413-Health Care X

Health Care Services PCA
NSQF Level -2
Class - X
Student Workbook
Health Care Services NSQF Level -1
Student Handbook, Class - IX
Price :
First Edition: January 2018, CBSE
Copies: 1000
Paper used : 80 GSM CBSE Water Mark White Maplitho
“This book or part thereof may not be reproduced by

any person or agency in any manner”
Published By The Secretary, Central Board of Secondary Education, Shiksha

Kendra, 2, Community Centre, Preet Vihar, Delhi-110092
Design, Layout Raj Printers, A-9, Sctor B-2, Tronica City, Loni,
& Composed By Ghaziabad, U.P.-201102
Forward
The Student Handbook is a part of the training package developed for the vocational
subject under the National Skill Qualification Framework (NSQF), an initiative of
Government of India. The NSQF sets common principles and guidelines for a
nationally recognized qualification system covering Schools, Vocational Education and
Training Institutions, Technical Education Institutions, Colleges and Universities. It is
envisaged that the NSQF will promote transparency of qualifications, cross-sectoral
learning, student-centred learning and facilitate learner’s mobility between different
qualifications, thus encouraging lifelong learning. The National Curriculum Framework,
2005 recommends that children’s life at school must be linked to their life outside the
school. This principle makes a departure from the legacy of bookish learning which
continues to shape our system and causes a gap between the school, home, community
and the workplace.
Pandit Sunderlal Sharma Central Institute of Vocational Education (PSSCIVE), a

constituent of National Council of Educational Research and Training (NCERT) has
developed modular curriculum and learning materials for the vocational subjects
offered from Classes IX to XII (NSQF Levels 1-4). This Student Handbook, which has
been developed keeping in view the National Occupational Standards (NOS) set by
the Healthcare Sector Skill Council (HSSC) for the Job Role of Patient Care Assistant/
General Duty Assistant is meant for students who have passed Class-VIII or equivalent
examination. The National Occupation Standards are a set of competency standards
used for recognizing and assessing occupational skills and knowledge needed to
perform effectively in the workplace.
The success of vocationalisation of education in schools depends on the steps that

Principals and Teachers will take to encourage children to reflect their own learning and
to pursue imaginative and on-the-job training activities. Participation of learners in skill
development exercises and inculcation of values and creativity is possible if we involve
children as participants in learning and not as receivers of information. Flexibility in
the daily time-table would be a necessity to maintain the rigour in implementing the
activities and the required number of teaching days will have to be increased for
teaching vocational subjects.
The Student Handbook has been developed and reviewed by a group of experts and
their contributions are admirably acknowledged. The utility of the Handbook will be
adjudged by the qualitative improvement that it brings about in teaching-learning.
The likelihood of text errors, including typographical errors cannot be ruled out. The
feedback and suggestions on the content by the teachers and other stakeholders will
be of immense value to us in bringing about necessary improvement in the Student
Handbook.
Chairperson, CBSE
V
Acknowledgements
Advisors
 Smt. Anita Karwal, IAS, Chairperson, CBSE
Content Developed By
PSSCIVE, Bhopal
Editing & Coordination
 Dr. Biswajit Saha, Additional Director (V.E & ART & I), CBSE
VI
Contents
Unit 1 : Hospital Structure and Functions 10
Session 1: Describe Healthcare Delivery Systems 13
Session 2: Describe the Role of Supporting Departments in a Hospital 20
Session 3: Classify Hospitals 24
Session 4: Describe the Role of and Function of General Duty Assistant / 28
Paitent Care Assistant
Session 5: Understanding the Qualities of a General Duty Assistant/Patient 30
Care Assistant
Unit 2 : Introduction to Care Plan and Care of Patients 33
Session 1: Describe the Role of General Duty Assistant Patient Care 36
Assistant in Care Plan
Session 2: Feed a Patient 40
Session 3: Identify Vital Signs and Report 46
Session 4: Identify Vital Signs and Report 52
Session 5: Demonstrate Patient Positioning 58
Unit 3 : Sterilization and Disinfection 63
Session 1: Describe the Disease Causing Microorganisms 66
Session 2: Describe the Causal Agents of Common Human Diseases 73
Session 3: Understanding the Role of Hospital Personnel in Prevention 77
and Control of Hospital Acquired Infections
Session 4: Disinfecting Ward and Equipment 83
Unit 4 : Basic First Aid and Emergency Medical Relief 92
Session 1: Describe Principles and Rules of First Aid 94
Session 2: Identify Facilities, Equipment and Materials for First Aid 98
Session 3: Performing the Role of First Aider in Fever, Heat Stroke, 103
Session 4: Back Pain, Asthma, and Food Borne Illness Performing the 108
Role of First Aider in Cuts, Bleeding, Burns, Insect Bites and
Stings, Dog Bites and Snake Bites
Unit 5 : Structure, Functions and Nutrition 113
Session 1: Identify the Parts of Human Body 115
Session 2: Describe the Role of Nutrition in the Growth and Development 130
of Human Body
Unit 6 : Public Relations in Hospital 137
Session 1: Describe the Role and Functions of Medical Receptionist 140
Session 2: Responding to Emergency Calls 143
Session 3: Using Computers in Maintaining Public Relations 147
Session 4: Dealing with Patients Attendant 149
Glossary 153
VII
UNIT – 1
HoSPITAL STRUCTURE AND FUNCTIoNS

Sector: Healthcare
Learning outcomes
Unit 1 HoSPITAL STRUCTURE AND FUNCTIoNS
Location Learning Knowledge Performance Teaching and
Classroom/
Hospital/ outcome Evaluation Evaluation Training Method
Clinic  Demonstrate  Describe the  Identify the various Interactive
the knowledge roles and functions types of hospitals. Lecture:
of roles and of various depart-  Distinguish between  Roles and
function of ments and profes- General Hospital function of
various depart- sionls in the Hos- Hospitals and Spe- hospitals.
ments, profes- pital. cialized Hospital.  Activity:
sionals and su-  Draw a chart Visit a nearby
pportive staff of depicting the roles hospitas and
the hospital. of departments, study the roles
professionals and and functions of
supporting staff of the various
the hospital. departments,
professionals
and supportive
staff of the hos-
pital.
 Prepare a
chart depicting
the roles and
functions of de-
partments/pro-
fessionals/sup-
porting staff.
 Demonstrate  Describe the role  Draw a chain of Interactive
the knowledge and functions of command in the Lecture:
of roles and various supporting various department  The Role and
function of sup- departments of and laboratories of function of vari-
porting depart- hospital. hospital. ous support-
ments in hosp-  State the services ing department
tal. provided by the in the Hospital.
medical record  Activity:
department and Visit nearby
outpatient depart- hospital and
ment. . study the roles
 Explain the activit- and function of
ies performed by the various su-
the hospital house- pporting depar-
keeping depart- tments in hosp-
ment. ital.
 Prepare a chart
showing the ch-
ain of comma-
nds in various
department.
11
Sector: Healthcare
Learning outcomes
 Classify the  State the criteria  Classify the Interactive
hospitals on the used for classify hospitals on the Lecture:
basis of differe- the hospitals. basis of bed  Classifying
nt criteria.  Describe the strength, speciality Hospitals.
different levels and level of medical  Activity:
of medical care. care. Internet search
on hospitals
and classify
them on the
basis of bed
strength, spe-
ciality and level
of medical care.
 Relate the role  Describe the roles  Demonstrate the Interactive

of General Duty and functions of knowledge of Lecture:
Assistant to the General Duty Assi- activities for  Roles and func-
various functi- stant in hospital. prevention of tions of Gene-
ons of hospital.  Explain the various spread of diseases. ral Duty Assis-
activities/tasks that  Draw a diagram tant.
should be perfomed depicting the  Activity :
by GDA to effecti- various role and Visit a nearby
vely discharge his/ function of GDA. hospital and
her duties and study the role
responsibilities in of General Duty
hospital. Assistant in
providing ser-
vices.
 Draw a diagram
depicting the
roles and func-
tions of GDA.
 Demonstrate  Describe the  Identify the activities Interactive
the knowledge qualities of a Good performed by GDA Lecture :
of the qualities Genetal Duty in supporting the  Qualities of a
of a Good Assistant in the the healthcare Good General
General Duty hospital. team member. Duty Assistant.
Assistant.  Demonstrate the
 Activity :
ablity to provide
Visit a hospital
personal care.
and enlist the
enlist the quali-
ties of a Good
General Duty
Assistant.
12
Sector: Healthcare
Session 1: Describe Healthcare Delivery Systems
Relevant Knowledge
H ealthcare is provided within many different types of facilities to meet the needs
of the people. A hospital is an institution for the medical and nursing care of ill
and injured persons needing complex services
with a high risk of complications. Hospitals are
organized institutions for the care of the sick and
injured.
In this session, you will learn about the various

roles and functions of hospital. The word hospital
is derived from the latin word “hospitalis” which
comes from “hospes” meaning a “host”. The
English word “hospital” comes from the French
word “hospitale” as do the words “hostel” and
“hotel”, all originally derived from Latin. The
three words hospitals, hostel and hotel, although derived from the same source, are
used with different meaning. The term hospital means an establishment for temporary
occupation by the sick and injured. The word hospital, therefore, means an institution
in which sick or injured persons are cared for and treated for ailments and diseases.
Definition
Hospital is an institution for the care, cure and treatment of the sick and wounded, for the
study of the diseases, and for the training of the doctors and nurses (Steadman’s Medical
Dictionary). In olden days, hospitals were guest houses for the shelter of the homeless
and of the treatment of travellers. In modern times, the chief function of the hospital is
to provide care and treatment to the sick. World Health Organization (WHO) defines
the term “hospital” as an institution that provides in-patient accommodation for medical
and nursing care. It further elaborates the definition to cover hospitals that assume
additional functions i.e., curative, rehabilitative and preventive services, directly or in a
consultative capacity, also participating in the training of personnel and in research work.
Types of Hospitals
1. General Hospitals: These hospitals offer treatment for common diseases. The
main objective of General Hospital is to provide medical care, whereas teaching
is secondary. For example, Taluka headquarter hospitals, Primary Health Care
Centres (PHCs), etc
2. Specialized Hospitals: These hospitals concentrate on giving medical and nursing
care in a specific area, e.g., ophthalmic hospital (deals with eye related problems),
orthopaedic hospital (deals with bone related problems), cardiac hospital (deals
with heart related problems), etc.
3. Isolation Hospital: This is a hospital in which clients requiring isolation or clients
suffering from communicable diseases are taken care of.
13
Sector: Healthcare
4. Teaching Hospital: The primary objective of teaching hospital is teaching and

training of doctors. For example, Medical Colleges.
5. Rural Hospitals: These hospitals are located in rural areas, permanently staffed
by at least one or more physicians, which offer inpatient accommodation and
provide medical and nursing care for more than one category of medical discipline.
A number of healthcare delivery models have been developed for the delivery of
healthcare services. The healthcare system/models in India can be categorized
under the following sectors or programme:
Departments in a Hospital
The following departments are generally available in a hospital:
1. outpatient Department (oPD): The word patient means ‘one who suffers’ and
it comes from the Latin word patiens, meaning “I am suffering”. An outpatient is a
patient who is not hospitalized for 24 hours or more but who visits a hospital, clinic,
or associated facility for diagnosis or treatment. Treatment provided in this fashion
is called ambulatory care. The admission to the hospital involves the production of
an “admission note”. The leaving of the hospital is officially termed discharge, and
involves the production of a “discharge note”.
2. Inpatient Department (IPD): An inpatient is admitted to the hospital and stays
overnight or for an indeterminate time, usually several days or weeks. Treatment
provided in this fashion is called “inpatient care”.
3. Medical Departments: The medical departments may include, but not limited to
the following:
Internal Diseases Department: This Department includes specialities of
cardiology (related to heart), dermatology (related to skin), diabetics (related
to pancreas), endocrine glands (related to hormone), digestive system,
hematology diseases (related to blood), infectious diseases, internal diseases,
kidney and urology unit, neurology (related to brain and nerves), psychiatry
clinic, lung diseases, and rheumatic diseases (related to joints and
connective tissues).
Surgery Department: This department deals with general surgery unit,
orthopedics unit, urinary tracts surgery, plastic surgery, brain and neurology
surgery, children surgery, ophthalmic surgery, and Ear Nose Throat (ENT)
surgery.
Anesthesia: Doctors in this department give anesthetics for operations.
Gynecology Department: These departments investigate and treat problems
of the female urinary tract and reproductive organs.
Pediatrics Department: It is the department that deals with the medical care
of infants, children, and adolescents, and the age limit usually ranges from
birth up to the age of 18 years.
Dentistry Department: This department deals with the diagnosis, prevention,
and treatment of diseases, disorders and conditions of the oral cavity,
especially the teeth, and to an extent related conditions in the jaws and face
area.
14
Sector: Healthcare
Emergency Department: An emergency department, also known as accident

and emergency department, emergency room, or casualty department is a
medical treatment facility specializing in acute care of patients who are present
without prior appointment, either by their own means or by ambulance.
Nursing: Nursing department provides nursing to patients at all general and
specialized clinics in addition to specialized care services to inpatients at all
units.
Supporting Departments
Catering and Food Services: This department provides catering and
food services to inpatients and accompanying individuals as well as
hospital staff.
Central Disinfection and Sterilization: This department is involved
in applying policies and procedures related to central disinfection and
hospital sterilization.
Cleaning and Laundry: This department is involved in all operations and
procedures that will keep the hospital clean and provide laundry services.
Educational Affairs Department: The activities of this unit include
organizing training courses and preparing educational programmes, and
development of manpower.
Finance Department: It performs all works related to budget, prepares
payrolls and monthly wages and contracts of operation and maintenance.
It makes available the money required for procurement of materials and
equipment.
Human Resources Department: This department works on appointment
of human resources to work in all specialties related to management and
operation. It applies policies and procedures that keep up the rights of
employees.
Laboratory and Blood Bank: This department undertakes lab investiga-
tions of patients seeking medical care in the hospital and primary care
clinics.
Medical Maintenance and Engineering: Medical Maintenance and
Engineering Department is responsible for keeping operable condition
of hospital facilities and equipment. It supports workshops, including
workshops of air-conditioning, electricity, plumbing, steel works, and
joinery and facilitate daily operations of maintenance of such facilities.
Medical Records Department: This department is involved in keeping
and organizing medical records (files) of outpatients and inpatients.
Patients Services Department: It provides services directly related to
welfare of patients and facilitate procedures and requirements of their
referral to the hospital. This unit coordinates, prepares, and arranges
reservations and admissions to patients inside various medical
departments.
15
Sector: Healthcare
Pharmacy: This department is responsible for providing patients

with medicines prescribed by specialist physicians and provision of
services corresponding to applicable drug precautions and professional
regulations.
Physiotherapy Department: It provides services to specialized clinic
inpatients who need physiotherapy. The professionals help people who
are physically or mentally impaired, including temporary disability after
medical treatment.
Public Relations Department: Public relations department deals with
media coverage of the activities of hospitals, including visits, meetings,
conferences, etc. It also prepares booklets, leaflets, and posters with the
aim of educating people on various aspects of health.
Social Work Department: This unit is involved in providing assistance
and help to some patients and their families who have social,
psychological, or financial problems.
Transportation Department: This department is involved in providing
transportation services to hospital’s employees and transporting patients
to other hospitals and health centers.
X-Ray Department: The X-ray unit support the medical staff in diagnosing
the disease and treatment using advanced X-ray equipment, including
Computed tomography (CT) scan, digital X-ray, endoscopy, and ultra-
sound scanning equipment.
Professionals
The following professionals are available in a hospital:
1. Doctors
2. Nurses
3. Pharmacist
4. Medical Lab Technician
5. X-Ray Technician
6. Physiotherapist
7. Dietician
8. Medical Social Worker
Supporting Staff
1. Administrator
2. Manager
3. Receptionist
4. Cook
5. Cook Helper
16
Sector: Healthcare
6. Data Entry Operator

7. Washerman
8. Attendant
9. Sanitary Worker
10. Security Guard
Exercise
1. Visit nearby hospitals and study the various departments and their functions.
Some of the Departments are listed here in the table. You may add some
more departments, depending on the size of the hospital.
S.No. Name of Department Functions
1. Outpatient Department (OPD)

2. Inpatient Department (IPD)
3. Medical Department
4. Nursing Department
5. Paramedical Department
6. Pathology Department
7. Physical Medicine and
Rehabilitation Department
8. Operation Theatre
9. Pharmacy Department
10. Radiology Department
11. Dietary Department
2. Visit nearby hospitals and study the roles and functions of the following medical
professionals and fill the table given below:
S.No Professional Functions

1. Doctors
2. Nurses
3. Pharmacist
4. Medical Lab Technician
5. X-ray Technician
6. Physiotherapist
7. Dietician
8. Medical Social Worker
17
Sector: Healthcare
3. Visit nearby hospitals and study the roles and functions of the supporting staff
and fill the table given below:
S.No. Staff Functions
1. Administrator
2. Manager
3. Receptionist
4. Cook
5. Cook Helper
6. Data Entry Operator
7. Washerman
8. Attendant
9. Sanitary Worker
10. Security Guard
Assessment
I Short Answer Questions
a) What are the basic roles and functions of a hospital?
b) Name any three medical professionals in a hospital.
c) Name any five medical departments of a hospital.
d) Name any five supportive staff in a hospital.
II. Fill in the Blanks

1. The meaning of latin word hospes is
2. The meaning of latin word ‘hospitalis‘ is
18
Sector: Healthcare
3. Orthopaedic hospitals deals with problems related with

4. ENT stands for Nose and Throat.
5. Medical College is an example of hospital.
6. Pediatrics department deals with medical case of ,
children and adolescents.
Checklist for Assessment Activity
Use the following checklist to see if you have met all the requirements for assessment
activity.
Part A
Differentiated between the following:
1. Medical and nursing care.
2. General hospital and specialized hospital.
3. Specialized hospital and isolation hospital.
4. Outpatient and inpatient.
Part B
Discussed in class the following:
1. Why do we need hospitals?
2. What are the roles and functions of a hospital?
3. What are the characteristic features of a good hospital?
Part C
Performance Standards
The performance Standards may include, but not limited to:
Performance Standards Yes No

Identify the various types of hospitals.
Demonstrate the knowledge of roles and functions of various depart-
ments in a hospital.
Demonstrate the knowledge of roles and functions of medical professi-
onals and supportive staff in a hospital.
19
Sector: Healthcare
Session 2: Describe the Role of Supporting Departments

in a Hospital
Relevant Knowledge
In this session, you will learn about the roles and functions of various supporting
departments/sections of a hospital and the equipment and accessories used by the
staff members.
Kitchen / Dietary Department
The dietary department has the responsibility for
ensuring quality food service to the client and according
to their needs and doctor’s prescription. This department
is responsible for teaching the client with regard to proper
diet after their discharge from the hospital.
One dietary staff member is required for about 15 to 20
patients. Dietician, food storekeeper, cook, cook helpers
and dish washer are engaged in this Department. One
dietician can look after up to 200 beds. One cook,
one cook helper, one bearer and one dishwasher are
sufficient to prepare and serve meals for 20 patients / staff members. The food service
department functions round the year.
Cleaning and Laundry Department: The cleaning and laundry department takes
care of the entire linen of the hospital. It has the following functions:
1. Washing the dirty linen
2. Repairing the torn linen
3. Replacing the condemned linen
One laundry operator can wash linen of 25 to 30 beds. One laundry orderly can
assist in washing the linen of 50 – 60 beds. The appointment of Laundry Supervisor,
Mechanic and Clerk and the number employed depend upon the size of the hospital.
One supervisor, one laundry mechanic and one laundry clerk are required in each
shift. One washerman can take care of 150 to 200 kg linen per day. Each operation
in Operation Theatre produces 7 to 8 kg of soiled linen. Each delivery in labour room
produces 7 to 8 kg of soiled linen. Each ward patient produces about 5 to 6 kg of bed
linen.
Housekeeping
The housekeeping department has the main function of keeping the hospital clean.
Housekeeping incharge should know the simple facts about bacteriology. Sanitation
incharge should also be able to train his employees in cleaning techniques that
prevent the spread of disease, since all cleaning is meant to remove organic matter
in which bacteria is harboured. A sanitary attendant should be allocated a work-area
of 1200 to 1500 square feet, keeping in view the policies of the hospital, the degree
of cleanliness required, and the electrical cleaning equipment used such as scrubbing
machine, vaccum cleaner, etc. For a nursing unit one sanitary attendant over 10 beds
20
Sector: Healthcare
is recommended on the basis of round the clock service. In Intensive Care Unit (ICU)
and Critical Care Unit (CCU) of higher degree of cleanliness is required, therefore
more sanitary attendants are provided there. One supervisor to supervise 10 sanitary
attendants is generally kept. For a 300 bed hospital, there should be 01 sanitation
incharge, 04 supervisors and 40 sanitary attended (30 sanitary attendants for the daily
requirement and 10 sanitary attendants as leave reserve).
out Patient Department
Most hospitals now have an Out Patient Department (OPD). The advantage of OPD is
that much of the investigative and curative work can be done there without admitting
the client, thus curtailing medical expenses. The scope of OPD includes the following:
1. Consultation and investigation
2. Preventive and promotive healthcare
3. Rehabilitation services
4. Health education
5. Counselling
OPD is located at the entrance of the hospital. It should be separate from inpatient
area connected to it. It should have easy access to Medical Record Department
(MRD), X-ray, Laboratory, Pharmacy and Billing counter. It should be easily accessible
to Casualty, but should be separated from Casualty.
Laboratories
The following laboratories are usually found in a hospital:
 Bacteriology Laboratory: It conducts tests

related to bacteria and the toxins produced by
them.
 Clinical Biochemistry Laboratory: It is involved
inconducting tests and research in biochemical
basis of diseases and clinical trials of new drugs.
 Haematology Laboratory: It is responsible for making haemoglobin
determinations, coagulation time studies, red and white cell counts and special
blood pathology studies for anaemia, leukaemia, etc.
 Parasitology Laboratory: it studies the presence of parasites and the cyst
and ovas of the parasites that are found in the faeces.
 Blood Bank: It has the responsibility for collecting and processing all blood
used in the hospital for transfusions. It makes studies on newborn infants who
may have haemolytic disease and does antibody studies on the prenatal client.
Laboratory services must be available day and night and the laboratories must be
located on the ground floor. Laboratory services should be easily accessible to the
outpatients.
21
Sector: Healthcare
Administration
The administration of the entire hospital cannot be vested on the administrator
alone. It is the collective responsibility of the medical professionals and supporting
staff. The administrative staff, depending upon the size of the hospital, comprises the
administrator, the assistant administrator, the business manager and the departmental
heads.
Purchasing Department
The purchasing department has the responsibility for purchasing all supplies and
equipment for the hospital.
Finance and Accounts Department
The Finance and Accounts Department has the responsibility for collecting the money,
paying for the supplies and equipment, handling all records pertaining to hospital
finance, keeping records of assets and liabilities and assist in budget preparation.
The business manager is responsible for the functions of the department and the
accountants help the business manager.
Exercise
Visit a hospital and write a function of the following departments of a hospital.
S.No. Name of Department Functions

1. Dietary Department
2. Laundry
3. Out Patient
Department
4. Laboratories
5. Administration
Assessment
I. Short Answer Questions
a) Describe three services provided by the Medical Record Department.
b) Write a note on hospital housekeeping.
22
Sector: Healthcare
c) Describe two services provided by outpatient Department.
d) Suppose you are a General Duty Assistant, and a patient approaches you, to
direct him to the laboratory for blood test. What will you do?
II. Fill in the blanks

1. The blood test is done in Laboratory
2. A sanitary attendant should be allocated a work-area of
square feet, keeping in view the policies of the hospital.
activity:
Part A
1. Roles and functions of various types of laboratories.
2. Roles and functions of administration and accounts.
Part B
1. Why a hospital needs so many departments and sections?
2. Why different types of laboratories should be established in a hospital?
3. Why utmost cleanliness and sanitation should be maintained in a hospital?
activity:
23
Sector: Healthcare
Part A
1. Roles and functions of various types of laboratories.
2. Roles and functions of administration and accounts.
Part B
1. Why a hospital needs so many departments and sections?
2. Why a different types of laboratories should be established in a hospital?
3. Why utmost cleanliness and sanitation should be maintained in a hospital?
Part C
Demonstrate the knowledge of roles and functions of supporting
departments in a hospital.
Demonstrate the knowledge of roles and functions of various types
of laboratories in a hospital.
Draw a chain of command in the various department and
laboratories of hospital
Session 3: Classify Hospitals

Relevant Knowledge
In this session you will learn about the classification of hospitals. Hospitals have
been classified, on the basis of different criteria, which include size or bed capacity,
ownership or control, objectives of the hospitals.
1. Size or Bed Capacity: The size of a hospital is determined by the number of beds
it has. Based on the bed capacity, hospitals can be categorized as follows:
1. Small hospital - Bed capacity of 100 or less.
2. Medium size hospital - Bed capacity of 101 to 300 beds.
3. Large hospital - Bed capacity of 301 to 1000 beds.
The bed strength of different types of hospitals is as follows:
1. Teaching and Referral Hospital - 200 to 300
2. District Hospital - 50 to 200
3. Taluka Hospital - 50 to 200
4. Community Health Centre - 30 to 50
24
Sector: Healthcare
5. Primary Health Centre - 6 to 10

2. ownership or Control: On the basis of ownership or control, hospitals are
classified into the following:
1. Government or Public Hospital: These are run by Central or State
Governments or local bodies on non-commercial lines. These are funded by
the government. They can be general or specialized hospitals.
2. Non-Government Hospitals: They are supported by client’s fees, donations, or
endowments (relating to funds or property donated to institutions or individuals).
Non-government hospitals are further classified as either proprietary or non-
profit organization. Proprietary hospitals are owned by individuals, partnerships
or corporation whose dividend is shared by the partners. They can be
categorized as follows:
a) Voluntary Hospitals: These are estab-
lished and incorporated under the
Societies Registration Act 1860 or Public
Trust Act 1882 or any other Central or State
Governments. They are run by public or
private funds on a non–commercial basis.
b) Private Nursing Homes / hospitals:
They are generally owned by an individual
doctor or group of doctors and they are
run on a commercial basis.
c) Corporate Hospitals: They are public limited companies formed under
the Companies Act and are run on commercial lines. They can be either
general or specialized or both.
3. objectives of the Hospital: Based on the objectives, hospitals can be classified
into the following:
1. Teaching-Cum-Research Hospital: The primary objective is training of
doctors and research. Healthcare is secondary. For example, Medical Colleges.
2. General Hospitals: These hospitals offer treatment for common diseases.
The main objective is to provide medical care, whereas teaching is secondary.
3. Specialized Hospitals: These hospitals concentrate on giving medical and
nursing care in a specific area, e.g. ophthalmic hospital, heart hospital, etc.
4. Isolation Hospital: This is a hospital in which client requiring isolation or
clients suffering from communicable diseases are taken care of.
5. Rural Hospitals: They are located in rural areas permanently staffed by
at least one or more physicians, which offer inpatient accommodation and
provide medical and nursing care for more than one category of medical
discipline.
4. Systems: According to the system of medicine, hospitals are classified into the
following:
1. Long – Term Care Hospitals or Chronic Care Hospital: In this client stays in
25
Sector: Healthcare
the hospital for a long time and the disease may be of chronic nature (Chronic
Disease is a long-lasting condition that can be controlled but not cured), e.g.
leprosy (leprosy is an infectious disease that causes severe, disfiguring skin
sores and nerve damage in the arms and legs), cancer, etc.
2. Short – Term Care Hospital or Acute Care Hospital: In this the client stay in
the hospital for a short period only and the disease is usually of acute nature,
e.g. pneumonia gastroenteritis.
5. Management: According to the management, hospitals are classified as follows:
1. Hospitals Run by Union Government /
Government of India: These hospitals are
funded by Government of India. For example,
hospitals run by railways and army.
2. Hospitals Run by State Government:
These are hospitals which are funded and
administered by State Government.
3. Hospitals Run by Local Bodies: E.g. hospitals run by municipality, Zila
parishad, Panchayat, etc.
4. Autonomous Bodies: These hospital have the operational responsibility
to the hospital governing board, usually granted by the government. The
management authority with respect to personnel administration and budget
administration rests with the governing board for more efficient performance
and more discretion by management to achieve it.
5. Private Hospital: A private hospital is owned by a profit company or a non-
profit organisation and privately funded through payment for medical services
by patients themselves.
6. Voluntary Hospital: It is a hospital supported in part by voluntary contributions
and under the control of a local, usually self-appointed board of governors.
Levels of Medical Care
It is customary to describe healthcare service at 4 levels, viz., primary, secondary,
tertiary and quaternary care levels. These levels represent different types of care
involving varying degree of complexity.
1. Primary Care Level: Primary care providers may be doctors, nurses or physician
assistants. Primary healthcare is the first level of contact with individuals, the
family and community, where “primary health care” (essential healthcare) is
provided. As a level of care, it is close to the people, where most of their health
problems can be dealt with and resolved. It is at this level that healthcare will
be most effective within the context of the area‘s needs and limitations.
In the Indian context, primary health care is provided by the Primary Health
Centres (PHCs) and their sub-centres through multipurpose health workers,
village health guides and trained Dais. Besides providing primary healthcare,
the village “healthcare centres” bridge the cultural and communication gap
between the rural people and organized health sector.
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Sector: Healthcare
2. Secondary Care Level: The next higher level of care is the secondary
(intermediate) healthcare level. At this level more complex problems are dealt
with. In India, this kind of care is generally provided in district hospitals and
community healthcare centres which also serve as the first referral level.
Secondary care simply means you will be taken care of by someone who has
more specific expertise. Specialists focus either on a specific body system
or on a specific disease or condition. For example, if there is problem with
heart and its pumping system, then the client need to consult a Cardiologist.
If someone is suffering from problems related to hormone systems and some
specialize diseases like diabetes or thyroid disease, then he/she needs to
consult an Endocrinologist.
3. Tertiary Care level: The tertiary level is a more specialized level than
secondary care level and requires specific facilities and attention of highly
specialized health workers. This care is provided by the regional or central
level institutions. For example, highly specialized equipment and expertise is
required for coronary artery bypass surgery.
4. Quaternary Care: Quaternary care is an extension of tertiary care and is
more specialized and highly unusual, therefore every hospital or medical
center cannot offer quaternary care. It includes experimental medicine and
procedures.
Exercise
1. Visit any 3 hospitals and fill the information in the table given below:
Name of Hospital:
Type of Ownership
Management
Objectives of Hospital
System of Medicine
Bed Capacity
Level of Healthcare
No. of Doctors
No. of Nurses
No of General Duty
Assistant
2. Visit any 03 hospitals and fill the information in the table given below:
Name of Hospital Number of Beds Type of Hospital (small,
medium, large)
27
Sector: Healthcare
Assessment
I. Fill in the Blanks
1. A highly specialized hospital comes under level.
2. The bed strength of the Community Health Centre is .
activity:
Part A
1. Corporate hospital and voluntary hospital.
2. Hospital and Community Health Centre.
Part B
1. How hospitals are categorized based on bed strength?
2. How hospitals are categorized based on levels of medical care?
Part C
The performance Standard may include, but not limited to:
Identify the type of hospital based on bed strength, speciality and level
of medical care
Session 4: Describe the Role of and Function of General

Duty Assistant/Paitent Care Assistant
Relevant Knowledge
In this session, you will learn about the role and
functions of General Duty Assistant/ Patient Care
Assistant in a hospital.
The purpose of healthcare services is to effectively
meet the total health needs of the community. Hospitals
play a major role in maintaining and restoring the
health of the community. The main functions of the
GDA are as follows:
 Promotive Functions: Health promotion is the process of enabling people to
28
Sector: Healthcare
increase control over health related problems and to improve health. It is not
directed against any particular disease, but is intended to strengthen the host
(client) through a variety of approaches such as health education, environmental
modification, nutritional support, lifestyle and behavioural changes. The GDA has
to educate the client on various aspects of health and nutrition. The GDA provides
information about health, treatment or therapy and lifestyle changes.
 Preventive Functions: It includes supervision of pervasion of normal pregnancies
and childbirth, supervision of normal growth and development of children, control
of communicable diseases, prevention of prolonged illness, provision of health
education services, occupational health services and preventive health checkup.
 Diagnostic Functions: The GDA helps the patient and health professional in
inpatient services involving medical, surgical and other specialties and specific
diagnostic procedures.
 Emergency Services functions: The GDA assists in emergency services required
for dealing with accidents, natural disasters, epidemics, etc. as per the instruction
of the healthcare team members.
 Caregiver: A GDA meets the client‘s holistic healthcare needs to promote health
and the healing process. The GDA provides treatment for specific disease and
applies measures to restore the emotional and social well–being of the client.
 Communicator: A GDA is required to communicate effectively with doctors, nurses
and other staff members, therefore he/she should possess good communication
skills.
 Curative Functions: It includes treatment of all ailments/diseases with the help
of healthcare team members. The GDA assist nurse in treatment of ailments/
diseases.
 Rehabilitative Functions: It include activities related to physical, mental and
social rehabilitation. The GDA ensures that the client returns to a maximal state of
normal functioning.
Exercise
a) How GDA can assist in prevention of spread of diseases?
b) What is the role of GDA in discharging the following functions by a hospital:

1 Promotive
2. Curative
3. Rehabilitation
29
Sector: Healthcare
4. Preventive
activity:
Part A
1. Preventive and curative role of GDA.
Part B
1. Why a GDA is expected to play so many role and functions?
2. How a GDA can effectively discharge various functions in a hospital?
Part C
Identify the role and functions of GDA in a hospital
Draw a diagram describing the various role and functions of GDA
Session 5: Understanding the Qualities of a General Duty

Assistant/Patient Care Assistant
Relevant Knowledge
In this session, you will learn about the qualities of
General Duty
Assistant/ Patient Care Assistant in a hospital.
A health team consists of a group of people who use
their skills to assist a client or his family. The personnel
commonly included in the health team are Physicians,
Nurses, Dietitian, Physiotherapist, Occupational
Therapist, Paramedical Technologist, Pharmacist,
Social Worker, etc.
The qualities that a GDA should possess to effectively deliver the services include the
following:
 The GDA must be loyal, honest, dependable and willing to carry out the Doctor‘s
30
Sector: Healthcare
and Nurse‘s orders in the matter of treatment and care of the client. Due respect
should be given to the Doctor’s and Nurse’s.
 The GDA should respect Nurses and give them full cooperation. The problems
experienced by the GDA in their work should be solved through Nurses. The
Nursing Superintendent has a complete control and responsibility of the Nurses
and the GDA.
 Any GDA who is senior even by a day must be treated with respect.
 Client is the most important person in the hospital. The client in the hospital
experiences new and unfamiliar surroundings. Due to hospitalization, the client
faces many physical and psychological problems. A GDA has to see that clients
feel homely. A GDA should help the client in adjusting to the new environment and
regaining health. A GDA should be sympathetic and understanding. He/she should
create confidence in the client about the care taken by the healthcare team. GDA
should help in establishing a good nurse–client relationship. He/she should always
speak of the client by his name and not by the bed number or disease. He/she
should be pleasant, cheerful and courteous, but should not become too informal.
GDA should not discuss personal affairs or whisper anything in front of client. GDA
should not have any personal reservations regarding caste, creed, etc.
Qualities of a General Duty Assistant
A General Duty Assistant has to provide service which calls for certain special qualities.
A GDA is required to provide personal care to the client, which include hygiene, bathing,
shampooing, shaving, nail trimming, dressing, skin care and so on. In order to provide
effective personal care, a GDA should possess the following qualities:
 Love for the fellow men
 Honesty and loyalty
 Discipline and obedience
 Alertness
 Technical competence
 Dependability and adjustability
 Ability to inspire confidence
 Resourcefulness, Ability to manage time and resources
 Courtesy and dignity
 Sympathy and Empathy
 Intelligence and common sense
 Patience and sense of humour
 Good physical and mental health
 Generosity
 Gentleness and quietness
Exercise
1. Write any three essential roles and functions of GDA in the table given below:
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Sector: Healthcare
Roles and functions of GDA in supporting the healthcare team member

1.
2.
3.
Assessment
a) List five qualities of a General Duty Assistant.
activity.
Part A
1. Sympathy and empathy.
2. Physical and mental health.
3. Gentleness and generosity.
Part B
1. Why is it important for a GDA to be pleasant and courteous to his/her client?
2. What are those qualities that a GDA should possess while dealing with
patient?
Part C

Demonstrate the knowledge of developing and maintaining
good relationship with people.
Demonstrate the ability to provide personal care.
32
UNIT – 2
INTRoDUCTIoN To CARE PLAN AND CARE

oF PATIENTS
Sector: Healthcare
Learning outcomes
Unit 2 INTRoDUCTIoN To CARE PLAN AND CARE oF PATIENTS
Duration: 25 Hours
Classroom/ outcome Evaluation Evaluation Training Method
Hospital/
 Identify the role  Describe the  Enlist the various Interactive
Clinic of General Duty objectives of steps involved in Lecture:
Assistant in care plan. formulating a care  Role of General
implementing  Describe the role plan. Duty Assistant
Care Plan. of General Duty  Identify role of in preparation
Assistant in General Duty and implemen-
preparation and Assistant in tation of Care
implementation of formulating care Plan.
care plan. plan.  Activity:
Visit a nearby
hospital and
study the care
plan prepared
for the patient
care.
 Demonstrate  Describe the  List the various Interactive
the knowledge characteristics of types of diet Lecture:
of roles of a healthy person. available in the  Feeding Pa-
General Duty  Describe the hospital / home. tients.
Assistant in various types of  Demonstrate the  Activity:
feeding a diets and their knowledge of Visit a hospital
patient. importance with feeding and and observe
regard to nutrition. assisting patients the type of
with their meals, diets being
according to their served to differ-
needs and in a safe ent patients.
and dignified  Observe the
manner. procedure ad-
opted by the
General Duty
Assistant /
Nurses in feed-
ing patients.
 Prepare a diet
chart for feed
ing a patient.
 Identify and  List the important  Demonstrate the Interactive
report vital vital signs of the knowledge of Lecture:
signs. body. taking temperature  Identify and
 Describe the reading pulse rate Reporting vital
abnormal vital and measuring signs.
signs. blood pressure.
 Fill the form for  Activity :
documenting Visit to nearby
information on vital hospital and
signs. observe the
34
Sector: Healthcare
Learning outcomes
 procedures and
recording being
done for vital
signs.
 Prepare bed  Describe the  Demonstrate the Interactive

according to the features and knowledge of Lecture :
patient’s need. importance of articles used in bed  Preparing Bed
various types of making. for Patients.
bed in a hospital.  Demonstrate the
 Describe the steps involved in  Activity :
various steps of in making of open Visit a nearby
bed making. bed. hospital and
 Describe the role learn the steps
and function of for making bed.
General Duty
Assistant in bed
making.
 Position the  Enlist various  Identify the various Interactive
patient accor- position of patients position of a Lecture:
ding to the  Describe therape- patient.  Positioning the
need. utic position.  Demonstrate the patient.
 Describe the procedures for
importance of changing the  Activity :
Fowler’s position. patient’s position. Visit a nearby
hospital and
learn the vari-
ous position in
which patients
. are placed on
the bed
35
Sector: Healthcare
Session 1: Describe the Role of General Duty Assistant

Patient Care Assistant in Care Plan
Relevant Knowledge
In this session, you will learn about the role of General
Duty Assistant (GDA)/Patient Care Assistant (PCA)
in the implementation of a “Care Plan”. A Care Plan
outlines the care to be provided to an individual. It is
a set of actions that the GDA will have to implement
to support patient care. The terms Plan of Care and
Care Plan are used interchangeably. The Care Plan
provides a systematic method of individualized care
that focuses on the patient’s response to an actual
or potential alteration in health, based on patient’s
assessment. This plan reflects all disciplines involved
in providing care to the patient. It communicates pertinent patient problems or needs,
outlines appropriate medical and nursing interventions to meet these needs, and
documents the effectiveness of those interventions in the medical record.
Characteristics of a Care Plan
The purpose of a care plan is to guide all who are involved in the care of a person and
to provide appropriate treatment in order to ensure optimal outcome during the stay in
hospital. The care plan process is dynamic and ever changing as the patient’s identified
needs change and/or problems are resolved. It involves the following processes:
1. Collection and recording health status.
2. Analysis of health status data.
3. Priorities and actions for care.
4. Implementation of Care Plan.
5. Evaluation of Care Plan.
A Care Plan has the following characteristics:
1. It is holistic and is based on the clinical judgment
of the nurse using assessment data.
2. It is based upon identifiable nursing diagnoses (actual, risk or health promotion),
which include clinical judgments about individual, family or community’s experiences
/ responses to actual or potential health problems.
3. It focuses on client-specific nursing outcomes that are realistic for the care recipient.
4. It includes nursing interventions which are focused on the risk factors.
5. It relates to the future course of actions.
objectives of Care Plan
The various objectives of a care plan includes the following:
36
Sector: Healthcare
 To provide each patient an individualized plan of care so that the patient can
be cured at the earliest.
 To determine priorities for action.
 To provide for effective communication among the nursing staff and
professionals from other disciplines.
 To encourage patient participation in planning patient‘s care and taking
decisions about patient healthcare.
 To provide for continuity of care, planning for further actions, and goal setting.
 To assist in documentation of the patient’s response and recovery.
Steps in Administration of Care Plan
The five steps involved in the planning and implementation of Care Plan are as follows:
Step 1 : Assessmentw
A systematic collection and analysis of history and health data about a client is the first
step in delivering nursing care and preparing a Care Plan. Assessment includes not
only physiological data, but also psychological, socio-cultural, spiritual, economic, and
life-style of the client.
All patients shall be assessed on admission, and a written Care Plan should be
developed and initiated within 8 hours of admission. The Care Plan shall reflect those
standards of care applicable to that individual. Care plan preparation process may vary
with hospital.
The admission assessment provides evidence of the patient’s history. The Care Plan,
along with the history/assessment reflects integration of information from various
disciplines involved in care of the patient and provides for identification of individualized
patient needs/problems and care prioritization. It helps in setting long term and short
term realistic measureable goals with target date for resolution of problem.
Step 2 : Problem Identification
It is the clinical judgment about the client’s response to actual or potential health
conditions or needs. It reflects not only that the patient is in pain, but that the pain has
caused other problems, such as anxiety, poor nutrition, and conflict within the family or
has the potential to cause complications.
Step 3: Planning Interventions
Based on the assessment and problem Identification, the GDA sets measurable and
achievable short-and long-range goals for the patient that might include moving from
bed to chair, maintaining adequate nutrition by giving smaller and more frequent meals,
resolving conflict through counselling or managing pain through adequate medication.
A GDA can assist the nurse in making care plan.
Step 4: Implementation
When care is implemented according to the care plan, continuity of care for the patient
during hospitalization and in preparation for discharge needs is assured. Care is
37
Sector: Healthcare
documented in the patient’s record and the progress in resolving the health problem is
continuously monitored.
Step 5: Evaluation / outcomes
Both the patient’s status and the effectiveness of the nursing care must be continuously
evaluated, and the Care Plan should be modified as per the need of the patient.
Assessment
Evaluation/ Problem
outcome Identification
Planning
Implementation
Interventions
Exercise
1. Visit a hospital nearby and see the care plan prepared for a patient. The format of
the care plan will look something like the one given below:
Nursing Care Plan
Name: Area: Date:
Year/Section: Clinical Instructor Group No.
Assessment Nursing Scientific Planning Interventions Rationale Evaluation

Diagnosis
Explanation
of the
Problem
1. Subjective 1. Dependent
2. Independent
2. Objective 3. Interdependent
2. Suppose you have a grandmother who is 80 years old and takes medicine in the
forenoon and evening. She is suffering from diabetes and hypertension and needs
medication on time before the meals. Consult a doctor and prepare a Care Plan
for your grandmother. Collect the sample of Care Plan being implemented in the
hospitals.
38
Sector: Healthcare
Assessment
a) What is Care Plan?
b) What are the characteristics of Care Plan?
c) What are the objectives of formulating a Care Plan?
II. Fill in the blanks

1. The Care Plan is a process.
2. is first step of preparing a Care Plan.
3. The Care Plan is formulated within hours of patient
admission.
activity.
Part A
1. Care plan and care management
2. Care plan and care standards
Part B
1. What are the advantages of a care plan?
2. What are the most essential data elements for preparing an effective care plan?
Part C
Demonstrate the knowledge of various steps of care plan.
Identify the role of GDA in formulating care plan.
39
Sector: Healthcare
Session 2: Feed a Patient
Relevant Knowledge
All staff of a hospital should understand the fundamental importance of nutritional care
and treatment of patients. In this session, you will learn about the various aspects of
nutrition and the role of General Duty Assistant in feeding a patient.
Nutrition
Nutrition is a basic human need that changes
throughout the life cycle and along the wellness-
illness continuum. Food provides nutrition for the
body and mind. Eating is not only a necessity in life,
but it may also be a source of pleasure, a pass time,
a social event, or an integral component of a medical
treatment. Because nutrition is vital for life and health,
and a poor nutrition can seriously decrease one’s
level of wellness, therefore it is a vital component of
nursing. Nutrition is the science of food and nutrients
and of the process by which an organism takes them in
and uses them for producing energy to grow, maintain
function and renew itself. Nutritional status is the condition of the body resulting from
the use of essential nutrient available to it. A client’s nutritional status may be good,
fair or poor depending on the intake of dietary essentials, on the relative need for them
and on the body’s ability to use them. A good nutritional status is essential for normal
growth, development and functions of the organs, or normal reproduction, growth and
maintenance, for optimal activity and working efficiency, for resistance to infection and
for repair of injury.
Factors affecting Nutritional Status
A person’s dietary pattern is usually slow to change because food habits are deeply
rooted in the past. Food choice has always been influenced by non-nutritional factors
including religious taboos, ethnicity, gender roles and social status.
Characteristics of a Well-Nourished Person
1. Normal weight and height for age, body build up and developmental stage.
2. Adequate appetite.
3. Active and alert.
4. Firm and healthy skin.
5. Erect posture with straight arms and legs.
6. Well – developed muscle without excess body fat.
7. Normal schedule of tooth eruption and healthy teeth and gums.
8. Normal urinary and bowel elimination patterns.
9. Normal sleep patterns.
10. Normal haemoglobin, haematocrit and serum protein levels.
11. Absence of diet related abnormalities.
40
Sector: Healthcare
Signs of Poor Nutrition

 Hair: Thin, coarse, lacking luster, breaks easily.
 Skin: Excessive bruising, bleeding, pressure sores, poor wound healing, lack
of growth.
 Skeletal: Motor weakness, poor posture, painful joints, bowed legs, increase
in bone fracture.
 Mental: Confusion, motor weakness.
Types of Diets Served in Hospital
A good diet must have all four food groups. The four food groups are as follows:
 Dairy Products: cheese, milk, paneer, ice cream, etc.
 Meat: chicken, fish, red meat, etc.
 Fruits and vegetables: apples, pears, lettuce, tomatoes, orange juice and
potatoes.
 Grains: Chapati, bread, cereals.
Full Diet
It is a regular, well–balanced and normal diet. It is
either vegetarian or non–vegetarian. It is served for
clients who do not require any modification.
Soft Diet
It is full diet but consisting of food substances that are
easy to chew and digest. Some clients, particularly
the aged clients cannot take food which require
chewing or the food that is difficult to digest. A soft
diet is enjoyed by these clients. A soft diet may include
double boiled rice, soft – cooked pulses and dals,
steamed fish, poached eggs, custards, sliced bread,
sieved cooked vegetables, cooked or ripe bananas,
dalia, etc.
Liquid Diet
Liquid diets must be used for clients who are unable
to take or tolerate solid food. It consists of clear fluids
(non – residual diet) and full fluid diet (residual fluid
diet).
 Clear Fluid Diet: Clear fluids are used
when there is a marked intolerance to foods
and roughage. These include clear tea,
weak black coffee, clear soups, whey water,
strained fruit juices, soda water and other
aerated beverages. Such fluids have particularly no food value, but can help
to maintain the fluid balance of the body. Calories can be added by the use of
sugar or glucose. Clear fluid diet should be used only for a short time since the
clients may develop deficiency symptoms.
41
Sector: Healthcare
 Full Fluid Diet: Full fluid diet is given when the total nutrition of the client has
to be maintained by fluids for a considerable time. This is necessary when a
client is unable to swallow solid food or if the client is fed by tube feeding. Milk
forms the basis of the diet. To this can be added egg in the form of egg flips,
thin custard, etc. to supply calcium, protein vitamin A, and iron calories can be
made up from carbohydrate in the form of starch in thin cereal preparation or
by adding sugar or glucose. Adequate amounts of vitamins can be supplied in
the form of medical concentrates. Salt should be added unless it is restricted.
Special Diets
Many pathological conditions bring about changes in the body process which
necessitate addition or omission of certain nutrients in the diet, as part of the treatment.
Some of the special diets served in the hospitals are as follows:
 High caloric or low caloric diet.
 High protein or low protein diet.
 Low salt or salt free diet.
 Sippy‘s diet (a bland diet for the treatment of peptic ulcer consisting mainly of
measured amounts of milk and cream, farina, and egg taken at regular hourly
intervals for a specified period of time).
Diet in Sickness
Diet is as important as medicine in the treatment of disease, a modification in the diet
or in the nutrients can cure certain diseases. For example, a client suffering from peptic
ulcer needs a bland diet for his recovery. Similarly, a salt free can reduce the blood
pressure in a client with hypertension. When a person is ill, the food intake becomes
a problem. The GDA’s responsibility with regard to the nutrition of the patient can be
analyzed into four major areas:
1. Assisting clients to obtain needed nourishment, either through feeding or
assisting with eating e.g. tube feeding, feeding a helpless client to eat his food,
etc.
2. Motivating client to eat.
3. Assisting clients to obtain needed nourishment by proper planning of the diet.
4. Assisting clients with special problems about therapeutic diets, etc.
5. Helping a client to accept a salt free diet.
6. Refer charts of dietician.
Principles Involved in Diet Therapy
Diet therapy refers to the usage of food and nutrition in creating the best possible life
for you through health and wellness. Some illnesses can be effectively managed by
altering your diet, and diet therapy is sometimes used to effectively manage health and
wellness. Some of the principles involved in the diet therapy are as follows:
1. The diet must be planned in relation to changes in metabolism, occurring as a
result of disease.
2. The diet must be planned according to the food habits of the client, based on
culture, religion, socio-economic status, personal references (likes and dislikes),
42
Sector: Healthcare
physiological and psychological conditions, hunger, appetite, as well as their

conditions.
3. Changes in the diet should be brought gradually and adequate explanation should
be given to the client for the changes made.
4. In short and acute illness, food should not be forced because as appetite is very
poor and the client may soon recover the normal appetite, but in prolonged illness
it is essential to provide adequate food to prevent wasting of tissues and proper
wound healing.
5. Whatever the diet prescribed, a variety of food should be selected for the diet.
6. Small and frequent feeds are preferred to the usual three meals.
7. Hot food should be served hot and cold foods should be served cold.
General Instructions for GDA in Feeding Patients
1. The diet of every patient in the hospital should be planned according to
his need, metabolic changes, food habit and socio-economic status.
2. Prepare the patient or resident for the meal.
3. Wash or ask the person to wash hands and face. Give time for mouth
care. Make sure that the clothes are clean. Ask if the patient would like to
use the bathroom, commode, urinal or bed pan before eating the food.
4. All food, regardless of who prepares it or serves it, should be presented
to the patient in an appealing way.
5. Food and drink should be served at the correct temperature for patient
preference and meets safety standards at all times.
6. Create a pleasant environment for the patient before serving the food.
7. Room should be well ventilated during the meals. Attractive surroundings
and a cheerful atmosphere add to the enjoyment of a meal by the patient.
The environment should be free from anything offensive to the senses,
such as noise, disorder, confusion, dirt unpleasant odours, excessive
heat or cold, etc.
8. The patient should be undisturbed by treatments dressings, visitors,
doctor’s rounds, loud cries of other patients during their meal times.
9. Dressings and painful treatments are finished at least 1 hour before meal
is served.
10. Offer bedpans or urinals about half an hour before serving meals so that
the patients are not disturbed during meal.
11. Strong emotions of fear, worry, anger, depression, homesickness, pain,
etc. interfere with digestion by inhibiting the flow of saliva, gastric and
intestinal juices. Eating should be postponed until a strong emotion on
excitement of the patient subsides.
12. Playing a soft music adds to the pleasure of the patient and can serve as
appetizer to the meals.
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Sector: Healthcare
13. The patient should be placed in a comfortable position in bed or out of

bed.
14. The bed patients should be able to see the food or they should be told
what food is served. The patients on tube feeding may be given a chance
to taste the food so as to arouse the appetite and for their satisfaction.
15. Physical exhaustion can be relieved by allowing to rest before a meal.
16. If the GDA sits near the patients and engages in the conversation, it
makes the meal a pleasure experience for the patient.
17. Meals should be served in clean and covered containers.
18. Care is to be taken to prevent transmission of diseases through the food
and drinks.
19. Provision should be made to wash hands and the face of the patient
before and after the meals.
20. Remember that a sick person has a poor appetite and poor liking for food.
Small and frequent feeds are appreciated. Never force the food.
21. The food should be cut into small pieces (mouth-sized) and is served one
piece at a time, one food after another.
22. The patient should have time to chew and taste the food. Never make
hurry to the patient.
23. The patient should be encouraged to take a variety of foods.
24. Fluid requirement should be met to prevent dehydration. Fluids are given
at the end of a meal or in between the meals.
25. Keep the patient in a sitting position for at least 30 minutes after the meal
so they do not choke.
26. The quantity of food that is left in the tray, the food that is vomited if any,
any signs of allergies developed after taking food should be reported to
the Dietician by the GDA so that appropriate and timely action can be
taken.
27. The GDA should record and report the quantity of food the patient has
eaten.
Exercise
1. Visit a hospital and observe the procedure adopted by the General Duty Assistant/
Nurse in feeding patients.
2. Visit near by hospital and observe the type of diets being served in the hospital
to different patients. Fill the name of food in the table given below for any three
patients.
Patient No. (Code Diagnosis of the Type of Diet Name of Food

No.) Patient
44
Sector: Healthcare
Assessment
a) What is the difference between nutrition and nutrient?
b) What are the characteristics of a healthy person?
II. State whether the statement is true or false

a) A good appetite is a sign of good health .
b) A balanced diet is an essential part of recovery from medical treatment .
c) Culture, ethnic, and religious restrictions of food must be considered while planning
a diet of a patient .
d) A patient should be kept in a sitting position for at least 30 minutes after the meal
.
e) Patients should be fed during strong emotions of fear, worry, anger, depression,
homesickness or pain .
activity:
Part A
1. Soft diet and liquid diet.
2. Clear fluid diet and full fluid diet.
Part B
Discuss in class the following:
1. What are the special needs of patients with respect to nutrition and meals?
2. What are the precautions to be taken while serving meals to a patient?
Part C
Identify the various types of diet available in the hospital/home.
Demonstrate the knowledge of feeding and assisting patients with their
meals, according to their needs and in a safe and dignified manner.
45
Sector: Healthcare
Session 3: Identify Vital Signs and Report
Relevant Knowledge
Vital signs are measurements of the body’s most basic functions. Vital signs are a
basic component of assessment of physiological and psychological health of a client.
In this session, you will learn about the various vital signs and how to identify them.
Body temperature, pulse, respiration and blood pressure are the four vital signs of life.
Assessment of vital signs allows the GDA to identify specific life threatening conditions
and plan the needed GDA interventions. It also helps a GDA to detect changes in the
client’s health status.
Vital signs / cardinal signs in a normal healthy individual remain constant. Vital signs
are useful in detecting or monitoring medical problems. Vital signs can be measured in
a medical setting, at home, at the site of a medical emergency, or elsewhere.
Temperature
Normal human body temperature, also known as normothermia
or euthermia, depends upon the place in the body at which the
measurement is made, and the time of day and level of activity of
the person. Different parts of the body have different temperatures.
Rectal and vaginal measurements, or measurements taken
directly inside the body cavity, are typically slightly higher than oral
measurements, and oral measurements are somewhat higher than
skin temperature.
The commonly accepted average core body temperature (taken internally) is 37.0 °C
(98.6 °F). The typical oral (under the tongue) measurement is slightly cooler at 36.8°
± 0.4°C (98.2° ± 0.7°F), and temperatures taken in other places (such as under the
arm or in the ear) produce different typical numbers. Although some people think of
these numbers as representing the normal temperature, a wide range of temperatures
has been found in healthy people.
Preparations for taking temperature
a) Wash hands.
b) Select appropriate equipment.
c) Introduce self and explain the procedure to the patient.
d) Shake the glass thermometer to lower the chemical to < 960 or inserts the tip
of an electronic thermometer into a disposable probe cover.
Taking oral Temperature
a) Place the tip of the thermometer in posterior sublingual
pocket.
b) Maintains the thermometer in the mouth for at least
3-5 minutes.
c) Remove and wipe the thermometer with tissue from
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Sector: Healthcare
the stem towards the bulb in order to read the

calibrations accurately.
d) Read the temperature at eye level and rotate slowly
until chemical level is visualized then read to the
nearest tenth of a degree or the digital display on
an electronic thermometer.
e) Record the reading.
Taking a Rectal Temperature
a) Place the patient in a Sim‘s position with upper knee flexed. Drape the patient
to expose only anal area.
b) Wear gloves.
c) Prepare the thermometer.
d) Lubricate the tip of the thermometer with water or vaseline.
e) With dominant hand, grasp thermometer. With other hand, separate the
buttocks to expose anus.
f) Instruct the patient to take a deep breath. Insert the thermometer or probe
gently into anus: infant - ½ inch, adult- 1½ inches. If resistance is felt, do not
force insertion.
g) Hold in place for 1 minutes.
h) Wipe secretions off glass thermometer with tissue and dispose of tissue.
i) Read temperature same as oral.
j) Documents the reading
Taking an Axillary Temperature
a) Gain access to the axillary area (remove gown from
one side).
b) Make sure axillary area is dry; if necessary, pat dry.
c) Place the thermometer or probe into center of
axilla. Fold patient’s arm straight down and place
arm across the patient’s chest.
d) Leave the thermometer in place, usually 5 minutes
or until signal heard.
e) Remove and read the calibration accurately.
Conclusion
a) Shake thermometer down and clean the reusable thermometer with soapy
cold water or alcohol wipe in a twisting motion.
oR
Push ejection button and discard disposable cover on electronic thermometer.
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Sector: Healthcare
b) Return to appropriate storage container.

c) Wash hands.
d) Record the temperature on a piece of paper for future reference.
e) Assist patient to comfortable position.
f) Record the temperature on appropriate form.
Pulse
The pulse rate is a measurement of the heart rate, or the number of times the heart
beats per minute. As the heart pushes blood through the arteries, the arteries expand
and contract with the flow of the blood. Taking a pulse not only measures the heart
rate, but also can indicate the following:
a) Heart rhythm.
b) Strength of the pulse.
The normal pulse for healthy adults ranges from 60 to 80 beats per minute. The pulse
rate may fluctuate and increase with exercise, illness, injury, and emotions. Females
aged 12 years and older, in general, tend to have faster heart rates than do males.
Athletes, such as runners, who do a lot of cardiovascular conditioning, may have heart
rates near 40 beats per minute and experience no problems.
As the heart forces blood through the arteries, feel
the beats by firmly pressing on the arteries, which are
located close to the surface of the skin at certain points
of the body. The pulse can be found on the side of the
lower neck, on the inside of the elbow, or at the wrist. For
most people, it is easiest to take the pulse at the wrist.
If you use the lower neck, be sure not to press too hard,
and never press on the pulses on both sides of the lower
neck at the same time to prevent blocking blood flow to
the brain. When taking pulse, the following steps are followed:
a) Using the first and second finger tips, press firmly but gently on the arteries
until you feel a pulse.
b) Begin counting the pulse when the clock’s second
hand is on the 12.
c) Count pulse for 60 seconds (or for 15 seconds and
then multiply by four to calculate beats per minute).
d) When counting, do not watch the clock continuously,
but concentrate on the beats of the pulse.
Respiration Rate
The respiration rate is the number of breaths a person takes per minute. The rate is
usually measured when a person is at rest and simply involves counting the number of
breaths for one minute by counting how many times the chest rises. Respiration rates
may increase with fever, illness, and with other medical conditions. When checking
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Sector: Healthcare
respiration, it is important to also note whether a person has any difficulty breathing.
Normal respiration rates for an adult person at rest range from 12 to 16 breaths per
minute.
Blood Pressure
Blood pressure, measured with a blood pressure cuff and stethoscope by a GDA or
other healthcare provider, is the force of the blood pushing against the artery walls.
Each time the heart beats, it pumps blood into the arteries, resulting in the highest
blood pressure as the heart contracts. One cannot take his or her own blood pressure
unless an electronic blood pressure monitoring device is used. Electronic blood
pressure monitors may also measure the heart rate or pulse.
Two numbers are recorded when measuring blood pressure. The higher number or
systolic pressure, refers to the pressure inside the artery when the heart contracts
and pumps blood through the body. The lower number or diastolic pressure, refers to
the pressure inside the artery when the heart is at rest and is filling with blood. Both
the systolic and diastolic pressures are recorded as “mm Hg” (millimeters of mercury).
This recording represents how high the mercury column in an old-fashioned manual
blood pressure device (called a mercury manometer) is raised by the pressure of the
blood.
High blood pressure or hypertension directly increases the risk of coronary heart
disease (heart attack) and stroke (brain attack). With high blood pressure, the arteries
may have an increased resistance against the flow of blood, causing the heart to pump
harder to circulate the blood.
High blood pressure for adults is defined as 140 mm Hg or greater systolic pressure
90 mm Hg or greater diastolic pressure. These numbers should be used as a guide
only. A single elevated blood pressure measurement is not necessarily an indication
of a problem. Multiple blood pressure measurements should be taken over for several
days or weeks before making a diagnosis of hypertension (high blood pressure) and
initiating treatment. A person who normally runs a lower-than-usual blood pressure may
be considered hypertensive with lower blood pressure measurements than 140/90.
Aneroid Monitor
The aneroid monitor is less expensive than the digital
monitor. The cuff is inflated by hand by squeezing a rubber
bulb. Some units even have a special feature to make
it easier to put the cuff on with one hand. However, the
unit can be easily damaged and become less accurate.
Because the person using it must listen for heartbeats with
the stethoscope, it may not be appropriate for the hearing-
impaired.
Digital Monitor
The digital monitor is automatic, with the measurements appearing on a small screen.
Because the recordings are easy to read, this is the most popular blood pressure
measuring device. It is also easier to use than the aneroid unit, and since there is no
need to listen to heartbeats through the stethoscope, this is a good device for hearing-
impaired patients. One disadvantage is that body movements or an irregular heart
49
Sector: Healthcare
rate can change the accuracy. These units are also more expensive than the aneroid
monitors.
Before Measure Blood Pressure:
 Place the patient for rest for three to five minutes without talking before taking
a measurement.
 Place the patient on a comfortable chair, with back supported and legs and
ankles uncrossed.
 Place the patient still and place your arm, raised level with heart, on a table or
hard surface.
 Wrap the cuff smoothly and snugly around the upper part of arm. The cuff
should be sized to fit smoothly, while still allowing enough room for one fingertip
to slip under it.
 Be sure that the bottom edge of the cuff is at least one inch above the crease
in elbow.
It is also important, when taking blood pressure readings, that the date and time of day
are recorded along with the reading.
Alteration in Vital Signs

Vital Signs High Low
Temperature Hyperthermia Hypothermia
Pulse Tachycardia Bradycardia
Respiration Tachypnoea Bradypnoea
Blood Pressure Hypertension Hypotension
Exercise
1. Visit a nearby hospital and observe the procedures adopted for observing vital
signs
Fill the information in the table given below for any five patients
Name of the Temperature Pulse Respiration Blood Pressure
Patient/Code No.
Assessment
a) What is vital sign?
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Sector: Healthcare
b) List the important vital signs of the body.
I. Fill in the Blanks

1. The normal body temperature is .
2. Pulse and blood pressure are related to functioning.
3. The respiration rate is the a person takes per minute.
activity:
Part A
1. Psychological and physiological health.
2. Pulse rate and heart rate.
3. Hyperthermia and hypothermia.
4. Hypertension and hypotension.
Part B
1. What is the role of GDA in checking the vital signs?
2. What are abnormal vital signs?
Part C
The performance standards may include, but not limited to:
Demonstrate the knowledge of taking temperature.
Demonstrate the knowledge of reading pulse rate.
Demonstrate the knowledge of taking blood pressure.
51
Sector: Healthcare
Session 4: Make Bed for Patient
Relevant Knowledge
In this session, you will learn how to make bed for the client/patient. Comfort is a basic
need of all human being. Every individual require basic comfort like mattress, pillow,
good environment, comfort devices for a good sleep. Bed making is the procedure
adopted for making beds using scientific principles of nursing so as to provide maximum
comfort of the patient.
Bed Making
The purpose of bed making is as follows:
1. To provide the clients with a safe and
comfortable rest and sleep.
2. To give the ward a neat appearance.
3. To adapt to the needs of the client and
to be ready for any emergency or critical
condition of illness.
4. To economize time, material and effort.
5. To prevent bedsores.
6. To observe the client, for the presence of bedsore, oral hygiene, client’s ability of
self care, etc.
7. To promote cleanliness.
8. To establish an effective GDA – client relationship.
9. To provide active and passive exercise to the clients.
10. To help the relatives to learn to care for the sick at home.
Principles involved in Bed Making
1. Micro-organisms are found everywhere on the skin, on the article used by the
client and in the environment. The nurse takes care to prevent the transference of
micro-organisms from the source to the new host by direct or indirect contact or
prevent the multiplication of the micro-organisms.
2. A safe and comfortable bed will ensure good sleep and would thus help to prevent
several complications in bedridden clients e.g. bedsore, foot drop, etc.
3. Good body mechanism maintains the body alignment and prevents fatigue.
4. Systematic ways of functioning saves time, energy and material.
General Instructions for Bed Making
1. Wash hands before and after the procedure.
2. Do not expose the client unnecessarily.
3. Protect the client from draught.
4. Do not cover the client‘s face while placing the linen.
5. Do not mix clean linen with soiled linen.
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Sector: Healthcare
6. Never place the woolen blanket next to the client‘s body except the bath blanket
and never allow the client to lie down on the mackintosh without lining.
7. Shake the linen gently.
8. Do not let the linen touch your body or uniform.
9. Maintain good body mechanics.
10. Make the bed firm, smooth and unwrinkled.
11. Practice economy of time, energy and material.
12. Arrange the bed clothes in such a way that they allow freedom in the day time but
come over the shoulders at night and the top linen loose over the feet.
13. The cotton mattress should be turned, aired and made free of lumps and creases.
14. Make adaptations according to weather, climatic difference, individual needs,
customs and habits of our clients.
15. Always get extra help to make a bed for helpless client’s and prevent them from
falling. The side rails may be used to prevent them falling if extra help is not
available.
16. Keep a reasonable distance from the face of the client to prevent cross infection
17. Inspect the cot, mattress and pillow daily for the presence of vermin‘s and destroy
them if found on the bed.
Preparation
The usual articles in the client’s unit are:
 Cot
 Mattress and pillow
 Chair or stool
 Bedside table or locker
 Mackintosh
 Blanket
Articles needed for the compete change of linen are:
 Mattress cover
 Two Sheets (Bottom and top sheets)
 Draw sheet
 Pillow Case
 Counterpane
Additional Articles Needed Purpose

Laundry Bag To discard the soiled linen and to send the soiled
linen to the laundry.
Dusters One dry duster to dust the mattress and sheets.
One damp duster to dust the furniture.
A bowl with antiseptic lotion To carbolise the furniture.
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Sector: Healthcare
Different Types of Bed

1. Open bed
2. Closed bed
3. Admission bed
4. Occupied bed
5. Cardiac bed
6. Fracture bed
7. Amputation bed
8. Blanket bed
Preparation of Client and the Unit
1. Explain the procedure to the client to win the cooperation and confidence of the
client.
2. Explain how the client can assist.
3. Screen the client to provide privacy.
4. Move furniture away from the bed and move the bed away from the wall.
5. Lower the backrest, if any.
6. Place the chair at the foot end of the bed and place the clean linen on it in the
reverse order of use.
7. Place the laundry bag within the reach.
Stripping and Remaking an open Bed
1. Wash hands.
2. Remove the pillow and place it on the seat of the chair with the open end away
from the entrance.
3. Remove the top linen.
a) Loosen the top linen stating from the head end and proceed to the foot end.
b) Remove the sheets one by one, by folding them into one. Bring the lower
third over the middle third and fold the upper third over the lower third. Fold at
the centre towards you, so that it falls in six. Shake them gently, and place it
over the back of the chair if it is to be reused or put it in the laundry bag.
c) Remove the bedspread, blanket and top sheet separately, holding the open
end towards the floor.
4. Fold the draw sheet.
5. Bring the opposite end to the middle of the bed and the near end over it and thus
fold them into three. Place it over the chair.
6. Roll the mackintosh and place it over the chair.
7. Remove the bottom sheet folding it into six.
8. Remove the mattress cover if soiled.
9. Turn the mattress.
10. Dust the mattress with a dry duster.
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Sector: Healthcare
11. Clean all the surface of the furniture using a damp duster dipped in antiseptic
lotion. Dust the cleaner areas first and then the less clean area.
12. Pull the mattress to the top. Put on the mattress cover. If it is loose on the mattress,
the excess can be under the mattress.
13. Make the base of the bed on one side of the bed.
a) When placing the linen on the bed and when tracking them under the mattress,
face in the direction of the work and move with the work rather than twisting the
body and over reaching.
b) When tucking the linen under the bed, separate the feet slightly apart (one leg
forward and the other leg backward) an flex the knees instead of the back.
c) Accomplish a task with each movement, e.g. when placing the bottom sheet
on the bed begin at the foot end, smooth to the head end, trunk the head end
under the mattress.
d) Place the bottom sheet on the middle of the mattress. Making sure that the
central longitudinal crease in the longitudinal axis of the bed. Unfold it and
spread it straight over the mattress allowing 30 to 37cm to tuck under the top
of the mattress and leaving just enough at the foot end to tuck in.
e) Tuck it securely at the top in the near side. Make a mitered corner. Tuck at the
foot end, secure the corner as before. Tuck the sheet along the sides.
f) Place the mackintosh approximately 37 cm from the head end and truck it
along the side.
g) Place the draw sheet over the mackintosh, keeping it about 25 cm from the top
of the mattress.
h) Go to the opposite side and tuck the sheets in the same manner.
14. Return to the side of the bed first made. Place the top sheet with the wrong side
out. Unfold it with the top edge even with the top of the mattress.
15. Place the blanket over the top sheet 15 to 20 cm below from the top of the mattress.
16. If the bedspread is used place it over the blanket with the outer side out.
17. Make the head end of the linen. Cuff the bedspread under the blanket and then
bring the top sheet over the spread as second cuff. Make sure that it will reach upto
client’s chin.
18. Tuck at the foot end altogether or separately and make mitre corners allowing the
sides to hand free or tucked according to the hospital routine.
19. Put the pillow case on the pillow and place the pillow at the head end. The open
end away from the entrance. While putting on the pillow case the pillow should not
touch the GDA uniform.
After Care of Client
1. Help the client to get into the bed. One corner of the top linen is folded back to let
the client in. Cover the client with the top linen.
2. Any comfort devices used by the client should be replaced.
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Sector: Healthcare
3. See that the whole unit is clean and tidy before you leave the unit. Ensure the
following:
a) The beds in a general ward should be arranged in a straight line.
b) The bedpans, urinals, sputum cups, kidney trays, etc. lying in the client’s unit
are taken away, emptied, cleaned and put back in their proper places.
c) The windows and doors are dusted to keep them dust free.
d) The cupboards are dusted and the articles are arranged in order and according
to the use.
e) The water flasks is washed and filled with clean water.
f) The flower vases are arranged and replaced.
g) The washing sinks if provided in the unit are clean.
4. Send the laundry bag with the soiled linen to the laundry if stains are present on
the sheets. Remove them by appropriate methods before it is sent to the laundry.
5. If there are any blankets, put them in the sun and disinfect before they are stored
in the cupboard.
6. The duster is soaked in antiseptic lotion to disinfect it. Rinse it with clean water and
put to dry.
7. Record the observations made on the client.
GDA Responsibility in Bed Making
1. Check the doctor’s order for specific precautions regarding the movement and
positioning of the client.
2. Assess the client‘s ability for self care.
3. Check the furniture and linen available in the client‘s unit.
4. Assess the number of clean linen needed.
5. Assess the articles needed for the comfort of the client e.g. blankets, backrest etc.
6. Change the linen.
Exercise
1. Visit a nearby hospital and see the various comfort devices used. Record the
procedure adopted for bed making in the hospital.
Assessment
a) What is the purpose of bed making?
b) What are the different types of bed?
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Sector: Healthcare
c) Describe the responsibility of GDA in bed making.
d) Enumerate the steps involved in making of open bed.
activity:
Part A
1. Open and closed bed
2. Occupied and unoccupied bed
Part B
1. Why training is needed for bed making?
2. What are the precautions to be taken while shifting a patient?
Part C

Demonstrate the knowledge of articles used in bed making.
Demonstrate the knowledge of bed making.
57
Sector: Healthcare
Session 5: Demonstrate Patient Positioning
Relevant Knowledge
One of the basic procedures that a General Duty Assistant/Nursing performs most
frequently is that of changing the patient’s position. Any position, even the most
comfortable one, will become unbearable for a patient after a period of time. In this
session, you will learn about the procedure adopted for positioning the patients as per
the need. Reasons for Changing Patient’s Positions The following are the reasons for
changing a patient’s position on the bed:
1. It helps in promoting comfort and relaxation.
2. It relieves pressure on the diaphragm.
3. It improves gastrointestinal function.
4. It improves respiratory function.
5. It allows for greater lung expansion.
6. It prevents deformities and pain.
7. It stimulates circulation of blood.
8. It helps in giving a range of motion exercises for relieving from stress.
Shearing of skin occurs when skin is dragged across a hard surface. The deep layers
of the skin are torn by the resistance of being dragged, which in turn may lead to skin
breakdown and ulceration. To prevent the shearing of skin and infection, position of
the client is changed frequently. Friction and excoriation can disturb the skin integrity,
which in turn can cause infection.
Therapeutic positions are used to promote comfort of the client. Proper turning
and positioning allows the healthcare personnel to make clients as comfortable as
possible, prevent contractures and pressure sores, and facilitates diagnostic tests or
surgical intervention and make portions of the client’s body available for treatment or
procedures. While positioning clients, three factors must be remembered: pressure,
friction and shear force.
Common positioning postures and their brief description are given in the table below:
Prone Face down
Supine Lying on back
High Fowler‘s Head of the bed elevated (300 – 900)
Semi Fowler‘s Head of the bed elevated (300 – 450)
Dorsal recumbent Supine with legs flexed in an elevated position
Knee – chest Client rests on his knees and chest
Trendelenburg Supine with head lower than feet
Lateral Side – lying position
Sim‘s lateral (semi prone left Between prone and side – lying position
lateral position)
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Sector: Healthcare
Regardless of the specific position, general principles of body mechanics must be

utilized in changing any position. The following points must be remembered:
1. Maintain proper body alignment.
2. Support all body parts.
3. Avoid pressure especially over bony prominences by adequately padding
these areas.
4. Use pillow, splints, foot boards and foam protectors which are helpful in
maintaining the position.
Prone Position
The client lies flat on the abdomen with
head turned to one side. The head rests
on a pillow. One or both arms rest in a
comfortable way either beyond the head or
at the sides of the head.
Uses
1. Assess the hip joint.
2. Assess the posterior thorax.
3. Position the client with injuries, burns and surgeries of the back.
4. Give comfort.
5. Relive pressure from pressure sore prone areas by providing a change of
position.
6. For clients after anesthesia to prevent aspiration of saliva, mucus and blood.
Contraindication
1. Clients with respiratory or spinal problems.
2. Clients after abdominal surgery.
Supine/Dorsal / Horizontal Recumbent Position
The client lies flat on back with legs extended and knees slightly flexed. Supine is
horizontal position. Pillows may be used under the head, knees and calves to raise
heels off the mattress: cotton rings at the elbow and heels, air cushion under the
buttocks to take off the pressure and thereby prevent pressure sores. In bedridden
clients, a foot rest is used to prevent the foot drop.
Uses
1. For comfort of the client.
2. Assessment of vital signs.
3. Physical examination of head, neck, anterior thorax and checking peripheral
pulses.
4. After surgeries involving the anterior portions of the body.
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Sector: Healthcare
Dorsal Elevated or Semi – recumbent Position

Client lies in the bed with two or more pillow
which may be arranged in armchair fashion
to support the shoulders, arms and elbows.
Additional comfort may be provided by means
of pillow under the knees and foot support.
Uses
1. Clients in convalescence period.
2. Clients with minor respiratory diseases.
Lateral or Side–Lying Position
The client lies on the side with weight on his hips and shoulder. Pillows support and
stabilize uppermost leg, arm, head and back. In the position the trunk is at right angle
to the bed. To increase the base of support and comfort, one or both legs are bent and
both arms are extended in front of the body. Because the body weight is borne on the
shoulders and hips, the semi-prone or the semi-supine position is preferred. A pillow
under the head supports the head, a pillow at the back gives support to the back, a
pillow in front supports the arms and abdomen, a pillow in between the knees takes
the weight off the upper leg.
Uses
1. To relieve pressure on bony prominences of the back and sacral region.
Contraindication
2. Not to be used after hip replacement and other orthopedic surgery.
Left Lateral Position
In this lateral position, the client is placed on the left side, with one pillow under the
head.
Uses
1. For giving enemas.
2. For inserting suppositories.
3. To take rectal temperature.
4. For performing rectal examination.
Fowler’s Position
This is a more erect position, in which an
effort is made to maintain the position of the
client in sitting posture as nearly upright as
possible. In this, the client’s head is raised to
80°– 90°. This position can be maintained by
means of a back rest and additional pillows.
The arms should be supported on pillows so
that client sits with arms supported in an arm
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Sector: Healthcare
chair fashion. An air cushion under the buttoks prevents the pressure over the sacral
areas. The knees may be raised over knee pillow or a bolster to prevent the client from
slipping.
Uses
This position improves cardiac output, promotes ventilation and eases eating, talking
and watching TV.
1. To relieve breathing difficulty (dyspnoea).
2. To relieve tension on the abdominal sutures.
3. To help in the draining of the abdominal cavity.
4. To relax the large muscles of the back and thighs.
This position gives the client a sense of well – being and makes it easier for self care.
Contraindication
1. Not to be used after brain or spine surgery
Precautions
Change of position is important to prevent circulation from getting sluggish and
development of thrombosis and pulmonary embolism. The chance of thrombosis and
embolism is increased when knee pillows are used for a long period due to pressure
on the blood vessels.
Exercise
1. Visit a nearby hospital and observe the various positions in which patients are
placed on the bed.
Assessment
a) What is therapeutic position?
b) List out various positions of patients.
c) What are the uses of Fowler’s position?
activity.
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Sector: Healthcare
Part A
1. High Fowler and Semi-Fowler Positions.
2. Lateral or Side–Lying Position and Left Lateral Position.
Part B
1. Why position of patient’s should be changed frequently and as per need?
2. What are the precautions to be taken while changing the positions of patient’s?
Part C
Identify various positions used in a hospital.
Demonstrate the knowledge of changing the patient’s position.
62
UNIT – 3
STERILIZATIoN AND DISINFECTIoN

Sector: Healthcare
Learning outcomes
Unit 3 STERILIZATIoN AND DISINFECTIoN
Duration: 20 Hours
Hospital/
 Describe the  What is disease  Demonstrate the Interactive
Clinic
diseases  What is the proc- knowledge of Lecture:
caused by ess of infection common places  The disease
microorganism due to microbes. of the body were causing micro-
.  What is pathogen. microbes are organisms.
 What are the three commonly found.
vertices of the  Identify the  Activity:
epidemiological common places Visit a nearby
triangle. in the hospital with hospital and
 Differentiate highest rate of discuss with
between different infection the medical
types of microorga-  Identify the factors professionals
nisms. affecting the about the com-
occurrence and mon causes of
prevention of diseases.
disease causing
microorganisms.
 Demonstrate  State the common  Differentiate Interactive
the knowledge diseases. between bacteria, Lecture:
of common  Enlist the names virus, fungi and  Human dis-
human disease s of bacteria and parasites. ease and their
and their viruses causing  Differentiate the causal agents.
casual agents. diseases in knowledge of
 Activity:
human. human diseases
Visit a hospital
caused by the
and discuss
Bacteria, Virus,
with doctors
Fungi and
about the com-
Parasites.
mon human
diseases, their
source of infec-
tion of infection
and casual
agents.
 Demonstrate  Describe the  Enlist the common Interactive
the knowledge meaning of places of infection Lecture:
of the role of Hospital Acquired in the hospital.  Prevention and
professionals Infection (HAI)  Demonstrate the control of Hospi-
and staff  Describe the knowledge of tal Acquired
prevention and activities to be causes of HAI. Infection
control of performed by
Hospital DGA for controlling  Activity:
Acquired Visit to nearby
Infections. hospital and
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Learning outcomes
study the activi-
ties performed
by various pro-
fessional in
prevention of
microorganism
or hospital acq-
uired infection.
 Perform  State the difference  Perform physical Interactive
disinfection of between antiseptic, method of Lecture :
ward and sterilization and sterilization.  Disinfecting
equipment. disinfectant.  Enlist the common ward and
 Differentiate disinfectant used equipment.
between the the hospital.
physical agents  Enlist the chemical  Activity:
and chemical used for disinfecting Visit a nearby
agents used in glassware hospital and
disinfection and study the vari-
sterilization. ous method of
sterilization and
disinfection.
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Session 1: Describe the Disease Causing Microorganisms
Relevant Knowledge
In this session, you will learn about the disease causing microorganisms. A
microorganism (from the Greek: mikrós, “small” and organismós, “organism”) or a
microbe is an organism that is microscopic (too small to be seen by the naked human
eye). The study of microorganisms is called microbiology, a subject that began with
Anton van Leeuwenhoek’s discovery of microorganisms in 1675, using a microscope. A
microbe, which is another word for microorganism is a tiny individual living thing that is
way too small to be seen by the human eye alone. The only way this tiny organism can
be seen is by using a microscope. This is why microbes are often called “microscopic
organisms.” These organisms are found almost everywhere you can think of here on
Earth i.e. in air, water, soil, rock, plants, animals and the human body.
Microorganisms are very diverse. They include bacteria, fungi, archaea, and protists,
etc. Some microbiologists also include viruses, but others consider these as non-
living. Most micro-organisms are unicellular (single-celled), but this is not universal,
since some multicellular organisms are microscopic.
Microorganisms live in all parts of the biosphere including water, soil, springs, ocean,
and air. Pathogenic microbes are harmful, since they invade and grow within other
organisms, causing diseases that kill people, animals and plants. Some microbes can
live in very hot temperatures, and others can live in the freezing cold. Some need
oxygen to grow and stay alive, while others survive without it. In the table given
below, a list of some microbes that are found in our bodies are given. The number of
microorganisms living on and in us is about ten times higher than the number of cells
that make up our entire body.
Microbes in Healthy Human Body
Microbes found in
Ear (outer) Aspergillus (fungus)
Skin Candida (fungus)
Small Intestine Clostridium
Intestine Escherichia vaginails
Stomach Lactobacillus
Urethra Mycobacterium
Nose Staphylococcus aureus
Eye Staphylococcus epidermidis
Mouth Streptococcus salivarius
Large Intestine Trichomonas hominis (protozoa)
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What are disease causing micro-organisms?

How many times we have been told to wash our hands before sitting down at the dining
table or before taking food? By washing our hands with soap and water we clean our
hands and make them micro-organism free. We take baths, cook our food and even
cover our mouths when we cough and sneeze to prevent the spread of those tiny dirty
particles (the disease causing microbes) that could make us sick.
While some microbes play an important part in our daily lives by keeping us healthy,
others are nothing but bad ones. These “bad-ones” are called disease-causing
microbes and can make humans, animals and plants sick by causing infection and
disease.
Most microbes belong to four major groups: bacteria, viruses, protozoa or fungi.
Disease-causing microbes can also be called pathogens, germs or bugs and are
responsible for causing infectious diseases.
Bacteria (singular: bacterium)
Bacteria are unicellular microorganisms. They are typically a few micrometers long
and have many shapes including curved rods, spheres, rods, and spirals. Bacteria
are prokaryotic and unicellular beings. Bacteria have simple organization. They have
an external cell wall, plasma membrane, Circular Deoxyribonucleic Acid (DNA) within
the cytoplasm and ribosomes for protein synthesis. The bacterial cell wall is made
of peptidoglycans. Some bacteria are encapsulated, i.e., they have a polysaccharide
capsule outside the cell wall.
According to their necessity of oxygen, bacteria are classified into anaerobic (those
that survive without oxygen) and aerobic (those that do not survive without oxygen).
Obligate anaerobes are those living beings that do not survive in the presence of
oxygen. For example, the bacteria Clostridium tetani, agent of tetanus, is an obligate
anaerobe. In superficial wounds, it is common to use hydrogen peroxide to expose
anaerobic microorganisms to oxygen and kill them.
Bacteria reproduce by binary fission. Some bacteria, however, present a kind of sexual
reproduction (transformation, transduction or conjugation) with a combination of
genetic material from different individuals. Sexual reproduction occurs when bacteria
incorporate genetic material into other bacteria of the same species; the inserted
genetic fragment then becomes part of the genetic material of the second bacteria.
This kind of reproduction can happen by means of transformation, transduction or
conjugation.
Pathogenic bacteria have characteristics, known as virulence factors that help them
to parasite their host. Some bacteria have fimbriae, cilium-like structures that attach
the bacterial cell to the host tissue. There are bacteria specialized in intracellular
parasitism. Other bacteria secrete toxins, molecules that cause disease.
There are also bacteria that cause diseases. Some human diseases caused by bacteria
are tuberculosis, pertussis, diphtheria, bacterial meningitis, gonorrhea, syphilis,
bubonic plague, leptospirosis, cholera, typhoid fever, trachoma, tetanus, anthrax.
Fungi
Fungi are like plants made up of many cells. They are not called plants because they
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cannot produce their own food from soil and water. Fungi are eukaryotic, so they
possess a true nucleus. Bacteria are prokaryotic, meaning they do not possess a true
nucleus. Viruses can not reproduce on their own, so they are sometimes just classified
as infectious biological agents.
Virus
A virus (from the Latin noun virus, meaning toxin or poison) is a sub-microscopic particle
(ranging in size from 20–300 nm) that can infect the cells of a biological organism. A
virus may have a spiny outside layer, called the envelope. Viruses have a core of
genetic material, but no way to reproduce it on their own. Viruses infect cells and take
over their reproductive machinery to reproduce.
The main viral diseases transmitted by respiratory secretions (sneezes, cough) and by
saliva drops are flu, mumps, smallpox (variola, already considered eradicated), rubella,
measles, Severe acute respiratory syndrome (SARS). Main viral diseases transmitted
through blood or sexual contact are Acquired Immuno Deficiency Syndrome (AIDS),
hepatitis B, hepatitis C, Human Papillomavirus (HPV), ebola hemorrhagic fever. Main
viral diseases transmitted by animal vectors are rabies, dengue fever, yellow fever.
Some viral diseases transmitted by fecal-oral route, including contaminated food, is
Hepatitis A.
Flu is a disease caused by the influenza virus, a highly mutant DNA virus. Due to the
high mutation rate of the virus, that forms many different strains, flu always presents
epidemic features in affected populations and people may have several flu episodes
during life.
Rabies, also known as hydrophobia, is a viral disease. It is found in dogs, cats, bats
and other wild mammals. The transmission to humans occurs through the saliva of
contaminated animals, mainly through bites.
Smallpox is a viral infection like measles. Smallpox is transmitted by respiratory
secretions, saliva and objects in contact with contaminated patients. The disease is
characterized by the appearance of numerous vesicles on the skin of the face, trunk
and limbs that can suppurate and form crusts; smallpox complications can lead to
death. Measles is transmitted by saliva drops and respiratory secretions too.
Bacteria, fungi and viruses are all very different from one another. A big difference is
what cell coating they have surrounding their cells. Bacterial cell walls are made of
peptidoglycan, fungal cell walls are made of Chitin and Viruses have a protein coat
around their genetic material. Bacteria and fungi are all extremely small, requiring a
microscope to view them. All bacteria and viruses operate as single cell, whereas fungi
can be unicellular or multicellular.
Bacteria form colonies containing large numbers of individuals, whereas viruses do not
usually colonise areas, since they can not reproduce on their own.
Parasite
A parasite is any organism which lives inside a different organism in a symbiotic
relationship in which only the parasite benefits from the symbiosis. This means that a
parasite basically feeds off a host and the host suffers as a result of this. Parasites can
be as small as viruses, or as big as a metre-long tapeworms.
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Sector: Healthcare
Microbes – The ones that make us Sick

Pathogens are organisms that cause disease. They are frequently, but not necessarily
micro-organisms. Whether an organism is pathogenic depends on the species with
which it is in contact.
Not all micro-organisms are unicellular, and not all micro-organisms cause disease.
Many micro-organisms reside in or on animals or plants without seemingly causing
any harm. Indeed, in many cases the union is advantageous for both a relationship,
known as symbiosis, for example, the cellulose digesting bacteria in the rumen of
cattle.
It is Important to RememberThat:
 A pathogen is a micro-organism that has
the potential to cause disease.
 An infection is the invasion and multiplication
of pathogenic microbes in an individual or
population.
 Disease is when the infection causes
damage to the individual’s vital functions or
systems.
 An infection does not always result in
disease.
Infectious diseases caused by disease-causing
microbes are responsible for more deaths worldwide
than any other single cause! Microbes can quickly
develop new features that make them resistant
to the drugs that were once able to kill them. The
effects of infection by pathogenic bacteria are also
variable and can include the following:
 Fever
 Inflammation
 Antibody synthesis
 Shock (only in extreme cases)
 Impaired blood clotting (only in extreme
cases)
Some of the diseases caused by bacteria include
tetanus, whooping cough, pneumonia, gonorrhoea,
meningitis and some forms of tonsillitis.
How do Microbes Infect?
How do we actually get infected with a disease-
causing microorganism? Every day we come into
contact with people or animals that may be infected
with disease-causing microbes. This puts us at risk
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of being exposed to disease. Disease-causing microorganisms use simple tricks to

enter our bodies so that they can cause disease. These germs have developed the
ability to trick the human immune system and get past the body’s defense system,
just like a thief enters the house by breaking the lock at the door or enters through the
window.
Becoming infected depends on the link between the pathogen, the environment and
the host - the host being you or I. The infection method may be thought of as six
different steps that all join together to form a circular chain, as shown in the figure
below.
The process of infection begins with a certain disease-causing microbe being present.
It is the first link in the chain.
The second link is the reservoir, the environment
where the pathogen can survive. Examples of a
reservoir include water, soil and inside someone who
is already infected with the germ. Having a way to
escape from the reservoir makes up the third link. If
we are the reservoir, the pathogenic microorganism
can escape when we cough or sneeze.
The fourth link of the chain is the mode of transmission
from the reservoir to the host. If water is the reservoir,
its mode of transmission could be our drinking water
supply.
To cause infection, the pathogen must find a way inside the host. A pathogen in water
would enter us if we drank the water it was in. A pathogen in the air would enter us if
we inhaled it.
The final link of the chain is how susceptible the host is to infection. Depending on the
germ and the disease it causes, some hosts will be easier to infect than others.
To cause an infection, microbes must enter our bodies. The site at which they enter is
known as the portal of entry. There are four major portal of entry:
 Respiratory tract (mouth and nose) e.g. Influenza virus, which causes the flu.
 Gastrointestinal tract (mouth oral cavity) e.g. Vibrio cholerae which causes
cholera.
 Urogenital tract e.g. Escherichia coli, which causes cystitis.
 Breaks in the skin surface e.g. Clostridium tetani which causes tetanus.
To make host ill, microbes have to:
 reach their target site in the body.
 attach to the target site they are trying to infect so that they are not dislodged.
 multiply rapidly.
 obtain their nutrients from the host.
 avoid and survive attack by the host’s immune system.
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The Epidemiological Triangle

The word epidemiology comes from three Greek
root words: Epi-means “on, upon, befall”, Demo-
means “people”, -ology-means “the study of”. So
Epidemiology is literally defined as “the study of
that which befalls people.” The Epidemiologic
Triangle is a model that scientists have developed
for understanding infectious diseases and how
they spread. There are other factors relating
to the host and environment which are equally
important to determine whether or not disease
will occur in the exposed host.
The Triangle has three corners called vertices, with agent, host and environment.
1. The Agent: The agent or microbe that causes the disease (the “what” of the
Triangle) is the cause of the disease. When studying the epidemiology of most
infectious diseases, the agent is a microbe.
2. The Host: Hosts or organism harbouring the disease (the “who” of the Triangle)
are organisms, usually humans or animals, which are exposed to and harbour a
disease. The host can be the organism that gets sick, as well as any animal carrier
(including insects and worms) that may or may not get sick. Although the host
may or may not know that it has acquired the disease or have any outward signs
of illness, the disease does take lodging from the host. The “host” heading also
includes symptoms of the disease. Different people may have different reactions
to the same microbe.
3. The Environment: The environment or those external factors that cause or allow
disease transmission (the “where” of the Triangle) is the favourable surroundings
and conditions external to the host that cause or allow the disease to be transmitted.
Exercise
1. Visit a nearby hospital and discuss with the medical professionals about the
common causes of diseases.
2. Visit a microbiology lab in a nearby hospital and study the following:
 Agent, Host and Environment relationship.
 Bacteria, Viruses, Protozoa and Fungi.
 Pathogens and microbes.
Assessment
a) What is Disease?
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b) What are the three vertices of the epidemiological triangle?
c) What is pathogen?
activity.
Part A
1. Pathogen and parasite
2. Disease and disorder
3. Microorganism and pathogen
Part B
1. What is the process of infection caused by a pathogen?
2. What are the different modes of transmission of microbes?
Part C
Demonstrate the knowledge of differentiating between different types
of microorganisms.
Identify the factors affecting the occurrence and prevention of disease
causing micro-organisms.
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Session 2: Describe the Causal Agents of Common Human

Diseases
Relevant Knowledge
In this session, you will learn about the common diseases of human beings and their
causal agents. There have been many attempts to define disease. Webster‘s Dictionary
defines disease as “a condition in which body health is impaired, a departure from a
state of health, an alteration of the human body interrupting the performance of vital
functions”. The Oxford English Dictionary defines disease as a condition of the body
or some part or organ of the body in which its functions are disrupted or deranged.”
A disease is a particular abnormal, pathological condition that affects part or all of an
organism. Illness and sickness are generally used as synonyms for disease. A disease
is associated with specific symptoms and signs. Distinction is also made between
the words disease, illness and sickness which are not wholly synonymous. The term
“disease” literally means “without ease” (uneasiness) – disease, the opposite of ease –
when something is wrong with bodily functions. “Illness” refers not only to the presence
of a specific disease, but also to the individual’s perceptions and behaviour in response
to the disease, as well as the impact of that disease on the psychosocial environment.
“Sickness” refers to a state of social dysfunction. It is easy to determine illness when
the signs and symptoms are manifest, but in many diseases the border line between
normal and abnormal is indistinct as in the case of diabetes, hypertension and mental
illness. The end-point or final outcome of disease is variable recovery, disability or
death of the host.
Difference between Sign and Symptoms
Sign and Symptom are terms with different meanings. While symptoms are problems
that a patient notices or feels, signs are whatever a physician can objectively detect
or measure. For example, if a patient feels hot after fever, this is a symptom. When a
physician examines the patient, touches the patient’s skin and notes that it is warm, this
is a sign. Fatigue is a symptom while muscle weakness is a sign of fatigue. Therefore,
a symptom is a phenomenon that is experienced by the individual affected by the
disease, while a sign is a phenomenon that can be detected by someone other than
the individual affected by the disease.
Infectious Diseases
Infectious diseases are diseases caused by microbes that spread. There are many
diseases including common cold and flu (influenza) that are infectious in nature.
Infectious diseases are caused by microbes-organisms too small to be visible to the
naked eye. The most common infectious disease-causing microbes are bacteria,
viruses, fungi, and protozoa (a type of parasite). The diseases may be passed from
person to person (for example, if someone coughs or sneezes on another person).
Sometimes, the disease is passed through another medium, for example, by drinking
water or eating food infected with bacteria. Sometimes, infectious diseases develop
new strains that resist older treatments.
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Common Human Diseases

Athlete’s Foot: A contagious fungal foot infection that causes the feet to itch, blister
and crack.
Autoimmune Disease: When the immune system attacks our body’s own cells,
tissues and organs, thinking that they are unwanted invaders.
Cancer: Any harmful growth or tumour caused by irregular and uncontrolled cell
division; it may spread to other parts of the body through the lymphatic system or the
blood stream.
Chickenpox: A very contagious viral infection that causes a blistery red rash.
Cholera: An acute infectious disease of the small intestine that causes frequent watery
diarrhea, vomiting, muscle cramps and severe dehydration.
Chronic Lung Disease: A long-term illness that affects the function of the lungs.
Coronary Artery Disease: The build-up of cholesterol in the inside layers of the arteries.
Hepatitis A: An infection of the liver caused by a virus that is usually spread by
swallowing infected food and water. It is also known as infectious hepatitis.
Hepatitis B: Is irritation and swelling (inflammation) of the liver due to infection with the
hepatitist B virus (HBV). One can catch Hepatitis B through contact with the blood or
body fluids (such as semen, vaginal fluids, and saliva) of a person who has the virus.
Hepatitis C: An infection of the liver caused by a virus that is usually spread by blood
and blood products and sometimes through sexual contact.
Malaria: An infectious disease that is passed to humans by female mosquitoes. It
affects the red blood cells and has fever, chills and sweating as its symptoms.
Measles: An acute, contagious, infectious disease caused by a virus. It usually occurs
in children and causes red spots on the skin, fever and inflammation of the air passages
of the head and throat.
Meningitis: Inflammation of the membrane that covers the brain and spinal cord,
caused by either bacteria (bacterial meningitis) or a virus (viral meningitis). Its
symptoms are fever, vomiting, intense headache and stiff neck.
Multiple Sclerosis: An autoimmune disease that affects the central nervous system-
the brain, spinal cord and optic nerves. The fatty tissue that surrounds the nerves is
lost in many areas leaving scar tissue behind. When the fatty tissue called myelin is
missing, the nerves cannot do their job of passing signals to and fro the brain, resulting
in the symptoms that are associated with this disease.
Pneumonia: Acute or chronic inflammation of the lungs.
Polio: A viral infection that attacks the nerve cells that activate the muscles, the
brainstem (the base of the brain that connects with the spinal cord) and the spinal cord.
Rabies: An acute, infectious and often fatal disease that attacks the central nervous
system (brain and spinal cord) and is passed to humans by the bite of an infected
animal.
Shingles: A disease in adults caused by the same virus that causes chickenpox in
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children. It causes an inflammation of the spinal and cranial sensory nerve cells that
will result in the appearance of blisters or cysts along the affected nerve path. It usually
affects only one side of the body and causes sudden, severe attacks of pain.
Sinusitis: Inflammation of a sinus or the sinuses, especially in the nasal area. Strep
Throat: a throat infection that causes fever and inflammation of the tonsils.
Tuberculosis: An infectious disease that is characterized by the formation of tubercles
on the lungs and other tissues of the body. A tubercle is a nodule or swelling, especially
a mass of lymphocytes (white blood cells) and epithelioid cells (cells that resemble
epithelium) that form the wound of tuberculosis.
Typhoid Fever: An acute, infectious disease caused by bacteria that is spread by
contaminated food or water. Its symptoms include fever, headache, coughing, bleeding
intestines and rose-coloured spots on the skin.
Urinary Tract Infection: An infection of any organ (kidneys, ureters, urethra) of the
urinary tract (tract involved in the formation and excretion of urine).
Whooping Cough: A bacterial infection that has symptoms including runny nose, low-
grade fever, inflammation of the eye membrane and a characteristic cough that ends
in a ‘whoop‘ caused by the forceful inspiration of air.
Yellow Fever: An infectious tropical disease that is passed by mosquitoes. Those
infected will have high fever, jaundice (a yellowing of the skin), black vomit, an absence
of urination and bleeding in the digestive tract.
Exercise
1. Visit a hospital and discuss with the doctors about the common human diseases
and their source of infection. Also take notes of the measures adopted by the
hospital to prevent and avoid the spread of diseases.
2. Visit a nearby hospital laboratory and write down the various instruments / chemicals
used in testing the following in the table given below:
Microbes Instruments / Chemical used

Bacteria
Virus
Fungi
Parasites
Assessment
a) List any three human diseases caused by bacteria.
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b) List any five human diseases caused by viruses.
c) List any two human diseases caused by fungi.
activity:
Part A
1. Bacteria, virus, fungi and parasites
2. Antibiotic and vaccine
Part B
1. What are the common diseases caused by micro-organisms?
2. What are the practices adopted in a hospital for preventing the spread of pathogenic
microorganisms?
Part C
Demonstrate the knowledge of human diseases caused by viruses.
Demonstrate the knowledge of human diseases caused by bacteria.
Demonstrate the knowledge of human diseases caused by fungi.
Demonstrate the knowledge of human diseases caused by parasites.
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Sector: Healthcare
Session 3: Understanding the Role of Hospital Personnel in

Prevention and Control of Hospital Acquired
Infections
Relevant Knowledge
In this session, you will learn about the role of doctors, nurses, general duty assistants
and other personnel in preventing and controlling the spread of Hospital Acquired
Infections.
Hospital Acquired Infections
Nosocomial infections, also called “Hospital-Acquired Infections” (HAI), are infections
acquired during hospital care which is not present or incubating at admission.
Infections occurring more than 48 hours after admission are usually considered as
nosocomial infection. Nosocomial infections may also be considered either endemic
or epidemic. Endemic infections are most common. Bacteria are the most common
cause of “Hospital-Acquired Infections” (HAI). HAI or nosocomial infections occur at a
cost to the community and the patient because they cause:
1. Illness to the patient.
2. Longer stay in hospital.
3. Longer recovery time.
4. Costs associated with a longer stay in hospital and longer recovery time.
Risk Factors
All patients admitted to hospital are at some risk of contracting an HAI. If you are
very sick or have had surgery, you have an increased risk. Some patients are more
vulnerable than others. They include the following:
1. Very young people or premature babies.
2. Very sick children.
3. Very old people.
4. People with medical conditions, such as diabetes.
5. People with defective immunity or people who are being treated with chemotherapy
(for cancer) or steroids.
There are other risk factors that may increase your likelihood of acquiring HAI. These
include the following:
1. Length of stay: A long hospital stay can increase the risk: for example, admission
for complex or multiple illnesses.
2. operations and surgical procedures: The length and type of surgery can also
have an impact.
3. Hand washing techniques: Inadequate hand washing by hospital staff and
patients may increase your risk of acquiring an infection.
4. Antibiotics: Overuse of antibiotics can lead to resistant bacteria, which means
that antibiotics become less effective.
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5. Equipment: Invasive procedures can introduce infection into the body: for
example, procedures that require the use of equipment such as urinary catheters,
Intravenous (IV) drips and infusions, respiratory equipment and drain tubes.
6. Wounds: Wounds, incisions (surgical cuts), burns and ulcers are all prone to
infection.
7. High-risk areas: Some areas of the hospital are more likely to have infection, such
as intensive care units (ICU) and high dependency units (HDU), where critically ill
patient are admitted.
Controlling Infection
Spread of infection can be controlled and reduced by adopting the following:
 Strict hospital infection control procedures and policies.
 Correct and frequent hand washing by all hospital staff involved in patient care.
 Cautious use of antibiotic medication.
Role of Hospital Management
The various measures that could be adopted by the hospital management include, but
not limited to the following:
 Establishing a multidisciplinary Infection Control Committee.
 Identifying appropriate resources for a programme to monitor infections and apply.
the most appropriate methods for preventing infection.
 Ensuring education and training of all staff through support of programmes on the
prevention of infection in disinfection and sterilization techniques.
 Delegating technical aspects of hospital hygiene to appropriate staff, such as:
 Nursing
 Housekeeping
 Maintenance
 Clinical Microbiology Laboratory
 Periodically reviewing the status of nosocomial infection.
 Effectiveness of interventions to contain them.
 Reviewing, approving, and implementing policies approved by the Infection Control
Committee.
 Ensuring that the infection control team has the authority to facilitate appropriate
programme function.
Role of Physicians
Physicians have unique responsibilities for the prevention and control of hospital
infections. They can contribute in the following ways:
 By providing direct patient care using practices which minimize infection.
 By following appropriate practice of hygiene (e.g. handwashing, isolation).
 By supporting the Infection Control Committee.
 Supporting the infection control team.
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 Protecting their own patients from other infected patients and from hospital staff
who may be infected.
 Complying with the practices approved by the Infection Control Committee.
 Obtaining appropriate microbiological specimens when an infection is present or
suspected.
 Notifying cases of HAI to the team, as well as the admission of infected patients.
 Complying with the recommendations of the Antimicrobial Use Committee regarding
the use of antibiotics.
 Advising patients, visitors and staff on techniques to prevent the transmission of
infection.
 Instituting appropriate treatment for any infections they themselves have, and
taking steps to prevent such infections being transmitted to other individuals,
especially patients.
Role of Microbiologists
The microbiologist is responsible for the following in prevention and control of HAI:
1. Periodic collection of specimen from wards and other areas.
2. Handling patient and staff specimens to maximize the likelihood of a microbiological
diagnosis.
3. Developing guidelines for appropriate collection, transport, and handling of
specimens.
4. Ensuring laboratory practices to meet appropriate standards.
5. Ensuring safe laboratory practice to prevent infections among staff.
6. Monitoring sterilization and disinfection wherever and whenever necessary.
Role of Nurses and General Duty Assistants
Implementation of patient care practices for infection control is the role of the nursing
staff. Nurses should be familiar with practices to prevent the occurrence and spread of
infection, and maintain appropriate practices for all patients throughout the duration of
their hospital stay.
The Senior Nursing Administrator is responsible for the following:
1. Promoting the development and improvement of nursing techniques, and ongoing
review of aseptic nursing policies, with approval by the Infection Control Committee.
2. Developing training programmes for members of the nursing staff.
3. Supervising the implementation of techniques for the prevention of infections in
specialized areas, such as the operating suite, the intensive care unit, the maternity
unit and newborns units.
The Nurse and the GDA is responsible for the following:
1. Strictly following universal precautions.
2. Maintaining hygiene, consistent with hospital policies and good nursing practices
in the ward.
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3. Monitoring aseptic techn iques, including hand washing and use of isolation.
4. Reporting promptly to the attending physician any evidence of infection in patients
under the care.
5. Initiating patient isolation and ordering culture specimens from any patient showing
signs of a communicable disease, when the physician is not immediately available.
6. Limiting patient exposure to infections from visitors, hospital staff, other patients, or
equipment used for diagnosis or treatment.
7. Maintaining a safe and adequate supply of ward equipment, drugs and patient care
supplies.
The Nurse and GDA is a member of the infection control team and are responsible for
the following:
1. Identifying nosocomial infections.
2. Participating in training of personnel.
3. Surveillance of hospital infections.
4. Educating people on proper disposal of wastes.
5. Initiating patient isolation and ordering culture specimens from any patient showing
signs of a communicable disease, when the physician is not immediately available.
6. Limiting patient exposure to infections from visitors, hospital staff, other patients, or
equipment used for diagnosis or treatment.
7. Maintaining a safe and adequate supply of ward equipment, drugs and patient care
supplies.
The Nurse and GDA is a member of the infection control team and are responsible for
the following:
1. Identifying nosocomial infections.
2. Participating in training of personnel.
3. Surveillance of hospital infections.
4. Educating people on proper disposal of wastes.
Role of the Central Sterilization Service
The responsibilities of the central sterilization service are to clean, decontaminate,
test, prepare for use, sterilize, and store aseptically all sterile hospital equipment.
Role of Food Service Department
The Food Service Department is responsible for setting the standards and criteria for
the purchase of foodstuffs, equipment use, and cleaning procedures so as to maintain
a high level of food safety and quality service.
1. Ensuring that the equipment used and all working and storage areas are kept
clean.
2. Issuing written policies and instructions for hand washing, clothing, staff
responsibilities and daily disinfection duties.
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3. Ensuring that the methods used for storing, preparing and distributing food will
avoid contamination by microorganisms.
4. Issuing written instructions for the cleaning of dishes after use, including special
considerations for infected or isolated patients where appropriate.
5. Ensuring appropriate handling and disposal of wastes.
6. Establishing programmes for training staff in food preparation, cleanliness, and
food safety.
Role of Laundry Service
The laundry service department is responsible for the following:
1. Selecting fabrics for use in different hospital areas, developing policies for working
clothes in each area and group of staff, and maintaining appropriate supplies.
2. Distribution of working clothes and, if necessary, managing changing rooms the
appropriate method for disinfecting infected linen, either before it is taken to the
laundry or in the laundry itself.
Role of Housekeeping Department
The housekeeping department is responsible for the following:
1. Classifying the different hospital areas by varying need for cleaning.
2. Developing policies for collection, transport and disposal of different types of waste
(e.g. containers, frequency).
3. Ensuring that liquid soap and paper towel dispensers are replenished regularly.
4. Informing the maintenance service of any building problems requiring repair:
cracks, defects in the sanitary or electrical equipment, etc.
5. Caring for flowers and plants in public areas.
6. Pest control (insects, rodents).
Role of the Central Sterilization Service
The responsibilities of the central sterilization service are to clean, decontaminate,
test, prepare for use, sterilize, and store aseptically all sterile hospital equipment.
Exercise
1. Visit a nearby hospital and check the role of various health professional in prevention
of microorganism or hospital acquired infection.
Assessment
I. Short answer Questions
1. What is a Hospital Acquired Infection (HAI)?
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2. What are the roles and functions of GDA in controlling HAI?
activity:
Part A
1. Microbiologist and pathologist.
2. Infection and hospital Acquired Infection.
Part B
Discussed the role of following in class:
1. How training of personnel helps in reducing the possibility of HAI?
2. What are the measures adopted by the hospital management for controlling HAI?
Part C
The performance standards may include but not limited to:
Identify the common places of infection in the hospital.
Demonstrate the knowledge of causes of HAI.
Demonstrate the knowledge of roles and functions performed by medical
professionals and staff in preventing and controlling HAI.
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Session 4: Disinfecting Ward and Equipment
Relevant Knowledge
Microorganisms are present everywhere. Since they cause contamination, infection
and decay, it becomes necessary to remove or destroy them from materials or from
areas in the hospital. There are various measures adopted in order to prevent the
spread of microorganisms in the hospital. Good housekeeping is therefore, of
paramount importance in a hospital. Providing safe, clean and orderly environment
is the responsibility of all the personnel in a hospital. Every patient has the right to be
protected from the Hospital Acquired Infections. In order to ensure that the patients
are protected from HAIs, various procedures and practices are adopted which include
cleaning, sterilization and disinfection using physical, chemical and other methods.
In this session, you will learn about the various agents, machines, equipment and
methods adopted by the medical staff in disinfecting ward and equipment.
Let us first try to understand the meaning of some of the common terms, such as
cleaning, sterilization and disinfection used in prevention and control of microorganisms.
Cleaning
Cleaning plays an important preparatory role before sterilization or disinfection.
Cleaning helps in removing soil and other dirt and reducing the microbial burden,
making sterilization more effective. The various equipments that are used for cleaning
include, but not limited to the following:
 Floor cleaning machines.
 Swiping machines.
 Floor scrubbing machines.
 Floor polishing machines.
 High pressure machines to clean bathrooms.
Daily Cleaning: This includes sweeping and mopping floors, dusting furniture, cleaning
fixtures, walls, ceilings, windows and bathrooms, emptying trash cans, etc
Periodic Cleaning: It includes washing windows, waxing floors, cleaning carpets,
dusting high ceilings and changing drapers.
Discharge Cleaning: This includes cleaning patient room after discharge or transfer
of a patient and readying it for another patient.
Exterminating Bugs and Pests: Hospital‘s Integrated Pest Management (IPM)
plans help direct a hospital in carrying out its pest control practices regularly. An IPM
programme is a pest management approach to preventing and managing pest problems
in the least hazardous manner possible. It emphasizes on pest prevention through good
sanitation practices and maintaining structures in optimum repair. Pesticides are used
only when needed, primarily in baits. Records are kept of all pesticide applications.
The hospital should utilize the services of a licensed pest control agency. All hospital
staff should be educated about the hazards of pesticides and the advantages and
principles of IPM.
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Prior notification of pesticide use in the hospital should be done well in advance and all
precautions should be taken. Trash and garbage removal: Waste generated from the
hospital has to be carefully disposed of as per the guidelines issues by the government.
The various types of waste generated in the hospital include, but not limited to the
following:
a) Solid waste: This waste is also called municipal waste or non-regulated
medical waste. This is general trash, similar to what you would find in a hotel
but with more plastics and packaging.
b) Regulated Medical Waste (RMW): This waste stream is also called. potentially
infectious material, red bag waste or bio-hazardous waste.
c) Pharmaceutical Waste: Some pharmaceutical waste is considered hazardous
while a large majority may not require handling as hazardous waste, but should
receive special disposal considerations, including controlled substances.
d) Universal Waste: Universal waste include batteries, pesticides, mercury-
containing equipment, bulbs (lamps), etc.
e) Recyclables: Recyclables are items and materials bound for the waste stream
that can be converted into a reusable material. Recyclables in healthcare
include the usual suspects found in commercial buildings such as paper,
cardboard, beverage and food containers, metal and glass.
Sterilization
Sterilization is defined as the process by which an article, surface or medium is freed
of all living microorganisms either in the vegetative or spore state.
Disinfection
Disinfection means the destruction or removal of
all pathogenic organisms, or organisms capable of
giving rise to infection. This is the freeing of an article
from some living organisms and is used in conditions
where sterilization is not needed, e.g., disinfection of
bed-pans, wash basins, furniture, eating utensils and
clothes. A perfect disinfectant would also offer complete
and full sterilization, without harming other forms of life,
be inexpensive, and non-corrosive.
Antisepsis
Antisepsis is used to indicate the prevention of infection,
usually by inhibiting the growth of bacteria in wounds
or tissue. Chemical disinfectants which can be safely
applied on the skin or mucous membrane and are used
to prevent infections by inhibiting the growth of bacteria
are called antiseptics.
Decontamination
Decontamination refers to the process of rendering an article or area free of danger
from contaminants, including microbial, chemical, radioactive and other hazards.
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Difference between Antiseptics and Disinfectants
Antiseptics Disinfectants
 Use on skin and mucous membrane  Use to kill microorgansim on inanimate

to kill microorganisms. objects.
 Not for use of inanimate objects.  Not for the use on skin and mucous
membrane.
Properties of an Ideal Disinfectant

The properties of an ideal disinfectant include the following:
 Resistant to inactivation.
 Broadly active in killing pathogen.
 Non-poisonous.
 Penetrating to pathogens.
 Not damaging to non-living materials.
 Stable.
 Easy to work with and not unpleasant.
The various agents used in sterilization can be classified as
follows:
A. Physical Agents
 Sunlight
 Drying
 Dry heat : flaming, incineration, hot air
 Moist heat: pasteurization, boiling, steam under
normal pressure, steam under pressure
 Filtration : candles, asbestos pads, membranes
 Radiation
 Ultrasonic and sonic vibrations
B. Chemical
 Alcohols: ethyl, isopropyl, trichlorobutanol
 Aldehydes: formaldehyde, glutaraldehyde
 Dyes
 Halogens
 Phenols
 Surface – active agents
 Metallic salts: e.g.salts of Ag, Cu, Hi
 Gases : ethylene oxide, formaldehyde, beta
propiolactone
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Effectiveness of Antimicrobial Agent Activity

Destruction of microorganism and inhibition of microbial growth are not simple matters
because the efficiency of an antimicrobial agent (an agent that kills microorganisms or
inhibits their growth) is a affected by at least six factors.
1. Population Size: Because an equal fraction of a microbial population is killed
during each interval, a larger population requires a longer time to die than a smaller
one. The same principle is applicable to chemical antimicrobial agents.
2. Population Composition: The effectiveness of an agent varies greatly with the
nature of the organisms being treated because microorganisms differ markedly in
susceptibility. Bacterial endospores are much more resistant to most antimicrobial
agents than are vegetative forms, and younger cells are usually more readily
destroyed than mature organisms. Some species are able to withstand adverse
conditions better than others. Mycobacterium tuberculosis, which causes
tuberculosis, is much more resistant to antimicrobial agents than most other
bacteria.
3. Concentration / Intensity of an Antimicrobial Agent: Often, but not always, the
more concentrated a chemical agent or intense a physical agent, the more rapidly
microorganisms are destroyed. Sometimes an agent is more effective at lower
concentrations. For example, 70% ethanol is more effective than 95% ethanol.
4. Exposure Time: The longer a population is exposed to a microbiocidal agent, the
more organisms are killed.
5. Temperature: An increase in the temperature at which a chemical acts often
enhances its activity. Frequently a lower concentration of disinfectant or disinfectant
or sterilizing agent can be used at a higher temperature.
6. Local Environment: The population to be controlled is not isolated but surrounded
by environmental factors that may either offer protection or aid in its destruction.
A second environmental factor is organic matter that can protect microorganisms
against heating and chemical disinfectants. It may be necessary to clean an object
before it is disinfected or sterilized. Surgical and medical or dental equipment
should be cleaned before sterilization because the presence of too much organic
matter could protect pathogens and increase the risk of infection. The same care
must be taken when pathogens are destroyed during the preparation of drinking
water. When a city’s water supply has a high content of organic material, more
chlorine must be added to disinfect it.
Antimicrobial Mode of Action of Disinfectants and Antiseptics
The disinfectants and antiseptics acts in the following ways:
1. Denaturation of bacterial proteins by disrupting hydrogen and disulfide bond (for
example phenol in high concentration, alcohol, heavy metal in high concentration,
acids, alkalis, aldehydes).
2. Damages to bacterial membrane (lipids and / or proteins), causing leakage of
intracellular molecules. (for example phenol in low concentration, surfactants,
dyes).
3. Interference of bacterial enzyme and metabolism (for example oxidants, heavy
metals in low conc., alkylating agents).
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Common Methods of Disinfection in Hospital

Soaps and Detergents
Soaps are sodium or potassium salts of fatty acids.
Detergents instead, are artificial surfactants . Soaps
are always negatively charged, some detergents are
negatively charged while others are positively charged.
Halogens
Two halogens are employed as antimicrobials; Iodine
and Chloride. Iodine commonly used as an antiseptic against all microbes, fungi, and
viruses. It inhibits protein synthesis and oxidizes-SH groups of amino acid. Chlorine
used as disinfectant (10% bleach). Hypochlorous acid (HOCl) is a product formed
in water, that is the active form of disinfectant, is applied in the treatment of drinking
water, swimming pool and sewage.
Phenols
Phenolics disinfectant are effective against bacteria, specially gram positive and
enveloped viruses. These disinfectants maintain their activity in the presence of
organic material. Phenolics are not reccommended for semi critical items, because
of the lack of validated efficacy data for many of the avaliable formulations and the
residual disinfectants on porous materials may cause tissue irritation, even when
thoroughly rinsed.
Alkylating Agents
 Formalin (formaldehyde) used as surface
disinfection, air, surgical instruments
 Glutaric dialdehyde used for disinfecting high
precision instruments, endoscopes
 50mg/L epoxy ethane used for disinfecting
surgical instruments and dressing.
oxidants
 3% peroxide used for disinfecting small trauma wound
 0.2% -1% peroxyacetic acid used for disinfecting plastics and glassware.
 0.1% potassium permanganate used for disinfecting skin
Alcohols
Alcohols refers to two water soluble chemicals: ethyl alcohol and isopropyl alcohol.
These alcohols are rapidly bactericidal rather than bacteriostatic against vegetative
forms of bacteria. Their germicidal activity drops sharply when diluted below 50%
concentration. Alcohols are commonly used as topical antiseptics, also used to disinfect
the surface of medical equipments. 70-75% ethyl or isopropyl alcohol is used for skin
and thermometer disinfection.
Iodine and Iodophore
These compounds have been incorporated in time release formulation and in soaps
(surgical scrubs). Simple iodine tincture (dissolve in alcohol) have limited cleaning
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ability. These compounds are bactericidal, sporicidal, virucidal,

and fungicidal but require a prolonged contact time.
Besides their use as an antiseptic, Iodophore have been used for
the disinfection of blood culture bottles and medical equipment
(like hydrotherapy tanks, thermometers, and endoscopes).
The disinfective ability of Iodine, like chlorine, is neutralized
in the presence of organic material and hence frequent
applications are needed for thorough disinfection. Iodine
tintures can be very irritating to tissues, can stain fabric and be
corrosive.
Hypochlorites
Hypochlorites have a broad spectrum of antimicrobial activity.
They are unaffected by water hardness, are inexpensive,
and fast acting, and have low incidence of serious toxicity.
Disadvantages of hypochlorites include corrosiveness to
metals in high concentration, inactivation by organic matter,
discolouring or bleaching of fabrics, and release of toxic
chlorine gas when mixed with ammonia or acid.
Hypochlorites can eliminate both enveloped and non-
enveloped viruses if used in correct dilution and contact time.
They are also effective against fungi, bacteria, and algae but not spores. Bleach
solutions have been recommended for use in both hospitals and the community as
disinfecting solutions.
Hypochlorites are also agent of choice in disinfecting surface used for food preparation
or in bathrooms. Hydrogen Peroxide Stabilized hydrogen peroxides can be used to
disinfect surfaces.
Formaldehyde
Formaldehyde is used as disinfectant and sterilant both in
the liquid and gaseous states. Formaldehyde is sold and
used principally as water based solution called formalin,
which is 37% formaldehyde by weight. The aqueous solution
is bactericidal, tuberculocidal, fungicidal, virucidal, and
sporocidal. Formaldehyde should be handled in the workplace
as a potential carcinogen with an employee exposure standard
that limits an 8 hour time weighted avarage exposure to a
concentration of 0.75 ppm. For this reason, employees shoud have limited contact
and this limits its use as disinfectant.
 Highly effective against most microbes.
 Higly diffusive.
 Compatible with a wide variety of materials in devices and packaging.
Glutaraldehyde
Aldehydes have a wide germicidal spectrum. Gluteraldehyde are bactericidal, virucidal,
fungicidal, sporicidal, and parasiticidal. They are used as a disinfectant or sterilant in
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both liquid and gaseous forms. They have moderate residual activity and are effective
in the presence of limited amounts of organic material.
Quaternary Ammonium Compounds
The quaternaries are good cleaning agents but high water hardness and material such
as cotton and gauze pads may make them less microbicidal because these materials
absorb the active ingredients. As with several other disinfectants (e.g. Phenolics,
Iodophore) gram negative bacteria have been found to survive or grow in these
preparation.
They are not effective against non - enveloped viruses, fungi, and bacterial spores.
They are commonly used in ordinary environmental sanitation of non-critical surfaces
such as floors, furniture, and walls.
Physical Agents
Dry heat and steam are used for sterilization. Steam above 100 C or saturated
steam has a better killing power than dry heat. Bacteria are more susceptible to moist
heat as bacterial protein coagulates rapidly. Saturated steam can penetrate porous
materials easily. When steam comes into contact with a cooler surface it condenses to
water and liberates its latent heat to that surface. For example, 1600 ml of steam at
1000 C and at atmospheric pressure condenses into one ml of water at 1000 C and
releases 518 calories of heat. The large reduction in volume sucks in more steam to
the same site and the process continues till the temperature of the article is raised to
that of steam. The condensed water produces moist conditions for killing the
microbes present. For all glass syringes and glasswares, hot air oven is a better
sterilising equipment.
Uses
 To sterilise culture media, rubber material gowns, dressing, gloves, etc.
 It is particularly useful for materials which can withstand the higher temperature
of hot air oven.
Exercise
1. Visit a nearby hospital and prepare a write-up on the various methods of sterilization
and disinfection. Study the various equipment, chemicals and procedures used by
the hospital.
2. Visit a nearby hospital and observe the use of following chemicals. Write any three
use of each chemical given in the table below:
Chemical Use
1
Chlorine 2
3
1
Phenol 2
3
1
Alcohol 2
3
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Sector: Healthcare
1
Iodine 2
3
1
Hydrogen Peroxide 2
3
Assessment
I. Answer the following questions:
1. What is sterilization?
2. What is disinfection?
3. What is antisepsis?
II. Fill in the Blanks

1. is used as a disinfectant or sterilant in both liquid and
gaseous form.
2. is used on skin and mucous membrane to kill microorganisms.
activity:
Part A
1. Physical agents and chemical agents.
2. Sterilization and disinfection.
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Part B
1. What precautions should be adopted while using chemical agents as disinfectants?
2. What is the role of GDA in sterilizing and disinfecting glassware, plastic wares,
linen and equipment?
Part C
Demonstrate the knowledge of physical methods of sterilization.
Demonstrate the knowledge of common chemical disinfectants used in
a hospital.
Demonstrate the knowledge of chemicals used for disinfecting glass-
ware.
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UNIT – 4
BASIC FIRST AID AND EMERGENCY

MEDICAL RELIEF
Sector: Healthcare
Learning outcome
Unit 4 BASIC FIRST AID AND EMERGENCY MEDICAL RELIEF
Duration: 20 Hours
Hospital/  Describe the  Describe the  Identify types of Interactive
Clinic principles and purpose of First health risk and Lecture:
rules of First Aid. hazards at various  Principles and
Aid.  State the principles departments of Rules of First
. of First Aid. hospitals. Aid.
 Enlist emergency
situations in a  Activity:
hospital. Visit a hospital
 Perform ABC on a and study the
dummy. First Aid prac-
tices.
 Identify facilities,  Describe the  Enlist the Interactive
equipment and facilities and equipment used Lecture:
materials used materials used for First Aid.  Facilities,
for First Aid. for administering  Demonstrate the equipment and
First Aid. knowledge of the materials for
First Aid. First Aid.
 Activity:
Prepare a First
Aid box.
 Perform the role  Describe the role  Perform ABC Interactive
role of first aider and function of a (Airway, Breathing Lecture:
in fever, heat First Aider. and Circulation).  Role of First
stroke, back  Measure body Aider in fever,
pain, asthma temperature using heat stroke,
and food borne a digital back pain,
illness. thermomete. asthma and
food borne ill-
ness.
 Activity:
Perform activi-
ties for measur-
ing and control-
ling tempera-
ture.
 Perform the role  Describe the cause  Administer first aid Interactive
of first aider in of various types of for cut and burns in Lecture :
cuts, bleeding, burns. hypothetical  Role of First
burns, insect  Describe the situations. Aider in cuts,
bites and stings, reasons for using  Demonstrate the bleeding,
dot bites and methods for knowledge of burns, inset
snake bites. treating burns. dealing with inset, bites and snake
dog and snake bite. bites.
 Activity:
Practice First
Aid on a
dummy with the
help of a First
Aider.
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Session 1: Describe Principles and Rules of First Aid
Relevant Knowledge
Injuries and pain are part of human life. In case of injury, some kind of immediate medical
attention or treatment is needed to reduce the discomfort, pain and deterioration of
the condition. The medical attention that is given at the first instance before seeking
professional medical help is called “First Aid”. First-aid is the immediate and temporary
treatment given to the victim of an accident or sudden illness, while awaiting the arrival
of “Medical Aid”. In this session, we will study the purpose, principles and general rules
of basic First Aid.
First Aid means providing the initial treatment and life support for people suffering
with an injury or illness at work. Here it is important to understand that First Aid has its
limitations and does not take the place of professional medical treatment. Proper early
assistance given by First Aider helps in saving the life of a patient. The ISO specified
symbol for the First Aid is white cross on a green background.
Purpose of First Aid
The purpose of first aid includes but not
limited to:
 Save the life of the victim before the arrival
of a qualified medical expert.
 Lessen pain.
 Help in early recovery.
 Prevent condition from worsening.
Principles of First Aid: The basic principles of first aid are as follows:
 Preserve life: This includes the life of the casualty and rescuer.
 Protect the casualty from further harm: Ensure the scene is safe and the
casualty is not affected by the presence of people.
 Provide pain relief: This could include the use of ice packs or simply applying a
sling.
 Prevent the injury or illness from becoming worse: Ensure the treatment you
provide as part of the First Aid does not make the condition of the casualty worse.
 Symbol of First Aid: The ISO specified symbol for the First Aid is white cross on
a green background.
Rules of First Aid
Important rules for First Aid are as follows: CHECK
 Check: Find out what has happened,

and then what is wrong with the person.
Comfort the victim and arrange shelter.
 Call: Arrange for professional medical aid. CARE CAll
 Care: Help the victim, preferably without
moving him or her.
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Health Emergency
A health emergency is a situation in which the health of a person is in danger because
of sudden illness or accident, and immediate help is required to “save a life”. In case
of any health emergency, the ill or injured person should be given immediate attention
and first aid before the medical help arrives. Now the question arises -What could be
various emergency situations? It could be (i) electric shock, (ii) difficulty in breathing
due to asthmatic attack, (iii) burns, (iv) bleeding, (iv) injury, (v) fracture, (vi) heart attack,
etc.
The Human Body
The human body is an amazing living machine in which hundreds of parts work
together to flawlessly perform countless tasks. It consists of a head, neck, torso, two
arms and two legs. By the time the child reaches adulthood, the body consists of
close to 100 trillion cells, the basic unit of life. These cells are organized biologically to
eventually form the whole body. At birth, a newborn baby has over 300 bones, whereas
on an average an adult human has 206 bones. The body includes the musculoskeletal
system (related to muscles), cardiovascular system (related to heart), digestive system
(related to stomach), endocrine system, integumentary system, urinary system (related
to kidney), lymphatic system, immune system, respiratory system (related to lungs),
and reproductive system.
We will now look at two aspects of life which are important from the point of view of
First Aid.
Breathing
Breathing is vital to life and a person breathes about 20,000 times a day. All of this
breathing could not happen without the respiratory system, which includes the nose,
throat, voice box, windpipe, and lungs. Air can be taken in through the nose and the
mouth. These two openings of the airway (the nasal cavity and the mouth) meet at
the pharynx or throat, located at the back of the nose and mouth. The diaphragm
that separates the chest from the abdomen plays a lead role in breathing. It moves
downward when we breathe in, enlarging the chest cavity and pulling air in through
the nose or mouth. When we breathe out, the diaphragm moves upward, forcing the
chest cavity to get smaller and pushing the gases in the lungs up and out of the nose
and mouth. When you breathe in, which is called as inhalation, the diaphragm moves
downward toward the abdomen, and the rib muscles pull the ribs upward and outward.
In this way, the volume of the chest cavity is increased.
Air pressure in the chest cavity and lungs is reduced, and because gas flows from
high pressure to low, air from the environment flows through the nose or mouth into
the lungs. When you breathe out i.e. exhalation, the diaphragm moves upward and
the chest wall muscles relax, causing the chest cavity to contract. Air pressure in the
lungs rises, so air flows from the lungs and up and out of respiratory system through
the nose or mouth.
Blood Circulation
Blood is the viscous fluid composed of plasma and cells. The composition of the
blood includes plasma, red blood cells, white blood cells and platelets. The centre
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Sector: Healthcare
of the circulatory system is the heart, which is the

main pumping organ. The heart is made of muscles.
The heart is in the middle of the chest. It is located
between the two lungs. The heart is tipped somewhat
so that there is a little more of it on the left side. The
pointed tip at the bottom of the heart touches the front
wall of the chest. Every time the heart beats it goes
“thump” against the chest wall. You can also listen
to them with your ear. When the heart contracts it
pushes the blood out into two major loops or cycles. In
the systemic loop, the blood circulates into the body’s
systems, bringing oxygen to all its organs, structures and tissues and collecting carbon
dioxide waste. In the pulmonary loop, the blood circulates to and from the lungs, to
release the carbon dioxide and pick up oxygen. The systemic cycle is controlled by the
left side of the heart, the pulmonary cycle by the right side of the heart.
Health and Safety Risks at Workplace: Risk is the chance or probability that a person
will be harmed or experience an adverse health effect if exposed to a hazard. Let us
now learn about the various types of hazards and their cause. This will help you to
recognize the various hazards that you may encounter at workplace.
Types of Hazards
 Biological: Biological hazards are
caused by living organisms like
bacteria, viruses, insects, plants, birds,
animals, humans, etc.
 Chemical: Chemical hazards, which
include acids, poisons, cleaning agents,
etc. depends on the physical, chemical
and toxic properties of the chemical.
The severity of the hazard depends on
the toxic properties of the chemical.
 Radiation: Radiation hazards are related to exposure to radiations from
radioactive substances.
 Ergonomic: Ergonomic hazards are caused due to repetitive movements,
improper set up of workstation (e.g. computer workstation, workstation for
repair of electrical gadgets, etc.), faulty designed chairs, tools and equipment,
wrong postures, etc. Wrong postures often bring about physical fatigue and/or
bodily harm, including back pain, and discomfort in shoulders and lower limbs.
 Physical: Physical hazards are caused due to slippery surfaces, falling objects,
manual handling (lifting, pushing, carrying), sharp tools and equipment,
radiation, magnetic fields, extreme pressure (high pressure or vacuum),
excessive loud and prolonged noise, and bullying (abnormal, repeated
behaviour directed against a worker or group of workers which results in a risk
to health and safety). It may result in stress, depression, loss of self-esteem,
feelings of guilt, phobias, sleep and eating disorders, sexual harassment (a
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Sector: Healthcare
situation in which unwanted behaviour with a sexual connotation, expressed

physically, verbally or non-verbally takes place), verbal threat, abusing, use of
weapons, etc.
 Psychosocial: Psychosocial hazards are caused due to violence, excessive
pressure or stress at workplace for meeting deadlines, conflicts at workplace,
etc. It also includes hazards due to discrimination on the grounds of caste,
race, skin colour, ethnic origin, sex, religion, etc.
 Safety: Safety hazards at workplace include slipping or tripping, inappropriate
machine guarding, collision, bumps, road accidents, fire accidents, equipment
malfunctions or breakdown and electrical accidents (it could result in skin
burns affecting the areas that have been in contact with the electrical current
or electric shock due to electrical discharge).
Exercise
1. Visit a hospital and find out first aid measures adopted. In your school find out
the steps taken by the administration to provide first aid during health/medical
emergency.
2. Visit a nearby hospital and observed various hazards. Fill the common hazards in
the table given below:
Type of Hazards Place Prone to Get the Hazard in the Hospital
Biological
Chemical
Radiation
Ergonomic
Physical
Psychosocial
Assessment
a) What is the purpose of First Aid?
b) State the principles of First Aid.
activity:
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Part A
1. Physical and mental health.
2. Danger and hazard.
Part B
1. What are the common health problems and safety risks of General Duty Assistant?
2. What are the basic principles of First Aid?
Part C
Identify types of health risks and hazards at workplace.
Enlist emergency situations in a hospital.
Demonstrate the knowledge of ABC.
Session 2: Identify Facilities, Equipment and Materials for

First Aid
Relevant Knowledge
In this session, you will learn about the various facilities, equipment, and materials
used for First Aid. First Aid facilities should be located at points convenient to workers.
An ambulance should also be made available at the workplace to meet any emergency.
Ambulance is a vehicle specifically designed to transport critically sick or injured
people to a medical facility. Most ambulances are motor vehicles, although helicopters,
airplanes, and boats are also used. The interior of an ambulance has room for one or
more patients plus several emergency medical personnel. It also contains a variety of
supplies and equipment that are used to stabilize the patient’s condition en route.
It is the responsibility of the head of the organization or the employer that the first
aid facilities, such as a First Aid room, a First Aid kit, a health centre and First Aid
equipment are made available in the premises to meet any emergency.
Once the employer has set up First Aid facilities, one or two persons should be
nominated as First Aider. They should be trained for First Aid facilities and services at
the workplace. Now let us look at each of these facilities and the important aspects that
we need to keep in mind when arranging these facilities.
(i) First Aid Room: It is the place where equipment and materials are made available
and systematically arranged for providing first aid services. It should have the
following:
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 A name plate with the symbol of FIRST AID.

 Proper lighting and ventilation.
 Toilets, which should be friendly for differently-abled persons (Persons with
disability).
 Facilities for easy movement of a person on a stretcher or a wheelchair.
The facilities at the First Aid Room should include:
1. Table and chairs.
2. Telephone.
3. Directory of emergency telephone numbers. (For example, in India telephone
number for fire service station is 101, for police it is 100 and for emergency
services / ambulance it is 108).
4. First Aid kit.
5. Examination lamp.
6. Medical examinations couch with blankets and pillows.
7. A portable screen.
8. Container for sharp equipment like surgical knives, etc.
9. Sink and wash basin with hot and cold running water.
10. Sterilizer.
11. Stretcher.
12. Workbench or dressing trolley.
13. Oxygen cylinder.
14. Sphygmomanometer – blood pressure
measuring instrument.
15. Resuscitation equipment.
16. Cupboards for storing medicines, dressings
and linen.
17. Electric power points.
18. Suitable seating.
19. Container for soiled dressings.
20. Medical waste containers.
First Aid Kit: The contents of the First Aid Kit are
mainly meant for providing first aid incase of bleeding,
bone fractures and burns. The contents of the first aid
kit could also be made industry/organisation specific
(nature of the job being undertaken at the industry/
organisation). For example, in casting and forging
industries, medicine used in burns and scalds should
be kept in the First Aid kit. A basic First Aid kit should include the following:
1. Band-aids of all sizes.
2. 4” by 4” gauze pads - for cleaning wounds.
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3. 4” by 4” dressing bandages - for wounds, cuts, and abrasions.

4. 2” dressing rolls or crepe bandage - for wrapping and bandaging injuries.
5. Medical tape.
6. Cotton balls.
7. Safety pins.
8. Alcohol pads or isopropyl alcohol for cleaning wounds.
9. Antimicrobial hand wipes - placed in a sealed plastic bag to keep them moist.
10. Hydrogen Peroxide for cleaning skin wounds.
11. Sterile water bottle.
12. Eye flushing solution bottle with an eye cup.
13. Ace bandage for wrapping sprains and contused soft tissue.
14. Arm sling.
15. Chemical ice pack.
16. Chemical hot pack.
17. Thermometer - oral and rectal (for kids).
18. Tweezers.
19. Scissors.
20. Torch.
21. Nail clippers.
22. Jack-knife.
23. Clean string for a variety of uses.
24. Sterile gloves.
Important medications and other relief materials that should be kept in a First Aid kit
and updated (check for expiry of the medicine and replace immediately with fresh
batch) include the following:
1. Antibiotic ointment - for cuts and scrapes of the skin.
2. Medicated sunburn spray or cream.
3. Calamine lotion.
4. Insect sting relief pads.
5. Tablet Tylenol (Acetaminophen) – It is used as pain and fever reducer.
6. Tablet Advil (Ibuprofen) – It is anti-inflammatory, used for pain, swelling, and
fever.
7. Syrup Benadryl (Diphenhydramine) – It is antihistamine for allergic reactions,
itching, and runny nose.
8. Cough suppressant.
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9. Throat lozenges.
10. Oral Rehydration Salts (ORS).
11. Defibrillators: An electronic device that administers an electric shock of preset
voltage to the heart through the chest wall. It is used to restore the normal
rhythm of the heart during ventricular fibrillation.
12. Tourniquet bandage (compression bandage): If the bleeding does not stop with
direct pressure within 15 to 20 minutes the tourniquet bandage is applied.
13. Slings: Sling is a bandage used to support an injured forearm. It is a wide
triangular piece of cloth which is used to support the hand from around the
neck.
14. Splints: Splints are orthopedic mechanical devices used to immobilize and
protect a part of the body in the case of a fracture (such as a broken leg or
hand).
Drugs for Common Ailments: There are a variety of common
ailments from which people suffer from. These ailments
are not very serious and can be cured by referring to some
home remedies or over the counter medicines. A number of
common illnesses are treated at home using non-prescription
medicines. Some ailments are serious enough to require
professional medical attention; even the common cold can
become very serious if not treated correctly, as it can advance
to other infectious diseases such as influenza and pneumonia. If ailments persist, then
the patient should immediately consult a doctor. Some of the common ailment and the
drugs generally prescribed are given in the table below:
DRUGS FoR AILMENTS
Ailments Drugs
Allergies Tablet Cetirizine.
Headache Saridon, Aspirin (Aspirin is also used in case of

chest pain).
Heartburn/ Acidity Tablet/Syrup Digene.
Nasal Congestion Vaporub for rubbing on nose and chest.
Cough and Cold Tablet for cough & cold or syrup.
Fever/Flu Paracetamol (also used as a General Pain Killer).
Constipation Isabgol Husk (with hot milk/water).
Sprains and Strains Tablet Flexon/Combiflam (used as a anti infla-

mmatory painkillers).
Dehydration Oral Rehydration Salt (ORS).
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Exercise
1. Prepare a First Aid box with all equipment and materials.
Assessment
Fill in the blanks
1. is a vehicle specifically designed to transport critically
sick or
2. is an electronic device that administers an electric shock of
preset voltage to the heart.
3. is a bandage used to support an injured forearm.
4. A , is someone who takes charge of an emergency
scene.
5. ORS stand for Salt.
activity:
Part A
1. Sling and splints
Part B
Discussed in class the following
1. What facilities should be established for administering First Aid at workplace?
2. What are the contents of a First Aid kit?
Part C
Identify equipment used for First Aid.
Demonstrate the knowledge of the use of first aid kit injured people
to a medical facility and gives first aid.
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Session 3: Performing the Role of First Aider in Fever, Heat

Stroke, Back Pain, Asthma, and Food Borne Illness
Relevant Knowledge
A First Aider is a person who takes charge of an emergency scene and gives first
aid. Often the first aider at an emergency scene is passerby who is willing to help. A
parent can be a First Aider to his or her child, a firefighter can be a First Aider to an
injured pedestrian, or an employee can be trained as a First Aider. A First Aider do not
diagnose or treat injuries and illnesses (except perhaps when they are very minor). In
this session, you will learn how to give first aid to a casualty with fever, heat stroke,
back pain, asthma and foodborne illness.
As a First Aider, the first thing is to take charge of the
situation and stay in charge until the arrival of the medical
help or ambulance. While in charge, many other people
may offer to help and crowd the place. In an emergency,
where there is a confusion and fear, the actions of a
calm and effective First Aider reassure everyone, and
can make the whole experience less traumatic.
Besides giving First Aid, one should ensure the following:
 Keep unnecessary people away.
 Protect the casualties belongings.
General Considerations and Rules
The elementary life saving procedures are head tilt, First Aid at choking and recovery
position. Important rules for first aid are as follows:
Check: Find out: (a) what has happened, (b) what is wrong with the person, (c)
comfort the victim and arrange shelter.
Call: Arrange for professional aid.
Care: Help the victim without unnecessary handling the casualty.
Now let us imagine that a person has met with an accident. The services of priority that
should be followed by the first aider in an emergency are as follows:
Step 1: Check for bleeding: Stop bleeding by applying direct pressure on the wound
site.
Step 2: Check for head, neck and spinal injury: If any of these are suspected, do
not move the victim unless it is absolutely necessary to prevent further injury. Moving
a victim will often make injuries worse, especially in the case of spinal cord injuries.
Step 3: Determine responsiveness: If a person is unconscious, try to arouse by
gently shaking and speaking. Do not give fluid, the victim cannot swallow and could
suffocate. Look for the victim’s chest to rise and fall and listen for sounds of breathing
(place your ear near the nose and mouth and feel for breath on your cheek).
If the victim is not breathing then mouth to mouth resuscitation is to be given. If you are
not trained to do that, then call for medical help at the earliest.
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If the victim is breathing, but unconscious, roll the casualty on one side, keeping the
head and neck aligned with the body. This will help drain the mouth and prevent the
tongue or vomit from blocking the airway if the person remains unresponsive, carefully
roll the casualty on back and open the airway.
a) Keep head and neck aligned.
b) Carefully roll onto the back while holding the head.
c) Open the airway by lifting the chin.
observe ABC as follows:
A – Airway
B – Breathing
C – Circulation
1. Airway: Ensure that the tongue or any foreign body does not obstruct the
airway.
2. Breathing: Make sure the victim is breathing. If you are trained to give mouth
to mouth respiration, then facilitate breathing.
3. Circulation: Check for the pulse to ensure that the heart is beating properly.
Check heart beat/pulse of the victim. If there is no pulse and if you are trained
to do Cardiopulmonary Resuscitation (CPR), then begin CPR immediately.
(Note: CPR is administered when both heart and lungs have ceased to function).
Step 4: Call Emergency Services: Call for help or tell someone else to call for help
as soon as possible.
If you are the only person on the scene, try to establish breathing before calling for
help, and do not leave the victim alone for an extensive amount of time. Stay calm and
don’t give up. Continue to aid the victim until medical help arrives.
Let us now learn about the basic first aid practices that may be utilized by the first aider
to provide first aid to people working in various occupations, with special reference to
the health sector.
Considering your age and body strength, we will take up only those first aid practices
that you can easily perform.
Fever
Fever is higher-than-normal human body temperature (normal body temperature is
370 C or 98.60 F). Your body temperature is a good indicator of your health. Fever is a
symptom and not disease. Fever can be categorized as given below:
 Low fever: 98.80 F to 100.80 F
 Mild to moderate: 1010 F to 1030 F
 High fever: 1040 F and above
If the temperature is high, then it is a sign that body is fighting illness.
Causes: Fever may be caused due to hot weather, bacterial or viral infection, spending
too much time under the sun or allergy to medication or food/water.
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Symptom: Symptoms may include hot flushed face, nausea, vomiting, head and body
ache, constipation, diarrhea.
First Aid: Monitor temperature using a digital thermometer. Remove the excess clothing.
Keep the person in a cool place and if required give a sponge bath in tap water. Give
plenty of fluids and prescribed dose of tablet paracetamol.
Taking Body Temperature
In case of fever, the body temperature is measured using a thermometer. Let us now
learn how to take body temperature.
Step 1 – Prepare: Wash the tip of the digital thermometer with clean water and wipe
it with a clean cloth. Wipe it with a paper tissue after it has been cleaned. This will
remove certain germs on the surface.
Step 2 – Switch on: Switch on the digital thermometer to make sure that it is working
properly. The LCD screen should read “0”. If this does not occur or the screen remains
blank, you may have to replace the battery. Check the instruction manual to replace
the battery. Use the thermometer when the starting reading is correct.
Step 3 – Position: Place the thermometer in the mouth of the person by laying the tip
on a middle point at the back of the tongue before asking the patient to close the lips
around it to hold the length of it.
Step 4 – Take Temperature: Press the button to make the appliance read the
temperature. This can take few seconds to a few minutes. Remove the thermometer
from the mouth and read the temperature.
Step 5 – Store: After you have finished using the thermometer, switch off the
thermometer and clean the tip with water and wipe with tissue paper or dry cloth. Keep
the thermometer in its protective case and store it at safe place, away from the reach
of children.
Heat Stroke
Heat stroke is the most severe of all heat-related
illness. It could be life threatening. It is caused when
the cooling mechanism of the body fails due to
excessive heat and humidity. Impairment in sweat
gland function may be another cause of heat stroke.
Symptoms: Body temperature greater than 1040 F.
Fever may cause headache, dizziness, fatigue,
fluctuating blood pressure and irritability.
First Aid: Shift the person to a shady place. Cool the person by sponging with wet
towel. Apply ice packs in armpits and groin. Give luke warm water with electrolyte.
Back Pain
Back pain is a short-term acute pain in the back of the body. It indicates that the body
is under stress. It is caused due to problems in bones, ligaments and muscles of spine
and nerves.
Triggering Factors:
Back pain may be aggravated due to poor posture, inappropriate footwear, incorrect
walking habits, prolonged sitting, sleeping on soft mattresses, kidney, bladder prostate
disorders, constipation, stress, etc.
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First Aid:
Massage with hot/cold packs and use painkillers or relaxants for pain relief.
Asthma
Asthma is a chronic inflammatory lung disease that causes airways to tighten and
narrow. It creates narrowing of air passages of the lung and therefore produces
difficulty in breathing.
Symptoms: Symptoms may include wheezing, cough and cold, tightness in the chest,
sticky mucus, disturbed sleep, and breathlessness.
Causes: It is believed that heredity factors are the main cause of asthma. Environmental
factors like dust, mite, pollen and occupational exposure to irritants aggravate asthma.
Cold, viruses, cigarette smoking, scent, pollution, change in weather, etc. are the
triggering factors.
First Aid: In case of asthmatic attack, use asthma inhalers. Asthma inhalers are hand-
held portable devices that deliver medication to the lungs. A variety of asthma inhalers
are available to help control asthma symptoms in adults and children. Types of asthma
inhalers include: (i) Metered Dose Inhalers: These inhalers consist of a pressurized
canister containing medication that fits into a boot-shaped plastic mouthpiece. (ii)
Metered Dose Inhaler with a Spacer: A spacer holds medication after it’s released,
making it easier to inhale the full dose. Releasing the medication into the spacer gives
you time to inhale more slowly, decreasing the amount of medicine that’s left on the
back of your throat and increasing the amount that reaches the lungs, (iii) Dry Powder
Inhaler: These inhalers do not use a chemical propellant to push the medication out
of the inhaler. Instead, the medication is released by breathing in a deep, fast breath.
Available types include a dry powder tube inhaler, a powder disk inhaler and a single-
dose powder disk inhaler. Finding the right asthma inhaler can help make sure you get
the right dose of medication to prevent or treat asthma attacks whenever you need it.
Foodborne Illness
Foodborne illnesses occur by eating unhygienic food and water. Bacteria are the most
common cause of food contamination.
Symptoms: Common symptoms include diarrhoea,
which may be bloody, nausea, abdominal cramps,
vomiting, fever, dehydration, shallow breath, rapid
pulse, pale skin, and chest pain.
First Aid: Oral Rehydration Salt (ORS) should be
given with luke warm water. In severe cases, the
patient should be hospitalized immediately. Recipe
for making a 1 litre ORS solution using Sugar, Salt
and Water.
1. Clean Water - 1 litre - 5 cupfuls (each cup about 200 ml.).
2. Sugar - Six level teaspoons.
3. Salt - Half level teaspoon.
4. Stir the mixture till the sugar dissolves.
Exercise
1. Practice the Cardiopulmonary Resuscitation (CPR) procedure on simulation.
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Assessment
Fill in the Blanks
1. A person is suffering from fever ranging from 98.8° F – 100.8° F is said to be
suffering from fever.
2. A person is suffering from a temperature of 104° F and above is said to be suffering
from fever.
3. In high fever, a person should be kept by sponging with wet
towel or applying ice packs in armpits.
4. is a chronic lung disease.
5. Back is caused due to problems in ligaments and muscles of
spine.
6. Bronchodilators are used in case of attack.
7. are the microorganisms which are said to be the most common
cause of food contamination.
activity.
Part A
1. Low, mild and high fever
Part B
1. What are the role and functions of first aider?
2. What are the precautions to be taken while taking temperature?
Part C
Performance standards
Demonstrate the knowledge of ABC (airway, breathing and circulation)
of first aid
Demonstrate the steps for measuring body temperature using a digital
thermometer
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Session 4: Performing the Role of First Aider in Cuts,

Bleeding, Burns, Insect Bites and Stings,
Dog Bites and Snake Bites
Relevant Knowledge
Let us now learn about the various first aid procedures that we need to adopt while
handling patients with cuts, bleeding, insect bites and stings, dog bites, and snake
bites.
Cuts
Cut is an injury which forms an opening in the skin.
Types of Cuts: The two types of cuts are minor and deep cuts.
(i) Minor Cuts / Scrapings: Minor cuts are caused
by sharp tools and equipment like scissors,
razors, saws, knives, pruners, chisels, and snips.
First Aid: Clean the cut with clean water and then
with savlon. Apply antibiotic ointment or first aid
band. Apply first aid bandage.
(ii) Deep Cuts: Deep cuts may expose the
underlying tissues and cause heavy bleeding.
First Aid: In deep cuts, stitching of tissues may be
required, therefore, immediate medical aid needs to be given. Tetanus toxoid injection
should be given to prevent tetanus.
Bleeding
Bleeding refers to the loss of blood. Bleeding can happen inside the body (internal
bleeding) or outside the body (external bleeding). Internal bleeding may also occur due
to an injury to blood vessel. External bleeding could be blood flowing through a natural
opening (such as the mouth, vagina or rectum). A cut on the skin can lead to severe
external bleeding. It involves loss of large amount of blood.
Causes: Severe bleeding may occur in case of accidents, blow to the head, or
due to certain illness like hemophilia, scurvy, cancer, thrombocytopenia, leukemia,
hemorrhage, peptic ulcer, etc.
Symptoms: Symptoms include discharge of blood from a wound.
First Aid: Wash your hands and wear surgical gloves before administering first aid to
victim. Make the victim lie down. Keep the affected area elevated. Remove any obvious
debris/particle. Apply direct pressure using clean cloth/bandage. Hold the bandage in
place using an adhesive tape. In case of bleeding does not stop, call the doctor.
Burns
Burns are injuries to the skin and tissues caused due to heat (e.g., fire, hot water, etc.),
chemicals (e.g., acids), electricity or radiation. Burns can cause swelling, blistering,
scarring and, in serious cases, shock and even death. They can lead to serious
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infections as they damage the skin’s protective covering. Severe burns affect muscles,
fat and even bones.
Burns can be classified into three categories viz., first, second and third degree burns,
depending on the severity of burn.
(i) First degree burns: In first degree burns, injuries are superficial or mild.
Symptoms: Swelling and redness of the injured area takes place. Pain develops. No
blisters are seen. Burned area becomes white on touch.
First Aid:
 Remove patient from heat source.
 Remove the burnt clothing.
 DO NOT apply lotions, ointment or fat (e.g. ghee) to burns.
 Run cool water over burnt area.
 Wear surgical gloves and gently clean the injured area and dry.
 Apply antibiotic, such as Silver Sulphadiazine or Burnol.
 Use a sterile bandage to cover burns.
(ii) Second-degree burns: Burns extend to middle skin layer. 90% body surface injury
results in death, while 60% injury in elderly is fatal.
Symptoms: Swelling, redness and pain are observed. Blisters develop, that ooze a
clear fluid. Dehydration may occur.
First Aid:
 Make the patient lie down.
 Apply antibiotic cream over affected area.
 Splints may be used to rest the affected joints.
 Take the patient immediately to the hospital.
(iii) Third-degree burns: Damage occurs to all the three skin layers. It destroys
adjacent hair follicles, sweat glands, and nerve endings.
Symptoms: Lack of pain due to destroyed nerves. The injured area does not turn
white on touch. No blisters observed. Swelling occurs. Skin develops leathery texture.
Discoloration of skin is observed. Scars develop. Crusty surfaces may occur.
First Aid: Move the patient to the hospital, without any delay.
Insect Bites and Stings

Insect bites are mostly not severe. Sometimes they cause a severe allergic reaction
known as anaphylaxis. Sting of bees, wasps, hornets, and bites of fire ants are painful.
Bites of insects, like mosquitoes cause itching and may result in diseases like malaria.
The bite of a black widow spider can be fatal, if left untreated.
Symptoms: General symptoms of insect bites and stings include localised pain,
swelling, redness, itching, numbness, burning, tingling sensation, breathlessness, and
weakness.
First Aid:
 Remove the stinger using a straight- edged object like sterilized needle.
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 Wash the area thoroughly with soap and water. Place ice wrapped in a cloth
on the affected area. Repeat after every 10 minutes.
 Apply a gentle cream to prevent itching.
 Consult a doctor in case of severe bite symptoms.
Dog Bite
Dogs can cause slight injuries such as lesions, light
traumas (scratches and bruises) and serious injuries
such as bites. They may also cause diseases as a
result of infections and allergies caused by bacteria,
fungi, acarids or viruses. Rabies-Latin rabies,
means-madness is (an acute viral disease of the
central nervous system that affects humans and
other mammals.) Rabies may be caused by non-
immunized dogs or stray dogs.
Symptoms: Symptoms may include skin break, bruise or puncture, cuts, bleeding,
swelling and redness of the area, and oozing of fluid. In case of rabies, the affected
person is scared of water (hydrophobia).
First Aid:
 Wash hands before attending to wound.
 Wash wound with soap and running water.
 Apply antibiotic ointment.
 Dress using sterile bandage.
Tetanus booster or antibiotics/ anti-rabies injection are required to be given at the
hospital.
Snake Bite
Snakebite is an injury caused by a bite from a snake often resulting in puncture wounds.
The outcome of snake bites depends on numerous factors, including the species of
snake, the area of the body bitten, the amount of venom injected, and the health
conditions of the victim. Feelings of terror and panic are common after snakebite and
can produce a characteristic set of symptoms mediated by the nervous system such
as increased heartbeat, nausea and giddiness. Even bite from a harmless snake can
cause allergic reaction.
Causes: Snakes which may bite a person includes Viper, Cobra, Rattlesnake, Water
moccasin and Coral snake.
Symptoms: Symptoms may include fang marks, swelling or severe pain at the site,
bloody discharge from wound, burning, blurred vision, numbness or tingling sensation,
vomiting, loss of muscle co-ordinations, rapid pulse, fainting, etc.
Treatment:
 Immediately call for medical help. Get the victim to the hospital as soon as
possible.
 Check the snakebite for puncture wounds. If one or two fang markings are
visible, the bite is from a poisonous pit viper.
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 Remember what the snake looks like. The doctor will need to know this to
provide proper treatment.
 Keep the victim calm. Keep the bitten arms or leg below the level of his heart
to slow the blood flowing from the wound to the heart. The more the victim
moves, the faster the venom spreads through the body.
 Wash wound with soap/water, keep the bitten area slightly elevated, and apply
cool compress/wet cloth to the affected part. Be sure to wipe away from the
bite. This keeps any venom on the unbroken skin around the bite from being
wiped into the wound.
 Watch for general symptom (i.e. sharp pain, bruising, swelling around the bite,
weakness, shortness of breath, blurred vision, drowsiness, or vomiting). If any
of the these symptoms occur within 30 minutes from the time of the bite, and
you are over two hours away from medical help, tie a constricting band (3/4 to
1 ½ inches wide) two inches above the bite or above the swelling.
 The band needs to be loose enough to slip a finger underneath it. The band
slows blood flow away from the bite, keeping the venom from reaching the
heart. The band must be applied within 30 minutes after the time of the bite
to be effective. If the swelling spreads, move the band so that it is two inches
above the swelling. Monitor for pulse, respiration and blood pressure till the
medical aid is given to the victim.
Exercise
1. Practice first aid on a dummy with the help of a first aider.
Assessment
Fill in the Blanks
a) The two types of cuts are and deep cuts.
b) Tetanus injection is given to prevent tetanus, which may be caused
due to cut in the skin.
c) In certain illnesses like ulcer, excessive takes place.
d) A first-aider should always wash hands with antiseptic soap and water before and
after administering .
e) You should wear surgical before administering first aid.
activity.
Part A
1. Different types of cuts.
2. Different degree of burns.
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3. Dog bite and snake bite.

Part B
1. How burns are caused?
2. Why bite of non-immunized dogs is dangerous?
Part C
Demonstrate the knowledge of administer first aid for cuts in
a hypothetical situation.
Demonstrate the knowledge of steps involved in providing first
aid to a victim of snake bite.
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UNIT – 5
STRUCTURE, FUNCTIoNS AND NUTRITIoN

Sector: Healthcare
Learning outcomes
Unit 5 HUMAN BoDY: STRUCTURES, FUNCTIoNS AND NUTRITIoN
Duration: 20 Hours

Hospital/  Identify the  Describe the  Identify the different Interactive
Clinic parts of human various tems of parts of the body. Lecture:
body. anatomy and  Draw diagrams of  Biological Parts
physiology. tungs, urinary of Human
.  Describe functions system, heart and Body.
of various tissues and kidney.  Activity:
and bones in  Demonstrate the Visit a biologi-
human body. knowledge of roles cal lab, Re-
and functions of search Labora-
various systems of tory and study
human body. the anatomy
and physiology
of human body.
 Demonstrate  Describe the role  Enlist the food Interactive
the knowledge of various nutrients source of Lecture:
of nutrients in and vitamins. carbohydrate,  Nutrition and
the nutrition of  Describe the protein and fat. Balanceed Diet.
human body. importance of a  Demonstrate the
balanced diet. knowledge of  Activity:
dieses / disorders Preparing a
caused due to the balanced diet.
dificiency of
vitamins.
 Demonstrate the
knowledge of a
balanced diet.
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Sector: Healthcare
Session 1: Identify the Parts of Human Body
Relevant Knowledge
Anatomy
The science that deals with the structures of the body and the relationship of various
parts to each other is known as Anatomy. The knowledge of these structures in very
important in order to understand the functions of the body. The discipline of anatomy
is subdivided into gross (or macroscopic) anatomy and microscopic anatomy. Gross
anatomy is the study of structures that can be seen by unaided vision with the naked
eye. Microscopic anatomy is the study of structures on a microscopic scale, including
histology (the study of tissues) and cytology (the study of cells).
Physiology
The science that elucidates the normal functions of the body and explains how the various
organs and systems work together to function as a single unit is called Physiology.
Human physiology is the science of the mechanical, physical, and biochemical
functions of normal human or human tissues or organs. Anatomy and physiology are
closely related fields of study: anatomy, the study of form, and physiology, the study of
function. The study of how physiology is altered in disease is Pathophysiology.
The subject anatomy includes the following
 Histology - Study of Tissues
 Cytology - Study of Cells
 Myology - Study of Muscles
 Osteology - Study of Bones
 Arthrology - Study of Joints
 Neurology - Study of Nervous System
 Splanchnology - Study of Visceral Organs
Anatomical terminology is often chosen to highlight the relative location of body
structures and the human anatomy may thus be described as per the following:
1. Median Line : The central plane which divides the body into two halves, i.e. right
and left.
2. Medial : Nearer to the median line.
3. Lateral : Away from the median line.
4. Anterior : Towards the front surface of the body, also called Ventral.
5. Posterior : Towards the back surface of the body, also called Dorsal.
6. Superior : Nearer to the head, also called Cranial.
7. Inferior : Nearer to the foot, also called Caudal.
8. Proximal : Position that is closer from the trunk of the body.
9. Distal : Position that is further from the trunk of the body.
10. Superficial : Nearer to the skin and surface.
11. Deep : Deeper from the skin and surface.
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General motion
The various parts of the body move with respect to each other and the plane of the
body and these movements can be described in general as follows:
 Flexion a movement that decreases the angle between body parts.
 Extension a movement that increases the angle between body parts.
 Abduction a motion that pulls a structure away from the midline of the body or limb.
 Adduction a motion that pulls a structure towards the midline of the body or limb.
 Internal rotation (or medial rotation) refers to rotation towards the center of the
body.
 External rotation (or lateral rotation) refers to rotation away from the center of the
body.
 Elevation refers to movement in a superior direction.
 Depression refers to movement in an inferior direction.
Composition of Body
The human body is organized into various levels that begin at the very small and basic
and come together to form the complete body whose different parts work in unison.
This can be seen as a kind of ‘ladder’ going from the basic to the very complex. At the
simplest level, the body is comprised of atoms.
Cell
The basic unit of body structure is the cell. It is like one brick of a wall. All cells need
food, water, and oxygen to live and function. As cells use or metabolize food and
oxygen they give off carbon dioxide and other wastes. The cell is comprised of the cell
membrane, which is the outer covering; it encloses the cell and helps it hold its shape.
The nucleus is the control centre. It directs the cell‘s activities. Cytoplasm surrounds
the nucleus. Organelles are structures that are suspended in the cytoplasm. The
protoplasm refers to all structures, substances and water within the cell.
Functions of the cell 2
 Respiration - all cells require oxygen to metabolize food.
 Ingestion and assimilation - cells are able to select chemicals from the surrounding
fluid for their structure.
 Growth and repair - cells can synthesize new cytoplasm so that growth can occur
and repair worn out parts.
 Excretion - waste products are eliminated into surrounding tissue to be transported
by the blood for elimination via organs.
 Irritability and activity - cells are able to respond to stimuli. For example, a stimulus
causes a muscle to contract or relax.
 Metabolism - cells are able to break down and use substances from food as fuel.
 Reproduction - cells reproduce by simple division but some cells can never be
replaced once destroyed. For example, central nervous system cells.
Tissues
Tissues are groups of similar cells that perform a common function. There are four
categories of tissues in the human body: epithelial, connective, nervous, and muscle.
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Figure 1 – A typical Human Cell
Types Function Example
Epithelial Protection Skin

Connective Support Bones
Muscular Movement Skeletal
Nervous Communication Brain
Epithelial Tissue
This tissue covers the body surfaces and lines its cavities. Some specialize to form
glands. The functions of epithelial tissue include:
 Protection.
 Absorption.
 Secretion.
 Excretion.
 Surface transport.
 Reception of sensory information - like touch, heat/cold, pain.
A gland is one or more epithelial cells specialized to produce and discharge substances.
Endocrine glands have no ducts or tubes and secrete hormones directly into the
bloodstream, for example pituitary gland. Exocrine glands release their secretions
through ducts, for example salivary and sweat glands.
Connective tissue
This tissue joins other tissues of the body together, supports the body and protects
underlying organs.
Some main types are:
 Ordinary connective tissue - subcutaneous tissue and collagen (Just below the
skin)
 Adipose tissue - stores fat
 Cartilage - protects joints and supports soft tissues
 Bone - rigid supporting tissue of the skeleton
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 Blood - lymph and lymphoid tissue (produce blood cells)

Muscular tissue
 Muscle is composed of cells, specialized to contract.
 Skeletal muscle is striated (striped) and is under voluntary control (in our control).
 Cardiac muscle is present only in the walls of the heart, is striated and is controlled
by involuntary nerve messages from the brain.
 Smooth muscle, also involuntary (not in our control), is responsible for movement
of food through the digestive tract, and changing the diameter of blood vessels.
Nervous tissue
Nervous tissue forms the brain, spinal cord and the nerves. The basic cell is called the
neuron. Specialized to receive stimuli and send impulses (messages) from one part of
the body to another.
The various systems that form the human body are:
 Cardiovascular system
 Respiratory system
 Digestive system
 Muscular system
 Nervous system
 Urinary system
 Integumentary system
 Organs of the sensory system
 Reproductive system
 Endocrine system
 Immune system
Cardio Vascular System
The circulatory system is an organ system that permits blood and lymph circulation to
transport nutrients, oxygen, carbon dioxide, hormones, blood cells, excretory material,
etc. to and from cells in the body to nourish it and help to fight diseases, stabilize body
temperature and pH, and to maintain homeostasis (i.e balance of chemicals).
The essential components of the human cardiovascular system are the heart,
blood, and blood vessels. An average adult contains about 5 liters of blood, which is
approximately 7% of total body weight. Blood consists of plasma, red blood cells, white
blood cells, and platelets.
Heart
Human heart is a pump with four chambered, hollow organ, which is responsible for
the circulation of blood throughout the body and along with it all the necessary gases,
nutrients and others. The heart is located in the thorax (chest) between the lungs
and behind the sternum. Two thirds of the heart lies on the left side and it is placed
obliquely. The heart has a mass of between 250 and 350 grams and is approximately
the size of the fist of the Individual. Heart is made of four chambers, two auricles
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and two ventricles, each further classified into right and left auricle and right and left
ventricle.
Figure 2 – Diagram of the Human Heart and the Location of heart

in the Body (Inset picture)
The heart beat is denoted by heart sounds – the ―Lub - Dub and the activity of the
heart is visualized electrically by the ECG, i.e., Electro Cardiogram.
The blood vessels are the part of the circulatory system that transports blood throughout
the body. There are three major types of blood vessels:
 Arteries - which carry the blood away from the heart
 Veins - which carry blood from the capillaries back towards the heart.
 Capillaries (Thinnest, located between Arteries and Veins) - which enable the
actual exchange of water and chemicals between the blood and the tissues
Respiratory System
The respiratory system is a system consisting
of specific organs and structures used for the
process of respiration in an organism. The
respiratory system is involved in the intake
and exchange of oxygen and carbon dioxide
between an organism and the environment.
The respiration takes place in the respiratory
organs called Lungs. The passage of air into
the lungs to supply the body with oxygen is
known as inhalation, and the passage of air out
of the lungs to expel carbon dioxide is known Figure 3 – Parts of the
as exhalation; this process is collectively called Respiratory
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breathing. The anatomical features of the respiratory system include trachea, bronchi,
bronchioles, lungs, and diaphragm. Molecules of oxygen and carbon dioxide are
passively exchanged, by diffusion, between the gaseous external environment and
the blood. This exchange process occurs in the alveoli or air sacs in the lungs.
Digestive System
The human gastrointestinal tract (GI tract is divided into the upper and lower
gastrointestinal tracts). It includes all the structures from the mouth to the anus. The
digestive system is a broader term that includes other structures, including the digestive
organs and their accessories. The whole digestive tract is about nine meters long and
is divided in to two major parts, the Upper GI tract and the Lower GI tract. The upper
gastrointestinal tract consists of the esophagus, stomach, and duodenum. The lower
gastrointestinal tract includes most of the small intestine and all of the large intestine.
The main organs in the digestive system are as follows:
 Oesophagus
 Stomach
 Duodenum
 Jejunum
 Ileum } Small Intestine
Figure 4 – Major organs of the Digestive System
 Ascending Colon
 Transverse Colon Large Intestine
 Descending Colon
 Rectum
} Large Intestine
 Anus
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Musculo-Skeletal System
The human musculoskeletal system is an organ system that gives humans the ability to
move using the muscular and skeletal systems. The musculoskeletal system provides
form, support, stability, and movement to the body. It comprises of the body’s bones
(the skeleton), muscles, cartilage, ligaments, tendons, joints, and other connective
tissue that supports and binds tissues and organs together.
The functions of the musculoskeletal system are as follows:
 Protect and support the internal structures and organs of the body
 Allow movement
 Give shape to the body
 Produce blood cells
 Store calcium and
phosphorus
Skeletal System
The skeletal system is comprised
of bones and joints and provides
the basic supporting structure of
the body. It consists of the joined
framework of bones called the
skeleton. The human skeleton
is made up of 206 bones.
Bones
Bone is a dry, dense tissue
composed of a calcium-
phosphorus mineral and
organic matter and water. The
centre of Long bone contains
bone marrow where blood
vessels, fat cells and tissue for
manufacturing blood cells are all
found. There are the following
four main shapes of bones:
 flat - as in ribs
 irregular - as in the vertebral
column Figure 5 – Major Bones in the Skeletal
System
 short - as in hands and foot
 long - as in femur and humorous
Joints
A joint is an area where two or more bones come in contact with each other. Joints
allow the movement of the bones and attached organs. The bones forming the joint are
held together by ligaments. There are the following 3 types of joints:
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1. Fibrous or immovable e.g. skull

2. Cartilaginous or slightly moveable e.g. vertebrae
3. Synovial or freely movable. These include the following:
a. Ball and socket - As in hip, shoulder
b. Hinge - As in elbow
c. Gliding - As in carpals at wrist (small bones of hand)
d. Pivot - As in radius and ulna
Muscular System
The muscular system allows us to move with help of the skeletal system. The human
body is composed of over 500 muscles working together to facilitate movement. The
major function of the muscular system is to produce movements of the body, to maintain
the position of the body against the force of gravity and to produce movements of
structures inside the body. There are the following 3 types of muscles:
1. Skeletal (voluntary) muscles are attached to bone by tendons
2. Smooth (involuntary) muscles control the actions of our gut and blood
vessels
3. Cardiac muscle in the heart
The Nervous System
The nervous system is responsible for conducting and coordinating all the activities of
the body. It controls not only the maintenance of normal functions but also the body’s
ability to cope with emergency situations.
Function
The nervous system has three general functions: a sensory function, an interpretative
function and a motor function.
1. Sensory nerves gather information from inside the body and the outside
environment. The nerves then carry the information to central nervous system
(CNS).
2. Sensory information brought to the CNS is processed and interpreted.
3. Motor nerves convey information from the CNS to the muscles and the glands
of the body.
Structure
The nervous system is divided into two parts:
1. The central nervous system consisting of the brain and spinal cord. These
structures are protected by bone (Skull and Vertebral Column) and protected
from injury by the cerebrospinal fluid (CSF) which acts as cushion or shock
absorber
2. The peripheral system which connects the central nervous system to the rest
of the body.
Brain and Spinal Cord
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The brain is a mass of soft nerve tissue,

which is placed within the skull. It is
made up of grey matter, mainly nerve cell
bodies, and white matter which are the cell
processes. The grey matter is found at the
periphery of the brain and in the centre of
the spinal cord. White matter is found deep
within the brain, at the periphery of the
spinal cord and as the peripheral nerves.
The spinal cord is about 45 cms long, acting
as a message pathway between the brain
and the rest of the body. Nerves conveying
impulses from the brain, otherwise known
as efferent or motor nerves, travel through
Figure 6: Parts of Nervous
the spinal cord down to the various organs
System
of the body.
Urinary System
The urinary system, also known as the
renal system, consists of the two kidneys,
ureters, the urinary bladder, and the
urethra. The purpose of the renal system is
to remove wastes from the body, regulate
blood volume and pressure, regulate blood
pH, and control levels of electrolytes and
metabolites. The kidneys have extensive
blood supply which enter the kidneys
through the renal arteries and leave the
kidneys through the renal vein. After the
Fig. 7: Parts of Urinary System
filtration of blood, wastes in the form of
urine exit the kidney via the ureters, tubes made of smooth muscle fibers that propel
urine towards the urinary bladder, where it is stored and subsequently expelled from
the body by urination. The female and male urinary system is very similar, differing only
in the length of the urethra. Each kidney consists of millions of functional units called
nephrons.
Functions of the Urinary System
There are several functions of the Urinary System:
 Removal of waste product from the body (mainly urea and uric acid).
 Regulation of electrolyte balance (e.g. sodium, potassium and calcium).
 Regulation acid-base homeostasis.
 Controlling blood volume and maintaining blood pressure.
Ureters
These are two hollow tubes that run from the kidney to the bladder. Urine is transported
through the ureters by peristalsis and gravity.
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Urinary bladder
The Urinary bladder is a hollow sac situated towards the front of the lower part of the
abdomen. The function of the bladder is to store urine.
Urethra
Urine is transported from the bladder through the urethra. In the female the urethra
is about 10cms long; in the male the urethra is about 20cms long and also conveys
semen.
The Nephron
The nephron is the functional unit of the kidney. Blood enters the nephron under
pressure and passes through the structures of the nephron for filtration. Most of the
water and many substances that are needed by the body are retained back after
filtration. The kidneys produce 1-1.5 litres of urine per day.
Many factors affect the production of urine. These include age, illness, the amount
of and type of fluids ingested, the amount of salt in the diet, caffeine, alcohol and
medications.
Integumentary system
The Integumentary system is the skin. It is the outermost covering of the body.
Functions
 Protection
 Temperature regulation — the skin has an abundant blood supply, which is
primarily for temperature regulation. For example, when we become hot, the
blood supply rushes to the skin surface and heat is lost through radiation. The
skin also regulates temperature by perspiration and when we perspire, heat is
lost through evaporation.
 Sensory input — the skin has millions of nerve endings, which allow us to
respond to the sensations of pain, heat and cold.
 Excretion of water and waste products.
 Manufacture of vitamin D.
Figure 8: Structure of the Skin
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Body Temperature
Body temperature is the balance between the amount of heat produced and the amount
of heat lost by the body. Body temperature remains fairly stable. Factors affecting body
temperature are age, weather, exercise, emotions, stress, pregnancy, the menstrual
cycle and illness. The normal body temperature range for an adult is between 97.02–
°F. Any temperature above 99.50 °F is considered a fever or Pyrexia.
The Sensory organs
Tongue
The receptors for taste lie in the tongue and are able to identify the following four types
of taste:
 Sweet
 Salty
 Bitter
 Sour
These taste pores or taste buds are found on papillae on the tongue and when they are
stimulated by chemicals in the saliva. They send impulses to the brain to be interpreted
by a specific area of the cortex.
The Nose
The receptors for smell are located in the upper part of each nasal cavity. Sniffing
helps bring more air (containing odours) over the olfactory mucosa.
Figure 9: Nose
Hearing and Balance - The Ear

The ear is divided into three main areas: the external ear; the middle ear; and the inner
ear. The outer and middle ear is involved in hearing only. The inner ear functions in
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both balance and hearing. The external ear is composed of the pinna and the external
auditory canal. In the walls of the external auditory canal are glands that secrete
earwax or cerumen.
Figure 10: Parts of Ear
Eye
The eye is a hollow sphere. The accessory structures of the eye include the extrinsic
eye muscles, the tear (lachrymal) glands and ducts, the eyelids, the eyelashes and the
conjunctiva.
Figure 11: Parts of Eye
Exercise
1. Visit a Anatomy Lab and identify the following:
a. Gross and microscopic slides of various body parts.
b. Draw and imaginary Medial, Median and lateral line on Torso.
c. Identify the anterior, posterior, superior and inferior parts of liver.
2. Prepare diagrams of the following organs and label them:
1. Lungs
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2. Urinary system
3. Heart
3. Visit a nearby laboratory and observe various body tissues. Fill the table given
below
Types Tissue obtained from which body parts
Epithelial
Connective
Muscular
Nervous
Assessment
1. Describe the functions of following:
a) Epithelial tissues
b) Muscular tissues
c) Nervous tissues
d) Heart
e) Lungs
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f) Kidney
g) Artery
II. Match the following

Column 1 Column 2
Integumentary Heart, vessels, blood

Cardiovascular Trachea, bronchus, lungs
Nervous Brain, spinal chord
Urinary Muscles, bones
Digestive Glands, hormones
Respiratory Kidney, bladder
Musculoskeletal Mouth, oesophagus, intestines, rectum
III. Fill in the blanks

1. Blood cells are manufactured in
2. Normal temperature of a human being is
3. The number of chambers in a heart are
4. An adult human skeleton has bones
5. Study of tissues is known as
6. Study of bones is known as
7. Study of nervous system is known as
IV. Match the organs with respect to their location in the body
1. Heart
2. Superior Venacava
3. Lungs
4. Inferior venacava
5. Heart
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V. Fill in the blank boxes from the following words:
Pharynx Larynx Bronchus
Trachea Nasal cavity Lungs
VI. Identify the parts of the body
1. Mouth
2. Stomach
3. Gall Bladder
4. Pancreas
5. Liver
6. Large Intestine
7. Small Intestine
activity.
Part A
1. Anatomy and physiology
2. Cells and tissues
3. Capillaries and veins
4. Metabolism and catabolism
5. Endocrine and exocrine glands
6. Histology and myology
Part B
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1. Why is it necessary to study the human anatomy and physiology?

2. What are the roles and functions of various tissues in human body?
3. How the study of human anatomy and physiology would help a GDA in
performing effectively?
Part C
Identify the parts of human body.
Demonstrate the knowledge of roles and functions of various systems
of human body.
Demonstrate the knowledge of different types of tissues and bones in
human body.
Session 2: Describe the Role of Nutrition in the Growth and

Development of Human Body
Relevant Knowledge
Nutrition is the process of providing or obtaining the food necessary for health and
growth. Nutrition is the intake of food, considered in relation to the body‘s dietary
needs. Good nutrition – an adequate, well balanced diet combined with regular physical
activity is a cornerstone of good health. Poor nutrition can lead to reduced immunity,
increased susceptibility to disease, impaired physical and mental development, and
reduced productivity.
Why is Nutrition Important?
The food habits of people have changed drastically in a short time and this has had
a big impact on our health. What we eat helps us to grow and develop properly, and
stay healthy and strong. Food plays an important part in healthy pregnancy, promoting
healthy babies and children that grow to their best mental, physical, social and
emotional potential.
Food plays an important role in preventing and treating conditions affecting people such
as diabetes, heart disease, hyperactivity, and obesity. Our food choices take place in
a social, cultural, political and economic environment that can aggravate the health
of communities unless active measures are taken to make the environment a health
promoting one. Nutrition also focuses on how diseases, conditions and problems can
be prevented or lessened with a healthy diet. In addition, nutrition involves identifying
how certain diseases, conditions or problems may be caused by dietary factors, such
as poor diet (malnutrition), food allergies, metabolic diseases, etc.
The human body requires seven major types of nutrients
A nutrient is a source of nourishment and an ingredient of foods, such as protein,
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carbohydrate, fat, vitamin, mineral, fiber and water. Macronutrients are nutrients we
need in relatively large quantities. Micronutrients are nutrients we need in relatively
small quantities.
A) Macronutrients
Carbohydrates
Molecules consist of carbon, hydrogen and oxygen atoms. Carbohydrates include
monosaccharides (glucose, fructose, glactose), sisaccharides, and polysaccharides
(starch). Nutritionally, polysac-
charides are more favoured for
humans because they are more
complex molecular sugar chains
and take longer to break down - the
more complex a sugar molecule is
the longer it takes to break down
and absorb into the bloodstream. It
yields energy equal to approx. 4 kcal
per gram.
Proteins
Molecules contain nitrogen, carbon,
hydrogen and oxygen. Simple
proteins, called monomers, are
used to create complicated proteins,
called polymers, which build and
repair tissue. When used as a fuel
the protein needs to break down,
as it breaks down it gets rid of
nitrogen, which has to be eliminated
by the kidneys. It yield energy,
approximately 4 kcal per gram.
Fats
Molecules consist of carbon,
hydrogen, and oxygen atoms. Fats
are triglycerides - three molecules of Pyramid of Nutrition
fatty acid combined with a molecule
of the alcohol glycerol. Fatty acids
are simple compounds (monomers) while triglycerides are complex molecules
(polymers). These do not provide energy. It yield approximately 9 kcal per gram.
Fiber
Fiber consists mostly of carbohydrates. However, because of its limited absorption by
the body, not much of the sugars and starches get into the blood stream. Fiber is a
crucial part of essential human nutrition.
Water
About 70% of the non-fat mass of the human body is water. Nobody is completely sure
how much water the human body needs - claims vary from between one to seven litres
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per day to avoid dehydration. We do know that water requirements are very closely
linked to body size, age, environmental temperatures, physical activity, different states
of health, and dietary habits.
B) Micronutrients
Nutrients required in small quantities throughout a person’s life include the following:
Minerals
Dietary minerals are the other chemical elements our
bodies need, apart from carbon, hydrogen, oxygen
and nitrogen. The term “minerals” is misleading, and
would be more relevant if called “ions” or “dietary
ions”. People whose intake of foods is varied and
well thought out - those with a well balanced diet -
will in most cases obtain all their minerals from what
they eat. Minerals are often artificially added to some
foods to make up for potential dietary shortages and
subsequent health problems. The best example of
this is iodized salt - iodine is added to prevent iodine
deficiency, which even today affects about two billion
people and causes mental retardation and thyroid
gland problems. Iodine deficiency remains a serious public health problem in over half
the world.
Potassium
Potassium is a systemic (affects entire body) electrolyte, essential in co-regulating ATP
(an important carrier of energy in cells in the body, also key in making Ribonucleic Acid
(RNA)) with sodium.
 Deficiency of phosphorus may result in hypokalemia (can profoundly affect the
nervous system and heart).
 Excess potassium may result in hyperkalemia (can profoundly affect the nervous
system and heart).
Chloride
Chloride is a key for hydrochloric acid production in the stomach, also important for
cellular pump functions.
 Deficiency of chloride may result in hypochleremia (low salt levels, which if severe
can be very dangerous for health).
 Excess chloride may result in hyperchloremia (usually no symptoms, linked to
excessive fluid loss).
Sodium
Sodium is a systemic electrolyte and essential in regulating ATP with potassium.
 Deficiency of sodium may result in hyponatremia (cause cells to malfunction;
extremely low sodium can be fatal).
 Excess sodium may result in hypernatremia (can also cause cells to malfunction,
extremely high levels can be fatal).
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Calcium
Calcium is important for muscle, heart and digestive health. Builds bone, assists in the
synthesis and function of blood cells.
 Deficiency of calcium may result in hypocalcaemia (muscle cramps, abdominal
cramps, spasms, and hyperactive deep tendon reflexes).
 Excess calcium may result in hypercalcaemia (muscle weakness, constipation,
undermined conduction of electrical impulses in the heart, calcium stones in
urinary tract, impaired kidney function, and impaired absorption of iron leading to
iron deficiency).
Phosphorus
Phosphorus is a component of bones and energy processing.
 Deficiency of phosphorus may result in hypophosphatemia, an example is rickets-
weak bones in children.
 Excess phosphorus may result in hyperphosphatemia, often a result of kidney
failure.
Magnesium
Magnesium processes ATP and required for good bones.
 Deficiency of magnesium may result in hypomagnesemia (irritability of the nervous
system with spasms of the hands and feet, muscular twitching and cramps, and
larynx spasms).
 Excess magnesium may result in hypermagnesemia (nausea, vomiting, impaired
breathing, low blood pressure). Very rare, and may occur if patient has renal
problems.
Zinc
Zinc is required by several enzymes.
 Deficiency of zinc may result in short stature, anemia, increased pigmentation
of skin, enlarged liver and spleen, impaired gonadal function, impaired wound
healing, and immune deficiency.
 Excess zinc suppresses copper and iron absorption.
Iron
Iron is required for proteins and enzymes, especially hemoglobin.
 Deficiency of iron may result in anemia.
 Excess of iron may result in overload disorder, iron deposits can form in organs,
particularly the heart.
Manganese
Manganese is a cofactor in enzyme functions.
 Deficiency of manganese may result in wobbliness, fainting, hearing loss, weak
tendons and ligaments. Less commonly, can be cause of diabetes.
 Excess of manganese may result in interferes with the absorption of dietary iron.
Copper
Copper is a component of many redox (reduction and oxidation) enzymes.
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 Deficiency of copper may result in anemia or pancytopenia (reduction in the number

of red and white blood cells, as well as platelets) and a neurodegeneration.
 Excess copper can interfere with body’s formation of blood cellular components; in
severe cases convulsions, palsy, and insensibility and eventually death.
Iodine
Iodine is required for the biosynthesis of thyroxine (a form of thyroid hormone).
 Deficiency of iodine may result in developmental delays, among other problems.
 Excess iodine can affect functioning of thyroid gland.
Vitamins
These are organic compounds we require in tiny amounts. Vitamin cannot be
synthesized in the body or if at all it is synthesized, it is not sufficient for the body. So
we have to obtain it from our food.
Vitamins are classified by what they do biologically.
Vitamins are classified as water soluble (they can dissolve in water) or fat soluble
(they can dissolve in fat). In humans, there are 13 vitamins, out of which there are 4
fat-soluble (A, D, E, and K) and 9 water-soluble (8 B vitamins and vitamin C) vitamins.
Daily Deficiency
Vitamin Chemical name Require disease/ Food sources
ment disorder
Retinol 900 µg Night-blindness, Orange, ripe yellow fruits,

and leafy Hyperkeratosis,
Keratomalacia vegetables, carrots, pumpkin,
Vitamin A spinach, milk
Vitamin Thiamine 1.2 mg Beriberi Oatmeal, brown rice,
B1 vegetables, potatoes, eggs
Vitamin Cyanocobalamin, 2.4 µg Megaloblastic Meat and other animal

B12 hydroxycobalamin, anemia products
methylcobalamin
Vitamin Riboflavin 1.3 mg Glossitis, Angular Dairy products,
B2 stomatitis bananas, popcorn, green
beans,
Vitamin Niacin, niacinamide 16.0 mg Pellagra Meat, fish, eggs, many
B3 vegetables, mushrooms,
Vitamin Pantothenic acid 5.0 mg Paresthesia Meat, avocados

B5
Vitamin Pyridoxine, 1.3– Anemia, Meat, vegetables, tree nuts,

B6 pyridoxamine, 1.7 mg peripheral bananas
pyridoxal neuropathy.
Vitamin Biotin 30.0 µg Dermatitis, Raw egg yolk, liver, peanuts,
B7 enteritis certain vegetables
Folic acid, folinic 400 µg Megaloblastic Leafy vegetables, pasta,

acid anemia and bread, cereal, liver
deficiency
Vitamin during
B9 pregnancy is
associated with
birth defects,
such as neural
tube defects
Vitamin C Ascorbic acid 90.0 mg Scurvy Many fruits and vegetables,
Vitamin D Cholecalciferol, 10 µg Rickets and Fish, eggs, liver, mushrooms
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Ergocalciferol 16 µg Osteomalacia
Tocopherols, 15.0 mg Deficiency is very Many fruits and vegetables,
tocotrienols rare; sterility in nuts and seeds
males and
Vitamin E abortions in
females,
mild hemolytic
anemia in
newborn infants.
Vitamin K phylloquinone, 120 µg Bleeding Leafy green vegetables such

phylloquinone, menaquinones as spinach, egg yolks, liver
diathesis
Exercise
1. Identify the food products available in nearby market according to nutritional
classification.
Fill the table given below with the five rich sources –
Nutrient Rich source
Carbohydrate
Fat
Protein
Vitamin A
Calcium
Phosphorous
Sodium
Assessment
1. Give three examples of food that provide the following nutrients:
(a) Carbohydrates
(b). Proteins
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(c). Calcium
(e) Fats
(f). Vitamin A
activity:
Part A
1 Macronutrients and micronutrients
2. Vitamins and minerals
Part B
1. What are the roles and functions of different vitamins?
2. What is the importance of minerals in our growth and development?
3. Why is it important to take a balanced diet?
4. Why is it important to understand the importance of nutrients in the diet?
Part C
Demonstrate the knowledge of nutrition in the growth and development
of human body.
Demonstrate the knowledge of diseases/disorders caused due to the
deficiency of vitamins.
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UNIT – 6
PUBLIC RELATIoNS IN HoSPITAL

Sector: Healthcare
Learning outcomes
Unit 6 PUBLIC RELATIoNS IN HoSPITAL
Duration: 20 Hours
Hospital/
 Domenstrate  Describe the  Demonstrate the Interactive
Clinic the knowledge qualities of a good knowledge of Lecture:
of the roles medical greeting patients  Function of
and function receptionist. and other callers Medical Recep-
performed  Describe the tasks in a courteous and tionist.
by a Medical. performed by a efficient manner.
Receptionist. Medical  Answer telephone  Activity:
Receptionist. calls courteously Visit a nearby
and as per hospital and
procedure and study the activi-
norms. ties in reception
 Demonstrate the area and the
knowledge of tasks being
making appoint- performed by a
ments for patients Receiptionist.
and maintaining
file medical records.
 Demonstrate  Describe the  Demonstrate the Interactive
the knowledge knowledge of knowledge of the Lecture :
of responding responding to responsibility in  Responding to
to emergency emergency calls. emergency emergency
calls.  Describe the roles management calls.
and functions of activities.
 Activity:
“on call duty  Demonstrate the Visit a nearby
doctor”. knowledge of hospital and
 Describe the routine call and
study the major
various equipments emergency call.
and minor
available in a 108
emergency and
emergency service
non-emergency
ambulance.
services pro-
vided by the
. hospital
 Use computers  Describe the  Demonstrate the Interactive
in maintaining impact of knowledge of Lecture :
public relations. technoogical application of  Using comput-
revolution in computer in ers in maintain-
healthcare sector. hospital. ing public rela-
 Describe the use  Demonstrate the tions.
of computer in knowledge of  Activity:
hospital maintaining files Visit a nearby
administration. and records in hospital and
 Identify the use of computer. study the use
computer in of computer in
various sections / maintaining files
departments of a and records in a
hospital. hospital.
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Learning outcomes
 Demonstrate  Enlist the general  Demonstrate the Interactive
the knowledge stressful situation knowledge of Lecture :
of dealing with. in hospital. handling people  Dealing with
 Describe the factor with emotional patients
affecting relation- stress or emotional attendant.
ship between a outbursts.
General Duty  Enlist the skills
Assistant and required for Activity :
patient. General Duty  Visit a nearby
Assistant in hospital and
managing study health
stressful situation. professional
handling the
patient’s rela-
tive to emerg-
ency situation.
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Session 1: Describe the Role and Functions of Medical

Receptionist
Relevant Knowledge
Medical Receptionist is part of the health services
front line staff. He/she is the first link for patients and
visitors who visit a doctor or other member of staff
for the first time. A General Duty Assistant may be
required to serve as Medical Receptionist, therefore,
he/she should be trained in the medical terminology,
application of software and office procedures.
The Reception is located near the entrance of the
hospital. The receptionist at the reception centre
handle all visitor‘s enquires, direct visitors to the
Public Relations Officer (PRO) and coordinates with other hospitals. A sufficient number
of reception staff / receptionist shall be there for assisting the patient and relatives. The
hospital reception functions 24 x 7. If it is not functioning during the night, an alternative
arrangement is made to provide services to the clients. The size of the reception area
and facilities depends on the size of the hospital and number of visitors and patients.
Physical Setup of Reception Counter
The following are the part of reception counter
 Reception desk
 Registration counter
 Record room
 Lightning
 Telephones
 Waiting area
 Public utility service
 Information kiosk
 Clock system
 Signage system
 Facilities for deaf/hard of hearing
 Seating facility
Role and Functions of Receptionists
Medical Receptionists are the first point of contact for the patients, visitors doctors, and
staff members. Doctors, nurses, and other medical and administrative staff members
depend on the receptionist to create a friendly, welcoming and well-organized front
office for patients and to facilitate their flow through the facility. Receptionist is required
to ensure paper work to be completed by the patients or his/her family/relatives/friends.
 Medical Receptionists work on their own or with one or two other receptionists.
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 They might also collect patient notes and ensure that these vital records go to
the concerned healthcare professional.
 In a clinic, they may arrange appointments and patient transport.
 Hospital receptionist helps the patient regarding information on Outpatient
Department‘s timing, investigation reports, location of department, etc.
 They have to manage the crowd.
Qualities of a Receptionist
The knowledge, skills and abilities that a receptionist should possess include the
following:
 Knowledge of departments and sections of the hospital
 Greeting clients.
 Arranging meetings.
 Answering and forwarding phone calls.
 Sorting and distributing posts.
 Recording information.
 Well organized.
 Efficient.
 Computer skills.
 Communication skills.
 Polite.
 Efficient.
 Discretion.
 A friendly, sympathetic and reassuring manner.
 Compassionate.
The size of the reception area and facilities depends on the size of the hospital and
number of visitors and patients.
Exercise
1. Visit a nearby hospital and observe the activities in the reception area and tasks
being performed by a Reception. Prepare a note on your observations
Assessment
Q1.Where the hospital reception is generally located?
Q2. What are the qualities of a hospital receptionist?
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Q3. What are the tasks performed by a Medical Receptionist?
activity.
Part A
1. Front desk operations and back office operations.
2. Customer and client.
3. Verbal and non-verbal communication.
Part B
1. What are the role and responsibilities of a medical receptionist?
Part C
Greet patients and other callers at the in a courteous and efficient
manner.
Answer the telephone promptly and courteously.
Demonstrate the knowledge of making appointments for patients
following set procedures.
File medical records.
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Session 2 : Responding to Emergency Calls
Relevant Knowledge
The perception of emergency may be different for patients and doctors. Emergency or
urgency is ill defined. It is derived from the Latin word “urgens” mean “pressing”. What
is urgent has to be done without delay. Casualty, as defined by the Ministry of Health,
London, means “a patient who comes to the hospital un-announced, with accidental
injury and is seen and treated otherwise that at consultative session”. Every hospital
big or small, therefore, requires setting up a well organized emergency unit, because
the image of the hospital mainly depends upon the quality and type of treatment a
hospital can provide to a patient suffering from any medical or surgical emergency.
Emergency department of a hospital, therefore, means a part of the hospital to which
person injured in road accidents or those suffering from serious complications are
admitted for treatment. The emergency department works round the clock. Immediate
diagnosis and urgent treatment for illness of emergency has been defined as “a condition
determined clinically or considered by the patient or his relative or representative,
requiring immediate medical, dental or allied services failing which may result in loss
of life or limb”.
Emergency situation may be dealt in the following manner:
01 Physically – Handled by expert available in the hospital like doctor, nurses,
etc.
02 Telephonically – Handled telephonically by an expert or general consultant.
Responding to Emergency Calls
An Emergency medical dispatcher is a professional telecommunicator tasked with the
gathering of information related to medical emergencies, the provision of assistance
and instructions by voice, prior to the arrival of Emergency Medical Services (EMS),
and the dispatching and support of EMS resources responding to an emergency call.
A skillful GDA may be appointed to deal with telephone as a receptionist in the
front office. They may be placed in a central telephone exchange room also. Like
receptionists, they are an important first point of contact for patients and their families
and are a vital link between a caller and the person who can help. Callers might be
anxious or upset, waiting to hear about a friend or relative, or phoning to check details
of an important clinic appointment, therefore good communication skills are important.
GDA can also handle urgent calls between members of the healthcare team in hospitals
and the community. A GDA might call to arrange an emergency appointment for a
patient or a health visitor might want to check some key information about a child.
The emergency team is a group people with different roles who provide the vital
back-up, as well as the non-emergency patient transport service that is valued by the
community. Before the accident and emergency crews take over, other members of
the trained team take the call, decide rapidly what action is needed and then ensure
that it happens. If the situation is critical, one of the control staff might have to talk a
distressed caller through a lifesaving procedure or collect more essential information
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as the ambulance travels to the scene. Less obvious on streets, but still essential,
are the non-emergency ambulances. Day after day, patient transport services, as
they are known, carry disabled, elderly and vulnerable people to and from outpatient
appointments, hospital admissions, day centres and clinics. Without them, many
people would be unable to carry on leading independent lives in the community.
Role of GDA during Emergency Call
Communicating an emergency situation
outside hospital:
 Identify basic call information, including
the location and telephone number of
the caller, the location of the patient, the
general nature of the problem, and any
special circumstances.
 Prioritize incoming calls, providing expert
systematized caller interrogation in order
to determine the likely severity of the
patient’s illness or injury, so that the most
appropriate type of response resource
may be expedited.
 Selection and assignment of the most
appropriate type of response resource,
such as an ambulance, from the closest
or the most appropriate location,
depending on the nature of the problem, and ensuring that the crew of the
response resource receive all of the appropriate information.
 Provide and assist the caller with pre-arrival instructions to help the victim,
using standardized protocols developed in hospital. Such instructions may
consist of simple advice to keep the patient calm and comfortable or to gather
additional background information for responding paramedics. The instructions
can also frequently become more complex, providing directions over the
telephone for an untrained person to perform Cardiopulmonary Resuscitation
(CPR), for example. CPR is an emergency procedure performed in an effort
to manually preserve intact brain function until further measures are taken
to restore spontaneous blood circulation and breathing in a person who is in
cardiac arrest.
 Provide information support to the responding resources. This may include
call backs to the call originator to clarify information. It may involve clarifying
the exact location of the patient, or sending a bystander to the ambulance and
direct paramedics to the patient.
Communicating an emergency situation to “oN CALL DUTY DoCToR”
“On-call” duties come with the privilege of practicing in a hospital. Every hospital should
have policies to ensure appropriate “on-call” coverage of the emergency department by
specialists and sub-specialists. Hospitals must maintain a list of physicians, including
specialists and sub-specialists, who are on call to evaluate and treat patients in the
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emergency department. Hospitals are responsible for ensuring that on-call physicians
respond within a reasonable period of time. The medical staff by laws or policies and
procedures must define the responsibility of on-call physicians to respond, examine,
and treat patients with emergency medical conditions. GDA may be given responsibility
to communicate with doctor on call. He/she should respond to the situation in effective
manner.
108 Emergency Response Service
108 Emergency Response Service (ERS) in India has two dimensions, one is the
promptness with which the ambulance arrives and the second is the care provided
en route. Trained paramedical staff and equipping the ambulances with all necessary
consumables and equipment, including five types of stretchers and a wheel-chair are
part of ERS. Every aspect of quality of care
during transport, before reaching a health
facility is taken care of. There is a documented
and verifiable system in place for measuring
the time taken from the moment of receiving
the call to the moment of reaching the patient
and the time taken to deliver the patient to
the facility. This system is well monitored and
supervised in a control room.
On dialing 108, ambulance of 108 reaches
the scene. 108 can be dialed from landline
and mobile without adding any code. In an
ambulance there is a paramedic to provide appropriate medical help and handles
the victim carefully. The 108 ambulance is fully equipped with all the medicines and
equipments which are required in an emergency. The victim is then taken to hospital
and on the way medical help is given in the ambulance itself. With pre-hospital care, a
life can be saved even in a critical condition. So if there is an emergency, call 108 and
wait till the ambulance to reach. Taking a victim into an ambulance is a wise decision.
So instead of rushing the victim from a private vehicle or auto, it is smart to wait for
108 ambulance.
Responding to Patient’s Feedback
The following are the important point to be kept in mind while responding to patients:
 Patient feedback is completely separate from the official complaints process.
If someone is following that process, they are still entitled to leave feedback.
 Respond to all comments, good or bad, as it shows you listen.
 Welcome all opinions and try not to be defensive or aggressive if they‘re
negative.
 Do not use the same stock response to each comment.
 Practice to respond to most comments without breaching patient confidentiality.
 Know who is asking and why particularly applicable to the group of people.
 Listen carefully, do not try to interrupt and give a straight answer.
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 Ensure first, who is authorized to communicate for a particular task.

 Develop your own communication skill.
 Do not answer quires that you do not know.
Exercise
1. Visit a nearby hospital and observe the major and minor emergency and non-
emergency services provided by the hospital.
Assessment
Q1. What is emergency?
Q2. What is 108 emergency services?
Q3. Explain the term ―call duty doctor ?
activity:
Part A
1. Differentiated between a routine call and an emergency call
2. Differentiated between an ambulance service and 108 emergency ambulance
service
Part B
1. What is the role of GDA in emergency situation?
2. What are the skills required for responding in emergency situation?
Part C
Demonstrate knowledge of the responsibility in emergency

management activities.
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Session 3 : Using Computers in Maintaining Public

Relations
Relevant Knowledge
Technology has revolutionized many aspects of business and society, and hospitals
are no exception. Hospitals rely on computers to perform numerous tasks whether it
is the cataloging of medical data with regard to storing medical records or basic tasks,
such as medical billing. Computers are utilized in scanning and imaging procedures
as well. The procedures range from simple blood tests to sophisticated Computerized
Tomography (CT) scans. Computers are also used in the monitoring of patients
records. Doctors are able to keep an eye on everything from blood glucose levels to
heart rates. Perhaps the biggest advantages computers provide to hospitals is speed
and accuracy.
The application of computer and information is used to promote and support the practice
of patient care and the delivery of care. In addition to the routine use of computer-
assisted technology, such as email, computers have many other applications in patient
care.
Computers are used in the administrative areas for basic tasks that once were done on
paper. Staffing and scheduling systems are used to construct daily, weekly or monthly
schedules. Many scheduling
systems also collect data on
individual employees, such as
the amount of sick time used or
vacation hours accumulated.
Staffing and scheduling systems
often provide a variety of reports
to the administrative officer.
Budgeting and
financial tracking are another way
in which computers are used in administration. Computers are valuable for patient and
education. Hospitals often use computer programmes to teach patients about chronic
disease management or to provide educational handouts. Preprinted documents, such
as discharge or pre-operative instructions can also be stored in the computer and
printed, as necessary.
Clinical applications of computers in patient care are numerous. Physicians prescribe
medications and treatments on the computer, and the GDA may be required to either
transcribe these orders onto paper or print the paper documents for use in patient
care. GDA may order medications or supplies on the computer.
A General Duty Assistant use computers for documentation with an electronic health
record or electronic medical record. When an organization uses an Electronic Medical
Record (EMR), all documentation related to patient care, diagnostic testing, specialty
referrals or any other aspect of patient care or management is done on the computer.
The computers can be stationed at the bedside, used on mobile carts or might be in
the form of a portable electronic tablet that the nurse carries in lieu of a clipboard with
paper documents.
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Exercise
1. Visit a nearby hospital and identify the use of computer for various services.
Assessment
Q1. Describe the impact of technological revolution in healthcare sector?
Q2. What are the uses of computer in hospital administration?
Q3. What are the use of computer in a hospital?
activity:
Part A
1. Differentiated between use of computers in diagnosing a patient disease and
maintaining public relation in hospital
Part B
1. What is the difference between office records and medical records?
2. What are the advantages of maintaining medical records on computer?
Part C
The performance standard may include, but not limited to:
Performance standards Yes No
Demonstrate the knowledge of applications of computer in hospital.
Demonstrate the knowledge of maintaining files and records in
computer.
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Session 4 : Dealing with Patients Attendant
Relevant Knowledge
Communicating in an effective manner, irrespective of the mode of communication
used is a skill. Effective communication occurs only if the receiver understands the
exact information or idea that the sender intended to transmit. It involves the use of
proper equipment, providing information to the appropriate people and carrying out
communication effectively. A simple rule that one should follow is that the message
must be complete, clear and delivered timely. Communication with others is to be
conducted in a courteous manner. The secret of good communication is to tailor your
approach to the individual. Breakdown in communication is either due to lack of skills
in communicating or lack of coherent thought process. It can also happen due to the
breakdown of the communication network. At times we do not listen, but only hear,
especially when there are more important things to be taken care of. For instance, if a
visitor comes to you at the same instance when you are answering the phone, then it is
important to excuse yourself from the person on the phone so that exclusive attention
can be given to the visitor or you may request the visitor to wait for some time.
Systematic communication between health care providers, patients and their families
results in better patient care and shorter hospital stays.
The quality of communication in the care of patients, with advanced and serious
illness, is a key determinant of patient‘s. Research in a variety of settings has found
that communication is often suboptimal. Patients and their families do better when
they are involved, informed and engaged in the process. Communication in the care of
patients with advanced and serious illness can be increased using quality improvement
interventions, particularly for healthcare utilization as an outcome.
Responding to Patients
Stress is common among caregivers, with significant increased risk for depression,
anxiety, and health problems. Because of stress, the patients and their attendant lose
control.
The GDA should remember the following points while responding to patient and
relatives during stressful situations:
 The first rule is to avoid taking the behaviour personally. Remember that in
most cases, patient or his/her relatives are speaking due to fear and are not
being intentionally aggressive.
 Focus on developing a therapeutic relationship with patient‘s family.
 Be patient, as the most important thing is to listen.
 Do not be defensive, even if the points raised by relatives seem irrational
or unjustified.nderstand that family members may feel that they are the only
ones who know how to care for the patient properly. Take advantage of
this attitude by making them feel they are valued members of the patient‘s
healthcare team, this in itself will reduce their stress and help them regain a
sense of control in a positive way.
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 If you can not answer a question, find a colleague who can address the
problem of patient
 Know the organization’s protocols for safe nursing, and plan for the possibility
of violence.
 Be alert for cues to potential violence, such as glaring, pacing, agitated
behaviour, and clenched fists
Emotional state at a particular point of time also affects communication. For example,
if you are shocked for whatever reasons, you may not able to express yourself as you
are in unstable state of mind. Stress and anxiety are two major facets of life. They are
natural physiological and psychological reactions that occur within everyone. Stress
results from an imbalance between demands and resources. In simple words, stress
arises when individuals perceive that they cannot adequately cope with the demands
being made on them or with threats to their well-being. The leading source of stress is
the workplace. The workplace and the type of work hold a number of anxiety producers
or stressors. Anxiety is defined as a state of uneasiness and apprehension about future
uncertainties. It usually occurs after the onset of stress and is a lot like fear. Stressors
are upsetting bad events and problems of life.
To communicate with patients and their relatives effectively, it is essential that you
develop good communication skills and listening skills. The following are some
suggestions for becoming a better listener:
 Do Not Interrupt: People have a tendency to become impatient while listening
and cannot wait for the speaker to finish. This limits the information exchange
and breaks the communication process.
 Do Not Jump to Conclusions: Do not assume that you know what the speaker
is going to say. Allow him/her to complete his message and then say whatever
you wish to say about the idea, issue or the problem.
 Concentrate on the Content: While communicating you must concentrate on
the content of the message. In case you miss out on certain points, you must
seek clarification.
 Ask Questions: Ask good questions and provide feedback.
Causes of anger: Anger could be caused by internal and external causes. Internal
causes are to do with the personality of the individual and external causes are to do
with the factors outside the individual. Some personality characteristics that cause
anger include the following:
 Negative self-talk
 Blaming
 Taking things personally
 Assuming
 Overeating
 Drinking alcohol
 Driving recklessly
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 Taking drugs
 Involvement in fights
 Feeling outraged
External factors
 Crisis in the form of an emergency or an important event.
 Angry visitors or customers.
 Being short-staffed.
Repercussions of anger: Anger can have immediate or far-reaching consequences.
Some of these consequences can be categorised as follows:
(i) Immediate consequences
 Physical harm to someone or self.
 Destruction of property.
(ii) Far-reaching consequences
 Getting a bad reputation
 Loss of family / friends
 Loss of job
 Loss of social privileges
 Going to jail
Anger Management
You can manage your anger in several ways. Some of the measures and methods that
could be adopted include the following:
 Take time out from your routine work and relax.
 Take deep breaths.
 Count to ten mentally.
 Name the problem, look for plausible solutions, pick the best solution and
solve the problem. Do not forget to congratulate yourself.
 Stop blaming others and self, as blaming only keeps people upset and keeps
you from respecting others.
 Do not holds on to anger, but find ways of letting it go.
 Look for someone with whom you will be comfortable enough to express
yourself.
 Be open to discuss your own words and actions that hurt others.
 Know yourself and choose to contain your rage and decide what to do.
 Stand up for yourself and others when you see that there is a chance of
being hurt.
 Watch your thoughts, words and actions about others.
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 Take ownership of the hurtful things that you do and say.

 Stop hurting people with your actions and words. Bullying hurts everyone.
Exercise
1. Visit a nearby hospital and observe health professional handling the patient‘s
relative in emergency situation.
Assessment
Q1. How effective communication skills are useful in dealing with patients?
Q2. What are the factors that affect relationship between a General Duty Assistant and
patient?
activity:
Part A
1. Differentiated between stress and anxiety?
Part B
1. What is the role of GDA in managing conflicts?
2. How a GDA should handle angry relatives of a patient in a hospital?
Part C
Demonstrate the knowledge of handling people with emotional stress
or emotional outbursts.
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GLoSSARY
Adhesive Tape Tape coated on one side with an adhesive mixture to stick on
something
Administrative and Staff engaged in administrative and clerical duties
clerical staff
Admitted patient A patient who undergoes a hospital’s admission process to
receive treatment and/or care
Adolescents One that is in the state or process of growing up
Aggravate To make worse, more serious, or more severe
Anthrax Acute infectious disease of animals that can besecondarily
transmitted to humans
Anxiety A painful or apprehensive uneasiness of mind usually over an
impending or anticipated ill
Appetite Any of the instinctive desires necessary to keep up organic life,
like desire to eat
Arteries A blood vessel that conveys blood from the heart to any part of
the body
Aseptic Preventing infection or free from pathogenic microorganisms
Available beds The average number of beds which are immediately available
for use by an admitted patient or resident within the establishment
Average available The number of beds available to provide overnight accommodation
beds for overnight- for patients, averaged over the counting period
stay patients
Average available The number of beds, chairs or trolleys available to provide
beds for same-day for same-day patients, averaged over the counting period
patients accommodation
Bacterial Maningitis Meningitis is inflammation of the protective membranes covering
the brain and spinal cord, known collectively as the meninges.
The most common symptoms of meningitis are headache and
neck stiffness
Bacteriology A science that deals with bacteria and their relations to medicine,
industry, and agriculture
Binary Fission Reproduction of a cell by division into two approximately equal
parts
Blistering A fluid-filled elevation of the epidermis
Cardinal Of prime importance, may be related to heart
Cardiovascular Pertaining to, or affecting the heart and blood vessels
Care type The care type defines the overall nature of a clinical service
provided to an
Coagulation A change to a viscous, jellylike, or solid state admitted patient
during an episode of care
Communicable An infectious disease transmissible (as from person to person)
diseases by direct contact with an affected individual or the individual’s
discharges or by indirect means
Conjugation The act of functioning or operating simultaneously as if joined
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Sector: Healthcare
Contagious Communicable by contact

Continuum Anything that goes through a gradual transition from one
condition, to a different condition, without any abrupt changes
Cortex The outer or superficial part of an organ or body structure
Curative Able to cure diseases or heal people
Diagnosis The art or act of identifying a disease from its signs and
symptoms
Diaphragm A body partition of muscle and connective tissue; the partition
separating the chest and abdominal cavities in mammals
Diastolic Pressure The diastolic arterial pressure is the lowest pressure during the
resting phase of the cardiac cycle
Diphtheria A disease typically marked by the formation of a false
membrane especially in the throat which produces a toxin
causing inflammation of the heart and nervous system
Electrolytes A nonmetallic electric conductor in which current is carried by
the movement of ions
Elucidates To make something clear or explained
Epidemics Affecting or tending to affect an atypically large number of
individuals within a population, community, or region at the
same time
Ethnicity The fact or state of belonging to a social group that has a
common national or cultural tradition.
Fatigue Weariness or exhaustion from labor, exertion, or stress
Gastroenteritis Inflammation of the lining membrane of the stomach and the
intestines
General Duty An individual who gives basic nursing care under the
Assistant supervision of a registered nurse or a licensed nurse. A GDA is
also called Nurse’s aide, Nursing attendant, Healthcare
Assistant and Patient Care Assistant
Gonorrhea A common infectious disease caused by a bacterium. It may
occasionally spread to membranes in other parts of the body,
especially those of the joints and the eyes
Hair follicles The tubular epithelial sheath that surrounds the lower part of
the hair shaft
Harboured To contain or be the home, habitat, or host of
Healthcare Provider Healthcare professionals and institutions, including hospitals,
clinics, laboratories, physicians, therapists, home health
agencies, chiropractors, etc.
Hemolytic Disease Hemolytic disease of the newborn (HDN) loss and death
among newborn babies
Holistic Relating to or concerned with wholes or with complete systems
rather than with the analysis of, treatment of, or dissection into
parts
Hospital A health care facility that has a governing body, an organized
medical and professional staff, and inpatient facilities and
provides medical, nursing, and related services for injured
patients
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Sector: Healthcare
Hyperphosphatemia The presence of excess phosphate in the blood

Hypertension Abnormally high arterial blood pressure that creats a risk factor
for various pathological conditions or events (as heart attack,
heart failure, stroke, end-stage renal disease, or retinal
hemorrhage)
Hypophosphatemia Deficiency of phosphates in the blood that is due to inadequate
intake, excessive excretion, or defective absorption and that
results in various abnormalities
Infants A child in the first year of life
Inflammation Reaction of the body to injury or to infectious,allergic,
or chemical irritatio n. The symptoms are redness,
swelling,heat, and pain resulting from dilatio n of the blood
vessels in theaffected part with loss of plasma and leucocytes
(white bloodcells) into the tissues
Ligaments Strong band of white fibrous connective tissue that joins bones
to other bones or to cartilage in the joint areas
Medication The act or process of medicating
Mental Retardation Below average level of intellectual functioning
Metabolism The sum of the processes by which a particular substance is
handled in the living body
Monomers A chemical compound that can undergo polymerization
Normothermia A condition of normal body temperature
Nurse Nurse is a graduate of a recognized nursing school who has
met the requirements for a registered nurse in a state in which
she is licensed to practice
Pasteurization partial sterilization of a substance and especially a liquid (as
milk) at a temperature and for a period of exposure that
destroys objectionable organisms without major chemical
alteration of the substance
Pedestrian A pedestrian is a person travelling on foot, whether walking or
running
Peristalsis Progressive wavelike muscle contractions
Pertusis An infectious disease especially of children caused by a
bacterium causing cough and sometimes followed by a crowing
intake of breath also called whooping cough
Phobia Extreme and irrational fear of a particular object, class of
objects, or situation
Pituitary Gland Pituitary gland, small oval endocrine gland that lies at the base
of the brain. It is sometimes called the master gland of the body
because all the other endocrine glands depend on its
secretions for stimulation
Pneumonia A disease of the lungs that is characterized especially by
inflammation and consolidation of lung tissue followed by
resolution, is accompanied by fever, chills, cough, and difficulty
in breathing, and is caused chiefly by infection
Polymers A chemical compound or mixture of compounds formed by
155
Sector: Healthcare
polymerization and consisting essentially of repeating structural

units
Preventive To stop (something) from happening or existing
Rehabilitative To bring (someone or something) back to a normal, healthy
ondition after an illness, injury, drug problem, etc.
Roughage Food containing much indigestible material acting as fiber
Sanitation The promotion of hygiene and prevention of disease by
maintenance of sanitary conditions
Scalds To burn with hot liquid or steam
Sterilization Process of making free from living organisms and especially
microorganisms
Stethoscope An instrument used to detect and study sounds produced in the
body
Systolic Pressure It is defined as the peak pressure in the arteries, which occurs
near the beginning of the cardiac cycle when the ventricles are
contracting
Taboos A prohibition in some cultures against touching, saying, or
doing something for fear of immediate harm from a mysterious
superhuman force
Therapentic Arrangement or posture of the human body
Position
Trachoma Trachoma , infection of the mucous membrane of the eyelids
caused by the bacterium. It begins as congestion and swelling
of the eyelids with tearing and disturbance of vision
Transduction The action or process of converting something and especially
energy or a message into another form
Transfusions The process of transfer fluid into a vein or artery
Traumatic An often serious and body altering physicalinjury, such as the
removal of a li mb
Tuberculosis Tuberculosis is a disease caused by a mycobacterium which
causes bloody coughs, lesions involving the necrosis of tissue
and severe weight loss
Ultrasonic Vibration Ultrasonic vibrations would refer to sound waves that have a
frequency higher then human hearing
Unicellular Having or consisting of a single cell
Venom Poisonous matter normally secreted by some animals
Vesicals Of or relating to a bladder and especially to the urinary bladder
Viscous Quality of sticking or adhering or resistance of a fluid to flow
156

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413-Health Care X

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Health Care Services PCA

First Edition: January 2018, CBSE

Paper used : 80 GSM CBSE Water Mark White Maplitho

“This book or part thereof may not be reproduced by

Published By The Secretary, Central Board of Secondary Education, Shiksha

Pandit Sunderlal Sharma Central Institute of Vocational Education (PSSCIVE), a

The success of vocationalisation of education in schools depends on the steps that

 Smt. Anita Karwal, IAS, Chairperson, CBSE

Editing & Coordination

HoSPITAL STRUCTURE AND FUNCTIoNS

 Relate the role  Describe the roles  Demonstrate the Interactive

Session 1: Describe Healthcare Delivery Systems

In this session, you will learn about the various

4. Teaching Hospital: The primary objective of teaching hospital is teaching and

Emergency Department: An emergency department, also known as accident

Pharmacy: This department is responsible for providing patients

6. Data Entry Operator

S.No. Name of Department Functions

1. Outpatient Department (OPD)

S.No Professional Functions

b) Name any three medical professionals in a hospital.

c) Name any five medical departments of a hospital.

d) Name any five supportive staff in a hospital.

II. Fill in the Blanks

3. Orthopaedic hospitals deals with problems related with

Checklist for Assessment Activity

Performance Standards Yes No

Session 2: Describe the Role of Supporting Departments

 Bacteriology Laboratory: It conducts tests

S.No. Name of Department Functions

b) Write a note on hospital housekeeping.

c) Describe two services provided by outpatient Department.

II. Fill in the blanks

Differentiated between the following:

1. Roles and functions of various types of laboratories.

2. Roles and functions of administration and accounts.

Discussed in class the following:

1. Why a hospital needs so many departments and sections?

2. Why different types of laboratories should be established in a hospital?

3. Why utmost cleanliness and sanitation should be maintained in a hospital?

Checklist for Assessment Activity

Session 3: Classify Hospitals

5. Primary Health Centre - 6 to 10

Checklist for Assessment Activity

Session 4: Describe the Role of and Function of General

a) How GDA can assist in prevention of spread of diseases?

b) What is the role of GDA in discharging the following functions by a hospital:

Checklist for Assessment Activity

Session 5: Understanding the Qualities of a General Duty

Roles and functions of GDA in supporting the healthcare team member

Checklist for Assessment Activity

Performance Standards Yes No

INTRoDUCTIoN To CARE PLAN AND CARE

 Prepare bed  Describe the  Demonstrate the Interactive

Session 1: Describe the Role of General Duty Assistant

Assessment Nursing Scientific Planning Interventions Rationale Evaluation

a) What is Care Plan?

b) What are the characteristics of Care Plan?

c) What are the objectives of formulating a Care Plan?

II. Fill in the blanks

Checklist for Assessment Activity

Session 2: Feed a Patient