
Malnutri�on
NCDs are the leading cause of death in Undernutri�on Overnutri�on
the world, responsible for 63% of the 57 million

deaths that occurred in 2008.The majority of these
Protein Energy
deaths are due to cardiovascular diseases and Malnutri�on
Obesity
Cardiovascular
Vitamin deﬁciencies
diabetes, cancers and chronic respiratory diseases. Mineral deﬁciencies
diseases
More than nine million of all deaths attributed to

noncommunicable diseases (NCDs) occur before According to World Bank report, India
the age of 60. Behavioral risk factors, including is ranking 2nd in the world of the number of
tobacco use, physical inactivity, and unhealthy children suffering from malnutrition (i.e. Under
diet, are responsible for about 80% of coronary weight (43.5), Stunting (47.9), Wasting (20) and
heart disease and cerebro vascular disease. overweight (1.9)).
201

Source: Asamadu et al, Nutritional Problems • Improper waste disposal and low level
and Intervention Strategies in India, A technical of sanitation leads to soil pollution and
Report (2012) breeding places of insects, flies and rodents.
a) Protein Energy Malnutrition- : Caused
• Sound pollution Traffic pressure.
by the defeciencies of protein and calories.
It occurs more commonly among weaned • Degradation of land Industrialization and
infants and pre school children urbanization
Kwashiorkor is the deficiency of • Radiation hazards
protein in the diet. • Excessive use of fertilizers and chemicals
Marasmus - severe deficiency of in agriculture.
protein and energy in the diet. • Destruction of forests
b) Vitamin Defeciencies: caused by the • Increasing population, poverty, illiteracy,
deficiency of vitamins in the diet. unemployment further increases
• Vitamin A deficiency – leads to Night environmental problems.
blindness and Xerophthalmia( dryness
Medical Care Problems
of cornea)
In rural area 74% population doesn’t get
• Vitamin C deficiency – leads to Scurvy benefit of modern curative and preventive
• Vitamin D deficiency – leads to Rickets health services. Approximately 80% of health
services are concentrated in urban area.
c) Mineral defeciencies: caused by the Addressing to meet inadequate and uneven
deficiency of minerals in the diet distribution of doctors, and medical services
• Nutritional anemia – decreased between rural and urban is the challenging
haemoglobin in the blood due to the task to health sector.
insufficient iron in the diet
Population Problem
• Iodine deficiency disorder (Goitre) –
During Independence in 1947 India's
decreased iodine intake.
Population was 30 crores. As on 2018 now
d) Out of these defeciencies the two major it is the second most populated country in
nutritional problems of India are the world, current population is 1.35 billion.
• Under Nutrition The population problem is the important
• Nutritional Anaemia problem faced by our country which affects all
aspects of, sanitation, housing, health care and
environment.
Environmental Sanitation
r populao
problem Ove n
Environmental sanitation is the most

difficult problem to handle in our country
which is multi-factorial and multifaceted.
Major environmental problems in India are

• Air and water pollution
• Depletion of natural resources
202

• Assure availability of free, comprehensive
India's population As of February primary health care services
01, 2019 is 1,350,262,913 (1.35
• Ensure improved access and affordability,
billion) and estimated to lead
of quality secondary and tertiary care
China by the year of 2030
services
National Health Policy Goals 2017

9.3 National Health Policy And
1. Increase Life Expectancy from 67.5yrs to
Planning 70yrs by 2025
2. Reduction of Total Fertility to 2.1 at
The Ministry of Health and Family
National level by 2025.
Welfare evolved a National Health Policy
which was approved by Parliament in 1983. 3. Reduce under five Mortality to 23 by 2025
The National Health policy of 1983 and and MMR(167) to 100 by 2020.
2002 have served well in guiding the health 4. Reduce IMR to 28 by 2019.
sector (Five year Plans). Now in 2017 the 5. Reduce neonatal and still birth rate to
last health policy is introduced. The National 'single digit by 2025.
Health Policy laid down specific targets to be 6. Achieve and maintain elimination status of
achieved by 2025 AD. Leprosy by 2018
Kala-Azar by 2017 and Lymphatic Filariasis
Definition by 2017.
"Health Policy provides a broad framework 7. Reduction of disease prevalence/incidence
of decisions for guiding health actions that are of HIV Global target of 90:90:90
useful to the community in improving the - 90% of people know about HIV/AIDS,
health status which ultimately contribute to the - 90% of all people diagnosed receive
quality of life. Antiviral treatment and
- 90% of all people receiving antiviral will
Objectives
have viral suppression.
• The need to establish comprehensive 8. Achieve and cure rate of more than 85% to
primary helath care services within the elimination status by 2025.
reach of population even in the remotest 9. To reduce the prevalence of blindness to
area of the country. 0.25 / 1000 by 2025.
• To achieve an acceptable standard of good 10. Increase utilization of public health facilities
health among the general population. by 50% by 2025.
• To Improve the health status in all sectors 11. Reduction in prevalence of tobacco use by
and provide preventive, curative, palliative 15% by 2020 and 30% by 2025.
and rehabilitative services through the
public health sector with focus on quality. 9.4 Health Planning
• Improve health status preventive,
promotive, curative, palliative and Planning of Health service is based on the
rehabilitative services provided through health needs and demands of the population.
the public health sector with focus on The main aim of health planning is to achieve
quality. the optimum level of health.
203

Objective 5. Public Health Services.
• To give a social and economic 6. Family Planning.
development. The achievement of optimal 7. Indigenous system of Medicine.
level of health. The health plan is implemented at all
Planning commission: levels such as National, State, District, Block,
and Village. Because of the Five Year Plans,
In March 1950, the Govt. of India has
considerable improvement has taken place in
appointed a Planning commission to "Promote
the field of health. Health is an important sector
a rapid improvement in the standard of living
for the national development, the Planning
of the people by the effective utilization of
Commission gave due importance to health
the resources, increasing production and
for the formulation of Health programmes.
providing employment in the service of the
community.
For the purpose of Planning the health 9.5 Health Services Organization
sector has been divided into the following sub The purpose of the health services is to
Services. improve the health status of the population. It
1. Water Supply and Sanitation. depends upon the health needs and problems
2. Control of Communicable diseases. and available resources. In India it is represented
3. Medical Education, training and Research. the five major sectors.
4. Medical Care.
LEVELS OF HEALTH SERVICES ORGANIZATION
NATIONAL LEVEL - Ministry of Health and Family Welfare
STATE AND UNION TERITORY - Ministry of Health and Family Welfare
NATIONAL LEVEL - DISTRICT HEALTH HOSPITALS CMO/DMOs/DHOs etc.,
TALUK LEVEL - TALUK / SUB DISTRICT HOSPITALS - Some Specialies
COMMUNITY HEALTH CENTRES - 4 MOs (Surgeon, Pediatricians, Obstetrician)

+21 Para medical staff. 30 bedded Hospital / Referral unit for 4 PHCs with
special services covers 158 villages
PRIMARY HEALTH CENTRES - Medical Officer and Para Medical staff.

A referral Unit for 6 sub-centres. 4-6 bedded - covers average 29 villages
SUB-CENTRES - Most peripheral contact point between PHC and Community

1MPHW(F)/ANM, 1 MPHW(M), Voluntary health worker / covers 4 Villages
VILLAGES - DAI, Trained Birth aendant, Acreted Social Health Acvist,

Village Health Guides
204

Health Care System In India improving the standard of nutrition, control
1. Public Health Sector of population and promotion of rural health.
a. Primary Health Care Various International agencies have been
providing technical and material assistance in
• Primary Health Centre
the implementation of these programmes.
• Sub centre
b. Hospitals/health centre Following are the some of the Health
• Community health Centre Programmes: -
• Rural Hospitals 1. National Health Mission

2. Reproductive And Child Health Programs
• District hospital/ Health Centre
3. Revised National Tuberculosis Control
• Specialist Hospitals
Program (RNTCP) : DOTS Strategy
• Teaching hospitals 4. National AIDS Control Program
c. Health Insurance Schemes 5. National Vector Borne Disease Control
• Central Government Health Scheme Program
• Employees State Insurance Scheme 6. Nutritional Programs
d. Other agencies 7. National Anti-Tobacco Program
8. National Program For Prevention And
II. Private Sector Control Of Cancer, Diabetes, Cardio
• Private hospitals vascular Diseases And Stroke
• Polyclinics 9. Integrated Disease Surveillance Project
10. Basic Minimum Service Program
• Nursing homes and Dispensaries
11. Programs For Water And Sanitation
• General Practitioners and clinics.
1. Nation Health Mission (NRHM and NUHM)
III. Indiginious System Of Medicine
National Health Mission is a strategic plan
AYUSH - Ayurveda, Yoga, Unani, Siddha of central health ministry to strengthen the
and Homeopathy health systems in rural and urban areas National
IV. Voluntary Health Agencies Health Rural Mission was launched in 2005
for strengthening health systems and provide
V. National Health Programmes
better rural health Services. It was converted to
Health Services Organization National Health mission in 2013.
The health services are organized in the It is provided under 2 sub - missions
country from the national level to the sub- NRHM - National Rural Health Mission was
centre level in the remote rural areas. launched in 2005 to provide health care to the
remote rural population.
NUHM - To meet the health care needs of the
9.6 National Health Programmes
urban population with the focus on urban poor.
After independence of our nation, the Goals of NHM
National Health Programmes are launched
➢➢ R
eduction in Maternal Mortality Rate
by the Central Government for the control/
and Infant Mortality Rate
eradication of the communicable diseases,
➢➢
Universal access to integrated public
improvement of environmental sanitation,
health services
205

• Child health, water, sanitation and hygiene from TB by effective treatment. The Govt. of
• revention and control of Communicable
P India, WHO and world Bank together reviewed
and noncommunicable deseases including the NTP in 1992. Based on the findings a revised
locally endemic diseases and emerging strategy for NTP was evolved. Short term
diseases chemotherapy has been introduced in 5 districts
• Population stabilization to achieve at least 85% cure rate through DOTS
(Direct Observation Treatment Short course). It
• Revitalize Indigenous System of Medicine
is done by voluntary workers such as teachers,
Functions of NHM anganwadi workers, dais, ex-patients and social
workers. NGOs are involved in Information,
• Antenatal and postnatal check up
Education and Communication.
• Improved facilities for Institutional
deliveries 4. National Aids Control Programme:
• Trained commuity level worker National AIDS Control Program was
• Complete Immunization launched in India in the year 1987 is to prevent
• Good Hospital care further transmission of HIV, to decrease
morbidity and mortality associated with HIV
• Provision of household toilets
infection and to minimize the socio economic
• Mobile Medical units
impact resulting from HIV infection.
• Health and Nutrition
5. National Family Welfare Programme
2. National Malaria Eradication Programme:
Family planning was started in the year
The National Malaria Control 1951. In 1977, the Govt. of India re-designated
Programme (NMCP) was launched in 1953 National Family Planning into National Family
which was upgraded to National Eradication Welfare Programme and was integrated with
Programme (NMEP) in 1958. The NMEP Mother and Child Health services. The aim of
achieved remarkable success during the family welfare programme is to improve the
period 1958-1965, by which the incidence of quality of life through education, nutrition,
Malaria came down to only 1lakh cases and health, employment, women's welfare and
no deaths in 1965. In 1994 Resurgence of rights, shelter, safe drinking water and all factors
malaria forced Govt. of India to appoint an vital to the life.
Expert committee on Malaria to identify the
problem areas and specific control measures. 6. Universal Immunization Programme (UIP)
Thus the Malaria Action Programme (MAP) UIP is a vaccination programme launched
was evolved and is being implemented. The by the Govt. of India in 1985. Currently
objective of the MAP is to prevent deaths, UIP is one of the key areas under NRHM
outbreaks and complications due to Malaria. (National Rural Health Mission) since 2005.
It has been decided to observe Anti Malaria It consists of vaccination against 12 diseases
Month before the onset of monsoon i.e. namely Tuberculosis, Diphtheria, Pertussis,
month of June every year. Tetanus, Polio, Measles, Hepatitis B, Japanese
Encephalitis, Rubella Pneumonia and
3. National Tuberculosis Control Programme:
Pneumococcal diseases. Immunization is one
The National Tuberculosis Control of the most effective methods of preventing
Programme was established in 1962 with the childhood diseases. With the implementation
objective of reducing the disability and death of the Universal Immunization Programme
206

(UIP) by the Government of India, significant that the prevalence of goitre was high. Hence the
achievements have been made in preventing programme was renamed as Iodine Defeciency
and controlling vaccine-preventable diseases Disorder Control Programme in 1992 and
(VPDs). Introduction of Pentavalent vaccine enforced on the fortification of iodine in salts at
(pilot project in Tamil Nadu)will further reduce the manufacturing level.
the incidence of pneumonia and meningitis
caused by Haemophilus, influenza type b (Hib) Our body requires very minimal
bacteria. quantity of Iodine (150 µg for an
7.
National Diarrheal Diseases Control adult). It can be supplied in 10
Programme gm of salt. Excess of Iodine in blood can be
excreted in urine.
Diarrhea is one of the leading causes of child
mortality. National diarrheal disease control
programme was launched in the year of 1978. 9. National Leprosy Control Programme
It was actually a renamed version of national The programme was launched in the year
cholera control programme. The programme of 1955. In 1983 it was renamed into National
emphasized on the use of Oral rehydration Salt Leprosy Eradication Programme. The main
(ORS) therapy. It also focussed on the rational objectives of the programme are to reduce
use of medications, adequate nutritional and the leprosy cases, early detection and treat the
fluid replacements during diarrhea, education known cases with effective multi drug therapy.
on personal hygiene, feeding practices among
Types of units functioning in the country
the mothers of under five.
1. N
ational Leprosy Control Units are
You can make your ORS at established in highly endemic areas.
home
2. S urvey, Education and Treatment (SET)
Centers attached to Primary Health
centers.
10. National Cancer Control Programme

National Cancer Control
Programme(NCCP) is a community health
programme designed to reduce the number of
cancer cases and deaths and improve quality of
life of cancer patients. NCCP helps to reduce
the cancer burden and improve services for
cancer patients and their families. The National
8.
National Iodine Deficiency Disorders Cancer Control Programme was launched in
Control Programme the year1975 - 76.
National Goitre Control Programme was 11. National Mental Health Programme
launched in the year of 1963 with the objectives
The Mental Health programme was
of reducing the incidence and prevalence of
launched during 1992 with a view to ensure
goitre in the country. Goitre is a condition
availability of Mental Health Services for all,
occurs due to the lack of iodine in the blood.
especially the community at risk and under
Iodine cannot be supplemented by any foods.
privileged section of the population.
Even after 20 years of measures, it was found
207

12. Respiratory Disease Control Programme
9.8 20 Point Programme TPP
The standard case management of ARI
twenty
and prevention of death due to pneumonia is
an integral part of RCH programme. Peripheral In addition to the Five Year Plans and
health workers are being trained to recognize Programme, in 1975 the Govt. of India initiated
and treat pneumonia with Co-trimoxazaole. a special activity called as 20 points programme
as an agenda to promote social justice and
13. Nutritional Programmes
economic growth. On August 20, 1986 the
The Govt. of India have initiated several existing 20 point programme was restructured
nutritional programmes to combat malnutrition. to eradicate poverty, increase productivity,
ICDS, Vit. A prophylaxis programme, reduce inequalities, remove social and economic
Prophylaxis against Nutritional Anemia, disparities and improve the quality of life.
Special Nutrition Programme, Mid-day Meal
8 out of 20 points are directly or indirectly
Programme, Special Nutrition Programme are
related to health.
sum ofthe nutritional programmes.
Components / ACTIVITIES
14.
Reproductive and Child Health
Programme (RCH): 1. Cataract surgery
Refer: Child Health Nursing Unit 8. 2. Eye screening(camp)

3. Eye Dination
9.7 National Programme for 4. Vitamin A prophylaxis

control of Blindness 5. voluntary organization
6. IEC Activities
The National Programme for control of Point 1 - Poverty eradication.
visual impairment and blindness was launched Point 2 - Power to people
in 1976 is the 100% centrally sponsored and Point 3 - Support to farmers
incorprates the earlier trachoma control Point 4 - Labour Worker
programme was started in 1963. Point 5 - Food security
Goals Point 6 - Housing for all
Point 7 - Clean Drinking water.
• o reduce the prevalence of blindness
T
Point 8 - Health For All
1.49% to < 0.3%
Point 9 - Education for all
• o establish an infrastructure and
T
Point 10 -
Welfare of schedule caste ST,
efficiency levels in the programme.
minority and OBCs
Objectives Point 11 - Women welfare
• To establish eye care facilities for every 5 Point 12 - Child welfare
lakh population Point 13 - Youth developments
• To develop human resources for eye care Point 14 - Improvement of slums
services at all levels. Point 15 -
Environment protection and a
forestation
• To imporve quality of service delivery.
Point 16 - Social security
• To secure participation of civil society
Point 17 - Rural Road
and the private sector.
Point 18 - Energisation of rural area
Point 19 - Development of backward areas
208

Point 20 - IT enabled E - Governance our first Prime Minister Jawaharlal Nehru.
The First Five Year Plan was one of the most
9.9 School Health Programme important because it had a great role in
India's development. Health as an important
School health is an important branch of factor in the utilization of the manpower and
community health nursing. In 1961 the five the uplifting the development of the country,
year plan, school health and school feeding health programmes were given considerable
program was started in many states. importance in the Five Year Plans. The main
objectives of the health programmes are the
Health problems of the school children
control or eradication of major communicable
• Infectious diseases diseases, strengthening of the basic health
• Malnutrition services, population control and the
• Dental carries development of health manpower resources.
11th Five Year Plan (2007-2012) aims to raise
• Intestinal parasites
the average economic growth rate to 9% from
• Disease of eye, ear and skin 7.6% during 10th Five Year Plan.
AIMS
Eleventh Five Year Plan
Promotion of Health & Well being of all The Eleventh Five Year Plan provides an
school children by Comprehensive health opportunity to restructure policies to achieve
care. good health for the people, especially the poor
1. Promotion of Positive Health and the under-privileged. The 11th Five year
Plan will give special consideration to adolescent
2. Prevention of Diseases
girls, women of all ages, children below the age
3. E
arly Diagnosis and adequate Treatment & of 3, older persons, disabled and tribal groups.
Follow up.
Goals to by Achieved by the 11th Five Year
4. P
romoting Health awareness among Plan
children.
1. Reduction of MMR to 1 per 1000 live births.
5. Provision of Healthy environment.
2. Reducing IMR to 28 per 1000 live births.
Services provided in School Health 3. Reducing Total Fertility Rate (TFR) to 2.1.
Programme
4. 4 . Provision of clean drinking water for all
• Health check up
by 2009.
• Prevention of communicable disease
5. R
educing the Malnutrition among the
• Spot treatment
children age group of 0-3 years
• Referral services
6. R
educing the anaemia among women and
• Health education
children by 50%.
Twelfth five year plan
9.10. Five Year Plans
The twelfth five year plan emphasized more
Centrally sponsored Five year plans on the strengthening of the health system
(FYPs) are integrated national economic
Goals:
programs. India launched its first FYP in 1951
• Universal access to services
after the independence under the influence of
209

• Safe drinking water and sanitation Welfare Programmes
• Wholesome nutrition 1. Welfare of the disabled: The Number
• Basic education and safe housing of disabled persons in the country has been
• Hygienic environment estimated to be around 2.21% of the total
population that is 2.68 Cr. (2016 updated)
Targets to be achieved
The Ministry of Welfare is implementing
• Reduce IMR to 25 by 2017 programmes for the early detection, treatment,
• Reduce MMR to 100 by 2017 education and rehabilitation of disabled persons,
• Reduce TFR to 2.1 namely the blind, the deaf, the orthopedically
• Prevent and reduce anemia among handicapped, spastics, the mentally retarded
women to 28% and the leprosy cured patients.
• Prevent and reduce burden of 2. Social defense : Problems of family
communicable diseases and non and social disorganization are manifest in the
communicable diseases form of delinquency, juvenile vagrancy, drug
addiction, alcoholism and crimes of various
NITI Aayog
types. In order to control these problems,
After the completion of 12th five year
programmes of social defense have been
plan, NITI Aayog ( National Institution for
launched by the Government, mainly within
Transforming India) takes up the planning and
the framework of specific legislation and
programming of the health sector functioning.
allied measures.
It was formed in January 1, 2015. It is the
3. Women and child development: The
‘Think Tank’ of the Government of India. It
Department of Women and Child Development
provides both directional and policy inputs. It
in the Ministry of Human Resource
designs policies, programmes and strategies for
Development has two sectors : (i) Nutrition and
the Government of India.
child development, and (ii) Women's welfare
and development. The Central Social Welfare
Prime Minister of India is the
Board and the National Institute of Public Co-
Chair person of the NITI Aayog
operation and Child Development assist the
Department in its functions.
9.11 Social Welfare Services Central Social Welfare Board
Social welfare services are organized to The Central Social Welfare Board was
cater to the people who are very poor. These set up in 1953 which surveys the needs and
include women and children, aged scheduled requirements of social welfare organizations in
castes and tribes. the country. Social welfare schemes sponsored
by the Board are implemented through
The Ministry of Welfare
voluntary agencies such as Mahila Mandals.
The Ministry of welfare, Govt. of India
The Mahila Mandals receive grants up to the
has been formed by pooling subjects related to
extent of 75% for approved activities.
welfare of the disabled, welfare of the scheduled
Some of the Activities of Social Welfare Board
castes and tribes and minorities. Women and
child welfare development programme is looked 1. Nutrition Programmes : These are
after by a separate department of Women and feeding programmes to children in the age
Child Development set up in the Ministry of group 0-6 years, nursing and expectant mothers.
Human Resources Development.
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2. ICDS Project: In the fifth year Plan • Initial treatment for the emergencies such
highest priority had been accorded to child as injuries and illnesses.
welfare programmes. The most important scheme • Early diagnosis of the occupational or other
in this field was the Integrated Child Development illnesses and to screen the people at risk.
Services.(ICDS) for children in the age group • Assist the management in placement of the
0-6 years, nursing and expectant mothers, etc., people in suitable work.
Under the scheme supplementary nutrition,
• Provide advice and supervision of conditions
immunization, health check up, referral services,
at work which may affect the health such as
nutrition and health education and non-formal
environmental sanitation.
pre-school education are provided. There are now
5422 ICDS projects operating in the country. • Health Education
A Child Development Project Officer is in- Role of Nurses in Occupational Health
charge of each ICDS project. An Anganwadi is Services
the focal point for the delivery of services to the
• ssist the doctor for the examination of the
A
community.
employees.
• Protect and improve the physical and mental
9.12 Voluntary Organizations/ health of the workers.
Agencies • Provision of first aid and treatment for

minor illnesses and injuries.
Apart from Central and State Governments,
• Assess, identify and notify the management
More than 10,000 voluntary organizations are
regarding the hazards affecting the workers.
also engaged in social welfare activities.
• Conduct health education
Functions • Home visit to the employees to educate

1. Supplimenting and gurding the work of regarding the health and family welfare.
government agencies • Nutrition
2. Pioneering: Example research • Communicable Disease prevention
3. Education • Environmental sanitation
4. Demonstration: bore hole latrins by • Protective Measures for the employees
Rockefeller foundation • Medical Check - up and Immunization
5. Advancing health legislation 2. Tuberculosis Nursing
In the control of communicable diseases
9.13 Special Community Health nurses play a vital role in the community level.
Nursing Services The following are the nurses role in control
of Tuberculosis which an airborne infectious
1. Industrial Nursing disease affecting the people living in poor
The aim of occupational health nurse is to living standards and with low immunity.
keep the people at work healthy and to prevent Pulmonary tuberculosis is responsible for the
them from illness and injury due to the working majority 85% of TB infections.
environment. 1. Case finding
The following are the basic functions of 2. Health Supervision (DOTS)
Occupational or Industrial Nurse 3. Domiciliary care - Isolation
• Identify the occupational Hazards 4. Prevention of the spread of infection
• Educate them about the control of the
5. Drug compliance
occupational hazards.
211

6. Nutrition ROLE OF NURSE
7. Health Education
CARE
PROVIDER
3. Leprosy Nursing
RESEARCHER EDUCATOR
Leprosy is one of the major health and
socio-economic problems in the country.
ROLE
Nurses responsibility in the care of Leprosy LEADER ADVOCATE
patients is divided into the following categories

1. N urse - patient relationship - An effective COLLABORATOR MANAGER
Nurse Patient Relationship enhances the
appropriate management of Leprosy cases.
2. Recorder and observer of facts - Accurate Functions of Public Health Nurse
observation and correct recording of facts 1. General Duties
are vital role of a nurse and she has to 99 Provision of nursing services to the
provide accurate account of health. community.
3. Health Education regarding 99 Maternal health (Antenatal, Intra natal
• Leprosy is curable and the deformities are and postnatal care)
preventable and must be educated about
99 Infant and pre-school health
the drug compliance.
99 Prevention of Communicable diseases.
• Family Education - about the preventive
measures, Isolation of under 15 years 2. Administrative Duties - is responsible for
children, especially infants from active the implementation of policies and programme
patients who are infective. relating to nursing and midwifery services.
• Need for assistance and support during the 3. Supervisory- To promote harmony and
course of illness and recovery stage. efficiency within the health teams to improve
the quality of life.
• Family Education - Educate the family
regarding the misconceptions regarding 4. Educational - Participating and organizing
Leprosy. In-service training programme.
5. Caregiver - They provide prenatal care
Qualities of a community Health Nurse and education for expectant mothers,
• The nurse must have interest on the people. including information about maternal
• Understand the human behavior. nutrition, referrals for childbirth classes, and
• Sincere. postpartum assistance.
• Empathy. 6. Community Educator - As educators,
• Honest. community health nurses focus on presenting
materials in a clear and understandable format.
• Charitable.
They provide information to individuals,
• Resourceful.
families, and communities that create a
• She must have observation, communication,
framework for healthy living and healthy
interview skills and technical skills.
choices.
• She must have ability to make interpretations,
7. Leader - Community health nurses use
make judgment, and take decisions.
evidence to implement policy changes and
• Self discipline on emotions and other
quality-based practices..
aspects of behaviour and action.
212

8. Researcher- As researchers, community (family size, occupation, income religion,
health nurses collect and use evidence to resources, customs and culture).
execute positive changes for better health. 4. Identify the health problems of the family.
9. Advocate - Advocate on the local, state, 5. U
se safe technical skills and nursing
and federal level to provide better access to procedures.
healthcare, protect funding for public health
6. In health teaching be sure of what you
programs, and reduce or eliminate health
teach to the family.
disparities.
7. B
e kind and courteous to the family will
10. Disease prevention specialist -
help to gain the confidence.
Community health nurses focus on long-
and short- term care for disease prevention. Planning And Evaluation Of Home Visit
Their work includes averting or controlling
The purpose of planning is to achieve
the spread of the flu and other communicable
definite objectives within a specified time and
diseases.
with the available resources.
11. Director and Co-ordinator - Community
1. First make survey and prepare a map of
health nurse has to plan and organize and
the area with following details
make sure that the work is done as planned and
organized. a. Topography(Area Map)
12. Collaborator - Community health problems b. Location of the village
cannot be solved by single health worker. It c. Population
involves many people who work together in a d. roads
team.
2. P
repare the family folders and individual
Healthcare experts say public health has
cards with adequate information.
made great strides in the past decades, allowing
people to live longer and healthier lives. 3. I dentify the families or individuals in need
of home visiting e.g. Antenatal, postnatal,
toddlers, infants, sick and those who are
9.14 Home Visiting
not in a position to reach the health care
Home visiting is the back bone of all MCH settings.
services. 4. T
reat minor illness with the help of
Purposes community bag. Refer if necessary.
• To carry out simple nursing care in home. 5. F
ollow up to find out how far the
• For the prevention of disease instructions given were followed.
• promotion of health of the members of
6. E
valuation - Evaluate what has been
the family.
achieved.
• To investigate the service of an infection
disease Even if the mother is attending the
• To make use of the inter – referral system antenatal clinic regularly, it is suggested that
she must visited at least one home visit by the
Principles Of Home Visiting
health care provider (ANM/VHN) because
1. Based on the needs of the people. the AN mother will be relaxed at home and
2. Planned prior to the visit also we can evaluate social and environmental
3. C
ollect the background information conditions at home.
regarding the family and community
213

• Smallpox was the first disease to be eliminated from the world through public
health efforts and vaccination.
• India, with 1,350,117,491 (1.35 billion) people is the second most populous country in the
world, while China is on the top with over 1,415,489,506 (1.41 billion) people
• Anti Malaria Month before the onset of monsoon i.e. month of June every year.
• Major Milestones in National Health Programs are
1992 – Child Survival And Safe Motherhood Program (CSSM)
1997 – RCH I and RCH II
2005 – National Rural Health Mission
2013 – RMNCH + A Strategy
2013 – National Health Mission
Nursing Career Profiles in Community Health
Community Mental Health & Palliave Home Diabetes Nurse Public Parish
Care Addicons Nurse Health Educator Health Nurse
Coordinator School Nurse Specialist Nurse Nurse
SUMMARY
Community health nursing is the newer aspect of healthcare that has grown in response to
changing environmental and social structure changes into a worldwide movement. Fast growing
elderly people, improvement in health technologies and rising healthcare costs has an impact upon
the development and scope of practice for community health nurse.
GLOSSARY
Anemia Dcreased number of circulating red blood இரத்த சோகை

cells in the body
Xeropthalmia Abnormal dryness of the conjunctiva and நீர்க் கசிவற்ற கண்ணழற்சி
cornea
Kwashiorkor Malnutrition caused by protein deficiency புரதச்சத்துப் ப�ோதாமையால்
in the diet வரும் ந�ோய்
214

Marasmus Severe malnutrition characterized by உடல் இளைப்பு
energy deficiency
Juvenile A young person who commits crimes இளம் குற்றவாளிகள்
delinquency
Eradication the complete destruction of something அழிப்பு
Immunization the process of protecting a person from நோய்த்தடுப்பு
infectious diseases
Isolation the complete separation of a person from தனிப்படுத்தப்பட்ட நிலை
others a person suffering from contagious
or infectious disease
Domiciliary of or relating to a domicile, or place of இருப்பிடத்தைச் சார்ந்த
residence
Empathy the ability to share someone else's feelings பரிவு / பச்சாத்தாபம்
or experiences
Parasite Organism obtaining nourishment from or பிறரை அண்டி வாழ்பவர்;
living one another organism ஒட்டுயிர்
Outbreak Sudden onset more than the normal திடீர்
expectation
Prevalent existing very commonly or happening அதிகமாக
often
Incidence the rate at which something happens நோய்நிகழ்வு
Goiter an enlargement of the thyroid gland முன்கழுத்துக் கழலை
Depletion the act or process of emptying or சிதைவு
removing
Radiation the action or process of radiating கதிர்வீச்சு
Palliative specialized medical care for people with நோய்த் தணிப்பு
serious illness
Rehabilitative to restore to a condition of good health மறுசீரமைப்பு
Hospice care supportive care to people in the final இறப்புநிலை உதவி

phase of a terminal illness
Student Activity Teacher Activity
1. Make a Visit to the Sub Center and Assign the students to conduct a
observe the functions of a village health survey in a street and find the prevalence
nurse in your area. of Clients with Non communicable
2. Make a Visit to the ICDS unit and assess diseases such Diabetes, Hypertension
the anganwadi worker in your area. and Heart Attack (Myocardial Infarction.
215

Evaluation
I. Choose the correct answer 8. Following are the common health problems
1. Malaria is transmitted by the bite of of the school children except
a) Female Mosquito a) Infectious diseases

b) Female Housefly b) Malnutrition
c) Male mosquito c) Dental caries
d) Male housefly d) Diabetes
2. Airborne disease which mainly affects lungs 9. Tuberculosis is a
a) Typhoid a) Waterborne disease

b) Cholera b) Airborne disease
c) Tuberculosis c) Vector borne disease
d) AIDS d) Food borne disease
10. D
OTS is a treatment given for the effective
3. Protein deficiency leads to
treatment of
a) Anemia
a) AIDS
b) Protein Energy Malnutrition
b) Leprosy
c) Goitre
c) Cancer
d) Rickets
d) Tuberculosis
4. Xeropthalmia is caused the deficiency of
II. Define the following
a) Vitamin C
b) Vitamuin D 1. Health.
c) Vitamin A 2. Community Health Nursing
d) Vitamin K 3. Primary Health Care
5. WHO was started
III. Write short notes on
a) 1948 1. W
hat are the aims of community health
b) 1950 nursing?
c) 1986
d) 1990 2. Mention the health problems of India.
6. Following are the vector borne diseases 3. What are the components of NRHM
except 4. Discuss the environmental sanitation
a) Malaria problem.
b) Filaria 5. W
rite about the targets of National Health
c) AIDS Policy
d) Dengue
6. E
numerate the functions of Village Health
7. Identify the communicable disease from Guide
the following
7. Mention the principles of Primary Health Care
a) Cholera
b) Cancer 8. V. Answer in detail:
c) Diabetes 9. E
xplain in detail about the national health
d) Cardiovascular Diseases problems.
216

10. W
rite about the National Health REFERENCE BOOKS
programmes
11. W
hat are the roles and functions of the 1. Park. K, “Parks Text Book of preventive
public health nurse? and social medicine”, 22nd edition,
Banarsidas bganot Publishers,(M.p.)
12. Write about the non communicable diseases
India, Pp811-831
and preventive measures
2. Gulani K.K, “Community Health
13. Explain the Five year Plan. Nursing”, 2nd edition, Kumar Publishing
14. Write about the Home visiting. Home, Delhi, Pp-673-683.
3. Park. K "Essentials of Community Health
15. Voluntary Health Agencies Nursing", 5th Edition M/s Barnabas
16. W
rite about the role of nurse in Tuberculosis Bhanot Publishers, Pp -320-357
nursing
INTERNET LINKS
17. 10 What are the qualities of community
health nurse? 1. www.tbcindia.com
18. Explain about home visiting 2. www.google.co.in
19. Write about the School Health Programme 3. www.who.int/malaria/en
217

CHAPTER
10
Mental Health
Nursing
Principles and Practices
மனநலம் நன்குடையார் ஆயினும் சான்றோர்க்கு

இனநலம் ஏமாப்பு உடைத்து.
“Even one has good mental strength already,

Having the company of great men will give more strength"
LEARNING OBJECTIVES

➢➢ define health, mental health, psychiatry, psychiatric nursing and mental illness
➢➢ enlist the characteristics of mentally healthy person
➢➢ enumerate misconceptions about the mental illness
➢➢ understand the mentally ill clients
➢➢ differentiate psychosis and neurosis
➢➢ elaborate mental disorders causes, types and management
➢➢ describe about drug abuse, alcohol abuse and management
➢➢ explain about childhood disorders like learning disabilities, ADHD
and care of mentally challenged
➢➢ gain knowledge about therapeutic nurse - patient relationship
➢➢ know about the mental health services and prevention of mental illness
determine how we handle stress, relate to others

Introduction
and make choices. Mental health is important
As you start to study psychiatric – mental at every stage of life, from childhood, through
health nursing, you may be excited and even adolescence to adulthood.
anxious. The field of mental health often seems
10.1 Terminologies
a little unfamiliar. The mind is about mental
processes, thought and consciousness, the body Health
is about the physical aspects of the brain –
The World Health Organization defines
neurons and how the brain is structured.
health as “a state of complete physical, mental,
Mental health includes our emotional, and social well being, not merely an absence of
psychological and social well-being, it affects disease or infirmity”.
how we think, feel and act. It also helps to
218
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Mental Health • Strange ideas
Mental health is a state of balance between • Anxiety, assaultive
the individual and the surrounding world, a • sadness
state of harmony between himself, with others • disturbed sleep
and their environment. • suicide
• alcohol intake
Mental Illness
• anger, lonely
Mental illness is a collective term that refers
to all the different types of mental conditions, Difference Between Mentaly Healthy person
including those that affect your mood, your and Mentaly Ill person
thinking and your behaviour”.
Mental Health Mental Illness
Psychiatry
Accepts self to others Feelings of inadequacy,
Psychiatry is a branch of medicine that deals poor, self-concept.
with the diagnosis, treatment and prevention of
Ability to cope and Inability to cope.
mental illness.
tolerate stress.
Psychiatric Nursing Ability to form Inability to establish
Psychiatric Nursing deals with the close and lasting meaningful
promotion of mental health prevention of relationship. relationship.
mental illness, care and rehabilitation of Uses sound judgment Displays poor
mentally ill individuals both in hospital and to make decision. judgment.
community.
Accepts Irresponsibility.
The word psychiatry is derived from the responsibility.
Greek word “Psyche” means soul or mind;
Optimistic (all is Pessimistic (the
“iatros” means healer.
going well) feeling of things badly)
Recognizes Does not recognize
10.2 Characteristics Of Mentally
limitations. limitations.
Healthy Person
Functions effectively Exhibits dependency.
• They have self-respect and independent.
• Accept their mistakes Able to perceive. Unable to perceive
• Emotionally mature reality
• They respect others
• They maintain a good relationship with Mental health team constitutes the following
others members
• They accept their responsibilities • Psychiatrist
• They shape their environment • Psychiatric Nurse Clinical Specialist
• Registered Nurse working in a psychiatric
Some Warning Signs of Mental Illness
unit / hospital
• Change in personality
• Clinical Psychologist
• Inability to cope with problems and daily
• Psychiatric social worker.
activities
• Psychiatric Para-Professionals
219

• Psychiatric Aids-ECT Technician • Marriage can cure mental illness.
• Occupational Therapist • Only adults and older adults experience
• Recreational Therapist mental illnesses.
• Diversional / Play Therapist / Art Therapist
• Clergyman (religious leader) •
The father of psychiatry is
Principles of Psychiatric Nursing Asciepiades.
• Accept the patients as exactly as they are • The first mental asylum in India is Dhar
• Use self-understanding as a therapeutic near Madhya Pradesh
tool
• Use self-awareness when dealing with Activity 1
clients
• Focuses on the strengths, not on weaknesses Teacher Activity
of client Arrange a visit to nearby mental health
• Views the client’s behavior non- hospital and orient the functions of that unit
judgmentally Student Activity
• Establish and maintain therapeutic nurse Submit a report on orientation
–client relationship programme to mental health hospital and
• Ensure clients security its functions.Recall the various emotions
• Give reassurance to the client in an experienced in the past one week, state the
acceptable manner reason and classify and submit the report.
• Change the client’s behavior by emotional
experience
10.4 Understanding of Patients
• Avoid approaches which will increase the
client’s anxiety Understanding of psychiatric patients
• Avoid physical and verbal forces as much is very important in mental health nursing.
as possible So a psychiatric and nursing assessment is
• Maintain the basic principles of nursing necessary. A psychiatric assessment is a process
while following any procedure of gathering information about a client from a
• Nursing care centered on client as a person person within a mental health service, with the
• Explain routines and procedures at the purpose of making a diagnosis. The assessment
client level of understanding is usually the first stage of a treatment process,
but psychiatric assessments may also be used
for various legal purposes.
10.3 Misconception about Mental
Nursing process is defined as a systematic,
Illness
continuous and dynamic method of providing
• Mental illness is caused by supernatural care to clients.
power
Steps in Nursing Process
• It is the result of curse by evil spirit.
• ASSESSMENT: collection of all the data
• Mentally ill people are violent.
that are adequate and relevant.
• Mental illness is something to be ashamed
• DIAGNOSIS: Analyzing the data and find
of.
out the diagnosis.
• Mental illness can not be cured.
220

• PLANNING: Developing a care plan Neurological Examination
according to the need of the client Neurological examination for cranial nerve
• IMPLEMENTATION: implementing the functions to be assessed.
actions to restore the physical and mental
health Physical Examination
• EVALUATION: Evaluating the client’s Physical examination includes head to foot
response for nursing actions taken. assessment of the client.
Methods of Assessment in Psychiatry Laboratory Investigations

• History taking Suggested for all psychiatric admissions.
• Mental status examination Complete haemogram, blood chemistry,
• Neurological examination serology studies, thyroid functions test, HIV
• Physical examination antibody, urine analysis, imaging studies like
chest x-ray, CT / MRI and also EEG and ECG.
• Laboratory investigations
• Psychological tests Psychological Test
History Taking Usually conducted by clinical psychologist.
History taking includes, patient’s Documentation
identification data, presenting complaints,
Assessment information is documented in
history of present illness, past history of
the nursing registers
medical, surgical, and psychiatric, family
history,Personal history, birth history, Moreover, documentation is recognized by
developmental history, occupational history, legal authorities
marital history and personal habits.
10.5 Psychosis and Neurosis
Mental Status Examination
Mental status exam ination includes Psychotic disorders are a group of illnesses
general appearance, behaviour, speech pattern, that affects the mind. These illnesses alter a
mood, delusion, changes in perception like person’s ability to think clearly, make good
hallucination and illusion. And also assessment judgments, respond emotionally, communicate
of higher mental functions of consciousness, effectively, understand reality and behave
attention, concentration, memory, orientation, appropriately.
intelligence and insight about illness. Neurotic disorders have common
historical origin, about one fourth of the
population in developed countries will suffer
from neurotic disorders during its lifetime
course.
Definition for Psychosis

Psychosis (psychotic disorders)are severe
mental disorders that cause abnormal thinking
and perceptions. People with psychoses lose
touch with reality. Two of the main symptoms
are delusions and hallucinations
221

Definition for Neurosis
10.6 Mental Disorders
Neurotic disorder (neurosis) is a mild
mental illness that is not caused by organic Mental illness is maladjustment in living.
disease of brain and not involve hallucinations It produces disharmony in the person’s ability
and delusions, and not loss of touch with reality. to meet the human needs. In general, the
physical health of an individual is given greater
Difference
S. No between psychosis and
Psychosis Neurosis
Neurosis importance and mental health aspect is often
1 Loss of contact with No loss of contact neglected.
reality present/lost with reality
2 Personality changes Purely functional. World wide Prevalence Rates of Mental
present Do not affect the Disorders are
personality
Disorder Prevalence Rate
3 The person with Aware of his/
Any mental or substance 1.1 billion
psychosis does not her personal
realize his / her problems use disorder
disorder Depression 268 million
4 The thought, Does not Anxiety disorders 275 million
speech, and affect language Bipolar disorder 40 million
communication communication Eating disorders 10.5 million
changed and thought Schizophrenia 21 million
5 Hallucination and No hallucination Alcohol use disorder 100 million
delusion marked and delusion
Drug use disorder 62 million
symptoms
(excluding alcohol)
6 Organic reason No organic
present reason Classification Of Mental Disorders
7 Genetic factors Genetic factors Classification of mental disorders is also
more important less important known as psychiatric “nosology” or “taxonomy”.
8 Stressful life events Stressful life
less important events more Classification of Mental Disorders Under
important (International Classification of Diseases)
9 Difficult to treat Easy to treat ICD-10
• Organic including symptomatic mental
disorders
Causes For Mental Illness

Biological Factors Psychological Factors Social Factors
• Genetic cause • Maternal separation • Poverty
• Bio chemical alterations • Abnormal parent – child relationship • Unemployment
• Infections • Marriage problems • Urbanization
• Intoxications • Stress • Alcoholism
• Brain damage • Season • Broken homes
• Vascular causes • Sexual difficulties • Religion and traditions
• Perinatal causes • Low self - esteem
222

• Mental and behaviour disorders due to • Disorders of thought
psychoactive substance use • Disorders of motor activity (increased,
• Schizophrenia, schizotypal and Delusional decreased, stereotype, violence, echolalia,
disorders echo praxia, waxy flexibility, restlessness
• Mood (Affective) Disorders and excitement)
• Neurotic, Stress related and Somatoform • Disturbances in speech (word salad,
disorders circumstantiality, mutism and neologism)
• Behavioural syndromes associated with • Disturbances in perception (hallucination,
physiological disturbances and physical delusion and illusion)
factors • Disturbances in emotions (elevation, panic,
• Disorders of adult personality and agitation, hostile, depressed and anxiety)
behaviour
Management of mental disorders
• Mental retardation
• Disorders of psychological development • Antidepressants
• Behavioural and emotional disorders • Antipsychotics
with onset occurring in childhood and • Mood stabilizing drugs
adolescence • Anxiolytics, hypnotics and sedatives
• Unspecified mental disorders • Anti parkinsonian drugs
• Psychoanalytic therapy
Indian Classification of Mental Disorders
• Supportive psychotherapy
It is a modification of ICD-8 to suit Indian
• Benzodiazepines
conditions. It is broadly grouped as follows
• Psychotherapy
• Psychosis
• Behaviour therapy
• Functional
• Cognitive therapy
• Affective
• Group therapy
• Organic • Play therapy
• Neurosis • Interpersonal psychotherapy
• Special disorders • Stress reducing techniques – Music , Dance,
• Childhood disorders Yoga, Medication and breathing exercises
• Conduct disorders
• Substance abuse Schizophrenia
• Psycho physiological disorder Meaning
• Mental retardation
The term schizophrenia was coined in
Signs and Symptoms of Mental Illness 1908 by the Swiss psychiatrist Eugen Bleuler.
The word was derived from Schizo (split) and
• Alterations in personality and behaviour
phren (mind).
• Alterations in biological functions (sleep,
appetite, sexual desire)
Definition
• Disorders of consciousness (conscious,
unconscious, coma, drowsy, and stupor) Schizophrenia a psychotic condition
• Disorders in orientation (time, place and characterized by a disturbance in thinking,
person) emotions, volitions and clear consciousness
• Disorders of attention and concentration which usually leads to social withdrawal.
223

Causes: The exact cause is not known Types of Hallucinations
• Genetic causes and hereditary
Hallucination Example
• Bio chemical – abnormalities in dopamine,
epinephrine, serotonin. Auditory hears voices frequently,
• Psychological factors – impaired ego, crisis hallucination the voice tells when to eat,
situation dress, and go to bed each
night
• Family factors – parent – child relationship,
family dysfunction Visual seeing spiders and snakes
hallucination on the ceiling of his room
• Social causes – social crisis,
without any external
• Endocrine and metabolic causes.
stimuli
Genec Predisposion
Environmental, Social and Olfactory smells rotten garbage,
Psychological Factor
hallucination although there is no
evidence of any foul-
Neurodevelopmental abnormalies
and target features smelling material in the
room.
Brain dysfucon, improper balance of
chemicals Gustatory (taste) complaints of a constant
hallucination taste of salt water in
SCHIZOPHRENIA
mouth.
Types of Schizophrenia Tactile complaints of feeling
• Paranoid Schizophrenia - hallucination worms crawling all over
• Hebephrenic Schizophrenia body.
• Catatonic Schizophrenia
• Undifferentiated Schizophrenia
• Post schizophrenic depression
• Residual Schizophrenia
• Simple Schizophrenia
• Schizo typal disorder
Auditory Visual
Symptoms of Schizophrenia
Positive Symptoms Negative Symptoms

Delusions (false Affective flattening
unshakable belief)
Hallucinations Avolition-Apathy
(Sensory perception (lack of initiative) Olfactory Tacle
without any external
stimuli) Diagnosis
Excitement/Agitation Attention impairment 1. History collection
Aggressive behaviour Anhedonia (Inability 2. Substance history
to experience pleasure) 3. CT, MRI and brain studies
Suspiciousness Alogia (lack of speech 4. Blood investigations
(doubt) output)
5. Mental status examination
Suicidal tendencies
224

Management of Schizophrenia Depression
Depression (The Common Cold of
MANAGEMENT Psychiatric Disorders)
HOSPITALIZATION Definition
“An alteration in mood that is expressed
PHARMACOTHERAPY
by feelings of sadness, despair, and pessimism.
ECT There is a loss of interest in usual activities, and
somatic symptoms may be evident. Changes
PSYCHO THERAPY in appetite and sleep pattern are common”.
- Mary C. Townsend
PSYCHO SOCIAL
REHABILITATION Etiology
Nursing Management • Due to loss of loved object
• Nursing assessment • Repeated losses in the past
• Health education • Negative expectations of environment,
Negative expectations of the self
Paranoid • Negative expectations of the future
Definition • Stressful life events, Death, Marriage,
Financial loss
Paranoid is a thought process that causes an
irrational suspicion (doubtfulness) or mistrust
of others.
Cause
Genetics, stress, brain chemistry and also
drug abuse.
Symptoms:
• A consistent stress or anxiety beliefs about
others
• A mistrust of others
• Feeling disbelieved /misunderstood
• Isolation
Diagnosis
Symptoms of Depression
History collection, physical examination
and mental status examination. • Sadness
• Sleep disturbances Insomnia -early
Management morning or over sleeping
• Accept their vulnerability • Hopelessness, Helplessness, Worthless
• Develop trust in others ness, restless, irritable.
• Encourage to express emotions in positive • Guilt,
manner. • Anger
• Psychotherapy • Fatigue
225

• Thoughts of death eurotic (Stress related)
N
• Spontaneous crying Disorders
• Avoids interactions with family or friends.
A. Phobia
Diagnostic Measure for Depression
Phobia is defined as unreasonable fear of a
• History collection specific object, activity or situation.
• Mental status examination
Examples
• Depression assessment tools
Acrophobia Fear of heights
Treatment for Depression
Haematophobia Fear of sight of blood
• Medication - antidepressants
Claustrophobia Fear of closed spaces
• Electro Convulsive Therapy
Insectophobia Fear of insects
• Psychotherapy
Zoophobia Fear of animals
Microphobia Fear of germs
Mania
Algophobia Fear of pain
Mania refers to a syndrome in which
the central features are over activity, mood
changes which may be towards elation or
irritability and self-important ideas.
- Dr. R. Sreevani
B. Panic Attack
Intense feeling of fear or terror that
Postpartum Psychosis
occurs suddenly and intermediately without
warning.
C. Anxiety
Anxiety is a feeling of uneasiness or tension
that a person experience to an unknown object
or situation.
D. Obsessive Compulsive Disorder

Postpartum psychosis (some times called Obsessive Com pul
sive Disorder is a
puerperal psychosis) that occurs in women who common chronic and long lasting disorder in
have recently delivered a baby. The syndrome is which a person has uncontrollable recurrent
often characterized by the mother’s depression, thoughts and behaviour that he/she feels the
delusions, and thoughts of harming either urge to repeat over and over like frequent
herself or her baby. hand washing, checking the doors.
- Sadock and Sadock
226

Eating Disorders
Definition
An eating disorder is when you have an
unhealthy attitude to food, which can take over
your life and make you ill.
Types Of Eating Disorder

a) ANOREXIA NERVOSA: anorexia
nervosa is an eating disorder in which people
E. Conversion Disorder have an intense fear of gaining weight and can
Conversion disorder formerly known become dangerously ill.
as HYSTERIA, which is a loss of or change in b) BULIMIA NERVOSA: Bulimia nervosa
body function resulting from a psychological is a psychological and severe life threatening
conflict, the physical symptoms of which cannot eating disorder characterised by ingestion of an
be explained in terms of any known medical abnormally large amount of food in short time
disorder or pathophysiological mechanism. followed by attempt to avoid weight gain, they
induce vomiting.
F. Psychosomatic Disorders
Usually found in school girls and college
The term psychosomatic disorder is mainly
students.
used to mean a physical disease that is thought
to be caused or made worse by mental factors. Management:
Eg. Chest pain may be caused by stress and not • Medications
by physical disease.
• Behaviour modification therapy
The word psychosomatic is now replaced
• Psychotherapy
with psychophysiologic disorder. They are also
called as stress related disorders. Most of the
Sleep Disorders
symptoms are treated in general hospital rather
than in mental hospital. Definition
Sleep disorders are changes in sleeping
G. Post-Traumatic Stress Disorder (PTSD) pattern or habit that can negatively affects
Post-traumatic stress disorder is a severe health.
anxiety disorder that can develop after exposure
to any event which results in psychological Types Of Sleep Disorders:
trauma. A) Insomnia: Disorder of initiation and
maintenance of sleep
H. Generalised Anxiety Disorder (GAD)
B) Hypersomnia: Excessive sleep pattern
Generalised anxiety disorder is
characterized by excessive anxiety and worry Sleep Disorders
about every day life events with no obvious • Sleep walking (somnambulism)
reasons for worry. It may be about money, • Bruxism (Tooth grinding)
health, family, work or school
• Sleep talking (somniloqy)
Personality Disorders • Sleep enuresis (Bed wetting)
• Night terrors
(Refer Applied psychology Chapter.)
227

Management Management:
• Treat the cause • Treat the underlying physical and
• Medications psychological problems
• Sleep hygiene • Medications
• Relaxation techniques • Psychotherapy
• Behaviour therapy
Sexual Disorder
Definition 10.7 Drug Abuse, Alcohol Abuse
Any disorder that involving sexual and De-Addiction
functioning, desire or performance
Types Of Sexual Disorders: Drug Abuse

1. Gender Identity Disorders Drugs are a pervasive part of our society.
TRANSSEXUALISM: Sense of Certain mood altering substances are quite
discomfort about one’s own sex. They want socially acceptable and are used moderately.
to change their sex permanently. (Male to They include alcohol, caffeine, and nicotine.
female or female to male) A wide variety of substances are produced for
DUAL ROLE TRANSVESTISM: Wearing medicinal Purposes. On the other hand, the
clothes of opposite sex to enjoy temporarily, but dangerous effects of other illegal substances
they do not want to change their sex have been well documented.
2.
Psychological and behavioural problems “At the bottom of every person’s
related to sexual development and dependency, there is always pain. Discovering
maturation the pain and healing is an essential step in
ending dependency”.
• Homosexuality of females (Lesbians)
Definition for Abuse: To use wrongfully or in a
• Homosexuality of males (Gay)
harmful way. (APA-2000)
3. Paraphilias
Types
Sexual activity with non- • Alcohol
Fetishism
living objects • Amphetamines and related substances
Sexual desire occurs by • Caffeine
Transvestism wearing clothes of opposite • Cannabis
sex • Cocaine
Physical and psychological • Hallucinogens
Sexual sadism
injury to opposite sex
• Inhalants
Exposure of ones genitals to
Exhibitionism • Nicotine
strangers
• Opioids
Involvement of children in
Paedophilia • Phencyclidine (PCP) and related substances
sexual activity
Act of touching and rubbing • Sedatives, hypnotics, or anxiolytics
Frotteurism against an unsuspecting Causes
person
• Genetic Factors
228

• Biochemical Factors: Alterations in • Recreational - functions like marriages,
neurotransmitters hostel days or college day, parties,
• Psychological: curiosity, escape from conference
reality, personality, life style and self- • Relaxation – whenever they want
medication relaxation, on holidays and Sunday, they
• Social: peer pressure, easy availability, start enjoying their drink and continue to
Culture, media, and popularity of drugs do so.
• Compulsive – some people who started
Management of drug abuse drinking occasionally, start drinking
Care for a substance using patient starts almost daily or drinking heavily for a
with an assessment during the phase of drug period of time for pleasure or to avoid the
intoxication and detoxification discomfort of withdrawal symptoms.
• Vital signs
Diagnostic Evaluation
• Intra Venous Fluid (IVF)
• Blood Alcohol level
• Medication
• Serum electrolyte
• Rehabilitation
• Urine toxicology
Alcohol Abuse • Liver function test
• ECG
Alcohol abuse can steal the best years of
your life. Alcohol does not kill the addict. It • CAGE Questionnaire: (Cut down,
kills the family, kids and people who tried to Annoyed, Guilt, Eye-opener)
help. Alcohol abuse is temporary fun with • AUDIT - Alcohol Use Disorders
permanent consequences. Identification Test
The word “alcoholism” was first coined • DAST - Drug Abuse Screening Tool
by “Magnus Huss”. It was derived from Arabic
word ‘alkuhl’, means ‘essence’. Management
The management includes outpatient and
Definition Inpatient modalities
“Alcoholism is defined as a chronic diseases • Informed consent
manifested by repeated drinking that produces
• Medications
injuries to the drinker’s health or to his social or
economic functioning” - S. Nambi • Vitamin and nutritional supplementary to
correct nutrition deficiencies
Epidemiology • IV fluids and electrolyte balance
The World Health Organization estimates • Symptomatic treatment
about 140 million people throughout world • Alcohol Deterrent therapy
Incidence - 2% in India
Rehabilitation of Alcoholic Dependence
Above 15 years - 20 – 40 %
Regular or excessive users - 10% • Alcoholics Anonymous (self-help groups)
• Aversion therapy
Process of Development
• Psychological method
• Experimental - person start drinking
• Counseling
alcohol due to peer pressure and curiosity
229

Complications
Physical Complications Psychiatric Complications Social Complications
• Accidents. • Dementia • Suffering in relationships with
• Suicide rates increased • Brain damage family, friends, and coworkers.
• GI ulcers, • Anxiety • divorce and separation
• liver disease, • Depression • Domestic violence
• malnutrition, • Psychosis • aggressive behavior.
• anaemia, and • Confusion • Missed work,
• Dehydration. • Antisocial personality • poor job performance,
• cardiac dysrhythmia, • Bipolar disorder • On job accidents are common.
• seizures, • Legal problems
• Acute renal failure.
• Mood changes
• Psychosis.
• short- and long-term memory loss
• Individual and group psychotherapy Mental retardation has

• Marital and family therapy a new name “Intellectual
• Behavioral modification (aversion disability” or “Intellectual
therapy) Developmental Disorder
or General Learning
• Relapse prevention therapy
Disability”.
Patient Education and Health Maintenance
Meaning
• Instruct patient and family about adverse
Retarded is derived from Latin Word
physiologic and psychological effects of
substance use. “Retardare” = which means to make slow,
keep back, or hinder.
• Discuss health maintenance practices to
minimize potential effects of substance use Definition of Mental Retardation:
(e.g., vitamin use, proper diet).
Mental retardation is a generalized neuro
• Explain the potential for injury from risk- developmental disorder characterized by
taking behaviours. Reinforce the need for significantly impaired intellectual and adaptive
aftercare groups and activities. functioning” –American Association on mental
deficiency (1983).
10.8 Mental Retardation
Causes for Mental Retardation
Mental handicap is more complex • Genetic Causes: Abnormal genes form
enterprise. Some children can go through life parents (chromosomal abnormalities)
but others need help depending upon their
• Metabolic: Phenylketonuria, Wilson’s
disability. Institutionalization and special
disease and Galactosomia
schooling are required for a number of mentally
• Cranial malformations: Microcephaly and
handicapped children.
hydrocephaly
230

• Prenatal: Infection Eg. Rubella Severe Mental Retardation (IQ 20 to 35)
• Intranatal: Birth asphyxia • Poor verbal
• Postnatal: Infections, Accidents, Lead skills, Poor
poisoning psychomotor
• Environmental And Socio – Cultural development,
Causes: Low socio economic status, cultural • Only able to
deprivations. develop simple
focus
Classification of Intellectual Disability
Profound Mental
S. No Types IQ Ranges
Retardation: (IQ < 20)
1 Mild mental
50-70 • No capacity for socialization skills,
retardation
2 Moderate mental • Lack of both fine and gross motor skills,
35-50
retardation • Requires constant supervision,
3 Severe mental • May associated with other psychosocial
20-35
retardation disorders.
4 Profound mental
<20 Signs and Symptoms
retardation
• Failure to Milestones
IQ Calculation (Interlligent Quotient) • Deficiencies in cognitive Function
IQ = Mental Age (MA)/ Chronological • Reduced ability
Age (CA) × 100 • Expressive or accepting language problem
For example: If 8 year old child has 4 year • Psychomotor skill deficits
of mental age , it would be considered as 4 years • Neurologic impairments
of mental age. • Lack of curiosity
Calculate as follow: IQ =4/8 × 100=50
(Mental age is calculated by psychiatrist Dignosis
and chronological age is the actual age from • History: Family History, and abnormalities
birth) in pregnancy and delivery, Developmental
milestone and Associated behavioural
Clinical Features
disorders.
Mild Mental Retardation: (IQ 50 to 70)
• Physical Examination: Height, weight,
• Deficit in intellectual, and academic head circumference physical sign of
performance, specific disorders.
• Motor or sensory deficits are slight. • Detailed Neurological Examination:
• Their mental retardation can not be detected Especially vision, hearing of specific sign.
until the start of schooling.
• Mental Status Examination
Moderate Mental Retardation: (IQ 35 to 50) • Investigation: Blood, Urine, CT Brain, and
• Trainable, unaware of the needs chromosomal studies.
• Poor communication skills, • Intelligence test
• Partially dependence on others for this care, • EEG.
• Difficulty in social relationship
231

Management • Home training will give good result.
Treatment Modalities • Home is the best place to train the child.
• Home training will lead to independent life
• No satisfactory treatment is available
till today. No drugs available to increase
intelligence. Do you know an Indian girl
who holds the world record for
• Behaviour and environmental supervision
highest IQ level?
• Monitoring the child’s developmental needs
and problems. K. Visalini, 19 year old female from
Tirunelveli. Her IQ level is 225.
• Programs that maximize speech, language,
cognitive, psychomotor, social, self-care,
and occupational skills. TEACHER ACTIVITY
• Ongoing evaluation for overlapping
psychiatric disorders Make a field visit to nearby mental
• Family therapy and Early intervention retardation school and orient the training
programs for children of mentally challenged children and their
parents.
• Provide day schools to train the child in
basic skills, such as bathing, brushing and
Social welfare schemes available for
eating.
mentally retarded in India
Prevention of Mental Retardation • Monthly maintenance charge of Rs.1000/-
• Genetic counselling, avoid consanguinity • Self-employment subsidy to persons
marriages. through banks, and free travel concession
• Good perinatal care and hospital deliveries with one escort, free special education,
• Avoiding marriages of mentally retarded appointment of legal guardianship, homes
• Early diagnosis and treatment. and vocational training programme from
non-governmental organizations are
Rehabilitation available.
Rehabilitation is aimed at
• Physical (appliances for handicaps), 10.9 Learning Disability
• Social (social skills training) and
Difficulties with reading, writing and/
• Occupational areas (e.g. by teaching and
or math are recognizable problems during
training the patients to make them self-
the school ages, the signs and symptoms of
sufficient).
learning disabilities are most often diagnosed
• Day care centres and schools, integrated during that time. Learning disabilities are
schools, vocational training centres, referred to as “hidden disabilities”. The
sheltered forms and workshops are useful. person looks perfectly “normal” and seems
Tips for Parents of Mentally Challenged to be a very bright and intelligent person,
Children: yet may be unable to demonstrate the skill
level expected from someone of a similar
• Mental retardation will not be caused by sin, age. Children with learning disabilities are as
god’s anger. smart as or smarter than their peers.
• Do not consider them as a burden.
232

Definition Management: Allow use of fingers, use
Learning diagrams and provide peer assistance. Also
disabilities are use mnemonic devices and schedule time for
disorders that practice.
affects one’s ability
B. Dysgraphia
to understand or
use spoken or written language, do mathematical T y p e
calculations or direct attention. of learning
disability that
Causes affects children
The causes for learning disabilities are not handwriting
well understood, and sometimes there is no ability and
apparent cause for a learning disability. However, fine motor
some causes of neurological impairments activity. It may
include: be illegible handwriting, spelling mistakes,
• Heredity and genetics: Learning disabilities spatial problem in paper.
often run in the family. Management
• Problems during pregnancy and birth:
• Conduct oral exams. Provide notes to
Malnutrition Anomalies in the developing
decrease writing.
brain, illness or injury, fetal exposure to
• Allow to use ruled paper and graph paper.
alcohol or drugs.
• Accidents after birth: Head injuries, C. Dyslexia
Malnutrition, Toxic exposure to heavy A learning
metals disability that
Characteristics of Learning Disability: affects reading
• Slow reading rate and related skill.
• Difficulty in recalling This also known
as language
• Difficulty in finding
based learning disability. It may affect fluency,
• Confusion
recall, writing, spelling and sometimes speech.
• Problems with reasonings
The student may read slowly, trouble in
Types of Learning Disabilities spelling, cannot exhibit recalling words. May
feel difficulty in handwriting.
A. Dyscalculia
This is a Treatment:
type of learning • Intensive teaching techniques
disability, where • Improve both spoken and written language
the children skills
have difficulty in
• Classroom modification
math fact. They
have poor understanding of math symbols, Management
numbers and feel difficulty in counting the Provide calm area for study. Provide copy
numbers. of notes, small unit of lessons, large print books.
Do not count the spelling in tests.
233

Non-Verbal Learning Disabilities Definition
It is defined as trouble Attention Deficit and Hyperactivity
in interpreting nonverbal Disorder is a Neuro behavioral developmental
cues like facial expression disorder characterized by inattentiveness, over
and body language. activity, easily distractable and impulsiveness.
Management: rehearse The child responds to multiple stimuli at same
getting from place to place. time.
Orally point out the difference, connection on Epidemiology
resemblance.
ADHD is most commonly studied and
Assessment diagnosed in, primary school children 1.7%,
Many normed assess ments can be used school aged children 3 %– 5%.
in evaluating skills in the primary academic The ratio of boys and girls ranges from 2: 1.
domains: it includes;
• Word recognition,fluency, and Risk Factors for ADHD
comprehension; • Drug exposure of baby during pregnancy
• Mathematics, including computation and • Birth complications
problem solving; • Low birth weight
• Written expression, including handwriting, • Lead poisoning
spelling and composition. Causes for ADHD:
Biological causes:
The purpose of assessment is
• Genetic: biological parents of ADHD.
• to determine what is needed for intervention,
• Bio chemical: alterations in dopamine and
• which also requires consideration of
nor – epinephrine.
contextual variables and
• Anatomical causes: Alteration in the
• whether there are comorbid disorders that
regions of frontal lobes, basal ganglia, and
must also be identified and treated,
cerebellum in brain
• such as behavioral issues or language
Psychosocial Causes
The World’s Most Famous • Family dysfunction
Genius, The Nobel Prize Winner • Stressful events
Is Believed To Have Learning • Emotional deprivation
Disability. Do You Know Who Is He? • Paternal criminality
Yes…… He Is Albert Einstein. • Low socio economic status and poverty
Perinatal Causes
10.10 Attention Deficit Hyperactivity
Disorder • Alcohol and tobacco smoke exposure
during pregnancy.
A t t e n t i o n • Head injuries.
Deficit Hyperactivity • Infections during pregnancy, at birth and
Disorder is early childhood.
otherwise known as • Prolonged labour
Hyperkinetic disorder. • Perinatal asphyxia
The syndrome was first described by Heinrich • Postnatal infections, CNS abnormalities
Hoff in 1854. due to trauma
234

Environmental Causes Diagnosis
Environmental lead. Elevated body levels • A detailed history about pre natal and
of lead affects the cognitive and behavioural developmental history
development in children. Food dyes and • Teachers school report and parents
additives (colouring preservatives), artificial report
flavours. • Child guidance clinic and complete
Clinical Features psychiatric evaluation with psychologist
• Sensitive to stimuli • Medical examination for neurological

examination, hearing and vision.
• Easily upset by noise, light and
environmental changes Treatment
• Short attention span, easily distractible, • Medications
• Failure to finish works • Therapies
• Poor learning capacity and memory. • Behaviour modification therapy
Types of ADHD • Family education

• Social skill training
A
An Inattentive Hyperactive Combined • Attention training
Type Impulsive Type • Visual training
Type • One to one talking
• Unable to pay • Excessive This is
attention and running the most ADHD in Classroom
careless and common • Reduce seating distractions
• Poor play climbing type and • Supervision
activities • Excessive combination
• Give positive reinforcement
• Listening talking of both
problems • Cannot be types. • Homework folder for parents
• Cannot able seated in a
to follow place
instruction • Answering Diagnosed with Attention
• Avoiding before Deficit Hyperactivity Disorder
works which hearing (ADHD) at age 9, swimmer
needs mental a full Michael Phelps, winner of 14 Olympic
efforts question gold medals, overcame the challenges of
• Loses things • Cannot his condition and hit his stride in the pool
like note wait for - thanks, in large part, to his mother’s help.
books, pencil their turn
and homework or in
frequently queue
in school
TEACHER ACTIVITY
• Forgetting the
daily activities Make a visit to child guidance clinic
• Unable to wait and show the assessment of ADHD child.
for their turn
and respond
235

Phase and Tasks
10.11
Therapeutic Nurse – Patient
Relationship
Repeated human contacts are essential to

develop trust, love, tenderness concern and
acceptable nature. The nurse has to act as a
parental role, and accept the client’s thoughts,
feelings, interest and problems. The nurse–
client relationship is the foundation upon which
psychiatric nursing is established.
Pre – interaction phase:
Definition for Relationship Nurse is assigned to take care of client. Plan for
“Relationship is a state of being related or first meeting with patient.
interrelated” -Webster new collegiate dictionary Introductory/ orientation phase: During this
phase the nurse and patient meet for first time.
Establish rapport, trust and acceptance. Gather
data including patient`s feeling, strengths and
weakness.
Working phase: Most of work is carried out
during this phase.
Social Relationship
Termination phase: Patient has achieved the
To satisfying needs of each other. - Example:
treatment goals
work colleagues, friends, functions and parties
Intimate Relationship Therapeutic Impasses

Two individuals committed to one another. For variety of reasons therapeutic
- Example: partner type and to reduce loneliness relationship is hindered. Therapeutic impasses
are blocks in the progress of nurse – patient
Therapeutic Relationship relationship.
Nurse – client or therapist – differs from
both social and intimate - client work together
towards the goal.
Components of Therapeutic Nurse – Patient

Relationship
• Rapport
• Trust, Respect and Genuineness
• Empathy, Sincerity and Concern
• Immediacy
• Communication skills
• Warmth
• Active listener
• Self-discipline Resistance: Resistance is the patient’s avoidance
of verbalizing
236

Transference: It is an unconscious response in Importance of Community Mental Health
which the patient experiences feelings towards • It will promote mental health of families
nurse. The nurse viewed as a person from past
• It will help the family members to know
life, loved object and expecting privileges.
the social, cultural and situational aspect
Counter Transference: It is created by the of care
nurse’s specific emotional response to the
• It will educate the family members
qualities of the patient and providing privileges.
regarding identification of stressor and
Boundary Violation: The nurse goes beyond coping mechanisms to deal problems.
the boundaries and establishes a social, personal,
• To remove stigma from community people
and economic relationship.
• To remove the misconception about mental
Intervention to overcome Therapeutic illness
Impasses
• Nurse must have the knowledge of the Mental Health Services
impasses available in the Community
• Nurse must reflect on feelings Partial Hospitalization
• Nurse must examine their strength and Partial hospitalization is an innovative
weaknesses alternative to hospitalizations. Individuals can
• Maintain open communication attend structured programmes throughout the
day and return to home in the evenings. The
advantage or partial hospitalization is of lesser
10.12 Mental Health Services
separation from families.
The attitude towards mental illness and
Group Homes
the treatment of mentally ill have undergone
considerable changes through the years. Mentally These homes may belong to a hospital
ill were often beaten, starved, burned and tortured or rented by 15 to 20 mentally ill recovering
in order to make the body unsuitable place for patients.
demons. Gradually man began the quest for
Foster Homes
scientific knowledge and truth.
The methods of treating mental illness have It is a home in which a patient recovering
changed dramatically in the past century. The from a mental disorder is placed in a voluntary
organization of mental health services demands family by a social agency for family care is
a wide variety of interventions, regarding from paid by the agency. Patient gets home like
public awareness, early identification, treatment environment.
for illness, family education, long term care,
Sheltered Workshop
rehabilitation, and ensure human rights of the
ill persons. Mental health services are delivered It is a work oriented rehabilitation facilities
through mental hospitals at central, state and with a controlled working environment to fulfill
district levels. individuals vocational goals.
Community Quarter Way Homes

Community is a group of people with This is the place usually located within
common value, belief, attitude, characteristics, the hospital campus itself, but not having
location and interest.
237

regular services of a hospital. There may not with a specific problem. The group helps the
be a routine rounds, nurses, and most of the members to become socialize. Ex. AA (Alcohol
activities carried out by patients themselves. Anonymous)
Half Way Home: Suicide Prevention Centers

A half way home is a transitory residential The incidence of committed suicide are
centre for mentally ill patient who no longer increasing day by day. These suicide prevention
need the full services of a hospital. centres help in decreasing the incidence of
Objective: to ensure a smooth transition suicide. Some of them are:
from hospital to the family • SNEHA in Chennai
• YWCA half way home for mentally ill in • SAHARA IN Mumbai
Chennai • SANJIVINI AND SUMAITRI IN New Delhi
• Dr. BOAZ’S rehabilitation centre in
Chennai Mental Health Services at Various Levels in
India
• Delhi psychosocial rehabilitation society
Central National levels hospitals.
Day Care Services: level Example, NIMHANS, Bengaluru
Patients discharged from the hospital and State level Hospitals. example
who are residents, services in the form of day Institute of Mental Health,
care program in the occupational therapy and State level Dharwad, Karnataka,
rehabilitation centre. It helps them to undergo Hospitals Tamil Nadu
different vocational training programs and thus National Mental Health
helps them in their future job-placement. Programme
The following arethe variousvocational General Hospitals psychiatric
training provided District units
• printing and book binding level District Mental Health
• tailoring and readymade garments , programme
• handloom carpentry Primary Health centres
• Candle unit, bamboo baskets sericulture, Community mental Health
Local level
• pottery, bakers craft work centres
• gardening , mat-weaving Sub-centres
• Leather work etc.
ational Mental Health
N
Day Care Services In India Programme
• NIMHANS in Bengaluru
To create more awareness on mental health
• SCARF in Chennai among rural people, National mental health
• SANJIVINI in new Delhi programme was started in 1982.
Slogan of National Mental Health
Self Help Groups
Programme: Reaching The Unreached
Self-help groups or mutual help are Aims of National Mental Health Programme
voluntary associations of people who share
a common desire to overcome mental illness • Prevention and treatment of mental and
composed of people who are trying to cope Neurological disorders and associated
disabilities
238

• Use of Mental Health technologies to Components of NMHP
improve general health services
• Application of mental health principles
in total national development to improve
quality of life
Objectives of National Mental Health istrict Mental Health Program

D
Programme (DMHP)
Availability &
The District Mental Health Program
accessibility of mental
health care to the most
(DMHP) was launched under National Mental
vulnerable and under-
privilaged secons of
Health Program in the year 1996. Presently
Mental health populaon Integraon of
mental health
the District Mental Health Program (DMHP)
knowledge in
general health services with
General Health
is being implemented in 123 districts.
care in social
development Services
THE MAIN OBJECTIVE IS: To provide

community mental health services and mental
Smulate efforts
health services with general health services
Community
towards self
help in the
parcipaon in through decentralization of treatment based
mental health
community Services on primary health care services.
Components of District Mental Health

Funtions of NMHP Program (DMHP)
Mental Hospitals • Training programs for all health workers in
• Very chronic and disturbed patient who mental health team
cannot be looked after in the community, • Public education to increase awareness
to be certified and admitted in mental
• Outpatient services and indoor services for
hospitals.
early identification and treatment
Medical Colleges • Providing valuable data to state for
• Will take the responsibility of training of planning, implementing and research.
general practioners and the medical offices
Prevention of Mental Illness
in the primary health centres. They will
function as research centres.
The concept of mental health has
District and Taluk Hospitals got great response in dealing with clients
of mental disorders. Community health
• Will have the department of psychiatry
movement has been considered as revolution
and psychiatrist.
in the field of psychiatry. Caplan discussed 3
• They will supervise the medical officers
levels of prevention in “public health model”
and general practioners in the PHC
in includes:
• Community health workers attached to
• Primary prevention
PHC will identify the patients who suffer
• Secondary prevention and
from psychiatric disorders and refereeing
the patient to the PHC for treatment • Tertiary prevention
239

Primary Prevention • Right to privacy
• Right to informed consent/Right to
treatment.
• Right to refuse treatment.
Some important milestones in Psychiatry

• 1773 – First mental hospital in
Williamsburg, Virginia, US.
• 1783 – Benjamin Rush wrote first textbook
Secondary Prevention
on psychiatry
Secondary prevention aims at lowering
• 1793 – Philippe Pinel removed the chains
the intensity and severity of the illness, early
from mentally ill was the first revolution in
diagnosis and early prompt treatment
Psychiatry
Tertiary Prevention • 1882 – First psychiatric nurse MS Linda
Tertiary prevention aims at lowering the Richards from U.S
disability and relapse, increasing self-esteem • 1908 – Clifford Beers an ex patient of a
and rehabilitation mental hospital wrote the book. “A mind
that found itself “based on his bitter
Specific Problems in Mental Hospitals experiences in the hospital,
• Escape from mental hospital • 1912 – Eugen Bleuler, a Swiss psychiatrist
• Death coined the term “schizophrenia”.
• Pregnancy • 1912 – Indian Lunacy Act was passed
• Unknown patient • 1920 – The term Lunatic Asylum was
• Mentally ill offender (mentally ill criminals) changed to “Mental Hospital “
Human Rights of Mentally Ill • 1927 – Insulin shock treatment was

introduced for schizophrenia
Psychiatry patients currently have the
• 1938 – Electro Convulsive therapy was
following rights;
introduced for treatment of psychosis
• Right to communicate with people outside
• 1947 – Indian psychiatric society was
the hospital through, telephone, and
formed
personal visits.
• 1949 – Lithium therapy was introduced for
• Right to keep clothing and personal effects
treatment of mania
with them in the hospitals.
• 1952 – Chlorpromazine was introduced –
• Right to religious freedom
revolution in psychopharmacology
• Right to be employed if possible.
• 1963 – Community health centres act was
• Right to manage and dispose of property passed
• Right to execute wills. • 1987 – The Indian Mental Health act was
• Right to make purchases passed.
• Right to education.
• Right to independent psychiatric
examination.
240

Institute of Mental Health, Theme of Mental Health Day
Chennai is involved in mental 10th October
health care for the past 206 years. 2018 – young
Founded in 1794 as an asylum to manage 20 people and mental health in
patients. Now it has grown into an institute a changing world
with bed strength of 1800 patients. It is the
second largest institute in India offering
mental health services.
SUMMARY
Most people with mental illnesses are treated in the community rather than in hospitals, but nurses
are needed in both settings. Demand for mental health services has increased significantly in recent
years. Around 20% of the world’s children and adolescents have mental disorders. Mental and
substance use disorder disorders are the leading cause of disability worldwide. War and disasters have
a large impact on mental health and psychosocial wellbeing. Mental disorders are important risk
factor for other diseases as well as intentional and unintentional injury. Stigma and discrimination
against patients and families prevent people from seeking mental health care. Financial resources to
increase services are relatively modest. About 800000 people commit suicide every year. Generally
there is huge inequity in the distribution of skilled human resource for mental health
GLOSSARY
Optimism All is going to turn out well நம்பிக்கை

Pessimism The feeling that things will turnout அவநம்பிக்கை
badly
Process The series of action செயல்முறை / செயலாக்கம்
Assessment Act of judging a person or situation மதிப்பீடு
Adoption The act of legally taking a child to care தத்தெடுத்துக் க�ொள்ளப்பட்ட
as your own.
Disharmony Lack of harmony or agreement ஒற்றுமைக்கேடு / ஒவ்வாததன்மை
Personality Combination of qualities ஆளுமை / தனித்தன்மை
Confused Unable to think clearly குழப்பமான
Mood A temporary state of mind or feeling மனநிலை
Depression The state of feeling very unhappy மனஅழுத்தம்
and without hope for the future
Chronic For a long time நாள்பட்ட
Compulsion State of forcing being forced to do வழுக்கட்டாயம் / நிர்பந்தம்
Neurosis Mild mental illness that is not caused நரம்பு சிக்கலால் ஏற்படும் மூளை
by organic disease, involving அமைதிக் க�ோளாறு
symptoms of stress.
Schizophrenia மனச்சிதைவு / பிளவுப்பட்டமனந�ோய்
Isolation A state of complete lack of contact தனிமை
between an individual and society
241

Mutism Unable to speak ஓசையற்ற/ஒலிநிறுத்தம்
Cognitive Connected with thinking or conscious அறிவாற்றல்
mental processes
Relationship State of being connected உறவு
Intimate Very close நெருக்கமான
Therapeutic Relating to the healing of disease ந�ோய்நீக்கநலம்சார்ந்த /
குணப்படுத்தும் இயல்புடைய
Termination Action of terminating something முடிவிடம் / கடைமுடிவு
Media The collective communication outlets தகவல்தொடர்புசாதனம்
Anemia A decrease in the total amount of red இரத்தச�ோகை
blood cells.
Retarded Less advanced in physical, mental, or சரியில்லாத
social development than usual age.
Hinder Make it difficult to do something தடங்கல்செய் / இடையூறாக
Abuse Treat with cruelty/violence. Use for a தவறானவகையில்
bad purpose பயன்படுத்துதல்
Disability A physical or mental condition that குறைப்பாடு / பலவீனம்
limits a person’s Activities
Head injury தலைக்காயம்
Any trauma to the scalp, skull or brain
Illegible Not clear enough to read தெளிவில்லாத / விளங்காத /
படிக்கமுடியாத
Genetic Relating to genes or heredity மரபணு
ADHD அவதானக்குறை மிகையியக்க
குறைபாடு.
Prevention The action ofstopping something from தடுத்தல் / நடைபெறாமல்செய்தல்
happening
Rehabilitation The action of restoring someone to மறுசீரமைப்பு / புனர்வாழ்வு
health or normal life that has Been
damaged.
CLINICAL EXAMPLE
The Client with Severe Mental Retardation
Mr. X 18 years old, was born by a normal spontaneous vaginal delivery without any complications.
Two months after birth, Mr. X developed a temperature of 105Â°F and had a grand mal seizure. He
was admitted to the neonatal intensive care unit with the diagnosis of fever of undetermined origin
(FUO). Diagnostic tests revealed the presence of encephalitis. MR. X recovered, but his parents
were cautioned about the possibility of central nervous system damage because of the severity of
his illness. During early childhood, ages 1 to 5, Mr. X was able to communicate with his parents
to some extent but exhibited poor motor-skill development. He was unable to learn basic skills
such as reading, writing, and arithmetic, and it became evident that he needed supervision in a
controlled environment. Testing revealed Mr. X’s IQ to be that of a person with severe retardation
or mental impairment. At age 18, he continues to live at home with very supportive parents who
have been able to teach him some self-care activities. He relates well to a pet cat, helps his mother
with simple household chores, and helps his father with gardening and lawn care.
242

Evaluation
I. Choose the correct answer III. 3 Marks

1. The term schizophrenia was coined by 1. Characteristics of mentally healthy person
2. Difference between psychosis and neurosis
a) Eugene Bleuler b) Aristotle 3. Mention the types of mental retardation
b) Pythagoras D) Plato 4. Types of ADHD
2. Electro convulsive therapy was started in 5. Mental health services available at various
a) 1936 b) 1938 levels
c) 1948 d) 1942
IV. 5 Marks
3. Who wrote the book “the mind that found
itself ”? 1. Explain the general principal if mental
health nursing
a) Clifford Beers b) Linda Richards 2. Define schizophrenia, explain the causes
c) Maxwell jones d) Philippe Pinel and management of schizophrenia.
4. The father of psychiatry is 3. Define therapeutic nurse – patient
a) Asciepiades b) Hippocrates relationship. Explain the phases and task of
c) Aristotle d) Benjamin Rush therapeutic relationship.
5. Expansion of ICD - 10 is an 4. Define alcoholism, list out the etiology,
a) International Classification of Diseases process of development and treatment of
b) Indian Classification of Diseases alcoholism.
c) Indian Medical Association 5. Explain about causes and symptoms of
d) World Health Organization Paranoid.
6. Mental retardation is otherwise known as
a) Intellectual disability REFERENCE BOOKS
b) Hyperkinetic disorder 1. BT Basavanthappa, (2007), “Psychiatric
c) learning disability Mental Health Nursing”, First edition, New
d) autism Delhi, Jaypee Brothers Medical Publishers,
7. ADHD is otherwise known as 2. KP Neeraja, (2008), “Essentials of Mental
a) Mood disorder Health and Psychiatric Nursing”, First
b) Mental Retardation edition, New Delhi, Jaypee Brothers Medical
c) Hyperkinetic disorder Publishers
d) learning disability 3. R. Sreevani, (2016), “A guide to Mental
8. Claustrophobia Health and Psychiatric nursing”, 4th edition,
a) fear of crowd b) fear of animals Jaypee Brothers Medical Publishers (pvt)
c) fear of Blood d) Fear of closed space Ltd, New Delhi.
9. Somnambulism is 4. Ram Kumar Gupta, (2016), “Mental Health
and Psychiatric Nursing”, 1st edition, S.
a) Sleep walking b) Day time walking
Vikas and Company Medical publishers,
c) Sleep talking d) Night tremors
Jalandhar city, India
10. Pedophilia is an act of sexual activity
involving INTERNET RESOURCES
a) Adult b) Adolescent
1. www.mentalhealth.com / www.
c) Geriatric d) Children
healthonline.com
II. 2 Marks 2. www.wikipedia.org / www.ncbi.nim.nih.gov
1. Mental health 3. American Psychiatric Association: www.
psych.org
2. Mental illness
4. www.mhsource.com / www.ldaamerica.
3. Psychiatric nursing org>types –of-learning
4. Nursing process 5. w w w. w i k i p e d i a . o r g > w i k i > l e a r n i n g
5. Phobia disability
243

CHAPTER
11
Communicable
Diseases
உற்றான் அளவும் பிணியளவும் காலமும்

கற்றான் கருதிச் செயல்.
The learned (physician) should ascertain the condition of his patient; the nature of his
disease, and the season (of the year) and (then) proceed (with his treatment).
LEARNING OBJECTIVES
At the end of the lesson students will be able to

➢➢ define technical jargons related to communicable disease
➢➢ list out the classification of communicable disease
➢➢ identify the clinical manifestation of communicable disease
➢➢ understands the complications and control measures of communicable
disease
Introduction 11.1 Terminology
Infections due to living organisms are 1. Infection: The entry and development or
called communicable diseases. They spread multiplication of an infectious agent in the
from person to person, or sometimes from body of human being or animals.
animals to people. They occur at all ages but 2. Contamination: The presence of infectious
are most serious in childhood and they are agent on a body surface or in clothes,
preventable to a great extent. In developed beddings, toys, surgical instruments or
countries, communicable diseases have been dressings or other inanimate articles or
prevented. But in India it is going through substances including water, milk and food.
a period of transition, both epidemiological 3. Infestation: For persons or animals the
and demographically. Infectious diseases are lodgment, development and reproduction
still persisting as major health problems in of arthropods on the surface of the body or
spite of having National programmes for the in the clothing (e.g) lice, itch mite.
control of many diseases.
244
Unit_11_Communicable_disease_Gen_Nur.indd 244 12/10/2021 10:32:36 PM

4. Host: A person or animal including birds
and arthropods that affords subsistence National Centre for Disease
or lodgment to an infectious agent under Control (NCDC) (previously
natural condition. known as National Institute of
Communicable Diseases) is an institute
5. Communicable diseases: An illness due to
under the Indian Directorate General of
specific infectious agent or its toxic products
Health Services, Ministry of Health and
capable of being directly or indirectly
Family Welfare. which was established in
transmitted from man to man, animal to
July 1963 .
animal or from the environment to man or
animal.
Definition
6. Epidemic: The unusual occurrence or
sudden outbreak of disease in a community Communicable Disease - “An illness
or region. due to a specific infectious agent or its
toxic products capable of being directly or
7. Endemic: It refers to the constant presence
indirectly transmitted from man to man,
of a disease or infections agent within a
animal to animal, or from the environment
given geographic area or population group.
(through air, dust, soil, water, food, etc.) to
8. Sporadic: The word sporadic means
man or animal.
scattered about. The diseases are so few and
separated widely in space. Chain of Infection
9. Pandemic: An epidemic usually affecting
a large proportion of the population, Infecous
Agent
occurring over a wide geographic area such
as a section of a nation, the entire nation, a Suscepble
Reservoir
continent or world (eg.) influenza pandemic Host
10. Zoonosis: An infection transmissible under Chain of

natural conditions from vertebrate animals infecon
to man. Eg. Rabies, plague
Portal of Entry Portal of Exit
11. Eradication: Termination of all transmission
of infection through surveillance.
Mode of
Transmission
Carriers
A carrier is defined as “an infected person or
animal that harbours a specific infectious agent 11.2 Source of Reservoir
in the absence of clinical manifestation and
serves as a potential source of infection to others. Definition
TYPES OF PATHOGENS
Infectious agent: An organism that is
capable of producing infection or infectious
disease.
BACTERIA VIRUS FUNGI A reservoir is defined as " living
or nonliving material in or on which an
infectious agent multiplies or develops and is
dependent for its survival in nature.
RICKETTSIAE PROTOZOA PARASITICWORMS
245

1. Human Reservoir 2. Droplet infection -This is direct
a. Cases - There are a number of important projection of a spray of droplets of salaiva and
pathogens that are specifically adapted nasopharyngeal secretions (airborne droplets
to man, such as: measles, smallpox, of saliva or sputum) containing infectious
typhoid, meningococcal meningitis, organisms. The spray of droplets during
gonorrhea and syphilis. The cycle of coughing and sneezing can spread an infectious
transmission is from human to human. disease.
b. Carriers - is a person who has become 3. Contact with soil - The disease
infected with a pathogen, but does not agent may be acquired by direct exposure
show any signs or symptoms. of susceptible tissue to the disease agent in
soil, compost or decaying vegetable matter.
Animal Reservoir - the source of infection
2.
Examples: hookworm larvae, tetanus, mycosis
may sometimes be animals and birds.
etc.
Nonliving things - soil and inanimate
3.
4. Inoculation into skin or mucosa -
matter can also act as reservoir of infection.
Rabies virus by dog bite, Hep. B virus through
eg. Tetanus in soil.
contaminated needles and syringes etc.
5. Transplacental (or vertical)
11.3 Mode of Transmission transmission - TORCH agents - (Toxoplasma
Gondii, Rubella virus, Cytomegalo virus,
Infectious diseases are transmitted from
and Herpes virus). Varicella virus, Syphilis,
person to person by direct or indirect contact.
Hepatitis B, Coxsackie B and AIDS. Some
Certain types of viruses, bacteria, parasites,
of the non-living agents (e.g., thalidomide,
and fungi can cause infectious disease.
diethylstilbestrol) can also be transmitted
Malaria, measles, and respiratory illnesses are
vertically (mother to child) which will affect
examples of infectious diseases.
the embryo and causes malformations in the
Susceptible Host - A person who lacks
foetus.
resistance to a particular pathogenic agent to
prevent disease if or when exposed.
11.4 Indirect Transmission
This embraces a variety of mechanisms

including the traditional 5 F's, such as
I. Direct Transmission 1. Vehicle-borne - An indirect transmission

1. Direct Contact - Infection may be of an infectious agent that occurs when a
transmitted directly from skin to skin, mucosa vehicle. (or formites) touches a persons body or
to mucosa, mucosa to skin of others or same is ingested
person. Example: skin-to-skin contact as 2. Vector - borne - Vector is defined
by touching, kissing or sexual intercourse. as an arthropod or any living carrier that
Diseases transmitted - STD and AIDS, leprosy, transports an infectious agent to a susceptible
leptospirosis, skin and eye infections. individual. Infectious agents are transmitted
246

by insects, especially those that suck blood. pathogenic agents are transferred to food
These include mosquitoes, fleas, and ticks. from the skin, nose, bowel, etc., as well as
The insects become infected when they feed from other food.
on infected hosts, such as birds, animals, and Chain of Disease Transmission
humans. The disease is transmitted when the The six factors involved in the chain of
insect bites a new host. Eg. Malaria, West Nile disease transmission are
virus, and Lyme disease are all spread this
way. 11.5 C
lassification Of
3. Airborne - An airborne disease is any Communicable Disease
disease that is caused by pathogens that can
be transmitted through air. Some infectious Epidemiologic classification of
agents can travel long distances and remain communicable diseases based on the mode
suspended in the air for an extended period of transmission of the infectious agent,
of time. Diseases spread by droplet include communicable diseases can be classified as:
tuberculosis, measles, Q fever, and Respiratory • Waterborne diseases: transmitted by
infections. ingestion of contaminated water.
4. Fomite - borne - Fomites are inanimate • Food borne diseases: transmitted by the
articles or substances other than water or food ingestion of contaminated food.
contaminated by the infectious discharges
• Airborne diseases: transmitted through
from a patient and capable of harbouring
the air.
and transferring infectious agent to a healthy
• ector-borne diseases: transmitted by
V
person. Fomites includes soiled clothes, toys,
vectors, such as mosquitoes and flies.
towels, linen, cups, spoons, pencils, books,
surgical dressing, etc., Diseases transmitted Vehicle borne
by fomites are typhoid, diphtheria, and skin
An indirect transmission of an infectious
infections.
agent that occurs when a vehicle (or fomite)
5. Unclean hands and fingers - Hands touches a person’s body or is ingested.
are the most common medium by which
WATER BORNE AIR BORNE VECTOR BORNE

1. T
yhoid Fever 1. Chickenpox 1. Dengue
2. Cholero 2. Measles 2. Malaria
3. Hepatitis-A 3. Mumps 3. Lymphatic Filariasis
4. A
cute Diarrheal Disease 4. Influenza 4. Chikungunya
5. Poliomyelitis 5. Diptheria
6. F
ood Poisoning 6. Whooping cough
7. Meningococcal Meningitis
8. Acute Respiratory Infection
9. Severe Acute Respiratory Syndrome
10. Tuberculosis
11. Swine Flu
247

1. Control of reservoir - The usual methods of
11.6 Water Borne Disease (Diseases
control are their identification
Transmitted Through Water) a. E arly Diagnosis : Culture of blood and
stools are the important investigation for
Typhoid fever the confirmation of the diagnosis of cases.
b. N otification : Notification to the health
Definition
authority to prevent the spread and
Typhoid fever is an acute bacterial infection control the infection.
mainly caused by Salmonella Typhi c. I solation : Infected cases should be
Causative Organism - Salmonella Typhi. isolated till three bacteriologically
Mode of transmission - By water and food negative stools and urine.
contaminated by faeces and urine of patients d. Treatment - Appropriate treatment
and carriers. Flies may infect Food which will to control the infection and prevent
turn in to source of infection. complications.
Incubation period -10 days to 14 days e. Disinfection :
1. Stools and urine should be received in
Clinical manifestations closed containers and disinfected with
5% cresol for at least 2 hours.
1. Fever (High grade 103 - 104F)
2. All soiled clothes and linen should be
2. Cough and sore throat
soaked in 2% chlorine solution and
3. Severe mental confusion steam sterilized.
4. Fatigue 3. All health care providers should
5. Weakness disinfect their hand(hand washing)
6. Vomiting 4. Follow-up examination of stools and
7. Weight Loss urine should be done for typhoid 3 to 4
8. Headache months.
9. Abdominal pain 5. Carriers should be identified by cultured
10. Severe Diarrhea and serological examination.
11. Severe Constipation 6. The carriers should be kept under
12. Skin rash ( pink spots) surveillance. They should be prevented
from handling food, milk or water for
If the typhoid fever continues untreated
others.
for more than two or three weeks, the affected
7. Health education regarding washing of
individual may be delirious or unable to
hands with soap, after defaecation or
stand or move and which will lead to fatal
urination and before preparing food is
complication.
an essential.
Diagnosis
2. Sanitation and Hygiene
Widal Test
1.
Protection and purification of drinking
Control measures water supply.
2.
Improvement of basic sanitation and
1. Control of reservoir
promotion of food hygiene.
2. Sanitation and hygiene.
3. Immunization - There are two vaccines to
3. Immunization prevent typhoid.
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1.
One is an inactivated (killed) Typhoid Causative organism - Vibrio Cholera
vaccine given in injection form.
Mode of transmission
2. The other is a live, attenuated (weakened)
vaccine which is taken orally (by mouth). Transmission occurs from man to man via
Treatment a. Faecal contaminated water
Appropriate Antibiotics b. Contaminated food and water
c. Direct contact
Nursing care Incubation period - Few hours to 5 days
1. Maintain body temperature to normal.
2. Provide comfort measures. Clinical manifestations
3. Follow side effects of drugs. Onset is abrupt with profuse, painless,
4. Monitor vital signs. watery diarrhea known as rice water stool.
5. Follow strict precautions such as hands • Muscular cramps
washing, wearing gloves and health •
In Children – Fever, convulsions or
education to all persons about personal coma, loss of muscular tone.
hygiene • Vomiting
6. Observe the patient closely for sign and • Sunken Eyes
symptoms of complications such as
• Hallow checks
bowel perforation.
• Skin pale
7. Accurately record intake and output.
• Husky voice
8. Provide proper skin and mouth care.
• Extremities are cold.
Complications • Pulse rapid and feable.
1. Intestinal bleeding • Blood pressure is low
2. Fresh blood in the motion • Shallow and quick respiration
3. Intestinal perforation (occur in the third Diagnosis
week).
Stool test
1. Antonius Musa, a Roman Complications
physician who achieved fame by
1. Shock,
treating the Emperor Augustus
2,000 year ago, with cold baths when he fell 2. Severe dehydration,
ill with typhoid. 3. Low blood sugar in children which can
2. Thomas Willis who is credited with the cause seizures, unconsciousness, and
first description of typhoid fever in 1659. even death
3. French physician Pierre Charles Alexander 4. hypokalemia(low potassium level)
Louis first proposed the name “typhoid"
Control measure
1. Verification of the diagnosis : All cases of

Cholera diarrhea should be investigated .
Cholera is an acute diarrhoeal disease 2. Notification : Cholera is a notifiable
caused by V . Cholera (Classical El. Tor) disease locally, nationally and
249

internationally. Health workers at all Treatment
levels should be trained to identify and
1. Replacement of fluids and Electrolytes.
notify cases immediately to the local
health authority. 2. Antibiotics
3. Early case finding : An aggressive search 3. Anti diarrheal drugs
for case (mild, moderate, severe) should 4.
Rehydration therapy : The oral
be made in the community to be able to rehydration therapy and intra venous
initiate prompt treatment. fluids (IVF).
4. Establishment of treatment centers : In 5. Vaccination to protect the people from
the control of cholera, no time should Cholera.
be lost in providing treatment for the
Hepatitis A
patients.
1. Easily accessible treatment facilities in Definition - Hepatitis A is a systematic disorder
the community that primarily affects the liver.
2. Treatment for dehydration
Causative organism
• For Mild dehydration - treatment at
home with oral rehydration fluid. Heptatitis A virus (Entero virus)
•
F or Severely dehydrated patients Mode of transmission - Faeco oral route and
requires intravenous fluids in a nearest direct contact
treatment centre or hospital. Incubation period- 14 -28 days
• hen it is endemic or threatening -
W
mobile teams should be established. Clinical manifestations
3.
Epidemiological investigations to study 1. Fever
the extent of the outbreak and identify the 2. Malaise
modes of transmission. 3. Severe anorexia, nausea and vomiting,
4. Sanitation measures 4. Pain in right hypochondriac region
a. Water Sanitation 5. Passing dark color urine and pale stool.
b. Excreta Disposal - Health education
messages should stress the proper use Complications
of such facilities. Acute liver failure
c. Food sanitation - Sale of foods under Control measures
hygienic conditions. Health education
regarding eating cooked hot food, and a) Control of reservoir
proper food handling techniques. Complete bed rest and disinfection of
d.
Disinfection: Most effective faeces and fomites by using 0.5 % sodium
disinfectant is bleaching powder. hypochlorite is recommended to prevent the
Clothes and personal items to be spread of infection to others.
disinfected with disinfectant (dettol). b) Control of transmission :
5.
Health Education regarding Oral 1. Hand washing before eating and after
Rehydration therapy, Early diagnosis and defaecation.
adequate treatment and Food sanitation 2. Sanitary disposal of excreta.
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3.
Purification of community water 2. Tachycardia
supplies by flocculation, Filtration and 3. Hypotension
adequate chlorination. 4. Irritable and restlessness
c) Control of susceptible population : 5. Pallor
Vaccines: Several inactivated or live 6. Rapid respiration
attenuated vaccines against Hepatitis A is
7. Sudden collapse if not treated properly
available to protect against the infection.
8.
Stools loose and fluid in consistency,
Treatment greenish or yellow green in colour, may
contain mucus or blood.
1.
The patient has to be provided with
adequate rest. 9. Vomiting
2. Bland diet should be provided 10. Fever
3. Avoid Alcohol 11. Poor skin turgor, dry skin and dry mouth
12. Sunken fontanels in children
Acute Diarrheal Diseases Diagnosis – Stool test
Definition Complications
According to WHO Acute diarrhea is 1. Persistent diarrhea
defined as an abnormally frequent discharge
2. Malnutrition
of semisolid or fluid faecal matter from the
bowel, lasting less than the 14 days by WHO. 3. Vitamins and mineral deficiencies
4. Hypoglycemia resulting in convulsions
ENTAMOEBA HISTOLYTICA
and brain damage
ENDOSOME 5. Electrolyte loss
FOOD VACUOLES
6. Hypovolemic shock
PLASMALEMMA
7. Acute renal failure
ECTOPLASM
Control Measures
ENDOPLASM 1. Promote exclusive breastfeeding
NUCLEUS 2. Immunization
Causative Organism 3. Using sanitary latrines
Bacteria: Escherichia coli, Shigella, 4. Keep food and water clean and closed.
salmonella etc., 5.
Wash hands before eating and after
Virus: Rota virus, adenovirus etc. defaecation.
Parasites: Endamoeba hystelytica, Giardia
Treatment
lamblin etc.
Mode Of Transmission - Direct Oral Rehydration Therapy: Give
transmission - Faeco – oral route some available liquids like rice water, oral
rehydration solution (ORS) packet to be
Incubation Period - Few Hour to one day.
dissolved in one litre of drinking water and
Clinical Manifestation stir with clean spoon, till it dissolves. Give ¼
to ½ cup after every loose motion to a child
1. Sunken eyes
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less than 2 years of age and 100-200 ml if the Droplet infection : Coughing and sneezing
child is above 2 years. The solution should be an important route of transmission during the
consumed within 24 hours and should not be acute stage.
heated or boiled. Incubation period - 7 to 21 days. It may
Appropriate feeding vary from 3 to 35 days.
a) Coconut water Clinical manifestation

b) Rice water a) Respiratory – Coryza, soar throat or
c) Dhal water cough.
d) Smashed banana b) Gastro Intestinal Tract – Vomiting,
e) Watery tea diarrhea or constipation.
f) Breakfast feeding to be continued. c) Continuous – Fever, headache,
drowsiness, restlessness, irritability and
Appropriate drugs: sweating.
a) Antibiotics for Bacterial infection d) Pain – Spontaneous by the movement of
b)
Symptomatic treatment for fever, back, neck, limbs.
vomiting etc. e) Hyperparesthesia
f) Nuchal and spinal rigidity
c) Anti – Motility agents.
g) Tachycardia
d)
Intravenous infusion to severely
h) Excessive perspiration
dehydrated clients.
i) Paralysis
Poliomyelitis Complications
Poliomyelitis is an acute viral infection 1. Myocarditis
caused by polio viruses. It is a crippling 2. Hypertension
disease. 3. Pulmonary edema
STRUCTURE OF POLIO 4. Pneumonia
Glycoprotein 5. Depression
Control measures
RNA
i) Sanitation : Measures to reduce
transmission such as improved water supply,
proper excreta disposal and improved domestic
and food hygiene. Simple hygienic measures
Viral Capsid
like hand washing with soap before preparing
Shell food, before eating,before feeding a child,
after defecation, after cleaning a child who has
defecated and after disposing off a child’s stool
Membrane
should be promoted.
Causative organism ii) Health education : important part of
Three types of polioviruses (Type I, II, III) health workers job is, to prevent diarrhea by
educating and helping community members to
Mode of transmission - Faeco – oral
adopt and maintain preventive measures such as
route: Through contaminated water, food,
breast-feeding, weaning, clean drinking water,
fingers etc.
252

use of plenty of water, use of sanitary latrine, • Acute cerebellar ataxia
proper disposal of stools of young children and The control measures are notifications
patients with infection, etc. isolation of cases for about 6 days after onset of
iii) Immunization : Immunization against rashes and disinfection of articles soiled by nose
measles is a potential intervention for diarrhea and throat discharges.
Control Measures Two types of vaccines are Clinical manifestations

used
Pre-eruptive
a. Inactivated (Salk) vaccine (Injection) Eruptive stage:
stage:
b. oral (Sabin) polio vaccine (OPV).
1. Rash, Clusters, itchy
iv) Fly control : Flies breeding in 1. Fever
blisters
association with human or animal faeces should 2. First appears on the
be controlled. 2. Pain in back trunk, then face, arms,
axilla and in legs.
Treatment
3. Rashes in buccal
1. Mild analgesics and sedatives to relieve 3. Shivering
surface.
pain and induce sleep.
4. Malaise
2. For constipation – Mild laxatives
3. Antibiotics to prevent respiratory Preventive measures
complication.
4. If respiratory failure occurs, treat with 1.
Varicella zooster immunoglobulin :
artificial respirators. Varicella zooster immunoglobulin given
5. Rehabilitation within 72 hours of exposure has been
recommended for prevention of chicken
11.7 Diseases Transmitted Through pox.
Air Vaccines : The live attenuated varicella
2.
virus vaccine is safe and currently
recommended for children between 12-18
Chickenpox (Varicella)
months of age who have not had chicken
Definition - Chickenpox or varicella is pox.
an acute highly infectious disease caused by
varicella zooster
Causative organism
Varicella zoster
Mode of transmission - Droplet nuclei
Incubation period - About 10 -21 days
Complications (Children and

Adults)
Medication
• Haemorrhages
• Pneumonia • Anti – pyretic
• Encephalitis • Anti viral drugs
253

2. Eruptive phase:
1. Duskyred
2. Macular
3. Maculo-papular rash
4. Rashes become confluent,blotchy
3. Post-measles stage:
1. Weight loss
2. Weakness
3. Growth retardation
4. Reactivation of Pulmonary tuberculosis
5. Nutritional and metabolic effects
Complications
Measles
1. Measles – associated diarrhea,
Definition 2. Pneumonia
Measles is an acute highly infectious 3. Otitis media.
disease of childhood caused by a specific virus 4. Febrile convulsions,
of the group Myxo viruses. 5. Encephalitis
6. Pan-encephalitis.
Causative organism Control measures
RNA Para Myxo viruses a) Isolation for 7 days after the onset of
Mode of transmission - Droplet infection rash.
Incubation period - 10 days from exposure b)
Immunization of contacts within 2
to onset of fever and 14 days to appearance of days of exposure. (if vaccine is contra
rash. Average 7 days. indicated immunoglobulin should be
given within 3 – 4 days of exposure)
Clinical manifestations
c) Prompt immunization at the beginning
There are three stages of an endemic is essential to limit the
spread.
1. Prodromal stage:
1. Fever Treatment
2. Coryza
There is no specific treatment for measles,
3. Sneezing but the condition usually improves within 7 to
4. Nasal discharge 10 days. Following measures are important to
5. Cough control infection.
6. Redness of Eyes 1. Controlling fever and relieving pain
2. Plenty of fluids to prevent dehydration
7. Lacrimation
3. Treating cold like symptoms
8. Photophobia 4. Care of the sore eyes - cleaning the crusts
9. Vomiting with wet cotton swabs.
10. Diarrhea Measles vaccine: Measles is best
11. Koplik”S Spots on A Red Base prevented by active immunization. The
254

vaccine is presented as a freeze dried product. 3. Pancreatitis
It is most important to store the vaccine at 2 4. Meningo-encephalitis
– 8 degree celsius. 5. Myocarditis
The most effective month of immunization 6.
Nerve deafness, poly arthritis and
by World Health Organization is at 9 months of hydrocephalous are rare
age.
Control measures
Mumps
1.
Early Diagnosis - The cases should be
Definition identified to take appropriate measures by
Mumps is an acute infections disease health authorities to control the disease
caused by virus infections. It is common in 2. Isolation- The case should be isolated till
winter. the clinical manifestations are cleared or
Mumps Virus subsided.
HN-Protein 3. Disinfection - As virus is present in saliva,
F-Protein
blood, urine. Articles used by patient,
M-Protein which come in contact with these should be
Polymerase
ss(-)RNA
disinfected.
(genome)
4. Surveillance - By surveillance source
Nucleocapsid of infection,route of transmission and
identification of cases and susceptible
contacts is possible to prevent the further
Causative organism spread of disease.
RNA virus classified as Genus Rubella Preventive measures

virus of the family paramyxoviridae. a. Vaccination: A single dose (0-5 ml) highly
Mode of transmission effective, live attenuated vaccine is now
1. droplet nuclei available for the prevention of mumps.
2. direct contact with an infected person. b. Immunoglobulin : A specific
Incubation period - Varies from 2-3 weeks immunoglobulin is available, but its
usually 18 days protective effect has not been established.
Clinical Manifestation Influenza
1. Pain,swelling in one or both the parotid

glands.
2. Ear ache
3. Pain and stiffness on opening the mouth
4. Fever
5. Headache
Complications
1. Orchitis
2. Ovaritis
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Definition white membrane which spread in to the air
Influenza (commonly known as Flu) is passages.
an acute infection of the respiratory tract. It is
Causative organism
caused by the influenza viruses. Influenza tends
to spread very rapidly. Corynebacterium diphtheria caused by
exotoxin of diphtheria bacilli.
Causative organism Mode of transmission
Influenza virus are 3 types. Namely A, B, C 1. Droplet infection.
Mode of transmission - Influenza spreads 2. Infected cutaneous lesions.
mainly from person by droplet infection created 3. Infective object or dust, contaminated
by sneezing, Coughing or talking. The portal of with nasopharyngeal secretions.
entry of the virus is the respiratory tract.
Incubation period - 2-6 days occasionally
Incubation period - 18 – 72 hours longer
Clinical manifestations Clinical manifestations

1. Fever The onset of symptoms is typically gradual.
2. Chills Most common presenting symptoms are
3. Aches • Sore throat
4. Pains
• Malaise
5. Cough
6. Generalized weakness • Cervical lymphadenopathy
Complications - Pneumonia • Low grade fever.
• haryngo tonsillar diphtheria - sore throat
P
Treatment and difficult in swallowing
Antiviral drugs: These drugs may also • ild erythema is the earliest pharyngeal
M
modify the severity of influenza. If started with finding
in 24-48 hours of onset of illness • Isolated spots of gray and white exudate.
• Membranous pharyngitis
Control Measures
• assive swelling of the tonsils, Uvula,
M
• Avoidance of crowded places cervical lymph nodes, submandibular
• Good ventilation of public buildings region, and anterior neck (the so-called
• overing the face when coughing and
C "bull neck" of toxic diphtheria).
sneezing with handkerchief or cloth • spiration of the membrane can lead to
A
• Isolation of cases of influenza suffocation.
• aryngeal diphtheria causes obstructive
L
Diphtheria croup stridor and eventually asphyxia.
Definition • espiratory stridor may ensue, leading to
R
respiratory insufficiency and death.
Diphtheria is an acute infections, caused by
the exotoxin of diphtheria bacilli. The disease Complications
attacks mainly the throat, tonsils, larynx or
nose. Where the baccilli produces a grayish- Diphtheria toxin can lead to
• Damage of the heart (myocarditis)
256

• Nervous system in doses ranging from 10,000 to 80,000
• Kidneys. units according to the severity of the case.
• Neurological (Encephalitis encephalopathy) • ntibiotics (penicillin) help to eliminate
A
• Prolonged convulsions the infection and prevent production of
further toxin.
• Infantile spasm
• B ed rest is essential to prevent heart failure.
Control measures • racheostomy may be needed if there is
T
1. Cases and carriers respiratory obstruction.
a) Early detection: Carriers can be detected Preventive measures
only by culture method. Swabs can be • iphtheria can be prevented by active
D
taken from both the nose and throat immunization either by DPT or diphtheria
and examined by culture methods for vaccine.
diphtheria bacilli. • The current practice is to immunize all
b) Isolation: Suspected cases and carriers infants with DPT starting from the age of
should be promptly isolated, preferably 6weeks.
in a hospital for at least 14 days. • DPT vaccine protects not only against

c) Treatment: For Cases when diphtheria diphtheria but also against pertussis and
is suspected diphtheria antitoxin should tetanus.
be given without delay. IM or IV in doses • A booster dose (0.5 ml) of DPT is

ranging from 20,000 to 1,00,000 units or recommended at the age of 1½ to 2 years
more depending upon the severity of the followed by another dose (DT only) at the
case. age of 5 and 6 years.
2. For Carriers : The carriers should be treated
Whooping Cough
with 10 days course of oral erythromycin which
is the most effective drug for the treatment Definition
carriers. A highly infectious disease of the
a. Contacts : Contacts need special respiratory tract, caused by the whooping
attention. They should be throat swabbed cough bacilli. The disease occurs in epidemics
and their immunity status determined. every 3-4 years.
The bacteriological surveillance of close
contact should be continued for several Causative organism
weeks.
Whooping cough bacilli Bordetella
b. Community : The only effective
pertussis.
control is by active immunization with
Mode of transmission - Droplet method and
diphtheria toxoid. All children who are
by personal contact.
not previously immunized should be
given a dose of 500 to 1000 IV diphtheria Incubation period - Usually 7 to 14 days but
antitoxin. not more than 3 weeks
Treatment Clinical manifestations
• e specific treatment is diphtheria

Th a. Catarrhal Stage
antitoxin which must be given immediately b. Paroxysmal Stage
c. Convalescent Stage.
257

1. Fever Causative organism
2. Cold
Neisseria meningitis
3. Running nose
4. Irritating cough which gradually becomes Mode of transmission - Droplet infection
paroxysmal within 1-2 weeks. Incubation period -2-10 days
Complications Clinical manifestations

• Hernia
1. Headache
• Prolapsed rectum
2. Fever
• Sub conjunctiva hemorrhage
3. Nausea/vomiting
• Encephalopathy
4. Photophobia
• Pneumonia and bronchiectasis
5. Neck stiffness and various neurological
sign.
Control measures
a. Early diagnosis Complications

b. Isolation and treatment of cases • Disseminated intravascular coagulation
c. Disinfection of discharges from nose and (DIC; blood clotting disorder)
throat are general principles of control • Encephalitis
d.
Early diagnosis is possible only by • Persistent fever
bacteriological examination of nose and • Seizures
throat Secretions. • brain damage
e. Enthroning may help to shorten the duration • Behavioral and personality changes
of illness. • Vision loss (partial or total)
• Cerebral palsy
Treatment
• Hearing loss (partial or total)
Activation Immunization: It is a practice • Learning disabilities or mental retardation
to administer pertussis vaccine in combination • Paralysis (partial or total) Speech loss
with diphtheria and tetanus toxoid as DPT (partial or total)
vaccine. • Severe bacterial meningitis also may cause
It can be treated with antibiotics, usually the head and heels to bend backward
erythromycin for 2 weeks. and the body to bow forward (called
opisthotonos),
Meaningococcal Meningitis • Coma, and death
Definition Control Measures

Meningococcal meningitis or
a. Control of cases, carriers and contacts.
cerebrospinal fever is an acute communicable
b. Cases: Treatment with antibiotics can save
disease caused by Neisseria. meningitis. It
the lives of 95% of patients provided that, it
usually begins with intense headache,vomiting
is started during the first 2 days of illness.
and stiff neck and progresses to coma within
Penicillin is the drug of choice.
a few hours.
c. Contact: Close contact of persons with
confirmed meningococcal disease patients
258

are at an increased risk of developing children with these infections have only mild
meningococcal illness. infection such as cold or cough.
d. Mass chemoprophylaxis: Mass medication
of the total population some of which Complication – Pneumonia
arenot infected. Mass chemoprophylaxis The high mortality and morbidity rate
be restricted and closely and medically attribute to acute respiratory infections.
supervised
e. Communities : Mass treatment causes an
HIB vaccine
immediate drop in the maintenance rate of
meningitis and in the proportion carriers. Hemophiles influenza type B, HIB is an
f. Environmental measures : Improved important cause of pneumonia and meningitis
housing and prevention of over-crowding among children in developing world.
are longterm measures. Treatment
• Antiboitic
Acute Respiratory Infections
evere Acute Respiratory
S
Definition Syndrome
Acute respiratory infections may cause
inflammation of the respiratory tract anywhere
from nose to alveoli.
Schematic drawing of SARS coronavirus
Spike glycoprotein
Membrane
glycoprotein
Small envelope
glycoprotein
Nucleocapsid
phosphoprotein
RNA
Definition
Severe acute respiratory syndrome is a
Causative organism communicable viral disease
- SARS Corona virus Causative organism

Mode of transmission - air-born route.
Corona virus
Incubation period - 18-72 hours
Mode of transmission
Clinical manifestations 1. Close contact with infected person
Running nose, cough, sore throat, 2. Contaminated air and surfaces

breathing difficult and ear problems. Fever is 3. If a person touches a contaminate surface
common in acute respiratory problem, most and then touches their eye, mouth or nose
Incubation period - 2 to 7 days
259

Clinical manifestations Incubation period - This may be weeks
or months, depending upon the host-parasite
1. Fever 2. Malaise chills
relationship and the dose of infection,
3. Headache 4. Myalgia
5. Dizziness 6. Cough sore throat
Clinical manifestations
7. Running nose 8. Acute respiratory
distress 1. Chronic cough
2. Continuous low grade fever
Complications
3. Chest pain
1. Pneumonia 4. Haemoptysis
2. Breathing problems. 5. Loss of weight
3. Orchitis
Complications
Control measures
• Hemoptysis • Asperigilloma
• Good hand hygiene • Pleurisy • Endobronchitis
• Pay attention to what surfaces you touch • Pleural effusion' • Bronchitis
• Infected person must cover their mouths • Empyema • Laryngitis
when they cough or sneeze • Pneumothorax • B ronchiectasis
• Use surgical mask
• Use gloves Control measures
Treatment a. Early case finding
There is no specific treatment for b. Chemotherapy
SARS. No clinical improvement has been c. BCG Vaccination
attributeable to the use of antibiotics d. Health education
Tuberculosis Early case finding

Definition - Tuberculosis is a chronic Case: The first step in tuberculosis control
infection disease caused by tubercle bacilli. programme is early detection of all cases in the
The disease primarily affects lungs and causes community. WHO defines a case of pulmonary
pulmonary tuberculosis. It can also affect tuberculosis as, "a person whose sputum is
intestine, meninges, bones and joints, lymph positive for tubercle bacilli".
glands, skin and other tissues of the body. Case finding tools: Sputum examination
The disease also affects animals such as cattle by direct microscopy is now considered for early
which is known as bovine tuberculosis. detection of cases. The reliability, cheapness and
case of direct sputum examination has made it
Causative organism number one case finding measure all over the
Mycobacterium tuberculosis world.
Mode of transmission Health education.

Droplet infection, Tuberculosis mainly The health education programme should
spread by droplet infection. motivate patients to undergo regular treatment
and follow up, disposals of sputum and co-
Other ways : Pulmonary tuberculosis is
operation with agencies administering the
also transmitted by inhalation of infected dust.
programme.
260

Treatment Treatment
Anti Tuberculosis Treatment Drugs • Vaccination is the best protection against
contracting the infection.
Swine flu • Antiviral drugs can be used for prevention
Definition - Swine flu which is called pig or treatment of flu viruses.
flu. Swine flu caused by swine influenza virus.
Causative Organism - influenza virus 11.8 Diseases transmitted through
subtypes H1N1, H1N2, H3N1 and H3H2 arthropods
Mode of Transmission
Dengue Fever
Influenza virus can be directly transmitted
from pigs to people.
Incubation Period - Within 7 days. Aedes mosquitoe
Clinical features Humans
• Fever • Nausea
• Sore throat • Chills
• Cough • Headache
• Body ache • Shortness of breath
• Fatigue
Definition
Control Measures A viral disease transmitted by mosquitoes,
• Adequate amount of sleep and supply and causing sudden fever and acute pains in the
nutritious food. joints.
• Consider taking multivitamins and vitamin A severe form of dengue fever, also called
C supplement. dengue hemorrhagic fever, can cause severe
• Wash your hands regularly with soap and bleeding, a sudden drop in blood pressure
water. (shock) and death.
• Avoid close contact or stay away from sick
people. Causative organism
• Avoid sharing drinks or utensils. Causative agent of the disease is the
• Avoid touching your face. Dengue virus,
• Wear a face mask as directed by physcian. Mode of transmission - Dengue fever
• Stay updated and avoid travelling to is transmitted to humans through the bites of
affected areas. infective female Aedes aegypti mosquitoes.
• Meat to be inspected and certified
Incubation period - 3 to 14 days usually 4
to 7 days.
• Adequate sewage treatment and disposal
• Early detection and early treatment Clinical manifestations
• Through cooking of beef and pork is the
most effective method to prevent food Dengue Haemorrhagic fever
borne infection. • All symptoms of dengue viral fever.
• Maculopapular
261

• Scarlatine form or petechial rash appears Treatment
on third day of illness
a. Bed rest is advisable during the acute
• Head ache febrile phase.
• Nausea, vomiting b. Antipyretics or sponging are required to
• Coffee colour vomiting keep the body temperature at 98.6 degree F
• Abdominal pain c. Oral fluid and electrolyte therapy is
• Pharyngitis recommended for patients with excessive
• Cough and dyspepsia sweating,vomiting or diarrhea.
d. Analgesics or a mild sedative may be
Dengue shock syndrome required for those with severe pain.
• In addition to signs and symptoms of the e. Home available fluids to be given to prevent
above clinical feature client may go for dehydration,
shock. f. Fluid replacement should be minimum
• Sudden collapse volume that is sufficient to maintain
• Cold and clammy extremities effective circulation during the period of
• Weak thread pulse leakage.
• Circumoral cyanosis along with • Management of shock : Immediate
haemorrhagic manifestation replacement of plasma loss with isotonic
salt solution.
• Occasionally epistaxsis, haematemesis,
malena or subarachnoid haemorrhage.
Malaria:
Control measures
Definition
• Mosquito control Malaria is a protozoal disease caused
a. Cover all water containers. by infection with parasites of the Genus
b. Change water in flower vases every week. plasmodium.
c. Clean the surrounding area of the house.
Causative organism
d. Use insecticide spray in the house to kill
adult mosquitoes. Female anopheles mosquitoes
• Vaccines : So far there is no satisfactory Mode of Transmission - Malaria is
vaccine and no immediate prospect of transmitted by the bite of infected female
preventing the disease by immunization anopheles mosquito.
Incubation Period - In some strains the
Other measures incubation period may be delayed for as long as
• Isolation under bed rest 6-9 months
• Wear full sleeves shirts and full pants. Intermittent fever has 3 stages.
• Use of mosquito repellent creams, liquids, 1. Cold stage (1/4 to ½ hours) - Head ache,
coils, mats etc. Shivering fever rising rapidly
• Use of bed nets for sleeping infants and 2. Hot stage (1/2 to 5 hours) - Very hot feeling,
young children during day time to prevent severe headache, skin flushed, fever starts
mosquito bite. falling
262

3. Sweating stage - Profuse sweating, Treatment
temperature normal, Enlargement of Chemotheraphy – Mass drug
spleen and secondary anaemia. administration (MDA) regimens.
Diagnosis Chikungunya Fever

Blood smear test A dengue like disease caused by a group A
Treatment virus.
Antimalarial drugs
Causative organism
Lymphatic Filariasis Aedes aegypt, Ades albopictus female
mosquitoes
Definition
Mode of transmission –Transmitted from
Lymphatic filariasis commonly known
human to human by the bites of infected female
as elephantiasis, is a mosquito borne disease
mosquitoes.
caused by the filarial parasites.
Incubation period - 4 to 7 days
Causative organism - Wucheriria
bronchofti, Brugia malayi Clinical manifestations
Mode of transmission - It is transmitted • High fever with chills
by the bite of culex mosquitoes.
• Severe articular pains in the limbs and
Incubation period - 5 to 10 months spinal column.
Clinical manifestations • Arthralagia

• Anorexia
• Fever
• Conjunctivitis
• Lymphangitis
• Coffee-coloured vomiting
• Elephantiasis evident in legs and arm
• Epistaxis
Control measures - Vector • Arthropathy : pain, swelling and stiffness,
control especially of the meta carpophalanges
wrist Elbow, shoulder, knee, ankle and
• Anti larval measures
metatarsal joints.
• Chemical control – mosquito larvicidal
• Removing the pistia plant from all water Diagnosis
collections and convert the ponds to fish or Serological tests: ELISA (Enzyme Linked
lotus culture. Immuno Sorbent Assays)
• Environmental measures : Larvicidal
operations are complemented by minor Complications
engineering operations such as filling up 1. Dementia
of ditches and pools, drainage of stagnant 2. Cerebral problems
water,adequate maintenance of septic tanks 3. Kidney disorders
and soakage pits etc., 4. Paralysis
Diagnosis test
Blood smear by microscopic examinations
263

Control measures
11.9 P
revention Of Communicable
• The Aedes aegypti mosquito breeds in clean Diseases
water.
• All water containers should be covered, to PRIMORDIAL – PREVENTION : It is a
eliminate mosquito from the breeding places. new concept, receiving special attention in the
• Abate is increasingly used as a larvicide. prevention of chronic diseases. This is primary
• Aerosol spray of ultra low volume (ULV) prevention in its purest sense, that is prevention
quantities of malathion or sumithion (250 ml of the emergence or development of risk factors
/ hectare) has been found to be effective in in countries or population. An groups in which
interrupting transmission and stopping they have not yet appeared eg many adult health
• Epidemics of dengue haemorrhagic fever. problems.
Treatment Primary Prevention

• Analgesics • Increasing the resistance of the host
• Anti – pyretics • Inactivating the agent
• Fluids • Interrupt the chain of infection
Prevention of communicable diseases • Restricting spread of infection
Communicable diseases can be prevented
by appropriate preventive measures which • Specific protection (eg) Immunization,
include: Chemoprophylaxis.
• Good site planning
Secondary Prevention
• Provision of basic clinical services
• Provision of appropriate shelter • Activities targeted at detecting disease at
• Clean water supply earliest possible. Examples case finding,
• Sanitation health screening, health education
• Mass vaccination against specific diseases Tertiary Prevention
• Regular and sufficient food supply
• Limits the progression of disability
• Control of vectors
• Treatment of symptoms and rehabilitation
• Health education specific protection. Eg.
vary with each specific disease
Immunization chemoprophylaxis
Surveillance
04
• Surveillance is the ongoing systematic
TERTIARY
collection, analysis and interpretation
of data in order to plan, implement and
evaluate public health intervention.
03 01
Outbreak Control
SECONDARY PREVENTION PRIMORDIAL
• An outbreak is occurrence of a number of
cases of a disease that is unusually large
or unexpected for a given place and time.
02 Early detection and control of the disease
PRIMARY is advisable.
264

Management of a communicable disease • Global Disease Eradication Efforts
outbreak Methods to accomplish the goal of
• Preparation eradication of diseases include:
• Detection • immunization and vaccination
• Response • drug therapy
• Evaluation • community training
• health education
Preparation for the outbreak • national disease surveillance efforts
• Health coordination meetings
Nurses’ Role
• Strong surveillance system
Community health nurses play an
• Outbreak response plan for each disease
important role with regard to all population at
• Stocks of IV fluids, antibiotics and vaccines risk for communicable disease
• Plans for isolation wards Nurses concerned with communicable
• Laboratory support disease control must
• Recognize vulnerable area.
Detection of outbreak
• Locate the reservoirs and source of
• Surveillance system with early warning
infectious disease agents
system for epidemic prone diseases.
• Identify the environmental factors which
• Inform ministry of health and WHO in
promote the spread of communicable
case of outbreaks of specific diseases.
disease.
• Take appropriate specimens (stool, CSF or
serum) for laboratory confirmation. • Identify characteristic of vulnerability
of community member and groups-
• Include cases in the weekly reports
particularly those subject to intervention
• Assess appropriateness and effectiveness of
containment measures. • Community health nurses must work
collaboratively with other public health
• Assess timelines of outbreak detection and
professional. Organize immunization
response.
and educational programs, to improve
• Change public health policy if indicated.
community infection control policies.
• Write and disseminate outbreak report
SUMMARY
1. The important water borne diseases are typhoid fever, cholera, hepatitis A and acute diarrhoeal
disease. Typhoid fever is caused by salmonella typhi and the mode of transmission is by faeco
oral route. Complication of typhoid fever is intestinal perforation.
2. Cholera is an acute infectious disease caused by cholera (vibrio cholera) and the mode of
transmission is by oro -faecal route.
3. Cholera is a notifiable disease and it not identified and treated early can cause sudden death.
4. Hepatitis - is a systematic disorder that primarily affects the liver. The causative organism is
hepatitis a virus. Mode of transmission is faeco oral route and direct contact and the incubation
period is 15 to 50 days usually 28 days.
265

5. Acute diarrheal disease - is an acute or chronic intestinal disturbance characterized bypassing
more than three loose motions in a day with in 24 hours. Oral rehydration therapy is the most
important thing in maintaining the hydration level.
6. Poliomyelitis - is an acute viral infection caused by polioviruses. It is a crippling disease. The
causative organism is three types of polioviruses (Type I, II and III) Mode of transmission is by
faeco oral route and droplet infection.
7. Food poisoning - is an acute gastro enteritis caused by the ingestion of food or drink
contaminated with either living bacteria or other toxins or chemical substances.
8. Diseases transmitted through parasites are amoebiasis, ancylostomiasis, Taenia solium and
Tarmia saginata and Ascariasis.
9. Amoebiasis - is a common infection of the human gastro intestinal tract and caused byEntamoeba
histolytica.
10. Hook worm infestation - is a chronic infestation of small intestine. The causative organism is
Ancylostoma duodenale, Necator americanus.
11. Ascariasis - is a common helmenthic infection in man caused by Ascaris lumbricoids.
12. Tape worm infestation or Taeniansis - is a group of cestode infections which are important
zoonotic disease.
13. All the diseases transmitted through oro-faeco route and the diseases caused by parasites may
be controlled and prevented by proper sanitation method, improved personal hygiene and
vaccines.
14. Chickenpox or varicella - an acute highly infectious disease caused by varicella – zooster. Virusit
is characterized by vesicular rash, that may be accompanied by fever and malaise.
15. Swelling of the parotid glands is the first indication of mumps.
16. Influenza spread mainly from person to person by droplet infection or droplet nuclei created by
sneezing coughing or talking.
17. Diphtheria spreads mainly by droplet infection. Transmission occurs by objects like
cup,thermometer, toys, pencils
18. Meningococcal meningitis or cerebro spinal fever is an acute communicable disease caused by
N. meningitis.
19. Acute respiratory infections may cause inflammation of the respiratory tract anywhere from
nose to alveoli.
20. The word rubeola means red spots.
21. There are three main test currently used in tuberculosis, mantoux intradermal test, the head
and the tiny multiple puncture test. Tuberculosis which affects animals is known as “bovine
tuberculosis.”
22. Swine flu which is called pig flu caused by influenza virus.
23. Malaria is a protozoal disease caused by infection with parasite of the Genus plasmodium and
transmitted to man by infected anopheline mosquito.
24. Lymphatic filariasis is caused by Wuchereria bancrofit. The lymphoedema management is
washing and drying the affected limb, elevating the limb and exercising.
25. Dengue fever is otherwise called as break-bone fever.
26. Chikungunya fever caused by group A virus, the chikungunya virus and transmitted byAedes,
culex and mansonia mosquitoes. The incubation period of chikungunya fever is 4-7 days.
27. Japanese encephalitis is a mosquito borne encephalitis infecting mainly animals and incidently man.
28. Tetanus is an acute neuromuscular disorder caused by clostridium tetani.Tetanus is entirely
preventable disease by active immunization with tetanus toxoid.
266

GLOSSARY
Portal of entry ந�ோய் நுழைவாயில் The site through micro organisms enters
in to host
Susceptible எளிதில் பாதிக்கக்கூடிய Can be easily affected
Contamination மாசுபட்ட / தூய்மைக்கேடு Presence of unwanted harmful substance
Notification அறிவிப்பு The act of notifying
Isolation தனிமைப்படுத்தப்பட்ட The process of being alone
Disinfection விஷ கிருமிகளை நீக்குதல் The process of cleaning by using
chemicals
Causative agent ந�ோய் த�ோன்ற காரணமாகும் acting as a cause / producing an effect /
Incubation period ந�ோய் அரும்பு / உருவாகும் The period between exposure to an
காலம் infection and appearance of first symtoms.
Sanitary சுகாதாரமான Hygienic and clean
Photo phobia கண்கூச்சம் Extreme sensitivity / to light
droplet நீர்த்திவலை A very small drop of a liquid/
Anthro pod கணுக்காலிகள் A type of animals with no spine, six or
more joined legs/
Surviellance ந�ோய்- நிகழ்வு ஆய்தல் Close observation
கண்காணிப்பு
chemoprophylaxis ந�ோய்க்கட்டுபாடு The use of drugs to prevent disease/
eradication ஒழித்தல் முற்றிலும் அழித்தல் The complete destruction of something/
Evaluation
I. Choose the best answer 3. Mode of transmission of cholera is

1. Typhoid fever is caused by a) Faeco oral route
a) salmonella typhi b) droplet
b) wuchereria bancrofti c) contact with infected persons
c) Varicella zoster d) blood transfusion
d) Mycobacterium tubercle 4. Incubation period of cholera is
2. Typhoid fever is a a) few hours to 2 days
a) vector borne disease b) few hours to 5 days
b) water borne disease c) few hours to 7 days
c) airborne disease d) more than 7 days
d) zoonotic disease
267

5. Control measures for food poisoning 13. Plague is caused by
a) food sanitation and personal hygiene a) Y.Pestis
b) good environmental sanitation b) T.Pallidum
c) antibiotics c) Vibrio cholera
d) bland diet d) C.tetani
6. Chickenpox is caused by 14. Genital herpes is caused by
a) Rubeola a) Herpes simplex virus
b) Varicella-zoster b) Heptatis B Virus
c) German measles c) Human papilloma virus
d) Varicella virus d) candida Albicam
7. A typical dusky red mucular or muculo 15. An example for viral sexually transmitted
popular rash begins at which stage disease
a) prodromal stage a) Gonorrhoea
b) eruptive phase b) syphilis
c) post measles stage c) chancroid
d) pre-eruptive stage d) Genital human papilloma
8. The incubation period of mumps is 16. Primary prevention includes which of the
a) 12 – 25 days following
b) 18-72 hours a) health promotion and specific protection
c) 2-6 days b) early diagnosis and treatment
d) 7-14 days c) disability limitation
9. The causative organism of d) all of the above
tuberculosis is 17. The best method to prevent pulmonary
a) M.leprae tuberculosis is
b) Mycobacterium tuberculosis a) case isolation
c) RNA virus b) treatment of cases
d) Y.pestis c) BCG vaccination
10. Dengue fever is caused by d) chemoprophylaxis
a) plasmodium vivax 18. Main aim of tuberculosis treatment is
b) Aedes aegypti a) radiological cure
c) plasmodium falciparum b) contact tracing
d) Aedes albopictas c) bacteriological cure
11. Filariasis is transmitted by the d) to prevent complications
a) bite of infected vector mosquitoes
II. Fill in the blanks
b) bite of infected animals
1. Poliomyelitis is a ___________disease.
c) bite of infected brids
2. Hepatitis affects ___________ organ.
d) bite of infected flies.
3. ___________, ___________, ___________
12. Incubation period of filaria is
causes acute diarrhoeal disease.
a) 1-6 months b) 6-8 months
4. Incubation period of malaria is
c) 8 to 12 months d) 16-18 months ___________.
268

5. Arthropathy is present in __________ REFERENCE BOOKS
fever.
6. Leptospirosis is transmitted from 1. Handerson Virginia & Gladys., Principles
__________ to man and practices of nursing, 6th edition,
7. Chickenpox is transmitted from _________ Macmillan Publications, New York, 1978.
to ________. 2. Kszier Dugas, Introduction to patient
8. Koplik’s spots appear on the ________ care, 4th edition, W.N.Sounder’ s Coy,
Mucosa. Philadelphia, 1983.
9. Influenza is a acute ________ infection 3. First and authorized manual of St. Johns
Ambulance Association and St. Andrew
10. Whooping cough otherwise known as
Ambulance Association.
___________
4. Dirasari G. and Brahmamker, Elements
11. SARS caused by ________ virus.
of Pharmacology, Ahemadabad, S.S. Shah
12. BCG vaccine is given to prevent
Publishers, 1973.
___________
5. Clark Mary Jo Dummer, Community
13. Gonorrhoea is transmitted through
Nursing, Reston Publications Inc., 1984.
_________
6. TNAI , A community health Nursing
14. The incubation period of tetanus is
manual , New Delhi,1989.
___________
7. Park J.E. & Park , Textbook of preventive
15. Japanese encephalitis is transmitted to man
and socialmedicine, Jabalpur, BB
by ___________
publishers, 1989.
III. Write short notes (5 marks) 8. Brunner & Siddarth, Textbook of medical
and surgicalnursing, J.B. Libbincott. Co.,
1. Poliomyelitis Philadelphia, 2000.
2. Tuberculosis 9. Davidson & Maccvdeved, Principle and
3. Dengue fever practice of medicinethe English language
4. Leprosy book society, London, 1988.
5. Malaria 10. Kasthuri Sundar Rao (1995), “An
introduction to Community Health
IV. Write briefly Nursing” 1st edition, B.I. Publications
Pvt. Ltd., Chennai, India,
1. Disease transmitted through parasites.
11. Park K “Text book of preventive social
2. Sexually transmitted diseases
medicine 20th edition, 2009,
3. Diseases transmitted through arthropod.
12. M/s. Banarsidas Bhanot Publishers,
4. Disease transmitted through animals. Jabalpur India.
V. Write in detail
13. Vijay. E (2004) “Community Medicine”, 2nd
Edition, Bencon Zen Publishers,
1. Disease transmitted through oro faecal Chennai, India, Page No.: E.50-54. 1
route
14. Brunner and Suddarth (2002), “Text
2. Disease transmitted through air. Book of Medical Surgical Nursing”,
3. Diseases transmitted through contact. 9th Edition, Lippincott Company,
Philadelphia.
269

CHAPTER
Nursing
12 Education And
Managemnet
தாமின் புறுவது உலகின் புறக்கண்டு

காமுறுவர் கற்றறிந் தார்.
The learned will long (for more learning), when they see that while
it gives pleasure to themselves, the world also derives pleasure from it.
Learning Objectives

➢➢ define nursing education
➢➢ know about the philosophy of Nurisng Eduction
➢➢ explain about the curriculum planning in nursing education
➢➢ enumerate principles of ward management.
➢➢ describe the qualities of the nurse manager in ward management.
Nursing Education is also coordinated with

Introduction
the Education of the professionals in allied
Education is the corner stone of Nursing sectors of Health and Development. Education
profession. Education in Health care has both encompasses both the teaching and learning
the patient education and Nursing staff student of knowledge, proper conduct and technical
education. It is a topic of utmost interest to competency. It thus focuses on the cultivation
nurses in every setting in which they practice. of skills,trades or professions as well as mental,
Teaching is a major aspect of Professional role. moral and aesthetic development.
Nursing has been called “the oldest of the art It aims the harmonious development of
and youngest of the professions” (Donabue, the physical, intellectual, social, emotional,
1985). Planning for nursing Education may spiritual and aesthetic powers or abilities of the
form the Education for the other health and student in order to render professional nursing
development professionals who also take into care to people of all ages, in all phases of health
account the characteristics of society as a and illness, in a variety of settings, in the best or
whole. Nursing Education is the “Production highest possible manner.
aspect” of Nursing manpower development.
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Definitions 2. evelop reciprocity
D and cooperation
among students.
Education is the all-round drawing out of
the best in child and man- body, mind and spirit” 3. Encourage active learning.
– Mahatma Gandhi. 4. Give prompt feedback
“Education is the natural, harmonious 5. Emphasize time on task.
and progressive development of man’s innate 6. Communicate high expectations
powers”. 7. Respect diverse talents and ways of learning
– Pestalozzi.
Nursing Education 12.2 Philosophy of nursing
Nursing education is a professional education
education which is consciously and
systematically planned and implemented • Beliefs and values with regard to man in
through instruction and discipline. general and specifically man as the learner,
teacher, nurse and the client and the beliefs
about health, illness, society, nursing, and
12.1 Principles of nursing
learning etc.
education
• Seeks to study the process and discipline
Ethical principles for nursing education. of education in order to understand how it
Caring: In order to care for others, one works, improve its methods and perfect its
must first care for self. applications in society.
Integrity: Integrity encompasses the • To improve education and its systems
ability to communicate honestly and sincerely, and methods for the betterment of
and take responsibility for one’s actions. humanity.
Diversity: Diversity does more than Ideally, it informs and raises the quality of
acknowledge and advocate for differences of curriculum, teaching methods and the overall
backgrounds and experiences. educational experience.
Excellence: Excellence is achieved through
Definitions
engagement in scholarship, professional growth,
and continual improvement. Philosophy
Philosophy is a search for a comprehensive
Caring view of nature, an attempt at a universal
explanation of nature of things
– Henderson.
Ethical
Diversity Integrity
principles Philosophy is the science of knowledge.
– Fitche
Philosophy is the science of all sciences.
Excellence
– Coleridge
Philosophy is the mother of all arts and the
Other principles true medicine of the mind.
1. ncourage contact between students and
E – Cicero.
faculty.
271

efinitions of Philosophy of
D Types of Philosophy
Nursing Education.
“Philosophy of nursing education is the Modern
Traditional
written statement of the believes, values, contemporary
philosophy
attitudes and ideas which the faculty as a philosophy
group agreed upon in relation to the nursing Naturalism Existentialism
educational program such as health, disease,
Idealism Progressivism
nursing, nurse, nursing profession, education,
learner, society, patient nursing education Pragmatism Behaviorism
and preparation of nurses.” Realism Humanism
Experimentalism
Relationship between
Eclectism
Philosophy and Education
Reconstructionalism
Philosophy Education
Traditional Philosophy
It sets the ideas, Education works Naturalism
principles, goals, out those values
• It is concerned with nature and believes
standards, values
that reality and nature are identical and
thus it is in reality
beyond nature there is no reality.
and truth.
• or naturalist, nature is everything and
F
It is the theory and It explains how nothing exists superior than nature so
speculative to achieve the they separates nature from God. Man is
goals through regarded as a child of nature.
man’s educational • aturalists also believe that all our
N
efforts. activities, whether it may be biological,
psychological or social are initiated by our
It is the It is the practice
instincts.
contemplative side
• atualism stresses the need to return to
N
It deals with It is active side the nature from artificiality.
abstract ideas and (Dynamic)
ends the situations It is applied Idealism
process philosophy • Idealism is the oldest philosophy. It
It deals with believes that man is the combination
concrete and of spiritual and material aspects,
means the spiritual aspect is more real and
important.
It is an art. It is the science. • Idealism regards spirit and intellect are
Philosophy It deals with of supreme value than physical matter. As
formulate the the process of per the idealism individual experience is
method method. valid than the material world and man
lives in the world of ideas rather than
facts.
272

Pragmatism Meaning
• ragmatism means thinking of or dealing
P Progressivism is the theory of education
with problems in a practical way rather that is concerned with learning by doing that
than by using theory or abstract principles. children learn best when pursuing their own
• ragmatism is essentially a humanistic
P interest and satisfying their needs.
philosophy maintianing that man creates
his won values in course of activity, that Behaviourism
reality is still making and awaits its part of Person’s behavior is the result of
completion from the future. environmental conditioning. Man is a passive
recipient, who reacts to external stimuli, he has
Realism no will or decision of his own or the capacity to
• ccording to this, things we see and
A take spontaneous action.
perceive are real and knowledge acquired
through senses is true. Principles
“Realism is the reinforcement of our common • Individual’s action are predetermined by
acceptance of this world as apears to us” his heredity or immediate surroundings.
– Butter • an is not separate from his surrounding
M
environment.
Modern contemporary • uman behavior
H is controlled by
philosophy creativity.
Existentialism
Educational applications
It is the youngest philosophy, described as
• earning is governed by man’s action
L
modern 20 th century philosophy.
and reaction to various media (oral,
Meaning: This philosophy stresses the written,machine).
important of human experience and says that
• earning occurs as a personal achievement
L
everyone is responsible for the results of their
through interaction between the learner
own action.
and environment.
Assumptions
Humanism
• e center of existence is man rather than
Th
truth, laws, principles or essence. Man is an end, not a means.
• an is not alone in the world. Man is a
M
Principles
social being.
The humanist emphasis is on literature.
• an cannot accept the ready-made
M
He has to overcome the conflicts of his own
concepts of existence forced upon him
time.
• an is free agent capable of shaping his
M
own live and shaping his own destiny. The role of Education
• an is not complete: Man has to meet the
M • hildren must be taught to respect
C
challenges in the changing society. language, a sense of language perfection.
• hildren must be trained in modern
C
Progressivism literary standards of academics.
It is an American philosophy.
273

Experimentalism Curriculum refers to the totality of
activity and experiences planned by the
It believes that things are constantly
school with a view to achieve the objectives
changing. It is based on the view that reality is
of education.
what works right now. Schools exist to discover
and expand the society we live in. Students
Definition
study social experiences and solve problems
Man is a social being and product of his According to Cunningham,’ Curriculum
environment. Learning depends on experiment. is a tool in the hands of an artist to mould his
material, according to his ideals in his studio.
Eclecticism In this definition, artist is the teacher, material
is the student, ideals are the objectives and
It is the process of pulling out and putting
studio is the educational institute.
together of the useful and essential aspects of
Nursing curriculum is the learning
various philosophies of education.
opportunities (subject matter) and the
Meaning learning activities (clinical experiences
• e fusion or synthesis of different
Th and practices) that the faculty plans and
philosophies of education. implement in various settings for particular
group of students, for a specified period of
• e process of putting together the
Th
time in order to attain the objectives.
common views of different philosophies
into comprehensive whole.
Three facets of curriculum are
Aims of education • Goals and purposes of education
• e child should become efficient member
Th • Process of curriculum
of society. • Evaluation of products
• Promotion of good health
• Skillful training. The four C’ s of curriculum
planning
• Development of moral character.
Cooperative: A programme prepared
12.3 Curriculum planning jointly by group of persons.
Continuous: Preparation of programme
The term curriculum is derived from and its revision should be continuous.
the latin word “currere” which means ‘run’.
Comprehensive: All the components of
Thus, curriculum is a runway for attaining
the programme should be included.
the goals of education. Curriculum may be
Concrete: Concrete professional tasks
considered as the blue print of an educational
must constitute the essential structure of a
programme. It is the base of education
relevant programme.
on which the teaching-learning process is
planned and implemented. Components of curriculum
• Philosophy
Meaning of curriculum
• Objectives
The systematic arrangement of certain • Total duration
courses designed with certain objectives for • Detailed course plan
the pupil. • Programme evaluation.
274

1. e statement of philosophy of the
Th There is significant relationship between
educational programme. curriculum and nature of society. According
2. e statement of the objectives of
Th to the needs of the society curriculum will be
educational programme. changed.
3.
Total duration of the educational
The institutional curriculum
programme. (theortical ,practical ,clinical
components.) • It is planned by faculty or teacher for a
4. etailed course plan for each course.
D clearly identified group of students who
(placement, sequences and learning will spend a specified period in a particular
situations, instructional methods) institution.
5.
Programme evaluation (evaluation • Cooperative planning through curriculum
methods, plan and schedule of evaluation, committee of the particular institution.
results of evaluation). • More active participation of each teachers
generally brings about change and
Levels of curriculum planning improvement.
Goodland names curriculum in 3 levels.
The instructional curriculum
• Societal
It consists of the content (subject matter
• Institutional
and learning activities) planned day by day
• Instructional and week by week by a particular teacher for a
particular group of students.
Societal curriculum
This curriculum which is planned for a Curriculum committee
large group or class of students, e.g BSc(N) The committee comprises the following
It is planned by groups outside of an members
educational institution, e.g. National league
for nursing. They are more immediately State departments of
concerned with Law makers
education
School boards Publishers
Curriculum
General characteristics
administrators
of curriculum content Principals Project directors
Educational researchers Authors
Teacher educators Testers
Communities Accreditors
Sequence Parents Polisters
Students Lobbyists
Non school educators philonthropists
Grading of curriculum content

Implementation
E- Essential or must learn.
D- Desirble or useful to learn.
S- Supportive or nice to learn.
275

rinciples of curriculum
P the school, the country and the international
development community at large
The conservative principles: this means Priniciple of variety and flexibility:
that the present, the past, and the future Variety should be provided in terms of learning
needs of the community should be taken into and teaching activities. Its not so rigid.
considerations. Priniciple of connecting to community
The forward- looking principles: Children needs: Curriculum should address the
of today are the citizens of tomorrow. community needs.
The creative principle: Curriculum Principle of connecting with social life:
should enable the child to exercise his creative Curriculum has to maintain to relation with
and constructive powers. social life.
Principle of totality form: The curriculum Training for leisure: The curriculum
should be total learning experience and total should have some provision for the co-
learning opportunity. curricular activities, relaxation, and library
utilization according to choice.
The activity principles: The curriculum
should be developed in terms of activity and Principle of core or common subjects:
experience. Broad areas of knowledge, skills and appreciation
should be included. Co subjects, like maths,
Principle of preparation of life: Enable
science etc.
the child to fulfil his responsibilities when he
becomes an adult. Principle of all round development
of body, mind and spirit: All kinds of
Principle of connecting to life:
experiences should be provided.
Curriculum should provide worthwhile life
experiences. Prinicples of dignity of labour:
Curriculum should help students to develop a
Child centered curriculum: Consideration
positive attitude towards all kinds of jobs.
should be given to the student’s age, their
educational level, needs and individual Principle of character building:
differences. Curriculum should promote human and social
values.
Priniciple of integration and correlation:
While developing curriculum, each year’s Principle of democracy, secularism and
course should be built on what has been done socialism: Curriculum should train the child to
in previous years and at the same time should imbibe ideals and values of a democratic, secular
serve as basis for subsequent learning. and socialist state. Principle of connecting
with social life: curriculum has to maintain a
Priniciple of comprehensiveness and
relations with social life.
balance. The curriculum should be framed
in such a way as every aspect of life, like
Types of curiculum
economic relationships, social activities and
• Legitimate curriculum
occupations.
• Illegitimate curriculum
Principle of loyalties: Curriculum
should be planned in such a manner that it • Hidden curriculum
teaches a true sense of loyalty to the family, • Null curriculum
276

Principles related to the Definitions
Development of Nursing Management is an art of getting things
curriculum done through and with people in formally
• ursing curriculum should equip the
N organized groups.
students with the essential knowledge, – Harold Koontz.
skills and attitude. Management is defined as a process by
• urriculum should be clear to the students
C which co-operative group directs action towards
as well as to the teacher. common goals.
• Consider the community needs. – Joseph Massie.
• urriculum should inculcate right attitude
C
Definition of nursing
to students.
management
• rame adequate teaching – learning
F
activities in the classroom, clinical area Nursing management consists of the
and community settings. performance of the leadership functions of
governance and decision-making within
• onsider the guidelines laid down by the
C
organizations employing nurses. It includes
statutory bodies line INC, Universities,
processes common to all management like
examination boards .
planning, organizing, staffing, directing and
• High-Tech-High-Touch approach in the controlling.
nursing care.
• articipatory approach in the teaching-
P What is ward management
learning process. Ward management is the duty of the head
• e learning environment should resemble
Th nurse, who is the administrative officer of the
the life situation. hospital. The nursing care is needed during
admissions and discharge of patients, doctors’
rounds, and drug administration and also
12.4 Management
during operation theatre administration.
Introduction:
Golden rules for a good ward
Management is the scientific art of
management
achieving the results or goals by effective
utilization of the resources. Management • Early arrival to duty.
generally lays emphasis on control. i.e., control • ake a note: Write down activities for the
M
of personnel, control of cost, time, salaries, day.
overtime, inventory etc. Management is • Time plan: Estimate how long it will take
required to plan, organize, co-ordinate and to accomplish a task.
control the affairs of the organization. It brings
• Prioritize task: There are list of tasks for
the human and material resources together
the day, there is need to prioritize based on
and motivates people for achievement of the
urgency.
objectives of the organization. Management is
• Follow schedule: Ignore tasks that are
an universal process in all organized social and
not on the list, to maximize best use of
economic activities.
time.
277

• irst thing first/Learn to say “No” with
F • In other words, a sub-ordinate should not
compassion: Attend to life threatening receive instructions from more than one
situation first. person.
• ake a break: Need to relax during stressful
T • It creates harmonious relationship between
situations. superiors and sub-ordinates.
• Be flexible 4. Unity of Direction
• Encourage Yourself: Appreciate yourself • One head one plan which means that there
for the achievements made so far. should be one plan for a group of activities
having similar objectives.
Elements of ward management • Related activities should be grouped
• Patient care together.
• Personnel management • According to this principle, efforts of all
• ard sanitation and
W provision of the members of the organization should be
therapeutic environment directed towards common goal.
• Supply the equipment 5. Equity
• Interpretation of policies and procedures. • The employees should be treated with
kindness and equity.
Principles of ward • Manager should be fair and impartial while
management dealing with the subordinates.
Apply the principles of administration in • Should give similar treatment to people of
ward management. similar position.
• Should not discriminate with respect to
1. Henri Fayol’s 14 Principles of management age,caste,sex, religion,relation etc.
• Division of work : 6. Principle of order
• Fayol has stressed on the specialization of • It refers to the systematic arrangement
jobs. of men and material in a fixed place
• Subdivision of work makes it simpler and for everything and everyone in the
results in efficiency. organization.
• It also helps the individual in acquiring • The right materials and the right employees
speed, accuracy in his performance. are necessary for each organizational
function and activity.
2. Authority and Responsibility.
7. Discipline
• Authority is the power to take decisions.
• Discipline means sincerity,
• Responsibility is the obligation to complete
obedience,respect of authority and
the job assigned.
observance of rules and regulations of the
• There should be balance between the two enterprise.
i.e. they must go hand in hand.
• This applies that subordinate should respect
3. Unity of command. their superiors and obey their order.
• A sub-ordinate should receive orders and 8. Principle of initiative
be accountable to one and only one boss • Workers should be encouraged to take
at a time. initiative in the work assigned to them.
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9. Remuneration • Anything which increase role of
• Remuneration to be paid to the workers subordinates is decentralization
should be fair, reasonable, satisfactory and and anything which decreases it, is
rewarding of the efforts. centralization.
• Wages should be determined on the basis • Sharing authority downwards is
of cost of living, work assigned, financial decentralization.
position of the business.
Basic functions/ Elements of
• Employees must be paid adequately, or give Management
them maximum satisfaction.
Management has been described as a social
10. Stability of Tenure
process involving responsibility for economical
• Employees should not be transferred and effective planning and regulation of
frequently or terminated. operation of an enterprise in the fulfillment
• Time is required for an employee to get of given purposes. It is a dynamic process
used to a new work and succeed in doing consisting of various elements and activities.
it well. According to George and Jerry. Four
11. Scalar chain fundamental functions of management are
• The chain of superiors ranging from the
ultimate authority to the lowest. Planning
• Every order, instructions, messages,
requests, explanation etc. has to pass
through scalar chain.
12. Sub-Ordination of individual interest to Controlling FUNCTIONS Organizing
general interest.
• Importance given to organization.
• Individual must sacrifice his own
interests sometimes for bigger interests of Actuating
organization.
• Organization is bigger than individual.
According Henry Fayol
• Interest of the organization which
supersedes the interest of the individuals. To manage is to forecast and plan, to
13. Esprit De’Corps organize, to command and to control.
• It means union is strength. Luther Gullick : POSDCORB
• Teamwork is fundamentally important to P - planning

an organization. O - Organizing
• Team work inspires workers to work S - Staffing
harder. D - Directing
14. Centralization and De-centralization C - Controlling / Monitoring
• Centralization is a situation in which top O - Ordering and Recording
management retains most of the decision R - Recording and Reporting
making authority. B - Budgeting.
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Positive attitude: treating people well,
12.5 Qualities of a Good
respond in difficult interactions with grace and
administrator
solve a range of sticky situations.
Communication: Interpersonal Skills
such as verbal communication, problem 12.6 S
kills of an effective
solving and listening skills are essential in any administrator
administrative role.
Administration rests on three basic
Customer service orientation: Having
developable skills.
a customer focused approach is a desirable
quality of an administrator. Technical: It implies understanding of,
and proficiency in, a specific kind of activity,
Organization: Prioritizing tasks by the
particularly one involving methods, process,
deadline will help to manage your time more
procedures or techniques.
effectively.
Technical skill involves specialized
Time management: Fixing deadline are
knowledge, analytical ability within that
particularly important to improve your time
speciality, and facility in the use of the tools and
management skill. Prioritizing duties that
techniques of the specific discipline.
have deadlines will help you stay focused, and
help you work more efficiently. Technical is primarily concerned with
working with things (processes or physical
Management: Need management skills
objects).
to direct others and review their performance.
Human: It is the executive’s ability to work
Dependability and Reliability:
effectively as a group member and to build
Confidentiality
co-operative effort within the team he leads.
Staying objective: she makes decisions
Human skill is primarily concerned with
about an employee bases on job performance
working with people.
and not on whether she likes or dislikes
someone. Treats all people with same respect Conceptual: It involves the ability to see
and fairness and does not play favorites. the enterprise as a whole, it includes recognizing
how the various functions of the organization
Providing motivation: an effective
depend on one another, and how changes in any
administrator is able to motivate his staff to
one part affect all others.
perform beyond company standards.
The success of any decision depends on
Mentoring others: an effective
the conceptual skill of the people who make
administrator doesn’t keep aloof from
decision.
employees, but rather seeks a mentoring
relationship to help them move up the corporate
ladder. 12.7 Extended Roles of The
Nurse
It’s also important to exhibit kindness
toward employees and remember that they have Nurses in extended care facilities assist
lives outside the office. clients with their daily activities. Provide care
Flexibility: administrator have to work when necessary and coordinate rehabilitation
well with a variety of personality types and be activities.
open to others. These nurses have increased
responsibilities and autonomy and they are
280

supposed to provide care in variety of settings of the health care team. (Nutritionists and
such as hospital, community etc., Physical therapists).
• Care giver 3. Protector and Advocate: The nurse helps
• Manager to maintain a safe environment for the
• Advocate client. The nurse takes steps to prevent
injury and protect client from possible
• Counselor
adverse effects of diagnostic or treatment
• Educator measures. As a advocate, nurse protects
• Consultant the clients' human and legal rights and
• Researcher provides assistance in asserting those
• Collaborator rights if the need arises.
• School health nurse 4. Counselor: Help patient and family to cope
with stressful problems. Provide emotional
• Occupational health nurse
and psychological support. Motivate
• Private duty nurse.
patient to adopt an alternative behavior.
• Parish nurse
5. Consultant: Nurse consultants are nurses
• Public health nurse who usually identify problems and develop
• Home care nurse solutions.
• Hospice nurse 6. Educator: Manage patient care. Educate
• Rehabilitation nurse patient, family and community.
• Office nurse 7. Collaborator: The nurse collaborates
• Nurse epidemiologist with other team members when providing
care to a client. Quality care is given
• Military nurse
when nurse and team members work
• Aerospace nurse together in planning for the patients care
• Tele nurse management.
• Disaster nursing 8. School Health Nurse: The role of the
• Prison nurse. nurse is to support the educational
• Forensic nurse. process by helping students to keep
• Peace corps nurse. healthy and by teaching students and
teacher’s regarding preventive practices.
• Communicator
9. Occupational Health Services:
1. Care Giver: Care giving role is a Occupational health nursing is providing
primary role of nurses. The provision of health services to workers in industry and
care to clients combines both arts and special community groups.
science of nursing which helps clients 10. Parish Nurse: Parish nurse respond to
regain health through healing process. health and wellness needs within the
The caregiver helps the client and families set context of populations of faith communities.
goals and meet those goals with a minimal (people gathering in churches, temples or
cost of time and energy. mosques)
2. Manager: As a manager, the nurse 11. Public Health Nurse: She is a registered
coordinates the activities of other members nurse with special training in community
health. Help the client and the family
281

with health concerns and parenting and 25. Communicator: Communication is
lifestyle issues. integral to all nursing roles. Nurses
12. Private Duty Nurse: Providing nursing communicate with the client, support
care at home or any other setting and person, other health professionals and
following physician orders. people in the community.
13. Home Care Nurse: She is a nurse who
provides care to patients with in their 12.8 Expanded Role of Nurses
environment as ordered by the physician.
An expanded role of nursing is one in
She acts as a referral agent for clients who
which a nurse assumes expanded or increased
are discharged from acute care settings
responsibilities in a practice area and in most
such as hospitals or mental health facilities.
cases practice with greater autonomy.
14. Hospice Nurse: She is the one who
• Advanced Nurse practitioner
provides a family centered care and allows
clients to live and remain at home with • Clinical Nurse specialist.
comfort, independence and dignity, while • Nursing administrator:
alleviating the strains caused by terminal • Nurse anesthetist:
phase. • Nurse researcher:
15. Rehabilitation Nurse: Rehabilitation • Nurse educator
nurse is a nurse who specialized in • Nurse entrepreneur.
assisting persons with disabilities and
• Acute care Nurse practitioner
chronic illness to attain optimal function.
• Operating home Nurse.
16. Office Nurse: Nurse who cares for
• Professional Nurse care manager.
outpatients in doctor’s offices, general and
specialty clinics and emergency medical • Rehabilitation Nurse.
centers. • Nurse analyst
17. Nurse Epidemiologist: Perform • Travel Nursing.
epidemiologic investigations. Controls and • Nurse Oncologist.
prevents infectious diseases. Participating • Sports Nursing
in surveillance. • Nurse authors
18. Military Nurse: Care of military personnel. • Nurse liaison
19. Aerospace Nurse: Provide care to • Space Nursing
passengers during travel in flight. • Hospice Nurse
20. Tele Nurse: Communicate with patients • School health Nurse
on telephone. • Tele Nursing
21. Disaster Nursing: Provide services during • Cruise ship/ resort Nurse.
and after disaster.
• Attorney
22. Prison Nurse: Provide nursing care those
• Disaster/ Bio terrorism Nurse
who are in prison. Works for improvement
• Epidemiology Nurse
in mental health .
• Ethicist
23. Forensic Nurse: Handle and preserve the
evidentiary materials. 1. Advanced Nurse Practitioner: A Nurse
who has an advanced education and is a
24. Peace corps Nurse: Works in remote areas
of the world.
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graduate of a nurse practitioner program and develops care according to expected
is employed in health care agencies or in outcomes in terms of cost and quality.
the community settings and deals chronic 11. Nurse Analyst: The nurse analyst is
illness and provide primary ambulatory involved in data analysis and interpretation
care with regards to effectiveness and efficiency
2. Clinical Nurse Specialist: The clinical of data collection, entry and use within the
nurse specialist has a master’s degree in various areas of the hospital and health
nursing and expertise in a specialized area care facility.
of practice. CNS may work in primary 12. Travel Nursing:
care, acute care, rehabilitative care and 13. Nurse Oncologist: A specialized nurse
community based settings. who cares for cancer patients.
3. Nursing Administrator: Manage client 14. Sports Nursing: Sports medicine is a sub-
care and the delivery of specific nursing specialty of orthopedic medicine, largely
services within a health care agency. involving injuries or traumas suffered as
4. Nurse anesthetist: Provide care pre- a result of training or competing in an
operative, intra operative and post- athletic event.
operative period. Assist to anesthetist 15. Nurse Authors: Nurse works in any area
during surgery. of writing, this written material may be
5. Advanced Nurse Educator: The nurse is used in research education, training and
more advanced and frequently an expert in marketing
a particular area of practice. 16. Space Nursing: Space nurses provides
6. Nurse Researcher: Participate in scientific health services to astronauts.
investigation. Complete the research 17. Nurse Liaison: The nurse Liaison’s role
process. is multifaceted. They are the vital link
7. Acute Care Nurse Practitioner: An between the potential patient and the
acute care nurse practitioner functions rehabilitation facility.
in the settings where critically ill patients 18. Hospice Nurse: The focus of hospice care
reside, this type of nurses provide special is a comprehensive physical, psychological,
expertise. emotional and spiritual care to terminal ill
8. Nurse Entrepreneur: An entrepreneur is persons and their families. Hospice care
an individual who organize operates and promotes quality of life.
assumes the risk of independent nursing 19. School Health Nurse: Nurse support the
practices, consultant services etc., the nurse educational process by helping students
may be involved in education consultation keep healthy and by teaching preventive
research etc. practices for students and teacher’s.
9. Operating Room Nurse: The nurse 20. Tele Nursing: Providing nursing services
monitor the progress of patients before by the use of telecommunication and
and after surgery from the time of entry information technology whenever a large
in the operating room until he/she is physical distance between patient and
dismissed to the attending staff nurse. nurse.
10. Professional Nurse Care Manager: The 21. Cruise Ship/ Resort Nurse: These
nurse case manager assesses the patients nurse work on ship or resorts to provide
283

emergency and general care to passengers 24. Epidemiology Nurse: The nurse
if required. epidemiologist investigates trends in
22. Attorney: Nurse attorneys engage in a range disease occurrence in particular area. They
of legal activities by legal consultation. identify the population at risk monitor the
23. Disaster/Bio Terrorism Nurse: These progress of disease, special areas of health
nurses works in disaster areas that are care need, determine priorities
result of bio terrorist attack or in situation
caused by natural or man-made disaster.
1. Tamil Nadu Nursing Council was established by the act in the year 1926 which
South East Asia’s first premier Council
2. In 1871, the first school of nursing was started in Government General Hospital,
Madras with a six-month diploma midwives programme with four students..
3. The first four-year bachelor’s degree programme was established in 1946 at the college of
nursing in Delhi and the Christian Medical College and Hospital (CMCH) in Vellore.
4. Florence Nightingale was one of the pioneers in establishing the idea of nursing schools
from her base at St Thomas’ Hospital, London in 1860 when she opened the ‘Nightingale
Training School for Nurses’, now part of King’s College, London.
5. In 1908, the Trained nurses association of India was formed to uphold the dignity and
honour of the nursing profession.
6. The Indian Nursing Council was passed by ordinance on December 31, 1947. The council
was constituted in 1949.
SUMMARY
Education is the corner stone of Nursing profession. Education in Health care today-both the
patient education and Nursing staff student education. It is a topic of utmost interest to nurses
in every setting in which they practice
Nursing education is a professional education which is consciously and systematically planned
and implemented.
A philosophy of nursing education includes beliefs and values with regard to man in general and
specifically man
Curriculum is a runway for attaining the goals of education. Curriculum may be considered as
the blue print of an educational programme
Nursing management consists of the performance of the leadership functions of governance
and decision-making within organizations employing nurse.
Management has been described as a social process involving responsibility for economical and
effective planning and regulation of operation of an enterprise.
Nurses have various number of Expanded roles and Extended roles in health care
284

GLOSSARY
Profession தொழில் Any type of work that needs special training or a

particular skill
Competent தகுதிவாய்ந்த The ability to do something well
Harmonious இசைவிணக்கத்துடன் Friendly, peaceful and without any disagreement
Aesthetic அழகான Made in an artistic way
Diversity பன்முகத்தன்மை Many different things existing together in group
Integrity ஒருமைப்பாடு The State of being whole and not divided
Curriculum பாடத்திட்டம் The subjects that are included in a course of study
Committee செயற்குழு A Group of people who are chosen usually by a
large group to make decisions or to deal with a
particular subject
Evaluation
I. Choose the correct answer

1. The corner stone of Nursing is 5. To study the process and discipline of
a) Education Education is
b) Practice a) Knowledge
c) Knowledge b) Philosophy
d) Economy. c) Learning
2. Nursing is the oldest of art and youngest of d) Planning
the profession said by. 6. Philosophy
a) Gandhi a) is an art
b) Abdul kalam b) is a science
c) Rajaji c) Both
d) Donabue d) None
3. The important aspect of Nursing in terms of 7. Education
man power is a) is an art
a) Development b) is a science
b) Production c) Both
c) Skill d) None
d) none
8. The youngest philosophy in 20th century
4. Ability to communicate honestly and a) Idealism
Sincerely is known as b) Existentialism
a) Wisdom c) Pragmatism
b) Integrity d) None.
c) Communication
d) Diversity.
285

9. The American Philosophy centred around REFERENCE BOOKS
the present life.
1. KP Neeraja, (2009),” Text Book of Nursing
a) Existentialism
Education”. JaypeeBrothers Medical
b) Idealism
Publishers (P) Ltd, New Delhi.
c) Progressivism
2. ShabeerP.Basheer, s. yaseenkhan (2014),’’
d) None.
A concise textbook of Advanced nursing
10. The Philosophy that state the person’s practice1 edition, Emmess medical
behaviour is the result of environmental publishers, page no: 500- 560.
condition. 3. Samita (2015),” Text book of advance
a) Idealism nursing practice, 1 edition, Jaypee brothers’
b) Progressivism 4. B.T. Basavanthappa,(2009)“Nursing
c) Behaviourism Administration” 2nd Edition, Jaypee
d) None Brothers Medical Publishers (P) Ltd, New
Delhi.
II. A
nswer the following 5. K.Deepak,“(2010), “Comprehensive
question in one or two lines Textbook Of Nursing ManagemenT” 2nd
1. Define Education. edition, Emmesspublication,Bangalore.
2. Define Nursing Education. 6. JogindraVati,(2013) “Principles & Practice
Of Nursing Management & AdministratioN”
3. Define Philosophy
Jaypee Brothers Medical Publishers (P) Ltd,
4. Define Philosophy of Nursing Education.
New Delhi.
5. Name two types of philosophy 7. Neelam Kumari,(2013) “Nursing Services &
6. Define Humanism Administration” Vikas&Company (Medical
7. Define Curriculum Publishers), India.
8. Name three facets of curriculum. 8. S.Priya,(2013)” Nursing Education”Vora
Publication,Mumbai,India
9. List the 4’c s of Curriculum.
10. Define management. INTERNET LINKS
III. Write in detail 1. medical publishers. https://www.ncbi.nlm.
nih.gov/pubmed/1994228
1. Explain in detail about the Principles of
Curriculum development 2. http://www.nln.org/centers-for-nursing-
education
2. Describe elaborately about the traditional
philosophy of Education 3. https://careertrend.com/professional-
ethics/
3. Write in detail about the modern
contemporary philosophy of Education. 4. http://executivesecretary.com/moving-
into-management/
4. Explain in detail about the Henri Fayol’s
principles of management 1. http://www.jaypeedigital.com/Video/
VideoListing
5. Explain the Extended and Expanded roles
of Nurses.
286

Introduction to
CHAPTER
13 Nursing Research
முடிவும் இடையூறும் முற்றியாங்கு எய்தும்

படுபயனும் பார்த்துச் செயல்.
Accomplishment the hindrances large profits won by effort; These compare, then let the work
to be done.
Learning Objectives

➢➢ define nursing research
➢➢ gain knowledge about importance of nursing research
➢➢ list out the steps in nursing research
➢➢ define the descriptive statistics
➢➢ define the inferential statistics
➢➢ explain about the current computer applications in nursing research
people to grow crops for the

Introduction
year. But along with the rich
soil, a large number of frogs
The meaning of the word ‘research’ is to
also appeared. Therefore,
find correct answers to questions raised or to
the Egyptian concluded that
find solutions to problems identified.
frogs came from muddy
In the past and for many years, people based soil. Here we can say that
their beliefs on presumptions or interpretations scientific research was not
of things that they saw or observed in and around used because the people never
them and then came to various conclusions. gave a thought if there can be
These conclusions were not tested to find out any other reason for the large
whether they were correct (valid) or not. number of frogs living in the
For example, in ancient days, in Egypt, floods. Later problems were
every year Nile river flooded and it left behind scientifically analysed based on data this is
very rich soil along the riverbanks which helped called scientific enquiry.
287
Unit_13_Introduction_to_nursing_research_Gen_Nur.indd 287 12/10/2021 10:35:23 PM

Every one will agree that if "Health is lost, format. In general, nurses try to understand
everything is lost". Nursing is a profession a question / problem and search for possible
and practice which serves as the foundation solutions.
in providing care for the sick and needy. The The quality of nursing practice and the
challenges faced by the nursing fraternity is future of health care depends on up-to-date
enormous. Thus research becomes the need and organized body of nursing knowledge. Research
necessity in this noble profession. is based on existing ideas and to improve the
Nursing is the profession and practice of knowledge of the individuals. The purpose of
providing care for the sick and needy. Nurses the systematic inquiry is to find out the evidence
play significant role in taking care of people. based method of solving the problem identified.
Nursing plays an vital role in the research The present era of complex health problems
activity. A well developed and reliable body makes interdisciplinary research, an important
of knowledge is a foundation for any course one to find out the study of health and illness
of study. Research provides a solid foundation experiences of the society. Currently a lot of
on which individual can develop and refine attention is being paid to research on nursing,
their basic knowledge and practice. Without which it seems will continue in the years to
knowledge we cannot improve in accustoming come, and will have its implications and impact
people to the latest techniques and therapies like on nurse administrators, nurse educators, as
infant care, pain management, grief counseling, well as practitioners.
health education, home care management, Hence, an expanded new knowledge is
palliative care and related intervention. required for a growing profession. The health
Research on nursing practices began care professionals should realize that nursing is
slowly, but since 1950, it has been accelerating developing rapidly and they must be ready to
rapidly. Nursing research continues to develop take challenges of currently growing demand
at a rapid phase and will undoubtedly flourish of new knowledge and to refine old outdated
in the twenty-first century. Broadly speaking, knowledge.
the priority for nursing research in the future
will be the promotion of excellence in nursing Meaning of Nursing Research
practices.
The word research is derived from the
Nowadays
French term researcher, a compound word
Health professionals
composed of a prefix ‘re’ and a verb ‘search’. Re
believe in
means ‘once again’ ‘a new’, or ‘a fresh’ and search
development of
means ‘to look for something’.
knowledge from
It is an systematic inquiry of investigation
logical reasoning
to validate and refine existing knowledge and
and problem
to generate and refine existing knowledge and
solving. It helps in identification of problem and
generate new knowledge.
planning evidence based care.
Research is a systematic inquiry that uses
Nurses must acquire knowledge in both
disciplined methods to answer questions to
unstructured and structured method. In
solve problems.
unstructured method, own experience,trial
and error are followed. The structured method Ultimate goal of research is to develop,
includes logical reasoning, problem solving refine and explore a body of knowledge.
and the research is conducted in a disciplined
288

Definition of Research 8. Research develops knowledge about the
current issues happening in medical field.
Research is a systematic and scientific 9. Research provides scientific basis for the
process to solve problems or to answer to practice of the nursing profession on need
questions about facts. Nursing research focuses based intervention.
primarily on developing knowledge about 10. Research prepares the individuals to be a
nursing including the care of person in health nurse scientists.
and illness.
In general, Nursing research is defined as 13.2 Types of Research
the systematic objective process of analysing
phenomena of importance to nursing. Research is classified according to their
According to Waltz and Bausell (1981) purposes and approaches.
Nursing research is a systematic formal rigorous • Basic research or fundamental research
process used to gain solutions to problem or are carried out in laboratory situations
to discover and interpret new facts in clinical • Applied research helps to evaluate
practice, nursing education and nursing practices and identifies the needs of the
administration. person
Wilson (1980) Differentiated nursing • Action research tries to solve ongoing
research and research in nursing. In that nursing problems
research is concerned with clinical problem.
Whereas research in nursing is the broader Research Approaches
study of the nursing profession which includes
There are two types of Research
historical, ethical and policy studies.
Approaches. Namely Experimental and Non
Experimental
13.1 Importance of Research in
Experimental
Nursing
1. Research builds an advanced body of Field Field studies

Laboratory
nursing knowledge. experiments experiments
2. Research provides a cost effective, and
efficient health care. Exploratory
3. Research moulds the attitude and improves Testing
technical skills.
4. Research fills the gap and helps in finding Hypothesis
out new knowledge of practice. Testing
5. Research makes individual health care
responsiblity and decision making in health 13.3 Steps in Nursing Research
related problems.
6. Research modifies the old theories and • Identification of the phenomenon/ problem
discovers new theories. of the study
7. Research adopts evidence based practice, • Review of literature
while providing care or health education to
• Deriving conceptual frame work
those who are in need.
289

Non-experimental
Philosophical Historical Case studies Methodological Survey
Statistical Obtaining and

Measurements
procedures analysing data
Exploratory Descriptive Explanatory Comprehensive Evaluative
• Identifying the assumption and formulation 2. Review of literature: It is one of the most
of Hypothesis important step in the research process.
• Selection of research design A literature review is an account of what
• Entry in to the research site (Pilot Study) has been already established or published
on a particular research topic by various
• Protect the rights of the participants
researchers.(University of Toronto 2001)
• Planning tools for data collection
• Collection of data
er
• Analysis of the data
e w spap e e.data
N azin Base
• Communicating the findings Mag
ary
B oo
Simple Steps In Research Process
ton
ks
1. Identifying the problem: It is a clear finding
Dic
Sources of
of the problem that should be studied. In Literature
Review
general broad topic area is selected and then ls
Thes
rna
the topic is narrowed down to a specific

Jou
is
one. It may be from personal experiences or Con s

literature sources. fer vi ou
pap ence i
Pr tudy
The purpose of the study: During the er s
formulation of the problem statement the
commonly used mnemonic is “SMART”
Sources of literature review
S – Specific
3. Developing the a theoretical/conceptual
M – Measurable
framework : It is the valuable part of
A – Achievable scientific research. Which helps in the
R – Relevant selection of the study characters and
T – Time Bound in defining them. It also directs to the
This will be easy while prediction and the interpretation of the
writing objectives for the study findings.
study. Objectives may be 4. Identifying the study Assumptions :
single or several. Assumptions are held to be true but have
not necessarily seen proven. It influences
290

the questions that are asked. It is based 7. Identifying the population/sample: The
on the information collected and study population means the complete set of
interpretation. individuals or objects that posses some
common characteristics of interest to the
There are three types of Assumptions. researcher. The subgroup of populations is
i) Universal Assumptions – Beliefs that are called study sample.
assumed to be true by a large percentage 8. Conducting a pilot study : A pilot study
of Society. is a miniature trial version of the planned
ii) Assumptions based on theory or research study. It reveals the feasibility of the study
findings- Previous research studies and helps to test the instruments. It also
which form the basis for assumptions in plays a role in gaining experience with the
the present study. study process and it indicates that where the
iii)
Assumptions that are necessary to revision should be made.
carryout the study – Need to conduct a 9. Collecting Data : It is the process of
research study. collection or gathering of pieces of
information’s facts that are related to the
5. Formulating the Hypothesis or Research
study.
Question: Hypothesis predicts the relationship
10. Organizing the data for Analysis : It is the
between two or more characters. According to
grouping of information’s for tabulation and
the asked questions in the problem statement.
evaluation purpose. A statistician should
The hypothesis furnishes the answer to it.
be consulted in the early and phase of the
It is testable or verifiable by the information
research process. The statistician can help to
gathered. The research is guided by research
follow the appropriate analytical method.
questions that are further elaboration of the
11. Interpreting the findings : After the data
problem statement.
are analyzed the finding of the result are
6. Selecting the research Design : It is the plan
compared with those of previous studies
for how the study will be conducted as well
for further recommendation
as concerned with the type of information
that will be collected.
13.4 Related Websites/Software Used In Nursing Research
S. NO USES OF COMPUTER IN RELATED WEBSITE AND SOFTWARE

1. Identification and formulation of PUBMED
problem statement
2. Review of literature MEDLINE, Open Access Journals
3. Framing of conceptual framework Visual display
4. Planning of research design Word processing, data base
5. Preparation of sampling process Word processing
6. Data collection procedure Video recorded, flash based narrator, Led interview
7. Analysis and statistical calculation SPSS, ANOVA
8. Presentation of research Open source software
9. Budget mobility Microsoft office, EXCEL
10. Reference sources Vancouver, APA, style
291

SUMMARY
Identifying a problem: Any problem or question which we want to clarify, instead of
assuming the answers or solutions
Searching professional literature for possible solutions: Looking up literature so as to know
what has been written or studied about the same problem earlier.
Prepare a research question in an answerable or testable format:
Writing the questions related to the study going to be conducted
Considering a solution to solve the problem: In problem – solving methods, one should put
down possible ways of solving the problem
Making a research hypothesis that can be tested: Writing a statement making a relationship
between various factors
Conducting the study or research (Pilot Study): Conducting the study using the selected tool
with minimum participants.
Analysing the result: Making sense of all the data collected by grouping and analyzing
during the research
Determining if the scientific hypothesis is correct: Checking back to see if the hypothesis or
factors have any relationship with each other or not
Applying the variant: Making a final judgement based on the results and preparing
recomadations
GLOSSARY
Conceptual – Strategy for expressing a framework of a study that diagrammatically

shows the interrelationships of concepts and statements
Conclusion – Synthesis and clarifications of the meanings of study findings
Data – Informations that are collected during a study
Data analysis – Technique used to reduce, organize and give meaning to data
Data collection – Systematic gathering of Information
Descriptive statistics – Statistics that allow the researcher to organize the data in ways that
give meaning and facilitate insight
Design – Blue print for conducting a study
Findings – The translated and interpreted results from a study
Hypothesis – Formal statement of expected relationship between two or more
variables in a specified population
Variables – Characteristics of person to be measured
Population – The individuals or objects having some common characteristics.
Theory – Integrated set of defined concepts used to describe, explain and predict
the relationship between study outcome and the view of the nursing
theorist.
Intervention – Treatment or independent factor while conducting the study.
292

Evaluation
I. Choose the correct answer 7. A

nalytical procedure that allows researcher
1. Nursing Research started since to describe and summarize data is known as
a) 1950 a) Descriptive Statistics

b) 1960 b) Inferential Statistics
c) 1917 c) Health Analysis
d) 1920 d) Health coding
2. Nursing Research is II. Short answers

based on 1. Define Nursing Research
a) Systemic enquiry 2. State the steps in Research
b) Improved knowledge
III. Brief answers
c) General knowledge
1. ist out the sources of Literature Review
L
d) Obtained Knowledge
2. State the steps in Problem Solving
3. Research means 3. Common statistical methods in nursing
a) Careful examination 4. Uses of statistics in Health sciences
b) Search again and again
IV. Detailed answers
c) Simple enquiry
1. W
rite in detail about the uses of computer
d) General Enquiry
in Nursing Research.
4. Nursing Research helps to 2.
Discuss the importance of Research in
a) Fulfill the gap Nursing.
b) Decrease the technical skills
c) Decrease communication
REFERENCE BOOKS
d) Increase workload
1. S uresh K Sharma (2011) Nursing research
5. Steps in Research excludes
and Statistics Mosby, Saunders, Elservier
a) Review of Literature India (P) Ltd
b) Communication of results 2. Mercy john (2008), Introduction to research,
c) Programme planning Mid India board of Education of the nurses
d) Presentation of data League Christian Medical Association of
6. F
rom the following table select the India. B. I. Publications Pvt. Ltd
appropriate steps in the preparation of data 3. Vanitha Vani . K (2010) Introduction to
analysis Research Florence Publishers, Hyderbad.
A B C D INTERNET LINKS
Coding Modifying Entering Transferring
Transferring Coding Coding Editing 1. h ttps://www.researchgate.net/figure/
Editing Transferring Transferring Entering Sources-of-literature-review
Modifying Entering Editing Modifying 2. https://www.google.com me country causes
Entering Editing Modifying Coding frustration.
293

Practicals
294
Practical 1-8.indd 294 12/10/2021 9:37:02 PM

Practical 1
HEALTH ASSESSMENT
Learning Objectives
➢➢ On completion of this chapter the learner will be able to

➢➢ List out the purpose the health assessment
➢➢ Describe the technique followed during physical assessment
• Location of pain or other symptoms related

Introduction
to the area of the body involved
Health is a state of well being. Assesment • Duration of health concern or complaint
is based on signs and symptoms observed, • Characteristics
examined. It helps in concluding the condition • Aggravating factors or what makes the
of the individual based on the findings. concern or complaint worse
• Relieving factors or what makes the
Definition concern or complaint better
• Treatments or what treatments were tried
Health assessment is the evaluation of the in the past or ongoing
health status by performing a physical exam
after taking a health history. Patient history and interview: should be
based on.
Objectives • present complaint and nature of symptoms
• To collect data pertinent to patient’s health • onset of symptoms
status (Subjective and Objective) • severity of symptoms
• To identify deviations from normal • classifying symptoms as acute or chronic
• To discover the patients strengths, • health history
limitations, and coping resources. • family history
• To pinpoint actual problems • social history
• To spot the factors that place the patient at • current medical surgical and/or nursing
risk of health problems
• management
• To build rapport with the patient and
• understanding about medical and nursing
family.
plans
Client Interview • perception of illness
Oldcart Physical examination

• Onset of health concern or complaint • A complete physical examination includes:
Head to toe assessment
295

– Skin- Approaches in Physical Assessment
– Head and neck I. Inspection- It is a systematic visual
– Thorax and lungs examination of the client made by the
– Breasts examiner.
– Cardiovascular system II. A
uscultation- it is a process of listening to
sounds that are generated within the body
– Rectum
– Genitalia
– Neurological system
– Musculoskeletal system
may be deferred depending on reason for
admission
Preparation of patient and environment for

Physical Examination:
– Physical examination is done after the
collection of health history is obtained.
– wash your hands before and after the III. Palpation- it is touching of the body or a
examination body part with hands to note the size and
– Provide a well lighted, and warm area. position of the organs
– warm your stethoscope in your hand
– Have patient change into a gown.
– Respect the patient. Privacy at all times.
Close doors, pull curtains, keep body
parts covered.
– Explain what you are going to do, obtain
individuals concern.
– Wear gloves when you may be exposed
to blood and body fluids.
Articles required for physical examination

– Stethoscope
IV. Percussion- It is the examination by
– Bp apparatus
tapping the fingers on the body to
– Flashlight determine the condition of the internal
– Reflex hammer organs
– Pulse oximetry
– Tuning fork
– Gloves
– Neurological exam tray
– Inch tape
– Weighing Machine
– Height Scale
– Pain Scale
296

Head-Toe-Assessment
Assessment conducted by ____________________________
LOC
☐ Alert ☐ Drowsy ☐ Lethargic ☐ Stuporous ☐ Coma
Orientation
☐ Person ___________________________
☐ Place ___________________________
☐ Time ____________________________
Situation ____________________________
Vitals
☐ Temp ___________________________ ☐ R __________________
☐ BP _____________________________ Pulse Ox _______________
Head
☐ Hair
☐ PERLA_________________________________mm
☐ Nose __________________________________
☐ Ears __________________________________
☐ Mouth ________________________________
• Midline tongue ______________________
• Moist _____________________________
• Lesions ____________________________
• Dentition __________________________
Neck
☐ Carotid Pulse _______________ ☐ JVD + ☐ Trachea midline
Chest
☐ Apical pulse _________ ☐ Muffled ☐ Arrhythmia
☐ Breath sounds. Anterior ___________________
Posterior ____________ Lateral ______________
☐ Chest symmetry ___________________________
☐ Skin Turgor (Clavicle) ______________________
Abdomen
☐ Inspection
☐ Ausculation
• LUQ (active / hypter / absent)
• RUQ (active / hypter / absent)
• LLQ (active / hypter / absent)
• RLQ (active / hypter / absent)
☐ Palpation ______________________
Upper Extremities
☐ Radial pulses equal, +2
☐Other: _________________________
☐ Temp vs. trunk (warm/cool)
☐ Grip equal and strong ___________
☐ Capillary refill <3 sec
297

☐ Vein filling rapid
________________________________
________________________________
Date: ___________________
Time: ___________________
Lower Extremities
☐ Hair present
☐ Edema _______________________
☐ Foot strength
☐ Homain’s (+/-) Claudication (+/-)
☐ Temp Vs. Trunk (warm / cool)
☐ Nails ☐ Yellowed ☐ Thickened ☐ Ingrown
______________________________________________________
Pedal pulse R (palp /doppler) L (palp/doppler)
ROM Strength
☐ Upper R __________________ ☐ Upper R __________________
☐ Upper L __________________ ☐ Upper L __________________
☐ Lower R __________________ ☐ Lower R __________________
☐ Lower L __________________ ☐ Lower L __________________
☐ Sensation ___________________________________________________________
___________________________________________________________________
General Assessment
☐ Weight/Height
☐ BM
Pain Assessment
☐ Acute/Chronic Intensity (0-10)
☐ Location ____________________________
☐ Duration ___________________________
☐ Characteristics _____________________
☐ Precipitation _______________________
☐ Frequency _________________________
☐ Non-verbals _______________________
☐ Relief factors ______________________
☐ Sleep _____________________________
Skin Assessment
☐ Description: __________________________________________
__________________________________________
__________________________________________
____________________________________
____________________________________
SUMMARY
Health assessment is very important in any health care settings. It includes health history and
complete physical examination. To get a clear picture of the client health status and health related
problems.
298

Practical 2
RYLE’S TUBE FEEDING
Meaning Equipments Required

Ryle’s tube feeding is a very useful method • Disposable gloves (1)
of ensuring adequate intake of fluid and • Feeding solution as prescribed
nutrients through a tube in to the intestinal • Feeding bag with tubing (1)
tract, in patients who are unable to use the oral
• Water in jug
route for variety of reasons.
• Large catheter tip syringe (30 ml or larger
Purposes than it) 1
• To provide adequate nutrition • Measuring cup (1)
• To give large amounts of fluid for • Clamp if available (1)
therapeutic purpose • Paper towel as required
• To provide alternative manner to some • Doctor’s Prescription
clients who has potential or difficulties • Stethoscope
S No Action Rational
1 Assemble all equipments and supplies after checking Organization facilitates accurate skill
the Dr.’s Prescription for tube feeding Performance
Checking the prescription confirms
the type of feeding solution, route,
and prescribed delivery time.
2 Prepare formula: Feeding solution may settle
In the type of can: and requires mixing before
Shake the can thoroughly. Check expiration date administration.
In the type of powder Out-dated formula may be
Mix according to the instructions on the package, contaminated or have lessened
prepare enough for 24 hours only and refrigerate nutritional value.
unused formula. Label and date the container. Allow Formula loses its nutritional value
formula to reach room temperature before using. and can harbour microorganisms if
In the type of liquid which prepare by hospital or kept over 24 hours.
family at a time Cold formula cause abdominal
Make formula at a time and allow formula to reach discomfort or sometimes diarrhea.
room temperature before using.
3 Explain the procedure to the diet Providing explanation fosters client’s
cooperation and understanding
299

4 Perform hand hygiene and put on disposable gloves To prevent the spread of infection
if available
5 Position the client with the head of the bed elevated This position helps avoiding
at least 30 degree angle to 45 degree angle aspiration of feeding solution into
lungs
6 Determine placement of feeding tube by: Aspiration of gastric fluid indicates
Aspiration of stomach secretions that the tube is correctly placed in
Attach the syringe to the end of feeding tube the stomach
Gently pull back on plunger The amount of residual reflects
Measure amount of residual fluid gastric emptying time and indicates
Return residual fluid to stomach via tube and whether the feeding should continue.
proceed to feeding Residual contents are returned to
the stomach because they contain
Nursing Alert valuable electrolytes and digestive
If amount of the residual exceed hospital protocol or enzymes.
Dr.’s order, refer to these order In the case of non present of residual,
you should check placement
carefully.
Residual over 120 mL may be caused
by feeding too fast or taking time
more to digest. Hold feeding for 2
hours, and recheck residual.
Injecting 10 – 20 ml of air into tube Inject 3-5mLof air for children
Attach syringe filled with air to tube A whooshing or gurgling sound
Inject air while listening with stethoscope over left usually indicates that the tube is in
upper quadrant the stomach
7 Taking an x-ray or ultrasound It may be needed to determine the
tube’s Placement
Intermittent or Bolus feeding Rapid feeding may cause nausea and
Using a feeding bag: abdominal cramping.
Feeding the following Water clears the tube, keeping it
1) Hang the feeding bag set-up 12 to 18 inches above patent.
the stomach. Clamp the tubing. Clamping when feeding is completed
2) Fill the bag with prescribed formula and prepare prevents air from entering the
the tubing by opening the clamp. Allow the feeding stomach
to flow through the tubing
Re clamp the tube.
3) Attach the end of the set-up to the gastric tube.
Open the clamp and adjust flow according to the
Doctor’s order.
4) Add 30-60 ml of water to the feeding bag as
feeding is completed. Allow the flowing to basin.
5) Clamp the tube and disconnect the feeding set-up.
300

Using the syringe:
Feeding the following
1) Clamp the tube. Insert the tip of the large syringe
with plunger, or bulb removed into the gastric tube.
2) Pour feeding into the syringe
3) Raise the syringe 12 to 18 inches above the Gravity promotes movement of
stomach. Open the clamp. feeding into the stomach
4) Allow feeding to flow slowly into the stomach. Controlling administration and flow
Raise and lower the syringe to control the rate of rate of
flow. feeding prevents air from
5)Add additional formula to the syringe as it entering the stomach and nausea
empties until feeding is complete and abdominal cramping from
developing
8 Termination of feeding: To maintain patency of the tube
1) Terminate feeding when completed. Elevated position discourages
2) Instil prescribed amount of water aspiration of
3) Keep the client’s head elevated for 20-30minutes. feeding solution into the lung
9 Mouth care: Mouth care promotes oral hygiene
1) Provide mouth care by brushing teeth and provide comfort
2)Offer mouthwash
3)Keep the lips moist
10 Clean and replace equipment to proper place To prevent contamination of
equipment and prepare for the next
procedure
11 Remove gloves and perform hand hygiene To prevent the spread of infection
12 Document date, time, amount of residual, amount Documentation provides continuity
of feeding, and client’s reaction to feeding. Sign the of care
chart Giving signature maintains
professional accountability
CONTRAINDICATIONS REFERENCE
Absolute contraindications SanjitaKhadka et al,(2008) Fundamental of
• Severe mid face trauma Nursing Procedure Manual, 1st edn. Japan
• Recent nasal surgery International CooperationAgency (JICA):
Nepal, pg - 104
Relative contraindications
• Coagulation abnormality
• Oesophageal varices or stricture
• Recent banding or cautery of oesophageal
varices
• Alkaline ingestion
301

Practical 3
INSTRUMENTS
INSTRUMENTS Uses
TOOTHED DESECTING FORCEPS
• Easily grasp small objects and tissues to

move and release it.
• To hold the tissues
RETRACTOR
• To separate the edges of a surgical incision
or wound
TOOTHED DESECTING FORCEPS
• To protect from contamination.
CHEATLE FORCEPS OR TRANSFERING

FORCEPS
• Transfering of sterile articles and
equipments from one to another and pick
autoclave articles
ALLIS TISSUE FORCEPS

• To hold the skin
• To pick up a fold of peritoneum during
laparotomy
• To hold linea alba while closing midline
incision.
302

ARTERY FORCEP
• To grasp vessels and allow ligation of those
vessels
• May also used to grasp tissues, sutures and
other prosthetic materials.
SPONGE HOLDING FORCEPS
• Handle sponges, gauze and sensitive

materials
THUMB FORCEPS
• Used for grasping, compressing, cutting,

pulling tissue.
SUTURE REMOVAL SCISSORS
• To remove sutures on skin and mucous

membrane
NEEDLE HOLDING FORCEPS OR NEEDLE

HOLDER
• To hold or grasp curved needle during

various suturing procedures
BARD PARKER HANDLE OR BP HANDLE

• To hold the scalpel.
• To cut skin, tissue and vessels
• For sharp dissections
303

Practical 4
DIET FOR VARIOUS CONDITIONS
ANTENATAL DIET MENU CARDIAC DIET MENU
RECEIPIE NAME: AMARANTH RECEIPIE NAME: SALAD

KEERAI CURRY
Ingredienets Quantity
Ingredienets Quantity Lettuce leaves 100 gms
Amaranth keerai 200 gms Carrot 25 gms
Onion, big 50 gms Beans 25 gms
Green chillies 10 gm Green peas 25 gms
Coconut scraping 20 gm Salt To taste
Oil 10 gm Lemon juice 1 no
Salt 1 tsp White pepper A little

Beet root 25 gms
Nutritive value / serving
Cucumber 25 gms
Calories 300Kcal
Proteins 10 gms Nutritive value / serving
Calcium 850 mgs Calories 140 Kcal
Iron 8 mgs
Proteins 8.7 gms
Carotene 11,000 µg
Vitamin C 210 mg Calcium 280 gms
Iron 20 gms
Method of preparation
B.carotene 3500 µg
Pick and wash amaranth keerai leaves.
Chop the amaranth, onions and green chillies. Method of preparation
Heat the oil in a kadai. Sauté the chopped onion,
Steam cook beet root slices, green peas
and green chillies. Add the chopped amaranth,
and beans. Slice cucumber. Grate carrots.
salt and cook till soft. Sprinkle the coconut
Place lettuce leaves as the outer ring. Arrange
scrapings and serve it hot.
cucumber slices on the next circle. Next comes
the beet root slices. Place carrot, beans and peas
in the centre. Squeeze the lime juice over this.
Sprinkle salt and pepper and serve.
304

TYPHOID FEVER DIET MENU PEPTIC ULCER DIET MENU
RECEIPIE NAME: WHEAT RECEIPIE NAME: CURD RICE

PORRIDGE
Maize noodles 10gm
Wheat 100 gms
Mustard 2 gm
Milk 100 ml
Curry leaves 2 gm
Honey For taste
Coriander leaves 2 gm
Calories 341 Kcal Curd 100ml
Proteins 41.1 gms Oil 5 ml
Iron 11.5 mg Salt To taste
Pepper A little
Soak crushed or shredded wheat for ½ an
Calories 92 Kcal
hour. Cook on slow fire till water dries up. Add
milk and honey. Proteins 4.24 gms
Iron 0.62 gms
HYPERTENSION DIET MENU B.carotene 251 µg
RECEIPIE NAME: GREEN GRAM Cook the noodles and keep it aside. Season
IDLY with mustard, and curry leaves, mix with curd.
Ingredienets Quantity Add the cooked noodles to the seasoned curd
and mix well. Garnish with coriander leaves.
Green gram 150 gms
Boiled rice 50 gms
RENAL MENU
Calories 510 Kcal
RECEIPIE NAME: BREAD
Proteins 36 gms SANDWHICH
Method of preparation Nutritive value / serving
Soak green gram and rice for 1 hour. Ingredienets Quantity
Then grind together for 15 – 20 minutes. Add Bread 5 slices 100 gms
salt as required. Keep this flour for ½ hour.
Egg 1 (40 gms)
Then make it as idly in idly pan. Can take
with jaggery Butter 10 gms
Pepper A little
Salt A little
305

Calories 413 Kcal Method of Preparation
Heat oil. Add chopped onion, green
Proteins 13.7 gms
chillies, green coriander and curry leaves
Iron 3.7 gms and fry. Add water and salt. When the water
Calcium 160 mg comes to boil add rawa and stir continuously.
B.carotene 46 µg When the water evaporates remove from fire
and serve.
Method of preparation:
Half boil the egg. Remove the shell. DIET FOR FEVER
Blend the half cooked, semi solid egg to get
smooth mixture. Add salt and pepper to this
and mix well. Spread the buttered side of one RECEIPIE NAME: WHEAT
slice. Place the buttered side of the second PORRIDGE
bread slice. Cut diagonally (Remove the crust Nutritive value / serving
of the bread).
Wheat rawa 150 grms
DIABETIC DIET MENU
Water 900ml
Salt To taste
RECEIPIE NAME: WHEAT
UPPUMA
Calories 525 Kcal
Nutritive value / serving Proteins 18 gms
Ingredienets Quantity Iron 16 gms
Wheat rawa 75 grms Calcium 30 gm
Onion 2 no B.carotene 45 µg
Green chillies 2 no Method of preparation
Mustard ½ tsp Boil water. When it comes to a boil add
Salt To taste wheat rawa. When the water is reduced to half
Oil 2 tsps its volume, if the wheat is cooked add salt and
remove from fire.
Green coriander A little
Curry leaves 1 spring
Water 225 ml
Calories 377 Kcal

Proteins 8.5 gms
Iron 1.5 gms
Calcium 187 mg
B.carotene 385 µg
306

Practical 5
PERFORMING AN ANTENATAL
ABDOMINAL EXAMINATION
• To determine abdominal muscle tone.

Definition
• To determine the fetal position,
Examination of a pregnant woman to presentation, volume of liquid.
determine the normalcy of fetal growth in • To observe the signs of pregnancy.
relation to the gestational age, position of fetus • To detect any deviation from normal.
in uterus and its relationship to the maternal
• To assess the fetel well being/
pelvis.
• To measure the abdominal girth.
Purposes
Articles
• To measure the SFH (Symphysis fundel
height) and fundal height. • Fetoscope/stethoscope
• To assess fetel size and growth. • Measuring tape

• Tray contains / Sheet, Towel
Procedure
S No Nursing action Rational/scientific principle

1. Explain the procedure and obtain her consent. Reduces anxiety and promotes relaxation
Avoids discomfort during palpation.
2. Instruct her to empty the bladder
3. Position the women
4 Expose her abdomen from below the breast to Visualization of the whole abdomen.
the symphysis pubis.
5. Inspect abdomen for scars, linea nigra, size It provides whether fetal growth
straie gravidarum, contourof abdomen, shape, corresponds to gestational period.
state of umbilicus and skin condition.
6. Determine the fundal height using the ulnar The number of centimeter measured
side of the palm. Measure fundal height using should be approximately equal to the
the inch tape. weeks of gestation after 24 weeks.
7. Measure the abdominal girth by encircling the Normally the measurement is 2 cm less
woman’s abdomen with a tape measure at the or more than the weeks of gestation (eg)
level of umblicus. 32 cm or 36 cm in 34 weeks gestation
Abdominal palpation: Cold hands may cause muscle
Hands are warm before palpation. contraction and discomfort.
307

8 Fundal palpation Round, hard regular mass – head .
Place the hands on the side of fundus and Irregular, less firm and not well defined –
around the top of the uterus. buttocks
9. Lateral palpation: A firm continues smooth curvature - it
Place the hands on both sides of the uterus indicates back or spine of fetus.
midway between symphysis pubis and the An irregular felt (nobby) parts – fetal
umbilicus. extremities
10. Pawlik’s grip: Fetal head above the brim – head is
Grasp the portion lower abdomen above the movable.
symphysis pubis between thumb and middle Fetal head not movable – engaged head.
finger.
11. Pelvic palpation: To determine the level of engagement
12. Auscultation: To hear the fetal heart sounds.
Place the fetoscope over the convex portion of
the fetus close to the anterior uterine wall.
13. Inform the mother about the findings and make It promotes confidence.
her comfortable.
14. Replace the articles and wash hands. Helps in further planning.
15. Record the findings in the patient’s chart (the
time, findings and remarks.)
EASUREMENT OF UTERINE
M Purposes
INVOLUTION • To identify abnormality
• To rule out infection.
Definition: Involution • To estimate the rate of uterine involution
Assessing the state of the uterus in post- take place.
delivery period as it returns to pre-gravid Equipment Required
state.
Screen, Inch tape, Clean gloves.
Procedure
Nursing action Rational/ scientific principle

Explain the procedure to the patient. Enhances cooperation
Save time and energy.
Assemble necessary articles at bed side.
Ensure the bladder is empty. Full bladder may cause upward displacement of
uterus
Drape the client exposing only lower abdomen. provides comfort to the women
Locate fundus with palm of one hand. Support and stabilize uterus.
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Firmly press abdomen towards the spine & then
slightly downward towards the perineum.
Measure the number of finger breaths at which Finger breath measurement correspond to the
the fundus is felt. number of days after delivery.
Day 1 : 10 – 12 cm
Day 5 : not palpable
With gloved hand check perineal pad for type,
amount color of lochia
Provide perineal care and provide clean pad. Maintains hygiene & prevents infection.
Prevents spread of microorganism.
Replaces the articles & wash hands. Documentation helps in obtaining a clear picture
about involution of uterus.
Mark the fundal height in patients record.
Practical 6
CHILD HEALTH NURSING
nthropometric Measurement
A The following measurement which is
of Children commonly used for assessment of children is
discussed in this unit.
Anthropometrics are a set of non-invasive,
quantitative body measurements used to assess • Weight
growth, development, and health parameters. • Recumbent length or height
The word “anthropometry” is derived from • Head circumference
the Greek word “anthropo” meaning “human” • Chest Circumference
and the Greek word “metron” meaning
• Mid arm Circumference
“measure” (Ulajaszek, 1994). Anthropometric
measurements, including length or height, Purposes of Anthropometric measurements
weight, and head circumference, it helps
• To assess the general health status of the
health care providers determine if a child is
child
growing properly and can indicate when the
• To assess the general nutritional status
children health and well-being are at risk.
Additionally, anthropometric measurements Measurement of Weight
assist in selecting appropriate treatment Quantitative expression of body mass,
options for children and adolescents. which indicates state of growth and health, is
309

measured in kilograms or pounds using adult
or infant weighing scale.
Nursing Alert
Children less than 2 years of age –
Weigh the child without clothes or a diaper
using a digital infant scale. Position child
in the center of the scale tray and read the
measurement to the nearest 0.1 kg.
Children more than 2 years of age –
Weigh the child on an electronic floor scale
Keep the weighing scale on hard and firm
with increments less than or equal to 0.1 kg.
surface.
Weigh young children without shoes and
1. Clean the weighing scale with duster
wearing underclothes only, unless privacy
cannot be assured. For older children and 2. Spread a towel or disposable lining on the
young children when privacy is a concern, scale
weigh the child wearing minimal inner 3. Balance the scale to read zero
clothing and without shoes. Request child 4. Place the weighing scale close to the wall
or adolescent stand in the center platform to prevent the child from falling
of the scale and remain motionless until the 5. Instruct the mother to stand beside the
measurement can be obtained. Measure the scale
weight to the nearest 0.1 kg.
6. Undress the child before weighing leaving
diaper alone
Purposes
7. Place the infant on the scale
• o check whether an infant/child has
T
8. Place the left hand over the infant without
adequate weight for age
touching
• To calculate nutritional requirements
9. Note the weight
• o calculate the quantity of intravenous
T
10. Lift the infant from the scale and help the
fluids and medications
mother to dress the infant
• o monitor the progress of weight gain or
T
11. Check and compare previous weight
loss following treatment
12. Difference of more than 100 gms, needs
Required articles to be clarified by rechecking the infants
• Infant weighing scale-infantometer or weight immediately. If the difference is
Electronic floor scale still the same, it should be informed to the
• Towel or disposable lining doctor concerned.
• Duster 13. If the weight is in pounds and it must be

converted to kilograms using conversion
• Paper and pencil for calculation
table.
Procedure 14. Document the weight. 1 Kg = 2.2 lbs
In case of a child less than 2 years of age
including Infant
310

In case of a child more than two years of age standing height and add 0.7 cm to convert
it to length. If a child aged 2 years or older
cannot stand, measure recumbent length and
subtract 0.7 cm to convert it to height.
Equipments needed
• Length board or Infantometer
• Height scale or Stadiometer
Measurement of recumbent length

1. Place the Electronic floor scale on the
firm surface
2. Provide privacy
3. Undress the child allowing only minimal
clothing (inner clothing).
4. Remove shoes/slippers
5. Adjust the scale to read zero 1. Place a length board on a flat, stable
6. Request child or adolescent stand in the surface such as a table.
center platform of the scale 2. Cover the length board with a thin cloth
or soft paper for hygiene and for the baby’s
7. Ask the child remain motionless until the
comfort.
measurement can be obtained.
3. Lay the child on his back with his head
8. Measure the weight to the nearest 0.1 kg.
against the fixed headboard, compressing
9. Check and compare previous weight the hair.
10. If the weight is in pounds and it must be 4. Quickly position the head so that the
converted to kilograms using conversion child’s eyes should be looking straight up.
table. 5. Ask the mother or helper to move behind
the headboard and hold the head in this
Measurement of Length/Height position.
A child’s length is measured in lying down 6. Stand on the side of the length board
position (recumbent). Height is measured in where you can see the measuring tape
standing upright position. 7. Check that the child lies straight along the
board and does not change position.
Nursing Alert 8. Shoulders should touch the board, and
If a child is less than 2 years old, measure the spine should not be arched.
recumbent length. 9. Hold down the child’s legs with one hand
If the child is aged 2 years or older and and move the footboard with the other.
able to stand, measure standing height. 10. Apply gentle pressure to the knees to
straighten the legs as far as they can go
In general, standing height is about
without causing injury.
0.7 cm less than recumbent length.
11. If a child is extremely agitated and both
If a child less than 2 years old will not legs cannot be held in position, measure
lie down for measurement of length, measure with one leg in position.
311

12. While holding the knees, pull the 8. If necessary, push gently on the tummy to
footboard against the child’s feet. The help the child stand to full height.
soles of the feet should be flat against the 9. Still keeping the head in position, use your
footboard, toes pointing upwards. other hand to pull down the headboard
13. Read the measurement and record the to rest firmly on top of the head and
child’s length in centimetres to the last compress the hair.
completed 0.1 cm. This is the last line that 10. Read the measurement and record the
you can actually see. (0.1 cm = 1 mm) child’s height in centimetres to the last
14. Remember: If the child whose length you completed 0.1 cm This is the last line that
measured is 2 years old or more, subtract you can actually see. (0.1 cm = 1 mm)
0.7 cm from the length and record the 11. Remember: If the child whose height you
result as height. measured is less than 2 years old, add 0.7
cm to the height.
Measurement of Height
Articles required for measuring
circumference
• Inch tape / measuring tape
• Marker pen
• Paper for recording.
Measurement of Head Circumference

1. Place light drape or paper on flat surface
2. Place infant/child in supine position or
seated on paper drape if the child could sit.
3. Use a measuring tape that cannot be
1. Mount a stadiometer at a right angle
stretched
between a level floor and against a straight,
vertical surface such as a wall or pillar. 4. Place tape measure over the most
2. Ensure that the height board is on level prominent point of the occiput, around
ground. the head just above the eyebrows and
3. Remove shoes, socks and hair ornaments pinna. This point should be taken as head
from the child. circumference.
4. Help the child to stand on the baseboard 5. Take the measurement to the nearest 0.1 cm
with feet slightly apart. The back of the
head, shoulder blades, buttocks, calves,
and heels should touch the vertical board.
5. The trunk should be balanced over the
waist, i.e., not leaning back or forward.
6. Ask the mother/helper to hold the child’s
knees and ankles to help keep the legs
straight and feet flat, with heels and calves
touching the vertical board.
7. Position the child’s head by holding your
thumb and forefinger over the child’s chin.
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Measurement of Chest Circumference between the acromion and olecranon is
32.6cm then the mid-point mark should
be drawn at16.3cm).
5. This marks the level at which the
circumference will be measured.
6. Ask the child to relax and to keep their arm
hanging by their side. This is important as
a very different reading may be obtained
if the arm is not fully relaxed.
Place tape measure underneath the
back of baby/child and bring it to front 7. Align the tape around the upper arm
measured at nipple line gives the chest such that the mid-point mark is situated
circumference. between the two parts of the tape. Ensure
the tape is horizontal. Make sure the tape
Measurement of Mid-Arm Circumference is not pulled too tight. It should rest on
the skin but not indent it.
8. Make measurement of mid upper arm
circumference and record it.
Success story of a baby born

preterm
Baby Vinay (name changed) was born
on October 23, 2014 at 4.24 pm by emergency
c-section, weighing 1.8 kg and 36.5 cm long
at 30 weeks of gestation. Since he was a
preterm as well as a low birth weight baby,
he was kept in Neonatal Intensive Care Unit
for further management. He was connected
1. Instruct the child to stand with their back to a ventilator to maintain his breathing
to the measurer and their arms hanging and oxygenation. He had a very bad case of
by their sides. jaundice and was on phototherapy. He could
2. Palpate for the acromion process and not suck breast for milk. So he was put on
mark. Ryle’s tube and he was fed with expressed
breast milk. His mother pumped breast milk
3. With the child’s arm flexed at 90°, palpate
for Baby Vinay. It took two weeks to hold
for the olecranon (tip of the elbow) and
the baby, cuddle and gently caress the child.
mark
Meanwhile, he got treated for his infections.
4. Using a tape measure, measure the distance It was a hard and long journey for Vinay to
between the mark at the acromion and the come out of NICU. Now he has grown to
mark at the olecranon. Whilst still holding be a 4 years old healthy baby without any
the tape in place, make a short horizontal complications. He is able to perform all the
line at the mid-point. This line marks the activities as expected from a 4 year old. He is
middle of the upper-arm (i.e. if the tape making his mommy and daddy very proud!
measure shows that the measured distance
313

Practical 7
HOME NURSING
Home is always associated with comfort, security and positive feeling.
Learning Objectives
➢➢ On completion of this chapter the learner will be able to

➢➢ List out the purpose the health assessment
➢➢ Describe the technique followed during physical assessment
Definition
Introduction
A home is where you feel cared for and Home care (Domiciliary care)
comfortable. Elderly persons choose to be at 1. Home care is the supportive health care
home than cared in the hospitals during acute provided in the home.
and chronic illnesses. Home nursing services 2. Home Care may be provided by licensed
comprises a wide range of health care which health care professionals who provide
can be handled easily at home. The services medical treatment or by professional
provided are based on the needs of the caregivers who provide daily assistance to
individual and family. Home care is planned, ensure the activities of daily living are met.
coordinated and made available by providers
organized for the delivery of home care. Purposes of Home health care
Recently there has been a shift of community 1. Promotion, maintenance and restoration of
based care. The nurse is a valuable team health
member home health care service.
2. Minimizing the effects of illness and
disability
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3. Prevention of disease • Vaccination against infectious diseases
4. Treatment of illness such as H1N1, Typhoid and Hepatitis
5. Relief of suffering and promoting the • Post operative care - pain, feeding,
comfort of the client respiratory and fluid management
6. Support and assurance to patient and family • Urinary Catheterization Care
• Oxygen Administration
Principles of Home care
• Injections or IV infusion
1. Establish good interpersonal relationship
• Physiotherapy
with family and others.
2. Collect information regarding the family Advantages of home health care
size, education, occupation, religion, 1. Cheaper
customs, and traditions. 2. Effective
3. Identify the health problem and set Priorities 3. Personalized nursing care at home setting
to deal.
4. Convenient
4. Proper Health Education
5. Helps to recover faster
5. Help the family members to plan and carry 6. Gives an older adult a some of independence
out the needed action. by offering an important measure of control
6. Help the family to meet their needs and over day to day events.
to improve the health, nutrition and the 7. Home care improves quality of care provided
welfare of the family. and increased patient satisfaction.
7. Coordinate with Health Care team.
Role of a Nurse in Home care
Types of Home Care 1. Monitor vital signs
1. Home based Primary care 2. Regular monitoring of the treatment course.
2. Transitional care 3. Pain management and relief from
3. Population focused Home care discomfort.
4. Hospice care 4. Provision of safety measures at home.
5. Educate the patient and family members
Persons Who Provide Home care
regarding self care.
a) Registered Nurse
6. Coordinate and communicate with the
b) Physiotherapist
doctor regarding the course of treatment.
c) Occupational Therapist
Conditions which can be dealt in the home. 1. Care of the sick in the Home
• Wound Care - Pressure sores or Surgical The health personal may be called to see
wound the person who is sick in the home and realizes
• Care of the old age and handicapped the individual needs of the family members and
persons take care of them according to the needs.
• Patient and caregiver education (Health Assess the Patient carefully in good light
Education)
• General appearance
• Intravenous Nutrition therapy
• Colour of the skin, eyes or any other signs
• Rehabilitation therapy of illness
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• Assess the condition of ears, mouth, 3. To carry out selected procedure,
tongue, throat and tonsils demonstrations, teaching and follow up
• Observe for any other gland enlargement services for patients and family
and discomfort in abdomen members
• Observe for any wound, swelling, scars,
patches, sores, rashes or loss of sensation Principles
and behaviour 1. The use of the bag technique should
• If it is a child, observe road to health card minimize prevent the spread of infection
and immunization status from individuals to families, hence, to the
community
Role of Nurse 2. Bag technique should save time and effort
• Give treatment depending upon the 3. Bag technique should show the effectiveness
nursing diagnosis as per the standing order. of total care given to an individual or family.
• Measures to relieve symptoms such cold
compress, hot water bag, eye care, etc., The Bag
Refer if any sign/symptom which cannot 1. The bag should be made of canvas, leather
be managed at home. BAG TECHNIQUE or light metal.
The Community health bag is designed 2. It should be such that it can be carried by
to carry equipment and material needed the hand or on the shoulder.
during a visit to the home, school or factory.
3. The bag should have outside pockets
Equipment and material are needed to make
for keeping a not-book, tape measure,
tests and to demonstrate patient care such as
newspaper or plastic sheet, towel, soap in a
eye irrigation, application of ointments and
soap dish and nail brush.
medications. (TNAI)
It contains basic medications and articles
USES
which are necessary for giving care.
1. Provide antenatal, intra natal and postnatal
Objective care to mother and child.
2. Perform certain diagnostic procedures
The objective of using community health
such as Hb testing, urine testing for early
bag in a systematic method is “to be able to
detection of high risk cases and provide
carry out nursing procedures in the family
timely treatment.
with improvised equipments articles available
at home. 3. Demonstrate certain Procedures to family
members or community such as preparing
Purposes oral dehydration solution (ORS),baby bath,
1. To prevent carrying of infection from one application of benzyl benzoate in cases of
patient to another and from one place to scabies.
another by keeping bag and its contents as 4. Provide emergency and first aid services
clean as possible. (+) in case of accidents and minor
2. To demonstrate the principles of cleanliness ailments. Provide and demonstrate care
to patients and family members by using in case of communicable diseases such as
the bag in orderly way. chickenpox.
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5. Provide follow up services in chronic illness 10. Replace cotton or plastic bags containing
such as diabetes, paraplegia or amputation. swabs and dressing with sterile one.
Access the need of individual and families 11. Check gloves, catheters, thermometer and
and give health education in care of glass articles, replace if spoilt or broken.
malnutrition, environmental hazards, home 12. Repack the bag in an orderly way.
accidents and immunization etc.
13. Keep the bag ready for next visit with all
Outer pocket: is used for keeping a equipment.
dairy to maintain records, clean paper bags
Topics for Health Education
and a square piece of newspaper or plastic
sheet to keep the bag on. The other one is 1. Cause of illness
used for keeping things for hand washing.
2. Cleanliness and disinfection
Internal Compartments - These are used for
3. Good ventilation
keeping solutions and medicines for internal
and external use, simple instruments for 4. Rest and sleep
dressing, articles for certain procedures such 5. Proper Diet
as temperature taking, urine testing, antenatal 6. Nursing Care such as change of positions to
examination and few additional things for prevent bedsore.
health teaching
Community health nurse is responsible to
Procedure provide primary health care in the community
1. Spread the news paper on a flat surface and Treatment of minor ailments and emergencies
place the bag in a clean area and place the is an important component of community health
bag on it nursing. Nurse should be able to identify the
2. Wash the hands with soap and water signs and symptoms of a patient and treat them
according to the standing orders.
3. Take out only the needed things to carry out
the procedure. Standing orders are the specific
instructions which should be followed during
4. Record all relevant findings about the client
the non availability of doctors, nurses only to
and members of the family.
supply and/or administer prescribed medcines
5. Take note of environmental factors which
and some controlled drugs It should be followed
affect the clients/family health.
in temporary basics / or in emergency situation.
6. Assess effectiveness of nursing care provided.
General standing orders. Eg – in case of
7. Clean the bag daily, protect from excessive diarrhea – ORS PACKET
heat or rain to reserve it in a good condition.
8. Replace the drugs, dressing General Minor Ailments
and linen daily in the bag. • Injuries and Falls
Empty all the contents, wash the bag with • Dog Bite
soap and water once in a week or more • Burns
frequently depending on how much it has
• High Fever
been used and dry it the sun.
• Heat Stroke
9. Wash the articles such as instruments, linen
and utensils with soap and water and boil them. • Diarrhea
• Fainting Etc
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Assessment of Minor Ailments S.No Action
1. Collect history 1. DIARRHOEA
2. Perform quick physical examination Monitor the symptoms of
3. Find out the cause dehydration
4. Find out the diagnosis and planning for care If the dehydration is severe
5. Provide treatment and nursing care or the patient is in the state
of shock – refer him to
6. Evaluate the care and condition of the patient
hospital
• If the outcome is successful ,plan for follow up Provide ORS to the patient
• If condition does not improve or serious Rice water, coconut water,
signs – refer to hospital lemon juice, light tea,
banana should be given to
FEVER the patient
S.No If there is epidemic of
Procedure Steps Action
diarrhea sample should be
1. Monitor vital signs send for stool test
2. Collect all information If cholera is prevalent
about other symptoms immunization should be
accompanying the fever – taken
head ache , nausea , vomiting, Food and water should be
shivering cold running nose, protected
allergy , skin infection,
Notification should be done
jaundice, fits, cough
2. INJURIES AND FRACTURES–SKELETAL
3. Provide rest and light meal to
Clean the wound with soap
the patient
and water
4. Prepare blood slide to
examine malaria parasite Apply the spirit around the
place of wound
5. Give paracetamol tablet as
per order Apply Betadine solution
6. Give lots of liquids to the and bandage the wound
patient with sterile solution
7. If the fever is more than 102 Monitor the condition of
deg F – tepid sponge the patient
8. Monitor the pattern of fever Treat the patient for shock
and wait for two days Immobilize the fractured
9. If the fever is accompanying area
with rashes- isolate the
Give analgesic and TT
patient
In case the wound is large
10. In case of delirium,
and need suture , or caused
convulsions, unconsciousness
by bullet or weapon refer to
and hyperpyrexia
hospital
accompanying the fever refer
the patient to the hospital
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Standing orders for MCH CARE Unconsciousness
Give tablets to check Lie down the person in a
vomiting and nausea in well ventilated area
early stages of pregnancy Remove dentures
In case of toxemia of Clean the secretions from
pregnancy , advice her mouth
restricted salt diet and Loosen the clothes from
complete rest neck, chest and waist
Send to hospital if there is Provide artificial
edema/ APH / PPH respiration in case of
If the mother develop blocked breathing
fever after delivery try to Try to find out the reason
ascertain the cause
Keep newborn in proper Role Of Community Health Nursing
warmth 1. History collection / assessment
Initiate breast feeding
2. Finding out the actions/ complications and
Convulsions in children any specifications
Lie down the child safely on 3. Vitals monitoring
a bed
4. Identifying the needs and problems
Loosen the clothes from 5. Nursing services under standing orders
the chest and let the fresh
6. Implementing referral system
air pcome
7. Informing authorities – outbreak of diseases
Clean the secretions from
his mouth and let the 8. Keeping medicine kit ready
respiratory tract function 9. Representing nurses view point in meting
properly 10. Being careful about limits
In case of fever give cold 11. Ensure safe and healthy environment
sponge
Evaluate the cause Wound Care
Hemorrhage
Wound
Lie down the person on back
Take BP A wound is any break in the skin or deep
Press a pad on the site of tissue. Normally the skin heals quickly on its
bleeding own. Wounds that don’t heal easily are called
chronic wounds. They require special care to
Give him liquids
heal.
Try to find out the cause of
bleeding Care of the Feet for Diabetic patients at Home
Monitor the state of shock People who have Diabetes are vulnerable
and in case of bleeding or to nerve and vascular damage that leads to
condition of shock getting loss of sensation and poor circulation which
out of control send the results in poor wound healing mostly feet is
patient for further treatment
319

affected. Foot care aims in reducing damage 8. Be gentle when washing feet. ...
from occurring to the feet and regularly 9. Moisturize your feet but not between your
checking feet for any signs of damage. toes.
10. Cut nails carefully.
11. Never treat corns or calluses yourself.
12. Wear clean, dry socks.
Regularly examine the feet for signs

of damage, especially one who is suffering
from poor circulation and numbness.
Purposes
Signs of foot damage:
1. To maintain skin integrity
• Cuts
2. To provide sense of comfort and well being
• Bruising
3. To prevent foot ulcer
• Swelling
4. To identify callus, corns and circulation
• Grazes
problem and treat them early
• Sores
5. To promote self care
• Changes in colour
6. Inspect feet daily.
• Ulceration
• Hard skin
• Any cracking from dry skin.
Articles required
1. Mackintosh
2. wash cloth
7. Bathe feet in lukewarm, never hot, water. 3. Soft towel
4. Wash Basin
5. Warm water
6. Soap
7. Lotion
8. Disposable gloves
9. Nail clippers
S.No Procedure Action

1. Wash hands To prevent
infection
2. Provide a To promote
comfortable comfort
position to the
patient
320

3. Fill the 3/4th Warm water softens 12. Educate the To prevent further
of the basin nails and improves clients to complications
with warm circulation. follow dietary
water 100*F- Make sure that the pattern
104*F. Place water is not too hot To avoid
the Rubber because diabetic smoking and
Mackintosh clients will not have drinking
under the basin sensation in the alcohol
and soak the feet.
client’s feet in Foot examinations
the basin Regular check-up from a health professional
at least once each year. Foot must be examined
4. Allow to soak Softening allows
for the following
feet for 20 easy removal of
minitues dead epithelial • Signs of neuropathy or development of
tissue and prevents neuropathy
the nails from • Blood circulation
crackling. • Any signs of damage
5. Apply soap Soap application Management of Diabetes will help to

and wash and washing prevent from foot complications
thoroughly prevents • An appropriate treatment regime
dirt from the feet • Healthy and balanced diet
6. Dry the feet Soft towel is good • Healthy life style, and regular exercise
thoroughly for easy absorption
with soft and drying in What is a diabetic foot ulcer?
towel specially between the toes. It
A diabetic foot ulcer is an open wound or
between the helps to prevent the
sore, commonly located on the bottom of the
toes bacterial growth.
foot, in a patient with diabetes. It may be due
7. Apply water To prevent skin Nerve damage and Blood circulation problems.
soluble lotion break due to the
dryness Wound care
8. Replace the Definition
articles Wound care refers to specific types of
9. Record the treatment for pressure sores , skin ulcers and
procedure other wounds that break the skin. Proper wound
10. Educate and To prevent care is important to prevent infection.
ask the patient complications Dressing is used by a doctor, caregiver and/
to care the feet or patient to help a wound heal and prevent
daily further issues like infection or complications.
11. Explain the Patient may not be Dressings are designed to be in direct contact
dangers of bare aware of the injury with the wound, which is different from a
foot due to the Loss of bandage that holds the dressing in place.
sensation
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Types of Dressing (7 types) Cleaning
1. Hydrogel solutions
2. Colloid (Betadine, To clean the
1.
3. Hydrocolloid Hydrogen wound
4. Alginate peroxide, Normal
saline)
5. Foams
Antiseptic
6. Clothe dressing To apply on the
2. ointment
7. Transparent dressing wound
(Povidone )
To fix the
Purposes of wound dressing Bandages,
3. dressing in its
1. Protect the wound from infectious Adhesive Plaster
site.
microorganisms To transfer the
2. Promote Healing by absorbing drainage 4. Transfer forceps sterile articles
3. Promote homeostasis and dressing
4. Protect the wound site with dressing To prevent the
Vaseline gauze (in
5. dressing sticking
a sterile box)
Articles required for wound care on the wound
To protect and
S.No Articles Purpsose
prevent the
A sterile Tray containing (Dressing pack) 5 Mask, Apron
transmission of
1. Artery forceps - 1 infection
To clean the
Dissecting forceps Sterile swab sticks To apply
2. wound
-2 6. in a container medications if
For debridement necessary
3. Scissors - 1
of the wound Kidney tray To discard the
To keep the 7.
waste
solution for Mackintosh and To protect the
4. A small bowl 9.
cleaning the towel patient and bed
wound
5. Sterile cotton balls Procedure
Sterile Gauze To clean and S.No Action Rationale
6.
Pieces dress the wound Tie the mask To prevent
1.
7. Sterile Pads infection
To protect and Wash hands with To prevent
8. Sterile Gloves
prevent infection soap and water or cross infection
To create a sterile an alcohol-based
9. Sterile Towel area around the hand rub
wound Use sterile gown, To protect
10. Sterile Bandages 2. gloves, etc., as from
A unsterile Tray contains required contamination.
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Gently and slowly Apply the To promote
3. remove the tape or 12 medication as wound healing
dressing. ordered
Lift the edges of Apply the sterile Application of
the dressing toward gauze pieces and cotton on the
13
the center of the cotton pads wound may
4
wound, then gently stick on it.
lift it from the Secure the dressing If it is not
wound. with adhesive fixed properly
14
If the dressing To help loosen plaster it will fall
sticks to the wound, it. down
5.
soak it with saline Proper
solution disposal is
Remove the gloves
Carefully discard important
15 and discard it in to
the old dressing to prevent
6. the waste bin
into a plastic Dust the spread of
bin. (BMW). infection
Remove the gloves To prevent
After care
7. and wash your infection
hands again Help the patient to dress up and take a
comfortable position in the bed. If the bed is
Open the sterile To create a
soiled during dressing, change the bed.
dressing pack and sterile area
8, spread the sterile around the 1. Replace the linen.
towel around the wound 2. Replace the articles in its place.
wound. 3. Remove the mackintosh and towel.
Note the type and 4. Wash hands and record the procedure
9. amount of drainage
5. Ensure the cleanliness of the patient and his
present
surroundings.
Ask the second To maintain
person to pour sterilization
10. Preparation of ORS
sterile solution in
Preparation of ORS treats dehydration
to the sterile bowl
caused by severe diarrhea through the
Clean the wound Cleaning
replacement of fluids. Sugar, salt and water - this
from centre to the should be
simple mixture saves the life. Easy to prepare and
periphery and done from
administer in the home. ORS empowers parents
discard the gauze the cleanest
with the first line of treatment of children
after each stroke. area to the less
11. suffering from diarrhea. ORS pocket is readily
After thoroughly clean area
available which can be prepared by mixing with
cleaning of the To keep the clean water. Put the contents of the ORS pocket
wound, dry the wound as dry in a clean container. Check the pocket and add
wound using the as possible the correct amount of water. When the ORS
same technique pocket is not available, we should prepare ORS
with available things at home.
323

Diarrhea usually cures itself in 3 or 4 Fluid Replacement amount
days with rehydration (Drinking a lot of Vomiting
fluids). Loss of fluid and nutrients from After drinking, the child or adult may
the body which can cause dehydration and vomit the sugar, salt and water. Do not worry.
malnutrition. Continue giving the drink. Give a little more
The best treatment for diarrhea is to to replace what has been vomited, and give
• Drink lots of liquids and Oral Rehydration it very slowly without forcing. Encourage the
solution. It is available in pockets. child to drink a diluted cereal as well as the
sugar and salt mixture. Eating or drinking a
Oral Rehydration Solution cereal food (such as rice or maize) may reduce
The spoon is used for measuring sugar stool volume by half.
and-salt has a large end (A) is for sugar. The
small end (B) is for salt. When to seek help when the person with
Using the spoon diarrhea:
1. Very small baby;
2. Green colour vomit;
3. becomes more ill;
4. does not answer clearly when spoken to.
5. Continue using the salt, sugar and water
until help comes.
Nursing care at Home for the follow up care

Home care is done by the health care
provider for the following various disease
Spoon for ORS Preparation at Home conditions and surgeries.
Preparation of ORS at HOme They are
1. Make the sugar and salt flat. a) Pneumonia
b) Laryngectomy
2. Put the sugar into the glass of water with the
c) Pulmonary tuberculosis
salt.
d) Cardiac surgery
3. Mix the water (250ml), sugar and salt.
e) Bronchial asthma
4. Taste before drinking. If it is very salty throw f) Mastectomy
it away and start making the drink again. It g) Coronary artery disease
should not be more salty than tears. h) Client with casts
5. Important Too much salt is dangerous. i) Diabetes mellitus
Use only small spoon of salt in one glass j) Ostomy such as gastrostomy
of water. k) Hypertension
6. Drink ORS slowly. l) Ortho surgeries
7. Take about 10 minutes to drink it. m) Anemia
n) Arthritis
8. Men and women must drink 2 glasses after
o) Blindness
every stool. Children must drink 1 glass
p) Cancer
after every diarrhea stool.
q) Cerebro vascular disease
324

r) Mentally challenged conditions c) Integrate the exercise in other daily
s) Epilepsy / fits activities such as bathing. Watching
television, or playing games.
The role of nurses at home in generally on the
aspects of Elimination:
a) Activity / rest The aspects of eliminative home nursing
b) Circulation care are
c) Elimination a) Providing assistive devices
d) Food and fluids b) Bladder training program
e) Hygiene (incontinence)
f) Monitoring / surveillance c) Bowel training
g) Safety d) Enema administration
h) Ventilation e) Care of indwelling catheter
Activity and rest: In activity and rest the f) Ostomy care
nurses role is on g) Supra pubic catheter care
• Active and passive range of motion
Providing assistive devices for
exercises
elimination: The bedpan and urinals are devices
• Body mechanics used to collect faeces and urine. They are used
• Low back pain exercises in home primarily for clients who are unable to
• Post Mastectomy exercises ambulate to toileting facilities. The placement
of bed pan, urinal and evaluate the body
Active and passive range of motion exercises alignment of the client should be observed. The
They are those that take the body joints sacral area, perineal area and rectal area should
through their extent of movement. Their be taken care.Bladder training programme
purpose is to maintain joint function and muscle (incontinence). The term urinary incontinence
tone. Ranges of motion exercise are categorized refers to inability of external urethral. Sphincter
according to the independence of performance. to control the urinary flow from the bladder, A
bladder training program consisting of exercise
Active range of motion exercise:
of sphincter to reduce the frequency of urinary
Those performed independently by client. incontinence. The program is lengthy one.
Motivation, persistence and family support are
Assisted Range of motion exercise:
essential to the success of the program.
Those the client can partially perform
but requires some assistance for the whole e) Hygiene:
performance.
The home care aspects in hygiene are:
Passive range of motion exercise: a) Baths b) Douche
Those exercise the client is unable to c) Eye care d) Ear care
perform and that requires total assistance from e) Foot care f) Oral care
another person. Bathe: Bathing is used to cleanse the body
The nurse role is to teach the client and of dirt and debris that accumulates due to direct
family to contact and elimination of waste through the
a) Perform each exercise accurately skin. Complete bed bath is given when the client
b) Perform the exercise consistently is completely bathed in the bed.
325

Foot Care: The feet of ill bed ridden clients involvement may be side effect of medication
are easily susceptible to infection and other therapy.
problems because the feet are far away from Urine glucose testing: Urine glucose
the heart than any other body part, they are testing is used to assess the status of person’s
most compromised by vascular conditions that diabetic condition. Diabetic results from body’s
interfere with normal circulation. inability to utilize food efficiently. When food
Conditions that generally affect bed ridden is digested, it is broken into glucose, which is
client include stored in liver and muscle tissue in the form of
1. Foot drop is a deformity in which the foot glycogen. Insulin facilitates the storage process.
is extended abnormally at the ankle in the Diabetics do not produce sufficient insulin:
direction of the sole of the foot. therefore blood glucose levels rise to abnormally
2. Intermittent claudications is a severe pain high levels. The normal fasting level of blood
in the calf muscles caused by inadequate glucose is approximately 60 mg/dl to 115 mg/
circulation. It usually occurs during walking, dl. Glucose does not appear in urine until the
but subsides with rest. blood level reaches 180 mg/dl. Therefore, urine
glucose level may be interpreted as reflection of
3. Ulcers and gangrene are common side
actual blood glucose level.
effects of diabetes. They occur because of
inadequate circulation to the foot which Vital signs: Measurement of vital signs is
retards natural healing process. done. To assess the physiological status of the
client in relation to those vital canters of the body
Oral Care: Cleansing of the mouth , teeth those are necessary to sustain life. The vital sign
and gums is important to maintain the client’s indicators are temperature, pulse, respiration
sense of well being as well as to prevent tooth and blood pressure. The temperature may be
decay and infection. Dental caries are the areas taken by oral, rectal or axillary route. The pulse
of localized destruction of tooth tissue by may be measured by palpation, on auscultation
bacterial action. Caries are actually caused by of chest area; blood pressure is measured by
acid production by bacteria which forms colony means of sphygmomanometer.
on the tooth surface. Hot and cold applications: Hot and
cold applications are applied to the clients in
f) Monitoring and surveillance:
order to change the tissue temperature locally
The aspects of home health care which
on systematically for a therapeutic purpose.
comes under monitoring and surveillance are
Insulin injection: Since the major diabetes
a) Neurological signs evaluation. is thought to be the lack of inadequate use of
b) Urine glucose testing. insulin diabetic therapy often includes the use
c) Vital signs. of insulin, in addition to dietary and exercise
Neurological Signs Evaluation: control. If the diabetic has little or no insulin
Neurological evaluation of the client can be production, capability in the pancreas, insulin is
obtained by objective and subjective data that are administered. The client family will be primarily
gathered through series of tests and evaluation responsible for performing the procedure on a
techniques. The neurological status evaluation daily basis. The injection should be performed
may be indicative of deteriorating condition or with aseptic technique.
assessment of cognitive state. This is particularly Intravenous therapy: Because of recent
important in home when traumatic injury is changes in health care industry encouraging
evaluated on when progressive neurological early discharge from hospital, increasing
326

number of clients requires (IV) therapy at effectively. A laryngectomy on tracheostomy
home. Home IV therapy can provide additional will facilitate suctioning the trachea but more
fluids and electrolytes selected, nutritional potential for respiratory infection. Endo-
supplements, on a route for medications. tracheal suctioning may be requiring if the
Insertion of IV cannula and initiation of the person cannot mobilize suctions and does not
infusion will usually rest with the how health have artificial airway in place. The technique
nurse. requires more skill and usually performed by
Oral administration of medications: home health nurse.
Oral administration of medications is the least Counseling services in home health care
expensive and the most convenient method for The counseling program provides intensive.
clients in the home physiologically oral route is Counseling services to families in the comfort
safest one. Drugs are given sublingually. Usually of their own home. The families typically have
are intended to be absorbed in to blood vessels children between the ages of 5 and 21 who are
of the underside of the tongue. Those given showing behavioral on emotional concerns.
basically act locally on the mucous membrane The services recognize each family individual
or systematically in the saliva. strengths and work with partners to achieve
Traction: Traction is applied for the goals. Commonly addressed Issues include
purposes of immobilization and the application a) Anger management
of force to a body part usually an extremity. b) Anxiety and depression
Traction is used to prevent movement of a body c) Alcohol and drug abuse
part to decrease muscular strain, to full fractured d) Child discipline techniques
or displaced bone in to connect alignment or e) Couples conflicts
prevent skeletal deformities. f) Different behavior such as violence
Wound care: A wound is a break in the g) Grief and loss
integrity of body tissue. It may be internal or h) Parent / child conflicts
external. Counseling sessions may include whatever
Wounds may also be contaminated or combination of members the family feels is
infected. The goal of wound care is to prevent important to achieve their goals. The length of
infection and hasten healing the treatment depends on family’s unique needs.
Ventilation: The home care of the Rehabilitation services in home nursing
ventilation aspects are
Community based rehabilitation is a
a) Oxygen administration strategy for enhancing the quality of life of
b) Suctioning the disabled people by improving the service
Oxygen administration: Oxygen is delivery system by providing equitable
commonly administered in the home who opportunities and by promoting and protecting
require supplemental oxygen for respiratory their human rights.
problem such as chronic obstructive pulmonary
Definition: Community based
disease. The equipment should be maintained
rehabilitation is a strategy within community
check nasal mucosa for irritation of using nasal
developmentfor the rehabilitation, equalization
prongs.
of opportunities, and social inclusion of all
Suctioning: Surgical procedures, pain and people with disabilities.
chronic medical problems such as muscular
dystrophy reduce the clients’ ability to cough
327

Objectives of community based rehabilitation 4. Utilization and strengthening of referral
• To identify all persons with disability in services at the district and national levels.
the community. 5. Utilization of co-ordinate approach and
• To provide required rehabilitation service education, health and social systems.
to disabled people.
• To create awareness about all issues related Advantage of community based rehabilitations
to disability. • Home based
• To priorities service for disabled person. • Less expensive
• Existing community response and
Characteristics of rehabilitation resources.
a) Reduction of disability and handicap. • Focus on quality rather than quantity
b) Empowerment: The individual
• Multiple approaches based on community
becoming more in control of himself
needs.
and his health and life through
mobilization of appropriate resources Planning for community participation in
to enable his needs to be met. community based rehabilitation
c) Independence Problem – solving:
1. Community participation requires an
Rehabilitation should aim to facilitate
understanding of the attitude of people
and develop further such as individuals
in the community, level of participation
problem solving skills, providing new
in the program and the expected level of
knowledge and training for life, to
participation to be achieved in the future.
enable effective decision making.
d) Client centered rehabilitation: To the 2. Community based rehabilitation program
notion of client centered. needs to find ways to motivate the
e) The holistic approach: The concept of marginalized groups of disabled persons,
holism suggests total well being. their families and community to follow
a participating mode of development in
Principles of community based rehabilitation
which the local community.
1. Utilization of available resources in the
community. 3. The community should support the basic
necessities of life and help to families who
2. Transfer of knowledge about disabilities carry out rehabilitation at home.
and skills in rehabilitation of people
4. Disabled community members and
withdisabilities, families and communities.
their families should be involved in all
3. Community involvement in planning, discussions and decision regarding services
decision making and evaluation. and opportunities provided for them.
328

Practical 8
MENTAL STATUS EXAMINATION
danger to self and others that are

Introduction
present at the time of interview
The mental status examination is the
part of the clinical assessment that describes Precautions
the sum total of examiner’s observation The MSE cannot be given to patient
and impressing of the psychiatric patient at 1. Who cannot pay attention to the examiner
the time of interview, whereas the patient’s for example coma or unconscious
history remains stable. The patient’s mental 2. Completely unable to speak (aphasic)
status can change from day to day or hour
3. Not fluent in the language of the examiner
to hour. Even when a patient is mute or
refuses to answer questions, the clinician can
obtain a wealth information through careful Description
observation.
General appearance and Behavior
MSE is developed by philosopher and
psychiatrist Karl Jaspers. The examiner notes the person’s age, sex
and overall appearance. These features are
Definition significant because poor personal hygiene
or grooming may reflect a loss of interest in
The mental status examination (MSE) is
self care or physical inability to bathe or dress
a cross-sectional, systemic documentation of
oneself.
the quality of mental functioning at the time
Appearance : A
pparent to age/ older
of interview.
than age
Grooming : N
ormally / abnormally
part of the clinical assessment that describes
dressed
the sum total of the examiner’s observations
and impressions of the psychiatric patient at Cleanliness : Adequate / inadequate
the time of the interview. Mode of entry : W
illingly came /
brought by force
Purpose Rapport : S pontaneous / not
1.
To make an accurate diagnosis and established
formulation Facial expression : H
appy / Sad / Anger /
2. To plan for the treatment Cannot be described
3. To obtain evidence of symptoms and Posture : R
elaxed / Changing
signs of mental disorders, including posture
329

Psychomotor Activity : 1) Subjective data : how the patient
• Motor activity Increased or decreased reports prevailing mood
• Abnormal involuntary movements like 2) Objective data : your
tics, tremors, akathisia, and restlessness impression
• Compulsive acts, rituals or habits (e.g.; (Elevated / Euthymia / Anxious /
nail biting) Irritable)
• Checking rituals: in which the patient
Thought Content
may repeatedly check the front door is
closed or electrical switches are in the ‘off ’ Thought can be divided into stream,
position. form and content.
• Cleaning rituals Stream : N
ormal / Thought
• Dressing rituals block / Flight of ideas
• Trichotillomania; a compulsion to pull Form : W
ord salad /
out ones hair Circumstantiality /
Neologism
Speach Content
Initiation : Spontaneous/ speaks Delusion : present / Absent
when spoken to Phobia : Present / Absent
Rate and quantity : Normal / absent Preoccupation : Present / Absent
(mutism)/ Increased /
Decreased Perception
Flow and rhythm speech : R apid / Slow / Hallucinations : present /
Monotonous / Absent
Loud / Illusions : Present / Absent
Relevance : Relevant / Irrelevant
COGNITIVE FUNCTION
Mood and Affect
Consciousness :
C onscious / Alert /
Drowsy / Coma
Mood
Attention : Normally aroused
Mood is defined as a emotion that colors
/ Aroused with
the person’s underlying perception of the
difficulty
world.
(Attention is assessed by calculations or by
Observe the patients’ mood during the
asking the patient to spell the word or others
interview and also ask how they are Feeling?
forward and backward)
Affect Concentration : Normal / Distracted
Affect can be defined as the patient’s (Names of months / Names of the week days
present emotional outward responsiveness; in backward )
inferred from the patient’s facial expression, Orientation : Oriented / not oriented
including the amount and the range of (Time / Place / Person)
expressive behavior.
Memory : Intact / Impaired
330

(Recent memory : C
an be checked by Insight : Present/ partially
asking patients about present / Absent
their appetite and (Insight is a patient’s degree of awareness and
then about what they understanding about being ill)
had for breakfast
or for dinner the Conclusion
previous evening.
Remote memory : Can be tested by part of the clinical assessment that describes
asking patients for the sum total of the examiner’s observations
information about and impressions of the psychiatric patient
their childhood that at the time of the interview. Whereas the
can be verified later. patient’s history remains stable, the patient’s
Immediate memory : Ability to repeat three mental status can change from day to day or
words immediately hour to hour. The mental status examination
and 3 to 5 minutes is the description of the patient’s appearance,
later) speech, actions, and thoughts during the
Intelligence : Intact / Impaired interview. Even when a patient is mute, is
(General knowledge / Arithmetic ability incoherent, or refuses to answer questions, the
/ Similarities and dissimilarities between clinician can obtain a wealth of information
paired objects) through careful observation.
Judgment : Intact / impaired
(Judgment is the ability to assess a situation
correctly and act appropriately within the
situation Personal / Social )
331

General Nursing - Class XII
List of Authors and Reviewers
Domain Expert Dr. Annie Raja,

Principal,
Dr. R. Shankar Shanmugam, St. Isabel’s College of Nursing,
Reader / Associate Professor, Mylapore, Chennai – 4.
College of Nursing, Madras Medical College, Chennai-3
P. Vanaja,
Reviewers Nursing Tutor,
Tamil Nadu Govt. Multi Super Specialty Hospital, Chennai – 2.
K. Senthamizhselvi,
Nursing Tutor / Principal, Anarkali,
Dept of Rheumatology, Nursing Tutor,
Madras Medical College Chennai – 3. School of Nursing, Govt. Head Quarters Hospital,
Nagapattinam.
P. Kalavathi,
Principal, A.I. Chithra,
School Of Nursing, Kasturba Gandhi Hospital for Professor,
Women & Children, Triplicane, Chennai. MD. Sathik, A.J. College of Nursing,
Chennai.
Vijayalakshmi,
Principal, College of Nursing, Cancer Institute WIA, K. Dhanabalan,
Adyar, Chennai – 20. Nursing Tutor,
School of Nursing, Madurai Medical College,
Dr. Thangam Jesudian
Madurai – 625020.
Lecturer, Dept of Anatomy, SRMC & RI, Porur,
Chennai – 116. Academic -Co ordinator
Authors G. Dhavamani Maheswari
Senior Lecturer,
Dr.A. Muralidharan DIET, Tirur.
Asst. Professor, Department of zoology,
Presidency College, Chennai. ICT Co ordinator
D. Anandhi, A. Ajay
Nursing Tutor,College of Nursing, PUMS. Nandhi Mangagalam,
Madras Medical College, Chennai – 3. Kumarachi block,
Cuddalore.
N. Vanitha,
Nursing Tutor, School of Nursing, Content Readers
Kilpauk Govt Medical College,
M. Anbalagan
Chennai – 10.
Nursing Tutors, college of Nursing,
Dr. R. Sudha, Madras Medical college,
Principal, M.A. Chidambaram College of Nursing, Chennai-600008.
VHS Campus, Chennai – 113.
S. Jayasudha
Staff Nursing,
Govt. Kilpauk Medical college Hospital
Chennai-10.
Art and Design Team Qr Code Management Team

J.F. Paul Edwin Roy, B.T. Asst,
Illustration PUMS -Rakkipatty, Veerapandi, Salem.
Muthu Kumar R
A. Devi Jesintha, B.T. Asst,
Adaikala Stephen S
G.H.S, N.M. Kovil, Vellore
Vinoth Kumar V
M. Murugesan, B.T. Asst,
Layout Artist PUMS. Pethavelankottagam, Muttupettai, Thiruvarur.
Adison Raj A
Porsellvan S
Arun Kamaraj Palanisamy This book has been printed on 80 G.S.M.
Daneil Elegant Maplitho paper.
Printed by offset at:
In-House QC
Rajesh Thangappan
Jerald Wilson C
Co-ordination
Ramesh Munisamy
332
12th_Nursing_General_Acknowledgement.indd 332 12/10/2021 9:36:24 PM

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GOVERNMENT OF TAMIL NADU

HIGHER SECONDARY SECOND YEAR

A publication under Free Textbook Programme of Government of Tamil Nadu

Department of School Education

12th_Nursing_General_ Front_Page_1-4.indd 1 12/14/2021 5:46:39 PM

First Edition - 2019

Revised Edition - 2020, 2022

(Published under New Education Syllabus)

NOT FOR SALE

State Council of Educational

Printing & Publishing

Tamil NaduTextbook and Educational

12th_Nursing_General_ Front_Page_1-4.indd 2 12/14/2021 5:46:39 PM

Student would be motivated and focus attention to

Life experiences and indepth understanding of the

Do you Gives additional related information for broader

Given to elicit critical thinking , creative thinking

Enhance long term memory through Audio Visual

References to the relevant website for enhanced

An outline map of the entire information given in

Glossary Detailed meaning in English and Tamil for new terms.

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Chapter Topic Page No Month

12th_Nursing_General_ Front_Page_1-4.indd 4 12/14/2021 5:46:40 PM

ந�ோய்நாடி ந�ோய்முதல் நாடி அதுதணிக்கும்

At the end of the chapter students will be able to;

of damages such as loss of water or damages

It comprises the skin and its appendages

Unit_1_Human_physiology_Gen_Nur.indd 1 12/10/2021 9:37:32 PM

Sensory Nerve Ending Sebaceous Gland

The skin has the following layers from

Unit_1_Human_physiology_Gen_Nur.indd 2 12/10/2021 9:37:34 PM

Disease related to Integumentary system Organs associated with the heart

Unit_1_Human_physiology_Gen_Nur.indd 3 12/10/2021 9:37:34 PM

The Fibrous Pericardium continues with the

Myocardium Pulmonary Circulation

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It is larger and more muscular chamber. Semilunar Valve

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Unit_1_Human_physiology_Gen_Nur.indd 6 12/10/2021 9:37:35 PM

Unit_1_Human_physiology_Gen_Nur.indd 7 12/10/2021 9:37:35 PM

Unit_1_Human_physiology_Gen_Nur.indd 8 12/10/2021 9:37:35 PM

BONES OF THE BODY 206

THORAX OR CHEST BONE (25)

Unit_1_Human_physiology_Gen_Nur.indd 9 12/10/2021 9:37:36 PM

•  e only movable joint in

The Cranium The face has the following 14 bones

Unit_1_Human_physiology_Gen_Nur.indd 10 12/10/2021 9:37:36 PM

The vertebral column Lower limbs

Unit_1_Human_physiology_Gen_Nur.indd 11 12/10/2021 9:37:36 PM

Cardiac muscles are striated muscles

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Unit_1_Human_physiology_Gen_Nur.indd 13 12/10/2021 9:37:37 PM

4. Control of metabolic functions like the • Spinal cord

Note: Both the brain and the spinal

The brain is also divided into three major

Unit_1_Human_physiology_Gen_Nur.indd 14 12/10/2021 9:37:37 PM

The brain stem has three sections

Unit_1_Human_physiology_Gen_Nur.indd 15 12/10/2021 9:37:37 PM

Autonomic nervous system

Sympathetic nervous system

Parasympathetic nervous system

Somatic nervous system

• e only movable joint in