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NURSING PROCESS

It is a systematic process of providing nursing care

Steps
I. Assessment
II. Nursing diagnosis
III. Planning
IV. Implementation
V. Evaluation

I. Assessment

It is collecting, organizing and verifying data.

Techniques of Assessment

A. History collection - Uses open ended questions

Types of Data
• Subjective data - what the patient says or it is the symptoms eg: patient complaints of
stomach pain
Most important subjective data - Pain
• Objective data - what the nurse find from examination or it is the signs eg: urine is
cloudy

Data verification - comparison of subjective and objective data.

B. Physical Examination
Steps
1. Inspection
2. Palpation ( IPPA )
3. Percussion
4. Auscultation.

Order of Abdominal examination

1. Inspection, 2. Auscultation, 3. Percussion and 4. Palpation. ( IAPP)

Abdominal Palpation has to done right lower quadrant and at last left lower quadrant.
If Tympanic sound during percussion - Indicate Gas
If flat sound present – Ascitis

II. Nursing Diagnosis

Identification of actual and potential health problems.

 P 124
Types of Nursing Diagnosis

1. Actual nursing Diagnosis - It indicates current problem. Eg: Acute pain related to
surgical incision.
2. Potential nursing diagnosis - It indicates problems originating in future Eg: Risk for
infection related to improper aseptic technique

Prioritizing nursing diagnosis

Priority is based on Maslow physiological need (air,comfort,water,food,sleep, excretion and
homeostasis).
Goals to be achieved
Short term goals - It is achieved within short period of time or within hospital stay.it focus on
immediate need of the patient.
Long term goals - It is to improve the functional ability and decrease disability. It is achieved
at home or in health care centre.

Common nursing Diagnosis

1. Asthma, COPD, Pulmonary embolism

Impaired gas exchange
2. pneumonia, pulmonary edema
Ineffective airway clearance.
3. Hypervolemia
Impaired gas exchange
Fluid volume excess.
4. Hypovolemia,dehydration

Fluid volume deficit

5. Burns, bedsore,

Impaired skin integrity

6. Stroke, Parkinson,

Impaired swallowing
Self care deficit
7. HIV/AIDS

Risk for infection

III. Planning
It includes listing therapeutic interventions. Eg: providing steam inhalation
IV. Implementation
Actualization of nursing care plan through nursing interventions. Eg:administrating
medications, giving nebulization
V. Evaluation
Checking the effectiveness and efficacy of intervention or checking whether the goals
are achieved or not.
 P 125
CALCULATION

MEDICATION DOSE FORMULA

Dose prescribed / Dose in hand X Total ml = dose in ml

Eg: A physician has prescribed an antibiotic Inj.Taxim 625 mg IV 8 hourly. The medication
available at pharmacy 10 ml= 1000 mg. Then how many ml administer to the child.
Answer:
Dose prescribed / Dose in hand X Total volume

625 / 1000 X 10 = 6.25 ml

CLARKS FORMULA - CALCULATING A CHILDS DOSAGE FROM THE ADULT

DOSAGE

Bodysurface Area of Child in m2 / 1.73 X Adult dose = Child Dose

Eg: a physician has prescribed an antibiotic for a child. The average adult dose is 250 mg. the
child has a body surface area of 0.41 m2. What is the dose of child?
Answer:
BSA of child m2/1.73 X adult dose

0.41/1.73 X 250= 0.236 X 250= 59.24 mg

FLUID DROP CALCULATION FORMULA

IV drip set is two types

Micro drip set- 1 ML= 60 drops
Macro drip set - 1 ML = 15 - 20drops

Formula
Total amount of fluid in ml X drop factor / total hour X 60
Eg: a physician has prescribed an IV fluid NS 800m1 over 6 hour through micro drip set.
Then how many drops per minutes you should administer to the client
Answer:
800 X 60/6 X 60= 48000/360= 133 drops/ mt
Note: if it is in macro drip set (put 15 or 20)
800 X 15/6 X 60= 12000/360= 33 drops /mt.

INFUSION PRESCRIBED BY UNIT DOSAGE PER HOUR

Calculation of these problems can be done by a two step process

Step I:
calculate the amount of medication per ML
Known amount of medication in solution/total volume of diluents = amount of medication per
ml
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Step II:
calculate milli litres per hour
Dose per hour desired/ concentration per ml = infusion rate or ml/hr
Eg: 500m1 D5 % with 20000 unit of heparin sodium. Physician ordered administer 1000
unit/hour. Then how many ml/hours you should administer to the client.

Step I: 20000/500 = 40 unit/m1

Step II: 1000/40 = 25 ml/ hour answer: 25 ml /hour
Exercise
1. A physician prescribed administer RL 800 ml over 4 hour. Then how many ml/hour
you should administer to the client?
a. 800/4 = 200 ml/hour

2. A physician has prescribed an antibiotic for a child is 50 mg/ kg/ day divided into 2
doses. The child has a body weight of 66 lbs (pound). The medication available at
pharmacy 1gm= 10m1. then how many ml you should administer at one dose?
a. Step I: convert the child weight from pound (lbs) to kg

2.2 lbs = 1 kg = 66/22= 30 kg

b. Step II : calculating one day dose

50mg/ kg/day
le, 50 X 30= 1500 mg/day
1500/2 = 750 mg each dose

c. Step 111: volume (ml) should administer at one dose

Dose prescribed/ dose in hand X total ml
le, 750(mg)/ 1 (gm) X 10 = 750 mg/1000 mg X 10 = 7.5 ml/dose

CALCULATION

Total Volume x Drop Factor

Drops/mt = -----------------------------------------
Time in Minutes
Drop Factor
Adult - 15
Pediatric - 60

Eg. Total Volume - 500 ml

Drop Factor - 15
Hour - 5 hr

Ans. Time in Minutes = 60 x 5hr = 300 mits

500 x 15 7500
--------------- = --------- = 25 drp/mt
300 300
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Formula For calculating a Medication Dosage

D
X = ------ x Q
A
D – ( Desired ) is the dosage that the health care provider prescribed.
A - ( Available) dosage strength as stated on the medication label.
Q - ( Quantity ) is the volume or form in which the dosage strength is available such as
tablets capsule, milly litres.

Eg. A Doctor prescription reads to administer 5 laks unit of pencillin, labal in 10 ml ampule
sent from pharmacy reads 3 laks unit/mt . The nurse prepared how much medication to
administer correct dose
500000
Ans . -------------- x 1 = 1.6
300000

Eg. A Doctor Prescribed K + 30 meq to be added in 1000 ml NS to be administer over 10 hr

period. Label 40 meq / 20 ml . The nurse prepare how many milliliters of K+

30
Ans. ------ x 20 ml = 15
40

Route of Medication Administration

P C - After meal
A C - Before meal

Enteral - Through GIT ( Oral, NG )

Oral
Buccal - Insert Cheek
Sublinqal - Behind
Paraentral
IM ( 900 )
S/C ( 450 )
IV ( 300 )
ID ( 150 )
IO Intra ocial route in to the bone
Most common IO route is TIBIA bone
IC Intra coronal
IT Intra Thecal ( Spine )

Types of Drug Reaction

1. Side effect : it is the predicted secondary effect that the drug cause. It is harmless and
common for all eg: side effect of bronchodilator is tachycardia
 P 128

2. Adverse/toxic effect : It is the unexpected toxic effect caused by drug which is not
discovered during drug testing. it is not common for all. eg: patient taking amikacin
complain of respiratory distress.
3. Anaphylactic reaction : it is due to hypersensitivity reaction or allergic effect due to
release of histamine. it may occur due to drug, blood transfusion or bee sting bite.
administer antihistamine for toxicity.
4. Idiosyncratic effect - it is unknown reaction of drug where the client may overreact or
under react or reaction opposite to normal.
5. Drug tolerance - it is reduced effect /decreasing therapeutic effect of drug due to long-
term use. eg: long term use of cetrizine may cause drug tolerance

TYPES OF IV FLUID

1. Isotonic Solution
• Same Osmolality as body fluid
• Increase ECF volume

Eg:- i) 0.9 %. NS - indication ischemic shock, contra indication CHF

ii) RL - content potassium.
• Indication- post operative bleeding and burn
• Contra indication- renal failure, hyperkalemia

iii) Dextrose 5% in distilled water

2. Hypotonic Solution
• More dilute solution and have as lower osmolality than body fluid
• Cause the movement of water enter in to the cell
• Administer slowly to prevent cellular edema. Eg: 0.45% NS, 0.33%NS, DNS

3. Hypertonic Solution
• More concentrated solution and have a higher osmolality than body fluid
• Cause movement of water from cells into extra cellular fluid
• Administer slowly for to prevent, organ shrinkage
• Example 3%NS , D10%, mannitol

4. Colloid - Plasma Expander

• Pull fluid from the interstitial compartment into the vascular compartment. Eg:
dextran, albumin

URINE

Normal Colour - Amber Pale Yellow

Hourly - 30 – 60 ml / hr < 30ml inform to doctor
Glomular Filtration Rate ( GFR ) - 125 ml/mt
Oliguria - b/w 100 – 400 ml / day
Anuria - < 100 ml /day
 P 129
DIURETICS
Loop Diuretics - Lasix / Frusimide
SE - Hypokalemia
+
Increase K intake

Potassium sparing diuretics ( Eg. Aldactone )

SE - Hyperkalemia
Avoid K + Containing foods

ELECTROLYTE IMBALANCE

SODIUM ( Na + ) = CNS SYMPTOMS Normal Value 135 – 145 meq/lt

It is rich in intravascular fluid

a. Normal value 135-145 Meq/It
b. Function- to maintain the oncotic pressure of the blood

Hypo Natremia Hyper Natremia

• Decrease 135 meq/lt • Increase 145 meq/lt

Cause Cause
1. Diarrhea 1. Sodium intake
2. Diuretics administration 2. Renal failure
3. Water toxicity 3. Corticosteroid
4. Fasting ( Increased H2O Intake )
eg: drowning, bladder irrigation 5. Diabetes Insipidus
4. Oxytocin overdose 6. Cushing
5. Addisons disease
Clinical Manifestation
Clinical Manifestation
• Altered Cerebral Function
• Headache
• Agitation, confusion
• Weekness
• Extreme thirst
• personality change
• Oliguria
• Confusion
• Dry skin
• Seizure
• Increased Urine Specific Gravity
• Coma
• Hyper tension
• Hypotension
• Polyuria
• Decreased urine specific gravity Management
• Monitor vitals
Management • Administer diuretics
• Monitor vitals • Restrict sodium intake
• Administer hypertonic saline. eg :-
3%.Ns Fluids
 • Increase sodium intake • If the cause is fluid loss prepare to
Eg:- Canned food, Tinned Foods, administer IV infusion
Table Salt, Butter, Cheese, Milk,
mustard

POTASSIUM ( K + ) = CARDIAC RHYTHM Normal Value 3.5 - 5.00 meq/lt

• It is rich in intracellular fluid.

• Normal value 3.5 — 5.00 meq/lt
• Function — It is helping for muscle contraction along with calcium.
• Potassium deficit is potentially life threatening. Because this can cause cardiac
dysrhythmia. So immediately report to the doctor.

Hypokalemia Hyperkalemia

➢ Less than 3.5 ➢ More than 5

Cause Cause
• Diuretics — Lasix • DKA
• Alkalosis / Hyperinsulinism • Renal failure
• Cushing Syndrome • Spironolactone
• Vomiting/ Diarrhea • Acidosis
• Water intoxications • Addison's disease
• Digoxin toxicity
Clinical Features
Clinical Features
• Thread, Weak irregular pulse • Slow weak irregular HR
• Orthostatic hypotension • Hypotension
• Shallow respiration • Muscle cramps
• Paresthesia • Diarrhea

ECG Changes ECG Changes

• ST- depression • Flat P — wave
• Shallow flat or inverted T —wave • Wide QRS complex
• Prominent u-wave • Tall peaked T— Wave

Management Management
• Monitor vitals and ECG • Monitor vitals and ECG
Administer injection KCL slow IV • IV regular insulin + Dextrose
with infusion pump • IV Calcium Gluconate
• Increase potassium intake. • Administer Albuterol
Eg:- Banana, Orange, Carrot, • Asthalin Nebulization
Mushroom, Fish, Avacado, • Restrict K + rich food
 Tomato, Raisins, Potato, Spinach
and fresh fruits.

CALCIUM AND PHOSPHORUS

• Calcium normal value - 8.6 - 10mg/dI

• Phosphorous normal value - 2.7 — 4.5 mg/dl

Function
• Calcium and phosphorus is equally responsible for the formation of bone and teeth.
• Calcium is helping for muscle contraction
• Vitamin D is help for the absorption of Calcium
• Sources – Milk and milk products ( Cheese ) Fish ( Sardine )

Hypocalcemia / Tetany Hypercalcemia

---------------------------------------------------------- -------------------------------------------------------

Calcium less than 8.6mg/dI Calcium more than 10mg/dI

Cause Cause
• Decreas e in tak e of calcium • Kid n ey d is eas e
• La ctos e in to lerance • U s e of T h ia zid e d iu ret ics
• Inadequate intake of vitamin D • Hy p erp a ra th y ro id is m
• End st ag e k idn ey d is eas e • U s e o f g lu co - co rt i co id
• Acut e p an crea t it is Clinical Features
• Immobility • Increased Heart Rate
• Rem ova l of pa ra thy ro id g land • H y p e rt en s io n
• • Pro f o u n d Mu s c le W ea k n es s
Clinical Features • D is o r ien t a t io n
• Increased heart rate • Coma
• Hypotension • R is k f o r Pa t h o lo g ic a l Fr a ct u re
• Twinkling sensation in face • Fo rm at ion of R ena l C alcu li
• Seziure • A bd o m ina l d ist en t ion
• Positive — Trousseau's sign • C o n s t ip a t i o n
• Positive Chvostek's sign • Decreas ed bo wel so und
Management
Management • Mo n it o r vit al s
• M o n it o r v i t a ls • ECG
• ECG • Short S T s eg men t
• Pro lo n g ed S T in t erv a l • Wide T —wave
• Prolonged QT interval • Administer Calcitonin
• Administer Calcium Gluconate • Decrease Ca + and Vitamin D intake
• Administer Vitamin D and • Increase water intake
• Calcium. Movement with caution because
• Init ia t e s eizu re p recaut ion chance for pathological fracture
• Increase Ca lcium fo od
• Eg. Milk or its p roducts, egg yo lk ,
• Yogu rt

Note :- Hypophosphatemia —> Same as hypercalcemia

Hyperphosphatemia ---> Same as hypocalcemia

MAGNESIUM :- Reflex activity and vital sign

Normal Value -> 1.6 – 2.6 mg/dl

Function
• It helps to maintain normal nerve and muscle function
• Keep the heart beat steady
• Helps bone remain strong

Hypomagnesemia Hypermagnesemia

Less than 1.6 mg/dl More than 2.6 mg/dl

Cause Cause
Malnutrition Mg containing antacid and laxativers
Vomiting / diarrhea MgSo4 administration
Celiac disease Renal Failure
Crohn’s disease
Hyperglycemia Clinical Features
Insulin administration Vitals and reflexes Decreased
Drug – Diuretics
ECG
Clinical Features Prolonged PR interval
Vitals and reflexes Increased Wide QRS complex
ECG Bradycardia
Tall T – Wave Hypotension
ST - Segment depression Reflexes decreased and vitals decreased
Tachycardia Eg. Absent deep tendon reflex poor knee
Hypertension jerk reflex
Reflexes increased in seizure Skeletal muscle weakness
Vitals increased Drowsy / Lethargy
Trousseaus Sign
Chvosteks Sign Management
Irritability / Confusion Monitor Vital / ECG
Diuretics for excretion
Management Administer antidote – calcium gluconate
Monitor Vitals/ ECG
Administer MgSo4 IV
 Increase magnesium food

GOUT

Excessive accumulation of uric acid in the body this is due to abnormal purine
metabolism. Instruct the client to avoid purin rich diet.
Avoid organ meats , beer , wine, sardine, green leafy vegetables.
Management - Allupurinol
Complication - uric acid kidney stone to treat these increase fluid intakes.

CRYO SURGERY

Distruction of tissue with the help of Nitrous Oxide ( Cooling Gas ) by freezing
especially cervical cancer

S L E ( Systamic Herpus Erythromatus)

Auto immune disease affect heart and kidney

C/M :- Butterfly Rash over face

Management :- Immuno suppresents , Plasmapherasis

PRINCE METALS ANGINA ( Variant Angina )

Due to the spasam of Coronary Artery.

Commonly occur at rest
St Segment elevation present
Management - Ca Channel blocker ( Nifidipine )
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P 134
TYPES OF PARESIS

Mono Parasis - One leg / one hand paralysed

Para parasis - Both leg paralysed
Hemi parasis - One side of body is paralysed
Tetra/ quadric parasis - 4 limb are paralysed.

PERLA - Puplis Equally Round Reacting to Light and Accomadate

Care after General Anesthesia , Priority is 1. Resp, 2. Cardiac, 3. CNS , 4. GIT

Complication of Surgical Site

1. Wound Dehiscence :- Rupture of suture due to increase pressure in the surgical

site.
2. Wound Eviseration :- Protruding of internal organs through ruptured suture site.
Intervention
Provide sterile NS dressing

Post OP exercise for the patient undergone GA

1. Deep breathing coughing exercise

2. Support the suture while coughing
3. Spirometric exercise ( Minimum 10 times every hours )

O2 Delivery Systems

1. Nasal Cannula - 1 – 6 Ltr O2 ( 24 – 44 % )

2. Ventury Mask - It delivers the most accurate O2 concentration
3. Non rebreather Mask ( NR ) - It provides high concentration O2

( 1 – 24% , 2 – 28 % , 3 – 32 %, 4 – 36 % , 5 – 40 % , 6 – 44 % )

TRACTION

Skin Traction
Bucks - Femur and Hip fracture
Russels - For Tibia Fracture
Skeletal
Halo fixation - Skull fracture

• Do not add / remove weight with out order.

• Weight should hang freely do not touch on floor
• Make sure that the Pulleys move freely

P 135
PLANTAR FASAITIS

Inflammation of Plantar skin, commonly seen in Marathon Runners and Athelects due
to Prolonged use of heel of the feet.

Post OP Intervention for Tonsilectomy And Adenoidectomy

• Suction is contra indicated

• Provide sidelying / prone position to facilate drainage
• Frequent swallowing indicate bleeding
• Dried blood clots on vomitus is normal
• Avoid milk products including ice cream

BSE

• Start after menarche

 • Ideal time for BSE is 7 – 10 days after Menstruation
• Post menopausal women and after hysterectomy perform BSE in a fixed date of every
month
• It helps to identify Ca breast early
• Advise the women to perform Mamogram after 40 yrs
• If one side mastectomy, then perform BSE in the remaining breast.

Cred’s Mannuer

It is method to empty the urinary bladder in patient with neural tube defect like spina
bifida. In this apply gently pressure from abdomen to symphsis pubis to open the spncher
muscle.
Leukemia ( Blood Cancer)

R/F :- Infection
R/F :- Bleeding

Provide Indore Games only

Avoid fresh flower, fresh fruits, fresh vegetables

Bone Marrow Aspiration

In adult - Iliac crest or Sternum

In children - Sternum or Tibia

Nephrotic Syndrome

Unknown etiology
Common in Young Children

P 136
C/M
• Protenuria
• Hypoalbuminemia
• Edema
Management
• Increase protein diet

Shaken Baby Syndrome

It is a type of child abuse due to shaking of head

C/M
• Subdural hemorrhage
• Retinal ’’
• Cerebral edema
Vitamin D deficiency in Children - Rickets
Vitamin D deficiency in Adult - Osteomalasia
Vitamin K deficiency :- Lead to abnormal bleeding
Swan Neck Sign – In finger - Deficiency of Calcium

Mononucleosis

It is a highly infectious disease caused by Epstinbar virus also known as Kidding

Disease spread through Respiratory Droplet infection

Complication :- Spleenomegaly

Graft Rejection Sign

• Severe itching
• Pain
• Redness

POSITION

Cardiac and respiratory problems- Fowlers Position

Venacava syndrome - Provide Lt. Lateral Position
Burns of head and face - Semi fowlers
Vaginal and perineal examination- Lithotomy
Paracentesis - Semi fowlers ( if Bedridden )
Sitting Upright on the side of the bed ( Normal Pt. )
Thoracentesis - Fowlers
Rectal Temperature - Left lateral
Clauidification - Leg dependend
Mastectomy - Elevate the affected extremity
Haemaroidectomy - Sider lying
Esophagical deodinoscopy - Semi fowlers
P 137
OD - Rt. Eye
OS - Lt. Eye
OU - Both Eyes

Hydatidiform Mole / Molar Pregnancy

C/M :- Expulsion of Grape like Vesicle from Vagina, Snow storm pattern shown in USG
Prevent Pregnancy for the next 1 Year

Diuretics

Osmotic Diuretics
Eg. Mannitol
Indication :- Increased ICP and cerebral edema
 Loop Diuretics
Eg :- Lasix / Frusimide
Side effect - Hypokalemia
Nursing intervention - Incrased k + Intake while providing Lasix

K+ Sparing Diuretics
Eg :- Aldactone
Side Effect – Hyperkalemia
Restrict/ avoid K + rich foods

COMMUNICABLE DISEASE

MEASELS or RUBEOLA

• Agent — Paramyxovirus / Morbillivirus

• Incubation period 4 10 — 20days
Mode of transmission
• Airborne / Droplet / Contact / Tran placental

Clinical Feature
• Fever
• Coryza
• Cough
• Conjunctivitis
• Kolpik's spot - small red spot with a bluish white center and a red base located on the
buccal mucosa .

Management
• Isolation
• Dark room / humidified room

P 138
RUBELLA

• Agent Rubella virus.

• Incubation period 14 -21 days
Mode of transmission
• Airborne / Droplet / Contact / Tran placental
• Communicable period 7 days before to about 5 days after the rash appear

Clinical Feature
Pinkish red maculopapular rash that begins on the face and spread of the entire body
within 1— 3 days.

Sources of Infection
Nasal secretion, Blood, Stool, Urine
Management
• Isolation
 • Special attention in pregnancy— Infection in pregnancy can cause CHD, cataract,
growth retardation, pneumonia, congenital defect in ear and brain.

Prevention
• Vaccine is available
• It is a live attenuated vaccine
• Vaccine contra indicated in pregnancy
• Women should conceive at least 3 month after Rubella vaccination

MUMPS OR RUBULA

• Agent Paramyxovirus
• Incubation period 14 — 21days
Mode of transmission — Droplet/ Direct contact

Clinical Feature
• Parotid gland swelling
• Jaw or Ear pain
• Orchitis

Management
• Droplet precaution
• Hot or Cold application
• Liquid diet.

PERTUSIS OR WHOOPING COUGH

• Agent 4 Bordetella Pertussis

• Incubation period -› 5 — 21 days
Mode of transmission - Direct contact/ Droplet

Clinical Feature
• Respiratory infection
• Cough
P 139
• Cyanosis
• Toung protrusion

Management
• Isolation
• Antimicrobial therapy
• Pertussis Immune globulin.

DIPHTERIA

• Agent Corny bacterium diphtheria

• Incubation period 2 — 5days
Mode of transmission
• More droplet
• Contact
Clinical Feature
• Low grade fever
• Sore throat
• Foul smelling mucopurulant nasal discharge
• Neck edema or bull neck
• Grey or white patch in throat

Diagnostic Test
• Throat swab culture
• Shick test

Management
• Isolation
• Administer diphtheria antitoxin
• Tracheostomy with mechanical ventilation.

CHICKEN POX

Agent Varicella Zoster

Incubation period 13 — 17 days
Mode of transmission Airborne / Droplet / Contact

Clinical Feature
Macular rash that first appear trunk and scalp and moves to the face and extremities.
Management
• Isolation — Negative pressure ventilation room
• Injection Acyclovir
• Supportive management

TETANUS
• Agent Clostridium tetani
• Mode of transmission — Direct contact
• Incubation period 7 — 10 days

P 140
Clinical Features
• Spasm and stiffness of jaw
• Seizure
• Opisthotonos posture

Management
• Isolation
• Antitoxin
• Symptomatic treatment

Prevention
• T.T vaccine
• Booster dose of TT every 10 yearly

RABIES
Causative Agent - Lyza Virus
• Infected from — Dog, Monkey, Fox, Bat, Raccoon
• NEGRI BODIES

SCARLET FEVER

Agent Group A Beta hemolytic streptococcus

Incubation period 1-7 days
Mode of transmission Direct contact / Droplet

Clinical Feature
• High fever
• Vomiting
• Headache
• Enlarged lymph nodes in the neck
• Red fine sand paper like rash develop in the Axilla, groin and neck that spread to
cover the entire body except face
• White strawberry tongue followed by red strawberry tongue

Management
• Antibiotic
• Isolation

AIDS

• Agent HIV virus

Mode of transmission - Blood, Body fluid, Sexual contact, Breast feeding, Not transmitted
through saliva
• Incubation period — Month to year

Clinical Feature
• Opportunistic infection
• Chronic cough leads to pneumonia
P 141
• TB
• Pneumocystis pneumonia
• Diarrhea
• Oral candidacies

Diagnostic Evaluation
• ELISA
• Confirmatory test is Western Blot test - In this CD4 + cell is less than 200 ( Normal 500 -
1200 )

Complication
Kaposi's Sarcoma — Skin cancer
Management
If Positive we can start Drug
• Administer ART. eg:- Zidovudine
• Benefit —>Decrease viral load
 • Increase CD4+ cell count
• Prevent opportunistic infection

HIV patient Needle Stick injury occur Nursing Responsibility

• Wash the area with running water
• Avoid squeezing
• Do not panic
• Do ELISA —test
• Taken ART within 72 hour
• Do ELISA after 6 MT

IMMUNISATION SCHEDULE

Age Vaccine
Birth BCG , OPV -0
6 Weeks DPT – 1 , OPV – 1, HIB
10 Weeks DPT – 2 , OPV – 2 , HIB
14 Weeks DPT- 3, OPV- 3, HIB
2,4,6 Month Rota Vaccine
9 Months Measles
16 – 24 Months DPT booster, OPV - 4
5 – 6 Years DT
10 Years TT
16 Years TT
Pregnant Women TT ( 2 dose at 4 weeks interval )

P 142

NUTRITIONAL DEFICIENCY DISORDER

CLASSIFICATION OF VITAMIN

WATER SOLUBLE VITAMIN

VITAMIN C — ASCORBIC ACID

Function Promote Immunity

➢ Helps in wound healing
➢ Increase absorption of Iron

Deficiency Scurvy
Sources Citrus fruits, tomato, Broccoli, Cabbage.
VITAMIN B —COMPLEX

B1 — Thiamine
Deficiency Beriberi
Sources -Bran, Spinach, Rice, legumes

B2 — Riboflavin
Function —> It is required by the body for cellular respiration Deficiency
Dermatitis, glossitis, Cheliosis
Sources Legumes, cereals, egg, milk, green leafy vegetables

B3 — Niacin
Deficiency Pellagra
Sources Chicken, peanut, mushroom, liver, beef, Avocado, seafood

B6 — Pyridoxine
Function It is needed to maintain the health of nerves, skin, and RBC
Deficiency Peripheral neuropathy and neuritis

B9 — Folic acid
Function Help in DNA synthesis and formation of blood tissue and cell division.
Deficiency In pregnancy — Neural tube defect
Non pregnancy — Megaloblastic anemia
Sources Green leafy vegetables, liver, grape fruit, Orange
Daily intake In pregnancy — 400mcg
Non pregnancy 200 mcg

Vitamin B12 — Cyanocobalamin

Deficiency Pernicious Anemia

Sources Brewer's yeast, citrus fruit, green leafy vegetables, Dry fruits, Nuts
Function Normal functioning of the Brain and Nervous system.
Involved in the formation of RBC helps to regulate DNA.

P 143
FAT SOLUBLE VITAMINS

Vitamin A (Retinol)

• Helps for vision

• Deficiency Night blindness/ Keratomalacia, or Xerophthalmia
• C/M Bitot spots
• Sources Liver, egg yolk, whole milk, green leafy vegetables, Orange

Vitamin D ( Calcitrol )

• Helps for absorb calcium

• Deficiency Rickets
• Sources Fortified milk, fish oil, sunlight

Vitamin E ( Tocoferol )
 • It is beauty vitamin
• Helps for fertility
• Sources Almonds, Spinach, sweet potato, Avocado

Vitamin K ( Menadiol )

• Helps for blood clotting

• Deficiency bleeding
• Sources Green leafy vegetables, Broccoli, Spinach, Cauliflower, Cabbage

P 144

PSYCHIATRIC NURSING

DEFENCE MECHANISM

It is an unconscious process that defense a person against anxiety. It is a coping

mechanism that enable a person to reduce stress or anxiety

1. DENIAL: When we refuse to accept or believe the existence of something that is very
unpleasant to us. Disowning consciously intolerable thoughts and impulses.

2. RATIONALIZATION: It is a defence mechanism in which the individual justify the

failure and socially acceptable behaviour, by giving socially approved reasons It
operates by 2 mechanisms
 a. Sour grape: (unskilled worker blames always the tool)
b. Sweet lemon: (a poor man says, he doesn't want to earn money because, money is the
root cause of many evil event)

3. CONVERSION: Expression of emotional conflict through physical symptoms

4. PROJECTION: Transferring one's internal feelings, thoughts, unacceptable ideas to
another person
5. DISPLACEMENT: Feeling towards one person are direct to another person who is
less powerful or less threatening
6. SUPPRESSION: Conscious deliberate for getting of painful thoughts, ideas and
feeling. They will be
7. REPRESSION: Unconscious process in which client black undesirable and
unacceptable thoughts
8. COMPENSATION: Putting forth extra effort to achieve in areas where one has a real
or imagined deficiency.
9. FANTACT : Gratification by imaginary achievements and wishful thinking
10. REGRESSION : Returning to an earlier developmental stage to express an impulse to
deal with anxiety

PHOBIA

Phobia is irrational fear of an object, for a situation that persist. Defense mechanism
commonly used in phobia is repression and displacement

Types
1. Acrophobia fear of height
2. Agoraphobia fear of open space
3. Aerophobia fear of flying
4. Astraphobia fear of electrical storms
5. Algophobia fear of pain
6. Agra phobia fear of sexual abuse
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7. Ailurophobia fear of cat
8. Hematophobia fear of blood
9. Claustrophobia fear of closed space
10. Arachnophobia fear of spider
11. Hydrophobia fear of water
12. Mysophobia fear of germs
13. Monophobia fear of being alone
14. Nyctophobia fear of darkness
15. Pyro phobia fear of fire
16. Gloss phobia fear of public speaking
17. Xenophobia fear of strangers
18. Zoophobia fear of birds

Management
FLOODING — some times referred to as in vivo exposure therapy, is a form of behavior
therapy and desensitization or exposure therapy. based on the principles of respondent
conditioning. As a psychotherapeutic technique, it is used to treat phobia and anxiety
disorders including post traumatic stress disorder
• Identify the basis of anxiety
• Allows the client to verbalized the feeling
• Teach relaxation techniques such as breathing exercises muscle relaxing exercises and
visualization of pleasant situation.
• Promote desensitisation by gradually introducing the client to the feared object or
situation, in small doses
• Always stay with the client, for safety and security, never force the client to
concentrate on phobic objects
• Encourage psychotherapy

OCD - OBSESSIVE COMPULSIVE DISORDER

Obsession : - Pre-occupation with persistently initiative thoughts and ideas.

Compulsion: - Performance of repetitive behaviors or rituals to divert the unacceptable
thoughts. DONE TO REDUCE ANXIETY

Causes
• Decreased serotonin level

Mgt of OCD
• Identify the situation that precipitate OCD
• Never stop the pt from OCD behavior
• Divert or distract the pt from the behaviour by giving games, puzzles, or simple task
• Allow the client to perform the behaviour, best set time limits
• Administer anti-depressant
• Recreational therapy
• CBT

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Nsg diagnosis
• Disturbed through process or disorder

SCHIZOPHRENIA ( SPLIT MIND EUGEN BLEULER )

It is a group of mental disorder characterized by psychiatric features ( hallucination,

delusion ) disordered thought process, disrupted interpersonal relationship. It can cause
disorders in effect mood, behavior, personality thought process.

Causes
Increase dopamine level high level of serotonin

Symptoms
Physical Characteristics
• Unkept- appearance (poor hygiene)
• Body image disturbance
• Preoccupied with somatic complain
• Neglect hygiene, eating, sleeping, elimination

Abnormal motor behaviour

• Echolalia (Repeated words of others)
• Echopraxia (repeated movement of others)
• Waxy flexibility (having one's arm or leg placed in a certain position and holding the
same position for hours)
• Dyskinesia (Difficulty in movement)
• Stupor (sitting on one area and fixed vision for a long period of time)

Emotional characteristics
• Mistrust
• Hostility (viewing the centric world as enemy)
• Helplessness
• Hopelessness
• Anxiety
• Anger
• Guilt
• Depression
• Ambivalence (status of having mixed fooling or ideas about something or someone (-ve
feeling)

Abnormal thought process

• Confabulation : filling the memory gap with fantasy
• Flight of ideas : Jumping from one to another without completion
• Neologism : creation of new words + meaning is known only to the pt
• Word salad : mixture of words + phrases that has no meaning
• Loosing of association : no connection with the sentences
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• Thought blocking : sudden cessation in the middle of sentences
• Circumstantialities : before getting into actual answer for the questions ask the client
gets caught with countless explanation

SCHIZOPHRENIA CARDINAL FEATURES

Delusions ( Disturbed thought process )

False fixed unshakable beliefs
Types of delusions
• Grandeour delusions : false beliefs that one's is a powerful and important person
• Jealousy: false beliefs that one's partner going out with another person
• Persecution: false belief that somebody is going harm them

Mgt of Delusion
 • Present reality to the pt
• Ask the client to describe the delusion
• Do not be aggressive
• Do not argue with the client hot delusions are false
• Validate if delusion are real
• Encourage the client to express the feelings

Abnormal perception
• ILLUSION: misinterpretation of stimulus
• HALLUCINATION: it is a false perception without a stimulus

Types
• Auditory
• Visual
• Tactile
• Olfactory
• Gustatory

Management.
• Encourage the pt verbalize about hallucination
• Present reality to the pt
• Avoid touching the client
• Decreased stimulus in the environment and shift the pt to another area

TYPES OF SCHIZOPHRENIA

1. Paranoid : - In which a person loses touch with reality. C/M including suspiciousness,
hostility, delusion, auditory hallucination, anxiety, anger/ violence
2. Catatonic : - Problem with movement or psychomotor disturbances. Most dangerous.
very less movement and does not respond to instruction

I. Stupor
II. Immobility
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III. Waxy flexibility
IV. Purposeless unwanted movement
V. Echolalia

3. Residual : Have previous history of schizophrenia pt shows intermittent signs of

schizophrenia negative symptoms.
4. Disorganized : Extreme social withdrawal, disorganized speech behaviour

Selfishness- stereotyped behaviour, inability to perform activity of daily living

5. Simple ( no positive symptoms)

Management
• Assess the client physical needs
• Maintain safe environment
 • Remove all sharp instrument
• Participate in one to one interaction with client
• Spend time with client if the client is unable to respond
• Avoid touching the client
• Sit with the client silently
• Tell the client when you are leaving
• Present reality to the client
• Do not make promises to the client that cannot be met
• Provide simple creative activity such as puzzle, or game
• Use canned or packed food
• Stay with the client if he or she is frightened
• Monitor for suicidal tendencies
• Provide radio for ask if insomnia

GRIEF

Natural response to loss

STAGES of grief : - DABDA ( according to kubler Toss theory )

D Denial :- Not believing what has occurred

A Anger :- Anger towards the last one
B Bargaining :- ( no, not, me, yes I am) bargaining to some one
D Depression :- After bargaining leads to depression and especially to good
tasty acceptance
A Acceptance :- Lastly will accept

BIPOLAR MOOD DISORDER

It is characterized by MANIA and DEPRESSION with normal mood in between

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MANIA

Cause — Increased Nor-Epinephrine

: Extroverted — highly energetic

Symptoms
• Become angry quickly
• Extraverted personality
• Grandeur delusion
• Persecutory delusion
• Flight of Ideas
• Unlimited energy
• Loss of appetite
 • Distracted by stimulus
• Buffoon like appearance
• Restlessness

Management - MANIA

Drug of choice : Lithium carbonate ( it is a mood stabilizing agent )

Therapeutic level : 0.6 — 1.2 mEq/L

Lithium antidote - diamox or acetazolamide

Other drugs - Sodium Valporate and carbamazepine

Nursing Management
• Provide less hazardous environment
• Avoid argue with the client
• High calorie finger like food
• Provide private room if possible
• Avoid competitive games
• Administer lithium

DEPRESSION

Cause — decreased nor-epinephrine and serotonin

It affects feeling, thoughts and behaviors

Symptoms
• Hopelessness
• Powerlessness
• Helplessness
• Low safe esteem
• Introverted
• Sleep disturbance
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• Lack of interest in physical appearance
• Decreased speech
• Increased or decreased appetite
• Somatic complaint
• Low mood
• Low mood with high energy high chance for suicide

Management of Depression

ANTIDEPRESSANTS ( First line drug SSRI SNRI ( insomnia) )

1. Reuptake Inhibitor
 Action : It inhibit serotonin uptake + elicit a anti-depressants action

Class -
A. SSRI — Selective Serotonin Reuptake Inhibitors

Eg: sertraline (Zoloft), Fluvoxamine, Fluoxetine (Prozac) , citalopram,

B. SNERI — Selective Non-Epinephrine Reuptake Inhibitor

Eg: Duloxetine, venlafaxine

C. A typical anti-depressant

Eg: Bupropion (Zyban), mirtazapine, nefazodone, trazodone

S/E: -
• Dry mouth
• Insomnia and sexual dysfunction

2. Tricyclic antidepressants ( TCA )

Action : block the release of non- epinephrine and serotonin from pre - synaptic
junction
Example . Amitriptyline, Imipramine, Amoxapine

S/E: Anticholinergic effect

Nsg responsibility
• Inform the client that anti-depression it may take several weeks for desired
effect (2 to 4 weeks)
• Take with food on milk
• Instruct the client to avoid alcohol and driving, avoid alcohol consumption

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3. Monoamine Oxidase Inhibitor ( MAGI )

Inhibit the enzyme MAO which is present in brain, platelet, liver, spleen, and kidney.
MAO metabolize amines, nor-epinephrine
Example — phenelzine, tranylcypromine, isocarboxacid, selegiline

Contraindications : should not be used with levodopa, OHA, dopamine, epinephrine,

nor-epinephrine, tyramine containing food, nasal decongestion. Because it cause
hypertensive crisis. Eg: phenelzine, isocarboxazid

S/E: - Insomnia
Dizziness
Anti-cholinergic effect
 Nursing management
• Remove all sharp equipment or instrument
• Monitor for one to one supervision
• Do not leave the pt alone

ECT - Electro Convulsive Therapy

An elective treatment for depression ( Not a curative care ) it consist of inducing tonic
clonic seizure by passing an electric current.

Contra indications of ECT

• Recent myocardial infraction
• Stroke
• Intracranial mass lesions

Indications of ETC
• Major depression
• Mania pt resistant to lithium
• Schizophrenia

S/E
• Confusion
• Disorientation
• Short term memory loss

Nursing intervention - before procedure

• Consent
• Explain the procedure to the client and teach the client and family what to expect
• Maintain NPO status midnight or at least 4 hour
• Monitor vitals
• Empty bladder and bowel before procedure
• Remove dentures, lenses, hairpins,etc.
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• Administer atropine sulphate before procedure ( it will help to decrease secretion and
bradycardia during procedure )

Nursing intervention - during procedure

• Monitor BO through out procedure
• Administer oxygen and insert at IV line
• Place ECH & ECG leads
• An airway is placed to prevent biting the toung
• Administer succinylcholine ( muscle relaxant ) and thiopental sodium ( short
anaesthetics)
• Amount of current using – ( 70 – 120 V )
• Timing ( 0.7 sec – 1.5 sec )
Nursing intervention - after procedure
• Priority for airway and keep emergency tray always at the bedside
• Monitor vitals
• Once the client is awake talk to the client and take the vitals
• Reorient the client frequently
• Before giving anything to mouth check the gag reflex.

DEMENTIA

It is an organic disorder with progressive deterioration functioning. It may result in

self-care deficit

1. Alzheimer's disease:
It is irreversible form of senile dementia memory. It affects the cerebral cortex
Incidence: - More common in female gender with genetic history
Stages: recent memory impaired remote intact

Symptoms
• Wandering ( REORIENT )
• Self-care deficit
• Confusion
• Altered sleep pattern
• Agnosia — inability to recognize familiar person or objects
• Apraxia — inability to comfort voluntary on skilful movement
• Aphasia — language disturbance in understanding and experiencing spoken words
• Amnesia — complete memory loss
• Sundowning syndrome —symptoms become prolonged on and increased in evening

Management
• Priority is providing safe environment
• Primary goal is to improve physical and functional ability
• Help the client to maintain independent
• Give simple game or activity
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• Provide ample time to complete the task
• Provide sedation to limit wandering
• Use simple sentences for communication
• Use from low pitched voice
• Provide hand over hand assisted exercise to improve the co-ordination such as wooden
multiple

Drug to treat Alzheimer's — Acetyl cholinesterase inhibitors

Eg: Donepezil : DOC too Alzheimer's, Memantine, galantamine, rivastigmine

S/E:
• Dizziness
• Headache
 • Nausea
• Diarrhoea
• Confusion

Nursing diagnosis - Risk for injury

Impaired physical mobility

DELIRIUM

Altered level of consciousness. Sudden onset of confusion

Causes
• Alcohol withdrawal
• Head injury
• Stroke
• Toxic levels of medicines or chemicals

Signs
• Confusion
• Disorientation Language deficit
• Hallucination
• Illusion

AUTISM

It is a disorder characterized by abnormal social interaction and impaired

communication. Parents can identify autism only by the age of 3yr.

Features
• Upto 3yr-only facial expressions
• By 6yr- tell words
• By 9yr- form sentences
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• Child uses repeatative words
• Attached to inanimate objects

Management
• Use communication board
• Decrease mental stress
• Encourage interactions with others.

CHILD ABUSE

It is a non accidental physical injury or act of avoiding care by a parent or person

responsible for the child
TYPES
• Neglect
• Physical.
• Emotional
• Sexual.

Shaken Baby syndrome :

It is a form of physical abuse characterized by violent shaking of infant younger than
1yr, which results in intracranial haemorrhage casuing cerebral edema and death.

S/S : Subdural haemorrhage, retinal bledding, cerebral edema.

Management;
Meet the physical and emotio

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COMMUNITY

HEALTH

Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity.

Roles of Community Health Nursing

Seven major role are :-
• Clinician
• Educator
• Advocate
 • Managerial
• Collaborator
• Leader
• Research

Disease Occurrence in Populations

• Sporadic :- Occasional cases occurring at irregular intervals , polio
• Endemic :- Continuous occurrence at an expected frequency over a certain period of
time and in a certain geographical location, eg. Common cold, fever
• Epidemic or outbreak :- Occurrence in a community or region of case of an illness
with a frequency clearly in excess of normal expectancy, TB
• Pandemic :- Epidemic involves several countries or continents, affecting a large
population. Eg. Influenza

SPECIFIC DEATH RATE

Disease - specific death rate

Total number of death due to a disease ( eg. Cancer ) in a defined area during a specified
period/ mid – year population x 1000

CRUDE DEATH RATE

Types of mortality rates

Crude death rate :- Number of death in an area in a year per 1000 population counted at
midyear total no. Of deaths from all causes in 1 year / no. of persons in the population at
mid - year x 1000

Example
Calculate specific death rate and crude death rate from the following table.

July 1 population - 254272

CVD - 5200
Cancer - 2500
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TB - 2500
Total - 10200

Solution :-
SDR due TB = 2500 / 254272 X 1000 = 0.0098 / 1000 population

CDR = 10200 / 254272 X 1000 = 0.040 / 1000 population

Epidemic Point Source ( Contaminated Water )

Epidemic source ( Stagnated Water )

 ADMINISTRATION

Roles of professional nurse

• Care provider
• Researcher
• Educator
• Leader
• Advocate
• Collaborator
• Manager

JOB DESCRIPTION OF NURSES

RN
• Clinical assessment
• Initial client education
• Discharge education
• Clinical judgment
• Initiating blood transfusion
• Psychological support

LPN / LVN
• Monitoring RN findings
• Reinforcing education
• Routine procedures ( Catheterization )
• Most medication administrations
• Ostomy care
• Tube patency & enteral feeding
• Specific assessments

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UAP
• Activities of daily living
• Hygiene
• Line change
• Routine, stable vitals
• Documenting input / output
• Positioning

LEADERSHIP STYLES

➢ AUTOCRATIC ( AUTHORITARIAN ) — This type of style is leader focused. Leader

dominates the group and give commands rather than seeking suggestions.
 ➢ DEMOCRATIC ( PARTICIPATIVE ) — In this style leader and each member of the
group is important. Leader seek suggestions from the group. It is not suitable during
emergency situation.

➢ LAISSEZ - FAIRE ( FREE- REIGN ) In the style leader assume a passive role and all
decisions are taken by members

Accountability
Accountability is a legal obligation in health care which is also an ethical and moral
responsibility. It is important to assume responsibility for one's own nursing practice. The
American Nursing Association (ANA) has a code that states, the nurse will assume
accountability for nursing judgment and actions.

REPORTS

Incident Reports
➢ Used to documents any unusual occurrence or accident in the delivery of client care
➢ The incident report is not part of the medical record, but it may be used later in
litigation.

NURSING DELIVERING SYSTEM

Modalities of patient care

1. Primary nursing : Total care of an individual Is the responsibility of one nurse
2. Team nursing : A group of nurses work together to fulfil the full functions of
professional nurse, to be led by one nurse
3. Case method / total patient care : Provides one-to-one RN- to-client ratio and constant
care for a specific period of time
4. Functional method / task nursing : the oldest nursing practice modality, task-oriented
method : I nurse for giving medicines, no one id responsible for total care of any
patient, it accomplished the most work in the shortest amount of time
5. Modular nursing : RN provides direct nursing care with assistance of aids.

P 158

TRIAGE SYSTEMS AND TAGS

The most common classification uses the internationally accepted four colour system.
Red : Indicates high priority treatment or transfer. Eg: massive Haemorrhage, Tension
Pneumothorax.
Yellow : Signals medium priority, eg, isolated simple femur fracture
Green : Is used for ambulatory patient's eg, isolated abrasions, contusions, sprains.
Black : For dead or those minimal chance of survival, eg, massive head injuries, 95%
coverage with third degree burns.

BIOMEDICAL WASTE MANAGEMENT

 COLOUR WASTE DESCRIPTION
Yellow Human tissues, organs, body parts, items contaminated by blood/body
fluids, soiled cotton and dressing, soiled plaster casts etc.
RED Catheters, tubes, cannula, syringes, plastic IV bottles and sets, used
gloves, infected plastics, specimen containers, lab waste, microbiology
cultures, used or discarded bags of blood/blood products, vaccines etc.
BLUE Glass items, needles, syringes, scalpes, blades, used and unused sharps etc

BLACK Discarded medicines, discarded cytotoxic drugs etc

GREEN General waste, non-infected plastic materials, papers, disposables,
carboards, metal containers, office waste, food waste etc.

RESEARCH & STATISTICS

RESEARCH

DEFINITION : - Systematic & scientific process of finding a solution to a problem or

relationship between facts

COHORT STUDY

➢ Form of observational study usually undertaken to find existence of association

between suspected cause and the disease. It is also called as incidental study.
➢ In this study cohorts are identified prior to the occurrence of the disease
➢ It proceeds from cause to effect (present-Future), hence it is prospective.
➢ For a medical entry, initial health examination was conducted and recorded from
1995-2016.some of them are having BMI more than 25 so the Researcher planned to
conduct a study to find out the relationship of development of CAD in people with
BMI more than 25. which among the following is the most suitable study?
P 159

CASE CONTROL
➢ Case are people already with suspected disease are compared with Control, are people
who are exposed to suspected cause
➢ It proceeds from effect to cause ( present-past ), hence it is retrospective
➢ In a community 100 males who are residing near to a power station were diagnosed
with hypertension. The researcher found that people living in this area are more prone
for hypertension, so planned to compare these patients with 100 males from the same
area without hypertension. Based on this situation which design the researcher will
conduct to find out the association?

ODD’ S RATIO
 Calculating Odds Ratio ( OR )

Disease ( Case ) No Disease ( Control )

Exposed A B

Unexposed C D

OR = Odds that a case was exposed ( A / C )

------------------------------------------------------
Odds that a control was exposed ( B / D )

= AD
----------
BC

ODDS RATIO CALCULATION

Endometrial
Carcinoma

Yes No

Yes 56 (a) 274 (b)

Estrogen
No 18 (c) 390 (d)

Odds ratio = ad / bc
= 56 x 390 / 18 x 274
= 21840 / 4932
= 4.42

P 160

Correlational Research Design

➢ Understand linkages and relationships among two or more variables without

introducing any intervention
➢ Generate hypothesis that can be tested in experimental research.( Polit & Beck, 2004 )
➢ Using correlational analysis, researcher determines:
➢ Strength type ( Positive or Negative )

CROSS SECTIONAL

➢ In this study design researcher collects date from the samples only one-time i.e one
period of data collection.
 ➢ Eg: researcher collects awareness about swine flu among people in a population

STATISTICS

MEASURES OF CENTRAL TENDENCY

MEAN

Sum of all data values

Mean = ---------------------------------
Number of data Values

Symbolically,
__
X= X
n

Where __
X ( Read as ‘ X bar’ ) is the mean of the set of X values,

 X is the sum of the x values, and n is the number of x values.

Sum of all data value

Eg:- Mean = -----------------------------
Number of data values

15 + 13 + 18 + 16 + 14 + 17 + 12
= ---------------------------------------------
7

= 105 / 7 = 15

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MEDIAN

Arrange the value in an ascending order.

5, 8, 10, 11, 13, 15, 17, 18, 22

There are 9 values here
Size of ( 9 + 1 ) th item
Median = ----------------------------------
2
th
= 10 / 2 = 5 item

The 5th item in the series is 13 :- Median = 13

 1. Eg. 1, 3 , 3 , 6 , 7 , 8 , 9

Ans :- Median = 6 is Middle of the number

2. Eg. 1, 2 , 3 , 4 , 5 , 6 , 8 , 9

Ans :- No one Middle number two middle numbers 4 , 5

(4 +5 )
------------ = 4.5
2

MODE

➢ This is the value that occurs most frequently in a data set

➢ Example:

Find the mode

• 6, 7, 2, 3, 4, 6, 2, 6 Mode is 6
• 5, 7, 2, 3, 4, 5, 9, 8 No Mode

RANGE

The range of a set of data values is the difference between the maximum data value and
the minimum data value.

Range = ( maximum value ) — ( minimum value )

It is very sensitive to extreme values; therefore not as useful as other measures of variation

Eg.. 3 4 6 7 9

Range :- 9 - 3 = 6

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