HEALTH EDUCATION
Item
- Title
-
HEALTH
EDUCATION - extracted text
-
Module - 403
HEALTH
EDUCATION
The Foundation for Research in Community Health
3 & 4, Trimiti B Apts., 85, Anand Park, Aundh, Pune - 411007
Tel: (020) 25887020, Fax: (020) 25881308
Email: frchpune@giaspn01 .vsnl.net.in
HEALTH EDUCATION
INDEX
1.
Respiratory Ailments (Indications and Symptoms)
01 - 06
2.
Diseases of the Nose and Throat Cough and Cold
07 - 28
3.
Acute Bronchitis (A Respiratory Disorder that grows fast)
29 - 38
4.
Asthma
39 - 42
5.
Pneumonia
43 - 53
6.
Tuberculosis
54 - 64
7.
Diarrhoea and Dehydration
65 - 79
8.
Types of Fever
80 - 99
9.
Medicines
100 - 103
1
Lession 1
Respiratory Ailments
Indications and Symptoms
Aims
On reading this lesson you will
1. Be able to narrate the symptoms and indications related to the respiratory system
2. Acquire the skill of the method of observing signs and indications by asking questions
and examining patients.
3. Identify the respiratory illness.
Knowledge
You will know about
• Information about particular indications and signs of the respiratory system
Skill
You will learn
• To observe signs of respiratory distress.
• Diagnose the location of the problem from the signs and indications related to the respiratory
system.
Perspective
You will understand
• How life-style affects the respiratory system.
Ii
2
Signs and Indications of Respiratory Ailments
A. Cough
This is an indication found most of the time. It occurs during the diseases Pharyngitis,
Bronchitis, Tuberculosis and Pneumonia. The sputum is not uniform. It is absent when there
is dry cough. The water-like variety flows through the nose while the thick variety is expelled
from the lungs.
The white-watery sputum is caused by viruses but the thick, greenish yellow-one is caused
by bacteria. TB or Pneumonia may include traces of red.
a.
According to place of origin
1.
2.
Sputum from the nose
Thick sputum from lungs
b.
According to source,
1. White watery sputum - virus
2. Thick greenish yellow sputum - bacteria
3.
Traces of blood in sputum - TB, cancer
Diseases of the upper/outer respiratory system
Colds, pharyngitis, tonsillitis, disorders of adenoids and vocal cords, diphtheria are all
respiratory disorders, of which diphteria is the most dangerous. Other ailments may get
well soon.
Cough accompanies both types of respiratory disorders except for those related to the
nose. Most often the cough is dry and the sound is shallow. But cough originating in the
lungs is deep and the sputum progressively increases. Cough from the trachea sounds like
a flute.
B. Pain
Cough may cause.
1. Pain while swallowing
pharyngitis, tonsillitis, laryngitis or diphtheria.
2. Chest pain with fever -
pneumonia or TB (though heart ailments cause chest pain,
hey are not accompanied by fever)
C. Fever
Infection of the respiratory system leads to fever There is no fever when pollution is the
sause of respiratory disorders
3
D. Increase in the rate of breathing
Faster breathing suggests a struggle for oxygen. This happens in case of TB, asthma,
pneumonia and heart trouble.
The normal rate of breathing provides sufficient quantities of oxygen. The rate of breathing
increases if there is obstruction of the air ways due to phlegm and chest pain which prevents
the lungs from expanding completely.
E. Cynosis
The lips, nails etc turn blue when oxygen is insufficient, this condition is called cynosis.
F. Flared nostrils
Difficulty in breathing leads to this condition.
G. Weight loss
When the body fights against germs during fever, the body loses energy. Additionally
fever reduces appetite. Together these conditions cause weight loss. TB is an illness that
affects a patient over a period of time during which weight decreases.
H. Increase of pulse rate
The pulse rate increases due to fever, stress or disorders related to the lungs.
I. Unequal expansion of chest
Normally left and right lungs expand equally during inhalation. However if one of them
gets affected by a disease like pneumonia or TB, it expands less.
J. Sounds heard when using a stethoscope
When the air sacs are full of fluid, there is friction between fluid and air. This friction
creates a sound like crumpling paper which can be heard through a stethoscope placed
over the patient’s chest.
Wheezing
When there is difficulty in exhalation we can hear a sound like whistling e g. - in case
of an asthma patient.
Barrel chest
The shape of a patient’s chest may get deformed by illness. A drum
shape is caused in emphysema creating difficulty during exhalation.
Percussion Sound
Since air has low density, thumping the chest creates a percussion sound.
But when the air sacs are congested, it creates a deep sound.
Drawing in of ribs
This sign is useful in case of children
To elicit this sign, quieten the child and remove the clothes covering the chest.
The ribs should expand during inhalation, but if the ribs get drawn inside, it suggests
pneumonia.
Self examination
Complete the sentences
1. Diseases of the upper respiratory system are
.
4.
3.
2. Diseases of the Lower respiratory system
1.
2.
3.
4.
3. A serious disease of the upper respiratory system is
4. Drawing in of ribs during inhalation indicates
5. Which two ailments are indicated by pain in the throat?
6. How will you recognize that vocal cords are affected?
7. Which are the symptoms accompanying cough in tonsillitis
?
8. Which 2 parts indicate cyanosis on observation?
9.
If someone is losing weight what is your opinion about the disease duration
10 Cough caused by pollution does not have
5
11. If only the right part of the chest expands properly it means that the left part is
Exercise
Choose the correct alternative
1. The most common symptom of a respiratory illness is
1. Cough
2. Fever
3. Headache
4. Weight loss
Phlegm caused by bacteria is
2.
1. Greenish yellow
2. Watery
3. White
4. All the above
3. The organs of the upper respiratory system are
1. Nose, throat, vocal cords
2. Nose, throat, trachea, vocal cords
3. Nose, throat, bronchus, lungs
4. Nose, vocal cords, lungs
4. The organs of the lower respiratory system are
1. Nose, throat, vocal cord, lungs
2. Trachea, bronchus, bronchioles, lungs
3. Throat, trachea, lungs
4. Trachea, lungs, vocal cords
5.
Which illness of the respiratory track
is serious?
1. Diphtheria
2. Tonsillitis
3. Pharyngitis
4. Adenitis
Fill in the blanks
(1. 16 to 20 times/min, 2. Drawn in ribs,
3. emphysema , 4. whistle like)
1. The breathing of an asthma patient sounds
2. The chest looks like a drum during
3.
is an important symptom of pneumonia among children
4. Normal breathing rate is
I
6
Match the suitable pairs
1
Cynosis
1. Shortage of O2 in the body
2. Increase in breathing rate
2. Blueness of Nails and lips
3. Rales
3. Increased rate of breathing
4. Pneumonia
4. Friction of air with fluid
5. Cough due to pollution
5. Presence of fever
6. Cough by infection
6. Absence of fever
Answers
Complete the sentences
1. Cold, disorder of vocal cords, diphtheria, tonsillitis
2. TB, pneumonia, cancer, emphysema, bronchitis
3.
Diphtheria
4.
Pneumonia
5. Diphtheria, tonsillitis, pharyngitis, inflamed vocal cords
6.
Cough will be accompanied by other symptoms like change in the voice, pain
on pressing the neck/ throat.
7.
Pain during swallowing, fever, redness of tonsils
8.
Lips, nails
9.
Long term, short term
10. Fever
11. Infected
Correct Alternatives - 1-1, 2-1, 3-1, 4-2, 5-1, 6-3, 7-1
Blanks Pairs -
1-4, 2-3, 3-2, 4-1
1-2, 2-1, 3-4, 4-3, 5-6, 6-5
7
Lesson 2
Diseases of the Nose and Throat
Cough and Cold
Aims
On reading this lesson you will understand
• What causes frequent coughs and colds
• How to prevent coughs and cold
Knowledge
You will know about
• Causative agents of coughs and colds
• Symptoms of coughs and colds
• Various methods of treating coughs and colds
Skill
You will learn
• Home Remedies
• To identify serious indications to refer patient to a doctor.
Perspective
You will understand that
• Medicines advertised for coughs and colds should be used after careful consideration.
• Medical treatment of coughs and colds is often unnecessary.
8
Coughs and Colds
Coughs and colds are common illnesses. Most of these are caused by viral infections
which require no medical treatment. This group of viruses (minute germs) are called
rhinoviruses.
However, coughs and colds do cause suffering. A patient gets headaches, looses appetite
and feels, lethargic. A remedy is needed to reduce the suffering. It is necessary to know
that
1.
Coughs and colds generally last for a week with or without treatment.
2.
Antibiotics are of no use.
3.
Drugs advertised for colds are useless. The syrups contain sugar and alcohol. The
linctus often contains codeine which induces sleep. But our mental respiratory
control needs to remain active for our health, even if the cough keeps us awake.
4.
When the viral infection weakens the respiratory system, there may be a bacterial
attack. If this affects the internal respiratory system, it can lead to serious diseases.
Bacterial infections should be diagnosed for starting treatment early.
Serious indications
•
Increased rate of breathing
•
Drawing in of the ribs
Wheezing
Cough not cured by proper antibiotics
Phlegm tinged with blood
How will you explain that
•
Cough and cold is a symptom of viral infection of our respiratory tract.
•
When some foreign body attacks the internal covering of the nose, the body secretes
a fluid to expel it. That is why a patient has a running nose.
Three Causes of cold and cough include
• Allergy
• Pollution
• Virus
Allergy
It may be caused by pollen, animal hair etc. which cause sneezing and water flowing
from nose. In such cases
9
•
Find out the cause of allergy and try to avoid it
•
Give a CPM tablet if symptoms persist
Pollution
This leads to dry cough and running nose. Constant contact with pollutants weakens
the respiratory system. Efforts should be made to reduce exposure to pollution or protect
against pollution by use of face masks.
People who frequently suffer from coughs and colds are
1. Age wise
•
Children below 5
- 4 to 7 times a year
•
Youth
- 2 or 3 times per year
•
Above 55
- Quite often
2. By nature of work
3.
4.
•
Women cooking on “Chulha”
•
People working in cotton or ginning factories
•
Potters
•
Stone - workers
•
Traffic Policeman
By habitat
•
People living in densely populated homes
•
Homes without proper ventilation
•
Homes in the vicinity of industry
By lack of proper diet
The complaints of cough and cold persist when the diet lacks sufficient protein and vitamins
A and C. Protein increases resistance while vitamins keep the internal organs healthy.
If you study the categories of people suffering from coughs and colds, you will find
most of these belong to the poor classes, women cooking with smoke around, especially
in rural areas. Also children in developing countries have complete respiratory ailments which
could prove fatal sometimes.
10
Which factors cause higher frequency of coughs and cold
Seasons
More frequent during January, March and October. In the cold season reduction of humidity
in the atmosphere and lowered temperature of the body causes dryness in the respiratory
tract which reduces resistance to infections.
Long-term infection
Continuous infection by germs can cause tonsillitis or sinusitis
How does a cold spread?
Sneezing and coughing throws out the virus from the body. This can infect other people
directly or through used handkerchiefs, hand-shake or kissing.
Complications resulting from coughs and colds
Bronchitis, tonsillitis or pneumonia and even diarrhoea can be caused due to persistent
coughs and colds.
Treatment for coughs and colds
Home-remedies continue to benefit us even today.
1. Rest for about 3 days
2. Covering with blankets or quills gives warmth and comfort
3. Avoid smoking
4. Administer vitamin C through lemon ‘sharbaC.
5. Hot drinks like tea with ginger
6. Gargling with warm water and salt 3 to 4 times a day.
7. Inhalation of steam
8. Take paracetomol or kadha (‘brew’/home made) for fever.
9. Do not take antibiotics or cough suppressants (Cough suppressants are medicines
which control or suppress the cough without any attention to its cause like infection,
irritation etc. and so can result in treating the symptom and allowing the underlying
disease to progress).
Natural Remedy/Naturopathy
This follows a thought process that the disease itself is the remedy. According to this
theory, improper excretion causes cough and cold in order to get rid of unwanted material.
11
Treatment
According to this theory, the body should rest not only without active work but also give
the digestive system rest by fasting. In addition the patient should either use enema or
drink soups to clean the intestines. Cut 1/2 kg ‘palak’ (spinach) and tomatoes with 75 gms
of turnips and 25 mgs ginger into small pieces. Boil in a litre of water in covered pan.
Add salt, lime-juice and jeera powder (cummin). Drink a cup every hour. Go for a brisk
walk. Later keep your feet, soaked in warm water. Provide this information. But the patient
should follow natural remedies / naturopathy only if he/she has faith and a strong will.
Home Remedies
Boil 10 to 15 leaves of ‘tulsi’ (Basil) in a cup of water with pepper till half remains.
1.
Drink it 3 to 4 times a day.
Boil 5 leaves of tulsi and 2 pepper seeds, a bit of ginger, a couple of 4-inch pieces
2.
of lemon grass in a cup of water, reducing to half. Drink it 3 times.
or
Drink lemon juice mixed with honey and warm water
Remedies for children’s colds
1.
Crush 3/4 tulsi leaves and give two drops of their juice to the children 3 times a day.
2.
Crush a spoonful of camphor in two spoonful of heated oil. Keep the mixture in a bottle.
Rub it on the nose and chest of the child to give relief.
Ayurvedic Remedies
Like naturopathy, Ayurvedic theory also believes that colds and coughs are caused by
constipation.
Ayurveda is based on the principle of balance. The body consists of the 5 elements
earth, wind, water, sky, and light. There are 3 ‘doshas\ (faults) ‘pitta', ‘kafa', ‘vaat'. If any
of these are increased too much, we fall ill.
Improper digestion or excessive eating creates a greater amount of ‘kafa’ (phlegm) which
results in coughs or colds.
Ayurvedic Medicines
1
Piper longum (pepper) - Boil with milk and drink 3 times a day.
2. Controlled diet
12
3 Abstain from sleeping in the afternoon
4 Avoid eating sour things
Homeopathy
This science believes that the very cause of the illness can help cure it, just as only
a thorn can remove a thorn. This theory recommends medicine according to the habits and
nature of individuals. The same medicine can cure different diseases. A particular remedy
is not specific for an illness. The remedy has to be decided after ascertaining the individual
nature of each patient by asking a series of questions.
Given below is a list of some features of disorders with suggested medicines to be
selected after interviewing the particular patient.
Acupressure
This system believes that obstruction in any of the routes of the flow of energy in the
body causes disease.
Features of the diseases
Medicines
1.
Running nose, sneezing, red eyes,
watering eyes, discomfort, feeling
better in fresh air/open.
Allium Cepa 6C
1 pill for children
2 pills every 2 hrs. for adults till relief
2.
Greenish yellow-flow, more in the
morning, blocked nose, relief in the
open/fresh air
Pulsatilla b c
3.
Lung infection, pain, wet productive
cough, fever, increased pulse-rate
Ferrum phos 6C
1 pill for children
2 per 2 hrs for adults till reduction in indi
cation
4.
Wheezing, mucous, noisy breath
Antimonuim Tart (as above)
5.
Sharp cutting pain cough, sneezing in
the chest
Bryonica 6 C (Quantity as above)
People can try home-remedies and try any method of treatment in which they can participate
actively
Some techniques of overcoming colds
Low fever -
Home remedies
Traditional methods
13
High fever -
Paracetamol
+
Home remedies
4-
Traditional Treatment
If available, homeopathic or ayurvedic medicines can be given according to the
symptoms. Suggest the practice of Pranayam. (Breathing exercise).
Jal neti (for older people) - (Fig. 1)
Take some water mixed with a little salt in a dish. Inhale water through one nostril
and let it flow out through the other. Insert through the other nostril and repeat.
Fig. 1
Steam inhalations
Inhale steam through the mouth and exhale through the nose. Mix some vicks or eucalyptus
leaves in the water when boiling. Continue for 5 minutes.
14
Sinusitis
Aim
On reading this lesson you will understand
I. The various causes of Sinusitis
Knowledge
You will know about
The structure and function of the sinusitis
The signs and indications of sinusitis
Various treatments for sinusitis
Skill
You will learn
How to treat sinusitis
When to refer the patient to the doctor
About methods for prevention of recurrence of sinusitis
Perspective
You will understand
That sinusitis is a chronic condition
15
Sinusitis
There are small air sacs above and below the
eyes which help us in our speech. The germs infecting
the nose may attack them causing sinusitis. During
sinusitis, the patient experiences pain when these
points are gently tapped. (Fig.1)
Indications of infection of the sinuses (Sinusitis)
•
When the patient bends down there is pain in
the area of these air spaces.
•
The patient gets a headache
•
The nose gets blocked often.
•
Sometimes there may be fever.
Treatment :
Natural Remedy (Naturopathy)
As mentioned before, fasting, participation and will-power are important in this method.
It is done as follows • Enema once a day
• Mud application on abdomen
• Diet control as given below-(abstain from salt)
Breakfast
- one glass of Tender Coconut water or snake gourd juice (Padwa/)
Noon
- Raw vegetable salad or shredded fruit with coconut.
Supper
- Boiled vegetables with a little rice or chapati
Continue till reduction of headache, breathing and voice improvement
Home Remedies
Application of ‘Dhavaf (White) ‘Lap’ (Paste).
Camphor - 10 gm. Franken sense (Bosvelia Gabra) 10 gm Grate them separately in water.
Mix them together with 30 ml ( 5 tea spoons) of coconut oil. Beat it till the mixture becomes
very soft. Use this ointment over nose and temple for sinusitis. If inhaled with boiling water,
it relieves blocked nose
I
16
Homeopathic Treatment
Eupatorium 6 C - 1 pill for children and 2 for adults every 2 hours till the patient gets relief.
Allopathic Treatment
• Use heat treatment for pain
• Steam inhalation
• Take phenylephrine drops to relieve the blocked nose. - (For proper dose and other
information about the medicines use the Drug list)
• Use the antibiotic cotrimaxozole in case of fever. (For proper dose and other information
about the medicines use the Drug list)
Ayurvedic Treatment
Apply a paste of ‘moong’ skins with (black) pepper on head and cheeks.
You can use any of the above systems of treatment as desired by the patient. Sinusitis
is a repetitive illness. Note the period of the gap between the repeated attacks and the
type of treatment. Use the method most suitable for a particular patient.
Hov/ever, if the condition worsens, send to a specialist whenever -
• The pain increases
• The problem recurs every month
Acupressure
Acupressure
Home Remedy or
Yogasana
+
Ayurvedic Medicine
Home Remedy or
Yogasana
+
Homeopathic Medicine
Acupressure
Home Remedy or
Yogasana
+
Allopathic Medicine
Your responsibility as a health worker is as follows
Cough and Cold
Explain that cough and cold can get cured by itself
Explain the importance of sinusitis
For Sinusitis
A patient suffering from sinusitis should be given information about the different
systems of treatment
17
Pharyngitis
Aim
On reading this lesson you will understand
I. The various causes of pharyngitis
Knowledge
You will know about
•
The signs and indications of pharyngitis
•
The reasons for irritation of the throat in pharyngitis
•
The different systems of treatment available for pharyngitis
Skill
You will learn
•
How to treat pharyngitis due to various causes
•
How to combine treatments in pharyngitis caused by worms
18
Pharyngitis
Itching in throat
Indications
Every person experience this disease in his/her life. The following are its symptoms
•
Pain while swallowing
•
Irritation/itching in throat
•
Dry cough
•
Redness of throat can be seen from the inside
Reasons for Pharyngitis
1. Allergy
2. Virus
1. Allergy
When people come in greater contact with particular items like pollen grains or dust
during certain reasons, they develop an allergy.
Allopathic Treatment
CPM (Chloraphinarmine) pills,
Homeopathic Treatment
Allium Sepa 6 Q every two hours till conditions prevail.
2. Virus
Cold and cough is often accompanied by Pharyngitis.
Homeopathic treatment - Bryonia 6 c every 2 hours
Also
•
Gargle using warm water with salt
•
Drink juice of tulsi leaves.
•
Drink milk heated with turmeric powder
19
Our responsibility as a health worker is to
• Explain the causes of pharyngitis to people
• Point out the significance of gargling for pharyngitis
• If fever is accompanied by throat - ache and difficulty in swallowing after 2-3
weeks, consult a doctor at once.
20
Tonsillitis and Adenitis
Aims
On reading this lesson you will understand
1.
The natural role of tonsils and adenoids in the protection.
2.
The limited use of tonsillectomy
3.
The role of immunization in protection against infections
Knowledge
You will know about
•
The structure and function of the tonsils and adenoids.
•
The symptoms and indications of infected tonsils and adenoids
•
The harmful effect of infected tonsils on other organs.
•
All remedies for cure and preventing of tonsilitis
•
When to ask for referral to a doctor
Skill
You will learn
•
Observation of tonsils
Perspective
You will realize that
•
Immunisation is a social responsibility.
•
Since tonsils and adenoid are protective glands in the respiratory system, specialists should
•
be consulted about operating on them.
Damage is caused to heart and kidneys through infected tonsils.
ID
The Conditions called Tonsillitis and Adenitis
Since the tonsils and adenoids both occur close to each other and are important in defending
our body, they are considered together for discussion of their disorders.
The tonsils are located in the throat (Fig.1) while the adenoids found behind the nose
..
X
IT
0
h__
\~v.... .-w
W
(Fig-i)
Tonsil
X. ••/'I-: —Z
Their functions are :
1. Developing resistance
2. Production of white blood cells
3. Tonsils prevent infection and prevent serious illnesses like bronchitis and pneumonia
Infected tonsils lead to
• Production of toxic material which affect the kidneys or heart through blood.
• The pus produced can infect vocal cords and the respiratory tract right upto the lungs.
Susceptibility of Tonsillitis occurs among the following
• Greater frequency between the age 5 and 30 especially upto 12 years of age.
• During illness like typhoid
• People consuming polluted water
• People living in dense areas or studying in over crowed schools.
• During spring and dry summer.
• Patients with sinusitis.
22
Symptoms
(Fig.3)
1. Pain ((Fig.3) while swallowing due to which children avoid
food or water. The pain may reach the ears, which becomes
sharper while swallowing
2. Fever from 102° F to 104°
3. Loss of appetite
4. Bad breath
Site of the pain
5. Great thirst
Indications
1. High fever
2. Increased pulse-rate
I
3. External examination - swelling of glands
Infected
4. Examination of throat - Tonsils look red with spots.
tonsil
In this condition send patient to the doctor imme
•••
diately otherwise patient could get rhumatic fever.
Treatment
Rest
for 3 to 5 days
Diet
Liquids, warm and nutritive food, warm water mixed with a spoonful of lime juice and
a quarter teaspoon of honey to be drunk slowly at least twice a day.
Gargling
With aspirin and warm water, twice a day for a week.
Fever and Pain
Give paracetemol till the patients feels better
23
Antibiotics
Cotrimaxazole for 5 days. In case of repeated attacks of tonsillitis, the patient must be
referred to the doctor.
Homeopathic Medicine
Pulsatila 6 C twice a day for 14 days
Your responsibility as a health worker is as follows
•
Explain to people that the tonsils operation is advised only in case of monthly
attacks
If there is difficulty in speaking
•
The idea that a tonsils operation results in better height or health is totally wrong.
Explain the seriousness of disease.
Administer one dose of cotrimoxazole and arrange to meet a doctor after that.
Ensure immunization of all the children of your region.
inform the villagers about diseases.
Let them know which symptoms in their children should be reported to you for
consultation.
Money, means of transport and people’s health is needed in case of emergency.
So try to raise, a combined fund for the village. Try to train health workers in
case of additional help.
f;
A KO
A • '•
<•
»
24
Exercises (Cough and Cold)
Choose correct alternatives
1.
What is cough and cold?
1. Disease
2. Indication
3. Illness
4. Symptoms
2.
They infect us in case of cough and cold
1. Virus
2. Bacteria
3. Parasite
4. Allergy
3. An indication of a serious ailment of respiration is
1. Fever
2. Phlegm
3. Running Nose
4. Difficulty in breathing
4.
Reason for cough/cold according to Ayurveda
1. Constipation
2. Vomiting
3. Pitta (Acidity)
4. Kafa (Phlegm)
5.
Frequent coughs and colds occur among
1. Children and aged
2. Stone Workers
3. Under nourished
4. All the above
6
Repeated cough/cold may cause
1 Bronchitis
2 Tonsillitis
3. Pneumonia
4. Diarrhoea
25
7.
Match the pairs
1. Allergy
1. Increasing Resistance
2. Protein
2. CPM pill
3. Vitamin ‘A
3. Natural remedy
4. Enima
4. Healthy internal linings
5. Lemon juice
5. Cough and cold
6. Extracts of Tulsi leaves
6. Vitamin C
Fill in the blanks
(1. Allergy, Poliution, virus ) (2. Centre of Respiratory control) (3. Antibiotic) (4. Pulsatila)
(5. 4-7) (6. Protein, vitamin C) (7. Virus) (8. On the disease/Person) (9. Resistance)
(10. Natural)
1.
Cough/cold is caused by infection due to
2.
Children below 5 years of age may be attacked
times by germs affecting
respiration.
medicines are not useful for cough/cold.
3.
in the diet increases suffering due to cough/cold.
4.
Lack of
5.
Homeopathy treats
6.
The causes of cough/cold are
not
is the reason behind cough/cold getting cured within seven days
7.
on its own.
remedy, medicine are not to be given for cough/cold.
8.
In
9.
Linctus Codein can harm the
Answers
Correct Answers
1-2,
2-1, 3-4, 4-1, 5-4, 6-3
Correct Pairs
1-2, 2-1, 3-4, 5-3, 6-5
Blanks
1-7, 2-5, 3-3, 4-6, 5-8, 6-1, 7-9, 8-10, 9-2
26
Exercises - Sinusitis
Fill in the blanks
(Participation of the patient), (14), (Sinus), (Sinusitis), (Camphor ointment), (Cotramexazole),
(Swelling and infection of sinus), (Pupetoruim), (Increased pain or repeated attack), (Tender
coconut water, (Snake-gourd)
1. The air bags above the eyes and beneath the frame of the face are called
2. Sinusitis means
3. A person who gets headache, fever at times and increased pain on bending may
have.
4. According to Natural Remedies, sinusitis should be treated for
5. Drinking the juice of
days.
gives relief in sinusitis according to natural remedy.
6. Inhaling the vapour of
remedy.
is beneficial for sinusitis according to home
7. Allopathic treatment uses the medicine
8. The sinusitis patient should be sent to a doctor in case of
9.
in natural remedies/naturopathy is essential while treating sinusitis.
10. Homeopathy recommends
for sinusitis
Answers
Blanks
1-3, 2-7, 3-4, 4-2, 5-10, 6-5, 7-6, 8-9, 9-1, 10-8
I
27
Pharyngitis
Fill in the blanks
(Mebendezole), (Fever and pain),(Swelling in the throat/infection), (Gargling with salt and
water), (Allergy, virus, worms), (Pharyngitis), (Bryonia), (Chlorophenaramine), (CPM)
1.
A person with pain while swallowing, irritation in the throat, and dry cough is likely to
have
2.
Pharyngitis means.
causes irritation in the throat.
3.
is the allopathic medicine for pharyngitis caused by allergy.
4.
in case of pharyngitis caused by virus.
5.
Homeopathy recommends
6.
The home-remedy for pharyngitis is
7.
If pharyngitis is caused by worms, allopathy recommends
8. The patient should be sent to a doctor if pharyngitis is accompanied by
Answers
Blanks
1-6, 2-3, 3-5, 4-8, 5-7, 6-4, 7-1, 8-2
28
Exercise (Tonsillitis and Adenitis)
Fill in the blanks
(1 Bone joints, 2. Tonsilitis, 3. Throat, 4. Red inflated spots with pus, 5. At the back of
nostrils, 6. Tonsillitis and Adenitis 7. Respiratory system, 8. Heart, kidneys, joints)
1. The tonsils are located in the
2. The adenoids are found behind the
and
3.
4.
glands works as protector of body.
Frequent infection in Tonsils and Adenoid can adversely affect
5.
6.
In tonsilitis
Match the following
Answers
Blanks
1-3, 2-5, 3-6, 4-7, 5-2, 6-4
Match the following
1-2, 2-1, 3-4, 4-3
indications are found.
l‘
29
Lesson 3
Acute Bronchitis
(A Respiratory Disorder that grows fast)
Aims
On reading this lesson you will understand
•
Give the symptoms of acute bronchitis
•
Give the indications of acute bronchitis
•
Treat acute bronchitis
•
Know the symptoms and indications when the patient must see the doctor
•
how to get proection from bronchitis
Knowledge
You will know about
•
Causes of Acute Bronchitis
•
Different types of treatment for Acute Bronchitis
Skills
You will learn
•
Observation of breathing
•
Ayurvedic Treatment for acute bronchitis
Perspective
You will understand
•
If not treated, acute Bronchitis can be long term and serious
i
30
When the respiratory tract and the trachea are affected, excess of fluids are produced.
Usually this problem results from, viral infection.
Present complaint of patient will be as follows Excessive cough and phlegm.
Green and yellow phlegm, fever.
Light pain in the chest and stomach.
Physical Examination
Acute bronchitis gets cured in a week or two by itself. But often, there is a possibility
of other infections during an illness. So care needs to be taken to ensure that there is
no bacterial infection.
Care of the Patient
1. Rest- The energy should be used only to resist germs.
2.
Nutritive Diet- A diet rich in protein and vitamins should be provided to increase the
resistance.
3.
Quantity of water- Drink lot of warm water. This should be increased to help dilution
of phlegm so that it can flow out .
4.
Adulsa Syrup- This ‘kadha’ heals cough.
5.
The homeopathic medicine Aconite may be used.
6.
The patient must not smoke.
7.
Steam inhalation
Treatment
If the patient is aged and has a history of lung ailments antibiotics, may be given. Smoking
is one of the main reasons for bronchitis which gets acute in crowds and cold seasons.
Early treatment and giving up of smoking cures the patient. But this doesn’t happen.
The cough is dry at first. Later it becomes productive and generates phlegm. The patient
repeatedly gets treated for cough If this continues for a whole year, the patient develops
chronic bronchitis or long-term/disorder of the respiratory system.
31
Your responsibility as a health workers is this
• If a patient gets acute bronchitis repeatedly, he should be made to realise the need
to change his habits and stop smoking.
• Since this complaint may result from the smoke of the ‘chulha’, patients should be
advised to improve their roof and 'chulha’ too.
I
32
Chronic Bronchitis (Along term disorder of the Respiratory System)
and
Emphicema
Aims
On reading this lesson you will understand
The symptoms of chronic bronchitis and emphicema
The indications of chronic bronchitis and emphicema
Give the treatment for chronic bronchitis and emphicema
Observe the symptoms and indications when the patient must be sent to a doctor.
Explain how to prevent it.
Knowledge
You will know about
•
The causes of chronic bronchitis and emphicema
•
The bodily changes caused by it
Perspective
You will understand
•
Smoking is the main cause of chronic bronchitis and emphicema
33
People who smoke or those who keep getting diseases of the respiratory tract are
prone to chronic bronchitis. Long-term cough seems to become a part of life and the patient
doesn’t consider it a complaint when he describes other complaints. If the trachea and lung
tissues get damaged, the air-sacs get enlarged resulting in the disease called emphysema.
Current Complaints
1.
A patient of chronic bronchitis has cough in the morning.
2.
He gets phlegm about a spoonful to a cupful
3.
The phlegm is greenish yellow.
Critical observation
1.
Cough and ‘kafa’ in the morning mainly signals that the patient has chronic bronchitis.
2.
Smokers have greater complaints. They may suffer from emphysema. In the beginning
the patient experiences difficulty in breathing. They cannot carry out their daily activities.
Rest leads to breathing problems.
Examination of the patient
1.
The chest resembles a drum.
2.
If the patient exhales slowly, it means he needs to use energy to breathe
out.
The natural effect of the illness-
The patient will get repeated attacks of coughs and cold, along with
pneumonia. All patients don’t get emphysema, but it proves fatal eventually
when the patient complains of breathlessness while resting, and the nails or lips turn blue,
you will know that the lung capacity has reduced.
Care of patients with chronic bronchitis
1.
Giving up smoking by the patient is advised.
2.
Fluid intake - Maximum consumption of warm water helps to dilute the phlegm and bring
it out.
3
Prevent pollution inside the house.
4
Give medicines to dilate bronchi and dilution of phlegm like cough syrup or Adulsa syrup
34
5
Give inhalation of steam
6
Make the patient lie down as shown in the figure to
remove the ‘kafa’ from the body, patting his back and
chest
Treatment
Home Remedies -1 Make a
‘Talis Patraadi Choorna’tor colds, cough, phlegm, bronchitis
1. Talis
5 gm
2. Black pepper
3. Ginger
10 gm
20 gm
Grind them into a powder and keep in a
4. Piper longum
5. Cinnmon
6. Cardomom
7. Sugar
40 gm
40 gm
40 gm
320 gm
closed container. Give the quantity according to
age
less than 1 year - 1 pinch with honey/mother’s milk 3 times a day
1-5 years - 1/4 spoon with pure ghee, 3 times a day
5 to 12 years - 1/2 spoon with honey, 3 times a day
Above 12 years - a spoon with honey, 3 times a day
(Without honey or sugar for diabetics )
This method may be used for long-term disorders,
Adulsa and ‘Kantakar’ Choorna
Take 25 leaves each Adulsa and 'Kantakar’, dry item and powder them together.
Kafa - 1 spoon with honey, 3 times x 5 days
Asthma - 1 spoon with honey or hot water x 3 times throughout the season
Cough - 1 spoon with honey x 3 times till better
TB - With allopathic medicines. 1 spoon with ghee x 3 times till better.
Bronchitis - 1 spoon with honey x 3 times till better
r35~i
3. Moonga Choorna
For bronchitis take a 4 inch piece of ‘Moonga’ and grind it with a spoonful of jeera.
Mix the powder with a raw egg and a spoonful of ghee. It should be consumed everyday
till complaints persist.
Homeopathic Medicine
Antimonuin Tart 6 c - 1 dose after every 3 hours till patient gets relief.
Your responsibility as a health worker is as follows
Explain the complications of chronic bronchitis
Ask patients to give up smoking.
36
Emphicema Chronic bronchitis or long-term respiratory ailments can result in complications like
Emphysema’. This is a Greek word which means ‘excessive breathlessness’. The air sacs
in the lungs expand excessively, reducing their elasticity. Though air enters the lungs, it is
difficult for it to go out. The oxygen and carbon dioxide cannot be exchanged properly, causing
suffering to the patient
1.
Breathing problem
2.
Pressure on the heart
3.
Death
The patient with emphysema should be given an antibiotic dose, a medicine to dilate
expand the respiratory tract and sent to the doctor.
Home Remedy - To dilute the ‘phlegm’
1. 1/2 gm powder of “Yashtimadhu” with hot water, 3 times a day.
2. 'Doob grass/’Haritaki’ - 1/2 gm powder with honey, 3 times a day.
3.
Mixture of 250 gm of black pepper (powdered) with 1 gm of jaggery - twice a day
with milk.
37
Exercises
Acute Bronchitis
Fill in the blanks
Adulsa, (Disorder of the Respiratory Tract and Trachea), (Smoking, cold, crowd), Aconite, (Rich
in protein and vitamin), Virus
1. Bronchitis means.
is the cause of acute bronchitis.
2.
3. A diet
should be given during acute bronchitis.
syrup (kadha) is given during acute bronchitis.
4.
5.
is the homeopathic medicine.
6. Bronchitis may be aggravated by.
Choose the correct Alternatives
1. A person with chest pain , fever, cough with greenish yellow phlegm has the disease
1. Bronchitis 2. Tonsillitis 3. Pharyngitis 4. Sinusitis
2. A bronchitis patient must be asked to drink more water because
1. A patient feels thirsty 2. Water brings relief 3. Water dilutes phlegm and brings it out 4.
It stops phlegm
3. A bronchitis patient is advised to give up smoking because
1. It can cause long-term damage to the bronchi.
2. It causes cough
3. It creates phlegm.
4. All the above
4. What should be done to treat bronchitis?
1. Rest/Advice to give up smoking
2. Nutritive diet/increased water in take
3. Adulsa syrup.
4. All the above
Answers
Blanks -1-2, 2-6, 3-5, 4-1,5-4, 6-3
Correct alternatives -1-4, 2-3, 3-4, 4-4, 5-1
38
Exercises (Chronic Bronchitis)
Fill in the blanks
(Morning), (lungs), (exhaling), (Long-term disorder or respiratory system) (drum), (cough)
1. A smoker who has repeated complaints of respiratory illness may have the disease
2. A patient of chronic bronchitis always complains of.
in chronic bronchitis.
3. There is greater cough in the
4. The chest becomes shaped like a
5. There is difficulty in
due to chronic bronchitis.
during chronic bronchitis.
6. Chronic bronchitis damage the.
Choose the correct alternatives
1. The main complaint in chronic bronchitis is
1. Flowing nose 2. Difficulty in swallowing 3. Cough and Phlegm in the morning
4. Ear-ache
2. In chronic bronchitis you should recommend
1. Giving up smoking 2. More water in take 3. Inhalation 4. All the above
3. A patient of chronic bronchitis should be sent to a doctor in case of the following systems.
1. Pain while swallowing 2. Chest pain 3. Greater cough and phlegm in the morning.
4. The patient has difficulty in stepping out/talking
4. The reduced capacity of lungs is gauged from
1. Difficulty in breathing 2. Chest pain 3. Breathlessness/nails and lips turning blue
4. Pain while swallowing
Answers
Blanks - 1 -4, 2-6, 3-1,4-5, 5-3, 6-2,
Correct alternatives -
1-4, 2-3, 3-4, 4-4, 5-3
Emphicema
1. Emphicema causes enlargement of
1. Air sacs 2. Trachea 3. Tonsils 4. Lungs
Answer
1-1
[391
Lesson 4
Asthma
Aims
On reading this lesson you will understand
•
•
The signs of Asthma
The indications of Asthma
•
•
Treatment for Asthma
Know the signs and indications when to send the patient to the doctor.
•
Explain the methods of prevention.
Knowledge
You will know about
•
The causes of Asthma.
•
The actual signs and indications.
Skill
You will learn
•
How to use the inhaler to reduce the suffering during Asthma.
Perspective
You will understand
•
Life style and allergy are responsible for Asthma.
I
40
The Illness of Asthma
One in every hundred people suffers from Asthma The English word Asthma has originated
from the original Greek word which means breathlessness/panting.
The respiratory tract of an asthma patient contracts/shrinks in size. Inhaling is smooth
but exhaling becomes difficult. There is friction between the air moving in and out. Asthma
is mainly caused by allergy to particular things. Thus the patient suffers during those particular
seasons.
Symptoms
1.
Difficulty in breathing out.
2.
Whistle like sound during breathing.
3.
Cold, cough, phlegm, ‘kafa’.
Indication
Exhaling takes longer -slow
Treatment
1.
Use of salbutomol inhaler
2.
Use medicine prescribed by doctor for emergency
In the absence of a prescription give the salbutomol pills/tablets with you and send the
3.
patient to the doctor. (Use Drug list)
4.
5.
Give steam
Find out the cause of allergy of the patient.
a. Pollen grains
Particular grass of flowers
b. Hair of animals
Cats / dogs
c. Smell
Odour of paint, flowers or incense
d. Working in the field e Food habits
Use of pesticide or sprouting of millet
f.
Dust pollution
Consumption of grain, moong etc.
Due to crackers.
For allergy due to dust
On it the whole night Add a spoonful of the bark of the 'Arjun ' tree to it at dawn and
have the porridge before sunrise
41
Acute signs and symptoms The patient must be immediately taken to a doctor / hospital on detection of any of the
following signs • Inability to speak a complete sentence due to breathlessness.
• Respiratory rate more than 40 / min.
• No relief of symptoms even 20 mins, after taking the medication
• No relief even after taking inhalation twice.
• Cyanosis of lips, tongue and skin (turns to blue colour)
Your responsibility as a health worker is as follows
•
Help the patient to understand his illness.
•
Help in changing the life style due to the illness
•
Discuss which medicine should be taken in case of emergency with the doctor,
and keep with the patient.
•
Help in identifying the allergy.
•
Encourage the patient to seek help of Ayurvedic doctors. Ayurvedic methods can
give a lot of comfort.
42
Exercises
(Whistle-like), (abstaining from allergy), (allergy of something)
1
Asthma is caused by
2. The breathing sound is
3.
in case of Asthma.
is the main solution in treating Asthma.
Choose the correct alternative
1. Which of these contracts in case of an asthma patients.
1. Trachea 2. Tonsils 3. Respiratory tract 4. Lungs
Answers
Blanks - 1-3, 2-1, 3-2,
Correct Alternatives - 1-3
43|
Lesson 5
Pneumonia
Aims
On reading this lesson you will understand
•
The symptoms of Pneumonia
•
The indications of Pneumonia
•
Treatment of Pneumonia
•
The symptoms and indications when the patient must see the doctor
•
Methods of Prevention
Knowledge
You will know about
•
The causes of Pneumonia
•
Symptoms and indications of Pneumonia in small children
•
Treatment of Pneumonia
Skill
You will learn
•
Observation of rate of breathing.
•
Send the patient to the doctor in case of serious indications.
Perspective
You will understand
•
Serious consequences can be prevented by treatment in the primary stage.
44
The Disease Pneumonia
The UNICEF and WHO figures show that 28% deaths among children below 5 years
of age are caused by rapid infections of the respiratory tract in developing countries. These
children get infected by germs in their respiratory system about 4 to 7 times a year (Fiona
Plus, A Quarterly Bulletin on Primary Health Care and Community Health, Issue 31, December
1993.) They are victimised due to malnutrition, overcrowding, pollution and unhygienic conditions
of living.
The maximum fatality occurs among infants below 6 months.
The name Acute Respiratory Tract Infection suggests the sudden onset of the ailment.
The illnesses are classified according to the infected area of the respiratory tract. They
are broadly divided into diseases of the upper tract (like the nose , throat or vocal chords
which are not serious) like infection of the tonsils, cold, cough, swelling, pharyngitis which
are mild.
The second category is the serious and sometimes fatal diseases of the inner respiratory
system as in the trachea, bronchitis and finally air sacs, or lung tissues which are its parts.
The two main illness of this kind are Pneumonia and TB.
It is easy to differentiate between the infections of the two parts of the respiratory factors.
If cough and the phlegm are the deciding factors. If the upper tract is infected, the cough
is dry and the sound shallow. There is pain while swallowing. However, the inner system,
when infected, creates a flute-like sound which is deep. The cough is productive (gives
out phlegm or ‘kafa’ ). The main diseases in this category are bronchitis, pneumonia and
TB.
Two months to 1 year (of age) - Indications
1. The baby cannot suck.
2. Attack of convulsion
3. The baby sleeps a lot and its difficult to awaken it.
4. The whistle-like sound is heard when the baby is fast asleep
5. Under nourished
Serious Illness - Treatment
1. Arrange to send to hospital immediately
2. Give the first dose of antibiotic
3. Give paracetamol in case of fever.
r~45
Serious Pneumonia- During breathing there is
1
Drawing in of ribs
2. Breathing rate is above 60 per minute
Treatment
1. Arrange to send to hospital immediately
2. Give the first dose of antibiotic
3. Give paracetamol in case of fever.
If it is not possible to send the baby to hospital, continue the dose of antibiotics and
observe the baby.
Follow -up
Whenever you visit the child, you should observe -
1. Whether the condition of the child is worse (than/before)
2. Whether the ribs are drawn in while breathing.
3. Whether there are signs and indications of serious illness.
In case of any of the above symptoms, the baby should be sent to the hospital immediately.
A) Pneumonia
1. If ribs are not drawn in while breathing.
2. If breathing becomes faster
2-12 months
above 50/minute
1-5 years
above 40 per minute
Treatment
Advise the mother to take the following care of the child-
1.
Give the dose of antibiotic properly
2.
Understand that paracetamol is used for fever.
3.
Decide whether you will visit the baby or call the mother to get information about its
condition after 2 days.
A
Inform the mother which symptoms and indications are serious enough to call you
I
46
B) In case of improvement of the child’s condition, it means the treatment is correct.
But if there is no improvement think of changing the antibiotic with another one like
amoxycilline. However if the condition becomes worse, the case is serious pneumonia,
treat accordingly.
c) If there is only cough and cold (not pneumonia)
•
Chest is not drawn in while breathing.
•
The breathing rate remains unchanged/steady-
2-12 months - 50 per minute
1 to 5 years - 40/minute
•
In case of cough for more than 3 days, send the patient to the hospital
•
Give paracetamol in case of fever.
•
Ask the mother to give. Adulsa syrup or any other 'kadha' for cough.
•
Explain that the child must get rest and comfort.
Decide the place and timing of the next visit after
Feedback
The treatment
is correct if
•
The breathing rate is normal
•
The fever is less
•
The child has a normal intake of food and liquid
Treatment
of Paediatric Pneumonia
There are 5 main medicines used to treat children suffering from Pneumonia Cotrimaxazole, Ampicillin, Chloramphenycol, Benejork, Penicylin and Gentamycin. They are
all life-saving drugs but should be given in the right dosage keeping their side-effects in
mind. Health workers must know when and how to use them.
Usually, pneumonia among children is caused by infection of bacteria like streptococcus
Pneumonia and Haemophilus Influenza. Cotrimaxazole is an effective and affordable medicine
with minimum side-effects.
Infants of less than 2 months are not much benefited by Cotra, so they should be given
ampicyllin. They should be sent to the doctor as soon as possible (using ‘cotra’ only as
a stop-gap arrangement for the time-being).
Cotrimaxazole (Adults) Cotrimaxazole (Children) Ampicillin children who cannot swallow
the pills should be administered its powder with honey and water or milk If there is improvement
after 48 hours, give the complete dose for 5 days
47
If there is no improvement, keep giving contrimaxazole for 2 days.
Use of medicines for children from 2 months to 5 years
Age/Weight
Children’s Tablet
(Sulphamethoxazol)
Tryomethoprim 20
mg (1 tablet)
Children’s Syrup
Sulphamethoxazol)
Tryomethoprim 200
mg (1 spoon/ 5 ml)
Adult tablet only if
children’s tablet
unavailable
Sulphamethoxazol
400 mg
Tryomethoprim 80 mg
_essthan2
months/upto
1 tablet twice a day
1/2 spoon
2.5 ml twice a day
1/4 tablet twice a day
2-12 months
3.5 to 10 kg
2 tablets twice a day
1 spoon
5 ml twice a day
1/2 tablet twice a day
' -5 years
10-19 kg
3 tablets twice a day
1 1/2 spoon
7.5 ml twice a day
1 tablet twice a day
3.5 kg
If condition worsens i.e., chest/ribs get drawn in, the child sleeps too much, turns blue,
gets a convulsion, arrange to send it to a hospital at once
Directions for the mother
The child must be taken to a hospital in case of •
Difficulty in breathing
•
Drawing in of chest
•
Inability to drink anything
•
The child being difficult to wake up
The antibiotics should be taken for at least 5 days, 3 days after improvement in condition.
I
48
Pneumonia
1.
Breathing rate 2m - 12 months more 60/minute
2.
1 year - 5 years - breathing more than 50 per minute
Cotra
V
After 2 days (48 hours later)
Improvement
Deterioration
No Change
Serious Pneumonia
Reduced breathing rate
▼
Easier breathing
Give Cotra
1. Drawing in of ribs
Call after 2 days
2. Difficulty in breathing
3. Unable to suck
4. Dull
▼
Child able to drink milk
Improvement
Deterioration
f
Give cotra for 3 days
Send to doctor
The main aim of the health worker is to recognize when the illness is serious and send
the patient immediately to a doctor so that he gets treated with the proper technique. This
can cure dangerous diseases and save lives of patients preventing the consequences of
serious illnesses is as important explaining the need to use the medicines prescribed by
the doctor. Otherwise the most skilled of doctors and the best of hospitals cannot save
a patient if medicines are not taken as advised
[491
Following is the method to question a parent who complains of respiratory problems
of his child, to find out the seriousness of the problem, whether -
1.
The child is consuming any diet
2.
The baby can suck its mother’s milk.
3.
Has an convulsion
4. Sleeps too much and is difficult to awaken
5. Strider - loud sound while breathing
6.
Weezing sound when child is quiet
7.
High or low temperature (not normal)
8. Very undernourished
If serious, the child must be sent to a hospital.
Acute Pneumonia
Less than 2 months
1. Breathing rate above 60/min
2. Drawing in of ribs.
2 months - 5 years
1. Breathing rate above 50/min
2. Drawing in of ribs
Treatment
1. Prescribe cotra according to age
2. Keep the child warm (wrapped up)
3. Let the child continue with/mother’s milk.
4. If unable to arrange for a vehicle to carry the child to the hospital, take care of the
child till then.
If pneumonia is absent, reduced conditions
1. Low rate of breathing.
2. No drawing in of chest
50
Advise the mother to take the following care
«
Keep the child warm
•
Continue breast feeding the child
•
Keep the child's nose clean.
•
Explain that she should call you in the following cases -
1. Increase of illness.
2. Difficulty in breathing
3. The child doesn’t drink milk.
•
The child can thus be saved from rapidly increasing
Respiratory Tract Infections
Weight at birth should be raised
•
Babies born underweight suffer seriously when infected. Carrying pregnant women
should be encouraged to eat well, exert less and have a regular check-up
•
Breast feeding is best for children and should be encouraged upto 6 months. From
6 months onwards it should be accompanied by top feeding
Suitable Diet
Sudden respiratory infections can lead to pneumonia in case of underdeveloped children.
Mother's should be explained what the children’s diet should be. They must understand that
children must be fed every 3 to 4 hours..
Vaccination
Respiratory diseases like measles, chicken pox, TB, diphtheria etc., often lead to
pneumonia. 25% infant mortality in developing countries is caused by pneumonia. Therefore
mothers should be encouraged to get their children immunized against these diseases
Vaccines for all of them are available
Vitamin A
Deficiency of vitamin A increases the risk of respiratory diseases. This is sufficiently
available in mother’s milk. After 6 months of breast feeding, top feeding should supplement
the quantity of the vitamin through carrots, mangoes, milk, leaves of 'moonga' , white gourds
('Kashiphal') Children should be given 2 lakh units of vitamin A at intervals of 6 months
tn
Pollution within the house
Homes are polluted by smoke. People should be encouraged to use smokeless chulha’s
for cooking or to arrange a chimney for the smoke to go out.
Family planning should be advocated to avoid over-crowding. Also the importance of
cross-ventilation should be explained and followed.
Adult Pneumonia
Signs and Indications
A patient suffering from Pneumonia complains of high fever, cough, phlegm, faster breathing
and chest-pain.
When you make enquiries you will discover that the patient had suffered from a cold
or flu just before this condition or even from
1. Measles
2. Chicken pox
3. Diphtheria
Pneumonia starts with high fever and shivering. The patient gets phlegm of yellowish
colour, sometimes with blood. There is pain in the chest with faster breathing.
Symptoms
1. Dilated nostrils
2. High fever
3. Faster breathing
4. Unequal expansion of chest
5.
Tapping of chest leads to no depth of sound
6. Sound of Rails on stethoscopic examination
7. Nails or lips turn blue in case of insufficient oxygen.
If treated, the patient shows improvement within 24 to 48 hours.
Children may even vomit. So they must be given sufficient water. Otherwise dehydration
can lead to death.
If a pneumonia patient doesn’t respond to treatment , he may have TB. So he should
be sent to a doctor.
T
’O
I
52
Care of a Pneumonia Patient
Observe the patient regularly and send to a doctor in case of no improvement after
•
24 hours.
•
Give cotrimaxazole or amoxcilli as antibiotics.
•
Keep giving water to drink.
•
Give paracetamol for fever and Ayurvedic Kadha or Adulsa Syrup for cough. Juice of
Adulsa leaves may be given, one spoon at a time.
•
Ensure a healthy diet/breast feeding for infants
•
Send the patient to a doctor in the following cases 1. The baby stops crying
2. Faster rate of breathing
3. Cough persists after treatment
Your responsibility as a health worker is as follows
•
Explain the symptoms of pneumonia to parents and guardians of young children
•
Explain the ways of reducing the risk of pneumonia
53
Exercises
Choose the correct alternatives
1.
percent of child mortality below 5 years of age in caused by Acute
Respiratory Tract Infection in developing countries.
1. 40
2. 28
3. 30
4. 20
2. How many times are children below 5 years infected by germs in the respiratory
tract?
1. 1-2
2. 4-7
3. 5-6
4. 7-8
3. The cause of Respiratory Tract Infections among children of developing countries is
1. Overcrowding 2. Undernourishment 3. Unclean Surroundings 4. Born under
weight
4. Send a child below 1 year to a doctor in case
1. The child cries excessively 2. Faster breathing
3. Drawing in of ribs
4. 2 and 3 above
5. If the child has pneumonia its mother should relate the indications
1. Difficulty in breathing 2. Drawing in of ribs
3. Lack of appetite
4. Difficulty in awakening the child 5. All the above.
6. In case of fever/cough/faster breathing/chest pain, the disease indicated is -
1. Pneumonia
2. Bronchitis
3. TB
4. Pharyngitis
Fill in the blanks
(Vaccination), (Streptococcus Haemophalus Pneumonia), (Five), (Yellow), (Age)
1. The colour or ‘kafa’ during pneumonia is
2. Small children can be prevented from getting pneumonia by
3. Cotramexazole should be taken for
4. Cotramexazole should be given according to
5.
and
cause pneumonia.
Answers
Alternatives - 1-2, 2-2, 3-4, 4-3, 5-5, 6-1
Blanks - 1-4, 2-1, 3-3, 4-5, 5-2
days.
54
Lesson 6
Tuberculosis
Knowledge
You will know about
Causation of TB including the medical and non-medical causes.
To list the cardinal symptoms of Tuberculosis.
To list the steps to be taken in managing a suspect of TB.
To list the available services in the public sector.
To describe the basic tenets of DOTS.
To understand the importance of completing drugs as per the full course.
To list the dangerous side-effects of the drug that need immediate referral.
To list various steps in the prevention of TB.
Skill
You will learn
To be able to advise a patient on collecting a sputum specimen and differentiate between
sputum and saliva.
To be able to advise a patient on the appropriate destruction of sputum.
To be
able to counsel a suspect on going for diagnostic tests.
To be
able to counsel a patient who has just been diagnosed as having TB.
To be
able to counsel a patient who has side-effects to the drugs.
To be
able to counsel a patient who had discontinued treatment.
Perspective
You will understand
•
•
To appreciate the link between TB and poverty and over-crowding.
To appreciate that the drugs for TB are available free of cost and that with appropriate
•
treatment most patients are completely cured.
To appreciate the importance of completing the course as per the doctors instructions.
•
To appreciate the importance of early suspicion so that people can get the specific
treatment immediately.
55
Tuberculosis
The disease of TB has been afflicting human beings since prehistoric times. Even the
Vedas refer to it. It is a great problem today also. Almost 4 lakh people succumb to this
disease annually in our country and the mortality rate for TB is the highest.
CAUSATION AND SPREAD
The primary cause in a type of bacteria called Mycobacterium tuberculosis.
However the mere entry of the bacteria into the body is not enough to cause the disease.
The conversion of infection into disease requires some important determinants like - the
number of bacteria entering the person, and the immunity of the person who has been infected.
The number of bacteria entering the patient depend on the crowding of his / her living
and / or working environment. The more crowded or underventilated the environment is the
more easily the infection spreads and the higher the dose per infection.
The immunity of the patient - ie. The ability to fight infections and diseases depends
on the overall health of the person and depends crucially on the nutrition and other diseases
like Cancer and HIV / AIDS.
From the above it is obvious that the poor are at a much higher risk of getting TB.
Apart from being at higher risk for the infection the difficulty in accessing proper treatment
from the government services also leads to increasing sufferring.
It is also important to note that that there is a varying period between the entry of the
bacteria and the onset of the disease.
TB is able to affect almost any part of the body, but the commonest and the most important
as far as spread is concerned is the lungs. It is infection in the lungs that give rise to the
classic picture of a person who is emaciated, coughing and spitting out blood.
TB can also affect the brain, bones, abdomen, lymphnodes etc each type of infection
leading to a
varying set of symptoms.
BCG is the vaccine given for TB.
It is given as soon after birth as possible.
It is not necessary that if you take the vaccine that you will not get the infection. However
it is supposed to prevent fatal child hood infections.
Symptoms
The symptoms of TB depends on the part of the body that is affected
The most common form of TB is that of the lung this is also the most dangerous in
terms of spread and the easiest to diagnose and treat The main symptoms are as follows!
[56
1. Cough > than 3 weeks.
2. Weight loss / weakness.
3.
Loss of Appetite.
4.
Fever.
5.
Hemoptysis.
While these symptoms occur specifically in patients with disease affecting the lungs,
regardless of the organs affected the following symptoms should make one suspect TB.
Chronic fever
Weight loss.
Weakness.
Diagnosis of TB in children.
The symptoms of TB in children are non-specific.
The key to diagnosis is early suspicion.
The most common symptom is a failure to thrive.
The child may also have chronic / recurrent episodes of fever.
The importance of early diagnosis.
TB can be suspected and diagnosed earlier if one sends all suspects for appropriate
investigation.
The advantages of early diagnosis is as follows:
•
There is a decreased sufferring due to prompt treatment.
•
There is decreased spread to uninfected individuals.
•
There is available a free and efficacious cure so prompt diagnosis can help a patient
hugely.
Check up
The easiest, quickest and cheapest test for TB the sputum test. The health worker can
learn the procedure of this test as follows -
The patient should be asked to
1. Rinse the mouth to remove food particular
2 Cup the hands over the mouth.
3. Take a deep breath
4. Cough out a sufficient quantity of phlegm for testing
5. Spit it into the sputum cup for the test
dz
The method of testing sputum
1. Spread some sputum on a glass slide and dry it on the flame of a spirit lamp.
2. Drop a little Carbol Fuschm on it and dry it again over the flame. Keep it aside
for about 5 minutes to cool.
3. Add some drops of alcohol and keep for 30 seconds. Wash the slide with water.
4. Put a few drops of blue Methyl. After 30 seconds, wash it again with water.
5. Dry the slide in the sun to get it ready for examination. If it displays reddish rod
shaped tubercule bacilli, the slide shows infection
When the sputum test is positive, the patient should be sent immediately for treatment
in the primary health centre. The greater the no. of bacteria seen, the stronger the infection
will be.
The national TB control programme was evaluated in 1992. The problems given earlier
were discussed during this. The WHO finalised a new programme to control TB. According
to the new method of treatment DOTS, (directly observed treatment for a short period ),
the medicine has to be taken in the presence of the health worker.
As per the Government Program for TB that has been introduced since 1992 the following
are the most important aspects that you need to remember:
•
Diagnosis is primarily and in the first instance on the basis of sputum examination (three
sputum samples on two days).
•
Patients are assured a full course of drugs as a whole set of drugs for the whole course
is kept aside for each patient.
•
The monitoring of treatment is by regular sputum examinations during the treatment period.
•
Treatment is directly observed - which means that the patient swallows the tablets in
front of a DOTS provider who is usually health worker or a responsible member of the
community of the patients choice.
Side effects that need immedicate referral
•
If a patient develops jaundice after starting treatment she / he must stop all the tablets
at once and go to the doctor immediately.
•
If the patient develops itching / abdominal pain and vomiting without jaundice he / she
needs to be referred to the doctor.
•
If the patient develops tingling sensation over the hands and feet he needs to go to
the doctor
r^i
•
In case the patient develops any other symptoms that started after the beginning of treatment
•
he needs to be refferred.
A general rule is that most side-effects require only the temporary stopping of drugs
or the introduction of alternative drugs. There is never the need to completely stop treatment
due to side-effects.
Counselling a lung TB suspect
•
Whenever one has cough for more than 3 weeks there is a high likelyhood of it being
•
TB.
TB is no more the dreaded disease it once was considered to be thanks to the very
effective treatment that is now available free of cost at all government hospitals.
•
The diagnosis of TB is simply achieved by giving 3 samples of our sputum.
•
•
The drugs are very effective in curing the disease.
While the whole treatment is long drawn symptomatic relief occurs in about 2-3 weeks.
•
Early detection and prompt treatment.
DOTS is conducted at 2 levels. At the intensive level, the patient has to take the 9
medicines thrice a week for 2 to 3 months infront of the health worker.
The second one is the regular level of 4 to 5 months when the patient takes the medicine
every week. The sputum test is conducted from time to time during the treatment as follows:
1.
Before the first level of treatment (3 samples)
2.
Just between the two levels of treatment (3 samples)
3.
At the end of the treatment
If the sputum test reveals bacteria again, the patient is treated by consulting the doctor.
After the programme was started, the Social Health Centre tried to find out the difficulties
in this method of treatment.
Main difficulties
1
Visiting the primary health centre frequently is costly and tiring. It disrupts employment.
If relatives need to accompany the patient, the frequent visits become even more expensive.
Treatment
Dots is still conducted in certain districts of the country. Only time will tell how useful
it is.
There have been good results from many areas 7 he medicines recommended at the
start are continued in DOTS Only its duration and combination varies. You can get details
59~]
from doctors at the primary health centre.
Since TB is a contagions disease, all Indians are threatened by it till it is totally eradicated
Collective Participation to prevent TB
Information about the disease must be spread in order to control it. Only when all the
members of the public will contribute, the disease be brought under control.
Spread of TB
TB is not hereditary. It spreads from one person to another. A patient suffering from
it gives out numerous bacteria through his coughing, which enter the bodies of the sur
rounding people through breathing.
How can we prevent the spread of TB?
1. To avoid the spreading of TB, the patient must begin treatment immediately. The treat
ment must be continued as long as recommended by the doctor. The patient must be
given medicines for a minimum of 6 months to 1 year. Within days of treatment the
coughing and spit will be reduced, so will the no. of bacteria in the sputum.
2.
The phlegm spit out while coughing should be kept in a container with Lysol. It should
either be burnt or poured out into the lavatory and the tin buried.
3. The TB patient must have a well-ventilated room. Fresh air will reduce the no. of germs
in the room.
Prevention through BCG
BCG is s cheaper, safe and more effective means of controlling TB than its treatment.
Since infection can occur at a young age, infants should be given BCG at the earliest.
Although, there are different opinions about. Continuing BCG, at present it is given because
it also helps to control leprosy.
Vaccination of BCG
It is given through injection. After about 8 weeks, a little swelling appears at the point.
The area of vaccination on the body should neither be covered nor be exposed to direct
sunlight.
The Cycle of TB
People who are continuously in close contact with TB patients for long can get the disease
rsoi
Children normally do not develop any symptoms in the primary stages of TB. They may
then go into the next stage which may be dangerous and even fatal. If treated on tome,
children can remain healthy and grow normally.
The third stage is often found among adults, particularly among those who become very
weak due to poverty. The bacteria lying inert in the lungs of such people become active
and even infect the people around. They can be cured by treatment but die if left-untreated.
Control of TB- 3 types of care
1. All the children must be given BCG to prevent infection.
2. TB patients must be identified for treatment. A person with cough for more than 15 days
must get a sputum test done.
3.
Spread awareness about the disease and its prevention in all parts of a town/village.
Counselling of a diagnosed patient
•
TB is no more the dreaded disease it once was as there is now a very effective cure
that is easily and freely available at all government centers.
•
It is however important to note that the drugs are effective only if the course is taken
completely as per the instructions of the doctor.
•
There are many tablets to take in the beginning and all of them have to be taken together.
This is quite inconvenient but to be effective they have to be taken this way. After the
initial few months the total number of tablets will be reduced.
«
The tablets are to be taken on 3 days of the week - make a regular schedule for this
and follow it without a break.
•
If there are any side-effects do not fail to go to the doctor who will treat these side
effects effectively. There is almost no need to totally discontinue treatment due to side
effects.
•
If there is jaundice this needs to be reported immediately.
•
You need to give your sputum for checking if the infection is cured at regular intervals
during the treatment.
•
You will get better after the first 3 weeks or so of the treatment - please do not stop
the treatment as the full course is essential for complete cure.
Who discontinues
•
TB is no more the dreaded disease it once was as there is now a very effective cure
that is easily and freely available at all government centers.
•
It is however important to note that the drugs are effective only if the course is taken
completely as per the instructions of the doctor
61
.
There are many tablets to take in the beginning and all of them have to be taken together
This is quite inconvenient but to be effective they have to be taken this way. After the
.
initial few months the total number of tablets will be reduced
If you do not complete the regular treatment the bacteria becomes used to the drugs
•
and the usual drugs then become ineffective.
Once this happens then only treatment with a completely different set of drugs for nearly
•
1-2 years will be effective.
How ever long you have stopped the treatment you should go back to the doctor and
restart the treatment.
•
This is important not only for you but also so that the infection is not spread to others
in the house and community.
Disposal of sputum
•
The ideal is to collect sputum in a cup and burn or bury it deep in the soil
Self-study
1. Which condition of a patient is favourable to attacks by the microbacteruim tubercule
2.
which causes TB?
How many TB patients are there in your village?
3.
Conduct a monthly survey about the amount of different medicines for TB they are required
How will you find out?
everyday from your primary health centre.
4. Present a skit to give people information about TB
5. Explain how the TB patients of your village can be encouraged to take their medicines
6.
regularly.
Write sequentially how you collected the phlegm of a TB patient.
Treatment
Treatment Regimen is the plan by a which a TB patient is treated with more than 2
medicines in combination for a long time. This strengthens the fight against the microbes
successfully.
62
Your responsibility as a health worker is as follows
•
The patient must be made to understand the need to take the medicines regularly
and on time.
•
Explain to the family how necessary it is to take medicines continuously.
•
Encourage the patient to take his prescribed dose.
•
Ensure that medicines are regularly available at the primary health centres
•
Make the family members understand the greater need for the patient to have
protein.
• TB can be cured and prevented. Yet it is one of the fatal diseases afflicting. India
specially among the poor and undernourished.
63
Exercises
Fill the blanks
(Protein-rich diet/Pollution free air), Bacteria, (Poverty/Mal-nutrition), (Myco bacteria tubercule),
TB (due to the phlegm from cough or sneezes of TB patients,),
BCG
1. TB is caused by.
is the bacteria which causes TB.
2.
3. TB spreads due to.
is the vaccination to control TB.
4.
5. If antibiotics cannot cure cough after 15 days, the patient is likely to suffer from
lead to TB.
6.
7. Along with medicine, a TB patient needs
and
Match the correct pairs
1. The microbes of TB
1. Prevents TB
2. BCG
2. Rod-shaped
3. Rifampicin
3. Problem of spinal cord
4. INH
4. Medicine taken on an empty stomach
5. TB
5. No. of microbes
6. Sputum Test
6. Infectious disease
Choose the correct alternatives
1. The National TB Control Programmer was reviewed in the year
1. 1991
2. 1992
3. 1987
4. 1986
2. Dots stands for
1. Taking medicine preventing TB
2. Completing the dose preventing TB
3. Testing for TB
4. Taking the medicine in front of the health worker
3. What kind of a disease is TB?
1. Hereditary
2. Non-infectious
3. Contagions
4 All above
64
4
Which is tested for TB?
1. Blood
2. Sputum
3. Urine
4. Skin
5. A TB patient must complete the recommended dose till the end so that
1. The disease is cured
2. Medicines fight against bacteria
3. Discontinuing medicine mid way reactivates microbes
4. All the above factors
6. The sputum of a TB patient must be destroyed in order to
1. Reduce unhygienic conditions
2. Prevent infection through bacteria
3. Repeated cough and phlegm
4. All the above
Answers
Blanks - 1-2, 2-4, 3-6, 4-7, 5-5, 6-3,7-1.
Pairs - 1-2, 2-1, 3-4, 4-3, 5-6, 6-5
Alternatives - 1-2, 2-4, 3-3, 4-2, 5-3, 6-2
65~|
Lesson 7
Diarrhoea and Dehydration
Aims
On reading this lesson you will understand
•
What is diarhoea?
•
What are the causes and types of diarhoea?
•
The symptoms of dehydration
•
The treatment for diarhoea.
Knowledge
You will know about
•
How serious diarhoea is, specially for children.
•
Which symptoms of dehydration can be seen.
•
How can diarhoea be controlled by nutritive diet.
Skill
You will learn
•
How can diarhoea be classified?
•
How do the symptoms of diarhoea indicate its seriousness.
•
Which treatment can be given for diarhoea.
•
How is oral rehydration and ORS conducted.
Perspective
You will understand
•
The information that diarhoea can prove dangerous for children necessitates imme
diate treatment with care.
66
Introduction
Diarhoea means having loose or watery motions. They are often frequent and are seen
as some disorder related to the stomach and intestines. Diarhoea is an important public
health problem among children in developing countries. Every year 50 lakh children die due
to diarhoea (below 5 years). In other words it is fatal for 4,000 children everyday. Malnutrition
aggravates these figures, just as it leads to other illnesses too.
‘Gastro Enteritis’ is the term used when diarhoea and vomiting are the symptoms. It
may be accompanied by fever when excreta contains blood or mucous, the illness is diagnosed
Dysentery. It is more common among children below 2 years of age. Fever is found with
it. Diarhoea is risky among infants. Every year, about 20 lakh children succumb to it in
the world.
10% of child mortality is caused by diseases involving loose motions. It must be noted
that this rate is less among those less than 6 months because these infants are breast
fed, thus protected from diarrhoea. However children above 6 months, being top-fed, they
are prove to the infections of their surroundings. This is the age when they can put anything
into their mouths. Other reasons include allergy to particular food, emotional outburst or
weakness, excessive intake of raw fruit etc. The virus like E coli, salmonella and stephylococus
are responsible for the infections.
Classification of diarhoea - into 2 groups
1. Acute diarrhoea upto 14 days.
2. Long-term diarrhoea - longer than 2 weeks.
Acute diarhoea
This occurs suddenly but for about a week. The frequency of motions increases from
4 to 5 times a day till upto 30 or even 40 times in 24 hours. Rarely a patient may get
upto 100 motions! These may be light fever. Older children get diarrhoea due to different
kinds of infections. Broadly, 50% of diarhoea cases are caused by virus, mainly the Rota
Virus. The remaining half have other reasons.
1. Toxins (food poisoning)
2. Attack on internal tissues
Toxins
These are released by bacteria which reduce water and electrolytes from the lining of
the intestines
1671
Internal attack - Microbes attack internal tissues which are then given out through motions.
Long - term diarrhoea
1.
This shows a hereditary disorder that requires enzymes for digestion. This does not
cause dehydration.
2. Amoeba can also cause long-term diarhoea.
Dehydration
If new-born babies suffer from motions and vomiting, there is a shortage of water content
in the body. This condition is called dehydration.
The following symptoms are observed in this-
Either no urine or very little is passed, that too, deep yellow
There is sudden weight-loss
The mouth becomes dry
Eyes are dry
The fontanelle gets a depression.
68
Symptoms of dehydration
Critical
Medium
Mild
Irritable child
Very disturbed
Lies very dull
Normal pulse
Weak pulse
Pulse -weak, limbs cold
Normal urine
Less urine
Urine greatly reduced
Fontanelle depressed
Top of head greatly depressed
Shrunken eyes
Eyes very greatly shrunk
Drawn, dry face
Face very dry and drawn
Lining of mouth-dry
Lining of mouth very dry
Flaky lips
Lips greatly flaked
Skin less soft
Hardening of skin
Thirsty
Feeling very thirsty
Child may get comatose
100% weight loss.
[5% weight less
5-10% reduction in weight
100% weight loss
If the skin doesn't return to its
normal shape on letting go, there
is dehydration.
I
Hold the skin between 2 fingers
to test its flexibility, and pinch, pull
it slightly.
69
Diarhoea among new-born infants
A normal new-born baby has a greenish motion the first day (meconium). This continues
for 3 more days. On the 4th or 5th day, the motion turns slightly yellowish. From the 6th
day it passes yellow motions. Upto one mouth, it is normal for babies to pass semi-liquid
motions while drinking milk.
Causes for loose motions among infants
1. Misconception- Passing motions upto 5 or 6 times a day is normal in the first 4 days.
It is not an illness.
2.
Infection- Those who look after the babies may pass on their own respiratory or internal
infections to them. More often improper sterilization of bottles in case of top-fed babies
causes loose motions.
3. Medicine induced - If the nursing mother is taking ampicilin, the baby may get loose
motions.
Symptomatic of disease
The incubation period is 1 to 3 days. The child drinks less milk and becomes irritable.
The temperature may become 100° F. When diarhoea, begins, the motions are watery, yellow
and acidic (causing inflammation at the rectum). They are frequent.
Signs of risk among infants
•
Lack of appetite
•
Eyes drawn in
•
Skin turns dusky
•
Depression of top of head( Depressed Fontanelle)
•
Dullness in the infant
Treatment of Diarhoea
1. Fluids
Mild and medium dehydration can be successfully treated by giving liquids through the
mouth. The mother should be advised to give liquids available at home in a quantity such
that the infant doesn’t vomit, e.g. -tender coconut, butter-milk, salted rice soup, sherbet, mild
tea. In case of great vomiting, give 2 to 3 spoonfuls at intervals of 5 minutes. If a very
large quantity of liquid goes into the stomach at one go, it increases the activity in the
I
70
-
stomach too much, causing vomiting or motion. In case the infant is breast-fed, that should
be continued.
Oral Rehydration Treatment
A mixture can be prepared for this at home. 8 flat spoons of sugar, one flat spoon
of salt mixed with a litre of water, should be used with some lime juice if available.
Alternatively mix 3 pinches of salt with a handful of sugar in 1/2 litre of water which
is pre boiled then cooled.
ORS
In case of continued diarhoea, use the following formula recommended by WHO for
rehydration of children.
Glucose 20 gm
Nacl 3.5 gm
NaHCO4 2.5 gm
in 1 litre water
Tri Sodium Citrate 2.1 gm
Kcl 1.5 gm
Give this is small sips or spoon by spoon. A 1 year old child should get 1000 ml
in 24 hours. The shortage caused by constant motions has to be compensated after every
loose motion. Prepare ORS sufficient for 6 to 12 hours at a time, so that it doesn’t get
spoilt
Emergency Treatment
Acute dehydration can lead to death if not controlled It reduces urine and circulation.
In such conditions, intravenous fluids need to be given (IV fluids)
71
Home-Made Saline
In the absence of the doctors (unavailability) this can be used. It is a life saving saline
taken orally Readymade packets are available in the market. But these should be mixed
with a litre of boiled water after cooling it. However, the solution can also be prepared at
home with the material in the following proportion- 1 litre water, 20 gm of glucose (or 40
gm i.e., 8 spoons of sugar), 3 to 5 gms of salt (3/4 spoon or a pinch), 2.5 gms of cooking
soda (1/2 spoon or 2 pinches) and 1.5 gm of KOI if available. It should not taste saltier
than tears, lime-juice may be added for taste.
This life-saving solution is a boon for rehydration of the body. Since salt and water cannot
be absorbed by themselves, it is necessary to add some sugar. Thus the fluid balance
of the body can be maintained.
Important tips while giving life-saving solution/mixture
•
Give Redydration in spite of vomiting
•
Rehydration has some use to contain vomiting
• The water used must be clean and pure. Since sugar can cause fermentation,
a limited quantity should be made at a time.
•
1 litre solution is sufficient for a 2 years old child for 24 hours. 100 ml
more should be given after every motion continuously
f72~]
•
Children less than 1 year old should be given double the quantity of water
since the salt is too much for it.
•
Even if ready-made packets are available in the market, the solution can
be made at home immediately with the onset of motions.
•
Dehydration makes a child irritable and other symptoms are also visible.
Keep giving saline solution till the dry skin and eyes, depression of head
and drying up of tongue and mouth continues.
•
If the child drying up of tongue and mouth continues needs IV fluid admin
istration. At times it is difficult to locate the veins of a child. Also, saline
has to be given very slowly through the needle-30 ml in 1 hour. Excess
of it may cause infection leading to death.
Thus it is important to remember then home-made/ ora/ solution is safer, quicker
and more effective.
Diet
Breast-feeding should be continued during diarrhoea or vomiting. Breast-milk has a certain
amount of resistance to these disorders, saves the child from malnutrition and also controls
the damage to the digestive system faster Dehydration is also controlled to some extent.
Top-fed children should be given milk diluted with an equal quantity of water. Avoid top
milk during vomiting but give it after vomiting stops. Older children should be given liquids
like gruel or soup rather than solid food like rice, dal, chapatti. Diet must be continued
to prevent undernourishment.
731
Guiding Principles of Treatment
•
Diagnose the disease correctly and give
treatment suitable to the disease.
•
Continue the life saving rehydration solution
to compensate for dehydration.
•
In case of acute dehydration, the child must
be shown to a specialist if it doesn't show
improvement. Sometimes it is necessary
to administer Intra Venous saline to the
child.
•
Whenever there are complaints like
bleeding, mucous, pain, bad odour orfever
accompanying microbe-included diarrhoea,
some antibiotics and oral rehydration must
be started. (Cotri or Ampi, antibiotic and
metronidazole are antiamoeba/ geardia).
•
Do not give injections. They are to be used
only in case of excessive bleeding or fever
in special diseases.
•
Indigestion causes motions till the factors
responsible for it are removed. Children are
unable to eat till digestive problems persist.
•
Breast-feeding should never be
discontinued. Except in case of indigestion
children must continue to receive nutritive
diet. Light food and milk ensures this is
continued
74
Preventive Measures
1
Encourage continuing breast-feeding for as long as possible
2.
Take care that the diet is hygienic In case of top-feeding, ensure that the spoons and
bowls used are germ-free.
3.
Malnourished children easily get diarrhoea Avoid giving open or fly-interested food.
4. Avoid giving open or fly-infested food
Cleanliness of the environment is very important. The most effective way to control diarrhoea
and other infections is to provide safe drinking water. We can fulfil our aim of preventing
diarrhoea by ensuring safe drinking water to our people.
<
*
****•
c
/
>
LIU
Treatment
Since loose motions are of different types, it is necessary to find the cause Viral motions
have no particular medicine in modern science. Metronidazole should be given for amoebiasis
or Giardiasis. Worms may cause motions (but not suddenly in adults) for which Mebendazole
is given.
Always use salt water and sugar solution to compensate for dehydration caused by loose
motions.
How is this disease caused? Reasons
Microbes cause diarrhoea. They spread through the excreta of the patient (by contact
with hands, food, water or flies). The contaminated water is mainly responsible for this.
Diarrhoea among those above 5 years of age is usually caused by amoebic and bacterial
infections caused by unhygienic food/water, lack of personal cleanliness. Usually the bacterial
infections spread in the beginning of the rainy season, like outbreaks of cholera. There
is great pain when caused by bacteria. Bleeding starts after 2 or 3 motions and fever may
also afflict the patient. But in amoebic dysentery motions are dilute and often contain blood
and/or mucous. Other symptoms are gases, a sense of incomplete motion and even froth.
Giardia is another microbe that causes frothy motions, which are accompanied by a peculiar
sound which cannot be controlled.
People can be made aware of information about indigestion, diagnosis of loose motions
etc.
Diarrhoea
Other signs
& symptoms
or important
past history
Likely
Diagnosis
1. Watery
stools &
vomit, past
history of cold
i and flu
Viral
gastroenteritis
(Infective
diarrhoea)
2. Abdominal
pain.
Abdominal
cramps.
Wonns in
faeces, foul
odour from
the faces
3. Watery
stools.
' persistent,
■ recurrent
1 problem
Worm
infestation
j (Worms)
Mental stress
R e fe rral
**
Primary Health
j Care (PHC)
Household Remedies
Allopathic
treatment
i
______________________ I
* Rural Hospital
1. Salt sugar solution
in water
2. Fluid intake like
starch water, paste
made of sagao
(sabudana)
3. 6 seeds of
fenugreek in 2
spoonful curd
It will stop in 48
hours, patient
should resort to
allopathic
treatment if it does
not cease
Even after 8 hrs of
administering
allopathic treatment if
the diarrhoeal
episodes do not slop,
the patient must be
taken to PHC.
Vidanga supari
(Embelia ribes)
A course of
Salt-sugar solution
in water
2 & 3. Same as viral
gastroenteritis
4. Try to reduce
mental stress by
sharing emotional
problems with
family members
1.
What needs to be
done if the patient
does not respond to
the treatment
District
Hospital________
Other symptoms that
can be observed
during treatment
phase
1.
2.
3.
4.
5.
Lusterless eyes
Excessive thirst.
Loss of skin turgor
In case of
infants/children
depression of the
anterior fontanel.
Reduction in
urinary output
Likely diagnosis
of signs /
symptoms
Dehydration.
Mebendazole
Take the patient to
Rural Hospital if
he/she does not
respond to the
treatment.
1!
Diarrhoea
Likely
Diagnosis
Household
Remedies
Primary
Health
Care (PHC
Allopathic
treatment
4. After initial two or
three episodes of
diarrhoea mucous
discharge with no
stools, mild fever
Bacillary
dysentery
(caused due to
bacteria)
1) &2) as
above
A course of cotrimaxazole
i 5. Diarrhoea with
: abdominal colic (colicky
pain), blood & mucus in
stools, cramps in the
lower limbs. ______
I 6. Abdominal cramps,
! yellowish frothy stools
; in large quantities,
many people in the
village suffer from this
■ 7. Vomit & diarrhoea
I within or 2 hours of
; food intake, the
1 symptoms repeat on
I intake of the same food,
| 8. Rice water stool,
I severe vomiting, many
| people get affected at
I the same time.
I 9. Cramps in lower
i abdomen, intermittent
' episodes of diarrhoea &
I constipation_____
Amoebiasis
(due
amoeba)
1)&2)
same as
above
A course of
Metronidazole
Other signs &
symptoms or
important past history
to
Giardiasis (due
to
giondia)
protozoa
u
Food poisoning
(Contaminated
food)
Cholera
____________ Refe rra I
* Rural Hospital
What needs to be
done if the patient
does not respond to
the treatment
* * District
Hospital
Other symptoms that
can be observed
during treatment
______ phase
Likely diagnosis ;
of signs /
symptoms
The patient must be
taken to a PHC, if
there is no
improvement in 3
days of stunting the
course
u
u
u
Medical care
should be sought
immediately.
1)&2)
same as for
option 6)
u
Colitis
(Inflammation
of the colon
intestine)
a
[781
Exercises
Fill in the blanks
(Environmental Cleanliness) (long term) (Ampicilin) (ORS) Breastfeeding, intravenous, Meco
nium
diarrhoea doesn’t cause dehydration.
1
2. The greenish motion passed by new-born on the first day is called—
3
by a nursing mother may cause diarrhoea in the baby.
Use of
4. The WHO has formed an
formula to treat dehydration caused by
diarrhoea among children.
5. One has to resort to
while treating acute dehydration.
to save a new born infant from diarrhoea.
6. It is cheaper and easier to give
is an important measure to prevent the spread of diarrhoea.
7
Choose the correct alternatives -
1. Acute diarrhoea lasts for
days.
1.0-14 2. Oto 8 3. Oto 15 4. upto 10 days
2. Long term diarrhoea continues for
days.
1.15 2.14 3. more than 15 4. 20 days
3. The symptoms of dehydration are
1. Drying of mouth / skin
2. Less or no urine
3. Depression of top of head
4. Weight loss
5. All the above
Match the correct pairs -
1. Rota Virus
1. E-coli
2. Medium Dehydration
2. Intravenous
3. Dehydration
3. Very irritable child
4. Acute dehydration
4. Viral motions
5. Infections Diarrhoea
5. Life Saving Solution
Answers
Blanks -1 -2, 2-7, 3-3, 4-4, 5-6. 6-5, 7-1
Correct Alternatives -1 -1,2-3, 3-5
Correct pairs -1 -4, 2-3. 3-5, 4-2, 5-1
79
Part 2
Fill in the blanks
(Breast feeding) (Metronidazole) (Mebendozole) (Dysentry) (Loose motions and Vomiting)
(Diarrhoea)
1. Having watery motions is called.
2. When loose motions are accompanied by mucous, bleeding stomach-ache, it is called
and
3. The patient gets
in cholera.
4. The medicine recommended for Amoebiasis and giardiasis is
5.
6.
must be given to children having diarrhoea
is recommended when motions are caused by worms.
Answers
Blanks - 1-6, 2-4, 3-5, 4-2, 5-1, 6-3
i
80
Lesson 8
Types of Fever
Aims
On reading this lesson you will understand
•
The different types of fever.
•
Classify the types of fever according to symptoms and indications, as well as methods
of treatment.
Knowledge
You will know about
•
Symptoms and indications related to types of fever
•
The causes of fever
•
The serious signs of fever
•
Treatment according to types of fever
Skill
You will learn
•
What are the home remedies for fever?
•
Give medicines according to their proportions.
•
What care needs to be taken alongside medicines.
Perspective
You will understand
•
Fever is not a disease,
but a symptom of illness.
81
Fever
The human body generally maintains a steady body temperature. It is 37 °C or
98.4 °F when not influenced by external temperature. This occurs through a particular centre
in the brain.
The body can function properly only within the particular temperature range. For example,
if the body temperature decreases, the blood flow will not occur smoothly. If the body tem
perature increases, the blood will expand and burst blood vessels and the blood will ooze
out. The body temperature must hence remain within a particular range, even though the
external temperature varies.
Let us now see how the body accomplishes such a difficult task.
How is heat generated in the body?
The thyroid glands present near the neck control the metabolic activities of the body.
Metabolic activities occur constantly and heat is generated during these activities. The thyroid
glands induce changes in the body temperature by accelerating or decelerating the metabolic
activities.
Heat is also generated in the body by the movement of the muscles. We all have ex
perienced that we feel hot after a run or a brisk walk. The muscles contract-expand rapidly
when heat is to be generated urgently, e.g. getting goose pimples, chills, etc. Heat is generated
thus and it aids in maintaining the body temperature within its range.
How does body heat decrease?
Body heat is discharged from the body / consumed in different ways. Some of the heat
is used up for heating the consumed food or drink. It is discharged form the body through
the respiratory system. Some of it is also discharged from the body through urine, excreta
and sweat.
Maximum heat is discharged from the body when the skin comes in contact with the
surrounding environment. Body heat is mainly controlled by reducing or increasing blood
flow towards the skin, e.g. when a person has fever, blood flow towards the skin increases
and heat is discharged through the skin. When a person is feeling cold, blood flow towards
the skin decreases and the heat is trapped in the body.
Sweating reduces heat. We store water in a clay pot in the summer. The more the pot
leaks, the more the water cools. The drained water turns to vapour Heat is used while
water is being converted to vapour
82
The same process takes place when we sweat. Body heat is consumed when sweat
dries or evaporates. Body temperature decreases. You must have noticed that when you
keep cold water strips on a body of a person having fever, the strips dry within a short
time. Why would this be happening and what could its benefit be? Here, water evaporates
and body heat is consumed to evaporate this water. The fever recedes.
The temperature of a healthy body always remains within a particular temperature range.
Normal body temperature is generally considered to be 98 °F. But, in some cases it could
also be 96.5 °F or 99 °F.
It is normal for the body temperature (morning and evening) of a healthy person to vary
slightly. The temperature is highest in the evening, between 6 and 10 O’clock and is the
lowest at dawn, between 2 and 5 O’clock.
This phenomenon can be observed even during fever. Most types of fever increase in
the evenings and decrease in the mornings.
An infant’s body temperature increases if the surrounding temperature increases, e g.
body temperature rises sharply in the summer. A similar rise in body temperature is observed
after playing or walking for long periods or in case of increased movement.
All movements and functions of our body are controlled by the brain. The nervous system
is perpetually ready to help the brain in this activity. A network of nerve fibres that receive
sensation are spread everywhere in the body. They record the changes in our body. These
changes are informed to the brain in the form of impulses. This information is analysed
and inferred in the brain and the brain then sends an order to the nervous system regarding
any action to be taken, the nervous system relays it to the organ that must carry out the
action.
The brain has to oversee the functions of the entire body. This is an extremely complex
and complicated process. Hence, particular parts of the brain perform particular tasks.
The hypothalamus in the brain regulates body temperature. Sensation-receiving nerve fibres
that measure temperature are spread across the body. These nerve fibres record any
malfunctions in the body, e.g. they record a decreased temperature in case of infection.
(This does not necessarily mean that the body temperature has decreased). The brain now
tries to increase the temperature by increasing muscle movement. We call this muscle
movement as feeling cold or shivering.
This subsequently leads to fever. If the cause of fever is eliminated the temperature reading
nerves will read the temperature correctly.
83
The functions of the body are not disrupted if the body temperature increases by 5 F
or 3.5 OC, but any higher and it may cause convulsions.
Fever is not a disease but is a symptom of one. We do not have to fight the fever;
we must instead try and change the environment due to which the fever arises.
Form the medical science viewpoint, fever commonly occurs when the body is trying to
destroy the virus that is causing the infection in the body. Fever is a symptom of the fact
that the body is fighting against the virus.
In order to find out whether a person has fever or not, we can use both our hands to
compare temperatures. Keep one palm on your forehead and the other on the person’s
forehead and observe whether there is any difference in the temperatures. However, you
cannot measure the exact temperature using this method.
Regular thermometers are used for taking temperature by placing it in the mouth, the
armpit or inserting it in the rectum using a rectal thermometer for one minute.
Another important factor about fevers is that the temperature must be taken two to three
times in a day if the temperature oscillates. The disease can be diagnosed by observing
when and by how much the fever increases or decreases.
The pulse rate increases along with increasing temperature. Generally, if the fever in
creases by 1 degree Fahrenheit, the pulse rate increases by 10 per minute. Barring one
or two exceptions, this presumed pulse rate is observed in all diseases.
Why does one get fever:
The white blood corpuscles in the blood are constantly fighting against microbes. The
constituents resulting from this battle give rise to fever. There are a few more reasons of
fever, e.g. if the temperature-control-centre of the brain is injured.
It is hence not necessary to administer medicines at the onset of fever. But, treatment
to get the temperature down to normal is necessary in case of high fever that leads to
hindrances in physical functions as mentioned above. The two important points in the
treatment of fever are, ‘Getting the temperature down to normal’ and the cause of
fever.
Ask the following questions to all patients having fever.
1
Since when do you have fever?
2.
Is the fever constant, or does it occur at particular times?
3.
Do you have a cold and cough?
84
4.
5.
Do you experience pain in any part of the body?
Do you have any other complaints? Do you get a burning sensation while urinating,
diarrhoea, etc.?
6.
Have you undergone any operation, been pregnant or had an abortion in the recent
past?
Decide on type of physical examination depending on the answers to the above questions.
Treatment:
• In case of high fever, sponge the body with room temperature water; just placing water
strips on the forehead is not enough. Do not use ice water for the same.
Do not cover the patient with blankets in case of fever. Instead, remove all clothes from
the body if possible. Keep the room airy and well ventilated by opening all doors and
windows.
Give the patient lots of water and fluids to drink.
Ask the patient to take rest.
Give the patient a light diet, but do not starve him/her.
For getting the temperature down to normal
Administer juice of the coral tree leaves, 2 tsp for adults and 1 tsp for children, to the
patient thrice a day.
Administer Paracetamol tablets to adults and Paracetamol syrup to children (up to 5 years).
(Refer to the medicine carton for dosage.)
Sometimes, household remedies can also be used for getting the temperature down,
e g. giving the patient a hot decoction of cinnamon, ginger powder, cloves and pepper
corns induces sweating and the fever decreases.
Ayurveda:
There are various stages of fever. At the onset of fever, one experiences a loss of appetite.
There is a separate investigation for a fever of the definite (diagnosis) type. Administering
200 to 300 mg of Godanti mixture (Godanti and Jahar Mohara Pishti) is found to be effective.
Stop the dose as soon as the fever goes down. In case of fever at specific times with
the chills, administer 2 tablets of Chirakin or Ayush 64 thrice a day for seven days. Fever
with chills is brought under control with these tablets.
High fever is mostly brought under control with other treatments, but usually a fever of
around 99 remains constant. Administer four to eight tablets of 64 mg Guduchighanvati
Sanshamtivati three to four times in a day. Chronic fever can be cured within three to four
85~]
days with this medicine
The skin becomes dry and the body is dehydrated in chronic fever Oils of bitter medicines
are useful in this case. Administer 15-20 ml
oil on an empty stomach for four to six
days.
It is not necessary to take injections in case of ordinary fever.
Sometimes, using all your available medicines, equipment of examination and knowledge
is insufficient. In such a case, get medical help immediately.
The following would be the symptoms.
1. In case fever is higher than 105 °F.
2. In case of high fever that does not decrease even with medicines.
3. In case of fever along with vomiting and stiffness of the neck.
4. In case of convulsions, unconsciousness and fits.
5. In case of breathlessness, cramps in the stomach
6. In case of high fever within fifteen days of an operation, pregnancy or abortion.
7. Incoherent speech.
8. Acute stomach ache, tautness of the abdomen.
Fever does not only occur due to microbial infections, it can also occur due to a brain
injury, cancer, etc. It is hence necessary that medical help be taken if fever persists even
after eight days of treatment.
The people who come to you with maximum complaints would be patients. If you note
the number of patients who came to you with complaints of fever and how many had to
be sent to the doctor, you will observe that you can examine many patients having fever.
One mostly gets fever due to microbial infections. Fever is caused due to the reaction
of certain chemicals, produced due to microbial infections, on the temperature-control-centre
of the brain. The speed of the chemical processes in the body increases due to fever,
this shows that, to some extent, fever must be necessary for treating the root disease. It
is not necessary to get the temperature down in case of low fever. But the brain may be
affected in case of high fever. Some children may get convulsions due to fever.
Types of fever
Hadi fever: This fever has been named thus by mistake. When a person has low fever
for a long period, we call it ‘fever seeping into the body' or ‘Hadi fever’. A person who
is afflicted with a chronic disease, like Consumption, will permanently have a low fever.
86
Oscillating fever: Fever that rises rapidly and comes down to normal (or decreases) as
rapidly can be ascertained by asking questions to the patient. Fever with the chills comes
under the same category. In this case the patient first feels cold and then gets fever. Such
oscillating fever also exists in case of fever with ague, pneumonia, kidney infection and
in case of abscess or lumps anywhere in the body.
Constant fever: Fever that does not decrease and always remains constant can be observed
in cases of remittent fever, hepatitis, etc.
Influenza:
During the rainy season, Ganga would often get wet on her way to meet her hard-working
mother in the fields. Once she caught a chill and began shivering. Her mother gave her
a ‘kadha’ of ginger and lime boiled together.
Though she drank it everyday, she continued to get drenched in the rain. She developed
a cough. One day she got fever. She wrapped herself in a blanket and lay down. Her mother
retuned to find her breathing disturbed and chest-pain on one side. Her condition worsened
at night. Next morning she went to the primary health centre in the neighbouring village
and got medicines for her. Then she decided to get herself and a group of women from
her own village trained to give medicines to villagers.
Questions
What kind of fever do you think Ganga had?
What will you ask the patient’s relatives about?
How will you check the patient? What will you examine?
What will you diagnose after observation?
Which medicines will you recommend?
What advice will you give the family members of the patient? Give reasons.
87
Rheumatic Fever
6 years old Pradeep went to a distant village to
attend school. It was winter. One day his throat was
hoarse. He couldn’t Swallow his food. His mother gave
him a soft diet. She made him gargle with warm salted
water. Within 2 days he recovered and attended school.
In December
they had guests He ate poorees
and meat with
them-Soon he got
fever. The next day
he had a swelling on his left knee. It spread to his feet,
turning red. After some days he became well again.
Soon he started falling ill repeatedly. He had chest
pain. His mother took him to the doctor. The doctor said
that Pradeep had got rheumatic fever. It can damage
the heart. So he had to give him a penicillin injection.
Rheumatic arthritis is also known as Rheumatic fever. One comes across this serious
illness in children (5 to 15 years). First, the throat swells up due to particular bacteria (strep
tococcus). The body produces antibodies against these bacteria. It then affects the joints
and the joints swell up. It can also affect the heart. There is a swelling in the children’s
joints and heart and they get fever. This fever poses a risk to life. The complaints occur
in the following sequence: first there is throat pain, next is joint pain and then is the malfunction
of the heart’s valves. For the first few years there is intermittent throat pain and swelling
in the joints. Fever is low or medium. The swelling and pain in the joints occur mostly in
the large joints - knees, elbows, ankle, wrist, and the joints swell up one after the other.
Many joints can also pain as well as redden at the same time. Sometimes, symptoms of
lumps under the skin, pain in the joint that is not swollen can also be observed. Symptoms
like pain in the left side of the chest in case of swelling of the heart, breathlessness and
palpitations can be observed and the heart’s valves can malfunction due to frequent swelling
causing hindrances in the heart’s functioning. A malfunctioning valve necessitates an ex
pensive surgery.
88]
Things to be done in such a case 1 Suspect all patients less than 20 years of age who have fever and shifting joint pain
and swelling and refer them to a specialist.
2 The adverse effects on the heart’s valves can be avoided by beginning treatment at the
proper time. You can do the important job of sending the patient to the doctor on time.
Preventive measures -
1. This disease can be mostly found in densely populated areas and in malnourished persons.
Hence, improvement in the living conditions is the most effective preventive measure.
2 Speedy diagnosis and treatment of this disease is extremely important in preventing an
adverse effect on the heart.
Questions
1
Which financial category of society gets this disease?
2. Which age is prone to get this disease?
3. What are the damages caused by this disease?
Exercises
- Rheumatic Fever
F II in the blanks
In the beginning Pradeep had difficulty in
2
(Swallowing)
(S
After some days, fever was accompanied by the symptoms
left leg, pain & redness)
3.
Repeated pain, swelling, fever suggests infection by
4
Symptoms of
5.
6
(Bacteria).
are pain, swelling and redness of joints ( rheumatic fever)
is severely affected due to Rheumatic fever.
Penicillin injection is an
medicine (anti bacterial)
[891
Sunstroke -
Working in extremely bright sunlight for long periods can have adverse effects on the
body. These effects can be classified into two categories depending on their severity.
1. Heat exertion
This is caused by working in the sun for long periods and due to profuse sweating.
Symptoms -
The affected person becomes very weak and listless, and may sometimes experience
dizziness. When a physical examination of this person is conducted, it is observed that
his/her body is bathed in sweat. The pulse is weak but rapid. Body temperature is normal.
Treatment In such cases, the affected person must be brought in to the shade and his/her feet
must be elevated and must be given a lot of water to drink. Give this person a salty drink,
like lemon sherbet.
2. Sunstroke
Though not very common, it is very dangerous.
Symptoms -
1. In case of sunstroke, the affected person’s skin is very red and dry. Even the armpits
are not dampened with sweat.
2. The body temperature increases alarmingly.
3. The person may faint.
Treatment
In this case it is extremely important that the treatment be started as quickly as possible.
Bring the affected person in to the shade immediately.
Try to bring his/her body temperature down to normal as soon as possible. Sponge his/
her body with cold water immediately. While the temperature is coming down, get medical
help, as it is imperative that the patient get admitted to the hospital immediately and receive
treatment in this state.
A middle-aged man was out in the sun with a young boy They drank some water
and continued walking in the hot sun. The man felt uncomfortable and vomited. He got fever
90
The boy thought he had acidity and would soon get well. He took him home. His wife gave
nim some jaggery to eat before drinking cold water. But he felt giddy and swooned.
Questions
How will you treat a man in the above condition?
What will you advise to control such fever?
What problems can acidity lead to?
Which home-remedies are possible for such problems?
Self Study
Fill in the blanks
1 The man faced this problem due to
(travelling in great heat)
KI
Urinary Tract Infection
Urinary tract infections are caused due to microbes. The symptoms of this type of infection
are - feeling extremely cold and getting fever, acute pain in the sides, nausea and vomiting,
extreme weakness, feeling a need to urinate frequently, burning sensation while urinating,
smoky greyish coloured urine, sometimes, passing blood or pus through urine and foul smelling
urine. There is pain in the lower abdomen as well.
Reasons
1. In the first three months of pregnancy there is pressure on the mouth of the bladder and
some of the urine remains inside. In this case infection may occur if the catheter is not
used with care.
2. Not drinking sufficient water.
3. The genitals are not kept clean.
4. Controlling the urge to urinate for a long time instead of urinating immediately.
5. Infections through sexual intercourse.
6. Owing to diseases like kidney stone, venereal diseases, consumption, etc.
7. In case a tube is used for draining urine due to an illness or after an operation.
The abovementioned reasons may cause urinary tract infection.
The following are the household remedies for the same 1. Drinking more water
2. Drinking a sherbet made of sandalwood.
3. Drinking water to which coriander seeds and cumin seeds are added.
4. Take one entire Tribulus Terrestris plant (Gokshur) along with its roots and boil it in one
cup of water and simmer till it reduces to half a cup. Advise the patient to take this
water twice a day for seven days.
Advise the patient to visit a doctor in case of fever with the chills, side pain, blood in
the urine or vomiting, as the infection may spread to the kidneys.
Questions
x Which types of fever cause shivering? What is the characteristic feature of this symptom
of shivering during fever?
Which other conditions cause this kind of fever?
What do you recommend to those who suffer these complaints repeatedly?
Explain which other serious diseases are caused by these complaints, their symptoms
and when the patient should be sent to the doctor.
Choose correct alternatives
has the symptoms of fever after shivering, suffering during passing
1.
urine and lower backache. Infection of the
1. Respiratory Tract 2. Urinary Tract 3. Digestive system 4. Reproductive Systems
Answer
Choose correct alternatives
1
2
[~93
Jaundice (Hepatitis)
Sakharam Patil was the village chief. He was healthy
and had worked hard doing physical exercises. He often
travelled to the District Office for administrative work.
People looked after his food and drink whenever he went
there. He felt he was unaffected by outside food or water
unlike women who fell ill with change of food. However,
once he lost his appetite.
He started getting light fever and was reluctant to
walk. His wife felt he was ill and wanted him to see a
doctor. But he inter
preted this as some black magic and tried some rituals
to set his health right.
Soon he started getting stomach ache. His stools
became whitish and urine looked smoky. Some villagers
advised him to sacrifice an animal which he did with
all rituals. However his wife consulted a doctor. Sakharam
refused to meet him because he thought jaundice could
be cured by a wise villager Maske Baba. The villager
asked him to drink the juice of ‘Eranda’ (Castor) 3 times.
He also made him wear a garland of some herbs.
Sakharam also did some things at home which his wife
suggested. Within 2 months he got well again, but continued feeling weak.
What is hepatitis
This is an illness of the liver. Hepatitis is caused when the quantity of yellow bile pigments
called belurubin, which is always produced the body, in the blood increases.
Symptoms of hepatitis -
At the beginning -
A constant medium fever, exhaustion, loss of appetite, headache/
body ache, nausea, vomiting, persons who smoke bidis/cigarettes,
suddenly have no desire for them.
Later -
Yellowness (can be first observed in the eyes), deep yellow coloured
urine, pain in the right side of the abdomen (under the ribs),
sometimes, the entire body itches
94
The causes and types of hepatitis
1.
The yellow bile pigments in the blood increases if the regular functioning of the liver
slows down. This type of hepatitis is very common and the reason is the hepatitis
virus. These viruses are of five types. Of these, the 'A' and E' types are more common.
Though viral hepatitis is contagious it can be avoided with proper prevention.
. Hepatitis 'A and 'E’ spreads through contaminated food and water. When we
hear of a hepatitis epidemic, it is due to the spreading of these viruses. This
type of hepatitis is colloquially known as ‘waterborne jaundice’.
• Hepatitis ‘B’ does not spread through contaminated food or water, but through
blood. That is why it is also known as the jaundice of the blood. This is a
very rare type. This type is sexually transmitted. In some cases, ‘B’ virus is
present in the host’s blood and the host does not display any symptoms, but
others can become infected.
2.
When the red blood corpuscles are destroyed rapidly, the production of yellow bile
pigments (belurubin) increases. This type of hepatitis is frequently observed in two-
three day old infants.
3.
In case the tube carrying the yellow bile pigments from the liver is blocked, it is
accumulated in the liver and its level in the blood also increases, e.g. all symptoms
of hepatitis, except that the faeces is whitish, are observed in case of hepatitis due
to gallstones, liver cancer.
4.
Misuse of certain medicines affects the functioning of the liver adversely and hepatitis
occurs. Though this type is rare, it can be avoided by taking proper precautions while
taking medicines.
I in our country and sometimes in the form of
Hepatitis ’A and ‘E’ are commonly found
be avoided with proper preventive measures and hence, we are
an epidemic. This can L
stressing on these types while providing this information.
What to do when afflicted with hepatitis
1.
Hepatitis ‘A’ or ‘E’ is mostly cured on its own But, it may sometimes become severe
and lead to death. Hence, observe the patient closely for the first ten days and send
him/her to the doctor in case any serious symptom arises.
2. Ask the patient to take complete rest.
Keep the patient on a light and simple diet. Preferably sugared water and sugarcane
3.
juice.
95~|
4. Do not strain the already delicate liver with unnecessary medicines. The health worker
(Tai) should not prescribe any medicines unless she is a doctor. Hepatitis is not cured
with saline, tonics or injections.
5. It is best for those who consume alcohol to permanently quit drinking Alcohol must
not be consumed at all for six months after hepatitis.
6. Treat with one of the following household remedies.
A) Administer one cup of castor leaves juice on an empty stomach for 7-10 days.
B) Administer 2 spoons of aloe vera pulp on an empty stomach for 7-10 days.
Hepatitis that is observed in two or three day old infants recedes by the seventh day.
Taking the child out in the mild morning sunlight for some time is sufficient. This type does
not require treatment. Just monitor the infant closely to ensure that the hepatitis is not increasing.
When would you send the patient to the doctor?: The patient must be immediately
sent to the doctor in case the following severe symptoms are displayed.
1. In case of stupor
2. Unconsciousness
3. Distension of the stomach
4
Contracting hepatitis during pregnancy.
5. Dehydration due to excessive vomiting.
6. Discovering hepatitis in a patient who is afflicted or is being treated for another disease.
A newborn infant must be sent to a doctor in case of the following severe symptoms
• Discovering hepatitis in an infant on the day of its birth (in the first 24 hours).
• If hepatitis that is observed in two or three day old infants does not recede by
the seventh day or increases.
Preventive measures
1. Waterborne hepatitis
• Disposing excreta using the proper method. This disease can be completely
prevented by keeping the food clean and water pure and improving the standard
of living.
• If a patient of this type of hepatitis is found in our area, this disease can be
prevented from spreading by testing water wherever necessary, by educating the
public regarding water purification, cleanliness and by performing the necessary
public procedure.
96
2. Spouses of persons and children of mothers with the hepatitis ('B') virus in the blood
must be vaccinated against this disease (Hepatitis 'B') at the advice of a doctor
A) It is necessary for the doctors, nurses and health workers coming in contact with blood
to be vaccinated as a precautionary measure.
B) In order to prevent hepatitis ‘B’ it must be ensured that there are no traces of this virus
in the blood while storing it. Injection/tattoo needles must not be reused or they must
be sterilised in the proper manner before being reused. Shaving, cutting blades or shavers
must not be shared.
C) The use of condoms prevents sexually transmitted diseases. All sex workers must be
vaccinated against hepatitis ‘B’.
Questions
1. Are man healthier than women? Why? What advise might the doctor have given to
Sakharam's wife?
2.
What are the harmful effects caused by jaundice? Describe its critical symptoms.
Choose the correct alternative
1.
What was Sakharam Patil’s first complaint?
1. Lack of Appetite
3. Mild Fever
2. Restlessness
4. Fatigue
2. What kind of disease is Jaundice?
3.
1. Non-infectious
2. Hereditary
3. Infectious
4. Allergy
What is the cause of Jaundice?
1. Virus
2. Bacteria
3. Divine Curse
4. Parasite
Fill in the blanks
(Smoky/Whitish), (Change in food/water/surroundings)
1.
In Jaundice, the colour of urine is
2.
Jaundice is caused by.
Answers
Alternatives - 1-1, 2-3, 3-1
Blanks - 1-2, 2-1
and faces is
FstI
Post-Pregnancy Fever
This is the story of the wife of Lord Chhatrapati Shivaji namely Saibai. She gage birth
to two children, Sakhu and Sambhaji. After her second delivery. She became seriously ill.
She had suffered a lot during labour and started getting fever everyday.
Though Lord Shivaji tried to get the best treatment for her, the royal Vaidya couldn’t
cure her. Special prayers and rituals were also conducted, but in vain. She had excessive
white discharge, which proved fatal for her.
Following are the symptoms and indications of fever within 10 days of delivery/miscarriageshivering followed by fever, fatigue, pain in private parts and lower abdomen, redness of
face due to high temperature, deep red vaginal flow with blood clots and odours, as well
as faster pulse.
In case of insufficient cleanliness at the time of delivery, remains of placenta or membrane
in the uterus can cause fever.
A patient being treated for such fever needs complete rest. The pulse, fever and breathing
should be checked and the patient sent to the doctor, without medical treatment it may
prove fatal.
The patient must be immediately sent to the doctor in case the following severe
symptoms are displayed.
Uterus infection -
This poses a hazard to the health and must be treated immediately as otherwise the
woman may become infertile and in rare cases may also die.
Sever symptoms of uterus infection -
1. Fever with the chills.
2. Pain in the abdomen
3. Foul smelling vaginal discharge.
How can the lives of these mothers be saved —
Women must receive a nourishing and balanced diet not only during pregnancy but also
otherwise, and it is essential that the time gap between two children be increased and
that pregnant women are cared for. The public must be educated about the same. Avoiding
delays in the following three scenarios goes a long way in saving the lives of the mothers.
I
98~]
Identifying the danger signs during pregnancy, delivery and post delivery. Taking her to
the health centre in case of any danger signs. Beginning proper treatment immediately on
reaching the health centre.
Questions
1. What caused Saibai’s death according to you?
2. What are the other symptoms of this illness?
3. What questions will you ask such a patient?
4. How will you check the patient?
5. What are the reasons for this type of fever?
Fill in the blanks
(Infection during delivery) (The place and time of delivery) (When did the fever start) (Excessive
white discharge with odours) (Constant fever after delivery)
1. Saibai lost her life because of.
2. This disease may be caused by.
3- This disease may lead to.
4. Such a patient should be asked about.
Answers Blanks
1-4, 2-1, 3-3, 4-2
99
Wound Infection
Rupali was descending the hill after collecting
flowers and leaves for her herbarium with her friends.
Suddenly she stumbled over a stone and fell down. The
stone injured her foot and it started swelling
A woman over there
crushed some leaves
and applied them to her
wound. When Rupali
returned home, her foot
was paining a lot. Her
mother applied turmeric to it. The wound had become red
and hot. After 3 days she got fever and a swelling in her
groin. Feeling worried
her mother took her to the
primary health centre.
There the doctor cleaned
her wound with iodine, dressed it and gave her medicine
for 3 days. He explained that she had got fever because
of the wound.
Questions
1. What questions will you ask the patient /his or her relatives?
2. Give reasons for means/ways of checking the patient.
3. How will you diagnose the problem?
Give reasons.
4. What will you ask the patient (and his relatives) to do? Explain why?
5. Are there any home-remedies for this kind of fever in your village
Choose the best alternatives
1. Why does a fever caused by a wounded foot cause a swelling in the groin?
1. Infection 2. Swelling 3. Increasing pain 4. All above.
Correct Alternatives
1-1
100
Lesson - 9
Medicines
Name
Description
Indications
Donts
Side -Effects
Nursing
mother Diarrhoea Rash
/liver
infection.
Single nuclei WBC
1. Amoxycillin
Anti-fever
Pneumonia Sinusitis
2. B-Complex
Vitamin B rash
Dry mouth rash
3. Benzyl benzoate
Itching Antibiotic Itching Anti biotic
New born infant skin Inflammation
Membranes
with scar
4. Chloroquine
Anti malaria
Malaria
Weak-liver
5. Chlorophenyr-amine
Anti -allergic
Rhinitis, all types of rash New-born
6 Codeine
Cures dry cough Dry cough
7. Cotramoxazole
Anti bacterial
No side effect
Vomiting,
giddiness
of
eyes,
headache
change
Fatigue,
in
appetite,
reduced
eyesight, dry mouth
asthma, Constipation vomiting
Past
faster heart beat
pregnancy
large
operation,
intestine problems
diarrhoea,
Infections of Ear, nose, Pregnant or Nursing Vomiting,
restlessness
rash,
throat,
urinary tract, mother
pneumonia
Nursing
8. Ferrous Sulphate
Pregnant
Mother
9. Folic Acid
Pregnancy,
Nursing
mother, inflamed mouth
Stomach-ache
constipation
or
diarrhoea, black stools
No side effect
HA/,IE
DESCRIPTION
DESEASE
Magnesium Hydroxide
Antadd
Acidity, gastrisis
Gentian Videt
Antifungal
Vaginal fungus/infections
Mebendazole
Anti-worms
Worm-infection
Metronidazole
...... _____________ Amoebiasis, Trichomoniasis,
........................
Paracetamol
Giardiasis, bacterium \feginosis
DO NOT USE I USAGE PROHIBITED
ADVERSE / SIDE EFFECTS
Stains clothes
Pregnancy, lactating mothers, children below
Dysentry, mild headache, stomach-ache,
2 years of age
dizzyness
Pregnancy, Lactating mothers, Alcohol-drinkers
Ind gestion, rash, headache, dizzyness, metallic
damaged liver
taste in mouth
Anti-fever, Pain-reliever All types of fevers, bodyache,
uneasiness, vomiting, anaemia
Pyrantel Pamoet
Primaquine
Sabjtamd
Atropine
Anti-worms
Anti-malarial
Pregnancy, children below 1 year of age
Malaria
Pregnancy, Lactating mothers, children
Anti-Asthma
Asthma I bronchitis
dizziness, rash_________________
Palpitation, vomiting, anaemia
Thyrotroxichosis, pregnancy
Increased heart-rate, palpitation, vomiting, blocked
urine
counters toxics
______
Heart patients, elderly patients (with enlarged
dmmed vision, rapid pulse, sudden feeling of
prostate gland), disturbed vision, patient
warmth, elderly people find passing of urine
suspected of poisoning must be taken to a
cifficdt, flushing of skin
rimmidiately________________
Gamma Benzene
Scabies, itching
Hexachloride (Linden'
Chlorhexidine
Loss of appetite, vomiting, dysentry, headache.
below 1 year of age, G6PD -defidancy
c
Calamine Lotion
headache, menstrual pains
worm-infection
Do not apply on face and neck. Do not apply
If taken orally can make one uncondous
on babies below 1 year of age
Anticeptic lotion
Insect bites and stings
Do not apply on an open wound or a wounds
External application is totally safe
with ous in them____________
Anticeptic meddne
To clean boils, alcer, wound etc.
Do not mix with soap. Do not bottle. Do not
for washing hands before surgery
apply on a patient's perforated ear-drum.
Allergic rash (multiple occurrance)
for cleaning of vulva and perenium
during labour
Ispaghula
Constipation
1 Do not take dry 2 Do not give to a patient
developing sudden constipation
Rare bloating of abdomen, formation of gas
KAf.lE
DESCRIPTION
DESEASE
DO NOT USE I USAGE PROHIBITED
ADVERSE/SIDE EFFECTS
Neomycin Bacitracin
Anti-bacterial
Skin infections such as
open wounds, scabies, alcer
Oral Rehydration
Salts (ORS)
Oral Contraceptive
Pis
A mix of salt and sugar
Dehydration due to dysentry
Hormonal pills
Consult a doctor - not a
health advisor - before taking
the pill. Menstrual pains or
Pregnancy, lactating mothers, female
heart patients, smokers, jaundiced
women; women suffering from
Magnesium Hydroxide
(preventing pregnancy)
irregularity, contraception
bleeding
Tonci litis, Infectious sexual
deseases (administered by
injection)________________
Infections of respiratory
organs, Pneumonia, infection
of external respiratory
organs, bacterial dysentry,
washinghands before surgery,
for cleaning bums and wounds,
treating ringworms_________
Ringworms
People sensi tive/al lergic to penici lin
Rash; injection can sometimes bring on
severe allergicreaction
White cells, lactating mothers, renal
failure, Iodine allergy, large-scale
skin-bums, pregnancy
Dysentry, stomach-ache, gastrisis, rash,
Allergy, stained clothes
Avoid contact with eyes
Skin irritation, rash
Constipation
Do not use to treat sudden constipation.
Do not give to children below 3 years' of
age.Pregnancy, Fever
Abdominal pain / colour of stools an dunne
changing to yellowish red
Pend in
Antibiotic
ATpdn
Antibiotic
RjngAom ointment
Antifungal
Senna
Avoid contact with eyes
Rare rash
SrJphadmidine
Antibacterial
Dysentry, fever, urinary
infections with blood and mucus,
tondlitis, infection of inner
throat, skin infections________
Allergy to sulpha drugs. Do not apply
on skin. Pregnancy, lactating mothers
Gastitis, palpitation, rash, fever, joint pains.
Long term application may cause anaemia
Tetracycline
Antibiotic for eyes
Do not apply on skin
Localised skin rash
VtanvnA
vitamin
Conjunctivitis, Trachoma
(scarring of tissues inside the
eyelids) ______________
Deficiency of vitamin A,
malnutrition, measles
take proper dose in pregnancy, do not
exceed
Loss of appetite, dry skin, loss of weight'
liver irritation/damage
o
DESCRIPTION
Vitamin D
Aspirin
Vitamin
pain-reliever, anti-fever,
anti-swelling
DESEASE
DO NOT USE/USAGE PROHIBITED
Rickets in children, as per requirement
in pregnancy
Fever, body-ache, headache,
spondHisis, ostio-artheritis
ADVERSE/SIDE EFFECTS
Uneasiness, vomiting, loss of appetite,
constipation, burning sensation in kidneys
bone deformity after long-term administration
Peptic alcers, pregnancy, lactating mothers /
children below 12 years' of age
Administer carefully on asthmatic patients.
Abdominal ulcers, bleeding, stomach-ache
- Media
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