Nursing Final Book

PREFACE
Welcome
Dear Students,
K.M. SANTHANAM RAMAYEE MEMORIAL INSTITUTE OF

PARAMEDICAL SCIENCES started in view of promoting the Paramedical
Science field, as it is the supportive hand for the General Medical Practitioner,
Physicians, Surgeons and other Hospital services
Medical Field is in great demand for the Paramedical Technologies

like Nursing, Lab Technician, Pharmacy Assistant , Operation Theater
Technician, Ophthalmic Assistant, etc. in India and Abroad.
This Paramedical College, run by the K.M. Santhanam Educational

Trust, Cuddalore. This College started for the memory of my father Mr. K.M.
Santhanam and my mother Mrs. Ramayee Santhanam.
This college is affiliated to Bharat Sevak Samaj (BSS) National

Development Agency, Promoted by Government of India. National Vocational
Education Mission, Central Board of Government of India. Bharat Sevak Samaj
Registration number TN 2562.
This College registered by Government of Tamilnadu vide Reg. no.

232/2006.
Tmt. S. Selvam, B.Sc., Nursing

Principal / Correspondent
ABOUT THE
BHARAT SEVAK SAMAJ - BSS
Bharat Sevak Samaj is the National Development Agency, promoted

by the Planning Commission, Government of India to ensure Public co-operation
for implementing Government plans the main purpose behind the formulation of
Bharat Sevak Samaj is to initiate a national wide, non official and non political
organization with the object of enabling invididual citizen to contribute, in the
form of an organized Co-operative effort, to the implementation of the National
Development Plan. The constitution and functioning of Bharat Sevak Samaj is
approved unanimously by the Indian Parliament.
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BSS DIPLOMA IN PRACTICAL NURSING
(TWO YEARS) COURSE -
1 st Year - SYLLABUS NOTES
NURSING DEFINITION
Nursing is the unique function of the nurse that is to assist the individual
sick or well in the performance of those activities contributing to health or its
recovery (or to peaceful death) that he would perform unaided if he had the
necessary strength, will or knowledge ICN).
NURSING PRINCIPLES
Safety :
It means prevention of mechanical, thermal, chemical and bacteriological

Injuries to the client and protection from all nuisance.
Therapeutic effectiveness:
It is to achieve the purpose for wish a procedure i5 done.
Comfort:
To provide comfort to give satisfaction to. the client. aid the workers.
Use of resources:
It implies the right use and the economy of time, energy and material.
Good Workmanship:
It is the art of doing.
Individuality :
It is to consider the needs and problems of a particular client when a

procedure is done.
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ETIQUETTES OF NURSING PROFESSION
Etiquette Is a code of good manners that a nurse should follow The nurse
Is an important member of the health team that must work In cooperation and
harmony for the care of the sick. For a smooth functioning and a good lnter
person relationship, you as a nurse should follow certain essential good
manners:.
1. You should be courteous to all. Be gentle and polite In your talk.
2. You should greet your seniors, co-workers, your client etc. with appropriate
words and according to the time the day, e.g., good morning, good evening.
3. You should address the seniors with proper title, e.g., SI Madam, Sister,
Mister etc.
4. Stand up when people of higher rank enter your room.
5. Stand up when answering questions in the classroom.
6. Open the door for the seniors and stand aside for them
7. Excuse yourself when overtaking a senior person
8. Stand aside and give way to seniors when you cross the ,on the ways, e.g.,
In the corridors, on the staircases et Maintain silence wherever and
whenever necessary, e.g classroom, library, study room and dormitories.
9. Keep your dress neat and tidy (sarees arranged and the hair put up).
10. While on duty never use any form of jewellery that ma interfere with work.
11. Obey seniors without arguing.
12. Help the seniors to carry a heavy load If you find them o the way.
13. Say Thank you when someone Is doing a favour for you, and also when
someone corrects you.
14. Get prior permission from the sister in charge before you take any article
from any department.
15. Do not delay the answers to the questions. Give the answer immediately
and appropriately.
16. Be punctual always.
17. Avoid thumb sucking and nail biting.
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18. In an assembly, let the seniors take the seat first.
19. Keep eye contact and sit face to face when listening to someone.
20. Say Excuse me even if you hurt others accidently.
21. Never let others secret go out of you.
22. Always close the door after getting Into a room or when you get out of the
room, if so desired.
23. Knock at the door and wait for the answer before you enter into
others room.
24. Do not cover the mouth while talking to others. Cover your mouth when
you cough or sneeze.
25. Excuse yourself before you interfere with others engaged In talking or
doing some work.
26. You should not give and receive any gifts or present especially from the
clients and their relatives.
ETHICS OF NURSING
Ethics are the rules or principles that govern right conduct. They deal with
what is good and bad, and with moral duty and obligation. Ethics are designed to
protect the rights of human beings.
The word ethics comes from the greek word ethos meaning custom or
guiding beliefs. Ethics are characteristics of a profession and are called a code.
The code of ethics will state what kind of conduct is expected from the members
of a profession, what are the responsibilities of its members towards those whom
they serve, their co-workers, the profession and the society as a whole. When a
person becomes a member of a profession, he accepts the responsibility of living
up to the code of ethics of that profession. In nursing, code of ethics provide
professional standards for nursing activities which protect the nurse and the
client.
DUTIES AND RESPONSIBILITIES OF A NURSE

Job Summary A staff nurse is a first level professional nurse who
provides direct patient care to the patients assigned to him/her in different
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shifts morning, evening and night. She assists in Ward Management and
supervision and is directly responsible to the nursing sister.
1. Is responsible to admit, discharge and transfer the patients.

2. Has to maintain personal hygiene and comfort of the patients.
3. Has to provide psychological support to the patients.
4. Has to see to the nutritional needs of the patients and should feed.
5. Is responsible to maintain clean and safe environment for the patients.
6. Has to perform technical tasks e.g. preparation and administration of

medications, assisting various medical procedures the patients undergoes,
recording vital signs, tube feeding, giving enema, bowel wash, dressing
stomach was, ECT eye and ear care, collection and sending of specimens etc.
7. Has to maintain nurses notes and intake and output chart.
8. Has to observe physical and mental change in patient condition and record
and take necessary attention and has to report to the concerned authority.
9. Should take initiative to hold ward meeting with patients and attendants.
10. Attitude towards patients: Nurses are expected to show extreme

forbearance and tack in their dealings with every patient. They should be
gentle, cheerful, patience ad humane in speech and action and should
themselves set examples of industry, order cleanliness and obedience.
11. Treatment of patients : Anything in the shape of a blow, no matter how

slight or ill-treatment in any form whatever, given to a patient by a nurse
shall -24-render her liable to instant suspension by order of Medical
Superintendent (Director).
12. Special Reports : Immediate and special reports must be made to the
Deputy Director/Director and Matron in all cases of accident, violence
(struggles), bodily illness, extraordinary mental symptoms, eruption of the
skin, succession of fits, unusually threatening language (suicidal or
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homicidal), sudden depression of spirits, attempt to abscond, loss of keys,
knives etc.
13. Suicidal case: on no account not even for a shortest period, shall a
nursing sister permit any patient of suicidal tendencies to be alone, no
matter upon what excuse or how plausibly the desire of privacy may be
urgent.
14. Search of patients: When it is necessary to search a patient, it should be

done thoroughly, but in such a manner as to avoid irritation, to him/her
and to give as little annoyance as possible. All rubbish and anything that
might be converted into a dangerous weapons should be taken away.
15. Locking up of brooms etc. Brooms, mops, squeezes should be kept locked
when not in use.
16. Medicines must never be entrusted to the care of a patient. They must be
kept under lock and key. They must not be placed in the same cupboard as
disinfectants.
17. Handling of violent patients: When dealing with violent patients, the
knees should not be placed on any part of the body. As soon as possible the
boots must be removed from a violent patient. Otherwise he may cause
serious injury to the attendant or other persons.
18. Restraint of privation of patients: No patient must ever be subjected to

restraint or privation (such a food, tobacco etc.) without the express orders
of Residents/Senior Residents.
19. Every sister will carry out any instructions given to her by the Residents/Sr.
Residents in the matter of medical or surgical treatment and she will on no
account entrust the administration of medicines to Ward Attendants (Male
and -25-Female). She shall be responsible that the correct doses as ordered
by the resident are administered at the correct time.
20. Duties of Ward Attendants : The sister on duty will be personally

responsible that the Ward Attendant (Male & Female) on duty understand
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properly the order given to them and that they discharge their duties in
accordance with the orders they have received. She shall inform them
regarding the precautions to be taken with patients placed on the Suicidal
and absconders list.
21. Misconduct: The sister on duty shall report in her report book any
misconduct on the part of any of the Ward Attendant (male or female). She
shall also inform the Matron and the Jamadar on duty on such an
occurrence.
22. Handling of noisy patients: The sister on duty at night shall be

responsible for the quiet and repose of the patient. If a patient is excited
and restless the Residents on duty shall immediately be informed.
23. Inspection of Meals: The sister on duty shall visit the dining halls during
meal time and notes any complaints from the patients about food or drink.
Such complaints shall be transmitted to the Matron. The sister n duty shall
see that the patients are cleanly and decently served with their food, she
shall observe the quality of food and the manner in which it has been
prepared.
24. Religious services: The sister on duty shall see that the patients are
paraded in good time for their religious services.
25. Noting of patients saying and doing: Sisters are reminded that they are
to take constant note of the sayings and doings of the patients. This is most
important, especially in the cases of patients who are recovering, or whose
recovery is reasonably expected to take place. Refusal to take food and
medicine are always important but they are not always so important as the
reasons given by the patient for indulging in such refusals. Great changes,
for the better as well as for the works are often indicated by the casual
remarks which a patient may let drop.
26. Management of difficult patient: In the event of a patient proving very

difficult to manage, the sister shall summon the resident for help and
advice.
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27. Defect in patients feed: Any defect in the quality of the diet of patients
must be brought to the notice of the Matron, who is turn, notify the
Administrative Officer.
28. She has to maintain ward equipment and supply and also prepare and check
ward supplies.
29. Assist nursing sister in ward management and officiate in her absence.
30. Participate in clinical teaching, both planned and incidental.
31. Help in the orientation of new staff.
32. Has to teach patient and guardian regarding the intake of medicines,
its side effect.
33. She will assist the nurse She will assist the nursing sisters in administering
treatment. She will assist resident doctor in giving ECT to patients and
collect all pathological specimens. She will also see that the attendants are
attending to patients properly as per the advice of resident doctor and
medical officer.
QUALITIES OF A NURSE
Nursing Is a career which calls for certain special qualities. Miss Florence
Nightingale mentioned in her notes on nursing about the characteristics of a
nurse. She says, A nurse must be no gossip no vain talker..., be strictly sober
and honest; but more than this, she must be a devoted woman, she must have a
respect for her calling, she must be a sound, a close and a quick observer, and
she must be a woman of delicate and decent feeling.
Some of the essential qualities of a nurse are as follows:
1. Love for the fellow men.
2. Honesty and loyalty. . .
3. Discipline and obedience.
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4. Alertness and intelligent observation. Technical competence.
5. Dependability and adjustability.
6. Ability to inspire confidence. Resourcefulness, economy of time, material

and energy.
7. Courtesy and dignity.
8. Sympathy, empathy, tact and poise. Intelligence and common sense.
9. Patience and sense of humour. Good physical and mental health.
10. Generosity.
11. Gentleness and quietness.
THE NURSE AND LEGISLATION
The nurse should be familiar with some of the legal principles that are to
be principles in her profession. The law imposes certain obligations on the
nurse. A nurse in order to discharge her functions as a legally qualified person,
should register herself as a licensed nurse. This means, the nurse must hold a
valid certificate and license showing that she has met the requirements to
practice as a Registered Nurse (R.N.) In the state in which she is employed.
When the nurse registers herself with any of the state registration council, in
India, automatically she becomes the member of the Indian Nursing Council. To
practice as a midwife, she should register herself as a Registered Midwife (R.M.),
she may place the Initials R.N.R.M. after her name.
The registration of nurses with the nursing council has the following
advantages:
1. Protection of the public.
2. Protection of the institution.
3. Protection of the client.
4. Protection of the health team.
5. Accountability for client care.
6. Updating the standard of nursing.
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The nurses who are qualified and possess certificates from other
countries, also need to register themselves with the nursing councils in India.
The law helps her to recognize the rights of her clients and to give best
possible health care. At the same time It helps her to prevent human error and
when it occurs ameliorate its effects.
Very seldom, the nurse may be accused of crimes, but she may be accused
for negligence including malpractice.
Negligence is the omission to do something that a reasonable and prudent

person would do, or doing something which a reasonable and prudent person
would not do. Malpractice is one part of the law of negligence as applied to the
professional person, e.g., if a nurse gives an incorrect medication even though it
is done in good faith, the fact that the nurse failed to read the label correctly,
indicates malpractice (commission), nurse can be guilty of malpractice by
forgetting to give a medication (omission).
Negligence is not a crime but it is a type of conduct that may form the
basis for criminal liability. Therefore, the nurse has an obligation to keep up her
knowledge up to date in order to maintain the highest standard of care, current
in the nursing practice.
HOSPITAL DEFINITION
Hospital is an institution for the care, cure and treatment of the sick and
wounded, for the study of the diseases and for the training of the doctors and
nurses (Steadmans Medical Dictionary).
TYPES OF HOSPITAL
General Hospitals: These hospitals offer treatment for common diseases.

The main objective is to provide medical care, whereas teaching is secondary.
For example, Taluk headquarters hospitals, PHC etc.
Specialized Hospitals: These hospitals concentrate on giving medical and

nursing care in a specific area, e.g., ophthalmic hospital, orthopaedic hospital,
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heart hospital etc. .Isolation Hospital: This is a hospital in which client requiring
isolation or clients suffering from communicable diseases are taken care of.
Hospitals are those located in rural areas i1anently staffed by at least one
or more physicians, which offer inpatient accommodation and provide medical
and nursing care for more than one category of medical discipline.
HOSPITAL HOUSEKEEPING
The housekeeping department has the function of keeping the hospital

clean. A well-managed housekeeping department can reduce the cost of hospital
operation considerably. For the smooth functioning of the housekeeping
department, the cooperation of all the hospital staff is necessary. If the hospital
housekeeping is of poor quality, nursing care suffers, nursing education is
adversely affected, efficiency is lowered and the morale is Impaired.
In many hospitals, the housekeeping responsibility is vested with the head

nurse, while in others, it is delegated to the housekeeping department, managed
by a housekeeper. Sometimes this responsibility is shared by both. The person
who is responsible for the hospital housekeeping must have an interest in
housekeeping and give a considerable place in the nursing service. He/she must
possess high standards of workmanship and good organizing ability. To be
successful, she must have an interest in the people, an appreciation of the
fundamental worth of mental task and an ability to direct and supervise people
under her, without antagonizing.
PRINCIPLES OF HOUSE KEEPING
1. Dust clings to the moist surfaces. Therefore, the dusting can be done best by
a damp duster or by an oiled cloth. A dry duster scatters the dust.
2. Dusting is done after sweeping and not before.
3. Soap and water are used for cleaning. Soap emulsifies the fat and lowers the
surface tension of the water. The water acts as a good solvent.
4. Friction aids in mechanical cleaning. Use brush when cleaning a grooved

surface. Dusting should be done with a firm and even stroke.
5. Abrasives are harmful to the painted and polished surfaces.
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6. Aluminous materials (e.g., body discharges) are coagulated by the heat. So,
It should be removed with cold water.
7. Bacteria grow in dark, moist and unclean places.
8. Exposure to sunlight destroys some bacteria.
9. Disinfection by chemicals depends upon the cleanliness of the article, the

strength of the disinfectant and the length of the exposure.
10. Effective sterilization depends upon the cleanliness of the articles, the
degree of heat and the length of exposure.
11. Heat, chemicals, abrasives and solvents are harmful to some materials.
12. Choosing the correct and the simplest method of cleaning, saves time,
material and energy.
13. Equipment suitable for the purpose for which it is used and in good
condition, conveniently located and arranged, saves time, material and
energy.
14. The cleaning articles are stored In a placement only for that purpose. Leave
the unit neat and tidy always.
CARE OF CLOTHES
These are expensive articles and do not stand washing or steam

disinfection without shrinkage. The blankets should be protected by sheets
under and over it. They should never be exposed to dust. When a blanket is to be
used next to the clients body, old ones or cotton blankets are used. Occasional
brushing will remove the dust. Though costly, blankets are cleaned by dry
cleaning. To disinfect them, expose them to sunlight.
When storing, blankets should be carefully protected from moths using

naphthalene balls. They should be covered wit Ii dust-proof sheets.
CARE OF PILLOWS AND MATTRESS
It is important to prevent the mattress from becoming wet and stained.

This is done best by the use of long mackintoshes. The mattress should be
brushed at regular and frequent intervals to prevent collection of dust along the
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seams. As far as possible washable covers which fit and completely cover the
mattress should be used and these can be changed at regular intervals.
To prevent rusting of the mattress from the wires or springs, use canvas
between the mattress and the bedstead. When a client is discharged, the
mattress should be thoroughly brushed and examined for stains and tears which
should be treated at once. They are disinfected by exposing them to sunlight.
Mattresses need airing by turning them daily. Care should be taken not to bend
the mattress at acute angles.
Pillows should be protected from becoming wet with blood, bodily

discharges or by other fluids. They should be protected with mackintoshes when
they are used for clients with bleeding, vomiting, etc. They should be protected
by pillow covers which are changed at regular intervals.
CARE OF FURNITURE
Furniture commonly seen in the clients unit are bedstead tables, charts,
lockers, stools, cupboards etc. They may be made of iron or wood.
Dust the wooden furniture with damp duster. Clean them with soap and
water If necessary. Keep them dry. If stains are present, scrape and polish them.
Iron furniture is cleaned with a dry duster. Keep them dry I o prevent
rusting. If dirty or rusty, painting Is done.
The cupboards In the clients unit should be cared appropriately. The

articles should be arranged according to their size, shape and use. Lining the
shelves with paper gives a neat appearance and prevent them from becoming
dirty. The airticles should be absolutely dry before they are kept in the
cupboards. The articles are protected from the moths using naphthalene balls.
Keep the door closed always.
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CARE OF SANITARY
Care of Sanitary annex attached to the wards consists of bathing looms,

lavatories, hand washing places, place for washing and storing of bedpans.
urinals etc., If proper care is not given, it will he. a source of bad odour and
nuisance in the ward. The files will find a breeding place In the sanitary annex.
The cleanliness of the whole hospital will be upset.
Bathing Rooms
The floor should be scrubbed and washed daily to prevent slipping. No

water should stagnate in the bathing rooms. Care should be taken to collect the
hairs which may be seen in the bathing rooms and dispose them in proper
containers, or it may block the drainage system.
Lnvatories
Lovatory pans should be cleaned with Vim or Sanifresh. using ii brush. If

stains are present, smear a small amount of acid and wash it off. Neither soap
nor disinfectants should be used because they will destroy the anerobic bacteria
which are necessary for the decomposition of organic matter. The floor also
should be scrubbed and washed daily to prevent slipping. No water should
stagnate on the floor. The clients and the relatives are taught regarding the
proper use of latrine. They should be told to flush out the latrine immediately
after use.
When emptying the contents of the bedpan and urinal, care should be
taken not to soil the sides of the pan. The contents should be Inspected and any
cotton if found should be removed to prevent blocking of the latrine.
PERSONAL HYGIENE ORAL HYGIENE
Nurses Responsibility in Attending the Mouth of a Client in Illness
Preliminary Assessment
Check the condition of the oral cavity.
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Check the ability of the client for self care.
Check the general condition of the client.
The frequency of mouth care needed.
Doctors orders for specific precautions regarding thc movement

and positioning of the client.
Articles available in clients unit.
Dentifrices Commonly used
Reliable toothpaste or tooth powder with a soft brush,
Glycerin with lime juice.
Sodium bicarbonate paste.
Equal parts of sodium chloride, sodium bicarbonate and
calcium carbonate.
Neem stick.
Solution Commonly used
Potassium permanganate (KMnO4) 1:5000 solution (one crystal to a glass

of water to give a pink colour and It should be freshly prepared each time).
Hydrogen peroxide (H 2 O 2 ) 1:8
Sodium chloride (normal saline), 1 teaspoon to a pint of water.
A number of commercial preparations are available in the iiiirket which

can be used as mouthwashes.
Emollients Used
Cream or Butter.
Liquid Paraffin
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Olive Oil.
White Vaseline.
Glycerin Borax.
A number of commercial preparations are available in the iiinrket e.g.,

Nivea cream.
Preparation of the Client and Unit
I. Explain the procedure to the client (if the client is conscious) o gain the
cooperation and confidence of the client.
2 Provide privacy.
3. Maintain a safe comfortable position for the client. Place Ilie client in a
sitting position or in a Fowlers position with a cardiac table in front.
Arrange all articles on the cardiac table and assist him as needed.
If the health of the client is contraindicated for an elevated position, place

him in a left lateral position with his face at the edge of the pillow and the nurse
stands at dir left side of the client to help him. In a left lateral position1 the
client can brush his teeth using his right hand.
If the client is unconscious or completely helpless, tutu him to the right

side and the nurse stands at the right stile of the client to do the procedure. The
side lying position will allow any secretion collected in the mouth to drain
through the corner of the mouth.
4. Place the mackintosh and face t6wel across the chest and under the chin
to protect the bed clothes and the garments.
5. Place the kidney tray close to the cheek with the concave side towards
the client or allow the client to adjust the kidney, if he can, according to his
convenience, to receive the waste water.
6. Remove dentures (if any) and place it in a bowel of clean water.
7. Arrange the articles conveniently convenient for lire nurse and the
client to avoid over reaching.
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Mouth care of a Client who is able to care for Himself
Steps of Procedure Reason
Wash hands. To prevent cross infection.
Prepare the mouthwash by adding hot Potassium permanganate solution acts

and cold water and drop one crystal of as an antiseptic arid deodorant.
potassium permanganate into it.
Help the client to rinse his mouth. Let Rinsing the mouth makes the mucus
the client hold kidney tray according membrane moist and prevents tissue
to his convenience for the return flow. trauma during brushing.
Pick up the toothbrush, wet it with Wetting the brush makes the bristles
water, spread a small quantity of soft and prevent tissue injury.
toothpaste on it and hand It over to
the client.
Instruct the client to brush all sides of Ensures thorough cleaning.

the teeth, outer side, inner side, right
and left side and the chewing surface
extending from the gum to the enamel.
When he finishes brushing. pour water Immediate washing of the brush

on the brush, holding It over the ensures thorough cleaning and it Is
kidney tray and clean the brush ready for the next use.
thoroughly and put back the brush.
Help the client to rinse his mouth Thorough rinsing ensures thorough
thoroughly. cleaning.
Ask the client to massage the gums. Massaging the gums stimulates
Place the thumb and the index finger circulation and toughens the oral
over the ridge of the gum using a press mucosa, thereby increasing the
and release motion. Help the client to resistance to tissue trauma.
wash his face and hands. Wipe with
the towel.
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Mouth care of Client Who is Not Able to Care For Himself
(An Unconscious Client)
Prepare the antiseptic solution for the

mouthwash.
Make a paste with soda To Clean to Teeth
bicarb or salt or use any
dentifrice which is available.
Place the kidney tray close the cheek. To collect the saliva or water that may
dribble from the mouth.
Do not pour water into the mouth if To prevent aspiration of fluid into the
the client is unconscious. lungs because of a poor gag reflex.
Take a gauze or rag piece, wrap it Cotton, when it is wet is slippery and
around the forceps, covering the tips does not thoroughly clean a coated
completely. tongue or teeth.
7. Moisten the gauze and dip it in the Ensure thorough cleaning and prevent
cleaning agent, swab each teeth gently injury to the oral mucosa and gums.
but firmly, taking care to clean all
sides of teeth (for a conscious client
the toothbrush and paste can be used).
To clean the inner and chewing Mouth gag helps to keep the mouth
surfaces of the teeth, use a mouth gag. opened and prevent Sir client to bite on
the forceps.
With mouth gag position, clean the Excessive fluid may cause aspiration of
tongue, using the gauze covered artery fluid into Sir lungs.
forceps. Wet the gauze only with a
small amount of solution. N.B.
Thorough cleaning of the teeth and
tongue is ensured by repeating each
stroke, a definite number of times on
each area. Brush one area at a time.
For each stroke, take a fresh gauze
piece.
When the teeth and tongue are

cleaned well, stop the procedure, wipe
the lips and face with the towel.
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After Care of the Client and Articles
1. Apply glycerin borax or any other emollient on the cracked lips and tongue
to keep them soft.
2. Remove the kidney tray, mackintosh and towel.
3. Make the client comfortable.
4. Tidy up the unit.
5. In case of unconscious or seriously ill clients, if there is collection of

secretions in the mouth, apply suction.
6. Take all articles to the utility room. Discard the wastes and clean the
articles with soap and water. Boil the forceps and replace them in their
proper places. Personal articles are replaced Into the bedside table.
7. Wash hands.
8. Record the time and nature of the treatment and the condition of the
mouth on the nurses record.
9. Take the opportunity to teach the client or his relatives on the principles of
oral hygiene.
HOT APPLICATION
Purpose
To stimulate circulation.
To promote suppuration.
To promote healing.
To relieve pain.
To reduce inflammation and congestion.
To supply warmth and comfort.
To relieve muscle spasm.
To relieve retention of urine.
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Application of Hot Water Bottle The Nurses Responsibility
1. Check the diagnosis and the physicians orders.
2. Assess the type of application to be used when specific orders are not
given.
3. Inspect the body part that is to receive the treatment for any lesions.
4. Determine the duration and frequency of the treatment.
5. Presence of any disorders that contraindicate the use of heat

applications
6. General condition of the client and his ability to follow instructions.
7. Condition of the heat appliances check for their working conditions.

For example, If a hot water bag is used, check for any leakage, see that
if It has a good washer.
8. Check the articles available in the clients unit.
Preparation of the Articles
Articles Purpose
Hot water bag (1)
Jug (1) To take hot water
Duster (1) To wipe the outside of the bag
Towel (1) To Insulate the hot water bag form heat

loss.
Vaseline or Oil To apply on the skin, if the skin is

reddened.
Lotion Thermometer To check the temperature of the wipe
water
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Preparation of the Client and Unit
1. Identify the client and explain the procedure to the to win the confidence
and cooperation.
2. Provide privacy, if needed.
3. Drape the part according to the need and expose only the part needs
treatment.
4. Prevent draughts. Provide warmth by covering all non treatment areas with
bath blanket or bed covers.
5. Place the client in a comfortable position.
Procedure
Articles Purpose
Take hot water In the jug. Pour some To warm the hot water bag, so that very
water into the hot water bottle and little heat is lost to warm the rubber
empty It. and the client gets the full benefit of the
heat application.
Check the temperature of the water (if The water should not be hot enough to
the lotion thermometer is available), scald the client, if the bag leaks or
or keep the boiled water until the bursts. The temperature of the water
steam disappears. should be between 120 and 149F (49 to
65C).
Fill one-third to half of the bottle with To avoid unnecessary weight on the
the hot water. body part, especially if applied over the
abdomen. Full bag is not pliable to
mould over the body area to provide
even heat.
Place the. bag over a flat surface and Air in the bag will interfere with the
expel the air. Cork It tightly. conduction of heat.
Dry the outside of the bag and test for To prevent scalding of the client.
leakage by holding the bag upside
down.
22
Put on the cover and take it to the The cover is used to absorb any
bedside. moisture. Since water is a good
conductor of heat, any moisture
between the hot water bottle and the
skin increases the risk of burns.
Apply the hot water bottle over the Towel or sheet Is used to insulate the
area and cover it with the towel or bag from the heal loss.
sheet.
Keep the bottle in place for about 20 Application of heat beyond 31) mm may
to 30 mm, changing the position of the lead to secondary effects, Inspection of
bag as necessary. Inspect the area the area and changing the position of
occasionally. Refill the bag if 11w bag will prevent burns.
necessary.
After Care of the Client and the Articles
1. Remove the hot water bag when the treatment is completed,
2. Dry the area if moist with perspiration.
3. Inspect the area for redness. If redness is present, apply Vaseline or oil.
4. Cover the client with sheets and remove the drapes if any.
5, Position the client comfortably on the bed.
6. Take all articles to the utility room. Remove the Cover of the hot water
bottle and put It in the laundry bag. Empty the bag. Wash the outside of
the bag with soap and water. Dry the inside of the bag by hanging it upside
down. When dried, fill It with air and cork it and store It in its proper
place. Replace all the other articles.
7. Wash hands.
8. Record the procedure with date and time, the area to which IL Is applied,
the purpose of the application and the reactions If any (e.g., redness,
blister formation etc.) in the nurses record.
N.B If the hot application is to be continued, refill the bag and apply to
the client to maintain the correct temperature of the el1cn. Report it to the
ward in-charge or to the relieving nurse, when leaving the ward.
23
SKIN CARE
The skin with its appendages (hair and nails) is commonly referred to as
integumentary system. The skin is an organ with highly specialized functions
that are essential for human survival. The surface area of the skin makes it one
of the largest organs in the body, covering approximately 20 square feet or 3000
square inches in an average-sized adult.
The skin is structurally composed of two layers; the outer layer is the
epidermis and the inner layer the dermis. Under the dermis lies the
subcutaneous tissue, also known as the hypodermis. Three kinds of glands are
associated with the skin. They are the sebaceous glands, sudoriferous or sweat
glands and ceruminous glands.
FUNCTIONS OF THE SKIN
Skin is the bodys first line of defence. Normally, the skin hosts large
number of resident bacteria, which on intact skin prevent excess growth of fungi.
Sebum secreted by the sebaceous glands has antibacterial and antifungal
Properities. Normal skin acidity also inhibits growth of pathogenic organisms.
The skin assists in regulating body temperature. The skin helps to screen
out harmful ultraviolet rays from the sun, but it also lets in necessary UV rays
that convert 7-dehydrochole- sterol into vitamin D for normal growth of bones
and teeth.
The skin is an important sensory organ containing sensory receptors that

respond to heat, cold, touch pressure and pain, the nerve endings on the skin
also helps to maintain homeostasis.
Melanocytes which are located at the base of the epidermis produce

melanin, a pigment responsible for skin colour. Other epidermal cells
Langerhans cells and Granstein cells interact with T cells to assist in the
immune process.
24
PRINCIPLES OF THE SKIN CARE
Principles Action
Intact skin and mucus Pressure exerted on the skin can cause tissue injury.
membrane serves as the In a sick person, the areas of tissue resting against the
first line of defence for mattress are vulnerable areas. The tissue over the bony
the body against injury structures, the occipital, the shoulder blades, the ribs, the
and diseases. spine, the coccix, the hip bones, elbows, ankles and heels
are exerting uneven pressure against the mattress. The
pressure in these areas causes depletion of the blood
supply with the failure of transportation of oxygen and
nutrients needed for cellular utilization and elimination of
metabolic products. If continued, this will result in tissue
damage and ultimate formation of Decubitus ulcer.
Hence, the nurses who care for the bedridden clients
should give special attention to these areas of pressure
points. A change of position every 2 or 4 hours will take
off the weight of the body from a particular area. A soft,
smooth and unwrinkled bed can prevent bedsores.
Emaciated and oedematous clients, clients with limited
movements, clients who are thin, fat and very old etc. need
special attention to the skin.
- Friction on the skin can cause tissue injury.
Contact with rough surfaces of the bed, plaster casts and
splints careless handling of bedpan. pulling sheets under
the clients are frequent causes of friction which results in
tissue injury.
- Rough handling can cause tissue injury. Prolonged skin
massage without enough lubricant, use of rough sponge
clothes etc., can cause tissue trauma.
- Prolonged application of heat and cold and the
application of caustics, can cause tissue trauma.
Pathogens grow well in The skin provides a suitable environment for the growth
a warm and moist and multiplication of microorganism. The body
environment. Greater temperature hi suitable for the growth of bacteria. The
the number of sweat provides a moist environment essential for the
organisms, the greater is growth and multiplication of bacteria. In a neglected skin,
the possibility of the accumulation of secretions and excretion together with
infection. the shed epithelium (debris) forms the food for the growth
of bacteria. Thus, pathogens grow well in a neglected
Skin.
When giving bath to the clients the creased areas of the
body should gel particular attention because these areas
are always moist e.g., the buttocks, the axillae, the groin,
under the breasts, between fingers and toes. In these
areas, two skin surfaces are always in contact with each
other. If the hygiene is not maintained, the excessive
perspiration in these skin folds interacts with bacteria and
25
cause an offensive odour, Therefore,
Is necessary to clean and dry the creased areas of the body
during a bath.
The skin that is poorly To maintain the health of the skin, a well
nourished balanced diet containing vitamin A, vitamin
And dry has less ability B, vitamin C and protein are necessary.
to protect and is more Dehydration of the body leads to cracks and
vulnerable to injury.
crust formation Of the skin and mucus
Membrane and ulcer formation. Therefore,
the following clients are protected from
Dehydration.
- Clients with fevers.
- Clients with excessive sweating.
- Clients with vomiting and diarrhea.
- Surgical clients.
- Clients who are on diuretics.
- Clients who are not able to take oral fluids.
Poor circulation Massage of the skin around the bony prominences
impedes nutrition to the stimulates circulation and the underlying tissues and
skin and causes skin prevents bedsore.
damage. A warm bath dilates superficial arterioles, bringing more
blood and nourishment to the skin.
An exercise taken by the client stimulates circulation and
helps to eliminate waste products from the body through
the skin.
Sensory receptors in the The temperature
skin are sensitive to Regulated according to the tolerance and likes of the
heat, pains touch and clients.
pressure. Every movement of the nurse should be gentle so as, not to
cause pain to the client.
Soap acts by lowering The skin is physiologically bathed continuously with the
surface tension of water sebum and perspiration. The sebum is an oily substance, if
which aids in the left on the skin allows the dirt and bacteria to stick on to
emulsification of fat. the skin. By the application of soap, the surface tension of
the water is reduced and the sebum together with the dirt
and bacteria is dissolved and is removed from the body.
Some soaps cause excessive drying by removing too much
sebum from the skin surface and cause excoriation of the
skin.
Hygienic practices vary Bathing and application of skin preparations are tied to
between individuals, the cultural influences more than any other hygienic
between people of practices. The nurse wherever possible should allow the
different economic client to have his usual bathing practices.
status & between
26
cultures.
Systematic ways of -Arrange all articles conveniently before starting the
working saves time, procedure,
energy and material. -Help the client to take bath as and when needed.
Offer bedpan before bath, if needed.
Sponging is done Systematically starting from the clean

area to the less clean area (from the head to foot).
Change water whenever necessary.
Any unfamiliar situation Provide privacy by placing screens.
produces anxiety. -Drape the client properly and expose only the needed
part.
-Explain the sequence of the procedure to secure
confidence and cooperation of the clients.
The movements of the Adjust the height of the bed to the working convenience of
body take place by the nurse.
means of muscles & The nurse should conserve her energy as well as the
bones functioning on energy of the clients; The act of raising arms and legs
the principles of requires muscle contraction which eventually produces
mechanical leverage and fatigue. Supporting the limbs at the joints minimizes the
gravitational pull. fatigue.
Bring the client to the edge of the bed and near to the
nurse to avoid over reaching. This reduces strain on the
back.
PROBLEM OF THE SKIN
Infants skin is delicate and sensitive and is prone to trauma in the form of
abrasion, which is breaks in the kin that may lead to infection; Adolescents are
prone to develop enlarged sebaceous glands of the face which may take the form
of black heads, pimples or boils.
Acne occurs in sebaceous follicles and may cause permanent scarring. Dry
skin is a problem of ageing. Skin rashes or dermatitis are also common skin
problems.
27
BATH
Bathing is an important intervention to promote hygiene. Choice of the
method depends on the nurses judgment as well as the medical plan of care in
regard to the clients activity level and mental and physical capabilities to
perform self-care. Several types of bath can be used depending on the clients
need. Baths may be used for cleansing or for therapeutic measures related to
some skin problems.
TYPES OF THERAPEUTIC BATH

Types Purpose
Sitz bath To decrease pain and inflammation after
related or perineal surgery or pain relief
From hemorrhoids.
Hot water bath To relieve muscle spasm and muscle
Tension.
Warm water bath To relax and soothe
Cool water bath To decrease fever and to reduce muscle tension.
Oatmeal or aveneo To sooth irritated skin, softness and lubricates
dry scaly skin.
Corn starch To sooth skin irritation.
BED BATH
Bed bath means bathing a client who is confined to bed and who does not
have the physical and mental capability of self bathing. The clients who need
bath in bed are those who are plaster casts and traction, on strict bed rest,
paralysed, unconscious and those who have undergone surgery.
Purpose
To clean the body off dirt and bacteria.
To increase elimination through the skin.
To prevent bedsores.
To stimulate circulation
To induce sleep.
28
To provide comfort to the client.
To relieve fatigue.
To give the client a sense of well being.
To regulate body temperature.
To provide active and passive exercises.
To observe objective symptoms
To give the nurse an opportunity for health teaching.
To establish an effective nurse-client relationship.
General instructions for giving a bed bath
Maintain privacy of the clients by means of screens, curtains or drapes.
Explain the procedure to win the confidence and the cooperation of the
client.
Wash hands before and after the procedure.
All articles used in bed bath should be absolutely clean.
Clients unit should be warm and free of draughts.
All needed equipment should be at hand and conveniently placed before

beginning the procedure so as to avoid leaving the client unnecessarily
until the entire procedure has been completed.
Conserve the energy of the client by avoiding unnecessary exertions.
Remove the soap completely to avoid the drying effects of soap residue left
on the clients skin.
Only small area of the body should be exposed and bathed at a time.
The wash clothes should be held with the corners tucked securely on the
palm of the hand to avoid dragging its cold and wet ends over the skin.
Each stroke should be smooth and long rather than short and jerky.
Support should be given to the joints in lifting the arms and legs while
washing and drying these areas.
29
Provide active and passive exercise whenever possible unless it is
contraindicated.
Wash the hands and feet by placing them in the basin i5ecause it promotes
thorough cleaning of the finger nails and toe nails.
Cut short the nails, if they are long.
A thorough inspection of the skin especially at the back should be done to

find out the early signs of bedsore. Redness in the skin, an excoriation of
the skin etc., should be reported immediately and treated adequately to
prevent development of bedsores.
All the skin surfaces should be included in the bathing process with
special care in cleaning and drying the creases and folds and the bony
prominences etc., since these parts are most likely to be excoriated by
moisture, pressure, friction and dirt.
Special attention is given to axillae and groins to prevent disagreeable

body odours due to the decomposition organic materials.
Cleaning is done from the cleanest area to the less clean area, e.g... Upper
parts of the body would be bathed before the lower parts.
Avoid bathing a client immediately after a meal as
Depletes the blood supply to the digestive organs and interfere with the
digestion.
Frequency and the time at which a cleaning bath is given should be

adjusted for the comfort of the clients and on the physicians orders. A
critically ill client may tolerate only a partial bath.
Do not touch the body with hands. It is unpleasant to the clients.
The temperature of the water is adjusted for the comfort of the client and
the water should be charged at intervals to maintain a comfortable
temperature. The temperature for the sponge bath should be 110 to 115F
(43.3 to 46.1C). For tub baths or bathroom bath the temperature of the
water should be 90 to 100F (32.2 to 37.8C).
Powders are used to prevent friction and to absorb moisture but they
should not be used on open draining areas, since powder can make or
form crust, causing skin irritation.
Use only a small amount of spirit in the back care. The rapid evaporation
of spirit causes rapid and excessive cooling of the body and also causes
drying of the skin.
Use soaps which contain less alkali.
30
Cream or oils are used to prevent or excoriation of the skin
The nurse should maintain good posture and balances of the body during
bed bath. Keep the client near to the edge of the bed to prevent over
reaching and strain on the lower back.
NURSES RESPONSIBILITY IN GIVING BED BATH
Preliminary assessment
1. Check the physicians orders to see the specific precautions if any,

regarding the positioning and movement of the client.
2. Assess the clients need for bathing.
3. Assess the clients ability for self care.
4. Assess the cardio respiratory functioning. Check T.P.R. and H.P.
5. Assess the clients mental state to follow directions.
6. Check the clients preference for soap, powder etc. t available in the
clients
7. Check the linen and equipment
8. Check whether the client has taken the meal in the previous 1 hour.
Preparation of Articles
All needed equipment should be at hand and conveniently placed before

beginning the procedure so as to avoid leaving the client unnecessarily until the
entire procedure has been completed. Arrange articles in the order of use, the
following articles are required:
Articles Purpose
Bath basin (1) To take water for bath
Small bowel (1) To keep the sponge cloth separately that is used
for putting the soap.
Soap with soap dish
Wash Clothes (2) One to apply the soap and the other one to clean
the skin
31
Bath towels (2) One protect the bed and the other one to dry the
skin
Face towel(1) To dry the face
Bath blanket or sheet To cover the client
Methylated spirit and powder To treat the pressure point
Scissor or nail cutters To cut short the nails
Nail file. To smoothen the cut surfaces of the nails.
Comb and Oil To attend the hair
Kidney tray and paper bag To collect the waste (nails hair, etc.)
Jugs (2) To keep hot and cold water
Bucket (1) To discard the waste water, when water is

changed in between.
Clean linen (personal and bed To keep the client clean

clothes as needed)
Bucket or a laundry bag To discard the soild linen.
Preparation of the client and unit
1. Explain the sequence of the procedure to the client and explain how the
client can assist you.
2. Move the unnecessary items from the work area.
3. Place the articles needed conveniently on the bedside table.
4. Adjust the height of the bed to the comfortable working of the nurse.
5. Bring the client to the edge of the bed and towards the nurse to prevent
overreaching.
6. Check the room temperature and warm it if necessary.
7. Close the windows if necessary and put off the fan to prevent draughts.
8. Provide privacy by the means of curtains.
9. Remove the top bed linen or fanfold them to the foot end of the bed, leaving
a sheet or bath blanket over the client. Keep if free at the foot end to allow
freedom for the legs.
32
10. Offer bedpan or urinal if necessary (wash hands).
11. Keep the client flat if the condition permits. Remove extra pillows and
back rest.
12. Remove the personal clothing and cover the client with the bath blanket, if
the client has 1.V., remove the gown from the arm without I.V. First, then
lower the I.V. bottle, slide gown up the 1.V. tubing and over the I.V.
container, Rehang the I.V. container and check the rate of flow.
PROCEDURE
Steps of procedure Reason
1. Wash hands To prevent cross infection
2. Mix hot and cold water in the basin and The skin on the bed of the hand is a
check the temperature on the back of the sensitive area to assess the temperature
hand. Fill the basin half full. of the water.
3. Place the towel under the chin. Protect the bed becoming wet.
Wash, rinse and dry the areas in Cleaning is done from the cleanest area
the following sequence face, to the least clean area. Upper part of
neck, farthest arm, near arm, chest, the body first, before the lower part of
abdomen, back, farthest leg, near the body.
leg and pubic region.
4. Take a wash cloth, wet it, squeeze the Wash cloth used for the application of
excessive water, make a mitten, apply soap is kept separately in order to keep
soap on it and clean the face, ears and the water in the basin as clean as
neck. Put hack the wash cloth in the possible.
small bowl provided.
5. Take the other wash cloth, rinse It The wash clothes are made into a
in water, squeeze It, make a mitten mitten to avoid dragging its cold wet
and clean the area where soap is ends over the skin of the client and
applied. Repeat the procedure till the make him uncomfortable.
area is cleaned thoroughly. Put back
the wash cloth in the basin.
N.B. Observe the eyes, nose, ears,
face etc., for any abnormalities.
Dry the face with face towel
Place the bath towel lengthwise under Axilla is moist with perspiration. If not
the farthest arm. Clean and dry the properly cleaned, the soap and dirt will
farthest arm as described above. Pay remain in the axilla and harbour micro-
special attention to axilla. Support the organisms. Arms are supported to
arm at the joints. prevent fatigue.
33
N.H. Observe the skin and look for any
palpable lymph nodes in the axilla.
8. Repeat the procedure on the near

arm.
9. Place the basin on the bath towel at Hands are more contaminated area and
the edge of the bed and let the client soaking in water enable the nurse to
place hands in the basin. Rinse and clean them thoroughly.
dry thoroughly, paying particular
attention to the skin between fingers
and nails.
10. Place one corner of the bath towel Draping the chest properly provides
over one shoulder and the opposite privacy and warmth while keeping the
corner folded back and placed on the bath blanket dry for later replacement
other shoulder. Both corners are fixed over the client.
under the back of the client. Fold bath
blanket down to the level of the
umbilicus.
l1.With the left hand raise the towel Observe the chest and breasts for any
and the right hand mitted, cleanse the abnormalities. Note the respirations.
chest as before. Replace the towel over
the chest between wash, rinse and dry
periods. Remember to wash under the
breasts.
12. While the towel remaining on the Observe the abdomen for
chest, fold back the bath blanket down abnormalities.
to the pubic region, clean and dry the
abdomen. Give special attention to the
cleanliness of the umbilicus and
creased folds of abdomen.
13. Remove the towel and put back the Care is taken to prevent draughts.
bath blanket and cover the client
completely.
14. Change water. The waste water is To get clean water for back care.
discarded into the bucket. Changing water at intervals, maintain a
comfortable temperature.
15. Turn the client to prone or side Allows the visualization of the back
lying position with the face away from when the client is turned away from
the nurse. Make sure that the client you.
will not fall to the ground.
16. Fold back the bath blanket from The entire back is exposed from the
the shoulder to the thighs and tuck the shoulder to the buttocks for the
edges securely around the thighs. thorough cleaning of the back.
34
Place the towel over the bed, close to
the back, lengthwise.
17. Wash, rinse and dry the back from A thorough cleaning; a back rub and
the shoulders to the buttocks with the application of spirit and powder
brisk circular movements. After drying prevents bedsores, The spirit hardens
the back give a thorough back rub with the protein. Therefore, it toughens the
methylated spirit and powder. Pay skin and makes the skin more resistant
particular attention to the pressure to pressure. Powder absorbs moisture
points. and keeps the skin dry. It also protects
the skin against friction.
Put on the upper garments and cover

him with the bath blanket.
19.Change water
20. Expose the farthest leg. Place the Placing the foot in the water and
bath towel lengthwise under the leg. cleaning facilitates thorough cleaning.
Flex the knee so that the sole of the The feet Is considered to be the least
foot is supporting on the mattress. clean area.
Place the basin on the towel and keep Observe the legs.
the foot in the basin. Wash and rinse
the thigh and leg with the wash
clothes. Clean the foot under the water
paying particular attention to the toes
and nails.
21. Remove the basin and dry the

entire leg and repeat the procedure on
the near leg.
22. Wash the pubic area. It can be The cleanliness of the pubic area is
done by the client if he is able. If he is often neglected by the clients and by
not able to do it for himself the nurse the nurses.
does for him making sure that the
entire area is washed thoroughly and
dried.
After Care of Client and articles
1. Replace the clients personal clothing.
2. Straighten the bed linen.
3. Remove the bath blanket and put it for washing.
4. Change the bed linen if needed.
35
5. Offer a hot drink if permitted.
6. Cut short the finger nails and the toe nails. The nail cuttings should be
received in the kidney tray.
7. Comb the hair and arrange the hair.
8. Position the client for comfort and proper alignment.
9. Take all articles to the utility room. Disinfect the bath basin and the wash
clothes; Send the soiled linen to the laundry. Put back all the articles in
the proper places after cleaning. Personal articles are replaced into the
bedside table.
10. Wash hands. Record the procedure in the nurses record with time and
date and the type of bath. Record any abnormalities observed.
11. Take the opportunity to teach the client or his relatives about the
personal hygiene.
36
DECUBITUS ULCER/PRESSURE SORE/BED SORE
Deceits ulcers, also known as pressure sores or decubiti, are ulcerated or
sloughed area of tissue subjected to pressure from lying on mattress or sitting on
a chair for a prolonged period of time resulting in the slowing of circulation and
finally death (necrosis) of tissues.
COMMON SITES
Pressure points are those that bear weight, so that the skin over them is
subject to pressure. This may happen more frequently over the bony
prominences of the body where there is no rich blood supply or nourishment and
also there is a thin layer of skin. The common sites depend upon the position of
the client in bed.
The pressure points in the supine position are back of the head (occiput),
scapula, sacral region, elbow and heels, in a side laying position the pressure
points are the ears, acromion process of the shoulder, ribs, greater trochanter of
the hip, medical and lateral condyles of the knee and malleolus of the ankle
joint.
In a prone position, the pressure points are ears, cheek, acromion process,
breasts (in the females), genitalia (in the males), knees and toes.
CAUSES OF PRESSURE SORE
Direct or Immediate causes
Pressure
Pressure is considered to be primary cause of the pressure sore. In a sick

person, the areas of tissue resting against the mattress are vulnerable areas. The
pressure in these areas causes depletion of blood supply with the failure of
circulation to the weight bearing area resulting in the tissue damage. The
pressure over these areas are increased in the following conditions:
37
(a) When there are lumps and creases on the bed.
(b) Incorrect positioning of the body.
(c) Infrequent change of position.
FRICTION
Friction of the skin with a rough or hard surface can cause tissue damage.
Contact with the rough surfaces of the bed, wrinkles on the bed clothes, hard
surfaces of the plaster casts and splints, presence of foreign bodies on the bed
(e.g., bread crumbs, orange peelings) careless handling of bedpan, pulling sheets
under the clients etc. are frequent causes of friction which cause tissue damage.
Friction is also caused due to the rough sponge clothes and prolonged massage
without lubricant.
MOISTURE
The skin contact with moisture for a period of time can lead to maceration
of the skin. Clients who are sweating profusely, with incontinence of urine and
stools are liable to pressure sores.
Presence of Pathogenic Organism
Lack of cleanliness harbours pathogenic organisms and infection settles

on the skin.
Predisposing Causes
Impaired circulation
Emaciation.
Obesity.
Lowered vitality.
Oedema.
38
PREVENTION OF PRESSURE SORE
1. Identification of clients who are particularly prone to the development of

decubitus ulcer.
2. Daily examination of the decubitus-prone clients for redness, discoloration

or blister on the pressure points and they should be reported and treated
immediately.
3. Keep the clients clean and dry.
4. Change the position of the client every 2 hours so that another body surface
bears weight.
5. Use a bed cradle to take off the weight of the bed linen of the client, so as
to enable him to move in bed with ease.
6. Keep the clients skin well lubricated to prevent cracking by using powder.
7. Protect the damaged skin. Damaged skin can be further irritated and
macerated by urine, faeces, sweat etc.
8. Provide the, client with adequate fluids and with a nourishing diet that is
high in protein and vitamins.
9. Attend to the pressure points as often as necessary to stimulate circulation.

The clients who are liable to bed sores must have their back treated two
hourly or more often. The back is washed with soap and warm water, dried
and massaged with powder. Avoid using excess alcohol for back rub
because it dries the skin and cause tissue damage. Attending to the back
alone is not sufficient but should include the pressure areas at the iliac
crests, ankles, heels, elbows and other pressure points.
10. Call assistance and lift the client before giving and taking bedpans. If the
bedpan is chipped, care should be taken to pad the bedpan to avoid
friction.
39
11. Provide a smooth, firm and wrinkle free bed on which the client can
take rest.
12. Use special mattresses and beds to decrease the pressure on body parts,
e.g., air mattresses, water mattresses etc.
13. Cut short the finger nails of the clients to avoid scratching on the skin.
14. Use adequate amount of cotton under splints and plaster casts to prevent
friction.
15. Use the comfort devices to take off the pressure from the pressure points,
e.g., air cushions, cotton rings etc. Avoid using rubber rings since they
compress the area of the skin beneath them, decreasing blood supply
around the pressure points.
16. Encourage the clients to move in bed as far as it is allowed.
17. Change the linen as soon as they become wet. The back and buttocks also
must be washed, dried and rubbed with powder. After each urination and
defecation the back must be attended.
18. Teach the clients and their relatives the hygienic care of the skin.
Signs and Symptoms of Pressure Sore
The early symptoms of pressure sore are redness, tenderness, discomfort

and smarting. The area becomes cold to touch and insensitive. There is local
oedema; Later the area becomes blue, purple or mottled. Due to continued
pressure, the circulation is cut off, the gangrene develops and the affected area is
sloughed off.
40
TREATMENT OF THE DECUBJTUS ULCER
Despite of the conscientious use of preventive measures, certain clients,

because of their extremely debilitated condition, do develop pressure sores. The
decubitus ulcers once developed are difficult to treat. The nurses should
remember that the decubitus ulcers are prone to infection. Moist and poorly
nourished tissue is, a good medium for the growth of pathogenic bacteria.
Therefore all precautions are taken to protect the wound from contamination.
The following steps are taken by the nurses:
1. Report to the sister in-charge and the physician the early symptoms of a
bedsore so that steps may be taken as early as possible to prevent further
damage.
2. Whenever possible, take off the pressure from the decubitus ulcers by
placing the client on pillows or foam cushions or change the position of the
client (prevent the development of a pressure sore in the new area).
3. Prevent the ulcerated area from becoming infected. Infection will retard
healing of an ulcer. Follow strict aseptic technique.
4. A cleaning agent is used to clean the ulcerated area e.g., normal saline.
5. Apply all the possible measures for the healing of the wound.
-Heat is applied by an electric bulb (100 watt). This is placed from 45 to 60 cm
away from the wound and is left in place for 10 mm.
Application of a few drops of insulin dropped from a syringe has a healing effect on
the wound. The wound is then exposed to air to dry.
Filling the ulcer cavity with granulated sugar, A and D ointment etc. assists the ulcer
to heal.
6. Application of waterproof ointment e.g., zinc oxide on the surface of the

wound will prevent infection of the underlying tissues. It will be of much
value in clients with incontinence of urine.
7. If slough is present, clean the area thoroughly twice a day with hydrogen
peroxide diluted with distilled water. If the slough is loose, the physician
may cut off the slough. If there is delay in healing of the wound, the surgeon
may debride the ulcer and a skin graft may be applied over the ulcerated
site.
8. If infections settled, it may be necessary to give some of the antibodies

prescribed by the physician.
41
CARE OF THE EYES, NOSE AND EARS
The eyes, nose and ears are important organs which require no special
care in daily life. Hygienic care of the eyes, ears and nose prevents infection and
helps to maintain the functions. Hygienic care of these organs is always done as
part of the general bathing procedure.
Care of Eyes
A common problem of the eyes are secretions that dry on the lashes as
crusts. This may need to be softened and wiped away under sterile conditions. In
newborns, the eyes are treated soon after the baby is born to prevent ophthalmia
neonatorum.
Eyes are cleaned from the inner to the outer canthus. This prevents the
particles and fluid from draining into the nasolacrimal duct. During a bath, each
eye is cleaned with a separate portion of the wash cloth. When sterile procedure
is required, each eye is cleaned with separate swabs, swabbing each eye once
only. This prevents spread of Infection from one eye to other and to avoid
possible recontamination of the same eye.
1. Check the diagnosis of the client.
2. Check the physicians order to see the specific precautions

Regarding the care of eyes, the clients movements and Positioning.
3. Assess the general condition of the client and the ability to

Follow directions.
42
Preparation of articles
Articles Purpose
A tray containing
Mackintosh and towel To protect the pillow and bed linen
Sterile bowl with sterile To clean the eyes

cotton swabs
Sterile normal saline or any To clean the eyes

other ordered solution
Kidney tray and paper bag To receive the waste
Clean tray and paper To wipe the face after the procedure
Preparation of the client and the unit
1. Explain the procedure to the client. Explain how the client can help you.
2. Adjust the bed to the comfortable working of the nurse.
3. Arrange the articles conveniently on the bedside table.
4. Keep the client flat if the condition permits. Remove all pillows leaving one
pillow under the head.
5. Protect the pillow and the bed with a mackintosh and towel placed under the
head.
1.Wash hands To prevent cross infection
2. Pour sterile saline into the

bowel and wet the cotton
swabs
3. Stand in front of the client, Take the following precautions

clean the eyes with the sterile - Area of the swab touched by the fingers should
swabs. Discard the swabs into not come in contact with eyes.
the paper bag. Continue
cleaning till all discharges are - Squeeze off the excessive water from the
removed from the eyes. swabs.
43
- No pressure on the eye ball.
- Gently wipe the lids from the inner to the
outer corner.
- One swab for one swabbing.
- Separate swabs for each eye.
4. For crusted secretions place Warm compress makes the crust to become soft
a wet warm gauze piece or so that it can be removed without traumatizing
cotton swab over the closed the mucosa.
eye. Leave it in place until the
crust becomes soft.
5. When the eyes are clean,

stop the procedure. Wipe the
face with the face towel.
1. Instill any medications that are ordered, if any.
2. Remove the mackintosh and towel from under the clients head.
3. Adjust the position of the client in bed.
4. Tidy up the bed and make the client comfortable.
5. Take all articles to the utility room. Clean them. Boil the bowl. S-end the
towels to laundry. Replace the articles to proper places.
6. Wash hands thoroughly.
7. Record the treatment with date and time. Record the observations made on
the nurses record.
44
CARE OF NOSE AND EARS
The nose and ears require minimal care in the daily life. Excessive
accumulation of secretions makes the client sniff or blow the nose. The
secretions can become crusted and obstruct the airway (another nares).
For clients who cannot remove the secretions, assistance is necessary to

clear the congestion and protect the nasal mucosa. External crusted secretions
can be removed with a wet wash cloth or a cotton applicator moistened with oil,
normal saline or water. For babies and small children, a wisp of cotton
moistened with warm water or oil, introduced into the anterior nares, and
rotated gently cleanses the nostrils.
When there l5 poor hygiene of the ears, debris may accumulate behind the
ear and in the anterior aspect of the lead to ulceration of the skin. Common
problem of the ears is the collection of cerumen or ear wax in the external
auditory canal. This may cause a person some difficulty in hearing. It can cause
discomfort when it hardens. Many people remove wax from their ears by using
sharp objects which can traumatize the ear drum, Warm liquid paraffin or a
vegetable oil instilled into the ear can soften the wax and it can be easily
removed. When it cannot be removed by ordinary measures, consult the E.N.T.
surgeon.
45
CARE OF THE PERINEUM
Perineal hygiene involves cleaning the external genitalia and surrounding
area. The perineal area is conducive to the growth of pathogenic organisms
because ft is warm, moist and is not well ventilated. Since there are many
orifices (urinary meatus, vaginal orifice and the anus) situated in this area, the
pathogenic organisms can enter into the body. Thorough cleanliness is essential
to prevent bad odour and to promote comfort.
The most pertinent principle for the perineal care is to clean the perineum
from the cleanest to the less clean area. The urethral orifice is considered as the
cleanest area and the anal orifice is considered as the dirtiest area. Because the
orifices in the perineal area are. In proximity, cross contamination is a potential
problem. The normal flora of the urinary system is different from that in the
gastrointestinal system. Entry of organisms from the anal orifice can cause
urinary tract infections, because these organisms are foreign to the urinary tract.
During the perineal care, clean the area around the urinary meatus before
cleaning the area around the anus. The perineal area also has hair follicles which
tend to harbour organisms.
The following clients require special attention to the perineal area:
1. Clients who are unable to do self care.
2. Clients with genito-urinary tract infections.
3. Clients with incontinence of urine and stool.
4. Clients with excessive vaginal discharge.
5. Clients with indwelling catheters.
6. Post partum clients.
7. Clients after surgery on the genito-urinary system.
8. Clients with injury, ulcer or surgery on the perineal area or rectum.
46
1. Explain the procedure to the client
2. Provide privacy by screens and drapes. Drape the client as for vaginal
examinations. Fanfold the top linen to the end of the bed.
3. Remove all articles that may interfere with the procedure e.g., air cushion,
knee pillow etc.
4. Give extra pillows to raise the head.
5. Roll the draw sheet to the opposite side to prevent soiling when bedpan is
placed or place a mackintosh under the buttocks, over the draw sheet.
6. Offer the bedpan. Keep the clean bedpmn on the bed on your working side.
Ask the client to flex the knees and lift her buttocks by pressing the foot
against the mattress. Place the bedpan in position, while the nurse slides
her left arm under the waist and lower the client gently over the pan. Adjust
it comfortable for the client.
7. Untie the pads, if any, and observe the discharges, its colour, odour, amount
etc. Discard the pads in the paper bags.
8. Leave the client for sometime so that she may pass urine or stool if
necessary (never leave the client alone if she is too Ill or weak and likely
4to faint).
9. Get the toilet Every person should clean the perineum after each urination
and defecation. Emphasize on hand washing after attending to the
perineum.
1. Assess the condition of the perineal skinany itching, irritation, ulcers,

oedema, drainage etc.
2. Assess the need and frequency of perineal care.
3. Assess whether the perineal care should be done under an aseptic

technique or a clean technique (remember when there t5 a wound, the
perineal care should be done under aseptic technique).
47
4. Check the physicians orders for any specific instructions.
5. Assess the clients ability for self care.
6. Assess the clients mental state to follow Instructions.
Preparation of the articles
Articles Purpose
Mackintosh To protect the bed
A Jug with warm water or antiseptic solution To clean the perineum
Wet cotton balls or rag pieces To clean the perineum
Gauze of rag pieces in a container To dry the perineum
Long artery forceps in the kidney tray. To hold the swabs for cleaning
Paper bag. To receive the wastes.
Clean linen (personal and bed line) pads, To keep the client clean
dressing etc. as needed soap, soap dish, towel
and wash cloth if the client is able to do
himself.
Bed pan If the client is in need of
passing urine or stool.
Preparation of the client and the unit
tray and arrange the articles conveniently on the bedside table.
1.Wash hands To prevent cross infection
2. Pour water over the perineum. To wash off the discharge from the
perineal area
3. Clean the perineum using the wet swabs. To prevent the entrance of
- Hold the swabs with forceps and clean bacteria from the colon into the
from above downwards towards the anal urinary tract.
canal. To prevent recontamination.
- Use one swab for one swabbing. Ensure thorough cleaning.
48
- clean the perineum from the midline
outward in the following order:
The vulva
The labia minora on both sides
Inside of the labia majora on both sides.
The outside of the labia majora on both
sides.
Clean the perineal region and the anus
thoroughly.
4. Remove bedpan by supporting the hip as

before. Turn the client to one side and dry
the buttocks with a dry rag piece.
After care of the client and articles
I. Apply the medicine and pad
2. Remove the mackintosh if an extra one is used.
3. Change the linen if necessary. Straighten the bed clothes. Arrange the
bed linen.
4. Make the client comfortable.
5. Take, the bedpan to the sanitary annex. Remove the cotton swabs, if any
and empties them contents into the toilet. Rinse the bedpan with cold water
using a brush. Immerse it in lotion to disinfect it. Wash and dry well and
keep it on the bedpan rack, ready for the next use.
6. Clean all the articles. Boil the forceps. Replace the articles.
7. Remove the screen and tidy up the unit.
8. Wash hands.
9. Record the procedure with date and time and observations made.
49
COMFORT DEVICES
Bed rest
Which a provides support for the client in the sitting position.
Knee rest
Knee rest may be substituted by a pillow gives relaxation and thus relieves
pain on abdominal muscle tendon the beneath the knee.
Foot rest
Is a device so placed that the foot rest firmly against.
Bed block
Made of wood or metal. Used to foot end or head end. Prevent shock,
arrest, hemorrhage.
Aircushion
Aircushion are made of rubber and inflated with air relieve pressure
certain parts the body.
Rubber and cotton ring- relieve pressure on elbow and heals.
HYGIENIC NEEDS
Oral hygiene means brushing the client health or cleaning the dentures
according to the clients used route care of skin, hair, eye, ear, and nose.
Spirituality & Health
Health is a state of wellbeing complete physical, mental, social, spiritual

wellbeing not merely absence of disease.
Physical Health
Physical fitness the body functioning a rest.
Emotional health
Feelings and attitudes that make one comfortable with himself.
Psychological or mental health
A mind that grows and adjust in control and is free of serious stress.
50
Social Health
A sense of responsibility and caring for the health and welfare of others.
Spiritual Health
Inner peace and serenity comfort with one supreme power.

SPIRITUAL NEEDS
Love, hope, trust, forgiveness, to be respected and valued, dignity, valves,

creativity, belong to a community, sense of purpose.
Goal of spiritual care
Fulfill religious obligations
Draw on and use inner resources more effectively establish a dynamic,

personal relationship with suffer me being in the face of unpleasant
circumstances.
CARE OF THE PATIENT WHILE USING BED PAN AND URINALS
Provide adequate privacy
Using the urinals patient placed in sitting or living down position
Before using urinals washed with antiseptic lotion the water
Inspected the bladder condition (distention, rention)
Encourage the patient to voiding
To ask the patient during urination any discomfort are ask there to notify
colour and volume of urine and appearance colour pale yellow. (50 ml is
an abnormal)
After usage of urinal cleaning the perineal area with soap and water.
Discard the urine and document the details in patient case sheet.
Urinals placed under the cot.
51
COLD APPLICATION
Local Cold Application
Ice Bag
An ice bag is a dry cold application. The bag is filled with crushed ice or
ice chips and sprinkled sodium chloride. The salt lowers the melting point and
prevents the ice from melting. Crushed ice is better than ice cubes. The smaller
pieces of crushed ice allow easier moulding of the bag to the body part. There is
less air space between crushed ice. The result is a more even cooling.
Articles Required
Ice bag or collar.
Crushed ice or ice chips.
Flannel cover.
Sodium chloride.
Paper towels.
PROCEDURE
I. Explain the procedure to the client.
2. Fill the ice bag with water, put in the stopper, turn the bag upside down for
leakage.
3. Empty the bag.
4. Kill the bag half to two-third with crushed ice.
5. Sprinkle sodium chloride,
6. Keep the bag on a flat surface and squeeze out the air. Presence of air will
interfere with the thermal conductivity,
7. Screw the cap tightly.
8. Wipe the outside of the bag and put on the cover.
9. Place the bag in the flannel cover. Flannel cover will absorb the moisture
collected on the outer side of the bag.
52
10 Apply it on the ordered area since the ice bag is cooler than the skin, the
Ice takes up heat from the body and reduce the temperature.
11. The ice bag is applied for 30 mm and then it is discontinued for at least 1
hour to allow for the recovery period.
12. Make sure the client is comfortable.
13. Empty the contents, clean the articles and replace it in proper place.
14. Wash hands.
15. Document the care given time, site, response of the client, observation of
the skin area.
ICE COLLAR
It is applied to the neck. Commercial ice bags are available. They are re-
frozen for reuse. They are filled with a special solution and kept in the freezer
until needed. Flannel covers are needed with ice, collars or commercial ice bags.
Cold Compress
It is a local moist cold application. It may be sterile or un sterile. Sterile

cold compresses are applied over open wounds or breaks in the skin. Cold
compresses are made out of folded layers of gauze, lint piece or old soft linen,
wring out of cold or ice water or in some evaporating lotion (1 part of spirit with
3 parts of water) and applied to the required area. It is left uncovered. Cold
compress is left in a place for not more than 20 mm.
Articles Required
Large basin with ice.
Small basin with cold water
Gauze pieces or small towels.
Waterproof pad.
Bath towel.
53
Procedure
1. Explain the procedure to the client.
2. Wash hands.
3. Place the small basin with cold water into large basin with ice.
4. Place the compress in the cold water.
5. Keep the waterproof material under the part.
6. Check the area every 5 mm.
7. Change the compress every 5 mm or when it becomes hot.
8. Remove the compress after 20 mm.
9. Put the area dry with a bath towel.
10. Make client comfortable.
11. Clean the equipment and place it in the proper place. Discard the used
articles.
12. Wash hands.
13. Document the care time, site, duration of the application.)
Cold Packs
Commercially prepared ice packs are available. These bags are sealed
containers filled with chemical or non-toxic substance. Depending on the type,
the bags are frozen in the freezer or squeezed to activate the chemical that
produces the (old. These packs have the advantage that the frozen solution
remains pliable and can be easily moulded to fit the body part. The skin beneath
the pack should be assessed periodically for symptoms of numbness and pain.
Non-commercially, the pack can be a washcloth, towel, flannel or a piece

of old line depending on the size of the body (curt receiving the application. A
basin of cold water is prepared and the packs are immersed into it. When
cooled, the excess water is wrung out and the pack is applied to the body put is.
Replace the pack as necessary to maintain coolness.
54
Cold Sponging
Cold sponging is used to reduce temperature in a client with hyperpyiexia.

Large areas of the body are sponged at one time permitting the heat of the body
to transfer to the cooler solution on the body surface. Often wet towels are
applied to the neck, axillae, groin and ankles where the blood circulation is close
to the skin surface. Each area is dried by patting rather than by rubbing, since
the rubbing will increase the cell metabolism and raise the heat production. The
vital signs are checked very frequently to detect the early signs of complications.
Cold sponging is hazardous to the client if the temperature of the body is

brought down rapidly from a high temperature to a very low temperature. In
cold sponging the temperature of the water is kept between 65 and 9OF.
Tepid Sponging
Tepid sponging is a safe method to reduce the body temperature in high

pyrexia. It is carried out on the order of a physician. The temperature of the
water is kept between 85 and 100 o F
Hypothermia
Hypothermia is used in order to decrease the clients metabolism and to

maintain a low body temperature. A number of methods are used In therapeutic
hypothermia. One method is by surface cooling, the client lies between two
cooling blankets and a cooling liquid circulates through the blankets which
serves to provide cooling to the surface of the body. Another method is by the
use of a heart and lung machine in which the blood can be cooled, thereby
reducing the temperature of the body.
Surface hypothermia can also be induced by the following methods:
1. Covering the clients with a wet sheet over which a fan is directed.
2. Covering the clients body surface with ice bags.
3. Immersing the client in a tube of cold water.
55
But these are drastic measures which should not be used unless it Is very
essential and there is an expert advice.
ENEMA DEFINITION
An enema (plural-enemas, enemata) is an introduction of fluid into the

lower bowel through the rectum for the purpose of cleansing or to Introduce
medication or nourishment.
Purpose of Enema
1. To stimulate defecation and to treat constipation e.g., simple evacuant

enema.
2. To soften hard faecal matter e.g., oil enema.
3. To administer medications e.g.! sedative enema.
4. To protect and soothe the mucus membrane of the intestine and to check
diarrhea e.g., emollient enema.
5. To destroy intestinal parasites e.g., anthelmintic enema.
6. To relieve gaseous distension e.g.. carminative enema.
7. To administer fluids and nutrients e.g., nutritive enema. j-To relieve

inflammation e.g., astringent enema.
8. To Induce peristalsis e.g.: purgative enema.
9. To stimulate a person in shock and collapse e.g., stimulant enema.
10. To reduce temperature e.g., cold enema or ice enema.
11. To clean the bowels prior to X-ray studies, visualization of (lie bowel,
surgery on the bowel or delivery of a baby e.g., saline enema.
12. To make diagnosis e.g., barium enema.
13. To establish regular bowel functions during a bowel training programme.
14. To Induce anesthesia e.g., anaesthetic enema.
56
CLASSIFICATION
Classification of Enema
Evacuant
Retained Enema
Simple Medicated Cold Stimulant

Evacuant Evacuant Enema Enema Nutrient Emollient Sedative Anaesthetic
Enema Enema Enema Enema Enema Enema
Oil Enema Purgative Enema Astringent Enema Anthelmintic Enema Carminative Enema
General Instructions for Giving Enema
1. The appropriate size catheter or rectal tube need to be used. For giving a
cleansing enema use no. 22 French for adults, no. 12 French for an infant
and no. 14 to 18 French for the school age child.
2. The rectal tube needs to be smooth and flexible. Any tube with a sharp or
ragged edge should not be used because of the possibility of damaging the
mucus membrane of the rectum.
3. The rectal tube is lubricated with a water soluble lubricant or with

Vaseline to facilitate insertion and to decrease irritation of the rectal
mucosa. Use only a small amount to prevent blockage of the tube.
4. The temperature of the solutions needs to be adjusted according to the

purpose of the enema. To give an evacuant enema, the temperature should
be between 105 and 110 o F (40.5Q to 43C) for adults and 1002F (37.7C)
for children. A retained enema should be given at the body temperature.
57
5. The amount of the solution to be administered depends upon the type of
the enema and the age and size of the person. For giving evacuant enema
use 500 to 1000 ml for adults, 250 to 500 ml for a child and 250 ml or less
for an infant.
6. For giving retained enema, the quantity given at a time should not be
more than 100 ml to 150 ml so that the rectum will not be distended to
cause peristaltic movement.
7. When an enema is administered, the client usually assumes a left lateral

position. In this position, the position of the sigmoid colon is below the
rectum, thus facilitating instillation of the fluid. For a high cleansing
enema, the client changes position during the administration of the enema
from left lateral to dorsal recumbent and then to right lateral. In this way
the entire colon will be reached by fluid. For an evacuant enema the bed
should be made flat and for a retained enema the foot end should be
raised.
8. The distance to which the tube is inserted depends upon the age and the
size of the client. For an adult it is normally inserted 7.5 to 10 cm (3 to 4
inches), for children it is inserted only 2.5 to 3.75 cm (1 to 1.5 inches). If
any obstruction is encountered, it should be withdrawn and reported.
9. The height of the can should be adjusted to regulate the flow of the
solution according to the type of the enema administered. For cleansing
enemas, the height of the can should not be above 18 inches (45 cm) from
the anus and for retention enemas, it should not be above 8 Inches (20
cm) from the anus. The higher the container, the greater is the force with
which the solution flows into the rectum. There is an increase of 0.5 lb of
pressure for every 12 inches of elevation.
The length of time that the enema solution is retained will depend upon
the purpose of enema and the ability of the client to contract the external
sphincter to retain the solution. Oil retention enemas are usually retained
for 2 to 3 hours. Other cleansing enemas are normally retained 5 to 10
58
minutes. To assist a baby to retain the solution, the nurse can press the
babys buttocks together, thus providing pressure over the anal area.
10. Make sure the whole apparatus used for the administration of enemas is in
a good working condition.
11. Regulate the flow of fluid according to the type of the enema give
retention enemas very slowly, usually by a Murphy drip. Before giving
cleaning enemas, regulate the how of fluid and pinch the tube before the
tube is inserted Into the rectum.
12. If the rectum is impacted, attempt to remove the faecal matter with a
gloved finger. The bowels should be cleaned not by a simple enema before
giving retention enema.
13. Prevent air from entering into the rectum:

By removing the froth from the solution.
By expelling air from the tube.
By not letting the fluid run in completely from tube.
14. Listen to the complaints of the client and should not ignore any discomfort
however small they are.
15. Prepacked enemas will have their own instruction which need to be
followed unless there are other instructions from the physician.
SIMPLE EVACUANT ENEMA (LARGE ENEMA TO BE EXPELLED)
1. To stimulate defecation and to treat constipation.
2. To relieve gaseous distension by stimulating the peristalsis.
3. To relieve retention of urine by reflex stimulation of the bladder.
4. To stimulate uterine contractions and to hasten the child birth.
5. To cleanse the bowel prior to X-ray studies, visualization of the bowels

(e.g., sigmoidoscopy). surgery and retention enemas.
59
Solutions Used
Soap and water: Soap jelly 50 ml to 1 liter of water. Normal saline: Sodium
chloride 1 teaspoon to half liter of water.
Tap water.
Amount of Solutions- to be Used
Adults - 500 to 1000 ml (1 to 2 pint)
Children - 250 to 500 ml (0.5 to 1 pint)
Infants - 250 ml or less
Temperature of the Solution
Adults- 105 to 1102F (40.5C to 432C)
Children- 100 O F (37.7 O c)
These are given to soften faecal matter in case of severe constipation,

before the first bowel movement after operations on the rectum and perineum,
to avoid straining injury to the sutures and wounds. It should be retained for
half an hour to 1 hour to soften the faeces. It should then be followed by a soap
and water enema to open the bowels.
Solutions Used
Olive oil.
Gingerly oil or sweet oil. Castor oil and olive oil (1:2)
Amount of solutions to be used: 115 to 175 ml Temperature of the

solutions: 100F (37.7C)
Purgative Enema
These are given to cause the bowel to contract actively and to evacuate its
contents. It acts by their Irritating effect on the mucus lining, stimulate
peristalsis and cause evacuation of the bowel) It also acts as a hygroscopic
substance It draws water itself. The stretching of the intestine due to this
inflow of fluid causes the intestine to contract and leads to the evacuation of the
bowel.
60
Solutions Used
o Pure glycerin 15 to 30 ml
o Glycerin and water 1:2 Ox gall 15 to 30 ml
o Glycerin and castor oil 1:1
Magnesium sulphate: 60 to 120 ml with sufficient amount of water to dissolve It.
o 1-2-3 enema: Magnesium sulphate 30 ml, Glycerin 60 ml, and water 90 ml.
o Amount and temperature of the solution is that of oil enema.
o Carmi native Enema (Antispasmodic)
These are given to relieve gaseous distension of the abdomen by causing

peristalsis and expulsion of flatus and faeces. It is given as simple evacuant
enema.
Solution Used
Turpentine 8 tq 16 ml of turpentine mixed thoroughly with 600 to

1200 ml of soap solution.
Tr.Asafoetida 8 to 18 ml of Tr. asafoetida mixed thoroughly with 600 to
1200 ml of soap solution.
Milk and molasses: 90 to 230 ml of molasses well mixed with equal quantity of
warm milk.
Anthelmintic Enema
This is given to destroy and expel the worms from the intestines. Before
the treatment is given, the bowel should be cleansed by a soap water enema so
that the drug may come in direct contact with the worms and the lining of the
intestines. The treatment is given until the worms are destroyed.
Solutions Used
Infusion of Quassia : 15 gms of chips to 600 ml of water.

Hypertonic Saline : Sodium chloride 60 ml with 600 ml of water.
Amount of the solution : 250 ml
Astringent Enema
It contracts the tissues and blood vessels, checks bleeding and

inflammation, lessens the amount of mucus discharge and gives a temporary
relief in the inflammed area) It is usually given in colitis and dysentery. They are
usuall3 given Iii the form of rectal or colonic irrigations. The solution is allowed
61
to run in slowly and return quickly to avoid distension, Pain and irritation of the
Inflammed wall.
Solutions Used
o Tannic acid : 2 gms to 600 ml of water

o Alum : 30 gms to 600 ml of water
o Silver Nitrate 2% : (Silver nitrate is dissolved in the distilled water)
Temperature of the solution: It is given as hot as the client can stand.
Cold Enema (Ice Enema)
This is given to decrease the body temperature in hyperpyrexia and heat

stroke. It is given in the form of colonic irrigation.
Complication
Hypothermia.
Abdominal cramps.
RETENTION ENEMA
Stimulant Enema
A stimulant enema is given in the treatment of shock and collapse. It is

also sometimes given in case of poisoning, e.g., coffee enema is given in cases of
opium poisoning.
Solutions Used
Black coffee: One tablespoon coffee powder to 300 ml of water.

Brandy : 15 ml. of brandy added to 120 to 180 ml of glucose saline.
Amount of solution : 180 to 240 ml.
Temperature of 108 to 1109F (42 to 43C)solution:
Sedative Enema
It is a retention enema containing a sedative drug given to induce sleep.
62
Drugs Used
Paraldehyde.
Chloral hydrate.
Potassium bromide.
Dose: As ordered by the doctor.
Anaesthetic Enema
It is a retention enema containing an anaesthetic drug to produce

anaesthesia in the client.
Drugs used: Avertin 150 to 300 mg per kg of body weight.
Emollient Enema
This is the introduction of bland solution into the rectum for he purpose
of checking diarrhoea or soothing and relieving irritation on an inflammed
mucus membrane.
Solutions Used
o Starch and opium: Tr.Opium to 2 ml added to 120 to 180 nil f starch

mucilage or rice water.
o Starch mucilage alone.
o Amount of Solution: 120 to 180 ml
o Temperature of solution: 100 to 105oF (37.8OC to 40.5OC)
Nutrient Enema
It is a retention enema to supply food and fluids to the body. Selection of

the fluids depend upon the ability of the colon to absorb it. Nutrient enema is
particularly useful in conditions like hemophilia which makes IV. infusion
difficult or undeT5J
Solution Used
Normal saline.
Glucose saline 2 to 5%
Peptonized milk 120 ml
63
Amount of solution 1100 to 1700 ml in 24 hourse or 180 to 270 ml at 4 hourly
interval
Temperature of solution 100F (37.8C)
METHODS USED IN GIVING ENEMAS
Using Enema Can and Tube
When large amounts of fluids are to be given, this method is used. e.g.,
soap and water enema.
Funnel and catheter method
When a small quantity of fluids are to be given, this method used. e.g., oil
enema.
Glycerin syringe and catheter method
When a small quantity of fluid is to be given, this method is used e.g

Purgative enema.
Drip Method
When the fluid is to be administered very slow in order to aid in its

absorption e.g. Nutrient enema.
Preliminary assessment
Check the diagnosis

Check the date and type of surgery
Check the abilities and limitations concerning movement.
Check the consciousness and the ability to follow direction.
Check the nature of enema ordered and special precautions, if any, to be
followed.
Check the general condition of the client and the ability to retain the
fluid.
Check the medical order for the collection of stool specimens if any, for
laboratory tests.
Check for any lesions on the rectal and perineal area.
Any extra help needed e.g., to place the bedpan in position.
Articles available in the clients unit.
64
Articles Purpose
Enema can, tubing, glass connection, To prepare the solution and adjust the
screw clamp etc. rate of flow,
Rectal tube (adults) or rectal catheter To introduce into the rectum.

placed in a kidney tray.
Mackintosh and towel. To protect the bed.
Water soluble jelly or vaseline. To lubricate the tube.
Rag pieces in a container, To apply the lubricant and to clean the

perineum when necessary.
Hot and cold water in jugs. To prepare the solution.
Soap jelly in a bottle. To prepare the solution.
Ounce glass. To measure the soap jelly.
Paper bag. To discard the wastes.
Specimen bottles (if needed). The first one to receive the contents of
the bowel and the second one to give
Bedpan (2) or commode. the perineal care.
Clean linen as needed. To change the linen after the procedure.
Toilet tray. To clean the perineum.
I.V. stand or over bed table. To hold the enema can in position.
Preparation of the Client and the Unit
1. Explain the procedure to the client to win his confidence and

cooperation. Explain the discomfort caused by the enema fluid and
the need for retaining the solution for some time.
65
2. Provide privacy with curtains. (Dover the client with a sheet or bath
blanket and fanfold the top linen to the foot end of the bed. Remove
the back rest and pillows. Place the mackintosh and towel under the
clients buttocks to protect the bed and the linen,
3. Place the client in a left lateral position with the buttocks close to
the edge of the bed.
4. Keep all articles arranged on the bedside locker.
5. Keep the bedpan under the bed over a paper or stool.
6. Adjust the I.V. pole or over bed table to hold the enema can at the
required height.
7. Remove bottom, garments or raise it above the waist level.
8. Drape the client immediately before giving the enema. Fold back a
small portion of the sheet or the bath blanket, covering the client to
expose only the anus.
Procedure
Attach the tubing to the enema can and To prepare the solution and be ready
clamp the tube. for the administration.
Prepare the solution at the required Temperature above 43C may injure
temperature. Add 30 ml of soap jelly to tissues and temperature below 21C
600 ml of water. Test the temperature may produce severe cramping.
of the solution at the inner aspect of the
wrist. Remove the froth from the can.
Hang the can with the solution on the The rate of flow and the presure of the
stand and adjust the height at 45 cm fluid will increase according to the
from the anus. height of the can.
Attach a rectal tube to the tubing. Running the fluid through tube will
Loosen the screw clamp and let a small help to expel the air from the tubing
amount of fluid to run into the kidney and make sure that the whole
tray. Regulate the flow of the solution apparatus is in working order.
by adjusting the screw clamp. Pinch the Reading the level of the fluid can help
tubing with fingers. Read the level of us to calculate the amount of fluid
the fluid in the enema can. introduced into the rectum.
66
Lubricate the tip of the rectal tube Lubrication of the tube will prevent
about 2 to 4 inches from the tip. friction. The lubricant should not
Lubricant is applied to the minimum block the tube.
with a rag piece.
Separate the clients buttocks to Forceful insertion of the rectal tube

visualize the anus clearly and insert the may injure the anal or rectal tissue.
tip 8 to 10 cm gently while the client
exhales a deep breath.
Hold the enema tube in place while Holding the tube throughout the
releasing the .pressure on the tube and procedure will prevent the
let the fluid run in. Read the level of the displacement of the tube.
fluid and make sure that it is flowing.
During the administration of the fluid Breathing with open mouth relaxes
ask the client to take panting breaths. the abdominal muscles, decreases
pressure on the colon. Also distract
the client enough to relax abdominal
muscles.
Temporarily stop the administration of Temporary stoppage of the fluid will

the solution (should not remove the relax the bowels as the peristaltic
tube before the desired amount of movement is passed off.
solution has gone in) if the client has an
urge to defecate or has abdominal
cramps or if the solution level is rising
in the enema can.
Continue the fluid administration to Large amount of faeces in the colon

give about 500 to 1000 ml of solution. decreases the volume of the solution
Stop the procedure if the client develops retained comfortably.
discomfort.
Clamp the tubing. Gently remove the Holding the rag pieces around the
rectal tube by pulling it through 3 to 4 tube cleanses the tube by removing
layers of rag pieces. Hold the rag pieces the faeces from the tube. The pressure
around the tube and firmly against the applied on the anus will help the
anus. client to maintain the control of the
anal sphincter.
Discard the rag pieces in the paper bag. Avoid contamination of the articles
Detach the rectal tube and place it in and environment, with the soiled
the kidney tray. articles.
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1. Encourage the clients to retain the fluid for 10 to 15 minutes. Encourage

slow breathing with open mouth for relaxation.
2. Turn the client on the back and assist him onto toilet, commode or
bedpan. (Refer pp. 286-289 for offering bedi3ans and cleaning the
perineum).
3. Give a call signal to the client and leave him alone for sometime if safe.
4. Observe enema results, noting the colour, consistency and the amount.
Obtain specimens if desired.
5. Bring the toilet tray and assist him for perineal care. If bedpan is used, the
second bedpan is placed under the buttocks before the perineal care (see
procedure on perineal care).
6. Remove the bedpan, dry the client, put on the garments, change the bed
linen if needed, straighten the sheets and adjust the position of the client
In the bed to make him comfortable.
7. Explain the client that he may need to evacuate the bowels several times in
the next few hours.
8. Take the bedpan to the sanitary annex, inspect the contents, empty the
bedpan, clean it and keep it on the bedpan rack ready for the next use.
9. Take all articles to the utility room. Disinfect the rectal tube, clean it and
boil it and store it in its proper place in the proper manner. (Refer the care
of the rubber goods, pp. 90-93). Tidy up the clients unit.
10. Wash hands.
11. Record the type of enema, the result, the untoward results observed, if
any, with date and time on the nurses record.
12. Return to bedside. Evaluate the clients condition and comfort. Take vital
signs if the client is pale and sweating report immediately and get medical
aid for the client.
13. 13. Send the specimens, if any to the laboratory.
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PHARMACOLOGY
DEFINITION
Pharmacology is defined as the study of pharmacy.
DRUGS
A drug is any substance that alters physiological function with potential

for affecting.
FORMS OF DRUGS
Medications are manufactured is a variety of forms or preparation to make

them more useful or easy to administer. (Ex. Aqueous solution, aqueous
suspension, caplet, capsule, emulsion, enteric coated tablet.)
ROUTE OF ADMINISTRATION
Drugs are administered according to the preparation of the drug,

administered and the effect desired.
1) Oral administration
2) Sublingual administration (T.Nitroglycerin)
3) Inhalation (Ether, Chloroform)
4) Inuction (Topical application)
5) Instillation (Liquid from into a body cavity ex. Eye and Ear)
6) Insertion (Suppositories)
7) Insufflations
8) Implantation
9) Parental administration (IM, IV, SC)
10) Intra arterial, Intra cardia
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CLASSIFICATION OF DRUGS
1) Analgesics, antibiotics
2) Anesthetics, androgens
3) Anti helmintics & vermifuges
4) Antipyretics
5) Anti infection, Anti inflammation
DOSAGE DEFINITION
A dose is the amount of drug administered at one true.
MINIMUM DOSE
Is the smallest quantity of the drug that will produce an effect in the body.
MAXIMUM DOSE
Is the largest quantity of the drug that can be administered at one time
with out producing harm to the body.
LETHAL DOSE
It larger than the maximum dose which will have poisonous effect on the
client (cause death of the client)
ORAL ADMINISTRATION
It is most common route and the most convenient route for most clients.
METHODS OF ADMINISTRATION
1) Right Client
2) Right drug
3) Right Dose
4) Right time
5) Right method
INJECTION DEFINITION
Injection of medicinal substance or nutrient material into subcutaneous

tissue, muscular tissue, a vein, an artery, the rectum the vagina, the urethra,
other canals or cavities of the body.
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PURPOSE OF INJECTION
1) To get a rapid and systematic effect of the drug (Oral administration
take time for their absorption)
2) To provide the needed effect even when the client is unconscious,
unable to swallow due to neurological or surgical alterations affecting
the throat & mouth or when the client is not co-operative.
3) Assess that the total dosage will be administered and the same will be
absorbed for the systemic actions of the drug.
4) Provides the only means of administration for medication that cannot
be given orally.
5) To obtain local effect at the sight of the injection (to treat local
condition eg. Hydrocortionsone injection into joint cavity)
6) To restore blood volume by replacing the fluid (e.g in shock condition)
7) To give nourishment when it cannot be taken by mouth.
COMMON DANGERS OF INJECTION

1) Allergic reactions. E.g Pencillins, sera etc. it produce allergic reactions
& can be prevented by the test dose.
2) Infections ( the careless handing & improper sterilization of syringes,
needles)
3) Pyrogenic reaction (producing fever)
4) Psychic trauma especially in children.
5) Pain
6) Accidental intravascular injections
7) Over dose & under dose of the medication
8) Errors in the administration of medicine.
9) Air embolism due to the introduction of air into the blood vessels.
DIFFERENT ROUTES
1) To give intramuscular injection (Dorsal gluteal site, ventro gluteal site,

vastus lateralis site mild deltoid site)
2) To give subcutaneous injection
3) To give intra dermal injections.
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MICROBIOLOGY
INFECTION DEFINITION
Infection condition caused by the invasion of the body by pathogenic

Microorganisms.
STERILIZATION DISINFECTION
STERILIZATION DISINFECTION
Heat, chemicals, irradiation, high Chemicals

pressure, and filtration.
Steam, Heating, Chemical Air disinfectants, Alcohols, Aldehydes,

sterilization, Radiation sterilization, Oxidizing agents, Phenolics.
Sterile filtration.
To sterilize means to kill ALL microbes To disinfect means to eliminate most

- whether harmful or not - and their harmful microorganisms (not
spores present on a surface or object . including their spores) from surfaces
or objects.
Sterilization is used for food, medicine Disinfection is used mostly to

and surgical instruments. decontaminate surfaces and air.
METHOD OF TRANSMISSION DISEASE
I. Direct Transmission
The spread of disease from one host to another host.
A. Contagious/Communicable Disease - spread of disease from

person to person
Venereal - sexual contact
Aerosol - airborne droplets and/or dust
Fecal-Oral - contamination of food or water
Fomites - inanimate objects involved in disease transmission
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B. Zoonotic Disease - spread of disease from animals to humans
Animal Bites
Contact with infected animal tissue, fluids, feces
II. Indirect Transmission
The spread of disease from host to host by means of a vector. A vector is

usually some type of invertebrate animal.
A. Non-contagious/Communicable Disease
Infected Person >>> Vector >>> Person
B. Zoonotic Disease
Infected Animal >>> Vector >>> Person
Vector Types:
A. Mechanical Vector - vector is physically contaminated with the

pathogen and serves only to carry the pathogen to a new host.
B. Biologic Vector - vector is a required part of the life cycle of the

pathogen; for disease transmission to occur. The pathogen must replicate
or undergo some part of its life cycle in the vector.
IMMUNITY DEFINITION
Immunity having resistance to, the quality of being insusceptible or

unaffected by a particular disease.
TYPES OF IMMUNITY
Innate (Natural) immunity
it is a non-specific immunity present at birth. It provides a nonspecific

response to any foreign invader, regardless of the number of times the invader is
encountered. The natural defense mechanisms such as physical and chemical
73
barriers, the action of WBCs and the inflammatory response, are examples of
natural immunity.
Innate immunity includes species immunity, racial immunity, herd

immunity and individual immunity.
Species immunity
There is a remarkable difference in susceptibility among various species of

animals. Most of the diseases that are common among human beings do not
affect lower animals. For example, birds do not become infected with the same
type of tubercle bacilli that affect cattle and humans.
Racial immunity
Certain groups of people are naturally resistant to some diseases. Hbrews

are more resistant to tuberculosis than other people.
Herd immunity
Herd immunity is the immunity developed in a community, or a group of

people, where a large number of people (80%) develop resistance to a particular
disease. Herd immunity implies group protection beyond specific protection to
immunized individuals in a community. Herd immunity helps to control the
spread of epidemics.
Individual immunity
Certain authorities believe it is possible that some people have a strong

natural resistance, or immunity to certain diseases.
Acquired (Adaptive) immunity
This is a specific immunity which develops after birth as a result of prior

exposure to an antigen through immunization, or by contracting the disease
weeks, or months after exposure to the disease, or vaccine. The body produces
an immune response that is sufficient to protect the individual upon re-exposure
to it.
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ACQUIRED IMMUNITY MAY BE CLASSIFIED AS:
Active immunity
Active immunity is the resistance developed by an individual because of an

antigenic stimulus. The immunologic defenses are developed by the persons
own body. This involves the active functioning of the persons immune system
leading to the synthesis of antibodies, or the production of immunologically
active cells. The immunity produced is specific for a particular disease. This
immunity usually lasts for many years, or even for a lifetime (a whole life time).
Active immunity may be acquired in three ways:
Following clinical infection, e.g. chickenpox, rubella and measles.
Following sub clinical infection, e.g. poliomyelitis and diphtheria.
Following immunization with an antigen, which may be a killed vaccine,

a live, attenuated vaccine, or a toxoid.
PASSIVE IMMUNITY
When antibodies produced in one body (human, or animal) are transferred

to another to induce protection against disease, e.g. transfer of antibodies from
the mother to the fetus, passive immunity is seen. In passive immunity,
immunity is rapidly established; however, the immunity produced is only
temporary (days to months). The maternal antibody transmitted to infants lasts
only for a period about 6 months. Thus, many infants remain free from infection
up to 3 months.
Passive immunity may be induced by:
Administration of an antibody-containing preparation (immunoglobulin,

or antiserum)
Transfer of maternal antibodies across the placenta.
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BACTERIA DEFINITION
Bacteria microscopic, single celled organisms that commonly multiply

by cell division, possess a cell wall.
Staphylococcus aureus
What is it: Gram-positive spherical bacterium. It develops between 10C

and 45C with temperature optimum between 30C and 37C; with regard to its
pH, it is between 4 and 9 with optimum between 7 and 7.5. Though it is not a
sporogenous, staphylococcus show remarkable resistance to unfavorable
environmental conditions.
Where does it thrive: in water, on the skin and the mucous membranes.
Human beings are constantly exposed to staphylococcus infection risk since
most people usually harbour potentially pathogenic staphylococcus.
How does it strike: once it is in our organism it may trigger infections of

several types: from skin infections, such as pimples, to lung infections, such as
bronchial pneumonia, to blood infections, such as septicemia. The incidence of
staphylococcus infection among the hospital population, which is more likely to
have open wounds and a weakened immune system, is particularly high. The
onset of such epidemics in specific wards may be highly risky since it causes
serious therapeutic and prophylactic problems.
Escherichia coli
What is it: Gram negative ubiquitous micro-organism form the

Enterobacteriaceae family. Its culture is very simple; it is very tolerant of pH
variation, with optimum of 7.5. The ideal temperature is 37C. It is quite heat
resistant: it incubates at 45C.
Where does it thrive: it is found in soil, water, vegetation and intestinal

flora of most animals. It is commonly found in the human organism; in the body
it is the predominant bacterial facultative species in the large intestine.
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How does it strike: some E.Coli strains are the etiologic agents of enteritis,
a serious problem for first infancy children (exogenous) since they are caught by
ingestion of food contaminated by immune carriers. E. coli is also the most
frequent and predominant etiologic agent of (endogenous) urinary ways
infections (cystitis, cisto-pyelitis, pyelitis). Besides urinary ways infection,
Escherichia coli may cause septicaemia and neonatal meningitis, though it is
important to underline that, especially over the last few years, a number of
opportunistic-type infections have increased, such as those affecting hospital
population, e.g. respiratory infections, wound infections, infections ensuing
instrumental endoscopy, etc.
Pseudomonas aeruginosa
What is it: Gram negative bacterium, capable of thriving at a temperature

comprised between min. 4 C and max. 42C, though it cannot survive below
pH 4.5.
Where does it thrive: very commonly found in water, soil and as a

commensally bacterium on the cutis and in the intestines. Because of its poor or
nonexistent sensitivity to the most common antibiotics, its development is
enhanced by any anti-bacterial based treatment which reduces the competition
from the remaining microbial population, thus allowing the bacterium to reach
otherwise impossible numbers.
How does it strike: predisposed humans, that is, people with a particularly
weak immune system, are subject to suffer from several conditions, such as
wound infections, burns, meningitis (lumbar punctures) or urinary ways
infection ensuing instrumental surgery.
Enterococcus faecalis
What is it: Very common Gram negative bacterium. It grows at 10- 45C,
in a solution containing up to 6.5% of sodium chloride, at pH 9.6, and survives
for approximately 30 minutes at a temperature of 60C.
77
Where does it thrive: it is part of the normal intestinal bacterial flora in
humans and animals, though it is also found in plants and insects. It is used as
faecal contamination indicator in water and food.
How does it strike: bacterium with a low pathogen charge, though it has
some genes able to code the resistance to specific antibiotics; thus it manages to
survive in environments where those are largely used. Over the last 15 years it
was detected to be the cause of hospital infections which mostly affect the
urinary ways and surgical wounds, causing bacteremia and even endocarditis.
Most infections of enterococcus nature are caused by E. facials (85-90%).
VIRUS DEFINITION
The smallest of microorganisms that can pass through a filter and cannot
be seen by ordinary microscopes.
MEASLES (Rubeola)
Children infected by measles virus, develop measles, develop clinical

measles, characterized by fever, generalized maculopapular skin rash, cough,
stuffs, or runny nose, conjunctival redness and Kopliks spots. Measles vaccine
is now widely used to prevent measles and its complications. Subacute sclerosing
panencephalitis, a disease affecting older children and young adults, is a late
sequela of measles virus infection.
GERMAN MEASLES (Rubella)
This is another exanthematous fever, occasionally confused with measles.

The illness is usually mild and often undiagnosed. Still, rubella virus infection in
a non-immune pregnant woman can affect the normal development of the fetus.
Therefore, it is medically significant.
CHICKENPOX (Varicella)
Chickenpox is a highly communicable disease, transmitted by respiratory

droplets and skin contact. The causative organism is the varicellazoster virus.
78
The resultant infection manifests in an illness characterized by a vesicular rash.
After recovery, the virus may remain dormant (latent) in the body for many
years and then cause another illness called herpes zoster. Children may acquire
chickenpox after contact with a patient with herpes zoster.
SMALLPOX (Variola)
This disease has been universally eradicated by the systematic

administration of smallpox vaccination throughout the world. Therefore,
vaccination against smallpox is no longer necessary.
Poliomyelitis
Polio (also called poliomyelitis) is a contagious, historically devastating

disease that was virtually eliminated from the Western hemisphere in the second
half of the 20th century. Although polio has plagued humans since ancient
times, its most extensive outbreak occurred in the first half of the 1900s before
the vaccination created by Jonas Salk became widely available in 1955.
79
ANATOMY & PHYSIOLOGY
HUMAN ANATOMY
Anatomy definition
Anatomy is the study of structure of different parts of the human body.
Physiology Definition
Physiology is study of the functions of the body.
SYSTEM
1) Integumentary system
2) Immune system
3) Respiratory system
4) Digestive system
5) Nervous system
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6) Endocrine system
7) Skeletal system
8) Cardiovascular system
Integumentary system
Integumentary made up of skin, hair, nail, sweat & sebaceous gland.
Function
Protects the body
Regulate the body temperature
It is execratory organ
Giving sensation like touch, pain temperature
Respiratory system
Made of lung, larynx, teacha & bronchi.
Functions
Supply 02 to the tissue and removal of CO2 from the body.
It helps in production of second.
81
Digestive system
It consists of GI tract associated organs like liver, gallbladder and

pancreas.
Renal system
It consists of kidney ureters, urinary bladder and urethra.
Nervous system
It consists of brain, spinal cord and special sense organs.
Function
It control and integrates activities the body.
Endocrine system
It has gland releasing their secretions chromes directly into the blood
vessels includes thyroid, pituitary, thymus, pancreas, adrenal.
Reproductive system
It is made of sex organs like male tests female ovaries and associated
organs fenies made vaginal in female, fallopian tubes, and uterus.
Function
Production of male and female gametes
Form new organism by fusion of male and female gametes.
Skeletal system
Human body having 206 bones children infant-213
Functions
Provides structured frame work.
Locomotion
Protects the internal organs.
Disease
Fracture
Osteoporosis
Osteomalacia
Arthritis
Cardiovascular system
It is a connective formed by bone marrow.
82
Function
Transport 02 & CO2 and nutritions
Transport waste materials for excretion
Disease
CAD- Coronary artery disease
MI- Myocardial infraction
ASD- Arial septal defect
VSD- Ventricle septal defect
Mitral valve stenosis
Pulmonary stenosis
Respiratory System
Respiratory consist nose, pharynx, larynx, trachea two bronchi, and lungs.
Digestive system
Digestive system GI mouth pharynx, esophagus, stomach, duodenum,

jejunum, ileum, caecum, ascending colons, transverse colon, descending colon,
sigmoid colon, anal cannel.
Function
Digested tea food.

HCL is antiseptic
Disease
GFRD- Gastric content flow back to esophagus

Hiatal Hernia- Protrusion of stomach through hiatus.
Excretory system
Consist kidney 2, bladder -1, and urethra- 1
Disease
ARF (Acute renal failure)
CRF (Chronic renal failure) Decline of kidney function.
Nervous system
Living being responded to changes in the external environmental various

system of the body are controlled by nervous and endocrine system.
83
CNS Consists
Brain, Spinal Cord
Peripheral nervous system consist
Sympathetic division
Parasympathetic division
Disease
Hemiplegia, Paraplegia, Monoplegia, Quadriplegia, seizure, Brian &

spinal injury, Bells palsy, cerebrovascular insuffiency, CVA, Meningitis,
Encephalitis, Parkinson Disease, Multiple Sclerosis, Myasthenia Gravis.
Endocrine System
Endocrine glands are directly releasing their secretion blood stream

without help of ducts so these called ductless gland. Pituitary, thyroid,
parathyroid, adrenal, pancreas, pineal gland, thymus, ovaries, testes.
Disease
Hypothyroidism, Hyperthyroidism, goiter, Diabetic mellitus, Pituitary

tumor.
Reproductive system
Male gamete spermatozoa Unit by process of fertilization
Female gamete ova formation of zygote
Disease
Vulvitis, vagnitis, human papillom infection, herpes genitors, syphilis,

gonorrhea, uterine prolase.
84
PSYCHOLOGY
DEFINITION
Psychology is defined from Greek word psyche and logos.
Psyche means solve or mind
Logos means the study of Psychology
Psychology began to be regarded as the study of an individual mind or

mental process. Psychology began to be regarded as a science of behaviour, both
human and animal.
SICK PERSON NEEDS OF PSYCHOLOGY SUPPORT
Receive the patient with warmth and kindness as if she or he is your guest.
Orient the patient to the ward, its surrounding the physical facilities
available, the various people who work in it and the various duties assigned to
them, this should be done in a sympathetic manner.
The patient may be anxious or tense because of the illness she have many
doubts and as such may ask many questioners (irrelevant). Try to answer the
question well as you can always impart correct information it is better to
postpone giving as answer, rather than give incorrect information.
Talk to the patient and relatives sympathetically explain things dearly and
in simple language at the level of the patient understanding, sympathy means
feeling with the patient, dignified kindness and consideration with out undue
and sentimental concern.
Try to lessen the self consciousness at her patient by diverting their

attention to impersonal topics.
Listen to the patient let him relate in his wards exactly trebles him when
he find that he is being listened to with interest and attention he will speak
freely and without embarrassment.
85
She has the opportunity to intervene a behaviour problem and the spot if
ignored or allowed to continue would aggravate. The patients psychological
condition.
She should conduct brief counseling with patient and their families.
The technical aspect of patient care represent major role.
Care giver plays the role of a surrogate mother when she takes care at the
activities of daily living. She keeps him clean, helps him in the elimination,
exercises his inactive limb, and makes sure that he gets sufficient nourishment
by well balanced diet.
Health education is another important role.
Care giver motivates the patient to participate activity in rehabilitation

programme. Like occupational therapy industrial therapy and recreation
therapy.
PSYCHOLOGICAL SUPPORT
An assistant
A care taker
A well wisher
A listener
A Observer
A therapist
A Motivator
A teacher
A surrogate mother
A Administrator
A healer
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MENTAL HYGIENE IN OLD AGE
1. The age of 60 years and above is commonly considered as old age.
2. They are having impairment of sensory functions (seeing and hearing).

They are also having slowing down of motor functions, and impairment
of muscle co-ordination.
3. Immunity power less
4. Old people also show a gradual decline in mental ability.
5. Memory, attention, thinking and ability to learn new things are

affected.
6. After the death of husband she loss that control and is generally,
ignored
7. Elderly people need to eat iron and calcium rich food
8. Elders still want to feel financially independent.
9. They should encourage maintaining normal relationship with other

people.
MENTALLY HEALTHY PERSON
Characteristic
1) A mentally healthy person is free from internal conflict. He is not at

war with himself.
2) He is well adjusted. He is able to get along well with others. He is able

to form effective relationship.
3) He is productive.
4) He has good control over his behaviours.
87
5) He faces problem and to solve them intelligently. Has ability to cope
with stress and anxiety.
6) He know himself, he needs, problem and goals.
7) He has a good control over his behaviour
8) He face problem and to solve them intelligently has the ability to cope
with stress and anxiety.
MENTAL RETARDATION
Mental retardation is below average general intellectual functioning

originating during the development period and associated with impairment in
adaptive behaviour.
IQ = Mental Age x 100

Chronological age
CLASSIFICATION
Mild MR - 50-60 (IQ)
Moderate MR 35- 49 (IQ)
Severe MR - 20 34
Profound MR Below 20
CARE OF MENTAL RETARDATION
1. Provide calm and quite environment
2. Maintained personal hygiene (bating, dressmaking, activities)
3. Encourage of promote activities of daily living
4. Give parents guardian counseling about the disease condition now to

take care at the patient.
5. Educate the parent regarding their role in the braining of retarded

child.
88
6. Encourage the patient to participate training programme (occupational
therapy, gardening, toilering, book binding)
7. Give medication correct him and correct dose.
8. Protect the patient from physical hazard
9. Give diet proper him and well balanced diet.
10. Keep the surrounding low in stimuli (dim lighting, few people,) a
stimulating environment may increase the level anxiety.
11. Understand the patients fear and help him or her to reduce.
12. Patient comfort and safety is first priority.
13. Help to maintain physical activity.
14. Elimination has to be carefully watched. The patient should take to the
toilet at regular intervals.
SOCIOLOGY
Definition
Sociology means the study of the science of society.
Social problem
Poverty, Unemployment, beggary, crime juvenile delinquency, alcoholism,

prostitution.
USES OF THE STUDY OF SOCIOLOGY
1) Sociology makes a scientific study of society.
2) Sociology studies the role of the institution in the development of the

individual.
3) The great institution through which society functions are the home and
family the school and education, the church and religion the state and
government, industry and work the community and association.
4) The study of sociology is indispensable for understanding and planning

of society.
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5) Society is made of complex relationship it is difficulty to understand it
and to solve the many problem with out help of sociology.
6) Sociology is of great importance in the solution of social problem.
7) The world problem of today can be solving only through scientific study
of the society.
8) The task of sociology is to study the social problem through methods of

scientific research and to find out solution for them.
9) Sociology has charged out with regard to the problem of crime.
10) Sociology is of great importance in the solution internal problem.
SOCIAL PROBLEMS
Poverty
Poverty means the condition of an individual in which he is unable to meet

out his natural dependent basic needs a to function normally as a part parcel of
the society.
Unemployment
It is said to be non availabity of opportunity for employment for able

bodied of working age who are willing to work at the present wage levels.
Crime
Crime is an act committed against law. Five conceptions of crime. (I)

Demonological (ii). Sociology (iii) legal (IV) socio legal (v) psyche- socio legal.
Juvenile delinquency
The commission of illegal activities which is committed by an adult is

considered as a crime, is considered as juvenile delinquency when committed by
a child.
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Alcoholism
The world health organization (who) expert committee. Defined drug

addiction as the state of periodic or chronic intoxication, detrimental to the
individual to the society produced by society produced by repeated consumption
of a drug either natural or synthetic.
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SOCIOLOGY
Sociology is science of society. It deals with the study of relationship
between human begins.
SOCIAL PROBLEMS
Sociology is the science of society. It deals with the study of relationship

between human begins.
Social problems
1. Alcoholism
2. Drug Dependence
3. STD (Sexually transmitted Disease)
4. Juvenile delinquency
5. Prostitution
Delinquency
A delinquent is one who shows deviation from normal behaviour. Eg

sexual offense.
Causes
Social maladjustment, poverty, disturbed home condition alcoholism, drug

addiction and modern way of living the programme for the prevention and
control of juvenile delinquency centese round the implementation of the
children act 1986.
Which provides a specialized approach towards case protection,

maintained, training, rehabilitation the institutional structure consist
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Dowry System
Power started as an innocent custom, a symbol

Child welfare boards
Remand homes
Certified schools
Children homes and after care facilities.
Prostitution
Is an age old social evil. Social problem in urban areas.
Causes
Chance in environmental breakdown of family relationship, parental

quarrels want of affection, easy money, low IQ, moral standard poverty.
Immoral traffic (prevention act in 1986. It covers all person whether male
(or) female who are exploited sexually for commercial purpose.
Poverty system
Power started as an innocent custom, a symbol of love from parent to their

daughter on the of her marriage. In recent years grown a big social evil. Dowery
prohibition act 1986 taking giving 5 years imprisonment and five of Rs.15,000/-
Drug addiction
Defined as state of periodic or chronic intoxication detrimental to the

individual and society produced by the repeated of intake habit forming agents
Psychological
Physical Dependence
Development of Tolerance
Maladjustment
Some people react sharply, where lose their temples, talk loudly make
excuses and make ever one around uncomfortable. He is called maladjustment
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Causes
Frustration the basic needs not an individual not satisfied tension worry
and mental tension sap vitality and upset.
Insecurity
Adverse environmental factors
1. Lack of love
2. lack of communication
3. Home situation
4. Lack of recreation
5. Alcoholism
6. Parental neglect
7. Severe punishment
Management
1. Improvement of family life
2. Child guidance
3. Schooling
4. MCH Service
5. Social welfare service
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FIRST AID
FIRST AID DEFINITION
First aid is the immediate care of the ill or injury treatment can be given
by medical professional.
FIRST AIDER
1. Coordinate communication between first aiders in a work area
2. Allocate duties to first aiders
3. Help with first aid assessments for a work area
4. Maintain first aid kits, supplies and equipment and monitor

associated record keeping
5. Liaise with the local ohs&e committee and ohs branch.
FIRST AIDERS RESPONSIBILITIES
1. Provide first aid as needed, always working within their skill level
2. Record all treatment, however minor, in a first aid injury report
3. Arrange referrals for treatment as needed
4. Encourage staff to report workplace injuries on an incident report

form
5. Maintain first aid kits and equipment and restock as needed
6. Can access information on an sos bracelet or similar to attend to a

casualty
7. Must keep information on casualties confidential apart from

reporting requirements and giving medical information to medical
staff
8. Report any concerns about the first aid service to their first aid
coordinator.
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ARTIFICIAL RESPIRATION
If a person has stopped breathing from any cause, start artificial

respiration at once. Seconds count! The most efficient and practical way to save
a life is to blow your breath into the victim's lungs like inflating a balloon,
letting out the pressure, inflating again. You can do this without help or
equipment. A child can save the life of an adult with this method.
Mouth to mouth (or mouth to nose) resuscitation:
1-Tilt victim's head back 2-Pull or push the jaw 3-Open your mouth Or close nostrils
so chin points upward into a jutting-out wide, place it with the pressure of
position tightly over the your cheek
victim's mouth.
Pinch victim's
nostrils shut.
Or close the victim's 4-Blow into the Remove your

mouth and place your victim's mouth or mouth, turn your
mouth over the nose nose head to the side,
listen for return of
air from victim's
lungs.
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If foreign matter is visible in the victim's mouth, wipe it out quickly with
your fingers or cloth wrapped around your fingers. For an adult, blow vigorously
at a rate of about 12 breaths per minute. For a child, take relatively shallow
breaths at a rate of about 20 per minute.
If you are not getting air exchange (expansion of victim's chest, return
outflow when you remove your mouth), recheck head and jaw positions; make
sure mouth and throat are clear.
If you still do not get air exchange, turn victim on his side and give several
sharp blows between shoulder blades in hope of dislodging foreign matter. Again
sweep fingers through mouth to remove foreign matter. A handkerchief or cloth
may be placed over the victim's mouth or nose if the rescuer wishes to avoid
direct contact. Several layers of cloth will not greatly affect air exchange.
Several sharp pats between shoulder blades may dislodge foreign matter
from victim's throat
Start artificial respiration immediately and continue until doctor arrives

or you are positive life is gone. It is the victim's only hope of life while rescuers
with equipment are on the way.
Infants and small children respiration mouth to mouth technique:
1. Clean visible foreign matter 2. If air passages are still blocked,

from mouth with finger; place child on suspend child by ankles--or--hold child
back; use fingers of both hands to lift head-down over one of your arms and
lower jaw from beneath and behind so it give several sharp pats between
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juts out (as with adults). shoulder blades to help dislodge
obstructing matter.
Place your mouth over both
mouth and nose of child to make
"leakproof" seal. Breathe into child with
shallow puffs of air, about 20 per
minute.
If air exchange seems to be

blocked, and you cannot breathe easily
into child, check "jutting out" position
of jaw to be sure tongue has not fallen
back and that airway is open.
Continue artificial respiration until the victim begins to breathe for

himself or until a physician pronounces the victim dead. Time your efforts to
breathe into the victim to coincide with the victim's first attempt to breathe for
himself.
Normally, recovery is rapid except in electric shock, and drug or carbon

monoxide poisoning, which may require artificial respiration for long periods.
SHOCK
Shock is a term used to describe an ineffective blood circulation.
Causes
Loss of Blood Volume : Bleeding or fluid loss

Loss of Blood Pressure: Hear/Pump failure or abnormal or external dilation.
Internal or external bleeding
Severe burns or scalds
Serve diarrhoea
Heat stroke
Heart attack
Serve infection
Brain/Spinal cord injury
Signs and symptoms
Pale, cool, clammy skin

Thirst
Feeling cold
Rapid, shallow breathing
Nausea, vomiting
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Confusion
Reduced level of consciousness
Rapid, Weak pulse,
Ridged, painful abdomen.
First Aid
Ensure your own safety call

If conscious-lie casualty flat with legs elevated.
Control external bleeding
Reassure
Give nothing by mouth
Keep casualty warm but dont overheat.
Monitor vital signs
If casualty becomes unconscious, vomits or has breathing difficulty, place

in recovery position legs elevated if possible.
ELECTRIC SHOCK
Cause
Respiratory arrest
Cardiac arrest
Burns
First aid
Disconnect electricity where possible (Switch off at fuse box or main

circuit breaker and or unplung applicance).
If not possible, use non conducting material (Wooden stick, dry clothing)
to move casualty from electrical supply.
Commence CPR if required
Apply first aid to burns.
BURNS
The severity of a burn depends upon its size, depth and location. Burns are
most severe when located on the face, neck, hands, feet and genitals. Also, when
burns affect large parts of the body, they cause severe fluid loss and infection, a
ad can be life threatening.
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Burns result in pain, infection and shock, They are also more serious when
the victims are very young or over old.
Burns can cause damage to the body tissues by:
1. Dry HeatFlames, Lighted Cigarettes, Hot Iron
2. Moist Heat)scalds( - Boiling Water or Hot Oil
3. Cold - Liquid Nitrogen
4. Chemical -Acids or Alkali
5. Electrical Burns - Electricity or Lightning
6. Radiation Sun Rays or Laser
To distinguish a minor burn from a serious burn, the 1st step is to

determine the degree and 1hz extent of damage.
Burns are classified
S.No Degree Reason
1. 1 st Redness
Degree
Swelling & Pain (Such as mild sunburn)
2. 2 nd Blisters, Redness very painful. Associated with loss of fluid

Degree through the damaged skin are the most painful because nerve
ending are usually intact despite serve tissue damage.
3. 3 rd Deepest
Degree
Skin is charred and waxy
Fat, Muscle even bone may be affected extremely painful or

relatively painless.
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Management:
Remember4 Cs while managing burns:

Cool the burnt part by keeping it under running water for at least 10 minutes.
Dont put ice on the burn.
Constrictors should be removed immediately like rings, braceletsetc before
swelling occurs.
Cover the burnt part to prevent infection by using any clean cloth for example
hand kerchief.
Consult Doctor immediately.
General care for burns:
Smother the flames or move the victim away from danger.

Lay the casualty down on the floor.
Check the response, airway, breathing and pulse while managing the burn.
Resuscitate the casualty if necessary.
Call for medical help immediately.
took and treat for associated injuries or shock.
Cover all the wounds with clean dressing.
Precautions
a, Do not touch or interfere with the burnt area.

b. Do not apply toothpaste, hair cream, butter or any ointment.
c. Do not cover with cotton.
d. Do not remove clothes sticking to the burnt area.
e. Do not break the blisters.
Chemical Burns
In case the burns are caused by chemicals, it is important to remove

clothing on which chemicals have spilled and flush the affected area with
copious amounts of water for 15 to 30 minutes,
Electrical Burns
An electrical burn may appear minor, but the damage can extend deep into
the tissues beneath the skin.
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Management:
Look first, dont touch.

Turn off the source of electricity if possible.
Assess breathing, check pulse.
Cover the affected area.
Call for help.
BLEEDING
Bleeding may be from an Artery, a blood vessel which carries oxygenrich

blood from the heart throughout the body. Bleeding may be from a Vein, which
carries blood back to the heart to be oxygenated or bleeding may be from a
Capillary, which are tiny blood vessels
How to recognize:
- Arterial bleeding is bright red and spurts out from a wound, (severe form
of bleeding). This requires immediate attention as large amounts of blood loss
can occur quickly, if uncontrolled.
- Blood that oozes out slowly and is darter red in colour indicates venous
bleeding (Milder form of bleeding). Venus bleeding is easier to control than
Arterial bleeding. Capillary bleeding is usually slow, oozing in nature,
How to control bleeding:
1. Apply pressure directly over the wound by placing sterile gauze, dressing or
a clean handkerchief on the bleeding point
2, Apply pressure by finger so by hand.
3. Once pressure is applied, keep it in place. If dressings become soaked with

blood, apply new dressings over the old dressings The less a bleeding wound
is disturbed, the easier it will be to stop the bleeding
4. Apply continuous pressure by putting more gauze on top of the previous one
if it is soaked. NEVER THROW AWAY SOAKEO GAUZE.
5. Support and elevate the bleeding part above heart level and treat the shock,
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6. Once the bleeding stops, do not try to remove the cloth that is against the
open wound as it could disturb the blood clotting and restart the bleeding.
7. Cover and bandage the mound before transporting to the hospital.
UNCONSCIOUSNESS
Unconsciousness is a state of unresponsiveness, where the casualty is

unaware of their surrounding and no purposeful response can be obtained.
The recovery position
Maintains a clear airway- allows the tongue to fall forward

Facilitates drainage and lessens the risk of inhaling
Permits good observation and access to the airway
Avoids pressure on the chest with facilities breathing
Provide a stable position and minimize injury to causality.
Step 1
Raise the casualtys furthest arm above the head.

Place the casualtys nearest arm across the body.
Bend up the casualtys nearest leg.
With one hand on the shoulder and other on the knee, roll casualty away from
you.
Step 2
Stabilize the casualty by flexing the bent knee to 90o when resting on the ground.
Tuck the casualtys hand under their armpit.
Ensure the casualtys head is resting on their outstretched arm.
Step 3
Carefully tilt the head slightly backwards and downwards. This facilities
drainage of saliva and or stomach contents and reduce the risk of inhalation
which may cause pneumonia.
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NOSE BLEEDING
The nose is a part of the body that is very rich in blood vessels (vascular)
and Is situated in a vulnerable position on the face. As
a result, any trauma to the face can cause bleeding.
The bleeding may be profuse, or minor. Nosebleeds
can occur spontaneously also. This is common in dry
climates, or during the winter months when the air is
dry and warm from household heaters, People are more susceptible to bleeding
if they are taking medications, which prevent normal blood clotting.
Causes:
1. Trauma to the nose (nose picking, foreign bodies, forceful nose blowing).
2. Drying of the nasal membranes.
3. Tumors, of the nose or sinuses.
4. Inflammation of the nose or sinuses and cold.
5. Foreign objects in the nose, or other
6. obstruction.
7. Recognition:
8. Blending from one or both nostrils.
9. Frequent swallowing.
10. Flow at the back of the nose and throat.
First aid
1. Calm the patient
2. The patient should sit with the upper part of the body tilted forward
and the mouth open so that he/she can spit out the blood instead of
swallowing.
3. Pinch all the soft parts of the nose together between the thumb and
index finger.
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4. Hold the nose pinched for at least 8-10 minutes (timed by the clock).
5. Repeat necessary until the bleeding stops.
6. Apply ice (crushed in a plastic bag or washcloth) to the bane of the

nose.
7. Seek medical help.
Dos and Donts to control nosebleed:
1. Avoid forceful blowing of the nose or putting anything into it.
2. Do not strain during bowel movements.
3. Try to keep the head higher than the level of the heart
4. Do not strain or bed down to lift anything heavy.
5. Do not smoke.
6. Nohotliquidsforatleast24hours.
7. Give cold liquids) Ice creams.
8.
FRACTURE AND DISLOCATION
Fractures, sprains, strains and dislocations may be hard for the non
medical person to
differentiate.
Fracture means broken or

cracked bones.
Fractures can be caused by:
1. Direct force - Bones are

broken at the point where
severe force is applied.
2. Indirect force - Bones are broken away from the point where severe
force is applied.
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Types of fracture:
Closed Fracture Skin is intact with broken bone.

Open Fracture : Broken bone with open wound
Skin is broken with evident bleeding.
Flow to recognize?
1. Immobility
2. Deformity
1. Look for pain
2. Look for tenderness
3. Look for Swelling
4. Look for Loss of function
5. Any unnatural movement
Complication of fracture
Associated injuries may be present
Shock- Hypovolemic or Neurogenic
Management:
- lmmobilization and support to the fractured part.
- Minimizing the painful movements.
1. Reassure the casualty and ask not to move.
2. Check circulation and treat for shock.
3. Steady and support the fractured limb.
4. Keep the joints above and below the fractured part immobilized with
splint (or any improvised item). Proper splinting may reduce pain.
S. To design a splint use a rigid material such as mood, plastic or metal.
6. Fasten the splint to the limb with gauze, bandages, and strip of cloth,
string or even a belt.
7. Tie bandages firmly.
B. Stop bleeding with direct pressure if possible.
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9. If possible elevate the injured part
1O.Transport the casualty to the nearest hospital.
11. Check circulation, breathing, level of consciousness every 10 minutes
First aid for strains1 sprains, confusions, dislocations, or uncomplicated

fractures.
R.I.C.E
(Rest, Ice, Compression, Elevation) Treatment
REST
1. Stop using injured part
a. Continued activity could cause further injury, delay healing,

increase pain, and stimulate bleeding
2. Use crutches to avoid bearing weight on injuries of the leg, knee, ankle, or
foot.
3. Use splint for injuries of the arm, elbow, wrist or hand
ICE
1. Hastens healing time by reducing swelling around injury
2. Sudden cold contracts blood vessels
3. Helps stop internal bleeding from injured capillaries and blood vessels
4. Keep damp or dry cloth between skin and ice pack
5. Do not apply ice for longer than 15 to 20 minutes at a time
6. Apply at least 3 times throughout the day for 15 to 20 minutes
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COMPRESSION:
1. Hastens healing time by reducing swelling around injury
2. Decreases seeping of fluid into injured area from adjacent tissue
3. Use elasticized bandage, compression sleeve, or cloth
4. Wrap injured part firmly
5. Do not impair blood supply
6. Too tight compression may cause more smelling
7. Wrap over ice
8. Loosen the bandage if it gets to tight
ELEVATION
1. Elevate injured part above level of heart
2. Decreases swelling and pain
DROWNING
When a person is drowning, the air passages close to prevent water from
entering the lungs. This also prevents air from entering the lungs, thus depriving
the victim of oxygen and eventually leading to unconsciousness and death.
Usually, only if the victim has been unconscious in the water for some time do
the lungs fill up with water. More commonly, the water goes into the stomach .
Rescuing a Drowning Person
As in all first aid, the key rule is to

protect yourself. A person who is drowning
will strike out and pull down even the most
competent swimmer; dirty water can hide
dangers such as metal rubbish with sharp
edges; and cold water can cause muscles to
cramp very quickly.
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Vomiting
A person who has nearly drowned is very likely to vomit. Maintain a close
watch for this. If the victim vomits while you are resuscitating him, turn him
toward you, and clear out the mouth before turning him on to the back and
resuming rescue breathing. If the victim vomits while in recovery position, clear
out the mouth and keep a close eye on breathing to ensure that it has not
stopped. If the victim is conscious and become sick encourage him to lean
forward and give support while he is vomiting
Treatment of a Near-Drowning Victim
Your priority is to ensure an open airway and that the person is breathing.
1. Open the airway by tilting the head, checking the mouth, and lifting the
chin. Check for breathing for up to 10 seconds.
2. If the victim is breathing, place into the recovery position.
3. If the victim is not breathing, provide rescue breathing before moving

on to an assessment of circulation and full CPR as necessary.
FOOD POISONING
When faced with suspected food poisoning, ask what food has been eaten
in the last 48 hours. Food poisoning can take some time to show (however, toxic
food poisoning tends to act much more quickly). Be alert to the possibility of
food poisoning if there is any combination of the following.
Strange-tasting food or food that has been left out in the heat.
Several people with the same symptoms.
Undercooked or reheated food.
Signs and Symptoms

Nausea and vomiting
Stomach cramps
Diarrhea
Fever
Aches and pains
Signs of shock
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SYMPTOMS OF TOXIC POISONING ARE DIZZINESS, SLURRED
SPEECH, AND DIFFICULTY BREATHING AND SWALLOWING.
Treatment
Monitor and maintain the persons airway and breathing. If there are breathing
difficulties, call 911.
Help the person into a comfortable position.
Call for medical advice on treatment and care.
Give plenty of fluids to drink, particularly if the person has vomiting and diarrhea.
Support the person if he or she vomits, providing a bowl and towel as necessary.
Do not underestimate food poisoning, particularly in the very young or the
elderly.
INSECT BITE
Insects that sting include:
Bumblebees
Honeybees
Hornets
Wasps
Yellow jackets
Most often, the symptoms that come from these insect stings include:
Quick, sharp pain
Swelling
Itching
Redness at the sting site
Insect stings can even result in a severe allergic reaction. Symptoms of

this include:
Severe swelling, all over and/or of the face, tongue, lips
Weakness, dizziness
A difficult time breathing or swallowing
Sometimes death due to airway obstruction or shock
Symptoms of a severe allergic reaction usually happen soon after or within

an hour of the sting.
If you've ever had an allergic reaction to an insect sting in the past, you
should carry an emergency kit that has:
Adrenalin (a medicine called epinephrine that stops the body-wide

reaction) and a needle to inject it
An antihistamine
An inhaler that contains adrenalin
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Instruction sheet that explains how to use the kit
You have to get this kit from your doctor. You should also wear a medic
alert bracelet that lets others know that you are allergic to insect stings. People
who have had severe reactions in the past to bee or wasp stings should ask their
doctor about allergy shots.
PREVENTION
Try to avoid getting stung.
Keep foods and drink containers tightly covered. (Bees love sweet foods like soft
drinks.)
Don't wear perfume, colognes and hair spray when you are outdoors.
Don't wear bright colors. Choose white or neutral colors like tan. These don't
attract bees.
Wear snug clothing that covers your arms and legs. . Don't go barefoot.
Be careful when working outdoors such as when pulling weeds or removing
shutters from the house to paint. Bees often build hives behind shutters.
If an insect gets in your car, stop the car, roll down the windows and get the insect
out of the car.
DOG BITE
As much as humans interact with canines, dog bites are common,

especially in children. Responding to a dog bite should always start with the
safety of all involved, including the victim, the rescuer, and if possible, the dog.
1) Stay Safe. Secure the dog or the victim. Move one away from the other. If the
dog's owner is around, instruct him or her to secure the dog. If not, move the
victim to a safe location. Dogs may bite because their territory is threatened.
Don't start any treatment until there is a reasonable expectation that the dog
won't attack again.
2) If you are not the victim, practice universal precautions and wear personal
protective equipment if available.
3) Control any bleeding by following the appropriate steps. Avoid using a

tourniquet unless there is severe bleeding that cannot be controlled any other
way.
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4) Once the bleeding is controlled, clean the wound with soap and warm water.
Do not be afraid to clean inside the wound. Be sure to rinse all the soap away,
or it will cause irritation later.
5) Cover the wound with a clean, dry dressing. You can put antibiotic ointment
on the wound before covering. Watch for signs of infection: Redness,
Swelling, Heat, Weeping pus
6) Always call a physician to determine if you should be seen. Some dog bites
need antibiotics, particularly if they are deep puncture wounds. Additionally,
many municipalities have regulations for reporting dog bites and monitoring
the dogs, and that is often initiated by contact with a doctor.
7) Any unidentified dog runs the risk of carrying rabies. If the dog cannot be
identified and the owner cannot show proof of rabies vaccination, the victim
must seek medical attention. Rabies is always fatal to humans if not treated.
8) The wound may need stitches. If the edges of a laceration are unable to touch,
or if there are any avulsions, the wound will need emergency medical
attention.
SNAKE BITE
1) Try to safely and quickly identify the species of snake if practical. Move
victim to safety. Have one person take firm command of the situation
very early to improve the coordination and decision making processes.
The victim's condition is assisted with an observation that calm and
competent assistance is being firmly applied. There will be no time for
shy or timid behavior! Action will be crucial! Proceed with no delay to
use judgment calls on all of the below suggested techniques.
2) Remove any jewelry or tight fitting clothing. Quickly tie a light

restricting band both above and below the bite area a few inches away
from the puncture/bite marks.
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3) Without cutting, apply strong suction, preferably within seconds of the
bite directly on the main or deepest puncture/bite marks. This can be
accomplished with the mouth or a commercial bite kit suction device.
Time is critical here as any venom present will become destructive very
quickly!
4) Rapidly apply antiseptic cleanser to the entire area and place cold
compress as closely as possible without interfering with suction
process.
5) Continue strong suction and alternate the location of compress to avoid

injury from severe cold.
6) Check constriction bands periodically as swelling may occur and loosen

as appropriate.
7) Monitor for symptoms of shock and be prepared to administer

appropriate treatment. At any signs of major stress or
unusual/unexplained discomfort, check for need to apply other first aid
techniques - elevate bitten extremity, elevate legs from lying down
position, keep warm, immobilize, etc. Do not administer alcohol or
cause additional stress to victim. Avoid food or liquid intake.
8) Keep victim warm and immobilize as practical. Movement to proper

treatment facility is more crucial than maintaining immobile status.
Maintain above treatment functions throughout.
9) Transport safely at the earliest possible time to competent medical

service. Ideally, all of the above steps can be administered concurrently
with transport phase. Keep victim as comfortable as possible and
reassure that survival is not in question. Rapid response reduces
damage levels.
10) If possible and voluntarily chosen, administer electroshock to bite

area in several one second bursts in a small circle around bite. Repeat
this at 10-15 minute intervals getting slightly farther from bite area
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seeking to follow course of venom flow. Take care to utilize DC current
at proper levels and prepare in advance to administer this technique.
11) If practical, dispatch snake and take along for any identification or
testing needs. The primary purpose of this first aid is to slow down or
reduce the invasion of the venom, to protect the victim from further
side effect trauma, to prepare the victim for later medical procedures
such that complications may be minimized, and generally to get the
victim to such treatment as quickly and safely as practical.
12) Stand by for back up assistance or side task assignments like contacting
relatives, protecting scene materials, providing useful information of
incident facts; describe first aid administered, etc.
13) Be confident that all which could have been done was applied to assure
as successful an outcome as possible given that a venomous bite is
difficult to control or establish a completely accurate prognosis.
Remember, early treatment is better treatment when such a bite
occurs.
SNAKE BITE
1. Try to safely and quickly identify the species of snake if practical. Move
victim to safety. Have one person take firm command of the situation
very early to improve the coordination and decision making processes.
The victim's condition is assisted with an observation that calm and
competent assistance is being firmly applied. There will be no time for
shy or timid behavior! Action will be crucial! Proceed with no delay to
use judgment calls on all of the below suggested techniques.
2. Remove any jewelry or tight fitting clothing. Quickly tie a light

restricting band both above and below the bite area a few inches away
from the puncture/bite marks.
3. Without cutting, apply strong suction, preferably within seconds of the

bite directly on the main or deepest puncture/bite marks. This can be
accomplished with the mouth or a commercial bite kit suction device.
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Time is critical here as any venom present will become destructive very
quickly!
4. Rapidly apply antiseptic cleanser to the entire area and place cold
compress as closely as possible without interfering with suction
process.
5. Continue strong suction and alternate the location of compress to avoid

injury from severe cold.
6. Check constriction bands periodically as swelling may occur and loosen

as appropriate.
7. Monitor for symptoms of shock and be prepared to administer

appropriate treatment. At any signs of major stress or
unusual/unexplained discomfort, check for need to apply other first aid
techniques - elevate bitten extremity, elevate legs from lying down
position, keep warm, immobilize, etc. Do not administer alcohol or
cause additional stress to victim. Avoid food or liquid intake.
8. Keep victim warm and immobilize as practical. Movement to proper

treatment facility is more crucial than maintaining immobile status.
Maintain above treatment functions throughout.
9. Transport safely at the earliest possible time to competent medical

service. Ideally, all of the above steps can be administered concurrently
with transport phase. Keep victim as comfortable as possible and
reassure that survival is not in question. Rapid response reduces
damage levels.
10. If possible and voluntarily chosen, administer electroshock to bite area

in several one second bursts in a small circle around bite. Repeat this
at 10-15 minute intervals getting slightly farther from bite area seeking
to follow course of venom flow. Take care to utilize DC current at
proper levels and prepare in advance to administer this technique.
115
11. If practical, dispatch snake and take along for any identification or
testing needs. The primary purpose of this first aid is to slow down or
reduce the invasion of the venom, to protect the victim from further
side effect trauma, to prepare the victim for later medical procedures
such that complications may be minimized, and generally to get the
victim to such treatment as quickly and safely as practical.
12. Stand by for back up assistance or side task assignments like contacting
relatives, protecting scene materials, providing useful information of
incident facts, describe first aid administered, etc.
13. Be confident that all which could have been done was applied to assure
as successful an outcome as possible given that a venomous bite is
difficult to control or establish a completely accurate prognosis.
Remember, early treatment is better treatment when such a bite occurs
CHEMICAL POISONING
1. Seek immediate medical help.
2. For poisoning by swallowing:
3. Check and monitor the person's airway, breathing, and pulse. If

necessary, begin rescue breathing and CPR.
4. Try to make sure that the person has indeed been poisoned. It may be
hard to tell. Some signs include chemical-smelling breath, burns
around the mouth, difficulty breathing, vomiting, or unusual odors on
the person. If possible, identify the poison.
5. Do NOT make a person throw up unless told to do so by poison control

or a health care professional.
6. If the person vomits, clear the person's airway. Wrap a cloth around
your fingers before cleaning out the mouth and throat. If the person
has been sick from a plant part, save the vomit. It may help experts
identify what medicine can be used to help reverse the poisoning.
7. If the person starts having convulsions, give convulsion first aid.
8. Keep the person comfortable. The person should be rolled onto the left
side, and remain there while getting or waiting for medical help.
9. If the poison has spilled on the person's clothes, remove the clothing
and flush the skin with water.
116
FOR INHALATION POISONING:
1. Call for emergency help. Never attempt to rescue a person without

notifying others first.
2. If it is safe to do so, rescue the person from the danger of the gas,
fumes, or smoke. Open windows and doors to remove the fumes.
3. Take several deep breaths of fresh air, and then hold your breath as you
go in. Hold a wet cloth over your nose and mouth.
4. Do not light a match or use a lighter because some gases can catch fire.
5. After rescuing the person from danger, check and monitor the person's
airway, breathing, and pulse. If necessary, begin rescue breathing and
CPR.
6. If necessary, perform first aid for eye injuries (eye emergencies) or

convulsions ( convulsion first aid).
7. If the person vomits, clear the person's airway. Wrap a cloth around
your fingers before cleaning out the mouth and throat.
8. Even if the person seems perfectly fine, get medical help.
DO NOT
1. Do NOT give an unconscious person anything by mouth.
2. Do NOT induce vomiting unless you are told to do so by the Poison

Control Center or a doctor. A strong poison that burns on the way down
the throat will also do damage on the way back up.
3. Do NOT try to neutralize the poison with lemon juice or vinegar, or any
other substance, unless you are told to do so by the Poison Control
Center or a doctor.
4. Do NOT use any "cure-all" type antidote.
5. Do NOT wait for symptoms to develop if you suspect that someone has
been poisoned.
117
NUTRTITION
FUNCTION OF BALANCE DIET
The recommended standard American diet consists of a balance of foods

such as fruits, vegetables, proteins, grains, dairy products and oils. However,
many Americans do not understand the importance of maintaining a balanced
diet, or feel that their busy schedules do not allow them to properly balance
foods for optimal health. A balanced diet serves several functions to promote
physical and mental health.
Proper Vitamin Balance
A balanced diet provides the proper balance of vitamins to support

optimal health. According to the Home Health UK website, several vitamins are
necessary for brain and organ function. Vitamin A, which supports the
manufacture of healthy cells, is available in dark green, leafy vegetables, dairy
products and liver. Vitamin C, found in citrus fruits, tomatoes and potatoes,
helps ward off infection and disease, and supports strong arteries and blood
vessels. Vitamin E may help prevent heart disease and cancer. This vitamin is
found in egg yolks, nuts and green vegetables.
Protein for Fuel
A balanced diet provides abundant lean protein for use as fuel. In the
standard American diet, protein is largely derived from meat sources; however,
meats such as pork and beef are high in saturated fats, which can contribute to
atherosclerosis, or hardening of the arteries. According to the Vegetarian
Society, nuts, seeds, low-fat dairy products and soybean products such as tofu
and soy milk can provide lean protein without adding saturated fats.
118
Carbohydrates for Energy
Although many diet plans emphasize the reduction or elimination of

carbohydrates, these building blocks are necessary for energy, according to
Western Kentucky University. A balanced diet focuses on complex carbohydrates
found in whole grains, rather than simple carbohydrates, which are derived from
white breads, pastries and doughnuts. Complex carbohydrates provide fuel
needed for exercise and daily activities.
Fats for Health
Like carbohydrates, fats are often eschewed as harmful to the body,

particularly among dieters. However, fats are essential for physical health,
according to the Body Building Tips Guide website. Essential fatty acids, which
are found in fish and flaxseeds, are necessary for proper brain function and
protection of the nervous system. Fats also aid in human physical growth and
development. A balanced diet provides essential fatty acids and unsaturated fats
in moderation, while limiting saturated fats and trans fats that can contribute to
heart disease.
MALNUTRITION
Malnutrition is the condition that occurs when your body does not get
enough nutrient
Causes
Inadequate or unbalanced diet

Problems with digestion or absorption
Certain medical conditions
Symptoms
Symptoms vary and depend on what is causing the malnutrition. However,

some general symptoms include fatigue, dizziness, and weight loss.
119
Signs and tests
Testing depends on the specific disorder. Most work-ups include

nutritional assessments and blood work.
Treatment
Treatment usually consists of replacing missing nutrients, treating

symptoms as needed, and treating any underlying medical condition.
UNDER NUTRITION
Undernutrition (or Malnutrition) is a condition caused by the lack of

proper nutrients over a period of time. This condition can be the result of not
eating enough, not eating enough of what you need for a balanced healthy diet,
or excessive loss of nutrients. Undernutrition occurs when for an extended
period of time, the body is not given the nutrients that it needs (vitamins,
minerals, proteins, calories) to properly function.
OVER NUTRITION
Feeding, particularly calories, in excess of requirements, leads to obesity,

rapid weight gain, and developmental skeletal abnormalities in dogs.
Causes
Fast food and bad eating habits can lead to overnutrition
120
FAMILY PLANNING
VARIOUS METHODS OF FAMILY PLANNING
Family planning refers to practices that help individual or couples to

attain certain objectives.
1) To avoid uncoated births
2) To bring about wanted births
3) To regulate the intervals between pregnancies
4) To control the time at which birth occur in relation to the ages of the
parent
5) To determine the numbers of children in the family.
CONTRACEPTIVE METHODS
Defined as preventive methods to help women avoid unwanted

pregnancies, there are two classes spacing & terminal methods.
Spacing methods
Barrier method To prevent live spasm from meeting the ovum.
Physical methods (Condom, female condom, diaphragm, vaginal

sponges)
121
Chemical methods
a) Foams, tablet, aerosol
b) Creams and paste
c) Suppositories
d) Soluble films
2) Intra uterine devices
Two types of IUD- Non medicated & mediated (both are usually made of
polyethylene or other polymers).
3) HORMONAL METHODS : AS CLASSIFIED
A) Oral pills
1) Combined pill
2) Progestogen only pill (pop)
3) Post coital pill
4) Once a month (long acting)
5) Make pill
B) Depot (slow release) formulations
1) Indictable
2) Subcutaneous
3) Vaginal rings
4) POST CONCEPTIONAL METHODS (TERMINATION OF

PREGNANCY)
1) Menstrual regulation
2) Menstrual induction
3) Abortion
122
4) MISCELLANEOUS
1. Abstinence
2. Coitus interrupts
3. Safe period (Rhythm method)
4. Nature family planning methods
5. Breast feeding
6. Birth control vaccine
TERMINAL METHODS
1) Male sterilization (vasectomy)
2) Female sterilization
i. Laparoscopy
ii. Minilap operation tubectomy
MTP (MEDICAL TERMINATION PREGNANCY)
Methods
1) Dilation & evacuation (up to 12th weeks)
2) Vaccum aspiration (upto 12 th weeks)
3) Termination & sterilization
4) Laminaria tent
123
ABORTIONS
Definition
Termination of pregnancy before the foetus become viable (capable of

living independently) before 28 th week gestation.
Types
1) Threatened abortion
2) Inevitable or incomplete abortion
3) Cervical abortion
4) Febrile abortion
5) Missed abortion
6) Therapeutic abortion
7) Septic abortion
METHODS OF EDUCATION TO SOCIAL GROUPS
Individual teaching
Personal contact
Home visit
Personal letter
124
Group approach
1) Lectures
2) Demonstration
3) Discussion methods
a. Group discussion
b. Panel
c. Symposium
d. Workshop
e. Conference
f. Seminars
g. Role play
FAMILY PLANNING GUIDANCE & COUNSELING
Create a comfortable atmosphere for family planning users
Have respect for the values and attitudes of users
Present information clearly
Encourage the formulation of questions
Listen and observe attentively
Be impartial or neutral
Ask questions in a manner that encourages clients to share

information and feelings
Facilitate effective counselor-user interaction
Speak the language of the client
125
COMMUNICABLE DISEASE & COMMON DISEASE
DROPLET INFECTION
Small pox
An acute infectious disease cause by

variola virus.
Sign & symptoms
Onset of fever, headache, back ache,

vomiting & some times, convulsions,
especially in children.
Chicken box
Is an acute, highly infectious varicella disease caused by varicella zoster virus.

It is characterized by vesicular rash that may be accompanied by fever & malaise.
Epidemiological determinants
a) Agent : V-Z Virus is also called Human (Alpha) herpes virus 3
b) Source of infection : The virus occur in the oropharyngel secretions,

lesions of skin and mucosa.
c) Infectivity: Communicability of patient range from 1 to 2 days before

the appearance of rashes & 4 to 5 days there after.
d) Secondary attack rate : Household contract approach 90%.
Host factors
Age : Under 10 years of age (few in adult hood)
Immunity : One attack gives durable immunity.
126
Environmental factors
Mostly during first size month of the year. In temperate climates
Transmission
Transmitted from person to person by droplet infection & by droplet

nuclei.
Incubation period
14 to 16 days
Clinical features
Pre eruptive stage
Onset is sudden with mild or moderate fever, pain in the back, shiver zing
and malaise. This stage lasting about 24 hours. In adult 2-3 days before the rash
comes out.
Eruptive stage
In children the rash in often the first sign fever the distinctive feature of
the rash are first appears on the trunk when it is abundant & then comes face
arms & legs.
Complication
These include hemorrhage pneumonia, encephalitis, acute cerebeller

ataxia & reyes syndrome.
Laboratory site
Vesicle fluid under microscope which shows round particles brink

shaped small pox & cultivation of virus may be used.
127
Control
Control measures are notifications, isolation their about to days after

onset rash & disinfection of articles, soiled by nose & throat discharge.
Antiviral compounds effective therapy for varicella including acyclovir.
Prevention
1) Varicella zoster immunoglobulin (vzig) given with in 72 hrs of

exposure.
2) Vaccine live attenuated varicella virus vaccine in safe & warranty

recommended for 12-18 months of children.
128
MEASLES
An acute highly infectious disease of childhood
caused by a specific virus of the group myxovirus.
EPIDEMIOLOGICAL DETERMINATIONS
Agent factors
A) Agent : Unless caused by on RNA

paramyxovirus
B) Source of infection : Source of infection is a case of measles.
C) Infective material : Secretions of the nose, throat & respiratory tract of

a case of measles.
Communicability
During the prodromal period at the time of eruption mostly 4 days before
to 5ays after the appearance of he rash.
Secondary attack rate
There is only one antigenic type of measles virus. Attacks represent errors
in diagnosis either in initial or second illness.
HOST FACTOR
Age : 6 Month & over 3 yrs older children over 5 yrs
Sex : Incidence equal
Immunity : One attack of measles generally confers life long immunity.
Nutrition : Serve in malnourished child.
129
ENVIRONMENTAL FACTORS
The virus spread in early season, temperature climates, measles is a winter

disease, probably because people crowd together indoors.
Transmission
Directly person to person mainly by droplet infection & nuclei.
Incubation period
10 to 14 days
Clinical features
It is clinically characterized by fever and cataract symptoms of the upper

respiratory tract (cough) followed by a typical rash.
Complication
Diarrhoea, Pneumonia and other respiratory complication and otitis

media.
Prevention of measles
Prevented by active immunization for infants a month administered in a

single subcutaneous dose of 0.5ml also prevented by administration of
immunoglobin (human) curly in the incubation period. Dose 0.25 ml/kg of body
weight.
Control measures
1) Isolation for 7 days onset of rash
2) Immunization of contract with 2 days of exposure
3) Prompt immunization.
130
MUMPS
An acute infectious disease caused by an RNA (Genus
Rublavirus)
Factors
Agent : The causative agent myxovirus parotiditis is

a virus of the myxovirus family.
Source of Infection : Both clinical & subclinical cases (from the saliva)
Period of communicability : Usually 4-6 days before the onset of

symptoms
Secondary attack rate : Estimated to be about 86%.
Host factor
Age & Sex : Frequent cause of parotitis in children (5-9 yrs)
Immunity : One attack, clinical or sub clinical is assumed to induce life

long immunity.
ENVIRONMENTAL FACTORS
Is an endemic disease occur in through out the year. Epidemics in over

crowding.
Mode of transmission
The disease is spread mainly by droplet infection, and after direct contact
with an infected person.
Incubation period
2 to 3 days
131
Clinical features
Characterized by pain and swelling in one or both parotid glands.

Associated with earache may be pain & stiffness on opening mouth.
Complication
These include orchitis, ovarities, panceratitics, thyroiditius, neuritis,

hepatitis & myocarditis.
Prevention
Vaccine- Highly effective live attenuated vaccine ( A single dose 0.5ml) IM
Control
The control of mumps is difficult because infectious disease. Sub clinical

case make the control of spread difficult.
INFLUENZA
Influenza is an acute respiratory tract infectious
caus ed by influenza virus.
Mode of transmission
Spread mainly from person to person by droplet

infection or droplet nuclei created by sneezing,
coughing or talking.
Incubation period
18 to 72hrs.
Clinical features
The virus the respiratory tract and inflammation and necrosis of

superficial epithelium of the tracheal & bronchial mucosa.
132
Characterized by sudden onset of chills, malaise, fever, muscular pains
and cough.
Laboratory sites
A) Nasopharyngeal secretions (specimen)
B) A Seroidiaynosis of influenza A or B
Prevention
All attempts to control influenza epidemics have so far mat. Achieving

control remain poor.
DISEASE AFFECTING RESPIRATORY SYSTEM

Bronchitis
Bronchitis is an infection of the lower respiratory tact that is generally an

acute sequel a to an upper respiratory tract infection.
Causes
1) Dyspena, Fever, tachypnea

2) Productive cough, pleritic chest pain
3) Diffuse rhonci and creakiness heard on auscultation
Diagnostic evaluation
1) Chest X-ray
2) Sputum for gram stain, culture and sensitivity
3) Spirometry
Management
1) Antibiotic therapy for 7 to 10 days

2) Hydration and humidification
3) Secretion clearance interventions (controlled cough, chest physical
therapy)
4) Bronchodilators
5) Symptoms management for fever, cough.
133
PNEUMONIA
Pneumonia is an inflammatory process
involvin g the terminal airways & alveoli of the
lung caused by infectious agents.
Path physiology
1) The organism gains access to the lungs

through aspiration of or pharyngeal
contents
2) Patients with bacterial pneumonia
3) Other predisposing factor include tumour, general anaesthesia,

alcoholism, smoking
Clinical manifestation
Most common of bacterial pneumonia
1) Fever 101 to 105 oF
2) Cough productive of purulent sputum
3) Pleuritic chest pain
4) Dyspnea, tachy pnea
5) Rapid, bounding pulse
Diagnosis evaluation
1) Chest X-ray
2) Gram stain and culture & sensitivity
3) Blood culture
4) Immunological test
Management
1) Anti microbial therapy
2) Oxygen therapy
134
TUBERCULOSIS
Tuberculosis is an infectious disease caused by
bacteria (mycobacterium tuberculosis) usually spread
from person to person the air.
Clinical feature
The bacilli of TB infect the lung, forming a tubercle

(lesion).
Symptoms
Fatigue, anorexia, wt loss, low grade feature night sweats, indigestion,

cough, hemoptysis, chest pain, dyspnea
Diagnostic evaluation
1) Sputum smear Detection of acid fast bacillus
2) Sputum culture
3) Chest x ray
4) Tuberculin skin test
Management
1) Follow with 4 months of isoniazid and rifampin six months of therapy

effective killing for bacilli.
2) Sputum smears may be obtained every 2 weeks until they are negative.
Sputum cultured don not become negative for 3 to 5 months.
135
DISEASE AFFECTING GI SYSTEM
Peptic ulcer
Peptic ulcer disease refers to ulceration in the mucosa of the lower

oesophagus, stomach or duodenam
Appendicitis
Appendicitis is inflammation of the vermiform appendix
Hepatitis
Hepatitis is a viral infectious of the liver
Cirrhosis liver
Cirrhosis of the liver is characterized by scarring. It is a chronic disease.

(Destruction and fibrotic regeneration of hepatic cells)
Scabies
Superficial infestation by itch mite
Psoriasis
Psoriasis is a chronic T-Cell mediated inflammation disorder.
Malaria
Malaria is vector borne through the birth of female anopheles mosquito.
Filarisis
The disease transmitted to men by the bites of infective mosquitoes.
Rabies
Rabies virus spread by direct contract virus sudden saliva of a rabid

animal into a bite or scratch.
AIDS
Acquired immuno deficiency is defined as most serve from of continuum

of illness. Associated with human immunodeficiency infection.
136
Glomerulo Nephritis
Acute glomerulonephritis refers to a group of kidney disease in which

there is an inflammation reaction in the glomeruli.
Pyelonephritis
Is an infection & inflammatory disease of the kidney & renal pelvis

involving both or one kidney.
Angina Pectoris
Serve constricting pain or sensation of pressure in the chest, often

radiating from the procordium to a shoulder (usually left) and down the arm,
resulting from ischemia of the heart muscle usually caused by coronary disease.
Anemia
Anemia is frequently manifested by pallor of the skin and mucous

membranes, shortness breath, palpitations of the heart, soft systolic murmurs
lethargy, and tendency to fatigue.
Lekemia.
Progressive proliferation of abnormal leukocytes found in hemopoietic

tissues other organ and usually in blood in increased numbers.
137

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PREFACE

K.M. SANTHANAM RAMAYEE MEMORIAL INSTITUTE OF

Medical Field is in great demand for the Paramedical Technologies

This Paramedical College, run by the K.M. Santhanam Educational

This college is affiliated to Bharat Sevak Samaj (BSS) National

This College registered by Government of Tamilnadu vide Reg. no.

Tmt. S. Selvam, B.Sc., Nursing

BHARAT SEVAK SAMAJ - BSS

Bharat Sevak Samaj is the National Development Agency, promoted

1 st Year - SYLLABUS NOTES

It means prevention of mechanical, thermal, chemical and bacteriological

It is to achieve the purpose for wish a procedure i5 done.

It is the art of doing.

It is to consider the needs and problems of a particular client when a

1. You should be courteous to all. Be gentle and polite In your talk.

4. Stand up when people of higher rank enter your room.

5. Stand up when answering questions in the classroom.

7. Excuse yourself when overtaking a senior person

11. Obey seniors without arguing.

16. Be punctual always.

17. Avoid thumb sucking and nail biting.

20. Say Excuse me even if you hurt others accidently.

21. Never let others secret go out of you.

DUTIES AND RESPONSIBILITIES OF A NURSE

1. Is responsible to admit, discharge and transfer the patients.

3. Has to provide psychological support to the patients.

5. Is responsible to maintain clean and safe environment for the patients.

6. Has to perform technical tasks e.g. preparation and administration of

7. Has to maintain nurses notes and intake and output chart.

10. Attitude towards patients: Nurses are expected to show extreme

11. Treatment of patients : Anything in the shape of a blow, no matter how

14. Search of patients: When it is necessary to search a patient, it should be

18. Restraint of privation of patients: No patient must ever be subjected to

20. Duties of Ward Attendants : The sister on duty will be personally

22. Handling of noisy patients: The sister on duty at night shall be

26. Management of difficult patient: In the event of a patient proving very

30. Participate in clinical teaching, both planned and incidental.

31. Help in the orientation of new staff.

Some of the essential qualities of a nurse are as follows:

1. Love for the fellow men.

2. Honesty and loyalty. . .

3. Discipline and obedience.

5. Dependability and adjustability.

6. Ability to inspire confidence. Resourcefulness, economy of time, material

7. Courtesy and dignity.

8. Sympathy, empathy, tact and poise. Intelligence and common sense.

9. Patience and sense of humour. Good physical and mental health.

11. Gentleness and quietness.

THE NURSE AND LEGISLATION

Negligence is the omission to do something that a reasonable and prudent

General Hospitals: These hospitals offer treatment for common diseases.

Specialized Hospitals: These hospitals concentrate on giving medical and

The housekeeping department has the function of keeping the hospital

In many hospitals, the housekeeping responsibility is vested with the head

PRINCIPLES OF HOUSE KEEPING

2. Dusting is done after sweeping and not before.

4. Friction aids in mechanical cleaning. Use brush when cleaning a grooved

5. Abrasives are harmful to the painted and polished surfaces.

7. Bacteria grow in dark, moist and unclean places.

8. Exposure to sunlight destroys some bacteria.

9. Disinfection by chemicals depends upon the cleanliness of the article, the

These are expensive articles and do not stand washing or steam

When storing, blankets should be carefully protected from moths using

CARE OF PILLOWS AND MATTRESS