COURSE TITLE – CLINICAL SKILL II

COURSE CODE – CHE 241

ASSESSING THE NUTRITIONAL STATUS OF A CHILD

Nutritional assessment can be described as the measurement of how well the body is utilizing
food. It is also known as anthropometric measurements. It s includes biochemical assessment,
Clinical evaluation and dietary intake. It is also refer to as the measurement of the human
individual.
Anthropometric Measurement:
This is the measurement of the physical properties of the human body, primarily dimensional
description of body size and shape. It is also refer to the measurement of the human individual.
Anthropometric measures the variations of the physical dimension and the gross composition
of the human body at all ages and degree of nutrition. It is the most widely used method of
nutritional status assessment.
The body variations commonly measured is:
Weight in kilogram
Height/ length in centimeter or meter
Hip circumference in centimeter
Mid-upper arm circumference (MUAC) in centimeter
Head circumference in centimeter
Abdomen circumference in centimeter
The body mass index (BMX)
The body mass index is another anthropometric measurement use to measure the variation or
composition of human body. The body mass index is used to group or classify individuals into
three namely: underweight, normal and obese.
Therefore, body mass index classification in described as follows:
Body Mass index (BMI) Classification
<18.5 –Underweight
18.5- 24.99= Normal
25.0- 29.99=obesity grade I
30 and above= Obesity Grade II
That is:
Underweight classifications are graded into three;
<16.0 =Chronic Energy Deficiency Grade III
16.0 – 16.9 = Chronic Energy Deficiency Grade II
17.0 – 18.4 = Chronic Energy Deficiency I
Normal weight classification is 18.5 – 24.99
Obese classification is grouped into two:
25.0 – 29.99 = Obesity grade I
30.0 And above = Obesity Grade II

There are three commonly used nutritional indices. These are;

i weight – for height (WFH)
ii weight – for age (WFA)
iii weight- for age (WFA)
Weight – for height (WFH): this compares a child’s weight to the weight of a child of the same
height and sex to classify nutritional status. –Continuation
** Body Mass Index (BMI) is the determining how much an individual should weigh,
considering the amount of bone muscle and fats in your body’s composition.
The amount of fats is the critical measurement which is a good indicator of how much fat out
carry in the body.
BMI is a measure of body fat based on height and weight that applies to adult individuals.
THE CALCULATION OF BMI
Body mass index is simply calculated using a person’s height and weight in meters squared.
The BMI is defined as the body mass divided by the square of the body height. It is universally
expressed in units of kg/ms2
NUTRITIONAL ASSESSMENT
The child’s nutritional status can be assessed with two methods, direct and indirect methods.
The direct methods of assessing the nutritional status of a child are:
Growth and monitoring
Measurement of circumferences
Physical examination or appearance
Comparing a child’s weight or height
Feeding methods
The indirect methods of assessing the nutritional status of a child are:
Family history e.g. low income, abject property
Heredity e.g. sickle cell
Psychological problem after child’s birth.
Marital problems or broken home
Economic problem
Natural disasters e.g. war, famine and draught etc.

Factor Affecting Nutritional Status of a Child

The factors affecting the nutritional status of a child are:
Food scarcity
Family income
Disease or illness
Parent educational level
Ignorance
Poor feeding methods
Nature of mother’s job
THE WEIGHING
Weighing can be defined of described as a method of determining the heaviness of an
individual child or adult using weighing scale.

There are different types of weighing scale used in the clinical setting. They are:
Bathroom weighing scale/floor
Baby weighing scale
Spring balance weighing scales
Standing weighing scales for child and adults
Procedures for weighing
Make patient comfortable
Explain the procedure to the mother or client
Ask the mother to help you undress the child
Select appropriate scale for the patient and clean the scale
Test the scale and balance the scale to zero (0) with a paper
Place patients, guard the patient while on the scale
Observe and read weight accurately to the nearest kilograms.
Plot the present weight on the weight chart clearly
Communicate the importance of the weight recorded to the mother patient and ensure
appropriate follow-up
Health educate mother or patient according to the reading

ASSESSING NUTRITIONAL STATUS USING MID-ARM CIRCUMFERENCE STRIP

The nutritional status of a child can be determined by using mid-arm circumference strip
called shakir’s strip. It was named after a German doctor. The shakir’s strip used in assessing
the nutritional status of children from one year to five years. The strips are easy to interpret
and can also be used for both the literate and illiterate. It is useful in screening for malnutrition
in children. The shakir’s strip has color indicated in the circumference which is read, green
yellow and red.
It is also known as “MUAC TAPE”. I t reads:
Green colour – indicates normal which indicates that the child is well nourished.
Yellow colour –indicates that the child is malnourished
Green colour – more than 13.56cm – Normal child
Yellow colour – 12.5cm Moderate Acute Malnutrition
Red colour – between 11.0cm to 12.5cm – severe.
USES OF MUAC TAPE (SHAKIR’S STRIPE)
MUAC tape or Shakir’s stripes are used for the following:
It is used in screening for malnutrition in children
It can be used to detect early signs of malnutrition children between one year to five years.
It is useful when assessing nutrition status of a child
It is tool used b health worker to check, if the milestone development of a children is accurate.
It is used to measure how well the child’s body utilized food
PROCEDURE FOR MEASURING MID-ARM CIRCUMFERENCE
Allow the patient or mother to carry the child in a comfortable position
Explain the procedure to the child caregiver or mother
With the arm hanging down and without bending the elbow
Determine the mid-point and wrap the MUAC measuring tape on the mid-point
Allow the MUAC measuring tape to be well place, flat against the arm.
Do not squeeze the arm by pulling too much on the arm
Check the colour opposite the point
Read the measurement through the window on the tape to determine the child’s nutritional
status.
Note and properly record your findings on the child’s health card.
Health educates the mother in the steps to promote her child’s health either negative or
positive.
REQUIREMENT
A tray containing the following:
Kidney dish
Shakir’s tape
Tape measures
Patient card
SHAKIR’S TAPE INTERPRETATION
GREEN: if found 0cm mark on the tape touches the green part, the child well nourished.
YELLOW: If the 0cm mark on the tape touches the yellow part, the child is moderately under
nourished. Teach the mother to give the child adequate diet to make the child healthy.
RED: if the0cm touches the red part, the child is severely malnourished. Find out the mother
of caregiver the caused and encourage the mother to embark on nutritional therapy.

IMMUNITY
Immunity

Natural Artificial

Active Passive from Active Passive serum

mother via Vaccine T.T with anti
Clinical placenta, bodies e.g.
Disease breast milk ATS

TYPES OF IMMUNITY
Immunity is described as either
Active immunity
Passive immunity
Active immunity involves the production of anti-bodies by the body itself to prevent the body
from invasion of an infection. Active immunity will result in long term immunity.
Passive immunity-this involves from the acquisition of the anti-=bodies from another source
which result in short term immunity.
Active immunity can be divided into two;
1. Natural active immunity
2. Artificial active immunity
Natural active immunity- This is producing anti-bodies in response to the exposure to a
pathogenic infection, that is tit can be gotten through infection.
Artificial active immunity- This involves the production of anti—bodies in response to
controlled exposure to an alternated pathogen {vaccination}.
PASSIVE IMMUNITY
Passive immunity can be divided into two;
Natural passive immunity
Artificial passive immunity
Natural passive immunity- this is receiving anti-bodies from another organism or person or
inmate e.g. from mother to fetus via umbilical cord and placenta; colostrums anti-bodies to
new born via breast milk
This can be from maternal transfer to the new born and it is short. E.g.T.T
Artificial passive immunity
This involves receiving manufactured antigens to stimulate the body to produce anti-bodies
against infectious diseases e.g. A.T.S
IMMUNIZATION
Immunization is a process of introducing an antigen into the body in order to stimulate the
body to produce antibodies to fight against a specific disease.
Immunization can also be defined as the artificial means of introducing antigen into the body
to protect the body against the deadly preventable and communicable diseases. It is classified
into two;
1. Active immunization: This involves the introduction of appropriate antigens or vaccines to
stimulate the body to produce antibodies against a specific pathogen or micro- organisms. It is
active because the host plays an active role in producing the antibodies and which provides
complete or partial protection which may last for years or life.
2. Passive immunization: This refers to the administration of specific antigen against a
particular infective agent into the body of a susceptible host. It offers temporary protection
e.g.ATS it is a ready produced antibody that is introduced into the patient ad a treatment. It can
be naturally or artificially acquired.
GENERAL IMMUNIZATION TRAY
The general immunization tray requires the following;
Kidney receiver (1 dish)
A receiver containing dissecting forceps and drawing needles
1 galipot with cover containing sterile cotton wool.
1 galipot with cover containing cotton wool balls soaked in water.
Vaccine in cold box or carrier
Safety box for sharps
Dust bin for soiled materials
Client card
Wash hand basin

THE VITAL SIGNS

The vital signs are the refectory signs of the body’s physiological state, which indicate how
body’s vital organs are sustaining lives.
The vital signs compromised the all signs that can be used to monitored, and know the health
conditions of the body’s organ. It includes temperature, pulse, and respiration [TPR].

TEMPERATURE
Temperature is the degree o f hotness and coldness of the body, environment or a substance
which is measure with a thermometer. The normal human temperature is between 36.6̊c-37.2̊c
[96̊f and 99̊f] and the average of 36.9̊c [94.8̊f].
The body temperature of human, like that of every other warm – blooded animals, remain
almost constant, there may be variation of about 0.5degree centigrade in the day. Due to some
factors in health which may cause a greater variation in temperature in human body. The
factors are; vigorous exercise, excessive external heat and excessive cold.
The temperature of human body is regulated by the heat regulating center in the brain [the
medulla oblongata] which is so delicate that it responds quickly to any abnormal changes
within the body.
Any lasting in the temperature may be regard as a sign of diseases. The human body
temperature can be regulated and lost mainly by the evaporation of sweat from the body and
during the excretion.
THERMOMETER
The thermometer is an instrument of vital signs; it is for the measuring of temperature. It
works on the principle of the expand of mercury substance on heating and contract on cooling.
TYPES OF THERMOMETER
There are different types of thermometer manufactured and used for specified purposed. These
are:
Bath thermometer
Lotion thermometer
Wall thermometer
Clinical thermometer
Electronic thermometer
Bath thermometer- This is a type of thermometer used to take the temperature of the patient’s
bath water. The scale on the thermometer usually ranges from – 1 to 65.5̊c [30̊ to 150̊f].
Lotion thermometer- This type of thermometer is used for taking the nursing treatment. This
kind of thermometer will only give accurate readings or result while place in the solution or
lotion. It ranges from- 19̊ to 115̊c[0̊-240̊f].
Wall thermometer- This type is used to register the room, and the atmospheric temperature in
the hospital ward or room. It is not a mercury thermometer but sometimes alcohol, colored
with red dye.
Clinical thermometer- This type of thermometer is used to take the patient’s temperature in
the clinical settings. It differs from the other thermometer in its self – registering.
There is a small link in the bore of the capillary tube that links to the bulk which contain liquid
substance called mercury; that expand on heating and contract on cooling
The range of thermometer usually extends from 35̊c-43̊c[95̊c to 110̊f].
There are three types of clinical thermometer; the rectal, the digital, and the oral thermometer.
It can be read and record in a suitable light after removing the thermometer from the patient.
Electronic thermometer- This is a sensitive type used for recording skin temperature and is
being used in some hospitals and special departments. It records temperature faster and have
an accurate reading either in Fahrenheit or centigrade scales

THERMOMETER SCALES
The thermometer scales have the standard scale most commonly in Fahrenheit and centigrade.
Initially, Fahrenheit scale was in common used in the country but now general change the
centigrade scale and the Reaumur thermometer which is rarely used.
The thermometer has the fixed point of the boiling and freezing points of water at normal
atmospheric pressure.
 Thermometer scales Freezing point Boiling point
Fahrenheit 32̊ 212̊
Centigrade 0 100̊
Reaumur 0 80̊

In case, the health care provider may come in contact with thermometer having Fahrenheit
scale. He or she should be able to convert Fahrenheit to centigrade and vice versa.
To convert Fahrenheit to centigrade for example – normal body temperature 98.4̊f to
centigrade, subtract 32 and, multiply with 5 and divide by 9.9:
98.4̊F-32 * 5/9
= [98.4 -32] * 5/9
=66.4* 5/9
=332/9
=36.88
=36.9̊C
To convert centigrade to Fahrenheit the temperature of 39̊c
: - formula; c ̊ * 9/5 + 32
: - 39*9/5 +32
= 351/5 + 32
= 102.2̊f
SITES FOR TAKING TEMPERATURE
The following are the sites for taking temperature;
In the rectum
In the maxilla
In the groin
In the mouth
EQUIPMENT REQUIRED FOR TEMPERATURE TAKING
The equipment required for temperature taking are;
A tray containing the following:
Thermometer – oral or rectal in a jar of disinfectant
Galipot for wet swab
Galipot for dry swab
Receiver for used swab
Temperature chart [if available]
CAUSES OF PYREXIA
1- Infection – it may be as a result of invasion of micro-organisms
2- Inflammation due to trauma
3- Severe pain
4- Injuries, tumor in the brain
5- Fever
6- Toxic infection
PROCEDURES FOR TAKING TEMPERATURE
Explain the procedure to the mother of the child or the patients
Ask the mother to help you undress the child
Take the tray to the bedside
Remove the thermometer from the test tube and dry it with a dry swab
Check the thermometer to see that there is no crack or broken in the glass and that the mercury
readings are below the 35̊c [95f].
If the mercury is above the level of 35̊c [95], shake the thermometer very well and ensure that
the tip does not hit any object or article close while shaking.
Place the thermometer in proper position and leave It there for one to four minutes.
Remove the thermometer with a dry swab, shake down the mercury.
Place the thermometer
DESCRIPTION GIVEN TO THE DEGREE OF TEMPERATURE
TEMPERATURE NAMES
Below 35̊c[95̊f] Collapse
35 to 36.2̊c[95 to97̊f Subnormal
36.2̊ to 37.2̊[97 t0o 99̊f Normal
Above 37.2̊c [99̊f] Pyrexia
37.2̊c to 38.3̊c [99-101̊f] Low pyrexia
38.3̊ to 39.4̊c [101 - 103̊f Moderate pyrexia
39.4̊ to 40.5̊c [ 103 to 105̊f] High pyrexia
Over 40.5̊c [105̊f] Hyper pyrexia

FACTORS AFFECTING BODY TEMPERATURE

The factor influencing body temperatures are:
1- Age
2- Exercise
3- Hormonal level
4- Stress
5- Environment
PULSE TAKING
The pulse is the wave of distention and elongation felt in an artery well as a result to
contraction and retraction of the left ventricle forcing blood into the full aorta.
When the left ventricle force blood, the aorta distended the wave passes along the walls of the
arteries and it be felt at a point where an artery can be pressed against a bone.
There are two types of pulse. These are: Normal pulse
: Abnormal pulse.
1. Normal pulse- It is also known as regular pulse goes rhythmically and maintains same
speed and volume.
2. Abnormal pulse- It is irregular in the speed and volume of heart beat.
CAUSES OF CHANGES IN PULSE RATE
There are causes in variation of pulse rate. Variation may be caused by;
1. Position of patient
2. Sex of patient
3. Age of the patient
1. position of the patient- When a patient is standing up, moving about, the rate is more rapid
than when he is lying down relaxed.
2. Sex of the patient- The pulse is to be slightly increased in women than in men in is usually
about five beat per minute.
3. Age of the patient- There is great variation. The pulse in infant and the young child is
much more rapid than in adults.
CHARACTERISTICS OS PULSE
The characteristics of pulse are
: Rate
: Rhythm
: Volume or strength
: Tension
1: The rate should be at speed the heart is beating
2: Rhythm – the length of time between each beat and the regularity
3: Volume or strength- volume or strength of the beat. It required a moderate pressure to
obliterate the blood vessel.
4: Tension –the vessel should feel soft under the nurse’s finger and it should not feel hard and
tortuous.
PROCEDURES FOR TAKING THE PATIENTS PULSE
1. Get your equipment ready.
2. Explain the procedures to the patient who must either be lying or sitting in a comfortable
position.
3. Wash your hand and dry it
4. If there are no contraindication for arm flexed at the elbow with hand resting on the chest.
5. Hold the patient’s wrist placing the index finger and the middle finger over the radial artery
and count the number of pulsations within 60 seconds {1 minute}.
6. If the health worker is using instruments make sure time measuring is working perfectly
7. Record appropriately, accurately on the patient’s chart or treatment card.
8. Explain findings to patient
9. Wash and dry your hand
10. Manage abnormalities according to standing order.
EQUIPMENT FOR PULSE TAKING
1- A second handed watch or pulse meter
2- Patient temperature chart
3- A biro for charting
SITES FOR PULSE TAKING
There are nine sites for where pulse can be taken
1.Radial artery
2.Temporal artery
3.Brachial artery
4.Carotid artery
5.Popliteal artery
6.Femoral artery
7.Dorsalis pedali artery
8.Apical artery
9.Posterior tibial artery
PULSE OF AGE VARIATION
AGE PULSE
Newborn infants 130-140/min
 12 months 110-120/min
2-5 years 100/min
5-10 years 70/min
Adult 60-80/min
Old age Tend to be lower
The rate of the pulse to respiration is fairly constant that is 4:1 with a rising temperature of
0.5oc that 1of, there is usually an increase of about 10 pulse rate.
RESPIRATION
Respiration is the breathing in of oxygen and breathing out of carbon dioxide and water vapor.
It can also be described as a process of taking in oxygen into the lung through the respiratory
organs and breathing out carbon dioxide and water vapor.
Respiration consists of a process which includes inspiration and expiration which is controlled
by the brain [the medulla oblongata] called the respiratory center.
Respiration rate- this can be described as the number of ventilation that takes place per
minutes. It can be notice by the steady rise and fall of the chest cavity.
The characteristics of respiration are;
Rhythmical
Quiet
Regular
Comfortable
Being neither deep nor too shallow
The respiration rate varies with age, sex and situation.
The respiration rate;
AGE RESPIRATION RATE
Newborn infants 30 to 35/min
12months-5years 25 to 30/min
Adults 12 to 18/min
It is slightly more rapid in women than in men and the rate varies with age, tending to drop as
a person grows older.
Some school of thought state that the adult respiration is between 16-24 per minutes, the
average is being 20 per minutes.
CAUSES OF INCREASE IN RESPIRATION RATE
Causes of increase in respiration rate are;
 Exercise
 Emotion and excitement
 Hemorrhage
 Heart disease
 Pyrexia Decrease in normal respiration rate

Decrease may occur in normal respiration rate as a result of the following

 Rest
 Sleep
 Sex [ female higher male]
 Shock
  Fatigue
 Drug therapy [ morphine depresses respiratory center]
 Toxemia.
ABNORMAL/SYSFUNCTIONAL RESPIRATION
Abnormal /dysfunction respiration can be described with some medical terms. These are;
Tarchprnea- Persistence rapid respiration [greater than 20 breath per minutes]
Bradypnoea- Abnormally slow breathing/less than 10n= breath per minutes
Apnoea- Cessation of breath which may be for few seconds or prolonged. It is also a period
which breathing has stopped.
Dispnoea- This is abnormal breath and is characterized by a state of difficulty in breathing,
which may not be accompanied by pain.
These difficulties may be in inspiration or expiration or both. Dyspnea can be due to
obstruction to the flow of air into and out of the lungs [as in Bronchitis and asthma] heart
diseases, cancer, emphysema, pneumococcus and emphysema
Stridelous breathing- This is a harsh whistling sound due to an obstruction in the larynx.
Wheezing is common in patients suffering from asthma and bronchitis as a result of air
passing through fluid I the air passages.
Whoop- Is the long drawn out noisy inspiration occurring after coughing in whooping cough
Inverse respiration-this is a of respiration abnormality sometimes found in children when there
is a pause in the respiratory cycle after inspiration instead of after expiration.
Cheyenne-stroke breathing- This is a distinctive type of breathing which occur in certain
cerebral conditions, uremia and in myopia poisoning. It is characterized by gradual decline
respiration until become deeper and deeper until they reach a climax and there is a complete
cessation of breathing for a few seconds.
Orthopnea- This is a breathing condition that patient has extreme difficulty in breathing
unless sitting upright. It is common and associated with advanced heart diseases.
Sighing respiration or air hunger is a very slow abnormal, which there is low inspiration and
rapid expiration. This occurs as a result of hemorrhage.
Grunting breathing- This is the type of abnormal breathing noticed or observed in patient
with pneumonia, injury, and Cerebra vascular accident. It is characterized by loud snoring and
puffing out of the cheeks.
FACTORS AFFECTING RESPIRATION RATE
The factors influencing respiration rate are;
1- Exercise
2- Body position
3- Emotions
4- Stress
5- Diseases- certain diseases conditions affect respiration. Diseases like URL, pneumonia,
heart disease, lung disease while some diseases decrease it.io
1- Fever
2- Cold
3- Acute pain
4- Smoking- especially long term smoking changes the lung, respiratory airways resulting in
an increased rate.
BLOOD PRESSURE
Blood pressure is pressure exerted by the blood upon the blood vessel wall as the heart beat
and measured in millimeter mercury (mmHg)
Blood pressure can also be described as the pressure or force of exertion of blood on the wall
of the artery when the heart pumps blood.
Blood pressure has two main components: Systolic and diastolic pressures.
a) The Systolic Pressure:
This is a pressure or force noticed when the heart muscle is at maximum contraction and it’s
the first to be heard and recorded. The systolic pressure is also the highest pressure when the
left ventricle contract.
b) The Diastolic Pressure:
This force is the lowest pressure when the heart is at rest or the left ventricle is at a state of
relaxation.
The different between the systolic and diastolic is called pulse pressure.
The normal range of systolic pressure is usually 100 - 130mmHg while the diastolic is 70 –
80mmHg. The instrument used in the measurement of blood pressure is sphygmomanometer
and stethoscope.
The normal blood pressure is: systolic /diastolic = B/P 120/80mmHg
The abnormal blood pressure is:
1. Hypertension – This is the name used to describe increased in blood pressure.
2. Hypotension - It is also used to describe low blood pressure.
Factors causing Rise (increase) in Blood Pressure.
There are factors causing rise in blood pressure. There are:
1. Disease e.g. diabetes, renal disease.
2. Smoking
3. Hereditary
4. Alcohol
5. Stress and anxiety
6. Exercise
7. Age
8. Emotions
9. Fever
10.Narrowing of blood vessel
11.Toxemia of pregnancy
Factors Causing Fall (Decrease) in Blood Pressure
1 Shock
2. Change of position
3. Dehydration
4. Debility
5. Addison’s disease
6. Heart problems
Requirement for Taking Blood Pressure
The tray for taking temperature should contain the following equipment.
 A tray containing
 Blood pressure apparatus – Sphygmomanometer.
 Stethoscope.
  Galipot with wet swab.
 Kidney dish to receive used swab.
 Patient card/treatment card.
Procedure for taking Blood Pressure
a. Put patient in a comfortable position either sitting or lying down.
b. Explain purpose procedure for the patient.
c. Bring the equipment to the patient side. Allow the patient to place the anterior part of
the arm facing up.
d. Expose the area (Upper arm) and free from tight cloth. Wrap the cuff around the patient
upper arm, above the bronchial artery, not more than 2.5cm, not covering the cubical
fossa, above it and not too tight or too loose.
e. Use the finger tip to feel the strong pulsation of the bronchial artery, tighten the screw.
f. Place the diaphragm of the stethoscope over the bronchial artery in the cubical fossa
and the earpiece in the ear.
g. Inflate the cuff and to the which the pulsation is not heard of gradually deflate the cuff
and continue to deflate until the pulsation is first heard which is the systolic and release
the screw and as the pressure is lowering, listen and observe where the last pulsation
sound is heard which is the diastolic sound or pressure.
h. Allow the remaining air to escape quickly.
i. Remove the stethoscope from the ear, unwrap the cuff from the upper arm and clean the
stethoscope with swab. Record in the patient card and interpret the result to the patient.
j. Discard your tray.
k. Wash and dry your hand.

PROCEDURE FOR TAKING TEMPERATURE PULSE AND RESPIRATION

 Exam plain the procedure and purpose the patient.
 Prepare material to use.
 Wash your hand with soap and dry clean it with cloth or towel.
 Selection of site for insertion (oral, rectal or auxiliary.
 Clean the thermometer.
 Shake down the thermometer to zero degree Celsius.
 Insert thermometer accurately and set time.
 Remove thermometer after two minutes.
 Read thermometer, strike sown the thermometer and put it back in container.
 Hold the patient’s wrist placing the index and middle finger over the radial artery.
 Count the number of pulsations within one minute.
 Position the patient correctly and comfortable.
 Watch the respiration from the chest or diaphragm region and count the amount of
depth for one minute.
 Interpreted the result and.
 Record accurately in patient’s card.
NOTE INTERPRETATION OF RESULTS
Temperature--- 370 c or 980f is normal for a person at rest.
380c--- some fever
 390c to400c---high fever
Pulse-----60 to 80 beats per/minutes.
Respiration: - Adult and children -12 to 20 breaths per minutes.

LABORATORY SAMPLES
There are various samples that can be collected in laboratory.
The laboratory samples includes
 Sputum
 Pus
 Body Fluid
 Blood
 Faeces
 Tissues
 Bone Tissues
 Urine.
URINE
The major component that is very common in urine is:
Water 96%
Urea 2 %
Uric acid 2%
Salt sodium chloride, potassium, urea, dissolve ions, and inorganic and organic
compounds. Several factors can influence urine Production or output in an individual. The
factors are;
 Medications
 Supplements
 Foods
 Medical conditions
 Age
 Bladder size
 Disease e.g. diabetes

CHARACTERISTICS OF NORMAL URINE

The normal urine has both the physical and chemical characteristics.
Physical characteristics that can be identified to urine include; color, odor, reaction, the
amount and specific gravity.
It is tagged “DORCAS”
D – Deposit
O – Odor – Aromatic
R – Reaction – use litmus paper to test
C – Colour – Amber or pale yellow
A – The amount produced
S – Specific gravity
Chemical characteristics that can be applied to the urine include the acidity, alkalinity,
molecule of ammonia, nitrogen and carbon dioxide.
ODOUR- Urine has a characteristics aromatic smell but if abnormalities are present the odour
presence can be a distinctly sweet smell, which indicate presence of acetone
ACETONE- may be present in diabetes mellitus or starvation patient.
PUS- The urine has fishy offensive odour.
AMMONIA- When urine smell of ammonia, it indicate that there is decomposition of urine.
REACTION- The urine normal reaction is acidic in reaction and is due to phosphate in the
urine, but urine can be alkaline or neural.
Acidic urine will turn blue litmus paper to red, but red litmus paper will not change.
Alkaline urine will turn red litmus paper blue. Urine can be alkaline if urine is contaminated
by vaginal discharge, bottle containing milk or if patient is on drug like antacid e.g. mist
magnesium trisilicate.
All urine must be acidic before any test is done. If urine is tested and it is alkaline, add drops
of acid and retest to make sure it is acidic.
- COLOUR- The normal colour of urine is amber or pale yellow.
Occasionally, blood may give urine look like strong tea or dark greenish if present in large
amount.
- AMOUNT- The amount of urine in 24 hours is 1000-1800mls; average of 1500mls. In case
of polyuria - which is increase above the normal limit of the amount of urine passed; oliguria-
which is decrease amount of urine passed in 24 hours.
The amount passed depends on the;
 Fluid intake
 Diseases-diabetes mellitus
 Weather
If the fluid intake more, patient will pass plenty of urine in cold weather, and less amount
of urine in hot weather when patient sweat.
Diseases like diabetes mellitus and diabetes insipidus there is polyuria.
SPECIFIC GRAVITY-Specific gravity is the weight of the urine compared with the weight
of the water density.
Specific density [SG] is a measure of the concentration of solutes in the Urine compared with
water in urine.
A urine specific gravity test gives information about how well the kidneys concentrate the
urine and person’s hydration status.
The normal specific gravity is 1010. The range is 11-1025; the specific gravity is measured
with an instrument called URINOMETER. The urine can be put in a big test tube so as to
allow the Urinometer to float and read
TEST ON THE URINE
The test that can be carried out on urine are
 Sugar test
 Acetone
 Acetone
Sugar test- There are two main type of sugar test, namely; cold and hot
- The cold test for sugar is divided into two;
 Clinistrix strips
 Clinistrix Tablet.
 1. Clinistrix strip- It is also known as the dip and read test. Dip the end of the Clinistrix
strip into the urine, remove and allow excess urine drop and wipe off at the edge of the
colour chart provided in the bottle read.
If the strip has not changed, it means there is no sugar.
If sugar is present, the segmented end will change from pink to deep or dark purple.
2. Clinistrix tablet- It is also cold test for sugar. In a clean test tube, put 5-10 drops of
water and add 5 drops of urine.
 Put in the test tube and clinic test tablet, shake the test tube gently.
 Allow the tablet to dissolve, and watch for colour changes.
 Compare the colour with the colour range scale on the bottle
 It changes from pink to deep or dark purple.
HOT TEST FOR SUGAR
Equipment – Bunsen burner, test tube, Benedict solution, spirit lamp.
PROCEDURE FOR TEST
 Put 5mls of Benedict solution into a clean test tube.
 Add 7-8 drops of urine
 Boil on a Bunsen burner or spirit lamp for 2 minutes
 Watch for colour changes, if her is no change I the Benedict solution, it means there is
no sugar
 If the colour changes to green, yellow, orange or brick red, it means there is sugar.
TEST FOR ALBUMIN
There are two main tests for albumin namely; cold and hot tests.
The cold test can be divided into three [3] while hot test is one which can albumin can be
detected by four method these are;
 Alburtis strips
 Salicyl-suphonic acid test
 Esbach quantitative test
Cold test
Alburtis for albumin test. It is also called dip and read test.
Procedures
1. Dip the albustex strip into urine in a test tube which is acidic.
2. Allow the excess urine to wipe off and at the edge of the colour chart provided on the
bottle read after some seconds by matching it.
3. If it remains, it means there no albumin. If it turns to light green or deep green, it means
there is albumin depending on the severity or degree.
REQUIREMENT FOR TEST
 Albustex strips
 Urine
 Test tube
 Salicyl-sulphonic acid test
Equipment- test tube, Salicyl-suphonic acid; urine

Procedure
 Add 5 drops Salicyl-suphonic acid to about 5ml of urine.
 Shake the test tube
  For colour changes to clouding in the urine.
Degree of cloudiness the solution gives indicates the relative protein concentration.
Esbach quantitative test- Esbach quantitative is to the Specify actual amount of albumin
only. The urine must be acidic and specific gravity must be 1008-1010. This is important
because albumin will not set well if the specific gravity is high or if there is too much solid in
urine. If the specific gravity is high, urine must be diluted with equal amount of water. If the
urine is alkaline, acidify it with a few drop of 10% acetic acid.
HOT TEST FOR ALBUMIN
Requirement- a test tube, urine, Bunsen burner, or spirit lamp, a test tube holder.
Procedures
 Fill the test tube with ¾urine
 Boil the urine in test tube while holding with the test tube holder
 Add acetic acid
Result – when boiling, if any cloudiness appears, add a few drops of acetic acid, after adding
acetic acid and the cloudiness still remain, it means presence of albumin.
Conditions that will give rise to albuminuria are pus or liquor ammonia, disease of kidney
and heart, pre-eclampsia toxemia, nephritis, cystitis and pyelonephritis.
TEST FOR ACETONE
There is only one test for acetone making use of ace test.
Procedure;
 Place an acutest tablet on a clean white sheet of paper.
 Put on the tablet a drop of urine.
 Wait for 30 seconds, if the tablets remain white or cream, there is no acetone. But if the
color changes to purple, it means there is acetone.
Acetone is found in urine of obstetric patients who are diabetics or when carbohydrate intake
is diminished. It can also be found in condition such as in hyperemesis prolonged labor or
obstructed labour dehydration due to diarrhea and starvation.

HEAMOGLOBIN ESTIMATION
The correct procedure for hemoglobin estimation is the used of Taliquist scale method.
Requirement:
 Taliquist scale
 Sterile lancet
 3 galipots – one containing dry swabs, one with wet swabs and the third with swabs
saturated with methylated spirit.
 Kidney dish receiver for waste.
Procedure-
 Explain purpose to the patient.
 Position the finger
 Clean the finger with methylated spirit swab
 Wipe the finger dry or allowing to
 Air dry before pricking
 Sharply prick the finger or heel
 Collect droplet sample of patient blood blotting paper
  Compare the colour of blood with the rating or grading behind the Taliquist scale.

ORAL TOILETING
Oral toileting is the care given to the mouth and its structures. It is also known as ORAL
HYGIENE.
RATIONALE FOR ORAL TOILETING
The reasons for oral hygiene are;
1. Prevent infection of the mouth and dental decay.
2. It prevents unpleasant odor from the mouth
3. It stimulates appetite
FACTORS THAT PROMOTE ORAL HYGIENE
Refined carbohydrate- Avoidance of refined carbohydrate that stick to the teeth and cause
decay quickly
Brushing- Regular brushing of the teeth everyday and immediately after each meal using
toothpaste and brush or chewing stick and salt water.
Toothpaste- using toothpaste that contain fluoride promote a health tooth
Diet- eating balanced diet with a lot of fruit and vegetables also promote a healthy tooth.
Bottle feeding- Desisting from bottle feeding for elder babies at night prevent tooth decay.
MATERIALS FOR ORAL HYGIENE
 Toothbrush
 Toothpaste
 Chewing stick
 Receiver
 Salt water solution
 Big cup for fresh water
PROCEDURES FOR ORALTOILETING/ HYGIENE
1. Keep the patient in a comfortable position
2. Explain the purpose and procedure to the patient
3. Wash hand and dry hands
4. Put the toothpaste on the brush
5. Wet the toothbrush with the paste
6. Ask the patient to open the mouth
7. Clean the back and the front of the teeth as well as the side using an upward movement
for the lower teeth and downward movement for the upper teeth.
8. Brush the front teeth, back and top of all the teeth.
9. Use scrubbing movement to wash the top of the tongue
10. Ask the patient to spit inside the receiver not on the floor
11. Wash the brush
12. Return all the material to their appropriate places.

VISUAL ACUITY
Visual acuity is the measure of the ability of the eye to distinguish shapes and detail of
an object in a given distance.
 It is important to assess the visual acuity in a consistent way in order to detect any
changes in vision.
LEVEL OF VISION
There are five levels of vision in visual acuity. These are:
 Normal vision
 Satisfactory vision

 Poor vision
 Very poor vision
 Blind
REASONS FOR CARRYING OUT VISUAL ACUITY
The rationales for visual acuity test are:
 To detect any functional eye defect
 To assess or evaluate the visuals of clients
 For pre-employment reasons
 To determine the state of vision of the patient after treatment.
REQUIREMENTS FOR VISUAL ACUITY
 Snellen’s lettered chart
 Measuring tape
 Occluder
 Ruler ( 1m)
 Chair
 Illumination bulb (240 volt)
PROCEDURES FOR VISUAL ACUITY
 Explain the procedure to patient.
 The chart should be pinned or hanged to wall.
 Measure the distance of 20 feet or 6 meters away from the hanged chart and mark
 The patient is allowed to sit or stand behind the mark.
 A piece of paper or card is then used to cover or occlude the eye while testing the
other eye.
 The right eye should be tested first while the patient occludes the left eye.
 Allow the patient to read from the top of the letters on each row until patient can
no longer read the letters.
 Do the same procedure to the left eye with eye covered
 The health worker should point at the letters with stick and the patient is allowed
to read row by row
 The last line the patient can read correctly is the visual acuity of that eye.
 Record all the findings.

INTERPRETATION OF VISUAL ACUITY RESULT

 The result is recorded as follows the distance is the numerator, 6 meter while the
last line read by the patient is the denominator. Each eye should be tested and recorded
separately; e.g., R- 6/12, L- 6/12.

Interpretation of Visual Acuity Test.

A. 6/6 ––– Normal vision

6/9 –––
Satisfactory vision
6/12 ––

6/24 ––

6/36 –– Poor vision

6/60 ––

B. C. F. 5 (counting of fingers mm)

C. F. 4 Very poor vision
C. F. 3
C. F. 2

C. H. M. (Hand movement)
P. L. (Perception of light) Blind
N. P.L (No perception of light)

ANATOMY OF THE BREAST

BREAST EXAMINATION
Breast self-examination is the examination of the individual’s breast by self. In breast
examination there are various ways, it can be carried out. The major ways which one can
examine breast are

1. Breast self-examination
 2. Medical breast examination
1. BREAST SELF EXAMINATION- Breast self-examination can be described as a
regular examination of breast used in attempt to detect early any abnormalities in the
breast. Breast self-examination is a technique which allows an individual to examine
his/her breast. It is also a screening technique you can do at home yourself to check for
any abnormality in the breast. Breast self-examination is for women of all ages.
REASON FOR BREAST SELF EXAMINATION
The reasons for breast self-examination are;
 It increases knowledge about breast abnormalities
 It helps to detect early if there are any changes in the normal look of the breast
 To enable an individual, feel any changes in their breast that seems abnormal
 It helps prevent breast cancer and identify risk of breast cancer
 It serves as a saving habit
 It helps you become familiar with your breast normal structure.
THINGS TO CHECK ON THE BREAST
Things to check on the breast are;
 Check for discharge (without breast feeding)
 Lumps
 Cracked nipples
 Tenderness and swollen
 Enlargement
 Hard node or knot or thickening
 Size and shape
 Ulceration

STEPS IN BREAST SELF- EXAMINATION

STEP 1 – STAND IN FRONT OF A MIRROR
Examine your breast with hands at sides, then clasped overhead. Look for changes in size or
shape or nipple between thumb and fore finger to check for discharge, then press hands and
push forward to tighten chest muscle. Look for dimpling, rashes, swelling or inversion,
redness, scaly, or changes in shape, size, texture, or skin color.
STEP 2— IN THE SHOWER
Breast self-examination is easier when your skin is wet and soapy. In the shower, raise
your right arm above your head, use the breast self-examination grid as you cover your entire
breast area using the touch technique. Repeat the examination to the left side.
STEP3—LYING DOWN
Lying supine helps to flatten the breast, divide the breast into four places with your mind, with
the palm pf your fingers. With the right-hand hand check for nodes or tenderness, lumps in the
left breast, with the left hand, repeat the examination to the side of the breast.
TOUCHES IN BREAST SELF EXAMINATION (BSE)
There are two major touches in breast self-examination procedures. They are
a. Breast self-examination touch
b. Breast self-examination grid
a. Breast self-examination touch: this is the use of the pads of your three middle fingers. Begin
in your armpit, using small circular motions with varying degree of pressure: to examine the
entire breast area.
b. Breast self-examination grid: This is the moving of your fingers up and down over the entire
breast area, from the collar bone to below the breast and side to side, from your breast bone to
the armpit.
PROCEDURES FOR BREAST SELF EXAMINATION
a. Allow the patient to sit in comfortable position
b. Take history of the patient
c. Ensure there is privacy
d. Undress appropriately
e. Assist the client to lie on her back
f. Place a pillow under the right arm and examine and repeat for the left arm and examine
the breast
g. Position the patient left arm over her head and make imaginary lines dividing the breast
into four quadrant and move your hand gently round the breast in a clockwise
movement or direction’
h. Instruct the client to do self-examination of breast, while you observe and correct.
i. Encourage the client to examine the breast every month, two – three days after
menstrual period and report if there are any changes.
j. Reassure the client.
k. Record your findings on the client card.
l. Wash and dry hands.