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12th Nursing General EM Book 2020
12th Nursing General EM Book 2020
12th Nursing General EM Book 2020
in
GENERAL NURSING
Theory and Practical
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Content Creation
The wise
possess all
II
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Learning List out all the major topics and provide students
objectives: with a clear purpose to focus their learning efforts.
References/ Website Basic raw materials used for the birth and development
links of the text.
III
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Contents
NURSING - GENERAL
Contents
IV
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HUMAN
1 ANATOMY AND
PHYSIOLOGY
Let the physician enquire into the (nature of the) disease, its cause and its method of cure
and treat it faithfully according to (medical rule).
Learning Objectives
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Skin
The human skin is the outer covering
of the body and is the largest organ of the
integumentary system. The main functions are
protection, regulation and sensation.
Hair
Epidermis
Nerve
Dermis
Muscle Schematic view of hair follicle and
Subcutaneous
sebaceous gland
tissue
Sweat Gland
Fat, Collagen, Fibroblasts
Eye lashes protect the eyes
Arteriole
from foreign debris getting into
Cross-section of all skin layers. the eye.
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the skin. They are found under the arms in nutrients and hormones. Blood circulation
the axillary area and perform little function controls the body temperature, the PH or acid
in humans. Sweat glands, are exocrine glands base balance of the body. Circulation fights
secrete a substance that cools the body off against infection, helps in clotting of blood
with perspiration and eliminate wastes. during injury and eliminates waste products
such as carbon dioxide.
Position
The heart lies in the thoracic cavity at the
mediastinum [the space between the lungs].
It lies obliquely a little more to the left than
the right. The apex is about 9cm to the left of
the midline at the level of the 5th intercostal
space and the base extends to the level of the
2nd rib.
Sweat gland
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to supply nutrients to all parts of the body. In the fig - 1.6 shows Red color indicates
This continuous activity uplifts the role of the oxygenated blood carried in arteries. Blue
heart as a vital organ. indicates deoxygenated blood carried in
Blood pumping cycle of the heart is called veins.
as cardiac cycle, which ensure that the blood is
The relationship between the heart and
distributed throughout the body. The oxygen
different types of blood vessels.
distribution process begins when oxygen –free
blood (impure) enters in to the heart through Heart
the right atrium goes in to the right ventricle,
• Aorta
enters the lungs for oxygenation and release
• Arteries
of carbondi-oxide and transfers in to left atrial
• Arterioles
chambers, ready for re-distribution. About 5-6
• Capillaries
liters of blood circulates in the body and cardiac
• Venules
cycles are completed per minute.
• Veins
• Venacava
A healthy heart beats 70 to 75
• Heart
times per minute, each cardiac
cycle, or heartbeat, takes about Arteries
0.8 seconds to complete the cycle. Arteries are the blood vessels that carries
oxygenated blood through out the body. Arteries
Oxygen reloading process occur in two consists of several layers and smooth muscles
phase. The systole is a short period that occurs, that enable them to pump blood throughout the
when the tricuspid and mitral valve close. body after it leaves the heart.
The diastole is a relatively longer period ARTERIES - It has three layers
when the aortic and pulmonary valve close. • Tunica adventica
The systole –disastole relationship is the mean • Tunica media
blood pressure. Other ways of physically • Tunica intima
determining the regular functioning of the
heart is through examining the pulse rate. Arterioles
Blood valve that receives blood from the
Circulatory System
arteries. Those are present next to the arteries
and before the capillaries. Arterioles also have
smooth muscles.
VEINS ARTERIES
VENULES
Capillaries
CAPILLARIES
These are the smallest structure of the
HEART ARTERIOLES
circulatory system. The point at which the
exchange of oxygen and corbon di-oxide
occurs through the thin walls of the capillaries.
Venules
Blood vessels that receive blood from the
capillaries and transport deoxygenated blood
Circulatory system to the veins.
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Veins Platelets
Veins are blood vessels that carry blood Platelets or thrombocytes(do not have
towards the heart. Blood vessels receive blood a nucleus) maintain haemostasis (clotting).
from the venules and transport blood back to Haemostasis is enabled by the coagulation or
the heart. Like arteries, veins, have three layers. thickening of blood by production of fibrin
from the clotting factors found within the
Blood Components platelets to prevent blood loss, when a blood
Blood is a body fluid that consists of: vessel has been broken due to injury.
• Plasma
Lymphatic system
• Red Blood Cells
The lymphatic subsystem, a part of the
• White Blood Cells
circulatory system, is closely aligned with
• Platelets the body’s immune system and removes
excessive fluid from the body. The lymphatic
Plasma
vessels contain lymph including lymphocytes.
Plasma in blood is over 50% of the volume
Lymphatic system also consists of lymph nodes
of blood and over 90% of plasma is water. The
and lymphatic organs. These organs include
main component of plasma is plasma albumin
the thymus gland, spleen, bone marrow
which is a protein that enables and controls
and tonsils. Nodes are found throughout
the osmotic pressure of the blood.
the lymphatic system and they serve to filter
Red Blood Cells (RBC) the blood as it travels throughout the body.
Swollen lymph nodes are a signal of a disease
Red blood cells or erythrocytes are disc
or an infection. Many lymph nodes are found
like in shape. RBCs are enucleated, do not
in the neck area, under the arms and in the
contain a nucleus. The red blood cells contain
groin area, although there are hundreds of
iron laden haemoglobin which carries oxygen
them throughout the body.
to the cells. Red blood cells also contain
glycoproteins which determine the blood Spleen
group of an individual. The blood types are
Spleen is an organ present in the upper
type A, type B, type AB and type O.
left part of the abdomen and to the left side
White Blood Cells of the stomach. The spleen plays multiple
supporting roles in the body. It acts as a filter
White blood cells or leukocytes are part
for blood as part of the immune system. Old
of the immune system which fights against
red blood cells are recycled in the spleen,
infections from pathogens. When the white
platelets and white bloods are stored.
blood cell count rises, it is a sign of infection.
All leukocytes have a distinct nucleus. Diseases related to blood and blood vessels
The various types of white blood cells are: • Phlebitis
• Eosinophils • Deep Vein Thrombosis (DVT)
• Basophils • Anaemia, including pernicious anaemia
and sickle cell anaemia
• Neutrophils
• Leukaemia
• Lymphocytes
• Lymphoma
• Monocytes
• Thrombocytopenia.
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Human Skeleton
Diagram of the front view of the Diagram of the rear view of the
human skeleton. human skeleton.
CRANIUM (8) FACE BONES (14) SPINE UPPER LIMB (64) LOWER LIMB (31)
1 - Frontal bone Lacrimal bone - 2 (Vertebral Column) Clavicle - 1 Hipbone - 1
(Collarbone) Femur -1
2 - Temporal bone Nasal bone - 2 Cervical Vertebrae - 7
Scapula - 1
2 - Parietal bone Cheek bone - 2 Thoracic vertebrae - 12 (Shoulder bone) Patella -1
1 - Occipital bone Curled bone - 2 Lumbar vertebrae - 5 Humerus - 1 Tibia -1
1 - Ethomoid Palate - 2 Sacral Vertebrae - 5 Radius - 1 Fibula -1
1 - Sphenoid Upper Jaw bone - 2 Coccyx - 4 Ulna -1 Tarsals - 7
Lower jaw bone - 1 Carpals - 8 Metatarsals - 5
Vomer - 1 Metacarpals - 5 Phalanges - 14
Phalanges - 14
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5. Cortical bone: the stronger bone that is structures, form the nasal cavity, enclose the
needed for support and movement. eyeballs, and support the teeth of the upper
6. Axial bones: Found in the skull, the ribs and lower jaws. The rounded brain cases
and the spinal column surrounds and protects the brain and house
the middle and inner ear structures.
7. Appendicular bones: found in the
arms,legs, shoulders and the pelvis. In the adult, the skull consists of 22
individual bones, 21 of which are immobile
8. Cancellous bone or spongy bone: not as
and united into a single unit. The 22nd bone
strong as cortical bone.
is the mandible (lower jaw), which is the only
9. Seasmaoid bones: embedded in tendons moveable bone of the skull.
eg. Patella.
The Cranium is made up of eight bones as
The skeleton is compossed of 206 separate follows:
bones in an adult. The cartilages and ligaments Frontal Two frontal bones, which
helps to unite the bones at the joint bone: forms the forehead and helps to
protect eyes
Skull
Parietal One at each side of the top of
The skull is a body structure that forms the
bone: the skull joined into the middle
head. It supports the structure of the face and
Temporal One on each side below the
provides a protective cavity of the face.
bone: parietal bones. These protect
Skull bones the inner parts of the ears and
The skull consists of two parts brains
• The cranium, which is like a box in which Occipital This forms the back of the head
the brain is well protected bone and part of the base of the skull
• The bones of the face One A Butterfly or bat shaped bone,
sphenoid which also forms part of the
base of the skull
Ethmoid Which forms the roof of the
nose and in between the eyes
• Th
e only movable joint in
the skulls is mandible.
• Human beings are the only living
organisms which sleep on their back.
Skull bone
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Two cheek bones – forms the check the coccyx. It is attached to the lower part
Zypomatic bone – of sacrum.
Two zygomatic bones
Upper limbs.
Two upper jaw bones Forms upper jaw.
Upper limb is divided into three regions.
Two Maxilla bones
Its consists of,
Two palatine bones which join with the
• Arm - located between the shoulder and
upper jaw bones
elbow joint.
forming the hard
palate • Fore arm - between the elbow and wrist
joints
Two Nasal concha one in each side of
wall of the nose • Hand - which is located distal to the wrist.
One Vomer bone which rests on the Chest (thorax)
palate and helps to
The rib cage forms the thorax portion of
form the nasal septum
the body. It consists of 12 pairs of ribs with
One Mandible bone It forms the lower their costal cartilage and the sternum. The ribs
jaw and horse shoe are anchored posteriorly to the 12 thoracic
shaped vertebrae. It protects the heart and lungs.
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• Circumduction: The muscular and joint • Pivot joint, e.g. atlantoaxial joint between
movement that entails complete 3600 the atlas and axis – neck
movement • Gliding joint (“Condyloid” joint), e.g.
• Inversion: The turning of a joint inward between radius, scaphoid and lunate
• Eversion: The turning of a joint outward bones – wrist.
• Plantar flexion: Movement of the foot Structural and functional
downward Structural (binding tissue)
• Dorsiflexion: Movement of the foot • Fibrous joint - joint by connective tissue.
upward • Cartilage joint - joint by cartilage
Cartilage • Synovial joint - not directly joined.
Cartilage is an important structural • Facet joint - between two vertebrae.
component of the body. It is less hard than Functional (movement)
bones and more flexible than bones and helps • Synarthrosis means no mobility (skull)
in articulations It protects the ends of the • Amphiarthrosis means slight mobility
bone. It is found in elbows , knees and ankle. (vertebrae)
• Diarthrosis means freely movable (knee)
Cartilage does not have
a blood supply, nerves and Fascia
marrow. A fascia is a band or sheet of connective
tissue, primarily collagen, beneath the skin
that attaches, stabilize, enclose and separates
Tendons
muscles and other internal organs.
A tendon is a tough band of fibrous
connective tissue that usually connects It is classified as
muscle to bone and is capable of withstanding • Superficial fascia
tension. It is made up of collagen.
• Deep fascial fascia
Ligaments • Visceral fascia
A ligament is a short band of tough, • Parietal fascia.
flexible fibrous tissues, tissues that connects
Diseases related to the bone
bones to bone to form a joint. It also maintain
position of the organs. • Arthritis
• Rheumatoid arthritis
Joints
• Osteoporosis
Joint or articulation is the connection
• Osteoarthritis
made between bones in the body which link
• Osteomyelitis
the skeletal system into a functional whole.
• Fractures
Types of Moveable Joints
Functions of musculo skeletal system
• Hinge joint, e.g. interphalangeal joints –
fingers and toes. The human skeleton and the skeletal system
perform several functions.
• Ball and socket joint, e.g. hip and shoulder
joints 1. The protection of the vital organs of the body
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2. The support of the human body which gives The parts of the central nervous system are
it its form and stability the
3. Body movement • Brain
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Cerebrum
The cerebrum is the largest part of the
brain and its lobes coordinate and enable body
movement, sensory perception, learning,
olfactory sense, gustatory sense, optic sense,
auditory sense, memory, thinking, judgment
and communication abilities.
Cerebellum
Brain stem
The brain stem lies at the base of the skull
and between the right and left hemispheres of
the brain.
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• Epilepsy Mouth
• Meningitis The cheeks,tongue and palate frame the
• Paralysis mouth, which is also called oral cavity .its
• Multiple sclerosis boundaries are defined by the lips, cheeks,
• Parkinson’s diseases soft palate and epiglottis. It is divided in to
two sections.
• Alzheimer’s disease
They are
• Bell’s palsy.
• The vestibule- the area between the cheeks
1.6 Gastro Intestinal System and the teeth.
• The oral cavity- filled by the tongue
Introduction
The mouth is the opening through which
The alimentary canal, is a continuous the person ingests food and fluids. Incisors,
hollow tube from the mouth to the rectum. canines, premolar and molars are the types of
The alimentary canal along with the associated teeth helps in mastication
organs like the salivary glands, liver, pancreas
and the gallbladder is called the digestive or Tongue
gastrointestinal system. The primary role of Tongue is one among the five sensory
the digestive system is to supply blood stream organ. It is a muscular structure used for
with nutrients that can be used by the body moving food in the mouth and to swallow
for its fuel, energy and fluid needs. fluid and food. Taste buds are found on the
upper surface of the tongue and the salivary
glands.
Salivary glands
Salivary glands produce saliva which
contains the digestive enzyme amylase.
Amylase digests and breaks down starch into
glucose and maltose.
Pharynx
The pharynx receives air from the nares
or the mouth and it also receives food from
the mouth. When people say that their food
has gone down the wrong pipe, they are
experiencing an abnormal small amount of
Parts of digestive system food moving from the pharynx to the trachea.
The organs that contribute to digestion
Epiglottis
are the tongue, salivary glands, the liver, the
The epiglottis is the flap like projection
gallbladder, and the pancreas. The gallbladder
in the back of the mouth attached to the
and the pancreas secrete and deposit bile and
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other molecules into the urine from the blood Disease related to urinary system
after it is processed by the kidney. • Urinary tract infection
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From the larynx air moves in to the trachea. It received inspired air from the
trachea and down to the intersection that pharynx and passes it to the trachea.
branches to form the right and left primary
bronchi, each of these bronchi, branch in to Trachea
secondary bronchi that branch into tertiary
bronchi that branch in to smaller airways
called bronchioles that eventually connect
with tiny specialized structure called alveoli
that function in gas exchange.
The respiratory system is divided into
the upper and lower respiratory system.
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from the hypothalamus of the brain to all several other glands included in the endocrine
the organs that control the body metabolism, system.
growth and development, reproduction and
also maintain homeostasis. Pineal Gland
The endocrine system regulates its The pineal gland is a small endocrine
hormones through negative feedback. gland that lies close to the hypothalamus,
Increases in hormones activity decrease the performs the coordination of circadian
production of that hormone rhythm (sleep - wake cycle).
Thyroid Gland
The endocrine system consists
of these glands The Thyroid gland shaped like angel
wings on each side of the throat just above the
• Hypothalamus • Pituitary gland trachea, are connected to each other with a
• Pineal gland • Thyroid thin connecting area called the Isthmus.
• Parathyroid • Adrenal glands The Thyroid gland regulates the body’s
• Pancreas • Ovaries metabolism, basal metabolic rate, cardiac
• Testes system’s function, physical growth and sexual
functioning.
NOTE: The Thymus is the only
endocrine gland that does not secrete any
hormones
The Thymus is considered as an
endocrine gland because it plays a role in
the immune system of the body.
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The Pancreas
The pancreas is located behind the
stomach. The islets of Langerhans secrete
glucagon, insulin, pancreatic polypeptide
and somatostatin. The pancreas produces
and releases digestive enzymes and juices
that break down foods as they enter the small Testes and Ovaries
intestine.
Diseases related to endocrine system
NOTE: Pancreas is called as a mixed • Diabetes insipidus
gland since it serves both as an endocrine • Acromegaly
gland and as a digestive organ and • Gigantism
exocrine body.
• Syndrome of Inappropriate Antidiuretic
Hormone Secretion (SIADH)
Testes and Ovaries • Hyperthyroidism
Ovaries and Testes are the endocrine • Hypothyroidism
glands and gonads, which is called as a sex • Cushing’s syndrome
and reproduction glandular structure.
• Addison’s disease
The ovaries produce progesterone,
estrogen, inhibin and androstenedione.
Progesterone regulates menstrual cycle 1.10 Reproductive System
and the preparation of the uterus for the
The role of the male and female
implantation of the egg. Estrogen regulates
reproductive system is to procreate and to
the development of breasts. Inhibin inhibits
provide sexual gratification to the person.
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Labia minora
The labia minora lies just inside the labia
majora and surround the openings to the vagina
and urethra.
The Clitoris
The clitoris lies above the vagina is covered
with a protective cover or hood.
Vestibule
It is a small space or cavity at the beginning
Female Reproductive System of a vaginal canal.
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Urethra
The urethra is an organ common for both
reproductive system and urinary system.
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Cochlea
This is a spiral that is covered in a stiff
membrane. It contains thousands of hair cells
Ear attached to the end of the organ of the auditory
The ear is the organ for hearing. It is nerve called organ of corti. These tiny hairs
divided into three parts. bend because of the vibrations caused by the
• Outer ear-pinna /auricle, auditory canal sound waves.
• Middle ear-ear drum, ossicles, Eustachian The auditory nerve
tube The vibration from the hairs stimulated
• Inner ear- cochlea, vestibule and tiny nerve cells. The nerve cells then send
semicircular canal. signals along the auditory nerve to the brain.
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Tongue
There are two groups of muscles of the
tongue.
1. Four intrinsic - alter the shape of the tongue
and not attached to the bone.
2. Four paired extrinsic muscles- change the Nose
position of the tongue and are anchored to
Olfaction
the bone.
It has olfactory receptor neuron and it is
The tongue upper surface is covered responsible for sense of smell.
by taste buds housed in numerous lingual
papillae. It is responsible for taste. Speech
The normal speech is produced with
Nose pressure from the lungs, this can be modified
The organ of smell is located in the middle using airflow through the nose in a process
of the face. The internal part of the nose lies called nasalization.
above the roof of the mouth.
The nose consists of external nose and
nasal cavity both are divided by the septum into
right and left.
SUMMARY
Integumentary system comprises the skin. Appendages protect the body from various
kinds of damage. Such as loss of water or damages from outside.
It consists of the skin, hair, finger nails, toe nails and other structures including glands.
Heart is the master of cardiovascular system. It pumps out blood to supply oxygen,
electrolytes, nutrients and hormones through out the body.
Blood circulation controls the body temperature, the PH or acid base balance of the body.
Blood pumping cycle of the heart is called cardiac cycle. The heart consists of four chambers,
valve, and three layers of covering.
Heart has three types of circulation like coronary, systemic and pulmonary circulation. It is
considered as a one of the vital organ of the body.
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SUMMARY (CONTD)
The musculo skeletal system is made up of the body’s bones, muscles, cartilage, tendons,
ligaments, joints, and other connective tissue that supports and bind tissues and organs
together.
The primary functions of the system is forming and supporting the body, allowing motion,
and protecting vital organs.
The nervous system is the most complex of all the systems which coordinates controls and
enables all body functions like movement, thinking, autonomic, or automatic, reflexes and
sensory perception.
The nervous system sends messages to all parts of the body and receives it.
The alimentary canal, with the other organs of digestion, is a continuous hollow tube from
the mouth to the rectum.
The alimentary canal along with the associated organs like the salivary glands, liver, pancreas
and the gallbladder is called the digestive or gastrointestinal system.
The stages of digestion are mastication, digestion, and the absorption.
Urinary system also known as the renal system, consist of kidneys, ureters, bladder, and
the urethra.
The purpose of the urinary system is to eliminate the excess water from the body, regulate blood
volume and blood pressure, control and regulate the level of electrolytes and blood PH.
The physiology of urinary system are filtration, reabsorption and secretion.
Respiratory system provides required oxygen to the body, to sustain life and to eliminate
carbon dioxide. The respiratory systems’ work is associated with the heart and lungs. It is
divided into upper and lower respiratory tract.
Air is breathed in through the nose or the mouth. Alveoli plays major role in process of
diffusion .
The endocrine system provides the body with the hormones that are needed to sustain life
and create life. Hypo and hyper secretion of the endocrine glands leads to physiological
problems.
The purpose of reproductive system is to procreate, and to provide sexual gratification to
the person.
Sensory organ responses to external stimuli by conveying impulses through the sensory
neuron to the appropriate places within the sensory nervous system.
The skin is the outer covering of the body and is the largest organ of the integumentary
system. The main functions are protection, regulation and sensation.
The eye is a sensory organ. It absorbs light rays from our environment and transforms them
in such a way that the information in the brain can be processed further.
The ear is the organ for hearing. The ear can be divided into outer and inner ear. Inner ear
plays major role in conduction of sound waves.
Tongue is a muscular organ situated in the floor of the mouth. It is associated with the
function of taste, speech, mastication, and deglutination.
Nose is the organ of smell located in middle of the face. The internal part of the nose lies
above the roof of the mouth.
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GLOSSARY
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Athlete’s foot - Also referred to as tinea pedis (foot), it is a fungal infection of the
feet
Sunburn - Burning of the skin as the result of exposure to the sun
Albinism - Defective melanin that causes an abnormal coloration of the skin and
hair
Herpes - A viral infection
Impetigo - A contagious skin condition that appears as a rash on the skin
Psoriasis - Thick skin surface as the result of an abnormal buildup of cells on
the skin surface
Rosacea - A skin disorder that causes redness and skin break outs
Ligaments - Connective tissue with collagen at the point of articulation
Tendons - Connective tissue with collagen that allow joint movement
Fascia - Connective tissue that connects muscles to other muscles
Fractures - The breakage of a bone
Greenstick fracture - A fracture that occurs when only one side of the bone is fractured
Dislocation - The joints are completely separated and are no longer articulated
and connected with each other
Arthritis - One of the many types of skeletal disorders that is characterized
with the inflammation of one or more skeletal joints in the body
Rheumatoid arthritis - A type of arthritis that affects the younger population, auto
immune disorder
Osteomyelitis - An infection of bone tissue
Glial cells - A type of nervous system cell, other than a neuron, that forms
myelin which is the covering or sheath over parts of the neuron
Synapse - The point at which neurons gently touch each other to send or
receive a nerve impulse or message.
Meninges - The protective membrane that covers the brain and the spinal
cord
Brain - The major organ of the body that controls and manages virtually
all physiological and emotion bodily responses
Pons - The mid-section of the part of brain stem that connects to the midbrain
above and the medulla below and the part that controls the rhythm of
respirations
Reflex - A muscle reaction that automatically occurs in response to a
certain type of stimulus, or stimulation
Seizures - Abnormal nervous system nerve activity in the brain that can lead
to a wide variety of signs and symptoms including uncontrolled
body movement and jerking or a short lapse of consciousness
Stroke - An episode of bleeding or a clot in the brain that causes
symptoms and damage to the brain and its functioning
Epilepsy - A group of disorders that lead to seizures
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Paralysis - The neurological loss of function to one or more parts of the body
Parkinson’s disease - A chronic and progressive disorder of the nervous system that
can lead to disability
Alzheimer’s disease - A progressive degenerative form of dementia
Bell’s palsy - A disorder of the facial nerve that adversely affects the face and
the muscular movements of the face
Neuralgia - Pain originating from a nerve or group of nerves
Procreate - To give life to a new person
Salpinges - An alternative name for the fallopian tubes
Fimbria - The hair like fringes of the fallopian tubes nearest to the ovaries
Vaginitis - Infection of the vagina and vaginal vault
Cystocele - The collapse of the urinary bladder into the vagina
Rectocele - The pushing of the rectum and part of the large intestine against
the vaginal wall
Nares - The nostrils of the nose
Pneumonia - An inflammation and infection of the lungs
Emphysema - A disorder characterized with an inability to expel air from the alveoli
Bronchitis - An inflammation and infection of the bronchi
Asthma - A lung inflammation that makes the work of breathing more difficult
Chronic obstructive - A chronic lung disorder that consists of chronic bronchitis and/or
pulmonary disease emphysema
(COPD)
Influenza or the “flu” - n acute inflammation and infection that can adversely affect the
A
lungs and respiratory functioning
Tuberculosis - A serious lung infection that is contracted with a bacillus
pathogen
Laryngitis - An inflammation and infection of the larynx
Pharyngitis - An inflammation and infection of the pharynx
Dyspnea - Difficulty breathing
Erythropoietin - The substance that is needed for the production of red blood cells
Vasopressin - An alternative name for antidiuretic hormone
Micturition - The synonym for urination or voiding
Urolithiasis - A kidney stone or calculi
Renal cysts - Infections in the kidney
Glomerulonephritis - Inflammation of the glomeruli of the kidneys
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Evaluation
I. Choose the best answer. 9. The point at which the exchange of oxygen
1. The largest organ of human body is and carbon dioxide occurs
2. Sweat glands are a part of 10. The red colour of blood is due to the
presence of
a. skeletal system
b. integumentary system a. hemoglobin b. erythrocin
c. urinogenital system c. xanthophyll d. rhodopsin
d. circulatory system 11. Thymus gland is a part of
3. _______ protect the eyes from foreign a. muscles b. lymphatic system
debris getting into the eye c. skin d. inner ear
a. eye brows 12. 90% of plasma consists of
b. eye lids a. protein b. sugar
c. eye lashes c. water d. salt
d. fore head
13. Red blood Cells contains
4. The finger and toe nails a. a prominent nucleus
are made of b. a dormant nucleus
a. chitin b. protein c. a pronucleus
c. insulin d. keratin d. no nucleus
5. There are no sebaceous glands in 14. Hemostasis is aided by
a. palms and sole of the feet a. thrombocytes b. leucocytes
b. palms alone c. erythrocytes d. granulocytes
c. sole of the feet alone
15. Adult human has
d. all are wrong
a. 206 bones b. 216 bones
6. Sweat glands are c. 226 bones d. 236 bones
a. endocrine glands
b. eccrine and apocrine glands 16. Malleus Incus and Stapes are
c. eccrine glands a. bones b. ear ossicles
d. apocrine glands c. tarsus d. carpals
7. _______ is the master of circulatory system 17. Sternum is a _____
a. brain b. kidney a. leg bone b. hand bone
c. heart d. liver c. breast bone d. hip bone
8. The blood vessels that carry oxygenated 18. The building blocks of bones are called
blood throughout the body are a. osteocytes
a. veins alone b. melanocytes
b. both arteries and veins c. thrombocytes
c. arteries alone d. leucocytes
d. all are correct
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41. Larynx in males are also called as Answer The Following Questions
a. Eve’s apple 1. Illustrate the structure of sebaceous glands
b. Guyton’s apple and label the parts
c. Newton’s apple 2. Briefly write about the layers present in the
d. Adam’s apple skin
42. Alveoli are the 3. Write short notes on lymphatic system
a. air sacs b. water sacs 4. What are the types of leucocytes?
c. water bags d. hairs in lungs 5. What are the functions of platelets?
43. Adults breathe ____ times in a minute 6. Briefly write about the structure of bone
a. 20-24 b. 16-20 7. Other than bones, what are the other tissues
c. 12-16 d. 18-22 and structure of musculo skeletal system?
8. Illustrate and briefly write about the
44. COLD is expanded as structure of a neuron
a. child of limited dystrophy 9. Write about peripheral nervous system
b. city old lantern dialling 10. What are the functions of small intestine?
c. chronic obstructive lung disease
11. What are the internal organs of male
d. children of lifetime diseases
reproductive system?
45. Human urine majorly consists of 12. Substantiate kidney as an organ
a. uric acid b. ammonia 13. Illustrate the structure of larynx
c. nitrogen d. urea 14. What is respiratory cycle?
46. Kidneys are _______ shaped 15. Draw and explain the structure of nephron
a. pearl b. bean
Write In Detail
c. triangle d. spherical
1. Explain the arrangement of integumentary
47. The inner layer of kidney is called the
system and in its functions
a. lamella b. cortex
2. Illustrate and explain the structure and
c. medulla d. glabella
function of human heart
48. _______ is performed in case of kidney 3. Classify human bones
failure
4. Illustrate and explain the structure of
a. paralysis b. haemolysis human brain
c. plamolysis d. dialysis
5. What are the different stages of digestion?
49. Antidiuretic hormone controls the amount 6. Illustrate and explain the structure of
of water in human ovaries
a. blood b. urine 7. List down the endocrine glands and the
c. sweat d. tears corresponding hormones secreted by it.
50. Polyuria is 8. Explain the structure and function of
a. frequent urination Thyroid gland
b. excess urination 9. Illustrate and explain the structure of
c. less urination human lungs
d. blood in urine 10. Explain the structure and function of
kidneys
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HUMAN ANATOMY
ICT CORNER
Through this activity you will
be able to learn the structure
of human
Steps
• Step 1: Type the URL link given below in the browser or scan the QR code.
• Step 2: Click on the name of the organ system you want to learn. A new page with
a diagram on the right side and list of parts on the left side will open.
• Step 3: You can further explore detailed information of a particular part by clicking
either the part on the diagram or part name fom the list given.
• Step 4: You can browse back to the previous page or to the home page and learn
more about the other systems.
URL : https://www.innerbody.com/htm/body.html
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CHAPTER
2
CHAPTER Medical Surgical and
APPLIED
3
Nursing Management
PSYCHOLOGY
of Human Diseases
Learning Objectives
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Scabies Management
Definition Medical management: Tropical application
Scabies is an infestation caused by itch • Permethrin 5 % Cream/lotion
mite due to poor personal hygiene. • Benzyl Benzoate 10 – 25% lotion
• Crotamition 10% ointment
Causes
• Lindane 1% lotion/cream
• Infestation by the itch mite otherwise
• Oral medication according to the severity.
called as Sarcoptes Scabiei”
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Triggers
Food: Whole milk, citrus fruits, gluten and
fatty foods.
Psoriasis is one of the commonest skin Drugs: Lithium, Non Steroidal Anti-
disorders. Psoriasis is a chronic autoimmune Inflammatory Drugs (NSAIDs), malaria drugs,
skin disease. In auto immune disease immune beta-blockers, tetracycline etc.
system of our body attacks our own tissues, Weather: Excess sun exposure, Cold, dry
which leads to the rapid build-up of skin weather
cells and causes scaling on the skin’s surface.
Psoriasis may begin at any age, but most Infections
diagnoses occur in adulthood. The average Others: Alcohol, Smoking, Stress, Obesity,
age of onset is between 15 to 35 years old. Scratches, bites and Skin injury.
According to the World Health Organization
(WHO) some studies estimate that about 75 Risk Factors
percent of psoriasis cases are diagnosed • Family history
before age 46. • Viral and bacterial infection
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• Oliguria Complications
• Nacturia • Intractable heart failure
NORMAL HEART ENLARGED HEART • Cardiac arrhythmias
• Myocardial failure
• Cardiac arrest
• Pulmonary infraction
• Pneumonia
Prevention
Lifestyle changes can help to prevent
The difference between the normal and heart failure include:
enlarged heart • No smoking
• Controlling certain conditions, such as
Diagnosis
high blood pressure and diabetes
• Echocardiography.
• Staying physically active
• ECG
• Eating healthy foods
• X-ray chest
• Maintaining a healthy weight
• Blood test
• Reducing and managing stress
• Cardiac catheterization
• Arterial Blood Gas analysis (ABG)
2.4 Fracture
Management
Bone fracture is
• Pharmacologic therapies include the
a medical condition
use of diuretics, vasodilators, inotropic
where the continuity
agents, anticoagulants, beta-blockers.
of the bone is
• Invasive therapies for heart failure broken. A significant
include electro physiologic intervention percentage of bone
• Cardiac resynchronization therapy fractures occur
(CRT) because of high force
• Pacemakers impact or stress. A
• Implantable cardioverter-defibrillators fracture caused by
(ICDs); revascularization procedures medical conditions which weakens the bone
(e.g Osteoprosis) is known as a pathological
Nursing management
fracture. A crack (not only a break) in the
• Provide comfortable bed bone is also known as a fracture. Fractures
• Oxygen administration can occur in any bone in the body.
• Start Intra Venous (IV) line
• Vital signs Definition
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4. May have vague complaints related to aging It’s often called “the silent killer” because it
process (Stiffness pain, weakness) can be asymptomatic for many years, and
5. Estrogen deficiency may be noted. people suffering of this problem can have a
sudden fatal heart attack
Diagnosis
1. X-ray Definition
2. Scan to measure Bone Mineral Density Hypertension(High Blood Pressure (BP))
(BMD). is a disease of vascular regulation in which the
3. Bone density scanning uses a type of X-ray mechanisms that control arterial pressure with
technology known as Dual-Energy-X- in the normal range are altered. (The systolic
ray Absorptiometry (DEXA) and bone pressure is above 140 mm Hg and the diastolic
densitometry. pressure is above 90 mm Hg).
4. Serum Calcium phosphate Classification of Blood pressure for adults
5. Serum bone matrix Glaprotein is elevated. Blood pressure
6. Bone biopsy shows thin porous. SBP* DBP*
classification
(mm of hg) (mm of hg)
(BP)
Nursing Management Normal <120 <80
• Adequate intake of calcium and Vitamin D. Prehypertension 120-139 80-89
• Major food sources are dairy products egg Stage 1-
140-159 90-99
yolks, fish and liver. hypertension
• Weight bearing exercise Stage 2-
≥160 ≥100
• Hormone Replacement Therapy (HRT) hypertension
• Prevention of falls. DBP: Diastolic blood pressure
• Encourage exercise for all age groups. SBP: Systolic blood pressure
• Provide dietary education for daily intake
of calcium and Vitamin D. Causes
• Encourage young woman at risk to • Increased Cardiac output
maximize bone mass through nutrition • Excessive dietary sodium intake
and exercise.
• Endocrine disturbances
Complications • Medications like Antidepressant steroids.
• Fractures • Stroke
• Kyphosis, loss of height
Risk factors
• Chronic back pain
• Age between 30-70
2.6 Hypertension • Diabetes Mellitus
• Metabolic syndrome
Worldwide prevalence is projected to
• Over weight
increase from approximately 1.0 billion in
• Family history
2000 to 1.5 billion by 2025. It is a major,
independent risk factor for cardiovascular • Smoking and alcohol
disease (CVD), and the chief risk factor for • Sedentary lifestyle.
stroke (accounted for about 62% of strokes).
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Signs and Symptoms • Advice low fat and low cholesterol diet
• Usually asymptomatic • Vital signs.
• Head ache and dizziness, Blurred vision • Advice life style modification
• high BP • Regular follow up
• Confusion Complications
• Shortness of breath • Myocardial infarction (MI)
• Nose bleeds
• Heart failure
• Chest pain
• Renal failure
• Irregular heart beat
• Stroke, hemorrhage
Diagnosis • Retinopathy
• BP measurements.
• ECG 2.7 Stroke (Cerebrovascular
• Chest X-ray Accident)
• BUN (Blood urea nitrogen) test and
Stroke occurs when there is an ischemia
creatinine levels
(inadequate blood flow) to a part of the brain
• Proteinuria
or hemorrhage into the brain that results
• Urine (24-hours) for catecholamine’s in death of brain cells. Functions such as
• Renal scan to detect renal vascular movement, sensation, or emotions that were
diseases controlled by the affected area of the brain are
lost or impaired. The severity of the loss of
Management
function varies according to the location and
• Lose weight extent of the brain involved. Following the
• Avoid alcohol onset of a stroke, immediate medical attention
• Regular aerobic exercise is crucial to reduce disability and death.
• Lower sodium intake (2.4 gram or less per
day) Definition
• Stop smoking Stroke or Cardiovascular Accident (CVA)
• Reduce cholesterol and trans fat diet is the onset and persistence of neurologic
Drug therapy dysfunction lasting longer than 24 hours and
• Diuretics resulting from disruption of blood supply to the
brain.
• Beta-adrenergic blockers
• Alpha-receptor blockers Types and Causes
• Central alpha agonists
Ischemic Stroke : About 80 percent of
• Peripheral adrenergic agents
strokes are ischemic strokes. A stroke may be
• Angiotensin converting enzyme (ACE)
caused by a blocked artery (ischemic stroke)
inhibitors
• Thrombotic stroke: A thrombotic stroke
Nursing management occurs when a blood clot (thrombus) forms
in one of the arteries that supply blood to
• Provide comfortable bed
brain. A clot may be caused by fatty deposits
• Measuring monitoring and charting BP.
(plaque) that build up in arteries and cause
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Management Complications
• Pharmacotherapy - Anti-Epileptic Drugs • Difficulty learning.
selected according to seizure type. • Aspiration pneumonia
• Surgery–operations (temporal lobectomy, • Injuries from falls, bumps, and self-
extratemporal resection, corpus inflicted bites.
callosotomy, hemispherectomy)
Self-care at home for epilepsy
• Vagal nerve stimulation anterior thalamic
stimulation • Loosen any tight neckwear.
• A ketogenic diet • Turn the person on his or her side.
• Do not hold the person down or restrain
Nursing Management the person.
• Establish airway • Do not place anything in the mouth or
• Maintain blood pressure (BP). try to pry the teeth apart. The person is
not in danger of swallowing his or her
• Monitor vital and neurologic signs on a
tongue.
continuous basis.
• Observe seizure characteristics – length,
• Administer oxygen–there is some
type of movements, and direction of
respiratory depression associated with
head or eye turning. These characteristics
each seizure,
may help the doctor diagnose the type of
• Establish I.V. lines, and keep open for
seizure.
blood sampling, drug administration, and
infusion of fluids.
• Administer I.V. anticonvulsant slowly to 2.10 Gastric Ulcer
ensure effective brain tissue and serum
concentrations.
• Monitor the patient continuously;
depression of respiration and BP induced
by drug therapy .
• Determine (from family member) if there
is a history of epilepsy, alcohol/drug use,
trauma, recent infection.
• Counsel patients with uncontrolled
seizures about driving or operating
dangerous equipment. Gastric ulcers are open sores within the
• Assess home environment for safety lining of the stomach. Stomach ulcers (gastric
hazards in case the patient falls, such as ulcers) are a type of peptic ulcer, meaning
crowded furniture arrangement, sharp having to do with acid. Because of the amount
edges on tables, glass. Soft flooring and of acid present in the stomach and the damage
furniture and padded surfaces may be that can occur, they are often extremely
necessary. painful. Although gastric ulcers can occur
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in any portion of the stomach, they are most • Anemia (symptoms can include tiredness,
commonly found on the lesser curvature close shortness of breath, or paler skin)
to the antral junction. • Dark, tarry stools
• Vomit that’s bloody or looks like coffee
Definition grounds
Causes
The most common cause of stomach ulcers is
• Helicobacter pylori, or H. pylori infection.
• Ulcers may also be caused by overuse of
painkillers, such as aspirin (Bayer), and
other nonsteroidal anti-inflammatories Diagnosis
(NSAIDs) • Barium Meal Study
Risk Factors • Routine blood test
• Alcohol • Oesophago Gastro Duodenoscopy (OGD)
• Burns Ulcer appear with or without slough or
• Cigarette Smoking bleeding in their typical locations.
• Drug induced NSAID • Gastric secretary Studies.
• Emotion / Stress • Serology to test for H.pylori.
• Family history • Breath test to detect H.pylori.
• Gastritis
• Hyperchlorohydria General Measures
• Injection of toxins • Avoid use of NSAID drugs.
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• Billroth II Gastrectomy: Here the • Other factors such as smoking, stress and
gastrectomy is done below the ulcer and drinking heavily may possibly increase
remant of the stomach is unastomosed to the risk of having a duodenal ulcer.
a jejunal loop. • Genetic causes family history of duodenal
ulcer.
Nursing Management
• Hyper secretion of stomach acid
• Take vital signs and BP.
• Promote healthy life style. Risk Factors
• Blood group ‘O’
Complications
• Alcohol
• Gastric Perforation, haematemesis,
• Smoking stress
melaena
• Gastric Outlet Obstruction (GOO) Signs and Symptoms
• GI haemorrhage • Pain in the upper tummy (abdomen) just
below the breastbone (sternum) is the
2.11 Duodenal Ulcer common symptom food intake may releive
the pain
Duodenal ulcers account for about 80% of • Pain may flare at night
all peptic ulcers. Approximately 10% of men
• Weight gain
and 5% of women at some time in their lives
will experience a duodenal ulcer. Duodenal • Vomiting
ulcers may occur at any age, but the incidence • Hemorrhage
is especially high between 35 and 45 years of • Haematemesis
age. Duodenal ulcers can develop in anyone,
regardless of occupation or socioeconomic Diagnosis
group. Although many factors are associated as same as gastric ulser
with the development of duodenal ulcers, H.
Pylori has been identified as playing a key Management
role. H. Pylori is found in approximately 90%
• Change in Lifestyle
to 96% of patients with duodenal ulcers.
• Lose weight.
Definition • Avoid any trigger foods.
Duodenal ulcer: A crater (ulcer) in the • Eat smaller meals and eat your evening
lining of the beginning of the small intestine meal 3-4 hours before going to bed.
(duodenum). • Stop smoking.
• Stop alcohol consumption.
Causes
• Acid-suppressing medication
• Infection with Helicobacter pylori (H. • A Proton Pump Inhibitor (PPI) -90-95% of
pylori) healing within 2-4 weeks.
• Anti-inflammatory medicines are • H2 receptor blockers for 6 weeks.
sometimes called non-steroidal anti
• Triple drug rigimens are used to treat
inflammatory drugs (NSAIDs).
H.pylori infection.
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camera. The recovery is faster and patient • Fluid in the abdomen, or ascites
can be discharged on the next day. • Abdominal surgery
• Open cholecystectomy is performed • Obesity
when laparoscopic cholecystectomy is not
possible. Open surgery causes more pain Types
and recovery time in hospital is around a
Inguinal hernia: Intestines push through
week.
the inguinal canal.
• Extra Corporeal Shock-Wave Lithotripsy
Incisional hernia: Resulting from an
(ECSW)
operated site.incision
Supportive Management Hiatal hernia: Part of the stomach
• Intravenous fluids administration protrudes up through the diaphragm into the
chest cavity.
• Nasogastric tube suction
Umbilical hernia: A part of the
• Pain management
bowel protrude through the belly button
• Antibiotics (umbilicus).
Complication Congenital diaphragmatic hernias is
• Cholangitis a birth defect in which there is an abnormal
opening in the diaphragm.
• Necrosis
Sports hernia is a tear or strain of any
• Gallstoneileus leads to intestinal
tissue in the lower abdomen or groin due to
obstruction
gym activity.
A hernia occurs when an organ pushes • Swelling in the abdomen or in the groin
through an opening in the muscle or tissue that which disappears when lying down.
holds it in place. • Pain on palpation
• Vomiting
Definition • Feeling of weight in the abdomen.
Hernia is a localized bulge in the abdomen • Constipation
that occurs when there is a weakness in the • Discomfort in the abdomen or groin when
muscular wall. coughing, lifting a weight or bending over.
• Fever
Causes • Upper abdominal pain
• Congenital - failure of the abdominal wall • Chest pain
to close.
Diagnosis
• Age – after 60 years
• History collection
• Chronic cough
• Physical examination
• Pregnancy - which puts pressure on the • Abdominal X-rays
abdomen • Complete blood count, electrolytes.
• Constipation • Ultrasonography of the abdomen
• Lifting heavy weight • CT abdomen
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Management Causes
Non Medical: Abdominal binder • Straining during bowel movements
• Sitting for long periods of time on the
Surgical management:
toilet
• Herniorrhaphy
• Chronic diarrhoea or constipation
• Hernioplasty
• Obesity
Nursing management • Pregnancy
• Provide trendelenburg’s position
• Administer stool softners Types
• Internal haemorrhoids - inside the
Inguinal hernias are the rectum.
most common type of hernia • External haemorrhoids - around the anus.
Symptoms
Prevention
• Painless bleeding during bowel
• Stop smoking movements
• Avoid developing a persistent cough
• Itching or irritation in anal region
• Maintain appropriate body weight for the
• Pain or discomfort
age.
• Avoid straining during bowel movements • Swelling around the anus
• Lift objects with knee flexion and not with
Diagnosis
hip flexion.
• Heavy lifting should be avoided for 4 to 6 • Digital rectal examination - to detect
weeks after treatment. the unusual growths.
• Inspection - examine the lower portion of
Complication
the colon and rectum with proctoscope
• Strangulation: reduced blood supply to a • Colonoscopy to examine the entire colon
herniated organ.
• Obstruction: the bowel contents may no Management
longer be able to pass through the herniated • Home remedies
area, leading to cramps, the absence of • Eat high-fibre foods (fruits, vegetables and
defecation and vomiting. whole grains.)
• Recurrence hernia • Increase fluid intake
• Use topical ointment
2.14 Haemorrhoids (Piles)
• Sitz bath for 10 to 15 minutes, two to three
Haemorrhoids, also known as piles are times a day.
swelling containing enlarged blood vessels • Keep the anal area clean.
found inside or around the rectum and anus. • Apply ice packs or cold compresses on anus
to relieve swelling and pain
Definition
Medical management
An abnormal mass of dilated and
engorged blood vessels either internally in • Lidocaine that can relieve pain and
the anal canal or externally around the anus itching
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Causes
• Airborne substances, such as pollen, dust
mites, mold spores, pet dander or particles Stress Bugs
of cockroach waste
• Respiratory infections, like common cold
• Physical activity Anger Cool Air
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Diagnosis
The more ozone you breathe,
Tests to measure lung function
the greater the likelihood of
• Spirometry. This test estimates the developing asthma.
narrowing of your bronchial tubes
• Peak flow. A peak flow meter is a simple device
that measures how hard you can breathe out. 2.18 Chronic Obstructive
• Skin testing to identify causative allergens Pulmonary Disease (COPD)
• X-ray chest
Chronic Obstructive Pulmonary
Medical management Disease (COPD) is an umbrella term used to
• Antibiotics describe progressive lung diseases including
• Immunotherapy emphysema and chronic bronchitis.
• Corticosteroids. Definition
• Bronchodialators COPD is a obstructive lung
Nursing management disease characterized by long-term breathing
problems and poor airflow.
• Assess the airway of the patient
• Assess the skin turgor for dehydration Causes
• Patient room should be free of respiratory • Cigarette smoking
irritants
• Indoor air pollution
• Exposure to fumes from burning wood
Lifestyle and home remedies
• Chronic respiratory infections
Avoid triggers
• Allergy autoimmunity
• Maintain optimal humidity. • Occupational exposure
• Reduce pet dander. • Hereditary and genetic factors
• Change the bed linen once in a week. • Alpha-antitrypsin deficiency
• Cover the nose and mouth during cold season.
Signs and Symptoms
Stay healthy
• Dyspnea Shortness of breath,
• Exercise regularly.
• Chronic coughing,
• Maintain a healthy weight.
• Wheezing,
• Control heartburn and Gastro Esophageal
• Chest tightness
Reflux disease (GERD).
• Production of thick, gelatinus sputum
Alternative medicine
• Acute or chronic reparatory failure,
• Breathing exercises.
• Weight loss,
• Herbal and natural remedies includes black
• Respiratory insufficiency,
cumin seeds.
• Tachypnea,Fatigue,Peripheral edema
Prevention
• Get vaccinated for influenza and 2.18.4 Diagnosis
pneumonia. • Lung (pulmonary) function tests
• Avoid asthma triggers • Spirometry
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• Chest X-ray
• CT scan Incidence of COPD is
9/1000 per year globally with a
• Arterial blood gas analysis
higher incidence in males and
Medical Management in smokers.
• Inhaled Bronchodilators
• Anticololinergic 2.19 Diabetes Mellitus
• Antibiotics
• Corticosteroids nebulization Diabetes mellitus is a chronic disease
caused by inherited and /or acquired deficiency
• Methylxanthines
in production of insulin by the pancreas, or
• Digitalis – to treat LVF, if present
by the increased insulin resistance such a
• Mucolytics eg: potassium iodide,
deficiency results in increased concentrations
guaifenesin
of glucose in the blood, which in turn damage
• Immunization many of the body's systems, in particular the
• Oxygen therapy blood vessels and nerves.
• Chest physiotherapy
Definition
Surgical management
The term Diabetic mellitus describes
• Lung volume reduction surgery a metabolic disorder of multiple etiologies
• Lung transplantation characterized by chronic hyperglycemia with
disturbance of carbohydrate fat and protein
Prevention metabolism resulting from defects of insulin
• Avoid cigarette smoking and other inhaler secretion, insulin action or both.
irritants.
Types
• Control of environmental temperature and
humidity • Type 1
• Proper nutrition and adequate hydration • Type 2
• Pneumococcal vaccination • Prediabetes
• Gestational diabetes
Nursing management:
• Eliminate pulmonary irritants like cigarette Type 1 diabetes/Insulin dependent/ Diabetes
smoking mellitus (IDDM)
• Train and monitor patients inhaler using Type 1 diabetes is also referred to as
techniques Juvenile diabetes Mellitus. It results from
• Restrict sodium destruction of pancreatic β cells which
• Encourage relaxation exercises produce insulin leading to absolute insulin
deficiency.
Complications
• Respiratory infection. Etiology
• Respiratory failure • Viral
• Right side heart failure
• Autoimmune
• Pneumonia.
• Environmental factors.
• Depression
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• Obesity Management
Prediabetes Type 1
Slight elevation of blood glucose levels, • Maintain and control sugar level
regarded as indication that the person is at • Insulin therapy
risk of progressing to Type 2 diabetes. • Healthy life style – exercise and diet.
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Nursing management the neck, below the larynx (the voice box).
The main hormone secreted by the thyroid is
• Monitoring blood glucose.
Thyroxin, (T4) and Triiodothyronine (T3).
• Administering antidiabetics/insulin.
• Foot care. Definition
• Monitoring for hyper/hypoglycemia.
Inadequate secretion for thyroid hormone
• Offering snacks at bedtime if permitted. during fetal and neonatal development,
• Lifestyle management resulting in retardation of growth and mental
Prevention development in children and adults.
Causes of hypothyroidism
• Iodine deficiency
• Lithium therapy
• Autoimmune disease
• Surgical removal of the thyroid
Complications of uncontrolled • Radiation treatment
diabetes • Overdose of anti-thyroid drugs
Diagnosis
Blood test for Thyroid-Stimulating
Hormone (TSH) T3 and T4.
• Elevated TSH level
• elevation of cholesterol level
• Hypoglycemia • Electro cardio gram (ECG)
• Macroangiopathy
• Peripheral Neuropathy Management Medical
• Micro angiopathy • Replacement of thyroid hormone
• Autonomic Neuropathy
Side effects of thyroid harmone
• Diabetic Keto acidosis (DKA)
• Headache.
• Shaking and trembling of arms and feet.
2.20 Hypothyroidism
• Nausea and Vomiting.
The thyroid is a butterfly-shaped • Diarrhea.
endocrine gland located in the lower front of
• Abdominal cramps.
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• Facilitate improved coping. nearly every tissue in the body. The growth
• Enhance client knowledge about of new capillaries into the inert material
hyperthyrodism (exudates or thrombus), the migration
of macrophages and the proliferation of
Dietary management fibroblasts resulting in fibrosis.
• Iodized salt.
Definition
• Vitamins or supplements that contain
iodine Pathological accumulation of
extracellular matrix (ECM) proteins resulting
• Milk or other dairy products including ice
in fibrosis or scarring and thickening of the
cream, cheese, yogurt and butter.
affected tissue.
• Seafood including fish, shellfish.
• Herbal supplements. Causes
• Unknown
Foods to be included
• Radiation
• Non-iodized salt. • Cigarette smoke
• Coffee or tea (without milk or dairy- or • Chemicals
soy-based creamers) • Chronic alcoholism
• Egg whites. • Occupational hazards (silicosis,
• Fresh or canned fruit. asbestosis)
• Unsalted nuts and nut butters. • Chronic infection
• Breads made without salt, dairy, and • Fatty liver disease
eggs. • Hepatitis B or hepatitis C.
• Popcorn with non-iodized salt. Types
• Oats.
• Lung fibrosis or pulmonary
fibrosis - occurs as a result of long
Women are 4-7 times more standing infections such as tuberculosis
likely to have THYROID disorders or pneumonia.
than men • Cirrhosis of liver refers to the scar tissue
and nodules that replace liver tissue that
Complication disrupt liver function.
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Definition • Cryosurgery
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Types
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Definition Diagnosis
Hydrocele is a collection of excessive fluid • History.
in the tunica vaginal sac. • Physical examination
• Ultrasound.
Types
• Blood and urine tests to check for
1. Vaginal Hydroceleoccurs when underlying infection.
hydrocele sac in patient only in the scrotum.
2. Infantile Hydrocele The sac from the Management
scrotum in patient upto the deep ingunial
• Lord/s Plication is indicated in small
rings
hydrocoeles. The sac is opened and the
3. True congenital Hydrocele The scrotal sac cut edge of the sac is plicated to tunica
communicates with peritoneal cavity. albuginea.
4. Hydrocele of canal of Nuck: It presents • Partical excision and eversion of the sac:
as a smelling in the inguinal region in Jaboula’s operation
female. • Aspiration-is a temporary method.
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Nursing management
Though hydroceles are
• Teach about the hydrocele bandage
associated with males, it can
• Teach coping techniques
occur in females too. It is termed
Complications as Hydrocele of canal of nuck. Most cases
of hydrocele, which are present from the
• Infection
birth, resolve within the first year.
• Inguinal hernia.
• Haematocoele
• Pyocoele
GLOSSARY
Dyspnoea (மூச்சுத்திணறல்) Difficulty in breathing.
Expectrant சளி (expulsion of mucus)
Dyspnoea மூச்சு திணறல் (difficulty in breathing)
a gland surrounding the neck of the bladder in
Prostate விந்துப்பை male mammals and releasing a fluid component
of semen.
Hyperplasia மிகைப்பெருக்கத்தில் the enlargement of an organ or tissue
Pee சிறுநீர் urine.
Kidney Stone சிறுநீரக கல் a hard mass formed in the kidneys
a swollen vein or group of veins in the region of
Hemarrhoid மூலநோய்
the anus.
a blood clot formed in situ within the vascular
Thrombus இரத்த உறைவு
system of the body and impeding blood flow.
a slipping forward or down of a part or organ of
Prolapse இறக்கம்
the body.
a compact mass of a substance, especially one
Lump கட்டி
without a definite or regular shape.
Topical மேற்பூச்சு applied directly to a part of the body.
the surgical procedure of tying a ligature tightly
Ligation கட்டுக்கட்டுதலுக்கு around a blood vessel or other duct or tube in the
body.
prevent circulation of the blood supply through
Strangulated நெரித்து (a part of the body, especially a hernia) by
constriction.
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Evaluation
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16. One of the symptoms of hypothyroidism is 25. The risk factors for type 1diabetes include
a) Intolerance to cold all of the following except
b) Hair loss a) Diet b) Genetic
c) All of the above c) Autoimmune d) Environmental
17. A person with untreated hypothyroidism 26. Prediabetes is associated with all of the
may also suffer from_________ following except
a) High cholesterol a) Increased risk of developing type 2
b) Low blood pressure diabetes
c) Low blood sugar b) Impaired glucose tolerance
d) None of the above c) Risk of heart disease and stroke
18. How is hypothyroidism treated? 27. Risk factors for type 2 diabetes include all of
a) With radiation the following except
b) With surgery a) Advanced age b) Obesity
c) With a synthetic hormone c) Smoking d) P h y s i c a l
d) The condition can't be treated inactivity
19. Where is the thyroid gland located? 28. Untreated diabetes may result in all of the
a) At the base of the spine following except
b) Neck a) Blindness
c) Abdomen b) Cardiovascular disease
d) Back c) Kidney disease
20. Thyroxine is contains the following. d) Tinnitus
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URL : https://symptomchecker.isabelhealthcare.com/suggest_diagnoses_advanced/
landing_page
*Pictures are indicative only
*Allow flash player.
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CHAPTER
3
APPLIED
PSYCHOLOGY
“Utter not a word which the conscience tells is false, lest your own conscience should smite
you”. Even to entertain the very thought of stealing is an evil to be avoided
Learning Objectives
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first four levels of the pyramid contains in the absence of physical safety – due to war,
“deficiency needs” such as physiological, safety, natural disaster etc. – people may experience
love/belonging and esteem needs. The basic stress and tension. Safety and Security needs
needs must be met before the individual will include personal security, emotional security,
strongly desire for the next level needs. For financial security, health and well being and
example, an individual will not expect safety safety needs against accidents/illness and their
needs until unless his physiological needs are adverse impacts.
met. He will not desire for love and belonging
Love/Belonging
before the safety needs are met. Maslow also
coined the term ‘meta motivation’ to describe The third level of human needs is
the motivation of people who go beyond the interpersonal and involves feelings of
scope of the basic needs and strive for constant belongingness. Social Belonging needs include
betterment. If these “deficiency needs” are not friendships, family and intimacy. Human beings
met, the individual will feel anxious and tense. need to feel a sense of belonging and acceptance
among social groups, regardless whether these
Maslow’s Hierarchy of Needs groups are large or small. The example for
Self actualisation large social groups may include clubs, religious
(Achieving individual groups, sports teams, gangs, etc and some small
potential)
social connections include family members,
Esteem (self) - esteem intimate partners, mentors, colleagues, etc.
and esteem from others Human beings need to love and be loved – both
sexually and non-sexually – by others.
Belonging (love, aftection
being a part of groups) Self esteem
Self Esteem is a belief about one’s own worth
Safety (shelter, removel based on an overall self evaluation. Esteem needs
from danger)
are ego needs or status needs which are related
Physiological (health, food, sleep,
to getting recognition, status, importance, and
shelter) respect from others in the society. All humans
have a need to feel respected; this includes the
Physiological needs need to have self esteem and self-respect. These
activities give the person a sense of contribution
Physiological needs are the physical
or value. Deficiency in this level leads to low self
requirements for human survival. If these
esteem.
requirements are not met, the human body
cannot function properly and will ultimately
fail. Physiological needs are the first and basic How people with low and high self esteem
need in the hierarchy. Without them, the other view themselves?
needs cannot follow up. Physiological needs Those with low self esteem tend to view
include breathing, water, food, sleep, clothing, themselves in negative terms. They do not
shelter and sex. feel good about them, tend to have trouble
in dealing effectively with others and are
Safety needs hampered by self doubts. High self esteem
Once a person’s physiological needs are individuals, in contrast, see themselves as
relatively satisfied, their safety needs take worthwhile, capable and acceptable.
precedence and dominate behavior. For example
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their behaviours, class mates or school mates Emotions are the outward expressions of the
and their behaviours, teaching methods and feelings. They are usually aroused by external
discipline all contribute towards attitude stimuli and emotional expression is directed
formation. towards the stimuli in the environment that
arouses it.
Attitudinal changes
Meaning of emotion
Attitude can be changed. It is not fixed one.
They can be changed through the acquisition Emotions are agitated states of our mind
of new experiences. The following are the ways and body leading us to perform some or other
and means of attitudinal changes:- types of behavioural acts.
• Providing proper education It is a subjective response that is usually
• Making use of the propaganda machinery accompanied by a physiological change and is
(eg, family planning, sanitation, road associated with a change in behavior.
safety)
Types of emotions
• Using fear inducing mechanism (eg.
Rules and legal laws against dowry, child Emotions are categorized as positive
marriage, child abuses) emotions and negative emotions.
• Using modeling technique (eg. Imitating
Positive emotions
the behaviours of the heroes and
The Positive emotions are pleasant
heroines)
emotions like amusement, love, curiosity, joy
• Direct personal experience ( eg. Lack of
and happiness which are helpful and essential
exercise leading to obesity and diabetes in
for the development of an individual.
a person will develop favourable attitude
towards exercises). Negative emotions
• Using cognitive dissonance mechanism Negative emotions are the unpleasant
(eg, In smoking, making a person to think emotions like fear, anger, jealousy which are
rationally instead of criticizing his negative harmful to the well being and development of
attitude towards smoking). an individual.
• Bringing desired changes in beliefs and
At the same time, too much of everything
values.
is bad. Emotions with too much intensity and
Implications for Nursing frequency whether positive or negative bring
harmful effects.
• Nurses can help patients to develop positive
and desirable attitude towards the things Components of emotion there
and persons are three basic components:
• She can help patients and their relatives to
• Congnitive:- Physiological and
bring about attitudinal changes.
behavioural
• She can use the techniques of attitudinal
• Cognitive component:- Includes the
change whenever and wherever applicable.
thoughts, values and expectations that help
in determining the intensity and type of
3.6 Emotions emotions.
• Physiological component:- It is also
Human beings are emotional beings and
known as a arousal. This is an internal
emotions add colour and spice to our life.
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Social and societal factors: Societal crisis. Crisis result in a disequilibrium from
norms and values impose certain obstacle in which many individuals require assistance to
meeting the individual needs which leads to recover.
frustration
Meaning of crisis
Economic and financial factors:
Unemployment and lack of money causes A sudden event in one’s life that disturbs
frustration in an individual. homeostasis, during which usual coping
mechanisms cannot resolve the problem
Internal factors
(Lagerquist, 2001)
Physical abnormality or defects: Too
small or too big a stature, very heavy or thin Characteristics of a crisis
body, an ugly face or dark complexion etc causes
frustration. Crisis occurs in all individuals at one time or
Conflicting desires or aims: When a another
person has conflicting desires, he develops • They are precipitated by specific identifiable
frustration. For example, a nurse wants to work events.
in abroad and does not want to leave her family • Crises are personal by nature. What may be
in home country causes frustration. considered as crisis by one individual may
Individual’s morality and high ideals: An not be so for another.
individual’s moral standards, code of ethics and • Crisis are acute, not chronic and will be
high ideals may become a source of frustration resolved in one way or another within a
to him. brief period.
Level of aspirations: One may aspire very
• A crisis situation contains the potential
high in spite of one’s incapabilities or human
harm for psychological growth or
limitations which may lead to frustration
deterioration.
Lack of persistence and sincerity in efforts:
Frustration may result in one’s own weakness in Causes of crises
putting continuous and persistent efforts with
courage, enthusiasm and will power. Crisis may arise as a result of
• Stress or from the environment
Reaction to frustration • Life transitions
It can be classified as simple reactions and • Traumatic experience in life like death of
violent reactions loved one, accidents,
Simple reactions: It includes • Life threatening illnesses
• Increasing trials or improving efforts • Stress out of promotions.
• Compromising with what is available • Existing psychiatric problems
• Withdrawal from the situation
• Submissiveness Crisis Intervention
Violent reactions: It includes aggression
Individuals experiencing crisis have
an urgent need for assistance. In crisis
3.9 Crisis intervention intervention the therapist, or other intervener
becomes a part of the individual’s life situation.
Stressful situations are a part of everyday’s
Because of the individual’s emotional state, he
life. Any stressful situation can precipitate a
or she is unable to solve a problem, so requires
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guidance and support from another to help coping strategies, growth and learning from
mobilize the resources needed to resolve the the crisis and plan of action for dealing with
crisis. stressors similar to the one that precipitated
the crisis. At the end of this phase, decision is
Goal of crisis intervention
made regarding follow up therapy; if needed,
• Resolution of immediate crisis the nurse provides referral information.
• Restoration of the individual to his pre-
crisis level of functioning Activity 1
Phases of crisis intervention Study the individual differences among
Phase 1: Assessment: It includes gathering your classmates on any five aspects such
of information regarding the precipitating as height, weight, BMI, colour of skin, IQ,
stressor and resulting crisis that prompted academic achievement etc and submit a
individual to seek professional help. It includes report.
assessment of physical and mental status, coping Recall the various emotions experienced
methods, support systems, individual’s personal in the past one week, state the reason and
strengths and limitations. classify and submit the report.
Phase 2: Planning: In these phase, goals
are established and appropriate activities
are planned to meet the goals based on the Sigmund Freud is known
individual’s needs and strengths. as Father of Psychology.
Phase 3: Intervention: This is the actual National Mental Health Programme
phase of implementation in which the person was launched in year 1982 by Govt of
suffering from crisis is helped to overcome/ India.
manage the crisis. It includes guidance services World mental Health day is observed
and utilizing the support systems in favour of on 10th October every year.
the individual. Institute of Mental Health, Kilpauk
Phase 4: Evaluation of crisis resolution: It was founded in 1794 by British.
includes reassessment to determine if the stated Child Helpline- No: 1098, to call for
objective was achieved. It includes reassessment help when any child is in distress.
for positive behavioural changes, adaptive
SUMMARY
Psychology is the scientific study of the activities of the individual in relation to his environment.
Maslow’s hierarchy of needs is a theory in psychology proposed by Abraham Maslow in 1943.
This theory is often portrayed in the shape of a pyramid with the largest, most fundamental
needs at the bottom and the need for self actualization at the top.
Individual difference is defined as the differences among individuals that distinguish or separate
them from one another and make one as a unique individual in oneself. The differences in
individual are due to heredity or environment or both.
An attitude is a readiness to respond in such a way that behavior is given a certain direction.
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Emotions are agitated states of our mind and body leading us to perform some or other types
of behavioural acts. Emotions are categorized as positive emotions and negative emotions. The
components of emotions are knowing, feeling and doing.
Emotions are capable of exercising a leading role in the health and happiness of the individual.
An emotionally adjusted person is found to possess a good health, free from illness or diseases.
Personality is the totality of emotional and behavioural characteristics that are peculiar to a
specific person and that remain somewhat stable and predictable over time.
Frustration refers to failure to satisfy a basic need because of either condition in the individual
or external obstacles.
Conflict is a state of tension brought by the presence in the individual of two or more opposing
desires. The conflict arises from the home environment, school environment, occupational
environment and social and cultural environment.
Stressful situations are a part of everyday’s life. Any stressful situation can precipitate a crisis.
Crises result in a disequilibrium from which many individuals require assistance to recover.
Individuals experiencing crises have an urgent need for assistance. In crisis intervention the
therapist, or other intervener becomes a part of the individual’s life situation.
The goal of crisis intervention is the resolution of immediate crisis and restoration of the
individual to his pre-crisis level of functioning
GLOSSARY
Evaluation
I. Choose the correct answer 3. Which one of the following is the self
1. The theory of hierarchy esteem need?
of need is proposed by a) Physiological need
a) Abraham Maslow b) Status need
b) Abraham Marlow c) Safety need
c) Abraham Mundro d) Security need
d) Abraham Muller 4. Which one of the following is not the ways
2. Which one of the following is not a of attitudinal changes?
physiological need according to hierarchy a) Providing proper education
of needs theory? b) Using modeling technique
a) Breathing b) Water c) Direct personal experience
c) Food d) Belongingness d) Avoiding /neglecting
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Steps
• Step 1: Type the URL link given below in the browser or scan the QR code.
• Step 2: Click the START button to begin the game.
• Step 3: Drag and drop the picture icons into the rectangle given, using the mouse.
• Step 4: Continue and complete the pyramid.
URL : http://planeta42.com/psychology/maslow/
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CHAPTER
4
Applied
Sociology
He who on earth has lived in the conjugal state as he should live, will be placed among the
Gods who dwell in heaven
Learning Objectives
a French philosopher.
Importance of
4.1 Definition Sociology in
Nursing
- Auguste Comete.
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Scope of Sociology
4.3 Importance of sociology in
HEALTH
EDUCATION Nursing
FAMILY / COMMUNITY PHYSICAL
INVOLVEMENT EDUCATION
Sociology plays an important role in the
area of health sciences medicine and nursing
HEALTHY PROMOTION
FOR STAFF
HEALTH
SERVICES
with the common goal of preventing illness
and restoration of health.
The study of sociology is important for
HEALTHY SCHOOL
ENVIRONMENT
NUTRITION
SERVICES
nurses due to the following reasons
COUNSELING
PSYCHOLOGICAL &
• Helps to understand those forces and
SOCIAL SERVICES pressures which affect patient adversely.
• It helps the nurses to understand the
4.2 Principles of Sociology behaviour, conflicts, Inter Personal
Relationship (IPR), hierarchy, groups and
Hirschman’s Principles of Sociology adaptation of different people working in
• Things are real because they are socially hospitals.
constructed. • Through sociology, the nurse gets
• Society is not just the aggregation of information about the socio cultural life of
discrete, pre-existing individuals. That is, the patient.
the individual is not ontologically prior to • To study the structure of family, community
the social. and society.
• The ideas we hold about the world change • To understand the characteristics of social
the world. relationship, its complexities, and its
impact on health care.
• The language we use to describe the world
• Helps in the understanding and eradication
changes the world.
of social problems.
• Society cannot be understood by looking
at individuals separately from their
interconnections and their environments 4.4 Family
(both social and physical). The family forms the basic unit of social
• The economy is not separate from the organization and it is difficult to imagine how
political or social world. human society could function without it. The
family has been seen as an universal social
Nature of Sociology
institution and it is an inevitable part of the
• It is the science of society and studies society.
organized in an organized society.
• It is a general science with all kind of social Definition
relationship. The family is a group of persons united
• It is an analytical science. by ties of marriage, blood or adoption
constituting a single household interacting
• In sociologist point of view, man is a social
with each other in their respective social
animal.
role of husband and wife, mother and father,
• It has wider scope. brother and sister creating a common culture
• It studies both conscious and unconscious -Burgess and Lock
activities of human being.
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Family is a more or less durable association Family of Procreation: The family where
of husband and wife with or without child or of an individual sets up after his/her marriage is
a man or woman alone with children. his/her family of procreation.
-Nimkoff
Based on Marriage
Characteristics Of Family Monogamous Family: This family consists
Universality: Malinowski writes the typical of one husband and wife, including children
family a group consisting of mother, father and is based on monogamous marriages.
and their progeny is found in all communities, Polygynous Family: A family consisting of
savage, barbarians and civilized. one husband, and more than one wife, and all
Emotional basis: It is built upon sentiments the children born to all the wives or adopted by
of love, affection, sympathy, cooperation and each of them.
friendship. Polyandrous Family: A family made up of
Limited size: The family is smaller in size. one wife and more than one husband, and the
It is a smallest social unit. children, either born or adopted with each one
Formative influence: It shapes the of them.
personality and molds the character of its
Based on Residence
members.
Family of Matrilocal Residence: When
Responsibility of the members:
a couple stays in the wife’s house, the family is
The members of the family has certain
known as family of matrilocal residence.
responsibilities, duties and obligations.
Family of Patrilocal Residence: When a
Social regulation: The society takes
family stays in the house of husband, the family
precaution to safeguard this organization from
is known as family of patrilocal residence.
any possible breakdown.
Family of Changing Residence: When a
Types of The Family family stays in the husband’s house for some
time, and moves to wife’s house, stays there
Based on Birth
for a period of time, and then moves back to
Family of Orientation: The family in husband’s parents, or starts living in another
which an individual is born is his family of place, the family is called a family of changing
orientation his family of orientation. residence.
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Based on Authority
Matriarchal Family: In these families, a
woman is the head of the family, and authority
is vested in her.
The matriarchal family is known as
mother centered or mother dominated family. FAMILY LIFE CYCLE
The mother or the woman is the head of the
family.
Newly married Wedding
Youthful
Patriarchal Family: In patriarchal Marriage
stage
families, the head of the family is a male, and (Ages 20-40) Early Parenthood Birth of first
Child
authority is vested with him. stage
Oldest child
Middle-Aged Later Parenthood begins
The patriarchal family is also known as Marriage adolescence
(Ages 40-60) stage
father centered or father dominated family.
Empty Nest Last child
stage Leaves home
Based on the Nature of Relations Aging Marriage
(Ages 60 ---) Rerement Rere from
Conjugal Family: A conjugal family stage
career
includes only the husband, wife and
Death of a spouse
unmarried children who are not adults. This stage
is also referred as nuclear family.
Consanguine Family: A consanguine 4.6 Needs of the Family
family consists of a parent, his or her children
and other relatives According to psychologist Abraham
Maslow, the needs of family can be divided into
Based on the size or structure: following:
Nuclear Family: A nuclear family is a • Basic needs: The most rudimentary
small group consisting of a husband, a wife human needs, associated with the survival
and children, natural or adopted. of human beings, are called basic needs.
Human beings cannot survive in the
Joint Family: A joint family consists of
absence of these things. One needs of food
three generation, living together under the
to eat, water to drink and house to live.
same roof, sharing the same kitchen and
purse or economic expenses. • Physiological needs: Physiological needs
are associated with the function of body
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GLOSSARY
Evaluation
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CHAPTER
5 Applied
Nutrition
Learning Objectives
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CLASSIFICATION OF CARBOHYDRATES
(Dextrose or grape sugar)
2.Fructose
(Fruit sugar)
3.Galactose
()
()
(
)
(
(
)
Fresh fruits 10 - 25
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Saturated fats
Unsaturated fats
Animal fats, butter, lard
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• Obesity
• Coronary heart disease
• Cancer
• High cholesterol
5.7 Proteins
Table 4
Classification of Proteins (Based on chemical composition)
Simple Conjugated Derived
Globular proteins Scleroproteins • Nucleoproteins Primary Secondary
• Albumins • Collagens • Glycoproteins • Coagulated • Proteoses
• Globulins • Elastins • Mucoproteins Proteins • Peptones
• Glutelins • Keratins • Lipoproteins • Proteans • Polypeptides
• Prolamines • Phoshoproteins • Metaproteins • Peptides
• Histones • Chromoproteins
• Globins • Matalioproteins
• Protamines
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Classification of Vitamins
5.8 Vitamins
Thirteen (13) recognized vitamins
Vitamins are essential organic, classified in two groups, based on their
compounds that are needed in small amounts solubility in fat or in water are as follows:
in the diet both to prevent deficiency diseases
and to support optimal health. The term Fat – soluble vitamins
vitamin (vital amines) was coined by Casmir
The four fat – soluble vitamins – vitamins
Funk. The term vital denoting essential for
A, D, E and K are often present in the fat portion
life and amines because these compounds
of foods, they are not easily lost from foods or
contained an amine functional group.
destroyed by exposure to water, heat, air, or
light.
Characteristics of vitamins
• Vitamins are vital, organic, dietary Vitamin A (retinol and beta –
substance that is necessary in only very carotene)
small amounts to perform a specific
Vitamin A and carotene can be obtained
metabolic function or prevent an associated
from either animal or vegetable sources.
deficiency disease.
The animal form is divided between retinol
• Vitamins are not synthesized by the body and dehydroretinol whereas the vegetable
and therefore must be supplied through carotene can be split into four very potent
food. groups– alpha– carotene, beta–carotene,
Table: 7 gamma carotene and crypto– carotene.
Fat – Soluble Water – Soluble Vitamins Function
Vitamins
Vitamin A has a variety of functions in
Vitamin A Vitamin C
the body. It is required for the synthesis of
Vitamin D B – Complex vitamins (8)
rhodopsin and other light – receptor pigments
Vitamin E Thiamine
in the eye and thus is essential for vision.
Vitamin K Riboflavin
Vitamin A is needed for normal growth and
Niacin
development to occur in the body, including
Pyridoxine
the formation of bone and cartilage.
Folate
Healthy epithelial or skin cells, which
Cyanocobalamin
line surfaces inside and outside the body,
Biotin
require vitamin A. Vitamin A plays a role
Pantothenic acid
in reproduction, metabolism, and immune
system function also.
Functions of Vitamins
Each vitamin has its specific metabolic Digestion and absorption
task. However the general functions are: Retinol esters in food are hydrolyzed by
• Function as control agents in cell pancreatic and intestinal enzymes to form
metabolism free retinol. After absorption, the retinol, is
• Components of body – tissue construction. reesterified and transported to blood.
• Prevent specific nutritional deficiency Carotenes are split in the intestines to
disease, which is considered as a result of form retinaldehyde, which is then reduced to
their primary role in cell metabolism.
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retinol. Some carotene may be absorbed intact inactive pro-vitamin D. Both inactive vitamin
and later converted to vitamin ‘A’ in the liver D formed in the skin and vitamin D absorbed
or kidney. Bile is necessary for the absorption from dietary sources are transported through
of vitamin A and carotene. Vitamin E in the the bloodstream to the liver, where they are
intestinal tract prevents oxidation of the stored.
vitamin. Mineral oil hinders absorption since
it dissolves the vitamin but is not absorbed. Functions
• Vitamin D helps with the absorption,
Food sources transport and use of calcium.
• Vitamin D assists in bone growth and the
integrity of bone and promotes strong
teeth.
• It also helps to regulate the amount of
phosphorus in the body as well as assisting
in a healthy heart and nervous system.
Food sources
Sources of Vitamin A
Liver, milk, egg – yolk, carrots, dark green
leafy vegetables and yellow fruits are high in
vitamin A or beta – carotene.
Deficiency
A diet deficient in vitamin A for several
months may lead to night blindness and flaking
skin.
A long – term vitamin A deficiency leads Sources of Vitamin D
Xerophthalmia, major symptom of which is dry, Vitamin D is present in fatty fish like
hard cornea. If this condition is left untreated, kipper, sardines, salmon, tuna and mackerel,
damage to the cornea progresses, leading to a liver, egg yolk and butter. Smaller amounts are
softening of the cornea and eventually total also present in dark leafy vegetables.
blindness.
Vitamin A deficiency also affects the skin, Absorption
causing it to become dry and rough. Dietary vitamin D is absorbed along
If xerophthalmia and the underlying with dietary fats in the small intestines and
vitamin A deficiency are treated at an early transported to the lymph system. Bile is
stage, blindness can be prevented. essential for the absorption of this vitamin
Excess vitamin is stored in the body.
Vitamin D (Calciferol)
The human body can produce vitamin Which is the only non-
D from cholesterol present in the skin. This animal natural source of
conversion depends on exposure of the skin vitamin-D – Mushroom. The
to the ultraviolet rays in sunlight and yields best source of vittamin D is Sun.
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Vitamin k
Catalyzes
Fibrinogen Fibrin
Forms
Deficiency of vitamin E
Deficiency of vitamin E is a not common,
and the symptoms not very clear cut, but may Sources of Vitamin K
include fatigue, inflamed varicose veins, slow
The best dietary sources of this vitamin
wound healing, premature ageing and sub –
are green leafy vegetables, cheese and liver.
fertility.
Deficiency
Vitamin K
Increased tendency to haemorrhage
Vitamin K can be produced in the defective blood clotting
intestines and this function is improved with
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• In children it is required for good appetite also available in good quantities in green leafy
and proper growth. vegetables, fish, legumes, whole grains, and
yogurt.
Food sources
Deficiency
A dietary deficiency of riboflavin leads to
ariboflavinosis.
Niacin (B3)
Niacin also called nicotinic acid or niacin
amide and can be manufactured by body. Niacin
is derived from two compounds – nicotinic acid
and niacin amide.
Sources of Vitamin B
Functions
Sunflower seeds, peanuts, wheat bran, beet
liver, pork, seafood, egg – yolk, beans whole • Niacin functions as a coenzyme in nearly
grains and yeast contain good amounts of all the metabolic pathways yielding energy
thiamine. from carbohydrates, fats, proteins, and
alcohol.
Deficiency • Niacin also plays a role in tissue
Beriberi occurs in two forms, wet beriberi respiration.
and dry beriberi, whose prominent symptoms • It is involved in the synthesis and
differ. breakdown of fats, and helps to maintain
healthy skin.
Riboflavin – (Vitamin B2)
Riboflavin is another B – complex vitamin Food sources
involved as a coenzyme in the metabolism of Liver, lean meat, fish, nuts, cereals, legumes,
carbohydrates, as well as of fats and proteins. asparagus, milk, green leafy vegetables and fish.
The adult RDA for riboflavin has been A cup of coffee also provides 3 milligrams of
established at a minimum of 1.2 milligrams niacin.
per day.
Deficiency
Functions
A deficiency of niacin is known as
• It is required by the body to use oxygen pellagra, which means rough skin (from the
and the metabolism of amino acids, fatty Italian words pelle for skin and Agra for
acids, and carbohydrates. rough).
• It is a used for red blood cell formation,
antibody production, cell respiration, and Pyridoxine (Vitamin B6)
growth. Pyridoxine is part of the B group vitamins
• It may be helpful in the prevention and and is water – soluble and is required for both
treatment of cataracts. mental and physical health.
Food sources Functions
Organ meats, nuts, cheese, eggs, milk and • Pyridoxine is required for the balancing of
lean meat are best sources of riboflavin. It is hormonal changes in women.
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• It is essential for the metabolism and fruit, starchy vegetables, beans, whole grains,
proteins, fats and carbohydrates. liver, kidney, egg, yeast etc.
• It assists in the maintenance of serum level
Deficiency
of sodium and potassium
A deficiency of folate can lead to
• It helps to promote red blood cell
macrocytic, megaloblastic anemia, diarrhea,
production.
fatigue, depression, and mental confusion.
• It is linked to cancer immunity and
fights the formation of the toxic chemical Cyanocobalamin (Vitamin B12)
homocysteine. Cyanocobalamin also known as cobalamin
is referred to as the energy vitamin. It is a
Food sources
very widely researched vitamin, and used in
Good sources to obtain pyridoxine are supplementation to a very large degree.
brewer’s yeast, egg, chicken, carrot, fish, liver,
kidney, pea, wheat germ and walnuts. Roots Functions
and tubers, cabbage, legumes, molasses, whole • Cobalamin is required in the metabolism
grains, etc., contain moderate amount of this of fats, proteins and carbohydrates.
vitamin. • It is needed in the manufacture of red
blood cells and the maintenance of red
Deficiency blood cells.
Irritability, nervousness, insomnia, • It stimulates appetite and Promotes
anemia, general weakness, skin changes such as growth.
dermatitis.
Food sources
Folic acid (Vitamin B9) – folic acid, folacin, Liver, organ meat, muscle meat, shellfish,
folate egg, cheese and fish are rich sources of this
Folic acid is also referred to as folacin or vitamin. It can be manufactured in the body.
folate. Its chemical name is pteroylglutamic Milk contains vitamin B12 however processing
acid. This vitamin can be produced by the of milk may destroy the vitamin.
body and be stored in the liver.
Deficiency
Functions Vitamin B12 deficiency results in
• Folic acid is required for DNA synthesis macrocytic, megaloblastic anemia (pernicious
and cell growth and is important for red anemia) similar to that occurring with folate
blood cell formation, energy production deficiency.
as well as the forming of amino acids.
Biotin (Vitamin B7)
• Folic acid is essential for synthesizing
heme, the iron containing substance in Biotin is also referred to as anti – egg white
hemoglobin, crucial for oxygen transport. injury factor.
Folic acid is very important in the Biotin present in foods in not affected by
development of the nervous system of a exposure to light. Biotin is also produced by
developing fetus. bacteria in the intestine.
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• Biotin is also indicated for healthy hair and lack of appetite, constipation, and tingling
skin, healthy sweat glands, nerve tissue, and numbness in both the feet and hands.
and bone marrow.
• Biotin is also helps in maintaining a steady 5.9 Minerals
blood sugar level.
The essential minerals are classified
Food sources according to their recommended intake.
Biotin is widely distributed in both animal Macro minerals, also called major minerals,
and plant foods. Liver, kidney, egg, yolk, milk, are needed in amounts greater than 100
tomatoes are rich sources. milligrams per day. Micro minerals, also
called trace minerals or trace elements, are
Deficiency
needed in less than 100 milligrams per day.
Dietary deficiency of biotin is rare.
Symptoms of biotin deficiency include lack of Table: 10 Classification of essential minerals
appetite, nausea, an enlarged tongue, mental Macro minerals Micro minerals
depression, pallor, loss of hair. (> 100 mg/day)* (<100 mg/day)*
Calcium Iron
Pantothenic acid (vitamin B6)
Phosphorus Zinc
Pantothenic acid referred to as the “anti –
Magnesium Copper
stress vitamin” is part of the B group vitamins.
Sulfur Iodine
This vitamin can be produced in the body by
Sodium* Fluoride
the intestinal flora.
Potassium* Manganese
Functions Chloride* Selenium
• Pantothenic acid plays an important role Chromium
in the secretion of hormones, such as Molybdenum
cortisone because of the role it plays in *Recommended intakes are greater or lesser
supporting the adrenal gland. than 100mg per day, as indicated.
• Pantothenic acid is also used in the release
of energy as well as the metabolism of fat, Macro minerals
protein and carbohydrates. There are seven macro minerals; calcium,
• It is used in the synthesis of lipids, phosphorus, magnesium, sulfur, sodium,
neurotransmitters and haemoglobin. potassium, and chloride. As well as being
Food sources needed in amounts greater than 100 milligrams
Beef, brewer’s yeast, egg, fresh vegetables, per day, each of the macro minerals makes up
kidney, legumes, liver, mushrooms, nuts, more than 0.01% of the body’s weight.
pork, royal jelly, saltwater fish, torula yeast,
Calcium
whole rye flour, and whole wheat contain this
vitamin. Calcium is by far the most prevalent
mineral in the body. About 98% of the 1200
Deficiency grams (2.5 pounds) of calcium in the average
Symptoms of a pantothenic acid adult body is found in the bones. Small
deficiency though rare, may occur in severely amounts of calcium (1%) are also found in
malnourished individuals and include fatigue, the extracellular fluid, certain intracellular
irritability, low blood pressure upon standing, structures, and cell membranes.
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Function Deficiency
• Calcium is one of the minerals needed for A phosphorus deficiency is characterized
the growth and strength of the bones. by weakness, lack of appetite, fatigue and
• Calcium is needed for muscle contraction muscle pain.
• Calcium ions are essential for blood
clotting. Magnesium
• Calcium is needed for the functioning of About 60% of the body’s magnesium is
neuro transmitters. contained in the bones; most of the remaining
magnesium is present in the muscles and
Food sources other tissues, with about 1% circulating
Milk and milk products are among the best extracellular fluids.
sources of calcium, other sources of calcium
includes leafy greens, firm tofu, and small fish Function
with bones, such as sardines. • The activity of hundreds of enzymes
depends on magnesium
Deficiency
• Magnesium also helps maintain calcium
A severe deficiency of calcium leads to the and potassium homeostasis.
condition hypocalcemia resulting in rickets in
children and osteomalacia in adults. Food sources
Nuts, legumes, dark green leafy vegetables,
Phosphorus
soya beans and milk are good sources.
Approximately 85% of the 700 grams of
phosphorus in the adult body is present in the Deficiency
bones. The ratio of calcium to phosphorus in Symptoms of magnesium deficiency
the bones is 2: 1. After calcium, phosphorus is include weakness, confusion, lack of appetite,
the second most common mineral in the body nausea, and lack of coordination.
by weight.
Sulfur
Function
Because sulfur is part of the essential
• Phosphorus is involved in a variety of amino acid methionine and the nonessential
chemical reactions in the body, many of amino acid cysteine, it is present in the body’s
which are related to energy metabolism. proteins. Interactions among sulfur atoms
• Mineralization of bones and teeth in cysteine helps to give proteins their three
• Facilitation of energy transaction dimensional shape.
• Absorption and transport of nutrients
The Electrolytes
• Regulation of protein activity
Three of the macrominerals – Sodium,
• Component of essential body compounds. potassium and chloride are the body’s main
electrolytes. The major function of the electrolytes
Food sources
is to maintain the proper distribution of water
In general, good sources of protein are inside and outside cells. If this water balance is
also good sources of phosphorus. Meat, not maintained, cells will shrink or swell beyond
poultry, fish and eggs are rich in phosphorus. their normal size. Sodium and chloride are
Milk and milk products, nuts, legumes, found in the extracellular fluid; potassium is
cereals and grams are good sources. found in the intracellular Fluid (ICF).
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6. Roughage: Excessive bulk hinders the 3,000 ml must be given in 24 hours with
penetration of the digestive juice, but it as much variety as possible, both in
may be necessary to include foods with appearance and in taste.
a moderately high residue content to
produce daily bowel action. Diabetes mellitus
7. Fluids are very important to prevent Diabetes mellitus is a condition in
dehydration which is common in which the secretion of insulin by the islets
conditions of fevers, diarrhea and of Langerhans in the pancreas is deficient or
vomiting. In such condition 2,500 – absent. It is characterized by hyperglycemia,
Table 12: Diabetes Mellitus Table 13: Daily menu for high blood pressure
Vegetarian Non – vegetarian Vegetarian Non – vegetarian
Morning Morning
Tea or coffee (without Tea or coffee (without Weak tea – 1 cup Weak tea – 1 cup
sugar) sugar) Breakfast
Breakfast Bread or corn flakes Bread or corn flakes
Corn flakes with milk Corn flakes with milk with skin milk or with skin milk or
Cheese Boiled egg idly – 1 serving idly – 1 serving
Toast with butter Toast with butter (with sugar and jam) (with sugar and jam)
Tea or coffee Tea or coffee (without salt) (without salt)
Mid – morning Fruits – 1 serving Fruits – 1 serving
Tea or coffee (without Tea or coffee (without Weak tea – 1 cup Weak tea – 1 cup
sugar) sugar)
Mid – morning
Lunch
Fruit juice – 1 glass Fruit juice – 1 glass
Cooked rice or Cooked rice or
Lunch
chapatti or bread chapatti or bread
Cooked rice or Cooked rice or
Cooked soup Cooked dal
chapatti – 1 serving chapatti – 1 serving
Vegetable soup Mutton or fish curry
Cooked dal – half Meat or fish curry –
Pappad Pappad
cup half
Curds Curds
Curds – 2 cups Curd – 1 cup
Roasted groundnut Roasted groundnut
Cooked vegetables Cooked vegetables
or cashewnut or cashew nut
and potato – 1 and potato – 1
Fruit (half apple or Fruit (half apple or
serving serving
one slice of papaya or one slice of papaya or
mango) mango) Fruits – 1 serving Fruits – 1 serving
Tea Skimmed milk Skimmed milk
Salt biscuits Salt biscuits pudding – 1 cup pudding – 1 cup
Roasted nuts Roasted nuts Evening
Tea or coffee (without Tea or coffee (without Biscuits – 2 Biscuits – 2
sugar) sugar Fruit juice – 1 glass Fruit juice – 1 glass
Dinner Dinner
Similar to Lunch Similar to Lunch
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and glycosuria accompanied by polyuria, Calories – 1800 – 2000 Kcal; Fat (rich in
polydipsia, polyphagia, and if untreated for a essential fatty acids) – 60 gm; Proteins – 50 –
long time by loss of weight. 60 gm
Note: one multivitamin tablet providing
Hypertension the daily requirements of all essential vitamins
Hypertension develops due to some should be given daily.
reason, there is increased resistance to the
Table 15: Daily menu for coronary heart
normal circulation of blood. This may be
disease
temporary, as the result of exercise, pregnancy,
or menopause; it may be permanent, Vegetarian Non – vegetarian
associated with atherosclerosis, cardiac Morning
failure or chronic kidney disease. Weak tea Weak tea
Breakfast
Notes Corn flakes with Corn flakes with
1. Salt should not be added in cooking skimme milk or skimmed milk or
2. One multivitamin tablet providing the bread of idly – 1 bread or idly – 1
daily requirements of all essential vitamins serving serving
should be included along with the diet Cheese – 2 slices Cheese – 2 slice
Fruits – 1 serving Fruits – 1 serving
3. Strong coffee is not permitted.
Weak tea – 1 cup Weak tea – 1 cup
Table 14: Daily menu for Hypertension Lunch
Non – Cooked rice or Cooked rice or
Food stuffs Vegetarian chapatti – 1 serving chapatti – 1 serving
vegetarian
Milled cereals 200 200 Dal soup – 1 cup Mutton soup – 1 cup
Skin mil (fluid) 1000 1000 Cooked vegetables – Mutton or fish curry
Pulses 60 40 1 serving – 1 serving
Cheese – 2 slices Curds – 1 cup
Cheese 60 20
Curds – 2 cups Fruits – 1 serving
Meat or fish - 20
Fruits – 1 serving Skimmed milk
Leafy vegetables 100 100
Skimmed milk pudding – half cup
Other vegetables 100 100
pudding – half cup
Fruits 300 300
Tea
Vegetable oils (sesame 60 60
Biscuits – 2 Biscuits – 2
or safflower or
Fruits – 1 serving Fruits – 1 serving
sunflower seed oil)
Weak tea – 1 cup Weak tea – 1 cup
Sugar and jam 40 40
Dinner
Coronary Heart Diseases Similar to Lunch
A majority of coronary heart diseases
are due to coronary antheroma (A fatty Chronic Renal Failure
deposit in the inner lining of an artery) and Chronic Renal Failure occurs
atherosclerosis, are used to denote conditions in glomerulonephritis, and chronic
in which lipid is deposited in the intima of the pyelonephritis. In this condition, the
blood vessels. glomeruli and tubules are heavily damaged.
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In 1954, the Government of India enacted established which are revised from time to
a Central Prevention of Food Adulteration time by the “Central Committee for Food
Act. The act has been amended several times, standards”.
the latest amendment is that of 1976 and in The purpose of PFA standards is to obtain
lately in 1986 to make the Act more stringent. a minimum level of quality of foodstuffs
Although it is a Central Act, its attainable under India conditions.
implementation is largely carried out by the
local bodies and State Governments. The Agmark Standards
These standards are set by the
Food Standards Directorate of Marketing and Inspection of
FAO/WHO formulates food standards for the Government of India.
international market. Codex Alimentarius
commission which is the principal organ Bureau of India Standards
of the joint FAO/ WHO food standards The ISI mark on any article of
programme. The standards in India are based food is a guarantee of food quality in
on the standards of the Codex Alimentarius. accordance with the standards prescribed by
the Bureau of Indian Standards (BIS) for that
PFA Standards commodity.
Under the Prevention of Food
Adulteration Act, 1954 standards have been
SUMMARY
Nutrition is the science of food and its relationship to health. It is concerned with the part
played by nutrients in body growth, development and maintenance.
Good nutrition is essential for attainment of normal growth and development during fetal
life and childhood. Physical growth, intellectual development, learning and behavior are
affected by malnutrition.
Adequate nutrition is needed for adult life maintenance for optimum health and efficiency.
Carbohydrates are the main source of energy for daily activities. Carbohydrates (primarily
starches) are the least expensive, the most plentifully available, easily obtainable and readily
digested form of nutrient.
The lipids are a heterogeneous group of substances found in plant and animal tissues, which
share the property of being relatively insoluble in water, and soluble in organic solvents,
such as ether, chloroform and benzene.
Proteins are polymer chains made of amino acids linked together by peptide bonds. Amino
acids can be divided into essential amino acids and non – essential amino acids. Proteins
and carbohydrates contain 4 kcal per gram as opposed to lipids which contain 9 kcal per
gram of energy.
Vitamins are essential organic, compounds that are needed in small amounts in the diet
both to prevent deficiency diseases and to support optimal health. The term vitamin (vital
amines) was coined by Casmir Funk. The term vital denoting essential for life and amines
because these compounds contained an amine functional group.
The four fat – soluble vitamins – vitamins A, D, E and K are often present in the fat portion of
foods, they are not easily lost from foods or destroyed by exposure to water, heat, air, or light.
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The water soluble vitamins include vitamin C and B complex vitamins – thiamine, riboflavin,
niacin, pyridoxine, folate, cyanocobalamin, biotin and pantothenic acid. Most of these are
unstable and thus easily destroyed by exposure to water, heat, air or light.
WHO has defined “Food fortification” as the process whereby nutrients are added to foods
(in relatively small quantities) to maintain or improve the quality of the diet of a group, a
community or a population.
GLOSSARY
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Evaluation
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Steps
• Step 1:
• Step 2: Click the START button to start the game activity.
• Step 3: A page with pictures of food varieties are arranged as a grid of picture tiles will
open.
• Step 4: Drag and drop the tiles into the buckets give below to sort. Continue the activity
as per the instructions displayed during the game and complete the game.
URL : https://www.brainpop.com/games/sortifynutrition/
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CHAPTER
Introduction to
6 Sex Education
Learning Objectives
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“Good” touch and “bad” touch are words • if that touch makes you feel scared and
most commonly used to explain to children nervous.
what is acceptable and not acceptable, and • if a person forces you to touch him or her.
how they should treat other people. Good • if a person asks you not to tell anyone.
touch or physical affection is a wonderful way
• if a person threatens to hurt you if you tell.
to bond with your child.
Head
Face
6.2 Good Touch
Mouth
Neck &
It feels good to be hugged and kissed by the Hand Shoulders
Chest
people you love. For example: Stomach Hand
Buocks & Part
between our legs
• When Mommy gives you a hug and kiss
Thighs
after you wake up. Good
May Not Like
Legs
• When Daddy gives you a good-night hug Bad
and kiss.
Teach your children the following safety
• When Grandma and Grandpa come to visit rules:
and everyone gets hugs and kisses.
It is not okay
• to touch someone else’s private body parts.
6.3 Bad Touch
• for someone to touch his or her own
Touches that make you feel uncomfortable private body parts infront of you.
are usually bad touch. • for someone to ask you to touch his or her
private body parts.
Good Touch Bad Touch
• for someone to ask you to take your clothes
+ Parents hug and kisses. = Makes you feel scared
+ Grandparents love. / nervous / ashamed. off except if they are a doctor helping to
+ Teacher pats you on the = Forced or Hurts.
= Told to keep it a SECRET see if you are hurt or sick
head “Good Job”.
= Touching or pang
+ Brief friendly hugs by
areas covered by a • for someone to take photos or videos of
family members.
SWIM SUIT. you with your clothes off.
+ Brief kiss on the = Kissing on the mouth.
cheek or forethead. = Touching the
+ Shaking hands or buocks.
giving Highs. = Hing, slapping,
+ Doesn’t scare or sping, pushing or
make you feel bad. punching.
It is a bad touch
• if it hurts you.
• if someone touches you on your body
where you don’t want to be touched.
• if the person touches you under
your clothing or tickles you under the Worldwide, around 15
clothing. million adolescent girls aged 15
to 19 have experienced forced
• if a person touches you in a way that
sex in their lifetime.
makes you feel uncomfortable.
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I. The number of cases registered for child abuse raised from 8,904 in the year 2014
to 14,913 in the year 2015, under the POSCO Act. Sexual offences and kidnapping
account for 81% of the crimes against minors
II. Preventive measures designed to ward off strangers (installing CCTV cameras and
providing self-defence training) will be ineffective, as children do not know how to ward
off unwanted sexual offences from their known relatives, acquaintances or workplace
seniors, who they trust.
III. POSCO: State wise cases - Uttar Pradesh led the highest number of child abuse cases
(3,078) followed by Madhya Pradesh (1,687 cases), Tamil Nadu (1,544 cases), Karnataka
(1,480 cases) and Gujarat (1,416 cases).
Along with workplace cases, here are other findings of rapists being known to children:
94.8% of rape cases saw children being raped by someone they knew, not strangers. These
acquaintances include neighbors (3,149 cases) who were the biggest abusers (35.8%). 10% of
cases saw children being raped by their own direct family members and relatives.
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Evaluation
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Steps
• Step 1: Type the URL link given below in the browser or scan the QR code.
• Step 2: Click and drag the slide bar given below to start the activity.
• Step 3: The changes can be observed from the tabs given such as Temperature
change, Hormonal change, Folicular change, Uterine lining change.
• Step 4: Changes happening on any of the 28days can be observed and compared
with the help of the slide bar.
URL: http://owensborohealthse3.adam.com/content.aspx?productId=
147&isArticleLink=false&pid=17&gid=000087&Category=Interactive%20Tool
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CHAPTER
7 Midwifery
Nursing
Learning Objectives
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Abdomen- A brownish black pigmented Ideally the weight gain depends on pre-
line appears on the abdomen stretching from pregnancy body mass index (BMI) level. Weight
the Xiphisternum to the symphysis pubis. It will gain for a woman with normal BMI (20-26) is 11
disappear after delivery (Linea Nigra). to 16kg. An obese woman (BMI>29) should not
Striae gravidarum-It is a specific form of gain more than 7 kg. Where as an underweight
scarring of the abdominal skin area due to rapid woman (BMI<19) may be allowed to gain upto
expansion of the uterus. It looks pinkish in first 18kg.
pregnancy, in subsequent pregnancy both pinkish
Maternal weight gain 6 kg
and white striae are visible (Striae albican).
• Increase blood volume 1.3 kg
• Increase in extracellular fluid 1.2 kg
• Accumulation of fat and protein 3.5 kg
Systemic Changes
Respiratory System:
Because of enlargement of the uterus, there
is an elevation of the diaphragm and breathing
becomes diaphragmatic. Upper respiratory tract
mucosa becomes congested. The respiratory
rate rises to from 18 to 20 breathes per minute
to meet demand of fetus. Decreased functional
residual capacity 1.7 to 1.35 litres due to the
compression of the diaphragm by the uterus.
Cardiovascular Changes:
The heart enlarges by 70 to 80ml due to
small increase in wall thickness and venous
filling. Cardiac output increases from 4.5 - 6.0
litre/min. Heart rate increases from 70bpm
Maternal Weight Gain in non-pregnant state to 78bpm at 20 weeks
gestation and a peak around 85 bpm in late
The total weight gain during the course
pregnancy.
of a singleton pregnancy for a healthy woman
averages 11kg. 1kg in first trimester (1-3 Haematological Changes
months). 5 kg each in second (4-6 months) and
Blood volume increases by 40-50% at 30-32
third trimester (7-9 months).
weeks of pregnancy. It causes Haemodilution.
Haematocrit decreases. The number of white
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blood cells (which fight against infection) wrist joint, leading to pain in the hands
increases slightly during pregnancy. Blood and arm called CARPAL TUNNEL
plasma volume increases to the extent of 1.25 SYNDROME may appear in late pregnancy.
litres (Non pregnant plasma volume is 2500 ml, • Nausea, vomiting, mental irritability and
increase about 3750ml during pregnancy. sleeplessness due to some psychological
background.
Urinary System
• Glomerular filtration rate (GFR) is
increased by 50% all throughout pregnancy. 7.3 Diagnosis of Pregnancy
Frequency of micturation is a common
symptom of early pregnancy. This is due First Trimester
to changes in pelvic anatomy. A degree Presumptive signs:
of hydronephrosis and hydroureter exist. • Amenorrhoea-Absence of menstruation.
These result from the loss of smooth muscle
• Morning sickness- Nausea, vomiting on
tone due to the progesterone, aggravated
rising from bed, loss of appetite.
by mechanical pressure from the ureters at
• Frequency of micturition due to congestion
the pelvic brim.
of the bladder mucosa.
• Vesicoureteric reflux is also increased.
• Breast discomfort- feeling of fullness and
These changes predispose to urinary tract
‘Pricking sensation’ is present.
infection.
• Darkening of the nipples, primary and
• Glycosuria of mild degree in 35% to 50% of
secondary areolar change.
all pregnant woman. Increased glomerular
filtration leads to more sugar reaching the • Fatigue or tiredness.
tubules that can be reabsorbed.
Probable signs
Gastrointestinal System • Breast changes: The breasts are enlarged,
• The gums become congested and spongy evident between 6 to 8 weeks.
and may bleed to touch. • Vaginal Sign- The walls become softened
• Relaxation of lower oesophageal sphincter and looks bluish in colour. Copious non
produces regurgitation and heart burn. irritating mucoid discharge appears at 6th
• Slight reduction in gastric secretion and week.
diminished gastric motility result in slow
• Osiander’s sign- There is increased
emptying and more effective pulping of
pulsation, felt through the laternal fornices
food and causes nausea.
at 8th week.
• Reduced motility of large intestine
increased time for water reabsorption • Jacquemier’s or Chadwick’s sign - a bluish
which leads to induce constipation. discoloration of the cervix, vagina and labia.
This is due to local vascular congestion.
Nervous System
• Hegar’s Sign- Upper part of the uterus is
• There may be generalised neuritis
enlarged by the growing fetus, and lower
probably due to Vitamin B 1 (Thiamine)
part of the body of the uterus is empty and
deficiency.
extremely soft.
• Compression of the median nerve
underneath the carpal ligament over the
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Nutrion
Respiratory Musculskeletal
Breasts Cardiovascular
Vagina Uterus
Endocrine
Integumentary
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[EDD] Aims
EDD is calculated from first day of the • To achieve a healthy mother and baby.
Last Menstural Period [LMP] by using Naegle’s • To provide psychological support to the
formula. For calculation, 9 calendar months women and her family.
and 7 days are added in the LMP • To educate the women regarding health
Gestational age – It is to be calculated as care during pregnancy.
completed weeks of gestation • To monitor progress of pregnancy and the
baby.
• 9 out of 10 women • To recognize deviation from the normal
experience a change in skin and provide treatment as required.
tone during pregnancy called • To prepare women physically and
hyperpigmentation. This is because emotionally for the child birth, lactation
the increased production of melanin and care of the baby.
during pregnancy.
• To prevent congenital deformities by
• During gestation, babies develop hair educating the mother to avoid smoking,
all over their body called “lanugo”. substance abuse and self medications.
This hair is typically shed before birth.
• Uterus stretches from the size of a pear Antenatal Visits
to approximately the size of watermelon Routine prenatal visits has been followed as
over the course of pregnancy. convention and not an evidence based benefits.
• Morning sickness is very common • Initial visits at early pregnancy (when a
and typically goes away by the second women missed her first period.
trimester. Try to eat bland diet like
• Every 4 weeks until 28 weeks
bananas, rice, and toast to settle your
stomach. Avoid spicy, oily and fried • Every 2 weeks until 36 weeks
foods during night.
• Every week until delivery
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Inspection Palpation
• Abdomen • Measure symphysis pubis - fundal height
• Size • Between 18-34 weeks measurements from
• shape pubis symphysis to the top of the uterus in
• Contour – spherical, cylindrical, cm correlates well with the weeks of
pendulous, flattened anteriorly, unduly gestation
enlarged or small.
• Skin – Striaegravidarum and lineanigra
• Scar of previous operations
• Prominent veins, evidence of skin
infections
• Umbilicus - Flat and dimple
A.A.First
FirstManeuver
Maneuver B.B.Second
SecondManeuver
Maneuver C.C.Third
ThirdManeuver
Maneuver
Uterus Size
12 Weeks-at the level of symphysis pubis
16 weeks- Half way between symphysis pubis
22 weeks- at the level of umbilicus
28 weeks- between umbilicus and Xiphoid
process
32 weeks- below the xiphoid process
A. First Maneuver
A. First Maneuver B. Second Maneuver
B. Second Maneuver C.C.
Third
ThirdManeuver
Maneuver D.D.Fourth
FourthManeuver
Maneuver
38 weeks- level of the xiphoid process
48 weeks- below the xiphoid process (if Abdominal –palpation
lightening occurs). • Measuring fundal height (Leopold
maneuver).
• Fundal palpation(first maneuver)
36 • lateral palpation(second maneuver)
40 • Pelvic grip-I
32 • Pelvic grip-II(Pawlik’s grip)
Feel for presenting part
26 • Determine lie
• Determine position of the presenting part
20
• Engagement
16
12
8
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Maternal Death Incidence • First degree (Type I): Low lying Placenta
the lower edge of the placenta reaches the
A maternal death is death of a Woman
lower uterine segment but not the internal
while pregnant or within 42 days of
cervical os.
termination of pregnancy irrespective of the
duration and the site of the pregnancy, from • Second degree (Type II): Marginal the
any course related to or aggravated by the lower edge of the placenta reaches the
pregnancy or in management but not from margin of the internal os but does not
accidental or incidental causes. - WHO cover it.
• Third degree (Type III): Incomplete or
• 20-25% deaths occur during pregnancy.
partial the placenta covers the internal os
• 40-50% deaths occur during labour and partially.
delivery.
• Fourth degree (Type IV): Total placenta
• 25-40% deaths occur after childbirth (More covers the internal os completely.
during the first seven days)
• Annually, 585,000 women die of pregnancy
related complications
Complete 40% Paral 30% Marginal Low-lying
Pelvic inlet
primigravida
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Risk factors
• Smoking
• Short umbilical cord
• Advanced maternal age
• HTN
Par
al placenta previa Marginal placenta previa
• PIH
• Cocaine use
Management
• Trauma to or near abdomen.
Management depends upon gestational
age, amount of bleeding and fetal condition.
• Monitor Fetal Heart Rate, maternal Vital
signs
• Intra Venus Fluid administration Paral separaon Paral separaon Complete separaon
(Concealed hemorrhage) (apparent hemorrhage) (Concealed hemorrhage)
• O2 administration
• Assess intake and output, amount of Manifestations: Tenderness mild to severe
bleeding constant pain; mild to moderate bleeding
• Do complete Blood count and Rh factor depending on degree of separation.
Total placenta previa Paral placenta previa
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Oligohydramnios Causes
It is a condition where the amniotic fluid is • Scarring of fallopian tubes (Chlamydia/
less than 500 ml in the amniotic sac. Gonorrhea).
• More common with infection of fallopian
Causes tubes or surgery to reverse Tubale
• Failure of fetal kidney development Ligation.
• Obstruction in urinary tract • Previous ectopic
• Intra Uterine Growth Restriction (IUGR) • Multiple induced abortions
• Post-term pregnancy
• Diethylstilbestrol (DES) exposure
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Normal labour
Labour is called normal when it satisfies the
following criteria
• Spontaneous onset of labour
• Starts at 38 – 40 weeks
• Vertex presentation
• Occipito-anterior position Effacement of the cervix: it is the
shortening of the cervix. The cervix is pulled
• Labour is not unduly prolonged (average
up and become a part of the uterine segment.
12 hours)
Effacement is expressed as ranging from 0%
• No complication to the mother and (no reduction in length) to 100% palpable
baby below the fetal presenting part.
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Dilatation of cervix: cervix dilates to a • Bearing down pain with strong uterine
maximum of 10 cm to enable the head to pass contraction.
through the cervix. • Bulging of the perineum and gapping
of the anus.
Diagnosis Of Labour
• Full dilatation of the cervix.
True labour pain:
Third stage: The 3 rd stage of labour
• Starts over the back (sacrum) radiates
is the interval between the delivery of the
to lower abdomen and thigh.
fetus to delivery of the placenta, umbilical
• Intermittent colicky pain. cord and fetal membranes and lasts 15-30
• Gradually the intensity, duration and minutes. Separation of the placenta is the
frequency of contraction increases. result of continuous uterine contraction
• Pain is associated with uterine after delivery of the fetus . The contraction
contraction. reduces the area of uterine placental bed,
• Pain is not relieved by enema. with placental separation occurring in the
spongiosa layers of the decidua Vera. Blood
Dilatation of cervix: Progressive dilatation &
loss is controlled by compression of spiral
effacement of cervix
arteries by the continued contraction which
Show: Blood stained mucus discharge per
transport the placenta from fundus into the
vagina due to separation of the cervical mucus
lower uterine segment and through cervix
plug.
into the vagina.
Stages and Phases Of Labour Fourth stage: The 4th stage is the stage
First stage: The first stage of labour is the of observation for atleast one hour after the
interval between the onset of true pain and full expulsion of the placenta and membranes.
cervical dilatation. Duration is 6-12 hours. The
Mechanism Of Normal Labour
first stage is further divided into a latent and an
Definition: A Series of movements adapted by
active phase.
fetus in the birth passage during expulsion.
• Latent phase:
Mechanism of normal labour falls on: - (3 P’s)
The latent phase extends from the onset of
• Power – strength of contraction
labour till 3 – 4cm dilatation. During this phase,
uterine contraction are mild and irregular. They • Passage – pelvic dimensions and
become intense, frequent and regular as the configurations
latent phase progress. • Passenger – size of the baby
• Active phase:
Mechanism
The active phase is characterized by
a. Engagement:
increased rate of cervical dilatation.
• When the greatest diameter of the
Second stage: The duration of the 2nd stage
presenting part (biparietal diameter
averages 2 hours for primi and 30 minutes for
in vertex) has passed the plane of the
multiparaThe 2nd stage of labour is the interval
pelvic brim, the head is said to be
between full cervical dilatation to delivery of
engaged.It occurs in late pregnancy
the baby.
(primi) or at the time of labour (multi).
Diagnosis of second stage of labour:
b. Descent:
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e. Crowning:
• After internal rotation and further
descent, vulva form a crown around
the head (i.e.) the biparietal diameter
distends the valval outlet without 03. Further descent, internal rotaon 07. Delivery of anterior
shoulder
any recession of the head even after
contraction is over.
f. Extension:
• Distension of perineum by vertex. 04. Complete rotaon,
08. Delivery of posterior shoulder
begining extension
• Occiput beyond symphysis &Head
stands out.
g. Restitution: At the moment a baby’s
born , 1/3 of their blood is still
• Untwisting of the neck, head rotates to
outside their body. If you delay
the position occupied at engagement.
cord clamping 90 seconds they get 60% more
h. External rotation:
blood cells. They get enough iron to last them
• Shoulder descends in the path similar through their first year. They get white blood
to that followed by the head and rotates cells to fight infection. They get antibodies.
anteroposteriorly. They get stem cells to help repair their body.
• Head swings.
i. Lateral flexion:
• Anterior shoulder comes under the 7.7 Normal Puerperium
symphysis pubis.
Puerperium is the period following
• Posterior shoulder sweep the perineum. childbirth during which the body tissues
j. Expulsion: especially the pelvic organs, revert approximately
• After delivery of the shoulder under to the pre-pregnant state both anatomically and
the symphysis pubis, the rest of the physiologically.
body expelled quickly. Rest of the Anatomic and physiologic changes
body expelled with lateral flexion
• Uterus involution
• Regeneration of endometrium
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Pelvic Floor
Uterine Involution
Normal by 6 weeks except varying degree
• In pregnancy, uterus increases 11 times in
of musculoskeletal laceration.
size and weight.
• Rapid involution – immediately following Urinary Tract
delivery it reduces from 1000gm to 100gm • Immediate postpartum – bladder
at the end of 6 weeks. mucosabecomes edematous
• Reversal of hypertrophy due to withdrawal
• Over distension – incomplete emptying
of sex hormone causes increases
and presence of , residual urine are
collagenase, proteolytic enzyme causes
common urinary problem in puerperium
autolysis of intracellular protein.
• 1 – 2 days – mild proteinuria in 50 % of
• Decrease uterine volume due to increase
women
myometrial force and intrauterine pressure
• By 8 weeks – renal plasma flow reduces to
150 mmHg.
normal, glomerular filteration returns to
• After pains 2 – 3 days more in multiparous
normal.
and more during lactation due to increase
in oxytocin. • Creatinine clearance becomes normal by
• Uterine cavity- sterile, bactericidal effects 1st week.
of granulation tissues. Fluids And Electrolytes
Lochia • Weight loss - immediately after delivery –
Lochia is the vaginal discharge after giving 5.5 kg – fetus, placenta, amniotic fluid 4 kg
birth. – excretion of fluids and electrolytes.
Rubra– last for 3 days, contains fresh blood • Fluid loss – 2 liltres during 1st week. – 1.5
and necrotic tissue. litres – next 5 weeks.
Serosa – last for 4-9 days, contains liquefied Electrolytes
blood, leucocytes, serous, palour and reddish
• Total exchangeable sodium decreased but
brown in colour.
body water loss exceeds sodium loss.
Alba – last for 10-15 days ,contains
• Decreased plasma progesterone causes
leucocytes, mucus decidual cells, yellowish
decreased aldosterone antagonism and
white in colour.
increased sodium.
Cervix • Tissue involution – cellular breakdown,
• 1ST week – closes to 1 cm. increases potassium level.
• External os – transverse slit. Cardio Vascular Changes
• Complete healing 6 – 12 weeks. i. Blood coagulation:
Vagina • Rapid and dramatic changes in the
coagulation and fibrinolytic system
• Smooth, swollen and poor tone after
after delivery.
delivery.
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f) Hygiene: Bed sheet, linen and clothing Underfeeding: It is diagnosed by (1) failure to
should be clean and changed as when gain in weight.(2) dissatisfied with feeds (e.g)
required. This will prevent infection. Bath, cry, disturbed sleep, (3) constipation or frequent
body sponging, cleaning at the breast and small stool (or) scanty urine.
nipple and toileting of the perineum should Overfeeding: usually occurs at the end of first
be done. week. Diagnosed by (1) vomiting soon after
g) Exercise: pelvic floor and abdominal feeding, (2) frequent loose bulky stool with
exercise to restore muscle tone undigested curds (3) excoriation over buttock.
Clothing: Should be appropriate for climate.
7.8 Care of Newborn
7.9 Reproductive Health Care and
First 24 hours is crucial for the newborn
Family Planning
where most of the complication occur during
that period. Definition Reproductive Health Care
Vital signs: Monitor cardio, pulmonary • Ability to reproduce and regulate fertility
function and vital signs at frequent intervals.
• Safe motherhood – safe pregnancy and
Temperature: once a day, may be recorded 6 child birth with resultant safe mother and
hourly if indicated. infant
Respiration: Normally regular, smooth and • Safe sex with no fear of pregnancy and of
quite with a rate of about 30 - 60 breaths controlling diseases.
per minute. Any abnormality e.g:- grunting,
dyspnoea may be noted. Components of reproductive health
Skin: Look for cyanosis, jaundice and Adolescent girl’s health
dehydration. problem
• Pre-
Head, eyes mouth – must be inspected for any Nutrition
reproductive
abnormalities and infection. Sex education
years:
Contraception and
Umbilical cord: check daily for any
Adolescent pregnancy
inflammation, discharge, smell. Cord usually
Age at marriage (ideally girls
comes out by 6 – 7 days.
21 – 25 yrs, boys 26 – 30 yrs)
Stool: Number, color and character of
• Reproductive Family planning
stools should be noted. First stool known as
years: Legal abortion
meconium is dark, greenish viscid substance.
Infections
After Subsequent to feeding of the baby, the
Infertility
color of stool changes to brownish yellow.
Education on menopause
Urine: Usually passed during or shortly after • Post-
Screening for genital cancer
birth. Most infant pass urine within first menopausal
Prevention and cure of
24hours. Urine may stain napkin pink due to years:
genital cancer
the heavy deposits of urates. Napkins should
be changed immediately following soiling and Definition Family Planning
local parts are cleaned and kept dry. Practices that help individuals or couples
Feeding: Encourage demand feeding baby should achieve the following:
be breast fed every 3 – 4 hours. Any abnormality • Avoid unwanted pregnancy
like vomiting, distension should be noted.
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• Achieve wanted pregnancy and child birth phase 2, the mucus is more abundant thick and
• Spacing the pregnancies clear and stretches easily.
• Determine the number of children in the Measuring basal body temperature:
family Basal body temperature should be
• Choose the age for becoming pregnant measured in the morning. A sustained rise
of temperature of 0.2 to 0.6 C indicates that
Contraception
ovulation has occurred
Measures designed to prevent pregnancy
due to coital act either temporary or Advantages Disadvantage
permanenty
• No physical side • High failure rate
Temporary Methods Of Contraception effects • No protection
I. Natural Method • Economical against sexually
Rhythm Method: • No method- transmitted diseases
The menstrual cycle is divided into three related health (STD’s) Hepatitis -
phases for purpose of assessment of likelihood risks B, HIV
of conception.
Abstinence Complete abstinence
Phase-1: relatively infertile phase last
Coitus interruptus - During sex the man
from onset of menstruation until the time of
withdraws his penis from the vagina before he
preovulation.
ejaculates
Phase-2: fertile phase. last from seven days
preovulation to 48hrs post ovulation. Lactational Amenorrhoea Method
Phase-3: absolutely infertile phase lasts
It suppresses ovulation and thickens
from 48hrs after ovulation until the onset of
cervical secretions. It is effective in women
menstrual, bleeding about 10 – 16 days.
less than 6 weeks of postpartum, who are
Methods to determine the phase of the cycle:
breastfeeding.
Emergrncy Contraception
It reduces sperm transport and changes the
endometrium thus unfavorable for fertilization.
It is effective for women who have had
unprotected intercourse within 72 hours and
for victims of sexual assault.
Advantages of natural methods
• Natural method that does not require
devices or medicine in the body.
• There are no side effects.
• No cost. Is morally and culturally
acceptable.
Testing cervical mucus: • Better than not using any birth control
During phase 1 and 3, the mucus is scanty , method
thick and breaks quickly when stretches. During
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• Fairly effective • High failure rate 3 to They are agents that cause destruction of
in preventing 15 per 100 women. the sperm cell membrane; thereby affecting
pregnancy mobility.
• Only synthetic
• Only condom can provide • Aerosol foams
contraceptive protection against • Creams and Jellies
method that HIV and HBV’s • Vaginal suppositories
provides • If either partners has • Films & sponges
protection latex allergy, a non- All contain spermicidal agents usually
against STD’s. latex product should nontoxic.
be used.
Advantages Disadvantages
Diaphragm:
• Serves as a lubricant • High failure rate
Advantages Disadvantages
and also provides • Effective for only
• Effective in •• High failure rate some protection 1-2 hours
preventing •• Slight risk of against STD’s
pregnancy if used toxic shock • Reduced risk of
properly and provide syndrome. cervical neoplasia
same protection •• Increased risk of
against STD’s UTI III. Iucd- Intra Uterine CONTRACEPTIVE
••Decreased risk of •• It requires initial Devices
cervical cancer fitting. Modern Methods
They are flexible plastic device medicated
Types:
with slowly released hormones. Copper –
i) flat spring ii) Coil spring iii) Arching spring released devices interferes with the ability
of sperm to pass through the uterine cavity.
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SURGICAL STERLIZATION
Advantages Disadvantages
Uterine CAUTERIZED
Fallopian tube Fundus
cavity
• Highly effective and • Permanent of uterus
Advantages Disadvantages
•• Outpatient procedure •• Permanent
under local anesthesia procedure
•• Less expensive •• No protection
•• Fewer complication against STD’s
Activity 1
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SUMMARY
Midwifery is the art and science of caring for woman undergoing normal pregnancy, labour
and the period following child birth.
Normal pregnancy involves a continuous process. It is divided into three trimesters. It starts
from fertilization to delivery of the fetus.
Physiological changes occur during pregnancy especially there is marked changes in
genitourinary system. Pregnancy is diagnosed by first in urine testing of beta HCG and
confirmed by ultasonogram. Expected date of delivery is calculated by last menstrual period.
Antenatal care refers to the care given to an expectant mother from the time of conception
to the beginning of labour. Importance of regular follow up should be insisted to the women.
Advise them to take regular calcium, iron and folic acid.
Identification of high risk pregnancy and provide appropriate treatment to reduce the
maternal and fetal morbidity and mortality.
Each visit should check blood pressure and weight in order to identity the early signs of
pregnancy induced hypertension which is major cause of maternal death and fetal death.
Labour is the process resulting from uterine contraction leading to expulsion of products
of conception from the uterine cavity through vagina. Labour is diagnosed by dilatation of
cervix and contraction of uterus.
A serious of movements adapted by fetus in the birth passage during expulsion is called
mechanism of normal labour. Mechanism of normal labour falls on: - (3 P’s) power, passage,
and passenger.
There are three stages of labor.
First stage: F
irst stage of labour is the interval between the onset of labour and full cervical
dilatation. Duration is 6 – 12 hours.
Second stage: I t is the interval between full cervical dilatation and delivery of the fetus.
Third stage: It is the interval between the delivery of the fetus and delivery of the plancenta,
umbilical cord and fetal membranes and last 15 – 30 minutes.
Puerperium is the period following childbirth during which the body tissues especially
the pelvic organs, revert approximately to the pre-pregnant state both anatomically and
physiologically. Post natal care which includes of rest, sleep, early ambulation, diet,
hygiene, etc.
First 24 hours is crucial for the newborn where most of the complication occur during that
period. Feeding should be planned for every 2 – 4 hours intervals including demand of the
baby
Early initiation of breast feeding should be initiated within 1 hour of child birth. Educate
the mother about the exclusive breast feeding for six month and continue for 2 years along
with weaning food.
Mother has to be instructed to follow contraceptive methods. There are two types of
contraception temporary and permanent. Temporary methods divided into natural,
hormonal, intrauterine devices and barrier methods. Tubectomy and vasectomy are the
permanent methods.
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GLOSSARY
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Evaluation
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Steps
• Step 1: Type the URL link given below in the browser or scan the QR code.
• Step 2: A picture of the foetus is displayed, week numbers of the trimester is given
above and trimester timeline is given below the picture.
• Step 3: Click any week number to know the position and growth condition of the
fetus on the particular week
• Step 4: Click the picture to see it enlarged.
URL : https://www.healthlinkbc.ca/health-topics/tn10283
https://www.webmd.com/baby/interactive-pregnancy-tool-fetal-development?week=3
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CHAPTER
8
Child Health
Nursing
“The pipe is sweet, the lute is sweet,” say those who have not heard the
prattle of their own children
Learning Objectives
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APGAR Score
Sign Score
0 1 2
Appearance Body pink Extremities Completely pink all
Blue/pale
(colour of the baby) blue over
Pulse(Heart rate) Absent Below 100 Above 100
Grimace (Reflex Facial movement only
No response Sneezes, Coughs
response) with stimulation
Lethargic and Some flexion of
Activity (Muscle tone) Active movements
extremities extended extremities
Respiration Absent Slow and irregular Regular with cry
Maintenance of Body temperature (warmth) Provide skin to skin contact to the baby if
Body heat is lost from the newborn by four possible
ways. They are as follows:- If skin-to-skin contact is NOT possible:
• Wrap the baby in a clean dry warm cloth
Convecon
Evaporaon
• Mummify the baby
Radiaon
• Cover the baby’s head with cap.
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Breast feeding
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Reflexes useful for breast The foremilk satisfies the thirst of the baby
feeding whereas the hindmilk which is high in fat
provides satiety.
• The following two reflexes are helpful for
the babies in breast feeding.
Techniques of breast feeding
• Rooting reflex: To find the nipple and
proper attachment to breast. Positioning
• Sucking reflex: To draw out milk from • The mother is relaxed and comfortable.
mother’s breast.
• The baby’s head and body are in a straight
Types of Breast Milk line
The breast milk secreted undergoes changes • The baby’s face is opposite the nipple and
as the days goes on to meet the demands of the the breast
baby.
• The baby’s upper lip or nose is opposite the
S. N Breast Milk Characteristics mother’s nipple
This milk is secreted • The baby is held or supported very close to
in the first week of the mothers body
1 Colostrum life.Thick and yellow.
Rich in protein and • The baby’s whole body is supported if the
antibodies mother is in a sitting position
Milk that is secreted Attachment: It is otherwise known as
between the 1st and the latching. It means attachment of nipple along
Transitional
2 2nd week. The fat and with areola in baby’s mouth and not nipple
milk
sugar content starts alone.
increasing.
Key points to good attachment
After 2 weeks, the
• The mouth is widely open
milk secreted is known
as mature milk It is • The tongue is forward in the mouth, and
3 Mature milk
thinner and watery may be seenover the bottom gum
Rich in all necessary
nutrients • The lower lip is turned outwards
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Sitting
Crawling
Squatting
Standing with support
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8.6 Weaning
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Techniques of weaning
• Wash hand thoroughly with soap before
preparation of weaning foods.
• Introduce one food at a time
• Let the baby get used to one food for a few
days before introducing another.
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• Use the cleanest water available for making and National Urban Health Mission (NUHM)
weaning foods and for washing uncooked as its two sub missions. The programme
foods. components include Reproductive-Maternal-
• If possible boil the water if it has not come Newborn-Child and Adolescent Health
from a clean source such as a tap or water (RMNCH+A); and control of communicable
pump. and non communicable diseases.
• Boiling water will kill the germs that cause Reproductive, Maternal,
diarrhoea. Newborn, Child and Adolescent
• Do not store weaning foods for more than Health (RMNCH+A)
two hours if possible. This programme has been launched
• Keep them stored in clean covered in 2013. It aimed to reduce the maternal
containers that keep out flies and other mortality and child mortality and addressed
insects. the delays in accessing and utilizing health
care and services. Under this programme, the
8.7 Maternal and Child Health areas of care include
services • Reproductive care
• Maternal care
Maternal and Child Health services
• Neonatal care
include the curative, preventive and social
aspects of maternity services, paediatrics, • Child care and
family welfare, nutrition, child development • Adolescent health care
and health education. The specific objectives The three goals that are relevant to
of MCH are: RMNCH+A strategic approach in 12th Five
• Reduction of morbidity and mortality rate Year Plan which has to be achieved by 2017 is
for mothers and children as follows:
• Promotion of reproductive health and • Reduction of Infant Mortality Rate (IMR)
• Promotion of the physical and psychological to 25 per 1,000 live births
development of the child within the family. • Reduction in Maternal Mortality Ratio
(MMR) to 100 per 100,000 live births
Components of MCH • Reduction in Total Fertility Rate (TFR) to
2.1
• Family planning and reproductive health
service Priority interventions in RMNCH+A
• Maternal, newborn and child health service The following are the intervention for
• Health Communication children. They are
• Health Commodities and supplies • Home-based newborn care and prompt
• Health systems strengthening referral
The Ministry of Health and Family Welfare • Facility-based care of the sick newborn
has launched National Health Mission in • Integrated management of common
May 2013. Many different health and welfare childhood illnesses (diarrhoea, pneumonia
programmes have been brought together under and malaria)
the umbrella of National Health Mission (NHM) • Child nutrition and essential
with National Rural Health Mission (NRHM) micronutrients supplementation
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SUMMARY
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GLOSSARY
Rooming in - An arrangement in hospitals where newborn babies stay with their mothers
Prelacteal - Any food except mother’s milk provided to a newborn before initiating
breastfeeding.
Abduction - Movement of a limb or other part away from the midline of the body, or
from another part.
Adduction - Movement of a body part toward the body’s midline.
Mortality - Death
Morbidity - Sickness
Satiety - State of being completely satisfied
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Evaluation
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CHAPTER
9
Community
Health Nursing
He who desires a good name must desire modesty; and he who desires (the continuance of) a
family greatness must be submissive to all.
Learning Objectives
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TUB
CHOLERA
LA RIA
MA in children below 5 years of age accounting for
COMMUNICABLE approximately 8% of all deaths among children
JAUNDICE DISEASES DIARR below 5 years worldwide in 2016. Outbreaks of
HEA
diarrheal diseases including cholera continue
AIDS to occurs due to the poor environmental
ACU PIRAT S
LEPROSY
RES ECTIO
INF
TE ORY
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strategy in 2016 –2020: accelerating towards Millions of deaths due to Non Communicable
a leprosy-free world – which aims to leprosy Diseases which can be prevented by promoting
control and prevent disabilities. the public awareness and participation.
Measures to Control Non Communicable
Leprosy is recorded in ancient Disease
vedic writings and it is termed as
• Stronger anti-tobacco
"Kusht" in those days
controls - No smoking
• Promoting healthier
VI. Acquired Immuno Deficiency diets
Syndrome(AIDS) • Promoting Physical
Since AIDS was first detected in the year activity
1986 and worldwide it stands in third place. It • Reducing/Stop the use of alcohol;
is estimated that by the end of year 2016, there • Improving people's access to essential
were about 2.1million cases of HIV positive health care.
cases and 62000 people died from AIDS related
illnesses in the country. Nutritional Problems
Malnutri�on
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Source: Asamadu et al, Nutritional Problems • Improper waste disposal and low level
and Intervention Strategies in India, A technical of sanitation leads to soil pollution and
Report (2012) breeding places of insects, flies and rodents.
a) Protein Energy Malnutrition- : Caused
• Sound pollution Traffic pressure.
by the defeciencies of protein and calories.
It occurs more commonly among weaned • Degradation of land Industrialization and
infants and pre school children urbanization
Kwashiorkor is the deficiency of • Radiation hazards
protein in the diet. • Excessive use of fertilizers and chemicals
Marasmus - severe deficiency of in agriculture.
protein and energy in the diet. • Destruction of forests
b) Vitamin Defeciencies: caused by the • Increasing population, poverty, illiteracy,
deficiency of vitamins in the diet. unemployment further increases
• Vitamin A deficiency – leads to Night environmental problems.
blindness and Xerophthalmia( dryness
Medical Care Problems
of cornea)
In rural area 74% population doesn’t get
• Vitamin C deficiency – leads to Scurvy benefit of modern curative and preventive
• Vitamin D deficiency – leads to Rickets health services. Approximately 80% of health
services are concentrated in urban area.
c) Mineral defeciencies: caused by the Addressing to meet inadequate and uneven
deficiency of minerals in the diet distribution of doctors, and medical services
• Nutritional anemia – decreased between rural and urban is the challenging
haemoglobin in the blood due to the task to health sector.
insufficient iron in the diet
Population Problem
• Iodine deficiency disorder (Goitre) –
During Independence in 1947 India's
decreased iodine intake.
Population was 30 crores. As on 2018 now
d) Out of these defeciencies the two major it is the second most populated country in
nutritional problems of India are the world, current population is 1.35 billion.
• Under Nutrition The population problem is the important
• Nutritional Anaemia problem faced by our country which affects all
aspects of, sanitation, housing, health care and
environment.
Environmental Sanitation
r populao
problem Ove n
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• Child health, water, sanitation and hygiene from TB by effective treatment. The Govt. of
• P
revention and control of Communicable India, WHO and world Bank together reviewed
and noncommunicable deseases including the NTP in 1992. Based on the findings a revised
locally endemic diseases and emerging strategy for NTP was evolved. Short term
diseases chemotherapy has been introduced in 5 districts
• Population stabilization to achieve at least 85% cure rate through DOTS
(Direct Observation Treatment Short course). It
• Revitalize Indigenous System of Medicine
is done by voluntary workers such as teachers,
Functions of NHM anganwadi workers, dais, ex-patients and social
workers. NGOs are involved in Information,
• Antenatal and postnatal check up
Education and Communication.
• I mproved facilities for Institutional
deliveries 4. National Aids Control Programme:
• Trained commuity level worker National AIDS Control Program was
• Complete Immunization launched in India in the year 1987 is to prevent
• Good Hospital care further transmission of HIV, to decrease
morbidity and mortality associated with HIV
• Provision of household toilets
infection and to minimize the socio economic
• Mobile Medical units
impact resulting from HIV infection.
• Health and Nutrition
5. National Family Welfare Programme
2. National Malaria Eradication Programme:
Family planning was started in the year
The National Malaria Control 1951. In 1977, the Govt. of India re-designated
Programme (NMCP) was launched in 1953 National Family Planning into National Family
which was upgraded to National Eradication Welfare Programme and was integrated with
Programme (NMEP) in 1958. The NMEP Mother and Child Health services. The aim of
achieved remarkable success during the family welfare programme is to improve the
period 1958-1965, by which the incidence of quality of life through education, nutrition,
Malaria came down to only 1lakh cases and health, employment, women's welfare and
no deaths in 1965. In 1994 Resurgence of rights, shelter, safe drinking water and all factors
malaria forced Govt. of India to appoint an vital to the life.
Expert committee on Malaria to identify the
problem areas and specific control measures. 6. Universal Immunization Programme (UIP)
Thus the Malaria Action Programme (MAP) UIP is a vaccination programme launched
was evolved and is being implemented. The by the Govt. of India in 1985. Currently
objective of the MAP is to prevent deaths, UIP is one of the key areas under NRHM
outbreaks and complications due to Malaria. (National Rural Health Mission) since 2005.
It has been decided to observe Anti Malaria It consists of vaccination against 12 diseases
Month before the onset of monsoon i.e. namely Tuberculosis, Diphtheria, Pertussis,
month of June every year. Tetanus, Polio, Measles, Hepatitis B, Japanese
Encephalitis, Rubella Pneumonia and
3. National Tuberculosis Control Programme:
Pneumococcal diseases. Immunization is one
The National Tuberculosis Control of the most effective methods of preventing
Programme was established in 1962 with the childhood diseases. With the implementation
objective of reducing the disability and death of the Universal Immunization Programme
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(UIP) by the Government of India, significant that the prevalence of goitre was high. Hence the
achievements have been made in preventing programme was renamed as Iodine Defeciency
and controlling vaccine-preventable diseases Disorder Control Programme in 1992 and
(VPDs). Introduction of Pentavalent vaccine enforced on the fortification of iodine in salts at
(pilot project in Tamil Nadu)will further reduce the manufacturing level.
the incidence of pneumonia and meningitis
caused by Haemophilus, influenza type b (Hib) Our body requires very minimal
bacteria. quantity of Iodine (150 µg for an
7. National Diarrheal Diseases Control adult). It can be supplied in 10
Programme gm of salt. Excess of Iodine in blood can be
excreted in urine.
Diarrhea is one of the leading causes of child
mortality. National diarrheal disease control
programme was launched in the year of 1978. 9. National Leprosy Control Programme
It was actually a renamed version of national The programme was launched in the year
cholera control programme. The programme of 1955. In 1983 it was renamed into National
emphasized on the use of Oral rehydration Salt Leprosy Eradication Programme. The main
(ORS) therapy. It also focussed on the rational objectives of the programme are to reduce
use of medications, adequate nutritional and the leprosy cases, early detection and treat the
fluid replacements during diarrhea, education known cases with effective multi drug therapy.
on personal hygiene, feeding practices among
Types of units functioning in the country
the mothers of under five.
1. N
ational Leprosy Control Units are
You can make your ORS at established in highly endemic areas.
home
2. S urvey, Education and Treatment (SET)
Centers attached to Primary Health
centers.
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2. ICDS Project: In the fifth year Plan • Initial treatment for the emergencies such
highest priority had been accorded to child as injuries and illnesses.
welfare programmes. The most important scheme • Early diagnosis of the occupational or other
in this field was the Integrated Child Development illnesses and to screen the people at risk.
Services.(ICDS) for children in the age group • Assist the management in placement of the
0-6 years, nursing and expectant mothers, etc., people in suitable work.
Under the scheme supplementary nutrition,
• Provide advice and supervision of conditions
immunization, health check up, referral services,
at work which may affect the health such as
nutrition and health education and non-formal
environmental sanitation.
pre-school education are provided. There are now
5422 ICDS projects operating in the country. • Health Education
A Child Development Project Officer is in- Role of Nurses in Occupational Health
charge of each ICDS project. An Anganwadi is Services
the focal point for the delivery of services to the
• A ssist the doctor for the examination of the
community.
employees.
• Protect and improve the physical and mental
9.12 Voluntary Organizations/ health of the workers.
Agencies • Provision of first aid and treatment for
minor illnesses and injuries.
Apart from Central and State Governments,
• Assess, identify and notify the management
More than 10,000 voluntary organizations are
regarding the hazards affecting the workers.
also engaged in social welfare activities.
• Conduct health education
Functions • Home visit to the employees to educate
1. Supplimenting and gurding the work of regarding the health and family welfare.
government agencies • Nutrition
2. Pioneering: Example research • Communicable Disease prevention
3. Education • Environmental sanitation
4. Demonstration: bore hole latrins by • Protective Measures for the employees
Rockefeller foundation • Medical Check - up and Immunization
5. Advancing health legislation 2. Tuberculosis Nursing
In the control of communicable diseases
9.13 Special Community Health nurses play a vital role in the community level.
Nursing Services The following are the nurses role in control
of Tuberculosis which an airborne infectious
1. Industrial Nursing disease affecting the people living in poor
The aim of occupational health nurse is to living standards and with low immunity.
keep the people at work healthy and to prevent Pulmonary tuberculosis is responsible for the
them from illness and injury due to the working majority 85% of TB infections.
environment. 1. Case finding
The following are the basic functions of 2. Health Supervision (DOTS)
Occupational or Industrial Nurse 3. Domiciliary care - Isolation
• Identify the occupational Hazards 4. Prevention of the spread of infection
• Educate them about the control of the
5. Drug compliance
occupational hazards.
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• Smallpox was the first disease to be eliminated from the world through public
health efforts and vaccination.
• India, with 1,350,117,491 (1.35 billion) people is the second most populous country in the
world, while China is on the top with over 1,415,489,506 (1.41 billion) people
• Anti Malaria Month before the onset of monsoon i.e. month of June every year.
• Major Milestones in National Health Programs are
1992 – Child Survival And Safe Motherhood Program (CSSM)
1997 – RCH I and RCH II
2005 – National Rural Health Mission
2013 – RMNCH + A Strategy
2013 – National Health Mission
Community Mental Health & Palliave Home Diabetes Nurse Public Parish
Care Addicons Nurse Health Educator Health Nurse
Coordinator School Nurse Specialist Nurse Nurse
SUMMARY
Community health nursing is the newer aspect of healthcare that has grown in response to
changing environmental and social structure changes into a worldwide movement. Fast growing
elderly people, improvement in health technologies and rising healthcare costs has an impact upon
the development and scope of practice for community health nurse.
GLOSSARY
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1. Make a Visit to the Sub Center and Assign the students to conduct a
observe the functions of a village health survey in a street and find the prevalence
nurse in your area. of Clients with Non communicable
2. Make a Visit to the ICDS unit and assess diseases such Diabetes, Hypertension
the anganwadi worker in your area. and Heart Attack (Myocardial Infarction.
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Evaluation
I. Choose the correct answer 8. Following are the common health problems
1. Malaria is transmitted by the bite of of the school children except
6. Following are the vector borne diseases 3. What are the components of NRHM
except 4. Discuss the environmental sanitation
a) Malaria problem.
b) Filaria 5. W
rite about the targets of National Health
c) AIDS Policy
d) Dengue
6. E
numerate the functions of Village Health
7. Identify the communicable disease from Guide
the following
7. Mention the principles of Primary Health Care
a) Cholera
b) Cancer 8. V. Answer in detail:
c) Diabetes 9. E
xplain in detail about the national health
d) C
ardiovascular Diseases problems.
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CHAPTER
10
Mental Health
Nursing
Principles and Practices
LEARNING OBJECTIVES
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HOSPITALIZATION Definition
“An alteration in mood that is expressed
PHARMACOTHERAPY
by feelings of sadness, despair, and pessimism.
ECT There is a loss of interest in usual activities, and
somatic symptoms may be evident. Changes
PSYCHO THERAPY in appetite and sleep pattern are common”.
- Mary C. Townsend
PSYCHO SOCIAL
REHABILITATION Etiology
Nursing Management • Due to loss of loved object
• Nursing assessment • Repeated losses in the past
• Health education • Negative expectations of environment,
Negative expectations of the self
Paranoid • Negative expectations of the future
Definition • Stressful life events, Death, Marriage,
Financial loss
Paranoid is a thought process that causes an
irrational suspicion (doubtfulness) or mistrust
of others.
Cause
Genetics, stress, brain chemistry and also
drug abuse.
Symptoms:
• A consistent stress or anxiety beliefs about
others
• A mistrust of others
• Feeling disbelieved /misunderstood
• Isolation
Diagnosis
Symptoms of Depression
History collection, physical examination
and mental status examination. • Sadness
• Sleep disturbances Insomnia -early
Management morning or over sleeping
• Accept their vulnerability • Hopelessness, Helplessness, Worthless
• Develop trust in others ness, restless, irritable.
• Encourage to express emotions in positive • Guilt,
manner. • Anger
• Psychotherapy • Fatigue
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B. Panic Attack
Intense feeling of fear or terror that
Postpartum Psychosis
occurs suddenly and intermediately without
warning.
C. Anxiety
Anxiety is a feeling of uneasiness or tension
that a person experience to an unknown object
or situation.
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Eating Disorders
Definition
An eating disorder is when you have an
unhealthy attitude to food, which can take over
your life and make you ill.
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Management Management:
• Treat the cause • Treat the underlying physical and
• Medications psychological problems
• Sleep hygiene • Medications
• Relaxation techniques • Psychotherapy
• Behaviour therapy
Sexual Disorder
Definition 10.7 Drug Abuse, Alcohol Abuse
Any disorder that involving sexual and De-Addiction
functioning, desire or performance
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Complications
Physical Complications Psychiatric Complications Social Complications
• Accidents. • Dementia • Suffering in relationships with
• Suicide rates increased • Brain damage family, friends, and coworkers.
• GI ulcers, • Anxiety • divorce and separation
• liver disease, • Depression • Domestic violence
• malnutrition, • Psychosis • aggressive behavior.
• anaemia, and • Confusion • Missed work,
• Dehydration. • Antisocial personality • poor job performance,
• cardiac dysrhythmia, • Bipolar disorder • On job accidents are common.
• seizures, • Legal problems
• Acute renal failure.
• Mood changes
• Psychosis.
• short- and long-term memory loss
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Perinatal Causes
10.10 Attention Deficit Hyperactivity
Disorder • Alcohol and tobacco smoke exposure
during pregnancy.
A t t e n t i o n • Head injuries.
Deficit Hyperactivity • Infections during pregnancy, at birth and
Disorder is early childhood.
otherwise known as • Prolonged labour
Hyperkinetic disorder. • Perinatal asphyxia
The syndrome was first described by Heinrich • Postnatal infections, CNS abnormalities
Hoff in 1854. due to trauma
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regular services of a hospital. There may not with a specific problem. The group helps the
be a routine rounds, nurses, and most of the members to become socialize. Ex. AA (Alcohol
activities carried out by patients themselves. Anonymous)
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Availability &
The District Mental Health Program
accessibility of mental
health care to the most
(DMHP) was launched under National Mental
vulnerable and under-
privilaged secons of
Health Program in the year 1996. Presently
Mental health populaon Integraon of
mental health
the District Mental Health Program (DMHP)
knowledge in
general health services with
General Health
is being implemented in 123 districts.
care in social
development Services
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SUMMARY
Most people with mental illnesses are treated in the community rather than in hospitals, but nurses
are needed in both settings. Demand for mental health services has increased significantly in recent
years. Around 20% of the world’s children and adolescents have mental disorders. Mental and
substance use disorder disorders are the leading cause of disability worldwide. War and disasters have
a large impact on mental health and psychosocial wellbeing. Mental disorders are important risk
factor for other diseases as well as intentional and unintentional injury. Stigma and discrimination
against patients and families prevent people from seeking mental health care. Financial resources to
increase services are relatively modest. About 800000 people commit suicide every year. Generally
there is huge inequity in the distribution of skilled human resource for mental health
GLOSSARY
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CLINICAL EXAMPLE
The Client with Severe Mental Retardation
Mr. X 18 years old, was born by a normal spontaneous vaginal delivery without any complications.
Two months after birth, Mr. X developed a temperature of 105°F and had a grand mal seizure. He
was admitted to the neonatal intensive care unit with the diagnosis of fever of undetermined origin
(FUO). Diagnostic tests revealed the presence of encephalitis. MR. X recovered, but his parents
were cautioned about the possibility of central nervous system damage because of the severity of
his illness. During early childhood, ages 1 to 5, Mr. X was able to communicate with his parents
to some extent but exhibited poor motor-skill development. He was unable to learn basic skills
such as reading, writing, and arithmetic, and it became evident that he needed supervision in a
controlled environment. Testing revealed Mr. X’s IQ to be that of a person with severe retardation
or mental impairment. At age 18, he continues to live at home with very supportive parents who
have been able to teach him some self-care activities. He relates well to a pet cat, helps his mother
with simple household chores, and helps his father with gardening and lawn care.
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Evaluation
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CHAPTER
11
Communicable
Diseases
The learned (physician) should ascertain the condition of his patient; the nature of his
disease, and the season (of the year) and (then) proceed (with his treatment).
LEARNING OBJECTIVES
Infections due to living organisms are 1. Infection: The entry and development or
called communicable diseases. They spread multiplication of an infectious agent in the
from person to person, or sometimes from body of human being or animals.
animals to people. They occur at all ages but 2. Contamination: The presence of infectious
are most serious in childhood and they are agent on a body surface or in clothes,
preventable to a great extent. In developed beddings, toys, surgical instruments or
countries, communicable diseases have been dressings or other inanimate articles or
prevented. But in India it is going through substances including water, milk and food.
a period of transition, both epidemiological 3. Infestation: For persons or animals the
and demographically. Infectious diseases are lodgment, development and reproduction
still persisting as major health problems in of arthropods on the surface of the body or
spite of having National programmes for the in the clothing (e.g) lice, itch mite.
control of many diseases.
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b. Carriers - is a person who has become 3. Contact with soil - The disease
infected with a pathogen, but does not agent may be acquired by direct exposure
show any signs or symptoms. of susceptible tissue to the disease agent in
soil, compost or decaying vegetable matter.
2. Animal Reservoir - the source of infection
Examples: hookworm larvae, tetanus, mycosis
may sometimes be animals and birds.
etc.
3. Nonliving things - soil and inanimate
4. Inoculation into skin or mucosa -
matter can also act as reservoir of infection.
Rabies virus by dog bite, Hep. B virus through
eg. Tetanus in soil.
contaminated needles and syringes etc.
5. Transplacental (or vertical)
11.3 Mode of Transmission transmission - TORCH agents - (Toxoplasma
Gondii, Rubella virus, Cytomegalo virus,
Infectious diseases are transmitted from
and Herpes virus). Varicella virus, Syphilis,
person to person by direct or indirect contact.
Hepatitis B, Coxsackie B and AIDS. Some
Certain types of viruses, bacteria, parasites,
of the non-living agents (e.g., thalidomide,
and fungi can cause infectious disease.
diethylstilbestrol) can also be transmitted
Malaria, measles, and respiratory illnesses are
vertically (mother to child) which will affect
examples of infectious diseases.
the embryo and causes malformations in the
Susceptible Host - A person who lacks
foetus.
resistance to a particular pathogenic agent to
prevent disease if or when exposed.
11.4 Indirect Transmission
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by insects, especially those that suck blood. pathogenic agents are transferred to food
These include mosquitoes, fleas, and ticks. from the skin, nose, bowel, etc., as well as
The insects become infected when they feed from other food.
on infected hosts, such as birds, animals, and Chain of Disease Transmission
humans. The disease is transmitted when the The six factors involved in the chain of
insect bites a new host. Eg. Malaria, West Nile disease transmission are
virus, and Lyme disease are all spread this
way. 11.5 Classification Of
3. Airborne - An airborne disease is any Communicable Disease
disease that is caused by pathogens that can
be transmitted through air. Some infectious Epidemiologic classification of
agents can travel long distances and remain communicable diseases based on the mode
suspended in the air for an extended period of transmission of the infectious agent,
of time. Diseases spread by droplet include communicable diseases can be classified as:
tuberculosis, measles, Q fever, and Respiratory • Waterborne
diseases: transmitted by
infections. ingestion of contaminated water.
4. Fomite - borne - Fomites are inanimate • Food
borne diseases: transmitted by the
articles or substances other than water or food ingestion of contaminated food.
contaminated by the infectious discharges
• Airborne
diseases: transmitted through
from a patient and capable of harbouring
the air.
and transferring infectious agent to a healthy
• Vector-borne
diseases: transmitted by
person. Fomites includes soiled clothes, toys,
vectors, such as mosquitoes and flies.
towels, linen, cups, spoons, pencils, books,
surgical dressing, etc., Diseases transmitted Vehicle borne
by fomites are typhoid, diphtheria, and skin
An indirect transmission of an infectious
infections.
agent that occurs when a vehicle (or fomite)
5. Unclean hands and fingers - Hands touches a person’s body or is ingested.
are the most common medium by which
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3. Avoid Alcohol 11. Poor skin turgor, dry skin and dry mouth
12. Sunken fontanels in children
Acute Diarrheal Diseases Diagnosis – Stool test
Definition Complications
According to WHO Acute diarrhea is 1. Persistent diarrhea
defined as an abnormally frequent discharge
2. Malnutrition
of semisolid or fluid faecal matter from the
bowel, lasting less than the 14 days by WHO. 3. Vitamins and mineral deficiencies
4. Hypoglycemia resulting in convulsions
ENTAMOEBA HISTOLYTICA
and brain damage
ENDOSOME 5. Electrolyte loss
FOOD VACUOLES
6. Hypovolemic shock
PLASMALEMMA
7. Acute renal failure
ECTOPLASM
Control Measures
ENDOPLASM 1. Promote exclusive breastfeeding
NUCLEUS 2. Immunization
Causative Organism 3. Using sanitary latrines
Bacteria: Escherichia coli, Shigella, 4. Keep food and water clean and closed.
salmonella etc., 5. Wash hands before eating and after
Virus: Rota virus, adenovirus etc. defaecation.
Parasites: Endamoeba hystelytica, Giardia
Treatment
lamblin etc.
Mode Of Transmission - Direct Oral Rehydration Therapy: Give
transmission - Faeco – oral route some available liquids like rice water, oral
rehydration solution (ORS) packet to be
Incubation Period - Few Hour to one day.
dissolved in one litre of drinking water and
Clinical Manifestation stir with clean spoon, till it dissolves. Give ¼
to ½ cup after every loose motion to a child
1. Sunken eyes
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less than 2 years of age and 100-200 ml if the Droplet infection : Coughing and sneezing
child is above 2 years. The solution should be an important route of transmission during the
consumed within 24 hours and should not be acute stage.
heated or boiled. Incubation period - 7 to 21 days. It may
Appropriate feeding vary from 3 to 35 days.
Control measures
RNA
i) Sanitation : Measures to reduce
transmission such as improved water supply,
proper excreta disposal and improved domestic
and food hygiene. Simple hygienic measures
Viral Capsid
like hand washing with soap before preparing
Shell food, before eating,before feeding a child,
after defecation, after cleaning a child who has
defecated and after disposing off a child’s stool
Membrane
should be promoted.
Causative organism ii) Health education : important part of
Three types of polioviruses (Type I, II, III) health workers job is, to prevent diarrhea by
educating and helping community members to
Mode of transmission - Faeco – oral
adopt and maintain preventive measures such as
route: Through contaminated water, food,
breast-feeding, weaning, clean drinking water,
fingers etc.
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Causative organism
Varicella zoster
Mode of transmission - Droplet nuclei
Incubation period - About 10 -21 days
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2. Eruptive phase:
1. Duskyred
2. Macular
3. Maculo-papular rash
4. Rashes become confluent,blotchy
3. Post-measles stage:
1. Weight loss
2. Weakness
3. Growth retardation
4. Reactivation of Pulmonary tuberculosis
5. Nutritional and metabolic effects
Complications
Measles
1. Measles – associated diarrhea,
Definition 2. Pneumonia
Measles is an acute highly infectious 3. Otitis media.
disease of childhood caused by a specific virus 4. Febrile convulsions,
of the group Myxo viruses. 5. Encephalitis
6. Pan-encephalitis.
Causative organism Control measures
RNA Para Myxo viruses a) Isolation for 7 days after the onset of
Mode of transmission - Droplet infection rash.
Incubation period - 10 days from exposure b) Immunization of contacts within 2
to onset of fever and 14 days to appearance of days of exposure. (if vaccine is contra
rash. Average 7 days. indicated immunoglobulin should be
given within 3 – 4 days of exposure)
Clinical manifestations
c) Prompt immunization at the beginning
There are three stages of an endemic is essential to limit the
spread.
1. Prodromal stage:
1. Fever Treatment
2. Coryza
There is no specific treatment for measles,
3. Sneezing but the condition usually improves within 7 to
4. Nasal discharge 10 days. Following measures are important to
5. Cough control infection.
6. Redness of Eyes 1. Controlling fever and relieving pain
2. Plenty of fluids to prevent dehydration
7. Lacrimation
3. Treating cold like symptoms
8. Photophobia 4. Care of the sore eyes - cleaning the crusts
9. Vomiting with wet cotton swabs.
10. Diarrhea Measles vaccine: Measles is best
11. Koplik”S Spots on A Red Base prevented by active immunization. The
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Complications
1. Orchitis
2. Ovaritis
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• Th
e specific treatment is diphtheria a. Catarrhal Stage
antitoxin which must be given immediately b. Paroxysmal Stage
c. Convalescent Stage.
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are at an increased risk of developing children with these infections have only mild
meningococcal illness. infection such as cold or cough.
d. Mass chemoprophylaxis: Mass medication
of the total population some of which Complication – Pneumonia
arenot infected. Mass chemoprophylaxis The high mortality and morbidity rate
be restricted and closely and medically attribute to acute respiratory infections.
supervised
e. Communities : Mass treatment causes an
HIB vaccine
immediate drop in the maintenance rate of
meningitis and in the proportion carriers. Hemophiles influenza type B, HIB is an
f. Environmental measures : Improved important cause of pneumonia and meningitis
housing and prevention of over-crowding among children in developing world.
are longterm measures. Treatment
• Antiboitic
Acute Respiratory Infections
Severe Acute Respiratory
Definition Syndrome
Acute respiratory infections may cause
inflammation of the respiratory tract anywhere
from nose to alveoli.
Spike glycoprotein
Membrane
glycoprotein
Small envelope
glycoprotein
Nucleocapsid
phosphoprotein
RNA
Definition
Severe acute respiratory syndrome is a
Causative organism communicable viral disease
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Treatment Treatment
Anti Tuberculosis Treatment Drugs • Vaccination is the best protection against
contracting the infection.
Swine flu • Antiviral drugs can be used for prevention
Definition - Swine flu which is called pig or treatment of flu viruses.
flu. Swine flu caused by swine influenza virus.
Causative Organism - influenza virus 11.8 Diseases transmitted through
subtypes H1N1, H1N2, H3N1 and H3H2 arthropods
Mode of Transmission
Dengue Fever
Influenza virus can be directly transmitted
from pigs to people.
Incubation Period - Within 7 days. Aedes mosquitoe
• Fever • Nausea
• Sore throat • Chills
• Cough • Headache
• Body ache • Shortness of breath
• Fatigue
Definition
Control Measures A viral disease transmitted by mosquitoes,
• Adequate amount of sleep and supply and causing sudden fever and acute pains in the
nutritious food. joints.
• Consider taking multivitamins and vitamin A severe form of dengue fever, also called
C supplement. dengue hemorrhagic fever, can cause severe
• Wash your hands regularly with soap and bleeding, a sudden drop in blood pressure
water. (shock) and death.
• Avoid close contact or stay away from sick
people. Causative organism
• Avoid sharing drinks or utensils. Causative agent of the disease is the
• Avoid touching your face. Dengue virus,
• Wear a face mask as directed by physcian. Mode of transmission - Dengue fever
• Stay updated and avoid travelling to is transmitted to humans through the bites of
affected areas. infective female Aedes aegypti mosquitoes.
• Meat to be inspected and certified
Incubation period - 3 to 14 days usually 4
• Health education
to 7 days.
• Adequate sewage treatment and disposal
• Early detection and early treatment Clinical manifestations
• Through cooking of beef and pork is the
most effective method to prevent food Dengue Haemorrhagic fever
borne infection. • All symptoms of dengue viral fever.
• Maculopapular
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Control measures
11.9 Prevention Of Communicable
• The Aedes aegypti mosquito breeds in clean Diseases
water.
• All water containers should be covered, to PRIMORDIAL – PREVENTION : It is a
eliminate mosquito from the breeding places. new concept, receiving special attention in the
• Abate is increasingly used as a larvicide. prevention of chronic diseases. This is primary
• Aerosol spray of ultra low volume (ULV) prevention in its purest sense, that is prevention
quantities of malathion or sumithion (250 ml of the emergence or development of risk factors
/ hectare) has been found to be effective in in countries or population. An groups in which
interrupting transmission and stopping they have not yet appeared eg many adult health
• Epidemics of dengue haemorrhagic fever. problems.
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SUMMARY
1. The important water borne diseases are typhoid fever, cholera, hepatitis A and acute diarrhoeal
disease. Typhoid fever is caused by salmonella typhi and the mode of transmission is by faeco
oral route. Complication of typhoid fever is intestinal perforation.
2. Cholera is an acute infectious disease caused by cholera (vibrio cholera) and the mode of
transmission is by oro -faecal route.
3. Cholera is a notifiable disease and it not identified and treated early can cause sudden death.
4. Hepatitis - is a systematic disorder that primarily affects the liver. The causative organism is
hepatitis a virus. Mode of transmission is faeco oral route and direct contact and the incubation
period is 15 to 50 days usually 28 days.
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GLOSSARY
Portal of entry ந�ோய் நுழைவாயில் The site through micro organisms enters
in to host
Susceptible எளிதில் பாதிக்கக்கூடிய Can be easily affected
Contamination மாசுபட்ட / தூய்மைக்கேடு Presence of unwanted harmful substance
Notification அறிவிப்பு The act of notifying
Isolation தனிமைப்படுத்தப்பட்ட The process of being alone
Disinfection விஷ கிருமிகளை நீக்குதல் The process of cleaning by using
chemicals
Causative agent ந�ோய் த�ோன்ற காரணமாகும் acting as a cause / producing an effect /
Incubation period ந�ோய் அரும்பு / உருவாகும் The period between exposure to an
காலம் infection and appearance of first symtoms.
Sanitary சுகாதாரமான Hygienic and clean
Photo phobia கண்கூச்சம் Extreme sensitivity / to light
droplet நீர்த்திவலை A very small drop of a liquid/
Anthro pod கணுக்காலிகள் A type of animals with no spine, six or
more joined legs/
Surviellance ந�ோய்- நிகழ்வு ஆய்தல் Close observation
கண்காணிப்பு
chemoprophylaxis ந�ோய்க்கட்டுபாடு The use of drugs to prevent disease/
eradication ஒழித்தல் முற்றிலும் அழித்தல் The complete destruction of something/
Evaluation
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CHAPTER
Nursing
12 Education And
Managemnet
ொமின் புறுவது உலகின் புறக்கண்டு
்காமுறுவர் ்கற்றறி்ந ொர்.
The learned will long (for more learning), when they see that while
it gives pleasure to themselves, the world also derives pleasure from it.
Learning Objectives
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Definitions 2. D
evelop reciprocity and cooperation
among students.
Education is the all-round drawing out of
the best in child and man- body, mind and spirit” 3. Encourage active learning.
– Mahatma Gandhi. 4. Give prompt feedback
“Education is the natural, harmonious 5. Emphasize time on task.
and progressive development of man’s innate 6. Communicate high expectations
powers”. 7. Respect diverse talents and ways of learning
– Pestalozzi.
Nursing Education 12.2 Philosophy of nursing
Nursing education is a professional education
education which is consciously and
systematically planned and implemented • Beliefs and values with regard to man in
through instruction and discipline. general and specifically man as the learner,
teacher, nurse and the client and the beliefs
about health, illness, society, nursing, and
12.1 Principles of nursing
learning etc.
education
• Seeks to study the process and discipline
Ethical principles for nursing education. of education in order to understand how it
Caring: In order to care for others, one works, improve its methods and perfect its
must first care for self. applications in society.
Integrity: Integrity encompasses the • To improve education and its systems
ability to communicate honestly and sincerely, and methods for the betterment of
and take responsibility for one’s actions. humanity.
Diversity: Diversity does more than Ideally, it informs and raises the quality of
acknowledge and advocate for differences of curriculum, teaching methods and the overall
backgrounds and experiences. educational experience.
Excellence: Excellence is achieved through
Definitions
engagement in scholarship, professional growth,
and continual improvement. Philosophy
Philosophy is a search for a comprehensive
Caring view of nature, an attempt at a universal
explanation of nature of things
– Henderson.
Ethical
Diversity Integrity
principles Philosophy is the science of knowledge.
– Fitche
Philosophy is the science of all sciences.
Excellence
– Coleridge
Philosophy is the mother of all arts and the
Other principles true medicine of the mind.
1. E
ncourage contact between students and – Cicero.
faculty.
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efinitions of Philosophy of
D Types of Philosophy
Nursing Education.
“Philosophy of nursing education is the Modern
Traditional
written statement of the believes, values, contemporary
philosophy
attitudes and ideas which the faculty as a philosophy
group agreed upon in relation to the nursing Naturalism Existentialism
educational program such as health, disease,
Idealism Progressivism
nursing, nurse, nursing profession, education,
learner, society, patient nursing education Pragmatism Behaviorism
and preparation of nurses.” Realism Humanism
Experimentalism
Relationship between
Eclectism
Philosophy and Education
Reconstructionalism
Philosophy Education
Traditional Philosophy
It sets the ideas, Education works Naturalism
principles, goals, out those values
• I t is concerned with nature and believes
standards, values
that reality and nature are identical and
thus it is in reality
beyond nature there is no reality.
and truth.
• F
or naturalist, nature is everything and
It is the theory and It explains how nothing exists superior than nature so
speculative to achieve the they separates nature from God. Man is
goals through regarded as a child of nature.
man’s educational • N
aturalists also believe that all our
efforts. activities, whether it may be biological,
psychological or social are initiated by our
It is the It is the practice
instincts.
contemplative side
• N
atualism stresses the need to return to
It deals with It is active side the nature from artificiality.
abstract ideas and (Dynamic)
ends the situations It is applied Idealism
process philosophy • I dealism is the oldest philosophy. It
It deals with believes that man is the combination
concrete and of spiritual and material aspects,
means the spiritual aspect is more real and
important.
It is an art. It is the science. • I dealism regards spirit and intellect are
Philosophy It deals with of supreme value than physical matter. As
formulate the the process of per the idealism individual experience is
method method. valid than the material world and man
lives in the world of ideas rather than
facts.
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Pragmatism Meaning
• P
ragmatism means thinking of or dealing Progressivism is the theory of education
with problems in a practical way rather that is concerned with learning by doing that
than by using theory or abstract principles. children learn best when pursuing their own
• P
ragmatism is essentially a humanistic interest and satisfying their needs.
philosophy maintianing that man creates
his won values in course of activity, that Behaviourism
reality is still making and awaits its part of Person’s behavior is the result of
completion from the future. environmental conditioning. Man is a passive
recipient, who reacts to external stimuli, he has
Realism no will or decision of his own or the capacity to
• A
ccording to this, things we see and take spontaneous action.
perceive are real and knowledge acquired
through senses is true. Principles
“Realism is the reinforcement of our common • I ndividual’s action are predetermined by
acceptance of this world as apears to us” his heredity or immediate surroundings.
– Butter • an is not separate from his surrounding
M
environment.
Modern contemporary • uman behavior
H is controlled by
philosophy creativity.
Existentialism
Educational applications
It is the youngest philosophy, described as
• L
earning is governed by man’s action
modern 20 th century philosophy.
and reaction to various media (oral,
Meaning: This philosophy stresses the written,machine).
important of human experience and says that
• L
earning occurs as a personal achievement
everyone is responsible for the results of their
through interaction between the learner
own action.
and environment.
Assumptions
Humanism
• Th
e center of existence is man rather than
truth, laws, principles or essence. Man is an end, not a means.
• M
an is not alone in the world. Man is a
Principles
social being.
The humanist emphasis is on literature.
• M
an cannot accept the ready-made
He has to overcome the conflicts of his own
concepts of existence forced upon him
time.
• M
an is free agent capable of shaping his
own live and shaping his own destiny. The role of Education
• M
an is not complete: Man has to meet the • C
hildren must be taught to respect
challenges in the changing society. language, a sense of language perfection.
• C
hildren must be trained in modern
Progressivism literary standards of academics.
It is an American philosophy.
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1. Th
e statement of philosophy of the There is significant relationship between
educational programme. curriculum and nature of society. According
2. Th
e statement of the objectives of to the needs of the society curriculum will be
educational programme. changed.
3. T
otal duration of the educational
The institutional curriculum
programme. (theortical ,practical ,clinical
components.) • It is planned by faculty or teacher for a
4. D
etailed course plan for each course. clearly identified group of students who
(placement, sequences and learning will spend a specified period in a particular
situations, instructional methods) institution.
5. P
rogramme evaluation (evaluation • Cooperative planning through curriculum
methods, plan and schedule of evaluation, committee of the particular institution.
results of evaluation). • More active participation of each teachers
generally brings about change and
Levels of curriculum planning improvement.
Goodland names curriculum in 3 levels.
The instructional curriculum
• Societal
It consists of the content (subject matter
• Institutional
and learning activities) planned day by day
• Instructional and week by week by a particular teacher for a
particular group of students.
Societal curriculum
This curriculum which is planned for a Curriculum committee
large group or class of students, e.g BSc(N) The committee comprises the following
It is planned by groups outside of an members
educational institution, e.g. National league
for nursing. They are more immediately State departments of
concerned with Law makers
education
School boards Publishers
Curriculum
General characteristics
administrators
of curriculum content Principals Project directors
Educational researchers Authors
Teacher educators Testers
Communities Accreditors
Sequence Parents Polisters
Students Lobbyists
Non school educators philonthropists
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• F
irst thing first/Learn to say “No” with • In other words, a sub-ordinate should not
compassion: Attend to life threatening receive instructions from more than one
situation first. person.
• T
ake a break: Need to relax during stressful • It creates harmonious relationship between
situations. superiors and sub-ordinates.
• Be flexible 4. Unity of Direction
• E
ncourage Yourself: Appreciate yourself • One head one plan which means that there
for the achievements made so far. should be one plan for a group of activities
having similar objectives.
Elements of ward management • Related activities should be grouped
• Patient care together.
• Personnel management • According to this principle, efforts of all
• W
ard sanitation and provision of the members of the organization should be
therapeutic environment directed towards common goal.
• Supply the equipment 5. Equity
• Interpretation of policies and procedures. • The employees should be treated with
kindness and equity.
Principles of ward • Manager should be fair and impartial while
management dealing with the subordinates.
Apply the principles of administration in • Should give similar treatment to people of
ward management. similar position.
• Should not discriminate with respect to
1. Henri Fayol’s 14 Principles of management age,caste,sex, religion,relation etc.
• Division of work : 6. Principle of order
• Fayol has stressed on the specialization of • It refers to the systematic arrangement
jobs. of men and material in a fixed place
• Subdivision of work makes it simpler and for everything and everyone in the
results in efficiency. organization.
• It also helps the individual in acquiring • The right materials and the right employees
speed, accuracy in his performance. are necessary for each organizational
function and activity.
2. Authority and Responsibility.
7. Discipline
• Authority is the power to take decisions.
• Discipline means sincerity,
• Responsibility is the obligation to complete
obedience,respect of authority and
the job assigned.
observance of rules and regulations of the
• There should be balance between the two enterprise.
i.e. they must go hand in hand.
• This applies that subordinate should respect
3. Unity of command. their superiors and obey their order.
• A sub-ordinate should receive orders and 8. Principle of initiative
be accountable to one and only one boss • Workers should be encouraged to take
at a time. initiative in the work assigned to them.
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supposed to provide care in variety of settings of the health care team. (Nutritionists and
such as hospital, community etc., Physical therapists).
• Care giver 3. Protector and Advocate: The nurse helps
• Manager to maintain a safe environment for the
• Advocate client. The nurse takes steps to prevent
injury and protect client from possible
• Counselor
adverse effects of diagnostic or treatment
• Educator measures. As a advocate, nurse protects
• Consultant the clients' human and legal rights and
• Researcher provides assistance in asserting those
• Collaborator rights if the need arises.
• School health nurse 4. Counselor: Help patient and family to cope
with stressful problems. Provide emotional
• Occupational health nurse
and psychological support. Motivate
• Private duty nurse.
patient to adopt an alternative behavior.
• Parish nurse
5. Consultant: Nurse consultants are nurses
• Public health nurse who usually identify problems and develop
• Home care nurse solutions.
• Hospice nurse 6. Educator: Manage patient care. Educate
• Rehabilitation nurse patient, family and community.
• Office nurse 7. Collaborator: The nurse collaborates
• Nurse epidemiologist with other team members when providing
care to a client. Quality care is given
• Military nurse
when nurse and team members work
• Aerospace nurse together in planning for the patients care
• Tele nurse management.
• Disaster nursing 8. School Health Nurse: The role of the
• Prison nurse. nurse is to support the educational
• Forensic nurse. process by helping students to keep
• Peace corps nurse. healthy and by teaching students and
teacher’s regarding preventive practices.
• Communicator
9. Occupational Health Services:
1. Care Giver: Care giving role is a Occupational health nursing is providing
primary role of nurses. The provision of health services to workers in industry and
care to clients combines both arts and special community groups.
science of nursing which helps clients 10. Parish Nurse: Parish nurse respond to
regain health through healing process. health and wellness needs within the
The caregiver helps the client and families set context of populations of faith communities.
goals and meet those goals with a minimal (people gathering in churches, temples or
cost of time and energy. mosques)
2. Manager: As a manager, the nurse 11. Public Health Nurse: She is a registered
coordinates the activities of other members nurse with special training in community
health. Help the client and the family
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emergency and general care to passengers 24. Epidemiology Nurse: The nurse
if required. epidemiologist investigates trends in
22. Attorney: Nurse attorneys engage in a range disease occurrence in particular area. They
of legal activities by legal consultation. identify the population at risk monitor the
23. Disaster/Bio Terrorism Nurse: These progress of disease, special areas of health
nurses works in disaster areas that are care need, determine priorities
result of bio terrorist attack or in situation
caused by natural or man-made disaster.
1. Tamil Nadu Nursing Council was established by the act in the year 1926 which
South East Asia’s first premier Council
2. In 1871, the first school of nursing was started in Government General Hospital,
Madras with a six-month diploma midwives programme with four students..
3. The first four-year bachelor’s degree programme was established in 1946 at the college of
nursing in Delhi and the Christian Medical College and Hospital (CMCH) in Vellore.
4. Florence Nightingale was one of the pioneers in establishing the idea of nursing schools
from her base at St Thomas’ Hospital, London in 1860 when she opened the ‘Nightingale
Training School for Nurses’, now part of King’s College, London.
5. In 1908, the Trained nurses association of India was formed to uphold the dignity and
honour of the nursing profession.
6. The Indian Nursing Council was passed by ordinance on December 31, 1947. The council
was constituted in 1949.
SUMMARY
Education is the corner stone of Nursing profession. Education in Health care today-both the
patient education and Nursing staff student education. It is a topic of utmost interest to nurses
in every setting in which they practice
Nursing education is a professional education which is consciously and systematically planned
and implemented.
A philosophy of nursing education includes beliefs and values with regard to man in general and
specifically man
Curriculum is a runway for attaining the goals of education. Curriculum may be considered as
the blue print of an educational programme
Nursing management consists of the performance of the leadership functions of governance
and decision-making within organizations employing nurse.
Management has been described as a social process involving responsibility for economical and
effective planning and regulation of operation of an enterprise.
Nurses have various number of Expanded roles and Extended roles in health care
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GLOSSARY
Evaluation
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Introduction to
CHAPTER
13 Nursing Research
Accomplishment the hindrances large profits won by effort; These compare, then let the work
to be done.
Learning Objectives
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Every one will agree that if "Health is lost, format. In general, nurses try to understand
everything is lost". Nursing is a profession a question / problem and search for possible
and practice which serves as the foundation solutions.
in providing care for the sick and needy. The The quality of nursing practice and the
challenges faced by the nursing fraternity is future of health care depends on up-to-date
enormous. Thus research becomes the need and organized body of nursing knowledge. Research
necessity in this noble profession. is based on existing ideas and to improve the
Nursing is the profession and practice of knowledge of the individuals. The purpose of
providing care for the sick and needy. Nurses the systematic inquiry is to find out the evidence
play significant role in taking care of people. based method of solving the problem identified.
Nursing plays an vital role in the research The present era of complex health problems
activity. A well developed and reliable body makes interdisciplinary research, an important
of knowledge is a foundation for any course one to find out the study of health and illness
of study. Research provides a solid foundation experiences of the society. Currently a lot of
on which individual can develop and refine attention is being paid to research on nursing,
their basic knowledge and practice. Without which it seems will continue in the years to
knowledge we cannot improve in accustoming come, and will have its implications and impact
people to the latest techniques and therapies like on nurse administrators, nurse educators, as
infant care, pain management, grief counseling, well as practitioners.
health education, home care management, Hence, an expanded new knowledge is
palliative care and related intervention. required for a growing profession. The health
Research on nursing practices began care professionals should realize that nursing is
slowly, but since 1950, it has been accelerating developing rapidly and they must be ready to
rapidly. Nursing research continues to develop take challenges of currently growing demand
at a rapid phase and will undoubtedly flourish of new knowledge and to refine old outdated
in the twenty-first century. Broadly speaking, knowledge.
the priority for nursing research in the future
will be the promotion of excellence in nursing Meaning of Nursing Research
practices.
The word research is derived from the
Nowadays
French term researcher, a compound word
Health professionals
composed of a prefix ‘re’ and a verb ‘search’. Re
believe in
means ‘once again’ ‘a new’, or ‘a fresh’ and search
development of
means ‘to look for something’.
knowledge from
It is an systematic inquiry of investigation
logical reasoning
to validate and refine existing knowledge and
and problem
to generate and refine existing knowledge and
solving. It helps in identification of problem and
generate new knowledge.
planning evidence based care.
Research is a systematic inquiry that uses
Nurses must acquire knowledge in both
disciplined methods to answer questions to
unstructured and structured method. In
solve problems.
unstructured method, own experience,trial
and error are followed. The structured method Ultimate goal of research is to develop,
includes logical reasoning, problem solving refine and explore a body of knowledge.
and the research is conducted in a disciplined
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Non-experimental
• Identifying the assumption and formulation 2. Review of literature: It is one of the most
of Hypothesis important step in the research process.
• Selection of research design A literature review is an account of what
• Entry in to the research site (Pilot Study) has been already established or published
on a particular research topic by various
• Protect the rights of the participants
researchers.(University of Toronto 2001)
• Planning tools for data collection
• Collection of data
er
• Analysis of the data
e w spap e e.data
N azin Base
• Communicating the findings Mag
ary
B oo
Simple Steps In Research Process
ton
ks
1. Identifying the problem: It is a clear finding
Dic
Sources of
of the problem that should be studied. In Literature
Review
general broad topic area is selected and then ls
Thes
rna
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the questions that are asked. It is based 7. Identifying the population/sample: The
on the information collected and study population means the complete set of
interpretation. individuals or objects that posses some
common characteristics of interest to the
There are three types of Assumptions. researcher. The subgroup of populations is
i) Universal Assumptions – Beliefs that are called study sample.
assumed to be true by a large percentage 8. Conducting a pilot study : A pilot study
of Society. is a miniature trial version of the planned
ii) Assumptions based on theory or research study. It reveals the feasibility of the study
findings- Previous research studies and helps to test the instruments. It also
which form the basis for assumptions in plays a role in gaining experience with the
the present study. study process and it indicates that where the
iii) Assumptions that are necessary to revision should be made.
carryout the study – Need to conduct a 9. Collecting Data : It is the process of
research study. collection or gathering of pieces of
information’s facts that are related to the
5. Formulating the Hypothesis or Research
study.
Question: Hypothesis predicts the relationship
10. Organizing the data for Analysis : It is the
between two or more characters. According to
grouping of information’s for tabulation and
the asked questions in the problem statement.
evaluation purpose. A statistician should
The hypothesis furnishes the answer to it.
be consulted in the early and phase of the
It is testable or verifiable by the information
research process. The statistician can help to
gathered. The research is guided by research
follow the appropriate analytical method.
questions that are further elaboration of the
11. Interpreting the findings : After the data
problem statement.
are analyzed the finding of the result are
6. Selecting the research Design : It is the plan
compared with those of previous studies
for how the study will be conducted as well
for further recommendation
as concerned with the type of information
that will be collected.
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SUMMARY
Identifying a problem: Any problem or question which we want to clarify, instead of
assuming the answers or solutions
Searching professional literature for possible solutions: Looking up literature so as to know
what has been written or studied about the same problem earlier.
Prepare a research question in an answerable or testable format:
Writing the questions related to the study going to be conducted
Considering a solution to solve the problem: In problem – solving methods, one should put
down possible ways of solving the problem
Making a research hypothesis that can be tested: Writing a statement making a relationship
between various factors
Conducting the study or research (Pilot Study): Conducting the study using the selected tool
with minimum participants.
Analysing the result: Making sense of all the data collected by grouping and analyzing
during the research
Determining if the scientific hypothesis is correct: Checking back to see if the hypothesis or
factors have any relationship with each other or not
Applying the variant: Making a final judgement based on the results and preparing
recomadations
GLOSSARY
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Evaluation
A B C D INTERNET LINKS
Coding Modifying Entering Transferring
Transferring Coding Coding Editing 1. h ttps://www.researchgate.net/figure/
Editing Transferring Transferring Entering Sources-of-literature-review
Modifying Entering Editing Modifying 2. https://www.google.com me country causes
Entering Editing Modifying Coding frustration.
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Practicals
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Practical 1
HEALTH ASSESSMENT
Learning Objectives
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Head-Toe-Assessment
Assessment conducted by ____________________________
LOC
☐ Alert ☐ Drowsy ☐ Lethargic ☐ Stuporous ☐ Coma
Orientation
☐ Person ___________________________
☐ Place ___________________________
☐ Time ____________________________
Situation ____________________________
Vitals
☐ Temp ___________________________ ☐ R __________________
☐ BP _____________________________ Pulse Ox _______________
Head
☐ Hair
☐ PERLA_________________________________mm
☐ Nose __________________________________
☐ Ears __________________________________
☐ Mouth ________________________________
• Midline tongue ______________________
• Moist _____________________________
• Lesions ____________________________
• Dentition __________________________
Neck
☐ Carotid Pulse _______________ ☐ JVD + ☐ Trachea midline
Chest
☐ Apical pulse _________ ☐ Muffled ☐ Arrhythmia
☐ Breath sounds. Anterior ___________________
Posterior ____________ Lateral ______________
☐ Chest symmetry ___________________________
☐ Skin Turgor (Clavicle) ______________________
Abdomen
☐ Inspection
☐ Ausculation
• LUQ (active / hypter / absent)
• RUQ (active / hypter / absent)
• LLQ (active / hypter / absent)
• RLQ (active / hypter / absent)
☐ Palpation ______________________
Upper Extremities
☐ Radial pulses equal, +2
☐Other: _________________________
☐ Temp vs. trunk (warm/cool)
☐ Grip equal and strong ___________
☐ Capillary refill <3 sec
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SUMMARY
Health assessment is very important in any health care settings. It includes health history and
complete physical examination. To get a clear picture of the client health status and health related
problems.
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Practical 2
RYLE’S TUBE FEEDING
S No Action Rational
1 Assemble all equipments and supplies after checking Organization facilitates accurate skill
the Dr.’s Prescription for tube feeding Performance
Checking the prescription confirms
the type of feeding solution, route,
and prescribed delivery time.
2 Prepare formula: Feeding solution may settle
In the type of can: and requires mixing before
Shake the can thoroughly. Check expiration date administration.
In the type of powder Out-dated formula may be
Mix according to the instructions on the package, contaminated or have lessened
prepare enough for 24 hours only and refrigerate nutritional value.
unused formula. Label and date the container. Allow Formula loses its nutritional value
formula to reach room temperature before using. and can harbour microorganisms if
In the type of liquid which prepare by hospital or kept over 24 hours.
family at a time Cold formula cause abdominal
Make formula at a time and allow formula to reach discomfort or sometimes diarrhea.
room temperature before using.
3 Explain the procedure to the diet Providing explanation fosters client’s
cooperation and understanding
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4 Perform hand hygiene and put on disposable gloves To prevent the spread of infection
if available
5 Position the client with the head of the bed elevated This position helps avoiding
at least 30 degree angle to 45 degree angle aspiration of feeding solution into
lungs
6 Determine placement of feeding tube by: Aspiration of gastric fluid indicates
Aspiration of stomach secretions that the tube is correctly placed in
Attach the syringe to the end of feeding tube the stomach
Gently pull back on plunger The amount of residual reflects
Measure amount of residual fluid gastric emptying time and indicates
Return residual fluid to stomach via tube and whether the feeding should continue.
proceed to feeding Residual contents are returned to
the stomach because they contain
Nursing Alert valuable electrolytes and digestive
If amount of the residual exceed hospital protocol or enzymes.
Dr.’s order, refer to these order In the case of non present of residual,
you should check placement
carefully.
Residual over 120 mL may be caused
by feeding too fast or taking time
more to digest. Hold feeding for 2
hours, and recheck residual.
Injecting 10 – 20 ml of air into tube Inject 3-5mLof air for children
Attach syringe filled with air to tube A whooshing or gurgling sound
Inject air while listening with stethoscope over left usually indicates that the tube is in
upper quadrant the stomach
7 Taking an x-ray or ultrasound It may be needed to determine the
tube’s Placement
Intermittent or Bolus feeding Rapid feeding may cause nausea and
Using a feeding bag: abdominal cramping.
Feeding the following Water clears the tube, keeping it
1) Hang the feeding bag set-up 12 to 18 inches above patent.
the stomach. Clamp the tubing. Clamping when feeding is completed
2) Fill the bag with prescribed formula and prepare prevents air from entering the
the tubing by opening the clamp. Allow the feeding stomach
to flow through the tubing
Re clamp the tube.
3) Attach the end of the set-up to the gastric tube.
Open the clamp and adjust flow according to the
Doctor’s order.
4) Add 30-60 ml of water to the feeding bag as
feeding is completed. Allow the flowing to basin.
5) Clamp the tube and disconnect the feeding set-up.
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CONTRAINDICATIONS REFERENCE
Absolute contraindications SanjitaKhadka et al,(2008) Fundamental of
• Severe mid face trauma Nursing Procedure Manual, 1st edn. Japan
• Recent nasal surgery International CooperationAgency (JICA):
Nepal, pg - 104
Relative contraindications
• Coagulation abnormality
• Oesophageal varices or stricture
• Recent banding or cautery of oesophageal
varices
• Alkaline ingestion
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Practical 3
INSTRUMENTS
INSTRUMENTS Uses
TOOTHED DESECTING FORCEPS
RETRACTOR
• To separate the edges of a surgical incision
or wound
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ARTERY FORCEP
• To grasp vessels and allow ligation of those
vessels
• May also used to grasp tissues, sutures and
other prosthetic materials.
THUMB FORCEPS
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Practical 4
DIET FOR VARIOUS CONDITIONS
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Method of preparation
RECEIPIE NAME: GREEN GRAM Cook the noodles and keep it aside. Season
IDLY with mustard, and curry leaves, mix with curd.
Ingredienets Quantity Add the cooked noodles to the seasoned curd
and mix well. Garnish with coriander leaves.
Green gram 150 gms
Boiled rice 50 gms
RENAL MENU
Nutritive value / serving
Calories 510 Kcal
RECEIPIE NAME: BREAD
Proteins 36 gms SANDWHICH
Method of preparation Nutritive value / serving
Soak green gram and rice for 1 hour. Ingredienets Quantity
Then grind together for 15 – 20 minutes. Add Bread 5 slices 100 gms
salt as required. Keep this flour for ½ hour.
Egg 1 (40 gms)
Then make it as idly in idly pan. Can take
with jaggery Butter 10 gms
Pepper A little
Salt A little
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Practical 5
PERFORMING AN ANTENATAL
ABDOMINAL EXAMINATION
Procedure
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Procedure
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Practical 6
CHILD HEALTH NURSING
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Nursing Alert
Children less than 2 years of age –
Weigh the child without clothes or a diaper
using a digital infant scale. Position child
in the center of the scale tray and read the
measurement to the nearest 0.1 kg.
Children more than 2 years of age –
Weigh the child on an electronic floor scale
Keep the weighing scale on hard and firm
with increments less than or equal to 0.1 kg.
surface.
Weigh young children without shoes and
1. Clean the weighing scale with duster
wearing underclothes only, unless privacy
cannot be assured. For older children and 2. Spread a towel or disposable lining on the
young children when privacy is a concern, scale
weigh the child wearing minimal inner 3. Balance the scale to read zero
clothing and without shoes. Request child 4. Place the weighing scale close to the wall
or adolescent stand in the center platform to prevent the child from falling
of the scale and remain motionless until the 5. Instruct the mother to stand beside the
measurement can be obtained. Measure the scale
weight to the nearest 0.1 kg.
6. Undress the child before weighing leaving
diaper alone
Purposes
7. Place the infant on the scale
• T
o check whether an infant/child has
8. Place the left hand over the infant without
adequate weight for age
touching
• To calculate nutritional requirements
9. Note the weight
• T
o calculate the quantity of intravenous
10. Lift the infant from the scale and help the
fluids and medications
mother to dress the infant
• T
o monitor the progress of weight gain or
11. Check and compare previous weight
loss following treatment
12. Difference of more than 100 gms, needs
Required articles to be clarified by rechecking the infants
• Infant weighing scale-infantometer or weight immediately. If the difference is
Electronic floor scale still the same, it should be informed to the
• Towel or disposable lining doctor concerned.
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In case of a child more than two years of age standing height and add 0.7 cm to convert
it to length. If a child aged 2 years or older
cannot stand, measure recumbent length and
subtract 0.7 cm to convert it to height.
Equipments needed
• Length board or Infantometer
• Height scale or Stadiometer
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12. While holding the knees, pull the 8. If necessary, push gently on the tummy to
footboard against the child’s feet. The help the child stand to full height.
soles of the feet should be flat against the 9. Still keeping the head in position, use your
footboard, toes pointing upwards. other hand to pull down the headboard
13. Read the measurement and record the to rest firmly on top of the head and
child’s length in centimetres to the last compress the hair.
completed 0.1 cm. This is the last line that 10. Read the measurement and record the
you can actually see. (0.1 cm = 1 mm) child’s height in centimetres to the last
14. Remember: If the child whose length you completed 0.1 cm This is the last line that
measured is 2 years old or more, subtract you can actually see. (0.1 cm = 1 mm)
0.7 cm from the length and record the 11. Remember: If the child whose height you
result as height. measured is less than 2 years old, add 0.7
cm to the height.
Measurement of Height
Articles required for measuring
circumference
• Inch tape / measuring tape
• Marker pen
• Paper for recording.
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Practical 7
HOME NURSING
Home is always associated with comfort, security and positive feeling.
Learning Objectives
Definition
Introduction
A home is where you feel cared for and Home care (Domiciliary care)
comfortable. Elderly persons choose to be at 1. Home care is the supportive health care
home than cared in the hospitals during acute provided in the home.
and chronic illnesses. Home nursing services 2. Home Care may be provided by licensed
comprises a wide range of health care which health care professionals who provide
can be handled easily at home. The services medical treatment or by professional
provided are based on the needs of the caregivers who provide daily assistance to
individual and family. Home care is planned, ensure the activities of daily living are met.
coordinated and made available by providers
organized for the delivery of home care. Purposes of Home health care
Recently there has been a shift of community 1. Promotion, maintenance and restoration of
based care. The nurse is a valuable team health
member home health care service.
2. Minimizing the effects of illness and
disability
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Conditions which can be dealt in the home. 1. Care of the sick in the Home
• Wound Care - Pressure sores or Surgical The health personal may be called to see
wound the person who is sick in the home and realizes
• Care of the old age and handicapped the individual needs of the family members and
persons take care of them according to the needs.
• Patient and caregiver education (Health Assess the Patient carefully in good light
Education)
• General appearance
• Intravenous Nutrition therapy
• Colour of the skin, eyes or any other signs
• Rehabilitation therapy of illness
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5. Provide follow up services in chronic illness 10. Replace cotton or plastic bags containing
such as diabetes, paraplegia or amputation. swabs and dressing with sterile one.
Access the need of individual and families 11. Check gloves, catheters, thermometer and
and give health education in care of glass articles, replace if spoilt or broken.
malnutrition, environmental hazards, home 12. Repack the bag in an orderly way.
accidents and immunization etc.
13. Keep the bag ready for next visit with all
Outer pocket: is used for keeping a equipment.
dairy to maintain records, clean paper bags
Topics for Health Education
and a square piece of newspaper or plastic
sheet to keep the bag on. The other one is 1. Cause of illness
used for keeping things for hand washing.
2. Cleanliness and disinfection
Internal Compartments - These are used for
3. Good ventilation
keeping solutions and medicines for internal
and external use, simple instruments for 4. Rest and sleep
dressing, articles for certain procedures such 5. Proper Diet
as temperature taking, urine testing, antenatal 6. Nursing Care such as change of positions to
examination and few additional things for prevent bedsore.
health teaching
Community health nurse is responsible to
Procedure provide primary health care in the community
1. Spread the news paper on a flat surface and Treatment of minor ailments and emergencies
place the bag in a clean area and place the is an important component of community health
bag on it nursing. Nurse should be able to identify the
2. Wash the hands with soap and water signs and symptoms of a patient and treat them
according to the standing orders.
3. Take out only the needed things to carry out
the procedure. Standing orders are the specific
instructions which should be followed during
4. Record all relevant findings about the client
the non availability of doctors, nurses only to
and members of the family.
supply and/or administer prescribed medcines
5. Take note of environmental factors which
and some controlled drugs It should be followed
affect the clients/family health.
in temporary basics / or in emergency situation.
6. Assess effectiveness of nursing care provided.
General standing orders. Eg – in case of
7. Clean the bag daily, protect from excessive diarrhea – ORS PACKET
heat or rain to reserve it in a good condition.
8. Replace the drugs, dressing General Minor Ailments
and linen daily in the bag. • Injuries and Falls
Empty all the contents, wash the bag with • Dog Bite
soap and water once in a week or more • Burns
frequently depending on how much it has
• High Fever
been used and dry it the sun.
• Heat Stroke
9. Wash the articles such as instruments, linen
and utensils with soap and water and boil them. • Diarrhea
• Fainting Etc
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affected. Foot care aims in reducing damage 8. Be gentle when washing feet. ...
from occurring to the feet and regularly 9. Moisturize your feet but not between your
checking feet for any signs of damage. toes.
10. Cut nails carefully.
11. Never treat corns or calluses yourself.
Articles required
1. Mackintosh
2. wash cloth
7. Bathe feet in lukewarm, never hot, water. 3. Soft towel
4. Wash Basin
5. Warm water
6. Soap
7. Lotion
8. Disposable gloves
9. Nail clippers
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3. Fill the 3/4th Warm water softens 12. Educate the To prevent further
of the basin nails and improves clients to complications
with warm circulation. follow dietary
water 100*F- Make sure that the pattern
104*F. Place water is not too hot To avoid
the Rubber because diabetic smoking and
Mackintosh clients will not have drinking
under the basin sensation in the alcohol
and soak the feet.
client’s feet in Foot examinations
the basin Regular check-up from a health professional
at least once each year. Foot must be examined
4. Allow to soak Softening allows
for the following
feet for 20 easy removal of
minitues dead epithelial • Signs of neuropathy or development of
tissue and prevents neuropathy
the nails from • Blood circulation
crackling.
• Any signs of damage
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Foot Care: The feet of ill bed ridden clients involvement may be side effect of medication
are easily susceptible to infection and other therapy.
problems because the feet are far away from Urine glucose testing: Urine glucose
the heart than any other body part, they are testing is used to assess the status of person’s
most compromised by vascular conditions that diabetic condition. Diabetic results from body’s
interfere with normal circulation. inability to utilize food efficiently. When food
Conditions that generally affect bed ridden is digested, it is broken into glucose, which is
client include stored in liver and muscle tissue in the form of
1. Foot drop is a deformity in which the foot glycogen. Insulin facilitates the storage process.
is extended abnormally at the ankle in the Diabetics do not produce sufficient insulin:
direction of the sole of the foot. therefore blood glucose levels rise to abnormally
2. Intermittent claudications is a severe pain high levels. The normal fasting level of blood
in the calf muscles caused by inadequate glucose is approximately 60 mg/dl to 115 mg/
circulation. It usually occurs during walking, dl. Glucose does not appear in urine until the
but subsides with rest. blood level reaches 180 mg/dl. Therefore, urine
glucose level may be interpreted as reflection of
3. Ulcers and gangrene are common side
actual blood glucose level.
effects of diabetes. They occur because of
inadequate circulation to the foot which Vital signs: Measurement of vital signs is
retards natural healing process. done. To assess the physiological status of the
client in relation to those vital canters of the body
Oral Care: Cleansing of the mouth , teeth those are necessary to sustain life. The vital sign
and gums is important to maintain the client’s indicators are temperature, pulse, respiration
sense of well being as well as to prevent tooth and blood pressure. The temperature may be
decay and infection. Dental caries are the areas taken by oral, rectal or axillary route. The pulse
of localized destruction of tooth tissue by may be measured by palpation, on auscultation
bacterial action. Caries are actually caused by of chest area; blood pressure is measured by
acid production by bacteria which forms colony means of sphygmomanometer.
on the tooth surface. Hot and cold applications: Hot and
cold applications are applied to the clients in
f) Monitoring and surveillance:
order to change the tissue temperature locally
The aspects of home health care which
on systematically for a therapeutic purpose.
comes under monitoring and surveillance are
Insulin injection: Since the major diabetes
a) Neurological signs evaluation. is thought to be the lack of inadequate use of
b) Urine glucose testing. insulin diabetic therapy often includes the use
c) Vital signs. of insulin, in addition to dietary and exercise
Neurological Signs Evaluation: control. If the diabetic has little or no insulin
Neurological evaluation of the client can be production, capability in the pancreas, insulin is
obtained by objective and subjective data that are administered. The client family will be primarily
gathered through series of tests and evaluation responsible for performing the procedure on a
techniques. The neurological status evaluation daily basis. The injection should be performed
may be indicative of deteriorating condition or with aseptic technique.
assessment of cognitive state. This is particularly Intravenous therapy: Because of recent
important in home when traumatic injury is changes in health care industry encouraging
evaluated on when progressive neurological early discharge from hospital, increasing
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Practical 8
MENTAL STATUS EXAMINATION
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(Recent memory : C
an be checked by Insight : Present/ partially
asking patients about present / Absent
their appetite and (Insight is a patient’s degree of awareness and
then about what they understanding about being ill)
had for breakfast
or for dinner the Conclusion
previous evening.
The mental status examination is the
Remote memory : Can be tested by part of the clinical assessment that describes
asking patients for the sum total of the examiner’s observations
information about and impressions of the psychiatric patient
their childhood that at the time of the interview. Whereas the
can be verified later. patient’s history remains stable, the patient’s
Immediate memory : Ability to repeat three mental status can change from day to day or
words immediately hour to hour. The mental status examination
and 3 to 5 minutes is the description of the patient’s appearance,
later) speech, actions, and thoughts during the
Intelligence : Intact / Impaired interview. Even when a patient is mute, is
(General knowledge / Arithmetic ability incoherent, or refuses to answer questions, the
/ Similarities and dissimilarities between clinician can obtain a wealth of information
paired objects) through careful observation.
Judgment : Intact / impaired
(Judgment is the ability to assess a situation
correctly and act appropriately within the
situation Personal / Social )
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In-House QC
Rajesh Thangappan
Jerald Wilson C
Co-ordination
Ramesh Munisamy
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