PTS BOOK final 2019.pdf

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PRELIMINARY TRAINING SESSION (PTS )
A Handbook for Students and Teachers

By: Mehmooda Afroz
RM,RN&BScN

Principal Cowasjee School of Midwifery
Lady Dufferin Hospital &
Secretory General Midwifery Association of
Pakistan (MAP)

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PRELIMINARY TRAINING SESSION (PTS )
Handbook for Students and Teachers
Based on
Community Midwifery Curriculum
Pakistan Nursing Counsel (PNC)

First Edition 2019

By: Mehmooda Afroz Ali Khowaja
RM, RN, BScN

Principal Cowasjee School of Midwifery
Lady Dufferin Hospital &
Secretory General Midwifery Association of
Pakistan (MAP)

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Table of Content
S# TOPIC PAGE #
1
NUTRITION

05
2
FUNDAMENTAL OF NRSING

Eithic value & morality
Hygiene and patient care
Back Massage
Perineal Care
Bed Patient Hair Care
Personal hygiene
Admission, transfer and discharge procedure
Bed making
Use and removal of bedpan
Hot and cold compression
Steam inhalation
Techniques of body mechanics
Positioning and ambulating the adult patient
Administering Enema
Assessing with bedpan
Height and weight
Vital Signs: Temperature, pulse, respiration and Blood
Pressure
Specimen collection
Urine testing by dip stick
Bedsore
Catheterization procedures

13
15
21
22
22
23
26
28
29
30
32
33
35
41
44
46
47
55
58
60
62

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FIRST AID

Shock
Haemorrhage
Wounds
Fractures
Burns
Chocking
Foreign bodies in eye, ear
Other emergencies
CPR

71
73
76
77
80
81
84
86
96

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4

MICROBIOLOGY

Infection prevention
Hand washing
Sharp Injury
EPI vaccine/Immunity and Immunization
Techniques of administrating vaccine
Cold chain

102
107
108
111
116
119

5

COMMUNICATION
Respectfull Maternity Care

121
122

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PHARMACOLOGY

Rights of Medication administration
Medication preparation
Principles and Responsibilities of Medication
administration
Content and Types of Drug orders
Medication orders
Drugs administration and Routs of Medication
administration
Medication Errors and Reporting

127
128
129
131

131
132
135

138

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ANATOMY AND PHYSIOLOGY

Introduction
Cell
Cell division
Tissue
Skeletal system
Muscular system
Nervous system
Respiratory
Digestive system
Urinary System
Blood circulatory System
Blood
Lymphatic system
Glandular system
Integumentary system
Female Reproductive system
Male Reproductive
Special senses

140
147
150
151
153
157
161
166
169
173
175
179
183
185
189
190
193
196

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NUTRITION:
BALANCED DIET : A diet that contains the proper proportions of
carbohydrates, fats, proteins, vitamins, minerals, and water necessary to maintain
good health

Vitamins:
Vitamins are organic compounds that are required in small amounts in our diet
but their deficiency causes specific diseases.
 Most of the vitamins cannot be synthesized in our body but plants can
synthesize almost all of them, so they are considered as essential food
factors.
 However, the bacteria of the gut can produce some of the vitamins required
by us.
 All the vitamins are generally available in our diet. Different vitamins belong
to various chemical classes and it is difficult to define them on the basis of
structure.
 They are generally regarded as organic compounds required in the diet
in small amounts to perform specific biological functions for normal
maintenance of optimum growth and health of the organism.
 Vitamins are designated by alphabets A, B, C, D, etc. Some of them are
further named as sub- groups e.g. B1, B2, B6, B12, etc.
 Vitamin A keeps our skin and eyes healthy.
 Vitamin C helps body to fight against many diseases. Vitamin C gets easily
destroyed by heat during cooking.
 Vitamin D helps our body to use calcium for bones and teeth.
 Excess of vitamins is also harmful and vitamin pills should not be taken
without the advice of doctor.
 The term ―Vitamine‖ was coined from the word vital + amine since the
earlier identified compounds had amino groups.
 Later work showed that most of them did not contain amino groups, so the
letter ‗e‘ was dropped and the term vitamin is used these days.

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Vitamins are classified into two groups depending upon their solubility in
water or fat.
Fat soluble vitamins:
 Vitamins which are soluble in fat and oils but insoluble in water are kept in
this group. These are vitamins A, D, E and K. They are stored
in liver and adipose (fat storing) tissues
Water soluble vitamins:
 B group vitamins and vitamin C are soluble in water so they are grouped
together.
 Water soluble vitamins must be supplied regularly in diet because they are
readily excreted in urine and cannot be stored (except vitamin B12) in our
body.
Deficiency Diseases:
 A person may be getting enough food to eat, but sometimes the food may not
contain a particular nutrient. If this continues over a long period of time, the
person may suffer from its deficiency.
 Deficiency of one or more nutrients can cause diseases or disorders in our
body. Diseases that occur due to lack of nutrients over a long period are
called deficiency diseases.
1. Vitamin A——— Night blindness
2. Vitamin B1———Beriberi
3. Vitamin B2——– Ariboflavinosis
4. Vitamin B3 ——–Pellagra
5. Vitamin B5 ——–Paresthesia
6. Vitamin B6 ——–Anemia
7. Vitamin B7 —— Dermatitis, enteritis
8. Vitamin B9 & Vitamin B12 —– Megaloblastic anemia
9. Vitamin C —— Scurvy, Swelling of Gums
10. Vitamin D —— Rickets & Osteomalacia
11. Vitamin E —— Less Fertility
12. Vitamin K —— Non-Clotting of Blood.
Vitamin A (Retinol) :
Sources : Dairy products, eggs, liver, fish and butter.

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Deficiency : The deficiency of vitamin leads to skin changes and to night
blindness or failure of dark adaptation due to the effects of deficiency on retina.

Vitamin B1 (Thiamine) :
Sources: Yeast, egg yolk, liver, wheatgerm, nuts, red meat and cereals.
Deficiency: Fatigue, irritability, loss of appetite; severe deficiency can lead to
beri-beri.

Vitamin B2 (Riboflavin):
Sources: Dairy products, liver, vegetables, eggs, cereals, fruit, yeast.
Deficiency: Painful tongue and fissures to the corners of the mouth, chapped
lips.

Vitamin B3 (Nicotinic acid or Niacin) :
Sources: Lean meats, peanuts and other legumes, and whole-grain or enriched
bread and cereal products are among the best sources of niacin.
Deficiency: The deficiency state in humans causes skin disease, diarrhea,
dementia, and ultimately death.

Vitamin B5 (Pantothenic acid):
Sources: liver, kidney, eggs, poultry, and whole grains and dairy products while
apart from that it is present in perhaps all animal and plant tissues, as well as in
many microorganisms.
Deficiency: There is no known naturally occurring deficiency state.

Vitamin B6 (Pyridoxine):
Sources: liver and other organ meats, corn, whole-grain cereal, seeds and soy
products.
Deficiency: can result in central nervous system disturbances e.g. convulsions in
infants, More generally the effects of deficiency include inadequate growth or
weight loss and anemia due to the role of B6 in the manufacture of hemoglobin.

Vitamin B7 (Biotin):
Sources: fruits and meats, egg yolk, kidney, liver, tomatoes, and yeast.
Deficiency: No deficiency yet is known associated with this vitamin.

Vitamin B9 (Folic Acid):
Sources: green leafy vegetables, fruits like apples and oranges dried beans,
avocados, sunflower seeds, and wheat germ.
Deficiency: Its Deficiency during pregnancy is associated with birth defects,
such as neural tube defects

Vitamin B12 (Cyanocobalamin):
Sources: Liver, red meat, dairy products and fish.
Deficiency: megaloblastic anaemia.

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Vitamin C (Ascorbic acid):
Sources: Green vegetables and fruit.
Deficiency: Scurvy.

Vitamin D (Calciferol):
Sources: Fish liver oils, dairy produce. Vitamin D is formed in the skin when it
is exposed to sunlight
Deficiency: Rickets.

Vitamin E (Tocopherol):
Sources: Pure vegetable oils, wheat germ, whole meal bread and cereals, egg
yolk, nuts sunflower seeds.
Deficiency: May cause muscular dystrophy

Vitamin K (Phylloquinone or Naphthoquinone):
Sources: Green vegetables.
Deficiency: vitamin K deficiency results in impaired blood clotting, usually
demonstrated by tests that measure clotting time. Symptoms include easy
bruising and bleeding diathesis. In infants, vitamin K deficiency may result in
intracranial hemorrhage.

NUTIRIENTS:
Nutrients are molecules in food that all organisms need to make energy, grow,
develop, and reproduce. Nutrients are digested and then broken down into basic
parts to be used by the organism.
There are two main types of nutrients, macronutrients and micronutrients.

Micronutrients – Vitamins and Minerals
Micronutrients, are comprised of vitamins and minerals which are required in
small quantities to ensure normal metabolism, growth and physical well
Five Important Micronutrients:
1. Vitamin A
2. Folate (folic acid)\
3. Iodine
4. Iron
5. Zinc

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Vitamin A:
 This vital micronutrient is found in a range of different foods including
carrots, spinach, broccoli, milk, egg, liver and fish.
 It plays an essential role in vision (lack of Vitamin A is a common cause
of blindness), reproduction and growth, and the functioning of a healthy
immune system (it plays a key role in the development of white blood
cells).
 Worldwide about 5 million children under the age of five are affected
by xerophthalmia, a serious eye disorder caused by vitamin A
deficiency.
 These children are at risk of becoming blind and are more likely to die
of common childhood disease
Folic Acid:
 This is a generic term for a group of B vitamins including folic acid
 Folic acid is a synthetic folate compound used in vitamin supplements
and fortified food of its increased stability.
 Folates are found in egg, dairy products, asparagus, orange juice, dark
green leafy vegetables, beans and brown bread.
 They play a key role in the metabolism of amino acids and
the production of proteins, the synthesis of nucleic acid (the molecules
that carry genetic information in the cells), and the formation of blood
cells.
Iodine:
 Seaweed and fish are rich sources but in many countries the addition of
iodine (known as iodization) to salt is an important source.
 Iodine is one of the most important elements required by the developing
foetus due to its effect on brain development.
 Iodine also serves a number of other important functions especially in
the production of hormones.
 Goitre is a visible sign of severe iodine deficiency.
Zinc:
Found in a range of foodstuffs including liver, eggs, nuts, cereals and seafood.
The absence of zinc is associated with a number of conditions including, short
stature, anemia, impaired healing of wounds, poor gonadal function, and
impaired cognitive and motor function.

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It can also lead to appetite disorders, as well as contributing to the increased
severity and incidence of diarrhea and pneumonia.
The most important effect of zinc deficiency is its impact on children‘s resistance
to infectious diseases including the risk of infection, the recurrence of infections
and the severity of infection. This is well document in the case of diarrhoea. Zinc
nutrition is therefore an important determinant of mortality in children.
Iron:
 Iron has a number of key functions within the body. It acts as a carrier for
oxygen from the lungs to the body‘s tissues – it does so in the form
of hemoglobin – and it also integral to the working of various tissues through
the role that it plays in enzymatic reactions.
 Iron deficiency ultimately leads to iron deficiency anemia, the most
common cause of anemia, a condition in which the blood lacks healthy red
bloods cells required to carry oxygen, and which results in morbidity and
death.
 Iron deficiency is the most widespread health problem in the world,
impairing normal mental development in 40‐60% of infants in the
developing world.
 Iron rich foods include lentils, red meat, poultry, fish, leaf vegetables and
chicken
MACRONUTRIENTS ( PROTEIN, CARBOHYDRATES AND FAT):
Macronutrients:
 a type of food (e.g. fat, protein, carbohydrate) required in large amounts in
the diet.
 a chemical element (e.g. potassium, magnesium, calcium) required in large
amounts for plant growth.

Carbohydrates:
Are a type of macronutrient used for quick energy in cells. The basic unit of
carbohydrates is a monosaccharide. An example of a monosaccharide
is glucose or sugar. Glucose can be by itself, or assembled into long chains to
make things like starch, which can be found in potatoes.

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Proteins: are a macronutrient that the cells in your body use for structure.
Protein is very important for building tissues, such as muscle. Muscle is mainly
made up of proteins. Proteins are made from smaller monomers called amino
acids. There are twenty amino acids that make up all the kinds of protein your
body needs. Your body can make some of the amino acids you need, but there are
nine that you must consume in your diet. These are called essential amino acids.
Meat, fish, beans, and eggs are examples of foods rich in protein.
Fats: are called lipids and are a macronutrient in your body that stores energy.
Fats have long chains of carbon and hydrogen, which store lots of energy in the
chemical bonds. Fats are important in our body to cushion organs, protect our
cells, and send signals in the form of hormones around our body. Foods that are
rich in fats are butter and oil.

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ETHICS VALUES & MORALITY

Ethics: is delivered from the great word is ethos meaning custom or character.

Values: Believes or attitude about the worth of a person, object, idea.

Maraility: is similar to ethics. It usually refers to personal stand of right &
wrong.

Honestly:Nurse should be honest in
 Her duty time
 Her clinical work
 With doctor & other health team worker.

Punctuality:
Nurse should be punctual in her duties and other activities.

Responsibilities:
Nurse is fully responsible all the work towards patient care should be awear of all
the care patient getting.

Behaviour:
Nurse should be well behaved polite with the patient relatives medical & pare
medical staff.

Manner:
Low tone and polite way of talking is the main quality of a nurse she should be
well mannered towards her elders.

Uniform Code
Means there are certain principles which should be obey while in uniform

 Neat & Clean
 Wear only when on duty
 No jewelries
 Heir should be above the shoulder
 Only black hair band no colour full pin or band.
 Very tile make up.
 No nails polish no long nail.
 Only black shoes for student
 No giggling, chatting improper sitting.
 Kit should be always her.
 No mehndi.

Sense of Judgment:
Means to know what is right and how it is applies

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General Rules:

 Never discuss personal matter in public or during lunch or tea break.
 Respect your patient matter.
 Respect patient need for privacy at all the time screen your patient for all
the time
 Remove patient chart is for private information never disclosed it always.
 Respect your Co- worker & call them by names notes by bed # or
nickname.
 Accept Responsibility anticipate patient need.
 Gratuities in the from of money, gift or tip is not allowed.
 Do not waste or misuse hospital supplies.
 Do not involve personally with your patient.
 Remain at your assign placed.
 Never eat chew gum when in uniform, or eat supari when on uniform
 Respect your uniform do not sit on floor when you are in uniform
 Do not screen or laugh in patient area
 Do not give any information when you don‘t know about that consult the
person when know of.

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HYGIENE AND CARE :
Providing for a patient's hygiene is probably the most basic of all nursing care
activities, but it is undoubtedly one of the most important. Not only is it a
provision for the patient's physical needs; it also contributes immeasurably to the
patient's feeling of emotional well-being.
PURPOSE OF THE PATIENT'S DAILY BATH :
1. Removal of bacteria from the skin.
2. Confinement in bed increases perspiration, and bacterial growth is
stimulated by moisture.
3. Skin irritation from hospital bed linens may result in skin breakdown and
subsequent infection.
4. Relaxation effect on the patient.
5. Stimulation of blood circulation to the skin, respirations, and elimination.
6. Maintenance of joint mobility.
7. Improvement of the patient's self-image and emotional and mental well-
being.
8. Providing the nurse with an opportunity for health teaching and
assessment.
9. Providing the nurse with an opportunity to give the patient psychological
support.
 The process of building rapport may begin during the initial bath.
 The bath aids in the development of the therapeutic nurse-patient
relationship as the patient has the nurse's undivided attention.
PHYSICAL CONDITIONS WHICH ENCOURAGE SKIN BREAKDOWN
IN A PATIENT WHO IS CONFINED TO BED:
a. Immobility. Continuous pressure over any body part impairs circulation
to that part and can cause breakdown and eventual ulcerations.
b. Incontinence. If the patient is unable to control the bladder or bowel
functions, skin breakdown is likely to occur due to the presence of
moisture and bacteria on the skin.
c. Emaciation. An emaciated patient may be prone to skin breakdown over
bony prominence (heels, elbows, and coccyx).
d. Obesity. An obese patient may have many skin folds where perspiration
and bacteria may contribute to skin breakdown.
e. Age-Related Skin Changes. An older person's skin is very thin and
inelastic. The sweat and oil glands are less active. Thin, dry skin is more
susceptible to pressure areas and skin breakdown.
f. Any Disease or Condition that Affects Circulation can encourage skin
breakdown in a patient who is confined to bed.

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NURSING INTERVENTION TO PREVENT SKIN BREAKDOWN :
1. The time of the patient's bath or back massage is the most logical time to
thoroughly observe the patient's skin for pressure areas.
2. At the first sign of redness, the area should be washed with soap and
water and rubbed with lotion; measures should then be taken to keep the
patient off the reddened area.
3. Report any signs of pressure to the charge nurse.
4. Keep sheets under the patient clean, smooth, and tight to help eliminate
skin irritation.
5. Ensure adequate nutrition and fluid intake, according to physician's
orders.
6. Every effort should be made to keep urine and feces off the patient's skin,
washing the skin with soap and water and keeping the buttocks and
genital area dry (lotion or powder may be used depending upon the
patient's skin type) when the patient is incontinent.
7. Obese patients may need assistance washing and drying areas under skin
folds (groin, buttocks, under breasts, and so forth.)
8. For the patient with very dry skin, various bath oils may be added to the
bath water.
 Soap may be omitted because of its drying effect.
 Lotions and oils may be used after the bath.
PROVIDING FOR SELECTED PA TIENT NEEDS WHILE BATHING A
PATIENT:
a. Safety:
1. The bed may be in the high position during the patient's bed bath, but should
be placed in the low position upon completion.

2. The side rails should be up after the patient's bath for the patient who is
confined to the bed.
 Side rails help to prevent falls for the elderly patient or the patient who is
confused or has a decreased level of consciousness.
 The legal aspect requires diligence on the part of nursing personnel.
3. The patient's call light should be within easy reach to prevent the need to reach
for it and risk falling out of bed and to provide easy access in case of pain or
distress.
4. Fire safety in the patient care area calls for the following rules:
 No smoking in bed.
 No smoking if oxygen is in use.

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5. Always wash your hands before entering and upon leaving the patient's room.

b. Privacy:
 Respect for the patient's privacy decreases the patient's emotional
discomfort during personal care.
 Keep the door to the patient's room closed.
 Pull the curtains around the unit and drape the patient's body during care.
 Allow the patient to complete as much personal care as possible; self-care
is appropriate and provides additional privacy.
c. Comfort.
 Ensure a comfortable temperature in the patient's room.
 Close any windows and the door to the patient's room to prevent drafts
and chilling.
 Drape the patient appropriately during the bath.
 For a bedside bath, maintain bath water between 110° F and 115° F;
change the water as it cools and/or gets soapy.
SIGNIFICANT NURSING OBSERVATIONS DURING THE BATHING
PROCEDURE
a. Physical Observations:
 Observe the skin under good, natural light.
 Any abnormal skin condition should be described as to its location, color,
and size and how it feels to the patient.
 The following skin observations should be checked upon admission and
daily thereafter:
Cleanliness:
 Odor. May be caused by sweat secreted by the sweat glands; by abnormal
conditions, such as infection or kidney disease; or by bodily discharges
(urine, feces) that need to be cleaned.
 Texture. Smooth and elastic or dry and rough; nutritional deficiencies can
influence skin texture.
 Color. Reddened areas that could indicate pressure, cyanosis (bluish
tinge) or jaundice (yellowish tinge).
 Tmperature. Hot skin could mean fever; cold skin could mean poor
circulation.
 (Sensitivity. Pain, tenderness, itching, or burning.
 Swelling (edema). Stretched or tight appearing; usually begins in the
ankles or legs or any other dependent part; may be associated with injury.

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 Skin lesions. Rashes, growths, or breaks in the skin.
 Observations may begin at the head (scalp) and proceed to the feet in a
systematic manner.
b. Psychosocial Observations:
 Problems in this area may be related to the patient's present problems.
 The time of the patient's bath may be a good time to find out more about
the patient's psychosocial needs.
 Remember that the patient's nonverbal communication may tell you much
about the way he/she is feeling.
MOUTH CARE:
a. Purposes:
 Provide oral care of the teeth, gums, and mouth.
 Remove offensive odors and food debris.
 Promote patient comfort and a feeling of well-being.
 Preserve the integrity and hydration of the oral mucosa and lips.
 Alleviate pain and discomfort, thereby enhancing oral intake.
b. General Guidelines:
 Oral hygiene should be performed before breakfast, after each meal, and
at bedtime.
 Oral hygiene is especially important for patients receiving oxygen
therapy, patients who have nasogastric tubes, and patients who are
NPO. Their oral mucosa dries out much faster than normal due to their
mouth-breathing.
 You should provide for patient privacy during the procedure, as this is an
extremely personal procedure for most patients.
 Oral care for the unconscious patient should be performed at least every
four hours.
 Lipstick, chap stick, or vaseline may be applied to the lips to keep them
from drying out.
c. Nursing Records. Nursing observations for the patient's mouth should be
recorded in the clinical record, noting such factors as:
 Bleeding.
 Swelling of gums.
 Unusual mouth odor.
Effect of brushing the teeth. Note if there is bleeding when you brush the
patient's gums and teeth.

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d. Conscious Patients with Dentures:
General considerations
 Many patients are sensitive or embarrassed about wearing dentures;
therefore, the patient's privacy should be respected when the dentures are
cleaned.
 Dentures must be handled carefully; they are fragile and expensive, and
the patient is handicapped without them.
 If the dentures are left out of the mouth for any period of time, place them
in a covered opaque container with the patient's name on the container.
 Dentures must be kept in water to preserve their fit and general quality;
the color may change if they become dry.
You may avoid breaking the dentures while cleaning them by holding them over
a basin of water with a washcloth folded in the bottom.
 Dentures are brushed in the same way as natural teeth; be sure to rinse
them well.
 The denture cup should be labeled with the patient's name and room
number.
 Never use hot water to rinse the dentures as it could warp them; use cool
or lukewarm water.
 The patient's gums and soft tissues should be cared for at least twice per
day while the dentures are out of the mouth; a soft-bristled toothbrush,
swab, or gauze-covered tongue blade dipped in mouthwash should be
used to cleanse the gums, tongue, and soft tissues.
e. PATIENTS WITH MOUTH COMPLICATIONS :
The following problems are common in patients receiving chemotherapy and
radiation therapy:
(1) Bleeding:
 Observe the patient's mouth frequently for the amount of bleeding present
and the specific areas.
 Do not floss the patient's teeth; use a Water-pik
Brush the teeth and clean the mouth using one of the following methods:
 Brush the teeth carefully with a very soft toothbrush.
 Wrap a tongue blade with a gauze sponge saturated with a prescribed
solution; carefully swab the teeth and mouth. Do not use lemon/glycerine
swabs or commercial mouthwash because they contain alcohol, which
causes burning.

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(2) Infection:
 Observe the patient's mouth for appearance, integrity, and general
condition.
 Wear clean gloves during the procedure.
 Obtain a culture, if ordered.
 Do not floss the teeth if the mouth is irritated or painful.
 Assist the patient with brushing the teeth and cleaning the mouth, using a
soft toothbrush or a gauze-padded tongue blade.
 Rinse the mouth with water and the prescribed solution, if ordered.
(3) Ulcerations, To Include Stomatitis:
 Basic procedure for the patient with an infection should be followed.
 If the patient's mouth is extremely painful, rinsing the mouth with a local
anesthetic, as prescribed by a physician, may be necessary.
 Mouthwash and other solutions which contain alcohol should not be used
for the patient with ulcerations as they are frequently very painful.
f. Unconscious Patients:
 Oral care should be performed at least every four hours.
 Oral suctioning may be required for the unconscious patient to prevent
aspiration.
 A soft toothbrush or gauze-padded tongue blade may be used to clean the
teeth and mouth.
 The patient should be positioned in the lateral position with the head
turned toward the side to provide for drainage and to prevent aspiration.

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BACK MASSAGE AS A PATIENT CO MFORT MEASURE :
Purpose:
 Decreases muscle tension and promotes relaxation.
 Increases circulation to the area.
 Aids in the development of the therapeutic nurse-patient relationship.
Basic Principles of Back Massage:
 The psychological benefits of back massage cannot be overstressed for
the hospitalized patient.
 The following statements illustrate the concept of therapeutic touch as an
integral part of the domain of nursing.
 Touch can be perceived as a manifestation of caring and communication
between the nurse and the patient.
 Tactile communication between healthy and ill individuals can have
highly beneficial results.
 Therapeutic touch may make some patients uncomfortable; you are
entering their personal space and their feelings must be respected, so
make sure you ask the patient if he/she would like a back rub.
Agents used for back massage:
1 .Lotions or emollients
 Lotions and emollients reduce friction and lubricate the skin.
 They are appropriate for most patients, especially those with a tendency
toward dry skin; that is, elderly patients.
2, Rubbing alcohol
 Alcohol evaporates quickly, so it has a cooling but very drying effect.
 A certain amount of alcohol is absorbed by the skin so it should not be
used on infants, elderly patients, or patients with liver disease.
3, Powder.
 Powder reduces friction but also has a drying effect on the skin.
 It may be appropriate for those patients who perspire freely and/or are
confined to bed
e. General guidelines:

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 A back massage should take about five to ten minutes and can be given
with the patient's bath, before bedtime, or at any other time during the
day.
 Determine if any patient allergies or skin sensitivities exist before
applying lotion to the patient's skin.
 The greatest relaxation effect of a massage occurs when the rhythm of the
massage is coordinated with the patient's breathing.

PERINEAL CARE:
 Perineal care is often referred to as "pericare;" it consists of external
irrigation of the vulva and perineum following voiding or defecation and
is part of the routine A. M. and P. M. care.
 Patients may be able to perform their own perineal care or may need
partial or total assistance from the nurse.
 Embarrassment on the part of the patient and the nurse can be effectively
dealt with by ensuring patient privacy during the procedure and not
totally exposing the patient's genital area.
Key points:
 Ensure patient privacy.
 Wipe from front to back (vagina toward rectum) on female patients to
avoid contaminating the vagina or urethral meatus.
 Do not use the same washcloth for any other portion of the patient's bath.
BED PATIENT'S HAIR CARE :
a. Principles for Shampooing the Bed Patient's Hair.
 The supine position is preferred for weaker patients.
 Patients with significant heart or lung disease will not tolerate being
supine; they must be in a sitting position.
 Hair care should be given regularly during illness, just as it would be
normally.
b. Purposes of Hair Care.
 Hair care improves the morale of the patient.
 It stimulates the circulation of the scalp.
c. Shampooing removes bacteria, microorganisms, oils, and dirt that cling to the
hairs

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PERSONAL HYGIENE :

Definition:

Personal hygiene is described as the principle of maintaining cleanliness and
grooming of the external body.
Failure to keep up a standard of hygiene can have many implications. There an
increased risk of getting an infection or illness.

Importance of Personal Hygiene:

 Personal grooming is important for a positive self-image.
 Self-esteem, confidence and motivation can all be altered by our body
image, often reflected on our ability to care for ourselves and keep good
hygiene practices.
 keeping a good standard of hygiene helps to prevent the development
and spread of infections, illnesses and bad odours.

Daily Hygiene Needs:

 Bathing
 Skin care
 Back care
 Oral hygiene
 Shaving
 Shampooing hair
 Hair care
 Nail care
 Perineal care
 Dressing and undressing

Factors That Affect Hygiene Practices:
 Culture
 Family Practices
 Illness
 Individual preferences
 Bath in morning or before going to bed
 Frequency of bathing, shaving
 Shampooing hair daily or weekly

Bathing:

Purpose of Bathing
 Removes perspiration, dirt and microorganisms
 Stimulates circulation

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 Exercises body parts
 Refreshes, relaxes and promotes physical comfort
 Removes odors
 Allows for evaluation of skin condition
Body Odor:

Perspiration, or sweat, comes from sweat glands. Due to puberty, these glands
not only become more active than before, but at the same time, they also begin to
secrete different chemicals into the sweat that has a stronger smelling odor.
The best way to keep clean is to bath or shower every day, because this will help
wash away any bacteria that contribute to the smells.

Skin Observations while Bathing:

 Color of skin, lips, nail beds and sclera of eyes
 Location and description of rashes
 Dry skin
 Bruises or open areas on skin

Hair Wash

Washing your hair every day or every other day can help control oily hair.
Don't scrub or rub too hard this doesn't get rid of oil any better and can irritate
your scalp or damage your hair.

Oral Hygiene

Definition: measures used to keep mouth and teeth clean and free of
microorganism

Teeth: Brushing

 Brushing your teeth properly, along with regular dental checkups, can
help prevent tooth decay and gum disease.
 To prevent cavities, you need to remove plaque, the transparent layer of
bacteria that coats the teeth.
 Brushing also stimulates the gums, which helps to keep them healthy and
prevent gum disease.
 Teeth: Brushing
 Bad breath is caused by odor-producing bacteria that grow in the mouth.
When a person doesn‘t brush and floss regularly, bacteria accumulate on
the bits of food left in the mouth and between the teeth.

Nail Care:
Requires daily cleaning and trimming of fingernails and toenails as needed
Maintain nails by keeping nails: Short, clean and free of rough edges

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Purpose:

Prevent infection
Prevent injury
Prevent odors
Steps of Hand Washing

Perineal Care:

 Used to clean genital and anal areas
 Prevents infection
 Prevents odors
 Promotes comfort
 Rules of medical asepsis and Standard Precautions followed
 Work from cleanest to dirtiest area (front to back)
 urethral area – cleanest anal area – dirtiest

26

ADMISSION, TRANSFER AND DISC HARGE PROCEDURE

ADMISSION PROCEDUR :

Definition:

Admission is a process through which the patient get admitted in the hospital
for a shorter or
longer period of time as prescribed by his/her doctor for treatment. A patient
coming into hospital
as occasionally frightened & uncomfortable. They may or may not be
seriously ill or in pain. This is a time where you are very important to the
patient. Being pleasant & courteous will make the
patient arrived easier for him. A nice relaxed environment & Well come well
create a favorable first impression.

Types of admission:

 Ordinary or elective
 Emergency admission
 Transfer admission
 Day care admission

Purpose of admission:

To get the treatment & care for his/her disease
 Diagnostic procedure
 Child birth
 Chemotherapy

Tips to follow when admitting the patient:

1. Introduction yourself
2. Learn patient name & use it often
3. your way of speaking & behaving will have a lot to do with the
patient impression of the institution
4. Be friendly
5. Smile
6. Do not arrear to be rushed or busy with other things
7. Do your work quietly & efficiently

27

DISCHARGE PROCEDURE :

Staff must be able to assist the patient while preparing to go home at the time of
discharge.

Discharging the patient:

The patient being discharged is often still weak and may get tired easily.
However, the patient is usually happy to know that he can go to home. Written
order from the doctor is required for the patient‘s discharge.
Health teaching to the discharge patient is the responsibility of the assign nurse
or the team leader. The nurse will give instruction about take home medication,
diet, exercise, activities of daily living the special care to a diabetic patient.

Types of Discharge

There are three types of discharge:
1. Ordinary / routine discharge: when the doctor give the written permission for
the patient to go home
2. Leave Against medical advised (LAMA): When the patient and his family
make the decision to leave the hospital on there own risk. A special from is
filled by the doctor and the patient. or his family member write stating that
they take the responsibility of the patient by discharge him against the
doctor‘s order and sign on it
3. Discharge by transfer: Patient are sometimes discharged from one health care
institution to another. These patients may leave the hospital in an ambulance.

Staff responsibility:
The assigned nurse or the team leader will tell you about the patient discharge.

1.Inform the patient and his attendant about the patient discharge. Help the
patient contact his family, if the patient is alone
2.Assemble all the patient‘s personal belonging and assist him in packing, for
example, his clothes, shaving box etc
3.Check that hospitals items are returned, for example, kidney dish, gallipots etc.
4.Assist the patient get dressed, if necessary. Cut the identification band.
5.Check that the assigned nurse has given health teaching, medication etc.
6.Make sure that she removes I/V Canula, catheter. N.G. Tube. If any doctor has
ordered to discharg the patient with N.G Tube or Foleys‘s catheter or n
intravenous canula, then the assigned nurse will change it with a new one before
the patient goes off.
7.Guide the patient to billing office ( follow unit policy)
8.Check that the discharge summary etc has handed over to patient.
9.Wheel the patient to the ear or taxi and say good bye to him.
10.Remove bed linen and place it in the hamper bag.
11.Report to the assigned nurse that the patient has been discharge safely, and
has accompanied the patient, husband wife etc

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BED MAKING:

Patients spend most of their time in bed during hospitalization. Therefore, it is
important to make patient‘s bed with great care as to maximize comfort & rest
to the patient.

Purpose of bed making:

 To provide comfort & promote rest to the patients.
 To promote safety by having a neat, clean & wrinkled free bed to patients.
 To conserve energy & add to a neat environment.

Principles of bed making:
1. Save energy & time by organizing items as per use & making bed on side
then moving to other side.
2. Tuck bottom sheet firmly to remove wrinkles.
3. Do not use torn linen.
4. Never place one patient linen on another patient bed.
5. Pull mattress well up to head of bed. It must be clean & dry before bed
making.
6. Do not expose the patient or cover his/her face while changing top sheet.
7. Do not mix clean linen with dirty linen.
8. Never throw dirty or soiled linen on the floor. Always use a hamper beg.
9. Place soiled linen (linen soiled with blood, stool) in a separate plastic beg &
label it.
10. Do not shake linen while making bed. Shaking will spread germs in the
environment.
11. Have everything ready before beginning.
12. Never use bed linen for any other purpose than that for which it is intended.
Types of beds:
There are four basic types of bed, which student usually makes.

1. Closed bed: Closed bed is made when house- keeping staff have
cleaned the one bed unit following a patient discharge. The bed is
made UP CLOSED so it will remain clean until a new patient
assigned to it.

2. Open bed: When a patient is admitted to a unit the closed bed is
made into an open bed fan folding the top sheets down to the foot of
the bed. An open bed is also made for a patient who is already
hospitalization & is up & about.

3. Occupied bed: Some patients are unable or not permitted to get out of
bed. As a result this many patients are fed, bathed & cared in bed.

29

When the patient the patient is completely bedridden, the bed is made
with the patient in the bed. It is called occupied bed.

4. Post-operative bed: A special way of making of bed to receive a patient
who returning to the unit after having a surgery.

USE AND REMOVAL OF BEDPAN :

Requirement
The bedridden client may have altered elimination patterns. Reduced mobility,
Pain, privacy issues, the need for assistant ,deleys in getting assistance when
needed, and the fear of interruption can all alter normal elimination patterns.
Voiding and bowel elimination for the client confined to bed require a bedpan .

Equipment Needed:
Bedpan (regular or fracture) or urinal
Disposable gloves
Bedpan cover
Toilet paper
Washcloth and towel.

Procedure:
1. Close curtain or door.
2. Wash hand; apply gloves.
3. Lower head of bed so client is in supin position.
4. Elevate bed.
5. Assist client to side-lying position using side rail for support.
6. Warm bedpan under warm water if needed; power if necessary
7. Place bedpan under buttocks.Place a fracture pan with the lower near the
client‘s lower back region. Place large bedpan with the opening near the
client‘s thighs.
8. While holding the bedpan with one hand, help the client roll onto the back,
while pushing against the bedpan (toward the center of the bed) to hold it in
place.Alternate: Help the client raise the hips using the overbed trapeze, and
slide the pan in place.Allternate:if the client is unable to turn or raise hips,

30

use fracture pan instead of a bedpan. With fracture pan ,the flat side in
placed to ward the client‘s head
9. Check placement of bedpan by looking between client‘s legs.
10. If indicate, elevate head of bed to 45* angle or higher for comfort.
11. Place cell light within reach of client; place side rails in upright position,
lower bed, and Provide privacy.
12. Remove gloves; Wash hands.

Removing a Bedpan:

1. Wash hands; apply gloves.
2. Gather toilet paper and washing supplies.
3. Lower head of bed to supine position.
4. While holding bedpan with one hand, roll client to side and remove the pan,
being careful not to pull or shear skin sticking to the pan and being careful
not to spill contents
5. Assist with cleaning or wiping; always wipe with a front to back motion.
6. Empty bedpan (measure urine output if ordered),clean bedpan, and store it in
proper place; if bedpan is to be emptied outside client‘s room ,cover in during
transport.
7. Remove soiled gloves. Wash hands.
8. Allow client to wash hands.
9. Place call light within reach.
10. Recheck that side rails are in the upright position
11. Wash hand

HOT AND COLD COMPRE SSION:

Purpose:

 To relieve pain.
 To relieve congestion.
 To reduce swelling.
 To control bleeding.

Procedure:

 Full the ice bag ½ -2/3
rd
full of crushed ice.
 Remove the residual air from the bag by pressing the bag against a flat
surface.
 Seal the bag.
 Dry the out side of the bag and cover it with towel.
 Refilling may be necessary at hourly intervals, or depending on the
environmental temperature.
 Remove the hag after 02 hrs for ½ hr before reapplying.
 Do not leave the bag on one area more than 02 hrs.

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 Check the under skin every10 minutes for blanches or white, if its so,
remove the ―ice bag‖.
 Cover the area informs your staff and head nurse.
 Make the patient comfortable.
 Clean and dry the equipment and replace back to the assigned place.
 Wash hand.

Report to your head nurse/team leader:

Time length.
Area of application.
How the patient to letrated.
Observe of any thing unusual. and report to team leader

ICE BAG:

Purpose:
 To relieve pain.
 To relieve congestion.
 To reduce swelling.
 To control bleeding.

Procedure:
 Full the ice bag ½ -2/3
rd
full of crushed ice.
 Remove the residual air from the bag by pressing the bag against a
flat surface.
 Seal the bag.
 Dry the out side of the bag and cover it with towel.
 Refilling may be necessary at hourly intervals, or depending on the
environmental temperature remove the hag after 02 hrs for ½ hr
before reapplying.
 Do not leave the bag on one area more than 02 hrs.
 Check the under skin every10 minutes for blanches or white, if its so,
remove the ―icebag‖. Cover the area informs your staff and head
nurse.
 Make the patient comfortable.
 Clean and dry the equipment and replace back to the assigned place.
 Wash hand.

Report to your head nurse/team leader:
1. Time length.
2. Area of application
3. How the patient to letrated
4. Observation of any thing unusual

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STEAM INHALATION :

Steam inhalation a method by which heated moisture is conveyed to the upper
respiratory tract by inhalation of steam.

Steam inhalation is one of the most widely used home remedies to soothe and
open the nasal passages and get relief from the symptoms of a cold or sinus
infection.

Also called steam therapy, it involves the inhalation of water vapor. The warm,
moist air is thought to work by loosening the mucus in the nasal passages, throat,
and lungs. This may relieve symptoms of inflamed, swollen blood vessels in your
nasal passages.

While steam inhalation won‘t cure an infection, like a cold or the flu, it may help
make you feel a lot better while your body fights it off.
Don't steam longer than 10 to 15 minutes for each session. However, you can
repeat steam inhalation two or three times per day if you're still having
symptoms.

Purpose:
 To ease breathing by increasing the humidity of the air in order to sooth
mucus membrane.
 To relieve and prevent inflammation, congestion and edema of the larynx
andair passages.
 To stimulate expectoration and loosen secretions of the respiratory
system.
 To relieve coughing.
Materials required for steam inhalation
 a large bowl
 water
 a pot or kettle and a stove or microwave for heating up water
 towel
Here’s the process:
1. Heat up the water to boiling.
2. Carefully pour the hot water into the bowl.
3. Drape the towel over the back of your head.
4. Turn on a timer.
5. Shut your eyes and slowly lower your head toward the hot water until
you‘re about 8 to 12 inches away from the water. Be extremely careful to
avoid making direct contact with the water.
6. Inhale slowly and deeply through your nose for at least two to five
minutes.

33

Don‘t steam longer than 10 to 15 minutes for each session. However, you can
repeat steam inhalation two or three times per day if you‘re still having
symptoms.
You can also purchase an electric steam inhaler (also called a vaporizer) online
or at a drugstore. For these, you just need to add water to the level indicated and
plug in the system. The vaporizer uses electricity to make steam that cools before
exiting the machine. Some vaporizers come with a built-in mask that fits around
your mouth and nose.
Steam vaporizers can get dirty with germs quickly, so you‘ll need to wash it
often to prevent bacterial and fungal growth. Wash the bucket and filter system
every few days during use, too.
TECHNIQUES OF BODY MECHANICS :
Some of the most common injuries sustained by members of the health care team
are severe musculoskeletal strains. Many injuries can be avoided by the
conscious use of proper body mechanics when performing physical labor.
Body mechanics is the utilization of correct muscles to complete a task safely
and efficiently, without undue strain on any muscle or joint.
Principles of good body mechanics
a. Maintain a stable center of gravity:
 Keep your center of gravity low.
 Keep your back straight.
 Bend at the knees and hips.
b. Maintain a Wide Base of Support. This will provide you with maximum
stability while lifting:
 Keep your feet apart.
 Place one foot slightly ahead of the other.
 Flex your knees to absorb jolts.
 Turn with your feet.
c. Maintain the Line of Gravity. The line should pass vertically through the
base of support:
 Keep your back straight.
 Keeps the object being lifted close to your body
d. Maintain Proper Body Alignment.

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 Tuck in your buttocks.
 Pull your abdomen in and up.
 Keep your back flat.
 Keep your head up.
 Keep your chin in.
 Keep your weight forward and supported on the outside of your feet.
Techniques of body mechanics:
A. Lifting.
 Use the stronger leg muscles for lifting.
 Bend at the knees and hips; keep your back straight.
 Lift straight upward, in one smooth motion.
b. Reaching.
 Stand directly in front of and close to the object.
 Avoid twisting or stretching.
 Use a stool or ladder for high objects.
 Maintain a good balance and a firm base of support.
 Before moving the object, be sure that it is not too large or too heavy.
c. Pivoting.
 Place one foot slightly ahead of the other.
 Turn both feet at the same time, pivoting on the heel of one foot and the toe
of the other.
 Maintain a good center of gravity while holding or carrying the object
d. Avoid Stooping.
 Squat (bending at the hips and knees).
 Avoid stooping (bending at the waist).
 Use your leg muscles to return to an upright position.
4-5. General considerations for performing physical tasks
 It is easier to pull, push, or roll an object than it is to lift it.
 Movements should be smooth and coordinated rather than jerky.
 Less energy or force is required to keep an object moving than it is to start
and stop it.
 Use the arm and leg muscles as much as possible, the back muscles as little
as possible.

35

 Keep the work as close as possible to your body. It puts less of a strain on
your back, legs, and arms.
 Rock backward or forward on your feet to use your body weight as a pushing
or pulling force.
 Keep the work at a comfortable height to avoid excessive bending at the
waist.
 Keep your body in good physical condition to reduce the chance of injury.
Reasons for the use of proper body mechanics
 Use proper body mechanics in order to avoid the following:
 Excessive fatigue.
 Muscle strains or tears.
 Skeletal injuries.
 Injury to the patient.
 Injury to assisting staff members.
POSITIONING AND AMBULATING THE ADULT PATIENT :
One of the basic procedures that nursing personnel perform most frequently is
that of changing the patient's position. Any position, even the most comfortable
one, will become unbearable after a period of time. Whereas the healthy person
has the ability to move at will, the sick person's movements may be limited by
disease, injury, or helplessness. It is often the responsibility of the practical nurse
to position the patient and change his position frequently. Once the patient is able
to ambulate, certain precautions must be taken to ensure the patient's safety.

36

Reasons for changing the position of a patient:
The following are reasons for changing a patient's position.
 To promote comfort and relaxation.
 To restore body function.
 Changing positions improves gastrointestinal function.
 It also improves respiratory function.
 Changing positions allows for greater lung expansion.
 It relieves pressure on the diaphragm.
 To prevent deformities.
 When one lies in bed for long periods of time, muscles become atonic and
atrophy.
 Prevention of deformities will allow the patient to ambulate when his
activity level is advanced.
 To relieve pressure and prevent strain (which lead to the formation of
decubiti).
 To stimulate circulation. . To give treatments (that is), range of motion
exercises).
Turning the adult patient :
a. General Principles for Turning the Adult Patient.
(1) Sometimes the physician will specify how often to turn a patient.
(a) A schedule can be set up for turning the adult patient throughout his "awake"
hours.
(b) The patient should be rotated through four positions (unless a particular
position is contraindicated):

37

Prone position

Supine position.

Sim's position

 Plan a schedule and follow it.
 Record the position change each time to ensure that all positions are used.
 One example of a schedule for turning would be:

38

10 a.m Prone position
12 p.m. Left Sim's position
2 p.m Supine position
4 p.m. Right Sim's position
6 p.m. Prone position
1 Notice that in the preceding sequence, the patient is required to make only a
quarter turn rather than a half turn each time the position is changed.
2 If the patient experiences pain while turning, a quarter turn will be less painful
than a half turn.
COMMON POSITIONS UTILIZED FOR THE ADULT PATIENT
A. Placing the adult patient in the supine position

(1) Collect equipment.
 Pillows.
 Positioning aids as indicated.
(2) Wash your hands.
(3) Approach and identify the patient (by checking the identification band) and
explain the procedure (using simple terms and pointing out the benefits).
(4) Provide privacy throughout the procedure.
(5) Position the bed.
 Place the bed in a flat or level position at working height, unless
contraindicated.
 Lower the side rails on the proximal side (as necessary).

39

(6) Move the patient from a lateral (side) position to a supine position.
 For the patient on his side, remove supportive pillows.
 Fold top bedding back to the hips, being careful to avoid any undue exposure
of the patient's body.
 With one hand on the patient's shoulder and one on the hip, roll his body in
one piece (like a log) over onto his back.
(7) Align the patient's body in good position.
 Head, neck, and spine are in a straight line.
 Arms are at the patient's sides (parallel to the body) with hands prone.
 Legs are parallel to his body.
 Hips, knees, and feet should be in good alignment.
(8) Support the body parts in good alignment for comfort.
 Place a pillow under the head and shoulders to prevent strain on neck muscles
and hyperextension and flexion of the neck.
 Support the small of the back with a folded bath towel or small pillow.
 Put a footboard at the foot of the bed and place the feet flat against it (at right
angles to the legs) to prevent plantar flexion ("foot drop").
 Arrange a sandbag along the outer portion of the right foot to keep the foot
upright.
 Make a trochanter roll and arrange it along the right hip and thigh to keep the
hip joint from rotating outward.
 Place a pillow under each forearm so the arm is at least six inches from the
body.
(9) Provide for the patient's comfort and safety.
 Replace the bedding neatly and raise the side rails, if used.
 Place the call light within reach.
 Position the bedside stand or overbed table so that the patient will be within
easy reach of drinking water and personal items.
 (d) Leave the bed in the low position.
(10) Report significant nursing observations to the charge nurse.
(11)Report significant nursing observations to the charge nurse.

40

B. Placing the adult patient in the fowler's and semi-fowler's positions.

Fowler's position

Semi fowler position

.

41

ADMINISTERING AN ENEMA :

Definition:
An enema is a solution inserted into the rectum and sigmoid colon for
the purpse of removing faces and /or flatus.

Types of Enema:
There are several types of enema used of purposes other than cleansing.
1. Clean enema.
2. Soapy water enema.

Large volume cleansing enema:

Equipment Needed:
 Absorbent pad for the bed.
 Disposable gloves.
 Bedside commonde or bedpan if client will not be able to ambulate to
 bathroom
 Lubricant..
 Enema container
 Tubing with clamp and nozzle. .
 Thermometer for enema solution
 Toilet tissue.
 IV pole.
 Wash Cloth, towel and basin.

Large volume cleansing Enema:

1. Wash hands.
2. Assess client‘s understanding of procedure and provide privavy.
3. Apply gloves.
4. Prepare equipment (see Figure 6-19-5)
5. Place absorbent pad on bed under client.Assist client in attaining left
lateral position with right leg flexed as sharply as possible.If there is
question regarding the client‘s ability to hold the solution, place a
bedpan on the bed near to the Patient.
6. If specified,heat solution to desired temperature using thermometer to
measure. enemas administered to adults are usually given at 105*-
110*F (40.5*-43*C),and those adminis-tered children are usually at
100*F(37.7*C)Solution should be at least body temperature to
prevent cramping and discomfort.
7. Pour solution into the bag or bucket ; add water if needed .Open
clamp and allow solution to prime tubing .Clamp tubing when
primed.

42

8. Lubricate 5 cm (2 inches) of the rectal tube unless the tube is part of
the rectal tube unless the tube is part of a prelubricated enema set.
9. Holding the enema container level with the rectum , have the client
take a deep breath. Slowly and smoothly insert rectal tube into rectum
approximately 7-10 cm in an adult. The rectum of an adult is usually
10- 20 cm (4-6 inches). Aim the rectal tube toward the client‘s
umbilicus.
10. Raise the container holding the solution and open clamp.(If using an
enemaset, sqeez the container holding solution).The solution should
be 30-45 cm(12-18 inches)above the rectum for an adult,and 7.5 cm
(3 inches)above the rectum for an infant.The solution may be paced
on an IV pole at the proper height.
11. Slowly administer the fluid.
12. When solution has been completely administered or when the client
cannot hold any more fluid,clamp the tubing and remove the rectal
tube, disposing of it properly.
13. Clean lubricant, any solution, and any faces from the anus with toilet
tissue.
14. Have the client continue to lie on the left side for the prescribed
length of time.
15. When the client has retained the enema for the prescribed amount of
time, assist to the bedside commode or toilet onto the bedpan .If the
client using the bathroom, instruct not to flash the toilet when
finished.
16. When the client finishing expelling the enema assist to clean the
perineal area if needed.
17. Return the client to a comfortable position place a clean, dry protective
pad under the client to catch any solution or feces that may continue
to be expelled.
18. Observe feces and document data.
19. Remove gloves and wash hands.

Small volume, Prepackaged Enema:

Equipment Needed:
 Prescribe package prepackage enema.
 Lubricant if the tip is not pre lubricated.
 Toilet tissue.
 Bedpan or commode if the client cannot use the bathroom.
 Absorbent pad for bed.

Small volume, Prepackaged Enema:

1. Wash hands.
2. Remove prepackaged enema from packaging. Be familiar with any
special instructions include with the enema .The packaged enema may
be stood in a basin of warm water to warm the fluid prior to use

43

3. Apply gloves.
4. Place absorbent pad on bed under client. Assist client in attaining left
lateral position with right leg flexed as sharply as possible .Or you
may use the knee-chest position If there is a question regarding the
client‘s ability to hold the solution, place a bedpan on the bed nearby.
5. Remove the protective cap from the nozzle and inspect the nozzle for
lubrication. If the lubrication is not adequate, add more.
6. Squeeze the container gently to remove any air and prime the nozzle.
7. Have a client take a deep breath. Simultaneously gently insert the
enema nozzle into the anus pointing the nozzle toward the umbilicus.
8. Squeeze the container until all the solution is instilled
9. Remove the nozzle from the anus and dispose of the empty container
in a trash receptacle

Equipment Needed:
 Absorbent pad for the bed
 Disposable gloves
 Bedside commode or bedpan if client will not be able to ambulate to
bathroom
 Prescribed solution
 Lubricant
 Enema container
 Tubing with clamp and nozzle
 Thermometer
 Toilet tissue
Procedure:
1. Wash hands Assess if client understands procedure.
2. Apply gloves.
3. Place absorbent pad on bed under client. Assist client in
4. attaining left lateral position with right leg flexed.
5. If specified, heat solution to desired temperature using thermometer to
measure Enemas
6. . Administered to adults are usually given a 105*-110-F(40.5—43-C) and
thos administered to children are usually administered at 100*F
7. Solution should be at least body temperature to prevent cramping and
discomfort.
8. Pour solution in to the bag or bucket ,open clamp,and allow solution to prime
tubing.Clamp tubing when primed.
9. Lubricant 5 cm (2 inches)of the rectal tube unless the tube is part of a
prelubricated enema set. Holding the enema container level with the rectum,

44

have a client take a deep breath.simultaneously; slowly and smoothly insert
rectal tube into rectum approximately 7-10 cm in and adult. Insertion of rectal
tube toward the umbilicus guides tube along rectum. Rectum of an adult is
usually 10-20cm (4-6inches).The tube should be inserted beyond the internal
sphincter. Aim the rectal tube toward the client‘s umbilicus.Raise the
container holding the solution and open clamp. The solution should be 30-
45cm (12-18 inches)above the rectum for an infant. The solution may be
placed an IV pole at the proper height.
10. Slowly administered the fluid.
8. When solution has been completely administered or when the client cannot
hold any more fluid, clamp the tubing and remove the rectal tube, disposing
of it properly.lubticant,any solution, and any feces from the anus with toilet
tissue.When the client has retained the enema for the prescribed amount of
time, assist to the bedside commode and toilet or on to the bedpan. if the
client is using the bathroom instruct not to flush the toilet when finished.
9. When the client‘s is finished expelling the enema, assist to clean the
perineal area if needed.
11. Return the client to a comfortable position. Place a clean, dry protective pad
under the client to catch any solution or feces that may continue to be expelled.
12. Observe feces and document data.
13.Remove gloves and wash hands

ASSISTING WITH A BEDPAN :

Use of Bedpan:

Voiding and bowel elimination for the client confined to bed require a bedpan
and /or a urinal.

Requirement:

The bedridden client may have altered elimination patterns. Reduced
mobility, pain ,privacy issues, the need for assistant ,delays in getting assistance
when needed, and the fear of interruption can all alter normal elimination
patterns.

Equipment Needed:

 Bedpan (regular or fracture) or urinal
 Disposable gloves
 Bedpan cover
 Toilet paper

45

 Washcloth and towel.

Procedure:

1. Close curtain or door.
2. Wash hand; apply gloves.
3. Lower head of bed so client is in supin position.
4. Elevate bed.
5. Assist client to side-lying position using side rail for support.
6. Warm bedpan under warm water if needed; power if necessary
7. Place bedpan under buttocks.Place a fracture pan with the lower near the
client‘s lower back region. Place large bedpan with the opening near the
client‘s thighs.
8. While holding the bedpan with one hand, help the client roll onto the back,
while pushing against the bedpan (toward the center of the bed) to hold it in
place.
9. Alternate: Help the client raise the hips using the ove-rbed trapeze, and slide
the pan in place.Allternate:if the client is unable to turn or raise hips, use
fracture pan instead of a bedpan. With fracture pan ,the flat side in placed to
ward the client‘s head
10. Check placement of bedpan by looking between client‘s legs.
11. If indicate, elevate head of bed to 45* angle or higher for comfort.
12. Place cell light within reach of client; place side rails in upright position,
lower bed, and provide privacy.
13. Remove gloves; Wash hands.

Removing a Bedpan:

1. Wash hands; apply gloves.
2. Gather toilet paper and washing supplies.
3. Lower head of bed to supine position.
4. While holding bedpan with one hand, roll client

46

HEIGHT AND WEIGHT :
The patient's height and weight are recorded on admission for several reasons.
1. Diet Management
The patient's ideal weight may be determined. The health care team will also be
able to monitor weight loss or gain.

2. Observation of Medical Status
Taking the patient's height and weight may indicate that the patient is
overweight, underweight, or is retaining fluids (edema). The health care team can
observe changes in weight caused by specific disease processes and determine
the effectiveness of nutrition supplements prescribed to maintain weight.
3. Calculation of Medication Dosages
Drug dosage is often prescribed in relation to a patient's weight when a specific
blood concentration of the drug is desired. Larger doses may be required in a
heavier person.

MEASURING HEIGHT AND WEIGHING THE PATIENT
a. To measure height, have the patient stand on the scale with the back to the
measuring bar.
b. Ask the patient to stand straight. Lower the bar so that it lightly touches the
top of the patient's head.
c. Record the height in inches or centimeters in accordance with local policy.
d. If the patient cannot stand, obtain an approximate height in bed.
 Have the patient lie on his back and stretch as much as possible.
 Place a mark on the bottom sheet at the patient's heel and at the top of
the patient's head.
 Measure between these two marks on the taut bottom sheet.
e. Principles related to weighing the patient.
 Weigh the patient before breakfast, at the same time each day.
 Use the same scale each time.
 Ensure that the scale is properly balanced.
 Weigh the patient in the same amount of clothing each day (i.e., hospital
gown or pajamas). Have the patient void before weighing.
 Avoid weighing any equipment attached to the patient such as drainage
bags. Hold the equipment while actually weighing the patient.
f. A helpless patient may be weighed while lying down on a litter scale. This
scale is a sling-type device that looks like a suspended hammock. You will
need assistance to place the patient on the scale.
g. Record the patient's weight on the graphic sheet and in the nurses' note

47

VITAL SIGNS:
TEMPERATURE, PULSE, RESPIRATION

Definition

Body Temperature: body temperature is the balance between heat produce and
heat lost from the body.

Pulse: the pulse is a wave of blood created by contraction of the left ventricle of
the heart. OR pulse assessment is the of a pressure pulsation created when the
heart contracts and ejects blood into the aorta.

Respiration: Respiration is the act of breathing, it include the intake of oxygen
and the output of carbon dioxide. OR respiratory assessment is the
measurement of the breathing pattern. When assessing respiration ascertain the
rate, depth, and rhythm of ventilator movement.

Vital Signs:

 Temperature, pulse, respiration, blood pressure (B/P) height & weight are
the most frequent measurements taken by HCP.

 Because of the importance of these measurements they are referred to as
Vital Signs. They are important indicators of the body‘s response to
physical, environmental, and psychological stressors.

 VS may reveal sudden changes in a client‘s condition in addition to
changes that occur progressively over time. A baseline set of VS are
important to identify changes in the patient‘s condition.

 VS are part of a routine physical assessment and are not assessed in
isolation.Other factors such as physical signs & symptoms are also
considered.

When to take vital signs:

Soon after a patient arrives on the nursing unit you should begin your nursing
assessment. You should take several measurements to establish a baseline for
further observations of that patient. Among these measurements are height,
weight, and vital signs. Other indications are as follow.

 On a client‘s admission
 According to the physician‘s order or the institution‘s policy or standard
of practice
 When assessing the client during home health visit

48

 Before & after a surgical or invasive diagnostic procedure
 Before & after the administration of meds or therapy that affect
cardiovascular, respiratory & temperature control functions.
 When the client‘s general physical condition changes
loss of conscious, pain
 Before, after & during nursing interventions influencing vital signs
 When client reports symptoms of physical distress

Body temperature:

 It is the balance b/w heat gain and heat lost.
 Core temperature – temperature of the body tissues, is controlled by the
hypothalamus (control center in the brain) – maintained within a narrow
range.
 Skin temperature rises & falls in response to environmental conditions &
depends on bld flow to skin & amount of heat lost to external
environment
 The body‘s tissues & cells function best between the range from 36 deg C
to 38 deg C
 Temperature is lowest in the morning, highest during the evening.
 Temperature varies with the type of food eaten.( cold or hot)

Routs for taking Temperature:

 Oral
 Rectal
 axillary

Thermometers – 3 types

 Glass mercury – mercury expands or contracts in response to heat. (just
recently non mercury)
 Electronic – heat sensitive probe, (reads in seconds) there
is a probe for oral/axillary use (red) & a probe for rectal use (blue). There
are disposable plastic cover for each use. Relies on battery power –
return to charging unit after use.
 Infrared Tympanic (Ear) – sensor probe shaped like an
otoscope in external opening of ear canal. Ear canal must be sealed &
probe sensor aimed at tympanic membrane – return to charging unit after
use.

49

PULSE:

 Left ventricle contracts causing a wave of bld to surge through arteries –
called a pulse. Felt by palpating artery lightly against underlying bone or
muscle.
 Carotid, brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis
 Assess: rate, rhythm, strength – can assess by using palpation &
auscultation.
 Pulse deficit – the difference between the radial pulse and the apical pulse
– indicates a decrease in peripheral perfusion from some heart conditions
ie. Atrial fibrillation.

Procedure for Assessing Pulses

Gather Materials:

You will need a clock or watch with a second hand, a pencil or pen, and
something to write on (form, note pad, and so forth).

Verify Patient's Identity.
If you are ordered to take a patient's pulse, make sure that you are taking the
pulse of the proper patient. For example, check the patient's name on your orders
against the name on his hospital identification bracelet or ask the patient his
name.
If you have already established the patient's identity, this step is skipped.

Select Site:

Select a site for taking the patient's pulse. Normally, the radial site is usually
chosen. The brachial and the carotid sites are other commonly used locations.
These sites are normally used because of their availability and because little or no
clothing have to be removed in order to expose these sites. Other sites may be
used when you wish to check the blood circulation to a specific body part.

Prepare Site:

Remove any clothing from over the site (open shirt for apical, remove boot and
sock for dorsalis pedis, and so forth.). Then position the body part so that you can
take the pulse easily.
When taking a patient's radial pulse, place the patient's arm across his chest as
shown in figure 3-3. This will allow you to count his breaths after taking his
pulse without having to move. The patient's breathing pattern may change if he
knows you are watching his breathing.

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Taking a patient's pulse

A - carotid pulse. B - radial pulse.

Locate Pulse:

Put the tips of your index finger and middle finger together and feel for the pulse
by pressing down moderately with you fingertips on the site.
If you cannot feel a pulse, move your fingertips around the area until you locate
the pulse. Do not use your thumb to search for the patient's pulse. The thumb
contains a blood vessel that is large enough for a pulse to be felt.
If you use your thumb, the pulse that you find may be your own thumb pulse, not
the patient's pulse.
Some people prefer to use three fingers to take a pulse.
Count Pulse Beats and Note Abnormalities. Count the pulse beats felt during a
60-second period. Use the clock or watch. As you count the beats, note the
strength and regularity (rhythm) of the beats.
 If you are using the dorsalis pedis site, use gentle pressure
when palpating the artery. Too much pressure at this or other sites may
press the artery closed and stop blood from flowing pass the site. Apical –
beat of the heart at it‘s apex or PMI (point of maximum impulse) – 5
th

intercostal space, midclavicular line, just below lt. nipple – listen for a
full minute ―Lub-Dub‖
 Lub – close of atrioventricular (AV) values – tricuspid &
mitral valves
 Dub – close of semilunar valves – aortic & pulmonic valves

Record Pulse Rate:

By convention (general agreement), the patient's pulse rate is recorded as an even
number (ending in 0, 2, 4, 6, or 8). For example, if you counted 72 beats during

51

the 60-second period, you would record "72." Suppose, however, that you had
counted 83 beats during the 60-second period. Would you record a pulse rate of
"82" or "84"? By convention, an odd pulse rate is recorded as the next higher
rate. Therefore, a pulse rate of 83 would be recorded as "84."
Once you have sufficient practice in taking pulses, you may wish to use a shorter
method of determining the pulse rate of a patient with a regular pulse. You may
count the number of pulse beats that you feel during a 30-second period and
multiply this number by 2. If, for example, you counted 37 pulse beats during a
30-second period, you would record "74" (37 X 2 = 74). This method will always
give you an even number as your pulse rate. This method is used only if the
patient has a regular rhythm. If the patient has an irregular pulse, you must use a
least a 60-second time period.

Assess: rate, rhythm, strength & tension:

1.Rate – N – 60-100, average 80 bpm
Tachycardia – greater than 100 bpm
Bradycardia – less than 60 bpm
2.Rhythm – the pattern of the beats (regular or irregular)
3.Strength or size – or amplitude

The volume of bld pushed against the wall of an artery during the ventricular
contraction
 weak or thready (lacks fullness)
 Full, bounding (volume higher than normal)
 Imperceptible (cannot be felt or heard)

Record any Abnormalities:

If you noticed anything about the patient's pulse that is not normal (irregular,
intermittent, thready, bounding, and so forth), record your observations on the
form or piece of paper.

If the patient's pulse is very different from the previous time (for example, a
patient whose pulse was normal four hours ago and is now irregular), notify the
appropriate nursing personnel.
Take Pulse at Other Sites, if Needed. Sometimes a pulse cannot be taken
accurately at a particular site because of blockage in the artery or other reasons.
In such a case, you should take a pulse at another site in order to check your
results. Sometimes a physician will order that the apical pulse be taken in
addition to the pulse at another site. Such a procedure allows the physician to
check the pulse at a particular site against the rate and characteristics of the
actual heartbeat (apical pulse).

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RESPIRATIONS:

Assess by observing rate, rhythm & depth
Inspiration – inhalation (breathing in)
Expiration – exhalation (breathing out)
I&E is automatic & controlled by the medulla oblongata (respiratory center of
brain)
Women breathe thoracically, while men & young children breathe
diaphragmatically usually.
Asses after taking pulse, while still holding hand, so pt is unaware you are
counting respirations.

BLOOD PRESSURE :

Force exerted by the bld against vessel walls. Pressure of bld within the arteries
of the body.
As left ventricle contracts – bld is forced out into the aorta to the large arteries,
smaller arteries & capillaries
Systolic- force exerted against the arterial wall as left. ventricle contracts &
pumps bld into the aorta – max. pressure exerted on vessel wall.
Diastolic – arterial pressure during ventricular relaxation, when the heart is
filling, minimum pressure in arteries.

Factors affecting B/P:

 lower during sleep
 Lower with bld loss
 Position changes B/P
 Anything causing vessels to dilate or constrict - medications

Measured in mmHg – millimeters of mercury

Normal range
syst 110-140 dias 60-90
Hypertensive - >160, >90
Hypotensive <90

Equipments for B/P measurement

1.Stethoscope
2.Sphygmomanometer
types of sphygmomanometers
Aneroid – glass enclosed circular gauge with needle that registers the B/P as it
descends the calibrations on the dial.
Mercury – mercury in glass tube - more reliable – read at eye level.
Electronic – cuff with built in pressure transducer reads systolic & diastolic B/P

53

3. Cuff – inflatable rubber bladder, tube connects to the manometer, another to
the bulb, important to have correct cuff size (judge by circumference of the arm
not age)
Support arm at heart level, palm turned upward - above heart causes false low
reading
Cuff too wide – false low reading
Cuff too narrow – false high reading
Cuff too loose – false high reading.
4. Sprit swab for cleaning ear piece

Do not take B/P in

 Arm with cast
 Arm with arteriovenous (AV) fistula
 Arm on the side of a mastectomy i.e. rt mastectomy, rt arm

How to Take Your Temperature
Using a thermometer to monitor your temperature can help you manage an
illness. A rise in your temperature is usually caused by an illness, infection, or
injury.

Normal body temperature

Normal body temperature is about 98.6 degrees Fahrenheit (or 37 degrees
Celsius). Your temperature often varies from 1 to 2 degrees Fahrenheit (.5 to 1
degrees Celsius) throughout the day. Your temperature is usually low in the
morning and gradually increases during the day, reaching its high in the late
afternoon or evening.

Types of thermometers

An oral thermometer has a long, slender bulb at one end, containing mercury.
Oral thermometers are usually used in the mouth, but can also be placed under
the armpit. A rectal thermometer has a shorter bulb of mercury at one end and is
used in the rectum, usually in children. As the mercury in the thermometer

54

expands in response to your body heat, it moves up the column to display your
temperature.
Electronic and temperature strip thermometers are also available, but might be
less accurate.
When purchasing a thermometer, choose one with a column that is easy to see
and with degree markings that are easy to read.
How to take your temperature
1. Wash your hands with soap and warm water.
2. Wash the thermometer in cold water.
3. Make sure the top of the mercury column is down near the bulb.
4. Hold the thermometer firmly at the end away from the mercury bulb and
shake it with a downward flick of your wrist. This drives the mercury level
down below the normal mark.
5. Insert the bulb end of the thermometer under your tongue and close your
mouth.
6. Wait one minute and remove the thermometer. To read the temperature, hold
the thermometer near the light and rotate it slowly until you see the silver
column of mercury. The number on the thermometer at the top of the
mercury column is your temperature.
7. Rinse the thermometer in cold water and clean it with alcohol before storing
it.
Thermometers: Taking your child's temperature
Thermometers differ in accuracy and ease of use. The best way to take your
child's temperature depends on his or her age and ability to cooperate.
Match method to age
The best place to insert the thermometer depends on the child's age.
 Newborns: For babies less than 3 months old, start with an armpit
(axillary) temperature. If it's higher than 99 F (37.2 C), take a second
measurement rectally. Rectal temperatures higher than 100.4 F (38 C) in
newborns and infants up to 3 months of age require immediate medical
attention.
 3 months old to 4 years old: For this age group, you can check your
child's temperature rectally, or with an electronic pacifier thermometer or
an ear thermometer.
 Older than 4 years: After age 4, most children are able to hold an oral
digital thermometer under the tongue for the short time it takes to get a
temperature reading.

55

Accuracy varies
A rectal temperature is the most accurate, although temperatures measured by
mouth and ear are accurate if done properly. Armpit (axillary) temperatures are
the least accurate, but are better than nothing.
Whatever the method, make sure you know exactly how to use your
thermometer. Read the instructions that came with your thermometer. For safety
— and to make sure the thermometer stays in place — never leave your child
unattended while you are taking his or her temperature.

SPECIMEN COLLECTION :
Specimen:

It is a sample of blood/body fluid or waste product of the body e.g.Urine, stool &
sputum.

Purpose
 To investigate disease in the patient.
 To find out diagnosis and decide appropriate treatment.
Specimens are collected on the units from patients and then they are send to
laboratory for investigation.

Right for specimen collection
1. Right patient.
2. Right specimen.
3. Right time.
4. Right amount.
5. Right container.
6. Right label.
7. Right requisition slip for lab.
8. Right method.
9. Right asepsis
10. .Right approach.
Specimen collection and transport:

Purpose:
To ensure that specimens being submitted to the laboratory meet the required
standards.

56

TYPES OF SPECIMEN COLLECTION:

 Urine Detail reports(D/R)
 Urine C/S.
 24hrs urine collection.
 Sputum collection.
 Stool D/R
 Stool C/S.

1. URINE DETAIL REPORTS (D/R):

Purpose:

The random urine specimen usually collected as a part of physical examination
or at
various times during hospitalization, permits laboratory screening for urinary and
systematic pathologies.

2. URINE CULTURE AND SENSITIVITY C/S:

Purpose:

To obtain sterile urine specimen for culture and sensitivity test.
A mid stream urine specimen is required for urine C/S.

Midstream specimen:

Means catching the urine specimen between the time the patient begins to void
and the time he stops. Clean catch refers to the fact that anything outside the
patient body does not contaminate the urine. Clean catch also requires careful
washing of genital area.

24 hours urine collection:

It is collection of all urine voided by the patient over 24-hrs period.
It is the diagnostic test for urinary tract disease.

COLLECTION SPUTUM SAMPLE:

Sputum is the substance collected from patient lungs, contains saliva, mucus ,pus
and sometimes blood. It is thicker than ordinary salvia.
.
Equipment:

 Sputum mug.
 Disposable gloves.
 Lab request.

57

Procedure:

Assemble equipment.
Wash hand.
Check I.D. band of patient.
Explained procedure to the patient.
If patient has eaten recently, rinse his mouth very well.
Give sputum container to the patient and asked him to take 3 three consequent
deep breath and on the third exhalation, cough deep from lungs to bring out he
sputum.
Cover the container immediately. Do not touch inside the
container.
Label the container right away and take to the lab immediately.
Make the patient comfortable.
Clean and replace things.
Wash hands.

Report to incharge /team leader:
 Sputum is obtained.
 Observation.Colour, odour, amount and consistency.
 How the patient has toleration the procedure.
STOOL SPECIMAN :
Stool for Dr or C/S is collection in the same container because it is contaminated
with organisms.

Procedure:

 Assemble equipment.
 Bed pan with cover.
 Specimen Container.
 Wooden Tongue Depressor.
 Lab request.
 Disposable gloves.

Procrdure

 Wash hand.
 Identify the patient.
 Provide privacy.
 Explain the patient, that stool specimen is required for lab test, so when ever
he moves his bowel, he calls you.
 Ask patient not to urinate in the bedpan, not to put toilet papers in the
bedpan (ifpatient is bed ridden.

58

 After patient has moved bowel, cover bedpan, taken to bathroom.
 Place the specimen in the container and put wooden tongue depressor in the
container.
 Cover the container immediately; empty the remaining feces in the toilet.
 Clean bedpan and put in the proper place.
 Wash hand.
 Make patient comfortable.
 Send the specimen to laboratory with lab request.
 Match the results with the color-chart on the multistix bottle in good
lightening.
 Discharge used strips properly.
 Wash hand.
 Record results in diabetic protocol.
 Report to your assigned nurse.

59

URINE TESTIND BY DIPSTICK :

A urine test strip or dipstick test is a basic diagnostic tool used to determine
pathological changes in a patient's urine in standard urinalysis. A standard urine
teststrip may comprise up to 10 different chemical pads or reagents which react
(change color) when immersed in, and then removed from, a urine sample.
It‘s dipped into urine, and the chemicals on the stick react and change color if
levels are above normal.

Things the dipstick test can check for include:
 Acidity or pH. If the acid is above normal, one could have kidney stones,
a urinary tract infection or another condition.
 Protein. This can be a sign that kidneys are not working right. Kidneys
filter waste products out of blood, and body needs protein.
 Glucose. A high sugar content is a marker for diabetes.
 White blood cells. These are a sign of infection.
 Bilirubin. If this waste product, which is normally eliminated by liver,
show up, it may mean liver isn‘t working properly.
 Blood in urine. Sometimes this is a sign of infections or certain illnesses.
 Nitrites. The presence of nitrites in urine most commonly means there‘s a
bacterial infection in urinary tract. This is usually called a urinary tract
infection (UTI).

Procedure:
 Wash hands use protective equipment
 Check urine dipstick expiry date.
 Explain procedure to patient
 Advise patient how to collect a fresh sample, preferably a mid-stream
sample if possible
 Remove testing strip from container.
 Fully submerge test strip in the urine sample.
 Remove the test strip & wipe away any excess urine. Hold for
approximately two seconds.
 Ensure the test strip remains horizontal to avoid cross contamination.
 Compare reagent strip against colour reference guide on outside of
container
 Dispose of urine, used strip, urine container and gloves,
 Document results, and inform doctor and patient; take appropriate action
as required

60

BEDSORE:

What are bed sores?

Bed sores are ulcers that occur on areas of the skin that are under pressure from
lying in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period
of time. Bed sores can occur when a person is bedridden, unconscious, unable to
sense pain, or immobile.
Bedsore is also called decubitus ulcer or pressure sore, are area where the skin
has broken down because of prolonged underlying pressure. The pressure can
come from the weight of the body, splints, cast or wrinkled. If bedsores are not
treated quickly it gets larger and become very painful and infected. It is often
made worse by continued pressure, heat, moister and lack of cleanliness.

61

Why does a bed sore develop?

A bed sore develops when blood supply to the skin is cut off for more than two to
three hours. As the skin dies, the bed sore first starts as a red, painful area, which
eventually turns purple. Left untreated, the skin can break open and become
infected. A bed sore can become deep, extending into the muscle. Once a bed
sore develops, it is often very slow to heal. Bed sores often occur in the buttocks
area (on the sacrum or iliac crest), or on the heels of the feet.

Preventing bed sores:

Bed sores can be prevented by inspecting the skin for areas of redness (the first
sign of skin breakdown). Other methods of preventing bed sores and preventing
progression of existing bed sores include:
 frequent turning and repositioning
 providing soft padding in wheelchairs and beds to reduce pressure
 providing good skin care by keeping the skin clean and dry
 Nursing consideration is:
 Change position q 2hrly for all bed-ridden patients.
 bed sheets should be wrinkle free
 keep the patient body clean and dry as possible
 Avoid friction when pulling the patient on and off bed pain pen.
 Wash patient skin with mild soap and warm water.
 To remove urine/ faces.
 Give back rub to all bed ridden patient when change the position it will
help to increase. Circulation and prevent bedsore.
 If sign of bedsore appear gentle rub the area with skin lotion rub in
circulatory motion away from affected area, rubbing stimulates the
circulation of blood.
Treatment for bed sores:

Specific treatment of a bed sore is determined by your physician and based on
the severity of the condition. Treatment may be more difficult once the skin is
broken, and may include:
1. removing pressure on the affected area
2. protecting the wound with medicated gauze or other special dressings
3. keeping the wound clean
4. transplanting healthy skin to the wound area
5. medication (i.e., antibiotics to treat infections

62

CATHETERIZATION :

Catheterization of the urinary bladder is the insertion of a hollow tube through
the urethra into the bladder for removing urine. It is an aseptic procedure for
which sterile equipment is required.

Purposes of urinary catheterization:

Purposes for urinary catheterization include the following.

a. Relieve Urinary Retention. Urine retained in the bladder for any reason causes
the patient discomfort and increases the likelihood of infection. A catheter may
be inserted to relieve urinary retention when a patient is temporarily unable to
void or has difficulty releasing urine from the bladder due to an obstruction of
the urethra or at the meatus.

b. Obtain a Sterile Urine Specimen from a Female Patient. At one time, this was
considered necessary to obtain a urine specimen entirely free of contamination.
Most physicians now order a collection of a voided, midstream clean-catch
specimen.

c. Measure Residual Urine. Catheterization can be done to measure the amount
of residual urine in the bladder when voiding only partly empties it.

d. Empty the Bladder Before, During, or After Surgery. A catheter may be
inserted before or following abdominal surgery, especially if the patient cannot
be up and about. Catheterization to keep the bladder empty of urine during a
surgical procedure permits the surgeon a better view and palpation of internal
tissue, and prevents accidental injury to the bladder.

The French scale (Fr.) is used to denote the size of catheters. Each unit is roughly
The smaller the number, the smaller the catheter. A larger sized catheter is used
for a male because it is stiffer, thus easier to push the distance of the male
urethra. Catheters come in several sizes:

a. Number 8 Fr. and 10 Fr. are used for children.
b. Number 14 Fr. and 16 Fr. are used for female adults.
c. Number 20 Fr. and 22 Fr. are usually used for male adults.

Types of urinary catheters:

The catheters most commonly used are made of plastic. Each type of catheter has
a rounded tip to prevent injury to the meatus or the urethra. The Foley catheter is
frequently used. It is usually inserted by the nurse. Catheters should be
considered disposable and discarded after they have been removed.

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a. Intermittent Catheter:

An intermittent catheter is used to drain the bladder for short periods (5-10
minutes). It may be inserted by the patient.

b. Retention/Indwelling Catheter:

This type of catheter is placed into the bladder and secured there for a period of
time. It is used following surgery, bladder injury, or in bladder infections. It may
also be used for an incontinent or nonresponsive patient.
1. It provides continuous temporary or permanent drainage of urine.
2. It is used for gradual decompression of an over distended bladder.
3. It is used for intermittent drainage and irrigation.
4. The most commonly used indwelling catheter is the Foley catheter. A
drainage tube and collection device are connected to the catheter. It has
a balloon at the distal end, which is inflated with sterile water or saline to
prevent the catheter from slipping out of the bladder. It is multi-lumened
(having several passages within the catheter). One lumen provides a
passage for fluid to inflate the balloon. This passage may be self-sealing
or may require a clamp. The second lumen is the passage through which
the urine drains. Some indwelling catheters have a third lumen for
instilling irrigation fluid.

c. Supra Pubic Catheter:

This type of catheter is inserted into the bladder through a small incision above
the pubic area. It is used for continuous drainage.

Preparing for catheterization:

A catheter should be used only when absolutely necessary and the catheterization
procedure itself should be done only by trained personnel under sterile
conditions. Infection is a major risk of urinary catheterization.

Gather All Equipment:

Disposable indwelling catheter kit. The kit contains the required equipment
needed for catheterization and is packaged to ensure that the equipment is sterile.
The kit includes the
 catheter,
 a drape,
 a receptacle to receive urine,
 materials to clean the area of insertion,
 a lubricant,
 a specimen container,

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 Sterile gloves.
 Lamp.
 Urine collection bag.
 leg strap or anchoring tape.
 Waterproof pad .

Explain the Procedure to the Patient:

Advise the patient that he may feel a burning sensation and pressure as the
catheter is inserted, and that he will feel that he needs to void after the catheter is
in place. Do not suggest to the patient that he may feel pain; however,
introducing a catheter in swollen or injured tissue may cause discomfort.

Provide for Privacy and Adequate Lighting:

1. Close the door or pull the curtain surrounding the patient's bed and
position the lamp at the end of the bed.
2. Position the female patient in a dorsal recumbent position with the knees
flexed and the feet about two feet apart. Place makintosh under the
patient's buttocks. Cover the upper body and each leg. Place the catheter
set between the female patient's legs.
3. Position a male patient in a supine position. Under the patient's buttocks.
Drape the patient so that only the area around the penis is exposed. Place
the catheter set next to the legs of the male patient.

INSERTING THE FOLEY CATHETER IN A FEMALE PATIENT :

The following procedures are used to insert the Foley catheter in a female
patient.
a. Wash the area around the meatus with warm soap and water. Rinse and dry.
b. Wash your hands.
c. Open the sterile catheterization kit, using sterile technique.
d. Put on sterile gloves.
e. Place the perineal sheet on the patient with the hole over the female genitalia.
f. Apply sterile lubricant liberally to the catheter tip. Lubricate at least three
inches of the catheter for the female. Leave the lubricated catheter over the
cotton balls.
g. Place the urine specimen collection container within reach.
h. Place the thumb and forefinger of your non-dominant hand between the labia
minora, spread and separate upward. The gloved hand that has touched the
patient is now contaminated.
i. Using the forceps, pick up a cotton ball saturated with antiseptic solution. Use
one cotton ball for each stroke. Swab from above the meatus downward
toward the rectum.
j. Keeping the labia separated, cleanse each side of the meatus in the same
downward manner . Do not go back over any previously cleansed area.

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k. Deposit each cotton ball into the disposal bag. After the last cotton ball is used,
deposit the forceps into the bag as well.
l. Continue to hold the labium apart after cleansing. Insert the lubricated catheter
into the female patient's urinary meatus.
m. Angle the catheter upward as it is advanced. If the catheter will not advance,
instruct the patient to inhale and exhale slowly. This may relax the sphincter
muscle. Do not force the catheter.

Cleansing the female meatus

Inserting the catheter in a female

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n. When urine starts to flow, insert the catheter approximately one inch further.
Place the cup under the stream of flowing urine to obtain a sterile specimen if
required.
o. Hold the catheter in place while the urine drains into the collection container.

NOTE: If the catheter is inadvertently placed in the patient's vagina, leave it
in place temporarily. Insert another catheter properly by repeating the
entire procedure using another sterile set; then remove the catheter from the
vagina.
p. Attach the syringe to the balloon port of the catheter. Inject the water slowly to
inflate the balloon. If the water will not inject easily or the patient complains of
pain, deflate the balloon completely and advance the catheter further, then re-
inflate.
q. Remove the syringe. To position the balloon correctly, pull on the catheter
gently until you feel resistance.
r. Connect the drainage bag to the catheter. Secure the catheter to the inner aspect
of the female patient's thigh.

s. Attach the urinary drainage bag
to the bed, below the level of the
bladder but off the floor. Coil any
extra tubing on the bed.
t. Remove any lubricant or
antiseptic on the patient's skin.
Remove your gloves, the drapes
from around the patient.
u. Discard disposable equipment
and return reusable equipment to
the appropriate area.
v. Record the time that the
procedure was done and by whom, the patient's reaction to the procedure, all
patient teaching done, and the patient's level of understanding.

Report observations to the in -charge nurse to include:

(1) The amount, color, and clarity of the urine.
(2) Any difficulty with the procedure.
(3) The presence of blood in the urine.

Maintaining an indwelling catheter:

When an indwelling or retention catheter is inserted, the nurse is responsible for
the daily care required to maintain proper drainage and reduce the possibility of
an infection occurring. Always have a confident, reassuring, and professional

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attitude when maintaining the catheter so that the patient will not feel
embarrassed.

a. Wash your hands before and after caring for the patient and wear gloves when
handling an indwelling catheter.
b. Clean the perineal area with soap and water twice daily and after each bowel
movement especially around the meatus. Use a separate area of the cloth for
each stroke.
d. In some cases, an antiseptic may be used for perineal care. Povidone iodine
(Betadine) is most commonly recommended.
d. Avoid use of lotions or powder in the perineal area.
e. Arrange for the patient to take a shower or tub bath when permitted. The
collecting container may be hung over the side of the tub. The catheter should
be clamped temporarily if the collecting container is higher than the bladder.

Removing an indwelling catheter:

Eventually, a catheter must be removed because the need for it no longer exist or
it is crusting and must be changed. The nurse usually removes the catheter.
Assemble all supplies and equipment.
1. 10 cc syringe.
2. Washcloth and towel.
3. Exam gloves.
4. Soap and water.
5. Makintosh

a. Identify the patient and explain the procedure to him. Advise him that
therewill be a slight burning during removal of the catheter.
b. Provide privacy and assist the female patient into a dorsal recumbent
position. The male should be in a supine position. Place Chux® under the
patient's buttocks and provide proper draping.
c. Wash your hands and put on exam gloves.
d. Empty the balloon by inserting the barrel of the syringe and withdrawing
the amount of fluid used during inflation.
e. Pinch off and gently pull on the catheter near the point where it exits from
the meatus.
f. Clean the perineum or penis with soap and water. Dry the area well.
g. Inspect the catheter to be sure no remnants remained in the bladder. If the
catheter is not totally intact, report this promptly and save the catheter for
further inspection.
h. Empty the drainage bag. Measure the amount of urine and record on the
intake and output (I&O) sheet.
i. Remove the gloves and wash your hands.
j. Discard disposable supplies and return reusable supplies and equipment
to the appropriate area.
k. Record that the catheter was removed, the time and date and by whom.
Note the amount, color, and clarity of the urine in the drainage bag. Also

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document all patient teaching done and the patient's level of
understanding.
l. After removal of the catheter, assess the patient for 24 hours for patterns
of urinary elimination.

Note the time and amount of the first voided urine. Report any of the
following:

1. Inability to void within 8 to 10 hours.
2. Frequency, burning, dribbling, or hesitation in starting the stream of
urine.
3. Cloudiness or any other unusual color or characteristic of the urine.
4. . Provide a level of fluids similar to the intake when the catheter was in
place.
5. Record that the catheter was removed, the date and time, and by whom.

69

70

DRAB in First Aid

DANGER

RESPONSE

SHOUT FOR HELP

YES AIRWAYBREATHING NORMALLY?

NO

CALL AMBULANCE

30 CHEST COMPRESSIONS

2 BREATHS

30:2

RECOVERY POSITION CALL FOR AMBULANCE

71

SSHHOOCCKK::

Definition:

It is depressed state of body in which there is a failure of blood circulation and all
vital organs are deprived of adequate blood.

Shock occurs when the metabolic needs of cells are not being met because of
inadequate blood flow. In effect, there is a reduction in circulating blood volume,
in blood pressure and in cardiac output. This causes tissue hypoxia, an
inadequate supply of nutrients and the accumulation of waste products.

A number of different types of shock are described:
 hypovolaemic
 cardiogenic
 septic
 neurogenic
 anaphylactic.

Hypovolaemic shock

This occurs when the blood volume is reduced by 15 to 25%. Reduced venous
return and in turn cardiac output may occur following:
 severe haemorrhage — whole blood is lost
 extensive superficial burns — serum is lost and blood cells at the site of
the burn are destroyed
 severe vomiting and diarrhoea — water and electrolytes are lost
 perforation of an organ allowing its contents to enter the peritoneal cavity
 (peritonitis).

Cardiogenic shock:

This occurs in acute heart disease when the damaged heart muscle cannot
maintain an adequate cardiac output, e.g. in myocardial infarction.

Septic shock: (bacteraemic, endotoxic)

This is caused by severe infections in which endotoxins are released into the
circulation from dead Gram-negative bacteria, e.g. Enterobacteria, Pseudomonas.
The mode of action of the toxins is not clearly understood. It may be that they
cause an apparent reduction in the blood volume because of vasodilatation and
pooling of blood in the large veins. This reduces the venous return to the heart
and the cardiac output.

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Neurogenic shock: (vasovagal attack, fainting)

The causes include sudden acute pain, severe emotional experience, spinal
anaesthesia and spinal cord damage. Parasympathetic nerve impulses reduce the
heart rate, and in turn, the cardiac output. The venous return may also be reduced
by the pooling of blood in dilated veins. These changes effectively reduce the
blood supply to the brain, causing fainting. The period of unconsciousness is
usually of short duration.

Anaphylactic shock:

In allergic reactions an antigen interacts with an antibody and a variety of
responses can occur (p. 383). In severe cases, the chemicals released, e.g.
histamine, bradykinin, produce widespread vasodilatation and constriction of
bronchiolar smooth muscle (bronchospasm). The vasodilatation profoundly
reduces the venous return and cardiac output resulting in tissue hypoxia.
Bronchospasm reduces the amount of air entering the lungs, increasing tissue
hypoxia

Physiological changes during shock:

In the short term these are associated with physiological attempts to restore an
adequate blood circulation. If the state of shock persists, the longer-term changes
may be irreversible.

Immediate or reactive changes:

As the blood pressure falls, a number of reflexes are stimulated and hormone
secretions increased in an attempt to restore homeostasis. These raise the blood
pressure by increasing peripheral resistance, the blood volume and the cardiac
output. The changes include:
 vasoconstriction, following: sympathetic stimulation of the adrenal glands
which causes increased secretion of adrenaline and noradrenaline
 increased heart rate, following sympathetic stimulation
 water retention by the kidney, following increased release of antidiuretic
hormone by the posterior lobe of the pituitary gland, increasing salt and
water retention.
 Long-term changes associated with shock If the state of shock is not
reversed, hypoxia and low blood pressure cause irreversible brain damage
and capillary dilatation and a vicious circle of events is established.

Sign and Symptoms:

Primary Shock:

1. Pallor of face and lips.

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2. Beads of sweet on the forehand.
3. Clamminess of the skin / clammy skin.
4. Cold hand and feet.
5. Rapid and thready pulse.
6. Shallow, signing breathing.

Secondary Shock:
1. All primary signs intensified along with sharp fall in Blood pressure.
2. Low temperature.
3. Thirst.
4. Vomiting.
5. Rest less ness.
6. Apathy.
7. Unconscious ness.
8. May lead to death.

Treatment:

 Lay patient flat, raise legs about 12 inches and well supported.
 Stop bleeding.
 Keep patient warm, do not over heat.
 Loosen clothing at neck and waist does not remove.
 Maintain patient airway.
 Provide drink, if conscious.
 Handle gently and support morally.
 Get a doctor / shift to Hospital ASAP

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HAEMORRHAGE

Definition:

It occurs after the rupture of any blood vessel. Whether it is an artery,vein or
capillary.

Sign and Symptoms:

 Bleeding – visible / invisible.
 Cold clammy skin.
 Rapid pulse.
 Increase air hunger, deep signs.
 Profuse sweating.
 Thirst.
 Dimness of vision.
 Drowsiness

Types of Haemorrhage:

1. External Haemorrhage.
2. Internal Haemorrhage.

External Haemorrhage:

In this the bleeding is from the surface of the body and is visible.

Parts of External Bleeding:

 Head
 Face
 Neck
 Trunk
 Limbs

Internal Haemorrhage:

It is serious as it after involves vital organs and is invisible. In this the condition
may reach dangerous degree before the condition is recognized.

Parts of Internal Haemorrhage:

 Tongue.
 Tooth socket.
 Haematemasis.

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 Haematuria.
 Haemoptysis.
 Epistaxis.
 Maleana.

First Aid Rx of Mild Bleeding:

For a cut

1. Lay patient down / position comfortably.
2. Wash your hands.(depends upon situation)
3. Expose bleeding point.
4. Wash area.
5. Apply a sterile bandage with a little pressure until bleeding stop( 3min).

For a raw wound:

1. Lay patient down / position comfortably.
2. Wash your hands (depends upon the situation).
3. Expose bleeding point.
4. Use Vaseline gauze instead of dry gauze. For a deep cut of fresh clean
wound.
5. Cleanse and dry.
6. Hold the edges of wound together and apply band aid or equilelant.
7. Use Vaseline gauze or any sterile ointment like polyfax and the apply
bandage.
Note:
*If bleeding profusely press the bandage that you have already applied or with
bare hands directly over the wound.
*Elevate the wounded area. It tends to reduce the blood flow to the injured site.

Moderate Bleeding:

 Lay patient down
 Act immediately and be Calm.
 Apply digital pressure (thumb / finger) for 10 – 15 min on pressure point.
 Over a bone on the heart side of the wound.
 Bandage a clean pad with pressure unless pressure of foreign body.
 Do not attempt to touch wound with your fingers.
 Treat for shock.
 Get patient to hospital ASAP.

Epistaxis (Nose bleeding)

 Sit upright in a chair.
 Do not tilt your head back.

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 Stay quit.
 Pinch the nostril towards the midline of the nose against the bony
cartilage.
 Apply cold compresses to the nose especially across the bridge of the
nose.
 Do not blow the nose for some hrs.
 If bleeding persists for more than 10-15 minutes, rush to the doctor.

WOUNDS:

Definition:

A wound is a break in the continuing of the tissue of the body caused by injury.
The skin usually being cut or torn so the germs are liable to enter.

Types of Wounds / Characteristics:

 Incised wound.
 Lacerated wound.
 Abrasion / Graces.
 Punctured wound.
 Gun shot / Missile wound.
 Raw wounds

Routine First Aid:

1. Handle the injured part as gently and as little as possible.
2. Lay patient down.
3. Stop bleeding. Do not disturb any blood clots.
4. Wash your hands. (If you think you have time).
5. Prepare dressing.
6. Place dry dressing.
7. Bandage on dressing.
8. Immobilize the injured part.
9. Treat for shock.
1. Transfer patient to Doctor.

Special Wounds (Bites):

Dog Bites: Small puncture wounds.
First Aid:

 Cover with dry dressing. Send to the doctor.

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 Rabies injection / tetanus.

Snake Bites:

The poison injected into the skin through two small holes and rapidly absorbed in
the circulation.

Signs and Symptoms:

 Fainting Sweating
 Vomiting
 Severe pain and swelling at site
 Death.

Treatment:

 Hang the limb down.
 Apply tourniquet on heart side of bite (Till half hour to congest vein).
 Suck the wound.
 Keep patient at rest.
 Bath the wound with water made dark red with potassium permanganate.
 Give warm drink (Tea or Coffee).

FRACTURES:

Definition:

It is the name given to the broken bone, whether it be cracked or split into two
pieces.

Types:

1. Closed / Simple:

There is no external wound and skin intact.

2. Open / Compound:

There is a wound of skin and soft tissue.

3. Complicated

In addition to broken bone, there is also injury of blood vessel or nerves or any
organ.

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4. Complete:

In this the bone is broken right across example: Oblique, Transverse.

5. Incomplete / Green Stick:

The bone is partially fractured and partially bent.

6. Comminuted:

In this bone is broken into several pieces can produce extensive bruising and are
more difficult to deal.

7. Impacted:

One end of a broken bone is driven into the other.

8. Depressed:

A piece of the skull is depressed and driven injure the brain.

First Aid:
 Have the victim lie flat.
 Handle gently and minimal.
 Never attempt to set bones.
 Immobilize injured part.
 Do not give food or drink.
 Elevate the victim's feet 8 to 12 inches.
 Cover the victim with a blanket or other item to keep him or her warm.
 Remove clothing covering the wound. Cut clothing away or rip at seams, if
necessary.
 To protect yourself against possible disease:
 If available, put on disposable latex gloves. If not available, use a plastic bag,
plastic wrap or many layers of gauze pads to apply direct pressure to the
wound to stop the bleeding. Try not to push on the injured bone.
 Cover the wounded area with a clean cloth or dressing.
 Continue to apply pressure as long as the wound bleeds. Add new dressings
over existing ones.
 Immobilize the injured area. A splint is a good way to immobilize the
affected area, reduce pain and prevent shock.

79

 Effective splints can be made from rolled-up newspapers and magazines, an
umbrella, a stick, a cane and rolled up blankets. Place this type of item
around the injury and gently hold it in place with a necktie, strip of cloth or
belt. The general rule is to splint a joint above and below the fracture.
 Or, lightly tape or tie an injured leg to the uninjured one, putting padding
between the legs, if possible. Or, tape an injured arm to the chest, if the elbow
is bent, or to the side if the elbow is straight, placing padding between the
body and the arm.
 For a broken arm, make a sling out of a triangular piece of cloth. Place the
forearm in it and tie the ends around the neck so the arm is resting at a 90
degree angle.
 Check the pulse in the limb with the splint. If you cannot find it, the splint is
too tight and must be loosened at once.
 Check for swelling, numbness, tingling or a blue tinge to the skin. Any of
these signs indicate the splint is too tight and must be loosened right away to
prevent permanent injury
 Send for Doctor.

FIRST AID KIT:

1. Include the following in each of your first-aid kits:
2. First-aid manual
3. Sterile gauze
4. Adhesive tape
5. Adhesive bandages in several sizes
6. Elastic bandage
7. Antiseptic wipes
8. Soap
9. Antibiotic cream (triple-antibiotic ointment)
10. Antiseptic solution (like hydrogen peroxide)
11. Hydrocortisone cream (1%)
12. Acetaminophen and Ibuprofen
13. Sharp scissors
14. Safety pins
15. Calamine lotion
16. Alcohol wipes or ethyl alcohol

80

17. Thermometer
18. Plastic gloves (at least 2 pairs)
19. Flashlight and extra batteries
20. Mouthpiece for administering CPR (can be obtained from your local Red
Cross)
21. Your list of emergency phone numbers

BURNS:
1. Flames, hot water or steam, sunlight, electricity, or corrosive chemicals may
cause burns of the skin.
2. The severity of burns ranges from minor to fatal and the classification of burns
is based on the extent of damage.
3. First-degree burn-:
only the superficial epidermis is burned, and is painful but not blistered. Causes
death of epidermal cells.
4.Second-degree burn:
deeper layers epidermis are effected, could have inflammation, blisters, and the
burned skin is often painful.
5.Third degree burn:
the entire epidermis is charred or burned away, and the burn may extend into the
dermis. Often such a burn is not painful at first, if the receptors in the dermis
have been destroyed.
6.Extensive third-degree burn:
potential life-threatening because of loss of skin, without this natural barrier,
living tissue is exposed to the environment and is susceptible to infection and
dehydration.

81

CHOKING:

Child-Adult-Infant
Choking occurs when a solid object or even a liquid blocks the respiratory
passage. This situation requires emergency treatment to prevent unconsciousness
or death !
Causes:
 Food bolus
 Beetle nuts
 Dentures
 Fish bone
 Inhalation of vomited material
 In children marbles, coins, stones etc.
 Any other foreign body etc.

Presenting Features:
 Grabbing the throat
 Cough
 Difficulty in breathing
 Agitation and distress
 Cyanosis (Blueness of skin)
 Eventual collapse
 Patient cannot speak to you
First Aid Management of Choking
A choking patient could collapse in one minute and might die without your
urgent help !
The Myth: slaps in this situation may cause the person to inhale the object and
cause complete obstruction and death.
Do nothing if the patient is coughing or can speak !
 Coughing keeps the obstructing object high in the trachea, though it may not
be able to expel it.

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 Coughing with an object at the entrance of the airway, however, will
generally cause it to be expelled.
 If a casualty initially coughs to no effect, and appears to be in increasing
distress, then the object may be totally obstructing the airway.
Take action if the patient cannot breathe or speak to you !
 Reassure the patient.
 Support his/her body and perform the Heimlich maneuver.
Heimlich Maneuver
The Heimlich Maneuver can be performed on victims who are either:
 Conscious
 Unconscious
 Standing
 Sitting
 Lying

You can even perform the
maneuver on yourself as well.
Child or Adult

1. For a choking child or adult who is standing and still conscious:
 Perform the procedure if the person is not coughing or speaking.
 Go behind the victim.
 Locate the top of the pelvis (approximately at the belly button).
 Put one foot between the victim's feet and slide one hand around the victim's
waist with your thumb pointing towards his belly button.
Put the other hand on top of the first, then pull up both of your hands and
back towards you, as many times as it takes to get the object out or until the
person becomes limp.

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 These will be violent thrusts, and must be performed for as many times as it
takes.
 Place your hands over the ribs, and deliver quick, firm thrusts.
 This may expel the object through the forcing of residual air from the lungs.
2. For a choking adult or child who is unconscious:
Call for help !
Place the victim on his or her back with arms on the sides.
 Perform head-tilt/chin-lift and finger- sweep to try to remove the foreign
body
 open airway (head-tilt/chin-lift) and attempt mouth to mouth breathing.
 If unsuccessful, give 6-10 sub-diaphragmatic abdominal thrusts (the Heimlich
maneuver).
 Repeat the above steps again.
 After obstruction is removed, begin CPR, if necessary.
 Continue uninterrupted until obstruction is relieved or advanced life support
is available.
 When successful, have the victim examined by a physician as soon as
possible.

3. For a victim who is sitting:
Repeat the procedure as with a victim who is standing.
 Stand behind the chair and grasp the victim around the
waist with the thumb pointing towards his belly button.
 put the other hand on top of the first, then pull up

 both of your hands and back towards you as many
times as it takes to get the object out or until the person
becomes limp.

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 These will be violent thrusts, and must be performed for as many times as it
takes to get the object out.
 Place your hands over the ribs, and deliver quick, firm thrusts.
 This may expel the object through the forcing of residual air from the lungs.
4. For a victim who is lying down:
 Roll the victim onto his or her back.
 Kneel at the victim's side, straddle her/his hips, or straddle one of her thighs.
 Your position is not that important, choose the one that is most comfortable
and affords you the greatest strength.
 Place one of your hands on top of the other on the belly button.
 The heel of your bottom hand should be positioned, just above the navel and
well below the lower tip of the breastbone.
 Move forward so that your shoulders are directly above the victim's
abdomen.
 Press your hands forcefully into the victim's abdomen with a rapid, upward
thrust.
 Repeat the thrusting until your effort is successful.
4. If you are alone and choke:
Quickly locate a firm, rigid, preferably non-moveable object that is about
the height of your abdomen.
 Place the baby's face down along your forearm with the head lower than the
rest of the body.
 Rest your forearm on your thigh.
 Deliver four back blows with the heel of your hand, striking the infant's
back forcefully between the shoulder blades.
 Immediately give the baby, chest thrusts.
 Turn the baby onto his or her back against your thigh, with the baby's head
lower than the chest.
 Place two fingers on the baby's breastbone just below the nipples.
 Give 4 quick thrusts down, depressing the breast ½ to 1 inch each time.
 Continue this series of 4 back blows and 4 chest thrusts until the object is
dislodged.
 If the baby becomes unconscious, give first aid for an unconscious patient,
Do CPR.
 If the baby becomes unconscious, give first aid for an unconscious patient,
Do CPR
 Rest your forearm on your thigh.
 Deliver four back blows with the heel of your hand, striking the infant's
back forcefully between the shoulder blades
 Immediately give the baby, chest thrusts.
 Turn the baby onto his or her back against your thigh, with the baby's head
lower than the chest.
 Place two fingers on the baby's breastbone just below the nipples.

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 Give 4 quick thrusts down, depressing the breast ½ to 1 inch each time
 Continue this series of 4 back blows and 4 chest thrusts until the object is
dislodged.
 Rest your abdomen across it so that it is positioned between the tip of your
breastbone and your navel.
 You can use the edge of a counter, the edge of a table or the back of a chair.
 Quickly and forcefully press your weight downward onto your abdomen.
 Repeat this action until the food is dislodged.
FOREIGN BODY IN THE EYE :
Emergency Care:

STEP 1:
 Advise the victim not to rub his or her eye.
 Ask him or her to sit down facing a light, so that you will be able to see into
the eye clearly.
 Using your finger and thumb, gently pull the eyelids of the injured eye apart.
STEP 2:
 If you can see the foreign body causing the irritation, wash it out with
clean water using a glass.
Allow the victim to sit down facing a light source. Gently pull the eyelids
apart.
STEP 3:
 If the foreign body has not moved, try to lift off with a moist swab, or the
dampened corner of a tissue or handkerchief.
DO NOT touch any object that is embedded in the eye, but seek medical help
immediately.
STEP 4:
 If the foreign body is under an eyelid, pull the upper lid over the lower one.
 The victim may also be able to dislodge the object by blinking the eye
 under water.
 If the foreign body is floating on the white of the eye or the inside of the
eyelid, try at first to wash it out using a glass and
clean water (sterile if possible)

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STEP 5:
 Seek medical help if attempts at removing the object are unsuccessful.
Wash the eye with clean water by bending the head towards the side of the
affected eye.
Corrosive chemicals in the eye

Emergency care:
 Chemicals or corrosive fluids splashed in the eye must be washed out quickly
by holding the person's face under a flow of running water for at least 10
minutes.
 Tilt the head with the injured side downwards so that the chemical is not
washed over the uninjured eye. Keep the eyelids apart with your fingers. If
necessary after flushing, cover the eye with a pad and get the person to
hospital.
Precautions:
 Never try to remove anything which is on the 'pupil' of the eye, or which
seems to be stuck or embedded in the white of the eye.
 In such circumstances, do not let the patient rub the eye, but cover it with a
soft pad and seek medical help.
Foreign Body In The Ear
 Children can often push objects into the ear, which become lodged and
cause temporary deafness, or may damage the eardrum.
 Adults may leave pieces of cotton wool in the ear after cleaning, and
sometimes insects can fly into an ear and cause annoyance.
Emergency Care:
 If a foreign body is lodged in place, DO NOT attempt to move it - you
may simply push the object further in.
 Take the child to hospital, and reassure him or her during the journey.
An Insect In The Ear
STEP1:
Sit the person down.

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STEP2:
Gently pour tepid water into the ear until it floods, carrying the insect out or pour
2-3 drops of oil at room temperature.
Gently pour lukewarm water to bring
the insect out of the ear.
STEP3:

If this does not work, take or send the person to hospital so that the insect can be
safely removed.

OTHER EMERGENCIES :

Fainting:

 If a patient has not lost consciousness, sit him down and lower his head
between the knees.
 If unconscious, lay the patient down with the head lower than the feet.
 Loosen clothing at neck and waist.
 Allow plenty of fresh air.
 Keep body warm.
 Sprinkle cold water on face.
 When consciousness returns, gradually raise the patient and give sips of
water or juice.
Asthma:

 Keep patient in comfortable position.
 Allow plenty of fresh air.
 Ask patient to take deep breathe.
 Give to puffs of prescribed inhalers if patient on regular use.

Home Accidents
Home is a place where one feels safe and secure, but unfortunately it is also the
place where one is most likely to have an accident which requires medical
treatment.
Some Facts:
The biggest single cause of accidents is human error !
 More people are injured in their homes than anywhere else.
 The kitchen, stairs and bathrooms are all potentially very dangerous places.

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 Many accidents occur in the home from everyday activities such as children
playing, preparing food, simply moving about the house and during
household repairs.
 Accidents involving children often occur in the presence of an adult.
HOME ACCIDENT
Falls
It includes also being hurt by falling objects and general "bumping into" type
accidents.
The elderly are particularly at risk from falls of any kind.
Heat Accidents: In our country, fire accidents are common especially in the
rural areas where poor people use oil stoves for cooking.
There are places where sui gas supply has not been provided and people use gas
cylinders for cooking. These are potential sources of serious fire accidents and
most of the time there is hardly any time available for

Poisoning
A Person Can Be Poisoned By:
 Ingestion (swallowing)
 Inhalation (breathing in)
 Skin contact
 Injection
Suspect poisoning if someone suddenly becomes ill for no apparent reason;
begins to act in an unusual way; is depressed and suddenly becomes ill; is found
near a toxic substance (for example, a chemical medication, or poisonous plant);
may have drunk contaminated water; has been breathing any unusual fumes; or
has stains, liquids, or powders on his or her clothing, skin, or lips.
The first aid you give before you get medical help can save the victim's life!
Ingested Poisons
An ingested poison is one that is introduced into the digestive tract by way of
mouth. Clues To

A Poisoning:
 Overturned or empty pill box
 Scattered pills
 Chemical

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 containers
 Household cleaners
 Empty alcohol bottles
 Over turned plants
Presentation:
 History of ingesting poisons
 Burns around the mouth
 Odd breath odors
 Nausea, vomiting
 Saliva or foaming at the mouth
 Abdominal pain
 Diarrhea
 Altered mental status
 Unresponsive
Emergency Care:
 Call for medical help!
 Your top priority is the victim's airway. Check the victim's ABCs, proceed
accordingly; DRABC of resuscitation in adults OR DRABC of resuscitation
in babies and young children
 Give first aid for seizures.
 You may be instructed to give activated charcoal till medical help arrives.
This is a finely ground charcoal that is very absorbent. It binds with the
poisons in the stomach and then passes through the body harmlessly. It may
be effective in reducing poisons for up to four hours after ingestion. Most
activated charcoal is mixed with water. If it is dry, then you must mix two
tablespoons of it in a glass of water.
 Never Induce Vomiting If The Victim:
 Is unresponsive,
 Cannot maintain an airway,
 Has ingested an acid, a corrosive, or a petroleum product,
 Has a medical condition that could be complicated by vomiting, such as heart
attack, seizures, and pregnancy.
Inhaled Poisons
Fire:
Sleeping in a closed room with no ventilation and with a heater on.
 Poorly Working gas applications

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Both the situations are a source ofcarbon monoxide gas, and can lead to
poisoning due to its inhalation.
Presentation:
 History of inhaling poisons
 Breathing of difficulty
 Chest pain
 Cough, hoarseness, burning sensation in the throat
 Blueness of skin and nails
 Dizziness and headache
 Seizures
 Unresponsiveness
Emergency Care:
 First rule is safety. You must protect yourself. Do not enter the scene of a
poisonous gas.
 When it is safe to enter the scene, quickly remove the victim from the source
of poison.
 Rest of the emergency care is the same as that of ingested poisons.
Absorbed Poisons (By Skin Contact)
An absorbed poison is one that enters the body upon contact with the skin. For
example, poison ivy, insecticides, cleaning products
Presentation:
 History of exposure
 Liquid or powder on the skin
 Burns
 Itching, irritation
 Redness, rash, blisters
Emergency Care
 Call for medical help.
 Remove the clothing that came in contact with the poison.
 Then with a dry cloth blot the poison from the skin. If the poison is a dry
powder, brush it off.
 Flood the area with copious amount of water.
 Continually monitor the patient's vital signs. Be alert for sudden changes.
Seizures and shock are not uncommon.
 The eyes are especially vulnerable to absorbed poisons. Flood the eyes with
copious amount of water.

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Injected Poisons
An injected poison is one that enters the body by way of an object that pierces
the skin.
Presentation
 Unresponsiveness
 Breathing difficulties
 Abnormal or irregular pulse
 Fever
 Vomiting with an altered mental status
 Seizures
 Visual disturbances
 Altered mental status
Emergency Care
 Establish an open airway. Do CPR, if necessary
 Call for help.
 Monitor the victim's mental status and vital signs frequently.
 Maintain the victim's body temperature.
 Take measures to prevent shock.
 Support and reassure the patient.
Using and Storing Household Products:
 Buy potentially poisonous substances in safety containers, and buy only as
much as you need.
 Store all household products safely immediately after use.
 Use products that give off fumes - including ammonia, bleach, petroleum
products, and paints - only in well- ventilated areas.
 Make sure you have adequate ventilation
around any fuel burning appliances and be
sure they are working correctly. When they
are operating, these appliances release
poisonous carbon monoxide gas that nee
Seizures
 A seizure is sudden involuntary contraction of a group of muscles, usually
due to uncontrolled electrical activity in the brain.
 A seizure may last for 30 seconds to five minutes or it may be prolonged. Its
symptoms can range from a twitch of a limb to whole body muscle
contractions.
 Seizures are rarely life threatening, but they do indicate a serious condition !

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Common Causes
 Epilepsy
 Infection
 Poisoning
 Head Injury
 Brain Tumors
 Hypoglycemia; low blood sugar level
 Stroke
Presentation
 Local tingling or twitching in any part of the body
 Brief black out or period of confused behavior
 Sudden falling; loss of consciousness
 Drooling; frothing at the mouth
 Vigorous muscle spasms; twitching; jerking limbs; stiffening
 Grunting; snorting
 Loss of bowel or bladder control
 Temporary cessation of breathing
Presentation of a Generalized Convulsive Seizure
There are four phases:
1. Aura phase
2. Tonic phase atlas
3. Clonic phase
4. Postictal phase
Aura phase:
Patient becomes aware that a seizure is coming on. It is often described as an
unusual smell or a flash of light.
Tonic Phase:
The patient becomes unresponsive and collapses to the ground. Then all muscles
of the body contract.
This causes a scream out of the patient. During this phase the patient may stop
breathing
Clonic Phase:
The muscles of the patient alternate between contraction and relaxation.
The patient may become incontinent of urine (unable to retain it). The patient
may bite the tongue and cheeks. So there may be blood in the mouth.
Postictal Phase
The patient gradually regains consciousness. At first, there is confusion and then
patient slowly becomes aware of the surroundings.

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A continuous seizure or two more seizures without a period of
responsiveness is called "status epilepticus". This is a true medical
emergency which can be fatal. In this case, transportation must not be
delayed.
Emergency Care: In case a person is known to have seizures, he or she should
always wear a "medical alert tag".
 Keep calm. Stay calm. Just wait. The seizure will be over in a few minutes.
 Protect from further injury if possible. Move hard or sharp objects away, but
do not interfere with the person's own movements. Place something soft, such
as a sweater under the head, loosen tight clothing, especially at the neck.
 Do not force anything in the person's mouth ! This could cause teeth and jaw
damage.
 Roll the person on the side.When the seizure stops, position the victim on the
side to allow drainage of saliva and vomit.
Do not be frightened if a person having a seizure appears to stop
 breathing momentarily
On Rare Occasions

If a seizure goes on longer than 5 minutes, or repeats without full recovery Call
For Medical Help!
Absence Seizure
Absence seizures affect mainly children and include sudden, brief periods of loss
of consciousness.
The eyes may blink, and there may be slight muscle movements around the
mouth. The child does not fall, and is able to resume full activity immediately.
Seizure Duration: 2 - 10 seconds.
Care of the Patient:

Though the child is not in physical danger, school results may suffer if these
seizures are taking place in the classroom.
The danger posed by absence seizures is that they can go unrecognized, causing
damage to the child's self esteem. If you believe seizures may be occurring, alert
the parents or guardians.
Partial non-convulsive seizures:
Care of the patient:

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 Stay with the person.
 Do not try to stop the seizure, but let it take its course. The person will be
unaware of his or her actions, and may or may not hear you.
 Gently guide the person away from danger.Move dangerous objects out of
the way.
 Observe carefully. Note different movements or behaviors.
 Partial seizures may spread to other areas of the brain.
Do not be alarmed if a convulsive seizure follows:
In Case of Infants/Children:
If the seizure seems to be the result of high fever (Febrile Seizure)
 Cool the child gradually using a dampened sponge or cool compress and
tepid water.
 An appropriate dose of paracetamol (Tylenol) may be used if the child is
awake.
 If a child is known to have seizures with fever, be alert and control fever and
the infection causing it, as early as possible to prevent from the seizure.
After all Types of Seizures:
Talk gently to the victim, be comforting and reassuring as it may take sometime
for the victim to become re-oriented.
 Do not restrain the victim.
 Do not place anything between the victim's teeth during a seizure.
 Do not move the victim unless he or she is in danger or near something
hazardous.
 Do not try to make the victim stop convulsing.
 Do not perform rescue breathing on a seizure victim, even if they are turning
blue.
Most seizures end long before brain damage would begin.Do not give the victim
anything by mouth until the convulsions have stopped and the victim is fully
awake and alert.
Place the victim in the recovery position
Carbon Monoxide Poisoning:
Carbon Monoxide Is A "Silent Killer".
It's a deadly gas, produced due to an incomplete burning of carbon containing
fuels.
Incomplete combustion occurs because of:
 Insufficient mixing of air and fuel.

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 Insufficient air supply to the flame.
 Insufficient time to burn.
 Cooling of the flame temperature before combustion is complete.
What makes it so dangerous?
 It has no color, no taste and no smell.
 There is no method of detecting it, other than by sensitive chemical detectors.
But there are certain "clues" that can help you avert the danger of being
poisoned by the gas.
What Happens When Carbon Monoxide Is Inhaled?
Carbon monoxide molecules attach to the red blood cells 200 times faster than
oxygen !
 When you breathe in carbon monoxide, it enters your bloodstream through
your lungs and attaches to red blood cells.
 These red blood cells, called hemoglobin, carry oxygen throughout your
body.
 Carbon monoxide molecules attach to the red blood cells 200 times faster
than oxygen, preventing the flow of oxygen to your heart, brain and vital
organs.
 As carbon monoxide accumulates in your bloodstream your body becomes
starved for oxygen.
 The amount of carbon monoxide in a person's body can be measured by a
simple blood test, called a "carboxyhemoglobin level" test.
 A person who has carbon monoxide poisoning may develop headaches,
dizziness, or nausea,
 If the exposure to carbon monoxide continues, the person may lose
consciousness, and even die.
Presenting Features
1. Mild Exposure Symptoms
 Slight headache
 Nausea, vomiting,
 Fatigue ("flu-like" symptoms).
2. Medium Exposure Symptoms
 Throbbing headache,
 Drowsiness,
 Confusion,
 Heart rate.

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3. Extreme Exposure Symptoms
 Convulsions,
 Unconsciousness,
 Heart and lung failure.
 It can cause brain damage and death.
 Unborn babies, infants and people with heart disease are affected to a
much greater degree, even by small amounts of the gas present in the air.
Sources Of Carbon Monoxide
Cigarette smoke contains large amounts of carbon monoxide !
 Any burning appliance that utilizes a form of carbon as fuel is a potential
source of carbon monoxide poisoning.
 Avoid smoking, both active and passive !
 In our country where the use of inadequately ventilated gas appliances
(cooking ranges, heaters, wood and coal stoves and charcoal grills etc.) is
very common, this produces an extremely dangerous situation both
indoors and outdoors.
 Automobile exhaust fumes.
Precautions
If you experience even mild symptoms of carbon monoxide poisoning, consult
your doctor immediately.
CARDIOPULMONARY RESU SCITATION (CPR)
Step 4:
 Repeat the compressions 15 times, aiming at a rate of 80 per minute.
 Continue resuscitation, giving two breaths of mouth-to-mouth ventilation
to every 15 chest compressions.

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DO NOT interrupt giving chest compressions to check the victim's pulse unless
there are signs of returning circulation Babies And Children
Take only shallow breaths because of the small size of a child's lungs !
Mouth to Mouth Ventilation in a Baby or Child:

Step 1:
 Place the child in the head-tilt/chin-lift position
 Step 2:
Seal your lips around the baby's mouth and nose.
Blow gently into the lungs, looking along chest as
you breathe out.
Step 3
 As you see the chest rise, stop blowing and allow the chest to fall again.
 Do this at a rate of 20 breaths per minute (1 breath every 3 seconds).
 Continue to give mouth to mouth ventilation until help arrives.
Step 4:
 Check the pulse after every 20 breaths; if it is still present and above 60 per
minute, continue mouth to mouth ventilation.
 If the baby starts breathing, place him or her in the
recovery position
Chest Compressions
Below 1 year
Step 1
Place the baby on a firm surface. Locate a position one finger - width below the
nipple line, in the middle of chest.
Step 2
Use two fingers to press the chest down by 2
cm (a bit less than 1 inch).
Step 3

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Press five times, at a rate of 100 per minute (almost twice a second)
step 4
Only if the baby's color improves, check the pulse. If the pulse is present and
above 60 per minute, stop the chest compressions but continue to ventilate the
lungs if necessary.

Summary of CPR (at Different Ages)
Adults (Over 8 Years)
Hand Position:
2 hands on lower half of sternum.
Compressions:
Approximately 1½ TO 2 inches in depth.
Breaths:
Slowly, until chest gently rises (about 1½ to 2 seconds per breath).
Cycle:
15 compressions, 2 breaths
Rate:
15 compressions in about 10 seconds or 80- 100 per minute.
Child (1 - 8 years)
Hand Position:
Heel of one hand on lower half of sternum.

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MICROBIOLOGY

Definition of microbiology:

Micro =Smallest
Bio =Life
Logy =Study
Thus it is the study of smallest organism which can not be seen with necked eye
without using microscope.
Microbes (germs) are everywhere, in the air that we breathe, the ground we walk
on, the water, the food we eat and on and inside us. Our body is home to trillions
of microbes.

Why do we study microbiology?
 To gain knowledge how these organisms transfer diseases from one person
to another?
 How their spread can be prevented?
 How can we prevent ourselves from them?
 A knowledge of immunity to infection will help in educating people on
prevention of diseases.

Classification:

Bacteria___________ Bacteriology
Fungi __________ fungi logy
Virus __________ Virology
Protozoa _________ Protozoa logy

A. BACTERIA

These are one celled (unicellular) organisms capable of causing many infectious
diseases. They are of different shape and are named accordingly.

COCCI; (round), bacilli (rod shaped), spirochete (spiral)

There are three types of Cocci

1. Diplococci = double or pair shaped cause diseases like pneumonia,
gonorrhea and meningitis
2. Staphylococci =are in cluster shape cause boils and food poisoning.

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3. Streptococci=are in chains cause pneumonia and other infections.

B. FUNJGI:

These microscopic plants- like organisms cause diseases like thrush and
ringworm. A yeast and mould are used in making bread, wine and penicillin.

C. PROTOZOA:

Microscopic parasites are called protozoa. These organisms are responsible for
causing malaria and dysentery.
Parasites are always harmful, since they depend on another living system for
their existence. They can not servive outside the host. Parasites usually live in
gastrointestinal tract and hatch from eggs to develop and mature inside the body.

D. VIRUS:

These are the smallest micro-organisms that can not be seen with an ordinary
microscope. They cause diseases like common cold. measles, polio, chickenpox
and rabies. Although bacteria, fungi and parasites can be treated by antibiotics
and other medicines but there is no treatment as yet for viruses.

NORMAL FLORA OR NON PATHOGENIC ORGANISMS:

Although microbes are capable of causing diseases but not all are harmful to the
body. Some organisms live in or on our body but do not cause diseases under
normal circumstances rather they protect invasion of certain diseases causing
organism in our body, These organisms are called normal flora of our body and
are non pathogenic (not causing disease).

On a human body they live:
 On skin
 In the nose, ears and on the tongue and in the upper respirator tract
 In the bowel
Most of the time microbes and human live in perfect harmony. Microbes even do
many good things.
Some organisms are useful to human they are used to make bread, yeast, wine,
cheese and penicillin.

PATHOGENIC ORGANISM:

These are harmful and cause disease of different types. Microbes, whether they
are pathogenic or nonpathogenic are present everywhere in our environment, in
our body, in air we breathe, in water we drink, in certain food we eat and in
refuse.
If food and water are contaminated with microbes they become sources of
infection. And when a person eat contaminated food or drinks contaminated

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water the organism get enter in body where they multiply, develop and cause
diseases.

Conditions where organisms can grow
 Moisture
 Damp & darkness
 Temperature 0 to -35C

Food of microbes:

 Carbohydrates
 Vitamins
 Fats
 Water

Mode of Entrance:

INFECTION:
When microbes gain entrance in human body they multiply & grow, cause injury
and produce reaction in the body. This is called infection. The reaction of the
body to infection is usually fever, chill, nausea and headache.
Signs & Symptoms of infection:

 Swelling
 Redness
 Pain
 Temperature/hotness
 Feeling of unwell being
 Tenderness (pain on touching)

S
#
Route Source Diseases
1 GIT (oral
route)
Contaminated food & water Foodpoison,Typhoid,Dys
entry,cholera,
Diarrhea e.t.c
2 Respiratory
route
Breathing, talking, sneezing &
coughing
TB, whooping cough
3 Skin Dog bite Rabies
4 Blood Bld transfusion, Contamenated
needle & mosquito bites
Hepatitis B&C, Malaria
& HIV Aids
5 Genital tract Vagina & Sex STI/STDs

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 Infection occurs because:
 The human defense mechanism is affected by illness or treatment
 Microbes are then able to penetrate the persons defense mechanism and
cause infection
 These microbes then become pathogenic

Infection cycle:

In order for an infection to occur, a number of components have to come
together. This phenomenon is described as the Chain of Infection.

INFECTION CONTROL

Meaning of Infection Control
Infection control tries to create safe environment in order to protect patient, their
visitor and staff member from risk of infection.
Why do we need infection control?
We need infection control to identify hazards associated with health care
practices and the environment and to take appropriate action to minimize the
risks.

Because infection:

 Cause pain and suffering to patients/clients and create anxiety and worry
for relatives and friends
 Lengthen patient hospital stay
 Increase cost of patient/client care
 Can result in death
 Resistant bacteria required highly toxic and expensive drugs.

These infection demands:

 Careful observation
 Strict precautions to prevent cross transmission
 Highly toxic drugs which often leads to further complication

BREAKING THE CHAIN OF INFECTION

 Employee Health:
 Ensure that the employee is healthy.
 Check their immunization status.
 Environmental Hygiene

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 The environment hygiene includes general domestic cleaning as well as
cleaning of patient care equipment, furniture, wall and floors etc.
 Cleaning with neutral detergent and hot water is adequate for routine
hygiene.
 Cleaning with a disinfectant based solution may be required in certain
infections and for blood and body fluid splashes.
 Contaminated work areas must be disinfected immediately after a spill
and at least every shift using products that are effective against
mycobacterium tuberculosis (MTB) and HIV.

Breaking of chain includes safe management of excretions and secretions,
clinical waste and used linen and use of protective wear.

PROTECTIVE WEAR

Protective wear will shield you form possible risks of infection from patients and
the patients from possible risks of infection from yourself. Example of protective
attire include:

 Gloves
 Plastic aprons, Gowns
 Masks and eye wear

Gloves

1.Protect hands from contamination with excretions / secretions and microbes.
2.Help reduce the risk of transmission of microbes to patients / clients and staff
3. Gloves should be worn as a single use item
4. Gloves should be used:
 for invasive procedures
 for contact with sterile sites, non-intact skin, mucous membranes
 when risk of exposure to blood, body fluids, excretions, secretions is
likely
 when handling sharp and contaminated instruments.

Glove Selection

 The type of gloves worn should reflect the risk of anticipated exposure.
 Sterile gloves are used for contact with normally sterile areas of the body.
 Non sterile examination gloves are used for contact with blood, body
fluids, excretions and secretions and contact with mucous.

Aprons:

Plastic aprons protect uniform / clothing from contamination with:

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 blood and body fluids, excretions and secretions
 microbes from patient / client, materials or equipment during close
contact

Gowns:

Use of gowns for routine care of patients is not necessary unless extensive
contamination with blood and body excretions and secretions is likely e.g. while
conducting delivery.

Masks:

In routine patient care, face masks and eye protection are worn when splashing of
face and eyes are likely.

Mask should be:

 well fitting
 handled by straps
 changed if wet and at the end of the task
 discarded immediately after use

Clinical Waste:

Clinical waste includes all waste generated in a health care environment except
for household items such as paper towels, flowers.

Clinical waste will contain pathogens and improper handling can result in
transmission of infection or injury to handlers.

The policies for defining, collecting, storing, decontaminating and disposing of
infective waste are determined and needs to be follow.

Used Linen:

Microbes from patients / clients can be transferred onto the bedding, towels etc.
Soiled used linen can become a source of pathogens, can contaminate hands.

Laundry is bagged or containerized at the location where it was used and is
handled as little as possible.

Contaminated laundry is transported in leak proof bags or containers labeled
indicate universal (standard) precautions must be used. Use Hypochlorite (bleach
1:10) to wash blood stained linen.

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MEANS OF TRANSMISSION :

Microbes need a vehicle to help move from its source to a susceptible person.
This can be hands, equipment, food, sharps and air. This route has to be
interrupted.

Means of Transmission: Hands:

Hands play a vital role in delivering care but can become contaminate with
microbes during patient/client care activities. These are termed transient
microbes because they are picked-up and are simply passing through.

Transient Microbes:

• Use hands as their means of transport to pass from the source to the
susceptible person
• Transient microbes pose a great threat of cross transmission of infection
between patients / clients

Transient organisms picked up during:

 Direct contact with patients
 Direct contact with patient care equipment handling soiled incontinence
pads/nappies
 Blowing the nose
 Visiting the lavatory

Resident Microbes:

• These are carried on skin, in the nose, mouth and bowel become transient
when transferred on to hands.
Cause no problem to the carrier but become transient during touching or
blowing the nose and visiting the lavatory

• These transient microbes can cause infection if hands are not washed before
handling patients / clients or patient care items.

Hand Hygiene:

 Hand Hygiene is the single most effective infection control measure.
 Types of Hand washing Techniques
 Which Wash When?

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HAND WASHING :

Hand hygiene is regarded as the most important intervention to reduce
healthcare-associated infections
You can help yourself and your loved ones stay healthy by washing your
hands often, especially during these key times when you are likely to get
and spread germs:
 Before, during, and after preparing food
 Before eating food
 Before and after caring for someone at home who is sick with
vomiting or diarrhea
 Before and after treating a cut or wound
 After using the toilet
 After changing diapers or cleaning up a child who has used the
toilet
 After blowing your nose, coughing, or sneezing
 After touching an animal, animal feed, or animal waste
 After handling pet food or pet treats
 After touching garbage.
TEN STEPS OF HAND WASHING
1. Wet your hands with clean, running water (warm or cold), turn
off the tap, and apply soap.
2. Rub your palms together.
3. Step 3 - Rub the back of each hand.
4. Step 4 - Rub both your hands while interlocking your fingers.
5. Step 5 - Rub the back of your fingers.
6. Step 5 - Rub the tips of your fingers.
7. Step 6 - Rub your thumbs and the ends of your wrists.
8. Scrub your hands for at least 20 seconds. Need a timer?
9. Rinse your hands well under clean, running water.
10. Dry your hands using a clean towel or air dry them.

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You can use an alcohol-based hand sanitizer that contains at least 60%
alcohol if soap and water are not available.
How to Use Hand Sanitizer
 Apply the gel product to the palm of one hand (read the label to
learn the correct amount).
 Rub your hands together.
 Rub the gel over all the surfaces of your hands and fingers until
your hands are dry. This should take around 20 seconds.
SHARPS INJURY:

Use of sharps in healthcare settings, pose a risk of sharps injury, exposing the
user to blood borne pathogens such as:

 Hepatitis B virus (HBV)
 Hepatitis C virus (HCV)
 Human immune deficiency virus (HIV)

Precautions to prevent sharps injury:

Do not:
 Re-cap or attempt to bend or break needles after used or
 Pass sharps from hand to hand
 Remove needles from syringes by hand
Place used sharps directly into a sharps container at the point of use.
Disposal of used sharps in a sharps container:

Sharps container should be:

 Puncture proof which meet BSI standards
 Placed as close as practical to the place of use
 Only filled up to the mark indicated i.e. ¾
 Place in a safe area

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Action to be taken in a case of an Injury:

 Encourage bleeding of the injured site by squeezing. Wash under running
water.
 Take full details of the circumstances surrounding the accident.
 Ensure an immediate management and subsequent follow-up.

STANDARD PRECAUTIONS :

• Protective clothing e.g., gloves, gowns, facemasks), depending on the
anticipated exposure
• Skin protection of cuts, wound, lesions
• Safe handling and disposal of sharps and prompt and appropriate actions in
cases of sharp injury
• Management of spillage of blood and body fluids, excretions and secretions
• Decontamination of used equipment
• Management of used linen
• Environmental Cleaning
• thorough hand hygiene
• Occupational Health and Blood borne Pathogens (immunization against
vaccinable diseases)
• Patient Placement respiratory hygiene and cough etiquette,

PRINCIPLES OF ASEPSIS:

1. Hand washing (before and after)
2. Masks should be worn to prevent droplet infections
3. Sterile procedures must be carried out before ward cleaning and bed
making or one hours later
4. Avoid draught from open windows, fan, door etc
5. All equipments must be sterile for sterile procedures
6. Ensure sterility by using transfer forceps or gloves
7. Never give back to sterile field
8. Hold sterile objects above waist level and within sight
9. Avoid spilling of solution over sterile field
10. Apply principle of ―clean to dirty‖ when doing any procedure
11. Use clean / sterile swab once only. Don‘t reuse it
12. Keep all Un-sterile equipments away from the wounds

HOW CAN WE DESTROY MICRO -ORGANISMS?

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Top 3 Physical Methods Used to Kill Microorganisms:

1. Heat (Temperature) Sterilization: Fire and boiling water have been used
for sterilization and disaffection since the time of the Greeks, and heating
is still one of the most popular ways to kill microorganisms. ...
2. Filtration:
3. Radiations:

CLEANING, DISINFECTION, STERILIZATION :

Cleaning
• All patient care equipments have to be made safe after each use.
• Routine cleaning with neutral detergent and water is often adequate and has
to be the first stage in making the item safe.
• Friction during cleaning is required to remove debris and microbes
• Physical cleaning will reduce the number of microbes present.
• Cleaning essential prior to disinfection or sterilization

Disinfection:
 Destroys, reduces or inactivates microbes but not spores.
 Required for items which come in contact with the body‘s
mucous membrane / non-intact skin
 Achieved with chemicals, by boiling, pasteurization

Sterilization:
 Destroys all forms of microbial life including high numbers of bacterial
spores. Required for ‗high risk‘ items
 Necessary for items which penetrate skin, mucous membrane, enter
vascular system or sterile spaces.
 Achieved with electric rays and steam under pressure.

Disinfectants: A guide to killing germs the right way:

1. Bleach. Bleach is a relatively inexpensive and highly effective
disinfectant. ...
2. Soap and water. Store shelves are filled with products that boast
antimicrobial properties.
3. Ammonia-based cleaners.
4. Alcohol-based hand sanitizers.
5. Vinegar.
6. Hydrogen peroxide.
7. Baking soda.
8. Tea tree oil.

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While pasteurization doesn't kill all the microorganisms in our food,
it does greatly reduce the number of pathogens so that they are unlikely to cause
disease. ... The specific temperatures allotted for pasteurization are based
on the ability to kill the most heat-resistant of pathogens,
The method of pasteurization simply involves heating food (usually a liquid) to a
specific temperature for a certain length of time and then immediately cooling it.

EXPANDED PROGRAMME ON IMMUNIZATION (EPI) :

The Expanded Programme on Immunization (EPI) was established in 1974
through a World Health Assembly resolution. In Pakistan it was initiated in 1978.

IMMUNITY:
is the ability of the body to protect against all types of foreign bodies like
bacteria, virus, toxic substances, etc. which enter the body. Immunity is also
called disease resistance. The lack of immunity is known as susceptibility.

Immunity Types: 3 Main Types of Immunity | Immunology:
 Type # 1. Innate (Natural or Nonspecific) Immunity:
 Type # 2. Acquired (Specific or Adaptive) Immunity:
 Type # 3. Active and Passive Immunity:

IMMUNIZATION :
is the process whereby a person is made immune or resistant to an infectious
disease, typically by the administration of a vaccine. Vaccines stimulate the
body's own immune system to protect the person against subsequent infection or
disease.

Immunizations:
Active vs. Passive: When child receives an active immunization,
the vaccine prevents an infectious disease by activating the body's production of
antibodies that can fight off invading bacteria or viruse

Types include:
 Viral: polio vaccine (Salk vaccine) and influenza vaccine.
 Bacterial: typhoid vaccine, cholera vaccine, plague vaccine, and pertussis
vaccine.

Vaccination:
is when a vaccine is administered (usually by injection).Immunisation is what
happens in body after one has the vaccination. The vaccine stimulates immune
system so that it can recognize the disease and protect from future infection (i.e.
one become immune to the infection).

Immunological substances:

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 Contain antigens
 Prepared from live or killed viruses or bacteria
 Attenuated or their toxins made harmless called toxids
 Should not produce the disease but prevent the disease
 There are 4 main types of vaccines: Live-attenuated vaccines.
Inactivated vaccines. polysaccharide, and conjugate vaccin

Live vaccines are used to protect against:
 Measles, mumps, rubella (MMR combined vaccine)
 Rotavirus.
 Smallpox.
 Chickenpox.
 Yellow fever.

Ten Diseases need immediate prevention
1. Tuberculosis
2. Poliomyelitis
3. Diphtheria
4. Whooping cough
5. Neonatal tetanus
6. Measles
7. Hepatitis B
8. Hib Meningitis and Pnuemonia
9. Bacterial Meningitis and pneumonia
10. Diarrhea

1. Child Hood Tuberculosis:

• The Childhood Tuberculosis is communicable disease caused by
Mycobacterium Tuberculosis.
• This spreads from T.B patient‘s Respiration and Cough through air to
other children.
• Conti…

Symptoms of Tuberculosis:

- Tiredness, Fever with sweat in night, when child will become serious
blood will come in the sputum.

2. Poliomyelitis:
• This is communicable disease caused by the Poliovirus which affects
mostly the young children. The poliovirus enters through the mouth and
goes to the Throat & then to intestines, where it grows from 5 to 34 days.

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3. Measles
• This is communicable caused by the virus called Measles virus.
• The viruses of this disease spread in Air through respiration and cough
from infected patient and infect other children. The secretions of nose &
throat can also cause the disease directly.

Sign and symptoms of measles
• Low grade fever.
• Redness of eyes, cold and cough etc.After 7 days.
• There are red spots on face then whole body, there are also spots inside
the neck, and mouth.

4. Diphtheria
• The Diphtheria is communicable disease caused by Corne Bacterium
diphtheria.
• It spread from one patient to other, this is mostly common in winter
season and affects under 15 years children, who are not protected with
vaccines (Non-Immunized).
• This affects mostly nose, throat usually Tonsils & Produce a membrane
whose sides are swollen and red.
Sign and symptoms:
• Sever pain in throat and involvement in lymph nodes
• Fever and tiredness

5. Pertussis (Whooping Cough)
• The Pertussis is also communicable disease caused by bacteria
(Brodetella Pertussis). It is common in small children.
Signs & symptoms are:
irritation & swelling of Air passages

6. Tetanus
Tetanus is caused by toxin-producing spores that inhabit the soil and the
bowels of animals and humans

7. Hepatitis-B
Hepatitis B virus (HBV) is a infection, which causes non-specific
symptoms like anorexia, nausea vomiting followed by jaundice.

8. Meningitis & Pneumonia
This is communicable disease caused by Bacteria called Haemophilus
Influenzae Type-b (Hib - Bacteria). It causes Pneumonia, Meningitis and
Epiglositis.

Signs and Symptoms:
- Fever, cough, pain in joints, pain in Ears, Pneumonia, involvement of
central nervous system

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- The death rate in under 5 years children due to other diseases is 17% due
to this disease.
• What are the Vaccines?
• The vaccines are the Immunogenic substances which contain antigen and
are prepared.
• The Viruses or Bacterias which cause the disease (live or dead).
• Which can prevent the disease and not produce the disease.

How Immunity is Produced?
• Before Birth:
From Mother‘s Blood, i.e. From Placenta through Umbilical Cord.
 After Birth:
From Mother‘s Milk specially first Milk (Colostrums).

Points to be remembered:

Live vaccines are damaged by heat and sun light
Killed vaccines and Toxids are damaged by freezing
All vaccines are damaged by antiseptics, disinfectants and detergents
All the vaccines should be kept between 0 to 8ºC

Contraindications to immunization:

There are no absolute contra indications against vaccinations
The child who has shown reaction with first DPT dose should not be given DPT
but give him DT or TT
The child whose mother is suffering from AIDS, should not be given BCG,
however give him remaining vaccines
The children, who need hospitalization due to sever illness, do not give them for
time being and give as soon as child recovers

It is very important to immunize sick and malnourished children against these
diseases
Do not give BCG to a child known to have AIDS
Do not give DPT2 or DPT 3 to a child who had convulsion or shock within three
days of the most recent dose
The child is very ill and requires hospitalization

Note:The IPV injection will be administered to the children at the age of 14
weeks along with OPV and shots of pentavalent-III and Pneumococcal-III
vaccine. Pentavalent-III is administered against the diseases of Diphtheria,
Tetanus, Pertussis, Haemophilus influenza B (Hib)& Hepatitis B while
Pneumococcal vaccine is given against Pneumonia and Meningitis.
The pneumococcal conjugate vaccine (PCV13) and the pneumococcal
polysaccharide vaccine (PPSV23) protect against pneumococcal infections,

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which are caused by bacteria. The bacteria spread through person-to-person
contact and can cause such serious infections as pneumonia, blood
infections, and bacterial meningitis

TT IMMUNIZATION SCHEDULE(15 TO 45 YEARS CBAs)
VVaacccciinnee WWhheenn ttoo ggiivvee DDoossee aanndd rroouuttee
TTTT11 AAtt ffiirrsstt ccoonnttaacctt OOrr DDuurriinngg PPrreeggnnaannccyy
(( wwiitthhiinn 33 mmoonntthhss))Will not provide any
Immunity.
00..55mmll ddeeeepp II//MM
TTTT22 AAtt lleeaasstt 44 wweeeekk aafftteerr TTTT11
Will provide Immunity for 3 years
00..55mmll ddeeeepp II//MM
TTTT33 AAtt lleeaasstt 66 mmoonntthhss aafftteerr TTTT22
Will provide Immunity for further 5 years,
00..55mmll ddeeeepp II//MM
TTTT44 AAtt lleeaasstt 11 yyeeaarr aafftteerr TTTT33
Will provide Immunity for further 10 years,
00..55mmll ddeeeepp II//MM
TTTT55 AAtt lleeaasstt 11 yyeeaarr aafftteerr TTTT33
Will provide Immunity for life long.
00..55mmll ddeeeepp II//MM
15 years RRuubbeellllaa 00..55mmll II//MM oorr SS//CC

117

EPI VACCINE SCHEDULE

Rotavirus Virus Vaccine : Rota vaccine included in EPI in 2017.Rota virus
can be prevented by vaccination of children. Rota Vaccine is given at the age of
6 and 10 week according to the EPI schedule. Improvement of hygiene and
sanitation are also recommended along with vaccination, in order to minimize
chances of disease.

TECHNIQUE OF ADMINISTRATION OF VACCINES

1. The Oral Polio Vaccine (OPV) is given orally.

2. The BCG is given Intra-dermal (Between Epidermis & Dermis in upper
portion of right Deltoid Muscle area).

3. The Measles vaccine is given in Upper portion of left Deltoid Sub-
contentiously i.e. between Skin and Muscle.

4. The Tetanus Toxoid vaccine is given in upper portion of left Deltoid area,
deep intramuscularly.

5. The Pentavalent (DPT + HB + Hib) vaccine is given in Upper and outer
portion of Right Thigh, Deep Intra Muscularly.

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WHAT CAN DAMAGE VACCINES

 If a vaccine is in good condition, and able to make a child immune, it is
POTENT.

 If a vaccine is damaged, and not able to make a child immune, then it has
LOST ITS POTENNCY.

 Vaccines have an EXPIRY DATE printed on the label after that date. It
should not be used if expired.

 Heat and sunlight damage all vaccines-but especially polio, measles, and
BCG.
 Freezing damages DPT and tetanus toxic, the safest thing to do is to keep
ALL vaccines at correct cold temperature, and out of sunlight.
 Chemicals-disinfectants, antiseptics, spirit, detergents, and soap

HOW TO PROTECT THE VACCINES?

 Don‘t apply Antiseptic (Dettol), Detergent (Soap) and Spirit on the skin or on
the Needle.
 Keep all the vaccines between +2º C to +8º C (Preferably +4º C to +5º C and
not at two extremities).
 Protect all the vaccines from Heat and Sunlight.
 Protect the Pentavalent
 (DPT + HBV + Hib),TT and DT
 vaccine from Freezing.

ROLE OF HEALTH CARE PROVIDER

 Wrap the vial or ampoule in silver foil, it protect the vaccine from sunlight
 Covert the open top of the BCG vaccine ampoule to keep out dirt and flies.
 Keep the ice and vaccines in a shade.
 Use reconstituted vaccine for only one session(6-8 hours)
 Clean the skin using watery swab before injection.
o Note: Never place edibles in vaccine Refrigerator

OPTIONAL VACCINES : The word optional means ―Not compulsory‖,
.
Vaccine vial monitors (VVM) are used to warn health care workers if
a vaccine was damaged by heat. The monitor is made of heat-
sensitive material that is light in color but darkens when exposed to
heat over time, which indicates the vaccine is no longer effective.

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COLD CHAIN SYSTEM

The way by which vaccine reaches from the Manufacturer to child at proper
temperature, in this two things are important, one is the cold chain Logistic and
the other is Man Power. These two things form a chain, this is why we call it cold
Chain.

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121

122

COMMUNICATION

 Communication is the exchange of information between two or more
people.
 Communication is a two way process involving the sending or the
receiving of the message
 Communication is a basic component of human relationship including
nursing.

ADVANTAGES :
 To help in building trust.
 Prevent legal problems.
 Provide nurse with professional satisfaction.
 To bring about change.

ELEMENTS OF COMMUNICATION :
 Sender
 Message
 Receiver
 Feed Back

TYPES OF COMMUNICATION
1. Verbal
2. Non Verbal

VERBAL COMMUNICATON :

1. Pace of speech
2. Simplicity
3. Clarity
4. Timing and relevance
5. Adaptability
6. Humor
7. Credibility

CHARACTERISTICS Of NON-VERBAL COMMUNICATION :

 Personal appearance
 Posture and gait
 Facial expression
 Touch
 Gestures

THERAPEUTIC COMMUNICATION :

 Promotes understanding and help establish constructive relationship
between the nurse and the client.

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THERAPEUTIC ENVIRONMENT...
 Protects privacy
 Establishes trust
 Allows emotion
 Promotes open, honest communication
 Minimizes distractions:
o noise
 Eliminates physical barriers
o furniture
o equipment

THERAPEUTIC COMMUNICATION TECHNIQUES :

 Using silence
 Providing general leads (would you like to talk about it……)
 Using open ended question (tell me about it more…..)
 Using touch (if appropriate)
 Summarizing

NON THERAPEUTIC COMMUNICATION TECHNIQUES :

 Stereotyping (women are complainers)
 Being defensive (no, this nurse is very good)
 Giving advices
 Passing judgments (that‘s not good)
 Challenging

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RESPECTFUL MATERNIT Y CARE :

Recommendation
Refers to care organized for and provided to all women in a manner that
maintains their dignity, privacy and confidentiality, ensures freedom from harm
and mistreatment, and enables informed choice and continuous support during
labour and childbirth – is recommended.
Remarks
 Provision of respectful maternity care (RMC) is in accordance with a
human rights-based approach to reducing maternal morbidity and
mortality. RMC could improve women‘s experience of labour and
childbirth and address health inequalities.
 There is limited evidence on the effectiveness of interventions to promote
RMC or to reduce mistreatment of women during labour and childbirth.
Given the complex drivers of mistreatment during facility-based
childbirth, reducing mistreatment and improving women‘s experience of
care requires interventions at the interpersonal level between a woman
and her health care providers, as well as at the level of the health care
facility and the health system.
 Effective communication and engagement among health care providers,
health service managers, women and representatives of women‘s groups
and women‘s rights movements is essential to ensure that care is
responsive to women‘s needs and preferences in all contexts and settings.
 Interventions should aim to ensure a respectful and dignified working
environment for those providing care, acknowledging that staff may also
experience disrespect and abuse in the workplace and/or violence at home
or in the community.
Background
Globally, approximately 140 million births occur every year. The majority of
these are vaginal births among pregnant women with no identified risk factors for
complications, either for themselves or their babies, at the onset of labour.
However, in situations where complications arise during labour, the risk of
serious morbidity and death increases for both the woman and baby.
Over a third of maternal deaths and a substantial proportion of pregnancy-related
life-threatening conditions are attributed to complications that arise during
labour, childbirth or the immediate postpartum period, often as result of
haemorrhage, obstructed labour or sepsis .
Similarly, approximately half of all stillbirths and a quarter of neonatal deaths
result from complications during labour and childbirth

125

The burden of maternal and perinatal deaths is disproportionately higher in low-
and middle-income countries (LMICs) compared to high-income countries
(HICs). Therefore, improving the quality of care around the time of birth,
especially in LMICs, has been identified as the most impactful strategy for
reducing stillbirths, maternal and newborn deaths, compared with antenatal or
postpartum care strategies
Over the last two decades, women have been encouraged to give birth in health
care facilities to ensure access to skilled health care professionals and timely
referral should the need for additional care arise.
However, accessing labour and childbirth care in health care facilities may not
guarantee good quality care. Disrespectful and undignified care is prevalent in
many facility settings globally, particularly for underprivileged populations, and
this not only violates their human rights but is also a significant barrier to
accessing intrapartum care services
In addition, the prevailing model of intra-partum care in many parts of the world,
which enables the health care provider to control the birthing process, may
expose apparently healthy pregnant women to unnecessary medical interventions
that interfere with the physiological process of childbirth.
As highlighted in the World Health Organization (WHO) framework for
improving quality of care for pregnant women during childbirth, experience of
care is as important as clinical care provision in achieving the desired person-
centered outcomes

This up-to-date, comprehensive and consolidated guideline on intrapartum care
for healthy pregnant women and their babies brings together new and existing
WHO recommendations that, when delivered as a package of care, will ensure
good quality and evidence-based care in all country settings.
In addition to establishing essential clinical and non-clinical practices that
support a positive childbirth experience, the guideline highlights unnecessary,
non-evidence-based and potentially harmful intrapartum care practices that
weaken women‘s innate childbirth capabilities, waste resources and reduce
equity.
To ensure that each recommendation is correctly understood and applied in
practice, the context of all context-specific recommendations is clearly stated
within each recommendation, and the contributing experts provided additional
remarks where needed.
In accordance with WHO guideline devel opment standards, these
recommendations will be reviewed and updated following the identification of
new evidence, with major reviews and updates at least every five years.
Provide maternity care that
 Is woman-centered, empowering, and supportive
 Is evidence-based and shown to be beneficial

126

 Permits free communication and full expression of trust and commitment
 Ensures that all women are treated equitably
 Offers and supports informed choices
 Respect for a woman‘s rights, choices, and dignity
 ―Does no harm‖
 Promotes positive parenting and improves birth outcomes
 Culturally sensitive and valued by the woman and community
 Respect for ―choice‖ recently endorsed by WHO within the quality of
care framework

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128

PHARMACOLOG Y/ MEDICATION ADMINISTRATION :

The science of drugs including their origin, composition, pharmacokinetics,
therapeutic use, and toxicology is called pharmacology.

Introduction

The administration of medication is often a chief responsibility of the
nurse. The practice of administering medication involves providing the patient
with a substance prescribed and intended for the diagnosis, treatment, or
prevention of a medical illness or condition.

Medication A substance administered for the diagnosis, cure, treatment, or
relief of symptoms or for prevention of disease. The word drug and medication
are generally used interchangeably

Prescription A written direction for the preparation and administration of drug is
called a prescription

Generic Name: is used before a drug becomes officially an approved
medication.

Official Name: is the name under which it is listed in one of the official
publications

Chemical name: is the name describes the constitutes of the drug precisely

Trade Name: name given by drug manufacturer

Brand Name: one drug may be manufacture by different companies so it can
have several trade
name

Pharmacology: study of the effects of the drugs on the living organisms

Pharmacy: art of preparing, compounding and dispensing drugs, the place where
drugs are prepared and dispensed

Pharmacist: a person licensed to prepare and dispense drugs and to make up
prescription

Pharmacopoeia: is a book containing a list of products used in medicine, with
descriptions of the product, chemical test for determining identity and purity, and
formulas and prescription.

Drugs may have natural (plant, mineral and animal) sources or they may be
synthesized in the laboratory

129

RIGHTS OF MEDICATION ADMINISTRATION :

When it comes to patient safety, it‘s never a bad time to review some of the
basics and increase your awareness. Following are the ten rights of medication
administration:

1.Right patient

 Check the name on the order and the patient
 Ask patient to identify himself/herself
2. Right medication
 Check the medication label
 Check the order

3. Right dose
 Check the order
 Confirm appropriateness of the dose using a current drug reference
 If necessary, calculate the dose and have another nurse calculate the dose
as well

4. Right route
 Again, check the order and appropriateness of the route ordered
 Confirm that the patient can take or receive the medication by the ordered
route

5. Right time
 Check the frequency of the ordered medication
 Double-check that you are giving the ordered dose at the correct time
 Confirm when the last dose was given

6. Right documentation
 Document administration AFTER giving the prescribed medication.
 Chart the time, route, and any other specific information as necessary e.g.
the site of an injection or any laboratory value or vital sign that needed to
be checked before giving the drug.

7. Right reason ( Right assessment)
 Confirm the rationale for the ordered medication. What is the patient‘s
history? Why is he/she taking this medication? Revisit the reasons for
long-term medication use.

8. Right response (Right evaluation)
 Make sure that the drug led to the desired effect. If an antihypertensive
was given, has his/her blood pressure improved? Does the patient
verbalize improvement in depression while on an antidepressant?

130

 Be sure to document your monitoring of the patient and any other
nursing interventions that are applicable.

9. Right to refusal
 Respect patient‘s right to refusal of routes or treatment. With physician
consultation route can be changed. And for refusal to treatment patient
can be educated.

10. Right education.
 Educate patient and family on proper medication and compliances with
medication.

MEDICATION PREPARATION :

The administration of medication is often a chief responsibility of the
nurse. The practice of administering medication involves providing the patient
with a substance prescribed and intended for the diagnosis, treatment, or
prevention of a medical illness or condition. Before administering medication, its
preparation is of pivotal importance. To prepare medication aseptically is not
only the responsibility of a health care provider but also the right of patients
receiving it. Sterility is a key concept which need to be addressed while
preparing and administering the medication

How to draw up medications?

Parenteral medications should be accessed in an aseptic manner. This includes
using a new sterile syringe and sterile needle to draw up medications while
preventing contact between the injection materials and the non-sterile
environment. Proper hand hygiene should be performed before handling
medications and the rubber septum should be disinfected with alcohol prior to
piercing it.

Pharmacokinetics The study of the bodily absorption, distribution, metabolism,
and excretion of drugs

Toxicology a science that deals with poisons and their effect and with the
problems involved (such as clinical, industrial, or legal problems)

Therapeutics relating to the treatment of disease or disorders by remedial agents
or methods

Where Should Medications Drawn Up?

Medications should be drawn up in a designated clean medication area that is not
adjacent to areas where potentially contaminated items are placed. include: used
equipment such as syringes, needles, IV tubing, blood collection tubes, needle
holders or other soiled equipment.

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The safest practice is to always enter a medication vial with a sterile needle and
sterile syringe. .

A Single-Dose or Single-Use Vial

 A single-dose or single-use vial is a vial of liquid medication intended for
parentral administration (injection or infusion) that is meant for use in a
single patient for a single case/procedure/injection.
 Even if a single-dose or single-use vial appears to contain multiple doses
or contains more medication than is needed for a single patient, that vial
should not be used for more than one patient nor stored for future use on
the same patient.
 The safest practice is to enter a single-dose or single-use vial only once so
as to prevent inadvertent contamination of the vial and infection
transmission.
 Do not combine (pool) leftover contents of single-dose or single-use vials
or store single-dose or single-use vials for later use
 Medication vials should always be discarded whenever sterility is
compromised or questionable.
 If a single-dose or single-use vial has been opened or accessed (e.g.,
needle-punctured) the vial should be discarded It should not be stored for
future use..

A Multi-Dose Vial:

 A multi-dose vial is a vial of liquid medication intended for parenteral
administration (injection or infusion) that contains more than one dose of
medication.
 Multi-dose vials should be dedicated to a single patient whenever
possible.
 If multi-dose vials must be used for more than one patient, they should
not be kept or accessed in the immediate patient treatment area. This is to
prevent inadvertent contamination of the vial through direct or indirect
contact with potentially contaminated surfaces or equipment that could
then lead to infections in subsequent patients.
 Examples of the immediate patient treatment area include patient rooms
or bays, and operating rooms
 The most essential step which a health care professional should perform
before preparing medication to ensure safety and aseptic environment is
to:
 Use sterile syringe and needle
 Check doctor‘s order for preparing medication for patient
 Prepare medication in a clean area to avoid contamination
 Perform hand hygiene when preparing medications

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PRINCIPLES AND RESPONSIBILITIES OF ADMINISTRATION OF
DRUGS

Nurse who administer medications is responsible for her own action

 Call the person who prescribed the medication for clarification
 Be knowledgeable about the medication you administer
 Know the federal laws govern the use of narcotics and barbiturates
 Use only medications that are clearly labeled container
 Do not use liquid medications that are cloudy or have changed color
 Calculate drug dose accurately. If you are uncertain, ask another nurse to
double-check your calculation
 Administer only medications personally prepared
 Before administrating the medication, identify the client correctly e.g by
checking identification bracelet
 If client vomit after taking an oral medication so inform to nurse in
charge
 When a medication is omitted for any reason , record the fact together
with the reason
 When medication error is made, report it immediately to nurse in charge

SUMMARY
 Assessment for client‘s condition:
 Alternate route (Child, unconscious patient)
 Any contraindication
 Allergies
 Client‘s knowledge (teaching purpose)
 Client‘s age
 Know the usual dose calculations
 Expected actions (Monitor client)
 Any Interactions with drugs or food
 Side effects/adverse reactions
 Poured medication should never be out of nurse views
 Never administer a prepared medication by anyone else
 Recording of administered medication

CONTENT OF DRUG ORDER :
Legal drugs order must indicate:

1. Patient Full name
2. Date the order was written
3. Name of medication: may be generic or trade name (combination drugs
are usually ordered by trade or brand name)
4. Dose
5. Frequency of administration
6. Route of administration

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7. Duration of order, if applicable (orders for some types of drugs such as
narcotics have an automatic expiration time)

MEDICATION ORDERS :

Following things need to be considered to ensure the medication orders:
 All drugs requiring administration should be entered in designated sheet
by a physician stating the name, date, time, dosage, frequency and route
of administration with the physician‘s legible signature.
 Medication orders will be reviewed once per shift by the assigned staff
with the date and time.
 The staff nurse will ensure that all medication is administered utilizing
the principle of the ―10 rights‖.
 All routine medication orders will be processed within 01 Hour of the
time the order is entered in designated sheet.
 In the case of orders combining, Stat and Routine Doses, when the time
of administration of the first dose is close to the time of ordering, the
nurse is expected to consult the Physician regarding the Stat Dose.
 If the stat dose is administered from floor stock, medication nurse is
responsible to replace it.
 Medications will be administrated by the nurse responsible for
preparation.
 All medication found unattended and unlabelled will be discarded, and
should be notified to nurse incharge.
 Drug labels, which are incorrect, illegible or show an expired date, will be
returned to the Pharmacy. Nursing staff will not attempt to label or re-
label any medication.
 All direct intravenous medication, i.e. IV ―Push & pause method‖ and IV
medications in the form of additives will be administered by a registered
nurse.
 Registered nurse/midwife will be delegated to administer medication via
IV ―Push‖ in designated clinical areas.

THERE ARE VARIOUS WAYS TO GET MEDICATION ORDERS!!

Telephone orders:
Telephone orders will only be accepted in emergency situations provided the
order is given by a physician and received by the assigned nurse or RMO.
The nurse receiving the order will repeat the order to the physician to ensure
accuracy and clarity.
The nurse will record the order on the medication order sheet, with the following
information:
 Name of drug, dose, route and frequency or rate
 Date and time order received
 Full name of physician
 Location of calling physician (OT, ER, External)

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 Statement ―by telephone order of ….‖ (name of physician)
 Signature of nurse accepting the order.
Telephone orders should be countersigned by the ordering physician within 24
Hours

Verbal Orders:
Verbal orders will only be implemented by a staff nurse in emergency
situations, when the physician is present and the patient‘s condition is critical,
e.g. ICU situations or cardiac arrest. Verbal order will be recorded in medication
sheet with doctor‘s name and medication assigned nurse will be responsible to
have it countersigned by the prescribing physician within her shifts.

Recording should include:

PRN Orders (Whenever Required/As Per Need):

PRN orders will include:
 Name of drug, dose and route
 Date and time of ordering
 Frequency
 Assigned nurse will ensure that dose and frequency is entered accurately
by physician in the designated sheet.
PRN orders will be recorded on the MAR sheet in the designated area. The
patient‘s response or reaction will also be recorded in the nurses‘ notes.

CONTROLLED DRUGS:

 Controlled drugs are morphine and pethidine, and any other substances
designated by the Pharmacy and central purchase department.
 Order for all controlled drugs will be valid for 24 hours only. Patient
should be reassessed if the drug is still required to be continued.
 All administered doses of controlled drug should be recorded on the
controlled drug administration form and MAR sheet.
 The disposal or discarding of a portion of any controlled drug (waste,
breakage) should be recorded, witnessed and cosigned by the witnessing
nurse.

DISCHARGE MEDICATION ORDERS:

As soon as the patient has been discharged, the discharge order for take-home
medication should be entered in discharged card/discharge slip.
The nurse will be responsible for receiving the take-home medication and for
giving appropriate instruction to the patient and/or his relative(s).

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DRUG ADMINISTRATION ROUTES :
The route of administration (ROA) that is chosen may have a profound
effect upon the speed and efficiency with which the drug acts. The ROA is
determined by the physical characteristics of the drug, the speed which the drug
is absorbed and/ or released, as well as the need to bypass hepatic metabolism
and achieve high conc. at particular sites. No single method of drug
administration is ideal for all drugs in all circumstances.
The possible routes of drug entry into the body may be divided into two classes:
 Enteral
 Parenteral
 Local

ROUTES OF DRUG ADMINISTRATION :

ENTERAL
Enteral - drug placed directly in the GI tract includes the following
routes:
oral - swallowing (PO, per os)
sublingual - placed under the tongue
rectum - Absorption through the rectum

PARENTRAL

Parentral- drugs are mostly placed directly into the blood circulation that includes
following routes:
 Intravascular (IV) - placing a drug directly into the blood stream
 Intramuscular (IM) - drug injected into skeletal muscle
 Subcutaneous - Absorption of drugs from the subcutaneous tissues
 Inhalation - Absorption through the lungs

Procedure:

 Perform hand washing
 Follow ten rights of medication
 Obtain accurate medication
 Compare the label of medication against the MAR sheet
 Check expiry date of medication

ENTERAL:

Administration by the oral route:

 The oral (by mouth) route is the most frequently used method of
medication administration. When giving a medication orally, have the
recipient in an upright position. Have a glass of water available and
encourage a drink prior to and after giving the medication.

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 The oral route is the easiest and safest route.
 The physical position and swallowing abilities of the patient will be
evaluated to avoid choking. Patients may also receive medication by the
buccal route (through the inner cheek or gum) or the sublingual route
(under the tongue).

Administration by the sublingual/buccal route:

Some drugs are taken as smaller tablets which are held in the mouth or under the
tongue.
Sublingual (SL) and Buccal medications are placed next to the mucous
membrane in themouth. The medication is absorbed through the mucous
membrane into the bloodstream.
Sublingual medications are placed under the tongue and Buccal medications are
placedbetween the cheek and gums. The person should not eat or drink until the
medication is completely dissolve.
Do not swallow a Sublingual or Buccal medication.

Administration by the rectal route:

Rectal or vaginal medications are most often given in suppository form and must
be introduced gently to avoid tearing or bleeding of tissue.

PARENTRAL:

Administration by intravascular route:
Intravenous medications are given through an intravenous line into the vein.
These medications may be mixed with a large amount of solution that is being
infused, given in a small solution through a port in the intravenous tubing
(bolus), or attached in smaller infusion containers to the larger infusion
(piggyback).

Intravascular route is:

 precise, accurate and almost immediate onset of action,
 large quantities can be given, fairly pain free
 greater risk of adverse effects
 high concentration attained rapidly
 risk of embolism

Administration by the intramuscular route:

Administration involving a needle or syringe occurs with several drug routes.
Care must be taken to maintain asepsis with all injections and injection sites.
Intramuscular medications are injected into the muscle. A special injection

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technique called Z-track can be used when administering intramuscular
medications that can be damaging to the tissue.
All intramuscular injections involve the practice of land marking, or identifying
anatomical markers that indicate the correct injection site and avoid damage to
bone or nerves.
Once they are used, the syringe and needle are both contaminated and must be
discarded. Use a new sterile syringe and needle for each patient.

IM Injection Sites
 Ventrogluteal Site
 Vastus Lateralis Site
 Dorsogluteal Site
 Deltoid Site
 Rectus Femoris Site

Administration by the intradermal route:

Intradermal medications are used much less frequently than subcutaneous
or intramuscular injections. They are injected into the skin.

LOCAL/TOPICAL:

Administration by the inhalation route:

Inhalational medications are inhaled via the respiratory tract, most often
to treat respiratory conditions. Metered dose inhalers (MDI) are often used. MDIs
involve pressing a specially designed canister to release a mist.

Administration by the topical route:
Mucosal membranes (eye drops, antiseptic, sunscreen, callous removal,
nasal, etc.)

Administration by the dermal (skin) route:
Dermal - rubbing in of oil or ointment (local action)

Administration by the nasal route:

Nasal medications are often instilled via spray or drops and often involve
closing one nostril and asking the patient to inhale gently. The head should be
tilted back to avoid aspiration.

Administration by the otic (ear) route:

Ear or otic medications are given in liquid form. The patient's head is
tilted to the side. Instruments should never enter the ear. If the medication is not
instilled correctly, the patient may via drops or ointment. The container for the

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medication should not touch the eye, and drops are introduced into the inner
canthus or corner of the eye.

MEDICATION ERROR & INCIDENT REPORTING :

"A medication error is any preventable event that may cause or lead to
inappropriate medication use or patient harm while the medication is in the
control of the health care professional, patient, or consumer. Such events may be
related to professional practice, health care products, procedures, and systems,
including
 prescribing (prescribing faults—irrational, inappropriate, and ineffective
prescribing, under prescribing, overprescribing); writing the prescription
(prescription errors);and errors in writing the prescription (including
illegibility).
 order communication
 product labeling
 packaging, and nomenclature
 compounding manufacturing the formulation (wrong strength,
contaminants or adulterants, wrong or misleading packaging);
 dispensing , dispensing the formulation (wrong drug, wrong formulation,
wrong label);
 distribution
 administration administering or taking the medicine (wrong dose, wrong
route, wrong frequency, wrong duration)
 education
 monitoring monitoring therapy (failing to alter therapy when required,
erroneous alteration).
 use

Avoiding medication errors is important in balanced prescribing, which is the use
of a medicine that is appropriate to the patient's condition and, within the limits
created by the uncertainty that attends therapeutic decisions, in a dosage regimen
that optimizes the balance of benefit to harm. In balanced prescribing the
mechanism of action of the drug should be married to the pathophysiology of the
disease.

Specific information on the errors is documented on an additional form; data
captured include the type of error, system breakdown point, and class of drug
involved. A severity ranking that reflects patient outcome is also assigned to each
medication error.

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Anatomy:
Human anatomy is the scientific study of the body‘s structures.

Physiology:
Human physiology is the scientific study of the chemistry and physics of the
structures of the body and the ways in which they work together to support the
functions of life.

Organization:
A human body consists of trillions of cells organized in a way that maintains
distinct internal compartments. These compartments keep body cells separated
from external environmental threats and keep the cells moist and nourished.
Cells, for example, have a cell membrane (also referred to as the plasma
membrane) that keeps the intracellular environment—the fluids and organelles—
separate from the extracellular environment. Blood vessels keep blood inside a
closed circulatory system, and nerves and muscles are wrapped in connective
tissue sheaths that separate them from surrounding structures. In the chest and
abdomen, a variety of internal membranes keep major organs such as the lungs,
heart, and kidneys separate from others.

Anabolism:
is the process whereby smaller, simpler molecules are combined into larger, more
complex substances. Your body can assemble, by utilizing energy, the complex
chemicals it needs by combining small molecules derived from the foods you eat

Catabolism:
is the process by which larger more complex substances are broken down into
smaller simpler molecules. Catabolism releases energy. The complex molecules
found in foods are broken down so the body can use their parts to assemble the
structures and substances needed for life.

Metabolism:
Taken together, these two processes are called metabolism. Metabolism is the
sum of all anabolic and catabolic reactions that take place in the body (Figure 1).
Both anabolism and catabolism occur simultaneously and continuously to keep
you alive.

Stores:
Every cell in your body makes use of a chemical compound, adenosine
triphosphate (ATP), to store and release energy. The cell stores energy in the
synthesis (anabolism) of ATP, then moves the ATP molecules to the location
where energy is needed to fuel cellular activities. Then the ATP is broken down
(catabolism) and a controlled amount of energy is released, which is used by the
cell to perform a particular job.

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Responsiveness:
Responsiveness is the ability of an organism to adjust to changes in its internal
and external environments. An example of responsiveness to external stimuli
could include moving toward sources of food and water and away from
perceived dangers. Changes in an organism‘s internal environment, such as
increased body temperature, can cause the responses of sweating and the dilation
of blood vessels in the skin in order to decrease body temperature,

Movement:
Human movement includes not only actions at the joints of the body, but also the
motion of individual organs and even individual cells. Red and white blood cells
are moving throughout the body, muscle cells are contracting and relaxing to
maintain posture and to focus vision, and glands are secreting chemicals to
regulate body functions. The body is coordinating the action of entire muscle
groups to enable to move air into and out of lungs, to push blood throughout the
body, and to propel the food have eaten through digestive tract. Consciously, of
course, contract skeletal muscles to move the bones of skeleton to get from one
place to another and to carry out all of the activities of daily life.

Development, growth and reproduction:
Development is all of the changes the body goes through in life. Development
includes the process of differentiation, in which unspecialized cells become
specialized in structure and function to perform certain tasks in the body.
Development also includes the processes of growth and repair, both of which
involve cell differentiation.

Growth is the increase in body size. Humans, like all multicellular organisms,
grow by increasing the number of existing cells, increasing the amount of non-
cellular material around cells (such as mineral deposits in bone), and, within very
narrow limits, increasing the size of existing cells.

Reproduction is the formation of a new organism from parent organisms. In
humans, reproduction is carried out by the male and female reproductive
systems. Because death will come to all complex organisms, without
reproduction, the line of organisms would end.

Body system
Cell is the basic building block of human body

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Homeostasis:

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Homeostasis is the activity of cells throughout the body to maintain the
physiological state within a narrow range that is compatible with life.
Homeostasis is regulated by negative feedback loops and, much less frequently,
by positive feedback loops. Both have the same components of a stimulus,
sensor, control center, and effector; however, negative feedback loops work to
prevent an excessive response to the stimulus, whereas positive feedback loops
intensify the response until an end point is reached.

Maintaining homeostasis requires that the body continuously monitor its internal
conditions. From body temperature to blood pressure to levels of certain
nutrients, each physiological condition has a particular set point.. For example,
the set point for normal human body temperature is approximately 37°C (98.6°F)
Physiological parameters, such as body temperature and blood pressure, tend to
fluctuate within a normal range a few degrees above and below that point.
Control centers in the brain and other parts of the body monitor and react to
deviations from homeostasis using negative feedback. Negative feedback is a
mechanism that reverses a deviation from the set point. Therefore, negative
feedback maintains body parameters within their normal range. The maintenance
of homeostasis by negative feedback goes on throughout the body at all times,
and an understanding of negative feedback is thus fundamental to an
understanding of human physiology.

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Positive feedback intensifies a change in the body‘s physiological condition
rather than reversing it. A deviation from the normal range results in more
change, and the system moves farther away from the normal range. Positive
feedback in the body is normal only when there is a definite end point. Childbirth
and the body‘s response to blood loss are two examples of positive feedback
loops that are normal but are activated only when needed.

Childbirth at full term is an example of a situation in which the maintenance of
the existing body state is not desired. Enormous changes in the mother‘s body are
required to expel the baby at the end of pregnancy. And the events of childbirth,
once begun, must progress rapidly to a conclusion or the life of the mother and
the baby are at risk. The extreme muscular work of labor and delivery are the
result of a positive feedback system

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CELL

The cell contains various structural components to allow it to maintain life which
are known as organelles. All the organelles are suspended within a gelatinous
matrix, the cytoplasm, which is contained within the cell membrane. One of the
few cells in the human body that lacks almost all organelles are the red blood
cells.

The main organelles are as follows :

 cell membrane
 endoplasmic reticulum
 Golgi apparatus
 lysosomes
 mitochondria
 nucleus
 microfilaments and microtubules

Diagram of the human cell illustrating the different parts of the cell.

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Cell Membrane:

The cell membrane is the outer coating of the cell and contains the cytoplasm,
substances within it and the organelle. It is a double-layered membrane
composed of proteins and lipids. The lipid molecules on the outer and inner part
(lipid bilayer) allow it to selectively transport substances in and out of the cell.
cytoplasm/Protoplasm
It is the fluid inside the cells, which allow a number of cell organs to float inside
the cell. It contains a nucleus surrounded by a nuclear membrane. It consists of
molecules, enzymes, fatty acids, sugar, and amino acids

The functions of cytoplasm are:
It contains molecules that aid in various metabolic functions of the body and
facilitates the breakdown of waste materials.
It gives the cell its shape.
It keeps the organelle in place.

Endoplasmic Reticulum
The endoplasmic reticulum (ER) is a membranous structure that contains a
network of tubules and vesicles. Its structure is such that substances can move
through it and be kept in isolation from the rest of the cell until the
manufacturing processes conducted within are completed. There are two types of
endoplasmic reticulum – rough (granular) and smooth (agranular).

The rough endoplasmic reticulum (RER / granular ER) contains a combination of
proteins and enzymes. These parts of the endoplasmic reticulum contain a
number of ribosomes giving it a rough appearance. Its function is to synthesize
new proteins.
The smooth endoplasmic reticulum (SER / agranular ER) does not have any
attached ribosomes. Its function is to synthesize different types of lipids (fats).
The smooth ER also plays a role in carbohydrate and drug metabolism.

Golgi Apparatus
The Golgi apparatus is a stacked collection of flat vesicles. It is closely
associated with the endoplasmic reticulum in that substances produced in the ER
are transported as vesicles and fuses with the Golgi apparatus. In this way, the
products from the ER are stored in the Golgi apparatus and converted into
different substances that are necessary for the cell‘s various functions.

Lysosomes
Lysosomes are vesicles that break off from the Golgi apparatus. It varies in size
and function depending on the type of cell. Lysosomes contain enzymes that help
with the digestion of nutrients in the cell and break down any cellular debris or
invading microorganisms like bacteria.

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Mitochondria
These are the powerhouses of the cell and break down nutrients to yield energy.
The mitochondria also contain DNA which allows it to replicate where and when
necessary.

Nucleus
The nucleus is the master control of the cell. It contains genes, collections of
DNA, which determines every aspect of human anatomy and physiology.. Within
the nucleus is an area known as the nucleolus. It is not enclosed by a membrane
but is just an accumulation of RNA and proteins within the nucleus. The
nucleolus is the site where the ribosomal RNA is transcribed from DNA and
assembled.

Microfilaments and Microtubules
Microtubules are moving chromosomes. They are hollow fibrous shafts.

The functions of microtubules are:

 They are essential for cell division. Microtubules pair with chromosomes
enabling the chromosomes to split and attach to new daughter cell.
 Microtubules support and give cells its shape.
 They help transport materials to and from the cells.
 They form a large structure outside the cells.

Functions of the Human Cell

The functions of the human cell varies based on the type of cell and its location
in the human body
1. Production
of new substances, cell replication and energy production.
2. locomotion
In specialized cells that need to be motile, like sperm cells, tail-like
projections allow for cellular locomotion.
3. The cell membrane allows substances to enter and leave the cell.
4. The endoplasmic reticulum and Golgi apparatus synthesize different
substances like protein and fats.
5. The genetic material housed in the nucleus provides the blueprint
necessary for the production of specific compounds by the endoplasmic
reticulum and Golgi apparatus.
6. stored substances
Secretory vesicles store some of the enzymes and other specialized
substances formed by the endoplasmic reticulum and Golgi apparatus.
These stored substances are released from the cell when necessary in
order to complete various functions that allow the body to function as a
whole.

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CELL DIVISIONS

Mitosis Beginning with the fertilized egg, or zygote, cell division is an ongoing
process. As the fetus develops in the mother's uterus, its cells multiply and grow
into all the specialities that provide the sum total of the body's physiological
functions. The life span of most individual cells is limited. Many become worn
out and die, and are replaced by identical cells by the process of mitosis. Mitosis
occurs in two stages: replication of DNA, in the form of 23 pairs of
chromosomes, then division of the cytoplasm. DNA is the only type of molecule
capable of independently forming a duplicate of itself. When the two identical
sets of chromosomes have moved to the opposite poles of the parent cell, a 'waist'
forms in the cytoplasm, and the cell divides. There is then a complete

Meiosis This is the process of cell division that occurs in the formation of
reproductive cells (gametes — the ova and spermatozoa). The ova grow to
maturity in the ovaries of the female and the spermatozoa in the testes of the
male. In meiosis four daughter cells are formed after two divisions. During
meiosis the pairs of chromosomes separate and one from each pair moves to
opposite poles of the 'parent' cell. When it divides, each of the 'daughter' cells has
only 23 chromosomes, called the haploid number. This means that when the
ovum is fertilised the resultant zygote has the full complement of 46
chomosomes (the diploid number), half from the father and half from the mother.
Thus the child has some characteristics inherited from the mother and some from
the father, such as colour of hair and eyes, height, facial features, and some
diseases.

Determination of sex depends upon one particular pair of chromosomes: the sex
chromosomes. In the female both sex chromosomes are the same size and shape
and are called X chromosomes. In the male there is one X chromosome and a
slightly smaller Y chromosome. When the ovum is fertilised by an X-bearing
spermatozoon the child is female and when it is fertilised by a Y-bearing
spermatozoon the child is male.

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TISSUE

The tissues of the body consist of large numbers of cells and they are classified
according to the size, shape and functions of these cells. There are four main
types of tissue, each of which has subdivisions. They are: • epithelial tissue or
epithelium • connective tissue • muscle tissue • nervous tissue.
Epithelial tissue This group of tissues is found covering the body and lining
cavities and tubes. It is also found in glands. The structure of epithelium is
closely related to its functions which include: • protection of underlying
structures from, for example, dehydration, chemical and mechanical damage •
secretion • absorption. The cells are very closely packed and the intercellular
substance, called the matrix, is minimal.

1. Simple epithelium Simple epithelium consists of a single layer of identical
cells and is divided into four types. It is usually found on absorptive or
secretory surfaces, where the single layer enhances these processes,

2. Squamous (pavement) epithelium This is composed of a single layer of
flattened cells. The cells fit closely together like flat stones, forming a thin
and very smooth membrane. Diffusion takes place freely through this thin,
smooth, inactive lining of the following structures:
a. heart
b. blood vessels
c. lymph vessels alveoli of the lungs. where it is also known as
endothelium

3. Cuboidal (cubical) epithelium This consists of cube-shaped cells fitting
closely together lying on a basement membrane (. It forms the tubules of the
kidneys and is found in some glands. Cuboidal epithelium is actively
involved in secretion, absorption and excretion.

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4. Columnar epithelium This is formed by a single layer of cells, rectangular
in shape, on a basement membrane
5. Stratified epithelia
Stratified epithelia consist of several layers of cells of various shapes. The
superficial layers grow up from below
6. Connective tissue
Connective tissue is the most abundant tissue in thebody. The cells forming
the connective tissues are morewidely separated from each other than those
forming theepithelium, and intercellular substance (matrix) is present in
considerably larger amounts. . Major functions of connective tissue are:

• binding and structural support
• protection
• transport
• insulation.

Muscle tissue
There are three types of muscle tissue, which consists of specialised contractile
cells: • skeletal muscle • smooth muscle • cardiac muscle.

Nervous tissue
Two types of tissue are found in the nervous system: • excitable cells — these are
called neurones and they initiate, receive, conduct and transmit information •
non-excitable cells — these support the neurones.

Membranes
Membranes are sheets of epithelial tissue and their supporting connective tissue
that cover or line internal structures or cavities.
The main membranes are: •

Mucous
This is the moist lining of the alimentary tract, respiratory tract and genitourinary
tracts and is sometimes referred to as the mucosa. The membrane consists of
epithelial cells, some of which produce a secretion called mucus, a slimy
tenacious fluidserous • Serous membrane Serous membranes, or serosa, secrete
serous watery fluid.
synovial. Synovial membrane This membrane is found lining the joint cavities
and surrounding tendons, which could be injured by rubbing against bones, e.g.
over the wrist joint. It

Glands
Glands are groups of epithelial cells which produce specialised secretions.
Glands that discharge their secretion on to the epithelial surface of an organ,
either directly or through a duct, are called exocrine glands. Exocrine glands vary
considerably in size, shape and complexity.

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SKELETAL SYSYTEM :

The skeleton The skeleton is the bony framework of the body. It forms the
cavities and fossae that protect some structures, forms the joints and gives
attachment to muscles.

The skeleton is described in two parts: axial and appendicular

The Axial skeleton (axis of the body) consists of:

• skull
• vertebral column
• sternum or breast bone
• ribs.

The Appendicular:

Skeleton (appendages attached to the axis of the body) consists of:

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• the bones of the upper limbs, the two clavicles and the two scapulae
• the bones of the lower limbs and the two innominate bones of the pelvis.

Anatomical terms

Directional term Meaning
Medial Structure is nearer to the midline. The heart is medial to the
humerus
Proximal Nearer to a point of attachment of a limb, or origin of a body
part. The femur is proximal to the fibulaa
Distal Further from a point of attachment of a limb, or origin of a
body part. The fibula is distal to the femur
Lateral Structure is further from the midline or at the side of the
body. The humerus is lateral to the heart
Anterior or
ventral
Part of the body being described is nearer the front of the
body.
The sternum is anterior to the vertebrae
Posterior or
dorsal
Part of the body being described is nearer the back of the
body.
The vertebrae are posterior to the sternum
Superior Structure nearer the head. The skull is superior to the
scapulae
Inferior Structure further from the head. The scapulae are inferior to
the skull

Cavities of the body
The organs that make up the systems of the body are contained in four cavities:
Cranial
• Thoracic
• Abdominal
• Pelvic.

Cranial Cavity
Brain

Thoracic Cavity

Contents The main organs and structures contained in the thoracic cavity are
 the trachea
 2 bronchi
 2 lungs
 the heart
 aorta
 superior and inferior vena cava
 numerous other blood vessels
 the esophagus

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Abdominal Cavity

Contents Most of the space in the abdominal cavity is occupied by the organs and
glands involved in the digestion and absorption of food These are:
 the stomach,
 small intestine and most of the large intestine
 the liver, gall bladder, bile ducts and pancreas.
 the spleen 2 kidneys and the upper part of the ureters
 2 adrenal (suprarenal) glands •
 numerous blood vessels, lymph vessels, nerves
 lymph nodes.

Pelvic Cavity

Contents The pelvic cavity contains the following structures:
 sigmoid colon, rectum and anus
 some loops of the small intestine
 urinary bladder,
 lower parts of the ureters and the urethra

REGIONS OF THE BODY:

Functions of the skull

The various parts of the skull have specific and differentfunctions:
 The cranium protects the delicate tissues of the brain.
 The bony eye sockets provide the eyes with someprotection against injury
and give attachment to the
muscles which move the eyes.
 The temporal bone protects the delicate structures ofthe ear.

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Some bones of the face and the base of the skull giveresonance to the
voice because they have cavities called sinuses, containing air. The
sinuses have tinyopenings into the nasal cavity.
 The bones of the face form the walls of the posteriorpart of the nasal
cavities. They keep the air passage open, facilitating breathing.
 The maxilla and the mandible provide alveolar ridgesin which the teeth
are embedded.
 The mandible is the only movable bone of the skulland chewing food is
the result of raising and
lowering the mandible by contracting and relaxingsome muscles of the
face, the muscles of mastication.

Vertebral column

 This consists of 24 movable bones (vertebrae) plus thesacrum and coccyx.
The bodies of the bones are separatedfrom each other by intervertebral discs,
consisting of cartilage. The vertebral column is described in five parts and
 the bones of each part are numbered from above downwards
• 7 cervical
• 12 thoracic
• 5 lumbar
• 1 sacrum (5 fused bones)
• 1 coccyx (4 fused bones)

Functions of the vertebral column

The vertebral column has several important functions:
 It protects the spinal cord. In each bone there is a holeor foramen and
when the vertebrae are arranged one above the other, as shown in Figure
3.29, the foraminaform a canal. The spinal cord, which is an extension of
nerve tissue from the brain, lies in this canal
 Adjacent vertebrae form openings (intervertebral foramina) through
which spinal nerves pass from the spinal cord to all parts of the body
There are 31 pairs of spinal nerves.
 In the thoracic region the ribs articulate with the vertebrae forming joints
which move during respiration.

Thoracic cage

The thoracic cage is formed by:
• 12 thoracic vertebrae
• 12 pairs of ribs
• 1 sternum or breast bone.

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MUSCULAR SYSTEM

The muscular system is responsible for the movement of the human body.
Attached to the bones of the skeletal system are about 700 named muscles that
make up roughly half of a person's body weight. Each of these muscles is a
separate organ constructed of skeletal muscle tissue, blood vessels, tendons, and
nerves.

The muscles of the body are divided into three main types: skeletal, smooth, and
cardiac. As their name implies, skeletal muscles are attached to the skeleton and
move various parts of the body. They are composed of tissue fibers that are
striated or striped.

Skeletal muscle

Skeletal muscles are the only muscles that can be consciously controlled. They
are attached to bones, and contracting the muscles causes movement of those
bones.

Any action that a person consciously undertakes involves the use of skeletal
muscles. Examples of such activities include running, chewing, and writing.

Smooth muscle

Smooth muscle lines the inside of blood vessels and organs, such as the stomach,
and is also known as visceral muscle.

It is the weakest type of muscle but has an essential role in moving food along
the digestive tract and maintaining blood circulation through the blood vessels.
Smooth muscle acts involuntarily and cannot be consciously controlled.

Cardiac muscle

Located only in the heart, cardiac muscle pumps blood around the body. Cardiac
muscle stimulates its own contractions that form our heartbeat. Signals from the
nervous system control the rate of contraction. This type of muscle is strong and
acts involuntarily.

The primary function of muscular system is to produce voluntary gross and fine
movements. Large movements include walking, standing, running, playing sports
and lifting weights and smaller movements include chewing, closing the eyes,
writing and talking are all produced by the muscular system of the body.

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The main functions of the muscular system are as follows:

1.Mobility

The muscular system's main function is to allow movement. When muscles
contract, they contribute to gross and fine movement.Gross movement refers to
large, coordinated motions and includes:

 walking
 running
 swimming
Fine movement involves smaller movements, such as:

 writing
 speaking
 facial expressions

The smaller skeletal muscles are usually responsible for this type of action.

Most muscle movement of the body is under conscious control. However, some
movements are reflexive, such as withdrawing a hand from a source of heat.

2,Stability

Muscle tendons stretch over joints and contribute to joint stability. Muscle
tendons in the knee joint and the shoulder joint are crucial in stabilization.

The core muscles are those in the abdomen, back, and pelvis, and they also
stabilize the body and assist in tasks, such as lifting weights.

3.Posture

Skeletal muscles help keep the body in the correct position when someone is
sitting or standing. This is known as posture.

Good posture relies on strong, flexible muscles. Stiff, weak, or tight muscles
contribute to poor posture and misalignment of the body.

Long-term, bad posture leads to joint and muscle pain in the shoulders, back,
neck, and elsewhere.

4. Circulation:
The heart is a muscle that pumps blood throughout the body. The movement of
the heart is outside of conscious control, and it contracts automatically when
stimulated by electrical signals.

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Smooth muscle in the arteries and veins plays a further role in the circulation of
blood around the body. These muscles maintain blood pressure and circulation in
the event of blood loss or dehydration. They expand to increase blood flow
during times of intense exercise when the body requires more oxygen.

5.Respirtion:
Breathing involves the use of the diaphragm muscle.

The diaphragm is a dome-shaped muscle located below the lungs. When the
diaphragm contracts, it pushes downward, causing the chest cavity to get bigger.
The lungs then fill with air. When the diaphragm muscle relaxes, it pushes air out
of the lungs.
When someone wants to breath more deeply, it requires help from other muscles,
including those in the abdomen, back, and neck.

6. Digestion:
Model of muscular system in foreground with other human anatomy models in
background.
The muscular system allows for movement within the body, for example, during
digestion or urination.
Smooth muscles in the gastrointestinal or GI tract control digestion. The GI tract
stretches from the mouth to the anus.

Food moves through the digestive system with a wave-like motion called
peristalsis. Muscles in the walls of the hollow organs contract and relax to cause
this movement, which pushes food through the esophagus into the stomach.

The upper muscle in the stomach relaxes to allow food to enter, while the lower
muscles mix food particles with stomach acid and enzymes.

The digested food moves from the stomach to the intestines by peristalsis. From
here, more muscles contract to pass the food out of the body as stool.

7. Urination:
The urinary system comprises both smooth and skeletal muscles, including those
in the:

 bladder
 kidneys
 penis or vagina
 prostate
 ureters
 urethra
The muscles and nerves must work together to hold and release urine from the
bladder.

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Urinary problems, such as poor bladder control or retention of urine, are caused
by damage to the nerves that carry signals to the muscles.

8.Childbirth:

Smooth muscles in the uterus expand and contract during childbirth. These
movements push the baby through the vagina. Also, the pelvic floor muscles help
to guide the baby's head down the birth canal.

9. Vision:

Six skeletal muscles around the eye control its movements. These muscles work
quickly and precisely, and allow the eye to:
 maintain a stable image
 scan the surrounding area
 track moving objects
If someone experiences damage to their eye muscles, it can impair their vision.

10. Organ protection:

Muscles in the torso protect the internal organs at the front, sides, and back of the
body. The bones of the spine and the ribs provide further protection.

Muscles also protect the bones and organs by absorbing shock and reducing
friction in the joints.

11. Temperature regulation:

Maintaining normal body temperature is an important function of the muscular
system. Almost 85 percent of the heat a person generates in their body comes
from contracting muscles.

When body heat falls below optimal levels, the skeletal muscles increase their
activity to make heat. Shivering is one example of this mechanism. Muscles in
the blood vessels also contract to maintain body heat.

Body temperature can be brought back within normal range through the
relaxation of smooth muscle in the blood vessels. This action increases blood
flow and releases excess heat through the skin.

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NERVOUS SYSTEM:

The nervous system is a complex collection of nerves and specialized cells
known as neurons that transmit signals between different parts of the body. It is
essentially the body's electrical wiring.

Structurally, the nervous system has two components: the central nervous system
and the peripheral nervous system. The central nervous system is made up of the
brain, spinal cord and nerves. The peripheral nervous system consists of sensory
neurons, ganglia (clusters of neurons) and nerves that connect to one another and
to the central nervous system.

Functionally, the nervous system has two main subdivisions: the somatic, or
voluntary, component; and the autonomic, or involuntary, component. The
autonomic nervous system regulates certain body processes, such as blood
pressure and the rate of breathing, that work without conscious effort, The
somatic system consists of nerves that connect the brain and spinal cord with
muscles and sensor

Neurons send signals to other cells through thin fibers called axons, which cause
chemicals known as neurotransmitters to be released at junctions called synapses

There are over 100 trillion neural connections in the average human brain,
though the number and location can vary.
A synapse gives a command to the cell and the entire communication process
typically takes only a fraction of a millisecond. Signals travel along an alpha
motor neuron in the spinal cord 268 mph (431 km/h); the fastest transmission in
the human body.Sensory neurons react to physical stimuli such as light, sound
and touch and send feedback to the central nervous system about the body's
surrounding environment, Motor neurons, located in the central nervous system
or in peripheral ganglia, transmit signals to activate the muscles or glands.

CENTRAL NERVOUS SYTEM:

Brain:
This incredibly complex and vital organ is made up of 100 billion or so neurons.
It controls your movement, speech, heartbeat, and breathing. And it's the root of

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all your thoughts and feelings. Around the size of two clenched fists and
weighing in at about 3 pounds, it's protected by your skull and the fluid it floats
in.

Cerebrum:
The largest part of the brain is divided into two halves called hemispheres. The
left one, which controls the right side of your body, handles speech, logic, math
calculations, and pulling facts from your memory, too. The right hemisphere,
which controls your left side, is also in charge of music, recognizing faces, and
understanding your body's position relative to what's around you, what's known
as spatial awareness

Cortex:
The outermost layer of the cerebrum has many wrinkles and folds. This is where
you'll find your brain's "gray matter," which processes information.

Basal Ganglia:
You'll find this network of circuits deep inside the hemispheres of your brain.
The basal ganglia

coordinate movement, behavior, and emotions. They make things that happen in
sequence possible, like walking and dancing, learning patterns, forming habits,
and stopping activities then starting new ones. Damaged basal ganglia cause
Parkinson's and Huntington's diseases.

Cerebellum:
Cerebellum oversees complicated movements, posture, and balance. It
coordinates different muscle groups and fine-tunes movements with practice, like
hitting a golf ball or hockey puck. Because of it, walking can be a smooth,
continuous motion. It's also important for language and speech.

Amygdala:
This almond-shaped area is responsible for your emotions and some behavior. It's
believed your amygdala helps you do everything from form memories to pick up
on social cues. It sounds the alarm that triggers your body‘s "fight or flight"
response to danger.

Hippocampus:
You have one on each side near the center of your brain. They help you learn and
remember important who, what, and where details -- like your boss's name and
the location of your house -- and turn short-term memories into long-term ones.
It's one of the first areas damaged by Alzheimer's disease.

Thalamus:
The top part of your brain stem is kind of like a post office for your senses. It
gets signals related to sight, smell, hearing, taste, and touch and passes the
information to other parts of your brain.

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Pons:
This key relay station is the middle part of your brain stem and a bridge between
the cerebrum and the cerebellum. It's the origin of nerves that control facial
expressions, eye movement, chewing and swallowing, and bladder control. It
plays a role in breathing. And it's probably where your dreams happen.

Medulla Oblongata:
Your medulla handles the autonomic things you don't think about, like your
breathing, blood pressure, and heart rate. It's found at the bottom of the brain
stem, where it helps transfer signals between the brain and spinal cord, too.

Spinal Cord:
It's probably smaller than you think: about 17 inches long (the diagonal of a large
laptop screen) and less than 1/2-inch wide, thinner than an adult's finger. It runs
from the base of your brain down your back, surrounded by bones called
vertebrae. Bundles of nerve fibers, protected by tissue and fluid, carry
information back and forth from your brain to your body.

PERIPHERAL NERVOUS SYSTEM :

Peripheral Nerves:
If the central nervous system is the main office, the peripheral nervous system is
the workers out in the field. There are 12 cranial nerves that connect to the brain,
including ones that let you smell, see, smile, and swallow. Another 31 pairs of
nerve roots (one sensory, one motor) branch out from your spinal cord between
the vertebrae. The sciatic nerve is the largest single nerve. It goes from your
pelvis down the back of your thigh.

Diseases and Conditions:
Infections, injuries, poisons, even high blood sugar can harm parts of your
nervous system. Stroke, meningitis, polio, migraine, carpal tunnel syndrome,
epilepsy, MS, and shingles are all nervous system disorders. Doctors who treat
them are called neurologists.

Cranial nerves:
There are 12 pairs of cranial nerves originating from nuclei in the inferior surface
of the brain, some sensory, some motor and some mixed. Their names and
numbers are:

I. Olfactory: sensory
II. Optic: sensory
III. Oculomotor: motor
IV. Trochlear: motor
V. Trigeminal: mixed
VI. Abducent: motor
VII. Facial: mixed

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VIII. Vestibulocochlear (auditory): sensory
IX. Glossopharyngeal: mixed
X. Vagus: mixed
XL Accessory: motor
XII. Hypoglossal: motor.

Functions
Each of the 12 cranial nerves has a specific function that helps the brain control
the actions of the body.

1. The olfactory nerve is involved in the sense of smell.
2. The optic nerve is involved in the sense of sight. Responsible for vision,
damage to this nerve can result in temporary or permanent blindness.
3. The oculomotor nerve controls pupil constriction and eye movement.
This nerve allows us to move our eyes in response to stimuli and dilate or
constrict our pupils in response to changing light conditions.
4. The trochlear nerve also plays a role in the movement of the eyes. This
nerve is especially important for looking down and looking in toward a
midline object.
5. The trigeminal nerve plays a role in controlling the muscles needed for
chewing. This nerve also provides the senses of pain and touch for the
head and face.
6. The abducens nerve allows the eyes to move away from the midline of
the face. This nerve must work with cranial nerves III and IV for correct
vision. If these nerves don‘t work together, double vision occurs.
7. The facial nerve controls the muscles used in smiling, frowning, and other
facial expressions. It also helps produce taste in two-thirds of the tongue
and allows for the sensations of touch and pain from the ear.
8. The vestibulocochlear nerve has separate acoustic and vestibular
divisions. The acoustic portion of the nerve allows for proper hearing.
The vestibular division is essential for normal balance.
9. The glossopharyngeal nerve allows for taste on the back portion of the
tongue, provides the sensations of pain and touch from the tongue and
tonsils, and participates in the control of muscles used during swallowing.
10. The vagus nerve plays an important role in the human body. It controls
the sensory and motor functions of the heart and glands. It also
participates in the process of digestion.

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11. The spinal accessory nerve allows the trapezius muscle and
sternocleidomastoid muscle to control the movements of the head.
12. The hypoglossal nerve allows the tongue to move properly.

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RESPIRATORY SYSTEM

Human Respiratory System and it’s Mechanism

The human respiratory system consists of a pair of lungs and a series of air
passages leading to the lungs.

The entire respiratory tract (passage) consists of the nose, pharynx, larynx,
trachea, bronchi, and bronchioles.

Human Respiratory System

Air enters the nose through the nostrils. When air passes through the nose, it is
warmed, moistened and filtered. The hairs present in the nose filter out particles
in the incoming air. The air is moistened by the mucus present in the nose, and it
is warmed by the blood flowing through the capillaries in the nose.

The respiratory tract from the nose to the bronchioles is lined by mucous
membranes and cilia. The mucus and cilia act as additional filters.

Behind the nose lies the pharynx (throat). There are two passages here—one for
food and the other for air. The air passes from the pharynx to the larynx, or the
voice box. The opening leading to the larynx is called glottis. It is protected by a
lid called epiglottis, which prevents food from entering the passage to the lungs.

From the larynx the air goes to the trachea, or the windpipe. The trachea is about
11 cm long. It is guarded by 16-20 C-shaped cartilage rings, which prevent the
trachea from collapsing. The trachea divides into two tubes called bronchi. Each
bronchus divides and branches out in the form of thinner tubes called
bronchioles.

The bronchioles enter the lungs and divide further into finer branches called
alveolar ducts. These open into extremely thin-walled, grape-shaped air sacs
called alveoli. Each alveolus is covered by a web of blood capillaries.

The lungs are a pair of spongy organs lying in the chest cavity formed by the
ribs. The actual exchange of gases between the air and the body takes place in the
capillary-covered alveoli inside the lungs. Here, oxygen from the air in the
alveoli goes into the blood, and the carbon dioxide in the blood goes out.

The oxygen binds to the haemoglobin molecules present in the red blood
corpuscles and is taken to different parts of the body.

Alveoli
The total surface area through which the exchange of gases can take place
increases because of the millions of alveoli in the lungs. Their total surface area
can be about a hundred times that of the body. The large surface area allows

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sufficient oxygen intake needed for releasing the large amount of energy required
by us.

Mechanism of Breathing:
There are two main steps in breathing: inspiration and expiration:

Inspiration:
Inspiration (inhalation) is the process of breathing in, by which air is brought into
the lungs.
Inspiration involves the following steps:

i. The muscles attached to the ribs on their outer side contract. This causes the
ribs to be pulled out, expanding the chest cavity.

ii. The muscle wall between the chest cavity and the abdominal cavity, called
diaphragm, contracts and moves downwards to further expand the chest cavity.

iii. The abdominal muscles contract.

The expansion of the chest cavity creates a partial vacuum in the chest cavity.
This sucks in air into the lungs, and fills the expanded alveoli.

Expiration:
After the exchange of gases in the lungs, the air has to be expelled. Expulsion of
the air from the lungs is called expiration. In this process, muscles attached to the
ribs on their inner side contract, and the diaphragm and the abdominal muscles
relax. This leads to a decrease in the volume of the chest cavity, which increases
the pressure on the lungs. The air in the lungs is pushed out and it passes out
through the nose.

When we breathe out, not all of the air in the lungs gets expelled. Some of it
remains in the lungs. This keeps the lungs from collapsing and allows more time
for the exchange of gases.

Transport of Gases:
In very small organisms, there is no need to have a separate transportation system
for gases because all its cells are involved directly in the exchange of gases by
diffusion. However, a large multicellular organism needs a mechanism for the
transport of gases for its different organs and tissues.

Human beings also have a system for transportation of gases. Oxygen is carried
by haemoglobin of the red blood cells. Haemoglobin has a great affinity for
oxygen—each haemoglobin molecule binds to four molecules of oxygen. The
oxygen ‗picked up‘ by haemoglobin gets transported with the blood to various
tissues.

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Carbon dioxide is more soluble in water than oxygen. So, some of it is
transported in the dissolved form in our blood. Some carbon dioxide is also
transported by haemoglobin. Not all of the carbon dioxide formed is expelled
from the body. Some of it reacts with water to form compounds useful for life
processes.

Emphysema (COPD) – Chronic Obstructive Pulmonary Disease, of which
emphysema

Atelectasis – a collapsed lung. Literally, ―an imperfect expansion‖

Epistaxis – want a fancier name for a ―nosebleed?‖
Pneumonian

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DIGESTIVE SYSTEM

The human digestive system consists of the gastrointestinal/Alimentary
tract plus the accessory organs of digestion.
The alimentary canal begins at the mouth, passes through the thorax, abdomen
and pelvis and ends at the anus.
It is thus a long tube through which food passes. It has various parts which are
structurally remarkably similar. The parts include:
1. Mouth
2. Pharynx
3. Oesophagus
4. Stomach
5. Small intestine
6. Large intestine
7. Rectum and Anal canal.
The mouth or oral cavity is bounded by muscles and bones: anteriorly —by the
lips, posteriorly — it is continuous with the oropharynx, laterally —by the
muscles of the cheeks, superiorly —by the bony hard palate and muscular soft
palate, inferiorly —by the muscular tongue and the soft tissues of the floor of the
mouth.
The tongue is a voluntary muscular structure which occupies the floor of the
mouth.
It is attached by its base to the hyoid bone and by a fold of its mucous membrane
covering, called the frenulum, to the floor of the mouth.
The superior surface consists of stratified squamous epithelium, with numerous
papillae (little projections), containing nerve endings of the sense of taste,
sometimes called the taste buds.
The tongue plays an important part in:
 mastication (chewing)
 deglutition (swallowing)
 speech
 taste
There are several organs and other components involved in the digestion of food.
The organs known as the accessory digestive glands are the liver, gall
bladder and pancreas. Other components include the mouth, salivary
glands, tongue, teeth and epiglottis.

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The largest structure of the digestive system is the gastrointestinal tract (GI tract).
This starts at the mouth and ends at the anus, covering a distance of about nine
(9) metres.
[1]

The largest part of the GI tract is the colon or large intestine. Water is absorbed
here and the remaining waste matter is stored prior to defecation.
[2]

Most of the digestion of food takes place in the small intestine.
A major digestive organ is the stomach. Within its mucosa are millions of
embedded gastric glands. Their secretions are vital to the functioning of the
organ.
There are many specialised cells of the GI tract. These include the various cells
of the gastric glands, taste cells, pancreatic duct cells, enterocytes and microfold
cells.
Some parts of the digestive system are also part of the excretory system,
including the large intestine.
Peristalsis
is the rhythmic contraction of muscles that begins in the esophagus and continues
along the wall of the stomach and the rest of the gastrointestinal tract.. Most of
the digestion of food takes place in the small intestine.

KEY POINTS
• Food is ingested through the mouth and broken down through mastication
(chewing).
• Food must be chewed in order to be swallowed and broken down by
digestive enzymes.
• While food is being chewed, saliva chemically processes the food to aid
in swallowing.
• Medications and harmful or inedible substances may be ingested as well.
• Pathogens, such as viruses, bacteria, and parasites, may be transmitted via
ingestion, causing diseases like hepatitis A, polio, and cholera.
 KEY TERMS
 ingestion: consuming something orally, whether it be food, drink,
medicine, or other substance; the first step of digestion
 bolus: a round mass of something, especially of chewed food in the
mouth or alimentary canal
 mastication: the process of chewing

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OBTAINING NUTRITION AND ENERGY FROM FOOD IS A MULTI -
STEP PROCESS:
The first step in this process is

Ingestion: taking in food through the mouth. Once in the mouth, the teeth, saliva,
and tongue play important roles in mastication (preparing the food into bolus).
Mastication, or chewing, is an extremely important part of the digestive process,

Digestion
Digestion is the mechanical and chemical break down of food into small organic
fragments. Mechanical digestion refers to the physical breakdown of large pieces
of food into smaller pieces which can subsequently be accessed by digestive
enzymes. In chemical digestion, enzymes break down food into the small
molecules the body can use.
The process of digestion has many stages. The first stage is the cephalic phase of
digestion which begins with gastric secretions in response to the sight and smell
of food. The next stage starts in the mouth.

Chewing,
in which food is mixed with saliva, begins the mechanical process of digestion.
This produces a bolus which can be swallowed down the esophagusto enter the
stomach. Here it is mixed with gastric acid until it passes into the duodenum
where it is mixed with a number of enzymes produced by the pancreas. Saliva
also contains an catalytic enzyme called amylase which starts to act on food in
the mouth.. Digestion is helped by the chewing of food carried out by the
muscles of mastication, by the teeth, and also by the contractions of peristalsis,
and segmentation. Gastric acid, and the production of mucus in the stomach, are
essential for the continuation of digestion.

Absorption
Absorption is the movement of molecules across the gastrointestinal (GI) tract
into the circulatory system. Most of the end-products of digestion, along with
vitamins, minerals, and water, are absorbed in the small intestinal

Elimination
Undigested food enters the colon where water is reabsorbed into the body and
excess waste is eliminated from the anus.

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URINARY SYSYTEM:

The urinary system consists of the kidneys, ureters, urinary bladder, and urethra.
The kidneys filter the blood to remove wastes and produce urine. The ureters,
urinary bladder, and urethra together form the urinary tract, which acts as a
plumbing system to drain urine from the kidneys, store it, and then release it
during urination. Besides filtering and eliminating wastes from the body, the
urinary system also maintains the homeostasis of water, ions, pH, blood pressure,
calcium

Kidney:

The kidneys are a pair of bean-shaped organs found along the posterior wall of
the abdominal cavity. The left kidney is located slightly higher than the right
kidney because the right side of the liver is much larger than the left side. The
kidneys, unlike the other organs of the abdominal cavity, are located posterior to
the peritoneum

Ureter:

The ureters are a pair of tubes that carry urine from the kidneys to the urinary
bladder. The ureters are about 10 to 12 inches long and run on the left and right
sides of the body parallel to the vertebral column. Gravity and peristalsis of
smooth muscle tissue in the walls of the ureters move urine toward the urinary
bladder. The ends of the ureters extend slightly into the urinary bladder and are
sealed at the point of entry to the bladder by the ureterovesical valves. These
valves prevent urine from flowing back towards the kidneys.

Urinary bladder:

The urinary bladder is a sac-like hollow organ used for the storage of urine. The
urinary bladder is located along the body‘s midline at the inferior end of the
pelvis. Urine entering the urinary bladder from the ureters slowly fills the hollow
space of the bladder and stretches its elastic walls. The walls of the bladder allow
it to stretch to hold anywhere from 600 to 800 milliliters of urine.

Urethra:

The urethra is the tube through which urine passes from the bladder to the
exterior of the body. The female urethra is around 2 inches long and ends inferior
to the clitoris and superior to the vaginal opening. In males, the urethra is around
8 to 10 inches long and ends at the tip of the penis. The urethra is also an organ
of the male reproductive system as it carries sperm out of the body through the
penis.

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Storage and Excretion of Wastes:

After urine has been produced by the kidneys, it is transported through the
ureters to the urinary bladder. The urinary bladder fills with urine and stores it
until the body is ready for its excretion. When the volume of the urinary bladder
reaches anywhere from 150 to 400 milliliters, its walls begin to stretch and
stretch receptors in its walls send signals to the brain and spinal cord. These
signals result in the relaxation of the involuntary internal urethral sphincter and
the sensation of needing to urinate. Urination may be delayed as long as the
bladder does not exceed its maximum volume, but increasing nerve signals lead
to greater discomfort and desire to urinate.

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BLOOD CIRCULATORY SYSTEM :

The blood circulatory system (cardiovascular system) delivers nutrients and
oxygen to all cells in the body. It consists of the heart and the blood vessels
running through the entire body. The arteries carry blood away from the heart;
the veins carry it back to the heart.
There isn't only one blood circulatory system in the human body, but two, which
are connected: The systemic circulation provides organs, tissues and cells with
blood so that they get oxygen and other vital substances. The pulmonary
circulation is where the fresh oxygen we breathe in enters the blood. At the same
time, carbon dioxide is released from the blood.

Blood is circulated throughout your body via your arterial system—arteries,
arterioles, and capillaries—and returned to your heart via the venous system—
veins and venules. Your blood is vital to your well-being and circulates nutrients
including electrolytes, oxygen, carbon dioxide and amino acids throughout your
body.

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The heart is a pump, usually beating about 60 to 100 times per minute. With each
heartbeat, the heart sends blood throughout our bodies,

The heart has four chambers — two on top and two on bottom:
The two top chambers are the right atrium and the left atrium. They receive the
blood entering the heart. A wall called the interatrial septum is between the atria.

The two bottom chambers are the right ventricle and the left ventricle. These
pump blood out of the heart. A wall called the interventricular septum is between
the two ventricles.

The atria are separated from the ventricles by the atrioventricular valves:

 The tricuspid valve separates the right atrium from the right ventricle.
 The mitral valve separates the left atrium from the left ventricle.
 Two valves also separate the ventricles from the large blood vessels that
carry blood leaving the heart:
 The pulmonic valve is between the right ventricle and the pulmonary
artery, which carries blood to the lungs.
 The aortic valve is between the left ventricle and the aorta, which carries
blood to the body.

Circulation
First of all the Right Atrium receives Deoxygenated blood from the whole body.
This blood is deoxygenated because the oxygen is utilised by the cells of the
body. This blood is carried by veins and enters the heart through Superior and
Inferior vena cava. From the right atrium, the blood enters the right ventricle
through the tricuspid valves.Ventricles are the distributing chambers of the heart.
The blood is carried from the right ventricle to the lungs by the aorta for their
oxygenation. This blood passes through semilunar valve in the heart. After
Oxygenation, the blood enters the left atrium of the heart through pulmonary
vein.
The blood passes to the left ventricle through the bicuspid valves. The walls of
the left ventricle are the thickest. The left ventricle distributes the oxygenated
blood to the whole body cells through arteries. This cycle repeats again and
again.

How Does the Heart Beat?
How the heart beats is controlled by a system of electrical signals in the heart.
The sinus (or sinoatrial) node is a small area of tissue in the wall of the right
atrium. It sends out an electrical signal to start the contracting (pumping) of the
heart muscle. This node is called the pacemaker of the heart because it sets the
rate of the heartbeat and causes the rest of the heart to contract in its rhythm.

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These electrical impulses make the atria contract first. Then the impulses travel
down to the atrioventricular (or AV) node, which acts as a kind of relay station.
From here, the electrical signal travels through the right and left ventricles,
making them contract.

One complete heartbeat is made up of two phases:

The first phase is called systole This is when the ventricles contract and pump
blood into the aorta and pulmonary artery. During systole, the atrioventricular
valves close, creating the first sound (the lub) of a heartbeat. When the
atrioventricular valves close, it keeps the blood from going back up into the atria.
During this time, the aortic and pulmonary valves are open to allow blood into
the aorta and pulmonary artery. When the ventricles finish contracting, the aortic
and pulmonary valves close to prevent blood from flowing back into the
ventricles. These valves closing is what creates the second sound (the dub) of a
heartbeat.
The second phase is called diastole This is when the atrioventricular valves open
and the ventricles relax. This allows the ventricles to fill with blood from the
atria, and get ready for the next heartbeat.

To help keep your heart healthy:
 Get plenty of exercise.
 Eat a nutritious diet.
 Reach and keep a healthy weight.
 If you smoke, quit.
 Go for regular medical checkups.
 Tell the doctor about any family history of heart problems.
 Let the doctor know if you have any chest pain, trouble breathing, or
dizzy or fainting spells; or if you feel like your heart sometimes goes
really fast or skips a beat.

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Coronary artery disease.
 Atherosclerosis, arteriosclerosis, and arteriolosclerosis.
 Stroke.
 Hypertension.
 Heart failure.
 Aortic dissection and aneurysm.
 Myocarditis and pericarditis.
 Cardiomyopathy.

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Blood:

Blood is a connective tissue. It provides one of the means of communication
between the cells of different parts of the body and the external environment,

Functions of blood . it carries:
 oxygen from the lungs to the tissues and carbon dioxide from the tissues
to the lungs for excretion •
 Nutrients from the alimentary tract to the tissues and cell wastes to the
excretory organs, principally the kidneys
 hormones secreted by endocrine glands to their target glands and tissues
 heat produced in active tissues to other less active tissues
 protective substances, e.g. antibodies, to areas of infection
 clotting factors that coagulate blood, minimizing its loss from ruptured
blood vessels.

Blood makes up about 7% of body weight (about 5.6 litres in a 70 kg man). This
proportion is less in women and considerably greater in children, gradually
decreasing until the adult level is reached. Blood in the blood vessels is always in
motion. The continual flow maintains a fairly constant environment for the body
cells. Blood volume and the concentration of its many constituents are kept
within narrow limits by homeostasis.

Blood is composed of a straw-coloured transparent fluid, plasma, in which
different types of cells are suspended. Plasma constitutes about 55% and cells
about 45% of blood volume

Plasma
The constituents of plasma are water (90 to 92%) and dissolved substances,
including:
• plasma proteins: albumins, globulins (including antibodies), fibrinogen, clotting
factors • inorganic salts (mineral salts): sodium chloride, sodium bicarbonate,
potassium, magnesium, phosphate, iron, calcium, copper, iodine, cobalt •
nutrients, principally from digested foods, e.g. monosaccharides (mainly
glucose), amino acids, fatty acids, glycerol and vitamins • organic waste
materials, e.g. urea, uric acid, creatinine • hormones • enzymes, e.g. certain
clotting factors • gases, e.g. oxygen, carbon dioxide, nitrogen.

Plasma proteins
Plasma proteins, which make up about 7% of plasma, are normally retained
within the blood, because they are too big to escape through the capillary pores
into the tissues. They are largely responsible for creating the osmotic pressure of
blood (

Clotting factors
These are substances essential for coagulation of blood

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Organic waste products
Urea, creatinine and uric acid are the waste products of protein metabolism. They
are formed in the liver and conveyed in blood to the kidneys for excretion.
Carbon dioxide, released by all cells, is conveyed to the lungs for excretion.

Nutrients
Food is digested in the alimentary tract and the resultant nutrients are absorbed,
e.g. monosaccharides, amino acids, fatty acids, glycerol and vitamins. Together
with mineral salts they are required by all body cells to provide energy, heat,
materials for repair and replacement, and for the synthesis of other blood
components and body secretions.

Hormones
pass directly from the cells of the glands into the blood which transports them to
their target tissues and organs elsewhere in the body, where they influence
cellular activity.

Gases
Oxygen, carbon dioxide and nitrogen are transported round the body in solution
in plasma. Oxygen and carbon dioxide are also transported in combination with
haemoglobin in red blood cells (p. 256). Most oxygen is carried in combination
with haemoglobin and most carbon dioxide as bicarbonate ions dissolved in
plasma. Atmospheric nitrogen enters the body in the same way as other gases and
is present in plasma but it has no physiological functio

Cellular content of blood
There are three types of blood cells
 erythrocytes or red cells
 thrombocytes or platelets
 leukocytes or white cells.

Erythrocytes (red blood cells)
These are circular biconcave non-nucleated discs Erythrocytes are formed in red
bone marrow, which is present in the ends of long bones and in flat and irregular
bones.. Their life span in the circulation is about 120 days.

The process of development of red blood cells from pluripotent stem cells takes
about 7 days and is called erythropoiesis (Fig. 4.2). It is characterised by two
main features:
• maturation of the cell • formation of haemoglobin inside the cel

Maturation of the cell:
During this process the cell decreases in size and loses its nucleus. These
changes depend on a number of factors, especially the presence of vitamin B12
and folic acid. Deficiency of either vitamin B12 or folic acid leads to impaired
red cell production.

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Hemoglobin
in mature erythrocytes combines with oxygen to form oxyhaemoglobin, giving
arterial blood its characteristic red colour. Each haemoglobin molecule contains
four atoms of iron. Each atom can carry one molecule of oxygen, therefore one
haemoglobin molecule can carry up to four molecules of oxygen.

Erythrocyte count
This is the number of erythrocytes per litre (1) or per cubic millimetre (mm3) of
blood.

Packed cell volume or haematocrit
This is the volume of red cells in 1 litre or 1 mm3 of whole blood.

Haemoglobin
This is the weight of haemoglobin in whole blood, measured in grams per 100 ml

Blood groups
Individuals have different types of antigen on the surfaces of their red blood
cells. These antigens, which are inherited, determine the individual's blood group

In addition, individuals make antibodies to these antigens, but not to their own
type of antigen, since if they did the antigens and antibodies would react causing
a transfusion reaction. The main signs are clumping of red blood cells,
haemolysis, shock and kidney failure.

If individuals are transfused with blood of the same group, i.e. possessing the
same antigens on the surface of the cells, their immune system will not recognise
them as foreign and will not reject them.

There are many different collections of red cell surface antigens, but the most
important are the ABO and the Rhesus systems.

Because blood group AB people make neither anti-A nor anti-B antibodies, they
are known as universal recipients: transfusion of either type A or type B blood
into these individuals is safe, since there are no antibodies to react with them.
Conversely, group O people have neither A nor B antigens on their red cell
membranes, and their blood may be safely transfused into A, B, AB or O types;
group O is known as the universal donor

The Rhesus system

The red blood cell membrane antigen important here is the Rhesus (Rh) antigen,
or Rhesus factor. About 85% of people have this antigen; they are Rhesus
positive (Rh+) and do not therefore make anti-Rhesus antibodies. The remaining
15% have no Rhesus antigen (they are Rhesus negative, or Rh~). Rh~ individuals
are capable of making anti-Rhesus antibodies, but are stimulated to do so only in

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certain circumstances, e.g. in pregnancy, or as the result of an incompatible blood
transfusion.

Leukocytes (white blood cells)

These cells have an important function in defending the body against microbes
and other foreign materials. Leukocytes are the largest blood cells and they
account for about 1% of the blood volume.

There are two main types
 granulocytes (polymorphonuclear leukocytes) — neutrophils, eosinophils
and basophils agranulocytes — monocytes and lymphocytes.

Anaemia

In anaemia there is not enough haemoglobin available to carry sufficient oxygen
from the lungs to supply the needs of the tissues.

The classification of anaemia is based on the cause:
• impaired erythrocyte production — iron deficiency — megaloblastic anaemias
— hypoplastic anaemia • increased erythrocyte loss — haemolytic anaemias —
normocytic anaemia.

Thelesemia
Hemophelia
Bllod cancer

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LYMPHATIC SYSTEM

The lymphatic system is a network of tissues and organs that help rid the body of
toxins, waste and other unwanted materials. The primary function of the
lymphatic system is to transport lymph, a fluid containing infection-fighting
white blood cells, throughout the body.
The lymphatic system primarily consists of
 lymph .lymphatic vessels, which are similar to the veins and capillaries of
the circulatory
system.
 The vessels are connected to lymph nodes, where the lymph is filtered.
 The tonsils,
 Spleen
 Thymus
 Adenoids
 Peyer‘s patches

Functions of the lymphatic system include the following.
Tissue drainage. Every day, around 21 liters of plasma fluid, carrying dissolved
substances and some plasma protein, escape from the arterial end of the
capillaries and into the tissues. Most of this fluid is returned directly to the
bloodstream via the capillary at its venous end, but 3-4 litres of fluid are drained
away by the lymphatic vessels. Without this, the tissues would rapidly become
waterlogged, and the cardiovascular system would begin to fail as the blood
volume falls.

Lymph
is a clear watery fluid, similar in composition to plasma, Lymph transports the
plasma proteins that seep out of the capillary beds back to the bloodstream. It
also carries away larger particles, e.g. bacteria and cell debris from damaged
tissues, which can then be filtered out and destroyed by the lymph nodes. Lymph
contains lymphocytes, which circulate in the lymphatic system allowing them to
patrol the different regions of the body. In the lacteals of the small intestine, fats
absorbed into the lymphatics give the lymph

Lymph capillaries
These originate as blind-end tubes in the interstitial spaces They have the same
structure as blood capillaries, i.e. a single layer of endothelial cells, but their
walls are more permeable to all interstitial fluid constituents, including proteins
and cell debris.

Lymph vessels
The tiny capillaries join up to form larger lymph vessels. All tissues of the body
have a network of lymphatic vessels, with the exception of the central nervous
system, the bones and the most superficial layers of the skin.

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Lymph vessels have numerous cup-shaped valves which ensure that lymph flows
in one way only, i.e. towards the thorax

Lymph nodes
Lymph nodes are oval or bean-shaped organs that lie, often in groups, along the
length of lymph vessels. The lymph drains through a number of nodes, usually 8
to 10, before returning to the venous circulation. There are hundreds of lymph
nodes in the human body. They are located deep inside the body, such as around
the lungs and heart, or closer to the surface, such as under the arm or groin,

The spleen acts as a blood filter; it controls the amount of red blood cells and
blood storage in the body, and helps to fight infection,"

If the spleen detects potentially dangerous bacteria, viruses, or other
microorganisms in the blood, it — along with the lymph nodes — creates white
blood cells called lymphocytes, which act as defenders against invaders. The
lymphocytes produce antibodies to kill the foreign microorganisms and stop
infections from spreading. Humans can live without a spleen, although people
who have lost their spleen to disease or injury are more prone to infections.

The thymus is located in the chest just above the heart.This small organ stores
immature lymphocytes (specialized white blood cells) and prepares them to
become active T cells, which help destroy infected or cancerous cells.

Tonsils are large clusters of lymphatic cells found in the pharynx. they are the
body's "first line of defense as part of the immune system. They sample bacteria
and viruses that enter the body through the mouth or nose."

LYMPHATIC SYSTEM

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Diseases of Lymphatic system:

 Hodgkin's disease – a type of cancer of the lymphatic system.
 lymphangitis
 lymphadenitis

THE GLANDULAR SYSTEM

The glandular tissue are a mixture of both endocrine (ductless, hormones are
secreted into the blood) and exocrine (have ducts, hormones are secreted onto
surfaces) glands. The exocrine glands are covered in the respective topics.

Five main functions of endocrine system

The endocrine system is the collection of glands that produce hormones that
regulate metabolism, growth and development, tissue function, sexual function,
reproduction, sleep, and mood, among other things

Functions of hormone
Causes puberty, increases bone density, triggers facial hair growth, and causes
muscle mass growth and strength. The sex hormones are estrogen and
testosterone. Like all hormones, they are chemical messengers, substances
produced in one part of the body that go on to tell other parts what to do

Parts of the Endocrine System
Many glands make up the endocrine system. The hypothalamus, pituitary gland,
and pineal gland are in brain. The thyroid and parathyroid glands are in your
neck. The thymus is between your lungs, the adrenals are on top of your kidneys,
and the pancreas is behind your stomach. Your ovaries (if you're a woman) or
testes (if you're a man) are in your pelvic region.
Hypothalamus. This organ connects your endocrine system with your nervous
system. Its main job is to tell your pituitary gland to start or stop making hormones.
Pituitary gland. This is your endocrine system‘s master gland. It uses information
it gets from your brain to tell other glands in your body what to do. It makes many
important hormones, including growth hormone; prolactin, which helps
breastfeeding moms make milk; and luteinizing hormone, which manages estrogen
in women and testosterone in men.
Pineal gland. It makes a chemical called melatonin that helps your body get ready
to go to sleep.

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Thyroid gland. This gland makes thyroid hormone, which controls your
metabolism. If this gland doesn't make enough (a condition called hypothyroidism),
everything happens more slowly. Your heart rate might slow down. You could get
constipated. And you might gain weight. If it makes too much (hyperthyroidism),
everything speeds up. Your heart might race. You could have diarrhea. And you
might lose weight without trying.
Parathyroid. This is a set of four small glands behind your thyroid. They play a
role in bone health. The glands control your levels of calcium and phosphorus.
Thymus. This gland makes white blood cells called T-lymphocytes that fight
infection and are crucial as a child's immune system develops. The thymus starts to
shrink after puberty.
Adrenals. Best known for making the "fight or flight" hormone adrenaline (also
called epinephrine), these two glands also make hormones called corticosteroids.
They affect your metabolism and sexual function, among other things.
Pancreas. This organ is part of both your digestive and endocrine systems. It makes
digestive enzymes that break down food. It also makes the hormones insulin and
glucagon. These ensure you have the right amount of sugar in your bloodstream and
your cells.
 If you don't make insulin, which is the case for people with type 1 diabetes,
your blood sugar levels can get dangerously high. In type 2 diabetes, the
pancreas usually makes some insulin but not enough.
Ovaries. In women, these organs make estrogen and progesterone. These hormones
help develop breasts at puberty, regulate the menstrual cycle, and support a
pregnancy.
Testes. In men, the testes make testosterone. It helps them grow facial and body
hair at puberty. It also tells the penis to grow larger and plays a role in making
sperm.

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Diseases of Endocrine

 Type 1 Diabetes:
 Type 1 diabetes (T1D) is an autoimmune condition in which the pancreas
can no longer produce insulin to control your blood sugar naturally. So
you need to take insulin in order to manage your blood sugar to remain
healthy and avoid serious complications.

 Type 2 Diabetes:

People with type 2 diabetes still produce insulin, however, the cells in the
muscles, liver and fat tissue are inefficient at absorbing the insulin and
cannot regulate glucose well

 Osteoporosis: Osteoporosis means "porous bone,"

 Thyroid Cancer:

 Addison's Disease: (adrenal insufficiency)

 Cushing's Syndrome: patients with central body obesity, glucose
intolerance, hypertension, excess hair growth, osteoporosis, kidney

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stones, menstrual irregularity, and emotional liability. It is now known
that these symptoms characterize Cushing's syndrome, which is the result
of excess production of cortisol by the adrenal glands.

 Graves' Disease. Graves‘ disease is a type of autoimmune problem that
causes the thyroid gland to produce too much thyroid hormone, which is
called hyperthyroidism. Graves‘ disease is often the underlying cause of
hyperthyroidism.

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INTEGUMENTARY SYSTEM:

The integumentary system consists of the skin, hair, nails, glands, and nerves.
Its main function is to act as a barrier to protect the body from the outside
world. It also functions to retain body fluids, protect against disease, eliminate
waste products, and regulate body temperature.

The skin performs six primary functions

 Protection. The skin functions as our first line of defense against toxins,
radiation and harmful pollutants. ...
 Absorption. ...
 Excretion. ...
 Secretion. ...
 Regulation. ...
 Sensation.

Skin has three layers:

 The epidermis, the outermost layer of skin, provides a waterproof barrier
and creates our skin tone. The epidermis is the outer layer, resting atop
the dermis. There is no direct blood supply to the epidermis. Nail: The
protective covering of the finger.
 The second major section of the integument is the dermis, and is
occasionally called the ‗true skin‘ since it is supplied with blood vessels
and nerve endings.
 The dermis, beneath the epidermis, contains tough connective tissue, hair
follicles, sweat glands. Sebaceous glands are also present in the dermis
 The deeper subcutaneous tissue (hypodermis) is made of fat and
connective tissue.

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Skin Health and Skin Diseases
 Acne—A disease that affects the skin's oil glands. ...
 Eczema—Also known as atopic dermatitis, this is a long-term skin
disease. ...
 Hives—Red and sometimes itchy bumps on your skin. ...
 Impetigo—A skin infection caused by bacteria. ...
 Melanoma—A severe and potentially life-threatening skin cancer. ...
 Moles—Growths on the skin.

FEMALE REPRODUCTIVE SYSTEM :

Female's reproductive system is divided into external and internal reproductive
system.

The external genital organs have three main functions:

1. Enabling sperm to enter the body
2. Protecting the internal genital organs from infectious organisms
3. Providing sexual pleasure

The external genital organs include the mons pubis, labia majora, labia minora,
Bartholin glands, and clitoris. The area containing these organs is called the
vulva.

The mons pubis is a rounded mound of fatty tissue that covers the pubic bone.
During puberty, it becomes covered with hair. The mons pubis contains oil-
secreting (sebaceous) glands that release substances that are involved in sexual
attraction (pheromones).

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The labia majora (literally, large lips) are relatively large, fleshy folds of tissue
that enclose and protect the other external genital organs. They are comparable to
the scrotum in males. The labia majora contain sweat and sebaceous glands,
which produce lubricating secretions. During puberty, hair appears on the labia
majora.

The labia minora (literally, small lips) can be very small or up to 2 inches wide.
The labia minora lie just inside the labia majora and surround the openings to the
vagina and urethra. A rich supply of blood vessels gives the labia minora a pink
color. During sexual stimulation, these blood vessels become engorged with
blood, causing the labia minora to swell and become more sensitive to
stimulation.

The area between the opening of the vagina and the anus, below the labia majora,
is called the perineum. It varies in length from almost 1 to more than 2 inches (2
to 5 centimeters).

The labia majora and the perineum are covered with skin similar to that on the
rest of the body. In contrast, the labia minora are lined with a mucous membrane,
whose surface is kept moist by fluid secreted by specialized cells.

The opening to the vagina is called the introitus. The vaginal opening is the
entryway for the penis during sexual intercourse and the exit for blood during
menstruation and for the baby during birth.

When stimulated, Bartholin glands (located beside the vaginal opening) secrete a
thick fluid that supplies lubrication for intercourse.

The opening to the urethra, which carries urine from the bladder to the outside, is
located above and in front of the vaginal opening.

The clitoris, located between the labia minora at their upper end, is a small
protrusion that corresponds to the penis in the male. The clitoris, like the penis, is
very sensitive to sexual stimulation and can become erect. Stimulating the clitoris
can result in an orgasm.

The internal reproductive organs in the female include:

Vagina: The vagina is a canal that joins the cervix (the lower part of uterus) to
the outside of the body. It also is known as the birth canal.

Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a
developing fetus. The uterus is divided into two parts: the cervix, which is the
lower part that opens into the vagina, and the main body of the uterus, called the
corpus. The corpus can easily expand to hold a developing baby. A channel
through the cervix allows sperm to enter and menstrual blood to exit.

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Ovaries: The ovaries are small, oval-shaped glands that are located on either side
of the uterus. The ovaries produce eggs and hormones.

Fallopian tubes: These are narrow tubes that are attached to the upper part of the
uterus and serve as tunnels for the ova (egg cells) to travel from the ovaries to the
uterus. Conception, the fertilization of an egg by a sperm, normally occurs in the
fallopian tubes. The fertilized egg then moves to the uterus, where it implants
into the lining of the uterine wall.

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MALE REPRODUCTIVE SYSTEM :

The purpose of the organs of the male reproductive system is to perform the
following functions:

To produce, maintain, and transport sperm (the male reproductive cells) and
protective fluid (semen)
To discharge sperm within the female reproductive tract during sex
To produce and secrete male sex hormones responsible for maintaining the male
reproductive system

The male reproductive system consists of a number of sex organs that play a role
in the process of human reproduction. These organs are located on the outside of
the body and within the pelvis

The most of the male reproductive system is located outside of the body. These
external structures include the penis, scrotum, and testicles.

Penis: This is the male organ used in sexual intercourse. It has three parts: the
root, which attaches to the wall of the abdomen; the body, or shaft; and the glans,
which is the cone-shaped part at the end of the penis. The glans, also called the
head of the penis, is covered with a loose layer of skin called foreskin. This skin
is sometimes removed in a procedure called circumcision. The opening of the
urethra, the tube that transports semen and urine, is at the tip of the penis. The
glans of the penis also contains a number of sensitive nerve endings.

The body of the penis is cylindrical in shape and consists of three circular shaped
chambers. These chambers are made up of special, sponge-like tissue. This tissue
contains thousands of large spaces that fill with blood when the man is sexually
aroused. As the penis fills with blood, it becomes rigid and erect, which allows
for penetration during sexual intercourse. The skin of the penis is loose and
elastic to accommodate changes in penis size during an erection.

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Semen, which contains sperm (reproductive cells), is expelled (ejaculated)
through the end of the penis when the man reaches sexual climax (orgasm).
When the penis is erect, the flow of urine is blocked from the urethra, allowing
only semen to be ejaculated at orgasm.

Scrotum: This is the loose pouch-like sac of skin that hangs behind and below the
penis. It contains the testicles (also called testes), as well as many nerves and
blood vessels. The scrotum acts as a "climate control system" for the testes. For
normal sperm development, the testes must be at a temperature slightly cooler
than body temperature. Special muscles in the wall of the scrotum allow it to
contract and relax, moving the testicles closer to the body for warmth or farther
away from the body to cool the temperature.

Testicles (testes): These are oval organs about the size of large olives that lie in
the scrotum, secured at either end by a structure called the spermatic cord. Most
men have two testes. The testes are responsible for making testosterone, the
primary male sex hormone, and for generating sperm. Within the testes are coiled
masses of tubes called seminiferous tubules. These tubes are responsible for
producing sperm cells.

The internal organs of the male reproductive system, also called accessory
organs, include the following:

Epididymis: The epididymis is a long, coiled tube that rests on the backside of
each testicle. It transports and stores sperm cells that are produced in the testes. It
also is the job of the epididymis to bring the sperm to maturity, since the sperm

195

that emerge from the testes are immature and incapable of fertilization. During
sexual arousal, contractions force the sperm into the vas deferens.

Vas deferens: The vas deferens is a long, muscular tube that travels from the
epididymis into the pelvic cavity, to just behind the bladder. The vas deferens
transports mature sperm to the urethra, the tube that carries urine or sperm to
outside of the body, in preparation for ejaculation.

Ejaculatory ducts: These are formed by the fusion of the vas deferens and the
seminal vesicles (see below). The ejaculatory ducts empty into the urethra.

Urethra: The urethra is the tube that carries urine from the bladder to outside of
the body. In males, it has the additional function of ejaculating semen when the
man reaches orgasm. When the penis is erect during sex, the flow of urine is
blocked from the urethra, allowing only semen to be ejaculated at orgasm.

Seminal vesicles: The seminal vesicles are sac-like pouches that attach to the vas
deferens near the base of the bladder. The seminal vesicles produce a sugar-rich
fluid (fructose) that provides sperm with a source of energy to help them move.
The fluid of the seminal vesicles makes up most of the volume of a man's
ejaculatory fluid, or ejaculate.

Prostate gland: The prostate gland is a walnut-sized structure that is located
below the urinary bladder in front of the rectum. The prostate gland contributes
additional fluid to the ejaculate. Prostate fluids also help to nourish the sperm.
The urethra, which carries the ejaculate to be expelled during orgasm, runs
through the center of the prostate gland.

Bulbourethral glands: Also called Cowper's glands, these are pea-sized structures
located on the sides of the urethra just below the prostate gland. These glands
produce a clear, slippery fluid that empties directly into the urethra. This fluid
serves to lubricate the urethra and to neutralize any acidity that may be present
due to residual drops of urine in the urethra.

How Does the Male Reproductive System Function?
The entire male reproductive system is dependent on hormones, which are
chemicals that regulate the activity of many different types of cells or organs.
The primary hormones involved in the male reproductive system are follicle-
stimulating hormone, luteinizing hormone, and testosterone.

Follicle-stimulating hormone is necessary for sperm production
(spermatogenesis), and luteinizing hormone stimulates the production of
testosterone, which is also needed to make sperm. Testosterone is responsible for
the development of male characteristics, including muscle mass and strength, fat
distribution, bone mass, facial hair growth, voice change, and sex drive.

196

SPECIAL SENSE ORGANS :

The special senses are receptors associated with the senses (touch, smell, hearing,
taste, vision &
equilibrium)

Types of Receptors:
1. Chemoreceptors: respond to changes in [chemicals] • Pain receptors:
respond to tissue damage
2. Thermoreceptors: respond to changes in temperature
3. Mechanoreceptors: respond to changes in movement or pressure
4. Photoreceptors: respond to changes in light energy The Eye & Vision

 The organs of sight are the eyes, the eyelids, & the lacrimal apparatus
 The eye orbit contains the above organs & fat, nerves, muscles, & blood
vessels
 The eyelids protect the eye (open & close)
 The conjunctiva is within the eyelids that provides mucous (is a mucous
membrane) to wash the eye.
 The lacrimal apparatus contains the lacrimal gland & a series of ducts that
connect the eye to the nose & throat. This secretes tears.
 This has 2 ducts which collect tears: – Lacrimal sac flows into the: –
Nasolacrimal duct (empties into nasal cavity)
 Tears have lysozymes (enzymes that aid in eye infection prevention)
 There are 6 extrinsic muscles of the eyes, which allow for movements in
all directions.

The Structure of the Eye:

1. The Fibrous Layer (outer layer): –
 The cornea (a transparent, thin layer of epithelium that allows for light
transmission into the eye)
 The sclera which is connected to the cornea (the white part of the eye)
which protects the eyes & is the attachment for the extrinsic muscles
 The optic nerve is in the back of the eye & blood vessels which attaches
to the sclera.

2. The Vascular Layer (middle layer):
 Choroid coat which nourishes the tissues of the eye & provides the
pigment (melanocytes)
 The ciliary body forms the ring around the front of the eye; these hold the
lens (transparent) in place
 The iris (a muscle) is the colored portion of the eye (the lens is directly
behind it) – The pupil is the opening of the eye that responds to light.

3. The Sensory Layer (innermost layer):

197

 The retina which contains the photoreceptors (visual receptor cells). This
is the inner lining of the wall.
 The vitreous humor is the jellylike fluid that maintains the globular shape
of the eyeball; this fills the posterior cavity of the eye.
 The lens is clear & elastic (flexible) meaning it can change its shape to
focus. – This is called accommodation.
 The iris separates the anterior chamber (between cornea & iris) &
posterior chamber (between iris & vitreous body which contains the lens)
of the eye.
 Aqueous humor is the watery fluid in the eye.

There are 2 types of visual receptors: rods and cones.

 Rods: more sensitive to light, provide vision in dim light, produce
colorless vision, & provide general outlines of vision (less precise
images)
 Cones: provide sharp images & detect color.

The Ear: Hearing & Balance:
• The ear is the hearing organ.
• It contains 3 parts: the external, middle & internal parts.

The external ear: 2 parts:
the auricle ( pinna) collects sounds & directs them through the external auditory
meatus
external auditory canal).

The middle ear:
 contains the tympanic cavity
 the eardrum ( tympanic membrane): pressure is changed by the entering
sound waves & reproduces vibrations
 the auditory ossicles (3 small bones:) bridge the eardrum & the inner &
transmit the impulses as they increase the force (amplify) the force of
vibrations.
• Malleus (hammer)
• Incus (anvil)
• Stapes (stirrup)
There is a tube that connects the inner ear to the throat. This is the auditory tube.
• This maintains air pressure on both sides of the eardrum (enables proper
hearing)
• When there is a change in altitude, the pressure of the eardrum is off and
hearing is impaired.
• A popping sound in the ear is the result of pressure equalizing (enabling
hearing)

198

The inner ear:
contains chambers & tubes referred to as a labyrinth. This includes: – 3
semicircular canals which enable equilibrium
– Cochlea which enables hearing
–The Organ of Corti contains the hearing receptors & also contains hair cells.

Equilibrium:
• Static equilibrium is located within the vestibular apparatus. This is the
maintenance & stability of the head when the head & body are still.
• Dynamic equilibrium is the balancing of the head & body during sudden
movement. This is due to the semicircular canals of the ear.

Sense of Smell:
• Olfactory receptors: chemoreceptors; only work when chemicals are dissolved
in a liquid (for
stimulation). Smell & taste work together.
• Olfactory organs: – located in the nasal cavity – contain olfactory receptors –
Contain bipolar
neurons with cilia
• Gases enter the nasal cavity & are dissolved into watery fluids for the
receptors to detect them.
• Odorant molecules are substances that trigger the sense of smell.
• Olfactory receptors adapt quickly.
• Anosmia is the partial or complete loss of smell

Sense of Taste:

• The taste organs are the taste buds.
• These are located on the tongue, roof of the mouth & pharynx.
• They have papillae, tiny elevations that contain the taste receptors; the
cells that respond are
gustatory cells (taste cells).
• These are chemoreceptors & detect chemicals when dissolved in liquids.
• This fluid is provided by the salivary glands
• There are 4 types of taste cells: – Sweet, sour, salty, & bitter

199

BIBLIOGRAPHY:
Microbiology:
Microbiology By Gerard J. Tortora ,
Introduction to Microbiology By (author) Berdell R. Funke ,
Microbiology: An Introduction, Global Edition By (author) Christine L. Case
Lippincott's Illustrated Reviews Microbiology
https://www.amazon.com/Microbiology-Introduction-Gerard-J-
Tortora/dp/0321929152http://www.mypearsonstore.com/bookstore/microbiol
ogy-an-introduction-0134605187
Pharmacology:
Lippincott Illustrated Reviews Pharmacology 6th edition Karen Whalen ..
ESSENTIALS OF PHARMACOLOGY 9th edition 2013 (paramount).
First Aid:
A Pocket First Aid Guide by George E. Dvorchak
https://www.redcross.org/get-help/how-to-prepare-for.
https://www.redcross.org/take-a-class/online-safety-classes
Fundamental of Nursing:
Fundamental of nursing A practical Manual by Lippincott 8
th
edition
https://books.google.com/books/about/Fundamentals_of_Nursing_E_Book.html?id
Fundamentals of Nursing
Patricia Bennett; Lucille Vickerman; Nancy L. Diekelmann; Margaret Shauger

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