SCHOOL OF HEALTH SCIENCES
COURSE CODE: PHS 422
COURSE TITLE: CLINICAL SKILLS I &II
NATIONAL OPEN UNIVERSITY OF NIGERIA
SCHOOL OF HEALTH SCIENCES
COURSE CODE: PHS 409
COURSE TITLE: Clinical Skills I
i
COURSE CODE: PHS 409
COURSE TITLE: CLINICAL SKILLS 1
COURSE DEVELOPMENT
Course Developer/Writer: Nnamdi Amadi
School of Community Health
College of Health Science &
Technology, Port Harcourt
Nigeria.
Course Editor;
Programme Leader:
School of Science
&Technology
National Open University of
Nigeria Lagos.
Course Coordinator: S.K. Olubiyi
School of Science & Technology National Open University of
Nigeria Lagos.
NATIONAL OPEN UNIVERSITY OF NIGERIA
ii PHS 409 CLINICAL SKILLS I
National Open University of Nigeria
Headquarters
14/16 Ahmadu Bello Way
Victoria Island
Lagos
Abuja Office No. 5 Dar es Salaam Street Off Aminu Kano Crescent Wuse II, Abuja Nigeria e-mail: [email protected] URL: www.nou.edu.ng
Published By: National Open University of Nigeria
First Printed 2011
All Rights Reserved
3 PHS 409 CLINICAL SKILLS I (3 units c)
STUDY UNIT.
The study units in this course are as follows.
MODULE 1: HISTORY TAKING
Unit 1 Basic definitions in history taking
Unit 2 Concept of interview in history taking
Unit 3 Approaches to history taking
Unit 4 Essential clinical history
Unit 5 Principles involved in history taking
Unit 6 Procedures in history taking
MODULE 2: PHYSICAL EXAMINATION
Unit 1 Definition of concept of physical examination
Unit 2 Qualities of a good examiner
Unit 3 (Materials for physical examination
Unit 4 Principles and rules involved in physical examination
Unit 5 Procedure for examination
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MODULE 3: MEASUREMENT OF VITAL SIGNS
Unit 1 Meaning of vital signs
Unit 2 Material/parts of the body for monitoring vital signs unit 3 Concept and reasons for tepid sponging
Unit 4 Materials for tepid sponging
Unit 5 Procedure and principles involved in tepid sponging
MODULE 4: ASEPTIC TECHNIQUES IN CLINICAL SKILLS Unit 1 Definitions and concept of aseptic technique
Unit 2 Instruments and sterilization process
Unit 3 Preparation and administration of salt, sugar solution
Unit 4 Preparation and administration of intravenous fluid
Unit 5 Principles and procedure of aseptic techniques in
clinical skill
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PHS 409 CLINICAL SKILLS II (units 3c)
Module 1: History Taking Unit 1: Basic Definition in History Taking
1.0 Introduction
2.0 Objective
3.0 Main Content
4.0 Conclusion
5.0 Summary
6.0 Tutor marked assignment
7.0 References/Further Reading
Unit 2: Concept of Interview in History Taking
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Types of interview
3.2 Materials for conducting interview
3.3 Principle and procedure involved in interview
4.0 Conclusion
5.0 Summary
6.0 Tutor marked Assignment
7.0 References/Further Reading
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UNIT 3: Approaches to History Taking
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Establishment of appropriate rapport
3.2 Use of appropriate language
3.3 Assurance of confidentiality
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 4: Essential Clinical History
1.0 Introduction
2.0 Objectives
3.0 Main content 3.1 Types of essential clinical history
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
vii 7.0 References/Further Reading
UNIT 5: Principles Involved in History Taking 1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Reasons for correct history
3.2 Problems associated with incorrect history.
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 6: Procedures in History Taking
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading •
8 MODULE 2: PHYSICAL EXAMINATION
UNIT 1: Definition and Concept of Physical Examination
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 2: Qualities of a Good Examiner
1.0 Introduction 2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
9 UNIT 3 Materials for Physical Examination
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 4: Principles and Rules Involved in Physical Examination
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
10 UNIT 5: Procedure in Physical Examination
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Preparation
3.2 Explanation of Purpose
3.3 Accurate Positioning
3.4 General Observation
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
MODULE 3: Measurement of Vital Signs
Unit 1: Meaning/Estimation of Vital Signs
1.0 Introduction
2.0 Objectives
3.0 Main content
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3.1 Temperature Taking
3.1.1 Temperature Sites
3.2 Pulse Rate
3.3 Respiratory Rate
3.3.1 Normal respiratory Rate
3.4 Estimate of Blood Pressure
3.4.1 Factors Responsible for High
Blood Pressure
3.5 Normal Blood Pressure
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 2: Materials for Measurement of Vital Signs
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Clinical thermometer-oral-rectal
3.2 Blood pressure apparatus
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4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 3: Concept and Reasons for Tepid Sponging
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Meaning of Tepid Sponging
3.2. Reasons for Tepid Sponging
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 4: Materials for Tepid Sponging
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
13 5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 5: Procedure and Principles Involved in
Tepid Sponging 1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
MODULE 4: ASEPTIC TECHNIQUES IN CLINICAL SKILLS
Unit 1: Definition and Concept of Aseptic Technique
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
14 5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 2: Instruments and Sterilization Process
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Hot air oven 3.1.1 Moist Heat (Boiling, Steam etc)
3.2 Chemical Sterilizing agents
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 3: Preparation and Administration of Salt, Sugar Solution
1.0 Introduction
2.0 Objectives
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3.0 Main content
3.1 Requirement for preparation of S.S.S
3.2 Preparation of SSS
3.3 Observation
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
UNIT 4: Preparation and Administration of Intravenous Fluid 1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Types of infusion
3.2 Materials for administration of an intravenous infusion
3.3 Procedure for administration of an intravenous infusion
3.4 Complications or dangers of intravenous infusion
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References / Further Reading
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UNIT 5: Principle and Procedures of Aseptic Techniques in Clinical Skills
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Principle of Non-touch technique
3.2 Procedure involved in aseptic technique
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
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PHS 409 CLINICAL SKILLS I
Unit 1: Basic Definitions in History Taking
1.0 Introduction
2.0 Objective
3.0 Main Content
4.0 Conclusion
5.0 Summary
6.0 Tutor marked assignment
7.0 References/Further Reading
1.0 Introduction In this unit, we shall discuss the basic definitions in History taking. It will also take account of how to carry out good history taking.
2.0 Objectives At the end of studying this unit the learner would be able to:
• Understand basic definition of history taking
• Define what is history taking
• Carry our good history taking
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3.0 Main Content The art of obtaining an accurate history expeditiously can be acquired and developed with practice.
In history taking, the first task is to listen and observe, not only to obtain information about the current problem but also to understand the patient as a person and his life situation.
Amadi (1996) defined “history taking as an act of obtaining relevant information from a patient which is aimed at making provisional diagnoses of the patient's health status”.
When the history has been obtained, the first step has been taken towards diagnosis. The information must be appraised, taking into account the reliability of the patient as a witness. The relevant facts must be separated from irrelevant ones and evaluated objectively.
When the basic technique has been acquired, skill will improve with experience until an efficient method has been developed.
4.0 Conclusion
In this unit you have learned what history taking is all about.
You should at this point be able to define history taking in your own understanding.
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You have also realized that history is usually most valuable part of clinical study, as well as the fact that every man has history.
Techniques of obtaining accurate history is said to improve with experience. The technique or procedure for history taking is discussed in unit 6.
5.0 Summary This unit focused on the definition of history taking. It also discussed issues in history taking and how to carry out good history taking.
6.0 Tutor Marked Assignment
1. Give a simple definition of history taking
2. Sate the basic techniques involved in obtaining history taking
7.0 References/Further Reading
Amadi, N. (1996), A Practical Approach to Clinical Studies for Medical and Health Students, Emhai printing and publishing co, Choba, University of Port Harcourt.
Macleod, J., and Munro, J. (1986), Clinical Examination Seventh Edition. Church Livingstone, medical Div. of Longman group Ltd, U.K.
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Unit 2 Concept of Interview in History Taking
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Types of interview
3.2 Materials for conducting interview
3.3 Principle and procedure involved in interview
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit we shall discuss the concept of interviewing a patient, it will also consider the various questioning technique and types of questions to ask. We shall equally discuss materials required to conduct interview and principles and procedures involved in interview.
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2.0 Objective
At the end of this unit, the student should be able to:
Define the concepts of interview
Understand the term structured and unstructured
interview (Types)
• Materials for conducting interview
• Principles and procedure involved in interview.
3.0 Main Content An interview is a process whereby someone (interviewer) asks
another, in this context a patient (interviewee) ask series of
questions and records the information supplied. (Eguavoen,
Omorogbe and Omohan 2006).
In a typical interview situation, there is a interviewer and the
interviewee. An interviewer is that individual who formulates and ask
the question(s) while the interviewee is that individual that responds
to questions asked.
3.1 Types of Interview There are several types of interview. These includes structural,
semi- structural and unstructured interview. Interview can be
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structured or unstructured if the interview is in the form of a well-
prepared list of questions and is carried out in a fairly controlled
environment, then, it is said to be structured. In some cases, the
interaction may be a little bit informal and the interview conducted in
a casual manner, such is an example of unstructed interview.
3.2 Materials for Conducting Interview The materials for conducting interview includes:
Memo pad and pen
Audio Tape Recorder
Questionnaire
Memo pad and pen is very essential tool in conducting interview, because it helps in jotting down the facts of interview by the interviewer.
Electronic device like audio tape recorder is another important material because this aids a replay of recorded version, by so doing eliminates forgetfulness.
Questionnaire is yet another important material for conducting interview, and it comes handy in structured interview.
3.3 Principles and Procedure Involved in Interview
The general principle guiding the conduct of interview is such that the interviewer chooses and arranges an appropriate venue,
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ensures everything is in place, ensures there is no interruption or disturbance during the interview session, and is also responsible for jotting down of facts or the audio recording. A simple procedure is such that the interviewer introduces the topic, such introduction could/begin from the general to the I specific. He does the asking of the questions, in the process shows flexibility and sensitivity and fact; probes for details or explanation.
And at the end articulates the facts and sum them up.
4.0 Conclusion
In this unit, you have learnt about the concept of interview, and should be able to define it. You have also learnt about the various types of interview and materials you require to conduct an interview. You have equally learnt about the principle and procedures involved in interview. It is hoped that you should be able to now define interview, state the various types of interview, list the materials required for conducting and interview as well as the procedure for interview.
5.0 Summary
The unit focused on interview in history taking. It has also dealt with the various types of interview, the materials for interview and the principle and procedure involved in interview.
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6.0 Tutor Marked Assignment
1. Define the terms structured and unstructured interview in your own words? 2. List three basic materials for conducting interview?
7.0 References/Further Reading
Eguavoen, A.N.T., Omorogbe, S.K,. and M, E, Omohan, (2006), Sociology, An Introductory Text, 2nd Edition, Lucosen publishing House Benin City.
Macleod, 3., and Munro, J. (1986), Clinical Examination, Seventh Edition, Churchill Livingstone, Medical Div. of Longman group Ltd. U.k.
8
Unit 3 Approaches to History Taking
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Establishment of appropriate rapport
3.2 Use of appropriate language
3.3 Assurance of confidentiality
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit, we shall discuss approaches to history taking. We will also discuss establishment of appropriate rapport as well as the use of appropriate language and assurance of confidentiality in history taking.
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2.0 Objective
At the end of this unit, the student should be able to:
Understand how to approach the patient courteously, which
will enhance the patient's co-operation.
• To establish appropriate rapport with a patient
Design a way of building confidentiality on the patient
3.0 Main Content It has been observed over time that patients often find it difficult
to give appropriate information or perhaps suppress vital information
of their health condition, often, these information are information that
the consultant will need in his diagnosis, so in order to ensure that a
patient gives an exact information; it becomes necessary to design a
form of approach that will ultimately encourage the patient to open-
up and give the necessary information without reservation: This can
be achieved by.
3.1 Establishment of Appropriate Rapport To establish an appropriate rapport on a patient involves creating of a friendly relationship with the patient, by simply greeting,
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smiling, being sympathetic etc. All these will make the patient to respond accordingly and give appropriate information.
3.2 Use of Appropriate Language
The use of language is very important in communication
especially in history taking. This is why a patients language
background is sought before history commences so that if the patient
is not lettered, and the consultant does not understand the patient
language, an interpreter could be assigned to relate the information,
otherwise the patient goes with grudges of not been understood, and
therefore feels inadequate in whatever remedy that will be applied
toward solving the health problems.
3.3 Assurance of confidentiality
The issue of confidentiality in clinical practice is not over- emphasized, no patient wants to be exposed. One of the ethics of medical and health profession is to ensure confidentiality of any patient, to this end, some documents especially the folders are inscribed confidential as a constant reminder not to divulge the health status of the patient.
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In order to achieve this goal, the consulting room where the information is obtained from the patient is organized in such a way as to aid obtaining this information without necessarily exposing the patient to other workers in a clinical set-up. The process of history taking is one-on-one basis. By so doing confidentiality is built because it is only the consultant that knows the actual health problem of the patient.
4.0 Conclusion In this unit, you have learnt about the approaches to history taking. You have also learnt about the use of appropriate language and how it can enhance understanding in history taking.
The importance of assurance of confidentiality in history taking has also been highlighted to your understanding.
5.0 Summary This unit examined approaches to history taking. It also
focused on establishment of appropriate rapport, the use of
appropriate language and assurance of confidentiality in history
taking.
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6.0 Tutor Marked Assignment 1. Enumerate three reasons why a patient can suppress vital information.
2. What measures will you put in place to enhance co- operation from your patient in approaches to history taking.
7.0 Reference/Further Reading
Amadi, N. (2006), A Practical. Approach to Clinical Practice, for Medical and Health Students (2nd Edition), Emhai printing and publishing co. Choba, University of Port Harcourt.
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Unit 4 Essential Clinical History
1.0 Introduction
2.0 Objectives
3.0 Main content 3.1 Types of essential clinical history
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit, the focus shall essential clinical history. We will
also discus the types of essential clinical history.
2.0 At the end of this unit, the student should be able to:
Understand the meaning of essential clinical history
Know the categories of essential clinical history
Differentiate between essential and nonessential clinical
history.
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3.0 Main Content An essential clinical history could be. described as those
important information supplied by the patient, that could assist the
consultant to gain insight into the patient's health problems.
It is called essential history because over time/ patients had
gone out of their way to give information which is not necessary and
therefore not essential. It has been observed that patients instead of
giving a direct information concerning their health status, prefers to
give information about their life style/ family background or social
status. In this process, if the consultant is not patient enough to
listen attentively to the patient's story "he may not be able to gather
essential information that will assist him in diagnosis. Often time
patients had gotten angry with the consultant, because he tried to
stop them from giving irrelevant information which were not
necessary, and had been called names from the patient.
3.1 Types of Essential Clinical History Essential clinical history are grouped into nine broad
categories, as can be seen below.
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3.1.1 Demographic History
Demographic history includes personal particulars e.g name,
address, sex, age, occupation, next of kin, height, weight, religion
etc.
3.1.2 Present Health History (Current Illness)
This has to do with the immediate complaints of the patient, e.g the current illness that brought the patient to the health facility for treatment. In this regard information required is about the present illness, e.g what is the problems, how serious is the problems, when did it begin, what medication had been applied for the problems etc.
3.1.3 Past Medical History This history is about whether or not the patent has had similar problems before, if yes, was the patient hospitalized, where and for how long, what form of treatment was given.
It should be borne in mind, however, that the diagnosis supplied by patient may not be correct. If medical records are not available the examiner may have to decide about past episodes on the patient description of symptoms and the circumstance at that time.
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3.1.4 Ante-Natal and Birth History This history is centred around the pregnancy, and child birth. If the woman is pregnant, determine if she is primigravida, multigravida or multipara. Get to know if there is any history of twin delivery, cesarean section, or possible death during child birth in the family.
This information helps to ensure that a more adequate attention is given in that regard.
3.1.5 Mental and Developmental History Obtain information on the developmental growth of the patient, because some early childhood impairments tends to re-surface in adulthood. In infants and children in particular, check the rate of their mental and physical development in relation to their age and in comparism to other children within their age bracket.
3.1.6 Immunization History Obtain adequate information on immunization, get to know if
the child completed the schedule of immunization.
3.1.7 Nutritional History
Information about nutrition has to do with the feeding habits, patterns and frequency of feeding, as well as its dietary
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components required for the individual. Ask if there were situations that gave rise to a patient being kept on special diet, review the implication of such diets, if found hazardous to health, encourage the patient to adopt a possible alternative. We have discovered that most malnourished patients are victims/of personal beliefs, anchored mostly on religion e.g vegetarians.
3.1.8 Family History The state of family income, low, medium or high determines the state of the well being of the individual. If patient's parents are dead, obtain information on the cause of their death. It is a well known fact that certain hereditary conditions play a predominant role in destabilization of most families. Such factor accounts for a possible presence of such a condition in a patient.
3.1.9 Social History
Individual's personal relationship with peer groups, if on the negative side, has an unquestionable potential influence on patient.
Patient's occupation and social environment may, like family influence, have profound repercussion on their health. Therefore
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inquiry should be made about home, occupation, personal interest and habits.
Patient's leisure pursuits, such as the amount of physical exercise undertaken, and intellectual activities should not be over-looked, as such positive indulgence promotes mental and physical well-being.
Some habits acquired may have disastrous negative implications on health e.g food, tobacco, alcohol etc. most lung diseases and psychological instability have over a long period of time been attributed to tobacco smoking.
4.0 Conclusion
This unit has highlighted the basic understanding of essential clinical history, which you ought to know. You have also learnt about the differences between the essential and non-essential clinical history.
From this unit you have also been informed that essential clinical history are grouped into nine categories, as seen in the main text.
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5.0 Summary This unit focused on essential clinical history. It also dealt with the types of essential clinical history and the differences between the essential and non-essential clinical history.
6.0 Tutor Marked Assignment
1. Outline the nine categories of clinical history
7.0 References/Further Reading
Akinpelu, M.O. (2002), Practical Skills in Primary Health Care
Setting. Big Olas (Nig) Priniter Ijebu-Ode.
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Unit 5 Principle Involved in History Taking
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Reasons for correct history
3.2 Problems associated with incorrect history.
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit, we shall discuss the principle involved in history taking, the reasons for obtaining correct history and problems associated with incorrect history.
The basic medical or health history of a patient is taking generally with a view to assisting in proper understanding of the patient's present health status.
Certain principles must guide the individual who is obtaining the history of a patient, in order to ensure that an erroneous history is not
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obtained which can lead to wrong diagnosis and wrong prescription and subsequent treatment.
2.0 Objective
At the end of this unit, the student should be able to
understand the under listed objectives
The basic principle involved in history taking
Reasons why correct history must be obtained
Problems associated with incorrect history
3.0 Main Content
The principles involved in history taking are as follows:
• You don't obtain history from a patient that is under the influence of alcohol. Obtain information from a relative or friend when the patient is unable to supply it because of immaturity, severe illness, senility or mental disturbance (insanity). Obtain an account from an eye-witness in a case of a patient who is unconscious. • Don't try to obtain information from a patient where there is a suspicion that such a patient might surpress vital information, as a result of the environment or exposure eg in the presence of other patients.
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Timidity, guilt or fear of the disease may cause a patient to surpress vital information.
3.1 Reasons why correct history must be obtained
Correct history must be obtained, because it has been observed that some patient's tend to exaggerate symptoms in an attempt to secure the attention and sympathy of the consultant. On the other hand, most patients with some imperfect medical knowledge tend to give a diagnosis rather than an account of symptoms; such statements must not be accepted without reviewing their bases.
3.2 Problems Associated with Incorrect History
Incorrect history are misleading, often time it leads to wrong diagnosis and wrong treatment. Wrong application of treatment leads to wastage of drugs and eventual death.
4.0 Conclusion In this unit you have learnt about the principle involved in history taking, and should be able to outline them. You have also learnt
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about the reasons why correct history should obtained, as well as the problems associated with incorrect history.
5.0 Summary
In this unit we were able to see the interplay between the principles of "dos" and "donts" in history taking.
The reasons why correct vital history must be obtained are also highlighted as well as problems associated with incorrect history.
6.0 Tutor Marked Assignment 1. What do you consider as the basic problems associated
with incorrect history.
7.0 References/Further Reading
Sorungbe, A.0.0. (1995), Federal Ministry of Health and National Primary Health Care Development Agency, Standing orders for Community Health Extension Workers, Training and manpower development division, Nigeria.
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Unit 6 Procedures in History Taking
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit we shall examine the procedures of techniques involved in history taking. In many aspects of clinical study, there are basic procedures an individual must adhere strictly, to be able to achieve the set objective. Procedures or techniques involved in history taking happens to be one of them.
2.0 Objective
On completion of this unit, the student should be able to:
• Understand the procedures in history taking
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3.0 Main Content
It has been emphasized in the earlier units that it is essential that the patient is put at ease through a courteous and friendly relationship to enable the patient give adequate vital information.
Therefore the first procedure in history taking is to establish an appropriate rapport (friendly relationship) with your patient.
It is also very important to let your patient express how he feels concerning his health without restriction. It is even encouraging to assist your patient in areas of difficulty in explanation of certain health feelings. Show sympathy and re-assure patients in distress condition.
Macleod and Munro (1986) advised that it is essential that record be made without delay basic facts about the history should be written down as it is given. This can be done as quickly as possible with little or ho interruption of the patient. Alternatively the consultant can jot down the main issues, especially in complicated cases, and later do the sequencing and elaborating of the fact.
When the history has been obtained satisfactorily, the first essential step towards diagnosis has been taken. The information must be appraised, taking into account the reliability of the patient as a witness. The relevant facts must be evaluated objectively; the logical analysis and interpretation of the evidence will usually lead to provisional diagnosis.
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4.0 Conclusion
In this unit, you have learnt about the procedure or techniques involved in history taking, and should be able to express them.
5.0 Summary
This unit focused basically on the procedures involved in history taking.
6.0 Tutor Marked Assignment
1. Enumerate at least three procedures involved in history taking.
7.0 References/Further Reading
Macleod, J., and Munro, J., (1996) Clinical Examination, Seventh Edition, Churchill Livingstone, Medical Div. of Longman group Ltd, U.K.,
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Module 2: Physical Examination
Unit 1: Definition and Concept of Physical Examination
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
10. Introduction
In this unit, we shall discuss the basic definition of physical examination, and the reasons for conducting physical examination.
The concept of physical examination basically is anchored on the fact that not all diseases or ailments are internal, very many diseases are found externally, and even the ones found internally has clinical manifestation on the physical body. Therefore it becomes necessary to look out for them.
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2.0 Objective At the end of this unit, the student should be able to understand
the following objectives.
• The basic definition of physical examination
• The reasons for conducting physical examination
3.0 Main Content
Physical examination is defined as an act or a process of
screening for features of diseases in a patient from head to toe.
For an examiner to accurately diagnose an ailment, it is pertinent that the fellow should be familiar with the range of normal signs before abnormalities can be confidently recognized. This is why
Merril C. Sosman in Boston, summarized physical examination as
"seeing only what you look for, and recognizing only what you know"
The individual carrying out a physical examination is entirely and solely responsible for seeking out the features of disease and must not expect the patient to draw attention to them. Occasionally and for a variety of motives according to Macleod and Munro (1996) patients will not reveal what they regard as stigmata of disease, but as a rule failure to recognize these signs are due to careless or inadequate examination.
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4.0 Conclusion
In this unit, you have learnt the definition of physical
examination, you should by now formulate your own definition base
on your understanding of the passage. You have also learnt why
physical examination is conducted on a patient.
5.0 Summary This unit focused on the definition and concept of physical examination, it also discussed why physical examination is necessary and why it should be carried out in a patient.
6.0 Tutor Marked Assignment
1. In your own understanding define the concept of physical examination.
7. References/Further Reading
Macleod, J., and Munro, 3. (1996) clinical examination,
Seventh Edition, Churchill Livingstone, Medical Div of
Longman Group Ltd, UK.
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Unit 2: Qualities of a Good Examiner
1.0 Introduction 2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
This unit shall discuss basically the qualities of a good examiner. Certain qualities must be possessed by a good examiner, according to Oruamabo (1995), an examiner must exhibit a true exemplary qualities, which must be identified in him, to enhance the patient to have confident in making himself available to the examiner for examination.
2.0 Objectives
At the end of this unit, the student should be able to understand such qualities which must be possessed by the examiner'.
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3.0 Main Content It has been observed that most patients find it difficult to expose their bodies for examination. Part of this problem stems from the way and manner some examiners appear. No patient wants his body to be unnecessarily perused and touched by an un-organized examiner.
An examiners appearance, utterances, reactions etc. is a true reflection of whom the examiner is, and therefore if on the negative side, does not encourage a patient to submit for examination.
a) To this end, therefore, a good examiner must be in a right
mood (happy).
b) Look composed, calm and competent.
c) Must be neat, show love and understanding.
d) Must avoid expressions of disgust, alarm, de-taste or any
other negative reactions resulting from coming in contact with
filthy things etc.
e) Ensure a strict adherence to privacy as most patients will not
co-operate if they are unnecessarily exposed.
4.0 Conclusion
In this unit you have learnt about the qualities of a good examiner and should be able to adopt them. It is a known fact that
32 quality attributes of an examiner accounts for co-operation on the part of the patient. And this can be identified in him by the way and manner he handles issues in relations to physical examination.
5.0 Summary
This unit examined the qualities of a good examiner which is essential in physical examination. It equally outlined the qualities one after the other to enhance understanding.
6.0 Tutor Marked Assignment
1. What could possibly discourage a patient from co- operating in physical examination?
7.0 References/ Further Reading
Oruamabo, J. (1995) Qualities of a Good Examiner Lecture
Notes on Clinical Skills, College of Health Science and
Technology, Port Harcourt.
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Unit 3: Materials for Physical Examination
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit, we shall outline the various materials used for physical examination. To achieve a high degree of success in physical examination, it is convenient to have all the examining materials made available in the consulting room and consideration has to be given to the condition under which the physical examination is conducted.
2.0 Objective
At the end of this unit, the student should be able to understand
the under-listed objectives.
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• To enumerate the materials for physical examination
• To know when to apply such materials.
3.0 Main Content
A number of materials are used in physical examination. Some
of these materials are diagnostic and therapeutic materials which
aids the examiner in eliciting information in the course of physical
examination.
In a Nutshell, some of the materials are as listed below.
* Diagnostic set
* Blood Pressure apparatus Sphygmomanometer
Stethoscope
* Thermometers Oral
Rectal
* Spatula Metal
Wooden
* Speculum
* Laryngoscope
* Phargngoscope
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* Pen Torch
* Weighing Scale
* Charts
* Hand Gloves
* Examination Couch
* Forceps
* Antiseptic lotions/ swabs/ Lubricants
* Ophthalmoscope with auriscope etc.
4.0 Conclusion
In this unit, you have learnt about various materials used in conducting physical examination. You should be able to identify the various materials and their uses.
5.0 Summary
High degree of success in physical examination depends on the availability of materials; This is why this unit outlined the various materials for physical examination, so that the learner can identify and know how to use them.
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6.0 Tutor Marked Assignment
1. Enumerate at least ten materials for conducting physical examination.
7.0 References /further Reading
Amadi, N. (2009) Parameters in Physical Examination
Lecture Notes on Fundamentals of Medical Practice,
College of Health Science and Technology, Port
Harcourt.
37
Unit 4: Principles and Rules Involved in Physical Examination
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit, we shall examine the principles and rules involved in physical examination. Physical examination is one such examination that borders on the integrity of both the examiner and the patient. And it is because of these that certain principles and rules must be adhered to in its conduct.
2.0 Objective At the end of studying this unit, the learner would be able to
know the principles and rules involved in physical examination.
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3.0 Main Content
Ideally in physical examination there is the principle of ensuring
your patient is made to be very comfortable before commencement.
It is salutary to start from one region especially the head region
in general physical examination. Then in a sequential order examine
the other areas.
The general rule of I.P.P.A is to be adopted in physical examination. I.P.P.A. means
I - Inspection: (observation by sight): This rule says carry out physical examination by mere close perusual of the patient; this method will highlight congenital abnormalities, colour, posture, spontaneous movement etc.
P - Palpation: (observation by Touch): This method will afford the examiner the opportunity to feel a hard mass under the skin/ which might possibly be a tumour. As a result of palpation the patient may complain of pain on touching an area of the body.
P - Percussion: (observation by sound): In this case tapping with the finger over a cavity will indicate the density of the under laying tissues e.g. posterior chest wall in a pneumonic patient can indicate the localized area of lung involved.
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A - Auscultation: (observation by sound): This rule involves
the use of stethoscope using a stethoscope, the heart/breath sounds
can be heard, as well as abnormalities associated with the
cardiovascular and respiratory region.
4.0 Conclusion
In this unit you have learnt about the principles and rules involved in physical examination. From the understanding in this unit, it's been observed that the patient's comfort is absolutely necessary.
It is also favoured to start general examination from one region and sequentially progress, than haphazardly.
5.0 Summary
This unit focused on the principles and rules involved in physical examination.
Physical examination requires some level of integrity. Its principles and rules must be followed strictly, as outlined in the course of the study.
6.0 Tutor Market Assignment
1. What do you understand as the IPPA rule in physical examination?
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7.0 References /Further Reading
Amadi, N. (2003) A practical Approach to Clinical Practice,
for Medical and Health Students. Emhai Publishing Co.
Choba Uniport.
41
Unit 5: Procedure in Physical Examination
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Preparation
3.2 Explanation of Purpose
3.3 Accurate Positioning
3.4 General Observation
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit, we shall discuss the procedures involved in physical examination. It will also emphasize the issue of compromise in physical examination because It would not be practicable for even the most professional to carry out examination in a patient with some degree of compromise.
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2.0 Objective
At the end of this unit, the student should be able to:
• Understand the procedure involved in physical examination
• Not compromise with any patient at the expense of the profession.
3.0 Main Content
Before discussing the basic procedures, consideration has to be given to the condition under which the physical examination is conducted.
Privacy is essential and this usually constitutes no problem in the home or the consulting room.
In some families, relatives may feel it is their duty to be present in numbers which may embarrass the patients and the examiner. The tactful dismissal of all, or all but one, is desirable. In a hospital ward, screens must be drawn round the bed before the examination begins.
When necessary, steps should be provided for easy access to a high couch in the consulting room. Comfort is important and encourages adequate relaxation.
Positioning of the examiner counts so much in any examination, as any awkward position impairs perception; therefore you can adjust
43
your examining couch to any reasonable height to ensure the comfort of the patient. Illumination must be good, exposure of the area to be examined must be adequate but not to an extent that might unnecessarily embarrass the patient.
While privacy is important, the presence of a relative or nurse is often desirable and is essential when a rectal or vaginal examination is performed by a male examiner to avoid embarrassment.
Let your patient be well-informed as you progress, remember to relate your findings to the patient appropriately, and if you have missed any portion, kindly explain and politely seek for permission to examine the portion.
Other aspects of procedure include.
• Preparation e.g. Hand washing
• Explanation of purpose to the patient, this may be advisable
mostly if examination commences at a point remote from the
site of complaint.
• General observations for:
i. State of alertness and temperament
ii. Signs of physical or mental disability
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iii. Signs of chronic illness
iv. State of cleanliness
4.0 Conclusion
In this unit, you have learnt that it is absolutely clear that physical examination follows a procedural approach; which can not be compromised. Anything short of that is unethical
5.0 Summary
This unit examined exclusively the procedure in physical examination. It also dealt with the issue of compromise which is seen as a human factor.
6.0 Tutor Marked Assignment
1. Name at least four factors necessary in procedure for physical
examination.
7.0 References / Further Reading Houghton, M., and Parnell, 3.E, (1969), Practical Procedure for Nurses. Williams and Wilkins Comp. Baltimore.
45
Module 3: Measurement of Vital Signs
Unit 1: Meaning / Estimation of vital signs
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Temperature Taking
3.1.1 Temperature Sites
3.2 Pulse Rate
3.3 Respiratory Rate
3.3.1 Normal respiratory Rate
3.4 Estimate of Blood Pressure
3.4.1 Factors Responsible for High
Blood Pressure
3.5 Normal Blood Pressure
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
46
1.0 Introduction
In this unit, we shall discuss the measurement of ital signs. It will also highlight the meaning of vital signs and how to estimate vital sings in a patient. We will equally consider the abnormalities associated with various vital signs.
2.0 Objectives
At the end of this unit, the student should be able to;
• Understand the meaning of vital signs
• How to measure vital signs
3.0 Main Content
Vital signs could be described as the necessary indication in a patient which helps to determine the health aspects of the patient.
Vital signs in a patient consist of measurement of temperature, pulse, respiration (TPR) and estimation of blood pressure.
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3.1 Temperature Taking
Combs (1976) defined temperature as the degree of intensity of heat especially as measured with a thermometer. According to
Akinpelu, temperature is a degree of hotness or coldness within a substance which can be measured against a standard scale. She further says regulation of body temperature is accomplished principally through thermo regulatory centre located in the hypothalamus of the brain.
3.1.1 Temperature Sites An individual's body temperature can be obtained either from
the:
a. Month b. Rectum
c. Groin
d. Axilla
The normal body temperature is 37°c, but any readin g which ranges between 36.5°c and 37.5°c (97.7° F. to 99.5 °F) is considered to be normal. Amadi (2003).
Surface temperature is 1/4 °c less in intensity th en internal temperature e.g Axilla and Rectum.
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The highest temperature is found mostly between the hours of
5-8 pm and the lowest between 2 and 6 am, as observed by Ross and Wilson (1970).
Temperatures are classified according to their intensity from collapse to hyper pyrexia.
3.2 Pulse Rate
The mechanism of pulse is the wave of expansion and
contraction of the left ventricle which forces a volume of blood
through the arterial wall into the aorta.
Pulse can be felt at any point where an artery can be pressed
gently against a bone (Pressure point). The most convenient point to
take the pulse is the anterior surface of the wrist. However, other
points include temporal, facial, groin, carotid, femoral etc.
Werner (1979) believes that the best time to take an individual's pulse and arrive at a fairly accurate result is when the fellow is at rest; otherwise a few alterations may be noticed. Conditions that may give rise to such alterations are namely positioning, sex, age etc.
However the normal pulse rate is said to be within the under listed range
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* Adults 60 - 80 beats per minute
* Children 80 - 100 Beats per minute
* Infants 100 - 140 beats per minute
* Neonates 140 and above
3.3 Respiratory Rate
Respiration is described as the inspiration and expiration of air
brought about by a collection of nerve cells in the respiratory centre
of the medulla oblongata.
Normal respiration should be quiet regular and rhythmical.
There are situations where there can be normal increment in respiratory rate. This occurs during exercise, excitement, emotional out burst or decrease in atmospheric pressure. Normal decrease occurs in sleep, rest or fatigue.
3.3.1 Normal respiratory Rate
* Adults 14 - 20 breaths per minute
* Children 20 - 30 breaths per minute
* Infants 30 - 40 breaths per minute
* Neonates 40 and above
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3.3.2 Abnormalities Associated with Respiration
Excessive rapidity in respiration may be brought about by disease of the lungs and air passage, febrile conductions, heart diseases, hemorrhage and cranial pressure, coma due to toxaemia, as well as administration of respiratory depressive drugs e.g. morphia and barbiturate overdose.
3.4 Estimation of blood pressure
Blood pressure is that pressure which is exerted on the arterial wall as a result of the total out-put of blood from the heart into circulation.
The brain cells and other vital organs in the body are constantly fed with oxygen which is brought about by this pressure. When the pressure is low, the brain cells suffer from lack of oxygen. Excessive high pressure can result in the rupture of the blood vessels in the brain, as is often the case in cerebral hemorrhage. It is therefore essential that a regular check should be observed to ensure that it is maintained at a normal limit.
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3.4.1 Factors Responsible for High Blood Pressure.
In the recent years, a number of factors have been identified as pre- disposing causes of high B.P some of them are:
* Environmental factors This consists of day-to-d ay interactions of an individual which brings stress, thinking as well as other parameters encountered in a place of abode, e.g. poverty, broken home unemployment etc., all these can lead to high blood pressure.
* Elasticity of Arterial walls
The constriction of the artery walls inhibits blood pressure. This situation eventually leads to high blood pressure as is often found with patents with severe rheumatoid arthritis and severe varicose veins.
* Arteriosclerosis: This is a state where the arteries or veins are
either thickened or hardened as to reduce the normal pressure in
them. A reduction in pressure, leads to an accreted blood pressure.
3.5 Normal blood pressure
The normal blood pressure is given as 120/80 mmHg (systolic/
diastolic).
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4.0 Conclusion
In this unit, you have learnt about the measurement of vital signs, and should be able to define it. You have also learnt about the estimation of vital signs and various aspects of vital signs.
It is hoped that you should be able to state the various aspects of vital signs, viz: Temperature, pulse and respiration and to estimate blood pressure, as well as enumerate the normal and abnormal factors associated with vital signs.
5.0 Summary
This unit focused on measurement of vital sings. It also dealt with the various aspect of vital signs and outlined the normal and abnormal factors associated with vital signs.
6.0 Tutor Marked Assignment
1. What is the importance of measurement of vital signs?
7.0 References /Further Reading
Amadi, N. (2003), A Practical Approach to Clinical Practice
for medical and Health students. Emhai Printing and
53
publishing co Choba. Uniport.
Combs. P.C.M. (1976) Illustrated medical Dictionary
Consolidated Book Publishers, New York.
Ross, J.S. and Wilson, K.J.W. (1970) Foundations of Nursing
and First Aid, Fifth Edition. Churchill Livingstone Medical
DIV. of Longman Group Ltd, U.K.
Werner, D. (1979) Where there is no Doctor, Macmillan
Publishers Ltd., London.
54
Unit 2: Materials for Measurement of Vital Signs
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Clinical thermometer-oral-rectal
3.2 Blood pressure apparatus
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit we shall discuss the materials for measurement of vital signs. Measurements of vital signs are technical skills that require materials or instruments to be able to measure them. Its measurement accuracy depends on materials and the skillful handling of the monitor.
2.0 Objective
At the end of this unit/ the student should be able to:
• Name the materials for measurement of vital signs
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3.0 Main Content
A number of materials are in use in the measurement of vital
signs, some of them are as follows.
3.1 Clinical Thermometer oral
Rectal
Different types of thermometer are in use for special
purposes, but we are concerned with the use of clinical
thermometer.
As the name implies/ this is the type that is used in the clinic,
hospitals and maternities to obtain the patient's temperature.
There are two types of clinical thermometer namely oral and
rectal. One considerable importance a clinical thermometer has over
others is that it is self-registering and readable in a suitable light
after removing it from the
In oral thermometer, the centigrade scale ranges from 5 °c to 42 °c. Each line represents I. unit, whereas in Fahrenheit
56
scale. It ranges from 94 °F to 108 °F where each li ne represents
2 units.
Most clinical thermometers are, however, of dual scale which means they are graduated both in °C and °F. O ne remarkable feature of the rectal thermometer is the blue or red dot at the tip of the bulb.
3.2 Blood Pressure Apparatus
According to Bur-ton (1976), there are two main clinical instruments which are used to determine blood pressure,
* Sphygmomanometer Aneroid
Mercurial
* Stethoscope Dual = Diaphragm with bell
Single = bell or diaphragm only
4.0 Conclusion In this unit you have learnt about the materials required for measurement of vital signs. Measurement of vital signs requires clinical materials, however we have just discussed two out of a lot other materials in use for vital signs.
57
5.0 Summary
Two most essential materials in measurement of vital signs
had just been highlighted.
It is of importance that these materials be used skillfully to be
able to achieve results.
6.0 Tutor Marked Assignment
1. Name two outstanding materials for measurement of vital signs.
7.0 References/Further Reading
Burton, J.L, (1976) Aids to medicine for Nurses Churchill
Livingstone, Medical Div. of Longman Ltd. U.K.
58
Unit 3: Concept and Reasons for Tepid Sponging
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Meaning of Tepid Sponging
3.2. Reasons for Tepid Sponging
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unite we shall discuss the concept and reasons for tepid
sponging. Tepid sponging or tepid bathing as its generally known
clinical skill aimed at resuscitating or reinvigorating an individual.
It is a practice, often time people look down upon, but proved to be
very efficient in the management of high grade fever.
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2.0. Objective
On conclusion of this unit, the student should be able to:
Understanding the meaning of tepid sponging
State the reasons for tepid sponging
3.0 Main Content
Tepid sponging is simply defined as an act or a process of the application of tepid (Luke Worm) water to the body of an individual with high pyrexia from head to toe.
3.1 Reasons for Tepid Sponging
Fever or pyrexia is a medical condition that calls for emergency. If this condition is not carefully handled, it could result to some complications or even death. Therefore once fever is noticed, especially high grade fever, efforts should be made to bring it under control to prevent further damage, more so when children are involved. High fever, if not controlled results to convulsion, shock, anorexia, brain damage etc.
The basic reasons for tepid sponging are:
To reduce the intensity of fever in a patient
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To resuscitate the patient
To prevent complication
To ensure the patient is brought to a level where he
could undertake treatment without reaction
To prevent death.
Conclusion
In this unit, you have learnt about the concept and the reasons for tepid sponging. The skill of Tepid sponging even though very simple has proved to be the very first step in the management of grade fever.
Therefore every individual should strive to undertake simple skill, during the onset of high grade fever.
5.0 Summary
This unit examined the concept of tepid sponging. It also focused on the reasons why tepid sponging has to be carried out in a patient as well as the advantages of tepid sponging.
6.0 Tutor Marked Assignment
1. State five reasons why tepid sponging should be undertaken as a clinical skill.
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7.0 References / Further Reading
Jelliffe, D.B. (1974) Child Health.in the Tropics Edward
Arnold Ltd., London.
62
Unit 4: Materials for Tepid Sponging
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit we shall discuss the materials used for tepid sponging, we shall also outline the necessary materials to enable the student identify them.
2.0 Objective
This unit is designed to ensure that the student: Understands the materials for tepid sponging.
Identifies the materials during the course of demonstration.
63
3.0 Main Content
The materials for tepid sponging are as listed below
An examination couch or bed
Bed cover
Mackintosh
Hand towel
Large size towel
Thermometer
Sterile tray
Sterile bowel with cover
Tepid water
4.0 Conclusion
In this unit, you have learnt about the materials for tepid sponging. From the list above, it is very clear that the materials required to conduct tepid sponging is such that can not be too expensive to obtain. To the end, therefore, refusal to conduct tepid sponging on account of materials cannot be entertained.
64
5.0 Summary
This unit focused on the materials for carrying out tepid sponging. It also outlined the materials for easy identification.
6.0 Tutor Marked Assignment
1. List any five materials for conducting tepid sponging.
7.0 References/ Further Reading
Jumbo, G. (1998) The Process of Tepid Sponging Lecture
Notes on Health Care Delivery/ College of Health Science and Technology, Port Harcourt.
65
Unit 5 Procedure and Principles Involved in Tepid Sponging 1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit we shall examine the procedure and principles involved in tepid sponging. The conduct of tepid sponging on an individual is guided on a number of principles and a laid down procedure. This skill is carried out on an individual and therefore such an individual require some degree of careful handling and respect.
2.0 Objective
This unit is designed to inculcate the principles and procedure of Tepid sponging in students. .
66
3.0 Main Content
Before the commencement of Tepid sponging the examiner must ensure that the materials are assembled and the stage ready for the patient.
It is absolutely necessary as well to commence tepid sponging from one region e.g. the head, and in that order gradually go down to the extremities.
Determine the intensity of the fever on arrival of the patient, with the clinical thermometer as to decide whether or not to carry out
Tepid sponging on the patient.
Basic procedure includes
• Assemble all the materials for the conduct of tepid sponging.
• Spread the mackintosh accordingly.
• Spread the large towel on top of the mackintosh
• Explanation of purpose to mother and soliciting for the
mother to undress the child and help to put the child on the
bed.
• Soak the hand towel in the tepid water and squeeze the
water out a little
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• Gradually rub the hand towel with the tepid water on the body
of the patient
• The duration of this exercise depends on the intensity of
fever.
Let the patient remain exposed for at least 30 minutes, after which temperature can be taken to determine if fever has gone down. If yes, institute actual treatment.
Note: If patient feels cool, in the course of tepid sponging stop and insulate.
4.0 Conclusion
In this unit, you have learnt about the procedure and the principles of tepid sponging and should be able to state them.
It is a skill that requires a lot of patient on the part of the examiner, as he has to monitor the gradual drop in temperature of the patient.
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5.0 Summary
This unit focused on the procedure and principles involved in
tepid sponging. It also highlighted the step-by-step approach
involved in tepid sponging.
The level of fever should first be ascertained as to know when it
has reduced. The basic procedure must be followed as outlined.
6.0 Tutor Marked Assignment
1. State step - by - step approach in conducting tepid sponging
7.0 References / Further Reading
Akinpelu, M.O (2002) Practical Skills in Primary Health Care
Setting, Big Olas (Nig.) Printer, Ijebu-Ode.
69
MODULE 4: ASPETIC TECHNQUES IN CLINICAL SKILLS
Unit 1: Definitions and Concept of Aseptic Techniques.
1.0 Introduction
2.0 Objectives
3.0 Main content
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit we shall discuss the definition and the concept of aseptic techniques. The concept of aseptic technique is a conscious effort made by health workers to ensure an all round free Pathogenic micro - organism both from the environment, as well as the materials used in the discharge of clinical duties.
70
2.0 Objective
At the end of this unit, the student should be able to:
• Understand the meaning of aseptic technique
• understand the reasons why aseptic technique is practiced in
health faculties.
3.0 Main Content.
The practice of aseptic technique is built on the premise that
pathogenic micro - organisms are abound within the health facility.
In order to control or possibly eliminate them, the act of practicing aseptic techniques in every aspect of health delivery, therefore becomes necessary.
By simple definition, the concept of aseptic technique could be described to mean the process of ensuring that all aspects of health delivery services are rendered with utmost sterility.
4.0 Conclusion.
In this unit you have learnt about the definition and the concept of aseptic technique. By now you should be able to define what
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aseptic technique is all about and why it is practiced in health facilities.
5.0 Summary
This unit focused on the basic definition and the concept of
aseptic techniques, it also dealt with the reasons why aseptic
techniques is very important in health facilities.
If all aspects of health care delivery system are practiced with
sterility, then there will be a total eradication of the incidence of
sepsis found within the health facility.
6.0 Tutor Marked Assignment.
1. What is the basic reason for practicing aseptic technique?
7.0 References /Further Reading.
Amadi, N. (2001) A practical Approach to Clinical Practice; for
Medical and Health Students: Emhai Printing and Publishing
Co. Choba, University of Port Harcourt.
72
Unit 2: Instruments and Sterilization Process
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Hot air oven 3.1.1 Moist Heat (Boiling, Steam etc)
3.2 Chemical Sterilizing agents
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction.
In this unit we shall study the instruments and sterilization process. We shall also consider the physical and chemical sterilizing agents used in the health facilities.
2.0 Objective
At the end of this unit, the student should be able to;
• Understand the instruments use in sterilization
• Understand the process of sterilization.
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3.0 Main Content.
Sterilization is defined as the process of rendering all articles free
from all living micro - organisms. Sterilizing agents can be grouped
into two.
• Physical sterilizing agents.
• Chemical sterilizing agents.
Physical sterilizing agents can further be sub - divided into sunlight, wind, heat etc.
Heat can either be dry or moist. An example of dry heat is hot air oven.
3.1 Hot Air Oven
This method consists of enclosed oven where the articles to be sterilized are subjected to the heated air.
Time of exposure and temperature depends on article to be sterilized. Hot air oven is best for glassware eg glass syringes, but should in no way be recommended for plastics/ Rubber or textile, as an attempt will seriously damage them.
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3.1.1 Moist Heat.
(a) Boiling. This method is often the practice in the clinics and health center where large scale sterilization is not required. It ensures a complete immersion of items to be sterilized in water e.g. Kidney dishes, forceps, gallipots etc.
It is timed from the point of boiling about 100°c. It is often advisable that sodium carbonate (washing soda) be added to help prevent rusting of metallic instruments.
( b) Steam pressure
The examples of steam pressure apparatus s are autoclave
I steam sterilizer.
The underlying principle of steam sterilization generally, is that an increase in pressure of steam brings about a rise in temperature.
Therefore, the length of time required to sterilized ides at whatever temperature depends on the pressure applied.
3.2 Chemical Sterilizing Agents.
There are a good number of chemical agents available in the drug and chemical manufacturing companies, all over the world.
Some of them are as follows
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Hibitane
Dettol
Cetalon
Formalin gas
Milton
Savlon Acriflavin
Methylated spirit
Articles to be sterilized in chemical fluids must be rinsed in cold water, washed in hot soapy water and scrubbed with brush to remove all organic materials. It has to be rinsed again in cold water, complicated instruments should be dismantled to ensure a thorough penetration to all parts, then all should be immersed in the fluid which must be an inch above all instrument. Removal of instrument should be by the use of sterile forceps.
4.0 Conclusion
In this unit you have learned what sterilization island that of definition of sterilization, as a process of rendering all articles free n
76
all living micro - organisms; you have also realized that sterilization involves the use of physical and chemical sterilizing agents.
You should at this point define sterilization in your own words and be able to classify the sterilizing agents into the physical and
Chemical agents.
5.0 Summary
This unit has focused on the importance of sterilization in clinical set - up. The main objective is to reduce the incidence of pathological micro -organism.
Sterilization involves the use of physical and chemical sterilizing agents.
6.0 Tutor Marked Assignment.
1. Name three physical and three chemical sterilizing agents. You
have studied.
7.0 References/Further Reading.
Akinpelu, M.O. (2002), Practical Skills in Primary Health Care
Setting. Big Olas (Nig) Printer, Ijebu- Ode
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Unit 3: Preparation and Administration of Salt, Sugar Solution.
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Requirement for preparation of S.S.S
3.2 Preparation of SSS
3.3 Observation
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit we shall discuss the preparation and administration of salt, sugar solution. We will also examine the requirement for preparation of salt, sugar solution.
2.0 Objective
At the end of studying this unit, the learner would be able to understand;
The preparation of salt, sugar solution
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How to administer salt, sugar solution.
3.0 Main Content
When there is an on -set of passage of watery stool, more frequently than normal, about 2- 5 times a day, and usually, lasting for one to four days, what readily comes to mind, before any other form treatment is the administration of salt, solution (SSS). This is aimed at preventing dehydration and replacement of fluids end electrolyte already lost.
Oral Rehydration therapy (ORT) which is a form of treatment of plain diarrhea from the mixture of salt, sugar solution is based on the scientific knowledge that when the gut is infected, some absorption still takes place. When a solution of salt and sugar prepared in the right proportion is given, the sugar aids the re-absorption of salt and water back into the body, therefore preventing dehydration. This application has proved to be very safe and highly effective in all ages according to Nigerian Medical Association booklet entitled
“Acute Diarrhea /ORT (1995).
3.I Requirements for Preparation of Salt, Sugar Solution SSS)
To prepare the SSS, the following under listed items are required.
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1 sterile empty beer bottle or 2 sterile empty mineral bottles
29cl )
Clean potable house hold water, which could have been boiled and allowed to cool, in a container with cover.
A sterile bowel for mixing of salt, and sugar
Cubes of sugar or granulated sugar in a container
3ml measuring tea spoon
1 desert spoon for mixing
1 funnel
1 cup to administer solution
1 sterile Napkin and soap for washing and drying of hands.
3.2 Preparation of Salt, Sugar Solution.
Create an appropriate report.
Explain the purpose and procedure to the patient or child's mother
Wash hands thoroughly with soap and water and dry hands.
Fix the funnel into the bottle and pour in the clean water, until it gets to the neck of the beer bottle or measure approximately
600mls of water.
80
Pour back the measured water into the bowel
Add 5 cubes of sugar or 10 level 3mls teaspoon of granulated
sugar.
Add 1 level 3ml teaspoon of salt into the water in the bowel.
Then use the desert spoon to mix all the contents very well.
Pour some quantity of the mixture into the cup and administer
with the teaspoon to the child or for adults drink freely.
Note: By the end of the day or 24 hours from the time of mixture, throw the first mixture away and mix another one, if patient continues to pass watery stool, continue to administer the mixture and gradually introduce solid food as problem improves.
4.0 Conclusion
In this unit, the students have learnt about the preparation : salt, sugar solution, as well the requirements and administration of the solution.
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5.0 Summary
This topic has informed the student that an onset of passage : watery stool should first be tacked with salt, sugar solution store any other form of treatment.
It is also from this unit, that the student understands the scientific knowledge behind the preparation and administration of
SSS.
6.0 Tutor Marked Assignment
1. Briefly outline the scientific knowledge behind the preparation
and administration of salt, sugar solution.
7.0 References /Further Reading
Amadi, N. (2003), A practical Approach to Clinical Practice,
for Medical and Health Students' (2nd Edition) Emhai printing
and Publishing Co. Choba, University of Port Harcourt.
Nigerian Medical Association Booklet (Acute Diarrhea ORT 1995).
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Unit 4: Preparation and administration of intravenous fluid. 1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Types of infusion
3.2 Materials for administration of an intravenous infusion
3.3 Procedure for administration of an intravenous infusion
3.4 Complications or dangers of intravenous infusion
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References / Further Reading
1.0 Introduction
In this unit we shall discuss the preparation and administration of intravenous fluid. It will also consider the types of intravenous infusion as well as the materials for administration of intravenous infusion. We shall equally discuss the procedure involved in the administration of intravenous infusion, and finally we will take a look at the complications or dangers of intravenous infusion.
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2.0 Objective
At the end of this unit, the student should be able to:
• Define intravenous infusion.
• Understand the types of intravenous infusion.
• Understand the complications or dangers involved in intravenous
infusion.
3.0 Main Content
Fluid lost from the body occurs in very many ways, and each time it occurs, efforts are made to quickly replace them, or implications will set in. This process of quick replacement resuscitates the patient.
Intravenous infusion is defined as an act of introducing fluids, through the vein into the circulatory system of the body.
Essentially the aim of administering an infusion is to combat dehydration, and maintain the body's electrolyte and water balance.
Burton (1976) emphasizes the use of infusion as that of the replacement of abnormal loses of body fluids and the correction of electrolyte depletion. However, he warned that patients with renal or cardiac disease require special care.
84
Houghton and Parnell (1969) described, intravenous infusion as the quickest and most controlled method of replacing serious loss of water and correcting electrolyte imbalance. Fluid lost may be due to a number of factors, namely, excessive vomiting, diarrhea, choiera, excessive sweating, bleeding, burns, pre and post- operative conditions etc.
3.1 Types of Intravenous Infusion
There are good numbers of intravenous infusion commercially available in our drug stores. The fluid to be administered depends on the condition of the patient, as specific fluids are more tolerable in certain conditions. However it must be on doctor's prescription.
Notable amongst the infusions are:
• Physiological (Normal) Saline
• Dextrose saline
• Ringer's solution
• Hartman's solution
• Antibiotic infusion
• Darrow's solution
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• Dextran I.V Saline
3.2 Materials for Administration of Intravenous
Infusion
A complete intravenous infusion tray must contain.
• 1 sterile kidney dish with cover
• sterile gdlipots with cover
• pack of adhesive stripping
• Intravenous infusion set/ which must contain hypodermic or
scalp vein needle and a drop counter.
• Sterile piece of toniquette
• In addition, a drip stand is required,
3.3 Procedure for Administration of an Intravenous
Infusion.
The following steps should be followed in administering an infusion.
• Explanation of purpose to the patient
• Washing and drying of hands with soap and water
• Setting of the tray.
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• Obtain an intravenous fluid set, which is most often
accompanied with half strength solution needle/ a drop counter,
and pieces of adhesive strip.
• Position a drip stand to give at least 45 centimetres (18 inches)
height for the bag above the couch or vein site, this secures a
good rate of flow.
• Tie the toniquette around the site of choice and let the patient
make a fist to ensure the bulging of views for visibility.
• Clean the site on the skin, where the vein will be pierced.
• Expel the air from the tubing by running a few drops of the fluid
out.
• Pierce the skin obliquely until the needle has gone in about one
inch (1 inch) and is in the vein, this occurs when there is a slow,
but free movement of blood back into the tube attached to the
needle, then ask patient to release the fist made.
• Check regularly to see that it is dripping and the fluid is going into
the vein properly, and the punctured site is not tissued.
• Observe for any possible reaction before you discharge the
patient.
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3.4 Complications or Dangers of Intravenous
Infusion.
A number of complications have been recorded due to careless administration of intravenous infusion, or perhaps situations which do not call for intravenous infusion.
Jumbo (1989) highlighted the dangers of intravenous infusion as that of:
• Air embolism
• Thrombophlebitis
• Septicemia
• Shock
• Gangrene
4.0 Conclusion
This unit has provided sufficient information for the student on the preparation and administration of intravenous infusion. By now the student should be able to define intravenous infusion.
It is from this unit that the student understands the motive behind the administration of intravenous infusion.
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5.0 Summary
This unit teaches the student that fluid lost is quickly replaced to prevent complication. Fluid lost occurs from various sources, as we were meant to understand.
Many types of intravenous infusion exists, the on e to administer depends on the condition and the prescription of the doctor, the materials for administration are highlighted, and the complications that could possibly arise following the administration of intravenous infusion are also noted.
6.0 Tutor Marked Assignment
1. Enumerate five types of intravenous infusion
7.0 References /Further Reading
Burton, J.L. (1976) Aids to Medicine for Nurses. Churchill Livingstone, Medical Div. of Longman Ltd. U.K.
Houghton, M./ Parnell, J.E; (1969), .Practical Procedure for
Nurses. Williams and Wilkins Comp. Baltimore.
89
Unit 5: Principles of Aseptic Techniques in Clinical Skills.
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Principle of Non-touch technique
3.2 Procedure involved in aseptic technique
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignment
7.0 References/Further Reading
1.0 Introduction
In this unit we shall discuss the principles of aseptic techniques in clinical skills.
2.0 Objective
At the end of this unit the student should be able to:
• Understand the principles involved in aseptic techniques.
• Understand the procedures in aseptic technique.
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3.0 Main Content
The health facility is one institution where all manners of diseases and ailments are treated. In the course of treating them, people get contaminated even without their knowledge. A number of health providers had died while trying to assist patient recover from their illnesses, as a result of contacting infection from either the patient or instruments used in treating patients.
Therefore, in other to reduce the risk of contacting infection, certain principles of aseptic techniques had been developed to solve these problems.
3.1 The Principle of Non-touch Technique
It is a general practice in all health facilities, that all health care providers should not touch fluids or other bodily substances with their bare hands without a glove.
It is equally a principle that you don't touch or administer drug
brought by the patient that had been opened and administered by
some one else.
All instruments for treatment e.g. forceps cannot be touched
with bare hands, no matter how clean the hands are. It is a principle
that all health care providers must appear in uniform and cover - all
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to perform specific assignment, for instance during a surgical section
all doctors and nurses must wear apron in addition to the usual
uniform.
It is a principle to discard all disposable items immediately, as soon as a specific assignment had been concluded.
3.2 Procedure Involved in Aseptic Technique
In aseptic technique, the procedure is to undertake the "first thing first". All procedures must be top - bottom approach.
4.0 Conclusion
In this unit you have learnt about the principles of aseptic techniques in clinical skills. The student should by now understand the principles guiding aseptic techniques.
5.0 Summary
This unit focused on the principles of aseptic techniques in clinical skills. It also considered the principle of non-touch technique,
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which is designed to ensure that pathogenic micro-organisms are not introduced in the course of carrying out skills.
All bodily fluids, substance, and instruments should not be touched without a protective device.
All disposables and non disposable are to be adequately taken care of accordingly.
5.0 Tutor Marked Assignment
Name three basic principles of aseptic techniques.
7.0 References /Further Reading
Sorungbe, A.0.0./ (1995), Federal Ministry of Health and National
Primary Health Care Development Agency; Standing Order
for Community Health Extension Workers, Training and
Manpower Development Division Nigeria.
93
NATIONAL OPEN UNIVERSITY OF NIGERIA
SCHOOL OF HEALTH SCIENCES
COURSE CODE: PHS 422
COURSE TITLE: CLINICAL SKILLS II
94
PHS 422 COURSE GUIDE
COURSE GUIDE
PHS 422 CLINICAL SKILLS II
Course Team Umar, Yusuf Kyari (Developer/Writer) - USAID Dr. Princess Christiana Campbell (Editor) - UNILAG
NATIONAL OPEN UNIVERSITY OF NIGERIA
2
PHS 422 COURSE GUIDE
National Open University of Nigeria Headquarters 145/16 Ahmadu Bello Way Victoria Island Lagos
Abuja Office No. 5 Dar es Salaam Street Off Aminu Kano Crescent Wuse II, Abuja Nigeria e-mail:[email protected] URL:www.nou.edu.ng
Published By: National Open University of Nigeria
First Printed 2011
ISBN: 978- 058- 369-6
PHS 422 COURSE GUIDE iii
4
CONTENTS PAGE
Introduction…………………………………………………………. 1 What you will Learn in this Course………………………………… 1 Course Aim………………………………………….………………. 1 Course Objectives…………………………………….……………... 1 Working through this Course…………………………..……………. 2 Study Units……………………………….…………………….…… 2 Presentation Schedule……………………………………………..... 4 Assignment File……………………………………...……………... 4 Tutor-Marked Assignment……………………..……………………. 4 Final Examination and Grading…………………………………….. 4 Course Marking Scheme……………………………………………. 5 Facilitation/Tutors and Tutorials…………………………………… 5 Summary……………………………………………………….……. 6
Introduction
Clinical skills are a core component of the study of B. Sc. Community Health.
Clinical skills expose students to techniques and clinical procedures that are necessary in achieving minimum standards for patient care, treatment and management. It is a three- credit unit course for second year students.
Over the years, clinical skills have been counted among the subjects necessary for the study of Nursing Science and Medicine. However, it has different approaches, limitations and applications in the study of B. Sc. Community Health.
That is why it is normally divided into three parts (clinical skills I, II and III) in the study of B.Sc. Community Health.
What you will Learn in this Course
The course consists of Modules, Units and a Course Guide. The course guide tells you briefly what the course is about and what course materials you will be using.
There will be regular tutorials for the course. It is advisable that you attend these tutorial sessions. The course will prepare you for the challenges you will meet in the field in terms of skills acquisition and applications in the management of patients in hospitals and community setting.
Course Aims
The course aims to provide you with an understanding of clinical skills focusing on the approaches and techniques needed to manage patients condition.
Course Objectives
The course has set objectives. Each unit has specific objectives which are mentioned at the beginning of the unit.
You should read these objectives before you study the unit and you may wish to refer to them during your study to check on your progress. You should always look at the unit objectives after the completion of each unit. On completion of this course, you should be able to:
PHS 422 CLINICAL SKILLS II
explain clinical procedures in managing patients’ condition. apply techniques and use of sterile materials in the management. of patients manage patients’ condition and minimise further complication.
Working through this Course
To complete this course, you are to read each study unit, text books and other materials which may be provided by the National Open University of Nigeria. You would also be required to do hospital attachment for practicals.
Modules and Study Units
The course has 20 study units arranged in four modules as follows:
Module 1 Simple Clinical Procedures
Unit 1 Administration of Injection Unit 2 Drip-Setting Unit 3 Use of Diagnostic Set Unit 4 Catheterisation Unit 5 Oral Hygiene
Module 2 Assessment for Clinical Diagnosis
Unit 1 Female Breast Self- Examination Unit 2 Body –Assessment of Dehydration Unit 3 Measurement of Weight to Assess Nutritional Status of Individuals Unit 4 Measurement of Height and Length of a Child Unit 5 Mid-Arm Circumference Measurement Unit 6 Eye – Visual Acuity Test
Module 3 Procedures for Simple Minor Surgery
Unit 1 Wound- Dressing Unit 2 Suturing of Wound Unit 3 Male Circumcision Unit 4 Episiotomy Unit 5 Ear- Piercing
Module 4 Simple Laboratory Investigation
7 PHS 422 CLINICAL SKILLS II
Unit 1 Collection of Urine Specimen Unit 2 Urine Test for Sugar and Protein Unit 3 Sahli Method of Haemoglobin Estimation Unit 4 Tallquist Method of Haemoglobin Estimation
Module 1 Units 1-5 focus on the application of simple clinical procedures for Administration of Injection, Drip Setting, Use of Diagnostic Set, Catheterisation and Oral Hygiene.
Module 2 Units 1-6 deal with the assessment for clinical diagnosis in areas of Nutritional Assessment, Visual Acuity, Breast Self- Examination and Assessment of Dehydration.
Module 3 Units 1- 5, explain the procedures for simple minor surgery in areas of Wound- Dressing, Suturing of Wound, Male Circumcision, Ear- Piercing and Episiotomy.
Module 4 Units 1- 4 focus on the simple techniques to apply and conduct in routine laboratory investigation of blood and urine specimen. It covers investigation on samples of blood for haemoglobin estimation and samples of urine for protein and sugar test.
This course entails that you spend a lot of time to read and practise skills. I would advise that after the study of each unit, you visit a health facility/hospital to acquaint yourself with the requisite skills.
The course should take you about 20 weeks to complete. At the end, there would be an examination.
However, each study unit consist of one or two weeks work, the session plans include an introduction, objectives, content and reading materials, self assessment exercise, conclusion, summary, tutor- marked assignments, references and further reading. The unit directs you to work through/reading and practice the exercises related to the required content. In general, these are meant to test you on the material content you have just covered and require you to apply it in the most practical way and thereby assist you to evaluate your progress and your comprehension of the course. Together with tutor-marked assignments, these exercises will help you to achieve the stated learning objectives of the individual units and of the course as a whole.
Presentation Schedule
7 PHS 422 CLINICAL SKILLS II
It is important to note that, every study unit has stipulated date and period of tutorials, practical attachment and submission of tutor- marked assignment. You should work and study within the stipulated time frame and guard against falling behind in your work.
Assignment File
There are three aspects to the assessment of the course. The first is made up of self assessment /practice exercises. Second, Tutor -Marked Assignment and third, is the written examination/end of course examination.
At the end of each study unit, you should visit a hospital nearby for practicals, your facilitators will introduce you to the study materials useful for self assessment and regular practicals to enable you acquire basic knowledge and techniques in this course.
Tutor-Marked Assignment
The TMA is a continuous assessment component of your course. It accounts for 30% of the total score. You will be given four (4) TMAs to answer. Three of these must be answered before you are allowed to sit for the end of course examination. The TMAs would be given to you by your facilitator and returned after you have done the assignment. Assignment questions for the units in this course are contained in the assignment file. You will be able to complete your assignment from the information and material contained in your reading, references and study units. However, it is desirable in all degree level of education to demonstrate that you read and researched more into your references, which will give you a wider view point and may provide you with a deeper understanding of the subject.
Make sure that each assignment reaches your facilitators on or before the deadline given in the presentation schedule and assignment file. If for any reason you cannot complete your work on time, contact your facilitator before the assignment is due to discuss the possibility of an extension. Extension will not be granted after the due date unless there are exceptional circumstances.
Final Examination and Grading
The end of course examination for Clinical Skills II will be for about 3 hours and it has a value of 70% of the total course work. The examination will consist of questions, which will reflect the exercise and tutor-marked assignment problems you have previously encountered. All areas of the course will be assessed.
4 PHS 422 CLINICAL SKILLS II
Use your time between finishing the last unit and sitting for the examination to revise the whole course. You might find it useful to review your practicals, TMAs and comment on them before the examination. The end of course examination covers information from all parts of the course.
Course Marking Scheme
Assignment Marks Assignment 1 – 4 Four assignments, best three marks of the four count at 10% each – 30% of course marks. End of course examination 70% of overall marks. Total 100% of course materials.
Facilitation/Tutors and Tutorials
There are 24 hours of tutorials provided in support of this course. You will be notified of the dates, time and location for these tutorials as well as the name and phone number of your facilitator, as soon as you are allocated a tutorial group.
Your facilitator will mark and comment on your assignments and practicals. Keep a close watch on your progress and any difficulties you might face and provide assistance to you during the course. You are expected to mail your Tutor-Marked Assignment to your facilitator before the scheduled date (at least two working days are required). They will be marked by your facilitator and returned to you as soon as possible.
Do not delay to contact your facilitator by telephone or e-mail if you need any assistance.
The following might be circumstances in which you would find assistance necessary, you would have to contact your facilitator if:
You do not understand any part of the study of the assigned readings. You have difficulty with the self tests (Practice Exercise). You have a question or problem with an assignment or with the grading of an assignment. Summary
You should endeavour to attend the tutorials. This would afford you an opportunity to have face to face contact with your course facilitators and
5 PHS 422 CLINICAL SKILLS II
to ask questions which are answered instantly. You can raise any problem encountered in the course of your study.
This course is a study unit of clinical skills. But tutorials and practical clinical skills – will be covered only by a practical attachment in hospital.
To gain more benefits from the course tutorials, please prepare a list of questions before attending them. You will learn a lot from participating actively in discussions.
I wish you success in the course and I hope that you will find it both interesting and useful.
6 PHS 422 CLINICAL SKILLS II
Course Code PHS 422 Course Title Clinical Skills II
Course Team Umar, Yusuf Kyari (Developer/Writer) - USAID Dr. Princess Christiana Campbell (Editor) - UNILAG
NATIONAL OPEN UNIVERSITY OF NIGERIA
7 PHS 422 CLINICAL SKILLS II
National Open University of Nigeria Headquarters 145/16 Ahmadu Bello Way Victoria Island Lagos
Abuja Office No. 5 Dar es Salaam Street Off Aminu Kano Crescent Wuse II, Abuja Nigeria
e-mail:[email protected] URL:www.nou.edu.ng
Published By: National Open University of Nigeria
First Printed 2011
ISBN: 978- 058- 369-6
9 PHS 422 CLINICAL SKILLS II
CONTENTS PAGE
Module 1 Simple Clinical Procedures ……………………..… 1
Unit 1 Administration of Injection ……………….………..... 1 Unit 2 Drip-Setting…………………………………….……… 6 Unit 3 Use of Diagnostic Set…………………………………. 9 Unit 4 Catheterisation…………………………………..……. 11 Unit 5 Oral Hygiene………………………………………….. 14
Module 2 Assessment for Clinical Diagnosis………….….….. 16
Unit 1 Female Breast Self- Examination………………….… 16 Unit 2 Body –Assessment of Dehydration …………………. 20 Unit 3 Measurement of Weight to Assess Nutritional Status of Individuals……………………….……….… 23 Unit 4 Measurement of Height and Length of a Child ….….. 25 Unit 5 Mid-Arm Circumference Measurement ……….……. 28 Unit 6 Eye – Visual Acuity Test……………………………... 31
Module 3 Procedures for Simple Minor Surgery…………..… 34
Unit 1 Wound - Dressing…………..…………………..……. 34 Unit 2 Suturing of Wound……………………………….….. 36 Unit 3 Male Circumcision……………………………….….. 40 Unit 4 Episiotomy……………………………………….…... 42 Unit 5 Ear- Piercing……………………………………..…… 45
Module 4 Simple Laboratory Investigation……………….…. 47
Unit 1 Collection of Urine Specimen………………………. 47 Unit 2 Urine Test for Sugar and Protein…………………..… 49 Unit 3 Sahli Method of Haemoglobin Estimation…………... 51 Unit 4 Tallquist Method of Haemoglobin Estimation……… 53
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MODULE 1 SIMPLE CLINICAL PROCEDURES
Unit 1 Administration of Injection Unit 2 Drip-Setting Unit 3 Use of Diagnostic Set Unit 4 Catheterisation Unit 5 Oral Hygiene
UNIT 1 ADMINISTRATION OF INJECTION
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Overview of Administration of Injection 3.2 Route of Injection 3.3 Sites for Injection 3.4 Injection Tray or Trolley 3.5 Procedures for Injection 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This module entitled Simple Clinical Procedures is made up of five units. This unit will discuss simple procedures on how to administer injection as indicated in the unit objectives below.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
mention the routes of injection set tray for injection select sites for injection.
3.0 MAIN CONTENT
3.1 Overview of Administration of Injection
This gives an insight into the administration of injection as a simple clinical procedure for introducing drugs into to the body by the use of
1
syringe and needle. It is usually done manually by a medical practitioner in a hospital setting, nursing home/centre and health units.
The standard route for giving injection and technique to apply in the process involved are as stated below;
3.2 Routes of Injection
Intramuscular – injection through the muscles, at angle of 90(degrees) deeply. Intravenous – injection through the blood vein Subcutaneous – injection through the subcut layer at angle of 45(degrees)
3.3 Sites for Injection
Buttocks - upper outer quadrate Thigh – upper outer muscle Vein-inside the vessel Arm-upper outer muscle
2
F ig.1.1: Diagram of Injection Sites (Modified from CHO Training Curriculum)
3.4 Injection Tray
Before you start the procedure of injection, all the items needed should be assembled in a tray or trolley and these should include:
Kidney dish with lid, containing sterile needle and syringes. A Galli pot with swabs Methylated spirit
3
Kidney dish for used swabs Kidney dish with a pair of forceps Container with drugs / injection vials and ampoules
3.5 Procedures for Injection
These are steps you should follow in giving injection:
explain procedure to the patient / client select and clean the site which can be the arm, thigh, buttock or vein read the label on the drugs for the expiry date before using it. use a syringe to draw drugs to the correct amount and expel the air bubbles insert the needle at an angle of 45 if its subcut routes at angle 90 deeply into the muscle’s intra muscular route. draw the plunger to make sure you are not in a blood vessel (artery or vein) insert your drug remove your needle and wipe the site with the swab. for subcutaneous injection repeat the same procedure above except for intravenous injection, then you do the following:
- pierce the skin obliquely until the needle has gone in about a half to one inch and blood can be seen at the tip of the syringe - draw blood a little and inject the prescribed drug - apply puncture with little pressure to the site until bleeding stops.
4.0 CONCLUSION
In this unit, you read that administration of injection is done manually using syringe and needle. You are to visit a hospital and apply the procedure of injection under the supervision of a qualified personnel or medical practitioner.
5.0 SUMMARY
This unit gave an overview of the administration of injection, route of injection and step by step clinical procedure for drugs administration with the use of syringe and needle. Unit 2 will build on the administration of injection using infusion line drip set.
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6.0 TUTOR-MARKED ASSIGNMENT
You should visit a hospital or clinic nearby, and do the following under the supervision of your tutor/facilitator:
1. physically examine and assemble the required content of injection tray. 2. practically administer injection following the procedures listed above. 3. examine the types of syringe and needle by their sizes and calibration in a hospital setting. 4. from your practical experience identify at least four common trouble shooting experienced with the application of procedure on administration of injection.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical Skills for Community Health Workers, Nigeria.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
Skeet & Muriel (eds.) (1984). First Aid for Community Health Workers in Developing Countries.
Kings & Mourice (eds.)(1984). Primary Child Care,Vol. 2.
5
UNIT 2 DRIP-SETTING
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Overview of Drip-Setting 3.2 Materials for Drip-Setting 3.3 Procedures for Setting Drip 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
In the previous unit, the administration of injection was covered and this unit is an aspect of it, because setting of drip is a line of intravenous infusion of fluid or drugs which has similar procedures with giving injection. However, it differs only in principle and instructions.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
assemble the materials needed for setting drips set drips.
3.0 MAIN CONTENT
3.1 Overview of Drip -Setting
Drip -setting is a simple clinical procedure for the administration of fluid, water and electrolyte, including drugs (injectable via veins) into human body to modify action. The setting of drips involves three sequential processes. These are: fixing of electrolyte fluid to the given set tube, then attaching the set to the human body through blood vessel, timing and setting of flow rate of the fluid in the drip.
3.2 Materials for Drip -Setting
Tray Kidney dish containing sterile needles and syringes Galli pot with spirit swabs
6
Kidney dish for used swabs Tourniquet
NB: An intravenous given set containing needle tubing and a drop counter (is supplied in a complete set).
Plaster or adhesive strapping A drip stand
3.3 Procedures for Setting a Drip (Intravenous line of infusion)
Set a tray containing all the materials needed for drip –setting. Obtain a drip stand and place it closer to the patient/client (stand should be at least 45cm (18inches) in height (Above the veins, site- patient’s bed) Select the site/vein with the swab Assemble the tubing solution according to the manufacturer’s instruction Let out the air from the tubing by letting some of the fluids run down the tubing. Tie a tourniquet tight above the site where the veins will be pierced or hold the skin above the site tight to make the veins prominent/visible Pierce the skin obliquely until the needle has gone about one inch, and is in the veins (this occurs when there is a slow, but free movement of blood back into the tube attached to the needle) Release the tourniquet Fix the needle in place with adhesion strapping Hang the bag at the correct height so that the fluid is dropping according to the prescribed rate per minute. Check regularly to see that the fluid is dropping and that fluid is going in to the vein properly and that the puncture site is not swollen.
4.0 CONCLUSION
This unit has elaborated on the steps to follow in setting drips, you are required to assemble the materials needed and applied in setting the line process.
5.0 SUMMARY
You recall the steps, procedures and materials needed for setting of drip were extensively discussed in this unit. However, regular application of
7
these procedures in a hospital setting will not only make you to acquire the skills, but to have adequate experience in setting infusion line.
6.0 TUTOR-MARKED ASSIGNMENT
You are advised to visit a hospital nearby and physically see, examine and perform the following:
1. Assemble the materials needed for setting drips. 2. Set drip on a patient/client under the supervision of your tutor/facilitator or an experienced nurse/ health worker in a hospital setting. 3. Describe what you experienced as trouble shooting in the setting of drip for the following categories of persons:
(a) old person (50yrs) (b) plump infant child (1yr) (c) slim young lady(18yrs).
4. List the materials needed for setting drips.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical skills for Community Health Workers. Nigeria.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
Skeet & Muriel (eds.) (1984), First Aid for Community Health Workers in Developing Countries. Kings & Mourice (eds.) (1984), Primary Child Care,Vol. 2.
8
UNIT 3 USE OF DIAGNOSTIC SET
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Overview of Diagnostic Set 3.2 Contents of Diagnostic Set 3.3 Procedure for using Diagnostic Set 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
Use of diagnostic set is a procedure that will be covered in this unit, but it is limited to few procedures because most of the uses of the diagnostic set were treated under another module as an independent unit (Ear, nose and throat).
2.0 OBJECTIVES
By the end of this unit, you should be able to:
identify the contents of a diagnostic set physically use an endoscope.
3.0 MAIN CONTENT
3.1 Overview of Diagnostic set
A diagnostic set is a kit containing single metallic pedal touch with different sizes of apparatus arranged for clinical examination, it is usually used for examination of internal parts like the ear, nose, mouth and eye.
3.2 Contents of Diagnostic Set
Speculum of smaller and big sizes for ear and nose viewing Pedal touch with adaptor head (auroscope) Spatula-metal with adaptor for throat/tongue explosive Eye lens with adaptor for viewing of eye Battery (dry cell) Revolving socket
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3.3 Procedure for using Diagnostic Set (auroscope)
Check auroscope to ensure light is bright and speculum clean Choose the right size of adaptor to fix on the auroscope touch Choose and fix right adaptor for examination, (speculum, eye lens, or spatula)
4.0 CONCLUSION
This unit has dealt with the uses of a diagnostic set. It is an instrument that cannot be found in every hospital, unless you search for it and use it to improve your skills and knowledge.
5.0 SUMMARY
You recall that the procedures and materials needed for the use of diagnostic set has been explained. However, the application of these procedures requires patience and composure to avoid error and wrong result.
6.0 TUTOR-MARKED ASSIGNMENT
You are advised to visit a hospital and physically see, examine and perform the following:
1. Examine Ear and Tongue with a diagnostic set. 2. Identify two situations that require the use of a diagnostic set. 3. List the contents/parts of a diagnostic set.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session plans on Clinical skills for Community Health Workers, Nigeria.
Skeet & Muriel (eds.) (1984). First Aid for Community Health Workers in Developing Countries.
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UNIT 4 CATHETERISATION
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Overview of Catheterisation 3.2 Equipment for Catheterisation 3.3 Procedures for Catheterisation (Male and Female) 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit explains the simple application procedures for draining urine from the bladder. It is like other sterile procedures, which require you to be attentive and composed while performing the skill.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
assemble the equipment for catheterisation perform the procedures for catheterisation.
3.0 MAIN CONTENT
3.1 Overview of Catheterisation
This is a process that involves simple procedures to drain urine out from the bladder using sterilised equipment. This procedure can be applied to both sexes, but there are particular steps to follow for infants.
3.2 Equipment for Catheterisation
Infant urine bag (sealed polythene bag) Kidney dish Bowl with swabs Disinfectant e.g. savlon Sterile catheter in bowl with lid A bowl containing water (to clean baby’s genital area)
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3.3 Procedures for Catheterisation
For children (infant): infant bag urine collection
Explain procedures to mother Clean the site of urethral opening For male child, insert the penis into the hole in the polythene bag to make sure the urine gets straight into the bag. For female child, try to ensure that urethral opening is at the centre of the bag opening. Ensure that adhesive on the bag grips the skin well enough Remove the bag immediately the child has urinated to prevent spilling and contamination Wash hands after the procedures
For: Female
Wash hand before starting the procedure Explain the procedure to the patient Clean the vulva Swab the vulva from in , up downward direction Use your left hand with your thumb and first finger to open the vulva properly Insert the catheter and pass it gently through the urethral opening to get out urine Collect the urine with a sterile kidney dish Remove the catheter and place in the receiver Clean the patient and reassured her Wash the catheter and other equipment
4.0 CONCLUSION
Catheterisation is a simple procedure, but you need to be at a bed site in a nursing home or hospital to acquire experience in performing the skill. The procedure requires privacy and confidentiality of patients.
5.0 SUMMARY
Catheterisation is aimed at expelling urine from the bladder and relieves pain using simple procedure. Procedure for catheterisation of infant is not the same with that for a female, but both require the same equipment with slight difference in application of the catheter.
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6.0 TUTOR-MARKED ASSIGNMENT
Discuss the procedures for catheterisation of a baby girl.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical Skills for Community Health Workers, Nigeria.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
Skeet & Muriel (eds.) (1984). First Aid for Community Health Workers in Developing Countries.
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UNIT 5 ORAL HYGIENE
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Overview of Oral Hygiene 3.2 Equipment for Oral Hygiene 3.3 Procedures for Oral Toilet 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit will cover oral hygiene and the practical skills to use step by step to clean the mouth cavity, tooth and gum.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
set a tray for oral toilet perform oral toilet
3.0 MAIN CONTENT
3.1 Overview of Oral Hygiene
Oral hygiene means cleanliness of oral cavity, its parts and organ which include teeth, tongue and gums while, oral toilet means the procedures use in cleaning the mouth cavity
3.2 Equipment for Oral Toilet
A tray Small galipot Cotton gauze Lint swab A clean tooth brush Spatula
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3.3 Procedures for Oral Toilet
Explain procedure to the patient Open the oral cavity Inspect the teeth and presence of any foreign body Rinse the mouth with clean water Wrap lint gauze on spatula and soak in salt water, then rub against the teeth in the front side, biting surface of the gum, tongue and lips Repeat as many times as necessary to clean up Ask patient to spit out solution.
4.0 CONCLUSION
Oral hygiene is a simple and common procedure that explains procedures to clean the mouth and oral cavity; it requires you to practice it even at home.
5.0 SUMMARY
Cleaning of mouth, tongue, lips and gums using simple techniques is known as oral hygiene and application of the procedures to perform oral hygiene is called oral toilet.
6.0 TUTOR-MARKED ASSIGNMENT
List the equipment needed for oral toilet
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical Skills for Community Health Workers, Nigeria.
Skeet & Muriel (eds.) (1984). First Aid for Community Health Workers in Developing Countries.
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MODULE 2 ASSESSMENT FOR CLINICAL DIAGNOSIS
Unit 1 Female Breast Self Examination Unit 2 Body-Assessment of Dehydration Unit 3 Measurement of Weight to Assess Nutritional Status of Individuals Unit 4 Measurement of Height and Length of a Child Unit 5 Mid-Arm Circumference Measurement Unit 6 Eye-Visual Acuity Test
UNIT 1 FEMALE BREAST SELF EXAMINATION
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Procedures for Breast Self Examination 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit covers female breast self examination, and explains how individuals can perform this examination by themselves. It usually reveals abnormalities or any sign of change in the normal status of the breast.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
examine each breast at a time.
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3.0 MAIN CONTENT
1.
• Brrost self examirotion.
2..
examination.
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3
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Fig.2.1: Self Examination of Breast Source: (Modified from CHEW Training Curriculum)
3.1 Procedure for Breast Examination
Stand up straight in front of a mirror and hold both hands up. If there is no large mirror, hold both hands up and look down at breast Look at both breasts, for equality of size, smoothness, and obvious bulges and dimples
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Put both arms down, still standing erect and look at both breast as indicated above Examine each breast, one at a time Use the pads of the fingers at opposite side of the body (i.e. right hand for left breast) to gently press from the nipple outward to the outer edge One part at a time then go from the outer part to the nipple, looking for nipple discharge Repeat this for the other breast Put both arms down and half -bend arms one at a time. Use pads of the finger of the opposite hands to poke into the armpit to feel for lumps in the armpits. Look at the nipples of both breasts, and carefully for dimples
4.0 CONCLUSION
Procedures for breast self examination should be done once every two months, and is advisable to start from the age of 14.
5.0 SUMMARY
Breast self examination requires less use of instruments. It is more useful to use both hands, that is, left hand is used to examine right breast vice versa
This examination is to be done individually, except where it is not possible due to ill health.
6.0 TUTOR-MARKED ASSIGNMENT
1. State three reasons for conducting self breast examination. 2. Outline three abnormalities that can be detected during self breast examination.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical Skills for Community Health Workers, Nigeria.
FMOH (1992). Reviewed CHEW Training Curriculum, Nigeria.
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UNIT 2 BODY-ASSESSMENT OF DEHYDRATION
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Overview of Assessment of Dehydration 3.2 Classification of Dehydration 3.3 Procedures for Assessment of Dehydration 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit covers the physical examination of some parts of the body to establish the clinical features of dehydration.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
classify degree of dehydration physically assess dehydration.
3.0 MAIN CONTENT
Table 2.1: Assessment of Dehydration
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3.1 Overview of Assessment of Dehydration
Dehydration simply means loss of fluid resulting in the change in normal physical status of some parts of the body such as the skin, eye, tongue, mental alertness, heart rate and urine output. Assessment of dehydration is a procedure based on physical observation to ascertain the presence of dehydration in the body
3.2 Classes of Dehydration
Dehydration is classified into three: mild, moderate and severe.
3.3 Procedures for Assessment of Dehydration
Sit or lay the patient on an examination bed Observe normal status of eye(for sunken) Observe fontanels in children (depression) Observe tongue for dryness or cyanosed Pinch skin for elasticity or cold and cyanosed Observe urine output for oliguria, anuria Flex muscles for tone and retraction Observe mental alertness for shock Observe heart rate for increase or decrease rate Observe body temperature for coldness/warm
4.0 CONCLUSION
During assessment of dehydration, whenever two abnormal findings or more appear in the body; it signifies the presence of dehydration.
5.0 SUMMARY
Assessment of dehydration is an observational method to reveal signs of dehydration in the body. It is classified into three mild, moderate and severe.
6.0 TUTOR-MARKED ASSIGNMENT
Visit a hospital and physically assess cases of dehydration in adult and children and identify four important signs noticed from the classes of dehydration.
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7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical Skills for Community Health Workers, Nigeria.
Skeet & Muriel (eds.) (1984). First Aid for Community Health Workers in Developing Countries.
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UNIT 3 MEASUREMENT OF WEIGHT TO ASSESS THE NUTRITIONAL STATUS OF INDIVIDUALS
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Equipment Needed for Weighing 3.2 Procedures for Weighing 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit explains the process to find out how heavy or light an individual is. This is done by putting him/ her on an appropriate weighing scale
2.0 OBJECTIVES
By the end of this unit, you should be able to:
identify the type of weighing scales appropriate to the age of users carry out/measure weight of individual according to their age.
3.0 MAIN CONTENT
3.1 Equipment Needed for Weighing
Standing scale (weighing scale for adult) Spring/hanging scale (for children) Table /basket scale (for infants)
3.2 Procedures for Weighing
(Sequential steps)
Test scale with a known weight for accuracy Balance scale at zero(0) level Explain procedure to patient or child’s mother
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Advise patient to undress the child and remove heavy bangles For adult and children, they should remove shoes, heavy objects and cloth Balance the scale at zero( 0)level, then Allow patient to climb the scale, or mother should put the child on the weighing scale Balance scale while patient is on it or child is on it Read the patient’s weight from the weighing scale and record reading
4.0 CONCLUSION
Weight is the most potential tool for assessing the current nutritional status of an individual provided the actual age is known..There are three types of weighing scales: Standing scale, Table scale and Spring scale.
Spring scale is simple to use and easy to transport or carry along to the field, it is reliable and accurate. While, Standing and Basket scales, which are also heavy and reliable are usually used in static health facilities.
5.0 SUMMARY
Procedures for weighing are steps arranged to serve as a guide to sequentially measure the weight of an individual. It is possible to have a wrong reading of weight when these procedures are not followed sequentially.
6.0 TUTOR-MARKED ASSIGNMENT
1. Pair-up with colleagues and practice by weighing your selves. 2. How would you assess the nutritional status of a child aged 2 years, who refuses to climb a weighing scale?
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Nutrition for Community Health Workers, Nigeria.
FMOH, (1992). Reviewed CHO Training Curriculum, Nigeria.
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UNIT 4 MEASUREMENT OF HEIGHT AND LENGTH OF A CHILD
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Overview of Measurement of Child’s Height and Length 3.2 Equipment Needed for Measurement of Height and Length 3.3 Procedures for Measurement of Weight and Child Length (Adult, older children) 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
In the previous unit, weight of a child was described as a method of assessing nutritional status. Similarly, this unit will discuss measurement of child length and height as another method of assessing nutritional status of a child.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
measure height and length of a child identify the equipment needed for measurement of height and length.
3.0 MAIN CONTENT
3.1 Overview of Measurement of Child Height and Length
A child’s height and length in centimetres or inches is measured in order to assess his nutritional status. This determines how tall a child is, when the child is standing upright. Also, length measurement will be able to show how tall or long a child is, but this is done when the child is lying down. While, height is not necessarily dependent on the age of the child.
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Height measurement is used for children 2 years and above while length measurement is used for children below 2 years of age because of their inability to stand upright.
The average length or height of a child at birth is 50 cm and this doubles after a year.
3.2 Equipment Needed for Measurement of Height and Length
Adult weighing scale which has graduated height indices Measuring tape calibrated in centimetres and inches A long plank or wall, graduated in centimetre from ground/ floor level which is zero(0) point
3.3 Measuring of Height and Length
(Adult and older children)
Ask subject (Adult and older children) to remove heavy objects, materials and clothes from their body e.g. shoe, head tie, cap, hat, bangles, handset. Adjust scale –by forwarding headpiece up right to the graduated measurement wall scale or long plank his/her feet parallel, with heels, buttocks, and back of head touching the graduated measurement board /mark Allow his/her arms to hang freely in a natural standing manner Adjust scale to down ward, lower the head piece gently to make contact with the top of the head of the client If subject is standing against wall or plank use any flat object to represent the head piece with the top of the head With the head piece at the correct graduation point Take reading and remove the lead piece Allow subject to get down
Infant and Children Below 2 Years of Age
Explain procedure to child or mother Get the Child’s co-operation Remove heavy materials, shoes, bangles, head tie, hat , cap from the child Solicit for help from two trained persons to assist in getting the child into appropriate position, since most children become upset and struggle when measurement is being taken
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Place the child in recumbent or lying down position on flat surface/board so that the child is looking straight up, Place the foot piece firmly against the child’s feet and make sure the knees are straight Read and record the length to the nearest 0.1cm
4.0 CONCLUSION
Measurement of height and length provides a basis to compare and relate the weight of a child with his height and length. It is an unbiased measurement that can ensure that even a child’s degree of thinness and stunted growth can be obtained.
5.0 SUMMARY
Use of relevant scale for measurement of length and height can provide accurate reading while the use of relevant scale and wrong positioning of client/subject on the measurement scale can yield wrong reading/result.
Board/scale can be used in the hospital set up. In the community or any place where there is no measurement board/scale, a graduated wall/plank can be used to assess length and height of an individual.
6.0 TUTOR-MARKED ASSIGNMENT
State three (3) possible reasons for wrong reading of individuals’ height and length
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical Skills for Community Health Workers, Nigeria.
King &, Mourice (eds.) (1984). Primary Child Care,Vol. 2.
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UNIT 5 MID-ARM CIRCUMFERENCE MEASUREMENT
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Materials Needed for the Measurement of Mid-Arm Circumference 3.2 Procedures for Measurement of Mid-Arm Circumference 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
Measurement of mid-upper arm circumference (MUAC) is another method of assessing the nutritional status of a child.. (MUAC) is measured in centimetres. This method is recommended for the age group 1-5 years.
In the previous unit, we discussed the measurement of height and length of a child as a method of assessing nutritional status. In this unit, we shall discuss other simple procedures that appear to be useful for field work to further assess the nutritional status of children.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
itemise the materials required for mid-arm circumference measurement measure mid-arm circumference.
3.0 MAIN CONTENT
3.1 Materials Needed for Measurement of Mid -Arm Circumference
Measuring tapes Shakir’s strip Biro and paper
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3.2 Procedures for Measurement of Mid- Arm Circumference
Tape Measurement
Obtain Shakir’s strip or measuring tape Let the child’s arm hang down ward Locate the middle upper part of the arm between the tip of the shoulder and the tip of otecranon of the elbow Place the zero point of the tape measure on the tip of the shoulder and stretch tape down to the tip of the elbow joint Read the measurement to the nearest 0.1cm point of the child’s upper arm Let the child’s arm hang down loosely by his side Put the tape round the mid-point of the child’s upper arm Read and record measurement
Fig. 2.2: Shakir’s Strip Source: (Modified from Primary Health Care Textbook 2)
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Shakir’s Strip Measurement
Locate the mid-point of the upper arm, as described previously Place the strip round identified point without squeezing the muscles or skin where the 0 cm mark meets the various colours is the correct measurement of the child’s mid upper arm circumference Note the colours and record Readings for Shakir’s strip and tape methods
- 13.5-17.5cm = green = Normal - 12.5-13.5cm =yellow = Mildly malnourished - 7.5-12.5cm = red = Severally malnourished
4.0 CONCLUSION
Mid-Arm circumference measurement is a measure of bone width, subcutaneous fat and muscles development. It is cheap, economical and faster to use especially during field work.
5.0 SUMMARY
Shakir’s strip and tape methods can be used for measuring mid- arm circumference, three colours interpret readings of the measurement:
Green-= Normal Yellow=Mild and malnourished Red =Malnourished.
6.0 TUTOR-MARKED ASSIGNMENT
What is the meaning of the various colours on Shakir’s strip?
7.0 REFERENCES/FURTHER READING
FMOH (1992). Reviewed CHO and CHEW Training Curriculum, Nigeria.
Skeet & Muriel (eds.) (1984). First Aid for Community Health Workers in Developing Countries.
Kings & Mourice (eds.) (1984). Primary Child Care, Vol. 2.
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UNIT 6 EYE-VISUAL ACUITY TEST
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Requirements for Distance Vision Test 3.2 Procedures for Distance Vision Test 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit explains the skills to apply in testing eye vision at a distance of 6 metres using E. chart.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
examine/test eye vision at a distance of 6 metres using E. chart identify possible signs of visual defect.
3.0 MAIN CONTENT
3.1 Requirement for Distance Vision Test
- E- Test Chart - A wall or standing pillar - Hanger/ sole tape - Space room/ Hall with good source of light - Cardboard paper.
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Fig.11.1: E-Chart for 6 Meter Visual Test Source: (modified from CHEW Training Curriculum)
3.2 Procedures for Measuring Vision Using E-Chart
Identify a place to conduct the test such as a room or Hall that has good light, not too bright or dark. Stand or Sit Patient 6 meters from the eye test chart (use ruler or tape to measure the distance). Hang or paste E-Chart on the wall or pillar 6 metres distance to the patient. Test both eyes one after the other. If patient wears glasses, test only with the glasses on. Explain and tell patient to indicate with hands which direction the 3arms of E. are pointing. Starting from top line of the test E-Chart, carefully point to the “E”s. Patient is to cover one eye with palm of hand or cardboard and read the chart with the one uncovered. The test line that is seen correctly is the visual acuity in that eye
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Record visual acuity as fraction e.g. . Where the numerator
(6) indicates the distance of the patient from the E-chart and is the distance at which a normal eye can read the E- Chart:
Thus: V = Visual R = Right Eye L = Left Eye
VR VL
Both eyes are to be tested but one at a time.
Common Signs of Visual Defect during E-Chart Test
- Exclusive eye-blinking - Thrusting head forward - Tearing or red of eye - Head felting - Eye squinting
4.0 CONCLUSION
Visual acuity test using E-chart is not only a skill to measure eye vision, but to identify common eye defects.
5.0 SUMMARY
Distance vision is measured using so many different vision test techniques that require less scientific equipment and always gives quick results. This test using E-chart is simple to perform and it is affordable.
6.0 TUTOR-MARKED ASSIGNMENT
1. Identify a place to use the Visual E-Chart in your location. 2. What are the normal colours and background colours of E-Chart?
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical Skills for Community Health Workers, Nigeria.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
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MODULE 3 PROCEDURES FOR SIMPLE MINOR SURGERY
Unit 1 Wound-Dressing Unit 2 Suturing of Wound Unit 3 Male Circumcision Unit 4 Episiotomy Unit 5 Ear- Piercing
UNIT 1 WOUND-DRESSING
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Materials Needed for Wound -Dressing 3.2 Procedures for Wound- Dressing 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit explains the procedures for dressing of wound. Dressing of wound is a process that involves cleaning of wound with antiseptic, applying of drugs and wrapping the wound with bandage and plaster.
2.0 OBJECTIVES
By the end of this unit, you should able to:
assemble wound- dressing materials dress wounds.
3.0 MAIN CONTENT
3.1 Materials Needed for Wound- Dressing
(TBC) Tincture of Benzoic Compound
Bandage Plaster
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Water and soap Hydrogen peroxide
3.2 Procedures for Wound –Dressing
Assess nature and type of wound Examine the general conditions of the injuries and the patient Put on hand gloves Clean the wound with water and soap Remove all dirt. Apply TBC, if fresh and superficial wound Cover the wound with firm, clean or sterile dressing Apply bandages or plaster to support dressing
4.0 CONCLUSION
Dressing of wound is part of medication. The procedure requires skills and frequent practice to clean wound and dress it properly.
5.0 SUMMARY
Wound-dressing is a normal, simple and sterile procedure, but requires skills in examining nature of wounds and injuries before dressing is applied
6.0 TUTOR-MARKED ASSIGNMENT
You should visit a nearby health facility to:
1. Assemble the materials needed for wound- dressing. 2. Perform dressing of wounds.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical Skills for Community Health Workers, Nigeria.
FMOH(1992). Reviewed CHEW Training Curriculum, Nigeria.
Skeet & Muriel (eds.) (1984). First Aid for Community Health Workers in Developing Countries.
35
UNIT 2 SUTURING OF WOUND
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Materials Needed for Suturing of Wound 3.2 Steps used in Suturing of Wound 3.3 Procedures for Suturing of Wound 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
You recall that in the previous unit, dressing of wound was discussed and in this unit another aspect of wound-dressing which is suturing of wound will be treated.
The suturing of wound is a procedure which involves bringing together parts of the tissue involved in a wound, using sterile tread and needle to accelerate the healing process.
� Wound Suturing Dressing
Medication
2.0 OBJECTIVES
By end of this unit, you should be able to:
assemble the materials needed for suturing of wound perform suture of wound.
3.0 MAIN CONTENT
3.1 Materials Needed for Suturing Wound
Kidney dish with lid containing sterile scissors, dissecting forceps (toothed and non - toothed) artery forceps, etc.
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Gallipot with sterile suturing materials e.g. catgut, threads, needles. Kidney dish with sterile syringe and needles. Kidney dish containing dry sterile gauze and cotton wool. Gallipot for pouring lotions such as Savlon, Hibitane in water, Hydrogen Peroxide, normal saline. Sterile needle holder. Bowl with clean water – injections e.g. Xylocaine Tray with hand gloves, plaster.
Fig.13.1: Suturing of Wound Source: (Modified from FMOH Clinical Session Plans)
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3.2 Steps for Suturing of Wound
- Inspect the wound. - Assemble the needed materials for suturing. - Prepare patient/client for suturing of wound. - Conduct physical examination and obtain history of the wound.
3.3 Procedures for Suturing of Wound
Wash with sterile water and soap, and then dry it. Put on sterile hand gloves. Infiltrate under the skin with 5% Xylocaine or Lignocaine and leave for about 1 – 2 minutes. Clean the wound with antiseptic. Irrigate with normal saline. Remove any expose foreign body, dead or non viable tissue. Depending on the depth of the wound; suture inner layers using strong chronic catgut for fascia, plain catgut for subcutaneous tissue, and Non absorbable suture (e.g. silk or nylon) for the skin. Use round bodied needles for inner structure e.g. fascia and subcutaneous tissue and cutting needle for skin. Suture the wound using simple interrupted suture. Applied techniques of suture on the wound using thread, the right type of needle with the appropriate suture. Make the first stitch in the middle of the wound. Holding the needle with the needle holder or hard, introducing the needle vertically through the skin, transferring the entire thickness bringing the needle out through the opposite side of the other cut surface. Tie the sutured closed using either the reef or triple knot (following the steps in figure 3&4 above) make enough other stitches to close the wound Suture the wound in layers, starting from inner most structures, and stitch the skin last Cover with dry sterile gauze and secure firmly with strip of strapping Inform patient / client to be re-assured to remove stitches after 7- 10days.
4.0 CONCLUSION a) Usually stitches takes between 6 to 7 days intact before removal. b) After suturing with thread and needle, then dry dressing is applied on it.
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5.0 SUMMARY
Suturing of wound simply refers to procedures of bringing back parts of an open wound together, to its original normal shape using thread and needle like sewing of a torn cloth.
It requires sterile simple procedures. This unit focused on procedures for suturing of a wound.
6.0 TUTOR- MARKED ASSIGNMENT
Visit a health centre and perform the following under supervision of an experienced Health Worker/Theatre Nurse
1. Inspect wound and suture it. 2. State the procedures for suturing a wound
7.0 REFERENCES/ FURTHER READING.
FMOH (1982). Session Plans on Clinical Skills for Community Health Workers, Nigeria.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
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UNIT 3 CIRCUMCISION
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Material Needed for Circumcision 3.2 Procedures for Circumcision 4.0 Conclusion 4.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
Circumcision is a surgical removal of the foreskin of the penis. This unit shall explain the procedures and materials needed to perform this activity.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
assemble the materials needed for circumcision perform circumcision.
3.0 MAIN CONTENT
3.1 Materials Needed for Circumcision
Scissors or surgical blade Small bandage A tray A bottle of (TBC) Tincture of Benzoic Compound Galli pot with cotton wool Antiseptic solution Kidney dish with lid containing sterile artery forceps 1 ampoule of Adrenaline (NOT TO INJECT PATIENT) 1 ampoule of Xylocaine.
3.2 Procedures for Circumcision
Place the patient properly on the bed or table Put on hand gloves
40
Clean the site properly with antiseptic Hold the penis with one hand Take the blunt artery forceps and pass gently through the opening at the top of the penis Draw the foreskin forward and clamp with artery forceps Administer Xylocaine to localise the foreskin Cut the foreskin with scissors or surgical blade Push the remaining foreskin down to completely expose the head of the penis Control bleeding by applying firm bandage soaked in TBC If oozing continues, squirt some Adrenaline to stop bleeding Wrap the glands with a strip of gauze soaked in TBC Observe the patient for a day.
4.0 CONCLUSION
Circumcision is limited to males and it is a simple procedure that requires constant and frequent practice before one can be familiar with the procedures.
5.0 SUMMARY
This unit dealt with male circumcision whereby profuse foreskin of the penis is removed using a sterile surgical procedure called circumcision.
6.0 TUTOR-MARKED ASSIGNMENT
You should visit nearby hospital and perform the following:
1. Assemble the materials needed for circumcision. 2. Perform circumcision under the supervision of a facilitator or theatre nurse.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical skills for Community Health Workers, Nigeria.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
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UNIT 4 EPISIOTOMY
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Material Needed for Episiotomy 3.2 Procedures for Episiotomy 4.0 Conclusion 5.0 Summary 6.0 Tutor- Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This Unit focuses on the procedures for conducting minor surgical incision about 4 – 5cm long at a right angle through the perineal tissue. It is designed to enlarge the vulval outlet during delivery. These processes are known as Episiotomy.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
assemble the equipment needed for episiotomy perform episiotomy.
3.0 MAIN CONTENT
3.1 Equipment Needed for Episiotomy
- Tray - Kidney dish with syringes (10ml and 5ml) - Gallipot with suturing material - Kidney dish with lid containing scissors - Gallipot with cotton wool swap soaked in disinfectant.
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Fig.3.1: Process of Episiotomy Source: Myles Textbook of Midwifery 13th International Edition
3.2 Procedures of Episiotomy
Put on hand gloves Infiltrate 10mls of lignocaine 0.5% under the skin of the perineum and wait for 3 minutes Place your two fingers under the left inner side of the labia to avoid injury to the child’s head Make an episiotomy cut between your two fingers using scissors/surgical blade – 107a Control bleeding by pressing swab on the episiotomy wound Allow the head slowly to be delivered Wait for the separation of placenta and deliver Suture the episiotomy wound layer by layer Clean and apply firm pad Re – visit and remove suture/stitches, where necessary after 5 – 10mls with the episiotomy (depending on the type of suture used).
4.0 CONCLUSION
Episiotomy is a minor surgical cut that takes few minutes; it is simple and easy to perform. You should be able to perform it practically after careful observation and participation in the process in a nearby health centre.
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5.0 SUMMARY
This Unit explained procedures of conducting episiotomy, and the equipment needed for the activity. It is a sterile procedure that requires the use of scissors, thread and needle.
6.0 TUTOR-MARKED ASSIGNMENT
Itemise the procedures for episiotomy.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Clinical Skills for Community Health Workers, Nigeria.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
Myles (1992). Revised 13th International edition of Midwifery Text Book.
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UNIT 5 EAR-PIERCING
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Materials Needed for Ear-Piercing 3.2 Procedures for Ear-Piecing 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit focuses on the procedures for ear- piercing and the logical way in incising a hole in the ear of a patient which can be used for ear rings and earth threads.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
perform ear- piercing.
3.0 MAIN CONTENT
3.1 Materials Needed for Ear- Piercing
A receiver for used swabs A kidney dish with spirit swabs A needle holder Galli pot containing needle and thread (immersed in spirit)
3.2 Procedures for Ear-Piercing
Position the baby on the mother’s laps Identify the area of the pinna to be pierced (usually lower part of the lobe) Wash your hand with soap and water and dry it Put on hand gloves Clean the area with spirit swab, pierce the ear at the selected spot using threaded needle Leave a small patent of the thread in place (about one inch long)
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Knot the thread at the two ends and cut Carry out the same procedure on the other ear Clean the pierced site daily with spirit swab and dab with olive oil or vaseline Leave the thread in place for at least 7 days to ensure that the wound is properly healed After 7 days, the thread can be replaced with ear-rings
4.0 CONCLUSION
Ear-piercing can be applied to all ages and it requires sterilised procedures
5.0 SUMMARY
Ear piercing is usually performed in a hospital setting, and it requires sterilised procedures.
A hole is created at the lobe of the pinna of the ear using thread and needle of the patient to enable ear ring passage.
6.0 TUTOR-MARKED ASSIGNMENT
1. Visit a health facility and: a) Assemble materials for ear- piercing b) Perform ear- piercing
2. Describe the procedures for ear- piercing.
7.0 REFERENCES/FURTHER READING
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
Skeet & Muriel (eds.) (1984). First Aid for Community Health Workers in Developing Countries.
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MODULE 4 SIMPLE LABORATORY INVESTIGATION
Unit 1 Collection of Urine Specimen Unit 2 Sahli Method of Haemoglobin Estimation Unit 3 Urine Test for Sugar and Protein Unit 4 Tallquist Method of Haemoglobin Estimation
UNIT 1 COLLECTION OF URINE SPECIMEN
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Procedures for Collection of Urine Specimen 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit explains the procedures for urine collection. It further explains how urine is collected from patients, deposited in a container and sent to the laboratory for examination.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
collect urine specimen.
3.0 MAIN CONTENT
3.1 Procedures for Collection of Urine Specimen
Prepare specimen container Label specimen container with marker/pen (name of the specimen, date and time of collection, name of the patient/client) Give specimen container to the patient/client to put urine, and instruct them as follows.
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For (mid-stream urine); client/ patient should pass few drop of urine first then catch the middle position of stream into the specimen container before finishing.
For terminal urine; client/patient to begin urination but collect into specimen container when it is towards end of urination.
4.0 CONCLUSION
Urine should not be contaminated with stool during collection; urine specimen container should be clean and dry. This unit explained procedures to conduct urine collection.
5.0 SUMMARY
Urine is collected at early morning hours, midstream or terminal, every urine specimen container should be labeled with date and time of collection and type of specimen collected (terminal or midstream).
6.0 TUTOR-MARKED ASSIGNMENT
Visit a hospital nearby and do the following: i. Inspect various types of specimen containers. ii. Collect urine specimen from a child of 5 years and label it accordingly.
7.0 REFERENCES/FURTHER READING
FMOH (1990). CHO Training Manual, pg 47.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
Author, M.C. (1974). Laboratory Services in Rural Hospitals.
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UNIT 2 URINE TEST FOR SUGAR AND PROTEIN
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Procedures for Urine Testing 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit is more or less a continuation of the previous unit, and it stresses the procedures for conducting routine laboratory test using dip- strip (album strip albumin clinix strip-sugar).
2.0 OBJECTIVES
By the end of this unit, you should be able to:
perform routine urine test for sugar and albumin.
3.0 MAIN CONTENT
3.1 Procedures for Urine Test
Collect urine specimen in a clean container Check dip strip for normalcy and expiry date Dip strip into the urine for 1 second Remove the stick of strip from the urine and wait for the prescribed length of time (10-12second) Examine the test area for any change in colours Match the dipped stick strip with the colour chart or the bottles (clinix strip for sugar test and albumin for protein) Read off the measurement and record Dispose of the urine and used dip strip.
4.0 CONCLUSION
Positive test result for albumin is indicated when colour of the strip test area changes from yellow to green; while, positive sugar is when the
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colour area of the test strip changes from pink to dark mauve. These results should be labeled on the colour chart of the bottle
5.0 SUMMARY
This test is a simple laboratory routine test that can be conducted in the laboratory or at home. It only requires urine specimen and the test can be performed and results obtained on the spot.
6.0 TUTOR-MARKED ASSIGNMENT
Visit a health centre and perform the following: i. Examine various types of dip strip for urine test. ii. Distinguish the differences in test for sugar and protein. iii. Perform urine test under the supervision of your facilitator or health worker.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Nutrition for Community Health Workers, Nigeria.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
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UNIT 3 SAHLI METHOD OF HAEMOGLOBIN ESTIMATION
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Equipment for Sahli Method 3.2 Procedures for Haemoglobin Estimation 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
Haemoglobin is an oxygen- carrying substance found at the centre of red blood cells and its reading is estimated in percentages. This unit focuses on the method of estimating haemoglobin using Sahli haemoglobinometre
2.0 OBJECTIVES
By the end of this unit, you should be able to:
itemise the equipment for haemoglobin estimation perform haemoglobin estimation.
3.0 MAIN CONTENT
3.1 Equipment for Sahli Method
American optical haemoglobinometre (set) Washing hand basin A set of tray with lid Two kidney dishes, one for sterile needles and stylets, and others with used swab and stylets Two Galli pot with cotton wool swab and other one with dry cotton wool
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3.2 Procedures for Haemoglobin Estimation
Test haemoglobinometre to ensure it is in good working condition Sit patient comfortably Clean the thumb with cotton wool soaked in methylated spirit Wipe the thumb dry or allow it to dry before pricking Slide blood chamber tightly into the clip Prick patient thumb or heal in cases of infants Place the edge of the blood chamber against the blood collecting on the pricked finger and allow blood to be sucked in by capillary action Insert entire unit into instrument Press illuminating (lighting) thumb button and observe through eye piece Move lever until both green field match in intensity Read finding is grain on scales as indicated by the lever Recording findings/reading
4.0 CONCLUSION
Haemoglobin estimation using haemoglobinometre is a standard and hospital- based system, any mistake may alter the reading.
5.0 SUMMARY
This method of haemoglobinometre estimation of HB is more scientific and it can provide on the spot results. This unit identifies the materials and procedures needed for the estimation.
6.0 TUTOR-MARKED ASSIGNMENT
1. Visit a hospital and perform Hb estimation using haemoglobinometre. 2. List the equipment needed for haemoglobin estimation.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Nutrition for Community Health Workers, Nigeria.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
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UNIT 4 TALLQUIST METHOD OF HAEMOGLOBIN ESTIMATION
CONTENTS
1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Equipment for Haemoglobin Estimation 3.2 Procedures of Tallquist Method 4.0 Conclusion 5.0 Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading
1.0 INTRODUCTION
This unit highlights another approach of haemoglobin determination using the Tallquist Method. It is a simple procedure that can be performed in a hospital or at home.
2.0 OBJECTIVES
By the end of this unit, you should be able to:
perform haemoglobin (HB) estimation using the Tallquist Method.
3.0 MAIN CONTENT
3.1 Procedures for Haemoglobin Estimation
Set a tray containing the following: a) Kidney dish with needle and stylets b) Galli pot with swab soaked with spirit c) Hand gloves d) Tallquist Paper Chart
3.2 Procedures for Tallquist Method
Swab the thumb and allow it to dry Prick the thumb with stylets Collect the blood with blotting paper
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Compare the degree of redness with the Tallquist Paper Chart to estimate the percentage Record findings
4.0 CONCLUSION
Haemoglobin is estimated using Tallquist Method and readings that match the Tallquist Chart is considered as normal and significant results.
5.0 SUMMARY
This method of haemoglobin determination is more economical and mobile. It provides results on the spot.
6.0 TUTOR-MARKED ASSIGNMENT
Discuss procedures of Hb estimation using Tallquist Method.
7.0 REFERENCES/FURTHER READING
FMOH (1982). Session Plans on Nutrition for Community Health Workers, Nigeria.
FMOH (1992). Reviewed CHO Training Curriculum, Nigeria.
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