NURSING

Theory

VocationalEducation
HIGHERSECONDARYFIRSTYEAR

A Publication under
GovernmentofTamilnadu
DistributionofFreeTextbookProgramme
(Notforsale)

Untouchabilityisasin
Untouchabilityisacrime
Untouchabilityisinhuman

CollegeRoad,Chennai600006.

GovernmentofTamilnadu
FirstEdition2010

CHAIR PERSON
Dr.Mrs.P. MangalaGowri
CollegeofNursing
MadrasMedicalCollege
Chennai600003.

Authors
Dr. Mrs.Prasanna Baby
CollegeofNursing
ChengalpetMedicalCollege
Chengalpet.

Mrs.M.Elizabeth
GovernmentHigherSecondarySchool
Ottanchantram.

Dr. Mrs.N. Jaya

CollegeofNursing
MadrasMedicalCollege
Chennai600003.

Prof. Kamala Subbaiyan

VenkateshwaraCollegeofNursing
Chennai.

ThisbookhasbeenpreparedbytheDirectorateofSchoolEducation
onbehalfoftheGovernmentofTamilnadu
Thisbookhasbeenprintedon60GSMpaper

FOREWORD
ThedevelopmentofthetextbookNursingresultedfromthecombinedeffortsofmanytalented
professional,committedtoexcellence.Specialrecognitionanddueacknowledgementisherebymade
totheDirectorofSchoolEducationandtheJointDirectorofSchoolEducationChennai.
Nursingisamajorcomponentofthehealthcaredeveliverysystemandnursesmakeupthelargest
employmentgroupwithinthesystem.
Nursingservicesarenecessaryforeverypatientseekingcareofvarioustypesincludingprimary,
secondary,tertiaryandrestorative.Asnursingisanimportantpartofhealthcaredeliverysystem,the
nursesneedtohaveasoundknowledgeaboutnursingasaprofessionandcommonprofessionalactivi
ties.
WiththepresentintroductionofVocationalcoursessuchasnursingintheacademicstreamasone
oftheoptions,itisbelievedthatitwillcontributetowardsthebasicnursingcareofindividuals,families
andcommunityforhealthandhappiness.Itwillalsobeafoundationcourseforfuturediplomaand
degreeprogrammesinNursing.
InthiseditionanewchapteronBioMedicalWasteManagementhavebeenaddedinviewof
thefactthattheseknowledgewillbeessentialforthestudentstolearnbeforeenteringintotheprofes
sionalcourse.Thesubjectcontentshasbeendeveloped,refinedandreconstructedatseveralpointsas
perthecurrentperspectives.
Dr.Mrs.P.MangalaGowri.

III

CONTENTS
S.No Subject
1.

2.

3.

PeriodsPageNo.

Nurse and Nursing as a profession

Definitionofhealth.
Conceptofhealth.
Health&illnesscontinuum.
HistoryofNursing
DefinitionofNursing&Nurse.
QualitiesofNurse.
Functionsof Nurse
Fundamentalrulesfornursing.
Codeofethicsinnursing.
FlorenceNightingalepledge.
Definitionofhospital.
Types of Hospitals
Functionof Hospitals

20

Anatomy and Physiology:

Definitionofanatomy&physiology
Anatomicalpositions
Cells&Tissues
Musculoskeletalsystem
Nervoussystem
CardioVascularsystem
Blood
Digestivesystem
Respiratory system
Excretory system
Endocrine system
Senseorgan
Reproductive system

50

Introduction to Psychology
Definitionofpsychologyandmentalhealth
Characteristicsofmentallyhealthyperson
Importanceofpsychologyinnursing
Factorsinfluencingmentalhealth

30

IV

1
1
1
2
9
9
10
11
11
13
14
14
15

19
19
20
22
33
37
38
40
46
49
51
55
61

73
73
73
74

S.No Subject

PeriodsPageNo.

DefinitionofLearning
Characteristicsoflearningbyinsight
Observation,Attention,&Perception
Emotion
Personality
Defencemechanism
4.

5.

74
76
77
80
83
87

Principlesandpractice ofnursing
DefinitionofNursingprocess
StepsinNursingprocess
Admissionofapatient
Orientationtotheward
Careofbelongings
Dischargeofapatient
Bed&Bedmaking
Therapeuticenvironment
Psychosocialenvironment
BodyMechanicsandPositioning
HygienicNeedsPersonalhygiene
Safety&ComfortNeeds
Activity&Exercises
Moving,shifting&liftingpatients
OxygenNeed
EliminationNeeds

60

HealthAssessment&PhysicalExamination
DefinitionofphysicalExamination
PurposesofphysicalExamination
MethodsofphysicalExamination
PrinciplesofphysicalExamination
- Headtofootexamination
Physiological assessment
- Temperature
-Pulse
- Respiration
- Bloodpressure(BP)
- Pain
Testing&examination

30

91
91
92
93
94
94
94
96
96
96
98
99
100
101
102
104

108
108
108
109
109
111
111
115
116
117
117
118

S.No

Subject

PeriodsPageNo.

-Urine.
-Stool.
-Sputum.
6.

7.

118
121
122

Medical & surgicalAsepsis:

Definitionofasepsis
Principlesofasepsis
Types of asepsis
Basicprinciplesofsurgicalasepsis
- Useofgloves
- UseofAprons
- UseofMasks
Sterilizationanddisinfection
- Definition
- Methodsofsterilization
Handlingofsterilearticles
BiomedicalWasteManagement
- Classificationofwaste
- Segregation,PackingandTransporting
- Categoriesofbiomedicalwaste

20

FirstAid:
DefinitionofFirstAid
RulesandprinciplesofFirstAid
FirstAidandEmergencysituations
- FireandBurns
- Fractures
- Drowning
- Haemorrhage
- Shock
- Bandagingandsplinting
- HeatstrokeorSunstroke
- Heatexhaustion
- Frostbite
- BitesandStrings
- Poisoning
- Foriegnbody
- CarAccident

60

VI

126
126
126
127
127
127
128
128
128
128
133
134
134
135
135

140
140
140
140
142
142
143
144
145
147
147
149
150
153
159
160

S.No Subject

PeriodsPageNo.

Cardiopulmonary resuscitation
Emergencykit
8.

Hospital Housekeeping
Principlesofgoodhousekeeping
Cleanlinessandorderliness
Careof rubbergoods
- Gloves
- Rubbertubes
Careofenamelwares
- Bedpan
- Urinal
- Kidneytray
- Sputumcup
Careofinstruments
- Sharpinstruments
- Glassware
- Syringeandneedle
- Careoflinen
CareofpatientsUnit
- Flooring
- Wall
- Sanitaryannex
- Bathroom
- Lavetory

VII

162
163
20
169
169
170
170
170
171
171
171
171
171
171
171
172
172
172
173
173
174
174
174
174

2.ANATOMYANDPHYSIOLOGY
DEFINITIONOFANATOMYANDPHYSIOLOGY
Anatomy: Itisthestudyofthestructureofthehumanbody.
Physiology:Itisthestudyofthe functionsofthehumanbody.
Thebodyasawhole:
Thebodyiswonderfullymade,likeacomplex,perfectmachine.Eachpartisspeciallyconstructed
tocarryoutitsownfunction,andtoworkasawholewiththeotherparts.
Lookatapersonstandingwitharmsatthesides,palmsturningforward,thisiscalledtheana
tomicalposition.Thebodyisseentoconsistofthehead,neck,trunk,upperlimbs(thearms)and
lowerlimbs(thelegs).
ANATOMICAL POSITION
Whenapersonstandinguprightwiththeheadfacingforward,armsbythesidesandthepalmsofthe
handsfacingforwardandfeetstogetherissaidtobeanatomicalposition
THEFOLLOWINGTERMSAREUSEDINANATOMY:
1)SUPERIOR

higher

2)INFERIOR

lower.

3)ANTERIOR

nearerthefrontofthebody.

4)POSTERIOR

nearerthebackofthebody

5)MEDIAL

nearertothemidline.

6)LATERAL

totheside.

7)PROXIMAL

nearertotheheadorsource.

8)DISTAL

distantfromtheheadorsource.

9)EXTERNAL

outside,orawayfromthetrunkcentre.

10)INTERNAL

inside,ornearertothetrunkcentre.

11)SUPERFICIAL

nearerthebodysurface.

12)DEEP

inside,awayfromthebodysurface.

Thebodyhasastrongframeworkofbonescalledthe skeleton. Theskeletoniscoveredby

musclesandothersofttissuesandbyskinontheoutside.
Cavitiesofthebodyandtheircontents:
Somebodypartsformspacescalled cavities,inwhichimportantinternalorgansareprotected.
1)The cranialcavityorskull containsthebrain.
19

2)The thoraciccavityorchest contains:

(a)Thelungs
(b)Theairpassagestracheaandbronchialtubes.
(c)Theesophagusorfoodpipe,whichliesbehindthetrachea.
(d)Theheart.
(e)Thegreatbloodvesselsandthethoracicduct(thelargestlymphaticvessel).
3)The abdominalcavity,whichisseparatedfromthethoraciccavitybyadomeshapedmuscle
calledthediaphragm.Itcontains:
(a)Thestomach
(b)Thesmallintestines.
(c)Thelargeintestineorbowel
(d)Theliver.
(e)Thespleen
(f)Thekidneys.
(g) Theureters
(i)Thepancreas.
4)The pelviccavity,whichcontains:
(a)Thereproductiveorgans
(b)Thebladderwhenempty(whenfullitrisesintotheabdominalcavity)
(c)Therectum.
CELLS AND TISSUES
Alllivingthings,includingthehumanbody,aremadeupoflivingcells.Thecellisthestructuraland
thefunctionalunitofthehumanbody.
Justasmanykindsofmaterialsmaybeusedintheconstructionofalargebuilding,inthesameway
manydifferentkindsofcellsarefoundinthebody.
StructureofaCell: Acellhasthefollowingparts:
(a)Cellmembrane,theoutercovering.
(b)Protoplasm,themainsubstanceofthecell.
(c)Nucleus,whichcontrolsactivitiesofthecell

Fig.2.1StuctureoftheCell

1)Vacuole
2

2)Cytoplasm

3
4

3)Nucleus
4)Endoplasmicreticulum
5)Mitochondrion
6)Cellmembrane

5
6
20

Functionsofcells: Byfunctionswemeantheactivities
(a)Digestion

intakeofthenutrients.

(b)Excretion

eliminationofwastes.

(c)Respiration

takingandusingoxygen,andgivingoutcarbondioxide.

(d)Growthandrepair

increasesthesizeofthecellandreplacementofwornoutcell.

(e)Somecellsmoveaboutz,andsomehavespecialfunctions.
(f)Reproductionisbyeachcellsimplydividingintotwo.
TISSUES
Tissuesarematerialsmadeupofgroupsofsimilarcells.Cellsareofvarioustypes,andtissuesvary
accordingtothetypesofcellsintheirstructure.Therearefourmaintypesoftissueinthehumanbody.

Fig.2.2Variouskindsofcells
1)Epithelialcells(2)Connectivetissue(3)Fattytissue(4)Cartilage
(1) Epithelial whichformscoveringsliketheskin,liningmembranesandglandsconnective,
whichhelpstosupportandbindpartstogether,holdingtheminplace.
(2) Thereareseveraltypesof connectivetissue includingbone,cartilage,ligaments,fattyand
elastictissue,alsobloodandlymph(thefluidtissues).
(3) Muscular thistissuehasthepowerofcontraction,whichcausesmovement.
(4) Nervous conductsnerveimpulses.
ORGANSANDSYSTEMS:
Tissuesarejointedinlargerunitscalled organs, suchastheheart,lungs,brain,liver.Eachorganis
madeupoftypesoftissue,whichenableittodoitsspecialwork.
Asystem isagroupoforgans,whichtogethercarryoutoneoftheessentialfunctionsofthebody.
Thereareninesystemslistedbelow.Allofthesesystemsworkharmoniouslytogetherinahealthybody.
21

S.No.SystemsofthebodyFunctions
1.

SkeletalSystem

Support,movementandprotection

2.

MuscularSystem

Movementsandproductionofheat.

3.

NervousSystem

Controlofbodyactivities.

4.

CircularSystem

Transportoffoodandoxygen,wasteproducts.etc.

5.

RespiratorySystem

Takinginofoxygenandgivingoffcarbondioxide.

6.

DigestiveSystem

Takinginfood,breakingitdownintonutrientsforuse
bybodycells.

7.

ExcretorySystem

Removalofwastematterfromthebody

8.

Endocrine

Productionofhormones,whichinfluencetheactivity
ofcells.

9.

ReproductiveSystem

Enablesnewindividualstobeborn.

(I)MUSCULOSKELETALSYSTEM
Theskeletonisthebonyframeworkofthebody.Thehumanskeletoniswonderfullymadeinsuch
away,thatitcansupportthebodyintheerectpositionandenablethebodytomovefreely.
StructureandFunctionsoftheSkeleton:Theskeletoniscomposedof 206separatebones inthe
adult,andthecartilagesandligaments,whichhelptounitethebonesatthejoints.
ThePartsoftheSkeletonare:
(1) Skull,madeupof29bonesinall(includingmiddleearbonesandthehyoid).
(2) SpineorVertebralcolumnmadeupof26Separatebones.
(3) ThoraxorChestmadeupof25(12pairsofribsandthebreastbone)
(4) Upperlimbs,each32bones.
(5)

Lowerlimbs,each31bones.

Thetotalbonesinourbodyis206.
TypesofBones:
(1) Longbones Theseareinthearms,legsandfingers.Theyactasleverstomoveparts.
(2) Shortbones Asinthewristsandankles.
(3) Flatbones Theseincludestheribs,shoulderandbonesofthecranium.
(4) Irregularbones Suchasthebonesofthefaceandofthespine.
22

2
2

Fig2.4aShortBone

Fig.2.3LongBone
1)HyalineCartilage2)Periosteum
3)MedullaryCavity

1)Fibula2)Tibia

1
Fig2.4bShortBone
2

1)Phalanges
2)MetatarsalBones
3)TarsalBones

FunctionsoftheSkeleton:
1) Supportsandgivesshapetothebody. 2) Protectsinternalorgans.
3) Movementswiththehelpofmuscles.

4) Formsbloodcells.

Structureofskeletaltissue:
1) Periostium: Thisistheoutercoveringofbones.Itcarriesbloodvesselsandnerves.
2) CompactBone: Mainlycomposedofcalciumandphosphorus,isthehardouterlayerof
bonetissue.
3) Cancellous Bone: insideisaporoustypeofbonewithmanytinyspaces.Ithelpstomake
theboneslight.
(a)

RedMarrow:Thisfillsthespacesincalcellousbone.Redbonemarrowproduces
redbloodcellsandsomewhitebloodcells.
23

(b)
(c)

YellowMarrow:Thisismainlycomposedoffatcells.Yellowbonemarrowfillsthe
shaftofthelongbonemakingthemlight.
Cartilage:Astrongplaintissuelikehardrubbersisattachedtosomebones.Eg.The
endofthenose,andofitsribs

4)Ligamentsaremadeofstrongfibroustissueandtheyholdbonestogetheratthejoints,
allowingsomemovement.
TheSkullconsistsoftwoparts:
1) Thecranium,whichislikeaboxinwhichthebrainiswellprotected.
2) Thebonesoftheface.
Thecraniumismadeupofeightbonesasfollows:
1)

Frontalbone: Whichformstheforeheadandhelpstoprotecttheeyes.

2)

Parietalbone Oneateachsideofthetopoftheskull,joinedintothemiddle.

3)

TemporalbonesOneoneachsidebelowtheparietalbones.Theseprotecttheinnerpartsof
theears.

1
6
7

8
9
10

3
4
5

Fig2.5TheSkull
1)ParietalBone2)TemporalBone3)OccipitalBone4)MaxillaryBone5)MandibleBone6)
FrontalBone7)SphenoidBone8)LacrimalBone9)EthmoidBone10)MalarBone
4)

OneOccipitalbone:Thisformsthebackoftheheadandpartofthebaseoftheskull.Ithasa
largeopeningforthespinalcordtopassthrough.

5)

OneSphenoid Ahatshapedbone,whichalsoformspartofthebaseoftheskull.Ithasa
littleseatforthepituitarygland,andsomeholesforbloodvesselsandcranialnervespass
through.

6)

OneEthmoid Whichformstheroofofthenoseandinbetweentheeyes.Ithasmanysmall
holesforthenervesofsmalltopassthroughthebrain.
24

TheFacehasthefollowingfourteenbones:
Two nasalbones,whichformthebridgeofthenose.
Two lacrimalbones,neartheeyes,whichcontaintherearducts.
Twocheekbones.
Two upperjawbones,withupperteeth.
Two palatebone whichjoinwiththeupperjawbonesinformingthehardpalate.
Two curledbone,oneineachsideofwallofthenose.
Two vomerbones,whichrestsonthepalateandhelpstoformthenasalseptum.
One lowerjawbone,whichconsistsofthehorizontalpartonwhicharethelowerteeth,and
twoverticalparts,whichmeetthetemporalbones.Theangleofthejawoneachsideis
important.Allthebonesoftheskullexceptthelowerjawarejoinedfirmlytogetherbyfixed
jointscalledSutures.
Sinuses.Someskullboneshavehollowspacescalledsinuseswhichconnectwiththenose
andarefilledwithair.Sinusesmaketheskulllighter,andhelpinthesoundofthevoice.
Sinusitisisinfectioninthesespaces.Themainsinusesarethefrontalonesabovetheeyes,
andlargeantrumsinuses,oneineachoftheupperjawbones.
Hyoidbones,thisisahorseshapedlittleboneintheupperpartoftheneck.Thetongue
muscleisattachedtothisbone.
TheVertebralColumn
Spineorbackboneisthecentralpartoftheskeleton.Itsupportstheheadandenclosesthespinal
cord.Itconsistsof33irregularbonescalledVertebraebutsomearefusedtogetherandsotheseare
actually26separatebonesformingthespine.
ThepartsoftheVertebralColumnareasfollows:
Cervicalvertebralcolumn intheneckregion.Thefirsttwo,calledatlasandaxisare
importantfornoddingandturningthehead.
12dorsalor thoracicvertebrae atthebackofthechest.Theribsarejoinedtothese
vertebrate.
5 lumbarvertebrae intheassistregion.Thesearebigandstrongforgivingsupport.
5 sacralvertebrae arefusedtogethertoformthesacrum,atriangularshapedbonewitha
hollowanteriorly.Thesacrumhelpstoformthepelvis.
4smallvertebraeinthetailregionarefusedtoformasmalltriangularbonecalledthe
coccyx.Itisattachedtothelowerpartofthesacrum.
IntervertebralDiscs
Betweenthebodiesofthevertebraetherearethickpadsofcartilagecalleddiscs.Theyallow
movementinthespine,andactasshockabsorbers.
Thevertebraearealsojointtogetherbyligamentsandmusclesattachedtothebackandside
processes.
25

Fig2.6VertebralColumn
1)CervicalRegion
2)ThoracicRegion
3)LumbarRegion
4)SacralRegion
5)CoccxygealRegion

3
4
5
FUNCTIONSOFTHEVERTEBRALCOLUMN
1) Movement:Forward,backward,fromsidetoside,alsonoddingandturningtheheadare
possiblebecausethespineismadeofnotonebutmanysmallbones,withdiscsofcartilagein
between.
2)

Thespinesupportstheweightofthehead,andoftheabdominalorgans.

3)

Protectionforthespinalcord,whichlieswithinthespinalcanal,andprotectionfrominjuryby
cushioningofthediscs.

4)

Balanceintheerectpositionismadepossiblebythecurvesofthespine.

TheThorax: Thethoraxorchestisformedbythe sternum (Breastbone)andcostalcartilagesinfront,

theribsatthesides,andthetwelvedorsalvertebralbonesattheback.

Fig2.7TheThorax
1&2)Sternum
3)TrueRibs
4)FalseRibs
5)FloatingRibs
6)Xyphisternum
7)LumbarVertebrae

Thesternumisaflatbone,shapedlikeadaggerpointingdownwards.Thetipconsistsofacarti
lageknownasthexiphisternum.Theupperpart,likethehandleisjoinedtothetwocollarbones.The
costalcartilagesarejoinedtothesidesofthesternumandtothetrueribs.
26

Theribsaretwelvepairsofthelongcurvedbones.Theuppersevenpairsarecalledtrueribs.
Theseareeachattachedtothesternumbyitscostalcartilages.
Thenextfivepairsofribsarecalledfalseribsbecausetheyarejoinedbytheircartilagestothose
oftheribsaboveandnotdirectlytothesternum.Thelasttwopairsarenotconnectedtothesternumat
all,andarecalledfloatingribs.
FunctionsoftheThorax:
1)

Protectionfortheheart,lungs,liver,stomachandspleen.

2)

Supportforthebonesoftheshouldergirdleandforthebreast.

3)

Importantinrespiration.

BonesoftheUpperLimbs:
Eachupperlimbconsistsofthirtytwobones.
One collarbone:Thesetogetherwiththoseoftheothersideformtheshoulderbone.
Shouldergirdle.
One humerus,theboneoftheupperarm.
One radius,theouterboneoftheforearm.
One ulnar,theinnerboneoftheforearm.
Eight carpalbones ofthewrist.
Fourteen phalanges ofthefingers.
1

2
1
2

5
Fig2.8aHumerus
1)Head2)Neck3)Shaft

Fig2.8bTheUlna&Radius
1)HeadoftheRadius2)NeckoftheRadius3)Shaftof
theRadius4)ShaftofUlna5)HeadofUlna
27

 The collarbone (clavicle)oneachsideisalongbonewithtwocurves.Itsinnerendis

attachedtothesternum,andouterendwiththeshoulderblade.Thecollarboneiseasilyfeltat
thelowerandfrontpartoftheneck.Itkeepstheshoulderbladeinplace.Whenitisbroken
theshoulderdropsforwardanddownwards.
The shoulderblade (scapula)oneachsideisattheupperandouterpartofthebackofthe
thorax.Itislargeflat,triangularshapedbonewitharidgeorspineattheback.Ittakespartin
theshoulderjoint.
The humerus isalongbonewitharoundedheadattheshouldersandabroadlowerendat
theelbowjoint.
The radiusandulnarbones oftheforearmreachfromtheelbowjointtothewrist.
Thewristconsistsofeight carpalbones.Theseshortbonesarearrangedintworows,
proximalanddistal,withfourbonesineachrow.
Thepalmconsistsoffivelongbonescalled metacarpal,whicharticulatewiththedistalrow
ofcarpalbonesandwiththeproximalrowof phalanges. Thephalangesarelongbones.The
thumbhasonlytwophalangeswhilethefingershavethreeeach.
1
2
3

BonesoftheLowerLimbs:
Eachlowerlimbconsistsofthirtyonebones:
Oneinnominate orhipbone,
One femur,thethighbone,
One patella orkneecap,
One tibia
One fibula thelowerlegbones
One tarsalbones oftheankle
Five metatarsalbones ofthefoot
Fourteen phalanges ofthetoes
28

Fig2.9TheHand
1)CartalBones
2)MetaCartalBone
3)Phalanges

1)TheInnominateBones: Oneoneachside,joinwiththesacrumtoformthepelvis.Besidespro
tectingthepelvicorgans,thepelvissupportstheabdomenandprovidesthedeepsocketsforthehip
joints.
Inthefemale,thetruepelvis(lowerpart)isroundsothatthehead,ofthebabycanpassthrough
duringdelivery.Inthemalethetruepelvisislong,narrowandheartshaped.
Theinnominateboneinachildisseparatedintothreebones,whicharefusedtogetherintheadult.
Thereforethebonehasthreepartsasfollows:

1
4

Fig2.10InnominateBone
1)Ilium2)Pubis3)Symphysispubis
4)SacroiliacJoint5)Ischium

2
5
3

1) Ilium,theupperflatpart,formsthefalsepelvis.Itsupperridgeiscalledtheiliaccrest.
2) Ischium,theheavylowerpart,whichsupportsthebodywhensitting.
3) Pubis,thefrontpart.Thepubicbonesfromthejointcalledsymphysispubis.
Thefemur(thighbone)isthelongestandstrongestboneinthebody.
Thepatella(kneecap)isasmallboneatthefrontofthekneejoint.
Thetibiaisthelongboneontheinnersideofthelowerleg.
Thefibulaisalongthinboneontheoutersideoftheleg.
Thetarsalbonesoftheankle.Thesearesevenshortbones.Thelargestistheheelbone
(calcanium).Theupperbonetakespartintheanklejoint.
Themetatarsalbonesarefivelongbonesinfrontofthefeet.Theysupportthetoes.
Thetoebones(phalanges)arefourteeninnumber.Likethefingerbones,theyaresmalllong
bones,twointhebigtoeandthreeineachoftheothertoes.
Joints: Ajoint isthepointatwhichtwoormorebonesmeet.Bonesareheldtogetheratthejointsby
otherconnectivetissuesuchasfibroustissue,cartilage,ligamentsandtendons.Musclesarethemeans
bywhichallmovementinthebodytakesplace,includingthemovementsofbonesatsomeofthejoints.
29

1
2

Fig2.11Joints
1)Femur
2)Patella
3)Cartilage
4)Tibia
5)SynovialMembrane
6)Fibula

TypesofJoints:
1)) Fibrousjoints inwhichthereisnomovement.Eg.Thesuturesoftheskull.Thebonesare
joinedtogethercloselyasthoughtheywerestitched(sutured)together
2) Cartilaginousjoints inwhichtwobonesarejoinedbyapadoffibrouscartilage,which
allowsslightmovement.Theyarefoundinthevertebralcolumnandpelvis.
3) Synovialjoints whicharefreelymovable,arefoundinthelimbsandjaw.
4) Ballandsocketjoints theroundheadofonebonefitsintothecavityofanotherbone:eg.
Shoulderandhipjoints.
5) Hingejoint theonlymovementsareflexionandextension.Eg.Elbow,knee.
6) Glidingjoint thebonesglideononeanotherandallowfairlyfreemovements.Eg.Wrist
andanklejoint.
7) Pivotjoint turningistheonlymovement.Eg.Themovementbetweentheatlasandaxisfor
turningthehead.

Muscular system
Thefunctionofamuscleistocontractandtoproductmovement.Amuscle ismadeupofbundles
offibersheldtogether.Thesearetheredfleshofthebody.Therearethreetypesofmuscles:
1) Voluntarymuscle:Theseareconnectedwiththeskeletalsystem,causingthejointstomove.
Theyarecalledvoluntarybecausetheiractioncanbecontrolledbythewill.
2) Involuntarymuscle:Workwithoutconsciouscontrolbytheindividualandarefoundinthe
internalorgans.
3) Cardiacmuscle:Aspecialtypefoundonlyintheheart.Thefibersarestripedbutthe
muscleisnotundercontrolofthewill.
30

StructuresandFunctionsofVoluntaryMuscles
Avoluntarymuscleisshapedlikeaspindle,andisenclosedinaprotectivecoatcalledfascia.
Thecentreofthemuscleiscalledthebodyorbelly.thebodyinthickandbecomeshorterand
thickerwhenthemusclecontracts.
Inhealththemusclesarealwaysinastateoftheslightconstractions,readyatalltimesforaction.
Thisstateofreadinessiscalledmuscletone.
Fucntionsare1)Movement,2)Maintainingposture.3)Producingbodyheat.
MainGroupofmusclesandtheiractions
Manymusclesarearrangedinpairs,andopposeeachotherinaction.Theyareoftengrouped
accordingtofunctionasfollows.
1)Flexorscausebendingofajoint.
2)Extensorsstraightenajoint.
3)Abductorsmovetheboneawayfromthemidline
4)Adductorsmovethebonetowardsthemidline.
5)pronatorsturnthehandpalmdownwards
6)Supinatorsturnthehandpalmupwards.
7)Levatorsraiseapart.
8)Sphinctersreducethesizeofanopening.

Fig2.12MusclesoftheBody(Anterior)
2

1)Sternomastoid
2)Deltoid
3)Pectorails
4)Biceps
5)Quadriceps
6)Illiopsoas
7)Sartorius

3
4

6
5
7

31

1
2
3
Fig2.13MusclesoftheBody(Posterior)
1)Sternomastoid
2)Trapezius
3)Deltoid
4)GluteusMaximus
5)Hamstrings
6)Gastronemus

4
5

Musclesoftheheadandneck: Sternomastoid,amuscleattachedtothemastoidprocessof
thetemporalboneandtothesternum.Thispairofthemuscleswhenusedtogetherflextheandhead.
Separatelytheyheldtoturntheheadtooneside.
Trapezius,alargediamondshapedmuscle,attachedtotheocciputanddorsalvertebrae.Itdraws
backtheshouldersandextendsthehead,thushelpingingoodposture.
MusclesthatmovetheupperArm: Deltoidatriangularmusclecoveringtheshoulderjoint,
andattachedtotheshoulderblade,collarboneandhumerus.Itraisestharmoutwardstoshoulderlevel
(abduction).
Pectoralisamusclecoveringthefrontofthechest,attachedthehumerus.Itadductsthearm
(drawsthearmacrossthechest).
Latissimusdorsialargemuscleoftheback,attachedtotheupperposteriorpartofthehumerus.
Itadductsthearm,drawingitdownandback.
Musclesthatmovetheforearm: Bicepsamusclewithtwoheadsfromtheshoulderblade.It
liesinfrontofthehumerusandisattachedtotheradius.Itflexestheelbowjoint.
Tricepsamusclewiththreeheadsfromtheshoulderbladeandhumerus.Itliesalongthebackof
thehumerusandisattachedtotheulna.Itextendstheelbowjoint.
Musclesthatmovethethigh: Iliopsoasmusclethatpassesfromthefrontofthelumbar
vertebraeandtheilium,tothefemur.Itflexesthehipjoint.
Glutealsmusclesofthebuttocks.Attachedtotheposteriorsurfaceoftheilium,andsacrum,and
tothefemur,theyextendthehipjoint.
32

MusclesthatmovethelowerLeg:Quadricepsfemorisaverystronggroupoffourmuscles,which
coverthefrontofthethigh.Passingfromtheiliumandfemur,theyareattachedtothepatellaandsoby
thepatellarligamenttothetibia.Theyextendedthekneejoint.
Harmstringsfromtheischiumandfemurtothetibiaandfibula,thismuscleliesatthebackofthe
thighandflexesthekneejoint.
Sartoriusfromtheiliacspinetotheinnersideofthetibia,thislongthinmusclehelpstoabductand
flexboththehipandknee,aswhensittingcrosslegged.
Musclesoftheabdominalwall:Rectusabdominisfromthesternumandcostalcartiliagestothe
publicbone,thesearetwostraightmuscleformingthefrontwalloftheabdomen.theycauseflexionof
thespine,andhelpindefaecationandinchildbirth.
Obliquemuscles,externalandinternal.Theseformthesidewallsoftheabdomen,andhelpsin
turningthetrunk.
MusclesthatmovetheChestwall: Intercoastalssituatedbetweentheribs,thesemuscles
elevatetheribsforbreathing.
Diaphragm is a dome shaped muscle which divides the chest from the abdomen. It is
attachedtothesternumandlowerribs,andtothelumbarvertebrae.Itsmovementsareessentialfor
breathing.Itflattenswhencontractedandthusthechestisenlargedforbreathingin.Ithelpsalsoby
downwardpressureindefaecation,passingurine,andinchildbirth.
NERVOUSSYSTEM
Thisfunctionslikeatelephonesystem.Withthebrainastheheadoffice,andnerveslikethe
telephonewirescommunicationtakesplacewithallpartsofthebody.Bymeansofnumerousmessages
sentandreceived,thevarioustissuesandorgansofthebodyworkinharmony
Thenervoussystemhastwoparts:
1) Centralnervoussystem madeupofthebrainandcranialnerves,spinalcord,andspinal
nerves.
Itcontrolsthevoluntarymusclesofthehead,trunkandlimbs.
Itreceivesmessagesfromsenseorganssuchasskin,eyesandears.
2) TheAutonomicnervoussystem thisismadeupofsympatheticandparasympathetic
nerves.Itcontrolsinvoluntary(internal)musclesandglandularsecretions.
NerveTissue: NerveTissue,ofwhichthesenervoussystemsarecomposed,issofttissuemadeupof
nervecellsandnervefibres.Thecellsmassedtogether,asinthebrain,formwhatiscalledthegray
matter.Thenervefibresformwhitematter.
Nervefibresareeachconnectedwiththeirownnervecells,formingaunitcalledaneurone.Messags
jumpacrossfromoneneuronethroughitsfirbestothenextneurone.Thefibresofsomeneuronesarevery
long(eg.thoseinthelimbs)andtheyaregroupedtogetherasvisiblewhitenervetrunks.
33

Nervesarethreetypes:
1)

Sensorynerves,whichcarrymessagesfromallpartsofthebodytothebrainandspinalcord.
Theyenablethebodytoreactforitsprotection.

2)

Motornerves,whichtakemessagesfromthebrainandspinalcordtomusclesandglandsinall
partsofthebody.theystimulateactivity.

3)

Mixednervesconsistsofbothsensoryandmotornervefibres,sotheycarrymessagesinboth
directions.

Thebrain:
Thisisthemostimportantpartofthecentralnervoussystem.Itiswellprotectedinthecranial
cavityandhasthefollowingparts.
1) Thecerebrumorforebrain.
2)Thecerebellumorhindbrain.
3)Themidbrain.
4) Thebrainstemconsistingofponsandmedulla.

Fig2.14TheBrain

1)Cerebrum
2)MidBrain
3)Cerebellum
4)Ponsvaroli
5)MedullaOblongata

TheCerebrum: Thelargestpartofthebrain,fillsthefrontandtoppartsoftheskull.Ithastwoparts
rightandleft.Thesetwopartscontroltheoppositesidesofthebody,sothatdiseaseorinjuryoftheright
sideofthecerebrumparalysestheleftsideofthebody,andviceversa.
FunctionsofCerebrum:
1) Frontallobe:
a)Motorcenterscontrollingvoluntarymuscles.b)Speechcentre.c)Mentalpowerssuchas
memory,intelligenceandwill.
2) Parietallobe:Thesensorycentersforsensationsoftouch,pain,heat,coldandpressure.
3) Temporallobe:Forhearing.
4) Occipitallobe :Forvision(sight).
TheCerebellum: Thecerebellumissituatedunderneaththecerebrumattheback.Itissmaller
thanthecerebrum.Italsohasarightandleftsides.Itsactivitiesareunconsciousandnotundercontrol
ofthewill.
34

FunctionsoftheCerebellum:
1)Helpstomaintainbalance
2)Helpstomaintainmuscletone.
3)Coordinatestheworkofmuscles.
TheMidBrain: Thisconsistsoftwoshortstalksofnervetissueattachedtothelowerpartofthe
rightandleftsidesofthecerebruminthecentre.
FunctionsoftheMidBrain:
1) Actsasapathwayformessagestoandfromthecerebrum.
2) Containsreflexcentresforvisionandhearing.
3) Containscentersforcontrollingbodytemperature(hypothalamus),theemotionsandsexual
responses.
Thebrainstem: TheBrainstemlikeastalkconnectingthebrain,withthespinalcord,hasthe
followingparts.
1)ThePons:Thispart,situatedbelowtheMidBrain,islikeabridgeconnectingthetwosidesof
thecerebellumandthemidbrainwiththemedullabelow.
2)themedulla.Thisjoinstheponsabovetothespinalcordbelow.Itlookslikethespinalcordbut
isalittlethicker.Itliesjustinsidetheskull.
FunctionsoftheMedulla:
1) Connectsthebrainwiththespinalcord,andconveysmessages.Itisinthemedullathat
cerebralnervefibrescrossovertotheoppositeside.
2) Containnervescenters,whichcontrolthevitalfunctionsofcirculationandrespiration.
3) Containreflexcentersofswallowing,vomitingandcoughing.
CranialNerves:
Thereare twelvepairs ofcranialnerveswhichcomeoutfromthebrainandbrainstem.They
passthroughholesintheskulltotheeyes,ears,face,tongue,throat,etc.
Thetenthcranialnervecalled vagus,givebranchestothelarynx,lungs,andheartanddigestive
organs.Thevagusnervefunctionsaspartoftheautonomicnervoussystem.
TheSpinalCord:
Thespinalcordisacordofnervoustissue,thethicknessofalittlefingerandabout12cmlong.It
liesinsideacanalformedbythevertebrae.Itconnectsabovewiththemedullawherethebackofthe
neckjoinstheskullandextendstothelevelofthefirstlumbarvertebrae.
FunctionsoftheSpinalCord:
1)Receivesmotorimpulsesfromthefrontallobeofthecerebrum,andpassesthemontomuscles
viathespinalnerves.
2)Receivessensationsfromtheskinandothertissuesandrelaysthemessagetothebrain.
3) Reflex action. This is the quick response in the spinal cord itself. Eg. If you touch
somethinghot,themessagereceivedinthespinalcordisimmediatelyflashedtothemusclesofthearm
beforethenewsreachesthebrainyouhavetakenyourhandaway.
35

Themeningesandcerebrospinalfluid(C.S.F.)
Thebrainandspinalcordarecoveredbythreemembranescalledmeninges.
3

1
Fig2.15TheMeninges
1)Piamater
2)ArachnoidMater
3)Duramater
4)Brain

4
1) Duramateristheouter,thickelasticcover.Itlinestheskullandspinalcord.
2) Arachnoid,athinmiddlemembrane.Itisaloosecoveringandunderisaspacecalledtheca
(subarachnoidspace)containingcerebrospinalfluid(C.S.F.)
3) Piamater isclosesttothenervetissueandcarriesbloodvessels.Whenthesemembranesget
infected,theconditionisknownasmeningitis.
CerebroSpinalFluid:(C.S.F.): Thisisaclearfluid,whichcirculatesbothinsideandoutsidethebrain
andspinalcord.Alittlecerebrospinalfluidissometimesremovedbylumbarpuncturetohelpindiag
nosingdiseaseofthenervoussystem.
FunctionsofCerebrospinalFluid:
Itactsasawatercushiontoprotectthebrainandspinalcordfromshocksandjarring.
Itnourishesandcleanses,washingawaywaterandtoxins.
TheAutonomicNervousSystems
Itisthesecondsystemofthenervesthatcontrolsthemovementsoftheinvoluntarymusclesand
thesecretionoftheglands.Wehavenocontroloverthesenervesalthoughtheyarecloselyconnected
withthecentralnervoussystem.
IntheANStherearetwosetsofnerves,whichopposeeachotherinaction.
SympatheticSystems: Thisconsistsoftwochainsofganglia(groupsofnervecells)oneoneachside
ofthevertebralcolumn.Thegangliaareattachedbyfibrestothespinalnerves.
Thesympatheticnervesarestimulatedbytheemotionssuchasfear,excitementandanger.The
results of the sympathetic nerve stimuli are: 1) dilated pupils 2) the heart beats quicker
3)breathingisquickeranddeeper4)thebloodpressureisraised5)digestionissloweddown
6)sweatingisincreasedand7) analandurethralsphincterstightenup.
36

ParasympatheticSystem: Thissystemisincontrolduringnormalquietliving.Certaincranialnerves
(thevagusespecially)havesuchactionsasthefollowing.1)pupilsoftheeyescontract.2)increasein
salivaflows3)digestionandperistalsisarestimulated.
THECARDIO VASCULARSYSTEM
Thecardiovascularsystemisthetransportsystemofthebody.Itisthemeansbywhichfood,
oxygen,waterandotherrequirementsareconveyedtothetissuecalls,andtheirwasteproductsare
carriedaway.
Theheartisimportantorganofthecirculatorysystem.Itisplacedbehindbreastboneandwithin
the thoracic cage. It is hollow muscular organ. It is enclosed in a sac known as the
pericardium.Itisaboutthesizeofapersonsclenchedfistandweighsaround300gminamanand
250gminawoman.
Thehearthasfourchambers,twoatria(upper)andtwoventricleslower.Valvesconnectthe
upper and lower chambers. The right and left sides of the heart are totally separated by a
muscularwallandthereisnocommunicationbetweenthem.
The rightside ofthe heart receivesthe deoxygenated (impure)blood collectedfrom the
differentpartsofthebodythroughsmallandbigveins,whichentersthelungs.Inthelungsthebloodis
oxygenatedandcarbondioxideandmetabolicwasteareremoved
Theleftsideoftheheartreceives(pure)bloodfromthelungsandsuppliesittotheentirebody
throughthemajorbloodvessel(aorta)anditsnumerablebranches(arteriesandcapillaries).
Theleftventriclegeneratesgreaterpressurethantherightventricletoenabletheboldtobepumped
throughoutthebody.Hencetheleftventricleismorethickerandmoremuscular.
Thecoronaryarteriesbranchout(leftandrightcoronaryarteries)fromtherootoftheaortanear
itsoriginfromtheleftventricle.Boththecoronaryarteriesbranchofintosmallervessels,whichare
distributedalloverthesurfaceoftheheart.Forefficientpumping,itisnecessaryforthehearttobeatat
areasonablerateof6090beatsperminute,whichisachievedthroughcontrolledelectricalimpulses
(conductivesystem).
Fig2.16TheHeart
1
6
2

7
8

3
9
4
10

5
37

1)Aorta
2)LeftAtrium
3)LeftVentricle
4)ApexoftheHeart
5)Aorta
6)SuperiorVenacava
7)RightAtrium
8)SemiLunarValves
9)RightVentricle
10)InferiorVenacava

FunctionsofHeart:
1)Itdrawsbloodbackfromthecapillariesandveins.2)Itsendsbloodintothelungswhereitis
oxygenated.3)Itsendsbloodthroughtheaortatoallthepartsofthebody.
Thepartsofthecirculatorysystemare:
1)Blood.2)Theheart,whichisthepumpforcingbloodintothecirculation.3)Thebloodvessels
inwhichthebloodtravels.4)Thelymphaticsystemiscloselyconnected,andcanbeconsideredapart
ofthecirculatorysystem.
THEBLOOD
About6litresofbloodcontinuouslycirculatesthroughtheheart,andbloodvesselsinallpartsof
thebody.Itisastickyredfluidisslightlyalkalineinreaction.Itismadeupofaliquid(plasma)andsolids
(thebloodcells).
Plasmaisapaleyellowfluidconsistingof
Water90%
Salts,inlcudingsodiumchloride0.9%
Proteins(albumin,globulin,fibrinogen)
Nutrients,suchasglucose,fats,aminoacidsvitaminsandminerals
Wasteproductssuchasureaandcarbondioxide
Antibodiesandantioxinsforresistancetodiseasegerms,
Hormonesproducedbytheendocrineglands.
Substancesforbloodclotingandforpreventingclotingofblood.
Plasmaisimportantforthelifeofthetissuecells,conveyingtothemwaterandnourishment,and
carryingawaytheirwasteproducts.

Fig2.17BloodCells
1)Platelets
2)RedBloodCells
6)Esoniophil 7)Basophil

3)WhiteBloodCells 4)Monocyte5)Neutrophil
38

Bloodcells(Bloodcorpuscles)
Therearethreemaintypes
RedbloodcellsorErythrocytes
WhitebloodcellsorLeucocytes
BloodPlateletsorThrombocytes.
Redbloodcellsareformedinthebonemarrowandwearoutinaboutthreemonths,soneed
placing.Theyareverytinydiscwithnonucleus,andarefilledwithhaemoglobin,whichismadefrom
ironandprotein.Haemoglobingivestotheblooditsredcolour.Thenormalamountofhaemoglobinis
14.515gms.per100ml.ofblood.Lackofirontomakehaemoglobiniscommoncauseofanaemia.
RBCshavetheimportantfunctionofcarryingoxygenfromthelungstothetissuecells.Whenunited
withoxygeninthelungs,thehaemoglobinhasabrightredcolur.Whenthebloodreturnsaftergivingup
itsoxygen,itischangedtoadullredcolour.
WhiteBloodcells
Whitebloodcellshelptofightinfection.Therearetwomaintypes.
1)

Leucocytesareproducedinthebonemarrow.Theycanchangeshapeandsqueezethroughthe
smallboodvesselwallsinordertofightgemsthathaveenteredthetissues.Manydieinthefight
andbecomepuscells.Inacuteinfectionmanymoreleucocytesareproducedtohelpinthefight
(leucocytosis)

2)

Lymphocytesareproducedinthespleenandlymphglands.Theyarelessmobilebuttheyare
helptofightinfectionespeciallywhenitischronic.

BloodPlateletes
Bloodplateletesareproducedinthebonemarrow.Theyhelpintheclotingofblood.
FunctionsofBlood:
Carriesoxygentothetissuesbymeansofredbloodcells.
Carriesfoodtothetissues.
Carriesawaywasteproductsfromthetissuestotheexcretoryorgan.
Carrieshormonesfromtheglandstothetargettissues.
Fightsgerminfectionbymeansofthewhitecellsandantibodies.
Distributesheatandhelpstomaintainbodytemperature.
Helpstomaintainwaterbalanceinthebody.
TheLymphaticSystemandSpleen:
Thelymphaticsystemisaspecialtypeofcirculatorysystem.Itiscomposedof1)Thelymph.2)
Thelymphaticvessels.3)Thelymphglandsornodes.
Lymphisafluidlikeplasmaandthetissuefluidbutincasesofinfectionitmaycontainbacteria.
Lymphisreallythetissuefluid,whichfindsitwayintothelymphaticvessels.
LymphaticVessels:Lymphaticstartintissuespacesbetweenthecellsandstartliketheveins.
Insidethemarethevalveswhichhelptheflowoflymphtowardsthetwolargestlymphatic
vessels.
39

 LymphGlands aresmallbeanshapedstructures,situatedalongthecourseofthelymphatic.
Theyarefoundmainlygroupedtogetherintheneck,axilla,andgroinsandinthepelvicand
abdominalcavities.Lymphoidtissueisalsofoundinthetonsils,pharynxandintestines.
FunctionsofLymph:
Lymphglandshelptoprotectthebodyfrominfectionby
1) Filteringthelymphtopreventgermsfromgettingintothebloodstream,andfightingto
overcomethem.
2) Producingnewlymphocytesfortheblood.
DIGESTIVESYSTEM
Digestionistheprocessbywhichthecomplexformsoffoodmaterialsarebrokendowninto
simplerformoffoodmaterialssuitableforabsorption.
Oncethefoodisdigested,itmustbetransferredtothebloodstreamandtheprocessbywhich
this transfer occurs is called absorption. Digestion and absorption are two chief functions of
thedigestivesystem.
TheAlimentaryCanal:
Thealimentarycanalisalongmusculardigestivetubeextendingthroughthebody.Itisabout
750cminlength.Itconsistsofthefollowingparts:
1) Themouth. 2)Oesophagus
3)Stomach 4)Smallintestine
5)Largeintestine.
6)Rectum
7)Analcanal.

Fig2.18DigestiveSystem
1)Mouth
2)Oesophagus
3)Stomach
4)Pancreas
5)Largeintestine
6)Smallintestine
7)Rectum
8)Liver
9)GallBladder
3

8
9

4
5
6
7
40

Thegastrointestinaltractconsistsatubecomposedoffourprincipallayersfromoutsideinwards:
1)Tunicaadventitiaorserouscoat
2)Tunicamediaorthemuscularcoat.
3)Tunicaintimaortheinnerliningofthebloodvessel.
FunctionsofDigestiveSystem:
1)Breakdownthefoodsubstancesintosmallparticles
2)Digestionoffoodsubstances.
3)Absorptionoffoodsubstances.
4) Excretionofundigestedfoodandtoxicsubstances.
Thealimentarycanal,whichisacontinuous,passagewaybeginningatthemouth,wherethefood
istakeninandterminatingattheanuswherethesolidproductsofdigestion,whicharenotabsorbed,are
expelledfromthebody.
Theaccessoryorganswhicharevitallynecessaryforthedigestiveprocess,donothappentobe
thepartofthealimentarycanal.
PhysiologyofDigestion:Digestiontakesplaceisthreepartsofthealimentarycanal.Theyare:
1)Mouthwiththehelpofsalivafromthreepairsofsalivaryglands, 2)Stomach withthehelpof
gastricjuicefromthestomachwalland 3)Smallintestine withthehelpofpancreaticjuicefromthe
pancreasbilejuicefromtheliverandtheintestinaljuicefromthesmallintestine.
TheMouth: Themouthisalsocalledtheoralcavity.Inthemouththereareabout32teeth.Theyare
(1)Molars12 (2)Premolars8 (3)Canines4

(4)Incisors8

Theteethhelptobreakdownthefoodsubstancesintosmallparticles.Amuscularorganprojects
intothisspaceiscalledthetongue.Ithelpsinchewingandswallowingandisoneoftheprincipalorgans
ofspeech.
Thetonguehasonitssurfaceanumberoftastebudsbymeansofwhichwecandifferentiate
sensationoftaste.(bitter,sweet,sourandsalty)
Inchewing,theteethgrindthefoodintopieceswhilethesecretionofsalivamoistensandlubri
catesthefood.
Salivaisajuicesecretedbythreepairsofsalivaryglandsinthemouth.theyare
1) Theparotid:locatedinfrontandbeloweachexternalear.
2) Thesubmaxillary:locatedbetweenthemandibleandthemuscleofthefloorofthe
mouth.
3) Thesublingualgland:locatedinfloorofthemouth.
Salivary secretion is a reflex process, both conditioned and unconditioned reflexes are
involved.Anewborninfantsalivateswhenfoodisplacedinitsmouth.Butthesightandsmelloffood
doesnotproduceanyreaction.
Laterbyassociatingthesightandsmelloffoodwithitstaste,thechildlearnsthatthefoodhas
certain qualities and these very qualities are after wards capable of eliciting salivary
secretion.
41

FunctionsofSaliva:
1) Itkeepsthemouthmoistandhelpsinspeech.
2) Ithelpsintheprocessofmasticationofthefoodstuffandinpreparingitintoabolussuitable
fordigestion.
3) Itdiluteshot,irritantsubstancesandthuspreventsinjurytothemucousmembrane.
4) Salivacontainstwoenzymes.PtyalinandMaltase,whichconvertsstarchyfoodintosugars.
5) Salivahelpsinthesensationoftaste.
6) Ithelpsheatloss.Thisismainlyfoundinanimals.Whentheybecomehot,moresalivais
secretedcausinggreaterheatloss.
7) Ithelpsintheexcretionofcertainsubstanceslikedrugscontainingmercury,leadandiodine.
Digestioninthemouth
Thefoodischewedandsalivathefirstofthedigestivejuicesactsonit,softensitsothatitcanbe
easilyswallowed.Salivacontainstwoenzymes.
(1)Ptyalin
(2) Maltase.
Ptyalinsplitsstarchintomaltoseandmaltaseconvertsmaltoseintoglucose.
Oesophagus :
Theoesophagusisatubeconnectingthepharynxandthestomach.Itconveysthefoodfromthe
mouthtothestomach.
Stomach
Thestomachisanenlargedsectionofalimentarytube.Bothendsofthestomachareguardedby
valveswhichnormallypermitthepassageofsubstancesinonlyonedirection.
Theproximalendisguardedbycardiacsphincterandthedistalendofthestomachisguardedby
pyloricsphincter.
Stomachactsasapouchforholdinglargequantitiesoffoodsothatfrequentfeedingcanbe
avoided. The stomach mixes up the food thoroughly by its movements. It also destroys the
bacteriabythehighacidity.
DigestionintheStomach
The food material after being broken down by mechanical grinding and having been
convertedintoaboluswiththesalivareachesthestomach,whichpoursalargequantityofgastricjuice
everyday.
Themechanismofproductionofgastricjuiceisachemicalorhormonalinnature.Whenthe
digestedfoodisincontactwithgastricmucosa,achemicalextractisformed.Itisnamedasgastrinand
belongstothegroupofgastrointestinalhormones.Thiscausesthedischargeofgastricjuice.
Thegastricjuicecontainsmainlyhydrochloricacidandenzymes.
1) Pepsin.
2)Rennin
3)Lipase
FunctionsofHydrochloricAcid:
1)Killsbacteriapresentinthefood.
2)Softenstheconnectivetissuesofmeat.
3) Convertsinactiveformofpepsinogenintoactiveformofpepsin.
42

FunctionsofEnzymes:
1)Pepsinconvertsproteinintopeptones.
2)Renninconvertstheindigestibleproteinofmilkintoeasilydigestibleone.
3) Lipaseconvertsfatsintofattyacidsandglycerol.
Liver
Theliverisoneofthelargestandimportantorgansituatedontherightsideoftheabdomen.Bileis
secretedbytheliver.

FunctionsofLiver:
1) Theproductionofbilefromthepigmentofbrokendownredbloodcells.
2) Theremovaloftoxinsthathavebeenabsorbedfromtheintestine
3) Thestorageofsimplesugarintheformofglycogenwhichisreleasedasneededintheform
ofglucose.
4) ThestorageoffatsolublevitaminsincludingA,D,EandK.
5) Themanufactureofheparin,whichpreventsclottingofthebloodinthebloodvessels.
6) Theformationofantibodieswhichactsagainstdiseaseproducingorganisms.
7) Theproductionofcertainbloodplasmaproteinssuchasfibrinogenandalbumin.
8) Theremovalofawasteproductcalledureafromaminoacids.
BileJuice:
1)Intheabsenceofbile,fatsarenotdigestedproperlywhichresultsinfattydiarrhea.Thusbileis
essentialfordigestionthoughitdoesnotcontainanydigestiveenzymes.
2)Thebileistakenbythehepaticductandisstoredinthegallbladder,whichissituatedonthe
lowersurfaceoftheliver.Thebileisconcentratedandsenttotheduodenumthroughthecysticduct
whenchimefromthestomachenterstheduodenum.
3)Bilecontainsbilesalt,bilepigment,mucinandwater.Thetwopigmentspresentinthebileare
calledBilirubinandBiliverdin.Thesepigmentsgivecolourtothefaecesandurine.
Duetoliverdamageorobstructionofthebileduct,bilirubincollectsinexcessquantitiesinbleed
andchangesthecolouroftheskinandtheeyes.Theremaybechangesinthecolouroftheurinealso.
Thisiscalledjaundice.
FunctionsofBileJuice:
1)Itstimulatesthefunctionsoftheproteolyticenzymesandtheamylase.
2)Itdissolvesfattyacidandglycerol.
3)Itcoordinateswithlipasetoconvertthefatintofattyacidandglycerol.
4)Acidicnatureoffood.
Pancreas
Pancreasanelongatedstructurelyingacrosstheposteriorwalloftheabdomen.Itisanexocrine
aswellasanendocrinegland.Thepancreasnotonlyproducesthepancreaticjuicebutalsosecretes
hormoneseg.Insulinandglucacon.Itisreleaseddirectlyinthebloodwhichregulatesthebloodglucose
level.Thepancreaticjuicecontainsthreeenzymes.Theyare
43

1) Trypsin. 2)Amylaseand3)Lipase.
Besidestheseenzymespancreaticjuicecontainslargequantitiesofsodiumbicarbonatewhich
neutralizesthehydrochloricacidpresentinthegastricjuicesecretedbythestomach.
TheSpleen: Thisisadarkpurpleorgansituatedintheleftsideoftheupperabdomen,behindthe
stomach.
FunctionsoftheSpleenare:
1) Itproducesnewlymphocytesfortheblood.
2) Ithelpstofightinfection.
3) Itdestroyswornoutredbloodcellsandremovestheironfromthemtobereused.
4) ItactsasareservoirforRedBloodCells,whichitreleasesintimeofneed,suchasasudden
haemorrhage.
Small Intestine
Thesmallintestineisabout600cmlonginadultextendingfromthepyloricsphincterofthestom
achtointestine.Thefirst25cmor30cmofthesmallintestineiscalledtheduodenumfollowedbythe
jejunumandtheremainderistheileum.
DigestionintheSmallIntestine:
Thefoodinthestomachispartiallydigestedbythegastricjuice,butthesmallintestineistheorgan
inwhichthecompletionofthedigestionandabsorptionoccurs.
Intheduodenumthereisanopeningintowhichleadtwoductscarryingdigestivejuicesi.e.,
pancreaticjuiceviathepancreaticductfromthepancreasandtheother,bile,viabileductfromtheliver.
Bileisnotprimarilyadigestivejuicebecauseitcontainsnoenzymebutithelpsinthedigestionof
fats.Thebilesaltemulsifiesfatsandhelpsthepancreaticlipasetoactanddigestiteasily.Thepancreatic
juicecontainsthreepowerfulenzymes.
Theyare:
1)Pancreatin:convertscarbohydratesintosimplesugarslikeamylaseglucose,fructoseand
galactose.
2)Trypsin:convertspeptonesintopolypeptides.Inthebeginningtrypsinispresentintheformof
inactivetrypsinogen.
Thistrypsinogenisconvertedintoactivetrypsinbyactionofenterokinasewhichissecretedinthe
smallintestine.
3)Pancreatic lipase:convertsfatsintofattyacidsandglycerol.
Afterpancreaticdigestion,thefoodwhichisnowcalledchymeproceedsfurtherintheintestine.
Hereitcomesintocontactwithsuccusentericuswhichisajuiceproducedbythesmallintestine.Succus
entericuscontainsthreeenzymes.Theyare
1)Pepsin:Itconvertspolypeptidesintoaminoacids.
2) Nucleotidase :ConvertsNucleotide,intonucleoside.
3)Nucleosidase:Convertsnucleosidesintopentose,purine,andpyramidin.
44

Italsocontainsthreesugarsplittingenzymescalledlactase,maltaseandsucraseconvertingthe
respectivesugarsintosimplesugars,mostlyglucose.Italsohaslipase,whichactsonfatsandconverts
themintofattyacidsandglycerol.
Thefinalproductofdigestionofthecarbohydratesisglucosewhiletheproteinsareaminoacids
andfatsarefattyacidsandglycerol.
LargeIntestine
Thelargeintestineisasthenameimplieshasthelargerdiameterthanthesmallintestine.Itisabout
150cminlength.Thesmallintestineopensintothelargeintestine.
Thereisasmallpouchatthebeginningpartofthelargeintestine.Thispouchiscalledthecaecum.
Largeintestineconsistsofascendingcolon,transversecolonanddescendingcolon.
Rectumandanalcanal:
Thedescendingcolonoflargeintestineopensintolastpart,therectumandanalcanal.Itisabout
15cmto20cmlong.Therectumservesasatemporarystorageareafortheindigestibleandnon
absorbablesubstances.
Thenarrowportionofthedistalpartofthelargeintestineiscalledtheanalcanal,whichleadsto
theoutsidethroughanopeningcalledtheanus.
AbsorptionofFood:
Absorptionistheprocessbywhichwater,minerals,vitaminsandendproductsofdigestionare
absorbedthroughthemucosaofalimentarycanal(especiallythesmallintestines)intobloodstream
eitherdirectlyorvialymphaticvessels.
In the stomach there is little absorption. Water, alcohol, glucose and simple salts are
absorbedtocertaindegree.Themainabsorptionoccursinsmallintestinesespeciallyinthelower(ileum)
part, the upper part of the small intestine is mainly associated with the process of
digestion.
Themucousmembraneofsmallintestineiscoveredwithminutefingerlikeprojectionsknownas
villi. Eachvilluscontainsarteriole,avenule,acapillarynetworkandalacteal(lymphaticvessel).

1
Fig2.19Villus
2

45

1)Epithelialcells
2)Bloodvessels
3)Lacteal

Nutrientsthatdiffusethroughtheepithelialcellswhichcoversthevillusareabletopassthroughthe
capillarywallsandthelactealenterstheblood.
About90%ofallabsorptiontakesplacethroughoutthelengthofthesmallintestine.Theother
10%occursinthestomachandlargeintestine.
Both monosaccharide and amino acids are absorbed by a positive pressure gradient
betweentheintestinalcontentandthebloodaswellasbyanactiveprocessinvolvingenzymaticreactions
andtransportedinthebloodstreamtotheliverviathehepaticportalsystem.
Theexcessamountofglucoseisconvertedintoglycogenandstoredintheliver,whenneedarises
glycogenisconvertedintoglucoseandisutilizedbythebody.
VitaminKwhichissynthesizedbythebacteriainthecolonareabsorbedfromthelargeintestine.
Largequantitiesofwaterarehoweverabsorbedfromthelargeintestineandthefluidcontentofthesmall
intestineareconvertedintothepastyconsistencyandejectedthroughtheopeningcalledthe anus.
Movementsofthegastrointestinaltract:
Deglutition istheprocessbywhichthemasticatedfoodistransportedacrossthepharynxand
reachesthestomach.Duetocontractilemovementsofthestomach,thefoodiswellmixedupwith
gastricjuice.
Afterbeinginthestomachfor3or4hoursthepyloricsphincteropenspushingthefoodintothe
duodenum.Theintestineshowsthreeimportanttypesofmovements.Theyare
1)PendularMovement:thesemovementsareinducedbycontractionsofthecircularand
longitudinalmusclesoftheintestine.Thismovementcontributestothethoroughmixingofchimewiththe
digestivejuice.
2) SegmentalMovement:thismovementoccursbythecontractionofthecircularmuscles,
whichproducestransversefolds,dividingtheintestineintoshortsegment.
3) PeristalticMovement:itisthewavelikecontractionofthealimentarycanal,whichpropels
thefoodthroughthegastrointestinaltract.
RESPIRATORY SYSTEM
Respirationistheprocessofgaseousbetweenanorganismanditsenvironment.Inthehigher
animals,andmanthegaseousexchangebetweenthetissuesandenvironmentistermed asInternalor
tissuerespiration.
Theexchangeofgasesbetweenthebodyandtheenvironmenttakingplaceinthelungsistermed
as externalrespiration.Theexternalrespirationconstitutesprocessesof inspiration and expiration.
Inspirationisanactivemuscularcontractionwhileexpirationismerelyapassiveactoftherelaxation
ofrespiratorymuscles.
Structureofrespiratorysystem:
Therespiratorysystemisresponsiblefortakinginoxygenandgivingoffcarbondioxideand
water.Itisdividedintotheupperrespiratorytractandlowerrespiratorytract.
1) Theupperrespiratorytract:Nose,Mouth,thethroat,pharynx,thelarynxandnumerous
sinuscavitiesinthehead.
46

2) Thelowerrespiratorytract:Thetrachea,thebronchiandthelungs,whichcontainbronchial
tubebronchiolesandalveoliorairsac.
Thetwo lungs,whicharetheprincipalorgansoftherespiratorysystem,aresituatedintheupper
partofthethoraciccage.
Theyareinertorgans,i.e.theydonotworkbythemselves,butfunctionwiththehelpofamuscular
wallknownasthe diaphragm.
Thepharynxisatubeapproximately12cminlength,whichisacommonopeningforbothdiges
tiveandrespiratorysystem.
Itconnectstheoralcavitytotheoesophagus(foodtube)andthenasalcavitytothelarynxand
windpipe.Theopeningintothelarynxisovalinshapeandguardedbytheleaflikeepiglottis.
The epiglottis foldsdownovertheopeninglikeatrapdoorwhilefoodorliquidisbeingswal
lowed,itpreventstheentryofforeignsubstancesintotherespiratorypassageways.
Theclosureofepiglottis,whenweswallow,isareflexactionandcanbeinterferedwith,ifone
attemptstotalkandswallowatthesametime.
Ifthishappensonemaychoketodeathintheabsenceofimmediateassistance.Fromthephar
ynx,airpassesthroughthetrachea,whichis12cmlongand1.5cmindiameter.Thetract,consistsofa
largenumberofCshapedcartilagerings.Thelarynxorthe voicebox isatthetopofthetrachea.Itis
thevocalcordsinsidethebox,whichbyitscomingtogetherandgoingawayfromoneanotherproduces
differentsounds.
Thetracheabranchesatitslowerendintotherightandleftbronchiwhichentersthelungs,within
thelungsthosepassagewaysrepeatedlydivide,formingmicroscopictubescalled bronchioles.
Eachbronchioleendswithseveralclustersofmicroscopicelasticairsacscalledalveoli,whichare
thefunctionalunitsoflungs.Thisresemblesbunchofgrapes.
1
2
3
4

Fig2.20Lungs
1)Larynx
2)Trachea
3)Bronchus
4)Lung

Thepairedlungsliewithinthelargecavityofthechest,thethoraciccavity.Thelungsaregrayish
colourandarespongyinappearance.
Therightlungshavethreelobesupper,middleandlower,andtheleftlunghastwolobesupper
andlower.Thefloorofthethoraciccavityisformedbyadomelikemuscularstructurecalled dia
phragm. Eachlungisenclosedbytwolayersofmembranecalled pleuralmembranes.
47

Thechestcavityisalsolinedwiththismembrane.Thislayerbeingknownastheparietalpleura,
whilevisceralpleuralinethelungparenchyma.
Respiration
Webreathecontinuouslyfrombirthtodeath,dayandnightinhealthanddisease.
Respirationmaybedefinedasthemechanicalprocessofbreathinginandout,afunction
whichinvolvesboththerespiratorysystemandmusclesoftherespiration.
The2phasesofbreathingare
1. Inhalationduringwhichairisdrawnintolungs
2. Exhalationwhichreferstotheexpulsionofairfromthealveoli
Inhalation
Thediaphragmwhenrelaxedisaflatteneddomeshapestructurepointingupwardstothelungs.
Duringtheprocessofinhalationitcontracts.
Itflattens,pullsdownthethorax,increasesthevolumeofthethorax,andthusdecreasesthe
atmosphericpressureinthelungs.Thiscausesairtorushinduringrespiration.
Exhalation
Duringtheprocessesofexhalation,thediaphragmrelaxes,thethoraxispushedup,thevolume
decreasesandtheatmosphericpressureincreasesandairrushesoutofthelungs.
Theinspiredair,whichcontainsoxygen,passesdownintothebillionsofminuteairchambersorair
cellsknownasalveoli,whichhaveverythinwalls.Aroundthesewallsarethecapillariesofthepulmo
narysystem.
Itisatthispointthatthefreshairgivesoffitsoxygentothebloodandtakescarbondioxidefrom
thebloodbydiffusion,whichisthenexpelledwiththeexpiredair.
PhysiologyofRespiration:
Therespiratorycenterofthebrainislocatedinthemedulla,immediatelyabovethespinalcord.
Fromthiscenternervefibersextenddownintothespinalcord.Fromtheneckpartofthecord,these
nervefiberscontinuethroughthe phrenicnerve tothediaphragm.
Thediaphragmdoesnotcontinuetoworkifitiscutofffromitsnervesupply.Ifonenerveiscut,
thediaphragmofthatsideisparalyzed.Thiscenterisgovernedbyvariationinthechemistryofthe
blood.
IfthereisanincreaseinCo2intheblood,thecellsoftherespiratorycenterarestimulatedandthey
intermsendimpulsesdownthephrenicnervetothediaphragm.
RespiratoryRate:
Inadults,therespiratoryrateis14to18timesperminute.Childrenbreathsmoresuperficiallyand
thereforehaveahigherrespiratoryrate.
Importanceofrespiration:
1) Itsuppliesoxygenandeliminatedthecarbondioxide.
2) Itexcretesvolatilesubstanceslikeammonia,ketonebodies,essentialoils,alcoholandwater
vapour,etc.,
48

3) Byadjustingtheamountofcarbondioxideelimination,ithelpstomaintaintheacidbase
balance.
4) Ithelpstomaintainthenormalbodytemperature.
5) Itisnecessaryforthemaintenanceofoptimaloxidationreductionprocessinthebody.
EXCRETORY SYSTEM
Duringthevitalactivityofthehumanandanimalbody,significantamountsoforganicdegradation
productsareproduced,aproportionofwhichisnotutilizedbycells.
These degradation products must be eliminated from the body. The end products of
metabolismwhichhavetoberemovedfromthebodyarecalled excreta,andtheorgansthatremove
themarecalled excretoryorgans.
Thelungseliminatedcarbondioxideandwatervapourintotheenvironment.Thegastrointesti
naltractexcretesasmallamountofwater,bileacids,pigments,cholesterol,certaindrugs(whenadmin
istered into t he body) salts of heavy met als (cadmium, iron, manganese) and
indigestiblefoodresidues(faeces).
Theskinperformsitsexcretoryfunctionbysweatandsebaceousglands.Sweatglandsexcrete
sweat,whichcontainswater,saltsurea,uricacid,creatinineandothercompounds.
The main excretory organs are the kidneys which eliminate in the urine most of the
metabolitesprimarilythosecontainingnitrogen.(Urea,ammonia,creatinine).
Kidneys:
Thekidneyisabeanshapedorganabout5cmlong,3cmwideand2cmthick.Theyaresituated
atbothsidesofthelumbararea.
Theweightofthekidneyisabout200250gms.Ontheinnerormedialborderthereisanotch
calledthe hilum atwhichregiontheartery,theveinandtheureterconnectwiththekidney.
Eachkidneyhasapelvis,wheretheurinecollects.Theurineisdrainedofffromthepelvisbythe
ureters.Theuretersendintheurinarybladder,whichcanholdabout800mlofurine.Theurethra
carriestheurinefromthebladderandvoidsitconvenientintervals.
Inalongitudinalsection,thekidneyisseentoconsistofoutercortexandinnermedulla.The
medulla consists of 1018 conical or pyramidal shaped structures, known as the renal
pyramids
Thebaseofarenalpyramidfacestowardsthecortex.Thepelvisthefunnelshapedupperendof
theureter.
Microscopicexaminationofmammaliankidneysrevealsthateachkidneyconsistsofaboutmillion
nephron,whicharethefunctionalunitofthekidney.
Thenumberofnephronsvariesdependingonspecies.Thenephronconsistsoftheglomerulus,
therenaltubules,thecollectingtubulesandtheassociatedbloodvessels.
49

Theglomerulusisatuftofcapillaryvessels,whichisinvaginatedintoanepithelialcupshapedlining
calledthe Bowmanscapsule.
Therenalarterydividesintoinnumerablebranchesandtheultimatedivisionsofthearteryforma
tuftofcapillariescalled glomerulus.
Thebloodpressureinsidetheglomerulusdrivesoutthefluidthroughitisopposedbytheosmotic
pressure.ThisfluidthusdrivenoutiscollectedintheBowmanscapsule.
Thefiltrateinthecapsuleconsistsofalltheconstituentsofblood,excepttheplasmaproteinsand
theformedelementsofblood.Thisprocessisknownas ultrafiltration.
2

Fig2.21Kidney
1)Cortex
2)Medulla
3)Pyramid
4)Pelvix
5)Ureter

1
4

Thefiltratedthenpassestothedescendingascendingportionofloop(HenlesLoop)andthento
theconvolutedtubules(proximalanddistal)andfinallyreachesthecollectingduct.
A large number of substances are reabsorbed (reabsorption) by the tubules, a few
substanceadded(secreation)tothefiltrateandthefinalurineisformed.
Forexample,water,glucose,somesaltsandasmallfractionofureaarereabsorbedfromthe
primaryurineintotheblood.Usuallyabout200litersoffiltrateisformedperdayofwhichoneandahalf
litersissentoutasurine.
Therefore, nearly 198 liters of water has to be reabsorbed every day by the kidney
tubules.About80%ofthisreabsorptiontakesplaceintheproximaltubulesandtherestisabsorbedin
thedistaltubules,andsentbacktothebloodstream.
Reabsorptioniscarriedoutwiththehelpof antidiuretichormone whichissecretedinthe
posteriorpituitarygland.
Thuseachnephronisabletocleanorfilteraverylargevolumeofbloodwithoutcausingthebody
tolosemuchofwaterorotheressentialmaterials.
Thecompositionoffinalurineradicallydiffersfromthatoftheprimaryurine.Itisdevoidofglu
cose,aminoacids,certainsalts(phosphatesandsodium)andhasaveryhighureaconcentration.
50

Theurinethusformedcollectsintothebladderthroughtheureterswhicharelong,slender,muscu
lartubethatextendfromthekidneytothelowerpartoftheurinarybladder.
Thebladderisamuscularbagwhichcollectstheurineandvoidsitatintervalsthroughtheurethra.
Whenthebladderisempty,themuscularwallbecomesthickandtheentireorganfeelsfirm
Theorganmayincreasefromthelengthof2or3inchesto5inchesormoreinches.
Amoderatelyfullbladderholdsabout800mlofurine.When400mlofurineiscollectedinthe
bladder,thenormaldesireformicturitionisfelt.Theprocessofexpellingurinethroughtheurethrais
called urinationormicturition.
Theactofmicturitionisareflexaction.Itiscontrolledbytheactionofcircularmuscles,continu
ouswiththoseinthewallsofthebladderandintheurethra.
Urine
Normalurineisfaintyellowincolour,clear,withacharacteristicsodour.Thespecificgravityis
1.010to1.020.NormallyurineiscomposedofWater96%Urea2%Salts2%
Thesaltsconsistsmainlyofsodiumchlorides,phosphatesandsulphates.Theaveragequantityof
urinepassedin24hoursis1.5litres.
ENDOCRINESYSTEM
Theglandsofthebodymaybedividedintothosewithandexternalsecretion(exocrineglands)
andthosewithInternalsecretion(endocrineglands).
Examplesofexocrineglandsarethesweat,lacrymalandmammaryglandswhichpasstheirsecre
tionalongtheductstotheexternalsurfaceofthebodyandtheglandsofthemouth,stomach,and
intestinewhichpasstheirsecretionsalongductsintothealimentarytract.
Theendocrineorductlessglandontheotherhandhavenoductsoropeningstotheexterior.Their
secretionarepasseddirectlyintothebloodstreamandtransmittedtothetissues.
Ahormoneisachemicalsubstanceproducedbytheendocrineglandsandtheiroverallfunctionis
toregulatetheactivitiesofvariousbodyorgansandtheirfunctions.
Themainendocrineglandsinthebodyare
1)Thyroid

2)Parathyroid

4)Adrenalgland 5)Pituitarygland

3)IsletsofLangerhans
6)Sexglands.

ThyroidGland:
Thelargestoftheendocrineglandsisthethyroidwhichislocatedintheneckregion.Thethyroid
glandweighs25gmsinahealthyadult.Ithastwoovalpartscalledthelaterallobesoneithersideofthe
trachea.Thesetwolobesareconnectedbyanarrowbandcalledisthmus.Theentireglandisenclosed
byaconnectivetissuecapsule.Thisglandproduceshormone,thyroxinrichiniodine.Thyroidgets
iodinefromthebloodstream.Itisthenfixedwiththeaminoacidsthyroxincompounds.Twomolecules
51

ofdiiodothyroxincombinetoformthyroxin.Thyroidstimulatinghormone(TSH)producedbythe
anteriorpituitarylobeincreasestheactivityofthyroidgland.Whenever,thethyroxinlevelfallsbelowa
particularlevelTSHisstimulated.

Fig2.22ThyroidGland
1

1)Larynx
2)Thyroidgland
3)Trachea

FunctionsofThyroxin:
1) Helpstoregulatetissuegrowthanddevelopment
2) IncreasestheBMRandthusraisesthebodytemperature
3) Itcontrolsthemetabolismbyregulatingtheanabolicand
4) Catabolicprocess
5) Stimulatethecellstobreakdowntheproteinsforenergy.
6) Decreasesthebreakdownoffats
7) Increasesthebreakdownofbodyglucoseandenhancestheglucoseabsorption.
8) CalciumandPhosphorousareremovedfromthebonesandexcretedinincreasedamounts.
9) HelpsintheconversionofbetacaroteneintovitA.
ParathyroidGland
Thesearetwotinyovalpair(6mmx2mm)ofglandssituatedatupperendandlowerpolesof
laterallobesofthyroidgland.Itsecretesthehormoneparathyroxin.
FunctionsofParathyroxin:
1)Increasestheconcentrationoforganicacidinthebone.
2)Increasesthecalciumandphosphorussolubility
3)Increasesthereabsorptionofcalciumfromthebones.
4)Increasesserumcalciumlevel
5)Increasesphosphateexcretionintheurine
52

6)Increasesthereabsorptionofcalciumfromtherenaltubules
7)Promotestheabsorptionofcalciumandphosphorusfromtheintestine.
8)Stimulatestheprocessoflactationinmammarygland.
IsletsofLangerhansinthepancreas:
Thepancreasisbothanexocrineglandsecretingdigestivejuicethroughaductintotheduodenum
andanendocrineglandsecretinghormoneintothebloodstream.
Itconsistsofhead,bodyandtail.Theheadfitintothecurveofduodenum.Thenbodyandtailare
directedtowardstheleft.Thepancreaticisletsrepresentstheendocrinepartofthepancreas.
Mostoftheisletsarelocatedinthetailandonlyasmallnumberintheheadofthepancreas.There
aretwodifferenttypesofcellsintheisletsofLangerhans.Thealphacellsandbetacellsarevery
important.
ThealphacellssecreteahormoneGlucagonwhereasthebetacellssecreteinsulin.
FunctionsofGlucagon:
1)Increasesthebloodglucoselevel
2)Breakdowntheliverglycogenintoglucose
3)Stimulatesthebreakdownoflipidinadiposetissue
FunctionsofInsulin:
1)Convertsglucoseintoglycogenandacceleratesthetransportofglucosefromtheblood
intothecells.
2)Decreasesthebloodsugarlevel
3)Builduptheglycogenstoreintheliver.
AdrenalGland:
Theadrenalorsuprarenalsaretwosmallglandseachonesituatedaboveakidney.Adrenal
glandsconsistsoftwodifferentpartseachofwhichactsasaseparategland.
Theinnerareaiscalledmedullawhichisbrownincolorwhiletheouterareaiscalledcortexwhich
islighterincolor
AdrenalCortex:
Itiscomposedofthreelayers.Theyare
1)Zonaglomerulosa(outerlayer)
2)ZonaFaciculate(middlelayer)
3)Zonareticularis(innerlayer)
Theadrenalcortexsecretesthreehormones.Theyare:
1. Glucocorticoids:Actsasantagoniststoinsulinandcauseincreaseinbloodsugar
2. Minerlocorticoids:Acts on sodium and potassium and help in the conversation of
sodiuminthebody
53

3. SexSteroids:Stimulatesthedevelopmentofthereproductiveorgansinthechildhood.Itis
responsiblefordevelopmentofsecondarysexcharacteristicsandreproductivefunction.
AdrenalMedulla
AdrenalMedullasecretestwohormones.Theyareadrenalineandnoradrenaline.
FunctionsofMedullaryhormones
1)Dilationofthepupilsandimprovesthevisualacuity
2)Increasesbothrateandamplitudeofcontractionofheartandraisesthecardiacoutput.
3) Increases both rate and amplitude of respiratory movements and causes dilation
ofthebronchioles
4)Raisesthebloodsugarlevelbymeansofglycogenolysis
5)Increasesthebasalmetabolicrate
6)Dilationofthewallsofintestineandtheurinarybladder
Thefunctionsofadrenalinearesimilartothatofnoradrenalineexceptinafewinstances.For
example,Adrenalinincreasestheheartratewhereasnoradrenalindecreasesheartrate.
Pituitarygland:
Thepituitaryglandisasmallglandaboutthesizeofthecherry.Itissituatedatthebaseofthebrain.
Itplaysapeculiarroleinthesystemoftheendocrineglands.
Itisreferredtoasthemasterglandofinternalsecretionbecauseitcontrolstheactivitiesofother
endocrineglands.Thepituitaryglandisdividedintotwomainparts.
1) Anteriorpituitarygland.2)Posteriorpituitarygland
Theanteriorpituitarygland:Thispartsecretesalargenumberofhormones.Manyofthemstimulate
otherglands.Itsmainhormonesare:
1) Growth hormone: it facilitates the growth of the bone and cartilage tissue. Over
activityoftheanteriorpituitarylobeinchildhoodresultsinexcessivegrowthandheight.Thiscondition
isknownasgigantism.
Adecreasedactivityoftheanteriorpituitarycausesaseveregrowthretardationleadingtodwarfism.
Excessiveproductionofgrowthhormoneinanadultleadstoexcessivedevelopmentofcertain
regionssuchasfingersandtoes,feet,hands,nose,lowerjaw,tongue,thoracicandabdominalorgans.
Thisconditionisknownasacromegaly.
2.Thyrotrophicstimulatinghormone(TSH):thishormonestimulatestheactivityofthethyroid
gland.Administrationofthishormonecausesovergrowthofthyroidtissue.
3. Adreniocorticotrophichormone(ACTH):thishormonestimulatesthecortexoftheadrenal
glandandincreasestheproductionofthehormonesoftheadrenalcortex.
4. Follicularstimulatinghormone(FSH):thishormoneinfluencesthegrowth,developmentand
maturationandoftheovarianfollicles.Inmales,thehormonestimulatestheformationofspermintestes.
54

5. Prolactinhormone:itactsonthemammaryglandandhelpsintheformationandflowofmilk
duringlactation.
6. Luteinisinghormone:itisrequiredforthegrowthoffollicleintheovaryandstimulatesovula
tion.Intheabsenceofthehormone,noovulationandproductionofthecorpusluteumcanoccur.In
malesitstimulatestheinterstitialcellsoftestestosecretetestosterone.
Theposteriorlobeofthepituitary:
Thislobeisjustbehindtheanteriorlobe.Itproducestwohormones.Oxytocinandvasopressin.
Oxytocinactsonthesmoothmusclesespeciallythatoftheuterusandproducespowerfulcontractions
oftheuterusandhelpsinparturition.
Vasopressin acts on the smooth muscle of the arterial system and increases the blood
pressure.Thishormonehelpsinthereabsorptionofwaterfromthedistalconvolutedtubule.Vaso
pressindeficiencyisthecauseofdiabetesInsipidusinwhichwaterisnotreabsorbed.Sogreatamounts
ofurineareexcretedwithnosugarinit.Suchpatientsfeelconstantlythirsty.
Thesexglands:
Thesexglandsincludingtheovariesofthefemaleandthetestisofthemaleareimportantendo
crinestructures.Thesecretionsofthisglandplayanimportantpartinthedevelopmentofthesexual
characteristics.
Themalesexglandsecreteshormonecalledtestosteroneandisresponsibleforsecondarysex
characteristics.Thefemalesexglandsecretesahormonecalledestrogenanditstimulatesthedevelop
mentandfunctioningofthefemalereproductiveorgans.
Thereisoneotherhormoneproducedbyfemalesexglandanditiscalledprogesterone.This
hormoneassistsinthenormaldevelopmentofthepregnancy.
SENSEORGANS
Theorgansofthespecialsensearespeciallyadaptedendorgansforthereceptionofcertainkinds
ofstimuli.Thesensoryimpressionswhicharesuppliedbythenervescarriedtothebrainwheresensa
tionsareinterpretedfore.g.
1)Taste

2)Smell

3)Sight4) Touch

5) Sound

Ineachcasethesensorynervesaresuppliedwithspecialnerveendingsforcollectingthestimuli
fortheparticularsensewithwhicheachorgandeals.Weapparentlytastewiththenerveendings
inthetongue,hearwiththoseintheearandsoon,butinrealityitisthebrainthatappreciate
thesesensations.
Skin
Theskinformsaprotectiveoutercoveringaroundtheentirebody.Itconsistsofanouterthinlayer
calledthe epidermis andaninnerthicklayercalledthe dermis.Numerousstructuressuchasglands,
senseorgansandappendagessuchashairnailsareembeddedintheskin.
Epidermis: Thisistheoutermostthinportionoftheskin.Nobloodvesselsarefoundinthislayer.
Itderivesitsnutritionfromlymph.Nervesarefoundinthislayer.Theepidermisconsistsoffourlayers
ofcells.
55

Theyare:
1)TheStratumCorneum

2)TheStratumLucidum

3)StratumGranulosumand

4)TheStratumMalphigi

TheStratumCorneum:Thecellsinthislayerarethin,scalelike,dead,andcornified.The
corneuslayeristhickenedinthosepartsofthebodysuchasthepalmandsoleofthefoot.Itisthinner
inthelips.Hoofs,horns,nails,feathers,thescalesofthefishesareallspecialoutgrowthsofthislayer.
TheStratumLucidum: Thisisathinmoreorlesstransparentlayer,inwhichthecellsare
indistinct.
The Stratum Granulosum: It consists of three to five layers of flattened cells,
containingdarkgranulesofirregularshape.
TheStratumMalphigi: Thislayeristhelowermostandbroadestlayeroftheepidermis.Itis
capableofactivemultiplication.Thislayerismadeupofpolyhedralcells.Theinnermostcellofthis
layercontainspigmentgranulescalled melanin whichgivetheskinitscolour.
Dermis:
Situatedbelowtheepidermisisthethickestdermisformedmostlyofconnectivetissuewhichis
richlysuppliedwithbloodvesselsandnerves.
Theboundarylinebetweenthedermisandepidermisisneithersmoothnorstraightitisratherzig
zagbecauseoftheconicalprojectionofthedermisintotheepidermis.
Theseprojectionsarecalled dermalpapillae.Thislayeristough,flexibleandhighlyelastic.
Itcontainsthefollowing:
1)Fineelasticfibres.

2)Capillarybloodvesselsandlymphatics.

3)Sensorynerveendingsofvarioustypes.

4)Hairrootsorhairfollicles.

5)Sweatglands.

6)Sebaceousglandsand

7)Involuntarymusclefibres.Thesemusclefibre,callederrectorespilorumareattachedtothehair
follicleandwhenthesemusclescontract,thehairsbecomeverticalandgooseskinisbroughtabout.
Glands:
Therearetwosetsofglandsintheskin.Theyare
1)TheSweatglands
2)Thesebaceousglands.
Eachsweatglandconsistsofalongtube,whichatoneendopensontothesurfacethroughthe
sweatspore.Attheotherends,inthedeeperpartofthedermis,thetubeformsacoiledmasswitha
blindend.
Inthecoiledportionofthesweatglandthereandglandularcells,whichseparatewaterandsmall
quantitiesofmetabolicwasteproductsfromthebloodthatcirculatesthroughthecapillarynetwork
associatedwiththegland.
Thesweatpassesthroughthesweatporeandevaporatefromthesurfacebytakingheatfromthe
skin.Thesweatglandsarepresentinlargeamountsonthepalms,soles,foreheadandinthearmpits.
56

Thesebaceousglandsareirregularlyshapedsaclikeglandsthatopenintothehairfollicle.The
oilysecretions(sebum)oftheglandsmakethehair,waterproofandprotecttheskinfromdryingeffects
oftheatmosphereduetohightemperaturesandlowhumidity.
SensoryNerveEndings:
Numeroussensorynervesspecializedtopickupstimulithatcausesensationsoftouch,pressure,
pain,heatandcoldarescatteredintheskin.
Theyareconnectedtothebrainbynervefibres.Stimulipickedupbythesenseorgansare
transmittedtothebrainwhentheyareinterpretedtogivethecorrectinformation.
Appendages:
Hairandnailsareappendagesoftheskinformedasaresultoftheoutgrowthorthickeningofthe
epidermis.
Functionsoftheskin:
Theskinisnotmerelyanoutercoveringforthebodybutitservesavarietyoffunctions.
1)Protection:Theskinprotectstheinnerpartsofthebodyfrommechanicalinjuries.Ahealthy
skinalsoprotectsthebodyfromtheinvasionofgermscausingdiseases.Thenails,hoofs,andhornsare
alsodefensiveappendagesoftheskin.
2)Excretion:Likekidneys,theskinthroughitssweatglands,eliminatessalts,andmetabolic
wasteproductsintheformofsweat.
3)Sensoryfunction:Thenumeroussenseorgansandnerveendingshiddenintheskinmakeitan
importantsensorystructurethatpicksupdifferentstimuliandinformsthebrainofsuchchangesinthe
environment.
4)ProductionofVitaminD:Theskincontainsasubstancecalled7dehydrocholesterolwhich
isconvertedintovitaminDbyultravioletraysofthesun.
5)Regulationofthebodytemperature:Byconduction,convectionandradiationalarge
amountofheatislostfromthebody.Thesubcutaneousfatandhairsactasnonconductorsofheat.
Evaporationofsweattakesawayalargeamountofheatfromthebody.
6)Waterbalance:Formationandevaporationofsweatisanimportantfactorintheregulationof
waterbalanceofthebody.
7)Acidbalanceequilibrium:Sweatbeingacidinreactionagoodamountofacidisexcreted
throughit.Inacidosis,itbecomesmoreacidandinthiswayhelpstomaintainaconstantreactioninthe
body.
8)Secretion:Sebumwhichissecretedbythesebaceousglandshelpstokeeptheskingreasyand
preventsdrying.Sweatissecretedbysweatgland.Milkissecretedbymammarygland.Themam
maryglandsaretheskinstructures.Theyarethemodifiedsebaceousglands.
9)Storagefunction:Thesubcutaneoustissuecanstore
a.fat

b.water

c.salts

d.glucoseandsuchothersubstances
57

Tongue
The tongue is concerned in the special sense of taste. It is a solid muscular organ of
deglutition,taste,speechandhelpsinmasticationoffood.Itissituatedintheoralcavity.Themucous
membraneofthetongueismoistandpinkinhealth.
Tongueconsistof3parts
Root Attachedwiththehyoidbone
Body surfaces
Apex Touchestheposteriorsurfaceoflowersurfacesincisorteeth
Surfaces:Bodycontainingdorsalsurfaceandinferiorsurface.Uppersurfacehasavelvetteap
pearancecoveredbythreevarietiesofpapillae
1) Circumvallatepapillae thesepapillaearearrangedinaVshapeatthebackofthe
tongueandtastebudsarefoundnumerousinthewallsofthe
circumvallateandfungiformpapillae.
2) Fungiformpapillae aredistributedoverthelipandsidesofthetongue
3) Filiformpapillae
areabundantandfoundoverthewholesurfaceofthetongue
Smell:
Noseisthespecialorganofthesmellandthenasalcavitiesarelinedbymucousmembrane.The
olfactoryorfirstcranialnervesuppliestheendorgansofsmell.Thefilamentsofthenerveariseinthe
upperpartofthenasalcavityiscalledolfactoryportionofthenoseandlinedwithhighlyspecialized
cells.
Theolfactorynervesandconnections
Theolfactorybulbisanoutlyingportionofthebrainistheslightlyenlargedportionoftheolfactory
nervetractwhichliesabovethecribriformplateoftheethmoidboneformtheolfactorybulbsensation
ispassedalongtheolfactorytractbyseveralrelayingstationsuntilitreachesthefinalreceivingareain
theolfactorycentrewhichisinthetemporallobeofthecerebralhemispherewherethesensationis
interpreted.Thesenseofsmellisstimulatedbygasesinhaledbysmallparticle.
OrgansofspecialsenseTheearandhearing:
Theearistheorganofhearing.Thenervesupplyingthisspecialsenseistheeighthcranialor
auditorynerve
Theearhasthefollowingparts
1)Externalear

2)Middleearortympaniccavity

3)Internalear.

Externalearconsistof
1)Pinnaorauriclecollectsthesoundwaves
2)Externalauditorymeatus
Middleearconsistof
1) Eardrum
2) Eustachiantube

conveysthevibrationsofsound

communicatestothemastoidprocess
maintainingthepressureofairinthetympaniccavity

3) Auditoryossiclesare3smallbones.Theyare
58

Malleus
Incus

Thischainofboneservestotransmitthe
vibrationsofsoundfromthedrumtotheinternalear

Stapes
Mastoidprocessisthepartofthetemporalbonelyingbehindtheearanairspacecommunicates
inthemiddleear
Internalear
Consistsofcavitiescalledthebonylabyrinthandmembranouslabyrinth.Bony
labyrinthconsistof3parts
2

Fig2.23Ear
1)Pinna
2)Auditorycanal 3)Eardrum
5)AuditoryNerve
6)Cochlea
Thevestibule

4)Semicircularcanals
7)EustachianTube

It is the central part with which all the others communicate, as

doorsmayopenoutofthevestibuleofadwelling

Semicircularcanals Assistthecerebelluminthecontroloftheequilibrium
Cochlea

Spiraltubetwistedresemblingasnailshell.Thefluidwithinthemembranous
labyrinthisendolymphandthefluidinthebonylabyrinthistheperilymp.The
fenestravestbuliandthefenestracochleaarewindowsdirectedtowardsthe
middleearandallowthevibrationstransmittedtoperiandendolymphtoacti
vatethenerveendingsoftheauditorynerve

Hearing: Soundwavespassalongtheexternalauditorycanalcausethetympanicmembranetovibrate.
Thevibrationstransmittedthroughmalleus,incusandstapes.Bymovementofthesebones,magnifythe
vibrations,thencommunicatedtothevestibularfenestratotheperilymphandtotheendolymphinthe
canalofthecochlea.Thisstimulireachesthenerveendingsintheorganofcorti,conveyedtothebrain
byauditorynerve.Thesensationofhearingisinterpretedbythebrainasapleasantorunpleasant
sound(noiseormusic).
Balance: Thechangeinthepositionofthefluidinthesemicircularcanalshelpsin ordertomaintain
balanceofthebodyandthiscanaldistributedbythevestibularnervewhichconveystothebrainthe
59

impulsegeneratedtherebyalterationsinthepositionofthefluidinthesecanalswhichhavetodowith
theknowledgeofthesenseofthepositionoftheheadinrelationtothebody
OrgansofspecialsenseTheeyeandsight:
Eyeballissphericalinshapesituatedintheanterior2/3oftheorbitalcavityanditisembeddedinthe
fatofthecavity.Theopticorsecondcranialnerveisthesensorynerveofthesight
Theeyeballcomposedof3layers
1) Outer
Fibrousandsupportinglayer
2) Middle
Vascular
3) Inner
nervouslayer(Retina)

1
2
3
4

Fig2.24Eye
6

5
7

1)Conjunctiva
2)Cornea
3)Iris
4)Pupil
5)Lens
6)Retina
7)OpticNerve

Fibrouslayer:
Sclera: Itisopaque,white,smoothandcontributestheposterior5/6thoftheeyeball.Itprotects
thedelicatestructureoftheeyeandhelpstomaintaintheshapeoftheeyeball
Cornea: Isatransparentfrontportion,avascularandcontinuouswiththesclera.Itconsistof
severallayersandithelpstofocusimagesontotheretina
Vascularlayer:
Choroid: Itishighlyvascularandpigmentedlayer,suppliesnutritiontotheouterlayerofretina,
absorbsthelightandpreventsreflectionoflight
Ciliiarybody: Itliesbetweenthechoroidandtheirisandhascircularmusclefibersandradiat
ingfibershelpsinmaintainingtheaccommodationoftheeye
Iris: Itisacircular,contractileandpigmenteddiaphragm.Itisthecolorcurtaininfrontofthelens
anditcontains2setsofinvoluntarymusclefibers,onesetcontractthesizeofthepupil&otherset
dilatesthepupil
Pupil: Itisthedarkcentralspotwhichisanopeningintheiristhroughwhichlightreachesthe
retina
Nervouslayer(retina): Composedofnumberoflayersoffibers,nervecells,rodsandcones.The
mostsensitivepartoftheretinaistheMaculalies,oppositetothecentreofthepupil.Atthemiddleside
ofthemaculathereisacircularpaleareawhichisinsensitivetolightcalledblindspot
60

Sight
Whenanimageisperceivedtheraysoflightfromtheobjectseen,passthroughthecornea,
aqueoushumor,lensandvitreousbodytostimulatethenerveendingsintheretina.Thestimulireceived
bytheretinapassalongtheoptictractstothevisualareasofthebraintobeinterpreted.Bothareas
receivemessagesfrombotheyesthusgivingperspectiveandcontour.Onelensisprovidedinanordi
narycamera,whereasintheeyesthecrystallinelensisimportantinfocusingtheimageontheretina
REPRODUCTIVESYSTEM
Thereproductivesystemconsistsofthoseorganswhosefunctionistoproduceanewindividual.
Maleandfemalesexualreproductiveorgans:
Thesexorgansinthemaleandfemalecanbedividedas
1. Primarysexorgansi.e.thoseproductionmaleandfemalegametes.
2. Secondary(oraccessory)sexorgansi.e.thoseconcernedwithcarriageofgametes
andotherfunctions.
Primarysexorgansinmaleandfemale:
Thereareapairoftestesproducingspermatozoa(malegametes)whileinfemalesareapairof
ovariesproducingovum(femalegamete).Theseprimarysexorgansinadditiontoproducingmale
andfemalegametessecretemaleandfemalehormonesaswell.
Accessorysexorgansinthemale:
1. Epididymisgland
2. Vasdeferens
3. Seminalvesicles.
4. Prostrategland.
5. Urethra.
6. Penis.
Malereproductivesystem:
Thereisonepairoftesteslyingoneineachscrotalsac.Thescrotumisabagofskinhavingtwo
separatecompartments.
Oneforeachtestislyingattherootofthepenis.Eachtestisisovalshapedmeasures.5x3x2cm
andweighsabout15gm.
Eachtestisiscoveredwithalayeroffibroustissuecalledtunicaalbuginea.Manyseptatefromthis
layerdividethetestesintopyramidallobulesinwhichlieseminiferoustubulesandinterstitialcells.
Theseminiferoustubulesareconcernedwithprocessofspermatogenesis.Theinterstitialcells
calledLudwigcellsliebetweenthetubulesandsecretethetestosterone(malesexhormone).
Fromtheliningofthesetubulesspermatozoaareproducedbytheprocessofcelldivision.The
epididymisisaveryfineconvolutedofsurvivingformonths.
Convolutedtube,being46meterslongandjointstheposteriorpartofthetestesandvasdeferens.
Itstoresthespermatozoa.Thespermatozoaremaininactiveinepididymisandarecapableof
survivingformonths.
61

Vasdeferensisafibroelasticduct3040cminlengthandextendsfromepididymistoendin
ejaculatoryductwhichisjoinedbyseminalductandopensinprostaticurethra.
TheSeminalVesiclesarelittlesacsoneoneachsideoftheurethranearthebaseofthebladder.
Theyreceiveandstorethespermsbroughtbythevasdeferens.Theyalsoaddafluidtothesemen.
Theirductspassthroughtheprostateglandtotheurethra.
The prostrate gland lies at the base of the urinary bladder and is covered with fibrous
capsulewhichbyanumberofseptadividesintomanyfollicles.Theprostrateaddsanotherfluidtothe
semen,whichmakesthespermsmoreactiveinswimmingtoreachtheovum.Inmiddleandoldage
prostatemayenlargeandcausemicturitiontroubles.
The ejaculatory ducts lead from the seminal vesicle through the prostrate gland to the
urethra.Inmalestheurethraisabout2022cminlengthandservesthepurposeofurinationaswellas
ejaculationofsemen.
ThePenisistheexternalorganofboththeurinaryandreproductivesystemsinthemale.Itconsists
ofspongytissuewithspacesforbloodtorushintomakethepenishardanderect.Theendofthepenis
iscalledtheglanspenis.Itisnormallycoveredwithaloosedoublefoldofskin(Theforeskin),whichcan
bedrawnback.Theforeskincanberemovedbycircumcision.
Theurethrapassesthroughthepenisandopensattheglanspenis.

Fig2.25MaleReproductivesystem
1
2
3
4

1)SpermDuct
2)Bladder
3)Prostrategland
4)Penis
5)Testis

Functionsoftestis:
1) Theyproduceandmaturethemalereproductivecellscalledspermatozoa.
2) Secreteseminalfluid.
3) Secretehormonetestosteronedirectlyintotheblood.
Functionsofhormone:
1) Androgens:Maintainsspermatogenesisandsexualactivity.
2) Testosterone:stimulatesthedevelopmentofthesecondarysexualcharacteristicsofthemale
suchasthegrowthofbeard,thedeepeningofthevoice,thegrowthandthedistributionof
haironthebody,thegrowthanddevelopmentoftheaccessorysexorgans.Stimulatethe
productionofspermsatpuberty.
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FEMALEREPRODUCTIVEORGANS
Thesearedividedintoexternalorgansandinternalorgans.
TheExternalOrgans:TheVulva
Theexternalorganstogetherformthevulva.Theyareasfollows.
MonsvenerisorpubicMont:itliesoverthesymphysispubis,andiscoveredwithhairafter
puberty.
Labiamajoraortheouter lips,formthesidesofthevulva.
Labiaminora,orsmallerlips,arewithinthelabiamajora.Theyaremoistbyglandsecretions.
Clitoris asmallsensitiveorganwitherectiletissuesimilartothemalepenis.
Vestibule: atriangularpartbetweenhelabiaminora.Theurethralopeningisinthevestibulein
frontofthevaginalopening.
Vagina: Itisamusculartubelinedwithmembranecomprisedofspecialtypeofstratifiedepithe
lium,wellsuppliedwithbloodvesselsandnerves.Itextendsfromthevestibuletotheuterus.
Perineum: Thisistheareaoftheskinfromthevaginalopeningbacktotheanus.Itcoverstheperineal
body,whichisawedgeshapedstructurebetweenthevaginaandlowerpartoftherectum.Themuscle
oftheperinealbodyformsthemainmuscleofthepelvicfloor.Itflattensduringthesecondstageof
labourandquiteoftengetstorn.

1
5

2
3

1)Clitoris

Fig2.26FemaleExternalOrgans
2)Urethra
3)Vagina
4)Anus5)LabiaMajora

6)LabiaMinora

Femalereproductiveinternalorgans:
Theinternalorgans,whicharesituatedinthepelvis,areasfollows:
1) Fallopiantubes
2)Uterus
3) Vagina
4)Ovaries
Fallopiuantubes: thefallopiantubesaretwothintubesconnectedtothesidesoftheuterus,justbelow
thefundus.eachtubeisabout10cmlong,curvesbackwardsbehindtheuterusandaroundtheovary
likeanarch.theouterendwidensandopensintotheperitonealcavity.Thisopeningissurroundedby
fingerlikeprocessescalledfimbriae,oneofwhichisconnectedtotheovary.Thefallopiantubeshave
wallsofmuscleandarelinedwithciliatdepitheliumandcoveredwithperitoneum.
63

Functions:
Thesetubesactasductsforthefemalegametesalthoughtheyarenotconnectedtotheovaries.
Thefunctionofthetubeistocollecttheovumdischargedfromovaryandpassitalongthetube.Itissent
alo ng partly by peristaltic act ion of t he muscles and partly by waving
movementsofthecilia.Fertilizationofthemaleandfemalegametesnormallyoccursinthetubesatthe
ampullaryportion.
Uterus: Uterusisapearshapedmuscularorgan.Thisinsideofwhichishollow.Itmeasuresabout7.5
x5x2.5cmandweighsabout60gm.consistsofanupperportioncalledthebodyandthelowerportion
calledthecervix.Theuterusislinedbyamucusmembraneknownastheendometrium.Theuterushas
threeparts:
1)Fundus,theupperpartbetweeenthetwofallopiantubes.
2)Body,themiddlepart,whichhasatriangularshapedcavity.
3)Cervix,thelowernarrowpart,whichprojectsintothevaginabelow.Thecervixisabout2.5cm
long,andhasacentralcanalwithtwocircularopenings:theinternaloswhereitjoinswiththebodyofthe
uterus,andtheexternalos,whichopensintothevagina.
Thewalloftheuterusisinthreelayers:
1)Perimetrium,theouterserouslayer.
2)Myometrium,themuscularlayer,whichisthickandstrong.
3)Endometrium,theinnerliningofspecialepithelialtissue.Thenarrowcavityoftheuterushas
threeopenings:oneintoeachfallopiantube,andonethroughtheexternalosofthecervixintothevagina.
2
1

3
4

6
7

Fig2.27TheUterus
1)Fallopiantube
2)Fundus
3)DevelopingEgg
5)BodyoftheUterus 6)Ovary
7)Cervicalcanal

4)Myometrium
8)Vaginalcanal

Functions
1)Menstruationthethickenedendometriumcomesawaycausingbleedingoftornvessels,and
theresultingmenstrualflowisdischargedthroughthevagina.
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2)Pregnancytheuterusreceivesthefertilisedovumandnourishesthedevelopingfoetus.
3)Labourcontractionsofthemuscularwallcausethefoetusandplacentatobeexpelled.
4)Involutionthegradualreturntonormalsizeoftheuterusfollowingdelivery.
Ovary:
Thegonadsofthefemalesarecalledovariesandthecellsthattheyproduceareknownasovaor
eggcells,eachfemalehasapairofovalshapedstructureaboutthesizeofaalmond.
Eachovarymeasures3.5x2.5x11.5cmandweighs810gms.
Theyaresituatedatthebackoftheabdominalcavityatthehiplevel.Anovaryconsistsofthe
following
1)Thegerminalepithelium:itistheouterpartoftheovaryfromwhichtheprimitivegraffian
folliclesdevelop.
2)Tunicaalbuginea:thisismadeupofconnectivetissuefoundunderthegerminalepithelium.
3)Stroma: itistheconnectivetissuenetworkcontinuouswithtunicaalbugineaandcontaining
involuntarymusclefibres.Itsupportstheovariantissuesandcarriesbloodvessels,lymphaticandnerves.
4)Graffianfollicles:thesearesmallislandsofcellsfoundattheperipheralpartoftheovary.The
femalegametescalledovaareproducedinthegraffianfollicle.
Whentheovummatures,thefollicleinwhichitdevelopsbursts.Thefollicleusuallytakes1014
daystorupture.Thisprocessofruptureofgraffianfollicleiscalledtheovulation.
5)Corpusluteum:whenthefolliclerupturescorpusluteumdevelops.Intheabsenceofpreg
nancyitpersistsupto27thdayanddegeneratesonthe28thday.Ifpregnancyoccursitpersiststoabout
45months.Itsecretesprogesteronewhichisessentialforthemaintenanceofpregnancy.
6)Interstitialcells:therearepolyhedralcellsfoundinbetweenthefollicles.Thesecellssecrete
oestrogen.
Functions:
1) Produceovaandexpeloneatapproximately28daysintervalduringthereproductivelife.
2) Secreteshormones(oestrogen&progesterone).Oestrogeninfluencesecondarysex
characteristicsandisresponsibleforthechangesintheaccessoryorgansofreproduction.
Theprogesteronepreparestheuterusforthereceptionofthefertilizedovum,
implantation,thedevelopmentoftheplacenta,developmentofthemammaryglands,and
inducingmultiplicationoftheuterinemusclefibres.
TheBreasts(Mammaryglands)
Theseareaccessorytothereproductivesystem.Theyarepresentinan,undevelopedforminthe
femalebeforepuberty,andalsointhemale.Theyaresituatedatthefrontofthethorax.
Thefullydevelopedfemalebreastiscircularinoutlineandcurvesoutwards.Inthecentreisthe
nipple,whichprojectsoutwardsandispinkinthevirgin,butpigmentedafterthefirstpregnency.It
becomeserectwhenstimulatedandagoodteatforthebaby.
65

Theglandisdividedintolobesbypartitionsoffibroustissue.Ductsfromtheglandulartissue
convergetowardsthenippleandopenonitssurface.
Duringpregnancyhormonesfromthepituitaryandovariescausethebreaststoincreaseinsize
andtosecreteasmallamountoffluid,whichcanbeexpressedfromthenipples.Thisisinpreparation
forthefunctionoflactation(milkproduction).
MenstrualCycle
This means the cycle of changes that regularly take place in the lining of the uterus
(endometrium)undertheinfluenceofhormoneswiththeoutwardsignofmenstruationormonthlyperiod
offemales.
Menstruationisafunctionoftheuterusthatstartsduringpubertyattheaverageageof13.It
occursontheaverageevery28days,untilitstopsat45to50years(themenopause).
Thepurposeofthemenstrualcycleistopreparetheendometriumtoreceivethefertilizedovum.It
becomesthicker,issoftandrichinbloodsupply.Whennofertilisedovumarrivesintheuterus,the
endometriumbreaksdownandresultsinthemenstrualflow.Theendometriumbleedsfor3to5days.
Thebloodcontainsepithelialcellsandmucus,anddoesnotclot.Theamountoffluidisnormallyfrom30
to180ml.inall.
Aftermenstruation,thereisaperiodofrepairfortheendometrium,followedbyarestingperiod
andslowgrowth.Duringthemiddleofthisrestingperiodanewovumisdischargedfromtheovary
(ovulation)
Themenstrualcyclecontainsthefollowingphases.
Premenstrualperiod,withcongestionintheuterus7days.
Menstruation

5days

Periodofrepair

6days

Restingperiodwithovulation

10days

Total

28days

Ovulationusuallytakesplacemidwaybetweenthebeginningoftwomenstrualperiods.Thisis
timewhenthewomanisfertileandpregnancymayoccur.
Menstruationstopsduringpregnancyandthisiscalledamenorrhoea.Themenstrualperiodsusu
allydonotstartagainuntilbreastfeedingisstopped.
Hormonesandthereproductivesystem
Hormonesaremostimportantintheworkingofthereproductiveorgans.Atpuberty,hormones
fromtheanteriorpituitaryglandstimulatesthesexglands(ovaryinthefemale,testesinthemale)to
producetheirsexhormones.
Themalehormonestestosteronepromotesthedevelopmentofmalecharacteristics.
Inthefemale,oestrogen,promotesdevelopmentofthefemalesexorgansandtissuegrowthfor
thedevelopmentoffemininefeatures.
66

Theanteriorpituitareyhormonesandadrenalcortexhormonesalsohaveeffectonthedevelpment
ofsexualcharacteristicsbothinthemaleandinthefemale.
Ovulation
TheFollicleStimulatingHormone(FSH)fromtheAnteriorpituitarycausesdevelopmentofa
Graafianfollicleintheovaryonceamonth.Thisislikeacystorsacoffluidprotectingtheovum.Atthe
timeofovulation,theovumissetfreeasthefollicleruptures.
Immediatelyafterovulation,theLuteinisingHormone(LH)fromtheanteriorpituitaryglandcause
therupturedfollicletochangeintotheCorpusLuteum(YellowBody)whichappearsontheovary
followingovulation.Iftheovumisnotfertilized,itdiesandpassedoutofthebodyinthemenstrualflow.
Thecorpusluteumalsodisappearswiththenextmenstrualperiod.
Summary:
Thebodyismadelikeacomplexperfectmachine.
Eachpartisspeciallyconstructedtocarryoutitsownfunction.
Thebodyconsistsofthehead,neck,trunk,upperlimbs,andlowerlimbs.
Thebodyhasastrongframeworkofbonescalledtheskeleton.
Therearespacescalledcavitiesinwhichimportantorgansareprotected.E.g.thecranial
cavitycontainsthebrain.
Thehumanbodyismadeupoflivingcells.
Eachcellhascellmembrane,protoplasmandnucleus.
Thefunctionsofthecellsaredigestion,excretion,respiration,growthandrepairand
reproduction.
Tissuesaremadeupofgroupsofsimilarcells.
Tissuesarejoinedintolargerunitscalledorgans.
Asystemisagroupoforgans.
Skeletalsystem,muscularsystem,nervoussystem,circulatorysystem,digestivesystem,
respiratorysystem,excretorysystem,endocrinesystem,andreproductivesystemarethe
systemsofourbody.
Nervoussystemhastwoparts:centralnervoussystemaneautonomicnervoussystem.The
centralnervoussystemismadeupofthebrainandcranialnerves,spinalcordandspinal
nerves.
Themainfunctionofcirculatorysystemistransportationofoxygen,nutrientstotissuesand
carriesmetabolicwasteproductstotheexcretoryorgans.
Thelymphglandshelptoprotectthebodyfrominfection.
Thefunctionsofdigestivesystemaredigestion,absorptionofnutrientsandexcretionof
undigestedfood.
Respirationistheprocessofgaseousexchangebetweenanorganismanditsenvironment.
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 Thelungs,kidneyandskinaretheimportantexcretoryorgansinourbody.
Themainendocrineglandsinthebodyarethyroid,parathyroid,adrenalandpituitary
glands.
Theendocrineglandsproduceachemicalsubstance,hormone,whichregulatestheactivities
ofvariousorgansandtheirfunctions.
QUESTIONS
PARTAWRITEINONEORTWOWORDS:(Onemark)
1) Whichistheimportantpartofthenervoussystem?
2) Whatistheendproductofdigestion?
3) Writethetwophasesofrespiration?
4) Whatarethelayersofskin?
5) Listdownthelayersofepidermis?
6) Whataretheglandsintheskin?
7) Whatarethehormonessecretedbyadrenalcortex?
8) Whataretheaccessorysexorgansinfemale?
9) Defineanatomy?
10) Howmanybonesarethereinthebody?
11) Whataretrueribs?
12) Whatarefalseribs?
13) Whatarethepartsofnervoussystem?
14) Whatconstitutethecentralnervoussystem?
15) Howmanycranialnervesarethereinthebrain?
16) Whatarethethreemembranesofthebrainandspinalcord?
17) Whatarethetwoenzymespresentinsaliva?
18) Whatarethepigmentspresentinbile?
19) Whataretheenzymespresentinthepancreaticjuice?
20) Whatarethetwochieffunctionsofdigestivesystem?
21) Whatarethetypesofnerves?
22) Whatarethetypesofbloodvessels?
23) Howmanylobesarepresentinrightlung?
24) Howmanybonesarepresentincranialcavity?
25) Mentionthepartsoftheinnominatebone?
68

PARTBMULTIPLECHOICEQUESTIONS:(Onemark)
1) Theimportantpartofthecentralnervoussystemis
a)Brianb)spinalcordc)nervesd)alloftheabove.
2) Thebiggerpartofthebrainis
a)Cerebrumb)cerebellumc)ponsd)medullaoblongata
3) Brainandspinalcordiscoveredby
a)Meningesb)pleurac)peritoneumd)periosteum.
4) Functionofthefrontallobeofthebrain
a)motorcentreb)speechcenterc)mentalpowersd)alloftheabove.
5) Theendproductsofproteindigestionare
a)glucoseb)aminoacidsc)fattyacidsd)alloftheabove.
6) Bileisstoredandconcentratedin
a)liverb)pancreasc)stomachd)intestine
7) The process by which the masticated food is transported across the pharynx to
reachthestomachis
a)peristalsisb)deglutitionc)mastication.D)micturituion.
8) Theopeningofthelarynxisguideby
a)glottisb)epiglottisc)cartilaged)noneoftheabove.
9) Thenervethatcontrolsthediaphragmis
a)vagusnerveb)sciaticnervec)phrenicnerved)alloftheabove.
10) Thetoughtofcapillaryvesselspresentinthebowmanscapsuleis
a)cortexb)medullac)pyramidd)glomerulus
11) Processbywhichcomplexformoffoodisconvertedintosimplenutrient
a)digestionb)absorptionc)assimilationd)noneoftheabove.
12) Thefingerlikeprojectionsfoundinthemucusmembraneoftheintestineis
a)villib)esophagusc)liverd)gallbladder
13) Thechemicalpresentinmostofthedigestivejuicesis
a)pepsinb)renninc)hydrochloricacidd)trypsin.
14) Theconditioninwhichtheskin,nails,andeyesbecomesyellowis
a)anemiab)jaundicec)dwarfismd)gigantism.
15) Theprocessofgaseousexchangebetweenanorganismanditsenvironmentis
a)inspirationb)internalrespirationc)externalrespirationd)expiration.
69

16) Theprincipalexcretoryorgansofthebodyare
a)lungsb)kidneyc)skind)alloftheabove
17) Theouterthinlayeroftheskinis
a)dermisb)epidermisc)subcutaneoustissued)alloftheabove
18) Thepigmentgranulewhichgivestheskinitscolouris
a)sebumb)melaninc)rennind)alloftheabove
19) Thenervouslayerofeyeis
a)corneab)sclerac)irisd)retina.
20) Thesecretionsofsebaceousglandisknownas
a)sebumb)melaninc)rennind)alloftheabove
21) Thetermsuperficialrefersto
a)Awayfromthebody

b)nearertothehead

c)nearertothebodysurface.

d)noneoftheabove.

22) Theyellowmarrowismainlycomposedof
a)fatcellsb)whitebloodcellsc)redbloodcellsd)noneoftheabove
23) Thefaceconsistsofthefollowingnumberofbones
a)22

b)12

c)18

d)14.

24) Theeighthcranialnerveis
a)facialb)vagusc)accessoryd)vestibulecochlear
25) ThefunctionofOccipitallobeofcerebrumis
a)speechb)memoryc)redbloodcellsd)noneoftheabove
26) Thegroupofnervecellsarecalledas
a)Gangliab)neuronsc)fibersd)sciatica
27) Thecoronaryarteriesbranchoutfromthe
a)Archofaortab)ascendingaortac)Rootofaortad)descendingaorta
28) Thedistalendofthestomachisguardedby
a)cardiacsphincter
c)pyloricsphincter

b)internalsphincter
d)noneoftheabove

29)Thefollowingorganisthevoicebox
a)pharynx

b)trachea

c)larynxd)glottis

30) Thelargestoftheendocrineglandis
a)parathyroidb)thyroidc)adrenalsd)pituitary
70

PARTCWriteShortNoteson:(5marks)
1)

Enumeratethefunctionsoftheblood?

2)

Whatarethefunctionsoftheheart?

3)

Whatarethefunctionsoftheliver?

4)

Whatarethetypesofthebloodvessels?

5)

Whataretheimportanceofrespiration?

6)

Enumeratethefunctionsofparathyroidgland?

7)

Fallopiantube.

8)

Tongue.

9)

Ovary.

10) Anteriorpituitarygland.
11) Whatarethesystemsfoundinthebody?
12) whatarethefunctionsofcell?
13) Howwillyouclassifyjoints?
14) Namethetypeoftissueswithexample?
15) Statethefacebones?
16) Whatarethefunctionsofskeleton?
17) Namethebonesofupperlimb?
18) Writeaboutinnominatebone?
19) Statethenamesofanteriormusclesofthebody?
20) Namesoftheposteriormusclesofthebody?
21) Whatarethefunctionsofspinalcord?
22) Whatarethefunctionsofbrain?
23) Listdownthefunctionsofspleen?
24) Drawthediagramofbrain?
25) Drawthediagramoftestes?
26) Writethefunctionsofmedullaryhormones?
27) Drawthediagramofkidney?
28) Whatarethefunctionsofsaliva?
29) Drawthestructureoftooth?
30) Whatarethepartsofcirculatorysystem?
71

PARTD WRITEINDETAIL: (10marks)

1) Drawthestructureofalimentarycanal?
2) Writeindetailsaboutendocrineglands?
3) Definejoints.Explainthevarioustypesofjointsinourbody?
4) Writeindetailaboutheart.?
5) Structureandfunctionsofkidney?
6) Structureandfunctionsofskin?
7) Definerespirationandexplainthephysiologyofrespiration?
8) Structureandfunctionsofeye?
9) Structureandfunctionsear?
10)Writedownthecaviesinourbody?
11) Statethetypeofboneswithexample?
12)Explainthefunctionsofblood?
13)Drawthediagramofgastrointestinaltract?
14)Discussthestructureofskeletaltissue?
15)Writeaboutthyroidglandwithexample?
PARTE WRITEESSAY: (20marks)
1) Whatisdigestionexplainaboutphysiologyofdigestion?
2) Drawthediagramofrespiratorysystemandexplainthephasesofbreathing?
3) Explainaboutpituitaryglandwithaneatdiagram?
4) Describethestructureofheartandbloodcirculation?
5) Describethestructureoffemalereproductivesystem?

72

3.INTRODUCTIONTOPSYCHOLOGY
DEFINITIONOF PSYCHOLOGYANDMENTAL HEALTH
Psychologyisabranchofsciencedealingwithknowledgeofmindandsoul.Itplaysavitalrole
intakingcareofthepatientsinnursing.
Theknowledgeofbasicprinciplesofpsychologyissignificantintakingcareofnurseherselfand
alsoinherinteractionwiththepatient.
Thenursesshouldunderstandthatthefulfillmentofbasicneedsasgivenbelowisimperativein
achievingonesownselfactualization.
Mentalhealthastheadjustmentofhumanbeingstotheworldandtoeachotherwithmaximum
ofeffectivenessandhappiness Meninger
Mentalhealthisanabilitytomaintain
1) Aneventemper
2) Analertintelligence
3) Asociallyconsideratebehaviorand
4) Ahappydisposition
CHARACTERISTICSOFMENTALLY HEALTHY PERSON
1) Heisfreefrominternalconflict
2) Heiswelladjusted
3) Hesearchesforanidentify
4) Hehasastrongsenseofselfesteem
5) Heknowshisneeds,problemsandgoals
6) Hehasgoodcontroloverhisbehavior
7) Heisproductive
8) Hefaceandsolvestheproblems
IMPORTANCEOFPSYCHOLOGY INNURSING
Thestudyofhumanbehaviorisofgreatvaluetoanursingprofessionalinanumberofways
1) Itwillhelphertounderstandherself
2) Itwillhelphertounderstandotherpeople
3) Itwillhelphertoimprovesituationsbyhelpingothertosolvetheirproblems
4) Itwillhelptounderstandthecloserelationshipofbody,mindandspirit
73

FACTORSINFLUENCING MENTAL HEALTH

1)Personalfactors

Age

Growthanddevelopment
Geneticsandbiology

Physicalhealthandhealthpractice
Responsetodrugs

Selfefficacy
Hardness(abilitytoresistillness)

Commitment,controlandchallenge
Resourcefulness

Spirituality
Resilience(healthresponsetostressfulcircumstances)
2)Interpersonalfactors:
Senseofbelonging

Socialnetworkandsocialsupport

Culture

Race

Gender

Sexualorientation

Socialclass

Economicsituation

Familysupport
3)Culturalfactor:

LEARNING
Oneofthemostimportantcharacteristicsofhumanbeingisthecapacitytolearn.Learningis
centraltoallourbehavior.Ourattitude&emotionalexpressionsarealsolearnedbehavior
Learningisdefinedasthementalactivitybymeansofwhichknowledge,skill,attitude,apprecia
tionsandideasareacquired,resultinginmodificationsofbehaviors
Factorsinfluencinglearning:
Itisdependsuponthefollowingfactors
1) Natureofthelearner
2) Natureofthelearningmaterial
3) Natureofthelearningsituations
Natureofthelearner:
Perception

Organicdefects
Fatigue

Timeoftheday

Age&learning

Senseorgansarethegatewaystoacquireknowledge.Processofperception
shouldbeperfect
Visualdefects,hearingimpairmentandinfections
Strain,loneliness,lackoffreshair,sunlightandcompulsivelearningcauses
fatigue.
Thereisnovariationinefficiencyoflearning.Itdependsonlywithlearners
willpower
Thecapacityoflearningimprovesupto23years&declinesafter40years

Natureoflearning:
Meaningfullearningeasierthanlearningwithoutknowingthemeaningofthelearningmethod
74

1) Definitegoal:Withacleargoalinmindthestudentworkstowardsadefinitepurpose.It
enhancesmotivation,intentiontolearnbetterlearning.
2) Knowledgeofresultsorpsychologicalfeedback.Regularandfrequentreviewofthe
amountofprogressbeingmadetowardsthegoalpromoteseffectiveleaning
3) Distributionofpracticeboard:Shorterpracticeperiodaremoreeffectivethanlonger
periodsthiswillreducesthementalfatigue
4) Wholeversuspartmethod:Wholemethodshouldbeadoptedwitheasyunitanddifficult
materialcanbelearnedinsmallunits
5) Logicallearning:Logicallearningcallsforanarrangementandalsoassimilationwithideas
inminds.Studentsshouldtrytograspthemeaningoftext
6) Rest: Takerestinbetweenstudiespreventsmentalfatigue
7) Levelsofanxiety:Avoidsundueworry,anxiety&nervousnesstopromotebetterlearning.
Otherwiseitwillhaveaninhibitingandinterferingeffect
8) Overlearning/repetitionsatregularintervals helpstoretainthematerialoveralonger
periodoftime
Theoriesoflearning
1) Trailanderror
2) Theoryofconditionedreflexes
A)Classicalconditioning

B)Operantconditioning

3) Cognitivelearning
A)Insightlearning

B)Signlearning

Trialanderror: EdwardLeeThorndikeAmericanPsychologistconsideredasthefatherofeduca
tional,psychologyconductedseriesofexperimentsontrialanderrormethodoflearningbyanimalsand
foundoutthatalllearningistrial&errorandhehasdevelopedcertainlawsoflearning.Theyare
Lawofeffect:Theresponsefollowedbyarewardwillbestrengthened
LawofExercise:Thereisadirectrelationshipbetweenrepetitionandthestrengthofthestimulus
response.AnytaskthatisrepeatedshowsatendencyforthestrengtheningofthebondEg:
Reading,writing,typing,singing,dancing,drawinglearnedbyconstantpractice
Lawofreadiness:Learningtakesplacebestwhenapersonisreadytolearn
Theoryofconditionedreflexes
Classicalconditioning: IvanPavlovaRussianphysiologist,aresearcherexperimentedonadog.A
capsuleattachedtoadogssalivaryglandtomeasurethesalivaryflow.Abellwasrungeverytimeand
meatpowderwasgiventothedog.Thiswasrepeatedseveraltimes.LaterPavlovobservedthatthe
dogsalivatedatthemeresoundofthebellwithoutgivingmeatpowder.Thusthedoghasbeenconditioned
torespond.Pavlovshowed,howtheinternalprocesssuchaslearningcanbestudiedobjectively.
Principlesofclassicalconditioningusedinthefollowingareasforlearning
75

1)
2)
3)
4)
5)

Developinggoodhabits
Breakingofbadhabitsandeliminationoffear
Trainingofanimals
Useinpsychotherapy
Usefulindevelopingfavorableattitude

Operantconditioning: Skinnerexperimentedonaratwhichwasplacedinsideaglassboxcontaining
aleverandfoodtray.Theratwasfreetoexplorethebox.Whenevertheleverintheboxwaspressed
automaticallyapelletoffoodwasdroppedonthetray.Thenumberoftimes,theratpressedonthelever
wasrecorded.Pressingtheleverwastheresponsetobelearned(theoperantresponse)andthefood
wasthestimulusconsequences(reinforcement).Thustherateofpressesincreasedwithrewardingof
theratwithfood
Cognitivelearning
Learningbyinsight:Gestaltpsychologistconcludedthattheindividuallearnsbyhisabilityknownas
insight&notbytrial&errormethod.TheyexperimentonaChimpanzeecalledsultan.Somebananas
wereplacedinsidethecageofhungrysultan,whowasthengiven2sticks.Hungrysultantriedtogetthe
bananasbyextendinghishands.Thenhetookuponeofthesticks&triedtopullthebananas.Theeffort
spentforonehour,gottiredandstartedtoplaywiththeSticks.Meanwhileoneendofonestickgot
incidentallyfastenedintotheringfixedontheendoftheotherstick,withtheresultthatboththesticks
werejoinedtogether.Nowsultanusedthisjoinedsticktopullinthebananas&succeeded.Gestalt
psychologistconcludedthat,sultanssuddenlearningwasduetoinsightdevelopedfromhisperception
ofthetotalsituationconsistingofthecage,sticks&bananasasawhole
CHARACTERISTICSOFLEARNINGBYINSIGHT
1)
2)
3)
4)
5)
6)

Insightissudden
Insightisduetounderstanding
Insightaltersperception
Oldobjectsappearinnewpatternsandorganizationduetoinsight
Higherspeciesofanimalsincludingmanhasmoreinsightthanmembersoflowerspecies
Insightdevelopsusuallyaftersometrialanderror

Tolmanstheoryofsignlearning: AccordingtoTolamns(1930)learningisatotalprocess.Ittakes
placebycognitionwhichincludesconceptslikeknowledge,thinking,planning,inferenceandpurpose.
Thelearnerthroughhisexperiencerecognizessomecuesorsignsandthenrelationshipswithgoals.
Learningconsistsintherecognitionofsignsandtheirmeaningsinrelationtogoalsinsignlearning,a
comparisonwasmadebetweentwogroupofhungryratsinamaze.Inonegroup,eachsubjectreceived
foodeachtimeitranthemazeandsteadyimprovementwasnoticed.Intheother,eachsubjectwas
givenaccesstothemazewithoutfindingafoodrewardandlittleimprovementoccurredintimeorerror
scores.
However,whenfoodwasintroducedatthetenthtrial,performancesoonapproximatedthatof
thegroupwhichhadbeenrewardedcontinually.Suchsuddenimprovementsuggeststhattheanimals
hadacquiredinformationaboutthemazewhichtheydidnotutilizeuntil,afterthetenthdayitbecame
advantageousforthemtodoso.Theratshaddevelopedacognitivemapofthemaze
76

Bandurassocialcognitivetheory:JustasTolmanbelievedthatratsgatherinformationandform
cognitivemapsabouttheirenvironmentsthroughexploring,Bandurabelievesthathumansgatherinfor
mationabouttheirenvironmentsandbehaviorofotherthroughobservations
Socialcognitivelearningresultsfromwatching,imitatingandmodelinganddoesnotrequirethe
observertoperformanyobservablebehaviororreceiveanyobservablerewardBandurabelievesthat
fourprocessattention,memory,imitationandmotivationoperateduringsocialcognitivelearning
Theoriesoftransferoflearning: AsperThorndike,thetransferoflearningfromonesituationto
anotherispossiblebecauseofidenticalcommonelements.Forexample,inlearningcyclinganddriving
acare,thetransfertakesplacebecauseofthecommonelementslikestearingmovements,knowledge
oftherulesoftheroadandlookingahead.Inlearningtypewritingandpianothetransfertakesplaceon
accountofthepresenceofcommonelementsliketheuseofbothhandsrequiredforpressingthekeys
andeyehandcoordination
OBSERVATION: ATTENTIONANDPERCEPTION
Definition: An expression of an opinion or judgment upon what one has observed a remark.
Observationinvolvestomentalactivitiesattentionandperception
Toimproveobservation
1) Fullattentiontoeachtask
2)Avoiddistraction
3) Observeaccurately&quickly
4)Showinterest
5) Haveactivemotivation
6)Avoidpersonalbiasorprejudice
7) Cultivatethehabitofobservingaccurately
ATTENTION
Attentionisthefocusingofconsciousnessonaparticularobjectorideaataparticulartimetothe
exclusionofotherobjectsorideas
Typesofattention: Attentioncanbeclassifiedintotwo
1) Involuntary
2)Voluntaryorhabitual
Involuntaryattention: Itdoesnotrequireanyconsciousefforttoattendanobject.Ex
Attentiontoloudsounds

Brightlights
Strongpenetratingodours
Factorsincreasingattentionbyexternalfactors:
1) Natureofthestimulus:Moreattractivestimuluscatchesmaximumattention(Picture)
2) Locationofthestimulus:Stimulusinfrontoftheeyeattractsourattraction
3) Intensity:Loudsound,brightcolors
4) Changeintheintensityofthestimulus:Tickingofaclockinourroommaynotattractour
attentionbutwhenitstopsourattentionisattracted
5) Movement:Afastmovingelectricsignattractsourattention
6) Size:Biggersizeattractsmoreattention
7) Contracts:Asinglemanamongthemanywoman,aspotonacleanwhitedressattractsour
attention
8) Novelty:Anewfashiondressattractsourattention
9) Repetition:Repeatedcry,repeatedringingofacallbellattractsourattention
77

Factorsincreasingattentionbyinternalfactors:
1)Interest:Whenwearemotivatedtoagoal
2)Motives:Whenachildishungryhelooksforafeedingbottleratherthanatoy
3)Experience:Weattendtoobjectwithwhichwearefamiliar
4)Mentalset:Whileexceptingafriend,weperceiveanyknockingsoundasthatoffriends
footstep
5) Emotionalstage: Understressfulconditionswefailtoperceiveoursurroundingsfully
Voluntaryorhabitual: Thereisnoconsciouseffortofsensation.Weattendtothembecauseofour
attitudes,habits,orinterest.Ex:Theattentionthatateachergivestoherstudents
Spanofattention:Themaximumamountofmaterialthatcanbeattendtoinoneperiodofattention
iscalledspanofattention
Distractionofattention: Referstoshiftingofattentionfromonestimulustoanother.
Externaldistraction: Noisepollution
Internaldistraction: Painheadache
Divisionofattention: Referstotheprocessofdividingourattentionequallyandsimultaneously
betweentwoormoreobjects.Ex:Whilestudentsreadingabookmayhearhisfavoritesong
Perception: Perceptionistheprocessbywhichwediscriminateamongstimuliandinterprettheir
meaningsandappreciatetheirsignificance.ExWhenwehearasound,weareabletoidentifyitasbeing
producedbyanaeroplane
Perceptionsaredividedinto
1)Visualperception
2)Auditoryperception
Factorsinfluencingperception:
Functioningofthesenseorgans
Functioningofthebrain
Previousexperience
Frequencyofexposure
Psychologicalstateoftheindividual
Interest
Motivation
Behavioroftheorganism
Theoriesoflawsofperceptualorganization:
1) Figuregroundrelationship: Themostfundamentalprocessinformperceptionisthe
recognitionofafiguresstandingoutfromabackground.Coloralsohelps,e.g.Ablackpanther
canbeseeneasilyagainstawhitegroundofsnowbutnotapolarbear.Thisisbecausethepolar
beariswhiteincolor

78

Intheabovefigureyouseethelightportionasafigure,youwillseeawaterglassorcandleholder,ifyou
seethedarkportionasafigure,youwillseetwofaces.Eitheroneisafigureagainstbackground
Groupingofstimuliinperceptualorganization: Stimuliaregroupedintothesmallest possible
patternthathasmeaning.Importantprinciplesofgroupingareproximity,similarity,symmetry,closureand
continuation

Proximity: Whenobjectsareclosetoeachother,thetendencyistoperceivethantogether
ratherthanseparately.Weseethreesetsoftwolineseachandnotsixseparatelylines

Proximity
Similarity: Itemsthatmostcloselyresembleeachotherorperceivedasunits

Inabovefigurethecirclesandtrianglesareseenastwoverticalrowsoftrianglesandonerowof
circlesandnotthreehorizontalrowsoftrianglesandcircles
Symmetry: Itemsthatformsymmetricalunitsaregroupedtogether

Weseethreesetsofbrackets.Wedonotseesixunconnectedlines
Closure: Itemsareperceivedascompleteunitseventhoughtheymaybeinterruptedbygaps
Continuation: Anythingwhichextendsitselfintospaceinthesameshape,sizeandcolorwith
outabreakinperceivedasawholefigure.

79

Infigureweseeacurvedlineandastraightline.Wedonotseeastraightlinewithsmallsemi
circlesaboveandbelowit
Perceptualconstancies: Perceptualconstanciesreferstoourtendencytoperceiveobjectsas
relativelystableandunchangingdespitechanginginformation.Perceptualconstancies
1)Spaceconstancy

2)Sexconstancy

3)Brightnessandcolorconstancy

4)Perceptionofspacebinoculardepthcues

5)Visualmonocularclues
Typesofperceptualconstancies:
1)Observercharacteristics: Dependsgreatlyonpastexperienceandlearning
2)Depthperception: Istheabilitytoperceivespaceanddistanceaccurately
3)Binocularcues: Helpsintheperceptionofdepthbyintegratingandsynchronizingthe images
ofboththeeyes.
4)Monocularcues: Helpsinperceptionofdepthanddistancewiththeimageofsingleeye
EMOTION
ThepsychologistKulpedefinesemotionasafusionoffeelingandorganicsensations.Thepsychologist
Hoffdingdefinesitasapleasurepaininassociationwiththeideaofitscause.Accordingtopsychologist
Ward,itisthecompletepsychosisinvolvingcognition,pleasurepainandconation.Ingeneralemotion
isacomplex,notasimpleelementary,mentalstate.
Thedifferencebetweenmotivesandemotionsareasfollows:
Emotionsareusuallyarousedbyexternalstimuliandthatemotionalexpressionisdirectedtoward
thestimuliintheenvironmentthatarousesit.
Motivesontheotherhand,aremoreoftenarousedbyinternalstimuliandnaturallydirected
towardscertainobjectsintheenvironment.(e.g.food,water).
Mostofthemotivatedbehaviourhassomeaffectiveoremotionalaccompanimentalthoughwe
maybetoopreoccupiedinourstrivingtowardsgoal.
Motivationisfocusedonthegoaldirectedactivity.Emotionisfocusedonthesubjective,affective
experiencesthataccompanybehaviour.
Emotionsareexpressedbylanguage,facialexpressionsandgestures.
Theemotionalstateischaracterizedby:
1) Amoreorlesspronouncedaffectivetone.Pleasureunpleasuresexperiencedinconnectionwith
someobjectiveorsituation.
2) Adiffusestimulationoftheorganicprocess,involvingpulse,respiration,glandularsecretions
whichisusuallycalledtheorganicresonanceoftheemotionbutaccordingtotheoryofthe
psychologistJamesLange,itisidentifiedwithemotionitself.
3) Anarrowingandspecializingofconsciousness,bothonthecognitiveandonthecurativeside,the
consequenceofwhatwemaycallemotionaldisassociation.
4) Animpulsiveforce.
80

Physiologicalchangesinemotions:
1) Allemotionalstatesaffecttheactivitiesofthesalivaryglands.Thebodilyeffectsofpain,hunger,
fearandragehavealltheemotionsofcharacteristically,negativepolarity.Insuchcasesthe
secretionofsalivaisdiminishedorinhibited.
2) Thereisafairpresumptionthatemotionsofanoppositeorpositive,polaritywillproducethe
oppositeeffectbutpracticallynoexperimentalevidence.
3) Theemotionaldisturbancesofanegativepolarity(thatisdisagreeable)involvedisturbanceofthe
digestivefunctionsinallitsaspects.
4) Theflowofsalivaisdiminishedoraltogetherinhibited,anditschemicalcompositionaltered.The
flowofgastricjuicesissimilarlydimishedorinhibitedandalteredchemically.Thenegative
momentsthentendtocease.
5) ThisfactsuggestedtopsychologistCannon,thepossiblythatemotionalexcitementmightinvolve
anincreasedsecretionofadeninesandthatthisadenineinthebloodmighthavetheeffectof
prolongingtheinhibitionoftheactivityofthedigestiveglandsaftertheemotionalexcitementitself
haddisappeared.
6) Bytestingbloodforadenineafteraperiodoftimeofthequantityofadenineintheblood,itis
greatlyincreasedasaresultofstrongemotion.
Thesympatheticsystemisresponsibleforthefollowingchanges:
1) Bloodpressureandheartrateincreases.
2) Respirationsbecomemorerapid.
3) Thepupilsoftheeyedilate.
4) Electricalresistanceoftheskindecreases.
5) Bloodsugarlevelincreaserstoprovidemoreenergy.
6) Thebloodbeginstoclotmorequicklyinthecaseofwounds.
7) Themobilityofthegastrointestinaltractdecreasesorstopsentirely.Bloodisdivertedfromthe
stomachandintestinesandaresenttotherbrainandskeletalmuscles.
8) HairsontheskinerectcausingGoosepimples.Inemotionthesympatheticsystemalsocauses
epinephrineandnorepinephrine.Nerveimpulseswithsympatheticsystem,whichreachadrenal
glandslocatedonthetopofthekidneys,triggerthesecretionofhormones.Theythengetintothe
bloodandcirculatearoundthebody.
Theoriesofemotion:
Jamestheoryoremotionproposesthefollowingsequencesofeventsinemotionalstate.
Firstweperceivethesituationthatwillproduceemotion.Secondwereacttothisemotion.Thirdwe
noticeouraction.Theperceptionofthereactionisthebasisoftheemotionaswefeelandexperienceit.
ThemajorobjectiontoJamesLangtheorycamefromCannonwhopointedout
1) Thatchangesdonotseemtodifferverymuchfromoneemotionalstatetoanother.
2) Theinternalorgansarerelativelyintensivestructuresnotwellsuppliedwithnervesandinternal
changesoccurtooslowlytobeasourceofemotionalfeelings.
81

3) Artificiallyinducingthebodilychangesassociatedwithanemotioninjectingapersonwithadrenaline
doesnotproducetheexperienceofthetrueemotion.
JamesLangesTheory
Perceptionof
emotion
producing
stimulus

Activationof
Visceraland
skeletal
responses

Feedbacktobrain
frombodily
responsesproduce
experienceof
emotion

Canontheory

Perceptionof
emotion
producing
stimulus

Stimulusprocessedby
Thalamus,which
simultaneouslysend
messagestothe
cortexandotherparts
ofthebody

Messagestocortex
produceexperience
ofemotion

Messagesfrom
thalamusactivates
visceralandskeletal
responses

Emotionwhensufficientlyintensecanseriouslyimpairtheprocessthatcontrolorganizedbehavior.
Emotionalbehaviorstudiesininfancyandearlychildhoodbymeansofdirectobservation.Motion
picturesandrecordingofchildrenscriesindicatethattheinfantsresponsetostimulidesignatedto
arouseemotionareverydiffuseandlackinginorganization.
Emotionalshocksandhurtssufferedbyindividualsatanearlyagecanhandicapthemaslongas
theylive.Childrensoonerorlateracquirethecapacityforexperiencingnegativeemotionssuchasanger,
fear,andalsosorroworgrieftoanintensedegree.
Thiscapacitydevelops,beforethechildismatureenoughtouselanguage,toformulatehis
experienceinwords.
Foratime,theinfantsexpressionofrageispoorlyrecognized.Laterhisangerbecomesmore
indefinitelydirectedatsomethingorsomebody.Changescanlikewisebenotedinachildsexpression
offearandhisreactionstopain.
Theseimprovementsintheyoungchildsabilitytorespondinspecificwaystosituationsthat
arousehim,parallelthedevelopmentofhismentalandmotorabilities.
Asthechildsintellectualandmotorcapacitymatures,heacquireslargevarietyofmeansand
formsofexpressionsuchasovertanddirecttomoregradedcovertandindirect.
Thehabitofconcealingemotionmaybecomespeciallyburdensomeundertwoconditions.Ifa
personmaymaskintensefeelingofangertatoccurswhensomeonehuntshisprideverysharplyandthen
stillharboringhisangermayexplodeonanotheroccasionsbecauseofaverytrivialaffront.
82

Againsuppressionofanyshowofemotionmayharmfulinanindividualforonereasonoranother
hasputalidonanyimpulsetoshowaffectionanditsawkwardandevenrude,whenhehappenstofeel
veryaffectionatetowardsomeoneandwishesthathecouldsomehowshowitinaspontaneousway.
Themostimportantfactorsinachildsemotionaldevelopmentandtheaffectionthathereceives
fromhisparents,peergroupandsociety.Thisgivesopportunitytodevelopwholesomeaffectionforhis
fellowcreatures.
Themoregenuinetheparentsloveforthechild,the,morethechildtendstofeelfreetoloveother
people.Moreoverheislikelytoexpressallhisemotionsatease.
Allphysiologicalhealthynursesarelikelytofeelsomeaffectionforpatientsintheirchargeorwith
whomtheyhaveachancetoassociateeventhoughthechildrenarenottheirown.
Affectionismoreimportantforanindividualsemotionalwelfarepromotingsecurity.Theirun
lovedpersonmaysufferinconnectionwiththedevelopmentofpositiveattitudesandconceptsconcern
inghisownworth.
PERSONALITY
ThewordpersonalityhasbeenderivedfromtheLatinwordpersonawhichwasthemaskwhich
Greekactorworkwhileacting.Thishoweverisnotthemeaningtakeninthemodernwordpersonality.
Thispersonalityisnotfixedstatebutdynamictotality,whichiscontinuouslychangingdueto
interactionwiththeenvironment.
Personalityisknownbytheconduct,behavior,activities,andmovements.Itisthewayofre
spondingtotheenvironment.Thewayinwhichtheindividualadjustswiththeexternalenvironmentis
personality.
Definitionofpersonality:
Inthewordsof Munn,itischaracteristicintegrationofanindividualsstructure.Modesofbe
havior,interests,attitudes,capacities,abilitiesandattitudes.Behaviorrequiresintegration.
Inthewordsof GordenAllport,personalityisthedynamicorganizationwithintheindividualof
thosepsychophysicalsystems,thatdeterminehisuniqueadjustmenttohisenvironment
Thepersonalityistheorganizationoftheinternalandexternalactivities.Itisnotacollectionof
traitsbutaparticularorganizationo0fthem.
Personalityisthetotalqualityofbehavior,attitudes,interests,capacities,aptitudesandbehavior
patterns,whicharemanifestedinhisrelationwiththeenvironment.
Anintegratedpersonalityleadstoorganizedcharacter.Disintegratedpersonalityleadstodisor
ganizedcharacter.
Abnormalitiesinpersonalityhamper,theorganizationofcharacter.Inmentalpatient,bothchar
acterandpersonalityareindisorder.
Thebasicsourcesofpersonalitydevelopmentarehereditaryandenvironment.Howeverasa
persongeneticinheritanceinteractswithandisshapedbyenvironmentalfactors,theemergesaself
structurethatbecomesanimportantinfluenceinshapijgnfurtherdevelopmentandbehavior.
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Traitandtypeapproachesofpersonality:
Thetraitapproachestopersonalityattemptstolistanumberofbasicpersonalitytraitsandthe
personalityofanindividualcanbedescribedbyitspositionanascaleofunitsineachofthesetraits.
Atraitisanenduringandconsistentcharacteristicofapersonthatisobservedinawidevarietyof
situations.Thetraitsareintelligence,emotionalsensitivityascendance,submission,irritable,warmetc.
InfactAllportandOdberthavelisted17,593wordsinEnglish,whichareadjectivesstandingfor
personalitytraits.Hedistinguishedbetweensurfacetraitsandsourcetraits.
Normanlisted5termsextroversion,agreeableness,consciousness,andemotionalstabilityand
culture.
H.J.Evsenckspeaksofthreebasiccategoriesofpersonality.
Extroversionintroversion.
Neuroticismstability.
Psychotismnormality.
Thishasbeenultimatelyreducedtostable,unstableandintroversionandextroversion.
1) Extrovertsaredescribedasoutgoing,uninhibitedfondofactivities,whichbringthemintocontact
withotherpeople.Introvertshavetheoppositetraits.
2) NeuroticismstabilityinEvsenchksmodelrangesfromstabilitytohighanxiety.Insituationsof
worry,panicking,stressandoveremotionalityahighlevelactivitycouldaffectperformanceadversely
inacademicworkofpupils,resultinginlearningdisabilities.
Thetypepersonality:
Itisolderthanthetraitapproach,whichdependsuponmodernstatisticalprocedures.Hippocrates
andGalenhaveassociatedpersonalitieswithcertainkindsofbodyfluidscalledhumours.
Galenhasspokenoffourkindsofhumantemperaments
Choleric.

Melancholic.

Phlegmatic.

Sanguine.

Krrichmerreferstofollowingtypesofhumanpersonalitybasedonbodilyfluid.Theseare:
Asthenic(thin,long)whoareshyandsensitive,withdrawn.
Pyknic(short,fat)whoarejovialoutgoingwithfluctuatingmoods.
Athletic(strongandsturdy).
Theathleticandasthenictypeofbodybuild,gowithwhatisknownasschizothymepersonality
andthepyknicbodygoeswithcyclothymicpersonality.Theformerisbasicallyinterestedinhimonly
andthelatterextroverted.
Sheldonspeaksofthreetypesofbodybuild.
1) Endomorphic(round,fatandmuscular)individualshavethetypeofpersonalitycalledviscerotonia
whichimpliesloveofleisure,desireforfoodandsleep.
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2) Mesomorphic(hardmuscular)havesoamtotomicpersonalities.Whoexhibitpersistencein
behaviordesirefroadventure,courageandinvolvementinactions.
3) Ectomorphic(delicateandlean)havecerebrotoniawhichimpliesdisciplinedbehavior,ready
responsetostimulation,lackofinterestinsocialinteraction,hypersensitivitytopainetc.
Psychologicaltheoryofpersonality:
Personalitytheoriesaregroupedunderthreemajorheads
1) Psychodynamictheories.
2) Sociallearningtheories.
3) Phenomenologicaltheories.
Psychodynamictheoriesofpersonality:
Psychoanalytictheoriesofpersonalityarereferredtoaspsychodynamictheory.Thistheoryat
temptstounderstandpersonalityintermsofmentalfunctionsmayberational,irrational,consciousor
unconscious.
Freudstheoryofpsychoanalysisemphasizesmanasdynamicsystemofenergiesandmainstore
houseofsuchenergiesinunconscious.Thecontentsoftheunconsciousinvariablyexhibitconflicts.To
Freud,thestructureofanindividualspersonalityconsistsofthreeseparateagencies.
1) Idistheinbornreservoirsofprimitivepsychicenergycalledlibido,unconsciousdemanding
immediatesatisfactiononthebasisofpleasureprincipleregardlessofexternalwhichegoand
superegodevelopsanditconsistsofenergythingthatisinherited.
2) Allenergyofhumanbehaviorisprovidedbytwoinbornidinstinctsnamelysexandaggression,
whichhespokeofEroslifeinstinctsandthantoes,deathinstincts.
3) Egoembodiesarationalcognitivecapacitythatdemandsofsuperego.
4) Idseekspleasureegotestrealityandsuperegostrivesforperfection.Fromanxiety,defense
mechanismorunconsciousattemptstoreduceanxietybydenyingordestroyingrealty,.
ThetechniqueofEricBernestransactionalreferstowholesometransactionfromchildhoodto
adulthood.Freudalsoemphasistheearlyexperiencesinpersonalitydevelopment.Hespeaksofpsy
chosexualdevelopmentoftheindividual.
1)Theoralstage,duringinfancy.
2)Theanalstagebetweentheage2and3.
3)Thephallicstagebetween3to5.
4)From5uptoearlyadolescencethestageofOedipuscomplex/Electracomplex.Thenfrom5
uptoearlyadolescencesexualforceissubordinatedwhichmarksthelatency,periodandfinallythe
genitalstageofheterosexuality.
5)Psychosexualmaturityisreachedbyanindividualastheendresultofsuccessfulpassage
throughthefullsequenceofstages.
CarlJungdiffersfromFreudintakingamorepositiveandoptimisticattitudetowardshuman
naturebelievingthatpeoplenotonlytrytogratifytheirinstinctsbutalsotrytodeveloptheirpotential.
JungagreeingwithFreudianviewofunconsciousness,whichrepresentstheaccumulatedexperi
ences,andcultureofthehumanspeciesthroughoutitsevolutionarydevelopmentfromprimitivetimes.,
85

AlfredAdlerspersonalitytheorystresstheuniquenessofonespersonalitylooksuponaggres
sionismoresignificantthansexasamotiveofbehavior.Hepointstotheinnatestrivingforsuperiority.
ToErickson,personalityistheresultantfrominteractionbetweentheneedsofapersonandthe
demandsofasocietyataparticularstageofdevelopment.
Herefersto8psychosocialstagesofdevelopment.Aparticulartypeofcrisischaracterizeseach
stage.Egoidentifycrisisduringadolescenceandnowanindividualresolvessuchcrisisdetermines
personalitycharacteristics.
H.S.Svilanhasstressedtheinterpersonalnatureofpersonalityandhaslaidontheacquisitionof
languageasameansofnormalpersonalitydevelopment.
Sociallearningtheoriesofpersonality:
Thesetheoriessaythatconsistencyofbehavior,resultsnotonlyfromrigidpersonalitytraitsbut
alsofromotherfactorslikeenvironmentalstability.
SkinnerandHullslearningtheoriesarebasedontheabovefactors.DollardandMiller
pointedfear,asanimportantfactorinpersonalitydevelopmentasitactsasapowerfulmotiveordrive
inthepromotionoflearning.
TheroletheoryofG.HMeadspeaksofdifferentrolesoneplaysinlife(ason,pupil,leader,
friendetc.)andgraduallyinternalizestheassociatedtraitstoformhispersonality.
Apersonsbehaviordependsuponthespecificnatureofthesituation,howthesituationis
appraisedbyhimaswellaspastreinforcementofbehaviourinsimilarsituations.
Behavioriststheoriesofpersonality:
Behavouristsissuchaskinneremphasizethatconditioningaloneisnotadequatetoexplainhuman
characterandpersonality.
Phenomenologicaltheoriesofpersonality:
Thisincludeshumanisticconceptionsofpersonality.Thesetheoriesemphasizetheexistenceof
positivegrowthpromotingforcesinpersonalitybeyondmoreconflictresolutionortensionreduction
andalsostressespresentratherthanpastexperiences.
Maslowstheoryemphasizesinherentpotentialitiestoseekselfactualization.MaslowandCarl
Rogerbothdealtonhumanisticandpsychoanalytictheoriesongrowthandselfactualization.
Rogersclientcenteredonnondirectivecounselingispopular.Themostimportantconceptis
self.Anindividualwithastrongpositiveselfconceptseekgrowthandhavepleasantproductive
relationwithothers.
G.Kellyscognitivetheoryofpersonalityconsistsofpersonalconstructsthatisthewaysaperson
hasofevaluatinghimselfandhiscircumstances.
Defensemechanism:Anothermodeofreactingtodifficultiesisthatofmentalmechanismordefense
orientedreactionstostressaimschieflyatprotectingtheselffromhurtanddisorganization.
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EGODEFENSEMECHANISMS
Sl.No
1
2
3
4
5
6

7
8

9
10
11
12

13

14

Expression
Withdrawal

Modeofreactions
Protectingselffromunpleasant,realitybyrefusalto
perceiveorfaceit.
Fantasy
Gratifyingfrustrateddesiresbyimaginaryachievements
Repression
Preventingpainfulordangerousthoughtsfromentering
consciousness.
Rationalism
Attemptingtoproveonesbehaviorrationalandjustifiable
andthusprojectworthyofitselfandsocialapproval.
Projection
Placingblamefordifficultiesuponotherorattributing
onesownunethicaldesirestoothers.
Displacement
Dischargingpentupfeelingusuallyofhostilityorobjects
lessdangerousthanthose,whichinitiallyarousedthe
emotions.
Emotional
Reducingegoinvolvementandwithdrawingintopassivity
insulation
toprotectselffromhurt.
Intellectualization Cuttingofaffectivechargefromharmfulsituationsof
(isolation)
separatingincompatibleattitudesbylogictight
compartment.
Undoing
Counteractingimmoraldesiresoracts.
Regression
Retreatingtoearlierdevelopmentslevelsinvolvingless
matureresponsesandusuallyalowerlevelofaspiration
Identification
Increasingfeelingsofworthbyidentifyingoneselfwith
personorinstitution.
Introjections
Incorporatingexternalvaluesandstandardsintoego
structuresothattheindividualisnotattheirmercyas
externalthreats.
Compensation
Coveringupweaknessbyemphasizingdesirabletraitor
makingupforfrustrationinoneorbyoverqualifyingin
another.
Actingout
Reducingtheanxietyarousedbyforbiddenordangerous
desiresbypermittingtheirexpression.

Summary:
Psychologyisabranchofsciencedealingwithknowledgeofmindandsoul.Itplaysavitalrole
intakingcareofthepatientsinnursing.
Factorsinfluencingmentalhealtharepersonalfactors,interpersonalfactors,andculturalfactors
Learningisdefinedasthementalactivitybymeansofwhichknowledge,skill,attitude,
appreciationsandideasareacquired,resultinginmodificationsofbehaviors
Factorsinfluencinglearningarenatureoflearner,natureoflearningsituation,natureofthelearning
material
TheoriesoflearningareTrailanderror,Theoryofconditionedreflexes,Cognitivelearning
87

 An expression of an opinion or judgment upon what one has observed isobservation

Attentionisthefocusingofconsciousnessonaparticularobjectorideaataparticulartimetothe
exclusionofotherobjectsorideas
Attentioncanbeclassifiedintotwotypesvoluntaryandinvoluntary.
Factorsinfluencingattentionincludesexternalandinternal.
Perceptionistheprocessbywhichwediscriminateamongstimuliandinterprettheirmeanings
andappreciatetheirsignificance
Perceptionareoftwotypesauditoryandvisualperception.
Emotionisthecompletepsychosisinvolvingcognition,pleasurepainandconation.
Mostofthephysiologicalchangesoccursduringintenseemotion.
ThetheoriesofemotionareJamestheoryandCannontheory.
Personalityisthedynamicorganizationwithintheindividualofthosepsychophysicalsystems,that
determinehisuniqueadjustmenttohisenvironment.
Atraitisanenduringandconsistentcharacteristicofapersonthatisobservedinawidevarietyof
situations.Thetraitsareintelligence,emotionalsensitivityascendance,submission,irritable,warm
etc.
Normanlisted5termsextroversion,agreeableness,consciousness,andemotionalstabilityand
culture.
H.J.Evsenckspeaksofthreebasiccategoriesofpersonality.
1) Extroversionintroversion.
2) Neuroticismstability.
3) Psychotismnormality
Galenhasspokenoffourkindsofhumantemperaments
1) Choleric.
2) Melancholic.
3) Phlegmatic.
4) Sanguine
Sheldonspeaksofthreetypesofbodybuild.Endomorphic,Mesomorphic,.Ectomorphic.
Personalitytheoriesaregroupedunderthreemajorheads
1) Psychodynamictheories.
2) Sociallearningtheories.
3) Phenomenologicaltheories
Defensemechanismoperateonrelativelyautomaticandhabituallevelsandtheytypicallyinvolve
somemeasureofselfdeceptionandrealitydistortion

88

QUESTIONS
PartA ANSWERINONEOR TWO WORDS: (Onemark)
1) Mentionthetypesofattention.
2) Whatarethetwotypesofmentalactivitiesinvolvedinobservation.
3) Whatarethetwotypesoftheoriesofemotion.
4) Writethebasicsourcesofpersonalitydevelopment.
5) Namethethreebasiccategoriesofpersonality.
6) Namethepsychologicaltheoriesofpersonality.
PartB MULTIPLECHOICEQUESTIONS: (Onemark)
1) Psychosexualtheorywasgivenby
a)Freudb)CarlJungc)Ericksond)Skinner.
2)Psychoanalysistheorywasemphasized
a)Freudb)CarlJungc)Ericksond)Skinner
3)Fearasanimportantfactorforpersonalitydevelopment waspointedoutby
a)Freudb)CarlJungc)Ericksond)Dollard.
4)Classicalconditioningwasgivenby
a)IvanPavlovb)Skinnerc)Dollardd)Freud.
5)Gratifyingfrustrateddesiresbyimaginaryachievementsis
a)Fantasyb)Repressionc)regressiond)submission.
6) Thefatherofeducationalpsychologyis
a)Gestaltb)EdwardLeec)Parlord)Skinner
7) Fourkindsofhumantemperamentswasspokenby
a)Sheldonb)Krichmerc)Galond)Hippocrates
8) Thephallicstageisbetween
a)23yrs

b)35yrs

c)12yrs

d)5yrstoadolescence

9) Theextroversionintroversioncategoryofpersonalityspokenby
a)Evsenckb)Rogerc)Kellyd)Galen
10)Preventingpainfulordangerousthoughtsfromenteringconsciousnessisknownas
a)Projectionb)Displacementc)Regressiond)Repression
11) AccordingtoErickson,thestagesofpsychologicaldevelopmentis
a)8

b)9

c)7

d)10

12)Thelawdescribedtheresponsefollowedbyarewardwillbestrengthenedisthe,
a)Lawofexerciseb)Lawofreadinessc)Lawofeffectd)allofthisabove
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13)Operantconditioningwasgivenby
a)IvanPavloub)Skinnerc)Dollardd)Freud
14)Theitemsareperceivedincompleteunitseventhoughtheymaybeinterruptedbygaps
isseenin
a)Continuationb)Closurec)Similarityd)Proximity
15)Thebasicsourcesofpersonalitydevelopmentarte
a)Hereditaryb)Environmentc)Educationd)Lifestyle
PartC WRITESHORT NOTESON: (5marks)
1) Statethestepsoflearningprocess.
2) Whatarethecharacteristicsoflearningbyinsight.
3) Howwillyouclassifythetheoriesoflearning.
4) Wherearetheareas,theprinciplesofclassicallearningcanbeused.
5) Whatarethekindsofmotivation.Giveexample.
6) StatethebodybuildaccordingtonSheldon.
PartD WRITEINDETAIL:(10marks)
1) Listthefactorsinfluencingperception.
2) Learningbyinsighttheorydiscuss.
PartE WRITEESSAY: (20marks)
1)Explainfactorsinfluencinglearning.
2)Describethefactorsincreasingattention.
3)Discussthephysiologicalchangesthatoccursduringemotion.
4)List down the defense mechanism and write the mode of reaction for any two
expression.
5)Freudstheoryofpsychoanalysis

90

4.PRINCIPLESANDPRACTICEOFNURSING
INTRODUCTION
Nursingisamajorcomponentofthehealthcaredeliverysystemandnursesmakeupthelargestem
ploymentgroupwithinthesystem.
Nursingservicesarenecessaryforeverypatientseekingcareofvarioustypesincludingprimary,
secondary,tertiaryandrestorative.Asnursingisanimportantpartofhealthcaredeliverysystem,the
nursesneedtounderstandthesystemtoeffectivelydeliverqualitycarewithinit.
Nursing: Nursingistheprocessofrecognizing,understandingandmeetingthehealthneedsofany
personorsocietyandisbasedonaconstantlychangingbodyofscientificknowledge.
DEFINITIONOFNURSINGPROCESS
Thedefinitionofthenursingprocessisaprofessionalnursesapproachtoidentifydiagnose,andtreat
humanresponsestohealthandillness(Americannursesassociation2003)
Itisadeliberateintellectualactivitywherebythepracticeofnursingisapproachedinanorderly,
systematicmannerofpatientcare,inadynamic,continuousmethodtoassistthepatienttoachieveand
maintainhealth.
Thenursingprocessisanorderlysystematicmannerofdeterminingthepatientsproblems,mak
ingplanstosolvethem,initiatingtheplanorassigningotherstoimplementitandevaluatingtheextentto
whichtheplanwaseffectiveinresolvingtheproblemsidentified.
Thenursingprocessisasystematicmethodforassessinghealthstatus,diagnosinghealthcare
needs,formulatingaplanofcare,initiatingplanandevaluatingtheeffectivenessofplan.
STEPSINNURSINGPROCESS
(1) Assessment(2)Diagnosis
(3)Planning(4)Implementation(5)Evaluation

Assesscollectinformationabout
Patientcondition

Evaluate

Nursingprocess
Implementation
Performthenursing
actions

Diagnose,identify
thePatientproblems

Planandsetgoalsfor
Careidentityapproachto
Nursingactions
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Assessment: Thisreferstoasystematiccollectionofdata,toassistinidentifyingneedsandproblems.
Dataarecollectedinasystematicfashion,utilizingtheinterviewornursinghistory,physicalexamina
tions,laboratoryresultsandotherresources.
Diagnosis: Nursingdiagnosisisaclinicaljudgmentaboutindividualfamilyorcommunityresponsesto
actualandpotentialhealthproblemsandlifeprocesses.Duringthisphase,thedatacollectedduring
assessmentarecriticallyanalysedandinterpreted.Conclusionsaredrawnregardingthepatientsneeds,
problems,concernsandhumanresponses.
Planning: Planningisasystematicapproachindevelopingaplanofactionbasedonacarefulassess
ment.Strategiesaredevelopedtoprevent,minimizeorconnecttheproblemsidentifiedinthenursing
diagnosis.
Itconsistsofseveralstepsincludingestablishingpriorities,settingobjectives,writinginterven
tions,recordingoutcomesofnursinginterventionsinanorganizedfashiontocompletethenursingcare
plan.
Implementation: Itreferstocarryoutaplanthatisbasedoncarefulassessmentofneed.Itisthe
initiationandcompletionofactionnecessarytoachievetheoutcomesorobjectives.
Evaluation: Itisanongoingprocessthatdeterminestheextenttowhichthegoalhasbeenachieved.
Thenursesassesstheprogressofthepatient,institutecorrectivemeasuresifrequired,andrevisethe
nursingcareplan.
Knowledge
Assessment

Diagnosis

Evaluation
Experience

Standards

NursingProcess

Implementation

Planning

Attitude

ADMISSIONOFTHEPATIENT
Theentranceofapatientintoahealthcareagencysuchasahospitaloraprivateclinicistermedas
admission.Apatiententersthehospitalbyhimselforhemaybebroughttothehospitalbyhisrelatives,
friends,neighboursorothers.
Mentallyillpatients,persons,whohavetriedtocommitsuicideandaccidentpatientsareadmit
tedthroughalegalprocess.
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Allillpersonentersthehospitaltogethisdisordercuredwhenahealthyindividualgetsadmitted
intoahospitalforadayorforinvestigationsandobservationsandinordertofindwhetherheissuffering
fromanyillnesswhichhasnotbeenmanifestedbyanyexternalsignsandsymptoms.
Patientswhohavebecomeseriouslyillsuddenly,comethehospitalwithouthavinghadanytimeto
settletheirfamilyworkaffairs.
Hence,theyarenotonlyworriedandanxiousabouttheillness,butalsoareupsetaboutvarious
otherproblemsaffecttheirfamily.Nursesmustunderstandtheirphysicalandmentalproblemsandbe
verykindandunderstanding.
Needforgoodreceptionofthepatient: Anursehasanimportantroletoplayinthereceptionthe
patienttothehospital.Thefollowingarethepurposesofthisprocedure:(1)Preparethepatientboth
physicallyandmentallyforhisstayinthehospital.(2)Tohelpthepatienttobecomfortableandto
providehimwithacleanandsafeenvironment.(3)Togiveagoodimpressionofthehospitalandits
servicesothatthepatientwillfullycooperatewiththetreatmentandnursingcare.
A patient may be coming to hospital for the first time. He leaves his familiar home
surroundingandhislovedonesandcomestoanunknownplaceandtounknownpeople.Anychangein
humanlifeisanxietyproducingandisviewedwithfear.
Addedtothis,hisphysicalconditiongiveshimfearandanxiety.Hence,itisthenursesdutyto
receivethepatient,kindlysympatheticallyandwithanunderstandingofhisillness.Ifheisadmitted,he
isgivenadietsheetandsenttotheward.Ifheistooillandneedsimmediateattentionheisgiven
emergencytreatmentandthentransportedtotheward.
Assoonasthepatientcomestotheward,receivehim,hisrelativesandhisfriendsasifyouare
receivingyourguestsintoyourhome.Askthemtobeseatedwhileyoupreparethebedreadyforthe
patient.
Ifthepatientisinaseriouscondition,thewardnurseisinformedinadvanceaboutthearrivalof
thepatient,sothatthepatientdoesnothavetowaittillthebedismadeready.
Need for orientation to place and people: Inform the patient and his relatives about the
hospitalroutine,thehospitalrules,thegeneralsetupofthewardandthepersonnelworkingintheward.
Informthepatientsrelativesaboutthetimeofvisitinghoursandsupplythemwithvisitingpasses.
Ifthepatientisseriouslyillgivetherelativeaspecialpasssothathewillbeabletostaywiththe
patientinthehospital.
Needforadmissionassessment: Doagoodassessmentofhisphysicalconditioninordertoplanhis
care.Ifhisphysicalstateneedsimmediatetreatmentreporttophysicianandprepareyourpatientfor
physicalexaminationandcarryoutthetreatment,whichthephysicianprescribesafterthephysical
examination.
ORIENTATION TO THE WARD
Thepatientwhoisnotveryill,areallowedtomoveaboutcanbetakenroundtheward.Introducethe
otherpatientstohimandviceversa,andalsowiththenursingpersonnelworkingintheward.Orientthe
patienttothewholeward,dutyroom,toiletrooms,andtheunitpreparedforhim.Aftermakingthe
patienttobeseatedcomfortablyexplainedthehospitalpolicies,procedures,androutinestothepatients
andhisrelatives.Tellhimwhatisexpectedfromhim.Explaintohimthetimeformealsserving,the
doctorsvisit,visitingtimetheprayerservice,ifanyandotherhospitalsroutines.
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CAREOFBELONGINGS
Itisalwaysgoodpolicytodiscouragepatientstokeep/valuablethingsandmoneywiththem.Sendthe
valuablestohomethroughrelatives.Ifhedoesnothaveanyonewithhim,enterthedescriptionofitems
intheregisterandsendthevaluablestotheofficeforsafecustody.Getthepatientssignatureorthumb
impressionintheregister.However,informthepatientthathewillgetbackhisvaluablesondischarge.
Itisimportantthatyoutakecareofthepatientsclothing,shouldseethattheclothingarecleaned
andstoredawaywithproperlabelorsendthemhomeforafreshsetofcleanclothes.
However,encourage,patientstousehospitalclothing.IfaPatientissufferingfrominfectious
disease,seethattheclothingaredisinfectedandcleanedbeforetheyaresenthomeorstoredaway.
DISCHARGING OFTHEPATIENT
Dischargeisapreparationofapatientanddischargerecordstoleavethehospital.
Purpose:(1) Toensurecontinuityofcaretothepatientafterdischarge.(2)Toassistthepatientin
dischargeprocess
Guidelines: Thepatientsaredischargefromthehospitalinoneofthefollowingways.
Dischargetohome:Thedischargetohomeoranotherhospitaloranotherunitwithinthehospitalis
initiatedbythedoctorwhoadvisesthepatientthatheiswellenoughtoleavethehospitalorrequires
treatmentinanotherunitwithinthehospitalorinananotherhospital.
Dischargetoanotherhospitaloranotherunitwithinthehospital (referral).Whenapatientor
familyisnotsatisfiedwiththetreatmentorcaregivenandwantstoleavethehospitalagainstthemedical
adviceinsuchcasesthepatientortherelativeisaskedtosignastatementthatheisgoingortakingthe
patientonhisownwillandresponsibility.
Dischargeagainstmedicaladvice(AMA): Patientleavesthehospitalagainstthemedicalofficers
advice,whenapatientescapesfromthehospitalwithouttheknowledgeofthehospitalstaffandwithout
signingthesaidstatementheistreatedasabscondedintherecords.
NursesResponsibility: Informthepatientandtherelativesadayortwobeforethedischarge.Get
thedischargeslippreparedaftercheckingthevitalsignsandexaminingthepatient.Thenurseshouldsee
thatthepatientspersonnelhygieneismaintained,heisdressedinhomeclothesandhastakenmeals.
Handoverthepatientsbelongingandanyvaluable,whichhavebeenkeptsafety,tothepatientorthe
relativeunderproperreceipt.Completetheunitadmissionanddischargeregisteredcasesheetand
otherrecords.Handoverthecasesheetandotherrecordsmedicalrecorddepartmentunderproper
receipt.Informthehospitalauthoritiesaboutthedischargeifthepatientismedicolegal.Handoverthe
dischargesliptothepatientorrelativeandexplainaboutthetreatmentandthediettobetakenathome,
followupvisitandinformtobringthedischargesliponeveryvisits,anyspecialadvicespertainingto
condition.Seethatthepatientreceivesallthemedicinesasperdischargeslip.Checkthehospitalthings
beforethepatientleavestheward.Placethepatientinthewheelchairorstretcheraccordingtothe
patientsconditionuntilheleavesthehospital.Immediatelyafterthepatientleaves,reorganisethepa
tientunit.
BED ANDBEDMAKING
Bedmakingisanart.Skillfulbedmakingcontributesmateriallytothepatientscomfort.Cleanand
comfortablebedincludesthepatientsunitinthehospital.
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Purpose:(1) Toprovidecleanandcomfortablebedtothepatient.(2)Toobserveandpreventpatients
complications.(3)Tosavetime,effortandmaterial.(4)Toprovideaneatappearanceoftheward/unit.
(5)Toadapttheneedsofthepatient
Typesofbed: Thebedsareoftwotypes,ordinaryandspecialbeds.
Open(simple)bed:Thisispreparedforanambulatorypatient
Indication:(1)Provideacleansmoothcomfortablebedtothepatient.
Closed(unoccupied)bed:Thisisanemptybedinwhichthetopcoversarearrangedinsuchawaythat
alllinenbeneaththecounterpaneorbedspreadisfull)protectedfromdustanddirtuntiltheadmissionof
newpatient.Onarrivalofthepatient,thisbedisconvertedintoopenbed.
Indication: Keepthebedreadyforreceivingthenewpatient.
Occupiedbed :Thisbedispreparedforbedriddenpatient,lyinginthebed.
Indication: Provideacleanandcomfortablebedwiththeleastdisturbanceofthepatientinit.
SpecialBeds
Admissionbed: Thisispreparedforthenewlyadmittedpatient.
Indications:(1) Provideminimumdisturbancetothepatientduringadmissionbathandphysical
examination.(2)Protectbedlinenduringadmissionbathandleaveafreshbedimmediatelyreadyfor
theuse
Postoperativebed:Thisispreparedforthepatientwhohasundergonesurgery
Indication:(1)Protectbedlinenfromvomiting,bleeding,drainageanddischarges.(2)Providewarmth
andcomforttothepatienttopreventshock.
Fracturebed: Thisisahardfirmbeddesignedforthepatientwithfractureparticularlyofspine,pelvis
orfemur.
Indication:(1)Aidinimmobilizingthefracture,(2)Preventunnecessarypain,(3)Providewarmthand
comforttothepatient(4)Preventunduesaggingofthemattress.
Plasterbeds:Thisisahardbeddesignedforthepatientwithplaster.
Indications:(1) Aidinimmobilizingthepartuntiltheplasterdries,(2)Aidindryingtheplasterincorrect
positionandshape,(3)Providewarmthtodrytheplasterandkeepthepatientcomfortable.
Amputationorstumpbed:Inthistypeofbedthetopbedclothesaredividedorsplit.Thisisknown
asamputationorstumpbedwhenitisusedforthepatientwithamputationoflegs.
Indications:(1) Avoiddisturbancetothepatientduringconstantobservation,repeatedapplicationsor
treatmentsarenecessaryforabdomenorlowerlimbs,(2)Taketheweightoftheclothesoffthesideof
theamputatedlimborstump,(3)Keepthestumpingoodposition,(4)Watchstumpforhaemorrhage
constantlyandapplyatourniquetinstantlyifnecessary
Cardiacbed:Thisispreparedforapatientwithheartdisease.
Indication:(1) Relievedyspnoea.(2)Assistinrecoveryofthepatient(3)Providecomforttothe
patient(4)Preventcomplications
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Rheumatismorrenalbed:Thisispreparedtoprovideextrawarmthtothepatient.
Indications:(1) Provideextrawarmthtothebodyincaseofgeneraldebilityandshock,(2)Provide
comforttotheachingjointsinpatientswithacuterheumatism.(3)Improveperspirationforexcretionof
wasteproductsincaseofnephritis
Burnsbed: Thisispreparedforapatientwithburns.
Indications:(1) Preventinfectiontotheburntarea,(2)Helpinhealingoftheburntarea,(3)Provide
comforttothepatient,(4)Preventthepatientfromstickingtothesheetasaresultofexudatesoozing
fromtheburntarea.
Thebedsmustbeversatileandadaptabletodifferentneedsofthepatientswithfollowingar
rangements
Siderails:Theseareusedtopreventthepatientfromfallingoutofbed,protecttherestlesspatient,
providethepatientsupporttograspandholdwhenmovingabout.
Handcranks :Thesearelocatedatthefootofbedandusedtoadjusttheheightofbed,raiseorlower
thehead,footorkneesectionsinordertomaintainvariousbedpositionsfortreatmentorcomfort.
Specialattachmentstheattachmentsofvariouspoles,framesandequipmentfortractionareused
tomodifythebedstomeetvariousneedsofthepatientfortreatmentandcomfort.
THERAPEUTICENVIRONMENT
(1)Maintainingandcreatingtrustfulsupportingrelationshipincareofpatients.
(2)Itisclearlyandgenuinelycommunicatingandperformingcareactivity.
(3)Allowingthesupportivegroupincareofpatients.
(4)Acceptanceofpatientsfeelingsandvaluesandworthyaswhole.
(5)Assistthepatientandfamilyinidentifyingsupportivegroups.Maintainingasafeandsecuredenvi
ronment.
(6)Reinforceprogressinbehaviourorselfcareactivitiesorterminatingtherelationship.
(7)Encourageevaluationofprogressbetweennurseand thepatient.
PSYCHOSOCIALENVIRONMENT
Mentalcomfortisprovidedforthepatientbyeliminatinghisfear,anxietyandworry.Heshould
receivesympathyandconsiderationfromthenursingandmedicalstaff.Hisrelativesshouldavoidun
pleasantnewstohimwhileheisinthehospital.Meetinghisspiritualneedsmayhelptogivehimmental
peaceandcomfortagain..
BODY MECHANICS ANDPOSITIONING
Definition: Bodymechanicsmeansthecoorienteduseofthebodypartstoproducemotionand
maintainequilibriuminrelationtobothinternalandexternalforces.Postureistherelationshipofthe
variouspartsofthebodyinactivityoratrest.Positioninpatientincorrectedbodyalignmentmeansto
givepropersupporttothebodyinordertomaintainmuscletoneandeliminatestrain.
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Purposeofgoodbodymechanicsandposture: (1) Toprovidemaximumcomfortandrelaxation.(2)

To aid in normal body function (3) To prevent cont ract ures and neuromuscular
deformities and complications (4) To conserve maximum possible energy by preventing
unnecessarystrain
Standingposition: Incorrectstandingpositiontheheadishelderect,backiskeptstraightasmuchas
possible,chestisputforward,shouldersarekeptback,elbowsareslightlyflexed,wristsareextended,
fingersareslightlyflexed,abdomenisdrawninwardandkeptflat,kneesareslightlyflexed,andare
pointingaheadandparalleltoeachotherabout3inchesapart.
Knowledge of correct standing position is necessary because all other positions are
modificationsofstandingposition.Whenanursehelpsthepatienttositorliedowninbed,shefollows
theprinciplesofcorrectstandingpositionandkeepspatientsbodyingoodalignment.
Sittingposition: Insittingposition,theweightofthebodyisbalancedbyischialtuberositiesthe
buttocksandthethighs.
Elbowsareflexedandsupported,hipsareflexedatrightanglestothetrunk,kneesareflexedat
rightanglestothethighs,andanglesareflexedtorightanglestothelegsandareflatonfloor.Backis
helderectandthebackandbuttocksaresupportedbythebackofthechair.
POSITIONSUSEDFORPATIENTS
Dorsalposition:Patientisflatonthebedwithlegsextendedandarmsatthesidesofthebody.Thisis
notacomfortableposition,asthecurvesofthebodyarenotsupported.
Dorsalrecumbentposition:Thisiscalledbacklyingposition.Thisisamodificationofstandingposi
tion.Theonlydifferencebeing,thepatientisinhorizontalpositioninsteadofvertical.
Patientliesflatonhisbackwithapillowunderhishead.Asmallpadisplacedinthehollowofthe
back,andthekneesareslightlyflexed.Asoftpillowisarrangedundertheknees.Afootboardispro
videdtopreventfootdrop.Armsarekeptatthesidesofthebody.Mostofthepatientsarenursedinthis
position.
LateralPosition:Patientliesonhissidewithspinestraight.Thekneesareflexedtheupperkneesare
moreflexedthanthelowerone.Pillowsmaybeprovidedforthehead,inbetweenthelegs,andto
supportbackandabdomen.Thelowerarmiskeptabovetheheadandtheupperarmisplacedona
pillowinfront.Thearmsandlegsdonotbeartheweightofthebody.Thispositionisusedforgeneral
comfort,restandrelaxation.Duringbackcare,patientisplacedinlateralposition.
Leftlateralposition isusedforvaginal,perinealandrectalexaminations,andthepostoperative
patientsarekeptinlateralpositioninordertomaintainaclearairway.
Jackknifeposition:Patientsliesonhisbackwithhisshouldersslightlyelevated.Thehipsandknees
areflexedandbroughtuptotheabdomenandchest.Thepositionisusefultoperformalumbarpunc
ture.
KneeChestPosition:Thepatientkneesonthebedandthenlowershishead,shouldersandchestand
reststhemonthebed.Headisturnedtooneside,andkeptonapillow.Thethighsarekeptvertical.
Armsarecrossedabovethehead.Thispositionisusefulforperformingvaginalandrectalexaminations
andforcorrectingdisplaceduterusorotherorgans.
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LithotomyPosition:Thepatientiskeptonhisback.Headandshouldersrestonasmallsoftpillow.
Kneesareflexedwellandbuttocksarebroughtovertotheedgeofthebed.Ifitisusedforalong
period,thelegsaresupportedbystirrups,attachedtothetable.Thepositionisusedforexaminationor
operationsonrectumandgenitalorgans.
PronePosition:Patientliesflatonhisabdomenwithheadkeptonapillowandturnedtooneside.
Pillowsarekeptunderthewaistandunderthelowerlegs.Thearmsareflexedattheelbowandkept
abovethehead.Thispositionisusedwhenthereisbedsoreorburnsoraninjuryatthebackandasa
changeofpositionforpatientswhichfracturedspine.
Simspositionorsemiproneposition:Thisisamodifiedleftlateralposition.Thepatientliesontheleft
side.Head,shouldersandchestareturnedforwardsothatherchestrestsonthepillow.Therightknee
iswellflexedandrestsonthebedinfront.Theleftkneeisslightlyflexedandispositionedbehindthe
rightknee.Thispositionisusefulforperformingvaginalexaminationsandforrestsandrelaxation.
FlowersPosition:Patientisinapartiallysittingposition.Thebackofthebediselevatedto45degrees
withtheaidofabackrestandpilloworbyadjustmentofthecot.Patientsbackshoulderandheadare
supportedwell.Thekneesareflexedandsupportedwithapilloworbycotadjustment.Afootrestis
providedtopreventfootdrop.Patientsarenotkeptinthispositionforlongtime,sincethereisalways
thedangerofthrombusformation.Thispositionisusedforpatientswithdyspnoea(difficultyinbreathing),
distendedabdomen,abdominalsurgery,cardiothoracicdisordersandascites.Thepositionisalso
usefulwhilepassingRylestubeandwhileperformingtappingofascitesfluid.
Trendelenburgposition:Thepatientliesonthisbackwiththefootatthebedelevatedonwooden
blocks.Patientsheadandtrunkarelowerthanthelegs.
ReverseTrendelenburgPosition:Theheadandshouldersareatahigherlevelthanthehips,legsand
feet.Thispositionisusedforreducingintracranialpressureandforothertreatmentmeasure.
BasicNursingCare: Patientandhisenvironmentincludingthebedcomprisesofpatientsunit,which
needstobemaintainedfacilitatinghygieneenvironmenthelpingthecureprocess.
HYGIENICNEEDSPERSONALHYGIENE
Definition: Thewordhygienereferstothescienceofhealthanditsmaintenance,thepreventionof
disease,andsanitarypractices.PersonalHygieneistheactivityofselfcare,includingbathingand
grooming.Careoftheskin,hair,nails,mouth,teeth,eyes,ears,nasalcavities,andperinealandgenital
areas.
Factorsinfluencingpersonalhygienepractices
1) Developmentlevel:Childrenlearnmostoftheirhygienepracticesathomeandintheirpersonal
environment.Theymodifytheirbehaviourwithotherfamilymembers.Manyofthesebehavioursstick
withthemthroughoutlife.Theadvancingage,hormonallevelsandchangesintheintegumentarysystem
oftenrequirehygienicpractices.
2) Culturalbackground:Normsrelatedtohygienepracticesdifferfromculturetoculture.Forexample,
NorthAmericancultureplacesahighvalueonpersonalcleanlinessandpeoplehaveahabitofbathing
dailywhereaspeoplefromotherculturemayormaynotconsiderbathingasadailypractice.
3) Socioeconomicstatus:Financialstatusoftenaffectsapersonsabilitytopurchasehygieneproducts.
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4) Religion: Somereligionsobservespecificrulesrelatedtopersonalhygiene.
5) HealthStatus:Personswhoareillareoftenunabletoattendtopersonalhygieneactivities,either
becausetheyhavealowenergysupplyoraspecificphysicaldeficit.
SAFETYANDCOMFORT NEEDS
Theenvironmentinwhichthepatientisplacedshouldbecomfortableandsafeanditshouldcontribute
tohiswellbeingsandshouldnotretardhisrecovery.
Safetymeansprotectionfrompossibleinjury.Manyfactorscontributetowardsthesafetyof
patientsinthehospital.Thehospitalbuildingsshouldbestructurallysoundforensuringsafetyforpatients
withphysicallimitationssuchas,blind,agedorhandicapped.
Thenursingpersonnelmustbesafetyconsciousandtheyshouldtakealleffortstopreventaccidents
inthehospital.sheshouldreportallaccidentspromptlyandtakemeasurestopreventthemfromhappening.
Comfort: Comfortisasenseofmentalandphysicalwellbeing.Physicalcomfortgetsaffectedduetoa
dirtyandwetbedandlackofbodyalignment.Hightemperatureandhumidity,poorventilationtoomuch
noise,unpleasantodoursandglaringlightingmakethepatientuncomfortable.Topromotecomfortfor
thepatients,certainmechanicaldevicescanbeused.Pillowscanbeusedforgivingsupportforthe
variouspartofthebody.Sometimespatientfeelscomfortableinaproppedupposition.Inahospital,
abackrestisprovidedforthepatienttokeephiminasittingposition.
Forrelaxationofabdominalmuscles,whenpatientsareinpainorafteranabdominaloperation,
kneescanbekeptflexedbymeansofakneerest.
Apilloworablanketorsheetrolledasapillowcanbeimprovisedasakneerest.Patientsshould
notbekeptwithflexedkneesforalongperiod.Hiscirculationmaygetaffected.Hencehispositionis
changedfrequently.
Forsupportingfeetandforpreventingfootdrop,footrestsareused.Thisdevicekeepsthefeet
atrightanglestothelegandpreventsdeformities.Footrestcanbeimprovisedwithsandbags.
Otherdevicesusedascomfortmeasuresareairringsorcottonringsandaircushionsairmattress,
watermattressaretopreventpressureulcer.
Mentalcomfortisprovidedforthepatientbyeliminatinghisfear,anxietyandworry.Heshould
receivesympathyandconsiderationfromthenursingandmedicalstaff.Hisrelativesshouldavoid
unpleasantnewstohimwhileheisinthehospital.Meetinghisspiritualneedsmayhelptogivehimmental
peaceandcomfortagain.
MechanicalDevicesforcomfortmeasures: Tohospitalsusemanymechanicaldevicesforensuring
safety/patients.
Bedbars(siderails): areusedtopreventpatientsfromfallingoutofbed.Patientswhorequirethis
safetymeasurearepostoperativepatients,unconscious,semiconsciousmentallydisturbed,sedated,
blindorchildrenorveryoldpatients.
Backrest:Theseareusuallymadeofmetals.Theseareusedtosupportthebackofthepatientin
uprightposition.
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Overbedtable: Thetablesuchasthecardiactableisplacedinfrontofthepatientandthetopofthe
tableisadjustedtothedesiredheight.Aspillowisarrangedonthetopofthetablesothatthepatientcan
leanforwardonitforsupport.Whenhewantstotakefood,readorwrite.
Footboards:(Footrests):ThesearemadeofwoodandareLshaped,sothatoneendcanbe
slippedunderthemattresstoholdtheotherendinafirmuprightposition.Thepatientisplacedinsupine
positiontorestthebottomsofthefeetflatagainstthesurfaceofthefootboard(coveredwithsheet).
Theseareusedtopreventfootdropbymaintaininggoodalignment.
Sandbags: Thesearecanvas,rubberorplasticbagsfilledwithsandandare1,5and10lbsinweight.
Theseareusedtoimmobilizethebodypart,placingthemsnuglynexttothepart.eg.Oneithersideof
thefeettomaintainthepositionofthefeetonthefootboard,immobilizethefracturedlimb.
Blocks(shockblocks): Thesearemadeofwood,maybehighorlow.Theseareplacedunderthe
footofthebedforvariousreasons.Eg.Surgicalshock,tractionandposturaldrainage.Thismaybe
placedundertheheadofbedtopromotedrainageandimprovecerebralcirculation.
Handrolls:Thesearemadeofcloththatisrolledintoacylinderabout45incheslongand23inches
indiameterandstuffedfirmly.Theseareusedtokeepthefingersformbeingheldinatightfistleadingto
flexioncontractureinpatientswhoareunabletomovethehandsduetoparalysis,injuryordisease.
Thighrolls:Thesearemadebyfoldingasheettoadesiredlengthof23feetandthenrolledintoatight
cylinder.Theseareusedtosupportthehipsandthighs,preventingthemoutwardrotationandkeeping
thefeetingoodalignment,incaseofparalysis,fractureofthefemurorhipsurgery.Tousetheroll,place
theloseend(flap)underthepatientshipsandthighswiththeroleundertheflapendandthentucking
snuglyalongthehipandthigh.
Cradle: Thesearemostlysemicircularinshape,madeofwoodormetal.Theseareusedtopreventthe
weightoftopbedclothesonpatientsfeetandtoes.Tousethecradle,Placeitoverthebottombedclothes
andthetopbedclothesarethenbroughtoverthecradle.Theseareusedforpatientsaffectedbyburns.
Restraints aredevicesusedtopreventagitatedpatients,personswhogetoutofbedatnightintheir
sleepandsmallchildren,fromfallingoutofbed.
Wiremesh forwindowsanddoorsarefixedtopreventinsects.
SafetyMeasures: Patientsshouldbesafeguardedfromfireaccidentsandfromcarelessapplication
ofheat.Fireaccidentsoccurmainlyduetoallowingpatientstosmokeinbed.Useoffaultyelectric
appliancesandcarelessuseofoxygencylinders.Patientmaygetinjuredfromcarelessapplicationofhot
waterbags,electricpadsandapplicationofmedicationsontheskin.Poisonousdrugsshouldbekept
underlockandkeywithspecificredlabel.
Patientsmaycometoharmthroughbacteriologicalsources,insectsandrodents.Foodandwater
shouldbemadesafeforconsumption.Insectsandrodentsshouldbeeliminated.
ACTIVITYANDEXERCISES
Activityandexercisearenecessaryforhealthyliving.Activitiesusuallyperformedinandaylikeeating,
dressing,grooming,bathing,brushingetcarecalledactivitiesofdailyliving.
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Activitiesofdailyliving: Itisessentialformeetingthedaytodayneeds.Whenapersonisnotmeet
theseactivities,itisthecaregiverresponsibilitiestomeettheirneeds.Accordingtotheirhealthstatusthe
degreeofassistancerequiredwillvarythosewhoarerecordingsickneedstotalassistanceinorderto
meettheirdailyneeds.Exerciseistheperformanceofphysicalexertionforimprovementofhealthorthe
correctionofphysicaldeformity.
Benefitsofexercise:(1) Exercisestrengthsmuscles(2)Helpstopreventconstipation(3)Increases
appetite(4)Improvessleep(5)Stimulatesbloodcirculation(6)Improveslungventilation(7)Prevents
obesity(8)Promotesphysicalandmentalwellbeing.(9)Promoteurinaryfunction(10)Itregulates
bodytemperature
Typesofexercise: Therearetwotypesofexercises.Theyare
Activeexercise: Activeexerciseisatypeofphysicalactivityaccomplishedbythepatientwithout
assistance.theseexercisehelpthepatienttoattainthenormalphysiologicalfunctionofthebody.
(1) Deepbreathingandcoughingexerciseforcompletelungexpansionusuallydonebypostoperative
patient.
(2) Exerciseofthelimbsthroughfullrangeofmotionwhichincludeflexion,extension,adduction,abduction
androtation
(3) Movinginbedtochangetheposition
(4) Footexercisetopreventfootdropandtoedeformities.
(5) Abdominalandglutealcontractionexercise
Passiveexercise: Inpassiveexercisethemovementsoractivityiscarriedoutbyanotherpersonand
thepatientmakesnovoluntaryefforttoassistorresisttheaction.Thepassiveexercisesareusually
carriedoutbythephysiotherapistorthenurse.Theperformanceofcertainnursingproceduressuchas
bathingthepatient,givingbackcareandchangingthepositionetc.,providessomepassiveexercisefor
the patient. Passive exercise is useful for patient with restricted movements, deformities and
unconsciousness.
MOVING,SHIFTINGANDLIFTING PATIENT
Asnursesyoumayberequiredtomoveandliftpatients.Animportantpointyouhavetobearinmind
whilemovingpatientsisthatyoumustobservecorrectbodymechanicforyourpatientsaswellasfor
yourself.
Whileliftingheavyobjects,itiswisetostandwithyourfeetwhileapartandfirmlyonthefloor.
Theweightshouldbeliftedclosetothebody.Flexyourkneessothatyourstrongmusclesofthelegs
beartheweightoftheobject.
Purposes:(1) Toperformthetaskefficiently.(2)Toavoidthepatientfromunnecessaryeffort(3)The
preventnursesfromstrainandbackinjuries(4)Topromotecirculationandmusculartone
Movingupwardordownward:Twonursesarerequiredtodothis.Onenurseplacesheronehand
underthepatientsshoulderandtheotherhandunderthelumbarregion.
Theothernursestandsontheothersideofthebedanddoesthesameasthefirstnurse.The
patient,ifheisable,isaskedtoflexthekneeandpushagainstthematterswithheels.Bothnurses
togetherbringthepatientup.
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Movingfromonesideofbedtoanother:Movepillowstowardsthesideofthebed.Placeyourone
armundertheshouldersandtheotherunderthelumbarregion.
Moveupperpartofthebodytothesideofthebed.Thenkeeponearmunderthelumbarregion
andtheotherunderthethighsandmovethemiddlepartofthebodyofthesideofthebed.Lastlyplace
onearmunderthethingsandtheotherundertheanklesandmovethelowerpartofthebodytotheside
ofthebed.Seewhetherthewholebodyisstraightandingoodalignment.
Turningonside:Beforeturningmovethepatientalittleawayfromthecentre.Ifheistobeturnedon
theleftside,youstandathisleft.Keephisrightarmcrossedonthechestandrightlegcrossedoverthe
leftleg.Flextherightkneeslightlykeeponehandonthepatientsrightshoulderandtheotheronhisright
hipandgentlyrollhimtoleftlateralposition.
Movingpatientsfromstretchertobed:Keeptheheadofthestretcheratrightanglestothefootof
thebed.Threenursesareneeded.
Allstandonthesamesideofthestretcheronenurseplacesherarmsunderthepatientsheadand
shoulders,anotherkeepsheranusunderthehips,thethirdhasherarmsunderthethingsandlegs.
Alltogetherlifethepatient,turnandplacehimonthebed.Theliftersobservebodymechanicsfor
themselves.Theykeeptheirbacksstraight,flextheirkneesandplacetheironefootforwardwhile
transferringthepatient.
OXYGENNEEDS
Oxygenisadministeredwheneverthereisdeficiencyinthebloodisshownbycyanosis.Patientswith
respiratorydysfunctionaretreatedwithoxygentherapytorelieveanoxaemiaorHypoxemia.Thenormal
amountofoxygeninthebloodmustbeintherangeof80to100mm.Hg.Ifitfallsbelow60mmofHg
irreversiblephysiologicaleffectmaytakeplace.Thebraincellsreceive20percentofthebodysoxygen
supplyandcanliveonlyfor3to5minutesiftheiroxygensupplycutoff.
Purpose:(1) Tosupplyoxygeninconditionswhenthereisinterferencewiththenormaloxygenationof
theblood.
IndicationsforOxygenInhalation:(1)Breathlessnessduetoasthma,pulmonaryembolism,
emphysema,cardiacinsufficienciesetc,(2)Obstructedairwayduetogrowth,enlargedthyroid,
(3) Cyanosis (4) Shock and circulatory failure (5) After severe haemorrhage (6) Anaemia.
(7) Patients under anaesthesia. (8)Asphyxia due to any reason e.g. drowning, inhalation of
poisonousgases,hangingetc.(9)Poisoningwithchemicalsthatalterthetissuesabilitytoutilize
oxygen e.g. cyanide poisoning. (10) Carbon monoxide poisoning. (11) Postoperative chest
surgeryandthyroidectomies.(12)Insufficientoxygeninatmosphere.(13)Airhunger
MethodsofOxygenAdministration: Administrationofoxygendependsupontheconditionofthe
patient,theconcentrationdesired,thefacilityavailableandthepreferenceofthedoctor.Itcanbegiven
byfollowingways:
Oxygenbynasalcatheter: Thisistheusualmethodofadministeringoxygentothepatientsinthe
ward.Thenasalcatheterisinsertedintothenostrilreachinguptotheuvula.Thecatheteristapedonthe
foreheadtokeepitinplace.Thenasalcatheterpermitsfreemovementforthepatientandnursingcare
maybegivenwithmuchmoreease.
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OxygenbyB.L.B.Mask: Whenoxygenconcentrationofover25%isneededorwhenoxygenis
givenunderpressurethemaskisused.Ifthemaskdoesnotfitsnuglyovertheface,oxygenwillbelost
fromthemask.Itisusefulforthepatientswhoareunabletobreathethroughthenose.Flowof8to12
litresoxygenwillbesufficienttomaintaintheconcentrationofoxygento25to60%.
B.L.B.[Boothby,LovelaceandBulbalian]isarubbermask.Itismadetofitoverthenoseor
noseandmouth.Thereservoirbagisattachedtoit.
OxygenbyTent: Itconsistsofacanopyoverthepatientswhichmaycoverthepatientpartiallyor
totally.Itisconnectedtoasupplyofoxygen.Thecanopiesaretransparent,sothatthenursecan
observethepatient.Thelowerportionofthecanopyistuckedunderthebedtopreventtheescapeof
oxygen.
O2 cylindersandaccessories: Oxygenissuppliedincylindersortanks.Itisstoredunderapressure
of2200lbs1000kgpersq.inch.Pipedinoxygenisstoredunderoxygencylinderarelowpressure
about50to60lbspersq.inch.Theoxygencylindersarepaintedblackwithwhiteneck.
TheWolfsbottlehastwoholedrubbercorkinwhichtwoglasstubesareinsertedoneshortand
onelong.Thelongtubeisattachedbyrubbertubingtooxygencylinder.Theshorttubeisattachedby
rubbertubingandglassconnectiontoanasalcatheter.Thelargevalveofthecylinderisopenedwith
keys.Thereisaregulatortoregulatetheflow.
Careofoxygencylinders:
1) Handlethecylinderwithcare.
2) Oxygenstandshouldbeusedtopreventfallingandcausinginjurytosomeoneortotheequipment.
3) Itshouldbealwaysplacedattheheadofthebed.
4) Oxygendoesnotcausefirebutitsupportscombustion.Soavoidanysourceoffirefromthe
cylinderforfearoffire.
5) Visitorsandotherpatientsmayneedtobereminded.HangNosmokingboardtotheoxygen
cylinder.
6) OxygencylindersshouldbestoredinacoolTemperature,becausehightemperaturecancause
expansionofthegaswithconsequentlossofgasthroughthesafetyvalve.
7) Donotuseelectricappliancesclosetooxygen.
8) Oilorgreaseshouldnotbeusedontheregulator,becauseinthepresenceofhighoxygenconcen
tration,oilislikelytocatchthefireandthecylindermayexplore.
9) Markemptycylinder,replaceprotectioncap,andsetasidefromfullcylinders.
10) Inspecttheapparatusatfrequentintervalsandmakesurethatitisinworkingcondition.Thenurse
shouldlearntheworkingofcylinders,itsregulatorsetc.beforehandlingtheapparatus.
Precautions:
1) Givingoxygenisanemergencyprocedure,soitshouldbereadyfor24hours.
2) Thenurseshouldseethatthecylindersarefullandalltheapparatusisinworkingcondition,thekey
isattachedwiththecylinderinabag.
3) Thereshouldnotbeanyleakageinrubbertubing.
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4) ThereshouldbewrittenorderforO2inhalationandspecificdoesmustbeprescribedtoavoid
oxygentoxicity.
5) Useregulartoreducethepressureoftheoxygeninthecylindertoasaferlevel.
6) Measuretheflowinlitresperminute.Adjusttheflowofoxygen2to4litresperminuteforadults
whenthenasalcatheterisused.
7) Usesterileordisposablenasalcatheterstoavoidinfection.
8) Thecathetershouldbechangedatleastevery8hourlytoavoidblockageofcatheter.
9) Thecathetermaybetapedtotheforeheadforthecomfortofthepatientandtokeepitinplace.
10) Patientsnostrilsshouldbelubricatedwithpetroleumjelly,ifthereisanysignofirritation.
11) Oxygenadministrationmustneverbestoppeduntilthecauseofhypoxiaisreversed.
12) Ifnurseisleavingthepatientforshortperiod,leaveacallbellnearthepatient
13) Theprematurebabiesshouldbegivenoxygeninhalationonlyforashorttimeandataverylow
concentrationtoavoidretrolentalfibroplasia.
14) Observethepatient,receivingoxygeninhalationcontinuouslytodetectearlysignsofoxygentoxicity.
15) Sinceoxygenhelpsincombustion,fireprecautionsaretobetakenwhentheoxygenisonflow.
ELIMINATIONNEEDS
Definition:Elimination istheprocessbywhichwasteproductsareremovedfromtheboweland
bladderbymeansoffaecesandurine.
Factorsaffectingbowelandbladderelimination: Age,dietaryintake,fluidintake,physicalactivity,
psychologicalfactors,positionduringdefecation,pain,pregnancy,surgery,anaesthesiaanddiagnostic
test.
Commonboweleliminationproblems:Constipation,impaction,diarrhoea,incontinence,flatulence,
haemorrhoidsandboweldiversion.
Commonbladderelimination problems:Incontinence,Urinaryretention.
SUMMARY
(1) Nursingistheprocessofrecognizing,understandingandmeetingthehealthneedsofanypersonor
societyandisbasedonaconstantlychangingbodyofscientificknowledge
(2) Therearefivestepsinnursingprocess.Theyareassessment,diagnosis,planning,implementation,
evaluation.
(3) Applicationofnursingprocess
(4) Theentranceofapatientintoahealthcareagencyistermedasadmission.
(5) NursesresponsibilitiesareInformthepatientandtherelativesadayortwobeforethedischarge
(a)Getthedischargeslippreparedaftercheckingthevitalsignsandexaminingthepatient(b)The
nurseshouldseethatthepatientspersonnelhygieneismaintained,heisdressedinhomeclothes
andhastakenmeals.(c)Handoverthepatientsbelongingandanyvaluable,whichhavebeen
keptsafety,tothepatientortherelativeunderproperreceipt
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(6) Skilfulbedmakingcontributesmateriallytothepatientscomfort
(7) Bedsareoftwotypesordinary,andspecialbeds
(8) Bodymechanicsmeansthecoorienteduseofthebodypartstoproducemotionandmaintain
equilibriuminrelationtobothinternalandexternalforces.
(9) Thehygienereferstothescienceofhealthanditsmaintenancethepreventionofdisease,and
sanitarypractices.
(10)Comfortisasenseofmentalandphysicalwellbeing
(11)Restraintsareusedtopreventagitatedpatientswhogetoutofbedatnightintheirsleepandsmall
children,whenfallingoutofbed
(12)Whileliftingheavyobjectsflexyourkneessothatyourstrongmusclesofthelegsbeartheweight
oftheobject.
(13)Patientswithrespiratorydysfunctionaretreatedwithoxygentherapytorelieveanoxaemiaor
Hypoxemia.Thenormalamountofoxygeninthebloodmustbeintherangeof80to100mm
(14)Oxygencanbeadministeredbythewaysofnasalcatheter,B.L.B.mask,andanoxygentent
(15)Eliminationistheprocessbywhichwasteproductsareremovedfromthebowelandbladderby
meansoffaecesandurine.
(16)Exerciseistheperformanceofphysicalexertionforimprovementofhealthorthecorrectionof
physicaldeformity.

QUESTIONS
PartA ONE WORD ANSWERS: (Onemark)
a)Nursing
b)PersonalHygiene
d)Position
e)Hypoxemia
g)Anoxia
h)Elimination

c)Dyspnoea
f)Cyanosis
i)Comfort

PartB MULTIPLECHOICEQUESTIONS: (Onemark)

1)
Therelationshipofthevariouspartsofthebodyinactivity(or)rest.
1)
2)

2)Implementation

3)Diagnosis

Occupiedbed

2)Closedbed

3)Openbed

Patientisinapartiallysittingposition
1)

5)

Assessment

Abedpreparedforbedriddenpatient.
1)

4)

3)comfort

Aclinicaljudgementtoactualhealthproblems
1)

3)

Posture 2)Exercises

Semiproneposition

2)Trendlenburgsposition

Senseofmentalandphysicalwellbeing
1)

Comfort

2)Position

3)Rest
105

3)Fowlersposition

6)

Themechanicaldeviceusedforthepatienttopreventfallingfromthebed
1)Backrest

7)

2)IShape

3)TShape

Thedeviceusedtoimprovecirculationandpromotedrainage
1)SandBags

9)

3)BedBares

Shapeofthefootboards
1)LShape

8)

2)Footboard

2)Blocks

3)Overbedtable

Colouroftheoxygencylinder
1)Bluewithwhiteneck2)Blackwithwhiteneck

10)

Flowofoxygenforanadultperminutes
1)24litresperminutes

11)

2)46litresperminutes3)12litresperminutes

Amountofoxygensaturationintheblood
1)80to100mmofHg2)60to70mmofHg

12)

3)Whitewithblackneck

3)50to60mmofHg

Thesystematicdatacollectioninidentifyingneedsandproblemsisknownas
1)assessment2)diagnosis3)implementation4)evaluation

13)

Thepatientleavesthehospitalagainstthemedicalofficersadviceisknownas
1)Discharge2)referral3)AMA4)abscond

14)

Thetypeofbedispreparedtoprovideextrawarmthtothepatient
1)Fracture2)Amputation3)cardiac4)Rheumatism

15)

Modifiedleftlateralpositionisknownas
1)Simsposition
3)Jackknifeposition

16)

2)Fowlersposition
4)Trendelenburgposition

Thedevicesusedtopreventagitatedpatientsfromfallingoutofthebed.
1)Handrolls2)Backrest3)blocks4)restraints

17)

Theindicationsforoxygenadministrationare
1)Breathlessness2)Asphyxia3)carbonmonoxidepoisoning4)alloftheabove

18)

Thenormalamountofoxygeninthebloodis
1)6070mmHg2)5070mmHg3)80100mmHg4)7090mmHG

19)

Deepbreathingandcoughingexercisesfallsunder
1)Activeexercise2)passiveexercise3)stretchingexercise4)relaxingexercise

20)

Thecommonbladdereliminationproblemis
1)Impaction2)incontinence3)flatulence4)diversionofbowel

21)

Thepositionusedforreducingintracranialpressureis
1)Trendelenburg2)ReverseTrendelenburg3)Prone4)Fowlersposition
106

PartC WRITESHORT ANSWERS: (5marks)

a)Typesofexercises
b)Therapeuticenvironment
c)Stepsinnursingprocess
d)Purposesofgoodbodymechanism
e)Factorsaffectingbowelandbladderelimination
PartD WRITEINDETAIL: (10marks)
a) Nursesresponsibilitiesindischargeprocedure
b) Purposesofbedmaking
c) Benefitsofexercises
d) Careofoxygencylinder.
PartEWRITEESSAY: (20marks)
a)Mechanicaldevicesforcomfortmeasure
b)Typesofpositioning.
c)Admissionprocedure.
d)Typesofbedmakingandindications

107

5.Healthassessmentandphysicalexamination
DEFINITIONOF PHYSICAL EXAMINATION
Itisdefinedasacompleteassessmentofapatientsphysicalandmentalstatus.
PURPOSESOF PHYSICAL EXAMINATION
(1)Togatherbaselinedataabouttheclientshealth.(2)Tosupplementconfirmorreputedataobtained
inthenursinghistory.(3)Toconfirmandidentifynursingdiagnoses.(4)Tomakeclinicaljudgmentabout
aclients.(5)Changinghealthstatusandmanagement.(6)Toevaluateandphysiologicaloutcomesof
care.(7)Itoffersanopportunityforhealthteaching(breastandtesticularselfexamination)
IndicationsofPhysicalExamination: Isdoneinhospitalsandduringhomevisits,onadmission,
beforeandafterdiagnostic&therapeuticprocedure,ondischarge,onfollowup,healthcampus.
METHODSOF PHYSICAL EXAMINATION
Observationofthepatient: Webstersdictionarydefinesobservationastheactorpowerofnotic
ing.Nursesarewiththepatientsthroughoutdayandnight.Yourreportofobservationisveryvaluable
inhelpingthephysiciantoarriveatproperdiagnosisandtreatment.Theessenceofgoodnursingde
pendslargelyonintelligentobservation.Itisthroughobservationyounoticeyourpatientsdeviations
fromnormalcondition.
Yourobservationandpromptactionsmayhelppatientsfromgettingintoseriouscomplications
suchashaemorrhageandothersimilarproblems.Yourplanofnursingcarealsodependsupongood
observation.
Goodobservationdependsonyourintelligenceandknowledge.Skillinobservationisacquired
throughcarefultraininginusingyoursensesnamely,seeing,hearing,touchingandsmelling.
Itisthroughthesenseofseeingyouobservewhetherthepatientiswalkingwithdifficulty,whether
heisinpainandwhetherhehasanyothervisibleproblems.
Fromhearingthesoundofhisbreathingyouwillabletounderstandwhetherthepatientishaving
difficultyinbreathing.Touchingthepatientrevealswhetherhisbodytemperatureisraisedabovenormal
orwhethertheskinisofnormaltextureornot.Yoursenseofsmelltellsyouthenatureofdischargefrom
woundsandbodycavities.
Observationisacontinuousprocessasapatientsconditionisneverstatic.Itchangescontinu
ously.Thesechangesarenoticedthroughcarefulobservation.Anursesobservationincludesnotonly
thephysicalconditionofthepatient,butalsohispsychologicalaspects.
Yourobservationbecomesmeaningfulwhenitisaccompaniedbyquestioning.Tocometoclear
interpretationsofyourobservations,youhavetoquestionyoupatientsothatyouwillbeabletofindout
theproblemsexperiencedbythepatient.
Throughobservationyouidentifytheobjectivesymptomsofyourpatient.Changesincolourof
theskin,pulse,respiration,dischargesfrombodycavitiesandchangesinspeecharesomeoftheex
amplesofobjectivesymptoms.
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Painnausea,fear,anxiety,dizzinessanditchingareidentifiedbyquestioningthepatient.Theseare
examplesofsubjectivesymptoms.
Certainsymptomscannotbeidentifiedbyobservationorquestioning.Forexample,somespecial
techniquesareneededtonotechangesintemperature,pulse,respirationandbloodpressureXrays
andlaboratorytestsareusedforfindingoutchangesinstructureandfunctionsofvarioussystemsofthe
humanbody.
Physiciansusemethodssuchasinspection,palpation,percussionandauscultationforobservation
ofpatientscondition.
Inspection isobservingwitheye.
Palpation istheartoffeelingwiththehand.
Percussion andauscultationdependontheproductionofsound.
Percussion istappinganareatoproducesounds.
Auscultation islisteningtosoundswithinthebodywith
astethoscope.Itistheartofhearingtheheartsound,bowelmovementetc.
Olfaction :Senseofsmell,(odour)
PRINCIPLESOF PHYSICAL EXAMINATION
Headtofootexamination: Whenapatientcomestothehospitalorclinic,doanoverallobservation
ofthepatient,notedownhisproblems,reporttotheseniornurseandwriteyourobservationsinthe
nursesrecordsheet.
Usethefollowingasaguideforyourobservationandforestimationofyourpatientscondition.
1)Thegeneralstructureofthebody:Whetherheisobese,malnourished,acutelyillor
chronicallyill.Whetherheisweakandunabletowalkorwalkswithaidwhetherheisinpain.Notethe
colouroftheskinpale,jaundiced.
2)Mentalstatusandlevelofconsciousness:Whetherthepatientischeerfulordepressed,anxious
andworried,irritate,afraidorsad.Whetherorientedtoplace,personandtime.Whetherfullyconscious,
drowsyorcomatose.
3)Hairandscalp:Whetherthehairisclean,thick,thin,matted,dirtyorcoarse.Whetherthereisany
lesion,dandruff,pediculiornitsonthescalp.
4)Eyes:Whethertheeyesareprotruding,sunkenorcrossed.WhetherthecolourisabnormalReddish
oryellow.Whetherthereisswelling,discharge,abnormalwatering,pain,burning,itching,photophobia
orheadache.Whetherthevisionisnormalorpoor.Whetherthepatientusesglasses.
5)Face: Whetherthefaceispale,flushedorjaundiced.Whetherthereisswelling,ulcers,rashesor
injuries.Whetherhiseyesareswollenorsunken.
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6)Mouth: Whetherhisbreathsmellsofdrugsoralcoholorhasabadsmell.Whetherthegumis
inflamed,swollen,bleedingorulcerated.Whetherthelipsarecyanotic,dryswollen,crackedorulcerated.
Whethertheteethareloose,broken,artificialorirregularlyarranged.Whetherhehasanytoothache.
Whetherthetasteisimpaired,ordisturbed.Whetherthetongueisdry,cracked,coated,inflamed,
ulcerated,blistered,fissuredorswollen.
7)Throat: Whetherthepatienthasanyulcer,inflammationorpain.Whetherhehasanydifficultyin
swallowing..
8)Speech: Whetherthespeechisabsent.Whetherhehasanydifficultyinspeechstammeringor
incoherent.Whetherthevoiceishoarseorweak.
9)Nose: Whetherthereisanydeformity,swellingordischargeofmucous,bloodorpus.Whetherthe
senseofsmellispresentorabsent.
10)Ears: Whetherheisabletohearornot.Whetherthereiscollectionofwaxintheear.Whetherthe
patientexperiencesanyringingorbuzzingsounds,dizziness,itchingorpricking.
11)Neck: Whetherthepatienthaspainanddifficultyinmovingtheneck.Whetherthereisanyswelling
ordistendedvein.
12)Chest: Whetherthepatientsuffersfromcough.Whetherthesputumisofabnormalcolouror
quantity.Whetherthebreathingislabouredornormal.
13)Breast: Whetherthereareanyabnormalitiesintheshapeandsize.Whetherthereareanylumpsor
dischargefromthenipples.
14)Abdomen: Whetheritissoft,tender,distended,hard,swollen,flabbyorprotruding.Whetherhe
hasanynausea,vomitingorpain.Whetherhisappetiteisnormalornot.
15)Back:Anyswellinglumporanysore/ulcerattheback.
16)UpperExtremities:Whetherthenailsarebrokenorbrittle.Whetherthereisclubbingoffingertips,
tremorsofhands,swellingofextremities,paininthejointsoranyotherabnormality,allrangeofmotions
present
17)Lowerextremities:Normalinshapeandsize,anydeformity,allrangeofmotionspresent.
18)Skin: Whetherthereareanysores,wounds,rashesorscales.Whethertheskinisdry.moist,hot.
coldorclammy.
19)Excretionsanddischarges: Whetherthecolour,consistency,amount,odour,andcharacteristics
ofstools,urine,sputum,perspiration,vomitusandvaginaldischargearenormalorabnormal.Whether
patientgetsanypainoranyotherdiscomfortduringexcretion.
Charting: Thenursesarerequiredtoreportandrecordtheirobservations.Shereportsherfindingsto
theprofessionalnurseandtothephysician.
Recordingoftheobservationsiscalledcharting.Thenursesshouldcharttheirobservationscor
rectly.Allchartingsshouldbebrief,concise,accountandcomplete.
110

Chartinghelpsphysicians,nursesandotherstounderstandtheconditionandprogressofthe
patient.Thechartisalsousedforlegalproceduresandresearch.
Apatientschartincludesrecordsmaintainedbyphysiciansandnurses.Anurseshouldbeableto
maintainrecordsrelatedtonursingandsheshouldbeabletounderstandthenotesmadebyphysicians
andothers.
PHYSIOLOGICAL ASSESSMENT
Vitalsigns: Temperature,pulserespiratoryrateandoxygensaturation,bloodpressure,painarecalled
vitalsignsasindicatorsofhealthstatus.Thesemeasuresindicateeffectivenessofcirculation,respiratory,
neuralandendocrinefunctionbecauseoftheirimportancetheyarereferredtoasvitalsigns.
Temperature: Degreeofheatmaintainedbythebody.Itisthebalancebetweentheheatsproduced
andheatlost.
Oraltemperature

:98.6F(37C)

Rectaltemperature/Tympanic :99.6F(37.5C)
Axillarytemperature

:97.6F(36.4C)

Fever: Itoccursbecauseofheatloss.Mechanismsareunabletokeeppacewithexcessheatproduc
tion,resultinginanabnormalraiseinbodytemperature
Thermometer: (clinicalthermometer): Itisusedformeasuringbodytemperature
Thermometerintotwotypes:(1)Basingonthematerials.(2)Basingontheroute
Basingonmaterials (a)Electronicthermometer(b)Disposablethermometer(c)Glassthermometer
(d)Temperaturesensitivestrip
Basingontheroute: (a)oraltemperature(b)rectaltemperature(c)tympanicthermometer
TheCommonSitesforTakingBodyTemperature:Togetaccuratemeasurementofthebody
temperaturethebulbofthethermometermustbeplacedwhereitcanbecompletelysurroundedby
bodytissueandwheretherearebloodvesselssituatednearthesurface.Thetemperaturemayvaryifthe
bulbofthethermometercomesincontactwithclothing,air.Moistureetc.thecommonsitesforraking
bodytemperaturearemouth,groin,rectum,axilla.
EachdevicemeasurestemperatureusingtheCelsiusorFahrenheitscale.Followingformulasare
usedinconvertingvalues
ToconvertFahrenheitintoCelsius
C=(F32)5/9
E.gconvert104FintoCelsius
C=104325/9
C=725/9=40C
111

ToconvertCelsiustoFahrenheit
F=C9/5+32
E.gconvert37CtoFahrenheit
=(379/5)+32
=66.6+32=98.6F
Contraindicationforrectalmethod
1)Thepatientswhohadrectalsurgeryorinflammationoftherectum
2)Thepatientswhoarehavingdiarrhoea
3)Whentherectumispackedwithfaecalmatter
4)Patientwhoarehavingsomekindoftreatments(eg)bowelwashenemaect
Contraindicationsfortheoralmethod: Patientswhoare
1)Extremelynervous
2)Delirious
3)Unconscious
4)HystericalandMentallyconfused
5)Patienthavingconvulsionmouthbreathe
6)Patientswhohaveinjuries
7)Inflammationofoperationinthemouth
8)Childrenundertheageof6years
9)Extremelyweakpatient
Typesoffever
Termsusedtodescribethetypesandphasesoffever
Onset: Onsetorinvasionoffeveristheperiodwhenthebodytemperatureisrisinganditmaybea
suddenorgradualprocess
Fastigiumorstadium: Fastigiumorstadiumoffeveristheperiodwhenthebodytemperaturehas
reacheditsreturningtonormal.Thefevermaysubsidesuddenly(declinebycrisisorgradually(decline
bylysis)
Crisis: Crisisissuddenreturntonormaltemperaturefromaveryhightemperaturewithinafewhoursof
days
Truecrisis:Thetemperaturefallssuddenlywithinfewhoursandtouchesnormal,accompaniedbya
markedimprovementinthepatentscondition
Subnormaltemperature:Whenthebodytemperaturefallsbelownormalitiscalledsubnormal
temperature.Thetemperaturemayvarybetween95to98For35to36.7c
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Hyperthermia: Whenthebodytemperatureisraisedto105Foraboveitiscalledhyperthermia
Hypothermia: Ifthetemperaturefallsbelow95For35C,theconditioniscalledhypothermia
Falsecrisis:Asuddenfallintemperaturenotaccompaniedbyanimprovementinthegeneralcondition
iscalledfalsecrisis.Itmaybedangersignalandnotasignofimprovement
Lysis: Thetemperaturefallsinazigzagmannerfortwoofthreedaysofaweekbeforereachingnormal
duringwhichtime,theothersymptomsalsograduallydisappear
ConstantfeverorContinuousfeverConstantfeverorContinuousfeverisoneinwhichthetemperature
variesnotmorethentwodegreesbetweenmorningandeveninganditdoesnorreachnormalfora
periodofdaysofweeks
Remittentfever:Remittentfeverisafevercharacterizedbyvariationsofmorethantwodegrees
betweenmorningandeveningbutdoesnotreachnormallevel
Intermittentorquotidianfever:Thetemperatureisraisesfromnormalorsubnormaltohighfeverand
backatregularintervals.Theintervalmayvaryfromfewhourstothreedays.Usuallythetemperatureis
higherintheeveningthanthemorning
Inversefever: Inthistypethehighestrangeoftemperatureisrecordedinthemorninghoursandthe
lowestintheeveningwhichiscontrarytothatfoundinthenormalcourseoffever
Hecticfever:Whenthedifferencebetweenthehighandlowpointisverygreat,thefeveriscalled
hecticorswingingfever.
Relapsingfever:Relapsingfeverisoneinwhichtherearebrieffebrileperiodfollowedbyoneormore
daysofnormaltemperature
Irregularfever: Whenthefeverisentirelyirregularinitscourse,itcannotbeclassifiedunderanyone
ofthefeversdescribedaboveanditiscalledirregularfever
Rigor: Rigorissuddensevereattackofshiveringinwhichthebodytemperaturerisesrapidlytoastage
ofhyperpyrexiaasseeninmalaria
Lowpyrexia:Inlowpyrexiathefeverdoesnotriseabove99to100For37.2to37.8C
Moderatepyrexia:Thebodytemperatureremainsbetween100to103For37.8to39.4C
Highpyrexia:Thetemperatureremainsbetween103to105For39.4to40.6C
Hyperpyrexia:Thetemperaturegoesabove105F
Frequencyoftakingtemperatureinthehospital:Frequencyoftakingtemperatureisdeterminedby
theconditionofthepatient.Forpatientswhoarenotseriouslyill,itneedstobetakeninthemorningand
evening.Thetemperatureistobecheckedevery4hoursofevenmorefrequentlyforthosewhoare
actuallyill,whoarehavinghighfever,andpostoperativepatients.Ifthetemperatureistakenbyrectum
oraxillaitshouldbespecifiedinthechart
Fever(PYREXA): Feverorpyrexiaisdefinedastheriseinbodytemperatureabove99F(37.2C).
thecauseoffeverareinfections,diseasesofthenervoussystem,certainmalignantneoplasms,blood
113

diseasessuchasleukemia,embolismandthrombosis,heatstrokefromexposuretohotenvironment,
dehydration,surgicaltraumaandcrushinginjuries,skinabnormalitiesthatinterferewithheatloss,allergic
reactionstoforeignproteinsandpyrogensetc.
Infever,allthesystemsofthebodyareaffected.Itmayvarywiththenatureofthediseases
Respiratorysystem:Shallowandrapidbreathing
CirculatorysystemIncreasedpulserateandpalpitation
Alimentarysystem:Drymouth,coatedtongue,lossofappetite,nausea,vomiting,constipation,
ordiarrhea
Urinarysystem:Diminishedurinaryoutput,burningmicturition,highcoloredurine
Nervoussystem:Headache,reslessness,irritability,insomnia,convulsions,delirium
Musculoskeletalsystem:Heavysweating,hotflushes,gooseflush,shiveringorrigors.
Integumentrysystem:Heavysweating,hotflushes,gooseflush,shiveringorrigors
Feverisnotadiseasebutitisasign.feverisaprotectivefunctionofthebody,becausetherise
intemperaturepreventsthegrowthoforganismscausingthedisease.Feverifnottoohighhastensthe
destructionofbacteriabyincreasingphagocytes,andbyproducingimmunebodies.Atemperatureof
104to105Fforseveralhourswilldestroytheorganismsofsyphilisandgonorrhoea.Therangeinthe
bodytemperaturewithinwhichthecellscanfunctionefficientlyisbetween34to41C(94to106F).
thecentralnervoussystemisextremelysensitivetothetemperaturevariations.Irreversiblechangesmay
occurinthenervoussystemifthebodytemperaturegoesabove41Corbelow34C
CareinFevers
1)Regulationofthebodytemperature: Careofthepatientsinfeversfocusesonreducingthe
elevatedbodytemperature.Whenthepatientstemperatureismoderatelyelevated,variousmethodsof
reducingthetemperaturebestarted.Theroomtemperatureshouldbemaintainedatacomfortable
temperature.Theroomshouldbewellventilated.Theblanketsandexcessclothingshouldberemoved
butpreventthepatientfromgettingdraughts.Thevariousmethodusedforcoolingthebodyare:
1)
2)
3)
4)
5)
6)

Exposuretocoolairanelectricfan.Administrationofcooldrinks
Applicationofcoldcompressandicebags
Coldspongingandcoldpacks
Coldbath
Icecoldlavagesandenemas
Useofhypothermicblanketsofmattresses

Whensurfacecoolingisusedtreatmentisdirectedatnotonlycoolingthebodybutalsoprevent
ingshivering.Shiveringmustbepreventedbecauseitincreasesmetabolicactivity,producesheat,in
creasestheoxygenusagemarkedly,increasescirculation,maycausehyperventilationandrespiratory
alkalosis.Ittakeslongertimetoreducebodytemperatureinashiveringpatient
2)Meetingthenutritionalneed:Thecellularmetabolismisgreatlyincreasedduringfever.The
oxygenconsumptioninthebodytissuesapproximately13percentforeachcentigradedegreeofrisein
114

temperatureof7percentforeachFahrenheitdegree,Thereforeahighcaloricdietisindicatedinfevers.
Sincerethedigestiveprocessissloweddownthedietshouldbeeasilydigestibleandpalatable.Mostof
thepatientspreferfluiddiet.
Unlessitiscontraindicated,thefluidintakeisincreasedto3000mlin24hourstopreventdehy
drationandtoeliminatethewasteproducts
Careinrigor: Rigorischaracterizedbythreestages:
1)Thefirststageorcoldstages:thepatientshiversuncontrollably.Theskiniscold,faceis
pinchedandpale,thepulseisfeebleandrapid.Thetemperaturerisesrapidlyto103F(39.4C)or
above.Inthisstage,coverthepatientwithblanketsandapplywarmthwithhotwaterbags.Givewarm
drinks.Protectthepatientfromfalling.
2)Thesecondstageorhotstage: theskinfeelshotanddryandpatientfeelsverythirsty.The
shiveringstops.Thepatientmayberestless.Thetemperaturemaycontinuetorise
Duringthesecondstage,removealltheblanketsandhotappliances.Coverhimonlywithathin
blanket.Givehimcooldrinks.Coldcompressesareappliedtotheheadtorelievecongestionand
headache.Thetemperatureiscarefullyrecordedevery10to15minutes.Watchpulseandrespirations
carefully.Ifthetemperaturegoesveryhigh(105F)(40.5C)coldspongingmaybestarted.Watchfor
theearlysignsofsweating.
3)Thethirdstageorstagesweating: thepatientsweatsprofusely.Thetemperaturefalls.The
pulseimproves.Acutediscomfortsarediminished.Thepatientmaygointostateofshockandcollapse
ifnotcaredproperly
PULSE
Definitionofpulse:Thepulseisthepalpableboundingofbloodflownotedatvariouspartsonthe
body.Pulseisrhythmicfluctuationoffluidpressureagainstthearterialwallcreatedbythepumping
actionoftheheartmusclebyplacingfingersoveranarteryparticularlyatthelocationwhereitcrossthe
bond
Sitesforcheckingpulse:
1)Temporalartery
3)Brachialartery
5)Femoralartery
7)Dorsalispedis

2)Carotidartery
4)Radialartery
6)Poplitealartery
8)Posteriortibialartery

ApicalpulseAuscultatedinadult
Apicalpulseispalpatedtocountpulserateininfants
Characteristicsofpulse
1)Rate: Itisnumberofpulsebeatsinaminute.Normalrateinadultis80to100perminute
2)Rhythm:Itreferstoregularityofthebeats,beatsarespacedatregularintervalstheyaresaidtobe
regular.Intervalvariesbetweenthebeatsitiscalledirregular
115

3)Strength: Thestrength/amplitudeofapulsereflectsthevolumeofbloodejectedagainstthearterial
wall
4)Volume:Itreferstothefullnessofthearteryitistheforceofthebloodfeltateachbeat
5)Tension: Itisthedegreeofcompressibility
6)Equality:Itreferstoassessbothradialpulsesandcomparethecharacteristicsofboth
7)Principles:Exercise,emotionandanxietywillcauseincreasedpulserate,fingertipssensitiveto
touchwillfellthepulsation.Moderatepressureallowonetofeelsuperficialradicalarterycharacteristics
ofthepulsevarywithindividuals
Factorsinvolvedinpulse
1)Age: Theheartrhythmininfantsandchildrenoftenvariesmarkedlywithrespiration
2)Autonomicnervoussystem:Stimulationoftheparesympatheticnervoussystemresultsindecreas
inginthepulserate.Stimulationofsympatheticnervoussystemresultsinanincreasedpulserate
3)Medications: Certaincardiacmedicationsuchasdigoxindecreasesheartrate
RESPIRATION
Meaningofrespiration: Respirationisthemechanismofbodyusestoexchangegasesbetweenthe
atmosphereandbloodandthecells
Rate: Rateisthenumberoffullrespirationinaminute,normalrateis1620breaths/minute
Depthofrespiration:Normalaveragemanatrestinspiresandexhalesabout500ccofairwitheach
respiration.Ifmorethanthisquantityofairpassesoutinandoutofthelungstherespirationissaidtobe
deep
Rhythm: Innormalrespirationrhythmisnormal
Varioussitesofrespiration
1)Chest

2)Abdomen

Factorsinvolvedinrespiration:
1)Age:Normalgrowthfrominfancytoadulthoodresultsinalargerlungcapacityaslungcapacity
increasestherespiratoryratedecreases.Medicationsnarcoticdecreasesrespiratoryrateanddepth
2)Stress: Stressincreasestherateanddepthofrespiration
3)Exercise: Itincreasesrateanddepthoftheairdecreasestomeetthebodysneedforadditional
oxygen
4)Altitude: Theoxygencontentoftheairdecreasesasthealtitudeincreases
5)Gender: Mennormallyhavelargerlungcapacitythanwoman
6)Bodyposition Astraighterectpositionpromotesfullchestexpansion.Asloppedasslumpedposition
impairsventilatormovement
7)Fever: Duringfevertherespiratoryrateincreasedbecauseheatcanbelostfromlungs
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BLOODPRESSURE
Definition: Bloodpressureisthepressureexertedbybloodonthewallofabloodvessel.Thenormal
rangeofbloodpressureis120/80mmofHginadult.
WhentheventriclesarecontractionthepressureisatitshighestthisisknownastheSystolic
Pressure
DiastolicPressureiswhentheventriclesarerelaxingandthebloodpressureisatitslowest
Hypertension:whenthesystolicpressureisabovethenormallevel
Hypotension: whenthesystolicpressureisbelowthenormalrange
Purposes:(1) Toacquireabaseline.(2)Monitorforfluctuation(3)Todiagnosedisease(4)Toassess
thecardiovascularsystem(5)Tomonitortheeffectsofmedication
Typesofequipmentrequired:
1)MercurySphygmomanometer:thisisthesimplestandmostaccurateandeconomicaldevicefor
measuringbloodpressureaslongasitisusedcorrectly
2)AneroidSphygmomanometer:thereregisterpressurethroughabellowsandleversystem,whichis
moreindicatethanthemercuryreservoirandcolumn
3)Automaticdigital sphygmomanometer: thereremove some ofthe human errorfrom BP
measurement,butobservertrainingisstillnecessary.
PAIN
Definition: Whateverthepersonsaysitisexistingwhenevertheexistingpersonsaysitdoes.(MC
Caffery1999).
Painisthefifthvitalsign.
Characteristicsofpain:
1)Severity :Rangesfromnopaintoexcruciatingpain
2)Timing :durationandonsetofpain
3)Location: bodyareainvolved.
4)Quality :whatthepatientfeelsthepainis
5)Personalmeaning:howaffectsthepersonsdailylife.
Factorsincreasinganddecreasingpain:age,gender,activity,rest,sleep,diet,culture,homerem
edies,drugs,alcohol,diversionalactivitieslikelisteningtomusic,watchingT.V.,yoga,meditation,etc.
PainAssessment: Painintensityscale

117

SimpleDescriptivePainIntensityScale

Mildpain

Nopain

Severe
pain

Moderate
pain

Very
Severe
pain

Worst

010NumericPainIntensityScale

12345678910
VisualAnalogScale

Nopain

painasbadasitcouldbepossible
orunbarrablepain

FacesPainScaleRevised:Thisinstrumenthas6facesdepictingexpressionsthatrangefromcon
tentedtoobviousdistress.Thepatientisaskedtopointtothefacethatmostcloselyresemblesthe
intensityofhisorherpain.
TESTINGANDEXAMINATION
URINE
Characteristicsofurine:
1)Color:Normalurinerangesfrompale,strawcolorsamber,dependingonitsconcentration.
Bleedingfromthekidneysorureterscausesurinetobecomedarkred,bleedingfromthebladder
orurethracausesbrightredurine.
Darkamberurinemaybearesultofhighconcentrationsofbilirubincausedbyliverdysfunction.
2)Clarity:thenormalurineappearstransparentatvoiding.Urinethatstandsseveral,minutesina
containerbecomescloudyrenaldiseasemanyappearcloudyorfoamybecauseofhighproteinconcen
trations.
3)Odour:Urinehasacharacteristicsodour.Themoreconcentratedtheurine.Thestrongertheodour

118

CharacteristicsofNormalUrine:
1)Volume:Onetotwolitresin24hoursbutvaries
2)Color:Yelloworamberbutvaries.
3)Turbidity:Transparentwhenfreshlyvoidedbutbecomesturbid(cloudy)uponstanding.
4)Odour:Urinehasacharacteristicodour.Themoreconcentrationtheurinethestongertheodour
5)pH: 4.6and8.0average6.0varies.
6)Specificgravity:1.001to1.035.
CommonUrineTests:
UrineTesting:Thenurseoftencollectsurinespecimensforlaboratorytesting.Thetypeoftestdeter
minesthemethodofcollection
Specimencollection:Thenursecollectsrandom.Cleanvoidedormidstream,sterile,andtimed
specimens.
Urinalysis: Thelaboratoryperformsaurinalysisonaspecimenobtainedbyanyofthepreviously
describedmethods.Thespecimenshouldbeexaminedassoonaspossible,preferablywithin2hours.
Specificgravity: Thespecificgravityistheweightordegreeofconcentrationofasubstancecom
paredwithanequalvolumeofwater
Urineculture:Aurineculturerequiresasterileorcleanvoidedsampleofurine.Ittakesapproximately
24to48hoursbeforethelaboratorycanreportfindingsofbacterialgrowth.
Urinetest
PurposesofSugartest:Testingtheurineforthepersonsandtheamountofsugarprovidesthe
doctorswithinformationabouttheamountofinsulinneededbythepatient.
PurposeofAcetonetest:Acetoneisanabnormalfindingthatindicatesthatthebodyhasbegunto
breakdownstoredfatstouseforenergy,sinceitisnotabletousethesugar.
PurposeofAlbumintest:Highalbuminexcretionisaprognosticofrenalfailureandcomplications
suchasmyocardialinfarction.
Indicationsfor Sugar,AcetoneandAlbumin
Sugarintheurineindicatesdiabetesmellitus.Inpregnancywhentherenalthresholdislowered.
Thesugarisfoundintheurine.
Acetoneisfoundintheurineofpeopleloosingweightorinstarvation.
Albuminuriaispresentlythemostreliableearlyindicatorofadverserenalandcardiovascular
eventsindiabeticpatients.Theconsensusisthatscreeningandinterventionforalbuminuriaareworthwhile
inpatientswithinsulindependentdiabetes,moreoftenintypeIdiabetesmellitusthantypeII.Increased
albuminexcretionsuggeststheonsetofdiabeticnephropathy.
119

Testingtheurineforglucoseandacetoneisgenerallydonefourtimesaday.Themostaccurate
methodistoobtainadoublevoidedurinespecimeninwhichthefirstvoidedissetasideandthepatient
isaskedtovoidashorttimelater.Thissecondvoidingconsistsofthemostrecentlyproducedurinefrom
thekidneyandisthebestindicatoroftheamountofsugarbeingexcretedatthatmomentnotofurine
thatmayhavebeeninthebladderforhours.IfthepatienthasaFoleyscathetertheurinespecimen
shouldbetakenfromthetubing,whichcontainsthelatestformedurinenotfromthedrainagebag.
Analbumintestingusuallyrequiresa24hourspecimenwithoutpreservatives.Somelaboratories
willacceptarandomspecimen.
Preparationofthepatient:
1) Onthepreviousdayexplaintheproceduretothepatient.
2) Explaintothepatientwhentheurinetocollecthowtocollectandtheamounttobecol
lected.
3) Provideanappropriatecontaineranddemonstratetohimhowtouseit
4) Instructhimnottocontaminatetheoutsideofthebottle.
5) Askthepatienttowashtheinternalgenitaliawithsoapandwaterandrinseitwithwater.
6) Ifthepatientisunabletodohimselfthenurseassistshim.
Preparationofarticles
Correctcollectionandpreparationofurinaryspecimensfordiagnostictestingcontributestoac
curatetestresults.Bedsidetestsforurineglucoseandacetonemustbedonepreciselyaccordingtothe
directiontoobtainaccurateresults.Timingofthereadingiscrucialandtheresultmaybeincorrectifthe
readingistakentooearlyortoolate.
Patientfamilyteaching:
1)Encouragereportingforroutineurinalysisandfollowupexamination
2)Adviceavoidanceofanymedicineunlessspecificallyprescribed
3)Teachthepatientandfamilytheimportanceoffluidintake
4)Teachthepatientandfamilyhowtoperformthetest
Patientcondition:
Presenceofsugarintheurineabout140180mgm/100mlofbloodisglycosuria
Presenceofketoneintheurineisketonuria.

120

STOOL
Characteristics
Volume

Colour

Odour

Consistency

NormalFindings
Variable

SpecialClassification
The diet high is roughage
produces more faeces than a
soft,blanddiet.
Consistency large diarrhoeal
stools suggest adisorder inthe
small bowel , small and
frequent stools urgency to bed
pan suggest a disorder of the
colon'or'rectum
Infant:Yellow
Thebrowncolourofthestool
Adult:Brown
is due to stercobilin, a bile
pigmentderivative
The rapid rate of peristalisis
intheinfantcausesthestoolto
beyellow.
The colour of the stool is
influenced by diet. For
example, the stool will be
almost black if the person eats
red meat & dark green
vegetables, such as spinach.
Thestoolwillbelightbrownif
the diet ishigh in milk & milk
productsandlowinmeat.
The absence of bile may
cause the stool to appear
whiterorclaycoloured
Certain drugs influence the
colour of the stool. For
example, iron salts cause the
stool to be black. Antacids
causeittobewhitish.
Bleeding high in the
intestinaltractcausesastoolto
beblackowingtothedigestion
oftheblood.
Bleeding in lower intestinal
tract will result in fresh blood
inthestool.
Aromatic, may be Excessive putrefaction
affected
by
foods causes a strong odour.
ingested
The presence of blood in the
stoolcausesauniqueodour.
Soft, SemiSolid, & Theconsistencyofthestoolis
formed
influenced by fluid & food
121

SampleoftheLabel
NameofthePatient:________________________Ward/BedNo.______
Age:________Sex:_____________OP/IP._________________________
NameofSpecimen:_____________________________________________
NatureofTesttobeDone:_______________________________________
DateofCollection:______________________________________________
AbnormalityofStool
BloodinstoolDifferentformsare
1)Haematochezia: Passageofbrightredbloodperrectummixedwithorwithoutstool,ex:
haemorrhoids,analfissure&fistula,trauma,ischemiccolitis,diverticulitis,polyps,malignancyetc.
2)Melena: Characteristicsareblacktarry(sticky)stool(usetoproductionofacidhaematin).
Offensive(acidhaematinisalteredbybacteria).Semisolidinconsistency.Redcolouredfluidcomesout
fromtheUsuallyassociatedwithvertigo,dizzinessorsyncopalattackduringdefecation.Causesare
(1)Duodenalulcer(2)Carcinomaofthestomach
3) OccultBlood Causesare:IntakeofNSAID,hookworminfestation&colorectalcanceretc.
SPUTUM
Sputumisthemucoussecretionfromthelungs,bronchi,andtrachea.Itisimportanttodifferen
tiateitfromsaliva,theclearliquidsecretedbythesalivaryglandsinthemouth,sometimesreferredto
spit.30ouncesofmucusproduced/day.
HealthyIndividualsdonotproducesputum.
Clientsneedtocoughtobringsputumupfromthelungs,bronchi,andtracheaintothemouthin
ordertoexpectorateatintoacollectingcontainer.
Documentamountofsputumcollected,color,odourconsistency(thick,tenacious,watery)and
presenceofhaemoptysis.
Characteristicsofsputum
C h a ra c t e ris tic s
N o rm a l
A b n o rm a lo rD is e a s e C o n d itio n
A m o u n t
N o s p u tu m o f v e r y A m o u n t m a y v a r y a c c o rd in g to
little is e x p e c to ra te d t h e d is e a s e . E g . A s th m a ,
B ro n c h itis .
C o lo u r
It is c o lo u r le ss & Y e llo w is h
c o lo u r
in d ic a te s
tra n s lu c e n t
b a c te ria lin fe c tio n
B la k is h c o lo u r in d i c a te s c a rb o n
p igm e n tE g .S m o k in g
B ri g h t re d / D a rk re d , ta rr y
c o lo u rin d ic a t e sb lo o d
G re e n ish
c o lo u r
in d ic a te s
b ro n c h ie c ta sis
B ro w n
c o lo u r
in d ic a t e s
g a n g re n o u sc o n d i tio n o flu n g.
O d o u r
O d o u rle s s
U n p le a s a n t o d o u r in d i c a t e s lu n g
a b sc e ss , lu n g c a n c e r, lu n g
g a n g re n e
C o n sis te n c y
F o rth y w a te ry te n a c io iu s a n d
t h ic k d e p e n d in g o n t yp e o f
c o n d itio n

122

Sputumproduction: Sputumproductionwithcoughingisnotnormal.Questiontheclientabout
sputumcolor(clear,yellow,green,rusty,bloody)andodor.
Quality: Watery,stingy,frothy,thick.
Quantity: teaspoon,tablespoon,cup.Documentinclientsmedicalrecordanychangesincolor,
odorquality,orquantity.Assertionwhethersputumisproducedonlyoftenthelyinginacertainposition.
Theamountofsputumproducedisincreasedseveraldisorder,forinstance.Clientswithbronchi
tismayexpectorateseveralcupsofsputumdaily.
Summary:
1)

Physicalexaminationisdefinedascompleteassessmentofapatientsphysicalandmental
status

2)

ThemethodsofPhysicalexaminationareinspectionpalpation,percussion,auscultation,
andolfaction.

3)

Therecordingoftheobservationsiscalledcharting.

4)

Temperatureisdegreeofheatmaintainedbythebody.Itisthebalancebetweentheheats
producedandheatlost.

5)

Thecommonsitesfortakingbodytemperaturearemouth,groin,rectum,axilla

6)

Feverorpyrexiaisdefinedastheriseinbodytemperatureabove99F(37.2C).

7)

Crisisissuddenreturntonormaltemperaturefromaveryhightemperaturewithinafew
hoursofdays

8)

Rigorissuddensevereattackofshiveringinwhichthebodytemperaturerisesrapidlytoa
stageofhyperpyrexiaasseeninmalaria

9)

Pulseisrhythmicfluctuationoffluidpressureagainstthearterialwallcreatedbythepump
ingactionoftheheartmusclebyplacingfingersoveranarteryparticularlyatthelocation
whereitcrossthebond

10) Respirationisthemechanismofbodyusestoexchangegasesbetweentheatmosphere
andbloodandthecells
11)

Bloodpressureisthepressureexertedbybloodonthewallofabloodvessel.

12) Hypertension:whenthesystolicpressureisabovethenormallevel
13) Hypotension:whenthesystolicpressureisbelowthenormalrange
14) Bleedingfromthekidneysorureterscausesurinetobecomedarkred,bleedingfromthe
bladderorurethracausesabrightredurine.
15) Absenceofbilemaycausethestooltoappearwhiterorclaycolour.
16) Theamountofsputumproducedisincreasedseveraldisorder,forinstance.Clientswith
bronchitismayexpectorateseveralcupsofsputumdaily
123

QUESTIONS
PARTA ONE WORD ANSWERS: (Onemark)
a)Physicalexamination
b)Olfaction
d)Temperature
e)Fever
g)Rigor
h)Pyrexia
j)Melena

c)Percussion
f)Fastigium
I)Haemoptysis

PARTB MULTIPLECHOICEQUESTIONS:(Onemark)
1)Artoffeelingwiththehand
1)Palpation

2)Inspection

3)Percussion

2)Recordingtheobservationiscalled
1)Monitoring

2)Charting

3)Documenting

3)Degreeoftheheatmaintainedbythebody
1)Saturation

2)Temperature

3)Bloodpressure

2)99.6degreeF

3)97.6degreeF

4)Normalrectaltemperature
1)98.6degreeF

5)
Suddenreturnedtonormaltemperaturefromaveryhightemperaturewithina
fewhoursofaday.
1)Lysis

2)Crisis

3)Fastigium

6)Thebodytemperatureisraisedto105degreeFiscalled
1)Hypothermia2)Hyperthermia

3)HecticFever

7)Temperaturefallsinazigzagmanner
1)Lysis

2)Hypothermia3)Hyperthermia

8)Exchangeofgasbetweenatmosphereandblood
1)Pulse

2)Respiration

3)Bloodpressure

9)Thenormalrangeofbloodpressureforanadult
1)120/80mmofHg

2)110/70mmofHg 3)120/90mmofHg

10)Browncoloursputumindicates
1)Bronchitis

2)Bacterialinfection 3)Gangrenousoflung

11)Coughingoutofbloodwithsputum
1)Haemoptysis2)Haematemesis

3)Epistaxis

12)Themethodtoproducesoundbytappinganareaisknownas
1)Percussion2)Auscultation3)palpation4)noneoftheabove
13)

TheformulatoconvertFahrenheitintoCelsiusis
a)C=(F+32))5/9b)C=(F+32))9/5c)C=(F32))5/9d)C=(F32))9/5
124

14)

Whenthedifferencebetweenthehightemperatureandlowtemperatureisgreat,
thefeveris
a)Inversefeverb)Hecticfeverc)Raisecrisisd)Rigor

15)

Thesecondstageofrigoris
a)Coldstageb)nSweatingstagec)Hotstaged)Warmstage

16)

Thedegreeofcompressibilityofpulseisknownas
a)Strengthb)Tensionc)Equalityd)Volume

17)

Thespecificgravityofurineis
a)1.000tto1.035b)1.010to1.035c)1.031to1.035d)1.010to1.031

18)

Blacktarrystoolis
a)Haematocheziab)Malaenac)Occultbloodd)Haematemsis

19)

Greenishcoloursputumindicates
a)Bacterialinjectionb)Bronchiectasisc)gangrenousconditiond)Asthma

20)

Thepressurewhentheventriclesarerelaxingandthebloodpressureatitslowestis
a)Systolicb)Diastolicc)Pulsepressured)meanpressure

PARTC WRITESHORT ANSWERS: (5marks)

a)Careofpatientwithfever
b)Characteristicsofpain.
c)Purposesofphysicalexamination
d)Methodsofphysicalexamination
e)WhataretheContraindicationfororaltemperature?
f)Whatarethemethodsusedforcoolingthebody?
PARTD WRITEINDETAIL: (10marks)
a)Describesitesandcharacteristicsofpulse?
b)Painscale
c)Characteristicsofurine
d)Explaincommonsitefortakingtemperature?
e)Abnormalitiesofstool
PARTE WRITEESSAY: (20marks)
1)Explainheadtofootexaminationofpatient?
2)Explainurinetesting?
3)ManagementofRigor
4)Characteristicsofstool

125

6.MEDICALANDSURGICALASEPSIS
Theconceptofasepsis(freedomfromorganisms)isimportantforallhealthcareworkerswho
havedirectorindirectpatientcontact.Nursesarethepersonswhohavefrequentcontactwiththe
patientstoprovidecarefor24hours.Itistheresponsibilityofthenursetobeawareofthepatientsat
riskofdevelopinginfectiousandalsoadutytoprotectthemwithaseptictechniques.
DEFINITIONOFASEPSIS
Asepsisisthepracticetoreduceoreliminatecontaminants(suchasbacteria,viruses,fungiand
parasites)fromenteringtheoperativefieldissurgeryormedicinetopreventinfection.
Definitionofaseptictechniques: Aseptictechniqueistheefforttokeepaclientasfreefrom
hospitalmicroorganismsaspossible.
PRINCIPLESOFASEPSIS
Threethingsthatareextremelyimportantisachievingasepsisarethereductionoftime,trauma
andtrash.
(1)Time: Thetimetakenforanymedicalorsurgicalprocedureisanimportantfactor.Longer
thetimetaken,havethepossibilityofgreaterexposuretocontamination.
(2)Trauma: Traumaoccurredduetoroughhandling,excessivedeadspace,foreignbodieswill
contributetoinfection.
(3)Trash: Itreferstocontaminationbybacteriaorforeignmatter.
Essentialcomponentsofmaintainingasepsisinahospitalinclude:
(1) Hand washing, (2) Utilizing gloves, gown and mask as indicated, (3) Cleaning
equipment.(4)Handlinglinensiswaysthatpreventgermsfromspreading.
TYPESOFASEPSIS
Thetwotypesofaseptictechniquesthenursepracticesaremedicalandsurgicalasepsis.
Medicalasepsis: Itisacleantechniquewhichincludesprocedureusedtoreducethemicro
organismsandpreventtheirspread.(e.g.)changingpatientsbedlinendaily,handwashing.
Surgicalasepsis: Itisasteriletechniquewhichincludesproceduresusedtoeliminatethemicro
organisms.Steriletechniqueisusedwheresterileinstrumentsareused(e.g.)inoperationtheatre.
Medicalasepsis:Medicalasepsisiscommonlyreferredascleantechnique.Thegoalisto
reducethenumberofpathogensorpreventthetransmissionofpathogensfromonepersontoanother.
Techniquesusedshouldbeappropriatetointerruptthespreadoftheknownpathogen.
Guidelinesformaintainingmedicalasepsis:
(1)Thoroughhandwashingisbasictechniqueforinfectiouscontrol.(2)Knowaboutpatients
susceptibilitytoinfection(e.g.)Age,Nutritionalstatus,Stressetc.,(3)Neveruseaseptictechnique
haphazardly.(4)Protecthealthworkersfromexposuretoinfectiousagents.(5)Awareofthebodysites
wherenosocomialinfectiouscanoccur. (6) Properusageofprotectivedeviceslikegowns,gloves,
masksandprotectiveeyewear. (7) Proceduresshouldfollowtheprinciplesoftechniques,soasto
interrupt.Thetransmissionofmicroorganisms.
126

Surgicalasepsis: Surgicalasepsisisasteriletechniquetoeliminateallmicroorganismsincluding
sporesandpathogens,fromanobjectandtoprotectanareafrommicroorganisms.Surgicalasepsisis
used in operat ing room, delivery room, certain diagnostic test ing areas,
certain procedures like insertion of urinary catheter, sterile dressing changes, preparing an
injectablemedicationetc.Whenfollowingsurgicalasepsis,areasareconsideredcontaminatedifthey
aretouchedbyanyobjectthatisnotalsosterile.Whiledoingtheprocedure,itisnecessarytoexplain
theproceduretothepatientstofacilitatetheircooperation.Informthepatientwhichobjectsandareas
maynotbetouchedanddirectthepatienttoavoidsuddenmovementsthatmightcontaminatethe
equipment.Thishelpsthepatientassistinmaintainingthesterilityofprocedure.
BASICPRINCIPLESOF SURGICALASEPSIS
(1)Sterileobjectremainssterilewhentouchedonlybyanothersterileobject.
(2)Onlysterileobjectsmaybeplacedonasterilefield.
(3)Anobjectheldbelowapersonswaistiscontaminated.Nursesneverturntheirbacksona
steriletray.
(4)Asterileobjectbecomescontaminatedbyprolongedexposuretoair.
(5)Avoidtalking,coughing,sneezingoversterilefieldorobject.
(6)Whenasterilesurfacecomesincontactwithawetcontaminatedsurface,thesterileobject
becomescontaminatedbycapillaryaction.
(7)Theedgesofsterilefieldorcontainerareconsideredtobecontaminated.
(8)Usedry,sterileforcepswhennecessary.Forcepssoakedindisinfectantarenotconsidered
sterile.
Useofgloves: Gloves,notsubstituteforgoodhandhygiene.Itshouldwornonlyonceand
discardedappropriately.Itismoreimportanttoperformgoodhandhygienebeforeandafterusing
gloves.Glovesprovideabarrierbutarenotimpenetrable.
Glovesareusedforthefollowingsituations:
(1)Highrisksettinglikeoperatingroom,labourroom.
(2)Handlingthesterilesurgicalinstruments.
(3)Whiledoingtheasepticprocedureslikecatheterization,suctioning,bowelirrigation,dressing
thewoundetc.
(4)WhiledoingsomeofthediagnosticprocedureslikeThoracentesis,liverbiopsy,renalbiopsy,
lumbarpunctureetc.
(5)Whilecaringthepatientswithinfectiousdiseases.
(6)Whilehandlingthebloodandbloodproducts.
Useofaprons: Apronsareusuallyworntopreventsoilingofthenursesclothingbythepatients
bloodandbodyfluids.Theyprovidebarrierprotectionandarewornbeforeenteringthepatientsroom.
Gowniswornonlyonceandisthendiscardedappropriately.Gownispreparedbyclothorwaterproof
materials.Ifagownbecomesheavilysoiledormoistenedwithbloodorbodyfluidswhencaringfora
patient,removeit,performthroughhandhygieneandputonacleangown.
127

Useofmasks: Maskshelppreventthewearerfrominhalinglargeparticleaerosols,whichusually
travelshortdistancesandsmallparticledropletnuclei,whichcanremainsuspendedintheairandtravel
longerdistances.Maskspreventthenursestotoucheyes,noseandmouth,thuslimitingthecontactof
organismswithmucousmembranes
Maskspracticesareusedinvarioussituationslikesometimesthepatientsvisitorsalsohavetobe
usedwhentheyarewithpatientswhohaverespiratoryinfections.Sometime,thepatientswithimmuno
suppressivedrugneedtowearmaskforspecificprecautionswhentransportedoutsidetheroom.
Amaskiswornonlyonceandneverloweredaroundtheneckandthenbroughtbackoverthe
mouthandnoseforreuse.Itshouldcertainlybechangedbeforeitbecomesdampfromthewearers
exhalations.
STERILIZATIONS ANDDISINFECTION
Definition:
Disinfectionisthedestructionusuallybychemicalsofpathogenicorganismsnotincluding
bacterialspores.
Guidelinestobeconsidered:
Someorganismsarecarriestodestroythanothers.
Thegreaterthenumberoforganisms,thelongerittakestodestroythem.
Thetypeofequipmenttobedisinfectedorsterilizesmakesadifference.
Itemsusedforcertainproceduresmustbesterile.
Methodsofsterilization:
1) Heat
:Itisrapidandreliablemethodtodestroythesmalland
heatresistantobjects.
2) Chemicals: Itisslow,corrosiveandusedforheatsensitiveobjectsforlarge
surfaces.
3) Filtration: Itrequiresmembranefiltrationapparatusandonlyusedfor
liquids.
4) Irradiation: Ionizingirradiationisreliablebutexpensiveanditisusedto
sterilizetherooms.
A)Tyndallisation:Repeatedsteamingat100degreecentigradeofculture
mediaoneachofthreesuccessivedays,allowingsporesto
germinateandtobesubsequentlykilled.
B)Boiling Thismethodissuitableforenamel.Metal,glassandrubberwares.Bowlsterilizersareused
forlargearticles,instrumentsterilizersforsmallerarticles.
Pointstoremember:
1)Seethatarticlesarequiteclean,andcompletelyimmersedinthewater,whichalsomustbe
clean.
2)Onlyafterthewatercomestotheboilstarttiming.Ifmorearticlesareadded,thesterilizing
timemustbeginagain.
128

3)Boilvigorouslyfor5minutes.boilingwillnotkillspores.
4)Removearticleswithsterilecheatleorotherliftingforceps.Ontoasterilesurface.
C)Autoclaving: Thisisareliablemethodandmaybeusedformostarticles.Theautoclaveisametal
chamberwithanouterjacketandalidordoor,whichcanbefirmlyclamped.Steamisgeneratedby
heatingwaterinaboilerorintheouterjacket.Airisevacuatedfromthechambereitherbydisplacement
withsteam,orbyavacuumattachment.Thenthesteamisallowedtobuilduppressure,usually15or20
lbspersquareinch,andiskeptatthatpressure,usuallyfro15to30minutes.Thentheheatisturnedoff,
thesteamevacuated,andthecontentstheautoclave.
Pointstoremember:
1)Allarticlesshouldbecleananddrybeforepacking.Anyorganicmattersuchasbloodorpus
preventspenetrationofsteam.
2)Theholesindrumsmustbeopenwhenplacingintotheautoclave,andclosedimmediatelyon
takingthemout.
3)Bundlesshouldbenottoolargeandnottightlypacked.Steamshouldbeabletopenetrateto
thecentre.
4)Rubberglovescannotstandhightemperatureandlongsterilizing.Autoclavethemseparatelyat
15lbspressurefor15minutes.
5)Toautoclavebottlesoffluid,loosenthescrewcaps.Evacuatethesteamslowly.
Generalinstruction:
1)Thearticlesbeingsterlizedshouldwithstandhightemperature.
2)Thewrapperandthecontainershouldallowpenetrationofthesteamintothearticle.
3)Theinnerchambermustnotbetoofullnorthecontentsarrangedtoocompactly.Bundlesand
drumsmustbepackedloose.Cansorjarsmustbeopenedandturnedontheirsidessothatsteam
caneasilypenetratethecontents.
4) The temperature and pressure of the steam should be high enough to kill all the
microorganismsincludingspores.Theusualtemperatureis121degreecelsiusandthepressureis1.05
kg/cm2.
5)Thedesructionofabacteriadependsuponthelengthoftimethearticlesareexposedtosteam
underpressure.Theminimumtimeis30minutes.Ifthepressureisincreasedtheexposuretimecan
bereduced.
6)Inoperatinganautoclave,itisimportanttorememberthatalltheairintheinnerchambermust
bedrivenoutandentirelyreplacedbysteam.Otherwisealthoughthegaugemayshowapressureof
15 lbs, this pressure would be caused by a mixture of steam and air and t he
temperaturewouldbelowerthanthatofthesteamalone.
7)Thearticlesshouldbeleftintheautoclaveforashorttimeaftertheprocedureisovertodrythe
materials.
129

Workingoftheautoclave:
Autoclave is the name given to a sterlizer that utilises saturated steam under pressure
(saturatedmeansthesteamexertsmaximumpressureforwateratthegiventime)
Thesteamisusedintheautoclavefortworeasons:
1)Whensteamisheldinaclosedcontainer,itiscompressedandthetemperaturerisesfarabove
thatoftheboilingpointofwater.
2)Steamisabletopenetrateporousmaterialsveryrapidly,providedthat,itisnotimpeded
byunsuitablewrappersorbyairtrappedwithinfabricsorhollowinstruments.
Anautoclaveconsistsofanouterchamberandaninnerchamber,whichcanbetightlyclosedby
asafetylock.Thesteamisintrroducedfirstintotheoutercahmberuntilthedesiredtemperatureis
reached.Atthispoint,thesteamisturnedintotheinnerchamberwhichispackedwitharticlesthatare
tobesterlized.
Asthesteamenterstheinnerchamber,theairisforcedoutthroughthevalves.Thesteamiskept
flowingintotheinner chamberuntilthedesiredtemperatureisreached.Itisveryimportanttonotethe
temperatureaswellasthepressureoftheinnerchamber.Whenthedesiredlevelsarereached,itshould
bemaintainedtothedesiredlengthoftime(Temp:121degreecelsius,Pressure:1.05kg/cm2andthe
exposuretimeis30minutes.)
Theremovalofairfromanauotclave,duringthesterlizationprocessisimpotantfortworeasons:
1)Airleftinthecenterofapackorinthecannulaofacatheterwillpreventthesteamfrom
comingintodirectcontactwiththecenterofthepackortothelumenofthecatheter.Failureto
contactmeansfailuretosterlize.
2)Airmixedwithsteamreducesthetemperatureofthesteam.
Attheendoftheperiod,thesteamsupplyisshutoff,butthedoorisnotopeneduntilthepressure
gaugeisatzeroandthetemperaturehasfallento100degreecelsius.Thisallowtheliquidstocooltoa
pointwhentheywillnotescapefromtheircontainerswiththereductionofpressureanditalsohelpsto
drythepackagedgoods.
D)Dryheat: Sterilizingofglasswareincludingsyringesisoftendoneinahotairoven,at160degree
centigradeforonehour.Sporesaswellasorganismsarekilled.Rubberwillnotstanduptothisheat.
Thismethodisefficientifheatpenetratesthroughdressings,towelsandgown.
Twomethodsareused
1) Incineration :Usedfordisposalofdressings,laboratorymediaandhumantissuesandusedoil.
Hospitalincineratormaycauseunacceptableenvironmentalpollution.
2) Hotairoven :Itisusedforobjectswhichcannottoleratemoisture.Mostlyusedforglassware,
oils,powders.
Methodsofdisinfection:
Destructionoforganismsbychemicalisusedinthefollowingcircumstances:
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 Environmental :Disinfectionofexcreta,floors,furniture,linenandfabrics.
Instruments/Equipments:Sterilizationofheatsensitiveobjectsincontactwithpatient.
Skinandwounds:Removalofpathogens.
Foodmedication:Preservationinpreventionofspoilage.
Water:Removalofpathogens.
Vaccines:Destructionoforganismsordenaturationoftoxins.
Chemicalsterilization: Itisthemethodusedforeyeinstrumentsandotherdelicateinstruments.
Pointstoremember:
1)Thearticlesmustbecleanandfreefrompus,bloodoroil.
2)Themustbecompletelyimmersedinthedisinfectant.
3)Thedisinfectantshouldbeofacertainstrengthandthearticlesmustbeincontactwithitfora
certainlengthoftime.
4)Aftersterilization,articlesmustbewellrinsedinsterilewaterbeforeuse.
Fumigationorgassterilization:
Totalsurfaceexposuretoformaldehydegasunderconditionsofcontrolledhumidity,temperature
andtimeexposurewilldestroyallvegetativeformsofbacteria,virusesandmostofthespores.Thebest
resultscanbecbtainedwithhighconcentrationsofgas,humidityabove60%andtempratureofnotless
than18degreecelcius.Theexposuretimevariesonetosixteenhours.Theagentsthatarecommonly
usedforthefumigationareformalintablets,ethyleneoxideliquidsetc.
Thedisadvantagesofthegassterlizationarethatithasapungentsmell,isirritanttotheeyes,skin
andmucusmembrane.
Ultravioletlightsterilization:
Ultravioletsterilizationiseffectivefordisinfectingworkingsurfacesandairinsidetherooms.
Disadvantages:
1)Lighttravelsinstraightlinesanddoesnotpenetrate.Onlythesurfaceofanobjectindirectline
withultravioletsourceisirradiated.Anybacteriainshadowsareunaffected.Allsurfacesshouldbe
exposedtotherays.Ultravioletraysdoesnotpenetratetheliquids.
2)Prolongedexposuretotheultravioletrayscausesconjunctivaldamage.Topreventthis,dark
glassesshouldbeworn.
3)Itisalsoinjurioustotheskinandtissues.
4)Itisexpensive.Thecheapestformofultravioletradiationisobtainedfreefromsun.Gamarays
havethegreatestpowerofpenetrationandisusedforthesterilizationofplasticitemssuchasdisposable
syringesandcatheterswhichwillnotwithstandheatsterilizationandsharpinstrumentssuchashypodermic
needles,andscalpelblades.Thegreatestadvantageofthismethodisthatthearticlescanbepacked
beforesterilizationinindividualsealedplasticpacksoraluminiumfoilswhichavoidsanyhandlingand
possiblerecontaminationaftersterilization.
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Principlesofdisinfection:
Onlyobjectswhichcannotbeheattreated.
Itisimportanttoremovegreaseandproteinsbeforeuse.
Dilutionofconcentrationshouldbeaccuratelymeasured.
Dilutionsshouldbemadeaseptically.
Disinfectantsshouldbeappropriatelychosenfortheirpurpose,costantimicrobialrange,
toxicityandcorrosiveness.
Disinfectantsforgeneralcleaningareawasteofmoney.
Typesofchemicals:
A) Alkylatingagents:
Theyarecapableofkillingbacteria,sporesandviruses.Theyaretheacceptablechemical
alternativetousualheattreatment.
Theyinclude:
1)
2)
3)
4)

Formaldehyde :usedforinstrumentsandmachinessterilization.
Gluteraldehyde:usedforinstrumentsterilization.
Ethyleneoxide :usedforrubberandplasticsarticlessterilization.
Propiolactone :Usedforgaseoussterilization.

B)Phenols:
Itincludesacidsandsemisyntheticcompoundsinsoapsolution.Itissomewhattoxicwitha
unpleasantsmell.Itisusedforgeneralpurposedisinfectantsforcontaminatedsurfaces.Ithasnoactivity
onspores.
Advantagesofdisinfection: Thisisthemethodusedtosterlizethearticlesthataredestroyedbyhead
andthemetalicobjectspronetocorosion.Thisisthemosteasymethodofdisinfectingarticles.
Disadvantages: Thismethoddoesnotensuresterlisation,becausethedisinfectantsdoesnotdestroy
thespores.Somedisinfectantsareinjurioustotheskinandarticles.
Importantpointstoremember:
1)Thedisinfectantchosenshouldbeefficienttodestroypathogens.
2)Theyshouldbeusedincorrectstrength.
3)Thearticlesshouldbefullysubmergedinit.
4)Theyareplacedforasufficientlengthoftime.
5)Theyshouldnotbeinjurioustotheskinandarticles.
6)Thearticleshouldbethoroughlycleansedtoremovetheorganicmaterialwhichwillprotect
thebacteriaagainsttheactionofdisinfectants.
7)Thedisinfectantshouldbeinexpensive.
8)Instrumentssoakedingermicidesmustbeadequatelyrinsedwithsterliewaterbeforebeing
used.
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HANDLING OF STERILE ARTICLES:

1)Alwayswearamaskwhenhandlingsterilearticles.
2)Sterilizedarticlesmustbekeptincontainersoronsteriletowels,andkeptcoveredtillused.
Neverallowcontactofunsterilewithsterilearticles.
3)Makesurethereisnodampness.Asthiscouldmakethethingsunsterile.
4)Neverallowanyunsterilearticleincludingthearmsandhands,topassoverasterilefield.
5)Nevertouchtheinsideofapackageorcontainerwithyourfingers.Usethecheatleforceps.
6)Topullacorkfromabottleofsterilefield,takecarenottocontaminatetheinsidepartofthe
corknorinsidetherimoftheinnersideup,andthenreplaceitwithoutdelay.
7)Whenliftingacoverfromasterilecontainer,layitdownwiththeinnersideup,thenreplaceit
withoutdelay.
8)Tocarryasterileasterilebowlorothercontainer,holditwithyourhandsunderneath,anddo
nottouchtherim.
Rulesforuseofcheatleforceps:
1)Thesterilejarholdingtheforcepsmustbecleaned,resterilizedandfilledwithfreshantiseptic
lotiondaily.Thecheatleforcepsshouldbecleanedandautoclavedorboiled.
2)Wheninuse,keeptheforcepsatelbowlevelandpointeddownwards,becauseifyouliftit
upwardsthesolutionmayrunontoyourhandandthenbacktotheforceps,makingitunsterile.
3)Puttheforcepsbackintothejarimmediatelyafteruse.Replacecarefullywithouttouchingthe
rimofthejar.Iftheforcepsbecomescontaminatedinanyway,itmustberesterilizedbeforebeingput
backintothejar.
Preparingarticlesforsterilization:
Aconvenientmethodoftenusedtobepreparedwithsetsoftheinstruments,swabs,sponges,
dressings,towelsandsuturesneededformeachtypeofoperationorsterileprocedure.Thesesetsare
packedintodrums,bundles,orontrays,labeledandkeptreadyforsterilization.Thearticlesshouldbe
carefullyarrangedsothatthoseneededfirstareontop.Theymustbelooselypackedforsteamto
penetrate.Drumsmusthavetheperforationsopened.Bundlesshouldhaveadoublewrapperorclose
wovenclothorofpaper.
Dressings,swabsandspongesareusuallymadeofseveralthicknessesofsurgicalgauze.Raw
edgesmustbefoldedin.swabsanddressingsareagainfoldedtothedesiredsize.Spongesusedfor
abdominalsurgeryneedtobelarge,stitchedaroundtheedgesandapieceoftapesewedtoonecorner.
Whenanarteryforcepsisclippedtotheendofthetape,thereisnoriskofthespongebeingleftinside
theabdomen.
Packinggauzeismadeinvarioussizes.Usegauzefourtimesthewidthofthedesiredpacking.
Foldtheedgessothattheymeetinthemiddle,andagainfolddownthecentre,androll.
Cottonwoolispreparedinvariousways.Cottonballsofvarioussizesarepreparedbyrolling
betweenthepalms.Somemaybeneededforinternalsurgery,andforthisthecottonballmustbe
coveredwithgauzeandtied.Thistypeofswabisgraspedwithalonghandledforceps.Cottonsquares
ofvarioussizesaretobecutforuseindressingwounds.Somemayrequiretobecoveredwithgauze.
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Instruments: Surgical instruments should be washed first in cold water, then in warm
waterwithadetergentafteruse.Useabrushtocleanwellespeciallybetweentheteethofarteryforceps
and clamps. To be properly sterilized, there should be no trace of dried blood or
discharge.Rinseincleanwater,thenboilfor5minutesanddrywell.
Sharpinstruments,knivesandneedlesshouldbedealtwithseparately,takingcaretoavoidcuts
andpuncturewounds.
Syringesandneedles:Assoonaspossibleafteruse,drawupsomewaterintothesyringeand
pushenoughthrougheachneedletomakesuretheyarenotblocked.Infectedsyringes(usedfor
withdrawingbloodorpus)shouldbewashedimmediatelyinacolddisinfectantsolution.Nextwashthe
syringesandneedlesinwarmsoapywater,usingabottlebrushforthebarrel.Rinseincleanwater.Take
carenottogetbarrelsandplungersmixed.Butkeepthemalwayspairedtogether.
Needlesshouldbeexaminedcarefullyforsharpness.Thetipsmayberubbedcarefullyona
sharpeningstone.Takecarenottoprickyourfingerasinfectionmaybetransmittedinthisway.
Rubbertubingafteruseshouldbecleanedwithcoldwater,thenwithhotsoapywater.Then
rinsed.Theinsidemustbethoroughlyclean.Thenitisboiled,andhungoverarailtodrain.Putaway
looselycoiled,toavoidkinking.Rubbercathetersshouldbecleanedbyrunningcoldwater,boilfor5
minutes,thendry,withatowelorbyhangingup.
BIOMEDICALWASTEMANAGEMENT
Biomedicalwasteisthewaste,whichisgeneratedbyhospital,nursinghomes,Clinic,dispensaries,
veterinaryinstitution,animalhouse.Pathologicallaboratoryandbloodbankandisnotdegradable.
Classificationofwaste:
1) Generalwaste:
a)Generalsweeping.
b)Kitchenwaste
c)Packingmaterial.
d)Paperpieces.
e)Wastefromlaundry,kitchen,wardsandlaboratory.
2) Infectiouswaste:
a)Humananatomicalwaste(humantissue,organandbodyparts).
b) Microbiologyandmicrotechnologywaste(wastefromLaboratorycultures,stocksor
specimens of micro organisms lie or attenuated vaccines, human and animal cell
culture used in research and industrial laboratories , waste from production of
biological,toxins,dishes,anddevicesusedfortransferofcultures.
c)Solidwaste(itemscontaminatedwithbloodandbodyfluidsincludingcotton,ressing,soiled
plastercasts,linen,beddings,othermaterialscontaminated).
3) Sharps:
a)Hypodermicneedles,stitchingneedles,needlesattachedwithtubing.
b)Scalpelblades,razors,nailsetc.
c)Brokenglassmaterials,syringes,bloodvials,edgesofslidesandcoverslipsincontactwith
infectiousagents.
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Segregation,packing,transporting:
1)Biomedicalwasteshallnotbemixedwithotherwastes.
2)Biomedicalwasteshallbesegregateintocontainers/bagsatthepointofgenerationpriorto
its storage, transportation, treatment and disposal. The containers shall be
labeled.
3)Notwithstandinganythingcontainedinthemotorvehiclesact,1988,orrulesthereunder,
untreatedbiomedicalwasteshallbetransportedonlyinsuchvehicleasmaybeauthorized
forthepurposebythecompetentauthorityasspecifiedbythegovernment.
4)Nountreatedbiomedicalwasteshallbekeptstoredbeyondaperiodof48hours:provides
thatifforanyreasonitbecomesnecessarytostorethewastebeyondsuchperiod,the
authorizedpersonmusttakepermissionoftheprescribingauthorityandtakemeasuresto
ensurethatthewastedoesnotadverselyaffecthumanhealthandtheenvironment.
Measurestominimizehealthriskduetomedialwaste:
1)Useappropriateprotectingclothinglikeapron,thicklayergloves,longbootwiththicksole,
facemasks,eyeglasseswhenrequired,witharrangementofdisinfectionanddisposal
arrangementforstaffhandlinghospitalwaste.
2)Popularizeuseofcolorandemblemcodeoncontainerbags.
3)Introducemonitoringandsurveillanceforproblemareasorhighriskareas.
4)ConstituteaHospitalAcquiredInfectioncontrolcommittee.
5)Incinerator.
6)Conformstopollutioncontrolboardnorms.
7)Builtinsafety.
8)Easytooperateandmaintain.
9)Minimumsitework.
10)Shredderforplasticmaterials(plastic,bottles,syringes,IVsetsetc)cutsplasticwasteinto
small pieces of 1 cm size chips thus ensuring that syringes, and other plastic
materialarerenderednonrecyclable.
11)SegregationofwastefromHospitalkitchen,canteenandhousesinsidethehospitalpremises
iscollectedfromhousetohouseandtransportedtovermicompostingsite.
Categoriesofbiomedicalwaste:
CategoryNo.I

Humananatomicalwaste

Waste

Treatment&disposal

Humantissue
Humanorgans
Humanbodyparts,
Incineration/DeepBurial.

Colourcoding

Yellow.

Container

Plasticbag.
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CategoryNo.II
Waste

Animalwaste
Animaltissuers,orghans,bodypartscarcassesbleeding
parts,fluidblood,experimentalusedinResearch,waste
generatedbyverterinary,hospitalscolleges,Discharge
fromhospitals,Animalhouse.
Treatment&disposal
Incineration/DeepBurial.
ColourcodingYellow.
ContainerPlasticBag
CategoryNo.III

Microbiology&Biotechnology

Waste

Treatment&disposal

Waste from labouratory culture, stocks or specimens of

microorganisms, live or attenuated vaccines human and
animalcellcultureusedinresearchandinfectiousagentsfrom
researchandindustriallaboratories,wastefromproductionof
biological,toxins,dishesanddevicesusedfortransferofcultures.
LocalAutoclaving/Microwaving/Incineration

Colourcoding

Yellow/Red

Container

PlasticBag/Disinfectedcontainer

CategoryNo.IV

WasteSharps

Waste

Needles,syringers,scalpels,blades,glass,etcthatmaycause
punctureandcuts.Thisincludebothusedandunusedsharps.
Disinfection Chemical treatment with 1% hypochlorite
solution/localautoclaving/shredding.

Treatment&disposal
Colourcoding

Blue/Whitetranslucent

Container

PlasticBag/Punctureproofcontainer

CategoryNo.V

DiscardedMedicinesandCytotoxicDrugs

Waste

Waste comprising of outdated contaminated and discarded

Medicines.

Treatment&disposal

Incineration/ destruction and drugs disposal in secured

landfills

Colourcoding

Black

Container

PlasticBag

CategoryNo.VI

SolidWaste

Waste

Treatment&disposal

Itemscontaminatedwithbloodandbodyfluidsincludingcotton,
dressings,soiledplastercasts,linen,beddings,othermaterial
contaminatedwithblood.
Incinerationautoclaving/microwaving

Colourcoding

Yellow/Red

Container

PlasticBag/Disinfectedcontainer
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CategoryNo.VII

SolidWaste

Waste

Colourcoding

Wastegeneratedfromdisposableitemsotherthanthewastesharps
suchastubings,catheters,intravenoussetsetc.
Disinfectionbychemicaltreatmentwith1%hypochloritesolution
autoclaving/microwavingandmultilation/shredding.
Red

Container

PlasticBag/Disinfectedcontainer

CategoryNo.VIII

LiquidWaste

Waste

Waste generated from laboratory and washing cleaning,

housekeepinganddisinfectingactivities.

Treatment&disposal

Disinfectionbychemicaltreatmentwith1%hypochloritesolution
anddischargeintodrains.

CategoryNo.IX

IncinerationAsh

Waste

Ashfromincinerationofanybiomedicalwaste

Treatment&disposal

Disposalinmunicipallandfill

ColorCoding

Black

Container

PlasticBag

CategoryNo.X

ChemicalWaste

Waste

Chemicalusedinproductioninbiologicals,chemicalsusedin
disinfection,asinsecticides,etc.

Treatment&disposal

Chemicaltreatmentwith1%hypochloritesolutionanddischarge
intodrainsforliquidsandsecuredlandfillforsolids.

ColorCoding

Blackforsolids

Container

PlasticBag

Treatment&disposal

Summary:
Nursesarethepersonswhohavefrequentcontactwiththepatientstoprovidecarefor24hours.
Itistheresponsibilityofthenursetobeawareofthepatientsatriskofdevelopinginfectiousandalsoa
dutytoprotectthemwithaseptictechniques.
Asepsisisthepracticetoreduceoreliminatecontaminants(suchasbacteria,viruses,fungi
andparasites)fromenteringtheoperativefieldissurgeryormedicinetopreventinfection.
Threethingsthatareextremelyimportantisachievingasepsisarethereductionoftime,
traumaandtrash.
Thetwotypesofaseptictechniquesthenursepracticesaremedicalandsurgicalasepsis.
Medicalasepsisisacleantechniquewhichincludesprocedureusedtoreducethe
microorganismsandpreventtheirspread.(e.g.)changingpatientsbedlinendaily,hand
washing.
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 Itisasteriletechniquewhichproceduresusedtoeliminatethemicroorganisms.Sterile
techniqueisusedwheresterileinstrumentsareused(e.g.)inoperationtheatre.
Disinfectionisthedestructionusuallybychemicalsofpathogenicorganismsnotincluding
bacterialspores.
Thethreemainmethodsofsterilizationareheat,chemicals,irradiation,andfiltration.
Themethodsofdisinfectionareenvironmental,equipments,skinandwound,food
medication,water,andvaccine.
Thetypesofchemicalsusedfordisinfectionarealkylatingagentsandphenol.
Questions
PartAANSWERINONEORTWOWORDS:(Onemark)
1) Whatisthesteriletechniqueusedtoeliminatemicroorganism?
2) Whatisusedforgaseoussterilization?
3) Whichmethodisusedtosterilizeinstrumentandmachines?
4) Whichmethodisusedtodisposedressings,laboratorymediaandhumantissues?
5) Whatisthepressuremaintainedintheautoclave?
PARTBMULTIPLECHOICEQUESTIONS:(Onemark)
1) The technique which includes procedures used to reduce the microorganisms and
preventtheirspreadis
a)medicalasepsisb)surgicalasepsisc)sterilizationd)disinfection
2)Thebasictechniqueforinfectioncontrolis
a)Wearingmaskb)wearingglovesc)wearinggownsd)handwashing.
3) To prevent soiling of the nurses clothing by the pat ient s blood
andbodyfluidsbywearing
a)maskb)glovesc)gownd)alloftheabove.
4)Thedestructionofmicroorganismbychemicalsis
a)medicalasepsisb)surgicalasepsisc)sterilizationd)disinfection
5)Exposureofheatresistantmaterialstosteamunderincreasedpressureis
a)autoclavingb)filtrationc)steamingd)dryheat
6) Asteriletechniqueiseliminatethemicroorganismsinoperationtheatresisknownas
a)Medicalasepsisb)surgicalasepsisc)disinfectiond)noneoftheabove
7) Frominhalinglargeparticlesaerosolspreventsby
a)Gownb)Maskc)Apronsd)Gloves
138

8) Enamelandclearwaresaresterilizedbythemethodof
a)Tyndallisationb)chemicalsc)boilingd)radiation
9) Thedesiredtemperatureforautoclavingis
a)121cb)112cc)100cd)125c
10)The effective sterilization for disinfecting working surfaces and air
insidetheroom
a)Chemicalb)Ultravioletlightc)Incinerationd)noneoftheabove
11)Theinstrumentsandmachinesforsterilizationthechemicalsused
a)Gluteraldehydeb)Propiolactonec)Ethyleneoxided)Formaldehyde
12)Whichisnotthegeneralwasteinthefollowingitems.
a)packingmaterialb)kitchenwastec)solidwasted)properpieces
13)Thecolourcodingfordisposingsharpsandglassesis
a)yellowb)redc)blued)black
14)Thetypesofchemicalsusedfordisinfectionare
a)alkalizingagentsb)Phenolc)bothd)noneoftheabove
15)Thetubings,catheter&IVsetscanbedisposedinthefollowingcolourcontainers
a)yellowb)blackc)redd)blue
PARTC WRITESHORT NOTESON: (5Marks)
1)Principlesofasepsis.
2)Principlesofsurgicalasepsis.
3)Principlesofdisinfection.
4)Useofgloves
5)Guidelinesformaintainingmedicalasepsis.
PARTD WRITEINDETAIL: (10Marks)
1)Explainaboutdisinfection?
2)Describeaboutmedicalasepsis?
PARTE WRITEESSAY: (20Marks)
1)Sterilizationanddisinfection.
2)Medicalandsurgicalasepsis.

139

7.FIRSTAID
DEFINITIONOF FIRST AID
FirstAidistheinitialassistanceortreatmentgiventosomeonewhoisinjuredorsuddenlytakenill.
Aimsoffirstaid:Firstaidtreatmentisgiventoacasualty:(1)Topreservelife.(2)Topreventworsen
ingofthecondition(3)Topromoterecovery
RULES ANDPRINCIPLESOF FIRST AID
(1) Gettothescenequickly,tohelpinsavinglife.(2)Ifthecauseoftheaccidentisstillthere,remove
itorthecasualtyfromdanger.(3)Becalm,Methodicalandquickbutgentleinhandlingthecasualty.(4)
Asfaraspossiblekeepthecasualtywhereheisuntileverythingisreadyfortransportinghim,(5)Look
forthefollowingandtreatthisfirst(a)FailureofBreathing.(b)Bleeding.(c)Unconsciousness.(6)Reas
surethecasualtyandotherspresenttoreduceshock,(7)Seethatthecasualtyisinbestpositiontoaid
recovery,(8)Clearthecloudtactfully.Thecasualtyneedsfreshair.Anyotherfirstaiderpresentmay
helpyou.Gethelpalsotocallthepolice,directtrafficetcasneeded.(9)Diagnoseinjuriesandgivefirst
aidthatisessential.Makeuseofavailablefirstaidequipments.Ifthereisnone,improvisethematerialat
hand.(10)Arrangeformedicalaidassoonaspossible,forcarefultransport,andforinformingrelatives.
(11)Staywiththecasualty,continuingtoobserveandgivecareuntilhandingovertothedoctor.(12)Do
notattempttoomuch:dotheminimumfirstaidsothattheconditionsdoesnotbecomeworseandlife
canbesaved.(13)Donotremoveclothingunnecessarily,asthismayaddtoshock.(14)Donotgive
anythingbymouthtoacasualtywhoisunconscious,whomayhaveaninternalinjuryorwhomaysoon
begivenananaesthesia.
FIRSTAIDINEMERGENCYSITUATIONS
FIRE
Rapidandclearthinkingatafireisvital.Firespreadsveryquicklysoyourfirstpriorityistowarnany
peopleatrisk.Ifinabuilding,activatethenearestfirealarm.Youshouldalsoalerttheemergency
servicesatonce.Panicspreadsfastamongpeopletrappedinfire.Encouragethepeopletoevacuatethe
area.Donotdelayorreenteraburningbuildingtocollectpersonalpossessions.Ignition(anelectric
sparkornakedflame)asourceoffuel/petrol,woodorfabric)andoxygen(air)
ClothingonFire: Alwaysfollowthisprocedure:(1)Stop,dropandRoll(2)Stopthecasualitypanick
ing,runningaroundorgoingoutside.(3)Ifpossible,wrapthecasualitytightlyinacoat,curtain,blanket
orheavyfabric.(4)Rollthecasualityalongthegrounduntiltheflameshavebeensmothered.(5)Ifwater
isavailablecooltheburnwiththeliquid.
BURNS
Skinplayskeyrolesinprotectingthebodyfrominjury,infectionandinmaintainingbodytemperature.
Theskinconsistsoftwolayers.Theouterlayer(epidermis)andtheinnerlayer (dermis)andfattytis
sue(Subcutaneousfat)theepidermisisprotectedbyanoilysubstancecalledsebumsecretedfrom
sebaceousglandswhichkeepstheskinsuppleandwaterproof.
Thedermiscontainsthebloodvessels,nerves,musclessebaceousglands,sweatglands,hair
folliclesEndsofthesensorynerves(sensationslikeheat,cold,touch,pain)Bloodvesselssupplynutri
entsandregulatesthebodytemperature.
140

Depthofburns:Burnsareclassifiedaccordingtothedepthoftheskindamage.Thereare3depths.
Superficial
:Onlyepidermis(eg)Sunburn
Partialthickness :Destroysepidermis,Pain,Blisterformation
Fullthickness
:Nopainsensation,skinscared.Needurgentmedicalattention.
AssessingaBurn
TypesofBurn
Dryburn
Scald
ElectricalBurn

Causesoftheburn
Flames,contactwithhotobjects
Steam,Hotliquids
High Voltage currents over head
cableslightingstrikesFrostbite
Frostbite
Industrial chemicals, inhaled fumes
andcorrosivegases,chemicalagents
Sun burn, over exposure to ultra
violet rays, Expose to radio active
sources.

Coldinjury
Chemicalburn
Radiationburns

Assessfor: Pain,difficultyinbreathing,signsofshock
Aims: (1)Tostoptheburningandrelievepain(2)Tomaintainanopenairway(3)Tominimizetheriskof
infection(4)Toarrangeurgentremovaltohospital(5)Principlestobefollowedstop,dropandroll(6)
Helpthecausalitytoliedown(7)Continuecoolingtheaffectedarea(8)Covertheinjuredareawith
sterile/cleanclothtoprotectfrominfection.(9)Monitorthevitalsignslevelofresponse.(10)Donot
breaktheblisters.(11)Donotapplyointmentsleadstoinfection.(12)Whilewaitingforhelptoarrive,
reassurethecasualtyandseeforshock.
ElectricalBurn: Bumsmayoccurwhenelectricitypassesthroughthebody.Burnsmaybecausedby
alightningstrikebyhighlowvoltageelectriccurrent.Anelectricshockcanalsocausecardiacarrest.If
thecausaltyisunconscious,makesurethatthecasualtyisinsafearea,openthecausaltysairwayand
checkforbreathinganddoC.P.R.Donotapproachthecausaltyofhighvoltageelectricityuntilthe
currenthasbeenswitchedoffandisolated.
ChemicalBurns:Mostcorrosive,strongchemicalsareinindustry.Chemicalburnsarealwaysserious
andcasualityneedsurgenthospitaltreatment.Neverattempttoneutraliseacidoralkaliburnsunless
trainedtodo.Chemicalburntotheeye,firstaideristowashouttheeyesothatthechemicalisdiluted
anddispersed.Donotallowthecasualirytotouchtheinjuredeyeorforciblyremovethecontactlens.
Sunburn: Causedbyoverexposuretosun.Reddenedskin,painandblistering.Ifthereisextensive
blisteringseekmedicaladvice.
HeatExhaustion:CausedbyJossofsaltandwaterfromthebodythroughexcessivesweating.
Complaintsofheadache,dizziness,confusionlossofappetiteandnausea,sweatingwithpaleandclammy
skin,crampsinthearm,legsandabdomen,Rapidpulseandbreathing.Helpthecasualitytoacool
place.Givehimplentyofwater,weaksaltsolution.Monitorthevitalsigns.BepreparedtogiveCPRif
necessary.Transferthecasualityifnecessary.
HeatStroke: Thisconditioniscausedbyfailureofbodytemperatureregulationinthebrain.Usually
duetohighfeverorprolongedexposuretoheat.Headache,dizziness,discomfort,restlessness,Hot&
flushed,dryskin,boundingpulse,hightemperatureabove1040F(400C).
141

Management:(1) Quicklyremovethecasualtytoacoolplacewarpthecasualtyinacold,wetsheet
untilthetemperaturecomesdownto1000Forgivecoldsponge.(2)Monitorandrecordthevitalsigns.
(3)IfthecasualtybecomesunconsciouspreparedtogiveCPR.Ifthecasualtyisbreathingnormally
placehiminarecoveryposition.
FRACTURES
Afractureisabreakincontinuityofabone,thismayvaryfromacracktoaCompletebreak.
CausesofFractures:DirectForce: Abonecanbefracturedatthepointwheretheforceofablow
isapplied. Indirectforce: Thebonebreaksawayfromthespotofapplicationofforce(eg.)fractureof
theclaviclewithoutastretchedhandwhilefallingopenandclosedfractures.
Inanopenfracture,oneofthebrokenboneendsmaypiercetheskinsurfaceortheremaybea
woundatthefracturesite.Anopenfracturecarriesahighriskofinfection.Inclosedfracture,theskin
abovethefractureinintact.Howeverbonesmaybedisplacedcausesdamagetotheinternalorgans.
Maycausebleeding(internal)andsuffershock.
TypesofFractures:
Greenstickfractures:Closedfracturemostlyitoccursinchildren..
Complicatedfractures:Theyoccurwhenthejaggedendsofthebonefragmentsdamagebloodves
sels,nervesorajoint,brokenbonesinthechestmaypenetratethelung,heartorliver.Infracturesofthe
skullthebrainisusuallydamaged.
Depressedfractures:Theseoccurintheskullwhenthebrokenendsofthebonesarepressedin
wards.
CommunatedFractures:Inthesecases,theboneisbrokenintoseveralfragments.Thisisserious
becausetherewillbemuscledamagewithmorebleedingatthefracturesite.
ImpactedFractures: Afteraheavyfall,thefracturemaybeimpactedbytheforce,(eg.)Spinalinjury
fallingfromtree.
PathologicalFractures: Theseoccurwhentheboneisweakenedbylossofcalcium,infectionor
cancer.Minimalcauseabreakinsuchcases.Inoldagethebonesaremorebrittle,andmaybreak
spontaneouslyduetocalciumlosswhichispartoftheageingprocess.
StressFractures:Stresscausedbyrepeatedminortraumaasinathletictraining.Involvedinstrenuous
training,suchasjoggingormarathonrunning.
Management:(1) Advisethecasualtytokeepstill.(2)Supporttheinjuredpartforimmobilization.
Splintscanbeusedforthesupportofthearea.(3)DressingtobedoneanddoBandagingtotheinjured
part.(4)Arrangetotransportthecasualtytohospitalasnecessary.Treatforshock.(5)Monitorthevital
signs.
DROWNING
Drowningisaconditionofsuffocationwhichmayleadtodeath,duetoairwayspasmorwaterentering
intotheairwayduringswimmingorwheninwater.
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Drowningisasilentkiller.Peoplewhoaredrownedmaynotbeabletocallforhelpbecausethey
expendalltheirenergytobreatheortokeeptheheadoverwater.Bealertforsignsthatsomeonemay
beintrouble.Aswimmerflailinghisorherarms.Displayingunevenswimmingmotions.Lyingfacedown
inwater.Onlythehead,showingabovewaterwithmouthopen.
Thedrowningsequence: Beginswithpanicorstrugglefollowedbysubmersionwithbreathholding,
thenwaterswallowingbeforepassingout,within3minutesofbeingunderwater,lossofconsciousness,
within5minutes,brainsuffersdamage,thentheheartgoesintoirregularrhythmbeforeitstopsbreath
ing.
Signs: Abdominaldistensionandvomiting.Bluishorpaleskinofthefaceandlips.Coughwithclearor
frothypinksputum.Decreasedconsciousnessorunconsciousness.Labouredornobreathing.Weakor
noheartbeat.
FirstAid:(1)Reachingthevictim.(2)Reachfromashore.(3)Ifyoucannotreachaperson,wade
closer.(4)Throwanobjectthatfloatswithalinetothevictim(throwandtow).(5)Useaboatifoneis
available.(6)Ifnotusemustswimtotheperson,useatowel/boardforhimtohold.(7)Stabilizethe
victiminwater.(8)Keepthevictimsheadandbodyaligned,placeonehandinthemiddleofhisback.(9)
Yourarmdirectlyoverthevictimshead.(10)Placeyourotherhandunderthevictimsupperarm,near
theshoulder.(11)Slowlyandcarefullyrotatethevictimoverinthewater,byliftingtheshoulderand
rotatingitover.(12)Supportthevictiminneutralpositioninwaterandstartmouthtomouthventilation.
(13)Ifindeepwater,givetheoccasionalbreatheofairwhiletowingthecasualtyashore.
AdditionalCareMeasures:(1) Whenyoucanplacehimonafirmsurface,checkbreathingand
pulseandcontinueresuscitationifnecessary(2)Assoonasthecasualtybeginsbreathing,placein
recoveryposition.(3)Keepthecasualtywarm.(4)Ifpossible,removewetclothinganddryhimoff.(5)
Coverwithspareclothesand/ortowels.(6)Ifneededtreatforhypothermia.(7)Arrangeremovaltothe
hospital.(8)Transportinastretchercase,maintainingthetreatmentposition.
HAEMORRHAGE
Haemorrhageorbleeding:isaflowofbloodfromanartery,veinorcapillary.
Typesofhemorrhage
ArterialBleeding: Bloodisbrightredincolour.Itspurtsateachcontraction.
VenousBleeding: Bloodindarkredincolour.Itdoesnotspurt.Steadyflow.
CapillaryBleeding:Bloodisredincolour.Itdoesnotspurt.Slowinflow.
Effectsofhemorrhage:Thelossofredbloodcellscausesalackofoxygentothetissuesofthe
body.Adecreaseinbloodvolumecausesdecreaseinbloodpressure.Theheartspumpingratein
creasestocompensateforreducedbloodpressure.Theforceoftheheartbeatisreducedsincethereis
lessbloodtopump.
Howtorecognizeexternalbleeding:Evidenceofmajorexternalbloodloss.Symptomsandsignsof
shock.Casualitycomplainsofthirst.Blurringvision,fainting,giddiness.Faceandlipsbecomepale.Skin
feelscoldandclammy.Pulsefasterandweaker.Restlessness.Breathingshallow(airhunger).Uncon
sciousnessmayoccur.
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InternalBleeding: Woundsthathavepenetratedskull.Woundthathavepenetratedthecheston
abdomen.Signsandsymptomsofshock.Bloodmayappearfromoneofthebodyorificeslikenose,ear,
mouthrectum,urethra,vagina.
Management:Controlbleedingassoonaspossible.Keepthewoundcleananddressittominimize
bloodlossandpreventinfection.Quicklytransferthecasualitytohospital.
HowtoControlBleeding.
Directpressure:Placeyourhanddirectlyoverthewoundandapplypressure,firmandsteadyuntilthe
bleedingstops.Tieabondagefirmlyenoughtocontrolbleedingbutnotsotighttocutoffthecirculation.
Immobilizetheinjuredpart.Neverreplaceanydressingonceitisapplied.Ifthedressingissoaked,
placeanotherdressingandholdbothinplacewithfirmpressure.
Elevation: Elevatethebleedingpartofthebodyabovetheleveloftheheartsothattheflowofblood
willslowdowninthatpartandbloodclothingtakeplace.
PressurePoints:Applyingpressureoverthepressurepointspressingovertheunderlyingbonepres
surepointsonthearms(brachialpressurepoint)onthegroin(femoralpressurepoint).
Applyingatourniquet:Astandardtourniquetisapieceofwebbeltingabout36"longwithabuckle
devicetoholdittightlyinplacewhenapplied.Thisisusedtosopbleeding.Caretobetakennottocut
offthecirculation.
Management: Applydirectpressureoverthewoundwithyourfingersandpalms,withcleanpad/cloth
youcanaskthecasualitytoapplydirectpressureherself.Elevateandsupporttheinjuredpartabovethe
levelofthecasualtyshearttoreducebloodloss.Ifyoususpectthecasualityisgoingintoshock,raise
andsupportherlegssothattheyareabovethelevelofherheart.Securethedressingwithbandage.Tie
itwithpressurenottootightlytocutoffthecirculation.Furtherbleedingstilloccurs,putontheanother
bandageoverthepreviousone.Monitorthevitalsigns.Watchforthesignsforshock.Dialforan
ambulanceandtransportthecasualitytohospitaltillthenthefirstaidershouldnotleavethecasualityuntil
takenoverbydoctorornurse.
BleedingfromtheNose(Epistaxis): Bleedingoccursfromthebloodvesselsinsidethenostrils.
BleedingcomingfromNoseisalsoasignoffracturedskull.Makethecasualitytositwiththeheadbent
forward,loosenthetightclothingaroundtheneck.Allowthebloodtodrainfromthenostrils.Askthe
casualitytobreathethroughhermouthandtopinchthesoftpartofthenostrilforI0mts.Ifthebleeding
restartstellthecasualitytoreapplypressure.Ifbleedingfollowsaheadinjury,thebloodmayappearthin
andwatery.Itisaserioussignbecauseitindicatesskullfracture.Tellthecasualtytopinchhernose.
Advisehernottospeak,swallow,coughspitbecauseshemaydisturbthebloodclotsthathaveformed
inthenose.Givehercleanclothtowipeoffthedribbling.Advisethecasualtytorestquietlyforfew
hours.Avoidexertion,blowingofnoseatleastfourhourssoastonottodisturbtheclot.Ifafter30mts
alsobleedingpersistsorrecurs,seekmedicalaid.
SHOCK
Shockoccurswitheveryaccidentorsuddenillness.Thenervoussystemisaffectedandlaterifthe
conditionofshockcontinues,thecirculationofbloodgraduallyfailsandthepatientdies.Promptfirstaid
treatmentisneededtopreventshockincreasing,andtohelpthepatienttorecoverfromtheprimary
shock.
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Signs,SymptomsandTreatmentofShock:Ashockedpersonmayonlyfeelalittlefaint,weakand
cold.Andlookpale,orhemaycollapsewithsignsandsymptomsasfollows:(1)Hefeelsfaint,weak
andgiddy.(2)Theskinfeelscoldanddampthereissweatingevenincoldweather.(3)Colourispaled
andcyanosed(4)Hewillusuallyvomit.(5)Thepulseisweakandbecomerapid.(6)Hemaybe
restless,mentallyconfused,andbecomeunconsciousinlaterstages
Treatment:
1)Reassurethecausalityifheisconscious
2)Layhimonhisbackwiththeheadlow.Ifshockissevere,raisethelowerpartofthebody
unlessisinjurytotheheadnorchest
3)Loosenstightclothing,butdonotremoveclothing
4)Ifhefeelscold,coverhimwiththeblanket,butdonottrytowarmhimbyanymeans
5)Offerhimawarmsweatdrink,e.g.teaorcoffee,unlessthereisinternalinjuryorheisnotfully
conscious.
6)Keephimquiet,andundisturbed,givingonlyessentialfirstaidtreatmentforinjuries.Avoid
causingpain
7)Iftherearesevereinjuries,orshockincreases,getthecausalitytothehealthcenterorhospital
withoutdelay.heurgentlyneedsI.V.fluids
ElectricalShock:Ifanelectricalcurrentorlightingflashpassesthroughapersonsbody.Theeffects
maybemildorsosevereastocauseimmediatedeath.Theremaybefailureofrespirationwhilethe
heartcontinuestobeat.Theremaybeburnswherethebodywasincontactwithalivewire.
Aimsoffirstaidtreatment:
1)Havethesourceofelectricityswitchedoff
2)Checkbreathing,andgiveartificialrespirationimmediatelyifheisnotbreathing.
3)Treatanyburns
BANDAGINGANDSPLINTING
Purposes:(1) Tosecuredressinginposition.,(2)Toformslingsforsupport.(3)Tosecurepads
RollerBandages: Thesebandagesaremadeofcotton,gauzecrepe,elasticfabricorlinenarewrapped
aroundtheinjuredinspiralturns,figureofeight.Toimprovise,materialmaybetornintostripsofthe
requiredlengthandwidth.
Widthrequired Forfinger2.5cm
Forheadandarm6cm
Fortheleg,about9cm
Forthebody15cm
Thebandagesshouldbetightlyandevenlyrolled.
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RulesforApplyingRollerBandages: Facethecasualty,exceptforbandagestheheadorbackof
theneck.Whenbandagingtheleftlimb,holdtherollofbandageintherighthandandviceversa.Apply
theoutersideofthebandagetothepart,andunrollnomorethan5cmatatime.Tobandagealimb,
workfrombelowupwards,andfrominsidetowardstheoutsideoverthefrontofthelimb.Seethatthe
bandageisneithertootightnortooloose.Eachlayershouldcovertwothirdsofthepreviouslayerof
bandage.Finishinfront,notoverthewound,andfixtheendwithasafetypin,stickingplaster,stitching,
orbytearingtheendintotwotailsandtying.Thecompletedbandageshouldbecomfortable,lookneat
andfulfilitspurposewithnorestrictionofcirculation.
PatternsUsedinBandaging
Circularturns,asusedforheadandtrunk.
Simplespiral, forpartsofuniformthickness,e.g.fingers,wrist.
Reversespiral,usedonlimbswherethethicknessofthepartvariouse.g.forearm,leg
FigureofEight: Thismaybeusedonlimbsinsteadofthereversespiral,alsoforthehandand
foot.
Spica, usedfortheshoulder,hipandthumb
Divergentspica,foraflexedjoint,e.g.elbow,knee,heel
Recurrent, tocovertipsoffingersorastump
Specialbandagessuch ascapeline forthehead,eyebandage,earandbreastbandages.
ChoosingtheCorrectSize:Beforeapplyingarollerbandage,checksuitablewidthforthe
injuredarea
ApplyingaRollerBandage: Keeptherollerpartofthebandage(Head)uppermostasyour
work(theunrolledpart)iscalledthetail.Standinfrontofthecasualtyexceptincapeline(Head
bandagingandeyebandageareappliedstandingbehindtheclient).Supportthepartwhilebandaging
.Learntousebothhandsequally,changingthebandagehandtohand.Workfrombelowtoupwards.
Finishoffsecurelywitheitherreefknot,safetypin,bandageclip,adhesivetap.Tuckingintheend.
Splinting:Splintscanbemadeoutofwood,cardboard,ironrodsusedtosupportthefractured
partandforimmoblization.
TraingularBandages: havevarioususeinfirstaid.Tomaketwobandages,takea1metre
squarepieceofstrongcottoncloth,cutinacrossfromcorner,andhemtheedges.Thelongsideiscalled
thebase,andthecorneroppositetoitthepoint,Thebandagesmaybeappliedopenedoutoritcan
befoldedintoabroadornarrowbandages.Areefknotisusedtotietheendsofthebandage,
becauseitisflatandwillnotslip.Therulefortyingareefknotisrightoverleft,thenleftoverright.If
youkeepthisruleyoucannotgowrong.
Slings areusedtosupportorlimitmovementoftheupperlimb,incasesofinjuryorinflammation.
Threetypesofslingsareused:
LargeArmsling:Thisisusedincasesofsimpleribfractureandforfractureoftheforearm.
Whenapplied,onlythefingertipsshouldshow,thewholearmbeingwellsupported.
CollarandCuffSling :Thissupportsthewristonly.Withthecasualtysforearmflexedand
fingerstouchingtheoppositeshoulder,aclovehitch,madefromanarrowbandage,isplacedroundhis
wrist.Theendsofthebandagesaretakenaroundtheneckandtiedinthehollowjustabovethecollar
bone,ontheinjuredside.
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TriangularSling:Thissupportsthearmwiththehandwellraised.Itgivesrelieffrompainwhen
usedinfractureofthecollarbone.Firstplacetheopenbandageacrossthechestwiththepointbeyond
theelbowandoneendoverthehand.Tuckthebasecomfortablyundertheforearm.Taketheend
behindtheelbowacrossthebackandtietothefirstendwiththeknotjustinfrontoftheshoulder,onthe
uninjuredside.Foldinthepointandfixthebandagewiththesafetypin.
ImprovisedSlings: Theloweredgeofthecasualtyscoatorshirtmaybeturnedupandpinned
tosupportthearm,orthehandmaybepassedinsideabuttonedupcoat.Amuffler,tieorothersuitable
clothmaybeusedtosupportthearm.
BandagefortheScalp :Placetheopenbandageontheheadwiththepointattheback.Folda
narrowhematthebase,placeitjustabovetheeyebrows,thentakethetwoendsbackwards,cross
thembelowtheocciputwiththepointunderneath,thenbacktotheforeheadwheretheyaretied.Draw
thepointdownandthenupwards,andfixitwithasafetypin.
EFFECTSOFEXTREMEHEAT
Peoplecanbeidentifiedashighriskinrelationtoheatandheatrelatedillness.Thereare3types
ofheatrelatedillness
1)Heatstroke
2) HeatExhaustion
3)Heatcramps
HEATSTROKEORSUNSTROKE
Thisconditioniscausedbyfailureofbodytemperatureregulationinthebrain.Usuallyduetohigh
feverorprolongedexposuretoheat.Heatstrokemaybecausedbyhightemperatureinfactoriesor
furnaces.
SignsandSymptoms: Headache,dizziness,discomfort,restlessness,Hot&flushed,dryskin,bounding
pulse,hightemperatureabove1040F(400C),rapidunconsciousness
Firstaid:
1) Removethepatienttodryandshadyplace,looseninghiscollar,andothertightclothings.
2)Risetheheadandupperpartofthebody
3)Sprinklecoolwateronhisbodyorwraphiminawetsheetandfanhim.
4)Keepontakingbodytemperatureevery10minutes.
5) Afterthebodytemperaturefallento102Fwraphiminadrysheetandkeepfanhim.
6) Ifthepatientisconscious,coolwatermixedwithsaltandglucosefordrinking.
7) Removetothehospital
HEATEXHAUSTION
Itiscausedbytoohightemperatureintheatmospheredirectlybythesun,orduetohardwork
andconfinementinaclose,hotatmospherelikefactoriesetc.
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Signs&Symptoms:
1)Headache,dizziness,nausea,vomiting,andsometimesabdominalcramps,orcrampsinthe
limbs.
2)Faceinpalewithcoldsweat
3)Pulseisweak
4)Shallowbreathing
5)Temperatureisnormalorslightlyraised
6)Sometimesthereisunconsciousness
7)Theremaybeashock
8)Lossofappetite
Firstaid:
1)Removethepatienttoacoolplace
2)Placehimflatonhisback
3)Loosenhisclothing
4)Givehimplentyofsaltedwater(1/4litreeveryhourly)
5)Observethepatient
HEATCRAMPS
Theseareintermittent,painfulcontractionsofskeletonmuscles.Thesecrampsoccursthefluidlost
insweatbydrinkingwaterbutdontreplacesodium.Sodiumdepletionisresponsibleforthecramps.
Heatcrampsusuallyoccurinmusclesthathavebeeninvolvedinastrenuousactivity.Bodytemperature
isnormalandtheserumsodiummaybenormalorlow.
Firstaid:
1)Replacethesodiumwithsalttabletsoranelectrolytesolution
2)Addingsaltinthedietwillpreventheatcramps
Pointstopreventheatinjury:
1)Limitingthestrenuousactivitiesinthehotweather
2)Stayindoorsandwearaminimumofclothingsduringheatwaves.
3)Whentemperaturesareunusuallyhighoutdooractivitiesshouldbecancelled.
4)Wearclothesthatareloosefitting,lightincolourandcoverthebodyasmuchaspossible
whenoutdoors
5)Looseweightifyouareobese
6)Avoidheavyexercise
7)Usemeasurestoimproveventilationandreduceheatbyshades
8)Cookingshouldbedoneinearlymorningorlateeveningtoavoidheatingupthehouseduring
thehotpartoftheday
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9)Fansandventsoverstovesandovensshouldbeusedtohelpremoveheatfromthehouse.
10)Eatingmoresalts,butmustbeaccompaniedbyanincreasedamountoffluids.
11)Drinklotofwater,eventhepersonwithcardiovasculardiseasewhomightotherwisebe
limitingfluids.
Effectsofextremecold: Effectsofextremecoldarecommoninpersonwholiveorworkinaclimate
wheretemperaturefallsbelow32Forareinhighaltitudes.
FROSTBITE
Frostbitesoccurswhenthebodyisexposedtoextremecoldtemperature.(i.e.)icecrystalsform
inginsidethecellcanresultinpermanentcirculatoryandtissuedamage.Bodyareassusceptibletofrost
bitearetheearlobes,tipofthenose,fingersandtoes.
Signsandsymptoms:
1)Theexposedpartbecomescold,painfulandultimatelynumb
2)Colourfirstisred,thenbecomewhitewhichmaylaterleadtogangrene
3) Injuredareaiswhite,waxyandfirmtotough.Patientusessensationintheaffectedarea.
Nursingaction: Gradualwarmingmeasures,analgesia,andprotectionoftheinjuredarea.
Firstaid:
1) Removeallwetortightclothingsfromthefrostbittenarea
2) Carrythepatienttoaclosedroomwithoutafireandundresshimcarefully.
3) Removetightgloves,boots,shocks,ringsetcfromthebody
4) Donotrubthefrozenpartwithsnoworanythingelse
5) Puthimtobedandcoverhimsnuglywithadrycloth.
6) Givehimwarmdrinks
7) Iffaceorearisaffected,coverthefrozenpatchwithaglovedhanduntilnormalcolourand
sensationreturn.
8) Sentforaphysicianimmediately
Importantpointstopreventcoldinjury:
1) Planactivitiescarefullytominimizeexposure
2) Dressfortheweather
3) Avoidvigorouswashingoftheface
4) Savingthebearduntilafterthedaysouting
5) Applyprotectivecreamtothefacepriortoexposure
6) Wearseverallayersofloosewarmclothing
7) Usehandprotection.Mittensaregenerallymoreeffectivethangloves
8) Avoidalcoholandcigarettes
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9) Avoidbecomingundulyfatigue
10) Donotusesnow,icecoldwater
11) Iffreezingoccurs,avoidthawingthepartuntilrefreezingiseliminatedasathreat.
BITESANDSTINGS
Bitesfromsharp,pointedteethcausedeeppuncture,woundsthatcarrygermsintothetissues.
SnakeBite:Commonlytwotypesofsnakesarefoundinourcountry.
1) Colubrine

2)Viper

Allsnakesarenotpoisonous.Identificationofthesnakeisimportanttoenabletogiveappropriate
treatmenttobegiven.Ifthesnakehasbeenkilleditshouldbetakenwiththecausalitytothehospital
mostofthepeoplediefromfear.
SignsandSymptoms
1) Apairofpuncturemarks.
2) Severepain,redness,swellingatthesiteofthebite.
3) Drowsiness.
4) Dimnessofvision.
5) Breathingdifficulty.
6)Unabletospeak.
7) Increasedsalivation.
8) Convulsions
9)Shock.
10)Weaknessofhandsandlegs,lossofsensation,wateringofmouth,slowrespirationandweak
pulse.
Firstaid:
1) Helpthecausalitytoliedown.Reassureher.
2) Washthewound.
3) Slashthewoundwithknife.
4) Immobilizetheaffectedpart.
5) Treatforshock.
6) Resuscitation,ifdifficultyinbreathing.
7) Shiftthecausalitytohospitalimmediately.
8) Takethekilledsnake,ifavailable,forpropermanagement.
Scorpionbites: Generallyscorpioncanbeseeninthemoistdarkplacesandinrainyseason.Though
thescorpionsarenotseriouslypoisonousbutsometimespersonscanbecomeunconscious
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Signs&Symptoms:
1) Severeburning
2) Intolerableincreasingpaininthebittenarea
3) Giddiness
4) Vomiting
5) Unconsciousness
Firstaid:
1) Patientshouldmaketoliecomfortablyandsoothingcreamapplied.
2) Ifthepatientisunconsciousness,sendhimtodoctororhospital
3)Ifabigblisterisseenafter612hoursanditburstbyitself,dothedressingwithantibiotic
cream
DogBite: Arabidanimalisaggressive,droolingsaliva,mustbeapproachedwithcare.Themost
seriousinfectionriskisrabies,apotentiallyfatalviralinfectionofthenervoussystem.Thevirusiscarried
inthesalivaoftheinfectedanimal.Tetanusisalsoapotentialriskfollowinganyanimalbite.Thedog
shouldbewatchedfor10days.Ifthedogishealthyafterthisperiodthenthereisnodangerofrabies.
Symptoms:
1) Headache,nausea,vomiting,fever.
2) Restlessness,confusion.
3) Difficultyinswallowing.
4) Foulsmellingofthemouth.
5) HydrophobiaDifficultyindrinkingwater.
6) Aerophobia
7) Respiratoryparalysis.
Firstaid:
1)Thoroughwashingofthebittenareaandwashthewoundwithsoapandwater(Detergent
solution)for510minutes.
2) Dressthewoundwithcleansterilegauzeorcloth.Applyantibioticcream
3) Shiftthecausalityimmediatelytothehospital
4)Thedogshouldbekeptunderobservationfor10days
Catbite: Catskeeproamingaroundthehousesbutiftheyaredisturbedandtouchedtheybecome
violentandcanattack.Itcausestwotypesofwounds
1.Onbitingwithteeth 2.Scratchesbythenails
Firstaid: Washthewoundandapplythedressingproperly.
Ratbite: Ratsareharmtothehumanbeingindifferentways.
1)Thefleafoundontheirbodyspreadadangerousdiseasecalledplague.
2) Sometimestheyscrapthepalmofthehandorfootofsleepingperson
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Signsandsymptoms: Fever
Firstaid:
1) Woundshouldbewashedanddressedproperly
2) Patientshouldbesenttothehospital
BeesandWaspbite:
InsectsuchasBeeandWaspthebiteispainfulratherthandangerous.
Startingpainwillbetherelatermildswellingandrednessappears.
Signs&Symptoms:
1) Localpain,itchingandsevereswelling
2)Lowbloodpressure
3) Unconsciousness
Firstaid
1) Torelievethepaintrytoremovethestingwithtweezer.
2) Treatmentofthelocalarea.
3) BeeVenomisacidneutralizewithammonia,sodawaspvenomisalkalineneutralizewithvinegar.
4) Torelievepainandswellingapplycoldcompress.
5) Sentthepatienttothehospital
TicksandMitesbites:
Tickisasmallinsectlikebedbug.Itisabouthalforonecentimeterlong.Ithasaterriblecapacity
tosticktothebodyandkeepsuckingthebloodduringthisperioditspreadsgermsofcertaindiseases
inthebodybywhichtuloramie,rockymountainspottedfever.
Signs&Symptoms: TyphusFever
Firstaid:
1) Thetickormitehasbittenanditisstickedshouldbeimmediatelyremoved.
2) Shouldbepulledforcefully
3) Applyburningcigarettesonthedorsalsurface.
4) Applyoilturpentineorkerosenetoremovethetickormite.
5)Thewoundshouldbewashedwithsoapandwater
6) Applyantibioticcream
7) Applybandage
Spiderbite:
Thereare2typesofspider.1.Blackspider2.Tarantula
Blackspiderismorepoisonous.Tarantulaisbig,hairyandlesspoisonous.
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SignsandSymptoms:
1)Redness
2)Severepain
3) Localswelling
4) Stomachcramps
5) Musclehardness
6)Theface,legsandhandslooksswollen
7)Breathlessnessandshock
Firstaid:
1) Patientshouldbemaketolieinacomfortableposition
2)Shouldbecoveredwithblanketorbedsheet
3) Aclothorropeshouldbetightatadistancefromthebittenarea.So,thebloodisnotabsorbed
inotherpartsofthebody.
4) Ifthepatientisconscious,givecoffeeorteatodrink.
5)Bittenareashouldbecleanandbandage
6) Senthimtothehospital.
Leechbite:
Leechisgenerallyfoundintanks,rivers,moistandmuddyplaces.Itsucksquitealargeamountof
blood.
Firstaid:
1) Applyaburningstickorcigaretteonthedorsalsurface.
2) Washthewoundandapplybandage.
Fishstings:
Twobreedsofthornyfishvizstingrayfishandjellyfishandgenerallyharmtothehumansby
stinging.
Signs&Symptoms: Severepain
Firstaid:
1) Thestingshouldbetakeitoutbyscratchingtheskin.
2) Washthewoundanddothedressing
3) Applycoldbandagesofammoniaandwatertogetrelievefromtheburningsensation
4)Ifthepainissevere,getthemedicalaid.
POISONING
Poisonisasubstancewhichistakenintothebodyinsufficientquantitymaycausetemporaryor
permanentdamage.Theymaybeconsumed,accidentally(bymistake,byIgnorance),forsuicidalpurpose,
intentionallyforkillingenemies
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RoutesofTakingPoisons:(1) Eatingordrinkingpoisonoussubstancebymouth.(2)Byinhaling
gases,fumes,chemicalvapours.(3)Byinjectionintotheskinasresultofbites(eg.)snakebites,
hypodermicinjection.(4)Absorptionthroughskin(eg.)poisonoussprays.
Anothercommontypeofselfpoisoningistermedparasuicide.Ayoungpersonwhoisemotionally
distributedmaytakesuchaspainkillerorsleepingtablets.Theobjectistoobtainattentionandtotry
andsolvetheemotionalproblem,ratherthantotaketheirlife.
Recognition:(1)Dependsonthepoison.(2)Vomiting,sometimesbloodstained.(3)Impaired
consciousness.(4)Painorburningsensation.(5)Emptycontainersinthearea(6)Historyofingestion/
Exposure
HOUSEHOLDPOISONING
Almosteveryhouseholdcontainspoisonoussubstances,suchasbleach,paintstripper,glue,
paraffin,insecticides,pesticides,alcohol,petroleumproducts,acids,alkalis,sedativesetc.
Diluteorweakenthepoisonoussubstances.
Excesswatershouldbegiventoweakenedtheirconcentratedstateexceptacidpoisoning.
Takingoutpoisonoussubstancesbyincludingvomiting:
Thepoisonoudsubstancescanbetakenoutofthebodybyinducingvomiting.Mixingtwo
tablespoonsofsaltinoneglassofwaterortwoteaspoonsofsodabicarbinaglassofwater
orbymixingoneteaspoonofmustardwaterpowderinlukewarmwater.Iftheabove
substancesarenotavailablethenlukewarmwateraloneisalsouseful.
Inallcasesofpoisoningseekthemedicalhelpofcallthedoctorimmediately.
Hypnotics:
Heroinesandbadbituratescanleadtosleep,deepcomabywhichtherespirationisslowed
down.
Takeoutthepoisonousmedicinesbyinducingvomitingorweakenthosesubstancesbygiving
morewatertodrink.
Keepthepersonawakenedwhoissleepingwiththeeffectofsleepingpills.
GASPOISONING: Itarisewithinhalationofpoisonousgasessuchcarbonmonoxide,carbondi
oxide,inflammablegases,steamofammoniaetc.
Theeffectsofthesepoisonousgases
1) Reducetheamountofoxygeninhaledair.
2) Affectstheoxygencaringcapacityofblood
3) Damagethemucousmembraneoftherespiratorytract,notallowingtheoxygenabsorbedin
thebloodfromthelungs
Signs&Symptoms:
1) dizziness
2) tighteningofchest
154

3) lossofconsciousness
4) meiosis
5) respiratoryfailure
6) fallinginbloodpressureandpulse
7) twitchingandconvulsion
8) asphyxia
9) cyanosis
10)circulatorycollapse
Firstaid:
1) Bringthepatientintheopenair
2)Keepthepatientwarmunderblanketorbedsheet
3) Iftherespiratoryprocessisstop,startgivingartificialrespiration
4) Thereisnoquickimprovement,makeanarrangementtosendhimtohospital.
FOODPOISONING:
Foodpoisoningoccursduetocontaminatedwater,foodsubstances,unboiledanduncleaned
vegetables,contaminatedkulfi,milkandcreamproductscontainsbacterias,itproducestoxins.
Signs&Symptoms:
1) nasueaandvomiting
2) crampingabdominalpains
3) diahorrea
4)headache
5) fever
6) featuresofshock
7) collapse
Firstaid:Themainaimoffirstaidistoeliminatethepoison,giveblandfluidssuchaswater,dilutedfruit
juiceorweaktea.Thepoisonouseffectcanbeweakenedbyinducingvomiting.Butwithconstant
vomitinganddiarrhoea,thewaterandelectrolytebalanceofthebodygetsdisturbedwhichresultsinto
theweaknessandconditionofshockarises,thepatientshouldbesentthedoctorandhospitalimmedi
ately.
Alcoholpoisoning: Alcohol(ethanol)isadrugthatdepressestheactivityofthecentralnervoussys
tem.Smallquantitiesgenerallyproduceonlyaslightchangeofmood.
Dangersofalcoholpoisoning:

Anunconsciouscasualtyisindangerofinhalingandchokingonvomit.
Hypothermiacanoccurwhenexposedtocold.
Misdiagnosed.
155

Signsandsymptoms:
Astrongsmellofalcohol
Unconsciousness.
Aflushedandmoistface
Deep,noisybreathing
Afull,boundingpulse.
FirstAid: Ifapersonisintoxicationofliquorthenheshouldbemadetositandvomit.Afterthisgivehim
strongteaorcoffee.Ifthepatientisunconsciousandthesymptomsofheadinjuryareseen,thenarrange
tosendhimtothehospitalimmediately.
Dhaturapoisoning: Thispoisoningisduetoconsumptionofseedsoftreedhaturawhichmaybe
eatenunknowinglyoraccidentallyormaybeduetoconsumptionofbelladonnaalkaloidscontaining
medicine.
Firstaid:
Keepthepatientincool,darkandsilentroomandcontroltheseveremovementspatiently.
Vomitingshouldnotbeinducedinconditionsofunconsciousnessandcramps.
Coldbandagesshouldbeapplied.
Artificialrespirationcanbegivenifnecessary.
Protectivemeasures
Medicinebottlesandpacketsshouldbeclearlylabeledandunlabelledbottlesshouldnotbe
usedanddestroyed.
Toxicmedicinesshouldbelabeledpoisonandkeepitinlockedalmirah.
Thelabelonthebottleshouldbereadbeforetakingthemedicine,duringmeasuringthedose
andwhilekeepingthebottlebacktotheplace.
Cleaningagentsshouldbelabeled.
Toavoidfoodpoisoningfoodshouldbepreparedwithcleanlinessandkeptcovered.
adequatecookingandboilingtobedone.
Leadpoisoning:Moreindustrialworkersareexposedtolead,asitismostcommonlyusedmetalin
industries.Mostcasesofindustrialleadpoisoningisduetoinhalationoffumesanddustofleadorits
compounds.
Symptoms:
Insomnia,headache,mentalconfusion,metallictaste,stomachburning,constipationfollowedby
diarrhea,convulsions,muscularweakness,skin,coldandcyanotic.
Firstaid:
Keepthepersonquiet.
Gastric lavage with magnesium or sodium sulfate and analgesics for pain. maintain
fluidandelectrolytebalance.
Diazepamforconvulsions.
Calciumethylenediaminotetraaceticacidisthespecificantidote.
Adequateurineflow.
Reduceoreliminateexposuretolead.
156

Mercurypoisoning: Itoccursintheoccupationsrelatedtocrushing,roastingandcondensationof
mercuryfromore,manufactureofpaints,chlorine,causticsoda,paperandpulp.
Symptoms: Tremor,gingivitis,disturbedsleep,burningsensationinmouth,throat.Abdominalpain,
nausea and vomiting. Diarrhea and bloody stools. Weak rapid pulse, slow shallow
respiration,coldandclammyskin.
Firstaid:
Eggwhite,milkorflourbymouth.
Lavagewithactivatedcharcoal.
DimercaprolI.M.pencillamine.
Demulcentsandanalgesics.
Treatforshock/acuterenalfailure.
Cyanidepoisoning: Cyanidesareamongthemostcommonandmostdeadlypoisonsknown.
Symptoms: Utteracry,unconscious,rapidrespiration,laterslowandgasping.Deathusuallywithin5
minutes.
Smallerdosesacridtaste,choking,anxiety,dizziness,headacheandconvulsionswithfrothiness.
Firstaid:

Immediateemesisandgastriclavagenodelay.Inhaleamylnitrateimmediately1530seconds
every23minutes.

I.Vsodiumnitrite.3gin10mlofwateratrateof2.5ml5mlthisisbeingdonesimultaneously.
2550mlofsodiumthiosulphate50%tobeadministered.
Artificialrespiration.
Recumbentposition.

Turpentinepoisoning: Itisderivedfromvariousconiferous,pinetrees,whichyieldsavolatileoil,as
oilturpentinewhichisusedinthepreparationofpaints,varnishesandinmedicine.Turpentinepoisoning
usuallyoccursbyinhalation.
Symptoms: Warmorburningsensationinthegulletandstomach,followedbycramping,vomitingand
diarrhea.weakrespirationandpulse.IrritationofurinarytractandCNS.
Firstaid:
Gastriclavage.
Soothingdrinksandstimulants.
Increasefluidintake.
Radiationhazards: Manyindustriesuseradiumandotherradioactivesubstancesandtheseexposures
willleadtovarioushazards.
157

Effectsofradiation: Acuteburns,dermatitis,blooddyscariasis,malignancies,,geneticeffects,lung
cancer,affectstheeyes,intenseconjunctivitis,keratitis
Prevention:
Avoiddirectcontact.
Wearxraythickshieldduringexposure.
Monitorfilmbadgeorpocketelectrometerfrequentlyforevery6months.
Adequateventilationinworkingarea.
Replacementandperiodicexaminationofworkersforevery2months.
Pregnantwomanshouldavoidexposure.
Noiseinducedhearingloss: Everyoneinindustryisconcernedaboutindustrialnoiseanditseffecton
thehearinginworkers.Butnoiseproblemisgenerallyaneglectedsubject.
Hearingconservationprogramme: TheprinciplesinvolvedinHCPareoutlinedbelow:
Noisesurvey
Audiometry
Hazardevaluation
Noisereduction
Hearingprotectivedevices.
Firstaidinestablishment:
Employersshoulddevelopappropriatefirstaidarrangementintheirundertakings.Regulation
andtheirassociatedcodeofpracticesbeevolvedwhichshouldapplytovirtuallyallpeopleatworkand
coverfirstaidregulation.
EmployersshouldprepareawrittenstatementofpolicyonfirstAID,coveringemployeesand
bringittothenoticeofallconcerned.
Firstaidroom.
GuidanceontherequirementofFirstAIDroomsiscontainedintheFactoriesAct1948.Thisisto
providetreatmentforminorinjuries,ambulanceshouldbethereandwellequippedfirstAIDboxtobe
there.
Controlmeasurestoavoidriskofoccupationaldiseases:
Preemploymentmedicalexamination
Periodicalmedicalexamination
Changeofjobassignment
Education
Useofpersonalprotectiveapplianceswhererequired
Substitution
Enclosure
Employment
158

Monitoringofworkenvironment
Adoptingengineeringcontrolmeasures
Goodhousekeepingandgoodventilation.
FOREIGNBODIES
Foreignbodiesintheskin: Smallforeignbodies(woodsplinters,shardsofglass)usuallycauseminor
puncturewoundswithlittleornobleeding.Ifforeignbodiesdeeplyembeddedinawoundisnotbe
removedbyafirstaided,itmaycausefurtherinjury.
Splinters: Smallsplintersofwood,metalorglassintheskinparticularlyofthehands,feetandknees
arecommoninjuries.Itshouldbedrawnoutbyusingtweezers.
Firstaid:
Cleanareaaroundthesplinterwithsoapandwater
Sterilizeapairortweezersbypassingthemthroughaflame
Graspthesplinterasclosetotheskinaspossible
Squeezethewoundtoencouragealittlebleeding
Applyanadhesivedressingplaster
Foreignbodiesintheeye:
Sandparticles,dust,smallpiecesofglass,coal,emerystone,metal,usuallyentertheeyeas
foreignbodies.Theseparticlesgetsituatedundertheeyelidsoreyeballs.
Signs&Symptoms:
1) Painandirritation
2) Wateryeyes
3) Photophobia
Firstaid:
1) Trytotakeoutonlythoseforeignbodieswhicharelyingonlyonthesurfaceareaoftheeyes.
2) Inanemergencycondition,itbecomesnecessarytotakeoutforeignbodiesthenthehand
shouldbewashedproperlyandcottonpieceorsofthandkerchiefshouldbemadewetwith
acornermadepointedandthentheforeignbodyshouldbetakenoutwithahelpofpointer
end.
3) Iftheforeignbodyinthemiddleportiondonottrytotakeitoutbecausethiscanleadtogreat
harm.Theeyesshouldbeclosed,paddedandthenpatientshouldbesenttothehospital.
4) Theforeignbodysometimescomesoutwhenthehairsofthelowereyelidgetrubbedwith
theupperunderpartoftheeye.
5) Donotrubtheeyesvigorously
6) Examinetheeyescarefullywithsofthands
Foreignbodiesintheear: Thecasesofforeignbodiesintheearoccurgenerallyinchildrenlikepeas,
buttons,seeds,flies,mosquitoesorbedbugs.
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Firstaid:
1) Neverusepinorpieceofwiretotakeoutforeignbodiesfromtheear.
2) Mosquitoes,bedbugsorfliesdiebyputtingoliveoilorsodabicarbinlukewarmwaterinto
theears.
3) Sentthepersontohospital.
Foreignbodiesinthenose: Certainforeignbodieslikepiecesofbetelnuts,grainsorpeasandother
seedsenterthenose.
Firstaid:
1) Puttingoliveoilorweatheroilinthenoseeithertheforeignbodycomesoutorirritationofthe
nosesubsides
2) Donotsneezeforcefully
3) Sentthepersontohospital.
Foreignbodiesinthethroat: Generallyinthethroatorupperpartoftherespiratorytract,some
piecesoffood,smallbonesoffish,coinsorartificialteethorotherthingscanenter.
Firstaid:
1) Generallytheforeignbodynotseeninthethroatandevenifitisseenthendonottrytotake
itoutbyfingerorothermeasures.
2) Bendthepersondownandbypattingontheshoulderthethingscomesout
3) Artificialrespiration
4) Sendthepatienttothehospital.
ForeignbodiesintheStomach: Theintroductionofforeignbodiesintothestomacharegenerally
foundinthechildrenlikebuttons,seedsoffruits,coins,safetypins
Firstaid:
1) Noimmediaterisk
2) Geteliminatedduringevacuation
3) Noneedtogivelaxatives.
CARACCIDENT
Thesituations
lookofvictims
inspectthevictimsforbleeding,asphyxiaorburningcar
Preventfurtheraccident.
putoutfirewitharug,soilorsand
turnoffcarlightsandswitchofftheigniter
applythebrakesorblocksthewheelswithabulkyobject
160

 setwarningsaredreflectortriangleandawhitescarfornewspaperalongtheroadupto200
yardseithersideoftheaccident
atnightwearboldlywhite
Thepatient:Patientshouldbeprotectedbysupportingneckandjawwithacollarmadefroma
newspaperthicklyfoldedtoformarigedbutpliablesupportabout3by12inchesandinsertedintoa
stocking.
Extractingthepatientfromabuckledcarespeciallyifthedoorsarejammedandiftheinjuries
includefracturedspineandlimbs.Leaveittotheexpectsofpolice,ambulance,firebrigade,rescue
doctors.
Thecarfirstaidkit:
Kitshouldbekeptinawellclosedbuteasilyopened,clearlylabeled,metalorplasticbox
Triangularbandages
Womendiscardedstockings
Whitegauze
Gamgeetissue(inlargepieces12inchesby18inches)
Cottonelasticorcrepebandages
Adhesivetape
Scissorsandarescueblanket
Whenbreaksdontworkwhattodo
pumpthebreakpedal
parkmeanstheparkingbreakuseitbutdontjamit.Itcancauseaspin
shiftintoalowergear
sideswipesomethingaguardrailorcurb,somebushes,evenparkedcar.
Sixthingstodobeforehelparrives:
avoidasecondcollision.Dontpackbehindthewreck,orontheoppositesideoftheroad
Reducethechanceoffirebyturningofftheignition
Assisttheinjured
Getthevictimsoutofdanger
Gethelp.Callthepoliceorambulance
Searchtheareaforvictimswhomighthavebeenthrownfromthecarsinvolved.
161

CARDIOPULMONARYRESUSCITATION(CPR)
Resuscitationincludesallmeasuresthatareappliedtorevivepatientswhohavestoppedbreathing
suddenlyandunexpectedlyduetoeitherrespiratoryorcardiacfailure.Cardiacarrestisoneofthe
commoncausesforcardiorespiratoryfailure.
Whenapersonstopsbreathingspontaneously,hisheartalsostopsbeating.Clinicaldearthoccurs.
Within4to6minutes,thecellsofthebrain.Whicharesensitivitytothepaucityofoxygenbeginto
deteriorate.Iftheoxygensupplyisnotrestored,thepatientsufferirreversiblebraindamageandsbiological
deathoccurs.
Cardiorespiratoryfailure:
Therespiratoryandcardiovascularsystemsareinterdependent.Theheartconsumedmoreoxy
genperminutethananyotherorganinthebody,becauseitisconstantlybeating.Consequently,when
thelungsstopsworking,theheartfailoccurs.Conversely.,theventilationofhelungsfailsoonafterthe
heartstops.Thisisbecausetherespiratorycentreinthemedullaoblongatacannotfunctionwithoutthe
continuoussupplythatisnormallytransportedtoitbythecardiovascularsystem.
Sequenceofcardiopulmonaryresuscitation:
AAirway.
BBreathing.

CCirculation

Generalinstruction:
1) CPRtechniquesareusedinpersonswhoserespirationsandcirculationofbloodhave
suddenlyandunexpectedlystopped.
2) Theimmediateresponsibilitiesoftheresuscitatorare:
Torecognizethesignsofcardiacarrest.
Toprotectthepatientsbrainfromanoxia.
Tocallforhelp.
3) TheCPRmustbeinitiatedwithin3to4minutesinordertopreventpermanentbraindamage.
4) TheCPRtechniquesshouldnotbediscontinuedformorethan5secondsbeforenormal
circulationandventilationoflungsareestablished.
5) BeforeCPRisattemptedinapatient,makesurethattheairwayisclear.
6) Cardiaccompressionshelptostimulatethecirculation.
7) Theartificialbreathingandthecardiacmassageshouldcorrespondtothenormalrespiration
andpulserate.Theratioofcardiaccompressiontoventilationrateis5:1i.e5cardiac
compressiontooneventilation.Cardiaccompressiongivenattherateof60perminute.
Ventilationsaregivenattherateof12perminute.
8) Whentherearetworescuers,bothpositionthemselvesoneithersidesofthevictimsi.eone
rescuerdoesartificialventilationwhileheotherdoesexternalcardiaccompressions.Theratio
ofcardiaccompressiontoventilationrateis15:2
9) Thecirculationofbloodisinitiatedwiththeexternalcardiacmassagebecause,thepressure
exertedonthepliablesternumsqueezestheheartagainstthespineforcingbloodoutofthe
heartintoaorta.
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10) Watchforcomplicationsthatmayoccurduringthecardiopulmonaryresuscitation.
11) Discontinuetheprocedureonlywhenyouaresurethattherespirationsandcirculationrere
established.
12) Patientsviralsignsarewatchedconstantlyoveraperiodof24to48hoursafterthecardiac
arrest,becauseofthedangerofrecurringanothercardiacarrestatanytime.
13) Anasogastricincubationandaspirationofgastriccontentsarenecessaryforapatientwith
fullstomachtopreventvomitingandaspirationofvomitusintothelungs.
Complications:
1) Damagetothecervicalspineduetohyperextensionoftheneck.
2) Fractureoftheribandxiphoidprocess.
3) Hemopericardium.
4) Pneumothorax.
5) Intraabdominalhemorrhage.
6) Gastricdistentionofair.
7) Aspirationofthevomitusintothelungs.
EMERGENCYKIT
Anemergencybagorkitwillhelpyoutoprovideemergencycareandtreatmentinanefficient
way.Thecontentsofanemergencybagwillvaryconsiderablyaccordingtoplkaceofpractice,proxim
ityofaprimaryhealthcentre,medicalclinicorhospital,yourindividualpreferenceforpracticeina
specialityareaonlyandstandingordersforadministrationofmedicines,injections,oranyothertreat
mentinanemergency.Somenursesmaywishtoaddordeleteitemsfromthelistofsuggesteditems
giveninthefollowingsection.
Theemergencybagshouldbeaportableone,withcompartmentsandpocketswithflaps.Re
placementofeachitemassoonaspossibleafteruseisimperativetoavoidwastingtimelookingfor
itemsinanemergency.Checkthebagregularlyreplenishwhennecessaryandkeepitemsinthesame
place.
EmergencyBagContents
ItemsandDesriptionQuantity

For
Assessment

Flashlight,(Medicaluse)
Tonguespatula
Thermometer
Aneroidsphygmomanometer
Stethoscope
Gloves,rubber
Smallwritingpad
Pen
163

1
1
1
1
1
1pair
1
1

ItemsandDesriptionQuantity
ForEmergency
CareTreatment

Bandages,assortedsizes
Bandagetriangular
Gauzepads,individuallypacked,sterile
Adhesivedressingstrips(bandaid)
Cottontippedapplicators
Cottonwool,smallpacket
Adhesivetape
Safetypins,assortedsizes
Eyepads
Splints,lightwood,plywood
Bottles,screwtopped,widemouthed(forspecimen)
Catheters,plasticorrubber,urethral
Gastriclavagetube,rubber,mediumsize
Tourniquetorrubbertubingstrip
Intravenousdripset,disposabletypewithneedle
Hypodermicsyringe2ml.
Hypodermicsyringe5ml.
HypodermicneedlesNo.26,24,22sizes
Fileforcuttingampoules
Pocketknife
Scalpel
Scissorsblunttipped
Scissorssharppointed
Forceps,arteryclamps
Forceps,dissecting
DextranorDextrosesolution(asintravenousdrip
starterinnonbreakableflaskorbag)
OralRehydrationpower
TetanusToxoid5ml.vial
InjectionAdrenalin1:10001ml.
InjectionPethedine100mgin2ml.
InjectionMorphineSulphate30mgin2ml.
InjectionAtropineSulphate1mgin1ml.
CombinedInjectionMorphineSulphateand
AtropineSulphate

6
2
6
1packet
6
1
1roll
1dozen
2
2
2
2
1
1
1set
1
1
4
1
1
1
1
1
2
1
500ml.
2packets
1vial
2ampoules
1ampoules
1ampoules
1ampoules
1ampoules

OralMedications
Antihistamineseg.
Antispasmodicseg.
Antimeticseg.
Analgesicseg.
Antiasthmaticseg.
Antacideg.

TabletAvil,Phenergan,Benadryl.
TabletSpasmindon,Belladonna
TabletSiquil,Stemetil,
TabletAspirin,Dispirin,Crocin,Paracetamol,
Novalgin
TabletAminophylline,Ephedrine
TabletAludrox,Gelusil
164

TopicalMedicationsforExternalApplication
RectifiedSpirit30ml.
Tincturebenzoin30ml.
TinctureIodine,weak
LotionCalamine30ml.
Lignocaine/Xylocaineointment9%

1bottle.
1bottle.
1bottle.
1bottle
1tube.

EyeOinment
TetracyclineEyeOintment1%

1tube

Summary:
1)FirstAidistheinitialassistanceortreatmentgiventosomeonewhoisinjuredorsuddenlytakenill.
2)Donotdelayorreenteraburningbuildingtopersonalpossessions
3)Burnsareaccordingtothedepthsaresuperficial,partialthickness,fullthickness.
4)Chemicalburntotheeye,firstaideristowashouttheeyesothatthechemicalisdilutedand
dispersed
5)Afractureisabreakincontinuityofabone,thismayvaryfromacracktoaCompletebreak.
6)Poisonisasubstancewhichistakenintothebodyinsufficientquantitymaycausetemporaryor
permanentdamage.
7)Drowningisaconditionofsuffocationwhichmayleadtodeath,duetoairwayspasmorwater
enteringintotheairwayduringswimmingorwheninwater.
8)Haemorrhageorbleedingisaflowofbloodfromanartey,veinorcapillary.
9)Bandagesaremadeofcotton,gauzecrepe,elasticfabricorlinenarewrappedaroundthe
injuredinspiralturns,figureofeight.
10)Frostbitesoccurwhenthebodyisexposedtoextremecoldtemperature.
11)SunburnisCausedbyoverexposuretosun.
12)Heatstrokeiscausedbyfailureofbodytemperatudeinthebrain
QUESTIONS
PARTA MEANING OF THEFOLLOWING TERMS: (Onemark)
1. Coldinjury.
2.Greenstickfracture.
3.Rabies
4. Epistaxis
5.Shoulderspica
PARTB MULTIPLECHOICEQUESTIONS: (Onemark)
1)Firstaidtreatmentisgiventoacasualtyto
a)Preservelife

b)Promotehealth

c)Preventillness

2)Scaldiscausedby
a)Hotobjects

b)Steam
165

c)Flames

3)Sunburnisatypeof
a)Superficial

b)Partialthickness

c)Fullthickness

4)Lossofsaltandwaterfromthebodythroughexcessivesweatingcauses
a)Heatexhaustion b)Thirst

c)Frostbite.

5)Theboneisbrokenintoseveralfragments.
a)Commnutatedfracture

b)Impactedfracture c)Stressfracture

6)Electricshockcancause
a)Cardiacarrest

b)Respiratoryarrest

c)Hypoxia

7)Chemicalburntotheeyes
a)Washouttheeyes b)Applyeyedrops

c)Dontdoanything

8)Temperatureofheatstrokeis
a)Above104degree

b)Below100degree c)102to104degree

9)Firstaidforfracture
a)Supporttheinjuredpartforimmobilization
b)Monitorthevitalsigns
c)Aboveall
10)TreatmentforScorpionbite
a)ApplycoldcompressandwashwithKMNo4
b)ApplyhotcompressandwashwithKMNO4
c)Dontapplyanything
11) Thefollowingarethesignsandsymptomsofheatstrokeareexcept
a) temperaturerisesupto104degreeForhigher
b) faceispalewithcoldsweat.
c) Restlessnessandconfusion.
d) Rapidunconsciousness.
12) Thefollowingarethefirstaidforthefrostbiteexcept
a) Gradualwarmingbybodyheat.
b) Givewarmdrinksandcoverpatientbydrycloth.
c) Takethepatienttotheclosedroom.
d) Rubthefrozenpartwithsnow.
166

13) Themainaimoffirstaidinfoodpoisoningisto
a) Eliminatethepoison.
b) Avoidtheirabsorption.
c) Makethemlessharmful.
d) Alloftheabove.
14) Thevomitingshouldnotbeinducedinthefollowingpoisoning
a) Acetylsalicylicacidb)Arsenicc)concentratedacidd)Atropine.
15) Ifthebrakesofthecardoesnotworktheorderoftechniquestobeusedis
a) Pump,park,shift,swipe.
b) Park,shift,swipe,pump.
c) Shift,swipe,pump,park.
d) Swipe,pump,park,shift.
16) Thefirstaidfortheforeignbodyintheeararethefollowingexcept
a) usepinorwiretoremove
b) useoliveoil
c) outsodabicarbinlukewarmH2O&pourintotheear
d) Refertheclienttothedoctor
17) Thespecificantidotefortheleadpoisoning
a) magnesiumsulphateb)diazepamc)Sodiumsulphated)calciumEDTacid
18) Thecommonfeaturesofgingivitis,tremorswithsleepdisturbanceareseenin
a)Mercurypoisoning
c)turpentinepoisoning

b)Leadpoisoning
d)cyanidepoisoning

19) Thesigns&symptomsofturpentinepoisoningare
a)Burningsensationsinthestomach
b)Diarrhea&vomiting
c)Weakpulse&shallowrespiration
d)alltheabove
20) Employeesworkinginradiationshouldbemonitoredforexposureofintervalsof
a)9month

b)3month

c)6month
167

d)4months

PARTC ANSWER THEFOLLOWING: (5marks)

1)DefinefirstAidandwriteaimsoffirstaid.
2)Whatarethetypesofhaemorrhage?
3)Typesofinsectsbite?
4)Writesignsandsymptomsofsnakebite.
5)Whatarethepatternsusedinbandages?
PARTD WRITEINDETAIL: (10marks)
1)Typesofburns
2)Typesoffracture
3)Drowningmanagement

4)Rulesforapplyingrollerbandage

5)Typesofsling
PARTE WRITEESSAY: (20marks)
1)Rulesandprinciplesoffirstaid
2)Burnsmanagement
3)Firstaidmanagementforpoisoning
4)Managementofbleeding
5)Managementofinsectbite

168

8.HOSPITALHOUSEKEEPING
Awellmanagedhousekeepingdepartmentcanreducethecostofhospitaloperationconsiderably.
Ifthehospitalhousekeepingisofpoorquality,nursingcaresuffers,nursingeducationisadversely
affected,efficiencyisloweredandthemoraleisimpaired.
PRINCIPLESOFGOODHOUSEKEEPING
1) Thedustingcanbedonebestbyadampdusterorbyanoiledcloth.Adrydusterscattersthe
dust.
2) Dustingisdoneaftersweepingandnotbefore
3) Soapandwaterareusedforcleaning.
4) Frictionaidsinmechanicalcleaning.Usebrushwhencleaningagroovedsurface..
5) Abrasivesareharmfultothepaintedandpolishedsurface.
6) Albuminousmaterials(e.g.,bodydischarges)arecoagulatedbytheheat.So,itshouldbe
removedwithcoldwater.
7) Bacteriagrowindark,moistanduncleanplaces
8) Exposuretosunlightdestroyssomebacteria
9) Disinfectionbychemicalsdependsuponthecleanlinessofthearticle,thestrengthofthedisinfectant
andthelengthofexposure.
10) Effectivesterilizationdependsuponthecleanlinessofthearticles,thedegreeofheatandthe
lengthofexposure
11) Heat,chemicals,abrasivesandsolventsareharmfultosomematerials.
12) Choosingthecorrectandthesimplestmethodofcleaning,savestime,materialandenergy
13) Equipmentsuitableforthepurposeforwhichitisusedandingoodcondition,conveniently
locatedandarranged,savestimematerialandenergy.
14) Thecleaningarticlesarestoredinaneatandtidyalways.
CLEANLINESSANDORDERLINESS:
Cleanlinessandorderlinessgohandinhand.Nursesareheldresponsibleforthecleanlinessof
thewards.
Purposeincleaning:
1) Toleaveacleanpolishedsurfacewherepossible,sothatdirtmaynotbeaccumulated.
2) Toremovealldust,dirtandbreedingplacesofmicroorganismswiththeleastdisturbanceto
thepatient.
3) Toprolongthelifeofthearticles.
4) Tokeepthearticlesinsuchaconditionthattheyarereadyforuseatanytime.
5. Tomaintaintheaestheticfactors.
169

CAREOFRUBBERGOODS:
Therubbergoodsincommonusearemackintosh,hotwaterbottles,icecaps,icecollars,rubber
tubes,catheters,glovesandrubberbeds.
Naturalandsyntheticrubberdeterioratewithage,exposuretoheat,light,moisturesandbychemi
cals.Rubbergoodshouldneverbedriedbyartificialheat,norbycontactwiththeradiatororstove.It
shouldbefreefromGreeceandacids.
Ifautoclavingisused,shortperiodsofexposurearerecommended(1015minutes).
Cleaningofrubbermackintosh:
1) Spreadthemackintoshonthetableoraflatsurfaceandwetwithcoldwater
2) Rubtheuppersurfacewithsoapandwater
3) Turntheothersiderubwithsoapandwater
4) Ifstrainsarepresenttoberemoved.
5) Fordisinfectionuselyzolordettol1:40
6) Hangthemonahorizontalcylindricalpole
7) Bothsurfacesabsolutelydrypowderthem.
8) Storethemflatorrolled,neverfolded.
9) Storetheminadarkcoolplace.
CareofRubberGloves:
1) Itisdesiredthattheweareroftheglovesshouldwashontheirhandsjustbeforetheyare
removed.
2) Afterremovingfromthehands,theyarewashedwithsoapandcoldwater,firstontheoutside
theninvertandrepeatontheinside.
3) Rinsewellwithwaterbothinsideandoutside
4) Holesandtearsarediscoveredbysubmergingtheglovefilledwithairinthewater.Ifthere
holes,separatethegloves.
5) Hangthemtodry.
6) Turninsideoutanddry
7) Whenbothsidesaredry,powderedinsideandoutsideandpackedinpairsofthesamesize.
8) Steamunderpressureisthebestmethodofsterilizinggloves.
CareofRubberTubes:
Cathetersvaryinsizeandqualityaccordingtothespecialneeds.
Cleaningofrubbertubes:
1) Afteruse,washthemunderrunningwater
2) Asmallquantityoforganicmattermaybelodgedattheeyeend.Removethemusingaswap
stick
3) Cleanthemwiththesoapandwater
170

4) Washthemagainunderrunningwater
5) Boiledtubesfor5minutesbyputtingthemintheboiledwater.
6) Dryitbyhanging
7) Whendried,powderedandstoretheminairtightcontainer
8) Reboilorautoclavethembeforeuse.
CAREOFENAMELWARE
Thearticlescommonlyusedarebedpans,urinals,kidneytrays,sputumcups,feedingcupsand
trays.
Careofthebedpans:
1) Beforeemptyingthebedpans,inspectthecontents.Iftherearecottonspongesorsanitarypads
shouldberemovedbyusingaforceps.
2) Emptythebedpantoalavatorypan
3) Rinsethebedpanwithcoldwaterunderforce
4) Washwithsoapandwarmwaterusingabrush
5) Todisinfectantthebedpans,soaktheminLysol1:40
6) Bedpansmaybeplacedindirectsunlightforfewhours
7) Keepthemdryforthenextuseonthebedpantrack
Careoftheurinals:
Theurinalshouldnotbeleftstandingforalongtimewithurine.Itshouldbecleansedanddisin
fectedbyusingLysolsolution1:40
Careofthekidneytrays:
1) Beforeemptyingthekidneytray,inspectthecontents.Iftherearecottonspongesorsanitary
padsshouldberemovedbyusingaforceps.
2) Emptythekidneytraytoalavatorypan
3) Rinsethekidneytraywithcoldwaterunderforce
4) Washwithsoapandwarmwaterusingabrush
5) Todisinfectantthekidneytray,soaktheminLysol1:40
6) Kidneytraymaybeplacedindirectsunlightforfewhours
7) Keepthemdryforthenextuseonthekidneytraytrack
Careofthesputumcups:
NoninfectioussputummaybeemptiedLavatorypan.
Infectioussputumshouldberenderedbyboilingordisinfectionbychemicalsordisposedbyburning.
CAREOFINSTRUMENTS
Careofsharpinstruments: Theknifesandscissorsarethemostcommonlyusedsharpinstruments.
Sharpinstrumentsaresterilizedbyhotairsterilizerexposingintoatemperatureof160cforanhour.
Chemicaldisinfectionscanbedonebysubmergingthemfullyunderpuredettolorotherdisinfectants.
171

Careofotherinstruments: Operationtheatreinstrumentsshoulddropintoabasinorbucket.Rinse
theinstrumentsthoroughlywithcoldwatertoremovethebloodorotherorganicmatter.
Cleantheinstrumentswithsodiumcarbonate(2%)andhotwater.
Careofglassware: Cleaningoftheglasswareshouldhaveahardsmoothsurfacegroundglasssusceptible
toerosionbywaterorsteam.Itshouldbesterilizedwithdryheat.Glasswaresusedfortheparenteral
therapyshouldberinsedwithfreshlydistilledwater.Whentheglassgoodsaresentforautoclavingor
boiling,shouldbeadequatelypaddedtopreventbrakingbyrubbingwithhardsurfaces.
Careofsyringesandneedles: Syringesareexpensiveandcommonitemoftheglasswareusedin
thehospital.Rinsingimmediatelyafterusetopreventthepistonsstickingtothebarrels,thusprolonging
thelifeofsyringes.
Stucksyringesplacedin25%ofaqueoussolutionsofglycerineandboiledfor10minutes.
Whencleaningandsterilizingthesyringesofthesamenumbershouldbekepttogether.Steriliza
tionbyhotairisthebestmethodofsterilizationofglasssyringes.
Theimportantpointstoremember
1) Afterusecoldwaterisforcedthroughtheneedlewiththesyringes
2) Againwashitwithwarmwater
3) Iftheneedlesareblockedwirestillestareusedtoremove
4) Needlesaresterilizedby1020minutes.
Careofthestainlessgood:
Stainlesssteelutensilsaresuitableforalmosteveryotherpurposebecausetheyareeasilycleaned,
heatresistantandunbreakable.
CAREOFLINEN
Careoflinenisimportantandexpensiveiteminthehospital.
Rules:
1) Thelinencupboardshouldbekeptinperfectorder.
2) Thecupboardsshouldbelockedwhennotinuse.
3) Careshouldbetakentoavoidlinenbeingtakenhomebythepatients
4) Stockshouldbecheckedatregularintervals.
5) Allitemsshouldbeusedforthepurposesforwhichtheyweremade.
6) Tornlinenshouldnotbeusedonthebedbutsentformending
7) Soiledlinenshouldnotbeplacedonthefloor
8) Damplinenshouldbedriedimmediately.
9) Ifsoiledwithurineormotion,theseshouldberinsedwithcoldwater
10) Removethestrainwherestrainingisunavoidableoldlinenshouldbeused.
172

11) Theinfectedlinensshouldbedisinfectedfirst.
12) Usemackintoshwhereveritisnecessarytoeconomizetheuseoflinen.
Generalinstructionsforremovalofstrainsfromthelinens:
1) Trywhetherthestrainscanberemovedwithcoldwater.
2) Thestrainswhichcontainsproteinssuchasblood,excreta,milk,pusfromthewoundare
coagulatedbytheapplicationofheat
3) Ifthestrainscontainedfattymaterial,hotwaterandsoakshouldbeused.
4) Whenthestrainsdonotresponsetothesimplemethods,bleachingagentsmaybeusedsuchas
lemonjuice,hydrogenperoxideandbleachingpowder.
5) Useequalpartsofhydrogenperoxideanddiluteammoniaandmoisturethestrainuntildisappears.
Bloodstains: Soakimmediatelyincoldwater.whenthestainsdisappear,washtheminwarmsoapy
water.Ifitisoldstain,soaktheminamixtureofhydrogenperoxideandammonia.
Forthethickbloodstainsonthemattress,applyathickpasteofstarchandwaterandallowto
standinthesun.Whenthepasteisdryanddiscoloured,brushoffthestain.
Teacoffee,coco: Linenwhenitisstainedwithtea,coffee,andcoco,removeitbypouringmilkoverit.
Washingthemincoldwaterorhotwater.Sodiumcarbonatewillremovethestains.
Rustmarks: Applysaltandlimejuiceandexposedtosunlight
Inkstrain: Sprinklesaltandlimejuiceandlayinthesuntobleachthestrain
Careofblankets: Theseareexpensivearticlesanddonotstandwashingorsteamdisinfectionswithout
shrinkage.Blanketsshouldbeprotectedbysheetsbyunderandoverit.
Blanketsarecleanedbydrycleaningtodisinfectthembyexposingthemtosunlight.Whenstoring
blanketsshouldbecarefullyprotectedfrommothusingnaphthaleneballs.
Careofmattressandpillows:
Mattressshouldbebrushedatregularandfrequentintervalstopreventcollectionofdustand
alongtheseams.Topreventrustingofthemattressfromthewiresorsprings,usecanvassbetweenthe
mattressandbedsheett.Whenthepatientdischarged,mattressshouldbethoroughlybrushedand
examineforstrainsandtears.Itshouldbetreatedatonce.Disinfectedbyexposingthemtosunlight.
Pillowsshouldbeprotectedfromwetwithbloodandbodilydischarges.Theyshouldbeprotectedwith
mackintosheswhentheyareusedforthepatientswithbleeding,vomitingetc.
CAREOF PATIENTSUNIT
Careoftheflooring: Floorsaremoppedwithmopsofgoodquality.Vacuumcleanersmaybeused.
Mostofthefloorswashedwithsoapandwater.
Woodenfloorsarekeptwellpolished.Theyaremoppeddaily.Watershouldbewipedofimmediately.
Cementfloorscanbecleanedwithhotwaterandweaksolutionofsodiumcarbonate.
Mosaicfloorscleanedwithmildalkalinesolutionsuchassoda,sodabicarbetc.
173

Careofthewalls: Cementandmarblewallscanbecleanedinthesamewayasthefloors.
Paintedwalls: Neverusecleaningsolutionsthatcontainsastrongalkaline.Paintedsurfaceshould
alwaysbecarefullyrinsedanddried.
Dailycleaning: Thepatientsunitissweptandmoppedtwiceorthriceadaytokeepitclean.The
furnitureshouldbemovedtocollectthedustpresentunderthem.Aftersweeping,allthearticlesare
dustedwithdampduster,dampenedwithdisinfectant.
Weeklycleaning: Theroofandwallsofthewallshouldbeswepteachweektoremovethecobwebs.
Theceilingfansaredustedwiththedampduster.Allthefurnituresshouldbescrubbed,washedand
carbolized.
Careofthesanitaryannex: Sanitaryannexattachedtothewardsconsistofbathingrooms,lavatories,
handwashingplaces,placeforwashingandstoringofbedpans,urinalsetc.
Bathingroom: Thefloorshouldbescrubbed,washeddailytopreventslipping.Nowatershould
stagnateinthebathingroom
Lavatories: Lavatoriespansshouldbecleanedwithvimorsanefresh,usingabrushifstrainsare
present,smearasmallamountofacidandwashitoff.Thepatientsandtherelativesshouldbetaught
regardingproperuseoflatrine.
Handwashingplace: Thedrainsmaybecomeblockedbytherefusethrownintothesinksbythe
patients.Theyshouldbetoldnottothrowintothesink.
Summary
Wellmanagedhousekeepingdepartmentcanreducethecostofhospitaloperation.
Effectivesterilizationdependsuponthecleanlinessofthearticles,thedegreeofheatand
thelengthofexposure.
Rubbergoodshouldneverbedriedbyartificialheatorbycontactwiththeradiatoror
stove.
Fordisinfectionofrubbermackintoshuselysolordettol1:40dilution.
Holesandtearsarediscoveredbysubmergingtheglovefilledwithairorwater.
Steamunderpressureisthebestmethodofsterilizinggloves.
Cleaningofrubbertubesareboiledfor5minutesbyputtingthemintheboiledwater.
Sterilizationbyhotairisthebestmethodofsterilizationofglasssyringes.
Needlesaresterilizedby1020minutes.
Removalofstrainsfromthelinensbyusingequalpartsofhydrogenperoxideanddilute
ammoniaandmoisturethestrainuntildisappears.
Mosaicfloorscleanedwithmildalkalinesolutionsuchassoda,sodabicarbetc.

174

QUESTIONS
PARTA ANSWERINONEORTWOWORDS:(Onemark)
1) Statesomerubbergoodsusedinhospitals?
2) Timeperiodrecommendedforautoclavingofrubbergoods?
3) Whatistheratiousedfordisinfectionofrubbergoodsbydettol?
4) Whichisthebestmethodofsterilizinggloves?
5) Howtodisinfectbedpan?
6) Whichoneisthebestmethodofsterilizingglasssyringes?
7) WhatIthetimedurationtosterilizetheneedles?
8) Howtoremovethestainsfromthelinen?
9) Whatisusedtocleancementfloor?
10) Howtoremoverustmarks?
PARTB MULTIPLECHOICEQUESTIONS:(Onemark)
1) Dustingcanbedonebestby
a)WetDuster

b)DryDuster c)Alloftheabove

d)Noneoftheabove

2) Bacteriagrowin
a)CleanPlaces b)DryPlaces
c)Dark,Moistanduncleanedareas
d)Areasexposedtosunlight
3) Howtoidentifytheholesandtearsinthegloves?
a)VisualInspection

b)VisualInspectionwithgoodlight

c)Submergetheglovefilledwithairinthewater
d)Whilewearing
4) Sharpinstrumentsaresterilizedbyhotairsterilizerexposingintotemperatureat
a)Temperatureof160deg.celciusperhour
b)Temperatureof180deg.celciusperhour
c)Temperatureof200deg.celciusperhour
d)Temperatureof220deg.celciusperhour
5) Toremovebloodstain(thick)fromthemattressbymeans
a)Applyathickpasteofstarchandwater
b)Applylemonjuice
c)Washwithsoapandwater
d)Washwithhotwater
175

6) Blanketsshouldbecarefullystoredtoprotectfrommothbyusing
a)UsingNaptheleneballs

b)Usinginsecticides

c)Usingcamphor

d)UsingSandal

7) Mosaicfloorsshouldbecleanedwith
a)Alkalinesolution

b)AcidicSolution

c)Water

d)Sodiumbicarbonate

8) Dustingisdoneby
a)BeforeSweeping

b)AfterSweeping

c)DuringSweeping

d)AfterMopping

9) Exposuretosunlightdestroy
a)Bacteria

b)Virus

c)Fungi

d)Spirochete

10) Rubbergoodsshouldneverbedriedby
a)ArtificialHeat

b)NaturalHeat

c)Air

d)Dusting

PARTC WRITESHORTANSWERS:(5marks)
1) Explainpurposeofcleaning?
2) Describecleaningofrubbermackintosh?
3) Enumertate4thestepsincareofrubbergloves?
4) Howtocaresharpinstruments?
5) Howtocleansyringesandneedles?
PARTD WRITEINDETAIL: (10marks)
1) Elicitthegoodprinciplesofhousekeeping?
2) Explainthecareofgoodinstruments?
3) Explaintherulesincareoflinen?
4) Enumerategeneralinstructionsforremovalofstainsfromlinens?
5) Explainthecareofpatientunit?
PARTE WRITEESSAY:(20marks)
1) Explainhospitalhouse keeping?
2) Explainthecareofrubbergoods?

176

NURSING
PracticalI&II
VocationalEducation
HIGHERSECONDARYFIRSTYEAR

A Publication under
GovernmentofTamilnadu
DistributionofFreeTextbookProgramme
(Notforsale)

Untouchabilityisasin
Untouchabilityisacrime
Untouchabilityisinhuman

CollegeRoad,Chennai600006.

GovernmentofTamilnadu
FirstEdition2010

CHAIR PERSON
Dr.Mrs.P. MangalaGowri
CollegeofNursing
MadrasMedicalCollege
Chennai600003.

Authors
Dr. Mrs.Prasanna Baby
CollegeofNursing
ChengalpetMedicalCollege
Chengalpet.

Mrs.M.Elizabeth
GovernmentHigherSecondarySchool
Ottanchantram.

Dr. Mrs.N. Jaya

CollegeofNursing
MadrasMedicalCollege
Chennai600003.

Prof. Kamala Subbaiyan

VenkateshwaraCollegeofNursing
Chennai.

ThisbookhasbeenpreparedbytheDirectorateofSchoolEducation
onbehalfoftheGovernmentofTamilnadu
Thisbookhasbeenprintedon60GSMpaper

FOREWORD
The development of the text book Nursing resulted from the combined efforts many
talentedprofessional,committedtoexcellence.Specialrecognitionanddueacknowledgeishereby
madetotheDirectorofSchoolEducationandtheJointDirectorofSchoolEducationChennai.
Nursingisapracticalorientedprofession.Thenursehasmultifacetedroleinhospitalsettingsasa
careprovidetoclients,administrator,superviosor,etc.Butthemainroleplayedinthehospitalisthe
careprovider.Thenurseshouldbewelltrainedtomanageallpracticalsituationindifferentareasof
treatment.Sheshouldbeabletoassesstheclientofvariousconditions.Sheshouldbeskilledinprovid
ingcareaspertheassessmentfindings.
Thisbookiswrittenforthehighersecondarystudentswhoneedtogainthepracticalbefore
joiningtheprofessionalcourseinNursing.
Inthiseditionvariousbasicnursingprocedureshavebeendescribed.Thiswillbeaguid
anceforthestudentstogaintheskilltopracticenursing.Thiswillpavethewayfortheprofes
sionalcareerinfuture.
Dr.Mrs.P.MangalaGowri.

III

VOCATIONALNURSING
HIGHERSECONDARY
FIRSTYEAR
PRACTICALSI

IV

PRACTICALSI
Sl.

Procedure

Date

No.
I.

Ward
Bedmaking.
Unoccupied bed.
Occupied bed.

II.

Basiccare
Mouthcare.
Backcare.
Sponging.
Nailcare.
Haircare.
Foot care

III.

Recordingofvitalsigns.
Temperature.
Pulse.
Respiration.
Blood pressure.

Classroom

Signature

PRACTICALSI
Sl.

Procedure

Date

No.
IV.

Ward
Positioningofpatients.
SupinePosition
Prone Position
LateralPosition
Fowlers Position
DorsalRecumbent
Dorsal(Supine)Position
SittingPosition
Lithotomy Position
KneechestPosition
Sims Position

VI

Classroom

Signature

CONTENTS
NursingLaboratoryhours200periods
Clinicalhours
80periods

S.No
I.

Subject

PageNo.

Bedmaking.

A.Unoccupiedbed.

B.Occupiedbed.

II.

Basiccare

Mouthcare.

Backcare.

Sponging.

10

CareofFootandNails.

12

CareofHair.

14

III.

Recordingofvitalsigns.

20

Temperature.

20

Pulse.

20

Respiration.

20

Blood pressure.

24

IV.

Positioningofpatients.

26

VII

BED MAKING
BEDMAKING(Proceduretokeepbedcleanandcomfortable)
1) BED/COT:Metalrods/spring,Wood/plasticwire
Length
:78inch.
Breadth
:38inch.
Height
:28inch
2) MATTRESS: Firm, thick smooth, with washable covers that are bigger than the
mattressmadeofcotton,coir,dunlop,air,water.
Length
:190cms.
Breadth
:90cms.
3) BEDSPREAD/TOPSHEET
Length
:3mts.
Breadth
:2mts.
4) DRAWMACKINTOSH:Shouldertobelowtheknees(rubberorplastic)
5) DRAWSHEET:drawnfromsidetoside
Length
:150cms.
Breadth
:110cms.
6) FOOTSHEET/BOTTOMSHEET
Length
:108inch.
Breadth
:76inch.
7) PILLOWS:Cotton/firmwithpillowcase
Length
:60cms.
Breadth
:45cms.
Thickness :10cms.
8) SPACEBETWEENCOTS:3to3.5feet.
Purposes
1) Toreceivethepatientcomfortably.
2) Togivetheunitorwardaneatappearance.
3) Toprovideasafebedtothepatient.
Guidelines
1) Worksystematically
2) Planthework
3) Collectequipmentintheorderthattheyaretobeused.
4) Arrangetheenvironmentconveniently.
5) Accomplishataskwitheachmovement.
1

6) Avoidtornlinen
7) Preventlinenawayfromyou.
8) Foldlinenandpreventtouchingthefloor.
9) Avoidplacingdirtylinenonthefloor.
10) Shakegently,donotflap.
11) Facedirectionofwork.
12) Workfromheadtofoot,fromneartofarandfromcleantounclean.
13) Makethebedsmooth,unwrinkledandflat
14) Tucklinenforenoughunderthematressandkeepitfixed,tightandsmooth.
15) Donotaltertheshapeofthemattress
16) Maintainbodymechanics
17) Ensuretheclientscomfortandsafety.
18) Ensureyourownpersonalsafety.
UNOCCUPIEDBED
Equipmentsrequired:
1)Carbolizationarticles,hamber,bucket,mattresswithcover.
2)Pillow,Pillowcase,Blanket,topsheet,drawsheet,DrawMackintosh,Bottomsheet,longmack
intosh.
Stepsforbedmaking:
1)Washhandsthoroughly.
2)Arrangethoroughlyinordertouseonastoolatthefootendofbed.
3)Carbolizethemattressandcot.
4)Turnthemattressandpullthecoveron.
5)Placebottomsheetwiththecreaseinthemiddleandrestinupperrightquadrantofmattress.
6)Unfoldandspreadstraight.
7)Tuck1218inchesunderthemattressonrightheadendwithhandsstraightandpalmsdown.
8) Makeamitredcornersandtuck.
9) Tuckatfootend.
10) Pulltightandtuckthesheetalongtherightside
11) Placedrawmackintosh15inch.fromthetopandtuckitalongtherightside
12) Placedrawsheetoverthemackintoshabout3.5inch.abovethemackintoshandtuckit
alongtherightside.
13) Gotooppositesideleftandtuckineachlinenasdoneontherightsidebutfanfoldandtuck
thedrawsheetontheleftside.
2

14) Cometotherightsideandplacethetopsheetwiththecreaseinthemiddleandrestofthe
sheetinrightlowerquadrant.
15) Unfoldthetoplayersandtuckatthefootendandmakemitredcornerontherightside.
16) Spreadtheotherendoverthemattressabout15inch.fromtheheadend.
17) Tuckalongtherightside
18) Gototheleftsideandtuckasdoneontherightside.
19) Ifablanketisusedthenspreadandtuckitlikeafootsheet.
20) Placethepillowwiththecoverattheheadend(openendawayfromtheentrance)
21)Coverbedwithcounterpan.
22) Straightentheunit,inorder
23) Cleanandreplacethearticles
24) Washhands.
OCCUPIEDBED: Makingabedwiththepatientinit(usuallydonebytwopersons)
ArticlesRequired: Likeforanunoccupiedbedandaircushion,BedCradle/Backrest/footrest,
serveralpillows.
PROCEDURE
1) Untucksheet,allaround,rollitontherightside.
2) Turncoveredpatienttotheleftsideandsupportwithpillows.
3) Carbolizerightside.
4) Rolltopsheetlengthwiseandplaceontherightside
5) Rolldrawmackintoshandplaceontherightside.
6) Gentlyturnthepatienttotherightsideandsupportwithpillows.
7) Secondnurseremovessoiledsheetsandcarbolizetheleftside,thenpulls.
8) Thepatientliesinthesupineposition.
9) Bothnurses,shouldtightenandtuck,thesheetsontheirrespectivesidesandmakemitred
corners(fanfolddrawsheetontheleftside)
10) Liftpatientslegs(secondnurse)
11) Placethefootsheet(firstnurse)atthefootend.
12) Spreadthesheettooppositeside
13) Tucktoplayerandmakemitredcorneratfootend.(rightside)
14) Firstnurseliftspatientslegssecondnursetuckattheleftside
15) Pullotherendofthetopsheetoverpatientslegandcoverhim.
16) Ifpatientcanbeliftedbutnotturndobedfromheadendtothefootend.
3

BASIC CARE
MOUTHCARE: Themouthcavityislinedwithmucousmembranecontinuouswiththeskin.The
mucousmembraneisanepithelialtissuethatlinesandprotectsorgans,secretesmucoustokeeppas
sagewaysofdigestivesystemmoistandlubricated,andabsorbsnutrition.
PurposesofMouthCare
1) OralHygienehelpsmaintainthehealthystateofthemouth,teeth,gumsandlips.
2) Brushingcleansestheteethfromfoodarticles,plaqueandbacteria.
3) Brushingmassagesthegums.
4) Brushingrelievesdiscomfortresultingfromunpleasantodours.
5) Flossinghelpsremoveplaqueandtartarfrombetweenteethtoreducetheguminflammation
andinfection.
6) Oralhygienegivesasenseofwellbeing.
7) ProperOralhygienestimulatedappetite.
8) Toimprovetaste.
ProperMouthCare
1) Goodoralhygieneinvolvescleanliness,comfortandthemoisturizingthemouthstructures.
Propercarepreventsoraldiseaseandtoothdestruction.
2) Brushing,flossingandirrigationarenecessaryforpropercleansing.
3) Topreventtoothdecay,reducestheintakeofcarbohydrates,especiallysweetsnacksbe
tweenmeals.
4) Brushingoftheteethatleastfourtimesadayisabasictoaneffectiveoralhygiene(after
mealsandatbedtime).
5) Toothbrushesshouldbereplacedeverythreemonths.
6) Afterbrushing,throughrinsingisimportanttoremovedislodgedfoodparticles.
RiskfactorsforOralproblems:
1) Patientswhoareparalyzedorseriouslyill.
2) Unconsciouspatients.
3) Diabeticpatients.
4) Patientsundergoingradiationtherapy.
5) Patientsreceivingchemotherapy.
6) Patientshavingoralsurgery,trauma.
7) Patientswithimmunosuppressantdrugeg.HIVpatients.
CommonOralproblems: ThetwomajortypesofOralproblemsaredentalcaries(cavities)and
periodontaldisease(Pyorrhoea)
Dentalcaries isthemostcommonoralproblemofyoungerpeople.Thedevelopmentofthe
cavitiesinvolvesthedestructionoftoothenamelthroughdecalcification.Decalcificationisaresultofan
accumulationofmucin,carbohydratesandlacticacidbacilliinthesalivanormallyfoundinthemouth,
whichformsacoatingontheteethcalledplaque.
4

Periodontaldisease isthediseaseofthetissuearoundthetooth.Itisaninflammationofthe
periodontalmembrane.Itisthemostcommonproblemofpeopleover35yearsofage.
Thecalculusdepositonteethatthegumline.Thealveolarboneisdestroyedandtheteethloosen.
Halitosis(Badbreath)isacommonproblemoftheoralcavity.
Causes: (1)Poororalhygiene.
(2)Infectionoftheoralcavity
(3)Liverdisease
(4)Diabetes
Cheilosis isthedisorderinvolvescrackingofthelipsespeciallyattheankleofthemouth.
Causes: (1)Riboflavindeficiency
(2)Mouthbreathing
(3)Excesssalivation
Stomatitis isaninflammativeconditionofthemouth
Causes: (1)Vitamindeficiency
(2)Infectionbybacteria,virusesorfungi
(3)UseofChemotherapeuticdrugs
Glossitis isaninflammationofthetongueresultingfromaninfectiousdiseaseorinjurysuchasburnor
bite.
Gingivitis isaninflammationofthegumsusuallyresultingfromPoororalhygiene.
Oralmalignancies: Themostcommonsiteisatthebaseofthetongue.
Causes: (1)Pipesmoking
(2)TobaccoChewing
Equipments
Atraycontaining
1) Cottonswaborcleanpiecesinabowl
2) Forceps(arteryanddissectingforceps)
3) Gallicups2nos.(OneforGlycerineboraxanotherforsaltsolution)
4) Feedingcupwithsaltsolution
5) Kidneytrays2
6) Swabssticks
7) Rubbersheet
8) Towel
9) Washtowel
Procedure:
1)
2)
3)
4)

Placeallthearticlesatconvenientlyonthebedsidetable.
Explaintheproceduretothepatient.
Puttherubbersheet(mackintosh)withtowelandkidneytrayunderthechin.
Havethepatientrinsedhismouthwithsaltsolutionfromthefeedingcup.
5

5)
6)
7)
8)
mouth.
9)
10)
11)
12)

Turnthepatientsheadtooneside.
Takethearteryforceps,wrapapieceoflinenaroundthetipoftheforceps.
Dipitinsidethesalinewaterandcleantheteethwithupanddownmovements.
Payspecialattentiontoinsidethemouth,gums,insidethecheeks,tongueandtheroofofthe
Changelinenpiecesasoftenasnecessary.
Discardusedcottonintheotherkidneytray
Allowthepatienttogargleasmuchasnecessary.
Diptheswapstickinglycerineborax,swabgums,rootandsidesofthemouth.

AftercareofEquipments:
1) Cleankidneytraysandfeedingcupswithsoapandwater.
2) Boilforcepsandgallicupsaftercleaning.
3) Placeallarticlesintheirplacesaftercleaningandboiling.
CareofDentures:
Ifthepatienthasdentures,careshouldbetakentokeepthedenturesclean.Ifthepatientisunable
todoso,thenursehastoremovethedenturesbygraspingitwithgauzepieces,placetheminatumbler
orcupcontainingwater.Denturesarewashedcarefullybyusingbrush,toothpasteandcoolwater.
Water,whichistoohot,mayinjurethecompositionofdentures.Ifthepatientistodobyhimself,he
maybeassisted.Removedenturesofpatientswhoareunconscious,mentallyillandwhohavevomiting
orcoughspasm.
BACKCARE
Careofpressurepointsandpreventionofdecubitusulcer
Preventionofdecubitusulcerintheirpatientswhoarebedriddenisamajorresponsibilityofnurses
workinginahospital.Whenwewalkorstandonourtwofeet,theweightofourbodyisbornebyour
feet.Butwhenanindividualisconfinedtobed,theweightofhisbodyhastobebornebyhisbackor
sides.Theskinofthesolesofourfeetisverytoughandthickanditdoesnotbreakeasilyinspiteofthe
entireweightofthebodybeingsupportedbyit.Thenaturehasdesignedthesoleoftheskinforweight
bearingwhereastheskinoverthebackofthebodyisnot.Whenthereispressureontheskinofthe
backbecauseoftheweightofthebody,theskinbreaksandanulcerdevelops.
DefinitionofDecubitusUlcer: Adecubitusulcerisapressuresoreresultingfromprolonged
confinementinbed.
Areaswhicharelikelytobeaffected.
Whenapatientliesinsupineposition,thefollowingareasarevulnerabletopressuresores.
1) Backofthehead

2)Shoulderblades

3)Elbows

4) BaseoftheSpine

5)Buttocks

6)Heels

Whenapatientisinlateralpositionthefollowingareaswillbeaffected.
1) Edgeofear

2)Shoulders
6

3)Knees4)Ankles

Alloranyoftheprotuberantpartsofabedriddenpatientmaybecomeliabletopressuresores.
Thesevariouspicturesareillustratingdifferentbodypositionsandthepressureareas

Heels
(Calcaneus)

Malleolus
(medial
and
lateral)

Scapulae Backofhead
Sacrum Elbows
(Occipitalbone)
(OlecranonProcess)

Knee
(medial
andlateral
condyles)

Llium
Greater
trochanter

Ear
Shoulder
(acromial
process)

Sideofhead
(parietaland
temporalbones)

C.PronePosition

Toes
(phalanges)

Knees
Genitalia Breasts
(patellas) (men)
(women)

Shoulder Cheekandear
(acromial (zygomatic
process) bone)

D.Fowlersposition.

Heels
(calcaneus)

Vertebrae
(spinalprocesses)
30
Sacrum
Pelvis
(ischial
tuberosity)

CausesofDecubitusUlcer:
Localcauses:(a)Pressure: Whenanybodyprominencepressesuponthebed,thetissueslying
betweenthemgetreducedbloodsupply.Ifthisconditionprolongs,thesuperficialtissuesnecroses,
skinbreaksdownandformationofanulcertakesplace.
Thefollowingconditioncausesprolongedpressure:
1) Leavingapatientinonepositionforalongtime.
2) Leavingapatientonabedpanforalongwhile.
3) Hardandlumpymattress.
4) Pressureexertedbysplintsandplastercasts.
(b)Friction:
1) Frictionfrombedclothesoranyothercauseirritatestheskinleadingtoinflammation.
2) Ifyoulieonabedsheet,whichhasaroughseaminthemiddleofit,forawhile,youwillnotice
theimpressionoftheseamonyourback.
3) Youwillalsoexperienceburningsensationandthepartwillberedcolour.
Thefollowingfactorscausefrictioninapatient:
1) Carelesspullingofpatientandhislinen.
2) Givingandremovingbedpancarelessly.
3) Leavingbroadcrumbs,orangeseedsandfoodparticlesonthebed.
4) Creasesinthebottomsheet.
5) Generalrestlessnessofpatient.
6) Rubbingtwoskinsurfacestogether.
(c)Moisture: Moisturemakestheskinswollen,unhealthyandeasilybreakable.
1)Thefollowingreasonsresultinmoistureoverthepressureareas:
1) Incontinenceoffaecesandurine
2) Severeperspiration
3) Leavingapatientinwetlinen.
4) Heat:Leavingapatientinonepositionforalongtime,thepartgetsheated.
5) Lackofcleanlinessandirritatingsubstancesontheskin.Eg.Perspiration,faeces,urineand
vaginaldischarge.
8

2)Predisposingfactorfordecubitusulcer:
1) Unconscious,helplessoracutelyillpatients.Thesepatientsareunabletoappreciatetheweight
ofpressureandchangetheirposition
2) Paralysedpatients(Paraplegicandquadriplegicpatients).Theyhavelostmotorandsensory
functions.
3) Patientswithincontinence(Spinalinjuries)
4) Agedpersons
5) Veryemaciatedandmalnourishedpeople
6) Patientswithdehydrationoroedema.
7) Veryfatpeople
8) Patientswithdiseaseaffectingcirculation.eg.Heartdiseasesandanaemia
9) Patientswithdebilitatingdiseasessuchascancerandtuberculosis.
10) Patientswithmetabolicdisorders.eg.Diabetes
Preventionofdecubitusulcers:
A)PreventPressure:
1) Establishaturningscheduleforbedriddenpatientsturnhourly.
2) Haveafirmcotandfoammattressforbedriddenpatientsuseextrapillows,padsandairringsto
reducepressure.
B)PreventFriction:
1) Whenchangingpositionofyourpatientlifthimanddonotdraghimontobed.
2) Keepsheetswithoutwrinklesandseams.
3) Keepbedcleanandfreefromcrumbs.
4) Ifpatientisrestless,protectpressurepointswithsoftpads.
C)PreventMoisture:
1) Keepdressingsandbeddryandclean.
2) Cleananddrytheincontinentpatientspromptly.
D)PreventPredisposingcauses:
1) Improvepatientshealthbymeansofgoodfood,ventilation,sunlightandexercises.
2) Encouragecirculationthroughmassage.
3) Havepatienttoambulateearly.
E)Observeearlysignsandsymptomsofdecubitusulcers:
1) Redness
2) Darkdiscoloration
3) Bruising
4) Tendernessofthearea
5) Burningsensation
9

F)Givegoodcaretopressurepoints:
Carefulcleaningandmassageshouldbecarriedout3or4timesadayforallbedriddenpatients.
Forsomepatients,itisnecessarytogivecareasoftenaseverytwohours.
Equipment
1) Abowlofwarmwater
2) Spongecloth
3) Soap
4) Towel
5) Dustingpowder
6) Spirit
Procedure:
1) ExplainproceduretopatientArrangearticlesatthebedside.
2) Screenthebed
3) Wetthepartwithsoapyhandmassagetheareaincircularmovementsothatthetissuesunder
theskingetsincreasedcirculation.
4) Removesoapbywashing.
5) Drytheareas
6) Applyspiritovertheareamassagewell.Spirithelpstohardentheskin.
7) Applylightlydustingpowdertokeepthepartthoroughlydry.
8) Dothistreatmenttoallpressurepoints.
9) Ifthepatientisincontinent,applyzinccreaminsteadofspiritandpowder.Thisprotectstheskin
frommoisture.
10) Leavethepatientcomfortableaftertheprocedure.
Treatmentofdecubitusulcer:
1) CleanulcerswithasepticprecautionsUseantisepticssuchaseusole(or)hydrogenperoxide.
2) Applymedicationorderedbythedoctor,eg.Antibioticointment,sharkliveroil,zincoxide,(or)
anyothertopicalapplications.
3) Coverwithsteriledressingsandbandage.
4) Surgicalformentation,ultravioletrays(or)heatlamparehelpfulinhealing.
5) Providegoodnutrition.
6) Preventsecondaryinfections.
SPONGING
Definition:Bathingthepatientwhileheisinbed.
Purpose:
1) Tocleansetheskinandthusincreaseeliminationthroughit.
2) Tostimulatecirculationthroughslightlyactive(or)entirelypassiveexercise.
3) Torefreshthepatientbyrelievingfatigueanddiscomfort
10

GeneralInstructions:
1) Thetemperatureofthewatershouldbe105oF107oF(40oC44oC).
2) Thewatershouldbechangedwhenitiscoolorsoapy.
3) Besuretoremoveallthesoapasitisirritatingtotheskin.
4) Donotexposethepatientunnecessarily.
5) Observethepatientsskinwhilebathing.Particularlyifitisthefirstbathafteradmission.It
offersanopportunityforthenursetoobserveanyrashesorpressuresores.
Equipment
1) Mackintosh(long)andtwobedsheets.
2) Soapinasoaptray
3) Twospongingpads
4) Towelone
5) Linentochange(Gown)
6) Twojugscontaininghotandcoldwater
7) Basin
8) Bucket
9) Screen
10) Urinalandbedpan
Procedure:
1) Closethewindowordoorandscreenthebedtopreventdraughtandtoavoidexposure.
2) Tocollecttheequipmentnexttothepatientsbed.
3) Andarrangetheitemsconvenientlyatthebedside.
4) Explaintheproceduretothepatientandgethiscooperation
5) Protectthebedwithmackintoshandsheet.
6) Removethepatientslinenandcoverthepatient
7) Takewaterinthebasinandfeelwiththebackofyourhand.Thetemperatureshouldbecomfortably
hot.
8) Withwetspongepad,moistenthepatientsfacefirst.
9) Applysoap.Carefullywashpatientsface,ears,andfrontoftheneck.Drywiththetowel
10) Washthelefthandfirstandtherighthand.Supportpatientsarmbyholdingthewrist.Washwell
betweenfingersifdesired.Thepatientmayplacehandsinbasin.
11) Removethesheetuptothewaist,askthepatientstokeepthearmsabovehishead.Itwillbeeasy
tocleantheaxillaeinthisposition.
12) Cleanchestandabdomen
13) Changewaterandturnthepatienttothesideandspongehisback.Givelongfirmstrokesfrom
backofnecktothebuttocks
14) Watchforanyrednessoverthepressureareas.
11

15) Dotheleftlegfirstandthentheright.Havethepatientskneeflexedsotofacilitatewashing.Give
thebedpanandaskthepatienttocleanthegenitals.Ifthepatientisunabletodohelptodoitfor
him.Patientshouldbegivenprivacyduringthisprocedure .
16) Thebackcareisdonebyapplyingalcohol,massageback,anduselongfirmstrokesstartingfrom
backoftheneckoutovertheshouldersanddowntothebuttocks.Usealsorotatormotionto
increasethebloodcirculation.Extraattentiontobegiventothepressureareas.
17) Applypowderifindicated.Thisdependsupontheconditionoftheskin.Iftheskiniswrinkledthe
applicationofpowderisnotadvisable.
18) Ifthepatientishavingdribblingofurine,zinccreamisapplied
19) Roleupthemackintoshandsheetwhenthepatientisontheside.Thenremoveitfromtheother
side.Putthesoiledlineninthereceptacle.
20) Dressupthepatientandremovethetopsheet.
21) Thebedismadetidy.
22) Thepatientisgivenawarmdrink.
23) Removethearticlesfromthebedside.
24) Cleanandreplaceinrespectiveplaces.
25) Sendsoiledlinenforwash.
TypeofTherapeuticBaths
1) Hotwatertubbath:Immersioninhotwaterhelpsrelievemusclesorenessandspasm.Water
temperatureshouldbe45o Cto46oC.
2) Warmwatertubbath: Bathinginwarmwaterrelievesmuscletension.Watertemperature
shouldbe43oC.
3) Coolwaterbath:Bathingintepidwaterhelpstolowerbodytemperaturewhenthebody
temperatureisover40oC(104oF).Watertemperatureshouldbe37oC.
4) SitzBath: Cleansesandreducesinflammationoftheperinealandanalareasofapatientwho
hasundergonerectalorperinealsurgeryorinhaemorrhoidsorfissures.Watertemperature
shouldbe43oCto45oC.
5) Coldsitzbath: Coldsitzbathismoreeffectiveinrelievingpaininthepostoperativeperiod.
6) Backruborbackmassage promotesrelaxation,relieves,musculartensionandstimulates
skincirculation.Aneffectivebackrubtakes35minutes.
CAREOFTHEFOOTANDNAILS: Thefeetandnailsrequirespecialattentiontoprevent
infection,odours,andinjurytotissue.Peopleareunawareoffootornailproblemsuntilpainor
discomfortoccurs.Problemsmayresultfrompoorcareofthefeetandnailssuchasbitingnailsor
trimmingthemimproperly,exposuretochemicalsandwearingpoorlyfittedshoes.
Purposesofcareofthenails
1) Tokeepnailsharmless
2) Topreventaccumulationofdirtunderthenailsandreduceoccurrenceofinfection.
Characteristicsofahealthynails:Anormalhealthynailistransparent,smoothandconvexwith
pinknailbedsandtranslucentwhitetips.
12

Careofnailandfoot:
1) Inspectthefeetdailyincludingthetopsandsolesofthefeetandtheareabetweenthetoes.
2) WashandsoakthefeetdailyusingLukewarm(37oC).
3) Ifthefeetperspire,applyablandfootpowder.
4) Ifdrynessisnotedalongthefeet,applysoftoilandrubgentlyintotheskin.
5) Filethetoenailsstraightacrossandsquare.
6) Avoidwearingelasticstockings.
7) Wearproperlytoimprovecirculationtothelowerextremities.
8)Immediatelywashminorcutsanddrythemthoroughly.Mildantisepticsmaybeappliedtothe
skin.
Riskfactorsforfootandnailailments:
1) Patientwithperipheralvasculardiseaseeg.Diabetesmellitus.
2) Patientswithneuropathy(degenerationofperipheralnervescharacterizedbylossofsensation)
3) Poorillfittingfootwear
4) Poorknowledgeoffootandnailcare.
Commonfootandnailproblems
1) Callus: Isathickenedportionofepidermiscausedbylocalfrictionorpressure.
2) Corns:Iscausedbyfrictionandpressurefromshoes.Itisseenmainlyontoes,overbonyprominence.
3) Plantarwarts:Arefungatinglesions,appearingonsoleoffootandiscausedbyPapillomavirus.
4) Athletesfoot:(Tineapedis) isthefungalinfectionoffootmainlyinducedbywearingofconstricting
footwear.
5) Ingrownnails: Toenailsorfingernailsgrowinwardintosofttissuearoundnailresultingfrom
impropernailtrimming.
6) Paronychia: Istheinflammationoftissuesurroundingnailsfollowinganinjury.Itiscommon
amongdiabeticpatients.
7) Footodour:Areresultofexcessiveperspirationpromotingmicroorganismgrowth.
Equipment:
Atraycontaining
1) Apairofscissorsoranailclipper.
2) Wetswabsinasmallbowl.
3) Ajugwithwaterforwashinghands.
4) Akidneytraywithdettol1in40solution.
5) Softnailbrush.
6) Apaperbag.
7) Atowel.
13

Procedure:
1) Assemblearticlesatthebedsideofthepatient.
2) Explaintheproceduretothepatientandgethiscooperation.
3) Placetowelunderthehands.
4) Washhandsofpatientwithsoapandwater.Usebrushifthenailsareverydirty,soaknailsin
watertocutthemeasily.
5) Cutfingernailstotheshapeofthenails.Cuttoenailsstraightacrosstopreventingrowingtoe
nails.Takecarenottoinjuretheflesh.
6) Receivesoiledwipersinthepaperbag.
7) Washhandsanddry.
8) Cleanandsterilizenailclipper/scissorsandreplaceintheirproperplace.
9) Disposeofsoiledwiperswiththepaperbag.
CAREOFTHEHAIR: Careofthehairisapartofdailyhygiene.Apersonsappearanceanda
feelingofwellbeingdependonthewaythehairlooksandfeelshairgrowth,distributionandpattern
canbeindicatorsofgeneralhealthstatus.
Properhaircare:
1) Frequentbrushinghelpskeephaircleananddistributesoilevenlyalonghairshafts.
2) Shorttoothcombsareadequateforshorthairs.
3) Largetoothcombsarepreferableforcurlyhair.
4) Avoidusingcombswithsharpandirregularteeth
Factorsthataffectthecharacterofhair
1) Hormonalchanges
2) Emotionalandphysicalstress
3) Ageing
4) Infection
5) Certaindiseaseslikecancer
6) Certaindrugslikechemotherapy.
Commonhairandscalpproblems:
1) Dandruff: Dandruffisthescalingofscalpaccompaniedbyitching.Inseverecases,dandruffis
foundoneyebrows.
2) Pediculosis(lice): Tinygrayishwhiteparasiteinsectsinfesthumanbeings.
a) Pediculosiscapitis(headlice): Parasiteisfoundonscalpattachedtohairstrands.
b) Pediculosiscorporis(bodylice): Parasiteclingstoclothingandsucksblood.
c) Pediculosispubis(crablice): Parasitesarefoundinpubichair.
3) Hairloss(alopecia)
14

Purposes:
1) Tomaintaincleanliness
2) Topreventmatting.
3) Topromotecomfort
4) Toremovedirtanddandruffbycombingandbrushing
5) Togiveexercisestoscalp
6) Togetanopportunitytoexaminethescalpandthehairofpatientswhoareacutelyill.
7) Tosoothenthepatientandtohelpinducesleep.
Equipment
Atraycontainingthefollowingarticlestobetakentothebedside.
1) Brushandcomb
2) Alittleoilinasmallbottle
3) Kidneytraywith1in40dettolsolution
4) Cottonswabs(wet)
5) Ribbon
6) Towel
Procedure
1) Arrangearticlesattherightsideofthepatient.
2) Explaintheproceduretothepatientandgethercooperation
3) Getthepatienttositupifherconditionpermits
4) Placeatowelaroundtheshoulderstopreventsoilingherbedclothes.
5) Smearyourfingerwithoilandapplyonthescalpandhair.
6) Massagescalpinacircularmovementtopromotegoodcirculation
7) Brushandcombhairfreefromtangles.Takeafewstrandsofhairatatime.Holditwithyour
lefthandtightlyattherootofthehairtopreventpullingofhairandcombitfromtoptodownwards.
Wipethecombwithwetswabsandexamineforpediculi.Disposeofsoiledswabsinapaper
bag.
8) Braidthehairandtiewithribbon.
9) Keeppatientcomfortableandcleanandarrangetheequipment.
ATTENDINGHAIRCAREWASHING
Purpose
1) Tokeepthehaircleanandhealthy.
2) Topreventitching,infection,infestation
3) Toprovideasenseofwellbeing
4) Todestroypediculi

15

Supplies:
1) Combinghairoil,combandpaperbag.
2) Washing
A)Atraycontaining
a) Hotandcoldwaterinjugs.
b) Abasinandamug
c) Protectivesheetstwo,onelargeandonesmall.
d) Apieceofbandage.
e) Soap/Shampoo
f) Littlecottoninbowl
g) Washcloth
h) Bathtowel
i) Hotwaterbottlewithcover.
B)Bucketone
(N.B.Makeatroughoflargeprotectivesheetwithapieceofbandagerolledinit.)
Fortreatingpediculosis
A)Pediculosiscapits(Headlouse)

Agownforthenurse

Atraycontaining
a) Finetoothcomb
b) Parasiticide
c) Antisepticlotioninakidneytrayandpaperbag.
d) Suppliesforwashinghairinbed(asabove)incasepatientisbedridden.

B)Pediculosiscorporisorvestimenti(Bodylouse)ReferAntisepticBathinprocedureApplyingHot
Applications.Forcepstopickuplicefromeyebrowsandeyelashes.
C)Pediculosispubis(Crablouse)
Atraycontaining
a) Protectivesheetandtowel
b) Bowlofwarmwater
c) Razorandblade
d) Soapandbrush
e) Antisepticlotioninakidneytrayandpaperbag.
Guidelines
1) Combing:Hairarecombedandarrangedinthestylethepatientprefersatleasttwiceaday.
2) Whenwashingthehair,followasunder
16

a) Thepatientsaregivenhairwashatleastonceaweekandbedriddenpatientsaregiven
hairwashinbed.
b) Avoidhairwashforthepatientwhohasjusttakenmealsatleastforanhour.
c) Avoidexposureandchillingby
Keepingthepatientcoveredwithtopclothes.
Closingthewindowsanddoorsoftheroom
Keepingtheroomwarm
Finishingthehairwashquickly
d) Ifthepatientisverysick,notepulsebeforeandafterthehairwash.
e) Donotletthepatientexert.Trytoavoidexertiontothepatientasfaraspossible.
3)Whentreatingpediculosis,nursemusthavefollowinginformation.
a) Thepediculiaresmall,greycoloured,bloodsuckingparasiteswhichliveforseveral
daysinthehair.Thefemalelaysabout50eggs/nitswhicharegreyorwhiteincolour,
clingtohair.
b) Thesymptomsofpediculiare
A)Itching
a) Scalp,neckandbehindearsinheadlouse.
b) Alloverthebodyinbodylouse.
c) Onandaroundthepartaffectedincrablouse.
B) Rash
a) Neckandbehindearsinheadlouse
b) Alloverthebodyinbodylouse
c) Onandaroundthepartaffectedincrablouse.
C)Sores
a) Scalpinheadlouse
b) Bodyinbodylouse
c) Onthepartaffectedincrablouse
Thecommonparasiticidesusedare:a) Mediker.b)Cyban
NursingActivity
a) Washyourhandsandputongown
b) Takesuppliestothebedside
c) Maintainprivacybyusingscreen
d) Explaintheproceduretothepatient
e) Givehaircare
17

1)Combing
a)
b)
c)
d)
e)

Loosenthehair
Applyoiltohairifnecessary
Coombandarrangethehairinthestylethepatientprefers.
Ifhairarebraided,securetheendofbraid.
Replacethesupplies

2)Washing
1) Positionthepatientbringingheadontheedgeofbedandshouldersraisedonapillow
sothatheadisslightlydown.
2) Placetheprotectivesheetandbathtowelunderthehead.
3) Placethetroughinthepatientsneckanddirectitintothebucket.
4) Placecottoninpatientearsandwashclothovereyes.
5) Loosenthehairandremovehairpins
6) Mixhotandcoldwaterandcheckthetemperatureofwateratthebackofhand.
7) Wetthehair,applysoapandshampooandworkupthelather.
8) Startcleaningatthehairlineandworktowardsthebackoftheheadandthentothe
frontofheadsymmetrically.Massagethescalpfirstandthenthehairwiththefinger
tips.Addwaterasnecessarytoworkupthelather.
9) Rinsethoroughly.Squeezeoffwaterfromthehair.
10) Wrapbathtowelaroundthehair.
11) Removethetroughandslipthepillowundertheheadbyraisingheadandshoulder.
Placepatientsheadonprotectivesheetoverthepillowandrubtheheadgentlywith
towel.Spreadthehairoutonbathtowelwithhotwaterbottleunderneathtodryin
winter.
12) Whenitisdryapplyoil,combitarrangeinthestylethepatientprefers.
13) Remove,clean,dry,andreplacethesupplies.
1)Treatingpediculosis
I) Prediculosiscapits(Headlouse)
1) Putongownandfollowfirstfivestepsofwashing
2) Wetthehair,pourmedikeronhair,massagethescalpfirstandthenthehair
withfingertipsworkingfromthehairlinetowardsthebackandthenthefrontof
theheadsymmetrically.Addwaterasnecessarytoworkupthelather.Leave
thehairinlatherforfiveminutesandrinse.
3) Followtheprocedurementionedabove.
4) Repeatthetreatmentwithinfewdays
5) Removethesupplies,washandboilthesupplies,soakgown,clothesandlinen
incarbolicsolution1:20forfourhoursbeforesendingtolaundary.
18

II) Pediculosiscorporis/vestimenti(Bodylouse)
1) Giveadisinfectantbath
2) Applyantisepticointmenttohealanyinjuriesproducedbyscratching
3) Followsteps4and5asabove
III)Pediculosispubes(Crablouse)
1) Thehairofaffectedareas(PubesorAxillae)shavedandburnt.
2) Applydisinfectantintotheareasandaftersomehourspatientgivenbath.
3) Incaseeyebrowsandeyelashesareaffected,pickuplicewithforcepsand
applytwopercentofyellowoxideofmercury.
4) Followstep5asabove
5) Washyourhandsthoroughly
Recording
Recordinthenursesnotesasunder
1. Combing: anydandruff,pediculosisoranyotherabnormalconditionregardinghairorscalp.
2. Washing: timeofgivinghairwash,soap,shampooused,patientsreaction.
3. Treatingpediculosis: Thetime,parasiticideusedandtheeffectoftreatment.
QUESTIONS
PARTA ONE WORD ANSWERS:(Onemark)
(a)Meaningofthefollowingterms:
1.Cheilosis
2.Halitosis
3.Gingivitis
4.Callus
5.Decubitusulcer
6.Paronychia
7.Allopecia
PARTB MULTIPLECHOICEQUESTIONS: (Onemark)
1)ThetermPyorrhoeameans
(a)Pusfromthegums
(b)Bleedingfromthegums
c)Badbreath
2)Oralhygienehelpsto
(a)MaintainHealthystateofthemouth
(b)Stimulateappetite
(c)Alltheabove
3)Coatingoftheteethiscalled
a)Plaque
b)Mucin
c)Gingivae
4)Cheilosisiscausedby
a)Thiaminedeficiency b)Riboflavindeficiency c)Irondeficiency
5)Commonsitesfordecubitusulcerinsupineposition
a)Heels,sacrum,backofthehead.
b)Knee,Ileum,sideofthehead.
c)Toes,knee,cheekandears.
19

6)Signsofdecubitusulcer
a)Rednessanddiscolouration
b)Burningsensationandheadache
c)Noneoftheabove
7)Theantisepticsolutionusedtocleandecubitusulcer
a)Dettol
b)EusolandHydrogenperoxide
c)Savlon
8)Watertemperatureforsponging
a)105degreeto107degree
b)100degreeto104degree
c)99degreeto100degree
9)Sitzbathgivenfor
a)Perinealsurgery
b)Abdominalsurgery
10)PediculosisCapitis
a)Headlice
b)Bodylice

c)Abdominalpain
c)Crablice

PARTC WRITE THESHORT ANSWERS:(5Marks)

1)Whatarethetypesoftherapeuticbaths?
2)Mentionthepurposesofhaircare?
3)Listoutthecommonfootandnailproblems?
4)Writethesymptomsofpediculosis?
5).MentiontheRiskfactorsfororalproblems?
6)Whatarethefactorsaffectingthecharactersofhair?
PARTD WRITEINDETAIL: (10Marks)
1)Listoutthepurposesofmouthcare?
2)Whatarethefactorsaffectingthecharactersofhair?
3)Mentionthecommonoralproblems?
4)Explainthecausesforthedecubitusulcer?
5)Explainthepredisposingfactorsofdecubitusulcer?
PARTEWRITEESSAY:(20Marks)
1)Describethenursesresponsibilitiesinhaircare?
2)Explaintheprocedureofmouthcare?
3)Describethestepsinprocedureofbedbath?
4)Mentionthecareofpressurepoints?
5)Describethecareofnailandfoot?
RECORDINGOFVITALSIGNS.
TEMPERATURE,PULSEANDRESPIRATION
ArticlesRequired:
Cleantraycontainingthree/fourthermometerinabottlecontainingdettol
lotion1:40withsomecottonatthebottomofthebottle
Kidneytray/paperbag
20

 Bottlecontainingplainwaterwithsomecottonatthebottomofthebottle
Cottonswabs,soapyswabs,wetswabsanddryswabsPen,chart,watch
withsecondhandpulsemeter

YourresponsibilityfortakingTPR(temperature,pulse,respiration)
Identifythepatient
Checkthediagnosis
Abilitytoretainthermometer
PreviousmeasurementandrangeofTPR
Procedure
Washthehandbeforeandaftertheprocedure
Thermometeraredisinfectedinaproperdisinfectanttopreventcross
infectionfortherequiredtome
Beforeproceedingdeterminetherouteoftakingtemperature
Beforetakingoraltemperaturecheckwhetherthepatienthadanyhotor
colddrinks,chewinggum/betelleaves.Waitforatleast15minutes
Beforeplacingthethermometerinthemouthrinsethethermometerincold
watertoremovealldisinfectants
Donotusehotwaterforwashingthermometer
Beforeplacingthermometerinpositionwipeitfromthebulbtostemto
keepthebulbclean
Aftertakingthethermometerwipeitfromstemtobulbtoavoid
contaminatingthefingersofthecaregiverwithsalivaandfaeces.
Bringdownthelevelofmercurytoobtainaccuratereading
Iforaltemperatureistakeninstructthepatientnottobiteonit
Neverleavethepatientalongwiththermometerinposition
Readthethermometerateyelevelagainstlight
Neverholdthermometeratthebulb
Useseparatethermometerforpatientssufferingfrominfectiousdiseases
Storethermometerproperly
RecordTPRimmediatelyandaccurately
Nevermakethepatientconsciousthatyouarecountinghisrespiration
Counttheinspirationonlynotethecharacteristicsofrespiration
Nevercounttherespirationwhenthepatientisinthestateoftension
Explaintheproceduretothepatient
Tellthepatientnottodrink,eatorchewbetelleaves15minutespriorto
thetakingoforaltemperature
Placethepatientincomfortableposition
Keepthehandoverthechestreadyfortakingthepulse
Keepthethermometertrayatthebedsidewithnecessary
21

Aftercareofthepatientsandarticles:
Makethepatientcomfortable
Tidyuptheunit
Discardthecottonswabs
Afterinfectingthethermometeritshouldbewashed,dried,andputinother
containersandstorethemintheirproperplace
Washandrefillthebottleswithcleanlotionssothattheyarereadyforthe
nextuse
Ifanythermometerisbrokenitshouldbereplacedimmediately
Seethatalltheequipmentareinorder
Washhands
Ifanychangesinvitalsignsinformthedoctor
Ifthetemperatureisveryhighcoldtherapymaybestarted.
TEMPERATUREBYAXILARYMETHOD
1) Beforeplacingthethermometer,drytheaxilla
2) Placethebulbofthethermometerintheaxillasothatthebulbisintouchwiththeskinfolds
ofaxilla.
3) Keepthethermometerinpositionbyplacingthearmoverthechest
4) Donotallowclothingtocomeincontactwiththebulbofthethermometer
5) Havethethermometerinplacefor2minutes.Inauxiliarymethodleavethethermometerin
positionfor5minutes
6) Countthepulseandrespirationswhilethethermometerisstillinplace
7) Placethepatientshandoverhischestwiththewristextendedandthepalmdownwards.
Placethefingertipsoverthepulsepoint
8) Holdingthewatchinthelefthand,starttocountthepulseratewithzerothen1,2etc.
9) Ifthepulseisregular,countthenumberofpulsationsforhalfminuteandmultiplyitbytwo.If
thepulseisnotregular,counttherateforonefullminute
10)Continuepalpationofthepulsetoassesstherhythm,volume,tensionandirregularity
11) Withtherighthandstillonthepulsecountrespirationbywatchingtheriseofthechest,with
outtheknowledgeofthepatient
12) Iftherespirationsarenormalcountthenumberofrespirationsinthe30secondsandmultiply
by2.Iftherespirationsareabnormal,counttherateforfulloneminuteandnotethepattern
ofbreathing
13) Removethethermometersafter2minutes(after5minutesincaseofauxillarymethod).Wipe
thethermometerfromthestemtothebulbwithacleancottonswab,usingrotating
movements.Discardtheswab
22

14) Readthelevelofmercury
15) Returnthethermometertothebottleno:2shakingitdownagain
16) Washhands
17) Recordthetemperature,pulseandrespirationsimmediatelybeforeproceedingtotake
anotherpatientstemperature
RECORDING OF RECTAL TEMPERATURE
1) Washhands
2) Drawcurtainaroundbedorcloseroomdoor.Assistclienttosimspositionwithproperleg
fixed.Moveasidebedlinentoexposeonlyanalarea.Keepclientsupperbodyandlower
extremitiescoveredwithsheetorblanket
3) Applydisposablegloves
4) Holdendofglassthermometerwithfingertips
5) Readmercurylevelwhilegentlyrotatingthermometerateyelevel.Ifmercuryisabove
desiredlevel,grasptipofthermometersecurely,standawayfromsoiledobjectsandsharply
flickwristdownward.Continueshakinguntilreadingisbelow35.5celciusor95.9farenheit
6) Insertthermometerintoplasticsleevecover
7) Squeezeliberalamountoflubricantontissues.Dipthermometerbluntendintolubricant
covering2.5to3.5cmforadults
8) Withnondominanthandseparateclientsbuttocksintoexposeanus.Asktheclienttodeep
breathslowlyandrelax
9) Gentlyinsertthermometerintoanusinthedirectionofumbilicus3.2cmforadults.Dont
forcethethermometer
10) Ifresistanceisfeltduringinserting,withdrawthethermometerimmediately.Neverforcethe
thermometer
11) Holdthermometerinplacefor2secondsoraccordingtoagencypolicy
12) Carefullyremovethermometer,discardplasticsleevecoverinappropriatecontainer,and
wipeoffanyremainingsecretionswithcleantissue.Wipeinrotatingfashionfromfingers
towardbulb.Disposeoftissuesinappropriatecontainer
13) Readthermometerattheeyelevel.Gentlyrotateuntilscaleappears
14) Wipeclientsanalareawithsofttissuetoremovelubricantorfecesanddiscardtissue.Assist
clientinassumingacomfortableposition
15) Removeanddisposeofglovesinappropriatecontainer
16) Washhands

23

BLOODPRESSURE
Articlesandequipmentsrequired

Sphygmomanometer:Tomeasurearterialpressure
Bladderandcuff:Toexertequalpressurearoundthearterybeingauscultated
Stethoscope:Auscultatesarterialpressurewaves
Pen,pencilandflowchart:Fortimelydocumentationoffindings

24

Procedure:
Washhands
Supporttheclientsforearmatheartlevelwithpalmturnedup
Exposeupperarmfullybyremovinganyconstrictingclothing
Palpatebrachialartery.Positioncuff2.5cmabovesiteofbrachialpulsation
Withcufffullydeflated,wrapthecuffevenlyaroundtheupperarm
Palpatethebrachialarteryorradialarterywithfingertipsofonehandwhileinflatingcuffrapidly
topressure30mmofHgabovepointatwhichpulsedisappears.Slowlydeflatethecuffand
notepointwhenpulsedisappears.
Deflatecufffullyandwaitfor30seconds
Placethestethoscopeearpiecesinearandbesuresoundsareclear,not
muffled
Relocatebrachialarteryandplacebellordiaphragmoveritwithouttouchingtheclients
clothing
Closevalueofpressurebulbclockwiseuntiltight
Inflatecuffto30mmHgabovepalpatedsystolicpressure
Slowlyreleasevalueandallowmercurytofallatrateof23mmHg/sec
Notepointonmanometerwhenfirstclearsoundisheard
Continuetodeflatecuffgradually,notingpointatwhichmuffledordampenedsoundappears
Continuecuffdeflation,notingpointonmanometeratwhichsounddisappears
Removethecufffrompatientsarmafterdeflating
Washhands
Skillsequenceforbloodpressurerecording:
Recordthebloodpressureontheobservationchart
Documentanyabnormalitiesorirregularitiesandreportthemtothemedicalteam
Theexpectedoutcomeisthatthebloodpressureiswithinthenormalaveragerangewhenthe
cardiovascularstatusisnormal
Theunexpectedoutcomeisthatthebloodpressureisaboveofbelowtheexpectedrangefor
clientsage
Whenmeasuredbeforeadministrationofanyantihypertensive.Someinstitutionsrecommended
recordingpressureonmedicationchart.
QUESTIONS
PARTA ONE WORD ANSWER:(Onemark)
1)Temperature
2)Pyrexia.
3)Bloodpressure.
4)WhatistheformulaforconvertingFahrenheitintoCelsius.
25

PARTB WRITETHESHORTANSWER:(5marks)
1)Whatarethetypesofpulse.
2)Mentionthetypesofthermometer.
3)Partsofstethescope
4)Whatarethecontraindicationsfororaltemperature.
5)Whataretheadvantagesofaxillatemperature.
6)Whatarethearticlesneededfortemperature.
PARTC WRITEINDETAIL:(10marks)
1)Explaintheprocedureoftakingtemperature
2)Explainthestepsinprocedureofbloodpressure.
POSITIONING OFTHEPATIENT
Supineposition
Thispositionmaybeemployedtoadvantagemanytimeswhenthenecessityfordrainagedoesnot
requirethefowlerposition.Itisbelievedthatwhenthepatientisflatinbed,respirationoftenismorefree
andturningiseasier,advantagesthatareimportantinthepreventionofrespiratorycomplications.
1)Theheadisinlinewiththespine,bothlaterallyandanteroposteriorly.
2)Thetrunkispositionedsothatflextionofthehipsisminimzied.
3)Thearmsareflexedattheelbowwiththehandsrestingagainstthelateralabdomen.
4)Thelegsareextendedwiththesmall,firmsupportunderthepoplitealarea.
5)Thehealsaresuspendedinaspacebetweenthemattressandthefootboard.
6)Thetoesarepointedstraightup.
7)Thetochantertollsareplacedunderthegreatertocahantersinthehipjointareas.

PronePosition:
Intheproneposition,theclientliesontheabdomenwiththeheadturnedtooneside.Thehipsare
notflexed.Bothchildrenandadultsoftensleepinthisposition,sometimeswithoneorbotharmsflexed
overtheirheads(Figure3416).Thispositionhasseveraladvantages.Itistheonlybedpositionthat
allowsfullextensionofthehipandkneejoints.Whenusedperiodically,thepronepositionhelpsto
preventflexioncontracturesofthehipsandknees,therebycounteractingaproblemcausedbyallother
bedpositions.Thepronepositionalsopromotesdrainagefromthemouthandisespeciallyusefulfor
unconsciousclientsorthoseclientsrecoveringfromsurgeryofthemouthorthroat.
26

LateralPosition
Lateralpositionwithpillowsinplacetuckbackpillowbehindclientsback.(Makebyfolding
pillowlengthwise.smoothareaisslightlytuckedunderclientsback.)Placepillowundersemiflexed
upperleglevelathipfromgrointofoot.

FowlersPosition:
Offallthepositionsprescribedforapatient,perhapsthemostcommon,aswellasthemost
difficulttomaintainistheFowlersposition.Thepatientstrunkisraisedtoformanangleoffrom60to
70degreeswiththehorizontalplane.Thisisacomfortablesittingposition.Thepatientswithabdominal
drainageusuallyareputinFowlerspositionassoonastheyhaverecoveredconciousness,butgreat
cautionmustbeobservedinraisingthebed.

27

CommonlyusedBedPositions:
POSITION

DESCRIPTION

INDICATIONFORUSE

Mattressiscompletely
horizontal

Clientsleepingandavarietyofbed
positionssuchasbacklying,side
lyingandprone(facedown)To
maintain spinal alignment for clients,
With spinal injuries

Semisittingpositionin
whichheadofbedisraised
toangleofatleast45
degrees.Kneesmaybe
flexedorhorizontal

Toassistpatientstomoveandturnin
bedbynurseConvenientforeating,
reading,visiting,watchingTV
Relieffromlyingpositions

Headofbedraisedonlyto
30degreeangle

Headofthebedlowered
andthefootraisedina
straight incline

Topromotelungexpansionforclient
withrespiratoryproblem
Toassistaclienttosittingposition
ontheedgeofthebed,Relieffrom
lyingposition,Topromotelung
expansion

Topromotevenouscirculationin
certainpatients
Toprovideposturaldrainageofbasal
lung lobes

Headofbedraisedandthe Topromotestomachemptyingand
preventesophagealreflexinclients
footlowered
withhiatal hernia
Straighttiltindirection
oppositeto
Trendelenburgs position
28

POSITIONSANDBODYAREAEXAMINED
POSITION
Dorsal
recumbent

Horizontal
recumbent

DESCRIPTION

Backlyingpositionwith
kneesflexedandhips
externallyrotated small
pillowsunderthehead

AREAEXAMINED
Headandneck,axillae,
anteriorthorax,lungs,
breasts,heart,abdomen,
extremities, peripheral
pulses,vitalsignsand
vagina

Backlyingpositionwith
legs extended small
pillowunderthehead

Head,neck,axillae,anterior
thorax,lungs,breasts,heart,
extremities, peripheral
pulses

Backlying position
withoutapillow

Asforhorizontalrecumbent

Aseatedposition,back
unsupportedandlegs
hanging freely

Head,neck,posteriorand
anteriorthorax,lungs,
breasts,axillae,heart,vital
signs,upperandlower
extremities, reflexes

Backlyingpositionwith
feetsupportedinstirrups
thehipsshouldbeinline
withtheedgeofthetable

Femalesgenitals, rectum
andfemalereproductive
tract

Dorsal(Supine)

SittingPosition

Lithotomy

29

POSITION

DESCRIPTION

AREAEXAMINED

Genupectoral
(kneechest)

Kneeling position with

torsoata900 angletohips

Rectum

Sims
Sidelying position with
lowermostarmbehindthe
bodyanduppermostleg
flexed

Rectum,vagina

Prone

Facelyingposition,with
ofwithoutasmallpillow

Posteriorthorax,hip
movement

QUESTIONS
PARTA ONEWORDANSWERS:(Onemark)
Meaningofthefollowing
1.Proneposition

2.Lateralposition

4.Trendelenburgposition

5.Lithotomyposition

PARTBWRITEINDETAIL:(10marks )
1.Explaintheindicationsforusingbedpositions
30

3.Fowlersposition

VOCATIONALNURSING
HIGHERSECONDARY
FIRSTYEAR
PRACTICALSII

31

PRACTICALSII
Date
S.No.

Procedure
Ward

Demonstration
Handwashingandscrubbing
technique
Wearingof
Gloves
Masks
Apron

II.

Transfering,Lifting&shifting
ofpatients

III.

Givingandremovingof
Bedpan&Urinal

IV.

Applicationofbandages
Spiralbandage
Reversedspiralbandages
Figureofeight
Divergentspica
Elbowbandage
Caplinebandage
Largearmsling
Cuff&Collarsling
Triangularbandage
Improvisedsling

Rangeofmotionexercises

VI

Enema

VII.

Cardiopulmonary
resusititation

32

Classroom

Signature

CONTENTS
NursingLaboratoryhours200periods
Clinicalhours
80periods
S.No
I

Subject

PageNo.

Demonstration
Handwashingandscrubbingtechnique
Wearingof
Gloves
Masks
Apron

34
37
37
37

II.

Transfering,Lifting&shiftingofpatients

40

III.

GivingandremovingofBedpan&Urinal

45

IV.

Applicationofbandages
SimpleSpiralbandage

48
50

Reversedspiralbandages
Figureofeight
Divergentspica
Elbowbandage
Largearmsling
Caplinebandage
TriangularSling
Cuff&Collarsling

50
50
50
51
51
52
53
53

Rangeofmotionexercises

54

VI

Enema

56

VII.

Cardiopulmonaryresusitation

58

33

HANDWASHINGAND SCRUBBINGTECHNIQUE
Handwashing
Definition:Atechniqueofcleaninghandsdevelopedtopreventtransmissionofmicroorganisms.
Handwashingisavigorous,briefrubbingtogetherofallsurfacesofhandslatheredinsoap,
followedbyrinsingunderastreamofwater.Thepurposeistoremovesoilandtransientorganismsfrom
thehandstoreducetomicrobialcountsovertime.
Purposes: 1) Cleanliness2)Aesthetic3)Removesoilandtransientorganism.
4)Reducethetotalmicrobialcountsovertime.5)Topreventcrossinfection.
Indication:

1) Attheendofeachtask.
2)Beforegoingintocleanareasorhandlingcleanarticles.
3)Beforesurgicalprocedure,delivery.
4)Beforeservingoreatingfood.
5)Atanytimewhennecessary.

Situationforhandwashing:Garner and Favero recommendthatnurseswashhandsinthefollowing

situations.
1) Beforecontactwithclientswhoaresusceptibletoinfection.
ex.Newborninfants,clientswithleukemia,clientswhoareHIVpositive
2) Aftercaringforaninfectedclient.
3) Aftertouchingorganicmaterial.
4) Beforeperforminginvasiveproceduresuchasadministrationofinjections,catheterizationand
suctioning.
5) Beforeandafterhandlingdressingsortouchingopenwounds.
6) Afterhandlingcontaminatedequipment.
7) Betweencontactswithclientsinhighriskunits.
8) Afterremovalofsterileandnonsterilegloves.
Stepsofeffectivehandwashing:
Step1: Washpalmsandfingers.
Step2: Washbackofhands
Step3: Washfingersandknuckles.
Step4 Washthumbs.
Step5:Washfingertips.
Step6:Interlockingofhands.
Step7:Washwrists.
34

GuidelinesforMaintainingHandWashing:
1) Cutnailshortstopreventaccumulationofdirt.
2) Removejewellerytoensurethoroughcleaning.
3) Removethewristwatchandpushlonguniformsleevesabovewrists.
4) Inspectthesurfaceofthehandsandfingersforbreaksorcutsinskinandcuticles.
MedicalHandWashing
Equipments:
1) Easytoreachsinkwithwarmrunningwater
2) Antimicrobialsoap/Regularsoap.
3) Cleantowel.
Procedure:
1) Removewristwatchandpushlonguniformsleevesabovewrists.
2) Avoidwearingrings
3) Besurefingernailsareshortandfiled.
4) Standinfrontofsink,keepinghandsanduniformawayfromsinkssurface.(ifhandstouch
sinkduringhandwashingrepeatit.)
5) Opentapandwetelbowhand(holdhandsbelowlevel).
6) Avoidsplashingwateragainstuniform.
7) Regulateflowofwatersothattemperatureiswarm.
8) Wethandsandlowerarmsthoroughlyunderrunningwater.Keephandsandforearmslower
thanelbowsduringwashing.
9) Apply1mlofregularor3mlofantisepticliquidsoapstohandslatheringthoroughly.
10) Washhandsusingplentyoflatherandfrictionforatleast10to15seconds.
11) Interlockfingersandrubpalmsandbackofhandswithcircularmotionatleast5timeseach.
12) Areasundernailsareoftensoiledcleanthemwithnailsofotherhandorcleanstick.
13) Rinsehandsandwristthoroughlykeepinghandsdownandelbowup.
14) Dryhandsthoroughlyfromfingerstowristandforearmswithtowel
15) Discardtowelinsoiledbin.
16) Turnoffwater
SURGICALHANDWASHING/SCRUB: Aseptictechniqueisdesignedtoeliminateallmicro
organisms,includingsporesandpathogens,fromanobjectandtoprotectanareafrommicro
organisms.
ARTICLES: 1)Soap/antisepticdetergent.2)Runningwarmwatertorinsesoapand
thoroughhandwash.3)Nailbrushinantisepticlotion.4)Maskandcap.
35

PRINCIPLES:
1) Asterileobjectremainssterilewhentouchedonlybyanothersterileobject.
2) Onlysterileobjectsmaybeplacedonasterilefield.
3) Anobjectheldbelowapersonswaistiscontaminated.
4) Asterileobjectbecomescontaminatedbyprolongedexposuretoair.
5) Whenasterilesurfacecomesincontactwithawetcontaminatedsurfacesterileobject.
STEPSTOPROCEDURE:
1) Ensurethatnailsareshort.
2) Inspecthandsforabrasionsandcuts.
3) Aftermedicalhandwash,wearcapandmask.
4) Turnonwater.
5) Wethandsandarmsunderrunninglukewarmwaterandlatherwithsoqpto5cmabovethe
elbows.
6) Handshouldbeheldaboveelbows.Usecircularmovementstowashpalms,backofhands,
wrists,forearmsandinterdigitalspacesfor2025Seconds.
7) Rinsehandsandarmsthoroughlyunderrunningwater.
8) Cleanundernailsofbothhands.
9) Scrubnailsofeachhandwith15strokesusingmicrobialagent.
10) Holdingthebrushperpendicularscrubpalm,eachsideofthumbandfingersandposterior
sideofhandwith10strokeseach.
11) Scrubfromwristto5cmaboveeachelbow.
12) Entirescrubshouldlastfor5to10minutes.
13) Discardbrushtosoiledbin.
14) Takecarenottotouchthetaporsidesofthesinkduringtheprocedure.
15) Useasteriletoweltodryonehandmovingfromfingerstoelbow.
16) Repeatdryingoftheotherhandusingadifferenttowel/Useonesidetodryonehand
reversesideforotherhand,ifonlyonetowelisavailable.
17) Discardtoweltothesoiledbin.
18) Oneassistpersontostaywhilesurgicalhandwashing
AFTERCARE:
1) Turnoffwater.
2) Towelshouldbesenttolaundaryforwashing.
3) Washednailbrushtobekeptindisinfectantsolutiontray.
4) Soaptobekeptinsoapbox,andantisepticsolutiontokeptincupboard.
36

QUESTIONS
PARTA WRITE THESHORT ANSWERS: (5marks)
1)
Definehandwashing.
2)
Whatarethepurposesofhandwashing?
3)
Whataretheindicationsforhandwashing?
4)
Definesurgicalhandwashing?
PART B WRITEINDETAIL:(10marks)
1)
Stepsofeffectivehandwashing.
2)
Guidelinesformaintaininghandwashing.
3)

Principlesofsurgicalhandwashing.

PARTCWRITEESSAY:(20marks)
1)
Writeindetailaboutmedicalhandwashing?
2)
Writeindetailaboutsurgicalhandwashing?
WEARINGOFGOWN,GLOVE,ANDMASK
GOWNING: Cleanordisposablegownsorplasticapronsarewornduringprocedureswhenthe
nursesuniformislikelytobecomesoiled.
INDICATION:
1) Whenthenurseschangesthedressingsofaclientwithextensivewounds,burns.
2) Duringdeliveryprocedureandsurgicalprocedure.
3) Clientwithmoresucceptabletoinfection.
4) ForstrictasepticdiagnosticprocedureslikeFNAC,lumbarpuncture,bonemarrowbiopsy
etc.
PURPOSE:
1) Topreventsoilingofclothingduringcontactwiththepatient.
2) Toprotecthealthcarepersonnelfromcomingincontactwithinfectedmaterials.
STEPSTOPROCEDURE
1) Pickupasterilegownandallowittounfoldkeepinginsideofthegowntowardsthebody
withoutallowingtheoutsideofthegowntotouchanyarea.
2) Withhandsatshoulderlevel,slipbotharmsintoarmholessimultaneously.Asktheassisting
nursetobringthegownovershoulders
3) Theassistingnursefastensthetiesattheneck.Overlapthegownatthebackasmuchas
possibleandfastenthewaist,tiesorbelt.
4) Preventthegownfrombecomingwet
5) Whileremovingavoidtouchingsoiledpartsontheoutsideofthegown.Rollupthegownwith
soiledpartinsideanddiscardintheappropriatecontainer.
37

GLOVING: Glovingisdefinedastheputtingonofapairofsterileglovestoprotectonesownhand
frompathogenicmicroorganismsandtoavoidcontaminationofasterileareabyhand.
PURPOSE:
1) Toprotectthenursefromthepathogenicmicrtoorganisms.
2) Tosafelyuseherhandstohandlewithoutcontaminatinganyobjects.
INDICATION:
1) Contactwithopenwound
2) Forstrictasepticdiagnosticprocedures.
3) Handlewithinfectedmaterialslikeblood,urine,faecesetc.
4) Nurseorhealthpersonnelwithanycutinjuryinhandsorfingers.
5) Forsurgicalprocedureanddeliveryprocedure
TYPES:
1) Closedmethod.
2) Openmethod
3) Plungemethod.
USES:
1) Itreducethelikelihoodofthenursestransmittingtheirownendogenousmicroorganismsto
individualsreceivingcare.
2) Ithelptopreventcrossinfection.
3) Ithelptomaintaintheinfectioncontrol.
STEPSTOPROCEDURE:
1) Whentheglovepacketiscollectedfromtheautoclavedbinandplacedflatonthesterile
towel.
2) Thepacketofpowderisremovedfromtheglovepackandthehandsarepowdered.
3) Identifyrightandlefthand.
4) Pickuptheleftglovewiththerighthand,bytheinsideturneddowncuff.
5) Carefullypushthefingersofthelefthandintothegloveuntilitreachesthecuff.
6) Pickuptherightglovebyputtingtheglovedhandunderthecuff.
7) Carefullypushthefingersoftherighthandintotheglovedhandintothegloveandpullthe
glovecuffoverthecuffofthegown.
8) Nowpullthecuffontheleftglovecompletelyoverthegowncufftothelefthands.
9) Adjustthegloves.
38

WEARINGMASK: Maskareworntoreducetheriskfortransmissionoforganismsbythe
dropletcontact,airborneroutes,andsplattersofbodysubstances.
PURPOSE:
1) Themaskshouldbewornbypersonnelwhoworkclosetotheclientiftheinfectionis
transmittedbylargeparticleaerosols.eg.Measles,mumps,acuterespiratorydiseasesin
children.
2) Themaskshouldbewornbyallpersonnelenteringtheroomiftheinfectionistransmittedby
smallparticleaerosols(dropletnuclei)eg.pulmonarytuberculosis.
STEPSTOPROCEDURE:
1) Findtopedgeofmask(usuallyhasthin,metalstripalongedge)
2) Holdthemaskbytoptwostrings.Tietwotoptiesatthetopofthebackoftheheadwithties
aboveears.
3) Tietwolowertiessnuglyaroundtheneckwiththemaskwellunderthechin.
4) Ensurethatthemaskcoversthemouthandthenoseadequately.
5) Ifglassesareworn,fittheupperedgeofthemaskundertheglasses
39

6) Avoidunnecessarytalkingand,ifpossible,sneezingorcoughing.
7) Whenremovingamaskwithstrings,firstuntiethelowerstringsofthemask.
8) Discardadisposablemaskinthewastecontainer.
9) Washthehandsiftheyhavebecomecontaminatedbyaccidentallytouchingthesoiledpartof
themask.
QUESTIONS
PARTAWRITETHESHORTANSWERS:(5marks)
1)
Whatarethepurposesofgowning?
2)
Definegloving?
3)
Whatarethepurposesofwearingmasks?
4)
Whatarethetypesofgloving?
PARTBWRITEINDETAIL:(10marks)
1)
2)
3)
1)

Indicationsofgowning.
Usesofgloving.
Indicationsofgloving.
Writeindetailaboutgloving?

LIFTINGANDTRANSFERINGTHEPATIENTSFROM
BEDTOSTRETCHER&STRETCHERTOBED
ArticlesRequired
1) Hospitalbed
2) Wheelchair(lockthebrakes)
3) Transferbelt(optional)
4) Siderails
5) Nonslipfootwear
6) Sheetforlifting
7) Stretcher(lockthebrakes)
Principlestobefollowedinlifting/transferringofpatient

Broadenthebaseofsupportbyplacingthefeetfartherapart

Bendthekneestolowerthebodytotheobject(patient)

Keepthebodyclosetotheobjectaspossible

Tightentheabdomenandbuttockmuscleandbreathnormally

Shiftthepositionoffeet,ratherthantwistingtheback
40

Requirementsintransferring

Transfersurfacesmustbefirmratherthansoft(becauseofenergyistransferred)

Stabilizethesurfacesbyapplyingbrakes/lockingthewheels

Siderailsoneonwhenlyingandhalforoffwhenturningpositiongettingout
respectively
Patientcanusetrapezebarsifupperarmhasstrength

Preliminaryassessmentofpatient
1.Assessthepatientsforfollowing:

Musclestrength

Jointmobilityandcontractureformation(arthritis)

Paralysisorparesis

Orthostatichypotension(riskoffainting)

Activitytolerance

Levelofcomfort(pain)

Vitalsigns

2.Assessthepatientssensorystatus

Adequacyofcentralandperipheralvision

Adequacyofhearing

Lossofperipheralsensation

Cognitivestatus

3.Assessforanycontraindicationstoliftortransfer

Checkforthedoctorsorder

Assesspatientslevelofmotivation

Patientseagerness

Whetherpatientavoidsactivity

Assesspreviousmodeoftransfer

Assesspatientsspecificriskforfallingwhentransferred

Assessspecialequipmentsneededtotransfer

Assessforsafetyhazards

Performhandhygiene

Explainproceduretopatient

Transferthepatient

Aftercare:

Followingeachtransferassessthepatientsbodyalignment,tolerance,fatigue,comfort

Ifthepatientistransferredtobedaftertransfer,siderailsareraised
41

Ifthepatientistransferredtowheelchairthebrakesarereleasedbeforemovingthe
patient
Recordtheprocedureaccurately.Thepatientsperformanceisalsorecorded
Anydifficultyofdisruptionoccurredduringthetransferisalsorecordedwithdate
andtime
Thepatientscomfort,vitalsignsareallrecorded

Procedure:

Transferringapatientfromabedtostretcher
Animmobilizedpatientwhomustbetransferredfromabedtoastretcherrequiresa
threepersoncarryortwopersoncarry
Anothermethodisusingasheettolift

Transferringapatientfromabedtostretcher:

Threeofyoushouldstandsidebysidefacingofpatientsbed

Eachpersonassumesresponsibilityforoneofthreeareas
a)HeadandShoulders
b)Hipsandthighs
c)Ankles

Performthreepersoncarryfrombedtostretcher(BedatStretcherlevel)

Threepersonsstandsidebysidefacingsideofpatientsbed
1. Eachpersonassumesresponsibilityforoneofthreeareas:headandshoulders,hips
andthighs,andankles
2. Eachpersonassumeswidebaseofsupportwithfootclosertostretcherinfrontand
kneesslightlyflexed
3. Armsofliftersareplacedunderclientsheadandshoulders,hipsandthighs,and
ankleswithfingerssecurelyaroundothersideofclientsbody(seeillustration)
4. Eachpersonshouldassumeswidebaseofsupportwithfootclosertostretchinfront
andkneesslightlyflexed

Armsofliftersareplacedunderpatient

Headandshoulders,hipsandthighs,ankleswithfingerssecurityandothersideofpatients
body

Liftersshouldrollpatienttowardstheirchestsoncountofthreepatientislifterandholded
againstthreepersons

Onsecondcountthreeofyoushouldbackandpivottowardsstretchermovingforwardif
needed

Gentlylowerthepatientontocenterofstretcherbyflexingknees,hipsuntilelbowsasa
levelwithedgeofstretcher

Assessthepatientsalignment,placesafetystrapsacrossbodyraisesiderails
42

TRANSFERPATIENTFROMBEDTOWHELLCHAIR
demonstratethetransferringthepatientfrombedtowheelchair
Transferringapatientfrombedtowheelchair:
Assistthepatienttosittingpositiononsideofbed.Havethewheelchair(lockthebrakesatits
45angletobed
Applytransferbelt(ifpresent)
Ensurethatthepatienthasstablenonskidshoes.Weightbearingorstronglegisplaced
forwardweakfootback
Spreadfeetapart
Flexhipsandkneesaligningkneeswithpatientsknees
Grasptransferbeltfromunderneath
Rockpatientuptostandingpositiononcountofthreewhilestraighteninghipandlegsand
keepingkneesslightlyflexed
Maintainstabilityofpatientsweakorparalyticlegwithknee
Pivotonfootfartherfromchair
Instructthepatienttousearmrestonwheelchairforsupportandeaseintochair
Assessthepatientforproperalignmentforsittingposition
Providesupportforparalysedextremities
Praisethepatientprogress,effortorperformance
43

QUESTIONS
PARTAWRITESHORTNOTES:(5marks)
1Writeaboutliftingandtransferringofpatients?
2.Mentionthepreliminaryassessmentofpatientbeforeprocedure?
3.Whatistheaftercareofpatienttransferredfrombedtostretcher?
PARTBWRITEINDETAIL:(10marks)
1. Explaintheprocedureoftransferringthefrombedtostretcher?
2. Explaintheprocedureoftransferringthefrombedtowheelchair?
44

GIVINGANDREMOVING OF BEDPAN&URINAL
OFFERINGURINAL
Definition:
Bedrestorimmobilitycaninterferewithmicturition(actofpassingurine)itdoesnotallowthe
patienttohavethenormalpositionforemptyingthebladder.
Thenursingbedsideassistantassiststhebedriddenwomentouseabedpanforvoiding.For
amanwhohasnotbeenabletoreachthetoiletfacilitieshemaystandatthebedsideandvoidintoa
plasticofmetalreceptacleforurine.Ifheisunconsciousorunabletostandatbedsidetheassistant
needstoassisthimtousetheurinal.
Purpose:
Provideacontainerforcollectionofurine
Tomeasuretheurineoutput
Forobservationofcolorandconsistencyofurine
Indications:
Forpatientwithimpairmobilityduetosurgery,fracture,injury
Elderlyman(agingimpairsmicturation)mayrequireurinalmorefrequentlytoavoidurinary
incontinence
Formobilepersonwhoisabletogotobathroom,doesnotrequireurinal.Encouragethepatient
togotobathroom.

OFFERINGBEDPAN
Objectives: attheendofthislessonyoushallbeableto
recognizetypeofbedpan
purposesofbedpanoffering
indicationsforbedpan
45

Typesofbedpan:
Regularbedpan
Madeofmetalorhardplastichasacurved,smoothupperendandataperedlowerend.Thepan
isapproximately5cmdeep
Fracturepan
Designedforpatientswithbodyorlegcasts,theshallowupperendapproximately13cmdeep
thatslipseasilyunderthepatient
Offeringbedpan
Abedpanforpatientsconfinedtobedprovidesameanstocollectstool
Femalebedpantopassurineandfeces,Formalebedpansonlyfordefecation
Sittingonabedpancanbeextremelyuncomfortable.Thecaregivershouldhelpthepatientassumea
positionsimilartothenaturalsquattingposition.
Purposes
Thenursingassistancepacesandremovesthebedpantobedtobedriddenpatients
Forboweleliminationwhenthepatientisnotpermittedtogooutofbed
Obtainastoolspecimen
Duringboweltraining,itfacilitatesbowelincontinence
Indication:
Forthepatientsrestrictedtobedmustusebedpanfordefecation.Patientswithfractureorinjuryuse
bedpans.

46

QUESTIONS
PART A WRITESHORT ANSWERS: (5marks)
1.Whatarethetypesofurinals?
2.Whataretheequipmentsneededforofferingurinal?
3.Whatarethetypesofbedpan?
4.Whataretheequipmentsneededforofferingbedpan?
5.Whatistheindicationforofferingbedpan?
PARTBWRITEINDETAIL:(10marks)
1.Explaintheprocedureofofferingbedpan?
2.Listoutthecharacteristicsofstool?
47

APPLICATIONOF BANDAGES
PreparatoryPhase:APreliminaryAssessment
Checkthedoctorsordertoseethespecificprecautionsifanyregardingthepositioningand
movement.
Assessthepatientsneedforapplicationofbandage.
Monitorvitalsigns
Assessthepatientsmentalstatus
Assesstheneedforpainmedication
Assurethepatient,thepatientsfamily.
Assesstheadequacyofcirculationbynotingsurfacetemperature,skincolor,and sensation
ofbodypartstobewrapped.
Fortyingthebandageareefknotmustbealwaysused.Tomakeareefknottaketheends
ofthebandageoneineachhandcrosstheendintherighthandunderandthenovertheendin
thelefthandthusmakingaturn.Thencrosstheendnowintherighthandoverandthenunder
theendinthelefthandthusmakingasecondturn.
Theusualgrannyknotshouldnotbeusedasitislikelytocomeloose.
Theknotshouldbemadewhereitdoesnothurttheskinorcausediscomfort.
Tuckthelooseendsofthebandageoutofsight.
Notinusethetriangularbandageshouldbefoldednarrow.Bringthetwoendstothecentreand
foldagain.Itbecomesapacketwhichmeasures16x9cmhandytocarry.
WrinkledBandagesareuncomfortable.
Neverignoreanycomplaintsofpainexperiencedbythepatient.ThisshouldbeInvestigated
andthecauseisremovedimmediately.
Donotuseextraturnsinordertouseallthebandages.
Whencompleted,fixthebandagewithacircularturnandsecureitwithasafetypinorother
suitablematerialssuchasadhesivestrapping.
PreparationofthePatient
Explainthesequenceoftheproceduretothepatientandexplainhowthepatientcanassistyou.
Placethearticlesneededconvenientlyinthebedsidetable.
Bringthepatienttotheedgeofthebed.
Closethewindowsandswitchoffthefan.
Provideprivacy
Helpthepatienttoassumecomfortableandcorrectposition.
Performhandhygiene.
RulesForApplicationOfRollerBandage
Facethepatient
Whenbandagingleftlimb,holdtheheadofthebandageintherighthandandviceversa.
48

 Applytheoutersideofthebandageoverthepadandwinditaroundtheinjurytwicesothatit
isfirm.
Bandagefrombelowupwardsoverthelimb.Alsomakeitarolltoapplybandagefromtheinner
sidetotheouterside.
Seethatthebandageisneithertooloosenortootight.
Rollbandagesothateachlayercoverstwothirdsoftheearlierlayer.Fixthebandageby
pinningituporusingadhesiveplaster.Theusualpracticeoftearingthefinalendintotwolong
tailsandtyingthemupisquitesatisfactory.
PERFORMANCEPHASE(PROCEDUREFOR APPLICATIONOF BANDAGE)
BANDAGING
Objectives: Attheendofthisexerciseyoushallbeableto
demonstratebandageapplication
ARTICLESANDEQUIPMENTSREQUIRED
1)

Correctwidthandnumberofbandages

2)

Disposablegloves(ifnecessary)

3)

Safetypins

4)

Scissor

5)

Adhesivetapes

6)

Rubbersheet(ifnecessary)

Applybandagefromdistalpointtowardproximalboundaryusingvarietytoturnstocover
variousshapesofbodyparts.
Unrollandveryslightlystretchbandage
Overlapturnsbyonehalftotwothirdswidthofbandagerolls.
Securefirstbandagewithcliportapebeforeapplyingadditionrolls
Applyadditionalrollswithoutleavinganyuncoveredskinsurface.Securelastbandageapplied.
Removeglovesifwornandperformhandhygiene
Assessdistalcirculationwhenbandageapplicationiscompleteandatleasttwiceduring8hours
period
ObserveTheBandageSite
FiveP
Pain
Pallor
Pulselessness
Palpateskinforwarmth
Paralysis
Itcomesinvariouswidthslengthsandtypesofmaterial.Forbestresults,usedifferentwidthsfor
differentbodyareas.
49

Fore.g

Fingers1inch
Hand&arm2to2.5inches

Leg3to3.5inches
Trunk4to6inches
(a) SimplespiralBandage

Thisisusedonfingersorotheruniformsurfaces.Thisbandageisjustroundinspirals.
(b) ReversedspiralBandage

Thispatterniselegantandwillfitashapedlimb,butisunstableandwillonlyremaininplaceifthe
limbisatrest,itmightbeusedforaforearmkeptinasling,ifnopressurewasrequired.Withtheback
ofthepatientshandtowardsyou,takeafixingturnroundthewristandcarrythenextturnupwardsat
anangleof45,turnthebandageovertocrossitselfatarightangle,andbringitroundthelimbreadyfor
thenextturn.Thereversemustbemadewithouttensionandthepatternkeptupthecentreofthe
pronatedforearm.
FigureofEight

Thisismuchthemostusefulpattern.Itcanbeusedtoapplypressureoveranextendedjointorto
bandagealeg,foot,handorarmifmovementisallowed.Touseitontheleg,takeafixingturn,then
carrythebandageupwardsacrossthefrontofthelimbat45roundbehinditatthesameleveland
downwardsoverthefronttocrossthefirstturnatarightangle.Repeattheturnsuntilthelimbhasbeen
sufficientlycovered.
DivergentSpica
Thispatternenclosesaflexedjoint(or)projection(e.g)knee,heelorelbow.Itmerelycoversthe
dressingandexertsnopressure.
50

Toapplyit,passthefirstandsecondturnsoverthecentreofthejoint.Succeedingturnspass
alternatelyaboveandbelowtheseturns,formingapatternateachsideofthejoint.
Elbowbandage

Rollerbandagescanbeusedatthesejointstoholddressingsinplace,ortosupportsofttissue
injuriessuchasstrains(or)sprains.Alwaysmakesurethatyourbandagingextendssufficientlyfaron
eithersidetoexertevenpressure.Themethodbelow,forbandaginganelbow,canalsobeusedfora
knee.
Largearmsling(usedtosupporttheforearm)
Standinfrontofthecasualty.Spreadthebandageoverthechest,withoneendgoingoverthe
shoulderontheuninjuredside,andtheotherhangingovertheabdomenthepointshouldbebeneaththe
elbow.Placetheforearmslightlyraisedoverthemiddleoftheslingbringthelowerendupandtieon
theinjuredshouldertotheotherendwithareefknot.Tuckintheends.Bringthepointroundtothefront
oftheelbow,foldinneatlyandpin.

51

Caplinebandage

a) one end being continued

roundthescalpandother
goingoverit

b)scalpturnsecuredby
horizontalturn

c) capline bandage
completed
Placetheopenbandageontheheadwiththepointattheback.Foldanarrowthenatthebase,
placeitjustabovetheeyebrows,thentakethetwoendsbackwards,crossthembelowtheocciputwith
thepointunderneath,thenbacktotheforeheadwheretheyaretied.Drawthepointdownandthen
upwards,andfixitwithasafetypin.
52

TriangularBandage

Atriangularbandageismadebycuttingapieceofcalico100cmsquarefromcornertocornerso
astogivetwobandages.Ithasthreeborders.Thelongestiscalledbaseandtheothertwoofthesides.
Therearethreecorners,theoneoppositethebaseiscalledthepoint.Theothertwoarecalledtheends
Cuffand Collar Sling

AClovehitch
Thissupportsthewristonly,withthecasualtysforearmflexedandfingerstouchingtheopposite
shoulder,aclovehitch,madefromanarrowbandage,isplacedroundhiswrist.Theendsofthebandage
aretakenaroundtheneckandtiedinthehollowjustabovethecollarbone,ontheinjuredside.
AdhesiveTapeAndStrips
Itcomesinrollsandinvarietyofwidth.Itisoftenusedtosecurerollerbandageandsmalldress
ingsinplace.
Forthoseallergictoadhesivetape,usepapertapeorspecialdermatologictape.
Adhesivestripsareusedforsmallcutsandabrasionandareacombinationofadressingand
bandage.
TheSpica
Thisisamodifiedfigureofeight,andisusefulforbandagingthehip,shouldergroinandthumb.
53

TBANDAGE
Itisusedforperinealdressingsonemeterlengthand10cmwidthbandageforthewaistband.One
meterof15cmbandagefortheperinealdressings.
MATERIALSUSEDFORBANDAGE
Flannel: Strong,warmandgivessupport,itissemielastic,butheavyandmaybetoohot.
Openwovecotton:Lightandexpensivebutdoesnotgivemuchsupport.Itisunwashablebutthe
edgesfray.
Calico:Harshandinelasticbutfirmusefulforslingsandforapplyingsplints.
Crepe: Comfortableandgivesgoodsupport,elasticandeasytoapplyexpensiveandwashable.
QUESTIONS
PARTAWRITESHORTNOTES:(5marks)
1.Whatisspica?
2.Materialsusedforbandages.
3.Mentionthearticlesusedforbandaging?
4.Whatarethe5ps?
5.Writethedifferentwidthsofmaterialusedforbodyarea?
PARTBWRITEINDETAIL:(10marks)
1.Explainabouttypesofbandages?

RANGEOFMOTIONEXERCISES
Definition:exerciseistheexertionofthebodyformaintenanceofitshealth.
Typesof exercises:
1) Activeexercises:activeexercisesarethemotionorfreemovementsperformedbytheindividual
withouthelp.
2) Passiveexercises:passiveexercisesarethemotionormovementsperformedbyanother
personforthepatient.
3) Activeassistanceexercise:activeassistanceexercisesiswhichthepatientperformsasmuch
ofthemotionaspossiblewiththehelpofanotherpersonasneeded.
4) Aerobicexercises:aerobicexercisesareactivitiesthatstimulateheartandlungssignificantly
increaseoxygenuptakeandisdeliverytothebodytissues.
54

5) Isotonicexercises:isotonicexercisesarethenormaltypeofexerciseswhichthemotionofa
parttakeplaceinvolvingshorteningofthemusclesandmusclecontraction.
6) Isometricexercises:isometricexercisesinvolvesactivecontractionandrelaxationofthemuscle
withoutmovementofthejointthatisnormallymobilizedbythesemuscles.
7) Rangeofmotion:rangeofmotionexercisearethoseinwhichajointismovedthroughitsfull
rangeofmotione.g.thefullextenttowhichitiscapableofbeingmoved.
Purposesofexercise:
1) Topromotehealth.
2) Toretainmovementinthejoints.
3) Torestorenormaltoneinthemuscle.
4) Todecreasecholesterollevel.
5) Todecreasebodyweight.
6) Todelaydegenerationchanges.
7) Topreparepatientforambulationinorthopedicconditionsandpostoperatively.
8) Topreventdeformity.
9) Topromotephysicalmobility.
10) Toimprovegaitincrutchwalking.
11) Toimprovebloodsupplyinvasculardisorders.
12) Topreventconstipation.
13) Toreducestress.
Movementsofvariousjoints:
1) Abduction:movementsawayfromthemidlineofthebody.
2) Adduction:movementstowardsfromthemidlineofthebody.
3) Flexion: bendingofajointsothattheangleofthejointdiminishes.
4) Extension:thereturnmovementfromflexionaroundjointangleisincreased.
5) Rotation: turningormovementofapartarounditsaxis.
6) Pronation: rotationoftheforearmsothatthepalmofthehandisdown.
7) Supination: rotationoftheforearmsothatthepalmofthehandisup.
8) Opposition: touchingthumbtoeachfingertiponthesamehand.
55

RANGEOFMOTIONEXEERCISES:

QUESTIONS
PARTAWRITESHORTNOTES:(5marks)
1) Writethetypesofexercises.
2) Whatarethepurposesofexercise.
3) Whatarethetypesofmovementofvariousjoints.
ENEMA
Enema:Enemaisaninjectionoffluidintothelowerbowelthoughtherectumforthepurposeofcleaning
ortoprovidemedicationornourishment.
Indication:
1)Stimulatethebowelmovementandcleaningthelargeboweleg.Soapandwaterenema.
2)Stimulateperistalsiseg.Asafoetida
3)Relievingflatulanceordistensioneg.Carminativeenema
56

4)Soothingirritatedmucosaofthecoloneg.starch.
5)Tocheckdiarrheaeg.starch
6)Tosupplyfluidsandnutrientseg.GlucoseandSaline
7)Tostimulatepatienteg.Coffee
8)Toreducetemperaturecoldenema
9)Toquietpatientbyintroducingsedatives
10)Tomakediagnosiseg.BariumEnema.
Procedure: ForSoapandWaterEnema
Equipmentrequired.
1)EnemaCan
2)TubingandClamp
3)Appropriatesizerectaltubeinasterilecontainer/wrapAdult2230Frenchgauge,Child1218
Frenchgauge
4)Correctvolumeofsolutionwarmedto105109deg.Fforadultsand98.6deg.Fforchild
5)Baththermameter
6)Lubricatingjelly
7)Mackintosh
8)Bathblanket
9)BedpanoraCommode
10)DisposableGloves
11)TowelandBasin
12)IVPole
13)Screen
Procedure
1)AssessStatusofpatientslastbowelmovementmobilityetc.
2)ReviewPhysiciansorder
3)Explainproceduretothepatient
4)Assembleequipmentnearbedside
5)ProvidePrivacy
57

6)Placemackintoshunderpatientship.
7)Positionpatientinleftlateralwithrightkneeflexed
8)Coverpatientwithbothblanketexpressingrectum
9)Placebedpanorcommodeineasilyaccessibleposition
10)Assembleenemacan,tubingandtheclampandrectaltube.
11)Add30ml.ofsoapsolutionwith500mlofwarmwater,checktempofsolutionandpour
solutionintocan.
12)Raisecontainer3045cm.abovetheanus.
13)Washhandsandweargloves
14)Lubricatesidesoftherectaltubewithvaseline
15)Gentlyseperatebuttockslocaterectumandinsertrectaltube7.510cmtoadultbyinstruct
ingthepatienttotakedeepbreath.
16)Holdtubinginplace.
17)Openregulatingclampandallowsolutiontoenterslowly.
18)Explainthefeelingofdistensionisnormal
19)Advicepatientretainsolutionfor510min
20)Discardenemacanandtubinginproperreceptacleafterthoroughwashing.

Questions
PARTAWRITESHORTNOTES:(5mark)
1)Defineenemaandindicationforenema?
2)Explaintheprocedureofsoapandwaterenema?
CARDIOPULMONARYRESUSCITATION
DEFINITION: Resuscitationisamethodwhichincludesallmeasuresthatareappliedtorevive
patientswhohavestoppedbreathingsuddenlyandunexpectedlyduetoeitherrespiratoryorcardiac
failure.
PURPOSE:
1) Tomaintainanopenandclearairway(A).
2) Tomaintainbreathingbyartificialventilation(B).
3) Tomaintainbloodcirculationbyexternalcardiacmassage(C).
4) Tosavelifeofthepatient.
5) Toprovidebasiclifesupport.
58

INDICATIONS:
CARDIACARREST:
1) Ventricularfibrillation(VF).
2) Ventriculartachycardia(VT).
3) Asystole.
4) Pulselesselectricalactivity.
RESPIRATORYARREST:
1) Drowning.

2)Stroke.

3)Foreignbodyinthroat.

4) Smokeinhalation.

5)Drugoverdose.

6)Electrocutionorinjurybylighting.

7) Suffocation

8)Accident,injury.

9)Coma.

10) Epiglottisparalysis.
PRINCIPLESOFCPR
1) Torestoreeffectivecirculationandventilation.
2) Topreventirreversiblecerebraldamageduetoanoxia.
GENERALINSTRUCTIONSFOREFFECTIVECPR:
1) CPRtechniquesareusedinpersonswhoserespirationsandcirculationofbloodhavesud
denlystopped.
2) TheCPRmustbeinitiatedwithinthreetofourminutes.
3) TheCPRtechniquesshouldnotbediscontinuedformorethanfivesecondsbeforenormal
circulationandventilationoflungsareestablished.
4) BeforeCPRisattemptedinapatient,makesurethattheairwayisclear.
SIGNSOFEFFECTIVECPR:
1) Movementandstruggling.
2) Distinctcarotidpulsationswitheachcardiaccompression.
3) Decreasedcyanosis.
4) Breathingthatbeginsspontaneously.
5) Blinkinguponstimulationoftheeyelid.
6) Constrictionofpupils.
59

INEFFECTIVE RESUSCITATION:

WhenCPReffortsarenoteffective,itisusuallybecauseofoneormoreoftheseproblems.
1) Thepatientisnotlyingonahardsurface.
2) Thepatientsheadisnotplacedintheproperheadtiltpositionforventilations.
3) Thepatientsmouthisnotopened.
4) Therescuesshandsareincorrectlyplaced.
5) Thechestisnotsufficientlycompressed.
6) Thecompressionratioistoorapidortooslow.
COMPLICATIONS :

1) Pneumothoraxasaresultofribsfracturedduringcardiacmassage.
2) Haemorrhagefromrupturedliver.
3) Braindamageasaresultofcerebralhypoxia.
4) Seizure.
SIGHT FOR CARDIAC COMPRESSION

1)

Firstofalltracethelastribandfollowtheribtothenotch.

2)

Thenplacetheheeloftheotherhandonthelowerpartofthesternumabout11inch
abovethepalpatinghand.

3)

Thenplacedonthetopofthehand,whichisrestingonthesternum.

4)

Bothhandshouldbeparallel.

5)

Keepfingersoffthechestorinterlocked.

6)

Iffingersarerestingonthechest,forcewillbedissipated.

7)

Theartificialbreathingandcardiacmassageshouldcorrespondtothenormalrespirationand
pulserate.

8)

Ventilationsaregivenbetweencardiaccompression.

9)

Theratioofcardiaccompressiontoventilationis5:1(ie)5cardiaccompressionstoone
ventilation.Cardiaccompressionisgiveattherateof60perminute.

PR OC ED UR E :
PREPARATION OF THE PATIENT:

1)

Notimeislostinexplainingtheproceduretothepatientorhisrelatives.

2)

Canexplaininsimplelanguagetotherelatives.
60

3)

Patientmaybeshiftedtoahardsurface.

4)

Removeorpushasidetheclothingwhichcoveredthepatientschesttoobserveforcardiac
beatsandrespirations.

5)

Place the patient back on his back without any pillows. This position helps in
maintainingairwaysandgivingexternalcardiaccompressions.

6)

Tightclothingaroundtheneckandchestshouldberemoved.

7)

Ensurefreshairintheroombyopeningwindowsanddoors.

8)

Externalcardiacmassagemustbestartedwithin4to6minutes.

PREPARATIONOFARTICLES:
EQUIPMENTS:
Atraycontainingthef ollowingarticles:
1)

Endotrachealtubesofvarioussizes(7,7.5,8).

2)

Anambubagwithmask.

3)

Stillet(inaplasticcover)

4)

Megalsforceps(inaplasticcover).

5)

Asuctiontubeorcatheter.

6)

Laryngoscopewithdifferentsizesofblades.

7)

Nasalairway.

8)

Oralairway

9)

Abowlwithgausepieces.

10) Lubricatingjelly.
11) Adhesivetapewithscissors.
12) Localanaesthetic(drug)spray.
13) Glovesincover.
14) Akidneytray.
15) Apaperbag.
16) Masksofvarioussizes.
17) Localanaestheticdrugs(xylocaine2%and4%)
18) Disposablesyringeswithneedles.
19) AnintravenousIVsetandacutdownset.
61

OTHERS:
1)

Oxygeninhalation(centralsupply)

2)

Suctionpoint(centralsupply).

3)

Defibrillator.

ATRAYCONTAININGEMERGENCYDRUGS:
1)

Inj.Adrenaline.

2)

Inj.Atropine.

3)

Inj.Digoxin.

4)

Inj.SodiumBicorbonate.

5)

Inj.Dopamine.

6)

Inj.Efcorlin.

7)

Inj.Decadron.

8)

Inj.Avil.

9)

Inj.Calciumgluconate.

10) Inj.Aminophylline.
11) Inj.Calmpose.
12) Inj.20%Dextrose.
13) Inj.Deriphyllyin.
Syringeswithneedlescannulaoncottonpadandglovesincover.
STEPSTOPROCEDURE:
ONERESCUER:
1)

Determineunresponsivesness.

2)

Placevictiminasupineposition.

3)

Opentheairwaywiththeheadtiltchin.

4)

Placeearonmouthandnoseandfeelforrespiration.

5)

Ifthepersonisbreathingbutunconsciousplacehimintherescueposition.

6)

Ifthevictimisnotbreathingobtainbarrierdevice.

7)

Placemaskovermouthandnoseanddeliver10to12breaths/minutes.

8)

Checkforpulseatcarotidarteryfor5to10seconds.
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9)

Ifnopulse,beginchestcompressions.

10) Placeheelofonehandoverlowerhalfofsternum,andplaceotherhandontop.
11) Straightenarmsandsockelbows.Keepshouldersdirectlyoverhands.
12) Compresschest1to2inches.Perform15chestcompressionsatarateof80to100/
minute.
13) Afterthe15compressions,delivertwoslowrescuebreaths.
14) Afterfourcycles,reassess.
15) IfthepersonispulselessandapneiccontinueCPR.
16) Ifpulsehasreturnedbeginrescuebreathing.
17) Ifeffectivebreathingandpulsehavereturnedplacethevictimintherecoveryposition.

TWORESCUERS:
1)

TworescuerCPRispreferable.

2)

Onerescuerperformschestcompressionswhiletheotherperformsrescuebreathing.

3)

Thecompressionventilationcycleis5:1.Afterfivechestcompressionsonebreathisdelivered.

4)

Whentherescuerperformingchestcompressionbecomesfatigued,therescuersshouldchange
positions.

POSTRESUSCITATIONCARE:
1)

Providingcardiorespiratorysupporttooptimizetissueperfusion,especiallytothebrain.

2)

Transportthepatienttothehospitalemergencydepartment.

3)

Attempttoidentifytheprecipitatingcausestothearrest.

4)

InstitutemeasuressuchasAntiArrhythmictherapytopreventrecurrence.
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Questions
PART A WRITESHORT NOTE:(5 marks)
1)DefineCPRandpurposeofCPR?
2)WhatarealltheindicationofCPR?
3)WritethesightsforCardiaccompression?
PARTBWRITEINDETAIL:(10marks)
1)WritetheprocedureofCPR?

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