Table Of Content

NURSING Theory Vocational Education HIGHER SECONDARY - SECOND YEAR A Publication under Government of Tamilnadu Distribution of Free Textbook Programme (Not for sale) Untouchability is a sin Untouchability is a crime Untouchability is inhuman TAMILNADU TEXTBOOK CORPORATION College Road, Chennai - 600 006. i © Government of Tamilnadu First Edition - 2011 CHAIR PERSON Dr. Mrs. P. MANGALA GOwRI Principal College of Nursing, Madras Medical College Chennai - 600 003. AUTHORS Dr. Mrs. Prasanna Baby Mrs. R. Pathima Bee Principal Vocational Nursing Teacher College of Nursing St. Anne’s Girls Hr.Sec.School Madurai Medical College Cuddalore. Madurai. Dr. Mrs. N. Jaya Mrs. D. Daisy Principal Incharge Vocational Nursing Teacher College of Nursing Christ King Girls Hr.Sec.School, Govt. Mohan Kumara Mangalam East Tambaram. Medical College, Salem. This book has been prepared by the Directorate of School Education on behalf of the Government of Tamilnadu This book has been printed on 60 G.S.M Paper Printed by Web Offset at : ii CONTENT Sl.No. Particulars Page No I. MICROBIOLOGY 1 - 11 II. ENVIRONMENTAL SANITATION AND HEALTH 12 - 52 III. COMMUNICABLE DISEASES 53 - 95 IV. NON- COMMUNICABLE DISEASES 96 - 117 V. NUTRITION 118- 113 VI. MATERNAL HEALTH 114 - 165 VII. CHILD HEALTH NURSING 166 - 222 VIII. GERIATRIC CARE 223 - 246 IX. EMERGENCY MANAGEMENT 247 - 268 X. HOME NURSING 269 - 294 XI. ADMINISTRATION OF MEDICINE 295 - 324 iii iv 1. Microbiology Microbiology is the study of microorganisms. These organisms are so small that they can be seen only with the help of a microscope. These include bacteria, viruses, protozoa, fungi and Rickettsiae. Viruses do not have a cell structure. Other microscopic organisms are made up of cells. Microbiology plays an important part in everyday life. For example, bread cannot be made without using yeasts for leavening it. Microbiology finds a wide range of applications in agriculture and industry as well. Microorganisms play important role in sewage treatment. They also decompose dead organic matter and return useful minerals present in them back to the ecosystem. At the sametime some microorganisms are harmful to us. They are responsible for many diseases in human and animals. There are other microorganisms that spoil the food. 1.1. classification of Micro organisMs There are four main groups of micro organisms 1. Bacteria 3. Protozoa 2. Virus 4. Fungi 1.1.1. bacteria Bacteria are heterogeneous and belong to both animal and plant kingdom. It include cocci, bacilli, spirella and spirochaetes. types strepto cocci : They are round shaped organisms arranged in chain. They are grampositive, non-motile, highly pathogenic and do not grow in ordinary media. They grow in blood and serum media. staphylo cocci : Saphylo Cocci are arranged in clusters like grapes. They are grampositive and violet in colour when stained. They are non-motile and non-spore forming organisms. There are two types of pathogenic staphylococci. Staphylo coccus albus and Staphylo coccus aureus Diplococci Diplococci are arranged in pairs and they are gram-negative organisms. Examples of diplo cocci are Neisseria gonococci and Neisseria meningo cocci. They grow in special culture media of heated blood. Preumococci are also arranged in pairs. They are gram-positive and found in nasopharynx. bacillus Bacilli are rodshaped organisms. These are gram positive and gram-negative organisms. Gram-positive bacilli are corynebacterium diptheriae. Clostridium tetani and bacillus anthracis and mycobacterium tuberculosis. 1 fig. 1.1 - bacillus 1.1.2. Viruses Viruses are smaller than bacteria. It can pass through the finest filters. They cannot be seen through an ordinary microscope, but only through an electron microscope. Common viral infections are common cold, measles chicken pox, small pox, rabies and poliomyelitis. 1.1.3. Protozoa Protozoa are microscopic organisms and they consists of single cells while helminthes are multicellular macroscopic organisms. 1.1.4. fungi A group of diverse, widespread unicellular and multicellular organisms, lacking chlorophyll and usually bearing spores and often filaments. 1.2. infection anD its transMission 1.2.1. entry of infection into human body Micro organisms may enter the body in one of the three ways. i. Digestive tract – Swallowed in food or water ii. Respiratory tract – breathed in with air. iii. Skin and mucus membranes – through a wound, weakened surface or injection. 1.2.2. organisms leave the body of an infected person in the following ways i. Excreta – Faeces and urine ii. Coughing sneezing and sputum. iii. Pus and wound discharges iv. Blood. Eg. Mosquitobites and injection needle Each type of organisms has its own special path for leaving an infected person and going into a healthy person. a) Faeco oral route b) Faeces to skin c) Airborne – droplet infection 2 a) faecal to oral route : Faeces may contain i. Intestinal parasites or ova of worms. ii. Amoeba Causing dysentery iii. Bacteria causing cholera, typhoid fever or dysentery. iv. Viruses of Polio or hepatitis. From the faeces, the organisms may get into drinking water. Flies and dirty hands act as carriers and spread infection by oral route. Children may suck the dirty fingers and organisms enter the body. Faecal to oral route infection can be prevented by means of i. Hand washing before preparing or eating food. ii. Eating only clean food, kept free from flies. iii. Getting rid of flies and breeding places. iv. Protecting the water supply and drinking boiled water. v. Use of latrines or covering of the faeces with earth. vi. Proper hand washing with soap after defection. b) faeces to skin : Hookworm ova passed in faeces hatch into larvae on the ground. Then the larvae can bite through the skin, usually through barefoot and grow into adult worms in the intestines. Hookworm disease can be prevented if people use latrines and wear slippers. The tetanus bacillus lives in the intestines of man and animals and is present in cowdung and soil. It enters into the body through a wound or a newborn baby’s umbilical cord. The best way to prevent tetanus is by immunization with tetanus toxoid. c) Droplet infection (airborne) : When a person with infection such as a common cold or tuberculosis, coughs, sneezes or eventalks, with his breath organisms are thrown into the air in very small drops of sputum. The droplets may dry up, leaving an infections dust on cloths, floors and furniture. When another person breathes in or inhales the infection affects the later. The diseases which are spread by droplet infections are diphtheria, mumps, measles, chickenpox, smallpox, whooping cough, pneumonia and upper respiratory infections. Droplet infection is difficult to prevent. Prevention of droplet infections is i. Breathe fresh air and avoid crowded places. ii. Have sufficient nutritious food. iii. Cover the nose and mouth when coughing. iv. Persons with tuberculosis should take proper treatment. v. Those with measles, chickenpox, diphtheria etc. should be isolated. vi. Immunizations especially to protect children. 3 1.2.3. Method used for identification of microbes Microbes are considered as unseen enemies of man. They can be seen only under microscope. To identify the specific microbes, the following methods are done. 1. Smear 2. Fixing 3. Hanging drop preparation 4. Staining 5. Culture 6. Animal innoculation 1.2.4. Microscope Microscope is the instrument, which is used to magnify objects and structure, which are too small to see by the naked eye. Since the science of microbiology is concerned with the micro organisms, we can appreciate that microscope is the most essential piece of equipment in the laboratory to identify bacteria. There are varieties of microscopes of which three are most important. i. The compound optical microscope, which is used for routine bacteriological examinations. ii. The dark field microscope, which is used to identify spirochaetes. Eg. Trepenoma Pallidum. iii. The electron microscope is the most powerful microscope used to magnify the object by 1,00,000 times. This is used in the identification of viruses. fig. 1.2 - Microscope 1.3. iMMunity Immunity is the power to resist and overcome infection caused by particular organism. 1.3.1. Factors influencing the immune status of individuals a) racial : Some races are susceptible or immune to certain diseases. For example, Hebrews are more resistant to tuberculosis than other people. b) species : Some of the species of animals have resistance to certain diseases. Eg. Lower animals never get measles or typhoid fever while man is susceptible to get these diseases. Birds do not get infection with certain kind of tubercle bacilli, which affects cattle or man. c) individual : Some people have a store natural resistance or immunity to certain disease. This is known as individual immunity. 1.3.2. types of immunity a) natural immunity : Natural immunity results after acquiring certain diseases like measles or chicken pox and usually lasts a life time. b) Artificial Immunity : Artificial immunity follows the receipt of a vaccine such as polio vaccine. c) active immunity : Non-virulent microorganisms are injected as antigens and the body produces antibodies against the antigen. 4 d) Passive immunity : Immuno globulins or antibodies are injected as a vaccine to neutralize the antigen. e) acquired immunity : Acquired immunity may be natural or artificial. i) Acquired artificial immunity : Immunity which is acquired artificially by introducing vaccine and toxoid (active) and serum (passive) is known as acquired artificial immunity. ii) acquired natural active immunity : People who suffered from disease will have immunity against that particular disease. Eg. Smallpox.This is known as acquired natural active immunity. iii) acquired natural passive immunity : The child gets antibodies from its mother through placenta and breast milk and has immunity for sometime against certain disease. 1.3.3. types of immunization active immunization : It implies administration of antigenic preparation in order to stimulate production of antibodies within the tissues of the individual. This is known as active immunity. The material used for producing active immunity are vaccines Eg. BCG. Passive immunization : Sera containing specific antibodies are directly injected to produce passive immunity. Eg. Anti-toxin sera in diphtheria (prepared from horse serum) and tetanus immunoglobulins. Vaccines may consist of a) Live, virulent organism in sub lethal doses Eg. Cholera vaccine, anti.-rabies vaccine. b) Live attenuated organisms. Eg. Vaccine for smallpox, tuberculosis (BCG) and yellow fever. c) Dead organisms Eg. Vaccines of typhoid, cholera and plague. d) Toxins of organisms, such as toxoids. Eg. Vaccines for diphtheria, tetanus and scarlet fever. 1.4 control anD Destruction of Micro organisMs terminology Asepsis : Freedom from infection or prevention of contact with micro-organisms. Antiseptic : An agent that will inhibit the growth and development of micro-organisms without necessarily killing them. Autoclaving : It is the process of sterilisation of articles by steam under pressure using an apparatus called autoclave. Bacteriocide : An agent that has the power to kill micro-organisms. Contamination : Contamination means the act of soiling or making dirty or impure by contact. Disinfection : It means destroying of all the pathogenic organisms. Concurrent disinfection : It is the immediate disinfection of all contaminated articles and bodily discharges during the course of disease. 5 Terminal disinfection : It means the disinfections of the patients unit with all the articles used by the patient on his discharge, death or release from isolation. Disinfectant : An agent which kills pathogenic organisms. Droplet infection : It is the infection of the individual by means of fine particles of Salaiva and mucus that are expelled from the mouth and nose of another person during coughing, sneezing or speaking. Infection : The entry and development of a disease producing agent in the body. Immunization : It is the act of creating immunity artificially against a particular disease. Isolation : It is the separation of infected person from non infected persons for the period of communicability under conditions which will prevent the transmission of infection to others. Sepsis : It is the infection of the body by pus forming bacteria. Sterilization : It is the destruction of all the micro-organisms both pathogenic and non pathogenic including their spores. 1.4.1. Destruction of microbes There are three main reasons for destroying removing or inhibiting the micro-organisms. a) To prevent infection and transmission of disease. b) To prevent decomposition and spoil of food and c) To prevent contamination of material used in pure culture. 1.4.2. sterilization It is a process of killing or completely removing all micro-organisms, both pathogenic and non-pathogenic. Terms Sterile or Sterility etc are also used in relation to the state of being completely free from any living organisms. Methods of disinfection a) Natural : sunlight and air b) Physical : Dry, heat, moist heat and radiation. c) Chemical : Liquids, solids and gases. a) natural method This method is used for contaminated linen and bed pans. Direct sunlight will have an effect an acid fast micro organisms. Place the linen and bed pans after washing in direct sunlight for six hours for two consecutive days. b) Physical method : i. Dryheat ii. Moist heat iii. Radiation i) Dryheat : Sterilizing of glassware including syringes is often done in a hot air oven at 160oc for one hour. Spores as well as organisms are killed. Rubber articles will not with stand this heat. This method is not efficient where heat has to penetrate as in dressings, towels and gowns. ii) Moist heat : • Boiling • Autoclaving 6