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EXAMINATION OF PATIENT
Purpose:

• To obtain baseline data about the patients functional abilities.

• To obtain data that will help establish the plan of care.

• To identify areas for health promotion and injuries prevention.

HEALTH HISTORY
A collection of information obtained from the patient and from other sources concerning the patient's
physical status as well as his or her psychological, social, and sexual function.

a. PRESENT ILLNESS:

SIGNS: Any objective evidence of a disease, such as blood in the stool, a skin rash, is a sign. It
can be recognized by the doctor, nurse, family members and the patient.

SYMPTOMS: A subjective report by the patient itself. It can only be detected or sensed by the
patient - others only know about it if the patient tells them.

Example: “Can you tell me what brings you to the hospital today?”

b. PAST HEALTH HISTORY

Previous hospital confinement (Do you have any history of an illness?)
Previous surgical procedure (Did you undergo any surgical operation procedure?)
Medication taken (Did you take any medications before?)
Allergic reaction (Do you have any allergic history?)
c. SOCIAL HISTORY

Smoking

Alcohol

Example: “Do you smoke?”, “Do you drink?”, and “Do you use illicit drugs?”

d. FAMILY HISTORY
“Do you have any family history of heart attack, stroke, cancer, diabetes, hypertension, or
hyperlipidemia?”

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 VITAL SIGNS
These are the key signs that are used to evaluate the patient’s initial condition. The first set of vital signs
that you obtain is called the baseline vital signs.

Body temperature: 36.5 – 37.5 degree Celsius

Pulse Rate: 60 – 100 beat per minute

Respiratory rate: 12 -24 cycle per minute

Blood pressure: 90/60 – 140/90 mmHg

BODY TEMPERATURE
Body temperature is measured by a clinical thermometer and represents a balance between the heat
produced by the body and the heat it loses.

PROCEDURE IN TAKING THE BODY TEMPERATURE:

1. Wash your hands with soap and warm water.

2. Use a clean thermometer, one that has been washed in cold water, cleaned with rubbing alcohol, and
then rinsed to remove the alcohol.
3. Place the thermometer tip under the armpit.
4. Hold the thermometer in the same spot for about 40 seconds.
5. Readings will continue to increase and the F (or C) symbol will flash during measurement.
6. Usually, the thermometer will make a beeping noise when the final reading is done. If you are keeping
track, record the temperature and the time.
7. Rinse thermometer in cold water, clean it with alcohol, and rinse again.
8. Document the reading.

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PULSE RATE

The pulse rate is a measurement of the heart rate, or the number of times the heart beats per minute.

PROCEDURE IN TAKING THE PULSE RATE:

1. Relax the patient arm on the table. The patient’s palm should be facing the ceiling and the fingers
should be relaxing as well.

2. Use the first and second fingertips, and place it on the patient’s wrist or where the forearm meets
the upper arm press firmly but gentle on the arteries until one can feel a pulse.

3. Keep hand on the pulse and begin counting the pulse. Count the second hand on whatever the
number that was start from. Count pulse for 1 full minute.

4. Record the results.

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RESPIRATORY 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.

PROCEDURE IN TAKING THE RESPIRATORY RATE:

1. Try not to let the victim become aware that you are monitoring respirations in order to obtain a
more reliable count.

2. Place the patient in comfortable position.

3. Observe the rise and fall of the victim's chest and count the number of respirations out loud for one
full minute. One respiration consists of one complete rise and fall of the chest, or the inhalation and
exhalation of air.

4. Categorize the rhythm, ease, and strength of the respiration. Normal respiration consists of deep,
even breaths during which the rib cage fully contracts and relaxes.

5. Record the findings.

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BLOOD PRESSURE
Blood pressure, measured with a blood pressure cuff and stethoscope by a nurse 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.

PROCEDURE IN TAKING THE BLOOD PRESSURE:

1. Rest for three to five minutes without talking before taking a measurement.

2. Sit in a comfortable chair, with your back supported and your legs and ankles uncrossed.

3. Sit still and place your arm, raised level with your heart, on a table or hard surface.

4. Wrap the cuff smoothly and snugly around the upper part of your arm. The cuff should be sized to
fit smoothly, while still allowing enough room for one fingertip to slip under it.

5. Be sure the bottom edge of the cuff is at least one inch above the crease in your elbow.

6. Two numbers are recorded when measuring blood pressure.

7. The higher number, or systolic pressure, refers to the pressure inside the artery when the heart
contracts and pumps blood through the body.

8. The lower number, or diastolic pressure, refers to the pressure inside the artery when the heart is
at rest and is filling with blood.

9. Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters of mercury). This
recording represents how high the mercury column is raised by the pressure of the blood.

10. Record the reading.

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 REVIEW OF THE BODY SYSTEM
GENERAL APPEARANCE: Note the position of the patient’s body & facial expression.
Ex.: Fever, chills, sweats, weight changes, weakness, fatigue, heat/cold intolerance, bleeding, radiation
SKIN, HAIR, NAILS: Rashes, lumps, sores, itching, color or texture changes, bruising, abnormal growths,
tatoos, piercings
HEAD: Headaches, injury, dizziness, syncope, LOC, stroke
EYES: Vision/correction, blurring, eye meds, trauma, redness, pain, glaucoma, cataracts
EARS: Hearing/loss, pain, discharge, infection, tinnitus, vertigo/"dizziness“
NOSE: Smell, obstruction, injury, epistaxis, discharge, colds, allergies, sinus pain
MOUTH & THROAT: Hoarseness, sore throats, gum problems, tooth abcess, dental care, sore tongue,
taste
NECK: Lumps, "swollen glands," goiter, pain/stiffness
LYMPH NODES: Enlargement, tenderness
RESPIRATORY: Pain, dyspnea, SOB, cyanosis, wheezing, cough, sputum (color & quantity),
CARDIOVASCULAR: Chest pain/distress, palpitations, SOB, dyspnea, orthopnea (pillows needed)
GASTROINTESTINAL: Appetite, digestion intolerance, heartburn, N&V, hematomesis, bowel irregularity,
stool appearance
ENDOCRINE: Thyroid enlargement/tenderness, heat/cold intolerance, unexplained weight change
MALE REPRODUCTIVE: Puberty onset, erections, testicular pain or masses, hernias, lesions/discharges,
libido, sexual activity, contraception, infertility, prostate, STDs
FEMALE REPRODUCTIVE: Menses: Menarche, regularity, duration & amt. of flow, dysmenorrhea, LMP,
sexual activity, libido, contraception, fertility, menopause, discharge, itching, sores, STDs
BREAST: Pain, tenderness, discharge, lumps, mammogram, SBE
GENITOURINARY: Dysuria, pain, frequency, urgency, nocturia, hematuria, stress incontinence, hernias,
STDs
MUSCULOSKELETAL: Joint stiffness, pain, motion restriction, weakness, cramps, deformities, back
problems
HEMATOLOGIC: Anemia, lymph swelling, bruising/petechiae, fatigue, transfusion
NEUROLOGIC: CNS disease, syncope, blackouts, dizziness, numbness, tingling, seizures,
weakness/paralysis, tremors coordination, memory, cognition, headaches, head injury

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PSYCHIATRIC: Depression, mood changes, difficulty concentrating, nervousness, tension, suicidal
thoughts, irritability, sleep disturbances.

ASSESSMENT OF LOC
Consciousness is defined as the state of being aware of physical events or mental concepts.
Conscious patients are awake and responsive to their surroundings.
The AVPU scale is a quick and easy method to assess level of consciousness:
A- ALERTNESS
V – VERBAL RESPONSE
P – RESPONSE TO PAINFUL STIMULUS
U – UNRESPONSIVE

ALERTNESS and VERBAL RESPONSE

a. Assess consciousness when administering first aid to an injured person by asking simple questions
you know the answer to.
b. Ask the person what day it is, what year it is or who the president is, etc.

c. Encourage the victim to explain how he or she became injured and the details of the situation.
d. Listen carefully when asking a victim questions and assessing his or her level of consciousness.

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RESPOND TO PAINFUL STIMULUS
a. Rub the victim's breastbone with your knuckles to assess consciousness during first aid.
b. Watch the victim's face for a response as you do this. Look for the victim's eyes to shift or facial
muscles to move in response to your touch.

UNRESPONSIVE
This is the most serious situation. If the person cannot vocalize and does not respond to even a painful
stimulus, he or she is considered unresponsive.
Repeat your assessment of the victim's level of consciousness frequently while administering first
aid.
Record the time of each assessment of consciousness you perform and the victim's response each
time.

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 PAIN LEVEL ASSESSMENT

Face 1: No hurts

Face 2: Hurts little bit

Face 3: Hurts little more

Face 4: Hurts even more

Face 5: Hurts whole lot

Face 6: Hurts worst

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 LABORATORY EXAMINATION
Purpose:
• Used to diagnose and monitor treatment for diseases.

• To obtain reliability and accuracy results to a disease.

• To seek an evidences in diagnosing a disease

URINALYSIS
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to
detect and measure various compounds that pass through the urine.

A urinalysis may be done:

• As part of a routine medical exam to screen for early signs of disease.

• If you have signs of diabetes or kidney disease, or to monitor you if you are being treated for these
conditions.

• To check for blood in the urine.

• To diagnose a urinary tract infection.

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PROCEDURE IN COLLECTING URINE SPECIMEN:
1. Instruct the patient to wash the genital area.

2. Collect urine midstream or catheter specimens of urine.

3. Always test fresh urine, collected in a clean dry container – if the urine is left standing for more than
four hours, there may be contaminants, leading to false readings.

4. Immerse all the regent area in the specimen and remove the strip immediately.

5. Hold the strip horizontally and compare the test areas closely with the colour chart on the bottle
label for the length of time specified.

6. Record the results in and report any abnormal findings.

NORMAL FINDINGS:

COLOR: Pale to dark yellow

Many foods and medicines can affect the color of the urine. Urine with no color may be caused by
long-term kidney disease or uncontrolled diabetes. Dark yellow urine can be caused by dehydration. Red
urine can be caused by blood in the urine.

ODOR: Slightly "nutty" odor

Some foods (such as asparagus), vitamins, and antibiotics (such as penicillin) can cause urine to
have a different odor. A sweet, fruity odor may be caused by uncontrolled diabetes. A urinary tract infection
(UTI) can cause a bad odor. Urine that smells like maple syrup can mean maple syrup urine disease, when
the body cannot break down certain amino acids.

SPECIFIC GRAVITY: 1.005-1.030

A very high specific gravity means very concentrated urine, which may be caused by not drinking
enough fluid, loss of too much fluid (excessive vomiting, sweating, or diarrhea), or substances (such as
sugar or protein) in the urine. Very low specific gravity means dilute urine, which may be caused by drinking
too much fluid, severe kidney disease, or the use of diuretics.

pH: 4.6-8.0
Some foods (such as citrus fruit and dairy products) and medicines (such as antacids) can affect
urine pH. A high (alkaline) pH can be caused by severe vomiting, a kidney disease, some urinary tract
infections, and asthma. A low (acidic) pH may be caused by severe lung disease (emphysema),
uncontrolled diabetes, aspirin overdose, severe diarrhea, dehydration, starvation, drinking too much
alcohol, or drinking antifreeze (ethylene glycol).

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PROTIEN: none
Protein in the urine may mean kidney damage, an infection, cancer, high blood pressure,
diabetes is present. Protein in the urine may also mean that heart failure, poison (lead or mercury
poisoning), or preeclampsia (if you are pregnant) is present.

GLUCOSE: none
Too much glucose in the urine may be caused by uncontrolled diabetes, liver damage, brain injury,
certain types of poisoning, and some types of kidney diseases. Healthy pregnant women can have glucose
in their urine, which is normal during pregnancy.

KETONES: none

Ketones in the urine can mean:

1. uncontrolled diabetes

2. very low-carbohydrate diet,

3. starvation or eating disorders (such as anorexia nervosa or bulimia)

4. alcoholism, or poisoning from drinking rubbing alcohol (isopropanol).

MICROSCOPIC ANALYSIS:
• Very few or no red or white blood cells or casts are seen. No bacteria, yeast cells, parasites, or
squamous cells are present. A few crystals are normally seen.

• Red blood cells in the urine may be caused by kidney or bladder injury, kidney stones, a urinary
tract infection (UTI).

• White blood cells (pus) in the urine may be caused by a urinary tract infection, bladder tumor,
inflammation of the kidneys or inflammation in the vagina or under the foreskin of the penis.

• Large amounts of crystals, or certain types of crystals, can mean kidney stones, damaged kidneys,
or problems with metabolism.

• Bacteria in the urine mean a urinary tract infection (UTI). Yeast cells or parasites (such as the
parasite that causes trichomoniasis) can mean an infection of the urinary tract.

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 BLOOD GLUCOSE TEST:

A blood glucose test measures the amount of a sugar called glucose in a sample of your blood.

PROCEDURE:
• Wash your hands thoroughly, including the area from which you are going to draw blood.
• Swab the area you are going to use to draw your sample from with the cotton ball
• Place a test strip into the slot provided on the glucometer.
• Wait for the readout on the diabetic glucometer to tell you to put the drop of blood on the strip.
• Use the lancet provided with the diabetic glucose meter and pricks the area for the sample.
• Place a drop of blood on the test strip.
• Wait for results.

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CARDIO PULMONARY RESUSCITATION (CPR)
CPR is a lifesaving procedure that is performed when someone's breathing or heartbeat has
stopped, as in cases of electric shock, drowning, or heart attack. It is a combination of:

Rescue breathing, which provides oxygen to a person's lungs.

Chest compressions, which keep the person's blood circulating.

Compression: Ventilation Ratio:

Adult: 30:2 (1 or 2 rescuers)

Child and Infant : 30:2 - 1 rescuer

15:2 – 2 rescuers

Depth of Compression:
Adult : 2-1 ½ inches

Child : 1 ½ -1 inch

Infant : 1 – ½ inch

No. of cycles for approximately 2mins.

Adult : 5 cycles (1 or 2 rescuers)

Child and Infant : 5 cycles – 1 rescuer

10 cycles – 2 rescuer

SEQUENCE OF THE CPR:

• Survey the area.

• Check for responsiveness. Shake or tap the person gently. See if the person moves or makes a
noise. Shout, "Are you OK?"

• SHOUT FOR HELP/CALL FOR HELP

• CHECK CAB

• Perform chest compressions:

• Place the heel of one hand on the breastbone -- right between the nipples.

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• Place the heel of your other hand on top of the first hand.

• Position your body directly over your hands.

• Give 30 chest compressions. These compressions should be FAST and hard.

• Press down about 2 inches into the chest. Each time, let the chest rise completely.

PATTERN OF COUNTING:
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30

BLOW, BLOW

1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30 –

BLOW, BLOW

1,2,3,4,5,6,7,8,910,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30 -

BLOW, BLOW

1,2,3,4,5,6,7,8,910,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30 -

BLOW, BLOW

1,2,3,4,5,6,7,8,910,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30

• Complete the 5 cycles.

• Give 2 breaths every end of the cycle, except the last cycle. (If using an ambu bag connect to
oxygen administration set with 8-10LPM regulation).

• Check the pulse.

• Continue CPR (30 chest compressions followed by 2 breaths, then repeat) until the person
recovers or help arrives. If an AED for adults is available, use it as soon as possible.

• If the person starts breathing again, place them in the recovery position. Periodically re-check for
breathing until help arrives.

• Place the patient in recovery position.

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WHEN TO STOP THE CPR:
S – Spontaneous breathing and pulse restored.

T – Turned the victim over to medical services.

O – Operator is exhausted.

P – Physician assumes responsibility.

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 Nasogastic tube
Body Substance isolation

Tepid Sponge Bath

Urinary Catheterization

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 1. BODY SUBSTANCE ISOLATION - is a practice of isolating all body substances (blood, urine, feces,
tears, etc.) of individuals undergoing medical treatment, particularly emergency medical treatment of those
who might be infected with illness.

BSI TECHNIQUE:

a. Handwashing
b. Personal protective equipment
c. Disinfection and sterilization
d. Immunization

2. TEPID SPONGE BATH - A bath using tepid water and wash cloth or sponge to
reduce fever.

PROCEDURES:

• Pour tap water into the basin

• Sponge the face in a patting motion extending to the neck.
• Bathe the patient’s body, part by part. Use long strokes. Expose one area of the body at a time.
• Place moist , folded cloths over blood vessels that lie close to the skin (Underarms and groin)
• Place moist , folded cloths over blood vessels that lie close to the skin (Underarms and groin)
• Turn the patient and repeat the procedure, beginning with neck , then going to the shoulders , the
back, and so forth.
• Check the body temperature and monitor.

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3. NASOGASTRIC INSERTION - NGT is a medical process involving the insertion of plastic tube
(nasogastric tube,) through the nose, past the throat, and down into to the stomach.

INDICATIONS:
• To drain gastric contents, decompress the stomach, obtain a specimen of the gastric
contents, or introduce a passage into the GI tract.

• It will also allow for drainage and/or lavage in drug over dosage or poisoning.

SUPPLY/EQUIPMENT:
Personal protective equipment
NG/OG tube
Water-soluble lubricant, preferably 2% Xylocaine jelly
Adhesive tape
Stethoscope
Rubber bulb syringe

PROCEDURE:
• Gather equipment.
• Don non-sterile gloves.

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• Explain the procedure to the patient and show equipment.
• If possible, sit patient upright for optimal neck/stomach alignment.
• Examine nostrils for deformity/obstructions to determine best side for insertion.
• Measure tubing from bridge of nose to earlobe, then to the point halfway between the end of the
sternum and the navel.

• Lubricate 2-4 inches of tube with lubricant (preferably 2% Xylocaine).

• Pass tube via either nare posteriorly, past the pharynx into the esophagus and
then the stomach.

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 • Instruct the patient to swallow (you may offer ice chips/water) and advance the tube as the patient
swallows.
• If resistance is met, rotate tube slowly with downward advancement toward closes ear. Do not
force.
• Withdraw tube immediately if changes occur in patient's respiratory status, if
tube coils in mouth, if the patient begins to cough or turns pretty colours.
• Advance tube until mark is reached.
• Check for placement by attaching syringe to free end of the tube, aspirate sample of gastric
contents.
• Secure tube with tape.

4. URINARY CATHETERIZATION - is a medical procedure used to drain and collect urine from the
bladder. A thin, flexible tube called a catheter is inserted into the bladder, usually along the tube through
which urine naturally passes (urethral catheter).

INDICATION:

• Urinary incontinence (leaking urine or being unable to control when you urinate).

• Urinary retention (being unable to empty your bladder when you need to).

• Surgery on the prostate or genitals.

SUPPLY/EQUIPMENT:

Gloves (sterile) Tape

Sterile water Foley catheter Tubing

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 Drainage bag Lubricant
Syringe Cotton swabs
Sterile water Solution for cleaning the skin
Drapes (sterile)

PROCEDURES:
• Explain the steps of the procedure to the patient before beginning.
• Assist the patient in getting into the supine position if necessary. The legs should be open.
• Put on gloves.
• Sterilize the genital area with the cleansing solution and cotton swabs.
• Apply lubricant to the portion of the catheter with
• The deflated balloon. This is the end you will
• Insert into the urethral opening.
• Hold open the labia and insert the catheter into the urethral meatus if the patient is female.

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• If the patient is male, hold the penis and then insert the catheter into the urethral opening.

• Use a syringe to inflate the balloon with sterile water. The amount of sterile water you use to
inflate the balloon depends on the size of the balloon on the catheter.

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• Connect the catheter to the drainage bag with the tubing.

• Monitor the input of fluids every 8 hours.

• Monitor the urine output every hour, including the color of the urine.
• Record the findings.

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PHARMACOLOGY
The branch of medicine concerned with the uses, effects, and modes of action of drugs.

DRUGS - A substance used in the diagnosis, treatment, or prevention of a disease or as a component of a

medication.

ROUTE OF ADMINISTRATION:
• Per oral
Giving a drug by mouth provides many advantages to the patient. Oral drugs are easily
self-administered and, compared to drugs given parenterally, have a low risk of systemic infections
that could complicate treatment.

• Sublingual
Placement under the tongue allows a drug to diffuse into the capillary network and,
therefore, to enter the systemic circulation directly. Sublingual administration of an agent has
several advantages, including rapid absorption, convenience of administration.

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• Nasal inhalation

This route involves administration of drugs directly into the nose. Agents include nasal
decongestants, such as oxymetazoline, and anti-inflammatory corticosteroids such asmometasone
furoate. Desmopressin is administered intranasally in the treatment of diabetes insipidus.
Salmon calcitonin, a peptide hormone used in the treatment of osteoporosis, is also available as a
nasal spray.

• Oral inhalation

Inhalation routes, both oral and nasal, provide rapid delivery of a drug across the large
surface area of the mucous membranes of the respiratory tract and pulmonary This route of
administration is used for drugs that are gases (for example, some anesthetics) and those that can
be dispersed in an aerosol. This route is particularly effective and convenient for patients with
respiratory complaints (such as asthma or chronic obstructive pulmonary disease), because the
drug is delivered directly to the site of action, thereby minimizing systemic side effects. Examples
of drugs administered via this route include bronchodilators, such as albuterol, and corticosteroids,
such as fluticasone.

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• Per Rectal
Like the sublingual route of administration, the rectal route has the additional advantage of
preventing the destruction of the drug by intestinal enzymes or by low pH in the stomach. The
rectal route is also useful if the drug induces vomiting when given orally, if the patient is already
vomiting, or if the patient is unconscious.

• Topical
Topical application is used when a local effect of the drug is desired. For example, clotrimazole is
applied as a cream directly to the skin in the treatment of dermatophytosis.

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• Transdermal

This route of administration achieves systemic effects by application of drugs to the skin,
usually via a transdermal patch. The rate of absorption can vary markedly, depending on the
physical characteristics of the skin at the site of application as well as the lipid solubility of the drug.
This route is most often used for the sustained delivery of drugs, such as the antianginal
drug nitroglycerin, the antiemetic scopolamine, and nicotine transdermal patches, which are used
to facilitate smoking cessation.

• Parenteral

The parenteral route introduces drugs directly across the body’s barrier defenses into the
systemic circulation. Parenteral administration is used for drugs that are poorly absorbed from the
GI tract (for example, heparin) and for agents that are unstable in the GI tract (for example, insulin).
Parenteral administration is also used for treatment of unconscious patients and under
circumstances that require a rapid onset of action.

1. Intravenous (IV)

IV injection is the most common parenteral route. IV delivery permits a rapid effect and a
maximum degree of control over the circulating levels of the drug. When injected as a bolus, the
full amount of a drug is delivered to the systemic circulation almost immediately.

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2. Intramuscular (IM)

Drugs administered IM can be in aqueous solutions, which are absorbed rapidly. The
position of needle should be in 90 degree angle and hold the syringe like a dart pin. The injection
site for IM are, deltoid, gluteus maximus and vastus lateralis.

3. Subcutaneous (SC)

This route of administration, like IM injection, requires absorption via simple diffusion and
is somewhat slower than the IV route. The position of needle should be in 45 degree angle.

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 PARTS OF THE SYRINGE

STEPS IN GIVING MEDICATION:

• Obtain an order from a doctor

• Right patient
In order to make sure that you are about to administer medications to the right
individual, you have to know the individual.

• Right medication
Read the medication order carefully. Make sure that the medication name on the
order matches the medication name on the label.

• Right dose
The right dose is how much of the medication you are supposed to give the
individual at one time.

• Right time
It is very important for medication to be given at the time of day that is written on
the medication order. If no specific time is written on the medication order, ask the
nurse or pharmacist about the best time of day to give the medication.

• Right route
The route means how and where the medication goes into the body.

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 • Right documentation
Each time a medication is administered, it must be documented. Your documentation of
medication administration must be done at the time that you give the medication.

INTRAVENOUS THERAPY
Intravenous therapy is the infusion of liquid substances directly into a vein. The word intravenous simply
means "within vein”.

INDICATION:

• Administration of prescribed IV fluids and medication.

• To maintain and correct electrolyte imbalance.
• Administration of emergency and lifesaving medication – where rapid effect is required.
• Administration of medication that may not be administered by any other route.

MATERIAL/EQUIPMENT:
IV tubing (macroset/microset)
IV cannula (gauage 26, 22, 20, 18)
IV stand
Adhesive tape
Cotton balls with alcohol
Torniquet
IV fluid solution

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 TYPES OF FLUIDS

IV FLUIDS USES

Dextrose 5% in water Fluid loss

(D5W) Dehydration
0.9% sodium chloride Shock
(Normal Saline) Blood transfusions
(NaCl) Resuscitation
Fluid challenges
Lactated Ringer’s Dehydration
(LR) Burns
Lower GI fluid loss
Acute blood loss

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PROCEDURE:
• Obtain an order from a doctor.
• Prepare the material.
• Practice sterile technique.
• Prime the IV line.

• Select an IV site and disinfect the area.

• Apply torniquet above the IV site.

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• Insert the needle gently using an upward angle.
• Decrease the severity of the angle slowly as you insert the needle.

• Wait for blood and then insert the needle about 1 centimeter.
• Advance catheter forward until completely inserted and then remove needle.\
• Remove torniquet and apply occlusive dressing.

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• Connect the IV tubing to the catheter hub.
• Open the IV flow control valve and run the IV for a brief period of time to ensure the line is patent.
To ensure proper IV flow rates, the IV container must hang at least 30 to 36 inches above the
insertion site.
• Start IV infusion and regulate the IV fluids as per order by the doctor.
• Record the important information.

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40
WOUNDS
A breakage of the continuity of the skin surface cause by injury and special procedure.

Types of Open Wounds:

1. Laceration - A laceration is an irregular or jagged break or tearing of the skin. Lacerations are
often caused from accidents with tools and machinery, and bleed rapidly and extensively.

2. Punctured - A puncture is a small hole caused by a long, pointy object, such as a nail, needle, or
ice pick. Sometimes a bullet can also cause a puncture wound. Punctures may not bleed much, but
they can be deep enough to damage internal organs. If you have a puncture wound—even a small
one—visit your doctor to get a tetanus booster shot and prevent infection.

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3. Abrasion - An abrasion occurs when the skin rubs or scrapes against a rough or hard surface.
Road rash is an example of an abrasion. There is usually not much bleeding, but the wound needs
to be scrubbed and cleaned well to avoid infection.

4. Avulsion - An avulsion is a partial or complete tearing away of skin and tissue. Avulsions usually
occur during violent accidents, such as body-crushing accidents, explosions, and gunshots. They
bleed heavily and rapidly. If a body part is severed, always send it with the patient to the hospital
for possible reattachment. Wrap the body part in moist gauze and pack it in ice if you can.

42
5. Amputation - Traumatic amputation is the loss of a body part -- usually a finger, toe, arm, or leg --
that occurs as the result of an accident or injury.

6. Evisceration - The process whereby tissue or organs that usually reside within a body cavity are
displaced outside that cavity, usually through a traumatic disruption of the wall of the cavity;
evisceration of bowel. Removal of the contents of the eyeball, leaving the sclera and sometimes
the cornea.

43
EMERGENCY TREATMENT:
• Assess the type of wound. Treat the life threatening condition.
• Calm down the patient.
• Apply the 4 C’s (clean, compress, cover and control)
• Watch out for shock and apply necessary treatment.
• Wound suturing if necessary.
• RMA

FOR PUNCTURED WOUND:

• Do not remove nor be moved the impaled object.
• Apply bulky dressing for stabilization of impaled object.

44
 FOR EVISCERATION WOUND:
• Place the patient in supine position with knee flex.
• Cover the internal organs with moist dressing.
• Wrap and secure the internal organs with plastic.
• Keep the internal organ wet.

FOR AMPUTATION WOUND:

• Clean and wrap the severed part with damp cloth.
• Secure and preserve in cool water.
• Cooling the severed part will keep it viable for about 18 hours. Without cooling, it will only remain
useable for about 4 to 6 hours.
WOUND SUTURING

45
 Surgical suture is a medical device used to hold body tissues together after an injury or surgery.

MATERIAL/EQUIPMENT:
• Surgical Drapes
• 4" x 4" Gauze
• Suture Materials - 4.0 and 6.0
• Antiseptic Solution and Saline
• Syringe with splash cover
• Surgical instrument (needle holder, forcep, scissor, clamp, scalpel)

SPECIAL CONSIDERATION:
• Assess the type of wound.
• Open wound should be close or suture within 6-8 hours.
• Strictly observe the principle of sterility.
• Local anesthesia should be administered in enough dosage.
• Practice daily wound care.
• Sutured wound should be maintained dry for 3-4 days.
• Instructions for suture removal need to be given in each case.

REMOVAL OF THE SUTURE

46
 • Check the intactness and dryness of the post surgery area.
• Clean the sutured area with betadine.
• Use the pair of tweezers to gently lift the knot of the first stitch slightly above the skin.
• Holding the knot above your skin, use your other hand to wield your scissors and snip the suture
next to the knot.

• Use the tweezers to continue grasping the knot and gently pull the stitch through your skin and out.
You might feel a bit of pressure, but it should not be painful.
• Continue removing the stitches.
• Apply sterile wound dressing.

TOXICOLOGICAL HAZARDS ON BOARD SHIP

A poison - also called a toxin - is a substance which, if taken into the body in sufficient quantity,
may cause temporary or permanent damage.

Poisons can be swallowed, absorbed through the skin, inhaled, splashed into the eyes, or injected.
Once in the body, they may enter the bloodstream and be carried swiftly to all organs and tissues.

ROUTE OF ENTRY OF POISON

• Ingestion - approximately 80% of all poisoning is by mouth; ingested products include household
products, food, plants and in the majority of cases... drugs.

47
 Signs and Treatment
Symptoms

Excessive salivation Rinse the mouth with water.

Give one glass of water to drink.

Frequent vomiting Do not give solid food.

Give Metoclopramide 10mg for vomiting as prescribed by the
doctor.
May administer intravenous fluids as per advice by medical
doctor.

Abdominal pain Paracetamol may given as per RMA.

May give activated charcoal as per RMA.

PARACETAMOL OVERDOSE:
• Give activated charcoal.

• Watch out for any complain in the liver and arrange immediate evacuation.

DISINFECTANTS/BLEACH:
• Give cool water and one glass of milk.

• Do not induce vomiting.

48
 • Inhalation- inhaled poisons include several substances including natural gas -- the most common
accidental inhaled poison -- pesticides, chlorine, smoke and others.

Signs and Symptoms: TREATMENT

• Soreness of throat, hoarseness or cough • Remove the casualty from the polluted area
• Dry cough, difficulty of breathing and and bring him to an open air environment.
wheezing sound • Encourage deep breathing.
• Severe difficulty of breathing • Placed the patient in sitting position.
• Severe breathlessness, frothy sputum, • Administer oxygen at 8 liters per minute until
blue skin discoloration, anxiety and symptom resolve.
sweating • CPR if necessary.
• RMA for prescription of medication.
• RMA

Carbon Monoxide:
• Watch out for redness of the skin.
• Give oxygen and regulate at 8LPM, continue oxygen for 24hours until further RMA.

49
 • Injection - injected poisonings are almost always the result of substance abuse. Heroin and
cocaine top the list... but injected poisons can also be the result of bites and stings.

Signs and Symptoms: TREATMENT

• Puncture wound/bitten mark • Apply torniquet above the wound.

• Redness • Wash the wound with running clean water and lean with
• Swelling soap.
• Sever pain • Disinfect with betadine and cover with sterile dressing.
• Administer anti-tetanus toxoid vaccine.
• RMA

VENOMOUS FISH AND SEA URCHINS:

• Immerse the affected part in water as hot as can be comfortably tolerated.

50
• Absorption - chemicals that contact the skin, mucus membranes or eyes have the potential to
cause severe damage. Alkalis, acids and hydrocarbons are some of the most destructive.

Signs and symptoms Treatment

SKIN • Flood large amount of water to affected area.
• Burns pain with redness or • Wash thoroughly the skin folds.
swelling, irritating rash • Dab gently any remaining dirt using a swab soaked
• Blisters in water. Be GENTLE as this may cause pain.
• Pain • Leave blisters intact, if blisters have burst, peel off
the dead skin. Flood affected area with clean
water.
• Seek RMA for prescription of pain medication
• May give mild pain reliever (Paracetamol).
• Direct water flow from the inner to outer corner of
the eye. Washing must be done thoroughly for 10
minutes.
• May give anesthetic eye drops if pain is severe as
per advice by a doctor.
• RMA

EYES • Immediate washing of the eye with copious

• Pain amounts of water.
• Redness • Keep the eyelid widely apart.
• Watering of the eye • Remove contact lens.

51
PHOSPHOROUS:
• Keep the injured part of the body under water or covered with wet dressings.

• Using chemical protective gloves, remove the phosphorus with a clean spoon or forceps.

HYDROFLUORIC ACID:
• Using latex gloves, massage exposed area with calcium gluconate gel for at least 15 minutes or
until pain is relieved.

• Gel should be re-applied 4 to 6 times daily for 3 to 4 days if chemical burn is present.

INJURIES TO EYES, EARS AND NOSE

1. EYE INJURIES

FOREIGN BODIES
CAUSE: small pieces of metal
S/S: TREATMENT:
Pain Do not attempt to remove the foreign body yourself.
Redness Advise the patient not to rub the affected eye.
Irritation
Teary eye In removing use moistened cotton cloth on a stick or a moistened cotton bud.
Use the fluorescien strip and mark any areas of staining on an eye diagram.
After removal of the foreign body, cover the eye lightly.
RMA

52
 EYE CONTUSSION
CAUSE: heavy blows on eye
S/S: TREATMENT:
Pain • Immediately apply ice or a cold compress for 15 minutes to reduce
Swelling swelling and minimize pain.
Inability to move • Do not press on the eye itself. Repeat every 1 to 2 hours for the first
the eye 48 hours.
Black and blue or • If there is still tenderness after 48 hours, apply a warm compress
purple mark every 1-2 hours.
• For pain, take acetaminophen.
• RMA

LACERATION
CAUSES:
flickering of cutting wood
grinding metal
trimming grass or carving stone hit directly to eye
S/S: TREATMENT:
Severe pain • Gently place a shield over the eye.
Tearing; • DO NOT rinse with water.
Sensitivity to light; • DO NOT remove the object stuck in eye.
Blurred or decreased vision; • DO NOT rub or apply pressure to eye.
Bleeding (blood in the eye); • Avoid giving aspirin.
The feeling that there is something in the eye. RMA

53
 ARC EYES (WELDER FLASH)
CAUSES:
Prolonged exposures to UV radiation.
S/S: TREATMENT:

foreign-body sensation, Flush eyes for several minutes with water

Irritation or saline solution.
Pain If the eyes feel gritty – apply Tetracycline
Photophobia eye ointment
Tearing, and decreased visual acuity 6-12 hours after Usually clear up in 48 hours.
the exposure. Avoid further exposure.

54
 CORNEAL ABRASION
(scratch on the eye’s cornea)
CAUSES:
• Dirt, sand, sawdust, ash, or some other foreign matter blowing into your eye and
getting caught under the eyelid.
• Chemical burns.
• Aggressively rubbing your eye.
• Poor fitting or dirty contact lenses.
S/S: TREATMENT:
• Redness, teary eye • Antibiotic eye drops or ointment may be
• Thick yellow discharge, recommended by doctor.
especially after sleep • Cover the affected eye.
• Green or white eye discharge • Pain medication may also be given.
• Itchy, burning eyes • Do not wear contacts until your eye has
• Blurred vision completely healed.
• Increased sensitivity to light • Wear sunglasses to help ease pain
caused by the glare of the sun.
• Do not rub your eye.

55
 CONJUNCTIVITIS
CAUSES:
• Viruses and bacteria
• Irritants such as shampoos
dirt, smoke and pool chlorine

• Redness in the white of the eye or inner For virus/bacterial:

eyelid • Avoid contact with others.
• Increased amount of tears • Don't touch your eyes with your hands.
• Thick yellow discharge that crusts over the • Wash your hands thoroughly and
eyelashes, especially after sleep frequently.
• Itchy eyes • Change your towel and washcloth daily,
• Burning eyes and don't share them with others.
• Blurred vision
• Increased sensitivity to light For irritants:
• Flush the affected eye with lots of water.
• Cover the affected eye with clean sterile
gauze.

2. EAR INJURIES

56
 FOREIGN OBJECT
CAUSES:
tiny objects inside the ear.
S/S: TREATMENT:
• Earache • Calm and reassure the person.
• Swelling • If the object is sticking out and easy to remove, gently remove it
• Visible object by hand or with tweezers.
in the ear • If you think a small object may be lodged within the ear, but you
• Sensation of cannot see it, DO NOT reach inside the ear canal with tweezers.
object in the • Try using gravity to get the object out by tilting the head to the
ear affected side. DO NOT strike the person's head. Shake it gently
• Bruising or in the direction of the ground to try to dislodge the object.
redness • If the object doesn't come out, RMA

INSECT IN THE EAR

CAUSES:
creeping of insects going inside the ears.
S/S: TREATMENT:
• Earache • DO NOT let the person put a finger in the
• Swelling ear.
• Visible object in the ear • Turn the person's head so that the affected
• Sensation of object in the ear side is up, and wait to see if the insect flies
• Bruising or redness or crawls out.
• If this doesn't work, try pouring mineral oil,
olive oil, or baby oil into the ear. As you pour
the oil, pull the ear lobe gently backward and
upward for an adult, or backward and
downward for a child.
• RMA

CUTS ON THE OUTER EAR

CAUSE:
57
 ear biting, wound
S/S: TREATMENT:

• Bleeding • Apply direct pressure until the bleeding

• Cuts on the outer ear stops.
• Cover the injury with a sterile dressing
shaped to the contour of the ear, and tape it
loosely in place.
• Apply cold compresses over the dressing to
reduce pain and swelling.
• If part of the ear has been cut off, keep the
part.
• Place the part in a clean cloth and keep it on
ice.
• RMA

3. NOSE INJURIES

58
 NOSE FRACTURE
Symptoms: TREATMENT:
• Blood coming from the nose • Try to stay calm.
• Bruising around the eyes • Breathe through your mouth and lean
• Difficulty breathing through forward in a sitting position to keep blood
the nose from going down the back of your throat.
• Misshapen appearance • Apply cold compresses to your nose to
(may not be obvious until reduce swelling.
the swelling goes down) • To help relieve pain, acetaminophen
• Pain (Tylenol) is recommended.
• Swelling

NOSE BLEEDING
CAUSES: TREATMENT:

59
Injury • Apply an ice or cold pack immediately to prevent or
minimize swelling.
• Apply the ice or cold pack for 10 to 20 minutes, 3 or more
times a day.
• Always keep a cloth between your skin and the ice pack,
and press firmly against all the curves of the affected area.
• Do not apply ice for longer than 20 minutes at a time, and
do not fall asleep with the ice on your skin.
• Keep your head elevated, even while you sleep.

BURNS

60
 TYPES OF BURNS:
1. THERMAL BURNS - A heat-induced or thermal burn can occur when the skin comes in
contact with any heat source, such as a cooking pan, an iron, a fire, a hot surface or a hot,
scalding liquid.

THERMAL BURNS
SIGNS AND SYMPTOMS: TREATMENT:

• Redness • Remove the victim from the heat source.

• Warmth to touch • Cool the affected area with cold water or cold
• Pain compresses until pain is reduced or alleviated.
• If a blister has formed, do not break it.
• Protect the burn with a dry, sterile, gauze
bandage or with a clean bed sheet or cloth.
• If victim's clothing is stuck to the burned area,
do not attempt to remove it. Instead, cut around
the clothing leaving the burn intact.
• Do not apply any ointments, oils, or sprays to
the burned area unless prescribed by your
doctor.
• If victim has burns on the hand, foot, face, eyes,
or groin, or burns that cover a large area, seek
RMA.

61
 2. CHEMICAL BURNS - Chemical burns occur when the skin or eyes come into contact with
irritants, such as acids or bases (alkaline). Most chemical burns are caused by contact
with acids and bases. Strong acids can cause severe burns.

Signs and Treatment

Symptoms

Redness • Rinse exposed area with running water for 20 minutes.

Blistering • Carefully remove the contaminated clothing, making sure
Irritation not to touch the unaffected skin with the contaminated
Intense pain clothing.
• If the chemical has splashed into victim’s eyes, begin
rinsing his/her eyes immediately and continue doing so
until RMA.
• Cover the burned area loosely with a dry, clean cloth.

3. ELECTRICAL BURN - An electrical burn is a burn that results from electricity passing through
the body causing rapid injury. An electrical burn may appear minor or not show on the skin at all,
but the damage can extend deep into the tissues beneath your skin. If a strong electrical current
passes through your body, internal damage, such as a heart rhythm disturbance or cardiac arrest,
can occur.

62
Signs and Symptoms Treatment

• Visible burns on the skin • Look first, don’t touch

• Muscle contraction or • Turn off the main switch
pain • Wear protective gear and bring non-conducting
• Numbness or tingling material (wooden stick and plastic material)
• Weakness • Bring the victim to safer place for CPR if needed.
• Bone fractures • Clean and cover the wound.
• Headache • RMA
• Feeling disoriented
• Low blood pressure
• Seizures

ENTRY OF CURRENT:

63
 DEPTH OF BURNS

FIRST DEGREE BURN

64
SECOND DEGREE BURN

THIRD DEGREE BURN

65
RULE OF NINE

66
 HEAT INJURIES

TYPES
HEAT STROKE: HEAT EXHAUSTION:

Cooling mechanism of the body Caused by excessive heat

fails due to: increased by overexertion / sweating / hot, humid
climate
Excessive humidity
Extreme heat
Activity in the hot sun
Sign and Symptoms: Sign and Symptoms:
Increase body Weakness / dizziness
temperature, above Headache / nausea, vomiting
40C Cold / moist skin
Severe head ache Paleness
Disorientation Dry tongue / thirst
Hot dry skin Loss of appetite
Rapid / shallow Excessive sweating
breathing Rapid / weak heart beat
Rapid heartbeat Fast / shallow breathing
Absence of sweating Cramps
Fluctuating blood
pressure
Irritability
Lack of consciousness

67
Treatment: Treatment:
Remove the person to a Remove the person to a shady place
shady place Loosen tight-fitting clothing
Cool the person by Remove extra clothes
sponging with wet towel Hydrating: give fluids like sports drink / fruit or
Apply ice packs in vegetable juices and water containing electrolytes
armpits and groin may be given.
Water with electrolyte, Give fluid every 15-20 minutes
fruit / vegetable juice RMA
should be given
Victim must be rested
RMA

68
 COLD INJURIES

FROSTBITE

HYPOTHERMIA

69
 TYPES
HYPOTHERMIA FROSBITE
Signs and Symptoms: Signs and Symptoms:
Pins and needles sensation
STAGE 1: Shivering Muscle stiffness, hardening and
STAGE 2: Decrease muscle function numbness
(numbness, stiffness, pale in Pale to bluish discoloration of skin.
appearance) Gangrene or permanent tissue damage
STAGE 3: Decrease responses in severe cases.
(disorientation, memory loss)
STAGE 4: Decrease vital signs
STAGE 5: DEATH
Treatment: Treatment:

Shelter the person from the cold and See the picture below
move him or her to a warmer place.
Be gentle in handling the patient.
Remove wet clothing.
Cover the person with blankets.
Share body heat.
Provide warm beverages.
Don't apply direct heat.
Monitor vital signs
RMA

70
 HEAD INJURY & SPINAL CORD INJURY
CAUSES:
• Motor vehicle accident
• Fall
• Acts of violence
• Recreational activity / sports
• Diseases (ex. Scoliosis)

TYPES OF THE HEAD INJURY

1. CONCUSSION

• A concussion is caused when the brain receives trauma from an impact or a sudden momentum or
movement change. The blood vessels in the brain may stretch and cranial nerves may be
damaged.

• A concussion can be caused by direct blows to the head, gunshot wounds, violent shaking of the
head, or force from a whiplash type injury.
• Both closed and open head injuries can produce a concussion. A concussion is the most common
type of traumatic brain injury.

71
2. SCALP WOUND

Minor cuts on the head often bleed heavily because the face and scalp have many blood vessels close
to the surface of the skin.

3. SKULL FRACTURE

A skull fracture is a break in one or more of the eight bones that form the cranial portion of the skull,
usually occurring as a result of blunt force trauma. If the force of the impact is excessive, the bone may
fracture at or near the site of the impact and cause damage to the underlying physical structures contained
within the skull such as the membranes, blood vessels, and brain, even in the absence of a fracture.

72
SIGNS AND SYMPTOMS:

• Being drowsy, hard to wake up

• Headache
• Loss of consciousness
• Memory loss of events
• Nausea and vomiting
• Seeing flashing lights
• Feeling like you have "lost time"

DANGER SIGNS:

• Becomes very sleepy

• Behaves abnormally
• Develops a severe headache or stiff neck
• Has pupils (the dark central part of the eye) of unequal sizes
• Is unable to move an arm or leg
• Loses consciousness, even briefly
• Vomits more than once

EMERGENCY TREATMENT:

• Provide ventilation as priority management

• Secure and maintain stabilization of victim’s head.
• Apply ice pack over the affected area.
• Stop any bleeding by firmly pressing a clean cloth on the wound.
• If you suspect a skull fracture, do not apply direct pressure to the bleeding site, and do not remove
any debris from the wound. Cover the wound with sterile gauze dressing.
• Complete bed rest
• Maintain calm and dim light environment.
• Administer intravenous fluids and pain reliever medication as order.
• RMA

73
 SPINAL CORD INJURY
A spinal cord injury — damage to any part of the spinal cord or nerves at the end of the spinal
canal — often causes permanent changes in strength, sensation and other body functions below the site of
the injury.

SIGNS AND SYMTPOMS:

• Extreme back pain or pressure in your neck, head or back

• Loss of movements, muscle weakness
• Numbness, tingling or loss of sensation in your hands, fingers, feet or toes
• Loss of bladder or bowel control
• Difficulty with balance and walking
• Impaired breathing after injury
• An oddly positioned or twisted neck or back

According to the location of injury:

74
 EMERGENCY TREATMENT:
• Don't move the injured person.
• Keep the neck and torso of the body as straight as possible.
• Provide ventilation.
• Place heavy towels on both sides of the neck or hold the head and neck to prevent them from
moving, until emergency care arrives.
• Provide basic first aid, such as stopping any bleeding and making the person comfortable, without
moving the head or neck.
• Monitor the mental status and vital signs.
• Place the patient in spinal board for evacuation.
• RMA

PREPARATION FOR TRANSPORT

(SPINAL CORD INJURY VICTIM)

1. Secure the head

2. Apply cervical collar
3. Apply long spinal board. A full backboard must be used whenever a back or neck fracture or injury
is suspected. Make sure that the backboard is close at hand, so that you can slide it under the
patient’s back.
4. At least four people are needed to place the victim on the backboard so as not to cause further
injury. Three first aiders should place themselves in a kneeling position along the opposite side of
the injured person. The fourth first aider should position himself at the head of the injured person.
He must hold the head securely in his hands at the same time as the body is being moved. The
fourth first aider should do his command to roll the patient on to the backboard
5. At the command of the team leader, the team should roll the patient onto the backboard, without
rotating the head, shoulders or pelvis. The middle first aider slides the backboard under the injured
person and then the injured person is gently rolled back onto the backboard. This entire operation
requires a great deal of coordination.
6. Once the injured person is on the backboard his head must be secured with a blanket roll or by
some other means to insure immobility
7. Secure the rest of the body including the head, upper torso, lower torso and legs, once the patient
is centered on the backboard, by applying the body strap.
8. Reassess the patient’s vital signs, motor function and sensory function periodically to make sure
that the straps are not too tight.

75
 FRACTURE

It is a complete or incomplete break or a crack in a bone due to an excessive amount of force.

76
Signs and Symptoms:
• Severe pain
• Difficulty in movement
• Swelling/ bruising / bleeding
• Deformity / abnormal twist of limb
• Tenderness on applying pressure

EMERGENCY TREATMENT:

• Provide ventilation
• Stop any bleeding
• Immobilize the injured area.
• Apply ice packs
• RMA

77
78
 MEDICAL EMERGENCY:

APPENDICITIS

• Is an inflammation of the appendix, a 3 1/2-inch-long tube of tissue that extends from the large
intestine.

• Appendicitis is a medical emergency that requires prompt surgery to remove the appendix.

79
Signs and symptoms:
• Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right
abdomen.
• Loss of appetite
• Nausea and/or vomiting
• Abdominal swelling
• Fever of 99-102 degrees Fahrenheit
• Inability to pass gas
• Painful urination
• Severe cramps
• Constipation or diarrhea with gas

MEDICAL TREATMENT:
• Start IVF administration
• Nothing by mouth
• Place patient in a comfortable position
• Observe for progression of pain within 24 hours
• RMA

MYOCARDIAL INFARCTION
• A heart attack (also known as a myocardial infarction or MI) is the damage and death of heart
muscle from the sudden blockage of a coronary artery by a blood clot.

• A heart attack, or myocardial infarction (MI), is permanent damage to the heart muscle. "Myo"
means muscle, "cardial" refers to the heart, and "infarction" means death of tissue due to lack
of blood supply.

80
RISK FACTORS:

• Increase cholesterol level

• Hypertension
• Smoking
• Family history

Signs and Symptoms:

• Chest heaviness or pain radiating to the arm, or below the breastbone

• Fullness, indigestion, or choking feeling (may feel like heartburn)
• Sweating, nausea, vomiting, or dizziness
• Extreme weakness, anxiety, or shortness of breath
• Rapid or irregular heartbeats
• During a heart attack, symptoms last 30 minutes or longer and are not relieved by rest.
• Extreme weakness, anxiety, or shortness of breath
• Rapid or irregular heartbeats
• During a heart attack, symptoms last 30 minutes or longer and are not relieved by rest.

MEDICAL TREATMENT:

• Administered oxygen per nasal cannula (2-3LPM)

• Complete bed rest.
• Place patient in semi sitting position.
• Administered drugs as prescribed (Aspirin, thrombolytic drugs and pain reliever)
• CPR if it is necessary to worst condition.
• RMA

GOUTY ATHRITIS
• Gout is a type of arthritis that is characterized by sudden, severe attacks of joint pain with redness,
warmth, and swelling in the affected area.

• Normal values of uric acid range between 3.5 and 7.2 mg/dl.

CAUSES:

• High protein diet

• Family history
• Stress

81
Signs and symptoms:

• Inflammation of the affected part (joints area: knees, toes and ankle)
• Intense pain
• Burning sensation
• Low grade fever

MEDICAL TREATMENT:

• Low protein diet

• Bed rest
• Increase fluids intake
• Administer medication as prescribe such as:
o Diclofenac Sodium
o Colchine
o Allupurinol
• RMA

PNEUMONIA
• Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with
fluid or pus, causing cough with phlegm or pus, fever, chills and difficulty breathing. A variety of
organisms, including bacteria, viruses and fungi, can cause pneumonia.

82
CAUSES:

• Community-acquired pneumonia causes by bacteria, such as Streptococcus pneumonia.

Signs and Symptoms:

• Fever, sweating and shaking chills.

• Lower than normal body temperature in people older than age 65, and in people with poor overall
health or weakened immune systems.
• Cough, which may produce thick, sticky fluid.
• Chest pain when you breathe deeply or cough
• Shortness of breath
• Fatigue and muscle aches
• Nausea, vomiting or diarrhea
• Headache

MEDICAL TEATMENT:

• Complete bed rest

• Drink more fluids
• Maintain nutritional status
• Administer medications as prescribe:
• Antibiotic (Ceftriaxone)
• Cough Medication (Zithromax)
• Paracetamol
• RMA
HYPOGLYCEMIA
Hypoglycemia is a condition characterized by abnormally low blood glucose (blood sugar) levels,
usually less than 70 mg/dl.

Signs and symptoms:

• Headache
• Hunger
• Palpitations
• Tremor
• Diaphoresis
• Severe: may have loss of consciousness
• Increased BP and pulse rate

83
MEDICAL TREATMENT:

• Allow patient to eat

• May give any of the the following:
 4-5 hard candies
 2-3 tbsp honey
 8 oz of juice, softdrinks
 Oral glucose tablets
• Start IVF with dextrose content
• RMA

INFECTIOUS DISEASES:
MALARIA
• Malaria is a life-threatening blood disease caused by a parasite that is transmitted to humans by
the Anopheles mosquito.

• Nigeria and the Democratic Republic of the Congo account for more than 40% of all malaria deaths
worldwide.

• As the parasite exists in human red blood cells, malaria can be passed on from one person to the
next through organ transplant, shared use of needles/syringes, and blood transfusion.

• An infected mother may also pass malaria on to her baby during delivery (birth) - this is called
'congenital malaria'.

• Severity of Malaria symptoms depends on:

o The type of parasite.

o The individual's level of immunity.

o Whether the person still has his/her spleen.

INCUBATION PERIOD:

Incubation means the time between becoming infected and the appearance of symptoms. This
generally depends on the type of parasite:

P. falciparum - 9 to 14 days
P. vivax - 12 to 18 days
P. ovale - 12 to 18 days
P. malariae - 18 to 40 days

84
TYPES OF MALARIA:
• Plasmodium vivax (P. vivax)

• Plasmodium malariae (P. malariae)

• Plasmodium ovale (P. ovale)

• Plasmodium falciparum (P. falciparum) - the most serious form of the disease.

• Plasmodium knowlesi (P. knowlesi)

Signs and Symptoms:

EARLY STAGE:

• A high temperature
• Chills
• Headache
• Sweats
• Tiredness
• Nausea
• Vomiting
• Dry cough
• Back pain
• Muscle ache
• Enlarged spleen

PREVENTIVE MEASURE:
o Avoiding mosquito bites:
• Vector control
• Insecticide-Treated Bed Nets
o Preventing disease
o Prophylaxis treatment

MEDICAL TREATMENT:
• Maintain nutritional status.
• Bed rest.
• Administer medications as prescribe:
o Chloroquine
o Clindamycin (used in combination with quinine)
o Doxycycline (used in combination with quinine)

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 DENGUE HEMORRHAGIC FEVER
• Through a bite of a female Aedes Aegypti Mosquito

• Dengue (DENG-gay) fever is a mosquito-borne disease that occurs in tropical and subtropical
areas of the world.

Signs and Symptoms:

• Fever, up to 106 F (41 C)

• Headaches
• Muscle, bone and joint pain
• Pain behind your eyes
• Widespread rash
• Nausea and vomiting
• Minor bleeding from your gums or nose

MEDICAL TREATMENT:

• Maintain nurtritional and hydration status.

• Intravenous (IV) fluid and electrolyte replacement
• Blood pressure monitoring
• Transfusion to replace blood loss (if needed)
• For prevention: have clean environment and get rid of mosquitoes breeding places.

TYPHOID FEVER

• Typhoid fever is an infection that causes diarrhea and a rash. It is most commonly due to a type of
bacterium called Salmonella typhi (S. typhi).
• Through ingestion of contaminated food or water.

Signs and Symptoms:

• Abdominal pain and tenderness.

• High fever (103°F, or 39.5°C) or higher
• Severe diarrhea
• Bloody stools, nosebleeds
• Confusion, hallucinations, severe fatigue
• Slow, sluggish, lethargic feeling
• Rashes called "rose spots," which are small red spots on the abdomen and chest.

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  The incubation period is usually 1-2 weeks, and the duration of the illness is about 3-4 weeks.

MEDICAL TREATMENT:

• Maintain hydration status.

• Maintain nutritional status.
• Bed rest
• Antibiotics:
o Chloramphenicol (classic drug)
o Ciprofloxacin (Cipro)
o Ceftriaxone (Rocephin), an intramuscular injection medication, is an alternative for pregnant
patients.

TETANUS INFECTION

• Tetanus is a condition caused by a nerve toxin that is produced by the bacterium Clostridium
tetani.
• They're commonly found in soil, but can also be found in the lower intestines of mammals.
• Anyone who cuts himself or herself with a dirty object is at risk of getting Clostridium tetani in the
wound.

Signs and symptoms:

Symptoms may appear anywhere from 2 days to 6 weeks after the wound has been infected, but the
typical incubation period (time between infection and symptoms) is 5 to 10 days.
• Chills, restlessness
• Difficulty swallowing, sore throat

Signs and symptoms:

• Headache, irritability
• Jaw and neck stiffness
• Low fever
• Stiff arms and legs

MEDICAL TREATMENT:
• Do not give anything by mouth
• IV fluids administratiom
• Administer medications and vaccination as prescribe:
o Metronidazole, Penicillin (antibiotics)
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 o Diazepam (muscle relaxant)
o Tetanus immunoglobulin Ig 250 IU/amp, 4 amps IM
o Tetanus toxoid 0.5 ml/amp 1 amp IM
• Monitor vital signs
• RMA

SEXUALLY TRANSMITTED DISEASES:

GONORRHEA

• Also called the "clap" or "drip," gonorrhea is a contagious disease transmitted most often through
sexual contact with an infected person.
• Gonorrhea is caused by Neisseria gonorrhoeae.
• Gonorrhea may also be spread by contact with infected bodily fluids a mother could pass on the
infection to her newborn during childbirth.

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Signs and Symptoms:

Gonorrhea symptoms in women:

• Greenish yellow or whitish discharge from the vagina
• Lower abdominal or pelvic pain
• Burning when urinating
• Conjunctivitis
• Bleeding between periods
• Spotting after intercourse
• Swelling of the vulva (vulvitis)
• Burning in the throat (due to oral sex)
• Swollen glands in the throat (due to oral sex)
• When symptoms do occur, they are often within two to 10 days after exposure, but they can take
up to 30 days to develop.

Gonorrhea symptoms in men:

• Greenish yellow or whitish discharge from the penis
• Burning when urinating
• Burning in the throat (due to oral sex)
• Painful or swollen testicles
• Swollen glands in the throat (due to oral sex)
• In men, symptoms usually appear two to 14 days after infection.

PREVENTIVE MEASURE:

• Use condoms correctly every time you have sex.

• Limit the number of sex partners, and do not go back and forth between partners.
• Practice sexual abstinence, or limit sexual contact to one uninfected partner.
• If you think you are infected, avoid sexual contact and see a doctor.

MEDICAL TREATMENT:

• No sexual contact with anyone while you are being treated. If your treatment is a single dose of
antibiotics, wait at least 7 days after taking the dose before having any sexual contact.
• Strictly follow prescribe antibiotic medication:
Cefixime/Suprax
Ceftriaxone/Rocephin
Azithromycin/Zithromax
Doxycycline/Doryx
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 SYPHILIS
• Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal
sex.
• Syphilis is caused by the bacteria Treponema pallidum.
• The disease can be passed to another person through prolonged kissing or close bodily contact.
• Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared
clothing, or eating utensils.

Signs and symptoms:

Primary stage: starts about three weeks after exposure.
• painless on the genitals, rectum, anus, or mouth.
• Lymph glands
Second stage: occurs approximately two weeks to two months after the appearance of the painless sores:
• a non-itchy red or reddish-brown spotty rash (palms of the hands and bottoms of the feet)
headache, fever,
• fatigue, sore throat,
• muscle aches, swollen lymph glands
• loss of appetite, weight loss, and pain in bones and joints.
Third (late) stage: start anytime from one year to several decades later
• joints may be affected, resulting in arthritis.
• infection can affect the brain, nerves, eyes, heart, blood vessels, bones, and liver.

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MEDICAL TREATMENT:
• Abstain from sexual contact
• Strictly follow prescribe medication:
o Penicillin
o Doxycycline
• RMA

GENITAL HERPES

• Genital herpes is caused by the herpes simplex virus (HSV).

• Sexual contact is the primary way that the virus spreads.
• No cure for genital herpes.

Signs and symptoms:

• Itching
• Small red bumps or tiny white blisters
o The signs and symptoms of HSV can be so mild that they go unnoticed.
MEDICAL TREATMENT:
• Maintain contact isolation.
• Keep infected area clean and dry.
• Wear loose clothes for comfort.

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 GENITAL WARTS
• The virus that causes genital warts is called human papilloma virus.

Signs and Symptoms:

In women:
• genital warts can grow on the vulva, the walls of the vagina, the area between the external genitals
and the anus, and the cervix.
In men:
• occur on the tip or shaft of the penis, the scrotum, or the anus.
• Genital warts can also develop in the mouth or throat of a person who has had oral sexual contact
with an infected person.
• Small, flesh-colored or gray swellings in your genital area
• Several warts close together that take on a cauliflower shape
• Itching or discomfort in your genital area
• Bleeding with intercourse
MEDICAL TREATMENT:
• Prescription medicines include:
o Imiquimod (Aldara)
o Podophyllin and podofilox (Condylox)
o Trichloroacetic acid (TCA)
• Surgical treatment:
o Electrocauterization
o Laser therapy
• Surgical excision

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93
 GYNECOLOGY AND PREGNANCY
GYNECOLOGY – is the medical practice dealing with the health of the female reproductive
system (uterus, vagina, and ovaries). Literally, outside medicine, it means "the science of women".

PREGNANCY - The period from conception to birth. After the egg is fertilized by a sperm and then
implanted in the lining of the uterus, it develops into the placenta and embryo, and later into a fetus.
Pregnancy usually lasts 40 weeks, beginning from the first day of the woman's last menstrual period, and is
divided into three trimesters, each lasting three months.

SIGNS OF PREGNANCY:

POSITIVE SIGNS:
• Visualization of embryo
• Fetal heartbeat When: 9th - 12th week using a Doppler16th - 20th week using a fetoscope.
• Fetal Movement (quickening)When: 20th week of pregnancy felt by a third party (doctor)

POSSIBLE SIGNS:
• Amenorrhea
• Morning sickness
• Frequent urination
• Tender, swollen breasts
• Nipple changes
• Food cravings
• Fatigue and sleepiness
• Loss in appetite

PROBABLE SIGNS:
• Color change in the tissues of the vagina and cervix to purplish blue
• Softening of cervix and uterus
• Uterus and abdomen size (becomes bigger)
• Fluttering in the lower abdomen

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 STAGES OF PREGNANCY

STAGE DEVELOPMENT OF THE FETUS

First month
At the end of the first month, the embryo is about a third of an inch long, and its head and trunk-
plus the beginnings of arms and legs-have started to develop. The embryo receives nutrients and
eliminates waste through the umbilical cord and placenta. By the end of the first month, the liver and
digestive system begin to develop, and the heart starts to beat.

Second month
In this month, the heart starts to pump and the nervous system (including the brain and spinal cord)
begins to develop. The 1 in (2.5 cm) long fetus has a complete cartilage skeleton, which is replaced by
bone cells by month's end. Arms, legs and all of the major organs begin to appear. Facial features begin to
form.

Third month
By now, the fetus has grown to 4 in (10 cm) and weighs a little more than an ounce (28 g). Now the
major blood vessels and the roof of the mouth are almost completed, as the face starts to take on a more
recognizably human appearance. Fingers and toes appear. All the major organs are now beginning to form;
the kidneys are now functional and the four chambers of the heart are complete.

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Fourth month
The fetus begins to kick and swallow, although most women still can't feel the baby move at this
point. Now 4 oz (112 g), the fetus can hear and urinate, and has established sleep-wake cycles. All organs
are now fully formed, although they will continue to grow for the next five
months. The fetus has skin, eyebrows, and hair.

Fifth month
Now weighing up to a 1 lb (454 g) and measuring 8-12 in (20-30 cm), the fetus experiences rapid
growth as its internal organs continue to grow. At this point, the mother may feel her baby move, and she
can hear the heartbeat with a stethoscope.

Sixth month
Even though its lungs are not fully developed, a fetus born during this month can survive with
intensive care. Weighing 1-1.5 lbs (454-681 g), the fetus is red, wrinkly, and covered with fine hair all over
its body. The fetus will grow very fast during this month as its organs continue to develop.

Seventh month
There is a better chance that a fetus born during this month will survive. The fetus continues to
grow rapidly, and may weigh as much as 3 lb (1.3 kg) by now. Now the fetus can suck its thumb and look
around its watery womb with open eyes.

Eighth month
Growth continues but slows down as the baby begins to take up most of the room inside the
uterus. Now weighing 4-5 lbs (1.8-2.3 kg) and measuring 16-18 in (40-45 cm) long, the fetus may at this
time prepare for delivery next month by moving into the head-down position.

Ninth month
Adding 0.5 lb (227 g) a week as the due date approaches, the fetus drops lower into the mother's
abdomen and prepares for the onset of labor, which may begin any time between the 37th and 42nd week
of gestation. Most healthy babies will weigh 6-9 lb (2.7-4 kg) at birth, and will be about 20 in. long.

PREGNANT MOTHER:

First trimester (week 1-week 12)

• Extreme tiredness
• Tender, swollen breasts.
• morning sickness)
• Cravings or distaste for certain foods

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 • Mood swings
• Constipation
• Need to pass urine more often
• Headache
• Heartburn
• Weight gain or loss

Second trimester (week 13-week 28)

• Body aches
• Stretch marks on your abdomen, breasts, thighs, or buttocks
• Darkening of the skin around your nipples
• Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. Patches often match
on both sides of the face.
• Numb or tingling hands
• Itching on the abdomen, palms, and soles of the feet.
• Swelling of the ankles, fingers, and face.

Third trimester (week 29-week 40)

• Shortness of breath
• Heartburn
• Swelling of the ankles, fingers, and face.
• Tender breasts
• Trouble sleeping
• The baby "dropping", or moving lower in your abdomen
• Contractions, which can be a sign of real or false labor.

There are a range of other prenatal tests that are routinely performed, including:

• PAP test
• gestational diabetes screening test at 24-28 weeks
• tests for sexually transmitted diseases
• urinalysis
• blood tests for anemia or blood type
• screening for immunity to various diseases, such as German measles

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CARE TO PREGNANT WOMEN:
• Prenatal care is vitally important for the health of the unborn baby.

• A pregnant woman should be sure to eat a balanced, nutritious diet of frequent, small meals.

• No medication (not even a nonprescription drug) should be taken except under medical
supervision, since it could pass from the mother through the placenta to the developing baby.
Some drugs, called teratogens, have been proven harmful to a fetus, but no drug should be
considered completely safe (especially during early pregnancy). Drugs taken during the first three
months of a pregnancy may interfere with the normal formation of the baby's organs, leading to
birth defects. Drugs taken later on in pregnancy may slow the baby's growth rate, or they may
damage specific fetal tissue (such as the developing teeth), or cause preterm birth.

• To have the best chance of having a healthy baby, a pregnant woman should avoid:

• smoking
• alcohol
• street drugs
• large amounts of caffeine
• artificial sweeteners

• Women should begin following a healthy diet even before they become pregnant. This means
cutting back on high-calorie, high-fat, high-sugar snacks, and increasing the amount of fruits,
vegetables and whole grains in her diet. Once she becomes pregnant, she should make sure to get
at least six to 11 servings of breads and other whole grains, three to five servings of vegetables,
two to four servings of fruits, four to six servings of milk and milk products, three to four servings of
meat and protein foods, and six to eight glasses of water. She should limit caffeine to no more than
one soft drink or cup of coffee per day.

BODY CHANGES AND DISCOMFORT DURING PREGNANCY

BODY CHANGES / MANAGEMENT

DISCOMFORT
Body aches • Lie down.
• Rest.
• Apply heat.

Breast changes • Wear a maternity bra with good support.

• Put pads in bra to absorb leakage.
Constipation • Drink eight to 10 glasses of water daily.

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 • Don't drink caffeine.
• Eat fiber-rich foods, such as fresh or dried fruit, raw vegetables, and
whole-grain cereals and breads.
• Try mild physical activity.
Fatigue, sleep problems • Lie on your left side.
• Use pillows for support, such as behind your back, tucked between
your knees, and under your tummy.
• Practice good sleep habits
• Go to bed a little earlier.
• Nap if you are not able to get enough sleep at night.
Dizziness • Stand up slowly.
• Avoid standing for too long.
• Don't skip meals.
• Lie on your left side.
• Wear loose clothing.
Heartburn and indigestion • Eat several small meals instead of three large meals.
• Drink fluids between meals.
• Don't eat greasy and fried foods.
• Avoid citrus fruits or juices and spicy foods.
• Do not eat or drink within a few hours of bedtime.
• Do not lie down right after meals.
Stretch marks, skin • Be patient — stretch marks and other changes usually fade after
changes delivery.
Leg cramps • Gently stretch muscles.
• Get mild exercise.
• For sudden cramps, flex your foot forward.
• Eat calcium-rich foods.
• Ask your doctor about calcium supplements.
Morning sickness • Eat several small meals.
• Don't lie down after meals.
• Eat dry toast, saltines, or dry cereals.
• Eat bland foods that are low in fat and easy to digest, such as cereal,
rice, and bananas.
• Sip on water, weak tea, or clear soft drinks. Or eat ice chips.
• Avoid smells that upset your stomach.
Swelling • Drink eight to 10 glasses of fluids daily.
• Don't drink caffeine or eat salty foods.
• Rest and elevate your feet.
• Ask your doctor about support hose.
Urinary frequency and • Take frequent bathroom breaks.
leaking • Drink plenty of fluids to avoid dehydration.
• Do Kegel exercises to tone pelvic muscles.

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A pregnant woman with any of the following signs should contact her doctor immediately:

• abdominal pain
• rupture of the amniotic sac or leaking of fluid from the vagina
• bleeding from the vagina
• no fetal movement for 24 hours (after the fifth month)
• continuous headaches
• marked, sudden swelling of eyelids, hands, or face during the last three months
• dim or blurry vision during last three months
• persistent vomiting

BLEEDING IN PREGNANCY
Vaginal bleeding in pregnancy is bleeding coming through the vagina during pregnancy, for any
reason.

CAUSES:
• During the first 3 months, vaginal bleeding may be a sign of a miscarriage or ectopic pregnancy.
• During months 4 - 9, bleeding may be a sign of:
o Abruptio plcenta
o Miscarriage
o Placenta previa
• Having sex
• An infection
• Hormone changes

MEDICAL MANAGEMENT:
• Complete bed rest.
• Monitor the vital signs.
• Maintain fluid intake.
• Call doctor if bleeding progress.

MISCARIAGE
A miscarriage is the loss of a fetus before the 20th week of pregnancy. The medical term
for a miscarriage is spontaneous abortion.

CAUSES:

• Infection
• Exposure to environmental and workplace hazards such as high levels of radiation or toxic agents

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 • Hormonal problems
• Uterine abnormalities
• Incompetent cervix
• Lifestyle factors such as smoking, drinking alcohol, or using illegal drug
• Severe malnutrition

SIGNS OF BLEEDING:
• Bleeding which progresses from light to heavy
• Severe cramps
• Abdominal pain
• Fever
• Weakness
• Back pain

MEDICAL TREATMENT:
• Complete bed rest.
• Start an hourly pulse chart
• If the pulse rate rises with or without severe bleeding, give ergometrine 0.5 mg IM
• Note the blood clots to see if miscarriage has already occurred
• RMA

ECTOPIC PREGNANCY
Ectopic pregnancies are pregnancies that implant somewhere outside the uterus. The
fallopian tube accounts for the majority of ectopic pregnancies.

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SIGNS OF ECTOPIC PREGNANCY:

• Cramping pain felt low in the stomach (usually stronger than menstrual cramps)
• Sharp pain in the abdominal area
• Vaginal bleeding

MEDICAL TREATMENT:
• Active monitoring
• Medication – a medicine called methotrexate
• Surgery –
• RMA ASAP!!!

PRURITUS VULVAE
Pruritus vulvae means itchy vulva. The vulva is the area of skin just outside the vagina.

CAUSES:

• Infections
• Sensitisation
• Urinary or faecal incontinence.
• Menopause.
• Pregnancy
• Diabetes

MEDICAL TREATMENT:
• Bland moisturisers (emollients) such as aqueous cream or emulsifying ointment.
• Try to avoid the itch-scratch cycle
• Wear loose 100% cotton underwear.
• Avoid wearing tight-fitting cloth Stockings are probably better than tights.
• Consider wearing no underwear.
• Wash your vulva gently, once a day.
• Do not put on your underwear until your vulva is fully dry

DYSMENORRHEA
• Dysmenorrhea can be literally translated as "difficult monthly flow.”
• Caused by excessive levels of prostaglandins, hormones that make your uterus contract during
menstruation and childbirth.

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SYMPTOM:

• Pain, for most women, the pain usually starts shortly before or during their menstrual period, peaks
after 24 hours, and subsides after 2 to 3 days.
• nausea, vomiting, diarrhea, lightheadedness, or general achiness.

MEDICAL TREATMENT:

• Lying on your back, supporting your knees with a pillow

• Holding a heating pad on your abdomen or lower back
• Taking a warm bath
• Gently massaging your abdomen
• Mild exercises like stretching, walking, or biking
• Getting plenty of rest and avoiding stressful situations as your period approaches
• NSAIDs such as ibuprofen*, naproxen, and acetylsalicylic acid (ASA) may help.

DENTAL CARE

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BASIC DENTAL CARE:

• Brush after eating.

• Brush your tongue.
• Flossing at least once a day.
• Frequent gargling and mouth washing.
• Eat a mouth-healthy diet.
• Use a fluoride toothpaste.
• Replace your toothbrush every 3 to 4 months.
• Dentist visit every 6 months – 1 year.

DENTAL PROBLEM:
TOOTHACHE
• Tooth decay is the primary cause of toothaches for most children and adults.
• Bacteria that live in your mouth thrive on the sugars and starches in the food you eat.

DENTAL TREATMENT:
• Rinse your mouth with warm water.
• Use dental floss to remove any food particles wedged between your teeth.
• Take an over-the-counter pain reliever to dull the ache.

PAINFUL WISDOM TOOTH

• Wisdom teeth are the third and final set of molars.

• Rinsing your mouth with a warm saltwater solution by swishing it around for 30 seconds and then
spitting it out.
• Oral numbing medications can be applied to the affected area.
• Give over-the-counter pain relievers.
• Chewing gum will gently massage the irritated area.

DENTURES IRRITATION

Wearing dentures can cause the gums underneath the dentures to become swollen,
irritated or painful. This condition is what is referred to as a denture sore.

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DENTAL TREATMENT:
• Use a soft toothbrush both for brushing your gums and teeth if there are any left.
• Brush your denture.
• Use some baking soda in some warm water, and soak your dentures in that for a few hours.
• A gum massage may also relieve symptoms as they occur.

ALCOHOL AND DRUG ABUSE

CONTRIBUTING FACTORS TO ALCOHOL AND DRUG ABUSE AMONG SEAFARERS

• Pressure/stress
• Boredom and repetition
• Too much time away from home
• Long hours
• Job fatigue
• Shift work
• Heat, cold, noise
• Financial reasons

ALCOHOL - a chemical substance derived from hydrocarbon that contains one or more hydroxyl that could
depresses the central nervous system.

ALCOHOLIC - an alcoholic is a man or a woman who suffers from alcoholism - they have a distinct
physical desire to consume alcohol beyond their capacity to control it, regardless of all rules of common
sense.

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 STANDARD UNITS OF ALCOHOL

Regular beer = 5% volume of alcohol

1 bottle 1 unit

Malt beer 9 – 10% volume of alcohol

1 bottle 1 unit
Table wine 12% volume of alcohol
1 glass 1 unit
Fortified wine 20% volume of alcohol
1 small glass 1 unit
Distilled wine 40 – 50% volume of alcohol
1 jigger/shot 1 unit

TYPES OF DRINKER
Social drinker: Problematic drinker: Alcoholic drinker:

• Drinks slowly • Drinks to get drunk • Drinking alone.

• Spaces out drinks • Drinks to cope with problems or • Drinking in secret.
• Eats before or stressful life events • Blacking out
while drinking • Experiences personality • Not being able to
• Abstains while changes limit how much
taking medication • Drinks when she or he should alcohol is consumed.
• Never drives not--before class, before/while • Feeling an urge to
during/after driving, before a game drink
drinking • May have "blackouts" • Nausea, sweating, or
• Knows and obeys • Hurting himself and others. even shaking when
laws related to not drinking.
drinking
• Respects
nondrinkers.

SIGNS OF ALCOHOLISM:
• Dropping hobbies and activities the person used to enjoy; losing interest in them.
• Feeling irritable when drinking times approach.
• Gulping drinks down in order to get drunk and then feel good.
• Having relationship problems (triggered by drinking).
• Having problems with the law (caused by drinking).
• Having work problems (caused by drinking, or drinking as root cause).

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 • Having money problems (caused by drinking).
• Requiring a larger quantity of alcohol to feel its effect.

MANAGEMENT:
• Do-it-yourself
• Counseling
• Treating underlying problem
• Detoxification - Chlordiazepoxide, a benzodiazepine medication, is frequently used for
detoxification (detox).
• Staying on the wagon (remaining abstinent)

PREVENTION:
• Know your limit. If you're not sure
• Eat food while you drink.
• Sip your drinks.
• Don't participate in "chugging" contests or other drinking games.
• Accept a drink only when you really want one.
• Skip a drink now.
• Keep active; don't just sit around and drink.
• Beware of unfamiliar drinks.
• Use alcohol carefully in connection with pharmaceuticals.

DRUG ABUSE
Substance abuse, also known as drug abuse, is a patterned use of a substance (drug) in which the user
consumes the substance in amounts or with methods which are harmful to themselves or others.

DRUG ADDICTION

Also called substance dependence or chemical dependency.

Is a disease that is characterized by a destructive pattern of drug abuse that leads to

significant problems as well as other problems that use of the substance can cause for the sufferer, either
socially or in terms of their work or school performance.

COMMONLY ABUSED DRUGS:

• Marijuana
• Depressants (including Xanax, Valium, GHB):

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 • Stimulants (including amphetamines, cocaine, crystal meth)
• Inhalants (glues, aerosols, vapors)
• Hallucinogens (LSD, PCP)
• Heroin

Physical warning signs of drug abuse:

• Bloodshot eyes, pupils larger or smaller than usual
• Changes in appetite or sleep patterns. Sudden weight loss or weight gain
• Deterioration of physical appearance, personal grooming habits
• Unusual smells on breath, body, or clothing
• Tremors, slurred speech, or impaired coordination

Behavioral signs of drug abuse:

• Drop in attendance and performance at work or school

• Unexplained need for money or financial problems.
• Engaging in secretive or suspicious behaviors
• Sudden change in friends, favorite hangouts, and hobbies
• Frequently getting into trouble (fights, accidents, illegal activities)

Psychological warning signs of drug abuse:

• Unexplained change in personality or attitude

• Sudden mood swings, irritability, or angry outbursts
• Periods of unusual hyperactivity, agitation, or giddiness
• Lack of motivation; appears lethargic or “spaced out”
• Appears fearful, anxious, or paranoid, with no reason

Stages of Drug Use

• Experimental use
• Regular use - the user misses more and more school or work; worries about losing drug source;
uses drugs to "fix" negative feeling; begins to stay apart from friends and family; may change peer
group

• Daily preoccupation - the user looses any motivation; the user is indifferent toward school and
work; behavior changes become obvious; preoccupation with drug use overrides all prior interests,
including relationships; the user engages in secretive behavior; may begin dealing drugs to help
support habit; use of other, harder drugs may increase; legal complications may increase.o others
who are regular users; takes pride in noting; increased tolerance and ability to "handle" the drug.

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 • Dependence - cannot face daily life without drugs; denial of problem; worsening physical condition;
loss of "control" over use; may become suicidal; financial and legal complications worsen; may
have severed ties with family members or friends by this time.

MEDICAL TREATMENT:

• Do it yourself
• Family support
• Counseling
• Rehabilitation

Support can come from:

• family members
• close friends
• therapists or counselors
• other recovering addicts
• healthcare providers
• people from your faith community

ENVIRONMENTAL SANITATION
GUIDELINES IN ENVIRONMENTAL SANITATION ON BOARD:
• The design and construction of the ship should be as safe as possible with respect to maintaining a
sanitary environment.
• The food, water and materials taken on board should be as safe as possible.
• Crew should be well trained in ship sanitation and have all the equipment, facilities, materials and
capacity necessary to permit the maintenance of a sanitary environment on board.
• A risk management system should be put in place and maintained to ensure the identification,
reporting and mitigation of public health risks.

RESPONSIBILITIES/ROLES in maintaining good sanitation on ships:

• Designer/constructor.

Good sanitary design greatly reduces the chances of poor health outcomes arising on board or
when the ship is in contact with external risks at port.

• Owner/operator

The owner should ensure compliance with sanitary design standards that support sanitary ship operation.

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 • Master/crew

The ultimate responsibility for all aspects of crew safety on board is vested withthe ship’s master,
as delegated by the operator.

• Port authorities
A responsibility of port authorities is to provide the required equipment, facilities, expertise and
materials so that ships can undertake operations (e.g. providing safe food and water, safely removing
ballast and waste) in a sanitary manner.

WATER SAFETY PLAN

Water safety plans (WSPs) are an effective overarching management approach for
ensuring the safety of a drinking-water supply.

WSP has three key components:

• System assessments - description of the water supply system in order to determine whether the
drinking-water supply chain (up to the point of consumption) as a whole can deliver water of a
quality that meets health-based targets; identification of hazards and evaluation of risks,
determination of control measures, reassessment and prioritization of risks; development,
implementation and maintenance of an improvement plan.

• Operational monitoring - identification and monitoring of the control measures that will ensure that
management processes are functioning efficiently.

• Management and communication - including verification, preparation of management procedures

and development of supporting programmes to manage people and processes, including upgrade
and improvement.

Health risks associated with potable water on ships:

• Contaminated water supplied at the port
• Contaminated bunkered water
• Cross-connections between potable and non-potable water
• Poor design and construction of potable water storage tanks
• Inadequate disinfection.

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Control measures on water supply:
• Disinfection - presence of a measurable disinfectant residual contributes to ensuring that water is
microbiologically safe for the intended use.

• Prevention of backflow and cross-contamination - The lines’ capacity should maintain positive
pressure at all times to reduce the risk of backflow. There must be no connections between the
potable water system and other piping systems.

• Water boats and barges - reception, handling, storage and delivery to ship water systems need to
be carried out under controlled, sanitary conditions. All hoses, fittings and tools need to be stored
in designated lockers that are closed and clean. Operators need to possess knowledge of water
hygiene and good sanitary practice.

FOOD PRESERVATION / STORAGE

Food storage facilities must be designed and constructed to:
• permit adequate maintenance and cleaning;
• avoid pest access and harbourage;
• enable food to be effectively protected from contamination during storage;
• provide an environment that minimizes the deterioration of food (e.g. by temperature and humidity
control).

FOOD HANDLERS
• All food handlers should practice good personal hygiene.
• Food handlers known to be infected with potentially hazardous conditions are not permitted to
handle food.
• Food handlers are adequately trained in food safety.
• Personnel need to wash their hands to ensure food safety, such as:
• at the start of food handling activities;
• immediately after using the toilet;
• after handling raw food or any contaminated material, where this could result in contamination
of other food items.
• People engaged in food handling activities should avoid handling ready-to-eat food and refrain
from behavior that could result in contamination of food, such as:
• handling money
• smoking
• spitting
• chewing or eating
• sneezing or coughing over unprotected food.

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 • Personal effects such as jewelry, watches, pins or other items must not be worn or brought into
food handling areas if they pose a threat to food safety.

DISEASE PREVENTION

FACTORS FOR SEAMAN’S HEALTH:

• Efforts to maintain physical and mental efficiency at on optimum level.
• Organization of the physical facilities & the supplies necessary to maintain a state of maximum
efficiency.
• Efforts of other personnel, ashore & afloat to create and maintain condition conducive to his health.
• Individual and group health are totally dependent on a proper give and take attitude among the
crew, as well as good medical service on board.

International Health Regulations 2005

“To prevent, protect against, control and provide a public health response to the
international spread of disease in ways that are commensurate with and restricted to public health risks,
and which avoid unnecessary interference with international traffic and trade”.

HEALTH REGULATIONS:
“Seafarers shall not work on a ship unless they are certified as medically fit to perform their duties”.
“Each Member shall ensure that ships that fly its flag provide and maintain decent accommodations
and recreational facilities for seafarers working or living on board, or both, consistent with
promoting the seafarers’ health and well-being”.
“Each member shall ensure that ships that fly its flag carry on board and serve food and drinking
water of appropriate quality, nutritional value and quantity that adequately covers the requirements
of the ship and takes into account the differing cultural and religious backgrounds”
Each Member shall ensure that seafarers on board ships in its territory who are in need of
immediate medical care are given access to the Member’s medical facilities on shore”

COMMON INFECTIOUS DISEASES ON BOARD

• Acute infectious gastrointestinal illnesses
• Acute respiratory illnesses

CAUSATIVE FACTORS:
• Having another infected person in the same family or group;
• Coming into contact with an infected person;
• Poor food and water handling hygiene;
• Contact with both faeces and vomitus, which appear to be equally important;
• Being in close proximity to a person who is infected and coughing or sneezing.
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DISEASE PREVENTION:
• Good personal hygiene practices are promoted on board and required by crew and staff.
• Stringent food and water hygiene is maintained on board.
• Stringent hygiene practices with regard to cleaning and waste management on board are
maintained.
• Good air quality is maintained to reduce the risk of airborne disease transmission.
• Cases and outbreaks are responded to effectively.
• Be responsible to one’s health.

DEATH AT SEA

Death is the cessation of all biological functions that sustain a living organism.

CONCEPT OF DEATH

• Being prepared for what may happen can make it a little easier to cope with the situation.
• People fear pain and distress but most fear the loss of control that happens with being ill and dying.
• Death, as the ultimate human mystery, is often feared but for most people it is the process of dying
that is more fearful.

SIGNS AND SYMPTOS OBSERVE IN DYING PERSON:

• Appetite and Thirst
• Sleep and Alertness
• Restlessness
• Continence

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 • Temperature and Circulation
• Breathing and secretions

CARE FOR THE DYING:

• Continued care
• Emotional and psychological care
• Social care
• Palliative care
• Spiritual and cultural care

5 IMPORTANT THINGS:
• Things they were once responsible for will be taken care of.
• The survivors will survive without them.
• All is forgiven.
• Their life had meaning.
• They will be remembered.

EXAMINATION OF DEAD BODY:

• Cause of death
• Time of death
• Location of accident happened wherein death occurs.
• Palpation of all major pulses.
• Auscultation of the heart and lungs for at least one minute, and repeated at intervals over at least
five minutes.
• Inspection of the eyes for fixed dilated pupils, absence of corneal reflexes, cloudiness of the cornea
and loss of eye tension.
• Examination of muscle tone for rigor mortis
• (begins approximately 3 hours after death).
• Decreased temperature - will depend on ambient temperature, but may not occur for up to 8 hours.
• There are no spontaneous movements.
• There is no respiratory effort (examine for one minute).
• There are no heart sounds or palpable pulses (examine for one minute).
• There is an absence of reflexes of corneal.
• The pupils are fixed and dilated.

KEEPING A CORPSE ON BOARD:

 Wash & dry the body all over
 Comb out & part the hair; give attention to fingernails.
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  Straighten arms & legs, & interlock hands over the thighs.
 Tie ankles together to keep the feet parallel
 Plug with cotton ball up in the rectum and into each nostril & ears, close the mouth
 Catheterize the bladder; if not possible, tie the base of penis
 Put in body bag.
 Place in refrigerator or cold store refs.

PRESERVATION OF DEAD BODY

• Use of dry ice (carbon dioxide ice)
• It gives perfect results in 95% of the cases.
• Dry ice is applied on different parts of the body, which freeze on contact (- 96 degrees).
The ice must be changed every 24 hours.
• Attention : Some funeral homes use products for freezing food product, not dry ice, in order to save
money. These products do not satisfy the criteria imposed for preservation of bodies.
• No administrative requirements, no authorization required, no police involvement.
• Burial at sea is the disposal of human remains in the ocean, normally from a ship or boat. It is
regularly performed by navies, and is done by private citizens in many countries.

EXTERNAL MEDICAL ASSISTANCE

RADIO MEDICAL ASSISTANCE

• Is to assist ships at sea, with no medical personnel embarked, experiencing a medical emergency
onboard.

Activation of RMA:
 Available by radio telegraphy or by direct radio – telephone contact with the doctor – from ports or
from ships.
 Use common language to both parties.
 Give all necessary information.
 If language is a limiting factor, the International Code of Signals (CDPUBNV102) can be used by
itself, or in conjunction with English or another language specified by the coast station called.
 Messages are generally addressed RADIOMEDICAL followed by the name of the coast station to
which the message is sent.
 The priority of the message should depend on the severity of the ailment.
 In extreme emergency the urgency signal (PAN PAN) should precede the address on
 the address line (example: PAN PAN RADIOMEDICAL HALIFAX RADIO).

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INFORMATION NEEDED IN RMA

• Vessel Information
• Personal information of the patient
• Patient assessment findings
• Treatment given to the patient

SHIP’S IDENTITY AND NAVIGATIONAL STATUS FORM

(To be used when calling for medical evacuation)
Vessel Name_____________________________________________________________
Call Sign________________________________________________________________
Date and Time (GMT)______________________________________________________

Communication Resources__________________________________________________
Flag of Registry___________________________________________________________
Home port_______________________________________________________________
Vessel classification________________________________________________________
Helicopter deck____________________________ YES _____________ NO _________
Length (m)_______________________________________________________________
Position (latitude/longtitute)_________________________________________________
Course__________________________________________________________________
Speed___________________________________________________________________
Intender port of destination__________________________________________________
Nearest port______________________________________________________________
Others possible ports of call__________________________________________________
On-scene sea state_________________________________________________________
Wind direction____________________________________________________________
Wind speed______________________________________________________________
Visibility________________________________________________________________
Weather conditions________________________________________________________

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 MEDIVAC
PROCEDURE IN MEDIVAC:
• Use only in an emergency
• Do not expect the helicopter to appear right away, apparent delay may ensue.
• The range of the helicopter is limited.
• In bad weather, even the helicopter needs an escort for safety reasons.
• Refueling stops may be made.
• Communicate with the helicopter on the VHF or 2182 KHz, if not possible communicate via a
lifeboat or Coast Radio Station or Coastguard Station on 2182 KHz, or on VHF.
• Set the ship on a steady course giving minimum ship motion.
• Put a wind indicator
• Clear as large an area of deck or covered hatching & mark with a large H in white. Remove all
whip or wind aerials.
• Secure all loose articles or remove to a safer place.
• Use a distinctive signal for the helicopter (orange smoke, Aldis lamp, heliograph).
• Never hook the hoist cable of the helicopter to any part of the ship.
• Wear rubber cloves.
• Avoid creating turbulence during rescue.
• Strap the patient securely. Make sure he does not fall out.
• Obey the instructions of the helicopter crew.
• If the hoist is being carried out at night, put adequate search lights pointed vertically to aid locating
the ship. Do not shine any lights on the helicopter. Put lights on obstructions.

PROCEDURE IN RMA
• Contact the coast radio station (details in ARLS Vol 1), ask for medical advice.
• Give the doctor all the information you can so that he can make an assessment of the seriousness
of the situation.
• After the link call is over, the doctor will advise the Search and Rescue (SAR) authority on the best
method of evacuation and, should helicopter evacuation be thought desirable.

SHIP TO SHIP TRANSFER OF DOCTOR OR PATIENT:

• Note the headway, large ships lose momentum for a long period.
• Light ships make considerable headway.
• Keep clear of overhang of bows or stern. Beware of tendering.
• Do not linger alongside for any reason.

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PREPARATION OF THE PATIENT FOR EVACUATION:
1) Put in plastic envelopes the patient’s medical records, and all pertinent papers.
2) List all medication given to the patient.
3) If possible, ensure that the patient is wearing a life jacket, before putting him in a stretcher.

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