THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH AND SOCIAL WELFARE

TEACHING GUIDES FOR NATIONAL TECHNICAL

AWARDS (NTA) LEVEL 4 CURRICULUM FOR MEDICAL
LABORATORY SCHOOLS IN TANZANIA

CEDHA, ARUSHA

JULY 19 – 30, 2010

1
 GROUP PHOTOGRAPH OF THE PARTICIPANTS, FACILITATORS AND MOHSW OFFICIALS

PREPARATION OF TEACHING GUIDES FOR NTA LEVEL 4 CURRICULUM FOR MEDICAL

LABORATORY SCHOOLS, CEDHA, ARUSHA, JULY 22, 2010

Teaching Guides for NTA Level 4 MLS Curriculum Page 2

 Table of Contents

List of Abbreviations and Acronyms ..................................................................................................... 11

Acknowledgement ................................................................................................................................ 15
Foreword............................................................................................................................................... 16
Executive Summary............................................................................................................................... 17
Chapter One (SEMISTER 1) ................................................................................................................... 18
Module Code MLT04101: Basic Laboratory Equipment and Instruments............................................ 18
Session 1: Basic Laboratory Instruments and Equipments ........................................................ 19
Session 2: Microscope Practical ................................................................................................. 25
Session 3: Centrifuge Machine Use............................................................................................ 33
Session 4: Refrigerator Use ........................................................................................................ 38
Session 5: Water bath Use ......................................................................................................... 42
Session 6: Autoclave Use: .......................................................................................................... 46
Session 7: Incubator Use ............................................................................................................ 51
Session 8: Hot Air Oven Use....................................................................................................... 55
Session 9: Weighing Scales (Balances) Use ................................................................................ 58
Session10: Colorimeter Use ........................................................................................................ 61
Session 11: Use Basic Laboratory Instruments and Equipments ................................................. 65
Session 12: Performance of Basic Laboratory Instruments and Equipment ............................... 69
Session 13: Planned Preventive Maintenance for Basic Laboratory Instruments and Equipment
73
Sessions 14: Apply Procedures of Planned Preventive Maintenance for Basic Laboratory
Instruments and Equipment ............................................................................................................. 76
Session 15: Document Planned Preventive Maintenance for Basic Laboratory Equipment ....... 79
Session 16: Common Problems Encountered when Operating Basic Laboratory Equipment .... 82
Session 17: Demonstrate Methods for Solving Common Problems in Basic Laboratory
Equipment and Instruments ............................................................................................................. 86
Session 18: Document and Report Occurrences of Basic Laboratory Instruments and Equipment
90
Chapter Two (SEMISTER 1)................................................................................................................... 93
Module Code MLT04102: Elementary Structures and Functions of Human Body ............................... 93
Session 1: Major External Anatomical Features of Human Body .............................................. 94
Session 2: Organs in Different Body Cavities ........................................................................... 100
Session 3: Relationship between Cell, Tissue, Organ and System ........................................... 113

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 Session 4: Structure and Function of Epithelial Tissues ........................................................... 119
Session 5: Structure and Function of Connective Tissues........................................................ 129
Session 6: Blood and its Constituents ...................................................................................... 139
Session 7: Structure and Function of Muscle, Nervous and Bone Tissues .............................. 151
Session 8: Parts and Functions of each System ....................................................................... 163
Session 9: Upper Respiratory Tract .......................................................................................... 166
Session 10: Structure and Function of Lower Respiratory Tract ............................................... 179
Session 11: Pulmonary Ventilation ............................................................................................ 192
Session 12: External and Internal Respiration ........................................................................... 202
Session 13: Structure and Function of the Kidneys and the Nephron ....................................... 208
Session 14: Mechanism of Urine Formation .............................................................................. 220
Session 15: Introduction to the Gastrointestinal System .......................................................... 231
Session 16: Stomach, Intestines, Sensory Organs and their Functions ..................................... 244
Session 17: Accessory Organs of Digestive System.................................................................... 257
Session 18: Digestive Secretions and Digestion. ........................................................................ 271
Session 19: Carbohydrate Metabolism ...................................................................................... 278
Session 20: Lipid and Protein Metabolism ................................................................................. 287
Session 21: Introduction to Cardiovascular System ................................................................... 294
Session 22: Physiology of the Heart ........................................................................................... 304
Session 23: Structure of Blood Vessels & their Response to Injury ........................................... 312
Session 24: Blood Circulation to the Head and Neck ................................................................. 324
Session 25: Blood Circulation to the Upper Limb and Thorax ................................................... 336
Session 26: Blood Circulation to the Pelvis and Lower Limb ..................................................... 350
Session 27: Male Reproductive System ..................................................................................... 365
Session 28: Accessory Organs and Physiology of Male Reproductive System .......................... 372
Session 29: Structural Organisation of Female Reproductive System ....................................... 380
Session 30: Internal Female Reproductive Organs and Accessory Gland .................................. 390
Session 31: Introduction to Endocrine System and Hypothalamus ........................................... 401
Session 32: Pituitary Gland. ....................................................................................................... 414
Session 33: Adrenal Glands, Pancreas and Local Hormones. .................................................... 425
Session 34: Thyroid and Parathyroid Gland. .............................................................................. 436
Session 35: Sensory Organs and their Functions ....................................................................... 446
Chapter Three ..................................................................................................................................... 460
Module Code MLT04103: Laboratory Safety and Waste Management(SEMISTER 1)........................ 460

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 Session 1: Control Work Place Contamination ........................................................................ 461
Session 1B: Observe Work Place Decontamination ................................................................... 468
Session 2: Protective Gear in Laboratory ................................................................................. 471
Session 2B: Observation of Protective Gear in Laboratory ........................................................ 477
Session 3: Apply Safety Rules in Laboratory Practice .............................................................. 479
Session 3b: Observe the Safety Rules in the Clinical Laboratory ............................................... 485
Session 4: Hazards in the Laboratory ....................................................................................... 488
Session 5: Control Measures for Common Laboratory Hazards .............................................. 491
Session 6: First Aid in the Laboratory ...................................................................................... 497
Session 6b: Observe the First Aid Kit in the Clinical Laboratory ................................................ 501
Session 7: Fire Fighting in the Laboratory ................................................................................ 503
Session 8: Demonstration of Use of Fire Fighting Tools .......................................................... 508
Session 9: Sterilization in the Laboratory ................................................................................ 512
Session 10: Application of Bio-safety and Bio-security in Laboratory ....................................... 515
Session 11: Control Intentional and Unintentional Exposure to Biological Materials ............... 519
Session 12: Safety Measures when Using Laboratory Containers ............................................. 521
Session 13: Safety Measures when Using Containers in the Clinical Laboratory ...................... 525
Session 14: Safety Measures in Specimen Collection in the Clinical Laboratory ....................... 527
Session 15: Safety Measures on Specimen Preservation in the Clinical Laboratory ................. 530
Session 16: Safety Measures during Specimen Collection in the Health Setting ...................... 532
Session 17: Waste Materials from the Laboratory .................................................................... 534
Session 18: Handling Laboratory Wastes ................................................................................... 537
Session 19: Clinical Laboratory Waste Disposal ......................................................................... 540
Session 20: Containers for Waste Disposal in the Laboratory ................................................... 543
Session 21: Safety Measures on Specimen Preservation in the Clinical Laboratory ................. 546
Chapter Four ....................................................................................................................................... 549
Module Code GST04101: Customer Care and Communication Skills (SEMISTER 1) .......................... 549
Session 01: Importance of Interpersonal Relationships ............................................................ 550
Session 02: Elements of Interpersonal Relationships ................................................................ 553
Session 03: Importance of Relating Client’s Information against Request Form ...................... 557
Session 04: Importance of Attending Customers and Reasons for Prioritization According to
Problems 561
Session 05: Applying FIFO in Attending to Clients ..................................................................... 565
Session 06: Reassuring the Client about the Procedure ............................................................ 568
Session 07: Importance of Turnaround Time (TAT) ................................................................... 571

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 Session 08: Elements of Turnaround Time ................................................................................ 574
Session 09: Importance of Communication ............................................................................... 577
Session 10: Elements of Communication Process ..................................................................... 581
Session 11: Communication Methods ....................................................................................... 585
Session 12: Barriers to Effective Communication ...................................................................... 589
Session 13: Overcoming Communication Barriers..................................................................... 594
Session 14: Effective Communication Skills ............................................................................... 597
Session 15: Demonstration of Effective Communication Skills ................................................. 601
Chapter Five ........................................................................................................................................ 606
Module Code MLT04104: Professional Ethics (SEMISTER 1) .............................................................. 606
Session 1: Introduction to Ethics and Code of Professional Conduct. ..................................... 607
Session 2: Principles of Ethics and Code of Professional Conduct ........................................... 611
Session 3: Principles of Ethics and Code of Professional Conduct ........................................... 616
Session 4: Importance of Confidentiality and Privacy in Laboratory Practices ....................... 620
Session 5: Methods of Maintaining Confidentiality ................................................................. 623
Session 6: Methods of Maintaining Privacy ............................................................................. 627
Session 7: Personal Presentation and Attire ............................................................................ 629
Session 8: Health Laboratory Guidelines in Health Care Delivery ........................................... 632
Session 9: Health Laboratory Guidelines in Health Care Delivery ........................................... 637
Session 10: Use of Health Laboratory Guidelines in Health Care Delivery ................................ 641
Chapter Six .......................................................................................................................................... 645
Module Code MLT04205: Basic Laboratory Investigations ................................................................ 645
Session 1A: Module 6: Haemoglobin Estimation ....................................................................... 646
Session 1B: Module 6: Haemoglobin Estimation Practical ........................................................ 651
Session 2A: Module 6: HIV Rapid Testing................................................................................... 654
Session 2B: Module 6: HIV Rapid Testing Practical .................................................................... 659
Session 3A: Module 6: Stool Analysis ......................................................................................... 662
Session 3B: Module 6: Stool Analysis Practical .......................................................................... 667
Session 4A: Module 6: Urine Analysis ........................................................................................ 670
Session 4B: Module 6: Urine Analysis Practical ......................................................................... 677
Session 5A: Module 6: Blood Smear Examination for Parasites ................................................ 680
Session 5B: Module 6: Blood Smear for Parasites Practical ....................................................... 686
Session 6A: Module 6: Ziehl Neelsen Stain for Examination of Sputum for Mycobacterium .... 689
Session 6B: Module 6: Ziehl Neelsen Stain for Examination of Sputum for Mycobacterium
Practical 695

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 Session 7A: Module 6: Pregnancy Test ...................................................................................... 699
Session 7B: Module 6: Pregnancy Test Practical ........................................................................ 703
Session 8A: Module 6: Syphilis Rapid Testing ............................................................................ 706
Session 8B: Module 6: Syphilis Rapid Testing Practical.............................................................. 711
Session 9A: Module 6: Hepatitis Rapid Testing .......................................................................... 714
Session 9B: Module 6: Hepatitis Rapid Testing Practical ........................................................... 718
Session 10A: Module 6: Glucose Testing in Urine by Benedict’s Method ................................... 721
Session 10B: Module 6: Glucose Testing in Urine by Benedict’s Method Practical ..................... 725
Chapter Seven .................................................................................................................................... 728
Module Code MLT04106: Prevention and Control of Disease Transmissions(SEMISTER 1) .............. 728
Session 1: Common Bacteria causing Diseases (Mycobacterium and Escherichia Species) .... 729
Session 2: Common Bacteria causing Diseases (Staphylococci, Streptococci, and Treponema
species.) 733
Session 3: Common Viruses causing Diseases (HIV and Hepatitis) .......................................... 737
Session 4: Entamoeba, Giardia and Trichomonas species ....................................................... 741
Session 5: Plasmodium, Trypanasoma and Borrelia species ................................................... 747
Session 6: Taenia and Schistosoma species ............................................................................. 753
Session 7: Ascaris, Trichuris and Enterobius species ............................................................... 759
Session 8: Hookworms and Strongyloides ............................................................................... 765
Session 9: General Disease Transmission, Modes of Transmission, and Diseases Transmitted
769
Session 10: General Prevention and Control Measures of Diseases – Part I ............................. 775
Session 11: General Prevention and Control Measures of Diseases –Part II ............................. 780
Session 12: Common causes of Non Communicable Diseases and Common Conditions ......... 784
Session 1: Demonstration of Mycobacterium Tuberculosis and Mycobacterium leprae ....... 789
Session 2: Demonstration of Staphylococcus and Streptococcus and Species ....................... 790
Session 4: Part I - Demonstration of Entamoeba histolytica ................................................... 791
Session 4: Part II- Demonstration of Giardia lamblia and Trichomonas vaginalis................... 792
Session 5: Demonstration of Plasmodium, Trypanasoma and Borrelia species ...................... 793
Session 6: Part I- Demonstration of Taenia species ................................................................. 794
Session 6: Part II- Demonstration of Schistosoma species ...................................................... 795
Session 7: Demonstration of Ascaris lumbricoide, Trichuris trichiura and Enterobius
vermicularis 796
Session 8: Demonstration of Hookworms and Strongyloides stercolaris ................................ 797
Session 10: Demonstration of Sterilizing Equipment................................................................. 798

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 Session 11: Part I -Demonstration use of Personal Protective Gears (gloves, masks) .............. 799
Session 11: Part II: Demonstration use of Personal Protective Gears (gowns, coats, goggles) . 800
Chapter Eight ...................................................................................................................................... 801
Module Code MLT04207: Basic Laboratory Specimen Management ................................................ 801
Session 1: Collection of Routine Specimens ............................................................................ 802
Session 2: Demonstration (Collection of Sputum Samples) .................................................... 808
Session 3: Practice to instruct patient on collection of Urine Samples ................................... 812
Session 4: Practice to instruct patient on collection of Stool Sample ..................................... 814
Session 5: Handling of Routine Specimens .............................................................................. 816
Session 6: Collection Routine Specimens for Laboratory Investigations ................................. 821
Session 7: Demonstrations Collection of Blood Samples (Venous blood and finger prick) ..... 831
Session 8: Demonstrations Collection of Blood Samples (Finger Prick) .................................. 838
Session 9: Demonstration Collection of Routine Specimens (Heel Prick)................................ 842
Session 10: Procedures of Accessioning Specimens .................................................................. 845
Session 11: Demonstration of Laboratory Accessioning Specimens ......................................... 850
Session 12: Containers for Laboratory Investigations ............................................................... 853
Session 13: Select Containers for Laboratory Investigations ..................................................... 856
Session 14: Use Appropriate Containers in Laboratory Investigations...................................... 860
Session 15: Apply Aseptic Techniques during Specimen Collection .......................................... 864
Chapter Nine....................................................................................................................................... 869
Module Code GST04202: Basic Computer Skills and Information Management ............................... 869
Session 1: Introduction to Basic Computers and its Application ............................................. 870
Session 2: Operations of computer and software ................................................................... 877
Session 3: Enter data into a computer ..................................................................................... 880
Session 4: Categorize laboratory information ......................................................................... 883
Session 5: Tools for information collection.............................................................................. 886
Session 6: Handling and Dissemination of Laboratory Information ........................................ 888
Session 7: Apply Planned Preventive Maintenance on Computer .......................................... 891
Session 8: Demonstration on Computer parts and how to operate computer ....................... 893
Session 9: Demonstration on Entering, Editing, Saving and Retrieving Data into Computer .. 897
Session 10: Demonstration on word processor ......................................................................... 912
Session 11: Demonstration on Creating Tables in Word Processor. ......................................... 929
Session 12: Demonstration on Working with Images ................................................................ 942
Session 13: Demonstration on Printing and Managing Documents .......................................... 955

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 Session 14: Demonstration on Excel Windows Features ........................................................... 965
Session 15: Demonstration on Creating Formulas in Excel ....................................................... 989
Session 16: Demonstration on Dealing with Excel Cells .......................................................... 1011
Session 17: Demonstration on Charts in Excel......................................................................... 1031
Session 18: Demonstration on Printing Management for Excel .............................................. 1054
Session 19: Demonstration on PowerPoint Basics .................................................................. 1066
Session 20: Demonstration on Enhancing Power Point Presentation ..................................... 1094
Session 21: Demonstration on Creating a PowerPoint Slide Show ......................................... 1121
Session 22: Demonstration on Internet, Web and Computer Communications ..................... 1141
Session 23: Demonstration on Computer Prevention and Maintenance ................................ 1155
Chapter Ten ...................................................................................................................................... 1167
Module Code MLT04208: Occurrence Management and Record Keeping ...................................... 1167
Session 1: Laboratory Accidents ............................................................................................ 1168
Session 2: Post Exposure Prophylaxis (PEP) ........................................................................... 1174
Session 3: Biosafety and Biosecurity Guidelines in the Laboratory ....................................... 1178
Session 4: Importance of Record Keeping in the Laboratory ................................................ 1183
Session 5: Types of Record Keeping in the Laboratory .......................................................... 1186
Session 6: Methods of Record Keeping ................................................................................. 1189
Session 7: Maintain Records of Collected Specimen ............................................................. 1200
Session 8: Planned Preventive Maintenance for Basic Laboratory Equipments ................... 1203
Session 9: Documentation and Reporting Occurrences of Laboratory Instruments ............. 1206
Chapter Eleven ................................................................................................................................. 1209
Module Code MLT04209: Preparation of Basic Laboratory Reagents and Solutions ....................... 1209
Session 01: Dilution Methods for Antiseptics and Disinfectants ............................................. 1210
Session 02: Application of Laboratory Mathematics to Determine Concentration................. 1215
Session 03: Ingredients for Preparing Antiseptics and Disinfectants ...................................... 1221
Session 04: Demonstration of the Preparation of 70% Methylated Spirits, 10% Bleach and 5%
Lysol Disinfectants ........................................................................................................................ 1225
Session 05: Preparation of Antiseptics and Disinfectants ....................................................... 1230
Session 06: Demonstrate the Application of Antiseptics and Disinfectants ............................ 1232
Session 07 Apparatus and Materials Needed for Preparation of Basic Laboratory Reagent . 1237
Session 08: Introduction to Weighing Basic Reagents and Solutions ...................................... 1242
Session 09: Dissolution and Mixing of Solutions and Reagents for Laboratory Use................ 1246
Session 10: Containers, Labels and Storage of Basic Reagents and Solutions ......................... 1249
Session 11: Description of Testing for Quality of Reagents and Solutions .............................. 1253

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 Session 12: Describe Basic Reagents for Parasitological Testing ............................................. 1257
Session 13: Materials for Microbiology Reagents and Solutions ............................................. 1261
Session 14: Materials for Basic Haematology and Blood Transfusion Reagent and Solution
Preparation 1265
Session 15: Materials for Clinical Chemistry Reagent and Solution Preparation .................... 1269
Session 16: Prepare Saline and Formal Saline Solutions for Parasitology ............................... 1274
Session 17: Prepare Solutions for Ziehl Neelsen Stain............................................................. 1278
Session 18: Preparation of Solutions for Ziehl Neelsen Stain for Clinical Laboratory ............. 1283
Session 19: Prepare Solutions for White Blood Cell Count and Urine Protein ........................ 1287
Session 20: Prepare Field Stain for Blood Parasite Examination ............................................. 1291
Session 21: Prepare Giemsa Stain for Blood Parasite Examination ......................................... 1296
Session 22: Prepare Iodine and Eosin Stains for Parasitology Testing..................................... 1299
Session 23: Prepare Basic Reagents for Parasitology for Clinical Laboratory .......................... 1303
Session 24: Prepare Basic Laboratory Reagent for Ziehl Neelsen Staining in Microbiology ... 1306
Session 25: Prepare Wayson’s Reagents for Microbiology...................................................... 1310
Session 26: Prepare Basic Reagents for Haematolology, Blood Transfusion and Clinical
Chemistry 1314
Session 27: Quality of Laboratory Reagents and Solutions ..................................................... 1319
Session 28: Standardization of Parasitology and Microbiology Reagents and Solutions with
Validation Procedures ................................................................................................................... 1325
Session 29: Documentation of Validated Reagents and Solutions .......................................... 1329
Session 30: Standardize Haematology and Clinical Chemistry Reagents and Solutions with
Validation Procedures ................................................................................................................... 1333
Session 31: Methods of Storing Reagents and Solutions ......................................................... 1338
Session 32: Storage Procedures for Laboratory Reagents and Solutions ................................ 1345
Session 33: Document Storage of Laboratory Reagents and Solution .................................... 1350
List of Participants............................................................................................................................. 1353

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LIST OF ABBREVIATIONS AND
ACRONYMS
µg microgram
µL microlitre
ACE Angiotensin Converting Enzyme.
ACh Acetycholine
ACTH Adrenocorticotrophic Hormone
ADH Antidiuretic hormone
ADP adenosine diphosphate
AFB Acid Fast Bacillus
AHF Antihemophilic factor
AHG antihemophilic globulin
AIDS Acquired immunodeficiency syndrome
ALL acute lymphoblastic leukaemia
AMREF African Medical and Research Foundation
ANH Atrial natriuretic hormone
ANS Autonomic Nervous System
ASCP American Society for Clinical Pathology
ATM Automated Teller Machine
ATP adenosine triphosphate
AV Atrioventricular
AVN Atrioventricular node.
BHP Blood Hydrostatic pressure
BOP Blood osmotic pressure
C4 cervical 4
Ca2+ calcium ions
CCK Cholecystokinin
CD Compact Disk
CD4 Cluster of differentiation
CDC Centres for Disease Control and Prevention
CEDHA Centre for Education Development in Health Arusha
CHO Carbohydrates
Cl- hloride ions
CN X Cranial Nerve 10
CN Cranial Nerves
CNS Central Nervous System.
CO Cardiac output
CO2 Carbon dioxide
CRH Corticotrophin Releasing Hormone
CSF Cerebral Spinal Fluid
DDT Dichlorodiphenyltrichloroethane
DHEA Dehydroepiandrosterone
DHL Deputy Head of Laboratory

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dL decilitre
DNA Deoxyribonucleic acid
DVD Digital Versatile Disk
ECF Extracellular Fluid
ECG Electrocardiogram
ELISA Enzyme-linked immunosorbent assay
EPO Erythropoietin
Eq Equivalent
EQA External Quality Assessment
ER endoplasmic reticulum
ERV Expiratory reserve volume
EZ Eastern zone
F Female
Fe3+ ferric ions
FIFO First In, First Out
FILO First In, Last Out
FSH Follicle Stimulating Hormone
g/mL gram per millilitre
GFR glomerular filtration rate
GH Growth hormone
GI gastrointestinal
Hb Haemoglobin
HBV Hepatitis B virus
HCL Hydrochloric acid
HCO3- bicarbonate ions
HCV Hepatitis C virus
HDL High Density Lipoprotein
HIV Human immunodeficiency virus
HLATC Health Laboratory Assistants Training College
HLS Head Laboratory Services
HPO4-2 phosphate ions
ICF Intracellular Fluid
IDSR Integrated Disease Surveillance Response
IFHP Interstitial fluid hydrostatic pressure
IFOP Interstitial fluid osmotic pressure
IGF1 Insulin Growth Factor one.
IJV Internal jugular vein
IQC Internal Quality Control
IRV Inspiratory reverse volume
ISBT International Society of Blood Transfusion
ISF Interstitial Fluid
ISO International Standard Organization
IT Information Technology
ITNs Insecticide Treated Nets
K+ potassium
L Litre
L4 Lumbar 4
LBB Left bundle branch

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LCD Liquid Crystal Display
LDL Low-Density-Lipoprotein
LH Lutenizing Hormone
LIMS Laboratory Information Management System
LLQ Left Lower Quadrant
LUQ Left Upper Quadrant
M Male
MDG Millennium Development goals
mL Millilitre
MMH Mnazi Mmoja Hospital (Zanzibar)
MOHSW Ministry of Health and Social Welfare
MSH Melanocyte Stimulating Hormone
MUHAS Muhimbili University of Health and Allied Sciences
Na+ sodium ions
NaCL Sodium chloride
NBTS National Blood Transfusion Services
ng nanogram
NHLQATC National Health Laboratory Quality Assurance and Training Centre
NK cells Natural Killer Cells
nL nanolitre
NOS Nitric Oxide Synthetase
NTA National Technical Awards
O2 Oxygen
OPD Out-patient department
OVLT Organus Vasculosum of the Lamina.
PCO2 Partial Pressure carbon dioxide
PCR Polymerase chain reaction
PEP Post exposure prophylaxis
pg picogram
pH potential of hydrogen ions
PHC Primary Health Care
PI Process Improvement
pL picolitre
PNS Peripheral Nervous System
PO2 Partial pressure oxygen
pOH potential of hydroxyl
POLT Programme Officer Laboratory Training
PP Pancreatic Polypeptide
PPE Personal Protective Equipment
PPM Planned preventive maintenance
PRL Prolactin Releasing Hormone
PTA Plasma thromboplastin antecedent,
PTH Parathyroid Hormone.
QAS Quality Assurance
RA Right atrium
RBB Right bundle branch
RBC Red blood cells
Rh Rhesus

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RHLPC Registrar Health Laboratory Practitioners’ Council
RLQ Right Lower Quadrant
RNA Ribonucleic acid
RUCO Ruaha University College
RUQ Right Upper Quadrant
SA Sinoatrial node
SAN Sinoatrial node
SCM Sternocleidomastoid.
SCP Specimen collection point
SFO Subfornical Organ
SL Semilunar
SMLS School of Medical Laboratory Sciences
SOPs Standard Operating Procedures
SV Stroke volume
TAT Turnaround Time
TB Tuberculosis
TDV Tanzania Development Vision 2025
TRH Thyroid Releasing Hormone.
tRNA Transfer RNA
TSH Thyroid stimulating hormone
TV Television
TV Tidal volume
UTI Urinary Tract Infection
V/V Volume for volume
VCD Video Compact Disk
VLDL Very-Low-Density lipoprotein
W/V Weight for volume
W/W Weight for weight
WHO World Health Organization
ZNZ Zanzibar

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 ACKNOWLEDGEMENT
The development of these Teaching Guides for National Technical Awards Level 4 for the
Competence-Based curriculum for Medical Laboratory Sciences has been accomplished through
involvement of different partners and stakeholders.

Special thanks go to the American Society for Clinical Pathology (ASCP) for funding the
activity and participants’ employers for allowing the team members to participate in the review.

I wish also to take this opportunity to acknowledge the Diagnostic Services Section in the
Hospital Services Department for their tireless efforts in looking for the funds and their
participation in this exercise.

Likewise, I do recognise great ideas and contributions by consultants from ASCP, CDC (Centre
for Disease Control and Prevention), AMREF, CEDHA, Muhimbili University of Health and
Allied Sciences (MUHAS) – School of Medical Laboratory Sciences from: Muhimbili, Singida,
Nkinga, Ruaha University College (RUCO), Mvumi, College of Health Sciences Zanzibar; and
Mt. Meru Regional Hospital, Arusha, Singida Regional Hospital and staff from the Diagnostic
Services Section, MOHSW

The list of those who contributed to this great job is too long to be registered here. The Human
Resources Development Directorate and the Ministry of Health and Social Welfare (MOHSW)
as a whole therefore wishes to take this opportunity to thank all those who actively took part in
these teaching guides for the betterment of health services development in Tanzania.

Last but not the least; the MOHSW would like to thank Mr. David Ocheng for compiling,
formatting, setting and arrangement of this document

Dr. B. Mwamasage
Assistant Director – Allied Health Training

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 FOREWORD
The MOHSW is committed to provide comprehensive access to quality health services for all
Tanzanians in line with the Tanzania Development Vision 2025 (TDV2025) and Millennium
Development goals (MDGs)

In order to attain these goals, the MOHSW established PHC Development Programme.
Among the strategies laid down in this programme is the human development to meet the
human resource demand for health and a balanced skill mix.

In order to achieve the goal, the MOHSW with support from ASCP organised a laboratory
experts workshop to prepare the Teaching Guide for NTA Level 4 Curriculum for Medical
Laboratory Schools in The United Republic of Tanzania. Members of the workshop were:
1. Vincent Y. Mgaya, HLS & RHLPC, MOHSW
2. Mwanaisha H. Jumbe, Principal, Laboratory School, Zanzibar
3. Asmaa H. Nassoro, Laboratory Technologist, MMH - Zanzibar
4. Thomson J. Mhema, Vice Principal, Mvumi Laboratory School
5. Colman P. Msuya, Principal, SMLS Muhimbili
6. Manase A. Nsunza, Principal, Singida School of Laboratory
7. Peter M. Kusuhibwa, Principal, Nkinga School of Laboratory
8. Sostenes D. Ntambuto, Tutor, SMLS Muhimbili
9. David Ocheng, Project Manager, AMREF
10. Dr. Khalidi Msangi, Medical Doctor, Singida Regional Hospital
11. Nestory Bukuru, Head of Laboratory School, Ruaha University, Iringa
12. John A. Mpiluka, Tutor, Mvumi Clinical Officers’ Training School
13. N. A. Towo, Quality System Officer, NBTS – Eastern Zone, Dar es Salaam
14. Fildorin Msami, Laboratory Technologist, Mt. Meru Regional Hospital, Arusha
15. Karen A. Brown, Consultant, ASCP, USA
16. Kay Harris, Consultant, ASCP, USA
17. Wendy Arneson, Consultant, ASCP, USA
18. Dickson M. Majige, POLT, MOHSW
19. Peter A. Mburah, POLT, MOHSW
20. Gamaliel Kisyombe, National Quality Systems Officer, MOHSW
21. Godfrey Hongoli, Laboratory Scientist, MUHAS
22. James Mwesiga, Tutor, CEDHA
23. Jackson Shayo, IT, CEDHA

The MOHSW hopes that these teaching guides for NTA level 4 curriculum will enable
tutors in our health laboratory training schools to effectively deliver the competence based
curriculum developed by the MOHSW for this level.

Dr. G. Mliga
Director, Human Resource and Development

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 EXECUTIVE SUMMARY
The development of this Teaching Guide for NTA Level 4 Certificate Curriculum in
Health Laboratory Sciences, is a result of collaborative efforts, between the Human
Resource and Curative Services Departments of the Ministry of Health and Social
Welfare (MOHSW), Centre for Disease Control and Prevention (CDC) and the
American Society for Clinical Pathology (SCP) under guidance of the National
Council for Technical Education (NACTE). Also Tutors from some Certificate and
Diploma Training Schools in Health Laboratory Sciences were involved. The
teaching guide was developed after successful reviews of both Certificate and
Diploma curricula which were required to be line with NACTE Competence Based
Standards and format.

This Teaching Guide is intended to be used by Tutors of NTA level 4 Certificate

Curriculum in Health Laboratory Science Training Schools. The aim is to establish
common teaching standards at all schools that ensures production of competent NTA
level 4 Graduates.
The Teaching Guide comprises a total of 11 Chapters that are spread over two
semesters. Each semester has 15 weeks which includes class study and clinical
practice. Students will be required to work in clinical areas under supervision as an
important learning method and gaining hands on experience in the provision of
Medical Laboratory Services as well as patient/client management and care. They will
write reports using practical/skill books noting clearly what they will have learnt in
their clinical practice. The chapters in this Teaching Guide are as follows: Chapter
One Basic Laboratory Instrumentation, Chapter Two Elementary Structure and
Functions of Human Body, Chapter Three Laboratory Safety and Waste Management,
Chapter Four Customer Care and Communication Skills, Chapter Five Professional
Ethics, Chapter Six Prevention and Control of Diseases Transmission, Chapter Seven
Basic Laboratory Investigation, Chapter Eight Basic Laboratory Specimen
Management, Chapter Nine Basic Computer Skills and Information Management,
Chapter Ten Occurrence Management and Record Keeping and Chapter Eleven
Preparation of Basic Laboratory Reagents and Solutions.
It is our sincere hope that this Guideline is useful in developing the necessary skills and
knowledge expected of the NTA level 4 Certificate Graduates in Health Laboratory
Sciences.

Teaching Guides for NTA Level 4 MLS Curriculum Page 17

 CHAPTER ONE

MODULE CODE MLT04101:

BASIC LABORATORY
EQUIPMENT AND
INSTRUMENTS

Teaching Guides for NTA Level 4 MLS Curriculum Page 18

Session 1: Basic Laboratory Instruments
and Equipments
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 360 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define basic laboratory Instrument and Equipment and limitation
 List basic Instruments and Equipments
 Discuss importance of Laboratory Instruments and Equipments
 Describe proper use and care of each Instrument and Equipment
 Explain limitation of each Instrument and Equipment

 .

Step 2: Definitions of Terms (10 Minutes)

 Basic Laboratory Equipments and Instruments:
 Equipments are set of tools or devices used for a particular purpose in the Laboratory
 Instruments are tools or measuring devices used for precision work in laboratory
 Equipments and instruments above have same function and purpose
 Limitation of instrument and equipment is a maximum capacity of equipment function

ACTIVITY:
ASK the student to buzz in pairs and allow them to answer the following questions
Define the following terms:
 Laboratory equipment
 Laboratory instrument

Step 3: List of Laboratory Instruments/Equipments (20 minutes)

 Equipments: Microscopes, Centrifuges, Refrigerators, General balances, Water baths,
Incubators, Ovens, Sterilizers (Autoclave), Colorimeter
 Instruments: Wares (glassware and plastic ware) e.g. Flasks, Beakers, Measuring
cylinders, Glass slide,
 Describe Funnels, Pipettes and Test tubes etc.

Step 4: Importance of instruments and Equipment (60 minutes)

 To run the laboratory procedures smoothly and accurate
 To reduce contamination, infections in the laboratory to workers and clients

Teaching Guides for NTA Level 4 MLS Curriculum Page 19

 To improve the laboratory services to patients

Step 5: Proper use and care of each instrument/ equipment (180 minutes)
 Microscope:
o Proper use and care of microscope:
 Always follow the manufacturer’s instruction
 Connect to the power supply, and switch on the light in case of using light source
microscope
 Adjust the eyepiece until both eyes fill comfortably
 Centre the condenser
 Clean and dry the underneath of glass slide by wiping with cotton gauze
 Rotate the nosepiece so the lowest objective is in position
 Place the slide carefully on the stage
 Adjust the illumination
 Focus the specimen by racking the stage carefully upward with x10 objective in
position
 After examination lower the stage or swing the lowest power objective into
position before removing the slide
 Wipe oil from x100 objective and microscope stage using a piece of cotton
 Switch off the microscope and disconnect from the power source
 Clean the lenses with lens tissue and not a cloth or ordinary paper. Do not use
Methanol
 Use a mild soap solution to remove heavy contamination. Never use acetone
 Cover the instrument after use
 Place the microscope in a small cabinet or cupboard
 Protect the microscope from power surges using a voltage stabilizer

 Centrifuge Machines:
o Proper use and care of Centrifuge Machine:
 Always follow the manufacturer’s manual
 Close the lid of the centrifuge
 Connect the centrifuge to the proper power supply
 Start the motor and increase the speed by turning the speed control knob slowly
until the required speed is reached
 Stop the motor after required time, or the centrifuge automatically switches off
 Allow the centrifuge to slow down and stop gradually by itself
 Disconnect the equipment from the power source at the end of the day work
 Remove blood spots or other material splashed on the bowl with suitable
disinfectant 5% Lysol, 2% Glutaraldehyde or 70% methanol
 Cover the instrument after use
 Protect the centrifuge from power surges using a voltage stabilizer

 Refrigerator:
o Proper use and care of microscope:
 Always follow the manufacturer’s manual
 Place the refrigerator away from the wall so that air can flow past the condenser at
the back
 The door must seal perfectly to prevent warm air entering the cooling chamber

Teaching Guides for NTA Level 4 MLS Curriculum Page 20

  Set the correct temperature (2 – 8oC)
 Open and close the door gently to avoid disturbing the contents
 Do not open the door immediately after closing
 Categorize different laboratory items and store them separately
 Clean the refrigerator regularly and defrost the freezer compartment monthly
 Wash the gasket (rubber lining the door) with soap and water
 Remove dirty and dust from the coils and condenser using a soft brush
 If there has been contamination of the refrigerator compartment disinfect with
70% methanol

 General balances:
o Proper use and care of weighing scale / balances:
 Always follow the manufacturer’s manual
 Place a piece of filter paper on the pan, if a hygroscopic reagent use a glass or
plastic container
 Slide the weights on the beam to set the balance to the required weight of the
chemical
 Place the chemical on a filter paper using spatula, add the chemical slowly and
carefully as the pointer reaches zero
 Remove the chemical from the pan and place it in a container for reagent
preparation
 Turn the dial knob to zero
 Clean any spilt chemicals with dry gauze
 Keep the weighing scale clean at all time, and cover when not in use
 Check the weighing balance weekly using a known calibration weight to detect
early drift
 Lock the instrument in a cupboard

 Water bath
o Proper use and care of water bath:
 Always follow the manufacturer’s manual
 Ensure the water is above the heating rib
 Connect the unit to the mains power supply
 Set the temperature control to the desired temperature
 Switch on the main switch
 Incubate open tubes (containers) in the water bath with the lid open to avoid
contamination
 Close the lid of the water bath when not in use
 Always set correct temperatures
 Use distilled water or rain water in the water bath
 Disconnect the water bath from power supply
 Change water weekly to avoid growth of bacteria

 Incubator
o Proper use and care of Incubator:
 Always follow the manufacturer’s manual
 The incubator must maintain a constant temperature of 35 – 37oC of the different
tests

Teaching Guides for NTA Level 4 MLS Curriculum Page 21

  Always set correct temperatures and close the door fully when in use
 Clean it regularly
 Lubricate the mechanical parts of the door lock every 3 months

 Hot Air Oven:

o Proper use and care of Oven:
 Always follow the manufacturer’s manual
 Connect the instrument to the power supply
 After the temperature has reached the pre- set value allow heating of items for
appropriate time
 Switch off the power
 Wait until the temperature falls to 40oC before opening the door to remove items
 Do not use it to dry stained or unstained blood
 Use the instrument to sterilize glass ware made of Borosilicate (Pyrex)

 Colorimeter:
o Proper use and care of colorimeter:
 Always follow the manufacturer’s manual
 Connect the instrument to the power supply and switch on
 Allow a 15 minute to warm before use
 Select the correct wavelength for the compound to be tested
 Arrange all required solutions in test tubes rack
 Clean a cuvette using soft tissue to avoid scratches
 Transfer the blank solution into the cuvette and place in the sample compartment
with clear sides
 Close the chamber and set the display to read zero
 Remove the cuvette from the compartment, pour the blank solution back to the
test tube, pour the standard solution into the cuvette and read the absorbance
 Rinse the cuvette with distilled water, drain dry, wrap in soft material and store
carefully in a small box.
 Cover the instrument after use
 Clean filters with soft cloth or cotton gauze when required
 Keep the cuvette chamber closed when not in use

 Autoclave:
o Basic manual bench top autoclaves or pressure cookers; are simple to operate and
economical to maintain.
o Large, fully automated autoclaves are available but are expensive to purchase and
maintain
 Proper use and care of colorimeter:
 Always follow the manufacturer’s manual
 Loosen the caps of the containers to be sterilized
 Pour distilled water or rain water into the autoclave
 Place the basket in the autoclave
 Close the lid and screw down the lid clamps
 Open the air outlet valve
 Turn on the heat source

Teaching Guides for NTA Level 4 MLS Curriculum Page 22

  When the air has expelled and temperature gauge reads 140oC, close the air outlet
valve, wait until the gauge reads 121oC, and reduce the heat.
 After sterilization is complete, turn off the heat completely, wait until the gauge
reads zero, open the outlet and open the lid
 Do not mix infectious and non infectious material in one load
 Never open the autoclave until the internal pressure has returned to zero
 Always use distilled water or rain water
 Clean it regularly using a swab moistened with distilled water
 Lubricate autoclave clamps using high melting point grease

Step 6.Limitations of each instrument and equipment (60 Minutes)

 Microscope:
o They only use day light for those with mirror and
o They only use electricity for those with inbuilt light source
o Not used beyond the manufacturer’s instructions
o In case of breakdown consult responsible personnel
 Centrifuge Machines:
o Some are operated manual
o Some use electricity
o Use centrifuge tubes made of quality glass ware, and should not be too long
o Do not attempt to slow down the centrifuge using hands
o In case of breakdown consult responsible personnel
 Refrigerator
o Some are use kerosene
o Some use electricity
o Follow manufacturer’s manual
o Blood bank refrigerator should not be mixed with other items
o In case of breakdown consult responsible personnel
 General balances:
o Some are for weighing large quantities
o Some are for weighing small quantities
o Follow the manufacturer’s manual
o In case of breakdown consult responsible personnel
 Water bath
o The user should be medical Laboratory qualified
o In case of breakdown consult responsible personnel
 Incubator / Hot air Oven:
o The user should be medical Laboratory qualified
o Must maintain a temperature of 35 – 37oC to Incubator
o Of a hot air oven should not exceed 180oC
o Sterilize glass ware made of borosilicate (Pyrex) in hot air oven, never plastic ware
 Colorimeter
o Avoid touching the sides of the cuvette facing the light path
o Use a correct filters to produce light of the desired wavelength selected to the colour
of the solution
o The user should be medical laboratory qualified
o Always remember to disconnect the power source whenever in use.
o Never use broken cuvette or having scratch.

Teaching Guides for NTA Level 4 MLS Curriculum Page 23

 Autoclave
o Operate it in a well – ventilated are
o Do not tight the air outlet valve until the gauge reads 121oC
o Open the outlet and the lid after the gauge read zero

Step 7: Key Points (10 Minutes)

 Instrument and equipment are those apparatus/machines which are used in the Laboratory
 Limitation is a maximum capacity of equipment function
 List of instruments and equipments are: Microscopes, Centrifuges, Refrigerators, General
balances, Water baths, Incubators / Ovens, Sterilizers (Autoclave), Colorimeter
 Instruments and equipments are used to run the laboratory procedures smoothly and
accurate
 Instruments and equipments are used to reduce contamination, infections in the laboratory
to workers and clients
 Instruments and equipments are used to improve the laboratory services to patients

Step 8: Evaluation (10 Minutes)

ASK STUDENTS TO:
 Define instruments and equipments
 Explain proper use and care of laboratory instruments and equipments
 Explain the limitation of each laboratory instrument and equipment

ASK STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press;
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd; and
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

* Practical session

Teaching Guides for NTA Level 4 MLS Curriculum Page 24

Session 2: Microscope Practical
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 360 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the Microscope
 List type of the microscope
 Identify the major parts of the microscope and their respective functions
 Explain the principle of microscope
 Explain safety precautions of the microscope
 Describe proper use of the microscope (demonstration and practical)
 Describe the limitation and troubleshooting of Microscope

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 05 Minutes Presentation Introduction Learning Objectives
2 05 Minutes Presentation Definition of terms
3 35 Minutes Presentation Laboratory types of microscopes
4 40 Minutes Presentation Major parts of the microscope
5 30 Minutes Presentation Principle of the microscope
6 60Minutes *Presentation & Care of the microscope
Practical
7 120Minutes *Presentation & Proper use of the microscope
Practical
8 45 Minutes Presentation Limitation of the microscope &
Troubleshooting
9 10 Minutes Presentation Key points
10 10 minutes Presentation Evaluation

Step 1: Microscope use in the laboratory (5 minutes)

 READ or ASK students to read the learning objectives and clarify.

 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 25

Step 2: Definitions of terms (05) Minutes
 Microscope: Microscope is a magnifying equipment, magnifies minute objects making
them visible to the eye
 ACTIVITY:
 ASK the student to buzz in pairs and allow them to answer the following questions
 Define the following term:
o Microscope
 Definition: Microscope is magnifying equipment, magnifies minute objects
making them visible to the eye

Step 3: Types of Microscope (35 Minutes)

 Types and models of microscope
o The main types of microscope are monocular or binocular (one or two eyepieces) and
the use of a daylight mirror or inbuilt light source. Binocular microscopes with inbuilt
light sources are the recommended type. Power may be provided by mains or 12 volt
sources. The quality of the microscope is dependent on the quality of the lenses.
Additional features of microscopes include moveable condensers, types of stage,
different magnifications of eye pieces and objectives, and dark field attachments.
o Fluorescent microscopes which detect light of certain wavelengths are also available,
but these are more costly. Fluorescent attachments may be fixed onto some light
microscopes

Step 4: Major parts of Microscope (40 Minutes)

Name of Part Function

Eyepieces Upper end magnifying lens

Objectives Brings the object into focus at a shorter distance
Revolving nose piece For quick exchange of objective
Mechanical stage Specimen stage
Specimen slide holder It holds slide in correct position
Condenser Adjust correct position of front lens for
illumination of large object
Diaphragm Adjusts the light intensity from the light source in
relation to the objective

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Fine and course adjustment Proper focusing
Tube, Mono/Binocular Light transmission media
Light source Bottom light the slide mounted specimen
Base Equipment holder

Source ASCP

Step 5: Principle of the Microscope (30Minutes)

 A Microscope magnifies minute objects making them visible to the eye. The Microscope
consists of mechanical components, a system of lenses that magnify the specimen placed
on the Microscope stage, and a light source or mirror that illuminates the specimen. The
Microscope is the most important instrument in the laboratory and is used for
examination (before or after staining) of blood (including bone marrow and splenic
aspirate), urine, stool, sputum, body fluids and discharges, and skin samples for blood and
tissue cells, bacteria, fungi, parasites, and structures such as crystals. The Microscope is
also used to confirm agglutination reactions, e.g. in blood transfusion reaction.

Step 6: Care of the Microscope (60 Minutes)

 Adhere to Bio safety precautions on handling biological specimen’s laboratory articles
including but not limited to wearing of laboratory coats and wearing of gloves
o Do not clean objective by xylene or ethanol (lenses will stuck)
o Never use ordinary paper to clean lenses
o Never touch lenses with your fingers
o Never clean support or stage with Xylene or acetone
o Never clean inside lenses of eyepiece or objectives with cloth or paper (This might
remove the antireflective coating); use a fine paintbrush only.
o Never leave the microscope without eyepieces unless the opening is covered
o Never keep the microscope in a closed wooden box in hot humid countries
o Never press the objective onto the slide, since both slide and objective may break.
Take care during focusing
o Keep the mechanical stage clean

Teaching Guides for NTA Level 4 MLS Curriculum Page 27

 o Do not leave microscope with immersion oil on the objective remove oil after daily
use. Mild soap solution is suitable for most cleaning
o Always use voltage stabilizer this is for those areas with voltage fluctuations

Step 7: Proper use of the microscope (120 Minutes)

 Always follow the manufacturer’s instructions.
 Place the microscope on a firm bench, free from vibration.
 Switch on the light source.
 Adjust the eyepieces by sliding them horizontally until both eyes fit comfortably and the
two fields merge.
 Centre the condenser as follows:
o Swing the x10 objective into position
o Raise the condenser to the uppermost position
o Open the iris diaphragm fully
o Open the light diaphragm to illuminate the whole field
 Clean and dry the underneath of a glass slide by wiping with lens tissue.
 Rotate the nosepiece so that the x 10 objective is in position. Slight resistance is felt as the
objective moves into the correct position.
 Place the slide carefully on the stage.
 Never place the slide on the stage when the x 40 or x 100 objectives are in position, to
prevent scratching of the lenses. Adjust the illumination:
o Control light intensity by using the light control
o Reduce the iris diaphragm to control brightness
 Focus the specimen by racking the stage carefully upwards with the x10 objective in
position. Using the coarse adjustment knob, rack downwards slowly until the image
comes into view. Use the fine adjustment knob to focus the image sharply.
 Swing the x 40 or x100 objectives into position to examine in more detail.
 After examination, lower the stage or swing the lowest power objective into position
before removing the slide.
 Never remove the slide when the x 40 or x 100 objectives are in position as this may
scratch the lenses.
 Wipe off any oil from the lenses using a piece of lens tissue and microscope stage using a
piece of cloth soaked in detergent
 Switch off the microscope, disconnect from the power source and cover to protect from
dust.

Step 8: Limitation of the microscope and troubleshooting (45 Minutes)

 Replace bulbs, which have blown.
 Clean the lenses with lens tissue and not a cloth or ordinary paper or cotton gauze
 To protect against fungus in humid climates, place the microscope in a small cabinet or
cupboard that is heated continuously from below by a low watt bulb. The bulb must be
left on continuously even when the microscope is not in the cupboard. OR
 Place the microscope in an airtight plastic bag (made from thick polythene) with self-
indicating blue silica gel in a dust-tight linen bag or in a dish. Silica gel is blue when
active but becomes pink when it is fully absorbed with water. To restore its activity,
gently heat it in an oven or over a flame until the colour returns to blue. When the silica

Teaching Guides for NTA Level 4 MLS Curriculum Page 28

 gel cools it must be returned to the airtight container. Do not store the microscope in its
carrying case or under a plastic hood in humid climates.
 For removal of heavy contamination from the instrument surface, use a non-corrosive
disinfectant e.g. 5% Lysol or 70% alcohol, then wipe with a damp cloth soaked in soapy
water. NEVER ACETONE
 Protect the microscope from power surges using a voltage stabilizer, e.g. Sollatek AVS
136.
 If the microscope is faulty, consult a qualified Biomedical Engineer.

Basic Troubleshooting:
PROBLEM CAUSE REMEDY
Field of view is out Nose piece is not clicked into place Slightly rotate the nosepiece
Off or illuminate until it clicks into position
irregularly Condenser is not correctly Re-insert the condenser all
mounted on the condenser holder the way without tilt
Field iris diaphragm is stopped Centre it correctly
down too much Open it properly
Dust or dirt on objective eyepiece, Clean each lens or glass
condenser of light exit glass on
microscope base
Dust or dirt is visible Dust on the light exit glass on the Remove dust or dirt or clean
in the field of view. microscope base the specimen slide
Dust on the condenser top lens Prepare a new sample by
Dirty specimen using a new/ clean slide
Dust on eyepiece
Excessive image Condenser is lowered too much Raise the condenser
contrast Aperture iris diaphragm is stopped Open the diaphragm
down excessively
Resolution problems Objective is not correctly engaged Slightly rotate the nose piece
Image is not sharp in the light path until it clicks into position
Insufficient contrast Dirt on the objective front lens Clean the objective
Image details lack Immersion objective is used Apply immersion oil
definition without immersion oil
Bubbles in the immersion oil Remove bubbles
Olympus immersion oil is not used Use Olympus immersion oil
Dirty specimen Clean the specimen slide,
Dust on eyepiece or eyepiece or condenser lens.
Condenser top lens
Field of view is Objective is not correctly Slightly rotate the nosepiece
partially out of focus positioned in the light path until it clicks into position
Specimen is not correctly place on Replace it on the stage
the stage correctly and secure it with
the specimen holder or stage
clips
Image is tinted Blue filter is not engaged Engage blue filter
yellowish
Focus adjustment Tension adjustment ring is Loosen the tension

Teaching Guides for NTA Level 4 MLS Curriculum Page 29

mechanism tightened too much adjustment ring slightly
a) Coarse adjustment User is trying to raise the stage Unlock the pre- focusing
knob are too tight passing over the upper focusing lever
limit imposed by the engaged pre-
focusing lever
b) Stage drops and Tension adjustment ring is too Tighten the ring properly
the specimen goes loose
out of focus
c) Stage cannot be Pre-focusing lever is engaged in Raise the sub stage
lowered to the lower than focusing position
lower limit of the
working range
d) Stage cannot be Pre-focusing lever is engaged in Unlock the lever
raised to the upper lower than focusing position
limit
e) Objective front Specimen is mounted on the stage Reverse the specimen
lens touches the upside down
specimen
Binocular tube Inter-papillary distance is not Correct the inter-papillary
incomplete binocular correctly adjusted distance
vision Diaphragm adjustment is Complete the diaphragm
incomplete adjustment
Right and left eyepieces are not User a pair of matched
matched eyepieces
User is unaccustomed to binocular Prior to look at the image of
vision the specimen try to look at
the entire field of view or
look at a far away object
before resuming microscopic
observation.
Stage: Image easily Stage clamping knobs are not Tighten clamping knobs with
goes out of focus tightened. a coin securely
when touch the stage
a) Image blurs as Specimen is not correctly Adjust specimen slide
you move the positioned on the stage position
specimen
Objectives change Specimen is mounted on the stage Reverse the specimen slide
front les of high upside down Use a 0.17mm thick cover
power objective glass
comes into contact Cover glass is too thick
with specimen when
it is engaged after low
power objective
Electric system Voltage selector switch is not Conform the switch to the
a) Illuminator is too matched with the line voltage line voltage
bright with the
voltage control Line voltage is too high Adjust the line voltage with a
dial even at the variable voltage transformer

Teaching Guides for NTA Level 4 MLS Curriculum Page 30

 lowest position Bulb is not a standard one Use a standard bulb
(closest to the
operator
b) Output voltage for Voltage selector switch is not Conform the switch to the
the illuminator matched with the line voltage line voltage
cannot be Adjust the line voltage with a
controlled (too Line voltage is too high/low variable voltage transformer
high or too low)
c) Light flickers andLive voltage unstable filament of Use a voltage stabilizer
intensity is
the bulb is likely to burn out loose replace the defective bulb
unstable electric cords
Secure the connection
d) Fuse burns out Fuse is not a standard on Use a standard fuse
too often Voltage selector switch is not Conform the switch to the
matched with the line voltage line voltage
e) Bulb does not Fuse is gone Replace the fuse
light Bulb is burned out Replace the bulb
Loose electric connections Secure the connections
f) Reduced bulb life Voltage selector switch is not Conform the selector switch
matched with line voltage to the line voltage
Bulb is not a standard one Use a standard bulb
Bulb was over voltage too long Reduce bulb voltage

Step 9: Key points (10 Minutes)

 Microscope is a magnifying equipment, magnifies minute objects making them visible to
the eye
 The main types of microscope are monocular or binocular (one or two eyepieces) and the
use of a daylight mirror or inbuilt light source. Binocular microscopes with inbuilt light
sources are the recommended type.
 Major parts of Microscope
 Functions of major parts of the Microscope

Step 10: Evaluation (10 Minutes)

ASK STUDENTS TO:
 Define microscope
 Explain proper use and care of Microscope
 Explain the limitation of Microscope

ASK STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press;
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd; and
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

Teaching Guides for NTA Level 4 MLS Curriculum Page 31

Indications:

*Practical sessions

Teaching Guides for NTA Level 4 MLS Curriculum Page 32

Session 3: Centrifuge Machine Use
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 240 Minutes

Pre- requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the Centrifuge Machine
 List type of Centrifuge Machine
 Identify the major parts of the Centrifuge Machine
 Explain the principle of Centrifuge Machine
 Explain safety precautions of the Centrifuge Machine
 Describe proper use of the Centrifuge Machine (demonstration and practical)
 Describe the limitation and troubleshooting of Centrifuge Machine

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 05 Minutes Presentation Introduction Learning Objectives
2 05 Minutes Presentation Definition of terms
3 10 Minutes Presentation Laboratory types of Centrifuge Machine
4 10 Minutes Presentation Major parts of Centrifuge Machine
5 10 Minutes Presentation Principle of the Centrifuge Machine
6 40 Minutes *Presentation & Practical Care of the Centrifuge Machine
7 120 Minutes *Presentation & Practical Proper use of the Centrifuge Machine
8 20 Minutes Presentation Limitation & troubleshooting of
Centrifuge Machine
9 10 Minutes Presentation Key points
10 10 minutes Presentation Evaluation

Step 1: Centrifuge use (05 Minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms (05 Minutes)

 Centrifuge is a machine using Centrifugal force for separating substance of deferent
densities for removing moisture or for simulating gravitational effects

Teaching Guides for NTA Level 4 MLS Curriculum Page 33

Step 3: Types of Centrifuge Machine (10 Minutes)
 Centrifuges may be manual or electric. Electric centrifuges operate from mains power or
12 volt power. There are many different models of electric centrifuges available, varying
in size, number of buckets, swing out or fixed-angle types with timers, brakes and other
accessories.

Source ASCP

Step 4: Parts of Centrifuge Machine (10 Minutes)

Name of Part Functions
Base Equipment support
Inner spinning cylinder Tubes carrier
Timer Duration of process cycle

Teaching Guides for NTA Level 4 MLS Curriculum Page 34

Speed regulator Is a device used to control operating speed
Speed gauge Indicator of operating speed
Break Used to stop the rotation by electrical application
Rubber support Absorbs vibrations due to motor speed (damping system).
Fuses Is the over current protective device
PCB Printed circuit board
Carbon brush Complete electrical circuit through commutator
Rotor Use to produce rotation for the tubes holder
On/off switch Power ON power OFF
Pilot lamp mains It indicates electricity presence
Speed indicator It indicates the speed at which the centrifuge spins

Step 5: Principle of Centrifuge Machine (10 Minutes)

 A centrifuge is used to hasten the sedimentation of suspended particles in liquids. A
centrifuge consists of a central shaft which rotates at high speed and a head with arms for
holding the buckets. When the buckets rotate, the particles suspended in the fluid are
subjected to a centrifugal force and sediment to the bottom of the tube, forming a deposit.
A centrifuge is used for the following medical applications: separation of serum; urine
sedimentation; sedimentation of other body fluids, e.g. CSF, pleural or peritoneal fluid;
concentration procedures on blood and stool; and in blood transfusion medicine.

Step 6: Care of Centrifuge Machine (40 Minutes)

 Make sure the load is balanced
 Do not open while it is running
 Must be positioned exactly on a flat bench to avoid movement of the instrument
 Open the lid when the motor is at stand still

Step 7: Proper use of Centrifuge Machine (120 Minutes)

 Always follow the manufacturer’s instructions for use.
 Place the centrifuge on a firm bench, away from the edge. Keep away from other
instruments, which may be affected by vibrations.
 It is critically important that the centrifuge load is balanced at all times:
o Tubes must be loaded in matched buckets fitted with rubber cushions to prevent
breakage, and should be arranged so that like loads are opposite.
o To balance diametrically opposite tubes, use similar test tubes and fill with same
amount of liquid. If there are an odd number of specimens, balance the extra tube with
an identical tube filled with water.
 Close the lid
 Connect the machine to the power supplies.
 Switch on the centrifuge and increase the speed gradually by turning the speed control
knob slowly until the required speed is reached.
 Stop the centrifuge after the required time, or the centrifuge may automatically switch
itself off. Allow the centrifuge to slow down and stop gradually by itself.
o Do not attempt to slow down the centrifuge using your hands. This is dangerous and
may damage the mechanism and cause re- mixing of the sediment.

Teaching Guides for NTA Level 4 MLS Curriculum Page 35

 o Do not attempt to open the centrifuge lid until the centrifuge has come to a complete
stop.
 Remove the tubes carefully not to disturb the deposit.
 Disconnect the equipment at the end of the day.

Step 8: Limitation and troubleshooting of Centrifuge Machine (20 Minutes)

 Disinfect bowls regularly with a non-corrosive disinfectant such as 5% Lysol, 2%
glutaraldehyde or 70% alcohol. Clean the buckets and the inside of the centrifuge with a
soapy soft cloth.
 Remove blood spots or other material splashed on the bowl immediately after use with
suitable non-corrosive disinfectant.
 Protect the centrifuge from power surges using a voltage stabilizer, e.g. Sollatek AVS 13.
 If you have been trained, replace carbon brushes when worn out. Other items that may
require replacement are: rubber feet, extra cushions for the bucket.
 In case of breakage
o Stop the centrifuge immediately
o Do not open until the centrifuge has completely stopped
o Wait for thirty minutes before opening the centrifuge to allow infected materials to
settle.
o Remove all pieces of glass from buckets and the bowl using forceps.
o Disinfect, clean and dry the buckets, cushions, bowl and underneath using 2%
glutaraldehyde and 10% formalin.
o Do not use hypochlorite as this is corrosive to the metal

Basic Troubleshooting:
FAULTS CAUSES ACTION
Loss of power Loss of Mains power Investigate cause
Neon indicator out Fuse blown Replace fuse
Neon Indication but no Electrical fault Call service Engineer
power at control panel
Motor fails to drive Incorrect program Check program
Electrical fault Call service Engineer
Lid indicator on Lid not properly closed Open and re-close lid
Fault safety circuit Call service Engineer
Touch indicator on Broken belt Call service Engineer
Fault in timing Call service Engineer
In balance indicator on Incorrect loading Correct loading motor
Damaged sensor Call service Engineer
System indicator off a run Microprocessor not Switch mains of item on to reset
functioning correctly microprocessor.
If fault persist call service
Engineer

Step 9: Key Points (10 Minutes)

 Centrifuge is a machine using Centrifugal force for separating substance of deferent
densities for removing moisture or for simulating gravitational effects

Teaching Guides for NTA Level 4 MLS Curriculum Page 36

 Centrifuges may be manual or electric. Electric centrifuges operate from mains power or
12 volt power
 Parts of Centrifuge Machine (refer above)
 A centrifuge is used for the following medical applications: separation of serum; urine
sedimentation; sedimentation of other body fluids, e.g. CSF, pleural or peritoneal fluid;
concentration procedures on blood and stool; and in blood transfusion medicine.
 Always follow the manufacturer’s instructions for use.
 Place the centrifuge on a firm bench, away from the edge. Keep away from other
instruments, which may be affected by vibrations.
 Make sure the load is balanced

Step 10: Evaluation (10 Minutes)

ASK STUDENTS TO:
 Define Centrifuge Machine
 Explain proper use and care of Centrifuge Machine
 Explain the limitation and Troubleshooting of Centrifuge Machine

ASK STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press;
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures - Care and Maintenance of Laboratory Equipments-By
AMREF (T)

Indications:
*Practical sessions

Teaching Guides for NTA Level 4 MLS Curriculum Page 37

Session 4: Refrigerator Use
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 240 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the Refrigerator
 List type of Refrigerator
 Identify the major parts of the Refrigerator
 Explain the principle of Refrigerator
 Explain safety precautions of the Refrigerator
 Describe proper use of the Refrigerator (demonstration and practical)
 Describe the limitation and troubleshooting of Refrigerator

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 05 Minutes Presentation Introduction Learning Objectives
2 05 Minutes Presentation Definition of terms
3 05 Minutes Presentation Laboratory types of Refrigerator
4 05 Minutes Presentation Major parts of Refrigerator
5 10 Minutes Presentation Principle of the Refrigerator
6 30 Minutes *Presentation & Care of the Refrigerator
Practical
7 120Minutes *Presentation & Proper use of the Refrigerator
Practical
8 40 Minutes Presentation Limitation& troubleshooting of
Refrigerator
9 10 Minutes Presentation Key points
10 10 minutes Presentation Evaluation

Step 1: Refrigerator use (05 Minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 38

Step 2: Definitions of Terms (05 Minutes)
 It is the equipment used for storage of samples and reagents at low temperatures.
Refrigerators are manufactured in different sizes. Some refrigerators have attached
freezing compartments

Step 3: Types of Refrigerators (05 Minutes)

 The types of refrigerators are:
 Electrical Refrigerators
 Battery operated Refrigerator (12 V)
 Kerosene Refrigerator (not recommended, difficult to control temperature and
maintenance).

Source ASCP

Step 4: Parts of Refrigerator (05 Minutes)

Name of Part Function
Compressor Pump for circulating refrigerant in the refrigeration
cycle
Relay Switches compressor ON/OFF
Thermo cut off Compressor protection device against over heating
Condenser unit Gas cooling device
Door gasket Seal the door to preserve coldness
Door switch Switches light in the fridge when the fridge’s door is
open
Temperature gauges Temperature indicator
Hinges Holds the door in position

Step 5: Principle of Refrigerator (10 Minutes)

 Refrigerator is equipment, which transfers heat from an area of low temperature to one of
a high temperature. It consists of a compressor and liquid refrigerant. The compressor
pumps the liquid refrigerant, which turns into gaseous and exchanging heat at the
surrounding/compartment.

Teaching Guides for NTA Level 4 MLS Curriculum Page 39

Step 6: Care of Refrigerator (30 Minutes)
 Adhere to Bio safety precautions on handling biological specimens, laboratory articles
including but not limited to wearing of laboratory coats, gloves and other protective
gears:
o Do not expose condenser to the sunlight
o Do not use sharp tools for defrosting.
o Do not install the refrigerator near the wall (leave 20cm from the wall)
o Use stabilizer to prevent damage due to voltage fluctuation.

Step 7: Use of Refrigerator (120 Minutes)

 Always follow the manufacturer’s instructions.
 Place the refrigerator sufficiently far from the wall (a minimum of 20 cm) so that air can
flow past the condenser at the back.
 The refrigerator door must seal perfectly to prevent warm air from entering the cooling
chamber.
 Set the correct temperature (2 – 8oC) for the refrigerator.
 The temperature must be checked twice daily and recorded on a temperature chart.
 Open and close the door gently to avoid disturbing the contents and do not leave it open
unnecessary.
 Do not open the door again immediately after closing. A negative pressure is created
inside the refrigerator after closing, requiring force to open the door, which may break the
handle.
 Categorize the different laboratory items and store separately, e.g. blood, microbiology
specimens and test kits.
 Reagent inside must be placed in a good order so as to allow good circulation of air inside

Step 8: Limitation and Troubleshooting of Refrigerator (40 Minutes)

 Clean the outside daily
 Defrost and clean the inside thoroughly once a month
 Defrost the refrigerator by switching the power off and leaving the door open overnight.
Never use sharp instruments to remove ice.
 Disinfect the compartment with 70% alcohol when there is any contamination.
 Remove dirt or dust from the coils and condenser using a brush.
 Protect the refrigerator from low voltages using a cut out device, e.g. Sollatek Fridge
Guard.
 Check the temperature twice daily and record on temperature log.
 Wash the gasket (rubber lining on the door) with soapy water.
 Replace the gasket when torn. Check the gasket by darkening the room, then placing a
flashlight (torch) inside the refrigerator and looking for light leaks around the perimeter.
 If the refrigerator is faulty, consult a qualified Biomedical Engineer

Basic Troubleshooting:
PROBLEM CAUSES REMEDY
Refrigerator is working but no cooling. Door gasket Replace if it is damaged
Compressor Call engineer/ technician
Gas leakage
Refrigerator is not working No power Switch ON / call

Teaching Guides for NTA Level 4 MLS Curriculum Page 40

 engineer/technician

Step 9: Key Points (10 Minutes)

 It is the equipment used for storage of samples and reagents at low temperatures.
Refrigerators are manufactured in different sizes. Some refrigerators have attached
freezing compartments
 Types of Refrigerators: Electrical Refrigerator, Battery operated Refrigerator and
Kerosene Refrigerator
 Do not install the refrigerator near the wall (leave 20cm from the wall)
 Use stabilizer to prevent damage due to voltage fluctuation.
 Place the refrigerator sufficiently far from the wall (a minimum of 20 cm) so that air can
flow past the condenser at the back.
 The refrigerator door must seal perfectly to prevent warm air from entering the cooling
chamber.
 Set the correct temperature (2 – 8oC) for the refrigerator.
 The temperature must be checked twice daily and recorded on a temperature chart.

Step 10: Evaluation (10 Minutes)

ASK STUDENTS TO:
 Define Refrigerator
 Explain proper use and care of Refrigerator
 Explain the limitation and Troubleshooting of Refrigerator

ASK STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

* Practical sessions

Teaching Guides for NTA Level 4 MLS Curriculum Page 41

Session 5: Water bath Use
NTA LEVEL 4, SEMESTER 1, MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 180 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the Water bath
 List type of Water bath
 Identify the major parts of the Water bath
 Explain the principle of Water bath
 Explain safety precautions of the Water bath
 Describe proper use of the Water bath (demonstration and practical)
 Describe the limitation and troubleshooting of Water bath

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 05 Minutes Presentation Introduction Learning Objectives
2 10 Minutes Presentation Definition of terms
3 10 Minutes Presentation Laboratory types of Water baths
4 15 Minutes Presentation Major parts of Water bath
5 10 Minutes Presentation Principle of the Water bath
6 30Minutes *Presentation & Practical Care of the Water bath
7 60 Minutes *Presentation & Practical Proper use of the Water bath
8 20 Minutes Presentation Limitation& troubleshooting of Water
bath
9 10 Minutes Presentation Key points
10 10 Minutes Presentation Evaluation

Step 1: Water bath use (05 Minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms (10 Minutes)

 It is an instrument used to incubate and provide moisture using heated water at a set

Teaching Guides for NTA Level 4 MLS Curriculum Page 42

Step 3: Types of Water bath (10Minutes)
 Water baths are manufactured in different sizes and with varying temperature ranges.

Source ASCP

Step 4: Parts of the Water bath (15 Minutes

Name of Part Function
Heating Element To produce heat
Thermostat Temperature control
Switch Mains ON/OFF
Pilot lamp Mains indicator
Pump Circulation of water
Lead Close/Open compartment

Step 5: Principle of water bath (10 Minutes)

 To provide and maintain constant humidity and temperature during incubation. A heater
and motor installed at lower part of water bath, when the instrument is switched on heats
up the water to a required set temperature.

Step 6: Care of the water bath (30 Minutes)

 Adhere to Bio safety precautions on handling biological specimens, laboratory articles
including but not limited to wearing of laboratory coats, gloves and other protective gears
o Never switch on the machine before refilling distilled water in the bucket to required
level
o Check the preset temperature corresponding with thermometer reading
o Place the water bath at level surface/table
o Drain water/distilled weekly
o Always drain water from the bucket when it is not in use

Step 7: Proper use of Water bath (60 Minutes)

 Fill the water bath to a minimum level of 10 mm above the top of perforated tray. The
maximum level is 40 mm from the top when the water bath is fully loaded
 Turn on the water bath
 Set temperature and time

Teaching Guides for NTA Level 4 MLS Curriculum Page 43

 Wait for heating light to switch off. When light switches off, the water bath is at the
required temperature
 Use water bath as required
 Set holding time
 Water bath switches off automatically

Step 8: Limitations and Troubleshooting of Water bath (20 Minutes)

 Avoid using tap water as salts are deposited in the water bath which enhances rusting
 If spillage of liquids occurs during incubation, clean the water bath immediately after use.
 Carefully follow all procedures recommended by manufacturer’s instructions.
 Keep the equipment clean daily
 Check the power cord and plug
 Check container for water leaks during cleaning of the trough
 Put an external thermometer to control the inbuilt thermometer
 Clean the water bath trough weekly using distilled water and disinfectant
 Change of distilled water in the water bath trough on weekly basis

Basic Troubleshooting:
PROBLEM CAUSE REMEDY
The machine “ON” but no Fuse Replace/ call
indicator light Indicator technician/service service
engineer
If not heating Element Call technician /service
Thermostat engineer
Reset the thermostat
Erratic temperature reading Thermometer Replace
Water leaks Container Call service engineer
No water circulation in the Circulation pump Call service engineer
trough
Electric shock on touching Electric leakage Call service engineer
the equipment

Step 9: Key Points (10 Minutes)

 To provide and maintain constant humidity and temperature during incubation
o Water baths are manufactured in different sizes and with varying temperature ranges.
o Never switch on the machine before refilling distilled water in the bucket to required
level
o Check the preset temperature corresponding with thermometer reading
o Fill the water bath to a minimum level of 10 mm above the top of perforated tray. The
maximum level is 40 mm from the top when the water bath is fully loaded
o Turn on the water bath
o Set temperature and time
o Avoid using tap water as salts are deposited in the water bath which enhances rusting
o If spillage of liquids occurs during incubation, clean the water bath immediately after
use.
o Carefully follow all procedures recommended by manufacturer’s instructions.
o Keep the equipment clean daily

Teaching Guides for NTA Level 4 MLS Curriculum Page 44

Step 10: Evaluation (10 Minutes)
ASK STUDENTS TO:
 Define Water bath
 Explain proper use and care of Water bath
 Explain the limitation and Troubleshooting of Water bath

ASK STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

* Practical sessions

Teaching Guides for NTA Level 4 MLS Curriculum Page 45

Session 6: Autoclave Use:
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 360 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the Autoclave
 List type of Autoclave
 Identify the major parts of the Autoclave
 Explain the principle of Autoclave
 Explain safety precautions of the Autoclave
 Describe proper use of the Autoclave(demonstration and practical)
 Describe the limitation and troubleshooting of Autoclave

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 10 Minutes Presentation Introduction Learning Objectives
2 10 Minutes Presentation Definition of terms
3 20 Minutes Presentation Laboratory types of Autoclave
4 30 Minutes Presentation Major parts of Autoclave
5 10 Minutes Presentation Principle of the Autoclave
6 120 Minutes *Presentation & Care of the Autoclave
Practical
7 120 Minutes *Presentation & Proper use of the Autoclave
Practical
8 20 Minutes Presentation Limitation& troubleshooting of
Autoclave
9 10 Minutes Presentation Key points
10 10 minutes Presentation Evaluation

Step 1: Use of Autoclave (10 Minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 46

Step 2: Definitions of Terms (10 Minutes)
 It is equipment used for sterilization of medical instruments, and equipment textiles (i.e.
theatre gowns and dressings) Lab. Culture containers and glassware.

Step 3: Types of Autoclave (20 Minutes)

Autoclaves have an inbuilt electrical power source or operate from external sources of heat,
e.g. a hot plate, gas or kerosene stove. Larger autoclaves are manufactured with various
accessories, e.g. pressure and temperature gauges. Basic manual bench top autoclaves (or
pressure cookers) are simple to operate. Large fully automated autoclaves are available but
are expensive to purchase and operate.

Source ASCP

Step 4: Parts of the Autoclave (30 Minutes)

NAME OF PART FUNCTION

Strainer Strain dust of fluid
Reducing valve Reduce the primary pressure to the secondary pressure
Safety value Replace steam automatically when the pressure comes to
the certain value (mechanical function)
Magnetic valve Control water flow by shut or open (electrical function)
Steam trap Drain condensate
Pressure bolts Proper tightening of the lid
Timer Duration of process cycle
Steam release valve Lets steam out of the chamber
Air removal valve Equalizes chamber pressure to atmospheric pressure
De- aeration valve Cooling effect
Control relay Switching process functions
Sight glass Water level indication
Rubber gasket Leakage seal
Pressure Ganges Pressure indicator
Thermostat Temperature control
On/Off switches Power “ON” power “OFF”
Dry heat protection unit Thermal cut – out
Pilot lights Mains indicator

Step 5: Principle of Autoclave (10 Minutes)

 It achieves sterilization (sterility) by applying moist heat. High pressure steam
sterilization (Moist heat) in an evacuated chamber. Pressurized high temperature steam

Teaching Guides for NTA Level 4 MLS Curriculum Page 47

 (coagulation at 121oC for 15 minutes for rubber materials and glassware 134oC for 3 to 10
minutes for surgical instruments, gowns dressing etc.

Step 6: Care of the Autoclave (120 Minutes)

 Adhere to Bio safety precautions on handling biological specimens laboratory articles
including but not limited to wearing of laboratory coats, gloves and other protective
gears.
 Do not operate the autoclave with a leaking rubber gasket
 Report any malfunctions to the maintenance Engineer
 Examine plugs
 Test pressure control switches
 Do not attempt to open the lid before the pressure ganged reaches zero.
 When sterilizing culture medium and solution, rapid pressure reduction (rapid air exhaust)
will cause bumping and bottle breaking. Do pressure reduction (exhaust) as slowly as
possible. When sterilizing polluted culture medium or metal instruments stained with oil
etc., set the sterilizing time rather longer.
 When sterilizing steel instruments and glass wares wash and rinse them with an ultrasonic
cleaner prior to the sterilization. Insufficient washing and rinsing may cause corrosion
and discoloration.
 Sterilize such bottles and test tubes that have no hole on their bottom in laying or upside
down after washing.
 Do not cram materials to be sterilized too much in the chamber to avoid sterilization
failure.
 Some plastic and rubber products are weak at heat and deformed or deteriorated by heat.
In case of sterilizing them, consult the manufacturers on sterilizing conditions. When
sterilizing these plastic and rubber products, never fold or pile them.
 Sterilization effect should be observed by using ideal indicators.
 Check water level: Amount should be sufficient for one cycle
 Use distilled water to avoid scaling
 Test indicator lights
 Examine cables
 Check electrical connections for tightness
 Conduct a sterilization test periodically to confirm the function of the instrument.
 It is recommended that optional sterilizing container should be used for sterilizing culture
medium and solutions to prevent bumping and breaking which will cause contamination
in the chamber, blocking of piping, and scales on the heaters and the bottom of the
chamber leading to corrosion or defects.
 Test low water cut-out
 Examine and test low water level switch
 Consult operation manual for specific instructions

Step 7: Proper use of Autoclave (120 Minutes)

 Loosen the caps of the containers that are to be sterilized
 Pack the containers in a wire basket or in the autoclave drum
 Pour distilled water or filtered rain water into the autoclave to the level indicated by the
manufacturer.

Teaching Guides for NTA Level 4 MLS Curriculum Page 48

 Place the basket or drum in the autoclave
 Close the lid tightly
 Switch on the autoclave
 Allow the inside air to escape depending on the type of autoclave
 Close the air outlet
 Re ensure that the lid is tightly closed
 Set the sterilization time (hold time) according to article to be sterilized.
 The autoclave automatically switches off
 Allow the temperature and pressure to develop (pressure should be zero)
 Open the lid
 Carefully take article out of the autoclave
 Record autoclave cycles in the autoclave log book

Step 8: Limitations and Troubleshooting of Autoclave (20 Minutes)

 Always fill the autoclave with the correct amount of distilled water or rainwater to avoid
damaging the autoclave.
 Avoid using tap water as salts are deposited in the autoclave which enhances rusting
 If spillage of liquids occurs during sterilization, clean the autoclave immediately after use.
 Carefully follow all procedures recommended by manufacturer’s instructions.
 Clean chamber interior as need arises.
 Examine lid gasket for leaks
 Lid gasket should be kept clean and regularly checked for cracks
 Check water level
 Do not dismantle any part of the autoclave
 Regular servicing (e.g. every 6 months) must be done by a reputable engineer

Basic Troubleshooting:
Problem Cause Remedy
Machine does not heat Power OFF Switch it ON
Burnt elements Call Engineer Technician
Blown fuse Call Engineer/Technician
Thermostat Check thermostat
settings/call Engineer
Technician
Heating but temperature not Low thermostat settings Reset thermostat/call
i. Rising Engineer Technician
ii. Pressure does not rise Pressure Gauge Check pressure gauge/call
Air release valve engineer/Technician
Close
iii. Autoclave switches OFF Low water level Add water to the required
Before boiling level
iv. Steam leakage on lid gasket Worn out gasket Replace gasket

Step 9: Key Points (10 Minutes)

 It is equipment used for sterilization of medical instruments, and equipment textiles (i.e.
theatre gowns and dressings) Laboratory culture containers and glassware.

Teaching Guides for NTA Level 4 MLS Curriculum Page 49

 Adhere to Bio safety precautions on handling biological specimens’ laboratory articles
including but not limited to wearing of laboratory coats, gloves and other protective
gears.
 Do not operate the autoclave with a leaking rubber gasket
 Report any malfunctions to the maintenance Engineer
 Examine plugs
 Test pressure control switches
 Loosen the caps of the containers that are to be sterilized
 Pack the containers in a wire basket or in the autoclave drum
 Pour distilled water or filtered rain water into the autoclave to the level indicated by the
manufacturer.
 Place the basket or drum in the autoclave
 Close the lid tightly

Step 10: Evaluation (10Minutes)

 ASK STUDENTS TO:
 Define Autoclave
 Explain proper use and care of Autoclave
 Explain the limitation and Troubleshooting of Autoclave

ASK STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

* Practical sessions

Teaching Guides for NTA Level 4 MLS Curriculum Page 50

Session 7: Incubator Use
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 240 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the Incubator
 List type of Incubator
 Identify the major parts of the Incubator
 Explain the principle of Incubator
 Explain safety precautions of the Incubator
 Describe proper use of the Incubator(demonstration and practical)
 Describe the limitation and troubleshooting of Incubator

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 05 Minutes Presentation Introduction Learning Objectives
2 05 Minutes Presentation Definition of terms
3 05 Minutes Presentation Laboratory types of Incubator
4 10 Minutes Presentation Major parts of Incubator
5 30 Minutes Presentation Principle of the Incubator
6 40 Minutes *Presentation & Care of the Incubator
Practical
7 120 Minutes *Presentation & Proper use of the Incubator
Practical
8 15 Minutes Presentation Limitation& troubleshooting of
Incubator
9 05 Minutes Presentation Key points
10 05 minutes Presentation Evaluation

Step 1: Use of Incubator (05 Minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 51

Step 2: Definitions of Terms (05 Minutes)
 It is an instrument used to keep specimens at a given temperature.

Step 3: Types of Incubator (05Minutes)

 Incubators are manufactured in different sizes and with varying temperature ranges.
Carbon dioxide incubators, and incubators that operate from 12 volt power sources are
also available

Source ASCP

Step 4: Parts of the Incubator (10 Minutes)

Part Function
Heating Element It produces heat
Timer Duration of process cycle
Fan Air circulation
Thermometer Temperature Indicator
Thermostat Control temperature
Door seal Gasket door to preserve coldness
Switch Power On / Off

Step 5: Principle of Incubator (30 Minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 52

 To provide and maintain constant temperature during incubation. When the thermostat is
set at a required temperature, and the instrument switched on, the heater heats up and the
fan, which is within the oven, circulates the temperature generated evenly within the
cabinet

Step 6: Care of the Incubator (40 Minutes)

 Adhere to Bio safety precautions on handling biological specimens laboratory articles
including but not limited to wearing of laboratory coats and wearing of gloves
o Make sure that the incubator is at least 20cm from the wall
o Place it on a solid level surface
o Consult operation Manual for Specific Instructions
o Check the growth characteristics of included the control organisms
o Check the internal quality control reagents/ specimens included

Step 7: Proper use of Incubator (120 Minutes)

 Equipment Standard Operating Procedures:
 Always follow the manufacturer’s instructions.
 Set the temperature
 Switch on the instrument and check if the fan working
 Arrange articles to be incubated and close the door
 When the required temperature is reached, time your instrument.
 Take care not to open the incubator in between incubation cycle.
 When the incubation time set is up take out articles
 Record the temperature on the temperature log twice daily
 Protect the incubator from power surges using a voltage stabilizer, e.g. Sollatek AVS 13.

Step 8: Limitations and Troubleshooting of Incubator (15 Minutes)

 Make sure the incubator is at least 20 cm from the wall
 Place it on a solid surface
 Check that the pilot lamps are functioning
 Always set correct temperatures and close the door fully when in use.
 Clean the incubator after every 14 days and immediately if any infectious material is
spilled. Use a non-corrosive disinfectant, e.g. 5% Lysol or 70% alcohol, then wipe with a
damp cloth soaked in soapy water.
 The incubator must maintain a constant temperature of 350C to 37 oC for bacterial
cultures. The temperature must be monitored daily and recorded on a chart, preferably
fixed to the door.
 For carbon dioxide incubation, a 5 - 10 % carbon dioxide concentration is maintained by
use of a candle inside a carbon dioxide jar.
 Ensure inclusion of appropriate controls
 Do not put objects on top of the incubator
 Lubricate the mechanical parts of the door lock every 3 months. Use heat resistant oil or
silicone grease.
 Consult operational manual for specific instructions
 If the incubator is faulty, consult a qualified Biomedical Engineer.

Basic Troubleshooting:

Teaching Guides for NTA Level 4 MLS Curriculum Page 53

 PROBLEM CAUSES REMEDY
Incubator operates Door gasket Call service engineer
but no heat increase Thermostat set at low value Re set value
No heat produced Burnt Element Call Service Personnel
Over heat Temperature set too high Reset temperature

Step 9: Key Points (05 Minutes)

 It is an instrument used to keep specimens/reactions at a given temperature. To describe
proper use of an incubator for preparation of reagents, culture, samples and incubation of
some tests.
 To provide and maintain constant temperature during incubation. When the thermostat is
set at a required temperature, and the instrument switched on, the heater heats up and the
fan, which is within the oven, circulates the temperature generated evenly within the
cabinet
 Equipment Standard Operating Procedures:
 Always follow the manufacturer’s instructions

Step10: Evaluation (05 Minutes)

 ASK STUDENTS TO:
o Define Incubator
o Explain proper use and care of Incubator
o Explain the limitation and Troubleshooting of Incubator
 ASK STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

* Practical sessions

Teaching Guides for NTA Level 4 MLS Curriculum Page 54

Session 8: Hot Air Oven Use
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 240 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the Hot air Oven
 List type of Hot air Oven
 Identify the major parts of the Hot air Oven
 Explain the principle of Hot air Oven
 Explain safety precautions of the Hot air Oven
 Describe proper use of the Hot air Oven (demonstration and practical)
 Describe the limitation and troubleshooting of Hot air Oven

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 05 Minutes Presentation Introduction Learning Objectives
2 05 Minutes Presentation Definition of terms
3 05 Minutes Presentation Laboratory types of Hot air Oven
4 10 Minutes Presentation Major parts of Hot air Oven
5 30 Minutes Presentation Principle of the Hot air Oven
6 40Minutes *Presentation & Practical Care of the Hot air Oven
7 120Minutes *Presentation & Practical Proper use of the Hot air Oven
8 15 Minutes Presentation Limitation& troubleshooting of Hot air
Oven
9 05 Minutes Presentation Key points
10 05 Minutes Presentation Evaluation

Step 1: Use of Hot air Oven (05 Minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms (05 Minutes)

 Hot air oven is a machine used to dry/sterilize laboratory glass ware/utensils

Teaching Guides for NTA Level 4 MLS Curriculum Page 55

Step 3: Types of Hot air Oven (05Minutes)
 Hot air ovens are manufactured in different sizes and with varying temperature ranges.
Small hot air ovens are placed on the bench; larger hot air ovens are placed on a special
trolley.

Step 4: Parts of the Hot air Oven (10 Minutes

Name of Part Function
Heating elements Used to produce heat
Thermostat Controlling temperature
Door gaskets Seal the door
Thermometers Temperature indicator
Switch Power ON, power OFF
Fan For air circulation
Timer Duration of the process cycle

Step 5: Principle of Hot air Oven (30 Minutes)

 It achieves sterilization (sterility) by applying dry heat from low temperature to high
temperature.

Step 6: Care of the Hot air Oven (40 Minutes)

 Adhere to Bio safety precautions on handling biological specimens laboratory articles
including but not limited to wearing of laboratory coats, gloves and other protective
gears.
o Make sure the oven is placed on the level surface, at least 20 cm away from the wall
or other equipment
o Do not use hot air oven for drying plastic material

Step 7: Proper use of Hot air Oven (120 Minutes)

 Put article to be sterilized in that air oven chamber and close the door
 Switch on the instrument
 Set the temperature and check if the fan working
 When the required temperature is reached, time your instrument.
 Take care not to open the oven in between sterilization cycle.
 When the sterilization time set is up, the buzzer turns ON and the sterilization is
completed
 Leave the oven to cool to 50oC
 Switch off the hot air oven
 Open the door and take out the sterilized article

Step 8: Limitations and Troubleshooting of Hot air Oven (15 Minutes)

 Clean the outside surface of the oven daily using disinfectant
 Clean the oven chamber using a soft cloth soaked in detergent
 Ensure the set temperature corresponds with the temperature shown at the thermometer
 Check the pilot lump is functioning properly
 Open the door by pulling and close by pressing the door knob. Do not turn the knob

Teaching Guides for NTA Level 4 MLS Curriculum Page 56

 If oven is used as a drying oven, open the air release vent
 Check the power cord and plug
 Check that the pilot lamp functions properly.
 Compare the inside temperature with the set thermostat.

Basic Troubleshooting:
PROBLEMS CAUSE REMEDY
Oven operates but no Door gaskets Replace
temperature rise
Thermostat set at low value Increase value
No heat Element Call Service Technician
Circulation fan not Fuse Call Service Technician
working
Motor Call service Technician
Over heating Operating temperature set too high Reset operating
temperature
Call service Technician

Step 9: Key Points (05 Minutes)

 Hot air oven is a machine used to dry/sterilize laboratory glass ware/utensils
 Hot air ovens are manufactured in different sizes and with varying temperature ranges.
Small hot air ovens are placed on the bench; larger hot air ovens are placed on a special
trolley.
 It achieves sterilization (sterility) by applying dry heat from low temperature to high
temperature
 Put article to be sterilized in that air oven chamber and close the door
 Switch on the instrument
 Clean the outside surface of the oven daily using disinfectant
 Clean the oven chamber using a soft cloth soaked in detergent

Step10: Evaluation (05Minutes)

 ASK STUDENTS TO:
o Define Hot air Oven
o Explain proper use and care of Hot air Oven
o Explain the limitation and Troubleshooting of Hot air Oven
 ASK STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

*Practical sessions

Teaching Guides for NTA Level 4 MLS Curriculum Page 57

Session 9: Weighing Scales (Balances) Use
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 240 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the Weighing Scales
 List type of Weighing Scales
 Identify the major parts of the Weighing Scales
 Explain the principle of Weighing Scales
 Explain safety precautions of the Weighing Scales
 Describe proper use of the Weighing Scales(demonstration and practical)
 Describe the limitation and troubleshooting of Weighing Scales

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 05 Minutes Presentation Introduction Learning Objectives
2 05 Minutes Presentation Definition of terms
3 10 Minutes Presentation Laboratory types of Weighing Scales
4 20 Minutes Presentation Major parts of Weighing Scales
5 30 Minutes Presentation Principle of the Weighing Scales
6 60 Minutes *Presentation & Practical Care of the Weighing Scales
7 60 Minutes *Presentation & Practical Proper use of the Weighing Scales
8 30 Minutes Presentation Limitation& troubleshooting of
Weighing Scales
9 10 Minutes Presentation Key points
10 10 Minutes Presentation Evaluation

Step 1: Weighing Scales (05 Minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms (05 Minutes)

 A weighing scale or balance is equipment which is used to measure the weights of
chemicals needed for the preparation of laboratory reagents.

Teaching Guides for NTA Level 4 MLS Curriculum Page 58

Step 3: Types of Weighing Scales (10Minutes)
 Different types Weighing Scales available includes
o Manual (single pan or double pan)
o Electric (Electronic) – analytical or non-analytical

Step 4: Parts of the Weighing Scales (40 Minutes

 Balance pan is to hold the chemical which is to be weighed
 Beam to hold weights
 Plumb line assists in leveling the instruments
 Knife edge used to make sure the required amount of chemical is correct

Step 5: Principle of Weighing Scales (10 Minutes)

 A weighing scale or balance is used to measure the weights of chemicals needed for the
preparation of laboratory reagents. A single pan balance with weights on a beam is simple
to use and has sufficient sensitivity for routine laboratory work.

Step 6: Care of the Weighing Scales(60 Minutes)

 Always carefully follow the manufacturer’s instructions.
 Keep the weighing scale clean at all times and protect it with a cover when not in use.
Clean with a damp cloth – not with detergent.
 Never apply oil or any lubricant to the knife-edges or bearings of a mechanical weighing
scale.
 Check the weighing scale weekly using a known calibration weight to detect early drift.
 For added security, lock the instrument in a cupboard.
 If the equipment is faulty, consult a qualified biomedical engineer.

Step 7: Proper use of Weighing Scales (120 Minutes)

 Always follow the manufacturer’s instructions.
 Place a piece of filter paper on the pan; if you are weighing a hygroscopic reagent, use
glass or a plastic container. Make sure all the weights are at zero.
 Slide the weights on the beam so that the balance is set to the required weight of the
chemical.
 Place the chemical on the filter paper using a spatula.
 Add the chemical slowly and carefully as the pointer approaches zero.
 Remove the weighed chemical from the pan and place in the flask for reagent preparation.
 Slide the weights or turn the dial knob to zero.
 Clean any spilt chemical with dry gauze.

Step 8: Limitations and Troubleshooting of Weighing Scales (60 Minutes)

 Always carefully follow the manufacturer’s instructions.
 Keep the weighing scale clean at all times and protect it with a cover when not in use.
Clean with a damp cloth – not with detergent.
 Never apply oil or any lubricant to the knife-edges or bearings of a mechanical weighing
scale.
 Check the weighing scale weekly using a known calibration weight to detect early drift.
 For added security, lock the instrument in a cupboard.

Teaching Guides for NTA Level 4 MLS Curriculum Page 59

 If the equipment is faulty, consult a qualified biomedical engineer.

 Troubleshooting a weighing scale

o Always refer to the operations manual.
o In case of a major break down of the equipment, consult a qualified biomedical
engineer.

Step 9: Key Points (15 Minutes)

 Place a piece of filter paper on the pan; if you are weighing a hygroscopic reagent, use
glass or a plastic container. Make sure all the weights are at zero.
 Slide the weights on the beam so that the balance is set to the required weight of the
chemical.
 Place the chemical on the filter paper using a spatula.
 Add the chemical slowly and carefully as the pointer approaches zero.
 Different types available include Manual (single pan or double pan) and Electric –
analytical or non-analytical
 Always refer to the operations manual.
 In case of a major break down of the equipment, consult a qualified biomedical engineer.
 Never apply oil or any lubricant to the knife-edges or bearings of a mechanical weighing
scale.
 Different types available include Manual (single pan or double pan) and Electric –
analytical or non-analytical

Step10: Evaluation (15 Minutes)

 ASK STUDENTS TO:
o Define Weighing Scales
o Explain proper use and care of Weighing Scales
o Explain the limitation and Troubleshooting of Weighing Scales
 ASK STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

* Practical sessions

Teaching Guides for NTA Level 4 MLS Curriculum Page 60

Session10: Colorimeter Use
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 240 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the Colorimeter
 parts of the Colorimeter
 Explain safety precautions of the Colorimeter
 Describe proper use of the Colorimeter s(demonstration and practical)
 Describe the limitation and troubleshooting of Colorimeter

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 05 Minutes Presentation Introduction Learning Objectives
2 05 Minutes Presentation Definition of terms
3 10 Minutes Presentation Laboratory types of Colorimeter
4 20 Minutes Presentation Major parts of Colorimeter
5 30 Minutes Presentation Principle of the Colorimeter
6 60Minutes *Presentation & Practical Care of the Colorimeter
7 60Minutes *Presentation & Practical Proper use of the Colorimeter
8 30 Minutes Presentation Limitation& troubleshooting of
Colorimeter
9 10 Minutes Presentation Key points
10 10 Minutes Presentation Evaluation

Step 1: Colorimeter (05 Minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms (05 Minutes)

 Colorimeter is an instrument that measures the concentration of a coloured solution

Step 3: Types of Colorimeter (10Minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 61

 Colorimeters are produced by several manufacturers and include types with inbuilt or
removable filters; those with needle or digital readouts; and colorimeters that operate
from mains or 12 volt power sources. Colorimeters may be manual or semi-automated.

Step 4: Parts of the Colorimeter (20 Minutes)

 Filter: Are used to provide a sufficient narrow spectral band
 Light source: From electric supply
 Photosensitive detector system: Shows the Absorbance and Transmittance Scales
 Cells to hold a solutions

Step 5: Principle of Colorimeter (10 Minutes)

 A colorimeter is an electrically powered instrument that measures the concentration of a
coloured solution. A colorimeter uses filters to produce light of a single wavelength,
selected according to the colour of the solution being measured. Coloured light is passed
through the solution and the amount of light emerging is measured on a scale of
absorbance. The absorbance is directly proportional to the concentration of the coloured
compound in the solution. A colorimeter is used for clinical chemistry and haemoglobin
determinations.

Step 6: Care of the Colorimeter (60 Minutes)

 Always carefully follow the manufacturer’s instructions.
 Keep the cuvette chamber closed when not in use.
 Clean filters with a soft cloth or cotton gauze when required (for non-inbuilt filters).
 At the end of every day, disconnect the power source by switching off at the wall socket
and removing the plug, or disconnecting the battery terminals.
 Cover the instrument after use.
 For added security, lock the instrument in a cupboard.
 Protect the colorimeter from power surges using a voltage stabilizer, e.g. Sollatek AVS
13.
 Replace blown bulbs and fuses, following the manufacturer’s instructions.
 If the equipment is faulty, consult a qualified biomedical engineer.

Step 7: Proper use of Colorimeter (120 Minutes)

 Always follow the manufacturer’s instructions.
 Connect the unit to the power supply and switch on.
 Allow a 15-minute warm-up period to ensure the optical and electronic systems have
sufficient time to stabilise.
 Select the correct wavelength for the compound to be tested e.g. 540 nm for
haemoglobincyanide.
 Select absorbance by use of the mode switch.
 Arrange all the required solutions in test tubes in a rack, i.e.:
 The blank - reagent containing no sample
 The standard - a solution of known concentration.
 Test solutions - samples to be tested.
 Carefully clean a cuvette using soft tissue to avoid scratching.
 Avoid touching the sides of the cuvette facing the light path.

Teaching Guides for NTA Level 4 MLS Curriculum Page 62

 Hold the cuvette by the ground sides that do not face the light path.
 Transfer the blank solution into the cuvette and place the cuvette in the sample
compartment with the clear sides of the cuvette facing the light path.
 Close the chamber and set the display to read zero by use of the SET BLANK control.
 Remove the blank solution from the compartment, pour the blank solution back into the
test tube, then pour the standard solution into the cuvette and read the absorbance.
 Obtain the absorbance of the test solutions in the same way.
 Using a table of values obtained from a calibration curve derived from the machine, read
the concentration of the test samples against the absorbance.
 After use, switch off the power supply and cover the equipment to protect from dust.
 Rinse the cuvette with distilled water, drain dry, wrap in soft material and store carefully
in a small box to avoid scratches and dust.

Step 8: Limitations and Troubleshooting of Colorimeter (60 Minutes)

 Avoid touching the sides of the cuvette facing the light path
 Use a correct filters to produce light of the desired wavelength selected to the colour of
the solution
 The user should be medical laboratory qualified
 Always remember to disconnect the power source whenever in use.
 Never use broken cuvette or having scratch.

 Troubleshooting a Colorimeter
o Always refer to the operations manual.
o In case of a major break down of the equipment, consult a qualified biomedical
engineer.

Step 9: Key Points (15 Minutes)

 A colorimeter is an electrically powered instrument that measures the concentration of a
coloured solution. A colorimeter uses filters to produce light of a single wavelength,
selected according to the colour of the solution being measured. Coloured light is passed
through the solution and the amount of light emerging is measured on a scale of
absorbance. The absorbance is directly proportional to the concentration of the coloured
compound in the solution. A colorimeter is used for clinical chemistry and haemoglobin
determinations.
 Always follow the manufacturer’s instructions.
 Connect the unit to the power supply and switch on.
 Colorimeter is an instrument that measures the concentration of a coloured solution
 Always refer to the operations manual.
 In case of a major break down of the equipment, consult a qualified biomedical engineer.

Step10: Evaluation (15 Minutes)

 ASK STUDENTS TO:
o Define Colorimeter
o Explain proper use and care of Colorimeter
o Explain the limitation and Troubleshooting of Colorimeter
 ASK STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

Teaching Guides for NTA Level 4 MLS Curriculum Page 63

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

* Practical sessions

Teaching Guides for NTA Level 4 MLS Curriculum Page 64

Session 11: Use Basic Laboratory
Instruments and Equipments
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 120 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define SOPs, Safety measures
 List types of SOPs
 Describe importance of SOPs of Equipments and Instruments
 Describe safety measures when operating Equipment and Instrument
 Explain on operating equipment
 Explain how to use the manufacturer’s manual

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 10 Minutes Presentation Introduction Learning Objectives
2 10 Minutes Presentation Definition of terms
3 05 Minutes Presentation Types of SOPs of Equipments and Instruments
4 15 Minutes Presentation Importance of SOPs of Equipment and
Instruments
5 20 Minutes Presentation Safety measures of Instruments and
Equipment
6 30 Minutes Presentation Operation of instruments and equipment
7 10 Minutes Presentation Use of manufacturer’s manual
8 10 minutes Presentation Key Points:
9 10 Minutes Presentation Evaluation

Step 1: Use of Basic Laboratory Instruments and Equipments 10 minutes

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms (10 Minutes)

 Standard Operating Procedures (SOPs):

Teaching Guides for NTA Level 4 MLS Curriculum Page 65

 o Are guidelines which are prepared to ensure that the Instrument and Equipment is
properly used and maintained according to needs of that laboratory.
 Safety measures:
o These are procedures or regulations which are designed to prevent ill – health,
disablement and interference with work which results from laboratory accidents

ACTIVITY:
 ASK the student to buzz in pairs and allow them to answer the following questions
o Define the following terms:
 Laboratory SOPs
 Laboratory safety measures

Step 3: Types of SOPS of Equipment and Instruments 05 minutes

 Standard Operation Procedures must be applicable and achievable in laboratory in which
they will be used. Clearly written and easy to understand and follow. Kept up to date
using appropriate valid techniques.
 May be:
o National SOPS: Are Standard Operating Procedure which are prepared by a
particular country e.g. MOHSW
o International SOPs: Are Standard Operating Procedure which are prepared by
International organization e.g. WHO, UNICEF

Step 4: Importance of SOPs of Equipments and Instruments 15 minutes

 The importance of standard operating procedures of equipments and instruments are as
follows:-
o Enhances proper use, maintenance and calibration of Instruments and Equipments
o Provides laboratory staff with written instructions on how to perform tests to an
acceptable standard
o Creates confidentiality to the user of that equipment and instruments
o Improves and maintains the quality of laboratory service to patients and identify
problems
o Identifies problems associated with poor performance
o Prevents changes in performance of tests which may occur when a new member of
staff is appointed
o Makes clinical and epidemiological interpretations of test results easier
o Facilitates the preparation of a list and inventory of essential reagents, chemicals and
equipment and instruments

Step 5: safety measures when operating Equipment and Instruments (20 minutes)
 Use certified safe equipment and instruments
 Decontaminate regularly equipment and instruments by use of disinfectants
recommended in standard operation procedures of MOHSW and AMREF (T)
 Use disposable plastic ware to avoid injuries
 Regularly test and service equipments and instruments
 Be careful when opening bottles and containers containing flammable solvents
 Use all laboratory equipment as per manufacturer’s recommendation and SOPs
 Any instrument and equipment with moving parts must be operated with regard to safety

Teaching Guides for NTA Level 4 MLS Curriculum Page 66

 o (e.g. Centrifuge Close the lid before turning it on)
 Use glassware that is free of chips and cracks
 Two hands will be used to lift large Equipment and Instruments e.g. When handling
Centrifuge, Microscope you must use two hand to lift it,
 Safety precaution regarding power connection

STEP 6: Operate Instrument and Equipment (30 Minutes)

The following are proper ways when operating equipments and instruments
 Follow the manufacturer’s manual
 Operate instrument in a well – ventilated area
 Connect equipment to power supply and switch on (for electrical equipments)
 Equipments and Instruments must be placed on a firm bench.
 Adjust variables according to temperature, volume, colour filter, time, speed of the
instrument and equipment
 Equipments and Instrument being cleaned, inspected, serviced and repaired correctly
 Before reuse , inspect instruments i.e. tubes , pipette and specimen container for cracks,
broken and chipped ends

Give chance for student to operate equipment and instruments

Step 7: How to use manufacturer’s manual (10 Minutes)

 This manual usually show the components of the instrument and equipment
 Read all required for operating instrument and equipment
 Read the procedure for the use of the equipment and instrument
 Check on the precautions required before using the instrument and equipment
 Check the accessories if are present or not e.g. bulbs, Cuvettes, objective lenses

Step 8: Key Points: 10 Minutes

 Standard Operating Procedures (SOPs): Are guidelines which are prepared to ensure that
Instrument and Equipment is properly used and maintained according to needs of that
laboratory.
 Safety measures: Are procedures or regulations which are designed to prevent ill – health,
disablement and interference with work which results from laboratory accidents
 National and International Standard Operating Procedures
 It enhances proper use, maintenance and calibration of Instruments and Equipments
 It improves and maintains the quality of laboratory service to patients
 Operate instrument in a well – ventilated area
 Read all required for operating instrument and equipment

Step 9: Evaluation (10 Minutes)

 ASK STUDENTS TO:
o Define the words “SOP” and “Safety measures” of laboratory equipments and
instruments
o Explain the importance of SOPs of Equipments and Instruments
o Explain safety measures when operating Equipment and Instrument
 ASK THE STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

Teaching Guides for NTA Level 4 MLS Curriculum Page 67

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)
 Planned Preventive Maintenance (PPM) manual - MOHSW

* Practical sessions

Teaching Guides for NTA Level 4 MLS Curriculum Page 68

Session 12: Performance of Basic
Laboratory Instruments and Equipment
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 360 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define Monitoring, Calibration, Control and Standard
 List monitoring tools of laboratory equipment and instruments
 Explain the importance of calibration of laboratory equipment and instruments
 Explain type of control used to basic laboratory equipments and instruments
 Describe the importance of monitoring of laboratory equipment and instruments
 Describe proper use of monitoring, controls and standards for laboratory equipment and
instruments

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 10 Minutes Presentation Introduction Learning Objectives
2 10 Minutes Presentation Definition of terms
3 20 Minutes Presentation Monitoring tools
4 120 Minutes Presentation& Practical Importance of calibration of
Equipments and Instruments
5 20 Minutes Presentation Types of controls
6 30 Minutes Presentation Importance of monitoring
7 120 Minutes Presentation &Practical Proper use of monitoring,
controls and standards
8 15 Minutes Presentation Key Points:
9 15 Minutes Presentation Evaluation

Step 1: Monitor performance of Basic Laboratory Instruments and Equipments (10

minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 69

Step 2: Definitions of Terms (10 Minutes)
 Monitoring: The way of making a close supervision for the performance of instruments
and equipments
 Calibration: Preparing an instrument or equipment meet certain criteria before using it
 Control: Is a way of making a constant check on the reliability of an instrument or
equipment
 Standards: Is a solution or substance which contain a known amount of a substance under
investigation used to determine the concentration of the same substance in a test sample

Step 3: List types of monitoring tools of equipment and instrument (20 minutes)
 In order the equipments and instruments to run smoothly the followings are types of
monitoring tools which are used in different type of equipments
o Graph papers: To the calibrating the working of equipment e.g. Colorimeter
o Autoclave tape (Adhesive): Used when sterilization of articles using autoclave
o Temperature charts: Used in recording temperature of refrigerator
o Balance
o Tachometer
 The above mentioned or listed monitoring tools
o Are tools which make a close supervision of the performance of an instrument and
equipment
o Show the irregularities and regularities of the performance of the equipments and
instruments
o (e.g. Temperature charts, autoclave adhesive tape, balance, tachometer and graph
papers)

Step 4: Importance of calibration (120 minutes)

 The importance of calibration of equipments and instruments are as follows:-
o Provides the accuracy, sensitivity (reliability) of an instrument and equipment
o Provides an early warning of the malfunction of the instrument and equipment
o Provides assurance of reliable laboratory results provided by instrument and
equipment
o Provides necessary check whether the equipment and instrument is following SOPs
o Enables instrument and equipment to be ready for use
 The following instruments and equipments are to be calibrated:
o Colorimeter, Capillary, Micropipette fillers

Step 5: Types of control (20 Minutes)

 Control: Is a way of making a constant check on the reliability of an instrument or
equipment
 Control helps in monitoring calibration of equipment in order to give accurate results
 There are two types of controls (External and Internal or Positive and negative)
o Locally prepared controls:- These are control prepared within the laboratory
o Commercially prepared controls:- These are controls prepared by manufacturer’s for
commercial purposes, these are of (i) Freeze dried controls (ii) Liquid controls
 The controls must be treated the same way as test specimen

Teaching Guides for NTA Level 4 MLS Curriculum Page 70

Step 6: Importance of monitoring performance of equipment and instrument (30
minutes)
 It provides discovery of malfunction of instrument and equipment early
 It guide the user for operating instruments and equipments

Step 7: Proper use of Monitoring tools, controls and standards (120 Minutes)
 Monitoring tools:-
o Follow manufacturer’s manual
o Use following monitoring tools respectively (Thermometers, Temperature charts,
Browne’s tube)
 Controls:
o Prepare controls as stipulated under SOPs
o Include controls in specimen investigations
o The controls must be treated the same way as test specimen
o When using commercially manufactured controls always select the true value which
applies to the assay method which is being used.
 Standards:
o Include standards in specimen or sample investigation
o Add equal volume of standard as in of test specimen
o Introduce a standard after every 10 tests

Step8: Key points (15 Minutes)

 Monitoring: The way of making a close supervision for the performance of instruments
and equipments
 Calibration: Preparing and instrument or equipment meet certain before using it
 Control: Is a way of making a constant check on the reliability of an instrument or
equipment
 Standards: Is a solution or substance which contain a known amount of a substance under
investigation used to determine the concentration of the same substance in a test sample
 Calibration provides the accuracy, sensitivity (reliability) of an instrument and equipment
 Calibration provides an early warning of the malfunction of the instrument and equipment
 Calibration provides assurance of reliable laboratory results provided by instrument and
equipment
 Calibration enables instrument and equipment to be ready for use
 Calibration provides necessary check whether the equipment and instrument is following
SOPs
 Use following monitoring tools respectively (Thermometers, Temperature charts,
Browne’s tube)
 There two types of controls : Locally and Commercially prepared (External and Internal
or Positive and negative)

Step 9: Evaluation (15 Minutes)

 ASK STUDENTS TO:
o Define Monitoring, Calibration, Controls and Standards
o List types of monitoring tools
o Explain importance of calibration, types of controls
o Mention proper use of monitoring tools, Controls and standards

Teaching Guides for NTA Level 4 MLS Curriculum Page 71

 ASK THE STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

Teaching Guides for NTA Level 4 MLS Curriculum Page 72

Session 13: Planned Preventive
Maintenance for Basic Laboratory
Instruments and Equipment
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 120 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define Planned Preventive Maintenance
 Define schedule and unscheduled maintenance
 List the significance of Planned Preventive Maintenance
 Discuss the significance of Planned Preventive Maintenance
 Describe the significance of Planned Preventive Maintenance

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 10 Minutes Presentation Introduction Learning Objectives
2 05 Minutes Presentation Definition of terms
3 05 Minutes Presentation List significance of PPM
4 20 Minutes Presentation Discuss significance of PPM
5 30 Minutes Presentation & Demonstration Ways of cleaning of equipments
before and after use
6 30 Minutes Presentation & Demonstration Ways of record keeping of all
equipments
7 05 Minutes Presentation Key Points
8 15 Minutes Presentation Evaluation

Step 1: Describe Planned Preventive Maintenance of Basic Laboratory Instruments and

Equipments (10 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms (05 Minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 73

 Planned Preventive Maintenance : Is the periodic maintenance of equipments and
instruments
 Schedule maintenance: Is a regular maintenance of instruments and equipments (Time
flamed/arranged)
 Unscheduled maintenance: Maintenance of equipments and instruments when there is
need (During breakdown or replacement of accessories)

Step 3A: List significance of Planned Preventive Maintenance of equipment and

instrument (05Minutes)
 Prevents Hazards
 Decreases cost of tests
 Performance increase
 Less waste production
 Easier communication with manufacturer
 Diminished major repair

Step 4: Significance of Planned Preventive Maintenance (20 minutes)

 Creates greater safety by preventing hazards resulting from breakdown
 Improves performance with regard to standard requirement
 Produces less waste of reagents and control materials and less time is spent repeating tests
 Improves effectiveness of laboratory equipment with diminished cost of tests
 Creates good relationship between the laboratory and those requesting tests
 Makes easier to communicate with manufacturer’s regarding what equipment is needed
and specification
 Makes less need for major repairs and lowers repair cost

Step 5: Ways of cleaning equipments and instruments (30 Minutes)

 Clean each type of equipments and instruments according to manufacturer’s manual and
SOPs
 Glassware should be soaked in water or if contaminated , in suitable disinfectant
 Used and new glassware should be cleaned by washing in hot detergent solution followed
by at least two rinses in clean water and finally using distilled water
 If glassware cannot be cleaned by ordinary washing clean chemically i.e. Use Chromic
acid
 Clean equipments regularly (Refrigerator, Colorimeter, Incubator, Microscope, Balances)

Step 6: Ways of record keeping of equipment and instrument (30 minutes)

 Provides discovery of malfunction of instrument and equipment early
 Guides the user for operating instruments and equipments

Step 7: Key Points (05 Minutes)

 Planned Preventive Maintenance: Is the periodic maintenance of equipments and
instruments
 Schedule maintenance: Is a regular maintenance of instruments and equipments (Time
flamed/arranged)

Teaching Guides for NTA Level 4 MLS Curriculum Page 74

 Unscheduled maintenance: Maintenance of equipments and instruments when there is
need (During breakdown or replacement of accessories)
 Creates greater safety by preventing hazards resulting from breakdown
 Improves performance with regard to standard requirement
 Clean each type of equipments and instruments according to manufacturer’s manual and
SOPs

Step 8: Evaluation (15 Minutes)

 ASK STUDENTS TO:
o Define Planned Preventive Maintenance , Schedule and Unscheduled maintenance
o List significance of Planned Preventive Maintenance of equipment and instrument
o Explain Ways of cleaning equipments and instruments
o Describe Ways of record keeping of equipment and instruments
 ASK THE STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

Teaching Guides for NTA Level 4 MLS Curriculum Page 75

Sessions 14: Apply Procedures of Planned
Preventive Maintenance for Basic
Laboratory Instruments and Equipment
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 120 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define schedule and unscheduled maintenance
 Demonstrate scheduled and unscheduled planned preventive maintenance
 Describe the ways of cleaning equipments
 Explain the ways of record keeping
 Demonstrate how to record equipment maintenance

Resources Needed:
 Flip chart, Marker pens
 Black/White board and chalk
 Handout with different types of diagrams

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 10 Minutes Presentation Introduction Learning Objectives
2 05 Minutes Presentation Definition of terms
3 30 Minutes Presentation & Demonstration of scheduled and
Demonstration unscheduled PPM
4 25 Minutes Presentation & Ways of cleaning equipment
Demonstration
5 10 Minutes Presentation Ways of record equipment
maintenance
6 20 Minutes Presentation & Demonstrate on how to record
Demonstration equipment maintenance
7 10 Minutes Presentation Key points
8 10 Minutes Presentation Evaluation

Step 1: Apply procedures of Planned Preventive Maintenance of Basic Laboratory

Instruments and Equipments (10 minutes).
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 76

Step 2: Definitions of Terms (05 Minutes)
 Schedule maintenance: Is regular maintenance of instruments and equipments in the
prepared timetable of maintenance (time flamed/arranged)
 Unscheduled maintenance: Irregular maintenance of equipments and instruments due to
breakdown or replacement of accessories when servicing

Step 3: Demonstrate schedule and unscheduled Planned Preventive Maintenance of

equipments (30 Minutes)
 Prepare timetable for Maintenance
 Perform replacement of various accessories of various equipments and instruments

Step 4: Explain the ways of cleaning equipments and instruments (25Minutes)

 Clean each type of equipments and instruments according to manufacturer’s manual and
SOPs
 Glassware
o Glassware’s: Immediately after use, glassware’s should be soaked in water or if
contaminated soak in a suitable disinfectant e.g. 5% Lysol.
o If glassware cannot be cleaned by ordinary washing, it must be chemically cleaned by
using cleaning solutions e.g. chromic acid cleaning solution.
o The instrument must be immersed in cleaning fluid for only as long as necessary, then
must be rinsed in several changes of clean water, followed by a final rinse in distilled
water e.g. Cleaning solution is prepared by using Potassium Dichromate (100g),
Concentrated Sulphuric acid (250 ml) and Distilled water (750ml)
o Glassware should be soaked in water or if contaminated , in suitable disinfectant
o Used and new glassware should be cleaned by washing in hot detergent solution
followed by at least two rinses in clean water and finally using distilled water
o Clean equipments regularly (Refrigerator, Colorimeter, Incubator, Microscope,
Weighing scale/balance, Hot air oven)
 Plastic wares:
o Immediately after use, plastic ware should be soaked in water or if contaminated, in a
suitable disinfectants usually a warm detergent solution, followed by two rinses in
clean water and final rinse in distilled water

Step 5: The ways of record keeping (10 Minutes)

 The ways of record keeping of equipments are as follows:
o Keep records of equipment in Ledger books, which shows data e.g. date of receiving,
cost and condition of equipment
o Bin cards usually show the balance and cost of instruments and equipments
o Electronically which may include the same information as in ledge books

Step 6: Apply recording of equipment maintenance (20 Minutes)

 The equipment maintenance should be recorded in Register book (manual) or
Electronically (Computer)
 The Maintenance Register book and Electronic should show the following:
o Type of equipment and instrument maintained
o Date when the equipment and instrument maintained

Teaching Guides for NTA Level 4 MLS Curriculum Page 77

 o When was the last time (date) maintenance
o What was maintained
o Cost or Price of Equipment
o Remarks – comments on when next maintenance to be done

Step 7: Key points (10 Minutes)

 Schedule maintenance : Is regular maintenance of instruments and equipments in the
prepared timetable of maintenance (time flamed/arranged)
 Unscheduled maintenance: Irregular maintenance of equipments and instruments due to
breakdown or replacement of accessories when servicing
 Glassware’s: Immediately after use, glassware’s should be soaked in water or if
contaminated soak in a suitable disinfectant e.g. 5% Lysol. Used and new glassware
should be cleaned by washing in a hot detergent solution, followed by at least two rinses
in clean water and finally rinse in distilled water
 Keep records of equipment in Ledger books, which shows data e.g. date of receiving, cost
and condition of equipment

Step 8: Evaluation (10 Minutes)

 ASK STUDENTS TO:
o Define Scheduled maintenance Unscheduled maintenance of PPM
o List types of monitoring tools
o Demonstrate on replacement of various accessories of various equipments and
instruments
o Describe the ways of record keeping of equipments
 ASK THE STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

Teaching Guides for NTA Level 4 MLS Curriculum Page 78

Session 15: Document Planned
Preventive Maintenance for Basic
Laboratory Equipment
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 120 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 List types of log books, Occurrence forms and Job Cards
 Define maintenance log book, Occurrence forms and Job Cards
 Explain importance of log book, Occurrence forms and Job Cards
 Demonstrate how to use maintenance log book, Occurrence forms and Maintenance Job
Cards

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 10 Minutes Presentation Introduction Learning Objectives
2 10 Minutes Presentation List maintenance log book,
Occurrence forms and Job cards
3 10 Minutes Presentation Definition of terms
4 30 Minutes Presentation Importance of maintenance log
books, Occurrence forms and Job
Cards
5 40Minutes Presentation & Demonstration use of maintenance
Demonstration log books, Occurrence forms and
Job Cards
6 10 Minutes Presentation Key points
7 10 Minutes Presentation Evaluation

Step 1: Document Planned Preventive Maintenance for basic laboratory equipments10

Minutes
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: List Maintenance log books, Occurrence forms and Job Cards (10 Minutes)
 Maintenance Log books for:
o Microscope
o Centrifuge machine

Teaching Guides for NTA Level 4 MLS Curriculum Page 79

 o Colorimeter
o Incubator
o Hot air oven
o Refrigerator
o Water bath
o Weighing scale ( Balance)
o Autoclave
 Occurrence forms for: All equipments and instruments mentioned above
 Job Cards for: All equipments and instruments mentioned above.

Step 3: Definitions of Terms (20 Minutes)

 Maintenance Log books: A book or register in which planned preventive maintenance
records are kept or recorded
 Occurrence forms: These are forms which show / record what damage of equipment
occurred
 Job Cards: A piece of still paper used to allocate work or job for a particular function and
at particular date

Step 4: Explain Importance of maintenance log books, Occurrence forms and Job
Cards (30 Minutes)
 Maintenance Log books:
o The following are the importance of maintenance log books:
 Keeps records of equipment repair
 Part of quality reporting system of equipments
 Keeps record of corrective action taken
 Enhances monitoring after repair to assure the fix is stable
 Records when the equipment is able to perform a particular functions
 Helps to identify at early stage of the equipment maintenance
 Occurrence forms:
o The following are the importance of occurrence forms:
 Keeps data of what damage has occurred on the equipment
 Keeps data of who was involved on equipment damage
 Keeps data on when equipment damage occurred
 Keeps data of where in laboratory the problem occurred
 Prioritizes management of problem
 Helps user to monitor equipment occurrence
 Job Cards:
o The following are the importance of Job Cards:
 Assigns what to do to a problem of equipment which occurred e.g. fixing a burnt
bulb to a microscope
 Allocates work to be performed in laboratory department at a particular date
 Shows arrangement processes to be followed by a worker

Step5: Demonstrate how to use maintenance log books, Occurrence forms and Job
Cards 40 Minutes
 The following are the procedures of using maintenance log books, occurrence forms and
job cards:
o Arrange Management log books, Occurrence forms and Job Cards

Teaching Guides for NTA Level 4 MLS Curriculum Page 80

 o Perform or show how to use Management log books, Occurrence forms and Job
Cards
o Give an assignment to perform the use of Management log books, Occurrence forms
and Job Cards.

Step 6: Key Points (10 Minutes)

 Maintenance Log books: A book or register in which planned preventive maintenance
records are kept or recorded
 Occurrence forms: These are forms which show / record what damage of equipment
occurred
 Job Cards: A piece of still paper used to allocate work or job for a particular function and
at particular date
 Keeps records of equipment repair
 Part of quality reporting system of equipments
 Keeps data of what damage has occurred on the equipment
 Keeps data of who was involved on equipment damage
 Assigns what to do to a problem of equipment which occurred e.g. fixing a burnt bulb to a
microscope

Step 7: Evaluation (10 Minutes)

 ASK STUDENTS TO:
o Define Management log books, Occurrence forms and Job Cards
o List types Maintenance log books, Occurrence forms and Job Cards
o Explain the importance of Maintenance log books, Occurrence forms and Job Cards
 ASK THE STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)
 Planned Preventive Maintenance Manual - MOHSW

Teaching Guides for NTA Level 4 MLS Curriculum Page 81

Session 16: Common Problems
Encountered when Operating Basic
Laboratory Equipment
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 120 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 List common problems
 Define overheating, breakage, non –functioning and mal-function
 Identify causes of problem of equipment,
 Explain each common problem
 Explain the effect of each common problem

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 10 Minutes Presentation Introduction Learning Objectives
2 10 Minutes Presentation List common problems
3 10 Minutes Presentation Definition of terms
4 30 Minutes Presentation Causes of problems of
equipments
5 20 Minutes Presentation Elaboration of common problems
6 20 Minutes Presentation & Effect of each common problem
Demonstration
7 10 Minutes Presentation Key points
8 10 Minutes Presentation Evaluation

Step 1: Describe common problem encountered when operating Basic Laboratory

Equipments 10 min.
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: List common problems (10 Minutes)

 Overheating:
 Breakage
 Non – functioning
 Mal- functioning

Teaching Guides for NTA Level 4 MLS Curriculum Page 82

Step 3: Definitions of Terms (10 Minutes)
 Overheating: The process whereby the equipment heats above normal temperature or
Equipment become to hot
 Breakage: The act or result of breaking or damaged while in use, transit etc
 Non – function: The procedure whereby the instrument and equipment is not working or
the equipment having no practical function
 Mal- function : The procedure whereby the equipment and instrument is not fully
working or works partially or failure to function properly

Step 4: Causes of common problems when operating basic laboratory equipments (30
Minutes)
 The causes of common problems are:
o Overheating:
 Extended use of equipment
 Temperature not maintained
 Use of unsafe adaptors
o Breakage:
 Improper handling of equipments and instruments
 Over heating of instrument e.g. glassware
 Improper balancing of instruments (Centrifugation)
o Non – function:
 Incorrect installation
 Improper correct positioning of equipments
 Equipment use not following manufacturer’s manual
o Mal – function:
 Not following proper procedures (SOPs)
 Not consulting instruction’s manual
 Equipment purchased incorrectly without essential replacement parts

Step 5: Describe each common problem occurs (20Minutes)

 The causes of common problems are:
o Overheating:
 When temperature is set too high e.g. Incubators, Hot air oven and Water bath
 Non – functioning
o Incubator no heat produced: Burnt element
o Refrigerator is not working :No power
o Autoclave does not heats : Power is off, burnt element and low thermostat setting
o Water bath not heating: Is due to element and thermostat
o Hot air oven when there is no heat: Due to element

 Mal – functioning
o Refrigerator is working but not cooling: Due to door gasket, compressor and gas
leakage
o Hot air oven operates but no temperature raise: Due to door gasket and thermostat is
set at low value
o Hot air oven, circulating fan not working: due to fuse and motor
o Centrifuge machine motor fails to drive: Is due to incorrect program and electrical
fault

Teaching Guides for NTA Level 4 MLS Curriculum Page 83

 o Centrifuge machine when in balance indicator is on: Due to incorrect loading and
damaged sensor
o Incubator is operating but no heat increase: Due to door gasket and thermostat is set at
low value
o Water bath machine is on but no indicator light: Due to fuse and indicator
o Water bath leaks: Is due to damaged container
o Water bath, no water circulation in trough: Is due to circulation pump.
o Microscope when field view is out off or illuminate irregularly: Due to nosepiece not
clicked into place, condenser is not mounted correctly, field iris diaphragm is top
down too much, dust or dirt on objectives, eyepiece and condenser of light exit glass
on microscope base
o Microscope resolution problems ( image is not sharp, insufficient contrast and image
details lacking definition): Is due to objective is not correctly engaged in light path,
dirt on the objective front lens, immersion objective is used without immersion oil and
bubbles in the immersion oil.

Step 6: Describe effect of each common problem occurs (20 Minutes)

 Overheating : Machines is destroyed,
o No service to the clients,
o Cause fire
 Mal – functioning: Poor services to clients,
o Reduced relationship with clients,
o Cause electrical shock
 Breakage: Cause injury to user,
o Cause infections
o Unable to perform investigations
 Non – function: Unable to perform investigations
o No service to the clients
o Equipment cannot be used

Step 7: Key Points (10 Minutes)

 Overheating, Breakage, Non – functioning and Mal- functioning
 Overheating: The process whereby the equipment heats above normal temperature or
Equipment become too hot
 Breakage: The act or result of breaking or damaged while in use, transit
 Non – function: The procedure whereby the instrument and equipment is not working or
the equipment having no practical function
 Mal- function : The procedure whereby the equipment and instrument is not fully
working or works partially or failure to function properly

Step 8: Evaluation (10 Minutes)

 ASK STUDENTS TO:
o List common problems when operating equipments and instruments
o Define Overheating, Breakage, Non – functioning and Mal - functioning
o Describe causes of common problems when operating basic laboratory equipments
 ASK THE STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

Teaching Guides for NTA Level 4 MLS Curriculum Page 84

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

Teaching Guides for NTA Level 4 MLS Curriculum Page 85

Session 17: Demonstrate Methods for
Solving Common Problems in Basic
Laboratory Equipment and Instruments
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 120 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Explain overheating,
 Explain non – functioning and mal – functioning problem
 Mention ways of solving common problems:
o Non – functioning problem
o Mal – functioning problem
o Over heating problems
o Perform ways of solving common problem

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 10 Minutes Presentation Introduction Learning Objectives
2 20 Minutes Presentation Overheating problems
3 20 Minutes Presentation Non – function and mal –
function
4 20 Minutes Presentation Ways of solving common
problems
5 30 Minutes Presentation Perform ways of solving common
problems
6 10 Minutes Presentation & Key points
Demonstration
7 10 Minutes Presentation Evaluation

Step 1: Document and report occurrence of Basic Laboratory Instruments and

Equipments 10 min.
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Explain overheating (20 Minutes)

 Overheating: The process whereby the equipment heats above normal temperature or
Equipment become too hot

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 The reasons of overheating of equipments are due to the following:
o Extended use of equipment
o Temperature not maintained
o Use of unsafe adaptors
 The above mentioned may cause the following:
o Machines is destroyed,
o No service to the clients,
o Cause fire to the equipment

Step 3: Explain non –function and mal - function of equipments and instruments (20
Minutes)
 Non – function: The procedure whereby the instrument and equipment is not working or
the equipment having no practical function
 The reasons of equipment non – functioning are as follows:
o Incubator no heat produced: Burnt element
o Refrigerator is not working :No power
o Autoclave does not heats : Power is off, burnt element and low thermostat setting
o Water bath not heating: Is due to element and thermostat
o Hot air oven when there is no heat: Due to element
o Mal- function : The procedure whereby the equipment and instrument is not fully
working or works partially or failure to function properly
 The reasons of equipments mal – functioning are as follows:
o Refrigerator is working but not cooling: Due to door gasket, compressor and gas
leakage
o Hot air oven operates but no temperature raise: Due to door gasket and thermostat is
set at low value
o Centrifuge machine motor fails to drive: Is due to incorrect program and electrical
fault
o Incubator is operating but no heat increase: Due to door gasket and thermostat is set at
low value
o Water bath, no water circulation in trough: Is due to circulation pump.
o Microscope when field view is out off or illuminate irregularly: Due to nosepiece not
clicked into place, condenser is not mounted correctly, field iris diaphragm is top
down too much, dust or dirt on objectives, eyepiece and condenser of light exit glass
on microscope base
o Microscope resolution problems ( image is not sharp, insufficient contrast and image
details lacking definition): Is due to objective is not correctly engaged in light path,
dirt on the objective front lens, immersion objective is used without immersion oil and
bubbles in the immersion oil.

Step 4: Mention ways of solving common problems (20 Minutes)

 Refrigerator is working but not cooling:
o Switch on/ Call Engineer
 Hot air oven operates but no temperature raise:
o Increase thermostat set at high value
 Centrifuge machine motor fails to drive:
o Check program / Call service Engineer
 Incubator is operating but no heat increase:

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 o Increase thermostat set at high value / Call service Engineer
 Water bath, no water circulation in trough:
o Call service Engineer
 Microscope field view is out off or illuminate irregularly:
o Slight rotate nosepiece until crick into to the position
o Re – inset the condenser all the way without tilt
o Centre iris Diaphragm correctly
o Clean each lens or glass
 Microscope resolution problems (image is not sharp, insufficient contrast and image
details lacking definition):
o Slightly rotate the noise piece until it cricks into position
o Clean objectives
o Apply immersion oil
o Remove bubbles

Step 5: Perform ways of solving common problems equipment and instruments (30
Minutes)
 Demonstrate ways of solving common problems of equipments and instruments:
o Microscope
o Water bath
o Incubator
o Centrifuge machine
o Hot air oven
o Refrigerator

Step 6: Key points (10 Minutes)

 Overheating: The process whereby the equipment heats above normal temperature or
Equipment become too hot
 Non – function: The procedure whereby the instrument and equipment is not working or
the equipment having no practical function
 Mal- function: The procedure whereby the equipment and instrument is not fully working
or works partially or failure to function properly
 Refrigerator is working but not cooling: Due to door gasket, compressor and gas leakage
 Hot air oven operates but no temperature raise: Due to door gasket and thermostat is set at
low value

Step7: Evaluation (10 Minutes)

 ASK STUDENTS TO:
o Explain Overheating of equipments and instruments
o Mention ways solving Overheating, Breakage, Non – functioning and Mal -
functioning
o Demonstrate ways of solving common problems when operating basic laboratory
equipments
 ASK THE STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:

Teaching Guides for NTA Level 4 MLS Curriculum Page 88

 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

Teaching Guides for NTA Level 4 MLS Curriculum Page 89

Session 18: Document and Report
Occurrences of Basic Laboratory
Instruments and Equipment
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04101 - BASIC LABORATORY
INSTRUMENTATION

Total Session Time: 120 Minutes

Pre – requisites:
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define occurrences, Management log book and action log sheet
 List equipment occurrence,
 Describe occurrence management log book
 Describe importance of documenting equipment occurrence
 Demonstrate occurrence recording
 Explain correction action log sheet

SESSION OVERVIEW:
Step Time Activity/ Method Content
1 10 Minutes Presentation Introduction Learning Objectives
2 05 Minutes Presentation Definition of terms
3 10 Minutes Presentation List equipment occurrences
4 25 Minutes Presentation Occurrence management log book
5 20 Minutes Presentation Importance of documenting equipment
occurrence
6 30 Minutes Presentation & Occurrence recording
Demonstration
7 10 Minutes Presentation Corrective action log sheet
8 10 Minutes Presentation Key points
9 10 Minutes Presentation Evaluation

Step 1: Document and report occurrence of Basic Laboratory Instruments and

Equipments 10 min.
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms (05 Minutes)

 Occurrence: Are hazards and accidents which occur due to laboratory work
 Management log book: A type of register which occurrence of equipments and
instruments are recorded

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 Action log sheet: This is a card or paper which shows what corrective measures have
been taken on equipment occurrences

Step 3: Lists of equipment occurrences (10 Minutes)

 The following are equipment occurrences:
o Equipment hazards: Fire caused by faulty electrical circuit
o Glassware hazards: Improper handling of glass wares
o Damaged equipment caused by insects and rodents infestation
o Damage of equipments and instruments due to unsafe laboratory premises
o Un reliable water supply cause damage of the equipments
o Equipment purchased incorrectly often without user’s manual and essential
replacement parts
o Improper correct positioning of equipments e.g. refrigerators must not be placed close
to a wall
o Electrical equipment not connected earthed correctly
o Incorrect installation and positioning of equipment

Step 4: Occurrence management log book (25Minutes)

 A register for documenting and addressing problems that occurs in the laboratory
equipments to:
o Promote s and develops a no – blame culture
o Focus on the equipment occurrences
o Occurrence data are used to identify problems for process improvement activity
o Shows how to investigate occurrence
o Shows corrective action to be taken
o Prioritize problems and assign to a process for improvement of the equipments

Step 5: Importance of documenting equipment occurrences (20Minutes)

 The following are importance of documenting equipment occurrences:
o Keeps proper record of equipment occurrences
o Promote safety awareness of user
o Identifies hazards and accidents of equipment at work place
o Makes easier to communicate with manufacturer’s regarding what equipment is
needed and specification
o Determine how the event occurred including any contributing factors.

Step 6: Demonstration of occurrence recording (30 Minutes)

 The demonstrations of occurrence recording are as follows:
o Explain on occurrence recording
o Perform occurrence recording

Step 7: Corrective Action log sheet (10 Minutes)

 It audits the corrective system later in time to assure stability of equipment late
 It show remedial actions taken to solve the immediate problem
 It identifies Corrective action be taken to solve system problems of equipment

Step 8: Key points (10 Minutes)

 Occurrence: Are hazards and accidents which occur due to laboratory work

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 Management log book: A type of register which occurrence of equipments and
instruments are recorded
 Action log sheet: This is a card or paper which shows what corrective measures have
been taken on equipment occurrences
 Damage of equipments and instruments due to unsafe laboratory premises
 Occurrence data are used to identify problems for process improvement activity
 Identifies hazards and accidents of equipment at work place
 It identifies Corrective action be taken to solve system problems of equipment

Step 9: Evaluation (10 Minutes)

 ASK STUDENTS TO:
o Define Occurrence, Management log book and Corrective Action log sheet
o List equipment occurrences
o Describe occurrence management log book
o Explain the importance of documenting equipment occurrence

ASK THE STUDENTS FOR ANY COMMENTS OR NEED CLARIFICATION

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001), Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Standard Operating Procedures- Care and Maintenance of Laboratory Equipments-By
AMREF (T)

Teaching Guides for NTA Level 4 MLS Curriculum Page 92

 CHAPTER TWO

MODULE CODE MLT04102:

ELEMENTARY STRUCTURES
AND FUNCTIONS OF HUMAN
BODY

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Session 1: Major External Anatomical
Features of Human Body
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time. 120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session the students should be able to;-
 Define the terms Anatomy, Physiology, cell, tissue, organ and system, cytology and
histology)
 Anatomical position and planes of the body (superior ,inferior, posterior and anterior)
 List four major external anatomical features of human body(Head, Chest, Abdomen,
Limbs)
 List four major external anatomical organs of the head (Ear, eye, nose and mouth)
 List nine regions of abdominal cavity (epigastric, right hypochondriac, left
hypochondriac, umbilical, right lumber, left lumber, hypogastric, right iliac, left iliac)
 List external anatomical parts of, chest, upper and lower limbs.
 Explain the basic functions of the chest, abdomen, upper and lower limbs.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer.
 Atlas of the human body.

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes Presentation Definition of terms
3 35 minutes Presentation Anatomical position and planes of the body
Demonstration
4 5 minutes Presentation Four major external anatomical features
5 10 minutes Presentation Major external anatomical organs of the head
6 20 minutes Presentation Nine region of the abdominal cavity
Demonstration
7 10 minutes Presentation External anatomical parts of chest, upper and
lower limbs
8 20 minutes Presentation Basic functions of the chest, abdomen, upper
and lower limbs
9 5 minutes Presentation Key points

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 10 5 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step no 2. Definition of Terms (5minutes)

 Activity: Brain storming. (5 minutes)
 ASK the students the following question:-
 What is: Anatomy, Physiology, cell, tissue, organ and system.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Anatomy: It is a study of structure of the body and physical relationship involved in

between body system.
 Cell: Is the structural and functional unit of a human body.
 Tissue: is the group of cells performing specific function.
 Cytology: Examines the structural features of cells using microscope
 Histology: Is the study of tissues, which are cells and the material surrounding them.
 Prokaryotic cells: Are those cells that have no nuclear membrane(e.g. bacteria and
viruses)
 Eukaryotic cells: Are those cell that have nuclear membrane ( multicellular organism)
 Organ: Is the group of tissues performing specific function.
 System: Consists a number of organs and tissues performing a specific function.
 Physiology: Is the study of how the systems of the body work and the ways in which their
integrated cooperation maintains life and health of an individual

Step no 3 Anatomical position and planes of the body.(35minutess)

 Activity: Demonstration. (5 minutes)
 ASK the student the following question:-
o Define anatomical position
o What is the location of the mouth in relation to the nose
 SUMMARIZE their responses using notes and the diagrams below

 Anatomical Position
o All anatomical descriptions are expressed in relation to the anatomical position. The
anatomical position refers to people regardless of the actual position they may be in as
if they were standing erect, with their:
o Head, eyes (gaze), and toes directed anteriorly (forward).
o Upper limbs by the sides with the palms facing anteriorly.
o Lower limbs close together with the feet parallel and the toes directed anteriorly.
o Anatomical Planes
o Anatomical descriptions are based on four imaginary planes that intersect the body in
the anatomical position. There are many sagittal, frontal, and transverse planes, but
there is only one median plane.

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 o Median (median sagittal) plane is the vertical plane passing longitudinally through the
centre of the body, dividing it into right and left halves.
o Sagittal planes are vertical planes passing through the body parallel to the median
plane. It is helpful to give a point of reference to indicate the position of a specific
plane for example, a sagittal plane through the midpoint of the clavicle. A plane
parallel and near the median plane may be referred to as a paramedian plane.
o Frontal (coronal) planes are vertical planes passing through the body at right angles to
the median plane, dividing it into anterior (front) and posterior (back) portion for
example, a frontal plane through the heads of the mandible.
o Transverse planes are planes passing through the body at right angles to the median
and frontal planes. A transverse plane divides the body into superior (upper) and
inferior (lower) part for example, a transverse plane through the umbilicus.
Radiologists refer to transverse planes as transaxial planes or simply axial planes.
 Terms of Anatomical Direction:
o Anterior: In front of, front
o Posterior: After, behind, following, toward the rear
o Distal: Away from, farther from the origin
o Proximal: Near, closer to the origin
o Dorsal: Near the upper surface, toward the back
o Ventral: Toward the bottom, toward the belly
o Superior: Above, over
o Inferior: Below, under
o Lateral: Toward the side, away from the mid-line
o Medial: Toward the mid-line, middle, away from the side
o Rostral: Toward the front
o Caudal: Toward the back, toward the tail

 Anatomical Position and Body Regions

Source: Lippincott Williams & Wilkins, 2007

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Body Planes

Source: Elsevier Ltd 2005.

Terms of Relationship and Comparison

Source: Lippincott Williams & Wilkins, 2007

Step no 4 four major external anatomical features of the human body. (5minutes)
 Activity: Buzzing. (2 minutes)
 ASK the students to buzz on major external anatomical features of the human body.
 WRITE THEIR answers on chalk board.
 SUMMARIZE their responses as follows:-
o The following are four major external anatomical features of human body.
 Head

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  Chest
 Abdomen
 upper limbs
 lower limbs.

Step no 5. Major external anatomical organs of the head (10minutes)

 Four major external anatomical organs of the head are:
o Eyes
o Ear
o Nose
o Mouth.

Step no 6. Nine region of the abdominal cavity.(20minutes)

 Nine regions of abdominal cavity includes;-
o Epigastric region.
o left hypochondriac region
o right hypochondriac region
o Umbilical region
o left lumber region
o right lumber region
o hypo gastric region

The diagram below shows the nine regions of the abdominal cavity.

Source: Elsevier Ltd 2005.

Step no 7. External anatomical parts of chest, upper and lower limbs (10minutes)
 The following are external anatomical parts for the following organs:-
o Chest –Sternum
o Breast
o Upper limbs
 upper arm
 lower arm
 Hand.

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 o Lower limbs:
 Thigh.
 leg
 foot

Step no 8. Basic functions of the chest, abdomen, upper and lower limbs (20minutes)
 Activity: Buzzing. (5 minutes)
 ASK the students the following question:
o What are the basic functions of the head, chest and abdomen?
 WRITE their responses on the flip chart
 SUMMARIZE: by giving their functions as follows:
o The basic functions of the chest is:
 Protection of the vital organs like lungs an heart
 Helps during respiration
o The basic functions of the Abdomen is:
 Protection of visceral organs like stomach, liver and intestines
o The basic functions of the upper limbs is:
 Body balancing
 Grasping of objects
o The basic functions of the lower limbs is:
 Movement
 Body weight support

Step 9: Key points. (5minutes)

 The common anatomical terms includes.(Cell, tissue, cytolology, histology, anatomincal
position)
 The body is divided into three major parts
 The basic functions of the Abdomen is:
o Protection of visceral organs like stomach, liver and intestines

Step 10: Evaluation (5minutes)

 Define the term: Anatomy
 List four major external anatomical features of a human body
 What are the functions the upper and lower limbs.

References:
 ROSS AND WILSON (1996): Anatomy and Physiology in Health and Illness; 8 th Edition
Churchill Livingstone, New York, London;
 ROSS AND WILSON (2001): Anatomy and Physiology in Health and Illness9th Edition
Churchill Livingstone Inc.;
 McMinn (1996): Lat’s Anatomy Regional & Applied, 9th ed. Persons Professional Ltd;
 Snell R. S. (1996) Clinical Anatomy, 7th Ed, Lippincott Williams & Wilkins; and
 Wilson K. J. W. (1995) Anatomy & Physiology in Illness, 7th Ed, Medical Division of
Pearson Professional Ltd.

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Session 2: Organs in Different Body
Cavities
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None

Learning Objectives
By the end of this session, students will be able are to:
 Define Body cavities
 Identify main body cavity
 Recognize thoracic cavity and its divisions
 Recognize Abdominal cavity and its Regions and Quadrants
 Explain Peritoneum and Peritoneal Cavity

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 6.1: Human Body Cavities
 Handout 6.2: Thoracic Cavity and its Divisions
 Handout 6.3: Abdominal Regions
 Handout 6:4: Abdominal Quadrants
 Handout 6.5: Surface Anatomy of the Abdomen
 The Viscera and the Arrangement of the Peritoneum
 Worksheet 6.1: Organs of different body cavities

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 05 minutes Presentation Definition of Body Cavity
Brainstorming
3 15 minutes Buzzing, Main Body Cavities
Presentation
4 25 minutes Presentation Thoracic Cavity and its Divisions
5 35 minutes Individual assignment Abdominal cavity and its Regions
Presentation and Quadrants
6 20 minutes Presentation Peritoneum and Peritoneal Cavity
7 05 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

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SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify
 ASK students if they have any questions before continuing.

Step 2: Definition of Body Cavity (5 minutes)

 Activity: Brainstorming (2 minutes)

 ASK students to brainstorm: What is Body cavity?
 ALLOW few students to provide response to the question.
 WRITE their responses on a flipchart.
 SUMMARIZE the definition of body cavity is as follows:
 Body cavities are spaces within the body that help protect, separate and support
internal organs

 By the broadest definition, a body cavity is any fluid filled space in a multicellular
organism. However, the term usually refers to the space, located between an animal’s
outer covering (epidermis) and the outer lining of the gut cavity, where internal organs
develop. "The body cavity" of human body cavities normally refers to the ventral body
cavity, because it is by far the largest one in volume.

Step 3: Main Body Cavities (15 minutes)

 Activity: Buzzing (5 minutes)
 ASK mention the body cavities found in the human body
 ALLOW students to buzz in pairs for 2 minutes then ALLOW them to respond to the
question.
 WRITE their responses on a flipchart.
 SUMMARIZE their responses using the information below

 The two major cavities of the body are:

o The dorsal cavity
o The ventral body cavities.

 The dorsal cavity

o The dorsal body cavity is located near the posterior surface of the body and has two
main subdivisions.
 The vertebral (vertebra _ back) canal that contains the spinal cord
 The cranial cavity that contains the brain
 The cranial cavity is the space within the calvaria that contains the brain,
meninges, and proximal parts of the cranial nerves, blood vessels, cranial venous
sinuses, eyes and ears.
 It is lined by the meninges which contains fluid to cushion blows.
 Eight fused cranial bones together form the cranial cavity: the frontal, occipital,
sphenoid and ethmoid bones, and two each of the parietal and temporal bones
 The capacity of an adult human cranial cavity is 1,200-1,700 cm3
 The spinal canal (or vertebral canal or spinal cavity) is the space in vertebrae
through which the spinal cord passes. This canal is enclosed within the vertebral

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 foramen of the vertebrae. In the intervertebral spaces, the canal is protected by the
ligamentum flavum posteriorly and the posterior longitudinal ligament anteriorly.
 The meninges divide the spinal canal into the epidural space and the subarachnoid
space. The pia mater is closely attached to the spinal cord. A subdural space is
generally only present due to trauma and/or pathological situations. The
subarachnoid space is filled with cerebrospinal fluid and contains the vessels that
supply the spinal cord, namely the anterior spinal artery and the paired posterior
spinal arteries, accompanied by a corresponding spinal veins.
 The cranial cavity and the vertebral canal are continuous.
o The ventral body cavities
 The ventral body cavity is located near the anterior surface of the body and has
two subdivisions
 The thoracic cavity
 The abdomino-pelvic cavity
 The abdomino-pelvic cavity, which is separated by the diaphragm consists of two
continuous cavities:
 The abdominal cavity
 The pelvic cavity.
 The abdominal cavity is the superior portion located between the diaphragm
superiorly and the brim of the pelvis inferiorly.
 The pelvic cavity, located between the pelvic brim superiorly and the body wall
inferiorly,is the inferior portion of the abdomino-pelvic cavity.

Refer students to Handout 6.1: Human Body Cavities for more illustrations and
information.

Step 4: Thoracic Cavity and its Divisions (20 minutes)

 Thoracic cavity is a space enclosed by the ribs, sternum, and vertebral column
 The thoracic cavity is separated from the abdominal cavity by the diaphragm. The
thoracic inlet is the upper limit of the thoracic cavity, formed by the manubrium in front,
the first ribs laterally, and the spine posteriorly.
 This cavity contains three small cavities (potential spaces):
 The pericardial cavity (peri _around; cardia _ heart)
 Two pleural cavities (pleura _ side or rib).
 The pericardial cavity surrounds the heart, and each pleural cavity contains a lung.
 Each pleural cavity is the potential space enclosed between the visceral and parietal
pleurae. They normally contain only a very thin layer of serous fluid. As a result, the
surface of the lung, which is covered by visceral pleura, directly opposes and freely slides
over the parietal pleura attached to the wall.

 The mediastinum
o The mediastinum is a broad central partition that separates the two laterally placed
pleural cavities. It extends from the sternum to the bodies of the vertebrae and from
the superior thoracic aperture to the diaphragm.
o The mediastinum serves as a passageway for structures such as the oesophagus,
thoracic duct, and various components of the nervous system as they traverse the
thorax on their way to the abdomen. The organs located in the mediastinum are the

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 heart, thymus gland, oesophagus, trachea and bronchi. The pleural cavities are located
on either side of the mediastinum
o For organizational purposes, the mediastinum is subdivided into several smaller
regions
o The middle mediastinum is centrally located in the thoracic cavity. It contains the
pericardium, heart, origins of the great vessels, various nerves, and smaller vessels.
o The superior mediastinum is posterior to the manubrium of the sternum and anterior
to the bodies of the first four thoracic vertebrae. The superior mediastinum is
continuous with the neck superiorly and with the inferior mediastinum inferiorly
o The anterior mediastinum is posterior to the body of the sternum and anterior to the
pericardial sac
o The posterior mediastinum is posterior to the pericardial sac and diaphragm and
anterior to the bodies of the mid and lower thoracic vertebrae
 The major structures found in the superior mediastinum include:
o Thymus,
o Right and left brachiocephalic veins,
o Left superior intercostal vein,
o Superior vena cava,
o Arch of the aorta with its three large branches,
o Trachea,
o Esophagus,
o Phrenic nerves,
o Vagus nerves,
o Left recurrent laryngeal branch of the left vagus nerve,
o Thoracic duct, and
o Other small nerves, blood vessels, and lymphatics
o Major structures in the posterior mediastinum include:
o Esophagus and its associated nerve plexus,
o Thoracic aorta and its branches,
o Azygos system of veins,
o Thoracic duct and associated lymph nodes,
o Sympathetic trunks, and
o Thoracic splanchnic nerves.
 Structures within the thoracic cavity include
o Structures of the cardiovascular system, including the heart and great vessels, which
include the thoracic aorta, the pulmonary artery and all its branches, the superior and
inferior vena cava, the pulmonary veins, and the azygos vein
o Structures of the respiratory system, including the trachea, bronchi and lungs
o Structures of the digestive system, including the esophagus, endocrine glands,
including the thymus gland,
o Structures of the nervous system including the paired vagus nerves, and the paired
sympathetic chains, lymphatics including the thoracic duct.

Refer students to Handout 6.2: Thoracic Cavity and its Divisions for more
illustrations

Step 5: Abdominal Cavity and its Regions and Quadrants (25 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 103

 Activity Individual Assignment (5 minutes)
 PROVIDE each student with a worksheet 6.1: Abdominal Pelvic Regions
 ASK student label the abdominal regions on the work sheet
 GIVE them 5 minutes to fill the worksheet
 COLLECT the sheet from students

After presentation of step 5 REVIEW with students their answers and CLARIFY if there is
any problem

 For descriptive purposes, the abdomen can be divided by a number of imaginary

horizontal and vertical lines drawn using the skeletal landmarks of the thorax and
abdomen.
 Projection of these lines into the sagittal or transverse planes can then be used to define
certain abdominal 'planes'. Apart from dividing the abdomen into different regions for
descriptive purposes, these planes are also of value in defining approximate vertebral
levels and the positions of some relatively fixed intra-abdominal structures.
 Vertical planes
o In addition to the midline, which passes through the xiphisternal process and the pubic
symphysis, there are two paramedian planes which are projected from the
midclavicular line (also sometimes called the lateral or the mammary line).
o This line passes through the midpoint of the clavicle, crosses the costal margin just
lateral to the tip of the ninth costal cartilage, and passes through a point mid way
between the anterior superior iliac spine and the symphysis pubis.
 Horizontal planes
o Several horizontal planes have been defined, but only the subcostal and
transtubercular Planes Are In Common Clinical Use.
o The subcostal plane is a line joining the lowest point of the costal margins, formed by
the tenth costal cartilage on each side. It usually lies at the level of the body of the
third lumbar vertebra, the origin of the inferior mesenteric artery from the aorta, and
the third part of the duodenum, although this varies with posture.
o The transtubercular plane joins the tubercles of the iliac crests and usually lies at the
level of the body of the fifth lumbar vertebra near its upper border. It indicates, or is
just above, the confluence of the common iliac veins and marks the origin of the
inferior vena cava.
 Abdominal regions
o The abdomen can be divided into nine arbitrary regions by the subcostal and
transtubercular planes and the two midclavicular planes projected onto the surface of
the body. These regions are used in practice for descriptive localization of the position
of a mass or the localization of a patient's pain.
o These four planes establish the topographical divisions in the nine-region
organization. The following designations are used for each region: superiorly the right
hypochondrium, the epigastric region, and the left hypochondrium; inferiorly the right
groin (inguinal or iliac fossa region), suprapubic region (hypogastrium), and left groin
(inguinal region or iliac fossa); and in the middle the right flank (lumbar region), the
umbilical region, and the left flank (lumbar region)

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 o For the simple four-quadrant topographical pattern a horizontal transumbilical plane
passes through the umbilicus and the intervertebral disc between vertebrae LIII and
LIV and intersects with the vertical median plane to form four quadrants
 Right Upper Quadrant (RUQ)
 Left Upper Quadrant (LUQ)
 Right Lower Quadrant (RLQ)
 Left Lower Quadrant (LLQ)
o This cavity contains the stomach, liver, gall bladder, pancreas, spleen, small intestine,
kidneys, appendix, and part of the large intestine.
o The pelvic cavity contains part of the large intestine, rectum, urinary bladder, female
reproductive organs (ovaries, uterine tubes, uterus, vagina), and male reproductive
organs (prostate, part of ductus deferens).
o It is important to note that the testes and penis are not located in the ventral body
cavity but are outside the body wall.
Refer students to Handout: 6.3: Abdominal Regions and Handout 6:4: Abdominal
Quadrants for more illustrations

Abdominal regions and quadrants may be used in the description of the location of the
abdominal viscera.
Refer students to Handout 6.5: Surface Anatomy of the Abdomen for more
information about abdominal organs.

Step 5: Peritoneum and Peritoneal Cavity (20 minutes)

 The peritoneum is the largest serous membrane in the body, and its arrangements are
often complex. In males it forms a closed sac, but in females it is open at the lateral ends
of the uterine tubes.
 The abdominal cavity is lined by peritoneum, which consists of an epithelial-like single
layer of cells (the mesothelium) together with a supportive layer of connective tissue.
Peritoneum is similar to the pleura and serous pericardium in the thorax
 Parietal peritoneum lines the abdominal wall;
 Visceral peritoneum covers suspended organs
 The peritoneal cavity is a potential space between the parietal peritoneum, which lines the
abdominal wall, and infoldings of visceral peritoneum, which suspend the abdominal
viscera within the cavity.
 It contains a small amount of serous fluid, but is otherwise empty. The fluid lubricates the
visceral peritoneum and allows the mobile viscera to glide freely on the abdominal wall
and each other within the limits dictated by their attachments. It contains water, proteins,
electrolytes and solutes derived from interstitial fluid in the adjacent tissues and from the
plasma in the local blood vessels.
 It consists of a main region, termed the greater sac, which is equivalent to the main
abdominal cavity surrounding the majority of the abdominal and pelvic viscera. The
lesser sac, or omental bursa, is a small diverticulum lined with peritoneum, which is
situated behind the stomach and lesser omentum and in front of the pancreas and
retroperitoneum. These two areas communicate via the epiploic foramen.
 For clinical purposes the peritoneal cavity can be divided into several spaces because
pathological processes are often contained within these spaces and their anatomy may

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 influence diagnosis and treatment. It is useful to divide the peritoneal cavity into two
main compartments, supramesocolic and inframesocolic, which are partially separated by
the transverse colon and its mesentery (the latter connects the transverse colon to the
posterior abdominal wall).
 The supramesocolic space lies above the transverse mesocolon between the diaphragm
and the transverse colon.
 The inframesocolic compartment lies below the transverse mesocolon and transverse
colon are far as the true pelvis.
 It normally contains a few cells, including desquamated mesothelium, nomadic peritoneal
macrophages, mast cells, fibroblasts, lymphocytes and other leukocytes. Lymphocytes
provide both cellular and humoral immunological defence mechanisms within the
peritoneal cavity.
 The peritoneal cavity never contains gas in normal circumstances, although the amount of
fluid may be increased in inflammatory conditions of the viscera. In females blood or
fluid may occasionally escape from the uterine tubes into the pelvic peritoneal cavity
during menstruation.
 Abdominal viscera are either intraperitoneal or retroperitoneal:
o Intraperitoneal structures, such as elements of the gastrointestinal system, are
suspended from the abdominal wall by mesenteries
o Structures that are not suspended in the abdominal cavity by a mesentery and that lie
between the parietal peritoneum and abdominal wall are retroperitoneal in position.
o Retroperitoneal structures include the kidneys, ureters, Pancreas and great vessels.
Refer students to Handout 6.6: The Viscera and the Arrangement of the Peritoneum
for more illustration

Step 6: Key Points (5 minutes)

 Body cavities are spaces within the body that help protect, separate and support internal
organs.
 There are four main body cavities: Cranial cavity, thoracic cavity, abdominal cavity and
pelvic cavity
 The abdominal cavity is lined by peritoneum, which consists of an epithelial-like single
layer of cells (the mesothelium)

Step 7: Evaluation (10 minutes)

 Mention organs found in the anterior mediastinum
 Mention organs which lie in the extraperitoneal cavity
 Mention 2 horizontal planes and 2 vertical palnes

References
 Human Body Cavities retrieved March, 17, 2010 from http://training.seer.cancer.gov/
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill

Teaching Guides for NTA Level 4 MLS Curriculum Page 106

 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 107

Handout 6.1: Human Body Cavities

Source: SEER Training Modules

Human Body Cavities and Membranes

Name of cavity Principal contents Membranous lining
Dorsal body cavity Cranial cavity Brain Meninges
Vertebral canal Spinal cord Meninges
Ventral body cavity Thoracic cavityLungs, Heart Pericardium Pleural
Membrane
Abdominopelvic cavity Abdominal cavity (Digestive Peritoneum
organs, spleen, kidneys)
Pelvic cavity Bladder, reproductive organs Peritoneum

Source: SEER Training Modules

Handout 6.2: Thoracic Cavity and its Divisions

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 108

Handout 6.3: Abdominal Regions

Source: Elsevier Ltd 2005.

Handout 6:4: Abdominal Quadrants

Source: Elsevier Ltd 2005.

Handout 6.5: Surface Anatomy of the Abdomen

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 109

 Spleen
 Liver
 Gallbladder
 Duodenum
 Appendix
 Root of small bowel mesentery

 Stomach; The stomach lies in a curve within the left hypochondrium and epigastrium
although, when distended and pendulous, it may lie as far down as the central or
hypogastric regions. The epigastrium is the usual place to auscultate for a 'succussion
splash' caused by chronic gastric stasis in upper intestinal obstruction.
 Duodenum; The first part of the duodenum sometimes lies just above the transpyloric
plane, depending on its mobility and length. The second part usually lies in the
transpyloric plane just to the right of the midline, and the third part usually lies in the
subcostal plane across the midline. The fourth part often lies in the transpyloric plane to
the left of the midline, although its position varies according to the length of its
mesentery.
 Small bowel and its mesentery: The small bowel is usually referred to as lying in the
central umbilical region, but often occupies part of both iliac fossae, both lumbar regions
and the hypogastrium.
 Appendix: The appendix is highly variable both in its length and in its position. Its base is
commonly referred to as lying beneath a point marked two-thirds of the way along a line
joining the umbilicus to the anterior superior iliac spine.
 Liver: The inferior border of the liver extends along a line that passes from the right tenth
costal cartilage to the left fifth rib in the midclavicular line. The upper border of the liver
follows a line that passes from the fifth rib in the midclavicular line on the right to the
equivalent point on the left. This upper border curves slightly downwards at its centre and
crosses the midline behind the xiphoid. The right border of the liver is curved to the right
and joins the upper and lower right limits. The outline of the liver may be defined by the
dull note it gives on percussion when compared with the resonance of the lungs above
and the hollow abdominal viscera below.
 Gallbladder: The fundus of the gallbladder is very variable in location. It is commonly
identified with the tip of the ninth costal cartilage (in the trans-pyloric plane), near the
junction of the linea semi-lunaris with the costal margin.
 Spleen: The spleen lies beneath the ninth, tenth and eleventh ribs on the left side. Its
surface markings can be delineated on the lower posterior thoracic wall by defining its
axis, which extends from a point 5 cm to the left of the midline at the level of the tenth
thoracic spine, and passes laterally along the line of the tenth rib to the mid-axillary line.
 Pancrea: The surface projection of the head of the pancreas lies within the duodenal
curve. The neck lies in the transpyloric plane, behind the pylorus in the midline. The body
passes obliquely up and left for 10 cm, its left part lying a little above the transpyloric
plane. The tail lies a little above and to the left of the intersection of the transpyloric and
left lateral planes.
 Kidney: The anterior and posterior surface projections of the kidneys are related to
anterior and posterior abdominal wall landmarks. The right kidney lies 1.25 cm lower
than the left. On the anterior surface,

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 Ureter: The ureter starts on either side approximately at the trans-pyloric plane (the left
higher than the right), 5 cm from the midline. Each passes downwards and somewhat
medially to enter the bladder at a point marked superficially by the position of the pubic
tubercle.
 Abdominal aorta: The abdominal aorta starts just to the left of the midline, at the level of
the body of the twelfth thoracic vertebra. It continues downwards for 10 cm as a band 2
cm wide, and bifurcates at the level of the fourth lumbar vertebra (which is marked by the
transtubercular plane), 1.5 cm below and to the left of the umbilicus. The pulsations of the
aorta can be felt in a thin individual in the supine position by pressing firmly in the
midline backwards onto the vertebral column. An easily palpable aorta in an obese person
should raise the suspicion of an aneurysm, to be checked by radiological imaging.

Handout 6.6: The Viscera and the Arrangement of the Peritoneum

Source: Lippincott Williams & Wilkins, 2007

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Worksheet 6.1: Abdomino-Pelvic Regions

Source: Elsevier Ltd 2005.

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Session 3: Relationship between Cell,
Tissue, Organ and System
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None

Learning Objectives
By the end of this session, students will be able are to:
 Define the terms: - Cell membrane, Cytoplasm, nucleus and cell organelles.
 List three major parts of human cell (Cell membrane, Cytoplasm and nucleus)
 Draw and label the simple diagram of a human cell.
 Explain the basic functions of: - cell membrane, cytoplasm, nucleus and the cell
organelles (mitochondria, ribosomes, golgi apparatus,centrosome, Lysosomes
,microtubules)
 Explain the linkage between cells, tissue, organ and system.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Coloured Atlas of the human body.

SESSION OVERVIEW

Step Time Activity/Method Content

1 5 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation/Brainstorming Definition of Terms
3 5 minutes Presentation Major parts of the human cell
4 30 minutes Presentation, Diagram of a human cell
demonstration
5 45 minutes Presentation Basic functions of cell membrane,
cytoplasm, nucleus and cell
organelles
6 10 minutes Presentation Linkage between cells, tissue, organ
and systems
7 5 minutes Presentation Key points
8 5 minutes Presentation Evaluation

SESSION CONTENT

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Step no 1. Presentation of Session Title and Learning Objectives (10 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.
Step no 2 Definition of Terms (15minutes)
 Activity: Brain storming. (5 minutes)
 ASK the students questions like;
 Define: cell membrane, cytoplasm and nucleus.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Definition of terms;
 Cell membrane: Is a semi-permeable barrier around the cytoplasm that only allow certain
material to pass in or out of the cell
 Cytoplasm: Is the material between the nucleus and cell membrane including fluid and
various membranes.
 The nucleus: is the part of the cell that carries the genetic in formations.
 Cell organelles :( small organs) have individual and highly specialized functions, and are
often enclosed with their own membrane within the cytosol. They include
 Nucleolus, nucleus, ribosome, vesicle, rough endoplasmic reticulum (ER), Golgi
apparatus, Cytoskeleton, smooth endoplasmic reticulum, mitochondria, vacuole,
cytoplasm, lysosome, and centrioles within centrosome

Step no 3. Major parts of the human cell (5minutes)

 Three major parts of the human cell includes:-
o Cell membrane
o Cytoplasm
o Nucleus.

Step 4: The diagram of a human cell (30minutes)

 Activity: Brainstorming. (5 minutes)

 Ask the students to mention the names to the letters representing unlabeled parts of the
human cell.
 Eg. What does the later A, B and C represents.
 Write their answers on a flipchart or chalkboard.
 SUMMARIZE: by showing a well labelled diagram of the human cell.-

Teaching Guides for NTA Level 4 MLS Curriculum Page 114

Structure of Generalized Cell

Source: Elsevier Ltd 2005.

Step 5: Basic functions of cell membrane, cytoplasm nucleus and cell organells.
(45minutes)
 Activity: Brain storming. (5 minutes)
 ASK the students questions like:-
 What are the basic functions of: cell membrane, cytoplasm, nucleus and cell organelles.
 and WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 The following are the basic functions of the cell membrane:-

o The cytoplasm of a cell is surrounded by a cell membrane or plasma membrane.
o All cells, have a membrane that envelops the cell, separates its interior from its
environment, regulates what moves in and out (selectively permeable), and maintains
the electric potential of the cell.
o Inside the membrane, a salty cytoplasm takes up most of the cell volume.
o This membrane serves to separate and protect a cell from its surrounding environment
and is made mostly from a double layer of lipids (hydrophobic fat-like molecules) and
hydrophilic phosphorus molecules. Hence, the layer is called a phospholipid bilayer.
o Embedded within this membrane is a variety of protein molecules that act as channels
and pumps that move different molecules into and out of the cell.
o The membrane is said to be 'semi-permeable', in that it can either let a substance
(molecule or ion) pass through freely, pass through to a limited extent or not pass
through at all.
o Cell surface membranes also contain receptor proteins that allow cells to detect
external signaling molecules such as hormones.
o The cell membrane also plays a role in anchoring the cytoskeleton to provide shape to
the cell, and in attaching to the extracellular matrix and other cells to help group cells
together to form tissues.

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 o The basic functions of the Cell nucleus include the following.
o The cell nucleus is the most conspicuous organelle found in a eukaryotic cell.
o It houses the cell's chromosomes, and is the place where almost all DNA replication
and RNA synthesis (transcription) occur.
o The nucleus is spherical in shape and separated from the cytoplasm by a double
membrane called the nuclear envelope.
o The nuclear envelope isolates and protects a cell's DNA from various molecules that
could accidentally damage its structure or interfere with its processing.
o The nucleolus is a specialized region within the nucleus where ribosome subunits are
assembled
o The following are basic functions of different cell organelles.
o Mitochondria (The “Power house”)
o Mitochondria are organelles found in nearly all eukaryotes. They are surrounded by
double membranes (known as the phospholipid bi-layer), the inner of which is folded
into invaginations called cristae, where aerobic respiration takes place (Fig.1 below).
Mitochondria contain their own DNA and ribosomes and are only formed by the
fission of other mitochondria.
o Mitochondria play a critical role in generating energy in the eukaryotic cell, by the
process of oxidative phosphorylation, utilizing oxygen to release energy stored in
cellular nutrients (typically pertaining to glucose) to generate ATP.

Figure1: Mitochondria

Source: "http://en.wikipedia.org/wiki/Eukaryote"

 Mitochondria structure: 1. Inner membrane, 2. Outer membrane, 3. Crista, 4. Matrix

 Ribosomes
 The ribosome is a large complex of RNA and protein molecules.
 This is where proteins are produced. Ribosomes can be found either floating freely or
bound to a membrane (the rough endoplasmic reticulum in eukaryotes).
 Endoplasmic reticulum
 The endoplasmic reticulum (ER) is the transport network for molecules targeted for
certain modifications and specific destinations, as compared to molecules that will float
freely in the cytoplasm.
 The ER has two forms: the rough ER, which has ribosomes on its surface and secretes
proteins into the cytoplasm, and the smooth ER, which lacks them.

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 Smooth ER plays a role in calcium sequestration and release also it synthesize lipid and
steroid hormones
 Golgi apparatus
 Consist of stacks of closely folded flattened membranous sacs. It is present in all cells but
is larger in those cells which synthesise and export proteins
 The primary function of the Golgi apparatus is to process and package the
macromolecules such as proteins and lipids that are synthesized by the cell.
 It is particularly important in the processing of proteins for secretion
 Lysosomes and Peroxisomes
 Lysosomes are secretory vesicles formed by the golgi apparatus
 Lysosomes contain digestive enzymes (acid hydrolases).
 They digest excess or worn-out organelles, food particles, and engulfed viruses or
bacteria.
 Peroxisomes have enzymes that rid the cell of toxic peroxides.
 The cell could not house these destructive enzymes if they were not contained in a
membrane-bound system.
 These organelles are often called a "suicide bag" because of their ability to blow up and
destroy the cell
 Centrosome
 Is the cytoskeleton organiser
 The centrosome produces the microtubules of a cell - a key component of the
cytoskeleton.
 It directs the transport through the ER and the Golgi apparatus.
 Centrosomes are composed of two centrioles, which separate during cell division and
help in the formation of the mitotic spindle.
 A single centrosome is present in the animal cells.

Step 6: Relationships between cells, tissue, organ and systems (10minutes)

 The cells, tissue, organ and systems are related in the following ways:-
 Cells are grouped together to form tissues eg. Blood, muscle and bones.
 Different tissues are grouped to together to form organs eg heart, stomach and brain.
 Different organs with a particular functions are grouped together to form system.eg.
Respiratory, circulatory and digestive systems.

Step 7: Key points (5minutes)

 Human cell is made up of three major parts.
 Each part of the human cell has got its specific functions.
 Cell organelles: (small organs) have individual and highly specialized functions, and are
often enclosed with their own membrane within the cytosol. They include Nucleolus,
nucleus, ribosome, vesicle, rough endoplasmic reticulum (ER), Golgi apparatus,
Cytoskeleton, smooth endoplasmic reticulum, mitochondria, vacuole, cytoplasm,
lysosome, and centrioles within centrosome

Step 8: Evaluation (5minutes)

 Which are three major parts of the human cell
 What is the function of the cell nucleus?

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 What are the cell organelles?

References:
 ROSS AND WILSON (1996): Anatomy and Physiology in Health and Illness; 8 th Edition
Churchill Livingstone, New York, London;
 ROSS AND WILSON (2001): Anatomy and Physiology in Health and Illness9 th Edition
Churchill Livingstone Inc.;
 McMinn (1996): Lat’s Anatomy Regional & Applied, 9th ed. Persons Professional Ltd;
 Snell R. S. (1996) Clinical Anatomy, 7th Ed, Lippincott Williams & Wilkins; and
 Wilson K. J. W. (1995) Anatomy & Physiology in Illness, 7th Ed, Medical Division of
Pearson Professional Ltd.

Teaching Guides for NTA Level 4 MLS Curriculum Page 118

Session 4: Structure and Function of
Epithelial Tissues
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Define a tissue,
 List types of tissues
 Explain functions of epithelial tissues
 Describe the structure of epithelial tissues,
 Describe structure of different types of epithelial tissue

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector or LCD and Computer
 Handout 3.1 Different Types of Epithelial tissue
 Handout 3.2 Different Types of Glandular Epithelium

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 05 minutes Presentation Definition of Tissue
Brainstorming
3 10 minutes Presentation Type of and Tissues
4 15 minutes Buzzing, Presentation Functions of Epithelial Tissue
5 20 minutes presentation General Structure of Epithelial Tissues
6 50 minutes Small Group discussion, Structure of Different Types of
Presentation Epithelial Tissues
7 05 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Introduction, Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 119

Step 2: Definition of Tissue ( 5 minutes)
 Activity: Brainstorming (5 minutes)
 ASK students what is a Tissue
 WRITE their responses on a Flip chart.
 SUMMARIZE as follows Tissue is defined as a collection of similar cells specialized to
perform a specific function

Step 3: Types of tissues (10 minutes)

 There are four types of tissues namely connective tissue, epithelial tissue, muscle tissue,
and nervous tissue.
 Epithelial tissue provides a covering (skin, the linings of the various passages inside the
body).
 Connective tissue supports other tissues and binds them together (bone, blood, and lymph
tissues).
 Muscle tissue includes striated (also called voluntary) muscles that move the skeleton,
and smooth muscle, such as the muscles that surround the stomach.
 Nerve tissue is made up of nerve cells (neurons) and is used to carry "messages" to and
from various parts of the body.

Step 4: Functions of Epithelial Tissue (15 minutes)

 Activity: buzzing (5 minutes)
 ASK student the functions of epithelial tissue.
 ALLOW them to buzz in two for two minutes then ask them to respond to the question
 WRITE their answers on the flip chart
 SUMMARISE their responses using the information below.

 Epithelia tissue performs the following functions:

 Protection: Epithelial cells from the skin protect underlying tissue from mechanical
injury, harmful chemicals, invading bacteria and from excessive loss of water.
 Sensation: Sensory stimuli penetrate specialised epithelial cells. Specialised epithelial
tissue containing sensory nerve endings is found in the skin, eyes, ears, nose and on the
tongue.
 Secretion: In glands, epithelial tissue is specialised to secrete specific chemical substances
such as enzymes, hormones and lubricating fluids.
 Absorption: Certain epithelial cells lining the small intestine absorb nutrients from the
digestion of food.
 Excretion: Epithelial tissues in the kidney excrete waste products from the body and
reabsorb needed materials from the urine. Sweat is also excreted from the body by
epithelial cells in the sweat glands.
 Diffusion: Simple epithelium promotes the diffusion of gases, liquids and nutrients.
Because they form such a thin lining, they are ideal for the diffusion of gases (eg. walls of
capillaries and lungs).
 Cleaning Ciliated epithelium assists in removing dust particles and foreign bodies which
have entered the air passages.
 Reduces Friction

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 Signal transduction- refers to any process by which a cell converts one kind of signal or
stimulus into another. Most processes of signal transduction involve ordered sequences of
biochemical reactions inside the cell, which are carried out by enzymes and activated by
second messengers, resulting in a signal transduction pathway.

Step 5: General Structure of Epithelial Tissues (20 minutes)

 Epithelial tissues are widespread throughout the body. They form the covering of all body
surfaces, line body cavities and hollow organs, and are the major tissue in glands.
 The cells in epithelial tissue are tightly packed together with no intercellular material
between the cells or very little intercellular materials. It also forms all glands including
endocrine and exocrine glands.
 Cells of epithelial tissue appear in different shapes and structure. These differences reflect
the functions of the epithelium.
 The cells are attached to the underlying connective tissue known as the basement
membrane and have three cell surfaces namely the basal surface, lateral surface and the
apical or luminal surface.
 Each surface has its own specialization
 The apical surface is for absorption and secretion
 The basal surface is for attachment with basement membrane and diffusion of material to
the cell
 The lateral surface is attachment with other cells and for cell protection because it form
the tight junction with other cells, therefore prevent the entry of material into intercellular
space
 The epithelial tissues are not penetrated by the blood vessels.
 The blood vessels end at the basement membrane and therefore nutrition is achieved
through diffusion from the connective tissue beneath.

 Basement Membrane
o The basement membrane is a connective tissue structure where the epithelial cells are
attached.
o It is made up of collagen fibers, reticular fibers and polysaccharide material.
o These fibers are secreted by the connective tissue cells and the cells associated with it.
o Functions of the basement membrane
 Support to the epithelium:
 Barrier to the epithelium:
 It regulates the exchange of materials between the cells and blood.

Step 6: Structure of Different Types of Epithelial Tissue (50 minutes)

 Activity: Small Group Discussion (35 minutes)
 DIVIDE the students into 4 groups
 ASSIGN one type of epithelial tissue to each group and ASK them to describe the
structure, classification and the site where that tissue can be found. The tissues are as
follows:
 Squamous epithelium, 2. Columnar epithelium, 3. Cuboidal epithelium and
 4. Glandular epithelium
 GIVE 15 minutes for preparations and five minutes presentation for each group
 LISTEN to their presentations and clarify concerns using the information below

Teaching Guides for NTA Level 4 MLS Curriculum Page 121

 SUMMARIZE the presentation by using the notes below

 The epithelial tissue is classified based on the following characteristics (Fig.1 below):
 Classification according to the cell shape.
 Squamous cells: are flat cells with an irregular flattened shape
 Cuboidal cells: have a shape similar to a cube, meaning its width is the same size as its
height
 Columnar cells: are taller than they are wide.
 Classification based on number of layers (Stratification). According to this classification
three types of epithelia can be identified as:
o simple epithelia
o stratified epithelia
o pseudostratified epithelia.
o Specializations
 Simple epithelium
o There is a single layer of cells.
o Cells are organized in a single layer and therefore all cells are attached to the
basement membrane.
o The cells that make simple epithelium can be squamous, cuboidal or columnar cells.
o Simple squamous epithelium,
o Simple cuboidal epithelium
o Simple columnar epithelium.
o They are found in different organs depending on their function.
 Simple squamous epithelium
o All Squamous cells are flat cells with an irregular flattened shape.
o A one-cell layer of simple squamous epithelium forms a thin membrane and therefore
it is found in places where exchange of material from one compartment such as the
alveoli of the respiratory membrane.
o Provide a minimal barrier to diffusion. Squamous cells can be found in the filtration
tubules of the kidneys, and the major cavities of the body, the mesothelium lining
different organs. These cells are relatively inactive metabolically, and are associated
with the diffusion of water, electrolytes, and other substances.
o Simple squamous epithelium also forms the endothelium of blood capillaries.
 Simple cuboidal epithelium
o As the name suggests, these cells have a shape similar to a cube, meaning its width is
the same size as its height. The nuclei of these cells are usually located in the center.
o Cuboidal cells are larger compared to squamous cells and therefore have a larger
cytoplasm for carrying synthetic activities and storage of secretory vesicles.
o Simple cuboidal epithelium forms secretory cells, lining of the small ducts of the
glands and it covers the outer surfaces of organs such as the ovaries and in the kidney
tubules
 Simple Columnar epithelium
o These cells are taller than they are wide. Simple columnar epithelium is made up of a
single layer of cells that are longer than they are wide. The nucleus is also closer to
the base of the cell. The small intestine is a tubular organ lined with this type of
tissue. Unicellular glands called goblet cells are scattered throughout the simple
columnar epithelial cells and secrete mucus. The free surface of the columnar cell has

Teaching Guides for NTA Level 4 MLS Curriculum Page 122

 tiny hairlike projections called microvilli. They increase the surface area for
absorption.
o Columnar cells carrying out metabolic activities and storage.
o Found in the glands where they form glandular cells and the walls of the large ducts
of the glands.
o They also line the absorptive surfaces of the gastrointestinal tract, proximal
convoluted tubules in the kidneys and the gallbladder.

Figure 1: Types of Epithelium

Source: SEER Training Modules

 Stratification
o Stratified: More than one layer of cells. The superficial layer is used to classify the
layer. Only one layer touches the basal lamina. Stratified cells can usually withstand
large amounts of stress.
o Pseudostratified with cilia: This is used mainly in one type of classification
(pseudostratified columnar epithelium). There is only a single layer of cells, but the
position of the nuclei gives the impression that it is stratified. If a specimen looks
stratified, but you can identify cilia, the specimen is pseudostratified ciliated
epithelium since stratified epithelium cannot have cilia but may be very rarely found
in fetal oesophagus. A cell that contains hairs will be around ten times stronger than a
regular cell
o Pseudostratified columnar epithelium lines portions of the respiratory tract and some
of the tubes of the male reproductive tract.
o Transitional: It is a specialized type of epithelium found lining organs that can stretch,
such as the urothelium that lines the bladder and ureter of mammals (Fig.2 below),
since the cells can slide over each other and can be distended or stretched. The
appearance of this epithelium depends on whether the organ is distended or
contracted. If distended, it appears as if there are only a few layers; when contracted,
it appears as if there are several layers. Protects organ walls from tearing

Figure 2: Transitional epithelium

Relaxed stretched
Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 123

 Specializations
o Keratinized cells contain keratin (a cytoskeletal protein). While keratinized epithelium
occurs mainly in the skin, it is also found in the mouth and nose, providing a tough,
impermeable barrier.
o In some organs the simple columnar epithelium contains small projections called
cilia;
o Free Surface of Epithelial Cells may show three types of these projections,
 Cilia
 Microvilli
 stereocilia.
o Cilia
 Hair-like processes, which protrude from the free surface of a cell.
 Cilia are motile and their function is to propel liquid, mucus or foreign bodies.
 Found in the cells that lines the respiratory tract, the uterus and the fallopian tubes.
o Microvilli:
 Cell membrane extensions from the free surface of epithelia;
 They are more prominent in absorptive and actively secreting cells.
 Presence of microvili is believed to increase the surface area for absorption or in
exocytosis in secretory cells.
 In the intestines and the proximal convoluted tubules they are numerous, regularly
arranged and uniform in height.
o Stereocilia (non-motile cilia)
 Long hair-like processes projecting from the free surface of a cell.
 Stereocilia are commonly found in the epididymis, where they are believed to be
absorptive in function.
 Also found in the hair cells, which are sensory cells of middle ear and they are
considered to increase the area for the sensory receptors.

 Glandular epithelium
o In glands epithelial cells are modified to synthesize and secrete the secretory
materials.
o This transformation from the epithelial cells to glandular cells occurs during
development, when the glands are developing. Fig.3 shows glandular epithelial cells.
o The epithelial cells proliferate to form cellular cords, which evaginate into the
underlying tissue to form clusters of cells, forming the secretory end-pieces of
exocrine glands.
o In some glands the cords persist to form the ducts of exocrine glands. Exocrine glands
discharge secretions into ducts
o In some glands all cords disintegrate so that the clusters are disconnected from the
surface, thus forming ductless glands or endocrine glands. Endocrine glands,
“ductless” glands discharge secretions directly into the blood stream or interstitial
fluid

Teaching Guides for NTA Level 4 MLS Curriculum Page 124

Figure 3: Glandular Epithelium

Source TutorVista

 Structural classification of exocrine glands

 Multicellular exocrine glands are classified by the shape of their ducts and the complexity
of their duct system.
 Shapes include tubular and alveolar
 Simple exocrine glands: only one duct leads to the surface
 Compound exocrine glands: have two or more ducts
 Simple tubular are intestinal glands, simple coiled tubular is sweat gland
 Simple branched tubular – gastric glands
 Simple alveoli sebaceous gland
 Multiple alveoli – sebaceous glands
 Compound tubular – mammary glands
 Compound alveoli – mammary glands
 Compound tubuloalveolar – salivary glands
 Functional classification of exocrine glands
o Apocrine glands
 Secretory products collects near apex of cell and are secreted by pinching off the
distended end
 Secretion process results in some damage to cell wall and some loss of cytoplasm
 Mammary glands are good example of this secretory type
 Holocrine glands
 Secretion products, which when released cause rupture and death of the cell
 Sebaceous glands are holocrine
o Merocrine glands
 Secrete directly through cell membrane
 Secretion proceeds with no damage to cell wall and no loss of cytoplasm
 Most numerous gland type
Refer students to Handout 3.1 Different Types of Epithelial tissue and Handout 3.2
Different Types of Glandular Epithelium for more information.

Step 7: Key Points (5 minute)

 There are four types of tissue namely epithelial tissue, connective tissue, muscle tissue
and nervous tissues
 Epithelial form outlining of the body cavities and organs
 Epithelial tissue is classified according to shape and number of layers of cells

Teaching Guides for NTA Level 4 MLS Curriculum Page 125

Step 8: Evaluation Questions (10 minutes)
 Define tissue
 List different types of tissues
 Mention different types of epithelial tissue
 Mention functions of epithelial tissues

References
 Glandular Epithelium image retrieved March, 17, 2010 from
www.tutorvista.com/search/types-of-glandular
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Types of epithelial tissue retrieved March, 17, 2010 from http://training.seer.cancer.gov/
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 126

Handout 3.1: Different Types of Epithelial Tissue

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 127

Handout 3.2: Different Types of Glandular Epithelium

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 128

Session 5: Structure and Function of
Connective Tissues
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes:

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Define connective tissue
 Identify connective tissues cells
 Identify connective tissue fibres
 Explain classification and functions of connective tissues
 Recognise specialized connective tissue

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Worksheet 4.1 : Connective tissue

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Brainstorming, Definition of Connective Tissue
Presentation
3 25 minutes Brainstorming, Connective Tissues Cells
Presentation
4 20 minutes Presentation Connective tissue fibres
5 20 minutes Presentation Classification and Functions of Connective
Tissues
6 20 minutes Presentation Specialized Connective Tissue
7 05 minutes Presentation Key Points
8 15 minutes Presentation Evaluation

Step 1: Introduction, Learning Objectives (5 minutes)

 READ or ASK students to read the Learning Objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition of Connective Tissue (10 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 129

 Activity: Brainstorming (5 minutes)
 ASK students: what does the word connection mean, then ASK what connective tissue is
 WRITE: their responses on a Flip chart.
 SUMMARIZE: their responses by using the notes below

 Connective tissue is the medium which surrounds and supports the other tissues of the
body.
 Composed predominantly of intercellular material (extracellular matrix) which is secreted
mainly by the connective tissue cells, cells and fibres
 The cells are usually widely separated by their matrix, which is composed of fibrous
proteins and a relatively amorphous ground substance.

Step 4: Connective Tissue Cells (25 minutes)

 Activity: Brainstorming (5 minutes)
 ASK students to brainstorm: which type of cells are found in the connective tissue
 WRITE their responses on the flip chart.
 SUMMARISE their responses using the information below.

 There are two types of cells

 Resident cells (fixed cells)
 Wondering cells
 Resident cells
o These cells are always found residing in the connective tissue. These include;
 Fibroblasts
 Macrophages (histiocytes)
 Mast cells
 Adipocytes
 Pigment cells (melanocytes)
 Undifferentiated mesenchymal cells.
 Fibroblasts
o Are flat, spindle shaped cells with branching of cytoplasmic processes with elliptical
and have elongated nucleus. The shape differs depending on activity.
o Fibroblasts are found in nearly all types of tissues
o Active fibroblasts have abundant cytoplasm
o Inactive fibroblasts (fibrocytes) are smaller and have diminished cytoplasm.
 Functions of fibroblasts
o Synthesis
 Secretes connective tissue fibres, these include collagen, elastic and reticular
fibres.
 They also secrete substances such as glycosaminoglycans and glycoproteins found
in the extracellular matrix (ground substance).
 Differentiation into other cells: Fibroblasts are capable of changing into a variety
of cell types depending on the body need.
o Wound healing
 Fibroblasts secrete connective tissue elements which help in remodeling the
extracellular matrix, which is important in wound healing and tissue repair.

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 During wound healing the fibroblast acquires contractile proteins to become the
myofibroblast which play an important role during wound healing.
 Contraction causes the wound edges to unite, which enhances wound healing.
o Histiocytes (tissue macrophages)
 They are polymorphic cells and can be ovoid or irregular with short and blunt
processes.
 They are derived from blood monocytes, which migrate into the tissues and
transform to become histiocytes.
 Main role in tissue is phagocytosis and antigen presentation.
o Mast cells
 Are large cells, round or oval in shape.
 Play an important role in allergic reactions.
 Mast cells are filled with secretory granules that are filled with substances of
inflammation such as histamine and heparin,
 Heparin, is an anticoagulant and Histamine, is released by the cells under allergic
conditions give rise to oedema, bronchospasm and other forms of allergic
reactions to the surrounding tissues.
o Wondering cells
 These are the cells which are temporarily found within the connective tissues
depending on the needs of the body, example during infection.
 They include monocytes, lymphocytes and granulocytes.

Step 5: Connective Tissue Fibres (20 minutes)

 There three types of connective tissue fibres
o Collagen fibres
o Elastic fibres
o Reticular fibres
o Collagen fibres
 Most abundant fibres formed by the union of many collagen fibrils that are made
up of collagen proteins.
 They are tough, inextensible and posses a high tensile strength.
 They appear white in fresh sections.
 Form major part of tendons, ligaments, cartilage, teeth (Dentin and cementum)
and bones.
 There different types of collagen fibres. There are many types of collagen fibles
but the most important are type I, II, III, and IV
o Characteristics of collagen fibres
 Stretching is restricted.
 Each fiber is composed of a number of fibrils. The fibres are strong and flexible
but not elastic.
 Found in all types of connective tissue proper and in cartilages and bones, but are
especially abundant in tendons and aponeurosis.
 Chemically, fibres are composed of an albuminous protein (tropocollagen) which
forms the fundamental building units of collagen and contains gelatin.
 They are acidophilic in their staining reaction and therefore take up eosin stain.
o Elastic fibres
 These are fine fibres made up of elastin protein (tropoelastin). They allow some
degree of distention and stretching. When stretched they usually recover the

Teaching Guides for NTA Level 4 MLS Curriculum Page 131

 original form and dimension when the force is eliminated and the elastic limit is
not exceeded. Elastic fibres changes as the age advances where it looses its
resilience
 Appear yellow in fresh sections. Stained by special stain such as Silver stain.
 Elastic fibres exist as accompanying structure of collagen fibres in the capsule of
many organs, vascular walls and the elastic cartilage. Also in ligamentum nuchae
and ligamentum flava of the spinal cord.
o Reticular fibres:
 Smaller fibres that branch and anastomose to form a netlike supporting framework
known as reticulum.
 They are closely related to the collagen fibres because they contain collagen fibrils
and they show cross-banding pattern, and are sometimes continuous with collagen
fibres.
 Reticular fibres form the supporting framework in the hemopoietic (Bone marrow)
and lymphoid organs such as the thymus, lymph node, spleen.
 In these organs the reticular fibres are produced by reticular cells.
 Also found in endocrine glands, small blood vessels, veins, muscle cells, fat
tissue, and in spaces between the epithelium with connective tissue.
 In these locations the reticular fibres are produced by fibroblasts, smooth muscle
cells, and the Schwann cells produce reticular fibres that surround the nerve fibres.
 In wound healing the reticular fibres are the first to be formed and as the wound
improves they gradually change to become collagenous.

Step 6: Classification and Function of Connective Tissue (20 minutes)

 Connective tissue is classified into
 Connective tissue proper, which consists of
 Loose connective tissue
 Dense connective tissue
 Specialized connective tissue, which consists of:
o Adipose tissue
o Blood tissue
o Cartilage
o Bone tissue
o Lymphoid tissue
 Connective Tissue proper
o Loose connective tissue (areolar tissue)
o Contains more cells than fibres and the fibres are thinner, delicate, sparse and loosely
arranged
o Found around vessels, between muscle fibres, lamina propria of the intestine and in
fascial spaces.
o It forms the essential medium for the nutrients and waste materials exchange between
tissues and blood, and also maintains osmotic pressure
 Dense connective tissue
o Contains more fibres than the cellular component.
o Fibres are densely packed with little space for ground substance.
o Based on the fiber arrangement and direction dense Connective tissue is divided into
o Irregular dense connective tissue.
o Regular dense connective tissue.

Teaching Guides for NTA Level 4 MLS Curriculum Page 132

 o Dense Irregular connective tissue
o Fibres are irregularly arranged.
o Fibres are mainly collagen but in some made up of elastic fibres e.g. walls of elastic
arteries, and elastic ligaments e.g. ligamentum flavum and ligamentum nuchae.
o It forms the dermis of the skin, superficial fascia, fibrous capsule of organs, tunica
albuginea of the testis, periosteum, perichondrium, epimysium, dura matter, and
septae and trabeculae in various glands.
o Also forms sheaths and fasciae e.g. the axillary sheath and fascia lata of the thigh.
o Dense regular connective tissue.
o Predominant fibres are the collagen fibres
o The fibres are densely packed and regularly arranged parallel to each other.
o Its arrangement gives rise to a strong structure that withstands tension exerted in one
direction.
o Comprises tendons, ligaments and aponeuroses.

Step 7: Specialized Connective Tissue (20 minutes)

 Adipose Tissue
o Formed by aggregation of fat cells (adipocytes) with few other cells such as
macrophages, fibroblasts, and leukocytes.
o Basically it is a storage tissue that stores nutritive material in the form of natural fat
that can be used to produce energy when the need arises.
o Other functions includes; protection and insulation
o There are two types
o White adipose tissue
o Brown adipose tissue
 White adipose tissue
o Is made up of unilocular adipocytes i.e. each cell contains one large lipid vacuole,
which fills the entire cells.
o The nucleus and cytoplasm are pushed to the periphery of the cell.
o They are organized into lobes and lobules separated by septae that are predominantly
made up of collagen fibres.
o When fat cells aggregate together they appear yellow.
o This is due to the presence of lipofuchsin pigment in fat cells.
 Brown adipose tissue
o Made up of aggregation of multilocular adipocytes, i.e. one cell contains numerous
vacuoles (fat droplets).
o Richly supplied with blood vessels. This makes it appear light brown in colour when
viewed in fresh conditions.
o Present in the infants and newborn, and decreases with age and may be replaced by
white adipose tissue.
o Found in the posterior cervical part, axilla, suprailiac and peritoneal regions.
o Main function is to protect newborn from cold.
 Cartilage
o It is a tough specialized connective tissue made up of cells, fibres and ground
substances.
o These elements make cartilage firm and compact.
o Cartilage is avascular.
o Cartilage cells

Teaching Guides for NTA Level 4 MLS Curriculum Page 133

 o Chondroblasts
o Chondrocytes
o Ground substance (matrix)
o It is homogenous and stains with basic dyes due to presence of chondromucoprotein.
o It surrounds the lacunae in which the cartilage cells lie.
o Fibres: Are either collagen or elastic fibres.
o Perichondrium is a specialized membrane that covers the cartilage. It is made up of
dense regular connective tissue with many blood vessels and nerve fibres. There are
two layers
o Outer fibrous layer containing fibroblasts.
o Inner chondrogenic layer that contains undifferentiated cells which can become
chondroblasts or chondrocytes.
o There are three types of cartilage based on the types of fibres it contains and the
composition of the ground substance.
o Hyaline cartilage
o Elastic cartilage
o Fibrocartilage
 Hyaline cartilage
o Most abundant type of cartilage in human body. It is solid but flexible and can be cut
with a knife. Consists of collagen fibres type II, cells and ground substance appear
shiny as glass.
o Microscopically, chondrocytes are ovoid or spherical in shape with large spherical
centrally placed nucleus.
o Hyaline cartilage is found in the following structures:
o Respiratory tract including nose, larynx, trachea and bronchi
o On the sternal ends of ribs, (costal cartilages)
o Covers the articular surfaces of joints.
o During embryonic life it forms the cartilage skeleton, from which the long bones
develop.
 Functions of hyaline cartilage
o Facilitation of joint movement as it lines the articular surfaces of all the synovial
joints, making them to be smooth.
o Support to the airways because of its firmness and does not collapse hence it assist in
keeping the tubes patent.
o Growth; it forms nearly all bones of the foetal skeleton, these are replaced by bone
tissue except at the distal ends of long bones where they form the epiphyseal cartilage.
The epiphyseal cartilage is responsible for the longitudinal growth of long bones in
the body.
 Elastic Cartilage
o Contains elastic fibres as major component but few collagen type II fibres.
o Chondrocytes occurs singly and in groups.
o Ground substance contains a network of branching and anastomosing elastic fibres.
o It is more flexible and elastic.
o Elastic cartilage found in epiglottis, auditory tube, pinna of the ear (external ear), and
the coniculate, cuneiform and arytenoids cartilages of the larynx.
o Functions of the elastic cartilage are to provide support and also to maintain the shape
and flexibility of the organs.
 Fibrocartilage

Teaching Guides for NTA Level 4 MLS Curriculum Page 134

 o Has an opaque appearance and fibrous texture and does not have perichondrium.
o Has numerous visible type I collagen fibres and sparse ground substance.
o Intercellular substance contains thick bundles of collagen fibres which run parallel to
one another, and are separated by narrow areas of non-fibrous matrix in which
cartilage cells are lodged.
o Found in areas where firm support and tensile strength are required e.g. the
intervertebral discs, pubic symphysis, articular discs in joints, the cartilaginous lining
of bony grooves in which tendons are lodged and rims of certain articular cartilages.
o Fibrocartilage functions as shock absorber and joint stability.

Step 8: Key Points (5 minute)

 Connective tissue is the medium which surrounds and supports the other tissues of the
body.
 Components of connective tissue are cells, fibres and ground substance
 Connective tissue cells are divided into resident cells (fixed cells) and wondering cells
 Resident cells are found residing in the connective tissue. These includes; Fibroblasts,
Macrophages (histiocytes), Mast cells, Adipocytes, Pigment cells (melanocytes) and
Undifferentiated mesenchymal cells.
 Wondering cells are the cells which are temporarily found within the connective tissues
these include monocytes, lymphocytes and granulocytes.
 There three types of connective tissue fibres collagen fibres, elastic fibres and reticular
fibres

Step 9: Evaluation Questions (15minutes)

 Activity: Individual Assignment (5 minutes)
 PROVIDE each students a worksheet 4.1
 ASK students to look at the diagrams on the worksheet fill in what type of connective
tissue they see and give the examples on where they can be found in the body
 GIVE the worksheet answers after completing or review their answers using answer
guideline of the worksheet

 What is connective tissue?

 Mention different types of connective tissue and their location
 Mention different types of cells found in the connective tissues

References
 Drake R .L, Vogl W, Mitchell A W M (2007). Gray’s Anatomy for Students, United
Kingdom: Churchill Livingstone Elservier
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 135

 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 136

Worksheet 4.1: Different Types of Connective Tissue

Name the following types of connective tissue

This is ----------------------------------------------

Answer: Dense regular connective tissue in a tendon

Source: Elsevier Ltd 2005.

This is ----------------------------------------------
Answer: Elastic fibres

Source: Elsevier Ltd 2005.

This is ----------------------------------------------
Answer: loose connective tissue

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 137

This is ----------------------------------------------
Answer: Adipose tissue

Source: Elsevier Ltd 2005.

This is ----------------------------------------------
Answer: Fibrous connective tissue

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 138

Session 6: Blood and its Constituents
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes:

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Explain blood constituents and its functions
 Distinguish different types of blood groups
 Describe blood plasma
 Describe production and functions of red blood cells
 Describe production of white blood cells
 Describe functions of white blood cells
 Recognise platelets

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout 9.1: Additional Information About Blood Groups
 Handout 9.2: Clotting Factors
 Handout 9.3: Haematopoiesis

SESSION OVERVIEW

Step Time Activity/Method Content

1 05 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation Blood; Constituents and Functions
3 20 minutes Presentation Different types of blood groups
4 10 minutes Presentation Blood Plasma
5 15 minutes Presentation Production and Functions of Red Blood
Cells
6 15 minutes Presentation Production of White Blood Cells
7 15 minutes Presentation Functions of White Blood Cells
8 10 minutes Presentation Platelets
9 05 minutes Presentation Key Points
10 10 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the Learning Objectives, and clarify.

Teaching Guides for NTA Level 4 MLS Curriculum Page 139

 ASK students if they have any questions before continuing.

Step 2: Blood; Constituents and Functions (15 minutes)

 Activity: Brainstorming (5 minutes)
 ASK student to define what is blood and mention the constituents of blood
 ALLOW them to respond
 WRITE their responses on the flip chart
 SUMMARISE their responses using the below information

 Blood is a specialized bodily fluid that delivers necessary substances to the body's cells
such as nutrients, oxygen and transports waste products away from those same cells.
 Blood accounts for 7% of the human body weight
 By volume the red blood cells constitute about 45% of whole blood, the plasma
constitutes about 55%,
 The average adult has a blood volume of roughly 5 litres, composed of:
 Plasma
 Formed elements
 These formed elements of the blood are:
o Erythrocytes (red blood cells). Adult humans have roughly 2–3 × 1013 red blood cells
o Leukocytes (white blood cells) and 4,000–11,000 white blood cells
o Thrombocytes (platelets). 150,000–400,000 platelets in each microliter
o Women have about 4 to 5 million erythrocytes per microliter (cubic millimeter) of
blood and men about 5 to 6 million; people living at high altitudes with low oxygen
tension will have more.

 Activity: Buzz (5 minutes)

 ASK students what are the functions of blood
 ALLOW them to buzz in pair for 2 minutes
 ASK them to respond to the question
 WRITE their responses on the flip chart
 SUMMARISE their responses using the below information

 Functions
o Blood performs many important functions within the body including:
o Supply of oxygen to tissues (bound to haemoglobin which is carried in red cells)
o Supply of nutrients such as glucose, amino acids and fatty acids (dissolved in the
blood or bound to plasma proteins (eg blood lipids)
o Removal of waste such as carbon dioxide, urea and lactic acid
o Immunological functions, including circulation of white cells, and detection of foreign
material by antibodies
o Coagulation, which is one part of the body's self-repair mechanism
o Messenger functions, including the transport of hormones and the signalling of tissue
damage
o Regulation of body pH (the normal pH of blood is in the range of 7.35 - 7.45)
o Regulation of core body temperature

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Step 3: Different Types of Blood Groups (20 minutes)
 A blood type (also called a blood group) is a classification of blood based on the presence
or absence of inherited antigenic substances on the surface of red blood cells (RBCs).
 These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending
on the blood group system, and some of these antigens are also present on the surface of
other types of cells of various tissues. Several of these red blood cell surface antigens,
collectively form a blood group system.
 A total of 30 human blood group systems are now recognized by the International Society
of Blood Transfusion (ISBT).
 Across the 30 blood groups, over 600 different blood group antigens have been found, but
many of these are very rare or are mainly found in certain ethnic groups.
 Blood types are inherited and represent contributions from both parents.

 ABO system
o The ABO system is the most important blood group system in human blood
transfusion.
o It is associated with anti-A antibodies and anti-B antibodies, which are usually
"Immunoglobulin M", antibodies to the RBC surface antigens abbreviated IgM,
antibodies.
o ABO IgM antibodies are produced in the first years of life by sensitization to
environmental substances such as food, bacteria and viruses in the same way as other
antibodies.

Source: WikiMedia

 Blood group AB individuals have both A and B antigen on the surface of their RBCs, and
their blood serum does not contain any antibodies against either A or B antigen.
Therefore, an individual with type AB blood can receive blood from any group (with AB
being preferable), but can donate blood only to another group AB individual.
 Blood group A individuals have the A antigen on the surface of their RBCs, and blood
serum containing IgM antibodies against the B antigen. Therefore, a group A individual
can receive blood only from individuals of groups A or O (with A being preferable), and
can donate blood to individuals with type A or AB.
 Blood group B individuals have the B antigen on the surface of their RBCs, and blood
serum containing IgM antibodies against the A antigen. Therefore, a group B individual
can receive blood only from individuals of groups B or O (with B being preferable), and
can donate blood to individuals with type B or AB.

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 Blood group O individuals do not have either A or B antigens on the surface of their
RBCs, but their blood serum contains IgM anti-A antibodies and anti-B antibodies against
the A and B blood group antigens. Therefore, a group O individual can receive blood only
from a group O individual, but can donate blood to individuals of any ABO blood group
(ie A, B, O or AB). If anyone needs a blood
 Rhesus Blood Group System
o The Rhesus system is the second most significant blood group system in human blood
transfusion.
o The term Rhesus (Rh) blood group system refers to the 5 main Rhesus antigens (C, c,
D, E and e) as well as the many other less frequent Rhesus antigens.
o The most significant Rhesus antigen is the RhD antigen because it is the most
immunogenic of the five main rhesus antigens.
o The terms "positive" or "negative" refer to either the presence or absence of the RhD
antigen irrespective of the presence or absence of the other antigens of the Rhesus
system.

Refer students to Handout 9.1: Additional Information about Blood Groups for more
information

Step 4: Blood Plasma (10 minutes)

 The fluid portion of the blood, the plasma, is a remarkable solution containing an
immense number of ions, inorganic molecules, and organic molecules that are in transit to
various parts of the body or aid in the transport of other substances.
 The normal plasma volume is about 5% of body weight, or roughly 3500 mL in a 70kg
man.
 Plasma clots on standing, remain fluid only if an anticoagulant is added.
 If whole blood is allowed to clot and the clot is removed, the remaining fluid is called
serum.
 Serum has essentially the same composition as plasma except that its fibrinogen and
clotting factors II, V, and VIII have been removed and it has higher serotonin content
because of the breakdown of platelets during clotting.
 The plasma consist of protein; albumin, globulin, and fibrinogen fractions.
 The capillary walls are relatively impermeable to the proteins plasma, and the proteins are
therefore exert an osmotic force of about 25 mm Hg across the capillary wall (oncotic
pressure) that pulls water into the blood.
 The plasma proteins are also responsible for 15% of the buffering capacity of the blood
because of the weak ionization of their substituent COOH and NH2 groups.
 At the normal plasma pH7.40, the proteins are mostly in the anionic form and constitute a
significant part of the anionic complement of plasma. Plasma proteins such as antibodies
and the proteins concerned with blood clotting have specific functions. Most of the other
plasma proteins are synthesized in the liver

Refer students to Handout 9.2: Clotting Factors for more information

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Step 5: Production and Functions of Red Blood Cell. (15 minutes)
 Red blood cells formation
o Red blood cells (Erythrocytes) are the most common type of blood cell. The cells are
filled with hemoglobin, a biomolecule that can bind to oxygen.
o They take up oxygen in the lungs and release it while squeezing through the body's
capillaries. The blood's red colour is due to the colour of hemoglobin.
o In humans, red blood cells develop in the bone marrow, take the form of flexible
biconcave disks, lack a cell nucleus, subcellular organelles and the ability to
synthesize protein, It takes about 7 days for erythrocytes to mature and live a total of
about 120 days.
o Erythropoiesis is the process by which red blood cells (erythrocytes) are produced.
o In human adults, this usually occurs within the bone marrow.
o In the early fetus, erythropoiesis takes place in the mesodermal cells of the yolk sac.
o By the third or fourth month, erythropoiesis moves to the spleen and liver.
o In humans with certain diseases, erythropoiesis also occurs outside the bone marrow,
within the spleen or liver. This is termed extramedullary erythropoiesis.
o The tibia and femur cease to be important sites of hematopoiesis by about age 25; the
vertebrae, sternum, pelvis and ribs, and cranium bones continue to produce red blood
cells throughout life.
o Erythrocytes and granulocytes belong to the myeloid lineage. The earliest identifiable
erythroid stem cells are capable of rapid bursts of cell division to form numerous
daughter cells
o In the process of red blood cell maturation, a cell undergoes a series of
differentiations. The following stages of development all occur within the bone
marrow:
o Pluripotent haematopoietic stem cell are cells which are capable of giving rise to all
blood cell types
o The first readily identifiable cell of the erythroid series is the proerythroblast, a large
cell with a large euchromatic nucleus and moderately basophilic cytoplasm.
o It also responds to erythropoietin.
o The proerythroblast contains small amounts of ferritin and bears some of the protein
spectrin on its plasma membrane.
o Proerythroblasts proliferate to produce smaller basophilic erythroblasts, rich in
ribosomes, in which haemoglobin-RNA synthesis begins.
o The cytoplasm becomes partially, and then uniformly, eosinophilic (the
polychromatic erythroblast and orthochromatic erythroblast respectively).
o The nucleus becomes intensely pyknotic and is finally extruded from the cell, leaving
an anucleate reticulocyte, which enters a sinusoid.
o Its reticular staining pattern, visible using special stains, results from residual
cytoplasmic RNA which is lost within 24 hours of entering the peripheral blood
circulation.
o Reticulocyte numbers in peripheral blood are therefore a good indicator of the rate of
red cell production. The whole process of erythropoiesis takes 5-9 days.
o After these stages, the cell is released from the bone marrow, and ultimately becomes
an "erythrocyte" or mature red blood cell circulating in the peripheral blood.

Refer students to Handout 9.3: Haematopoiesis for more illustrations

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Regulation of erythropoiesis
o Erythropoietin (EPO) is a glycoprotein (protein-sugar conjugate) that serves as the
primary regulator of red blood cells (erythrocytes). It stimulates bone marrow stem
cells to differentiate into red blood cells and controls haemoglobin synthesis and red
blood cell concentration.
o EPO production is stimulated by reduced oxygen content in arterial blood in the
kidneys. Circulating EPO binds to receptors on the surface of erythroid progenitor
cells that in turn mature into red blood cells.
o In infants, EPO is produced mostly in the liver, but the kidneys become the primary
site of EPO synthesis shortly after birth.

Step 6: Production of White Blood Cells (15 minutes)

 White blood cells, or leukocytes, are cells of the immune system defending the body
against both infectious disease and foreign materials.
 Five different and diverse types of leukocytes exist, but they are all produced and derived
from a multipotent cell in the bone marrow known as a hematopoietic stem cell.
 Leukocytes are found throughout the body, including the blood and lymphatic system.
 The number of leukocytes in the blood is often an indicator of disease.
 There are normally between 4×109 and 11×109 white blood cells in a litre of blood,
making up approximately 1% of blood in a healthy adult.
 In conditions such as leukemia, the number of leukocytes is higher than normal, and in
leukopenia, this number is much lower.
 Types of White blood cells
o There are several different types of white blood cells. They all have many things in
common, but are all different. One primary technique to classify them is to look for
the presence of granules, which allows the differentiation of cells into the categories
granulocytes and agranulocytes:
 Granulocytes (polymorphonuclear leukocytes)
o Leukocytes characterised by the presence of differently staining granules in their
cytoplasm when viewed under light microscopy.
o These granules are membrane-bound enzymes which primarily act in the digestion of
endocytosed particles.
o There are three types of granulocytes: neutrophils, basophils, and eosinophils, which
are named according to their staining properties.
o Granulocyte formation involves major changes in nuclear morphology and
cytoplasmic contents which are best known for the neutrophil.
o Initially, myeloid stem cells transform into large myeloblasts which are similar in
general size and appearance to proerythroblasts.
o These proliferative cells have large euchromatic nuclei and lack cytoplasmic granules.
o They differentiate into slightly larger promyelocytes, in which the first group of
specific proteins is synthesized in the rough endoplasmic reticulum and Golgi
apparatus.
o The proteins are stored in large primary (non-specific) granules, which are large
lysosomes containing acid phosphatase. Smaller secondary (specific) granules are
formed in the smaller myelocyte, which is the last proliferative stage. The nucleus is
typically flattened or slightly indented on one side in myelocytes.
o In metamyelocyte, stage, the cell size decreases, the nucleus becomes heterochromatic
and horse-shoe shaped, and protein synthesis almost stops.

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 o As the neutrophil is released, the nucleus becomes first heavily indented and
subsequently segmented into up to six lobes, characteristic of the mature neutrophil.
o The whole process takes 7 days to complete, of which 3 days are spent proliferating,
and 4 days maturing.
o Neutrophils may then be stored in the marrow for a further 4 days, depending on
demand, before their final release into the circulation.
o Eosinophils and basophils pass through a similar sequence but their nuclei do not
become as irregular as that of the neutrophil.
o Basophils nucleus is bi- or tri-lobed, but it is hard to see because of the number of
coarse granules which hide it. They are characterised by their large blue granules
o Eosinophils nucleus is bi-lobed. The cytoplasm is full of granules which assume a
characteristic pink-orange color with eosin stain.
o Neutrophils are also known as polymorphonuclear leukocytes.
o They have a multilobed nucleus which may appear like multiple nuclei, hence the
name polymorphonuclear leukocyte. The cytoplasm may look transparent because of
fine granules that are faintly pink in color.
 Agranulocytes (mononuclear leucocytes)
o Leukocytes characterized by the apparent absence of granules in their cytoplasm.
o Although the name implies a lack of granules these cells do contain non-specific
azurophilic granules, which are lysosomes.
o The cells include monocytes, macrophages and lymphocytes.
o Monocyte progenitors pass through a proliferative monoblast stage
o A typical monoblast is about 12 to 20 µm in diameter, has a round to oval nucleus
with fine chromatin structure.
o The nucleus can be central or eccentric and it can show evidence of indentation or
folding.
o The cytoplasm is agranular, stains moderately to lightly basophilic, and often has an
intensely stained periphery and a prominent perinuclear zone.
o Monoblasts are normally found in bone marrow and do not appear in the normal
peripheral blood.
o They mature into monocytes which in turn develop into macrophages.
o The monoblast is the first stage of monocyte-macrophage maturation.
o The developmental stages of the monoblast are:
 Pluripotential Hemopoietic Stem Cell or hemocytoblast
 Monoblast
 Promonocyte
 Monocyte
 Macrophage.
 Lymphoblasts are immature cells which typically differentiate to form mature
lymphocytes.
 Lymphoblasts are normally found in the bone marrow, but in acute lymphoblastic
leukaemia (ALL), lymphoblasts proliferate uncontrollably and are found in large
numbers in the peripheral blood.
Refer students to Handout 9.3: Haematopoiesis for more illustrations

Step 7: Functions of White Blood Cells (20 minutes)

 Neutrophil

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 o Neutrophils defend against bacterial or fungal infection and other very small
inflammatory processes that are usually first responders to microbial infection; their
activity and death in large numbers forms pus.
o Neutrophils are very active in phagocytosing bacteria and are present in large amount
in the pus of wounds. These cells are not able to renew their lysosomes used in
digesting microbes and die after having phagocytosed a few pathogens
 Eosinophil
o Eosinophils primarily deal with parasitic infections and an increase in them may
indicate such.
o They are also the predominant inflammatory cells in allergic reactions.
o The most important causes of eosinophilia include allergies such as asthma, hay fever,
and hives; and also parasitic infections.
o Basophil; Basophils are chiefly responsible for allergic and antigen response by
releasing the chemical histamine causing inflammation.
 Monocyte
o They have the kidney shaped nucleus and are typically agranulated. They also possess
abundant cytoplasm.
o Monocytes share the "vacuum cleaner" (phagocytosis) function of neutrophils, but are
much longer lived as they have an additional role: they present pieces of pathogens to
T cells so that the pathogens may be recognized again and killed, or so that an
antibody response may be mounted.
o Monocytes eventually leave the bloodstream to become tissue macrophages which
remove dead cell debris as well as attacking microorganisms. Neither of these can be
dealt with effectively by the neutrophils.
o Unlike neutrophils, monocytes are able to replace their lysosomal contents and are
thought to have a much longer active life.
 Macrophage
o Once monocytes move from the bloodstream out into the body tissues, they undergo
changes (differentiate) allowing phagocytosis and are then known as macrophages.
 Lymphocyte
o Lymphocytes are much more common in the lymphatic system.
o Lymphocytes are distinguished by having a deeply staining nucleus which may be
eccentric in location, and a relatively small amount of cytoplasm.
 The blood has three types of lymphocytes:
o B cells; which make antibodies that bind to pathogens to enable their destruction.
o T cells; these include CD4+ (helper) T cells co-ordinate the immune response (they
are what become defective in an HIV infection). CD8+ (cytotoxic) are able to kill
virus-infected and tumor cells. T cells are crucial to the immune response because
they possess a unique 'memory' system which allows them to remember past invaders
and prevent disease when a similar invader is encountered again.
o Natural Killer Cells (NK cells). Natural killer cells are able to kill cells of the body
that are infected by a virus or have become cancerous

Step 8: Platelets (10 minutes)

 Platelets or thrombocytes are minute fragment of cells consisting of a small amount of
cytoplasm surrounded by a plasma membrane.
 Platelets are roughly disk-shaped and an average about 3µm in diameter

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 They play an important role in controlling blood loss by forming platelets plugs which
seal holes in small vessels
 The life expectancy of platelets is about 5 - 9 days
 Platelets arise in a unique manner by the shedding of thousands of cytoplasmic fragments
from the tips of processes of megakaryocytes in the bone marrow
 The first detectable cell of this line is the highly basophilic megakaryoblast, followed by a
promegakaryocyte stage, in which synthesis of granules begins. Finally, the fully
differentiated megakaryocyte, a giant cell with a large, dense, polyploid, multilobed
nucleus, appears.

Refer students to Handout 9.3: Haematopoiesis for more illustrations

Step 9: Key Points (5 minutes)

 Blood is a specialized bodily fluid that delivers necessary substances to the body's cells
 The ABO system is the most important blood group system in human blood transfusion.
 The fluid portion of the blood, the plasma
 White blood cells, or leukocytes, are cells of the immune system defending the body
against both infectious disease and foreign materials
 Platelets play an important role in controlling blood clotting

Step 10: Evaluation (10 minutes)

 What are the components of blood?
 What is blood plasma?
 What is the difference between plasma and serum?
 What are the functions of neutrophils?
 What are the functions of eosinophils?

References
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.
 ABO blood type table retrieved March 24, 2010 from http://en.wikipedia.org

Teaching Guides for NTA Level 4 MLS Curriculum Page 147

Handout 9.1: Additional Information about Blood Groups

 Almost always, an individual has the same blood group for life; but very rarely an
individual's bood type changes through addition or suppression of an antigen in infection,
malignancy or autoimmune disease.
 An example of this rare phenomenon is the case of an Australian citizen, whose blood
group changed after a liver transplant.
 Another more common cause in blood type change is a bone marrow transplant. If a
person receives a bone marrow from someone who is a different ABO type (ex. a type A
patient receives a type O bone marrow), the patient's blood type will eventually convert to
the donor's type.
 Some blood types are associated with inheritance of other diseases. Certain blood types
may affect susceptibility to infections, an example being the resistance to specific malaria
species seen in individuals lacking the Duffy antigen. The Duffy antigen is a protein
located on the surface of red blood cells and is named after the patient in which it was
discovered. On erythrocytes the Duffy antigen acts as a receptor for invasion by the
human malarial parasites Plasmodium vivax.
 Duffy negative individuals whose erythrocytes do not express the receptor are believed to
be resistant to merozoite invasion
 A connection has been found between HIV susceptibility and the Duffy antigen
expression. The presence of the Duffy antigen receptor appears to increase the
susceptibility to infection by HIV.
 After birth an infant gut becomes colonized with normal floras which express these A-
like and B-like antigens, causing the immune system to make antibodies to those antigens
that the red cells do not possess. So, people who are blood type A will have Anti-B, blood
type B will have Anti-A, blood type O will have both Anti-A and Anti-B, and blood type
AB will have neither. Because of these so called "naturally occurring" and expected
antibodies, it is important to correctly determine a patient's blood type prior to transfusion
of any blood component.
 Rhesus factor
o Cross-matching for the RhD antigen is extremely important, because the RhD antigen
is immunogenic, meaning that a person who is RhD negative is very likely to make
Anti-RhD when exposed to the RhD antigen (perhaps through either transfusion or
pregnancy).
o Once an individual is sensitised to RhD antigens their blood will contain RhD IgG
antibodies which can bind to RhD positive RBCs and may cross the placenta.
o A RhD negative patient who does not have any anti-RhD antibodies (never being
previously sensitized to RhD positive RBCs) can receive a transfusion of RhD
positive blood once, but this would cause sensitization to the RhD antigen, and a
female patient would become at risk for hemolytic disease of the newborn
o RhD positive blood should never be given to RhD negative women of childbearing
age or to patients with RhD antibodies. In extreme circumstances, such as for a major
bleed when stocks of RhD negative blood units are very low at the blood bank, RhD
positive blood might be given to RhD negative females above child-bearing age or to
Rh negative males, providing that they did not have anti-RhD antibodies, RhD
positive patients do not react to RhD negative blood.

Handout 9.2: Clotting Factors

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 System for Naming Blood-Clotting Factors.
o Factora Names
 I Fibrinogen
 II Prothrombin
 III Thromboplastin
 IV Calcium
 V Proaccelerin, labile factor, accelerator globulin
 VII Proconvertin, SPCA, stable factor
 VIII Antihemophilic factor (AHF), antihemophilic factor A, antihemophilic
globulin (AHG)
 IX Plasma thromboplastic component (PTC), Christmas factor,
antihemophilic factor B
 X Stuart-Prower factor
 XI Plasma thromboplastin antecedent (PTA), antihemophilic factor C
 XII Hageman factor, glass factor
 XIII Fibrin-stabilizing factor, Laki-Lorand factor
 HMW-K High-molecular-weight kininogen, Fitzgerald factor
 Pre-Ka Prekallikrein, Fletcher factor
 Ka Kallikrein
 PL Platelet phospholipid
a
Factor VI is not a separate entity and has been dropped.

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Handout 9.3: Haematopoiesis

Source: McGraw-Hill Companies, Inc. 2006

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Session 7: Structure and Function of
Muscle, Nervous and Bone Tissues
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes:

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Describe muscle tissue in general
 Describe structure and function of skeletal, cardiac and smooth muscle tissue
 Identify components of nervous tissue
 Distinguish different types of neurons
 Distinguish different types of neuroglia and their functions
 Describe the bone tissue in general
 Describe the bone formation

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector, Transparencies, Anatomy Atlas and Models, LCD and Computer
 Handout 5.1: The Muscle Fibre
 Handout 5.2: Skeletal, Cardiac, and Smooth Muscle
 Handout 5.3: The Neuron
 Handout 5.4: Bone Tissue

SESSION OVERVIEW
Step Time Activity/ Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation Overview of Muscle Tissue
Brainstorming
3 30 minutes Presentation Structure and Function of Muscle Tissues
4 15 minutes Presentation Components of Nervous Tissue
5 15 minutes Presentation Neuroglia and their Functions
6 15 minutes Presentation Bone Tissue
7 15 minutes Presentation Bone Formation
8 05 minutes Presentation Key Points
9 05 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

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 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Overview of Muscle Tissue (15 minutes)

 Activity: Brainstorming (5 minutes)
 ASK students, what is a muscle tissue? What are the main characteristics of muscle
tissue?
 ASK one student to come in front and to write the responses of the rest of the class on a
flip chart.
 SUMMARIZE the activity by clarifying on students responses.

 Muscle tissue is specialized to contracts when it is stimulated and thus to exert a physical
force on other tissue.
 When a skeletal muscle contracts pulls on a bone and enhance movement, the heart
muscle contracts and expel blood.
 Other processes like digestion, waste elimination, breathing speech and blood circulation
depends on muscular tissue.
 The muscles are also an important source of body heat
 As any other tissue, muscular tissue is made up of cells

 Muscle Cells
o These are also often referred to as myocytes or muscle fibers. Muscle cells are usually
grouped into bundle, the muscles
o Muscle cells are usually elongated and spindle-shaped. They function by shortening
their length, approximating the two opposite points, which are attached to connective
tissue structures such as septa, trabeculae, fasciae, tendons, periosteum or bone.
o The shortening of the muscle cell is called contraction.
o The structural unit of a muscle is a muscle fibre
o The muscle fibres are made up of fibrils and fibrils are divisible into individual
filaments.
o The contractile property of muscle cells is determined by the presence of the
filamentous contractile proteins, actin and myosin.
o Three types of muscle can be distinguished basing on both structure and functions,
o Skeletal muscle (striated voluntary muscle)
o Cardiac muscle (striated involuntary muscle)
o Smooth muscle (smooth involuntary muscle)

Refer Handout 5.1: Muscle Fibre for more elaboration

Step 3: Structure and Function of Muscle Tissue (30 minutes)

 Skeletal Muscle Tissue
o This type is described as skeletal because it forms those muscles that form movement
of the skeleton; it is also known as striated or voluntary muscles.
o Striated because striations can be seen on microscopic examination, and voluntary as
it is under conscious control

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 o It consists of bundles of very long cylindrical, multinucleated cells called muscle
fibers.
o The oval nuclei are usually found at the periphery of the cell under the cell membrane.
This characteristic nuclear location is helpful in distinguishing skeletal muscle from
cardiac muscle, which has centrally located nuclei.
o Connective tissue covering individual muscle fibers is called endomysium, a group of
fibers (fiber bundles) is invested by perimysium, and the entire muscle is surrounded
by epimysium. The functional unit of a muscle, consisting of a motor neuron and the
muscle fibers it controls, is a motor unit.
o When a motor neuron in the spinal cord is stimulated, it initiates an impulse that
causes all the muscle fibers supplied by that motor unit to contract simultaneously.
o The sarcoplasm also has many alternating light and dark bands, giving the fibre a
striped or striated appearance (hence the name striated muscle).
o The contraction of skeletal muscle tissue is very quick and forceful.
o The initiation and execution of muscle contraction occur in the following sequential
steps.
o An action potential travels along a motor nerve to its endings on muscle fibers.
o At each ending, the nerve secretes a small amount of the neurotransmitter substance
acetylcholine.
o The acetylcholine acts on a local area of the muscle fiber membrane to open multiple
"acetylcholine-gated" channels through protein molecules floating in the membrane.
o Opening of the acetylcholine-gated channels allows large quantities of sodium ions to
diffuse to the interior of the muscle fiber membrane. This initiates an action potential
at the membrane.
o The action potential depolarizes the muscle membrane, and much of the action
potential electricity flows through the center of the muscle fiber.
o Here it causes the sarcoplasmic reticulum to release large quantities of calcium ions
that have been stored within this reticulum.
o The calcium ions initiate attractive forces between the actin and myosin filaments,
causing them to slide alongside each other, which is the contractile process.
o After a fraction of a second, the calcium ions are pumped back into the sarcoplasmic
reticulum by a Ca++ membrane pump, and they remain stored in the reticulum until a
new muscle action potential comes along; this removal of calcium ions from the
myofibrils causes the muscle contraction to cease.
 Functions of Skeletal Muscle Tissue
o Muscles serve specific functions in moving and positioning the body. The same
muscle may act as a prime mover, antagonist, synergist, or fixator under specific
conditions. The functions include.
o A prime mover or agonist is the main muscle responsible for producing a specific
movement of the body (e.g. concentric contraction).
o Fixators steady the proximal parts of a limb while movements are occurring in distal
parts.
o A synergist complements the action of prime mover for example, by preventing
movement of the intervening joint when a prime mover passes over more than one
joint.
o An antagonist is a muscle that opposes the action of a prime mover. As a prime mover
contracts, the antagonist progressively relax, producing a smooth movement.

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 Cardiac Muscle Tissue
o This is a unique tissue found only in the walls of the heart.
o Cardiac (Heart) Muscle Tissue shows some of the characteristics of smooth muscle
and some of skeletal muscle tissue.
o Its fibres, like those of skeletal muscle, have cross-striations and contain numerous
nuclei.
o However, like smooth muscle tissue, it is involuntary
o Cardiac muscle forms the muscular wall of the heart the myocardium. Some cardiac
muscle is also present in the walls of the aorta, pulmonary vein, and superior vena
cava cardiac muscle contractions are not under voluntary control. Heart rate is
regulated intrinsically by a pacemaker, composed of special cardiac muscle fibres that
are influenced by the autonomic nervous system
 Smooth Muscle Tissue
o This type is also called non-striated or involuntary muscle.
o Each cell has many myofibrils which lie parallel to one another in the direction of the
long axis of the cell. They are not arranged in a definite striped (striated) pattern, as in
skeletal muscles, hence the name smooth muscle.
o This muscle is mainly visceral in distribution, forming the contractile portion of the
wall of the digestive tract from the mid-oesophagus to anus, including the ducts of
glands associated with the system.
o It is found in the respiratory, urinary and genital system; in arteries, veins and larger
lymphatics, in the dermis and in the iris and ciliary body of the eye.
o In these locations, it functions in moderating and maintaining lumen diameter of the
hollow viscera.
o Smooth muscle is composed of long spindle-like cells, which in cross-section appear
as narrow circular profiles.
o Each cell possesses a characteristic centrally located elongated nucleus. In
contracted cells, these nuclei are frequently folded or pleated.
o At the poles of the nucleus lie numerous mitochondria, well-developed rough
endoplasmic reticulum, and a large golgi apparatus.

Refer Handout 5.2: Skeletal, Cardiac and Smooth Muscle

Step 4: Components of Nervous Tissue (15 minutes)

 Nervous tissue is distributed throughout the body as an integrated communications
network.
 Structurally, nerve tissue consists of two classes of cell types:
 Neurons, the nervous tissue is made up of billions of cells called neurons that are
specialized to respond to stimuli and to transmit a signal to activate other cells.
 Glial cells or neuroglia, non excitable supporting cells, participate in neural activity,
neural nutritional and defense processes of the central nervous system
 A Typical Neuron Consist of
o Cell body, which has many radiating processes called dendrites, which are specialized
to receive signals from other neurons.
o Axon, a single long process, which is capable of generating a nerve impulse and
conducting it over a long distance to stimulate other neurons in the CNS, or muscular
or secretory cells elsewhere in the body.

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 o Neurons usually receive information through dendrites, the information is integrated
in the cell body and transmitted onwards via axons.
 Types of Neurons
o Unipolar neurons, these neurons have single processes, the axon arising from the cell
body. Have no dendrites.
o Bipolar neurons, have two processes (both axons) emerging directly and oppositely
from the cell body. Bipolar neurons are found in the cochlear and vestibular ganglia
as well as retina and olfactory mucosa.
o Multipolar neurons, has one axon and many dozens of dendrites. Most neurons in the
CNS are multipolar.
o Pseudounipolar neurons, has a single short process (an axon) with a T-shaped
branching, one branch extending towards the CNS, and the other extending to a
periphery ending.
o In typical pseudounipolar neurons, both branches are axons on both structural and
electrophysiological grounds.
 Neurons can also be Classified according to their Functional Roles
 Motor neurons, motor neurons are involved in stimulating muscles or glands (effector
organs) in the periphery.
 Sensory neurons, sensory neurons receive sensory stimuli from the environment or from
tissues and organs of the body
 Interneurons, maintain connection between neurons in the CNS, forming complex
functional chains or circuits.

 Refer Handout 5.3: Neuron

Step 5: Neuroglia and their Functions (15 minutes)

 Neuroglia (Glial cells)
o These are supporting cells found in the central nervous system and peripheral nervous
system
o There are 6 types of supporting cells
o 4 are found in the CNS and 2 are found in the PNS
o Neuroglia found in central nervous system are,
o Astrocytes: Star-shaped, abundant, and versatile. Guide the migration of developing
neurons, they are found in large numbers adjacent to blood vessels. They form a
blood-brain barrier, i.e. the blood is separated from neurones by capillary wall and a
layer of astrocytes foot process
o Microglia, specialized immune cells that act as the macrophages of the CNS. They
derived from monocytes.
o Ependymal Cells, these cells form the epithelial lining of the ventricles of the brain
and the central canal of the spinal cord
o Oligodendrocytes, these are found in clusters around cell bodies. They form and
maintain the myelin, having the same functions as schwann cells in peripheral
nerves.These cells have clinical importance as most tumours of the brain are arising
from them
 Glia Cells Found in the Peripheral Nervous System
o Satellite cells, surround clusters of neuronal cell bodies in the PNS, they are of
unknown function

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 o Schwann cells, form myelin sheaths around the larger nerve fibers in the PNS, they
are for neuronal regeneration

Step 6: Bone Tissue (15 minutes)

 Bone is a hard and rigid connective tissue that forms the bony skeleton of the body.
 Bone supports the body weight and provides attachment to muscles.
 It acts as lever for movements, and provides protection to organs.
 Inside the bone there are spaces, which are filled with the bone marrow that produce red
blood cells, platelets and cells of the immune system.
 Cells of the immune system produced in bone marrow include monocytes, lymphocytes,
mast cells, neutrophils, eosinophils and basophils.
 The only difference with other connective tissues is that its ground substance is made up
of inorganic salts, mostly calcium ions.
 The bone is highly vascularized, and in living conditions the bone appears pinkish in
colour.
 Bone consists of.
o Cells,
o Fibers
o Ground substances.
 Bone Cells; The bone contains four types of cells namely the osteoprogenator cells,
osteoblasts, osteocytes, and the osteoclasts.
 Bone Matrix (Intercellular substance)
 It is made up of the collagen fibers (osteocollagenous fibers), amorphous ground
substance and inorganic salts which constitute about 74% of bone mass.
 Classification of Bone Tissue
o Can be classified basing on the gross appearance and histologically.
o Basing on gross appearance
o Long bones
o Short bones
o Flat bones
o Histologically bone tissue is generally classified into two types
o Compact (cortical) bone
o Cancellous (spongy) bone
o But many bones have both the compact and spongy portions
o The compact bone is found on the outer parts and inner to it is the spongy bone.
o Compact (cortical) bone
o Under the microscope the compact bone is made up of calcified matrix arranged in
thin layers known as lamellae.
o Spongy (cancellous) bone
o It is composed of bony spicules and plates that branch and anastomose with one
another to form a meshwork.
o The spaces or cavities in the meshwork are filled with bone marrow.
o Microscopically the spongy bone is also lamellated.
 Harvesian System
o Harvesian canals are the longitudinal channels that traverse the bone longitudinally
and they branch and anastomose freely.

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 o This ensures nutrient supply to the bone tissue because each contains blood vessels,
lymphatics and nerve fibers.
o The lamellae, osteocyte, and blood vessels within the Harvesian canal form units of
bone referred to as the Harvesian system or osteon.
o Within the lamellae there are lacunae and canaliculi.
o Lacunae, are small bone cavities that contain the osteocytes
o Canaliculi, Are microscopic channels, which radiate from the lacunae and are
normally occupied by cytoplasmic processes of osteocytes.
 Inorganic Matter (Salts)
o Inorganic matter constitutes about two-thirds of the weight of bone.
o The major component is calcium phosphates (85%), calcium carbonate (10%) and
small amounts of calcium fluoride and magnesium chloride.
o Calcium phosphate is in the form of hydroxyapatite crystals [Ca10 (PO4)6(OH) 3].
 Periosteum
o A special connective tissue membrane that covers the outer surface of bone.
o It is composed of mostly collagen fibers, and few elastic fibers.
o It covers most of bone surface up to the margins of articular surfaces where it
becomes continuous with the fibrous capsule of the joints.
o In the bones of the limbs and at the sites of attachment of muscles, tendon and
ligaments the periosteum is firmly adherent to the bone.
 Functions of the Periosteum
o Osteogenic activity
o The cells in the periosteum can differentiate into bone forming cells and begin the
process of lying down bone.
o This is particularly true during healing of fracture and during bone growth.
o Entry of vessels
o It facilitates entry of blood vessels, lymphatic vessels and nerves into the bone.
o Periosteum has many vessels, which pass to enter the bone via the Volkman’s canals
and nutrient foramina.
o Muscle attachment
o Facilitates attachment of muscles, tendons, and ligaments to the bone.
o Tendons utilize these collagen fibers to attach to the bone.
 Endosteal Membrane
o The endosteal membrane is equivalent to the periosteum and it lines the inner surfaces
of bone marrow cavities.

Refer students to Handout 5.4: Bone Tissue for more elaboration

Step 7: Bone Formation (15 minutes)

 Bone formation is commonly referred to ossification and it occurs in two environments or
in two processes.
 Intramembranous Ossification
 The bones that form by this process include most of skull bones such as frontal, parietal,
maxilla, mandible, clavicle and parts of occipital and temporal bones.
 Bone formation occurs in four main stages, these are
 development of the ossification centers (special membrane)
 Formation of bone matrix

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 deposition of minerals or calcification
 Formation of trabeculae and appearance of periosteum.
 Endochondral Ossification
 In endochondral ossification bone is formed from the pre-existing hyaline cartilage that
has the shape that closely resembles the bone to be formed.
 Most long and irregular bones form via endochondral ossification, such as the base of the
skull, vertebral column, the pelvis and bones of the extremities (limbs).
 During this process the cartilage is gradually replaced by bone
 Only a small amount of cartilage remains covering the articular surfaces of the joints.
 During endochondral ossification the bone also grows in length and width.
 Generally flat bones develop by intramembranous ossification while long bones develop
by intracartilagenous ossification
 Remodeling and reorganization
 Bone undergoes continuous surface and internal remodeling and reorganization to
maintain bone size and shape.
 Remodeling involves bone resorption and deposition and takes place in compact as well
as trabecular bone

Bone Marrow
 There are two types of bone marrow (Red and Yellow bone marrow)
 It is located in the central part of the compact bone in long bones and spaces between the
trabeculae of spongy bones.
 It is made up of cells, (Stem cells, reticular cells, macrophages), framework of reticular
fibers and blood vessels. The reticular cells and macrophages lie along the reticular fibers.
 There are two types of stem cells in the bone marrow; these are the
 haemopoietic cells which differentiate to give rise into blood cells (leukocytes,
erythrocytes and megakaryocytes) and
 Mesenchymal cells.
 The mesenchymal cells are also known as ‘gatekeeper’ cells; they are capable of giving
rise into many types of cells such as osteoblasts, chondrocytes and myocytes.
 The bone marrow contains a large number of specialized capillaries known as sinusoids.
The sinusoids have pores in their walls and are lined by phagocytic cells. Pores allow the
newly produced blood cells to gain access to the circulation.
 The red bone marrow is generally present in all bones up to the time of puberty; thereafter
it gradually disappears and become replaced by the yellow bone marrow in advanced age.
 In adult bone it is mainly found in the epiphyses of long bones, in the sternum, scapulae,
pelvis, ribs, vertebrae and the cranial bones.
 The main function of the red bone marrow to generate cells of the blood; it is a blood
forming tissue. The process of blood cell formation is also called haemopoiesis.

Step 8: Key Points (5 minute)

 Structurally the muscle tissue is divided into skeletal, smooth and cardiac muscle tissue
 The skeletal muscle tissue is voluntary while smooth and cardiac muscle tissue are
involuntary
 The nervous tissue consists of neurons and supporting cells.
 Neurons are for the transmission of nerve impulses

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 Bone is a hard and rigid connective tissue that forms the bony skeleton of the body
 Bone consists of cells, fibers and ground substances
 Can be classified basing on the gross appearance and histologically.
 Bone formation is commonly referred to ossification and it occurs in two environments or
in two processes, namely Intramembranous ossification and Endochondral ossification

Step 9: Evaluation (5 minutes)

 List different types muscle of tissues
 Mention components of nervous tissue
 Mention supporting cells of nervous tissue
 Define the bone tissue

 ASK students if they have any comments or need clarification on any points.

References
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology McGraw-Hill
 Standring S. Grays’s Anatomy (2008) the anatomical basis of clinical practice Churchill
Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999) Anatomy & Physiology Mosby, Inc. Von Hoffman
Press, Inc.
 Waugh A & Grant A (2006) Ross and Willson Anatomy and physiology in Health and
illness Churchill Livingstone Elservier. Elsevier Limited China.

Teaching Guides for NTA Level 4 MLS Curriculum Page 159

Handout 5.1: Muscle Fibre

Source: Lippincott Williams & Wilkins, 2007

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Handout 5.2: A, Skeletal Muscle, B. Cardiac Muscle and C. Smooth Muscle.

A.

C
Source: Lippincott Williams & Wilkins, 2007

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Handout 5.3: A Neuron

Source: Strandring (2005),

Handout 5.4: Bone Tissue

Haversian canals and their contents (blood vessels)

Osteons in a dry ground transverse section of bone

Source: Elsevier Ltd 2005.

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Session 8: Parts and Functions of each
System
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes:

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 List eight human body systems (Respiratory, digestive, Skeletal ,Circulatory, urinary,
Nervous ,Endocrine, Reproductive )
 List organs found in each system.
 Identify illustrated diagram of each system.
 Explain the basic functions of each system.
 Explain the basic functions of organs in each system.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Coloured Atlas of different systems of the human body.

SESSION OVERVIEW

Step Time Activity/ Method Content

1 10 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Human body systems.
3 20 minutes Presentation Organs found in each system.
4 40 minutes Presentation, Illustrated diagram of systems.
demonstration
5 40 minutes Presentation Basic functions of each system.
6 5 minutes Presentation Key points
7 5 minutes Presentation Evaluation.

SESSION CONTENT:
Step no 1. Presentation of Session Title and Learning Objectives (10 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step no 2: The human body systems (10minutes)

 Activity: Buzzing. (5 minutes)

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 ASK the students the questions like:
 Mention body systems.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 The following are the eight human body systems:-

o Respiratory
o Digestive
o Skeletal
o Circulatory
o Urinary
o Nervous
o Endocrine
o Reproductive

Step 3: Organs found in each system. (20minutes)

 Activity: Brainstorming (5 minutes)
 ASK the students the following questions:
 What are the organs found in( respiratory, digestive, skeletal systems etc)
 RECORD their responses on a flip chart or chalk board.
 SUMMARIZE their responses using notes below

 The table below shows the systems and their respective organs:-
o The name of system Organs.
 Respiratory Nose
 Pharynx
 Larynx
 Trachea
 Bronchus
 Bronchioles
o Digestive Mouth.
 Oesophagus.
 Stomach.
 Intestines
 Liver.
 Pancreas.
o Skeletal Bones
 Muscles
o Circulatory Heart
 Blood vessels
 Lymphatic vessels
o Urinary Kidneys
 Ureter.
 Urinary bladder
 Urethra.
o Nervous Brain
 Spinal cord.

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 o Endocrine Pituitary.
 Thyroid.
 Parathyroid.
 Adrenals.
 Pancreas.
 Kidney.
o Reproductive Testis.
 Penis.
 Vagina.
 Cervix.
 uterus
 Uterine tubes.
 Ovaries.

Step 4: Identify illustrated diagram of each system (40minutes)

 Demonstration of coloured atlases of different systems using the resources available.

Step no 5. Basic functions of each system (40 minutes)

 Activity: Brainstorming (5 minutes)
 Ask students the following questions.
 What is the basic functions of:-
 Respiratory system
 Digestive system
 Skeletal system etc.
 Record the responses and write them on a flip chart.
 Conclude: by explaining the functions of each systems as follows:-

The table below shows the systems and their respective functions:-
The name of system Functions
Respiratory To take in air containing oxygen for aerobic
cell metabolism
To expel air containing carbon dioxide
Digestive To ingest and digest food so that nutrients
can be absorbed
Skeletal To provide framework for the body support
Body movement
Circulatory Transportation of oxygen, nutrients,
hormones and enzymes
Transportation of the end product of
metabolism for removal
Urinary Removal of waste products
Water and electrolytes balance
Reabsorption of nutrients
Nervous Co ordination activities of the body in
harmony with the environment
Endocrine Regulation the body’s activities with the aid
of hormones

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 Reproductive To produce new offspring’s

Step 5: Key points (5minutes)

 The body is made up of different systems.
 Each system is composed of different organs.
 Each system has got its basic functions:

Step 6: Evaluation. (5minutes)

 Ask the student the questions like:
o List different systems;
o Organizations of any system.
o Functions of any system.

References:
 Monica Cheesebrough - Medical laboratory/Manual for tropical countries
 Ross and Wilson 10th Edition- Anatomy & Physiology in health and illness.
 Anmstray - Foundation of Anatomy and Physiology
 Ross Church Liv - Anatomy and Physiology in Health and illness
 MC Geown – Physiology, church Liv.

Session 9: Upper Respiratory Tract

NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Identify organs and roles of respiratory system
 Explain Structure and Functions of Nose
 Explain structure and function of pharynx
 Explain structure of larynx
 Recognize function of larynx

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Anatomical models and atlas
 OHP and Transparencies or Slide Projector/LCD and Computer
 Handout 17.1: External Nose
 Handout 17.2: Bone Structure of the Nose
 Handout 17.3: Paranasal Sinuses

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 Handout 17.4: The Pharynx
 Handout 17.5: The Larynx
 Handout 17.6: Blood supply and Nervous Innervation of Larynx
 Handout 17.7: Rima Glottidis

SESSION OVERVIEW
Step Time Activity/ Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Organs and Roles of Respiratory System
3 20 minutes Presentation Structure and Functions of Nose
4 25 minutes presentation Structure and Function of Pharynx (Throat)
5 25 minutes presentation The Structure of Larynx (Voice Box)
6 20 minutes presentation Function of Larynx (Voice Box)
7 05 minutes presentation Key points
10 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the Learning Objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Organs and Roles of Respiratory System (10 minutes)

 Activity: Brainstorm (5 minutes)
 ASK students what is the role of respiratory system? Which organs are involved in the
respiratory system
 ALLOW them to respond, and write their responses on the flip chart.
 SUMMARISE their responses using the information below

 The respiratory system is divided into two divisions:

 Upper respiratory tract; The organs are located outside of the thorax and consists of the
nose, pharynx and larynx
 Lower respiratory tract; The organs are located within the thorax and consists of the
trachea, the bronchial tree and the lungs
 The main role of the respiratory system is to provide gas exchange between the blood and
the environment.
 Primarily, oxygen is absorbed from the atmosphere into the body and carbon dioxide is
expelled from the body.
 The following organs form the respiratory system:
o Nose
o Pharynx
o Larynx
o Trachea
o Bronchi
o Lungs

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Step 3: Structure and Functions of Nose (20 minutes)
 The nose
o The nose is the part of the respiratory tract superior to the hard palate and contains the
peripheral organ of smell.
o The external portion of the nose consists of a bony and cartilaginous frame covered by
skin containing sebaceous glands
o The two nasal bones meet and are surrounded by the frontal bone to form the root of
the nose and is surrounded by the maxillary bone laterally and inferiorly
o The nasal cavity lies over the roof of the mouth, separated by the palatine bone.
o Cribriform plate is a portion of the ethmoid bone that separates the roof of the nose
from the cranial cavity.
o The cribriform is perforated by many openings that permit branches of the olfactory
nerve responsible for the special sense of smell to enter the cranial cavity and reach
the brain.
o Septum separates the nasal cavity into a right and left cavity.
o Each nasal cavity is divided into three passageways:
o Superior meatus
o Middle meatus
o Inferior meatus
o The nose is lined with ciliated columnar epithelium which contains mucus secreting
goblet cells.
o The inferior two thirds of the nasal mucosa is the respiratory area, and the superior
one third is the olfactory area.
o Air passing over the respiratory area is warmed and moistened before it passes
through the rest of the upper respiratory tract to the lungs.
o The olfactory area is specialized mucosa containing the peripheral organ of smell;
sniffing draws air to the area
Refer students to Handout 17.1: External nose and Handout 17.2: Bone structure of
the nose for more information.

 Activity: Brainstorm (5minutes)

 ASK students what are the functions of the nose
 WRITE their responses on the flip chart
 SUMMARISE their responses using the below information

 The function of the nose

o Respiration (breathing). The nose is the first part of the respiratory system through
which the inspired air passes. The nose humidify, warming, filtering and cleaning of
air.
o Reception and elimination of secretions from the nasal mucosa, paranasal sinuses, and
nasolacrimal ducts.
o Olfaction (smelling). The nose is the organ of sense of smell.
o It aids speech- this is enhanced by the presence of paranasal sinuses, which act as
resonating chambers for speech.

 Paranasal sinuses

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 o Paranasal sinuses are air-filled extensions of the respiratory part of the nasal cavity
into the following cranial bones: frontal, ethmoid, sphenoid, and maxilla. They are
named according to the bones in which they are located. Each is lined with respiratory
mucosa a continuation of mucous membrane lining the nasal cavity. They include:
 The frontal sinus
 Maxillary sinuses
 Sphenoid sinus
 Ethmoid sinuses
o Paranasal sinuses reduce the weight of the skull, they also give resonance to the voice
o These sinuses have clinical importance; The mucous secretion drain from the sinuses
into the nasal cavity, if there is infection of the nasal cavity, the swollen mucous
membrane of the nasal cavity may block this drainage increasing pressure within a
sinus and causing headache Also the infection of upper respiratory tract may extend to
the sinuses causing condition called sinusitis
Refer students to Handout 17.3: Paranasal Sinuses for more information.

Step 4: Structure and Function of the Pharynx (Throat) (25 minutes)

 The pharynx is a fibromuscular tubelike structure extending from the base of the skull.
 It lies anterior to the cervical vertebra, roughly corresponds to the levels between C4 to
C6.
 It is the part of the neck and throat situated immediately posterior (behind) to the mouth
and nasal cavity, and superior, to the oesophagus, larynx, and trachea.
 The pharynx is composed of three layers of tissue, namely the inner surface mucous
membrane lining, the intermediate fibrous tissue and the outer smooth muscles.
 The muscles of the pharynx include superior, middle and inferior constrictor muscles
 It is divided into three parts:
 Nasopharynx; lies behind the nasal cavity. It is continuous with lining of the nose and
consists of ciliated columnar epithelium. The intermediate layer is fibrous tissue.
 Oropharynx; lies behind the oral cavity. It is lined with stratified squamous epithelium
which is continuous with lining of the mouth and oesophagus
 Laryngopharynx also known as the hypopharynx, this is also lined with moist stratified
squamous epithelium. Extends from the tip of the epiglottis to the oesophagus.

Refer students to Handout 17.4: the Pharynx for more information.

 Blood supply is from several branches of facial artery. Venous return is into facial and
internal jugular vein
 The nerve supply is from both parasympathetic and sympathetic. The parasympathetic is
from vagus and glossopharyngeal nerves. While the sympathetic is from superior cervical
ganglia

 Seven openings found in the pharynx

o Right and left Eustachian tube opening into the nasopharynx from the middle ear. Air
passes through them to equalize air pressure between the atmosphere and the middle
ear. The clinical importance of Eustachian tube is that any infection to the upper
respiratory tract can complicate to infection of the middle ear (otitis media)

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 o The two posterior nares into the nasopharynx
o Opening from the mouth known as fauces into oropharynx
o The opening into the larynx from laryngopharynx
o The opening into the oesophagus from the laryngopharynx

 Functions
o Passageway for air and food
o Warming and humidifying air
o Protection
o Taste
o Facilitates Hearing
o The pharynx is also important in vocalization and Speech

Step 5: Structure of Larynx (Voice Box) (25 minutes)

 The larynx (plural larynges), known as the voice box, is an organ situated in the neck
involved in respiration and sound production.
 The larynx houses the vocal folds, and is situated just below the pharynx between the root
of the tongue and upper end of the trachea.
 The larynx consists of cartilages attaches to each other by ligaments and membranes. The
framework of the larynx is formed by nine cartilages connected to one another by
muscles, ligaments and membranes. Three cartilages are single (thyroid, cricoid, and
epiglottic) and three are paired (arytenoid, corniculate, and cuneiform). The corniculate
and cuneiform cartilages appear as small nodules in the posterior part of the aryepiglottic
folds
 Epiglottis is a flap of fibro-elastic cartilage tissue covered with a mucous membrane
which is stratified squamous epithelium, attached to the root of the tongue. It projects
obliquely upwards behind the tongue and the hyoid bone. It is often incorrectly used to
refer to the uvula. This protects the airway during swallowing
 The inner surface is lined by a ciliated columnar epithelium membrane.

 Muscles of Larynx
 The laryngeal muscles are divided into extrinsic and intrinsic groups:
 The extrinsic laryngeal muscles move the larynx as a whole, these include.
 The infrahyoid muscles; are depressors of the hyoid and larynx,
 The suprahyoid and stylopharyngeus muscles are elevators of the hyoid and larynx.
 The intrinsic laryngeal muscles move the laryngeal parts, making alterations in the length
and tension of the vocal folds and in the size and shape of the rima glottidis. All but one
of the intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve, a
branch of CN X. The cricothyroid muscle is supplied by the external laryngeal nerve, one
of the two terminal branches of the superior laryngeal nerve. The actions of the intrinsic
laryngeal muscles are described below.
 The intrinsic muscle of the larynx, are important in controlling vocal cord length and
tension in regulating the shape of laryngeal inlet, these include:
 Crico-thyroid muscle lengthens and stretches the vocal cords.
 Posterior cricoarytenoid muscle abducts the vocal cords.
 Lateral cricoarytenoid muscle adducts the vocal cords.
 Thyroarytenoid muscle (also called vocalis muscle) shortens vocal cords.

Teaching Guides for NTA Level 4 MLS Curriculum Page 170

 Transverse arytenoid muscle adducts the vocal folds.
 Blood supply is through superior and inferior laryngeal arteries. Venous drainage is by
thyroid veins which join the internal jugular
 Nerve innervation is through parasympathetic and sympathetic fibres;
 The parasympathetic supply is from superior and recurrent laryngeal nerve which is the
branch of vagus nerve. Sympathetic is from superior cervical ganglia.
 Injury to one of the recurrent laryngeal nerves produces hoarseness, if both are damaged
the voice is completely lost and breathing becomes difficult. Possible injury can occur
during thyroid surgeries.

Refer students to Handout 17.5: The Larynx, Handout 17.6: Blood supply and Nervous
Innervation of Larynx and Handout 17.7: The surface anatomy of larynx for more
information.

Step 6: Function of Larynx (Voice Box) (20 minutes)

 Respiration; It filters, humidifies and warms air as it passes to the lungs
 Swallowing; The epiglottis and vestibular folds prevent swallowed material from moving
into the larynx
 Phonation; the vocal folds are the primary source of sound production.
 It serves as the organ of voice production- the pitch of the voice depends upon the length
and tightness of the cords.
 The vocal folds produce audible vibrations when their free margins are closely (but not
tightly) apposed during phonation and air is forcibly expired intermittently. The vocal
folds also serve as the main inspiratory sphincter of the larynx when they are tightly
closed. Complete adduction of the folds forms an effective sphincter that prevents entry
of air
 Sound has the properties of pitch, volume and resonance.
 Pitch of the voice depends upon the length and tightness of the cord.
 Volume of the voice depends upon the force with which the cords vibrate.
 The greater the force of expired air the more the cords vibrates and the louder the sound
emitted.
 Resonance or tone is dependent upon the shape of the mouth, the position of the tongue
and the lip, facial muscles and the air in the paranasal sinuses.
 Speech - This occurs during expiration when the sound produced by the vocal cords is
manipulated by the tongue, cheeks and the lips.

Refer students to Handout 17.9: Rima Glottidis for more clarification on the shape of
the rima glottidis which varies according to the position of the vocal folds during sound
production.

Step 7: Key Points (5 minutes)

 The nose is lined with ciliated columnar epithelium which contains mucus secreting
goblet cells.
 The pharynx is composed of three layers of tissue, namely the inner surface mucous
membrane lining, the intermediate fibrous tissue and the outer smooth muscles.

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 The larynx houses the vocal folds, and is situated just below the pharynx between the root
of the tongue and upper end of the trachea.
 Injury to one of the recurrent laryngeal nerves produces hoarseness
 The vocal folds are the primary source of sound production

Step 8: Evaluation (15 minutes)

 What are the functions of the nose?
 Mention the function of the pharynx
 Mention seven opening of the pharyns
 Name the intrinsic muscles of the larynx

References
 Drake R .L, Vogl W, Mitchell A W M (2007). Gray’s Anatomy for Students, United
Kingdom: Churchill Livingstone Elservier
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 172

Handout 17.1: External Nose

Source: Lippincott Williams & Wilkins, 2007

Source: Elsevier Ltd 2005.

Handout 17.2: Bone Structure of the Nose

Teaching Guides for NTA Level 4 MLS Curriculum Page 173

Source: Elsevier Ltd 2005.

Source: Lippincott Williams & Wilkins, 2007

Handout 17.3: Paranasal Sinuses

Teaching Guides for NTA Level 4 MLS Curriculum Page 174

Source: Lippincott Williams & Wilkins, 2007

Teaching Guides for NTA Level 4 MLS Curriculum Page 175

Handout 17.4: The Pharynx

Source: Lippincott Williams & Wilkins, 2007

Handout 17.5: The Larynx

Teaching Guides for NTA Level 4 MLS Curriculum Page 176

Source: Elsevier Ltd 2005.

Handout 17.6: Blood supply and Nervous Innervation of Larynx

Source: Lippincott Williams & Wilkins, 2007

Teaching Guides for NTA Level 4 MLS Curriculum Page 177

Source: Elsevier Ltd 2005.

Handout 17.7: Rima Glottidis

Teaching Guides for NTA Level 4 MLS Curriculum Page 178

Session 10: Structure and Function of
Lower Respiratory Tract
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Identify structure of trachea
 Explain bronchial tree structure
 Explain the lung morphology
 Describe blood supply to the lungs
 Describe the nervous innervations of the lungs
 Describe pleura and pleural cavity

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Anatomical models and atlas
 OHP and Transparencies
 Handout 18.1: Trachea and Main Bronchi
 Handout 18.2: Major Bronchial Divisions
 Handout 18.3: The Lung
 Handout 18.4: The Respiratory Membrane
 Handout 18.5: Pulmonary Circulation
 Handout 18.6: Pulmonary Innervations
 Handout 18.7: The Pleura

SESSION OVERVIEW

Step Time Activity/ Method Content

1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes presentation The structure of trachea
3 20 minutes presentation The bronchial tree structure
4 25 minutes Presentation The lung morphology
5 20 minutes Presentation Blood supply of the lungs
6 10 minutes Presentation Nervous innervations of the lungs
7 15 minutes Presentation Pleura and pleural cavity
8 5 minutes Presentation Key points
9 10 minutes Presentation Evaluation

Teaching Guides for NTA Level 4 MLS Curriculum Page 179

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the Learning Objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Structure of Trachea (10 minutes)

 Activity: Brainstorm (5 minutes)
 ASK student what is trachea and where is it located
 WRITE their responses on the flip chart
 SUMMARISE their responses by using the information below

 The trachea is a tube formed of cartilage and fibromuscular membrane, lined internally by
mucosa. The anterolateral portion is made up of incomplete rings of cartilage, and the
posterior aspect by a flat muscular wall.
 It descends from the larynx from the level of the sixth cervical vertebra to the upper
border of the fifth thoracic vertebra, where it divides into right and left principal
(pulmonary) bronchi.
 It lies approximately in the sagittal plane, but its point of bifurcation is usually a little to
the right. The trachea is mobile and can rapidly alter in length: thus, during deep
inspiration, the bifurcation may descend to the level of the sixth thoracic vertebra into
 Behind the cervical trachea is the oesophagus, which runs between the trachea and the
vertebral column. The recurrent laryngeal nerves ascend on each side, in or near the
grooves between the sides of the trachea and oesophagus.
 The lateral relations of the trachea are the paired lobes of the thyroid gland, which
descend to the fifth or sixth tracheal cartilage
 In the mediastinum, at the level of the fifth thoracic vertebra, the trachea divides into the
right and left primary bronchi
 The right main bronchus is wider, shorter, and runs more vertically than the left main
bronchus as it passes directly to the hilum of the lung.

Refer students to Handout 18.1: Trachea and Main Bronchi for more elaborations.

Step 3: Bronchial Tree Structure (20 minutes)

 A bronchus (plural bronchi, adjective bronchial). It conducts air into the lungs. It is made
up of hyaline cartilage
 No gas exchange takes place in this part of the lungs.
 It is lined by the mucous membrane which undergoes a transition from ciliated
pseudostratified columnar epithelium to simple cuboidal epithelium to simple squamous
epithelium
 The left main bronchus subdivides into two lobar bronchi while the right main bronchus
divides into three.
 The left main bronchus passes inferolaterally, inferior to the arch of the aorta and
anterior to the esophagus and thoracic aorta, to reach the hilum of the lung

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 The right principal bronchus is wider, shorter and more vertical than the left, being 2.5 cm
long: this explains why inhaled foreign bodies enter it more often than the left.
 The right main bronchus gives rise to its first branch, the superior lobar bronchus, then
enters the right lung opposite the fifth thoracic vertebra.
 After giving off the superior lobar bronchus, which arises posterosuperior to the right
pulmonary artery, the right main bronchus crosses the posterior aspect of the artery,
enters the pulmonary hilum posteroinferior to it, and divides into a middle and an inferior
lobar bronchus.
 The lobar bronchi divide into tertiary bronchi.
 Each of the segmental bronchi supplies a bronchopulmonary segment.
 A bronchopulmonary segment is the area of lung supplied by a segmental bronchus and
its accompanying pulmonary artery branch.
 A bronchopulmonary segment is the smallest, functionally independent region of a lung
and the smallest area of lung that can be isolated and removed without affecting adjacent
regions.
 Tributaries of the pulmonary vein tend to pass intersegmentally between and around the
margins of segments.
 Each bronchopulmonary segment is shaped like an irregular cone with the apex at the
origin of the segmental bronchus and the base projected peripherally onto the surface of
the lung.
 There are ten segments per lung, but due to anatomic development, several segmental
bronchi in the left lung fuse, giving rise to eight.
 The segmental bronchi divide into many primary bronchioles which divide into terminal
bronchioles, each of which then gives rise to several respiratory bronchioles, which go on
to divide into 2 to 11 alveolar ducts.
 There are no glands or cartilage in any of the bronchioles, and the epithelial cells become
more cuboidal in shape.
 There are 5 or 6 alveolar sacs associated with each alveolar duct.
 The alveolus is the basic anatomical unit of gas exchange in the lung.

Refer students to Handout 18.2: Major Bronchial Divisions for more information.

Step 4: Lungs Morphology (25 minutes)

 The lungs are the vital organs of respiration. Their main function is to oxygenate the
blood by bringing inspired air into close relation with the venous blood in the pulmonary
capillaries. The healthy lungs in living people are normally light, soft, and spongy. They
are also elastic and recoil to about one third their size when the thoracic cavity is opened
 They are situated on either side of the heart and other mediastinal contents in the thoracic
cavity.
 At birth the lungs are pink, but in adults they are dark grey and patchily mottled. As age
advances this maculation becomes black, as granules of inhaled carbonaceous material
are deposited in the loose connective tissue near the lung surface.
 The adult right lung usually weighs 625 g, and the left 565 g, but they vary greatly. Their
weight also depends on the amount of blood or serous fluid contained within them. In
proportion to body stature, the lungs are heavier in men than in women.

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 Each lung has an apex, base, three borders and two surfaces. In shape each lung
approximates to half a cone.
 The right lung is divided into superior, middle and inferior lobes by an oblique and a
horizontal fissure.
 The left lung is divided into a superior and an inferior lobe by an oblique fissure which
extends from the costal to the medial surfaces of the lung both above and below the
hilum.
 The lobes are further divided into functional units; the bronchopulmonary segments
 The diaphragm rises higher on the right to accommodate the liver, and so the right lung is
vertically shorter (by 2.5 cm) than the left. However, cardiac asymmetry means that the
right lung is broader, and has a greater capacity and weight than the left
 The bronchopulmonary segments are subdivided into lobules by incomplete connective
tissue walls. The lobules are supplied by bronchioles. The terminal bronchiole divides to
form respiratory bronchioles which give rise to alveolar ducts, which are like long
branching hallways with many open doorways. The doorways open into alveoli, which
becomes so numerous that the alveolar duct wall is little more than a succession of
alveoli. The alveolar ducts end as two or three alveolar sacs, which are chambers
connected to two or more alveoli.
 Approximately 300 million alveoli are in the two lungs. The average diameter of alveoli
is approximately 250µm and their walls are extremely thin.
 Two types of cells form the alveolar wall
 Type I pneumocytes; are thin squamous epithelial cells that form 90% of the alveolar
surface. Most gas exchange between alveolar air and the blood takes place through these
cells
 Type II pneumocytes; are round or cube-shaped secretory cells that produce surfactant,
which makes easier for the alveoli to expand during inspiration.
 Since lungs are the principal organs of respiration, it has the respiratory membrane where
gas exchange between the air and the lungs takes place. The respiratory membrane of the
lung is very thin and it consists of :
 A thin layer of fluid lining the alveolus
 The alveolar epithelium composed of simple squamous epithelium
 The basement membrane of the alveolar epithelium
 A thin interstitial space
 The basement membrane of the capillary endothelium
 The capillary endothelium composed of simple squamous epithelium

Refer students to Handout 18.3: The Lung and Handout 18.4: The respiratory
membrane for more information.

Step 5: Blood Supply to the Lungs (20 minutes)

 Activity: Brainstorming (5 minutes)
 ASK students to explain the pulmonary circulation
 ALLOW few students to respond
 SUMMARISE their responses using the information below

Teaching Guides for NTA Level 4 MLS Curriculum Page 182

 Each lung has a large pulmonary artery supplying blood to it and two pulmonary veins
draining blood from it. The right and left pulmonary arteries arise from the pulmonary
trunk at the level of the sternal angle.
 The pulmonary arteries carry poorly oxygenated (venous) blood to the lungs for
oxygenation. The pulmonary arteries pass to the corresponding root of the lung and give
off a branch to the superior lobe before entering the hilum. Within the lung, each artery
descends posterolateral to the main bronchus and divides into lobar and segmental
arteries.
 Consequently, an arterial branch goes to each lobe and bronchopulmonary segment of the
lung, usually on the anterior aspect of the corresponding bronchus. The pulmonary veins,
two on each side, carry well-oxygenated (arteria) blood from the lungs to the left atrium
of the heart.
 Beginning in the pulmonary capillaries, the veins unite into larger and larger vessels.
Intrasegmental veins drain blood from adjacent bronchopulmonary segments into the
intersegmental veins in the septa, which separate the segments. A main vein drains each
bronchopulmonary segment, usually on the anterior surface of the corresponding
bronchus.
 The bronchial arteries supply blood to the structures making up the root of the lungs, the
supporting tissues of the lung, and the visceral pleura. The left bronchial arteries arise
from the thoracic aorta; however, the right bronchial artery may arise from:
 A superior posterior intercostal artery.
 A common trunk from the thoracic aorta with the right 3rd posterior intercostal artery.
 A left superior bronchial artery.
 The small bronchial arteries provide branches to the superior esophagus and then pass
along the posterior aspects of the main bronchi, supplying them and their branches as far
distally as the respiratory bronchioles. The distal most branches of the bronchial arteries
anastomose with branches of the pulmonary arteries in the walls of the bronchioles and in
the visceral pleura.
 The bronchial veins drain only part of the blood supplied to the lungs by the bronchial
arteries primarily that distributed to or near the more proximal part of the root of the
lungs. The remainder of the blood is drained by the pulmonary veins. The right bronchial
vein drains into the azygos vein, and the left bronchial vein drains into the accessory
hemiazygos vein or the left superior intercostal vein.

Refer students to Handout 18.5: Pulmonary circulation for more information

Step 6: Nervous Innervations of the Lungs (10 minutes)

 The nerves of the lungs and visceral pleura derive from the pulmonary plexuses located
anterior and (mainly) posterior to the roots of the lungs.
 These nerve networks contain parasympathetic fibers from the vagus nerves (CN X) and
sympathetic fibers from the sympathetic trunks. Parasympathetic ganglion cells, cell
bodies of postsynaptic parasympathetic neurons are in the pulmonary plexuses and along
the branches of the bronchial tree.
 The parasympathetic fibers from CN X are motor to the smooth muscle of the bronchial
tree (bronchoconstrictor), inhibitory to the pulmonary vessels (vasodilator), and secretory
to the glands of the bronchial tree (secretomotor). The visceral afferent fibers of CN X are
distributed to the:

Teaching Guides for NTA Level 4 MLS Curriculum Page 183

 Bronchial mucosa and are probably concerned with tactile sensation for cough reflexes.
 Bronchial muscles, possibly involved in stretch reception.
 Interalveolar connective tissue, in association with Herring-Breuer reflexes (mechanism
that tends to limit respiratory excursions).
 Pulmonary arteries serving pressor receptors (blood pressure) and pulmonary veins
serving chemoreceptors (blood gas levels).
 Sympathetic ganglion cell bodies of postsynaptic sympathetic neurons are in the
paravertebral sympathetic ganglia of the sympathetic trunks. The sympathetic fibers are
inhibitory to the bronchial muscle (bronchodilator), motor to the pulmonary vessels
(vasoconstrictor), and inhibitory to the alveolar glands of the bronchial tree.
 This has clinical importance in bronchial asthma management.

Refer students to Handout 18.6: Pulmonary innervations for more elaborations

Step 7: Pleura and Pleural Cavity (15 minutes)

 Each lung is invested by and enclosed in a serous pleural sac that consists of two
continuous membranes the pleurae
 The visceral pleura (pulmonary pleura) covers the lungs and is adherent to all its surfaces,
including the surfaces within the horizontal and oblique fissures; it cannot be dissected
from the lungs.
 The parietal pleura line the pulmonary cavities, adhering to the thoracic wall, the
mediastinum, and the diaphragm.
 The pleural cavity the potential space between the visceral and the parietal layers of
pleura contains a capillary layer of serous pleural fluid, which lubricates the pleural
surfaces and allows the layers of pleura to slide smoothly over each other during
respiration. Its surface tension also provides the cohesion that keeps the lung surface in
contact with the thoracic wall; consequently, the lung expands and fills with air when the
thorax expands while still allowing sliding to occur, much like a layer of water between
two glass plates.
 The parietal pleura consists of four parts
 Costal part (pleura) covers the internal surfaces of the thoracic wall (sternum, ribs, costal
cartilages, intercostal muscles and membranes, and side of thoracic vertebrae) and is
separated from the wall by endothoracic fascia.
 Mediastinal part (pleura) covers the lateral aspects of the mediastinum (the central
compartment of the thoracic cavity).
 Diaphragmatic part (pleura) covers the superior or thoracic surface of the diaphragm on
each side of the mediastinum.
 The parietal pleura is highly sensitive to pain; the visceral pleura is not due to its lack of
sensory innervation.

 Pleural fluid
o Pleural fluid is a serous fluid produced by the pleurae. In normal pleurae, most fluid
is produced by the parietal circulation (intercostal arteries) via bulk flow and
reabsorbed by the lymphatic system. Thus, pleural fluid is continuously produced
and reabsorbed.

Teaching Guides for NTA Level 4 MLS Curriculum Page 184

 o There is no anatomical connection between the left and right pleural cavities, so in
cases of pneumothorax, the other hemithorax will still function normally.
o The pleurae are coated with lubricating pleural fluid which allows the pleurae to slide
effortlessly against each other during ventilation.
o Surface tension of the pleural fluid also leads to close apposition of the lung surfaces
with the chest wall. This physical relationship allows for optimal inflation of the
alveoli during respiration.

Refer students to Handout 18.7: The Pleura for more information.

Step 8: Key Points (5 minutes)

 The trachea is a tube formed of cartilage and fibromuscular membrane, lined internally by
mucosa
 The left main bronchus subdivides into two lobar bronchi while the right main bronchus
divides into three.
 The lungs are the vital organs of respiration
 Two types of cells form the alveolar wall

Step 9: Evaluation (10 minutes)

 Describe the division of bronchial tree
 Describe the pulmonary circulation

References
 Drake R .L, Vogl W, Mitchell A W M (2007). Gray’s Anatomy for Students, United
Kingdom: Churchill Livingstone Elservier
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 185

Handout 18.1: Trachea and Main Bronchi

Source: Elsevier Ltd 2007.

Teaching Guides for NTA Level 4 MLS Curriculum Page 186

Handout 18.2: Major Bronchial Divisions

Figure 1:

Source: Elsevier Ltd 2007.

Teaching Guides for NTA Level 4 MLS Curriculum Page 187

Figure 2:

Source: Elsevier Ltd 2005.

Handout 18.3: The Lung

Source: Lippincott Williams & Wilkins, 2007

Teaching Guides for NTA Level 4 MLS Curriculum Page 188

Handout 18.4: The Respiratory Membrane

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 189

Handout 18.5: Pulmonary Circulation

Source: Lippincott Williams & Wilkins, 2007

Source: Lippincott Williams & Wilkins, 2007

Handout 18.6: Pulmonary Innervations

Figure 1

Source: Elsevier Ltd 2007

Teaching Guides for NTA Level 4 MLS Curriculum Page 190

Figure 2

Source: Lippincott Williams & Wilkins, 2007

Handout 18.7: The Pleura

Source: Lippincott Williams & Wilkins, 2007

Teaching Guides for NTA Level 4 MLS Curriculum Page 191

Session 11: Pulmonary Ventilation
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Explain respiratory process
 Explain mechanism of Breathing
 Explain control of breathing
 Recognize pulmonary volumes and capacities

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Anatomical models and atlas
 OHP and Transparencies or Slide Projector/LCD and Computer
 Handout 19.1: Inspiratory Process
 Handout 19.2: Expiratory Process
 Handout 19.3: Thoracic Volume During Breathing Process
 Handout 19.4: A Spirometer
 Handout 19.5: Lung Volumes and Some Measurements

SESSION OVERVIEW
Step Time Activity/ Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 20 minutes Presentation Respiratory Process
3 20 minutes Presentation Mechanism of Breathing
4 20 minutes Demonstration, Control of Breathing
presentation
5 40 minutes Presentation Pulmonary Volumes And Capacities
6 5 minutes presentation Key points
7 10 minutes Presentation Evaluation

SESSION CONTENT
Step: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify
 ASK students if they have any questions before continuing:

Step 2: Respiratory Process (20 minutes)

 Activity: Brainstorm (5minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 192

 ASK students to define what does the term respiration means
 ALLOW them to respond and WRITE their responses on the flip chart
 SUMMARISE their responses using the information below

 The term respiration means the exchange of gases between body cells and the
environment. This involve two main processes
 Breathing (pulmonary ventilation): Ventilation is the process of moving air into the lungs
(inspiration) and out of the lungs (expiration). The flow of air in and out of the lungs
require pressure gradient in the opposite direction.
 Exchange of gases in the lungs; external respiration and in the tissues; internal respiration
 Breathing (ventilaton)
 Breathing supply oxygen to the alveoli and eliminate carbon-dioxide
 Expansion of the chest during inspiration occurs as a result of muscular activity, partly
involuntary and partly voluntary.
 The main muscles used in normal breathing are the intercostals muscles and the
diaphragm.
 Intercostal muscles. There are eleven pairs of intercostals muscles that occupy the spaces
between the 12 pairs of ribs.
 They are arranged in two layers, the external and internal intercostal muscles.
 Thoracic diaphragm
 The Diaphragm is a dome-shaped musculo-fibrous septum which separates the thoracic
cavity from the abdominal cavity, its convex upper surface forming the floor of the
former, and its concave under surface the roof of the latter.
 The diaphragm is pierced by a series of apertures to permit of the passage of structures
between the thorax and abdomen.
 There are three large openings (diaphragmatic hiatus); the aortic, the esophageal, and the
vena cava openings and a series of smaller ones. The clinical importance of oesophageal
opening is that; weakness can occur and this can cause the development of hiatus hernia.
 The diaphragm is crucial for breathing and respiration. The diaphragm is innervated by
the phrenic nerve.
 During difficult or deep breathing, muscles of the neck, shoulders and abdomen assist in
respiration. These muscles are: sternocleidomastoid and scaleneus muscles- anterior,
middle and posterior.

Step 3: Mechanism of breathing (20 minutes)

 The average respiratory rate is 12 to 15 breaths per minute. Each breath consists of three
phases:
o Inspiration
o Expiration
o Pause
o Inspiration
 During inspiration, the diaphragm contracts and moves downwards while the external
intercostals muscles contracts raising the ribs and elevate the sternum, increasing the size
of the thoracic cavity even more.
 This causes expansion of the lungs, as a result, the intra-alveolar pressure falls and the
atmospheric pressure forces more air into the airways.

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 The process of inspiration is active, as it needs energy for muscle contraction.
 This process is enhanced by the following:
o Compliance; ability of pulmonary tissue to stretch, making inspiration possible
o The pressure between parietal and visceral pleura is always less than atmospheric
pressure
o Elastic coil – tendency of pulmonary tissue to return to a smaller size after having
been stretched, passively during expiration
Refer students to Handout 19.1: Inspiratory Process for more information

 Expiration
o During expiration, the Diaphragm and intercostals muscles relax, causing the lungs to
recoil, and return to the original shape.
o This increases the intra-alveolar pressure above the atmospheric pressure, so the air
inside the lungs is forced out through the respiratory passages.
o Because normal resting expiration occurs without the contraction of muscles, it is
considered a passive process.
o At rest, expiration lasts about 3 seconds and after expiration there is a pause before
the next cycle begins.
o Expiration – a passive process that begins when the inspiratory muscles are relaxed,
decreasing the size of the thorax and increasing intra-pleural pressure

Refer students to Handout 19.2: Handout 19.2: Expiratory Process and Handout 19.3:
Thoracic Volume during Breathing Process for more information

Step 4: Control of breathing (20 minutes)

Activity: Demonstration (15 minutes)

 DIVIDE students into groups of 5-8, one male student, to put off his shirt, the rest should
observe the movement of the chest during normal breathing, and during laboured
breathing.
 ASK students to count the respiration rate, during normal breathing and after exercise
 Then, each group will report findings during the class discussion
 SUMMARISE their findings using below information

 Normal breathing is a rhythmic, involuntary act that continues when a person is

unconscious.
 Groups of neurons in the brainstem form the respiratory centre which controls breathing.
 This centre periodically initiates impulses that travel on cranial and spinal nerves to the
breathing muscles causing inspiration and expiration.
 Voluntary control of breathing is exerted during activities such as speaking and singing
but it is overridden if blood carbon dioxide rises.
 Breathing may be modified by the higher centres in the brain by:
o speech, singing
o emotional displays, e.g. crying, laughing, fear
o drugs, e.g. sedatives, alcohol
o Sleep

Teaching Guides for NTA Level 4 MLS Curriculum Page 194

 Temperature influences breathing. In fever, respiration is increased due to
increased metabolic rate, while in hypothermia it is depressed, as is metabolism.
Temporary changes in respiration occur in swallowing, sneezing and coughing.

Factors affecting Breathing

Activity: Brainstorm (5 minutes)
 ASK student what are the factors that influence breathing pattern
 ALLOW them to respond and write their responses on the flip chart
 SUMMARISE their responses using the information below

 The partial pressure of a gas is determined by the concentration of that gas in a mixture of
gases or the concentration of gas dissolved in a liquid
 Chemicals, lung tissue stretching and emotional state affect breathing
 Chemosensitive areas are associated with the respiratory centre. Stimulation of these
areas increases alveolar ventilation
 Peripheral chemoreceptors in the carotid bodies and aortic bodies of certain arteries sense
low oxygen concentration , when oxygen is low, alveolar ventilation increases
 Stretching of the lung tissue trigger an inflation reflex. This reflex reduces the duration of
inspiratory movement, so prevent overinflation of the lung during forceful breathing
 Emotional upset or strong sensory stimulation may alter the normal breathing pattern.
 Gasping, and rapid breathing are familiar responses to fear, anger, shock, excitement,
horror, surprise, sexual stimulation or even the chill of stepping into a cold water
 Hyperventilation decrease carbon dioxide concentration, but this is very dangerous when
it associated with breath holding during underwater swimming
 Sometime a person who is emotionally upset may hyperventilate, become dizzy, and lose
consciousness. This is due to a lowered carbon dioxide concentration followed by a rise
in pH (respiratory alkalosis) and a localised vasoconstriction of cerebral arterioles,
decreasing blood flow to nearby brain cells. Hampered oxygen supply to the brain causes
fainting.
 A person should never hyperventilate to help hold the breath while swimming, because
the person may lose consciousness under water and drown

Step 5: Pulmonary Volumes and Capacities (40 minutes)

 Spirometry is the process of measuring volumes of air that move into and out of the
respiratory system. Spirometer is a device used to measure these pulmonary volumes.

Refer students to Handout 19.4: A Spirometer for elaboration.

 Pulmonary volumes are the amount of air moved in and out and the remaining. These are
important for normal exchange of oxygen and carbon dioxide to take place.
 There are four volumes that can be measured by spirometer, these are:
 Tidal volume (TV) - amount of air exhaled or inhaled after normal inspiration or
expiration is approximately 500mls
 Expiratory reserve volume (ERV) – Maximum volume of air that can be forcibly exhaled
after a normal expiration (normal tidal volume) is approximately between 1.0 and 1.2
litres.

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 Inspiratory reverse volume (IRV) – Maximum amount of air that can be forcibly inhaled
after normal inspiration (normal IRV is 3 - 3.3 litres)
 Residual volume amount of air that cannot be forcibly exhaled (1.2 litres) i.e. the amount
of air that remain in the lungs after the most forceful expiration

Refer students to Handout 19.5: Lung volumes and some measurements for
elaboration.

 Pulmonary capacities are the sum of two or more pulmonary volumes. The following are
pulmonary capacities:
 Vital capacity Vital capacity is the maximum volume of air that a person can exhale after
maximum inhalation. It can also be the maximum volume of air that a person can inhale
after maximum exhalation. Therefore; it equals the inspiratory reserve volume plus the
tidal volume plus the expiratory reserve volume; it is about 4600 millilitres. (IRV + TV +
ERV it is 4.6 litres)
 A person’s vital capacity depends on many factors, including the size of the thoracic
cavity and posture so with other physiological measurements, the vital capacity can help
make a diagnosis of underlying lung disease
 Functional residual capacity – the amount of air remaining in the lungs at the end of a
normal expiration, therefore it the sum of ERV + RV = 2.2 -2.4 litres
 Total lung capacity – the sum of all four lung volumes – the total amount of air a lung can
hold i.e. = TV+ IVR + EVR + RV = 5.7 – 6.2 litres
 Inspiratory capacity is the Tidal volume plus the inspiratory reserve volume, which is the
amount of air that a person can Anatomical dead space – air in passageway that do not
participate in gas exchange
 Dead space. Since gaseous exchange in the respiratory system occurs only in the terminal
portions of the airways, the gas that occupies the rest of the respiratory system is not
available for gas exchange with pulmonary capillary blood. This gas is known to be in
dead space. Dead space can be:
 Anatomical dead space – Anatomical dead space is the gas in the conducting areas of the
respiratory system, such as the mouth, trachea and bronchi where the air doesn't come to
the alveoli of the lungs, that do not participate in gas exchange
 Physiological dead space. The physiological dead space is equal to the anatomical dead
space plus the alveolar dead space.
 Alveolar dead space is the area in the alveoli that does get air to be exchanged, but there
is no enough blood flowing through the capillaries for exchange to be effective. It is
normally very small (less than 5 mL) in healthy individuals. It can increase dramatically
in some lung diseases.

 Physiologic dead space can be measured by Bohr's method.

o An equation and example are provided below:

VD = dead space

Teaching Guides for NTA Level 4 MLS Curriculum Page 196

 VT = tidal volume
PaCO2 = partial pressure of carbon dioxide in arteries
PECO2 = partial pressure of carbon dioxide in exhaled air
 In physiology, dead space is air that is inhaled by the body in breathing, but does not
partake in gas exchange. In adults, it is usually in the range of 150 mL.

Step 6 Key Points (5 minutes)

 The main muscles of respiration are the intercostals muscles and the diaphragm.
 There are two types of respiration, the external and internal respiration
 Pulmonary capacities are the sum of two or more pulmonary volumes
 Pulmonary volumes are the amount of air moved in and out and the remaining
 Dead space is the space that does not participate in gas exchange.

Step 7: Evaluation (10 minutes)

 Define the following lung volumes
 Tidal volume
 Expiratory reserve volume
 Inspiratory reverse volume
 Residual volume
 Mention factors affecting breathing

NB: Optional activity

 If the training centre has skill lab with spirometer or the teaching hospital has
physiotherapy department where there is a functioning spirometer. Arrange with the
students to practice how to measure the lung volumes.

References
 Drake R .L, Vogl W, Mitchell A W M (2007). Gray’s Anatomy for Students, United
Kingdom: Churchill Livingstone Elservier
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 197

Handout 19.1: Inspiratory Process

Contraction of Relaxation of Contraction of

diaphragm expiratory chest elevating
muscles muscles

Increase in vertical Increase in anteroposterior and

diameter of thorax transverse diameter of thorax

Decrease in intra-thoracic Cohesion of viscera

pressure and parietal pleurae

Expansion of lungs

Decrease in alveolar pressure

Establishment of pressure
gradient

Inspiration

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Handout 19.2: Expiratory Process

Relaxation of inspiratory Contraction of expiratory

muscles muscles

Decrease in size of Elastic recoil of the

thorax lung tissue

Increase in intra-thoracic
pressure

Decrease in size of lungs

Increase in alveolar pressure

Establish Pressure gradient

from alveolar to atmosphere

Expiration

Handout 19.3: Thoracic Volume during Breathing Process

 The figure below shows that during expiration, relaxation of the intercostal muscles and
the diaphragm results in downward and inward movement of the rib cage and elastic
recoil of the lungs. As this occurs, pressure inside the lungs exceeds that in atmosphere
and so air is expelled from the respiratory tract. The lungs still contain some air, and are
prevented from complete collapse by the intact pleura. This process is passive as it does
not require the expenditure of energy. At rest, expiration lasts about 3 seconds and after
expiration there is a pause before the next cycle begins

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Source: Lippincott Williams & Wilkins, 2007

Handout 19.4: A Spirometer

Source: Mosby, Inc. 1999

 A device used to measure the volumes of gas that the lungs inhale and exhale. Diagram A
shows a classic spirometer design, showing how the volumes of air exhaled and inhaled is
recorded as a rising and falling line. Diagram B, a simple spirometer attached to a
computerized recording device. This apparatus is used frequently for routine assessment
of ventilation.

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Handout 19.5: Lung Volumes and Some Measurements

McGraw-Hill companies, Inc 2006

Teaching Guides for NTA Level 4 MLS Curriculum Page 201

Session 12: External and Internal
Respiration
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Explain external respiration
 Explain internal respiration
 Describe transportation of oxygen in blood stream
 Describe transportation of carbon dioxide in blood stream

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 20.1: Gas exchange in the Alveoli
 Handout 20.2: Oxygen-Haemoglobin Dissociation Curve

SESSION OVERVIEW
Step Time Activity/ Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 20 minutes Presentation External respiration
3 20 minutes Presentation Internal respiration
4 30 minutes Presentation Transportation of oxygen in blood stream
5 25 minutes Presentation Transportation of carbon dioxide in blood
stream
6 5 minutes Presentation Key Points
7 15 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the Learning Objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: External Respiration (20 minutes)

 Activity: Buzz (5 minutes)
 ASK students to what is external respiration

Teaching Guides for NTA Level 4 MLS Curriculum Page 202

 ALLOW them to buzz in pair
 WRITE their responses on the flip chart
 SUMMARISE their responses using the information below

 This is exchange of gases by diffusion between the alveoli and the blood in the
alveolar capillaries, across the respiratory membrane.
 Each alveolar wall is one cell thick and is surrounded by a network of tiny
capillaries (the walls of which are also only one cell thick).
 Venous blood arriving at the lungs has travelled from all the tissues of the body,
and contains high levels of CO2 and low levels of O2 Carbon dioxide diffuses from
venous blood down its concentration gradient into the alveoli until equilibrium
with alveolar air is reached. By the same process, oxygen diffuses from the alveoli
into the blood.
 The PO2 within alveoli averages approximately 104mmHg, and as blood flows
into the pulmonary capillaries, it has a PO2 of approximately 40mmHg.
Consequently, oxygen diffuses from the alveoli into the pulmonary capillary blood
because the PO2 is greater in the alveoli than in the capillary blood.
 The slow flow of blood through the capillaries increases the time available for gas
exchange to occur. When blood leaves the alveolar capillaries, the oxygen and
carbon dioxide concentrations are in equilibrium with those of alveolar air

Refer students to Handout 20.1: Gas exchange in the Alveoli for illustration

Step 3: Internal Respiration (20 minutes)

 Activity: Brainstorming (5 minutes)
 ASK students what is internal respiration
 ASK few students to respond to the question
 WRITE their responses on the flip chart
 SUMMARISE their responses using the information below

 This is exchange of gases by diffusion between blood in the capillaries and the
body cells.
 Gaseous exchange does not occur across the walls of the arteries carrying blood
from the heart to the tissues, because their walls are too thick. P02 of blood arriving
at the capillary bed is therefore the same as blood leaving the lungs. Blood arriving
at the tissues has been cleansed of its CO2 and saturated with O2 during its passage
through the lungs, and therefore has a higher P02 and a lower PC02 than the tissues.
 Carbon dioxide is continually produced as a by-product of cellular respiration, and
a diffusion gradient is established from tissue cells to the blood within the tissue
capillaries. The intracellular Pco2 is approximately 46mmHg, and the interstitial
fluid Pco2 is approximately 45 mmHg. At the arterial end of the tissue capillaries,
the Pco2 is a close to 40 mmHg. As blood flows through the tissue capillaries,
carbon dioxide diffuses from a higher Pco2 to a lower Pco2 until equilibrium in
Pco2 is established.
 At the venous end of the capillaries, blood has a Pco2 of 45 mmHg

Teaching Guides for NTA Level 4 MLS Curriculum Page 203

 This creates concentration gradients between capillary blood and the tissues, and
gaseous exchange therefore occurs O2 diffuses from the bloodstream through the
capillary wall into the tissues. CO2 diffuses from the cells into the extracellular
fluid, then into the bloodstream towards the venous end of the capillary.

Step 4: Transport of Oxygen in Blood Stream (30 minutes)

 Transport of blood oxygen and carbon dioxide is essential for internal respiration
to occur
 Oxygen is carried in the blood in:
 Chemical combination with haemoglobin as oxyhaemoglobin (98.5%)
 Solution in plasma water (1.5%).
 The amount of O2 in the blood is determined by the amount of dissolved O2, the amount
of hemoglobin in the blood, and the affinity of the hemoglobin for O2.
 In normal adults, most of the hemoglobin molecules contain two and two chains
Heme
 Each of the four iron atoms can bind reversibly one O2 molecule. The iron stays in the
ferrous state, so that the reaction is an oxygenation, not an oxidation
 The reaction is rapid, requiring less than 0.01 s. The deoxygenation (reduction) of Hb4O8
is also very rapid
 Combination of the first heme in the Hb molecule with O2 increases the affinity of the
second heme for O2, and oxygenation of the second increases the affinity of the third, etc,
so that the affinity of Hb for the fourth O2 molecule is many times that for the first.
 When blood is equilibrated with 100% O2 (PO2 = 760 mm Hg), the normal hemoglobin
becomes 100% saturated. When fully saturated, each gram of normal hemoglobin
contains 1.39 mL of O2. However, blood normally contains small amounts of inactive
hemoglobin derivative.
 Oxy-haemoglobin is an unstable compound that under certain conditions readily
dissociates releasing oxygen. Factors affecting the affinity of hemoglobin for oxygen
are pH and temperature and the concentration of 2,3-biphosphoglycerate.
 A rise in temperature or a fall in pH shifts the curve to the right. When the curve is shifted
in this direction, a higher PO2 is required for hemoglobin to bind a given amount of O2.
Conversely, a fall in temperature or a rise in pH shifts the curve to the left, and a lower
PO2 is required to bind a given amount of O2.
 The decrease in O2 affinity of hemoglobin when the pH of blood falls is called the Bohr
effect and is closely related to the fact that deoxygenated hemoglobin (deoxyhemoglobin)
binds H+ more actively than does oxyhemoglobin. The pH of blood falls as its CO2
content increases, so that when the PCO2 rises, the curve shifts to the right.
 In active tissues there is increased production of carbon dioxide and heat, which
leads to increased release of oxygen. In this way oxygen is available to tissues in
greatest need.
 When oxygen leaves the erythrocyte, the deoxygenated haemoglobin turns purplish
in colour.
 The affinity of fetal hemoglobin (hemoglobin F) for O2, which is greater than that for
adult hemoglobin (hemoglobin A), facilitates the movement of O2 from the mother to the
fetus

Teaching Guides for NTA Level 4 MLS Curriculum Page 204

 Refer students to Handout 20.2: Oxygen-Haemoglobin Dissociation Curve for
illustration of curve

Step 5: Transport of Carbon Dioxide in Blood Stream (25 minutes)

 Carbon dioxide is one of the waste products of metabolism. It is excreted by the lungs and
transported in three mechanisms.
 As bicarbonate ions (HC03-) in the plasma (70%)
 Some is carried in erythrocytes, loosely combined with haemoglobin as
carbaminohaemoglobin (23 %).
 Some is dissolved in the plasma (7%).
 The solubility of CO2 in blood is about 20 times that of O2; therefore considerably more
CO2 than O2 is present in simple solution at equal partial pressures. The CO2 that diffuses
into red blood cells is rapidly hydrated to H2CO3 because of the presence of carbonic
anhydrase.

 The H2CO3 dissociates to H+ and HCO3–, and the H+ is buffered, primarily by

hemoglobin, while the HCO3– enters the plasma. Some of the CO2 in the red cells reacts
with the amino groups of hemoglobin and other proteins (R), forming carbamino
compounds
 Since deoxygenated hemoglobin binds more H+ than oxyhemoglobin does and forms
carbamino compounds more readily, binding of O2 to hemoglobin reduces its affinity for
CO2 (This is known as Haldane effect). Consequently, venous blood carries more CO2
than arterial blood, CO2 uptake is facilitated in the tissues, and CO2 release is facilitated
in the lungs. About 7-11% of the CO2 added to the blood in the systemic capillaries is
carried to the lungs as carbamino-CO2.
 In the plasma, CO2 reacts with plasma proteins to form small amounts of carbamino
compounds, and small amounts of CO2 are hydrated; but the hydration reaction is slow in
the absence of carbonic anhydrase.
 Carbon dioxide from tissue diffuses into red blood cells within the capillaries. Some of
the carbon dioxide binds to haemoglobin, but most of it reacts with water inside the red
cells to form carbonic acid, a reaction catalyzed by carbonic anhydrase. The carbonic acid
then dissociates to form bicarbonate and hydrogen ions.
 Since the rise in the HCO3– content of red cells is much greater than that in plasma as the
blood passes through the capillaries, about 70% of the HCO3– formed in the red cells
enters the plasma. The excess HCO3– leaves the red cells in exchange for Cl–
 This exchange is called the chloride shift. Because of it, the Cl– content of the red cells in
venous blood is therefore significantly greater than in arterial blood. The chloride shift
occurs rapidly and is essentially complete in 1 second

Step 6: Key Points (5 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 205

 External respiration is exchange of gases by diffusion between the alveoli and the
blood in the alveolar capillaries, across the respiratory membrane.
 Internal respiration is exchange of gases by diffusion between blood in the
capillaries and the body cells.
 Oxygen is carried in the blood in Chemical combination with haemoglobin as
oxyhaemoglobin by (98.5%)
 Carbon dioxide is transported as bicarbonate ions (HC03-) in the plasma by (70%)

Step 7: Evaluation (15 minutes)

 Mention factors that influence oxygen dissociation
 In which form oxygen is transported in the blood?
 In which form does carbon dioxide is transported?

References
 Ganong. W. F, (2005). Review of Medical Physiology, United States of America:
McGraw-Hill Companies, Inc.
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 206

Handout 20.1: Gas exchange in the Alveoli

Source: Elsevier Ltd 2005.

Handout 20.2: Oxygen-Haemoglobin Dissociation Curve

Teaching Guides for NTA Level 4 MLS Curriculum Page 207

Session 13: Structure and Function of the
Kidneys and the Nephron
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Identify organization of urinary system
 Explain structure of the kidney
 Explain function of the kidney
 Describe structure and functions of a nephron
 Describe structure of ureter
 Describe structure urinary bladder
 Describe structure of urethra

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 OHP or LCD and Computer
 Anatomy Models
 Handout 27.1: The Kidney
 Handout 27.2: Kidney Blood Supply
 Handout 27.3: The Nephron
 Handout 27.4: Functions of Nephron Components
 Handout 27.5: Kidneys And Ureter Blood Supply
 Handout 27.6: The Urinary Bladder
 Handout 27.7: The Urethra

SESSION OVERVIEW
Step Time Activity/ Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Organisation of the Urinary System
3 20 minutes Presentation Structure of the kidney
4 15 minutes Presentation Functions of the Kidney
5 20 minutes Presentation Structure and Functions of Nephron
6 10 minutes presentation The Ureter
7 15 minutes presentation Urinary Bladder
8 10 minutes presentation Urethra

Teaching Guides for NTA Level 4 MLS Curriculum Page 208

 9 5 minutes Presentation Key Points
10 10minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of session title and learning objectives (5 minutes)

 READ or ASK students to read the Learning Objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Organisation of the Urinary System (10 minutes)

 Activity: Buzz (5 minutes)
 ASK Students what is urinary system and what are the principal and accessory organs
 ALLOW student to buzz in pairs 2 minutes
 ALLOW them to respond to the above question
 WRITE their responses on the flip chart
 SUMMARISE their response using the information below.

 Urinary system is the system which regulates the content of blood plasma to maintain the
homeostasis of the internal fluid environment within normal limits (control the
composition of blood and blood volume).
 It removes waste products from the blood, of which many of them are toxic.
 The principal organ of the urinary system is the kidney.
 The accessory organs include the ureters, urinary bladder and urethra.

 Anatomical location
o The kidneys lie in retroperitoneal position i.e. lies posterior to parietal peritoneum.
o They are located in either side of the vertebral column and extend from the level of
the last thoracic vertebra (T12) to the third lumbar (L3) usually the right kidney is a
little lower than the left, because of the liver which lies superior to the right kidney.
o The kidney is encased with the cushion of fat which help it to be in position

Step 3: Structure of the kidney (20 minutes)

 The kidneys are bean shaped organs with a medial indentation.
 An average size is approximately 11cm by 7cm by 3 cm.
 The left kidney is often slightly larger than the right.
 The medial surface of each kidney has a concave notch called the hilum, where the renal
artery and nerves enter and renal vein ureter exit the kidney
 The kidney is covered by a thin connective tissue membrane called capsule. The renal
capsule is a smooth, transparent, fibrous membrane that surrounds, encloses, and protects
the kidney. The renal capsule is itself surrounded by a mass of fatty tissue that also helps
to protect the kidney by damage by cushioning it in cases of impact or sudden movement
 a small part of the superior pole, on its medial side, is covered by the left suprarenal gland

Cross-section of the kidney

 There are three major regions of the kidney, renal cortex, renal medulla and the renal
pelvis.

Teaching Guides for NTA Level 4 MLS Curriculum Page 209

 The Renal cortex is the outer part of the kidney. It has a smooth texture and is the location
of the Bowman's Capsules and the glomeruli, in addition to, the proximal and distal
convoluted tubules and their associated blood supplies. The Renal medulla is the inner
part of the kidney. "Medulla" means "inner portion". This area has striated triangular
structures called "Renal Pyramids”. The appearance of striations is due to many straight
tubules and blood vessels within the renal pyramids.
 The Renal pelvis is the funnel-shaped basin (cavity) that receives the urine drained from
the kidney nephrons via the collecting ducts and then the (larger) papillary ducts.
 The Renal hilus is an indentation near to the centre of the concave area of the kidney.
 This is the area of the kidney through which the ureter and the other structures including
blood vessels (illustrated), lymphatic vessels, and nerves enter/leave the kidney.

Refer students to Handout 27.1: The kidney for more information.

 Kidneys are highly vascular. The large branch which bring blood to the kidney is the
renal artery a branch of abdominal aorta
 Entering the kidney it divides into segmental arteries, and then interlobar arteries between
the pyramids, these arteries extend toward the cortex, arch over the base of the pyramid
and form arcuate arteries. From arcuate arteries the interlobular arteries penetrate the
cortex.
 Branches of interlobular arteries are the afferent arterioles branching into capillary
network called glomeruli
 Efferent arterioles are formed from the glomerular capillaries. The efferent arterioles give
rise to peritubular capillaries (vasa recta), around the proximal and distal tubules.
 The peritubular capillaries drain into the interlobular vein then the interlobar vein then
into the renal vein.
 The renal vein connects to the inferior venacava.

Refer students to Handout 27.2: Kidney Blood Supply for more information.

Step 4: Functions of the Kidney (15 minutes)

 Small Brainstorming (8 minutes)
 ASK students: “What are the functions of the kidney
 ALLOW groups 5 minutes for this exercise.
 ASK few students to respond to the question
 Write their responses on the flip chart
 SUMMARIZE responses by using the notes below

 The kidneys are the major excretory organs of the body. The skin, liver, lung and intestine
eliminate some waste products, but if the kidneys fail to function, these other excretory
organs cannot adequately compensate. The following functions are performed by the
kidney:
 Filtering of blood. Protein and blood cells are retained in the blood, while a large volume
of filtrate is produced. Most of the filtrates volume is reabsorbed back into the blood

Teaching Guides for NTA Level 4 MLS Curriculum Page 210

 along with useful molecules and ions. Small volume of water, metabolic wastes, toxic
molecules, and excess ions remain in the filtrates and the result is the formation of urine
 Regulation of blood pressure. The kidneys regulate blood pressure by adjusting the
volume of blood in the body through:
o Renin-angiotensin-aldosterone mechanism and the action of Antidiuretic hormone
o Regulation of blood volume. The kidneys play a major role in controlling the
extracellular fluid volume in the body by producing either large volume of dilute
urine or small volume of concentrated urine.
o Regulation of the plasma electrolytes; the kidneys also regulate the quantities of
plasma solutes. Important examples of such electrolytes regulated by the kidney are
sodium ions (Na+), potassium ions (K+), calcium ions (Ca2+), chloride ions (Cl-), and
phosphate ions (HPO4-2).
o Regulation of the pH of the blood; the kidneys secrete H+ ions to help regulate blood
pH. At the same time, the kidneys also conserve bicarbonate ions (HCO3-), which are
an important buffer of H+.
o Synthesis of Vitamin D; the kidneys synthesize calcitrol, which is the active form of
vitamin D.
o Production of Red blood cells; the kidneys contribute to the production of red blood
cells by releasing the hormone erythropoietin which stimulates Erythropoiesis (the
production of red blood cells).
o Excretion of waste products and foreign substances; the kidneys excrete waste
products of metabolism in form urine. Examples of waste products from metabolic
reactions within the body include Urea (from the breakdown of amino acids),
bilirubin in a form of Urobilinogen (from the breakdown of haemoglobin), and
creatinine (from the breakdown of creatine phosphate in muscle fibres).

Step 5: Structure and Functions of Nephron (20 minutes)

 Kidney nephrons are the functional units of the kidneys. That this, it is the kidney
nephrons that actually perform the kidney's main functions. There are approx. a million
nephrons within each kidney
 There are two parts of a kidney nephron:
 Renal corpuscle which has; the renal corpuscle is the part of the kidney nephron in which
blood plasma is filtered. It has two parts:
 Glomerulus which is a network of small blood vessels called capillaries
 Bowman’s capsule which is the double-walled epithelial cup within which the glomerulus
is contained.
 Renal tubules.
 Glomerulus
 Within the glomerulus are glomerular capillaries that are located between the afferent
arteriole (bringing blood into the glomerulus) and the efferent arteriole (draining blood
away from the glomerulus).
 For filtration to occur, the (outgoing) efferent arteriole has a smaller diameter than the
(incoming) afferent arteriole.
 This difference in arteriole diameters helps to raise the blood pressure in the glomerulus
 Bowman’s capsule
 Bowman's capsule is the blind expanded end of a renal tubule. It is a double-walled
epithelial cup lined by a simple squamous epithelium on its outer (parietal) wall; its

Teaching Guides for NTA Level 4 MLS Curriculum Page 211

 glomerular, juxtacapillary (visceral) wall is composed of specialized epithelial the
podocytes.
 The area between the double-walls of the Bowman's capsule is called the capsular space;
a continuous with the proximal convoluted tubule
 The glomerular endothelium is finely fenestrated This membrane is formed by several
layers of cells clustered together
 Its function is Filtration of blood.
 Renal tubules; is the part of the kidney nephron into which the glomerular filtrate passes
after it has reached the Bowman's capsule
 Portions of the renal tubules are:
o Proximal convoluted tubule
o Loop of henle
o Descending limb
o Ascending limb
o Distal convoluted tubule
o Collecting duct
o The main function of nephron is filtration and reabsorption of essential elements
required by the body. In doing so it maintain the homeostasis

Refer students to Handout 27.3: The nephron and Handout 27.4: Functions of Nephron
Components for more information

Step 6: The Ureter (10 minutes)

 The ureters are the tubes that convey urine from kidneys to urinary bladder.
 They are about 25-30 cm long with a diameter of about 3mm.
 Is continuous with the funnel shaped renal pelvis
 It passes behind the peritoneum in front of the psoas muscles into the pelvic cavity, and
passes obliquely through the posterior walls of the bladder.
 When urine accumulates, the pressure in the bladder rises. The ureters are compressed
and openings are occluded, this prevents reflex of urine from the ureters to the kidney
 Ureter consist of three layers:
 An outer covering layer of fibrous tissues which continues with fibrous capsule of the
kidney
 Middle muscular layer; consist of interlacing smooth muscle fibres that form a functional
unit spiralling around the ureter in clockwise and ant clockwise direction. The lower third
of the ureter contains longitudinal muscles
 The inner mucosa layer, is composed of transitional epithelium
 Ureters propel urine from the kidneys to the bladder by peristaltic contraction of the
smooth muscle layer. This originates in the pacemaker in minor calyces and not under
autonomic nerve control.
 Blood supply is through testicular and ovarian arteries, branches internal iliac artery.

Refer students to Handout 27.5: Kidneys and ureter blood supply for more elaboration

Step 7: Urinary Bladder (15 minutes)

 Is the reservoir for urine

Teaching Guides for NTA Level 4 MLS Curriculum Page 212

 It lies in the pelvic cavity
 Its size and position varies depending on the volume of urine it contains, when distended
it rises into the abdominal cavity.
 Is pear shaped, but becomes oval when filled with urine
 It opens to the urethra at its lowest point-neck
 Superiorly it is covered by peritoneum, posteriorly it surrounds the uterus in female and
rectum in male
 The urinary bladder is composed of three layers;
 Outer layer of loose connective tissues, containing blood lymphatic vessels and nerves
 The middle layer, consist of interlacing smooth muscle fibers and elastic tissue arranged
in three layers. This is called destrusor muscle which when contracts empty the bladder.
 The mucosa layer composed of transitional epithelium.
 The three orifices in the bladder wall form a triangle or trigon; the upper 2 ofirices are
ureters and the lower opening is for Urethra.
 The internal urethra sphincter (thickening of the urethral smooth muscle layer) controls
outflow of urine from the bladder.
Refer students to Handout 27.6: The urinary Bladder for more elaboration

Step 8: Urethra (10 minutes)

 Is a canal extending from the neck of the bladder to the exterior at the external urethra
orifice.
 In male (19-20cm) is longer than females (4cm)
 The male urethra is associated with the urinary and the reproductive system, it is
consisted of three parts;
 Prostatic urethral, which originate from the bladder and pass through the prostate gland
 Membranous Urethral, is the shortest and narrowest extend from the prostate gland to the
bulb of the penis
 Penile or spongiose, lies within the corpus spongiosum of the penis and terminates at the
external urethral orifice in the glans penis.
 Female urethral runs behind the symphysis pubis and opens at the external urethral orifice
infront of the vagina. The external urethral orifice is guarded by external urethral
sphincter which is under voluntary control.

Refer students to Handout 27.7: The urethra for more elaboration

Step 9: Key Points (5 minutes)

 Urinary system is the system which regulates the content of blood plasma to maintain the
homeostasis of the internal fluid environment within normal limits.
 Kidney nephrons are the functional units of the kidneys.
 Kidneys are highly vascular. The large branch which bring blood to the kidney is the
renal artery a branch of abdominal aorta
 The male urethra is associated with the urinary and the reproductive system

Step 10: Evaluation (10 minutes)

 Describe the blood circulation division of the kidney from renal artery

Teaching Guides for NTA Level 4 MLS Curriculum Page 213

 Mention parts of nephron
 Function of the Kidney

References
 Drake R .L, Vogl W, Mitchell A W M (2007). Gray’s Anatomy for Students, United
Kingdom: Churchill Livingstone Elservier
 Kidney Blood Supply retrieved March, 25 2010 from
http://health.allrefer.com/health/goodpastures-syndrome-kidney-blood-supply.html
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Nephron retrieved March 25 from http://en.wikipedia.org/wiki/File:Gray1128.png
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Urinary bladder retrieved March 25, 2010 from
http://training.seer.cancer.gov/module_anatomy/images/illu_bladder.jpg
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 214

Handout 27.1: The Kidney

Source: Elsevier Ltd 2007.

Teaching Guides for NTA Level 4 MLS Curriculum Page 215

Handout 27.2: Kidney Blood Supply

1 – Renal corpuscle
4 – Ascending limb
6 – Collecting duct
7 – Arcuate artery
– Interlobular artery
– Afferent artery
– Efferent artery
12 – Vasa recta
24 – Papillary duct
25 – Interlobar artery
A – Medulla
B – Cortex

Source: A.D.A.M. online image

Teaching Guides for NTA Level 4 MLS Curriculum Page 216

Handout 27.3: The Nephron

Source: Gray1128.png

Teaching Guides for NTA Level 4 MLS Curriculum Page 217

Handout 27.4: Functions of Nephron Components

Source McGraw-Hill companies, Inc

Handout 27.5: Kidneys and Ureter Blood Supply

Source: Elsevier Ltd 2007.

Teaching Guides for NTA Level 4 MLS Curriculum Page 218

Handout 27.6: The Urinary Bladder

Source US National Cancer Institute

Handout 27.7: The Urethra

Source: Elsevier Ltd 2007.

Source McGraw-Hill companies, Inc

Teaching Guides for NTA Level 4 MLS Curriculum Page 219

Session 14: Mechanism of Urine
Formation
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None

Learning Objectives
By the end of this session, students will be able are to:
 List steps in the production of urine
 Explain filtration process
 Explain control of filtration rate
 Explain tubular reabsorption
 Explain control of tubular reabsorption
 Explain tubular secretion
 Explain mechanism of micturition

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout 27.1: Renin-angiotensin-aldosterone System
 Handout 27.2: Juxta-glomerular Apparatus
 Handout 27.3: Tubular Reabsorption
 Handout 27.4: Tubular Reabsorption and Secretion

SESSION OVERVIEW
Step Time Activity/ Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 05 minutes Buzzing, Presentation Production of Urine
3 20minutes Presentation Filtration Process
4 30 minutes Presentation Control of Filtration Rate
5 10 minutes Presentation Tubular Reabsorption
6 10 minutes Presentation Control of Tubular Reabsorption
7 15 minutes Presentation Tubular Secretion
8 15 minutes Presentation Mechanism of Micturition
9 5 minutes Presentation Key Points
10 5 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the Learning Objectives, and clarify.
 ASK students if they have any questions before continuing.

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Step 2: Production of Urine (5 minutes)
 Activity: Buzz (2 minutes)
 ASK students what are the three process in urine formation
 ALLOW them to buzz in two for 2 minutes then respond to the question
 SUMMARISE their responses using the information below

 Nephrons are the functional units of the kidney because they are the smallest structural
components capable of producing urine. The function of nephron reflect the process
involved in urine production
 Urine is formed in three steps:
 Filtration
 Reabsorption
 Secretion

Step 3: Filtration Process (20 Minutes)

 Activity: Brainstorm (5 minutes)
 ASK student what are the forces involved in filtration
 ALLOW them to respond. WRITE their responses on the flip chart
 SUMMARISE their responses using the information below

 Filtration is movement of fluids across the filtration membrane into the lumen of
Bowman’s capsule as results of pressure difference.
 The part of the total Cardiac output that passes through the kidney is called the renal
fraction; it varies from 12-30% of the Cardiac output. The renal blood flow is
1176mls/minute.
 The fluid entering the nephron is called the filtrate. The filtrate in the glomerolus is
similar to plasma with the exception of plasma protein. Filtration takes place through the
semi permeable walls of the glomerulus and glomerular capsule.
 The amount of filtrate produced each minute is called the glomerular filtration rate (GFR)
is 125mls/minutes
 Normally, GFR is about 180 L/day and tubular reabsorption is 178.5 L/day, leaving 1.5
L/day of fluid to be excreted in the urine.
 The formation of filtrate depend on a pressure gradient, called the filtration pressure,
which forces fluid from the glomerular capillary across the filtration membrane into the
lumen of Bowman’s capsule.
 The filtration pressure results from the sum of the forces that move fluid out of the
glomerular capillary into the lumen of Bowman’s capsule and those that move fluid out of
lumen of Bowman’s capsule into the capillary.
 The glomerular capillary pressure is the blood pressure inside the capillary, moves fluid
out of the capillary into the Bowman’s capsule (45mmHg) is much higher than that in
most capillaries. Opposing the movement of fluid into the lumen of Bowman’s capsule is
the capsule pressure, which is approximately 10mmHg, caused by the pressure of filtrate
already inside Bowman’s capsule. The colloid osmotic pressure within the glomerular
capillary exists because plasma protein does not pass through the filtration membrane.
Instead, they remain within the glomerular capillary and produce an osmotic force of

Teaching Guides for NTA Level 4 MLS Curriculum Page 221

 about 28mmHg that favour fluid movement to the glomerular capillary from Bowman’s
capsule. The filtration pressure is therefore approximately 7 mmHg
 Filtration capillary pressure (7 mmHg) = Glomerular pressure (45 mmHg) – Capsule
pressure (10 mmHg) – Colloid osmotic pressure (28 mmHg)

Step 4: Control of Filtration Rate (25 minutes)

 The kidneys are capable of renal auto regulation, through the specialized activities of the
juxtaglomerular apparatus
 The juxtaglomerular apparatus is a microscopic structure in the kidney, which regulates
the function of each nephron. The juxtaglomerular apparatus is named for its proximity to
the glomerulus: it is found between the vascular pole of the renal corpuscle and the
returning distal convoluted tubule of the same nephron. This location is critical to its
function in regulating renal blood flow and glomerular filtration rate.
 The three cellular components of the apparatus are the macula densa, extraglomerular
mesangial cells, and juxtaglomerular cells (also known as granular cells).
 Granular Cells. These are modified pericytes of glomerular arterioles. They are also
known as Juxtaglomerular cells. The granular cells secrete renin in response to:
 Beta1 adrenergic stimulation
 Decrease in renal perfusion pressure (detected directly by the granular cells)
 Decrease in NaCl absorption in the Macula Densa (often due to a decrease in glomerular
filtration rate, or GFR).

Refer students to Handout 27. 1: Mechanism of action of Renin for more information

 Macula Densa Cells

o Macula densa cells are columnar epithelium thickening of the distal tubule. The
macula densa senses sodium chloride concentration in the distal tubule of the kidney
and secretes a locally active (paracrine) vasopressor which acts on the adjacent
afferent arteriole to decrease glomerular filtration rate (GFR), as part of the
tubuloglomerular feedback loop.
o Excessive filtration at the glomerulus or inadequate sodium uptake in the proximal
tubule thick ascending loop of Henle brings fluid to the distal convoluted tubule that
has an abnormally high concentration of sodium. NaCl cotransporters move sodium
into the cells of the macula densa
o So the cell's osmolarity increases. Water flows into the cell to bring the osmolarity
back down, causing the cell to swell. When the cell swells, a stretch-activated non-
selective anion channel is opened on the basolateral surface. ATP escapes through this
channel and is subsequently converted to adenosine.
o Adenosine vasoconstricts the afferent arteriole via A1 receptors and vasodilates (to a
lesser degree) efferent arterioles via A2 receptors which decreases GFR. Also, when
macula densa cells detect higher concentrations of Na and Cl they inhibit Nitric Oxide
Synthetase (decreasing renin release).
o A decrease in GFR means less solute in the tubular lumen. As the filtrate reaches the
macula densa, less NaCl is re-absorbed. The macula densa cells detect lower
concentrations in Na and Cl and upregulate Nitric Oxide Synthetase (NOS).
o Mesangial cells are structural cells in the glomerulus that under normal conditions
serve as anchors for the glomerular capillaries.

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 o The mesangial cells within the glomerulus communicate with mesangial cells outside
the glomerulus (extraglomerular mesangial cells), and it is the latter cells that form
part of the juxtaglomerular apparatus. These cells form a syncytium and are connected
with glomerular mesangial cells via gap junctions.
o The function of the extraglomerular mesangial cells remains somewhat mysterious.
They contain actin and myosin, allowing them to contract when stimulated by renal
sympathetic nerves, which may provide a way for the sympathetic nervous system to
modulate the actions of the juxtaglomerular apparatus. In addition, extraglomerular
mesangial cells are strategically positioned between the macula densa and the afferent
arteriole, and may mediate signalling between these two structures.

Refer students to Handout 27.2: Juxtaglomerular apparatus for more elaboration

Step 5: Tubular Reabsorption (10 minutes)

 Selective reabsorption takes place in the proximal convoluted tubule of the kidney. It is
the process by which certain substances that are required by the body (such as glucose,
amino acids, vitamins and water) that have been filtered out of the blood during
ultrafiltration, are reabsorbed. As only certain substances are reabsorbed, it is known as
selective reabsorption.
 In this way, many useful solutes (primarily glucose and amino acids), salts and water that
have passed in the proximal tubule through the Bowman's capsule, return in the
circulation. These solutes are reabsorbed isotonically, in that the osmotic potential of the
fluid leaving the proximal tubule is the same as that of the initial glomerular filtrate.
However, glucose, amino acids, inorganic phosphate, and some other solutes are
reabsorbed via secondary active transport through cotransport channels driven by the
sodium gradient out of the nephron
 Normally, about 65 per cent of the filtered load of sodium and water and a slightly lower
percentage of filtered chloride are reabsorbed by the proximal tubule before the filtrate
reaches the loops of Henle
 The loop of Henle is highly permeable to water and moderately permeable to most
solutes, including urea and sodium . About 20 per cent of the filtered water is
reabsorbed in the loop of Henle
 Because it is essential to maintain a precise balance between tubular reabsorption and
glomerular filtration, there are multiple nervous, hormonal, and local control mechanisms
that regulate tubular reabsorption, just as there are for control of glomerular filtration.

Step 6: Control of Tubular Reabsorption (10 minutes)

 Hormones That Regulate Tubular Reabsorption
o Aldosterone Increases Sodium Reabsorption and Increases Potassium Secretion.
Aldosterone, secreted by the zona glomerulosa cells of the adrenal cortex, is an
important regulator of sodium reabsorption and potassium secretion by the renal
tubules
o Activation of the sympathetic nervous system can decrease sodium and water
excretion by constricting the renal arterioles, thereby reducing GFR. Sympathetic
activation also increases sodium reabsorption in the proximal tubule,
o Antidiuretic Hormone. Is a powerful feedback system for regulating plasma
osmolarity and sodium concentration that operates by altering renal excretion of water

Teaching Guides for NTA Level 4 MLS Curriculum Page 223

 independently of the rate of solute excretion. When osmolarity of the body fluids
increases above normal (that is, the solutes in the body fluids become too
concentrated), the posterior pituitary gland secretes more ADH, which increases the
permeability of the distal tubules and collecting ducts to water.This allows large
amounts of water to be reabsorbed and decreases urine volume but does not markedly
alter the rate of renal excretion of the solutes.
o When there is excess water in the body and extracellular fluid osmolarity is reduced,
the secretion of ADH by the posterior pituitary decreases, thereby reducing the
permeability of the distal tubule and collecting ducts to water, which causes large
amounts of dilute urine to be excreted. Thus, the rate of ADH secretion determines, to
a large extent, whether the kidney excretes a dilute or concentrated urine
Refer students to Handout 27.3: Tubular reabsorption for more information.

Step 7: Tubular Secretion (15 minutes)

 As the glomerular filtrate enters the renal tubules, it flows sequentially through the
successive parts of the tubule-the proximal tubule, the loop of Henle, the distal tubule, the
collecting tubule, and, finally, the collecting duct-before it is excreted as urine.
 Along this course, some substances are selectively reabsorbed from the tubules back into
the blood, whereas others are secreted from the blood into the tubular lumen.
 Eventually, the urine that is formed and all the substances in the urine represent the sum
of three basic renal processes-glomerular filtration, tubular reabsorption, and tubular
secretion-as follows:
 Some substances are removed from blood through the peritubular capillary network into
the distal convoluted tubule or collecting duct, by secretion mechanism.
 These substances are Hydrogen ions, creatinine, and drugs.
 Substances which are not reabsorbed after glomerular filtration and those secreted into the
tubules forms the components of Urine
 For many substances, reabsorption plays a much more important role than does secretion
in determining the final urinary excretion rate.
 However, secretion accounts for significant amounts of potassium ions, hydrogen ions,
and a few other substances that appear in the urine.
 For a substance to be reabsorbed, it must first be transported
 Across the tubular epithelial membranes into the renal interstitial fluid and then
 Through the peritubular capillary membrane back into the blood
 Composition of Urine
 Is clear and amber in colour due to the presence of urobilin
 The specific gravity is between 1020 and 1030, and the pH is around 6(normal range of
4.5 to 8)
 The healthy adult passes 1000-1500mls per day
 Composition;
o Water 96%, urea 2% and others like Ammonia, Potassium ,Sodium etc 2%
Refer students to Handout 27.4: Tubular Reabsorption and Secretion for more
information.

Step 8: Mechanism of Micturition (15 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 224

 Urination, also known as micturition, voiding, peeing, and more rarely, emiction, is the
process of disposing of urine from the urinary bladder through the urethra to the outside
of the body. In healthy humans the process of urination is under voluntary control.
 In infants, elderly individuals and those with neurological injury, urination may occur as
an involuntary reflex.
 Physiologically, micturition involves coordination between the central, autonomic and
somatic nervous systems. Brain centers that regulate urination include the pontine
micturition center, periaqueductal gray, and the cerebral cortex.
 In healthy individuals, the lower urinary tract has two discrete phases of activity: the
storage phase, when urine is stored in the bladder; and the voiding phase, when urine is
released through the urethra.
 At low bladder volumes, afferent firing is low, resulting in excitation of the outlet (the
sphincter and urethra), and relaxation of the bladder. At high bladder volumes, afferent
firing increases, causing a conscious sensation of urinary urge. When the individual is
ready to urinate, he or she consciously initiates voiding, causing the bladder to contract
and the outlet to relax. Voiding continues until the bladder empties completely, at which
point the bladder relaxes and the outlet contracts to re-initiate storage.
 The muscles controlling micturition are controlled by the autonomic and somatic nervous
systems. During the storage phase the internal urethral sphincter remains tense and the
detrusor muscle relaxed by sympathetic stimulation. During micturition, parasympathetic
stimulation causes the detrusor muscle to contract and the internal urethral sphincter to
relax. The external urethral sphincter (sphincter urethrae) is under somatic control and is
consciously relaxed during micturition.
 In the adult, the volume of urine in the bladder that normally initiates a reflex contraction
is about 300-400 ml.
 The impulses are sent to the spinal cord is modified by centres in the cerebral cortex.
 The impulses from the brain cortex are sent back as efferent nerve impulse to the sacral
region of the spinal cord and then to the external urinary sphincter muscles, which relaxes
and thus urine flow from the bladder to urethra.
 Injury to any of these leads to involuntary micturition (incontinence)

Step 6: Key Points (5 minutes)

 Nephrons are the functional units of the kidney
 Filtration is movement of fluids across the filtration membrane into the lumen of
Bowman’s capsule as results of pressure difference
 The kidneys are capable of renal auto regulation, through the specialized activities of the
juxtaglomerular apparatus
 Selective reabsorption takes place in the proximal convoluted tubule of the kidney
 Urine is clear and amber in colour due to the presence of urobilin

Step 7: Evaluation (5 minutes)

 What are the functions of nephron components?
 Mention three hormones involved in kidney auto-regulation mechanism

References
 Ganong. W. F, (2005). Review of Medical Physiology, United States of America:
McGraw-Hill Companies, Inc.

Teaching Guides for NTA Level 4 MLS Curriculum Page 225

 Renin-angiotensin-aldosterone System retrieved March, 25, 2010 from
http://en.wikipedia.org/wiki/File:Renin-angiotensin-aldosterone_system.png
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Tubular Reabsorption and Secretion retrieved march, 24, 2010 from
http://www.flickr.com/photos/dokidok/2369788540/
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 226

Handout 27.1: Renin-angiotensin-aldosterone System

Source: en.wikipedia A. Rad

 Renin circulates in the blood stream and breaks down (hydrolyzes) angiotensinogen
secreted from the liver into the peptide angiotensin I.
 Angiotensin I is further cleaved in the lungs by endothelial-bound angiotensin converting
enzyme (ACE- which is found mainly in lung capillaries) into angiotensin II, the most
vasoactive peptide.
 Angiotensin II is the major bioactive product of the renin-angiotensin system, binding to
receptors on intraglomerular mesangial cells, causing these cells to contract along with
the blood vessels surrounding them so is a potent constrictor of all blood vessels. It acts
on the musculature and thereby raises the resistance posed by these arteries to the heart.
The heart, trying to overcome this increase in its 'load', works more vigorously, causing
the blood pressure to rise. Angiotensin II also acts on the adrenal glands and releases
Aldosterone from the zona glomerulosa in the adrenal cortex, which stimulates the
epithelial cells of the kidneys to increase re-absorption of salt and water, leading to raised
blood volume and raised blood pressure. The RAS also acts on the CNS to increase water
intake by stimulating thirst, as well as conserving blood volume, by reducing urinary loss
through the secretion of Vasopressin from the posterior pituitary gland.
 Angiotensin II constricts efferent arterioles, which forces blood to build up in the
glomerulus, increasing glomerular pressure. The glomerular filtration rate (GFR) is thus
maintained, and blood filtration can continue despite lowered overall kidney blood flow.
Because the filtration fraction has increased, there is less plasma fluid in the downstream
peritubular capillaries. This in turn leads to a decreased hydrostatic pressure and
increased osmotic pressure (due to unfiltered plasma proteins) in the peritubular
capillaries. The effect of decreased hydrostatic pressure and increased osmotic pressure in
the peritubular capillaries will facilitate increased reabsorption of tubular fluid.
 Angiotensin II decreases medullary blood flow through the vasa recta. This decreases the
washout of NaCl and urea in the kidney medullary space. Thus, higher concentrations of
NaCl and urea in the medulla facilitate increased absorption of tubular fluid. Furthermore,

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 increased reabsorption of fluid into the medulla will increase passive reabsorption of
sodium along the thin ascending limb of the loop of Henle.
 Angiotensin II stimulates Na+/H+ exchangers located on the apical membranes (faces the
tubular lumen) of cells in the proximal tubule and thick ascending limb of the loop of
Henle in addition to Na+ channels in the collecting ducts. This will ultimately lead to
increased sodium reabsorption
 Angiotensin II stimulates the hypertrophy of renal tubule cells, leading to further sodium
reabsorption.
 In the adrenal cortex, it acts to cause the release of aldosterone. Aldosterone acts on the
tubules (e.g the distal convoluted tubules and the cortical collecting ducts) in the kidneys,
causing them to reabsorb more sodium and water from the urine. Potassium is secreted
into the tubules in exchange for the sodium, which is excreted. Aldosterone also acts on
the central nervous system to increase an individual's appetite for salt, and to stimulate the
sensation of thirst.
 Release of Anti-Diuretic Hormone (ADH), also called vasopressin -- ADH is made in the
hypothalamus and released from the posterior pituitary gland. As its name suggests, it
also exhibits vaso-constrictive properties, but its main course of action is to stimulate
reabsorption of water in the kidneys.
 These effects directly act in concert to increase blood pressure.
 An over-active renin-angiotension system leads to vasoconstriction and retention of
sodium and water. These effects lead to hypertension. Therefore, renin inhibitors can be
used for the treatment of hypertension. This is measured by the plasma renin activity.

Handout 27.2: Juxta-glomerular Apparatus

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 228

Source: wikimedia.org

Handout 27.3: Tubular Reabsorption

Source: Elsevier Ltd 2007.

Hormones Site of Action Effects

Aldosterone Collecting tubule and duct ↑NaCl, H2O reabsorption, ↑
K+ secretion
Angiotensin II Proximal tubule, thick ↑NaCl, H2O reabsorption, ↑
ascending loop of Henle/distal H+ secretion
tubule, collecting tubule
Antidiuretic hormone Distal tubule/collecting tubule ↑H2O reabsorption
and duct
Atrial natriuretic peptide Distal tubule/collecting tubule ↓NaCl reabsorption
and duct
Parathyroid hormone Proximal tubule, thick ↓PO4 reabsorption, ↑ Ca++
ascending loop of Henle/distal reabsorption
tubule

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Handout 27.4: Tubular Reabsorption and Secretion

Source: en.wikipedia

Source: McGraw-Hill companies, Inc

Teaching Guides for NTA Level 4 MLS Curriculum Page 230

Session 15: Introduction to the
Gastrointestinal System
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None

Learning Objectives
By the end of this session, students will be able are to:
 Explain Gastrointestinal System Overview
 Explain Functions of the Gastrointestinal System.
 Describe Structure of the Oral Cavity.
 Describe Structure and functions of the tongue
 Explain Constituents of salivary glands
 Explain Mechanism of Swallowing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 21.1: The overview of alimentary canal
 Handout 21.2: General structure of the alimentary canal
 Handout 21.3: The Teeth
 Handout 21.4: The Salivary glands

SESSION OVERVIEW
Step Time Activity/ Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation Gastrointestinal System Overview
3 15 minutes Presentation Functions of the Gastrointestinal System.
4 25 minutes Presentation Structure of the Oral Cavity.
5 15 minutes Presentation Structure and functions of the tongue
6 15minutes Presentation Salivary Glands and Its Constituents
7 15 minutes Presentation Mechanism of Swallowing
8 05 minutes Presentation Key Points
9 10 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

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 READ or ASK students to read the learning objectives and clarify
 ASK students if they have any questions before continuing.

Step 2: Gastrointestinal System Overview (15 minutes)

 Activity: Brainstorm (5 minutes)
 ASK student to define digestive system and mention the organs of this system
 ALLOW them to respond
 WRITE their response on the flip chart
 SUMMARISE their responses using the information below

 Digestive system consist of the digestive tract, (alimentary canal), a tube extending from
the mouth, pass through the thorax, abdomen and pelvis and ends at the anus and its
associated accessory organs.
 The gastrointestinal system is the portal through which nutritive substances, vitamins,
minerals, and fluids enter the body.
 Proteins, fats, and complex carbohydrates are broken down into absorbable units
principally in the small intestine; the digestion.
 The products of digestion and the vitamins, minerals, and water cross the mucosa and
enter the lymph or the blood; the absorption. These are necessary for growth and
maintenance
 The regions of the digestive tract include:
o The mouth or oral cavity, which has salivary glands and tonsils as accessory organs
o The pharynx, or throat , with tubular mucous glands
o The oesophagus, with tubular mucous glands
o The stomach, which contains many tubelike glands
o The small intestine, consisting of the duodenum, jejunum and ileum, with the liver,
gallbladder and pancreas as major accessory organs
o The large intestine, including the cecum, colon, rectum and anal canal, with mucus
glands
o The anus
o Accessory organs will be discussed in session 23 of this module.

Refer students to Handout 21.1: The overview of alimentary canal for more
elaboration.

 The gastrointestinal tract is made of four layers of tissues:

o Mucosa is the innermost layer made up of three layers:
 The inner epithelium,
 lamina propria and
 muscularis mucosae.
 Submucosa this layer is composed of connective tissue, it contains numerous
small glands, blood vessels, and parasympathetic nerves that form the submucosal
plexus (Meissner plexus)
 Muscular is thick layer of smooth muscle tissue which consists of inner circular
layer and outer longitudinal layer. Between the two layers of muscles there is a
nervous plexus called myenteric plexus (Auerbach plexus)

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  Serosa is the outermost layer of made up loose connective tissue (visceral
peritoneum)
 Layers of the GI tract have various modifications to enable it to perform various
functions

Refer students to Handout 21.2: General structure of the alimentary canal for more
elaboration

Step 3: Functions of the Gastrointestinal System (15 minutes)

 Activity: Brainstorming (8 minutes)
 ASK student to mention the functions of the digestive tract
 ALLOW them to respond
 WRITE their answers on the flip chart
 SUMMARISE their responses using below information

 Digestive system has the following functions:

o Ingestion; taking in food into the stomach through the oral cavity although liquid can
be introduced directly into the stomach by nasogastric tube.
o Mastication; is the process by which food taken into the mouth is chewed by the teeth
and broken down into small particles. Digestive enzymes cannot easily penetrate solid
food particles and can only work effectively on the surfaces of the particles
o Propulsion; moves the contents along the alimentary tract. Each segment of the
digestive tract is specialised to assist in moving its contents from the oral to the anal
end.
o Deglutition or swallowing moves food and liquids called bolus from the oral cavity
into the oesophagus. This function is enhanced by:
 Peristalsis is responsible moving material through most of the digestive tract.
 Muscular contractions occur in peristaltic waves, consisting of a wave of
relaxation of the circular muscles, which forms a leading wave of distension in
front of the bolus, followed by a wave of strong contraction of the circular
muscles behind the bolus, which forces the bolus along the digestive tube.
 Mixing; some contractions don’t propel food (chime) from one end of the
digestive tract to the other but rather move the food back and forth within the
digestive tract to mix it with digestive secretion and help break into smaller
pieces. Segmental contraction are mixing contractions that occur in the small
intestine
 Secretion; As food moves through the digestive tract, secretion are added to
lubricate, liquefy, and digest the food
 Mucus secreted along the entire digestive tract lubricates the food and the lining
of the tract
 The secretions contain large amount of water which liquefies the food, thereby
making it easier to digest and absorb
 Liver secretions break large fat droplets, which makes possible the digestion and
absorption of fats
 Enzymes secreted by the oral cavity, stomach, intestine and pancreas break large
food molecules into smaller molecules that can be absorbed by the intestinal wall

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  Digestion; is the breakdown of large organic molecules into their components
parts; carbohydrates into monosaccharides, protein into amino acids, and
triglyceride into fatty acids and glycerol. Digestion consists of
 Mechanical digestion, which involve mastication and mixing of food
 Chemical which prepares food for absorption and utilization by all the cells of the
body.
 Absorption; is the movement of molecules out of the digestive tract and into the
circulation or into the lymphatic system.
 Elimination; is the process by which the waste products of digestion are removed
from the body. Food material not absorbed becomes faeces that are eliminated by
the process of defecation.

Step 4: Structure of the Oral Cavity (15 minutes)

 The oral cavity or mouth is that part of the digestive tract bounded by the lips anteriorly,
the fauces throat; opening into the pharynx posteriorly, cheeks laterally, the palate
superiorly, and a muscular floor inferiorly.
 The oral cavity is lined throughout with mucus membrane consisting of stratified
squamous epithelium containing small mucus secreting glands.
 The oral cavity is divided into two regions:
 The Vestibule; part of the mouth between Gums and Cheeks
 The oral cavity proper; which lies medial to the alveolar processes (gums)

 Structure of the oral cavity (the buccal cavity)

o Lips:
 Are muscular structure formed mostly by the orbicularis oris muscles.
 They are covered externally by skin and internally by mucous membrane
 The junction between skin and mucous membrane is highly sensitive.
 When lips are closed, line of contact is oral fissure.
o Cheeks
 The cheeks are formed in large part by buccinator muscles covered by adipose
tissue
 They form the lateral boundaries of the oral cavity, they are continuous with lips
and lined by mucous membrane.
 They contain mucus secreting glands which are placed between mucous
membrane and buccinator muscle. Their ducts open opposite the last molar teeth.
 Hard and soft palates; Forms the roof of mouth consists of two parts:
 The anterior bony part the hard palate consist of portions of four bones, two
maxillae and two palatine bones
 The posterior non bony part the soft palate forms partition between the mouth and
nasopharynx and is made of muscles arranged in an arch
 Suspended from midpoint of the posterior border of the arch is the uvula
 The opening from the mouth into the oropharynx is called fauces.
o Teeth
 The teeth are hard conical structures set in the dental alveoli (tooth sockets) of the
upper and lower jaws and are used in mastication (chewing) and assisting in
articulation
 These are organs of mastication
 Humans have two generations of teeth:

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  The deciduous (primary) dentition
 The permanent (secondary) dentition.
o Deciduous teeth
 They are temporary teeth, twenty in number, and ten on each jaw.
 They start to emerge at 6 months after birth
 They should all be present at 24-36 months.
o Permanent teeth
 They are thirty two in number, they begin to replace deciduous teeth at 6 years of
age, and become complete when the third molars erupt at 18 - 24 years of age.
 Of these 32 teeth there are 8 incisors, 4 canines, 8 Premolars and 12 Molars.
 Incisors and Canines are for cutting and Premolars and molars for grinding of
food.
 There are two incisors, a central and a lateral, in each half jaw or quadrant
 Behind each lateral incisor is a canine tooth with a single cusp
 Distal to the canines are two premolars, each with a buccal and lingual cusp
 Posterior to the premolars are three molars whose size decreases distally
 A typical tooth has the following parts:
- Crown; exposed portion of a tooth, covered by enamel; ideally suited to
withstand abrasion during mastication
- Neck; narrow portion that joins the crown to the root; surrounded by the
gingiva
- Roots fits into the socket of the alveolar process and is suspended by fibrous
periodontal membrane
- In the centre of the tooth there is pulp cavity containing blood vessels, lymph
vessels and nerves.
- Surrounding the pulp cavity there is hard ivory like substance called dentine.
- Outside the dentine of the crown is the thin layer of the very hard substance
called enamel.
- The root of the tooth on the other hand is covered by substance resembling the
bone called the cement which secures the tooth in its socket.
Refer students to Handout 21.3: The Teeth for more information and elaboration

Step 5: Structure and Functions of the Tongue (10 minutes)

 The tongue is a highly muscular organ of deglutition, taste and speech
 It is made up of skeletal muscles covered by a mucous membrane. It has the root, tip and
the body.
 It is attached by its base to the hyoid bone and by the lingual frenulum to the floor of the
mouth.
 There are two types of muscles forming the tongue;
 Intrinsic muscles; they originate and insert in the tongue itself. An example of the
intrinsic muscles includes Genioglossus. They are responsible for changing the shape of
the tongue such as flattening and elevating the tongue during drinking and swallowing
 Extrinsic muscles are those muscles that insert into the tongue but originate from other
structures such as hyoid bone. An example of the muscles includes hyoglossus. They are
responsible for protruding and retract the tongue, move it from side to side and change its
shape.

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 The dorsal mucosa is covered by numerous papillae; tiny projections, some of which bear
taste buds. There are three types of papillae; vallate, fungiform and filariform (Fig. 1)
 Circumvallate papillae, arranged in an inverted V shape at the base of the tounge. Are the
largest papillae
 Fungiform pappilae; are situated mainly at the tip ad the edge of the tongue.
 Filiform papillae; are the smallest of all three. Most numerous on the surface of the
anterior two-thirds of the tongue.

Figure 1: The Tongue

Source: Elsevier Ltd 2005.

 There are four basic taste sensation:

o Sweetness; apex (tip)
o Saltiness; lateral margins
o Sourness; posterior part of the tongue
o Bitterness; posterior part of the tongue
o Although it is commonly stated that particular areas of the tongue are specialized to
detect these different tastes, evidence indicates that all areas of the tongue are
responsive to all taste stimuli. Each afferent nerve fibre is connected to widely
separated taste buds and may respond to several different chemical stimuli. Some
respond to all four classic categories, others to fewer or only one
o Blood supply of the tongue is by lingual branch of the external carotid artery and
venous drainage is by lingual veins, which joins the internal jugular vein.
o Nerve innervations of the tongue is through:
o The hypoglossal nerve(12th cranial nerves)
o The lingual branch of the mandibular nerves
o The facial and glossophayngeal nerves (7th and 9th CN) the nerves of taste.
 The parasympathetic innervation of the various glands of the tongue is from the chorda
tympani branch of the facial nerve

Teaching Guides for NTA Level 4 MLS Curriculum Page 236

 The postganglionic sympathetic supply to lingual glands and vessels arises from the
carotid plexus

Step 6: Salivary Glands and Its Constituents (10 minutes)

 Salivary glands are compound, tubulo- alveolar exocrine glands, whose ducts open into
the oral cavity.
 They secrete saliva, a fluid which lubricates food to assist deglutition, moistens the buccal
mucosa, which is important for speech, and provides an aqueous solvent necessary for
taste and a fluid seal for sucking and suckling.
 They also secrete digestive enzymes, e.g. salivary amylase and antimicrobial agents e.g.
IgA, lysozyme and lactoferrin, into saliva.
 Conditions where there is a significant decrease in the production of saliva (xerostomia)
may result in periodontal inflammation and dental caries
 Three pairs of compound tubulo-alveolar glands secrete approximately 1 litre of saliva
each day.
 The major salivary glands are the paired parotid, submandibular and sublingual glands. In
addition, there are numerous minor salivary glands scattered throughout the oral mucosa
and submucosa.
 Parotid glands – largest of the paired salivary glands produce watery saliva containing
enzymes
 Submandibular glands – compound glands that contain enzymes and mucous-producing
element
 Sublingual glands – smallest of the salivary glands produce a mucous type of saliva
 Buccal glands are important for hygiene and comfort of oral tissue.
 In the unstimulated state, the parotid gland contributes 20%, the submandibular gland
65%, and the sublingual and minor salivary glands 15% of the daily output of saliva.
When stimulated, the parotid contribution rises to 50%.

Refer students to Handout 21.4: The Salivary glands for more elaboration

Step 7: Mechanism of Swallowing (15 minutes)

 Swallowing is a mechanism used to accomplish primary function of digestive system
 Deglutition; is a process for swallowing. It is a complex process requiring coordinated
and rapid movement. Swallowing transports the chewed food into the esophagus, passing
through the oropharynx and hypopharynx. The mechanism for swallowing is coordinated
by the swallowing center in the medulla oblongata and pons. The reflex is initiated by
touch receptors in the pharynx as the bolus of food is pushed to the back of the mouth.
 This occurs in three stages after mastication is completed and the bolus has been formed.
It is initiated voluntarily but completed by a reflex action
 Oral stage (mouth to oropharynx), voluntarily controlled. Formation of food bolus in the
middle of the tongue; The mouth is closed, tongue presses bolus against the palate, and
the voluntary muscles of the tongue and cheeks push the bolus backwards into the
oropharynx.
 Pharyngeal stage (oropharynx to oesophagus) involuntary contraction of muscles of the
pharynx propels the bolus down into the oesophagus. It begins with the elevation of the

Teaching Guides for NTA Level 4 MLS Curriculum Page 237

 soft palate, which closes the passage between the nasopharynx and oropharynx. This is
controlled by the medulla and lower pons in the brain stem.
 Oesophageal stage. The presence of the bolus in the pharynx stimulates a wave of
peristalsis that propels the bolus through the oesophagus to the stomach. Involuntary
movement; contractions and gravity moves bolus through oesophagus and into stomach.
So the function of the oesophagus is to convey food from the pharynx to the stomach. The
chewed food is pushed down the esophagus to the stomach through peristaltic contraction
of these muscles.
 It takes only about seven seconds for food to pass through the esophagus and no digestion
takes place.
 Peristalsis; wave like ripple of the muscle layer of a hollow organ progressive motility
that produces forward movement of matter along the GI tract

Step 9: Key Points (5 minutes)

 The gastrointestinal system is the portal through which nutritive substances, vitamins,
minerals, and fluids enter the body.
 The gastrointestinal tract is made of four layers of tissues: the mucosa, submucosa,
muscular and serosa
 The tongue is a highly muscular organ of deglutition, taste and speech
 There are four basic taste sensation; sweetness, saltiness, sourness and bitterness
 Salivary glands secrete saliva, a fluid which lubricates food to assist deglutition, moistens
the buccal mucosa, which is important for speech, and provides an aqueous solvent
necessary for taste and a fluid seal for sucking and suckling
 Teeth are organs of mastication and Humans have two generations of teeth; the
deciduous and permanent
 The oesophagus has 4 constrictions where adjacent structure produce impression

Step 10: Evaluation (10 minutes)

 Mention the functions of digestive system.
 Describe wall structure of digestive system.
 Mention the salivary glands
 How many teeth does adult human being has

References
 Gastrointestinal tract image retrieved March, 17, 2010 from http://www.free-
ed.net/sweethaven/MedTech/NurseCare/fig91801
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc

Teaching Guides for NTA Level 4 MLS Curriculum Page 238

 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 239

Handout 21.1: The overview of alimentary canal

Source: SweetHaven

Handout 21.2: General structure of the alimentary canal

Teaching Guides for NTA Level 4 MLS Curriculum Page 240

Source: Elsevier Ltd 2005.

Handout 21.3: The Teeth

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 241

Source: Lippincott Williams & Wilkins, 2007

Handout 21.4: The Salivary glands

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 242

Teaching Guides for NTA Level 4 MLS Curriculum Page 243
Session 16: Stomach, Intestines, Sensory
Organs and their Functions
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None

Learning Objectives
By the end of this session, students will be able are to:
 Identify structure and functions of oesophagus
 Identify stomach and its functions.
 Describe structure of the stomach.
 Describe structure of the small intestines.
 Describe structure of the large intestines

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 22.1: The Oesophagus
 Handout 22.2: General Structure of Stomach
 Handout 22.3 Blood Supply to the Stomach
 Handout 22.4: The duodenum
 Handout 22.5: Structure of Small Intestine
 Handout 22.6 Large Intestine
 Worksheet 22.1: Gastrointestinal tract

SESSION OVERVIEW
Step Time Activity/ Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Structure of the Pharynx and Oesophagus
3 20 minutes Presentation Stomach and its Functions
4 20 minutes Presentation Structure of the stomach
5 25 minutes Presentation Structure of the small intestines.
6 25 minutes Presentation structure of the large intestines
7 05 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 Minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 244

 READ or ASK students to read the Learning Objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Structure of the Pharynx and Oesophagus (10 Minutes)

 Pharynx is a tube through which a bolus passes when moved from the mouth to the
oesophagus by the process of deglutition. The pharyns is divided into three parts namely
Nasopharyx, Oropharynx and Laryngopharynx.
 The Oropharynx is important for digestive system.
 The wall of the pharynx consists of three layers. These are the Mucosa, Middle layer
(Fibrous tissue) and Outer layer consisting of Smooth muscles involved in swallowing.
 When food enters the pharynx swallowing is no longer under voluntary control.
 The oesophagus is a narrow muscular tube about 25 centimetres long diameter of 2cm,
which starts at pharynx at the back of the mouth. It passes through the thoracic
diaphragm, and ends at the cardiac orifice of the stomach
 It lies in the median plane in the thorax in front of the vertebral column behind the trachea
and the heart.
 The oesophagus has 4 constrictions where adjacent structure produce impression
 At the beginning approximately 15cm from the incisor teeth and caused by the
cricopharyngeus muscles – upper oesophageal sphincter
 Where it crossed by the arch of aorta 22.5cm from the incisor teeth
 Where it crossed by the left main bronchus 27.5cm from the incisor
 Where it passes through the diaphragm – lower oesophageal sphincter
 At the top of the oesophagus, is a flap of tissue called the epiglottis that closes during
swallowing to prevent food from entering the trachea (windpipe)
 It has four layers; from outside:
o The adventitia,
 Muscular layer; The muscles are striated (voluntary) in the upper third and mixed
(striated & smooth) in the middle and smooth (involuntary) in the lower third. There are
two layers:
o The inner is circular
o The outer is longitudinal.
o Sub-mucosa layer
o Mucosa layer which is made up of stratified squamous epithelium.
o Arterial blood supply of the oesophagus is through oesophageal arteries, branches of
thoracic aorta, inferior phrenic arteries and the left gastric branch of the celiac artery.
o Venous drainage is through the azygos and hemiazygos veins.

Refer students to handout 22. 1: The oesophagus for more elaboration

Step 3: Stomach and its Functions (20 minutes)

 Activity: Brainstorm (5 minutes)
 ASK students to define the stomach and mention its location
 WRITE their answers on the flip chart
 SUMMARISE their responses using the below information

Teaching Guides for NTA Level 4 MLS Curriculum Page 245

 The stomach is the most dilated part of the gastrointestinal tract and has a J-like shape.
Positioned between the abdominal esophagus and the small intestine, the stomach is in the
epigastric, umbilical and left hypochondrium regions of the abdomen.
 Its shape and size varies from person to person; even within the same individual its size
and shape change from time to time depending on its food contents and the moisture of
the body. However in adult capacity range from 1.0 to 1.5 litre

 Activity: Buzz (5 minutes)

 ASK students what are the functions of the stomach
 ALLOW them to buzz in pairs for 2 minutes then
 LISTEN to their responses
 SUMMARISE their responses using the information below

 The stomach has the following functions:

o Reservoir for food until it is partially digested and moved further along the GI tract
o Secrete gastric juice to aid in digestion of food
o Breaks food into small particles and mixes them with gastric juice
o Secrete intrinsic factor
o Carries limited absorption
o Produces gastrin hormone
o Helps protect body from pathogenic bacteria swallowed with food

Step 4: Structure of the Stomach (20 minutes)

 The stomach is divided for descriptive purposes into four regions by arbitrary lines drawn
on its external surface. The regons are:
o The cardia, which surrounds the opening of the esophagus into the stomach
o The fundus of stomach, which is the area above the level of the cardial orifice
o The body of stomach, which is the largest region of the stomach
o The pyloric part, which is divided into the pyloric antrum and pyloric canal and is the
distal end of the stomach
o The outlet of the stomach (pyloric orifice) is marked on the surface of the organ by
the pyloric constriction and surrounded by a thickened ring of gastric circular muscle
(the pyloric sphincter). The pyloric orifice is just to the right of midline in a plane that
passes through the lower border of vertebra LI (the transpyloric plane).
 Other features of the stomach include:
o The greater curvature, which is a point of attachment for the gastrosplenic ligament
and the greater omentum;
o The lesser curvature, which is a point of attachment for the lesser omentum;
o The cardial notch, which is the superior angle created when the esophagus enters the
stomach;
o The angular incisure, which is a bend on the lesser curvature.
o The stomach is lined with simple columnar epithelium. The epithelium forms
numerous tubelike gastric pits, which are the opening of the gastric glands. The
epithelial cells of the stomach are of five types. The first type is surface mucous cells
which produce mucus, is on the surface and lines the gastric pits. The remaining four
cell types are in the gastric glands. They are mucous neck cells which produce mucus;
parietal (oxyntic) cells which secrete hydrochloric acid and intrinsic factor needed for

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 vitamin B12 absorption; Chief (zymogenic) cells which produce pepsinogen and
endocrine cells, which produce regulatory hormones.
Refer students to Handout 22.2: General structure of stomach for more elaboration

 Blood supply of the stomach; a rich arterial supply, arise from the celiac trunk and its
branches. Most of the blood is supplied by anastomoses formed along the lesser curvature
by the right and left gastric arteries and, along the greater curvature, by the right and left
gastro-omental artery (gastroepiploic artery).
 The fundus and upper body of stomach receive blood from the short and posterior gastric
arteries branches of the splenic artery.
 Venous drainage is through gastric veins parallel the arteries in position and course.

Refer students to Session 15: Blood supply to the abdomen for more information and
Handout 22.3: Blood supply to the stomach

Step 5: Structure of the Small Intestines (25 minutes).

 The small intestine extends from the pyloric sphincter to the ileocecal valve.
 It is highly adapted for digestion and absorption. Its glands produce enzymes and mucus.
 The walls of small intestine are composed of four layers of tissues and there are some
modifications of the peritoneum and mucous membrane.
 The surface area of the mucosa is greatly increased by permanent circular folds, villi and
microvilli.
 Villi are tiny finger like projections of the mucosa layer into intestinal rumen about 0.5
too 1mm long, the function of villi is for absorption.
 It consists of three parts:
 The duodenum
 The jejunum
 The ileum
 Duodenum is the first section of the small intestine. It begins with the duodenal bulb and
ends at the ligament of Treitz.
 The duodenum also regulates the rate of emptying of the stomach via hormonal pathways;
Secretin and cholecystokinin which are released from cells in the duodenal epithelium in
response to acidic and fatty stimuli present there when the pylorus opens and releases
gastric chyme into the duodenum for further digestion.
 The duodenum is divided into four sections for the purposes of description. The first three
sections curve in a "C" loop concavity in which the head of the pancreas lies. Only the
first 2 cm of the superior part is mobile (not covered by peritoneum), the distal 3cm of the
first part along with the rest of the duodenum is retroperitoneal (immobile).
 The first (superior) part begins as a continuation of the duodenal end of the pylorus
 The second (descending) part of the duodenum begins at the superior duodenal flexure. It
passes inferiorly to the lower border of vertebral body L3, before making a sharp turn
medially into the inferior duodenal flexure
 The third (inferior/horizontal) part of the duodenum begins at the inferior duodenal
flexure and passes transversely to the left, crossing the inferior vena cava, aorta and the
vertebral column.

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 The fourth (ascending) part passes superiorly, either anterior to, or to the right of, the
aorta, until it reaches the inferior border of the body of the pancreas. Then, it curves
anteriorly and terminates at the duodenojejunal flexure where it joins the jejunum.

Refer students to Handout 22.4: The duodenum for more elaborations

 The jejunum is the middle section of the small intestine

o In adult humans, the small intestine is usually between 5.5-6m long, 2.5m of which is
the jejunum.
o The inner surface of the jejunum, its mucous membrane, is covered in projections
called villi, which increase the surface area of tissue available to absorb nutrients from
the gut contents. The epithelial cells which line these villi possess even larger
numbers of microvilli.
o The villi in the jejunum are much longer than in the duodenum or ileum.
o The jejunum contains very few Brunner's glands (found in the duodenum) or Peyer's
patches (found in the ileum). Instead, it has many large circular folds in its submucosa
called plicae circulares which increase the surface area for nutrient absorption.
o The ileum is the final section of the small intestine. It is separated from the cecum by
the ileocecal valve.
o The function of the ileum is mainly to absorb vitamin B12 and bile salts and whatever
products of digestion which were not absorbed by the jejunum.
o The wall itself is made up of folds, each of which has many tiny finger-like
projections known as villi on its surface. In turn, the epithelial cells which line these
villi possess even larger numbers of microvilli. Therefore the ileum has an extremely
large surface area both for the adsorption (attachment) of enzyme molecules and for
the absorption of products of digestion.
o There is no line of demarcation between the jejunum and the ileum. There are,
however, subtle differences between the two.
o The ileum has more fat inside the mesentery than the jejunum.
o The ileum is a paler color, and tends to be of a smaller caliber as well.
o While the length of the intestinal tract contains lymphoid tissue, only the ileum has
abundant Peyer's patches, unencapsulated lymphoid nodules that contain large
amounts of lymphocytes and other cells of the immune system.

Refer students to Handout 22.5: Structure Small Intestine for more elaboration

Step 6: Large Intestine (25 minutes)

 The large intestine extends from the ileocecal valve to the anus.
 Its subdivisions include the cecum, colon, rectum, and anal canal.
 The mucosa contains numerous goblet cells and the muscularis consists of taeniae coli.
 The large intestine is the second to last part of the digestive system, the final stage of the
alimentary canal is the anus
 It starts in the right iliac region of the pelvis, just at or below the right waist, where it is
joined to the bottom end of the small intestine. From here it continues up the abdomen,
then across the width of the abdominal cavity, and then it turns down, continuing to its

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 endpoint at the anus. Its length is about 1.5 metres long, which is about one-fifth of the
whole length of the intestinal canal. The following are the parts of the large intestine:
 The cecum or caecum (from the Latin caecus meaning blind), is a pouch, connecting the
ileum with the ascending colon of the large intestine.
 It is separated from the ileum by the ileocecal valve is considered to be the beginning of
the large intestine. It is also separated from the colon by the cecocolic junction.
 The ascending colon is smaller in caliber than the cecum, with which it is contiguous.
 It passes upward, from its commencement at the cecum, opposite the colic valve, to the
under surface of the right lobe of the liver, on the right of the gall-bladder, here it bends
abruptly forward and to the left, forming the right colic flexure (hepatic).
 Hepatic (or the right colic) flexure is the sharp bend between the ascending and the
transverse colon. The right colic flexure is adjacent to the liver, and is therefore also
known as the hepatic flexure.
 The left colic flexure is also known as the splenic flexure (as it is close to the spleen).
 The transverse colon the longest and most movable part of the colon, passes with a
downward convexity from the right hypochondrium region across the abdomen, opposite
the confines of the epigastric and umbilical zones, into the left hypochondrium region,
where it curves sharply on itself beneath the lower end of the spleen, forming the splenic
or left colic flexure. Toward its splenic end there is often an abrupt U-shaped curve which
may descend lower than the main curve.
 The descending colon passes downward through the left hypochondrium and lumbar
regions, along the lateral border of the left kidney. At the lower end of the kidney it turns
medial-ward toward the lateral border of the psoas muscle, and then descends, in the
angle between psoas and quadratus lumborum, to the crest of the ilium, where it ends in
the sigmoid colon.
 It is smaller in caliber and more deeply placed than the ascending colon.
 The sigmoid colon (pelvic colon; sigmoid flexure) is the part of the large intestine that is
closest to the rectum and anus. It forms a loop that averages about 40 cm. in length, and
normally lies within the pelvis, but on account of its freedom of movement it is liable to
be displaced into the abdominal cavity.
 It begins at the superior aperture of the lesser pelvis, where it is continuous with the iliac
colon, and passes transversely across the front of the sacrum to the right side of the pelvis.
(The name sigmoid means S-shaped.). It then curves on itself and turns toward the left to
reach the middle line at the level of the third piece of the sacrum, where it bends
downward and ends in the rectum.
 The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final
straight portion of the large intestine and terminating in the anus. Its length is about 12 cm
long. Its caliber is similar to that of the sigmoid colon at its commencement, but it is
dilated near its termination, forming the rectal ampulla.
 The rectum intestinum acts as a temporary storage site for feces. As the rectal walls
expand due to the materials filling it from within, stretch receptors from the nervous
system located in the rectal walls stimulate the desire to defecate. If the urge is not acted
upon, the material in the rectum is often returned to the colon where more water is
absorbed. If defecation is delayed for a prolonged period, constipation and hardened feces
results.

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 The rectum shortens as material is forced into the anal canal and peristaltic waves propel
the feces out of the rectum. The internal and external sphincters allow the feces to be
passed by muscles pulling the anus up over the exiting feces.
 The anus is an opening at the opposite end of the digestive tract from the mouth. Its
function is to control the expulsion of feces, unwanted semi-solid matter produced during
digestion. Flow of substance through the anus is typically controlled by the anal sphincter
muscle.
 The peritoneum covers the ascending and descending colon on the anterior surface and
sides, and therefore they are described as retroperitoneal. The transverse colon and
sigmoid colon are intraperitoneal.

Refer students to Handout 22.6: Large intestine for more information

 Activity: Individual assignment (5 minutes)

 PROVIDE each student with a worksheet 22.1: Gastrointestinal tract.
 ALLOW students to label the diagrams.
 REVIEW with them the correct answers using Handouts of this session.

Step 7: Key Points (5 minutes)

 The stomach is the most dilated part of the gastrointestinal tract and has a J-like shape
 The small intestine extends from the pyloric sphincter to the ileocecal valve
 Small intestine consists of three parts the duodenum, the jejunum and the ileum
 Subdivisions of large include the cecum, colon, rectum, and anal canal.

Step 8: Evaluation (10 minutes)

 Mention parts of the stomach.
 Mention parts of the small intestine.
 Mention the functions of the stomach

 ASK participants if they have any comments or need clarification on any points.

References
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 250

Handout 22.1: The Oesophagus

Source: Elsevier Ltd 2005.

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Handout 22.2: General Structure of Stomach

Source: Elsevier Ltd 2005.

Handout 22.3 Blood Supply to the Stomach

Source: Elsevier Ltd 2005.

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Handout 22.4: The duodenum

Source: Elsevier Ltd 2005.

Handout 22.5: Structure of Small Intestine

Source: Elsevier Ltd 2005.

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Source: Medical-Look

Source: Elsevier Ltd 2005.

Handout 22.6 Large Intestine

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Source: Elsevier Ltd 2005.

Worksheet 22.1: Gastrointestinal tract

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Teaching Guides for NTA Level 4 MLS Curriculum Page 256
Session 17: Accessory Organs of
Digestive System
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Explain overview of accessory organs of digestive system
 Explain structure and functions of the liver.
 Explain functions of the liver.
 Explain structure of gallbladder
 Explain organization of the biliary system
 Explain bile production, circulation and functions
 Recognize structure of Pancreas

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 23.6: The pancreas
 Handout 23.5: The Biliary System
 Handout 23.4: Structure of Gallbladder
 Handout 23.3: Blood Supply to the Liver and Gallbladder
 Handout 23.2: Microscopic Structure of the Liver
 Handout 23.1: Macroscopic Structure of the Liver

SESSION OVERVIEW
Step Time Activity/ Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Overview of Accessory Organs of
Digestive System
3 35 minutes Presentation, Buzz & Structure and functions of the liver.
Brainstorming
4 15 minutes Presentation Structure of gallbladder
5 10minutes Presentation Organization of the biliary system
6 15 minutes Presentation Bile production, circulation and
functions
7 15 minutes Presentation Structure of Pancreas

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 8 5 minutes Presentation Key Points
9 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the Learning Objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Overview of Accessory Organs of Digestive System (10 minutes)

 Activity: Brainstorming (4 minutes)
 ASK student to mention the accessory organs of the digestive system
 ALLOW them to respond
 SUMMARISE their responses using the information below

 Accessory organs of gastrointestinal tract are the organs which are not directly part of
gastrointestinal tract but their products are essential for the digestive system to
accomplish its primary function.
 These organs include:
o The liver,
o Gallbladder and bile duct
o Pancreas.
 These are essential for the digestive system as they either produce or store secretions
essential the digestion to take place.

Step 3: Structure and Functions of the Liver (35 minutes)

 Is the largest gland in the body, weighing between 1 and 2.3Kg i.e. In adults the liver
weighs 2% of body mass
 Occupying the greater part the right hypochondriac, part of the epigastric and frequently
extending into the left hypochondriac regions as far as the left lateral line.
 The liver is divided into right and left lobes by fossae for the gallbladder and the inferior
vena cava. The right lobe of liver is the largest lobe, whereas the left lobe of liver is
smaller wedge-shaped. The quadrate and caudate lobes are described as arising from the
right lobe of liver, but functionally are distinct these are seen on the posterior side of the
liver making it to have four lobes.
 The quadrate lobe is visible on the upper part of the visceral surface of the liver and is
bounded on the left by the fissure for ligamentum teres and on the right by the fossa for
the gallbladder. Functionally it is related to the left lobe of the lever:
 The caudate lobe is visible on the lower part of the visceral surface of the liver and is
bounded on the left by the fissure for the ligamentum venosum and on the right by the
groove for the inferior vena cava. Functionally, it is separate from the right and the left
lobes of the liver.
 Surfaces of the liver include a diaphragmatic surface in the anterior, superior, posterior
directions and a visceral surface in the inferior direction
 The diaphragmatic surface of the liver, which is smooth and domed, lies against the
inferior surface of the diaphragm. Associated with it are the subphrenic and hepatorenal
recesses

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 The subphrenic recess separates the diaphragmatic surface of the liver from the
diaphragm and is divided into right and left areas by the falciform ligament, a structure
derived from the ventral mesentery in the embryo.
 The hepatorenal recess is a part of the peritoneal cavity on the right side between the liver
and the right kidney and right suprarenal gland. The subphrenic and hepatorenal recesses
are continuous anteriorly
 The visceral surface of the liver is covered with visceral peritoneum except in the fossa
for the gallbladder and at the porta hepatis (gateway to the liver).
 Structures related to Liver
o The right anterior part of the stomach;
o The superior part of the duodenum;
o The lesser omentum.
o The gallbladder.
o The right colic flexure.
o The right transverse colon;
o The right kidney;
o The right suprarenal gland.

Refer students to Handout 23.1: Macroscopic Structure of the Liver structure for more
information.

 The porta hepatis serves as the point of entry into the liver for the hepatic arteries and the
portal vein, and the exit point for the hepatic ducts.
 The liver is attached to the anterior abdominal wall by the falciform ligament and, except
for a small area of the liver against the diaphragm (the bare area), the liver is almost
completely surrounded by visceral peritoneum. Additional folds of peritoneum connect
the liver to the stomach (hepatogastric ligament), the duodenum (hepatoduodenal
ligament), and the diaphragm (right and left triangular ligaments and anterior and
posterior coronary ligaments).
 The connective tissue septa divide the liver into hexagon-shaped lobules with a portal
triad at each corner. The triad are so named because three vessels – the hepatic portal
vein, hepatic artery and hepatic duct are commonly located in them
 Hepatic nerves and lymphatic vessels often too small to be easily seen in light
micrographs are also located in these areas.
 Liver lobules are hexagonal in outline and are formed by cubical-shaped cells; the
hepatocytes arranged in pair, between them are columns of cells called sinusoids. Hepatic
macrophages (Kupffer cells) are also present which function in destroy and ingest worn
out cells and foreign particles in the liver.
 A central vein is in the centre of each lobule. Central veins unite to form hepatic veins,
which exit the liver on its posterior and superior surface and empty into the inferior vena
cava.
 Hepatic cord radiate out from the central vein of each lobule like the spokes of a wheel.
The hepatic cords are composed of hepatocytes, the functional cells of the liver. The
spaces between the hepatic cords are blood channels called hepatic sinusoids. The
sinusoids are lined with a very thin, irregular squamous epithelium consisting of two cell
populations; Endothelial cells and Hepatic phagocytic cells (kupffer cells).
 A cleft-like lumen, the bile canaliculus lie between the cells within each cord

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 Refer students to Handout 23.2: Microscopic Structure of the Liver for more
information and elaborations

 Activity: Buzz (5 minutes)

 ASK student what are the functions of hepatocytes
 ALLOW them to buzz in pairs for 2 minutes the allow them to respond
 WRITE their responses on the flipchart
 SUMMARISE their responses using the information below.

 Hepatocytes have six major functions, which are:

o Bile production
o Storage
o Interconversion of nutrients
o Detoxication
o Phargocytosis
o Synthesis of blood components

 Activity: Brainstorming (5 minutes)

 ASK students what are the functions of the liver
 ALLOW them to respond while writing their responses on the flip chart
 SUMMARISE their responses using below information

 The liver is an extremely organ, the main functions are:

o Nutrient and vitamin metabolism and storage
o Glucose and other sugars
o Amino acids (Deamination of amino acids),the end product is urea which is then
excreted in the urine)
o Lipids
o Fatty acids
o Cholesterol
o Lipoproteins
o Fat-soluble vitamins
o Water-soluble vitamins
o Breakdown of erythrocytes and defence against microbes
o Detoxification of drugs and noxious substances
o Inactivation of hormones such as Steroids
o Production of heat
o Formation and Secretion of biles
o Synthesis of plasma proteins
o Acute-phase proteins
o Albumin
o Clotting factors
o Steroid-binding and other hormone-binding proteins
o Immunity; by Kupffer cells

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 Vascular supply and lymphatic drainage
o The vessels connected with the liver are the portal vein, hepatic artery and hepatic
veins. The portal vein and hepatic artery ascend in the lesser omentum to the porta
hepatis, where each bifurcates. The hepatic bile duct and lymphatic vessels descend
from the porta hepatis in the same omentum. The hepatic veins leave the liver via the
posterior surface and run directly into the inferior vena cava
Refer students to Handout 23.3: Blood Supply to the Liver and Gallbladder for more
information and elaboration

Step 4: Structure Gallbladder (15 minutes)

 The gallbladder is a pear-shaped sac lying on the visceral surface of the right lobe of the
liver in a fossa between the right and quadrate lobes. It is about 8 cm long and 4 cm wide
 The gallbladder has the following structures:
o A rounded end (fundus of gallbladder), which may project from the inferior border of
the liver,
o A major part in the fossa (body of gallbladder), which may be against the transverse
colon and the superior part of the duodenum;
o A narrow part (neck of gallbladder) with mucosal folds forming the spiral fold.
 The walls of the gallbladder is formed by three tunics which are
o Inner mucous layer which folded into reggae and this allows it to expand.
o The muscular layer which contains smooth muscles that allows the gallbladder to
contract
o The outer covering layer of the serosa
 Function of the gallbladder;
o It stores and concentrates the bile which is secreted by the liver
o Concentration of the bile by up to 10 or 15 fold by absorption of water through the
walls of the gall bladder
o Realise of stored bile
o Gallbladder receives many small vessels from hepatic bed and cystic arteries a branch
of right hepatic artery
o Venous drainage is through the multiple small veins from the gallbladder bed.

Refer students to Handout 23.4: The Gallbladder for more information.

Step 5: Organisation of the Biliary System (10 minutes).

 Is the duct system for the passage of bile extends from the liver, connects with the
gallbladder, and empties into the descending part of the duodenum. The coalescence of
ducts begins in the liver parenchyma and continues until the right and left hepatic ducts
are formed. These drain the respective lobes of the liver.
 The two hepatic ducts combine to form the common hepatic duct, which runs, near the
liver, with the hepatic artery proper and portal vein in the free margin of the lesser
omentum.
 As the common hepatic duct continues to descend, it is joined by the cystic duct from the
gallbladder. This completes the formation of the bile duct. At this point, the bile duct lies
to the right of the hepatic artery proper and usually to the right of, and anterior to, the

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 portal vein in the free margin of the lesser omentum. The omental foramen is posterior to
these structures at this point.
 The bile duct continues to descend, passing posteriorly to the superior part of the
duodenum before joining with the pancreatic duct to enter the descending part of the
duodenum at the major duodenal papilla
 Therefore the bile either empties directly into the duodenum or is diverted for minutes up
to several hours through the cystic duct into the gallbladder,
 The clinical importance of this system is if there is a tumour of the head of pancreas will
cause obstruction to the bile duct and cause a condition known as obstructive jaundice.

Refer students to Handout 23.5: The biliary system for more information.

Step 6: Bile Production, Circulation and Functions (15 minutes)

 The liver produces and secretes about 600-1000ml of bile each day. Continuous bile
formation is an important function of the liver, and bile is used as a vehicle for the
secretion of bile acids
 Bile salts are quantitatively the major constituents of bile and are circulated in the
enterohepatic circulation between the liver and the small intestine with high efficiency.
 Synthesis of bile acids is a major route of cholesterol metabolism. Bile is synthesised
through a series of chemical reactions in hepatocytes then secreted into minute bile
canaliculi that originate between the hepatic cells. The mechanisms involved in the
transcellular movement of bile salts across hepatocytes is poorly understood
 The body produces about 800 mg of cholesterol per day and about half of that is used for
bile acid synthesis.
 90% of excreted bile acids are reabsorbed by active transport in the ileum and recycled in
what is referred to as the enterohepatic circulation which moves the bile salts from the
intestinal system back to the liver and the gallbladder.
 Clinical significance is, since bile acids are made from endogenous cholesterol, the
enterohepatic circulation of bile acids may be disrupted to lower cholesterol.
 Bile circulation
 Bile is produced by hepatocytes in the liver, draining through the many bile ducts that
penetrate the liver. During this process, the epithelial cells add a watery solution that is
rich in bicarbonates that dilutes and increases alkalinity of the solution. Bile then flows
into the common hepatic duct, which joins with the cystic duct from the gallbladder to
form the common bile duct.
 The common bile duct in turn joins with the pancreatic duct to empty into the duodenum.
If the sphincter of Oddi is closed, bile is prevented from draining into the intestine and
instead flows into the gallbladder, where it is stored and concentrated to up to five times
its original potency between meals. This concentration occurs through the absorption of
water and small electrolytes, while retaining all the original organic molecules.
 Cholesterol is also released with the bile, dissolved in the acids and fats found in the
concentrated solution. When food is released by the stomach into the duodenum in the
form of chyme, the duodenum releases cholecystokinin, which causes the gallbladder to
release the concentrated bile to complete digestion.
 Most bile salts are absorbed in ileum and carried in the blood back to liver

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 The concentration of bile salts in bile is 0.8%, however the gall bladder removes water
from the bile, concentrating it between meals. It concentrates it up to 5 times
 Bile has no enzyme but plays a role in the digestion by neutralize and diluting stomach
acids and emulsifying fat.
 Bile constitutes of water, mineral salts, mucous, bile pigment (bilirubin), bile salts which
are derived from the primary bile acids and cholesterol
 Bile plays an important role in fat digestion and absorption due to the presence of bile
acids by do the following;
 They help to emulsify the large fat particles of the food into many minute particles, the
surface of which can then be attacked by lipase enzymes secreted in pancreatic juice,
 They aid in absorption of the digested fat end products through the intestinal mucosal
membrane.
 Bile serves as a means for excretion of several important waste products from the blood.
These include especially bilirubin, an end product of hemoglobin destruction, and
excesses of cholesterol.
 Composition of bile
o Bile contain the following
o Water constitute 97.0%, in the gall bladder the amount is reduced 5 folds
o Bile pigments 0.2%
o Cholesterol0.06%
o Inorganic salts 0.7% such as Na+, K+& Ca2+ salts Cl- HCO3- & Phosphorus
o Fatty acids 0.15%
o Lecithin 0.1%
o Fat 0.1%
o Alkaline phosphatase
o Proteins

Step 7: Structure of Pancreas (15 minutes)

 The pancreas lies mostly posterior to the stomach. It extends across the posterior
abdominal wall from the duodenum, on the right, to the spleen, on the left. It is 12 to 15
cm long; weighs approximately 60gm
 Composed of endocrine and exocrine glandular tissue
 Exocrine portion makes up majority of pancreas; has a compound acinar arrangement and
tiny ducts which unite to form the main pancreatic duct, which empties into the
duodenum. It secretes pancreatic juice which consists of pancreatic enzymes.
 Endocrine portion – embedded between exocrine units; called pancreatic islets; constitute
only 2% of the total mass of the pancreas; made up of alpha cells and beta cells which
produce glucagon and insulin respectively and pass its secretions into capillaries
 The pancreas is (secondarily) retroperitoneal except for a small part of its tail and consists
of a head, uncinate process, neck, body, and tail:
 The head of pancreas lies within the C-shaped concavity of the duodenum;
 Projecting from the lower part of the head is the uncinate process, which passes posterior
to the superior mesenteric vessels;
 The neck of pancreas is anterior to the superior mesenteric vessels, and, posterior to the
neck of the pancreas, the superior mesenteric and the splenic veins join to form the portal
vein;
 The tail of pancreas ends as it passes between layers of the spleno-renal ligament.

Teaching Guides for NTA Level 4 MLS Curriculum Page 263

 The pancreatic duct begins in the tail of the pancreas. It passes to the right through the
body of the pancreas and, after entering the head of the pancreas, turns inferiorly. In the
lower part of the head of pancreas, the pancreatic duct joins the bile duct. The joining of
these two structures forms the hepatopancreatic ampulla (Ampulla of Vater), which enters
the descending part of the duodenum at the major duodenal papilla. Surrounding the
ampulla is the sphincter of ampulla (sphincter of Oddi), which is a collection of smooth
muscle. The accessory pancreatic duct empties into the duodenum just above the major
duodenal papilla at the minor duodenal papilla. If the accessory duct is followed from the
minor papilla into the head of the pancreas, a branch point is discovered:
 One branch continues to the left, through the head of the pancreas, and may connect with
the pancreatic duct at the point where it turns inferiorly;
 A second branch descends into the lower part of the head of pancreas, anterior to the
pancreatic duct, and ends in the uncinate process.
 The main and accessory pancreatic ducts usually communicate with each other. The
presence of these two ducts reflects the embryologic origin of the pancreas from dorsal
and ventral processes.
 The blood supply; the arterial supply is through pancreatic arteries the branches of splenic
artery, gastro-duodenal and superior mesenteric arteries.
 Venous drainage follows arterial supply. Splenic vein drains the body and tail
 Innervation of Pancreas is from sympathetic and parasympathetic nerves of coelic and
superior mesenteric ganglion of thoracic plexus and vagus nerve.

NB: Digestive enzymes produced by pancreas will be discussed in Session: 24 of this

module.

Refer students to Handout 23.6: The pancreas for more elaboration

Step 8: Key Points (5 minutes)

 Accessory organs of the gastrointestinal tract are the liver, gallbladder, bile duct and
pancreas
 Liver consists of four lobes
 Concentration of the bile by up to 10 or 15 fold by takes place through the walls of the
gall bladder by absorption of water
 Pancreas composed of endocrine and exocrine glandular tissue

Step 9: Evaluation (10 minutes)

 Ask students to:
 Mention the lobes of the liver
 Mention the functions of the liver.
 Describe the bile flow
 Mention the composition of bile
 ASK participants if they have any comments or need clarification on any points.

References
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins

Teaching Guides for NTA Level 4 MLS Curriculum Page 264

 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 265

Handout 23.1: Macroscopic Structure of the Liver

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 266

Handout 23.2: Microscopic Structure of the Liver

Source: Elsevier Ltd 2005.

Handout 23.3: Blood Supply to the Liver and Gallbladder

Source: Lippincott Williams & Wilkins, 2007

Teaching Guides for NTA Level 4 MLS Curriculum Page 267

Source: Lippincott Williams & Wilkins, 2007

Source: Elsevier Ltd 2005.

Handout 23.4: Structure of Gallbladder

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 268

Source: Elsevier Ltd 2007.

Handout 23.5: The Biliary System

Source: Elsevier Ltd 2005.

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 269

Handout 23.6: The pancreas

Source: Elsevier Ltd 2005.

Source: Elsevier Ltd 2005.

Source: BrooksCole Thomson learning, 2001

Teaching Guides for NTA Level 4 MLS Curriculum Page 270

Session 18: Digestive Secretions and
Digestion.
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 State functions and control of saliva secretion
 List secretions of gastric glands
 Explain regulation of gastric secretion
 Explain production of pancreatic secretions
 Recognise intestinal juice and bile secretions
 Describe digestion process
 Describe absorption and elimination processes

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer

SESSION OVERVIEW
Step Time Activity/ Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Buzzing, Presentation Control and Function of Saliva
3 15 minutes Presentation Secretions of Gastric Glands
4 20 minutes Presentation Regulation of Gastric Secretion
5 15 minutes Presentation Pancreatic Secretions Production
6 10 minutes Presentation Intestinal Juice and Bile Secretions
7 20 minutes Brainstorming, Presentation Digestion Process
8 10minutes Presentation Absorption and Elimination
Processes
9 5 minutes Presentation Key Points
10 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the Learning Objectives, and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 271

Step 2: Control and Function of Saliva (10 minutes)
 Activity: Buzz (2 minutes)
 ASK students to mention three glands that secret saliva
 ALLOW them buzz in pairs
 WRITE their responses on the flip chart.
 SUMMARISE their responses

 Their answer should include: Submandibular glands are compound glands that contain
enzymes and mucous-producing element; Parotid glands are the largest of the paired
salivary glands produce watery saliva containing enzymes and Sublingual glands are the
smallest of the salivary glands produce a mucous type of saliva

 Digestive secretions are secretions which are important for the process of digestion.
These secretions are produced by various glands in the gastrointestinal tract and its
accessory organs.
 As the digestion process start in the mouth. In the mouth there is salivary glands which
produce saliva.
 Saliva is secreted in large amounts (1-1.5 litres/day) by three pairs of Salivary glands
 Saliva consists of Mucus which lubricates food and water, facilitate mixing of food
 Amylase is an enzyme that begins digestion of starches by converting it to maltose and
isomaltose.
 There is a small amount of salivary lipase released but its function is uncertain
 Sodium bicarbonate increases the pH for optimum amylase function
 Control of saliva secretion is by
 Only reflex mechanisms control the secretion of saliva
 Chemical and mechanical stimuli come from presence of food in the mouth
 Olfactory and visual stimuli come from smell and sight of food
 In the oesophagus the mucosa lining of the oesophagus secrete mucus secretions which is
important for lubrication and allow food to move more smoothly through the oesophagus
 Step 3: Secretions of Gastric Glands (15 minutes)
 The gastric mucosa lining has secretory cells which secrete secretions essential for the
digestion to take place.
 Pepsinogen is produced by chief cells, this is inactive. It is activated by hydrochloric acid
by removing some of its amino acids and converts it to pepsin. This is a protease that
begins the digestion of protein.
 In infants, the chief cells also secrete gastric lipase and chymosin (rennin). Gastric lipase
digests some of the butterfat of milk, and chymosin curdles milk by coagulating its
proteins.
 Hydrochloric acid (secreted by parietal cells) decreases the pH of chyme for activation
and optimum function of pepsin other functions include:
 It activates the enzymes pepsin and lingual lipase.
 It breaks up connective tissue and plant cell walls, helping to liquefy food and form
chyme
 It converts ingested ferric ions (Fe3+) to ferrous Fe2+ form of iron that can be absorbed
and used for haemoglobin synthesis

Teaching Guides for NTA Level 4 MLS Curriculum Page 272

 It contributes to nonspecific disease resistance by destroying ingested bacteria and other
pathogens.
 Intrinsic factor (secreted by parietal cells) protects vitamin B12 and later facilitates its
absorption. Without vitamin B12, haemoglobin cannot be synthesized and pernicious
anemia develops
 Mucus and water lubricates, protects and facilitates mixing of chime

Step 4: Regulation of Gastric Secretion (20 minutes)

 The nervous and endocrine systems collaborate to increase gastric secretion and motility
when food is eaten and suppresses them as the stomach empties. Gastric activity is
divided into three stages called the cephalic, gastric, and intestinal phases, based on
whether the stomach is rolled by the brain, by itself, or by the small intestine respectively.
These phases overlap and all can occur simultaneously.
 Cephalic phase - This phase occurs before food enters the stomach and involves
preparation of the body for eating and digestion. Sight and thought stimulate the cerebral
cortex. Taste and smell stimulus is sent to the hypothalamus and medulla oblongata. After
this it is routed through the vagus nerve and release of acetylcholine. Gastric secretion at
this phase rises to 40% of maximum rate.
 Gastric phase. This phase takes 3 to 4 hours. It is stimulated by distension of the stomach,
presence of food in stomach and decrease in pH. Distension activates long and myentric
reflexes. This activates the release of acetylcholine which stimulates the release of more
gastric juices.
 Intestinal phase. When the partially digested contents of the stomach reach the small
intestine two hormones Secretin and Cholecystokinin (CCK) are produced by endocrine
cells in the intestinal mucosa. These they slow down secretion of Gastric juice and reduce
Gastric motility.
 By slowing rate of the stomach, the chime and the duodenum become more parallel
mixed with bile and pancreatic juice. This phase of gastric secretion is most marked
following a meal with high fat content.

Step 5: Pancreatic Secretions Production (15 minutes)

 Pancreatic juice; secreted by acinar and ducts cells of the pancreas are important for the
digestion of all major classes of food (lipids, proteins, and carbohydrates are not
adequately digested without pancreatic juices). The major enzymes produced by the
pancreas are:
o Proteolytic enzymes the; Trypsin, chymotrypsin and carboxypeptidase. They are
secreted in their inactive forms as trypsinogen, chymotrypsinogen, and
procarboxypeptidase.
 If were produced in active form they would digest the tissues producing them.
 Within the pancreas, enzyme activation is prevented by an antiproteolytic enzyme
secreted by the acinar cells
 Are enzymes essential for proteins digest and polypeptides
 Duodenal enzyme, enterokinase, converts trypsinogen to trypsin. Trypsin, in turn,
activates chymotrypsin, elastase, carboxypeptidase, and phospholipase
 Amylase is an enzyme that digests starches. Panreatic amylase continues the
polysaccharide digestion which was initiated in the oral cavity
 Only digestive enzyme secreted by the pancreas in an active form

Teaching Guides for NTA Level 4 MLS Curriculum Page 273

 Functions optimally at a ph of 7
 Hydrolyzes starch and glycogen to glucose, maltose, maltotriose, and dextrins
 Lipid digesting enzyme called pancreatic lipase, break down lipids into free fatty acids
and cholesterol.
 Function optimally at a ph of 7 to 9
 Emulsify and hydrolyze fat in the presence of bile salts
 Lipases are enzymes that digest nucleic acid such as DNA and RNA
 Sodium bicarbonates increases the pH for optimum enzyme function; its manufacture also
helps restore normal pH of blood
 Pancreatic secretion is stimulated by several hormones released by intestinal mucosa
 Secretin evokes production of pancreatic fluid low in enzyme but high in bicarbonate
 CCK has several functions :
 Causes increased exocrine secretion from the pancreas
 Opposes gastrin, thus inhibiting gastric HCL secretion
 Stimulates contraction of the gallbladder so that bile is ejected into the duodenum

Step 6: Intestinal Juice and Bile (10 minutes)

 Intestinal juice is secreted by cells of the intestinal exocrine cells
 Mucus and water lubricate and aid in continued mixing of chyme
 Sodium bicarbonate increases pH for optimum enzyme function
 Enzymes of the intestinal mucosa are bound to the membranes of the absorptive cell
microvilli. These enzymes are not secreted into the intestine. These surface-bound
enzymes include
 Disacccharidases (sucrase, maltase, and lactase) which break disaccharides (sucrose,
maltose and lactose) down to monosaccharides (glucose, fructose & galactose).
 Peptidases, which hydrolyse the peptide bonds between small amino acid chains
 Nucleases, which break down nucleic acids.
 Intestinal lipase which splits fats into fatty acids and glycerol.
 Little is known on how intestinal secretion is regulated; suggested that the intestinal
mucosa is stimulated to release hormone that increase the production of intestinal juice
 Bile secreted by the liver, stored and concentrated in the gallbladder
 Lecithin and bile salts emulsify fats by encasing them in a shells to form tiny spheres
called micelles
 Sodium bicarbonate increases pH for optimum enzyme function
 Cholesterol, products of detoxification and bile pigments (e.g. bilirubin) are the waste
products excreted by the liver and eventually eliminated in the faeces
 Bile is secreted continually by the liver; secretin and CCK stimulate ejection of bile from
the gallbladder

Step 7: Digestion Process (20 minutes)

 Activity: Brainstorming (5 minutes)
 ASK students to define digestion and what is the importance of digestion
 ASK few students to respond to the question
 SUMMARISE their responses using the information below

 Digestion is a multi-stage process in the digestive system, starting from ingestion.

Teaching Guides for NTA Level 4 MLS Curriculum Page 274

 Mechanical digestion breaks large food particles into smaller one and chemical digestion
involves the breaking of covalent chemical bonds in organic molecules by digestive
enzymes
 Is the process by which the body breaks down chemicals into smaller components that
can be absorbed by the blood stream.
 Digestion begins in the oral cavity where food is chewed and mixed with saliva
containing enzymes.
 The stomach continues to break food down mechanically and chemically through the
churning of the stomach and mixing with enzymes
 The acid itself does not break down food molecules; rather it provides an optimum pH for
the reaction of the enzyme pepsin and kills many microorganisms that are ingested with
the food.
 Other small molecules such as alcohol are absorbed in the stomach, passing through the
membrane of the stomach and entering the circulatory system directly.
 Food in the stomach is in semi-liquid form, which upon completion is known as chyme.
 The digestive process is enhanced by gastric and intestinal motility, the peristalsis and
segmentation. These are produced by the smooth muscles of the GI tract. They can occur
together, in an alternating fashion
 Peristalsis is wave like ripple of the muscle layer of a hollow organ; progressive motility
that produces forward movement of matter along the GI tract
 Segmentation is a mixing movement; digestive reflexes cause a forward and backward
movement with a single segment of the GI tract; helps breakdown food particles, mixes
food and digestive juices and brings digested food in contact with intestinal mucosa to
facilitate absorption
 Chemical digestion is a change in chemical composition of food as it travels through the
digestive tract; these changes are the results of hydrolysis
 Carbohydrates are saccharide compounds. Are the most abundant biological molecules,
and fill numerous roles, such as the storage and transport of energy (starch, glycogen) and
structural components
 Polysaccharides are hydrolyzed by amylase to form disaccharides (sucrose, lactose, and
maltose
 Final step of carbohydrate digestion are catalysed by sucrase, lactase, and maltase, which
are found in the cell membrane of epithelial cells covering the villi that line the intestinal
lumen.
 The basic carbohydrate units are called monosaccharides, include galactose, fructose, and
most importantly glucose.
 Monosaccharides can be linked together to form polysaccharides in almost limitless ways.
 Protein digestion
 Proteins are made of amino acids arranged in a linear chain and joined together by
peptide bonds.
 Many proteins are the enzymes that catalyze the chemical reactions in metabolism.
 Protease catalyse hydrolysis of protein into intermediate compounds and finally into
amino acids
 Main protease: pepsin in gastric juice, trypsin in pancreatic juice, peptidase in intestinal
brush border
 Fat digestion
 Fats must be emulsified by bile in the small intestine before being digested

Teaching Guides for NTA Level 4 MLS Curriculum Page 275

 Pancreatic lipase is the main fat-digesting enzyme
 The presence of fat in the small intestine produces hormones which stimulate the release
of lipase from the pancreas and bile from the gallbladder. The lipase (activated by acid)
breaks down the fat into monoglycerides and fatty acids. The bile emulsifies the fatty
acids so they may be easily absorbed.

Step 8: Absorption and Elimination (10 minutes)

 Absorption and transport are the means by which molecules are moved out of the
digestive tract and into the circulation for distribution throughout the body.
 Process of absorption
 Passage of substances through the intestinal mucosa into the blood or lymph
 Most absorption occurs in the small intestine
 Mechanism of absorption
 For some substances such as water, absorption occurs by simple diffusion or osmosis
 Other substances are absorbed through complex mechanisms. Some monosaccharides like
fructose are transferred by facilitated diffusion to the capillaries of the intestinal villi.
Sodium is absorbed by active transport and glucose and amino acid co-transport.
 After food is absorbed, it travels to the liver via the portal system
 Most absorption takes place in the small intestine in the duodenum and jejunum although
some absorption occurs in the ileum such as Vitamin B12 and bile salts are absorbed in
the terminal ileum. Iron is absorbed in the duodenum.
 Absorption of certain molecules can occur all along the digestive tract. A few chemicals
such as nitroglycerin, can be absorbed through the thin mucosa of the oral cavity below
the tongue
 Alcohol and aspirin are absorbed in the stomach
 Water and lipids are absorbed by passive diffusion throughout the small intestine.
 Elimination – the expulsion of faeces from the digestive tract; act of expelling faeces is
called defecation
 Defecation occur as a result of a reflex brought about by stimulation of receptors in the
rectal mucosa that is produced when the rectum is distended
 Constipation – contents of the lower colon and rectum move at a slower than normal rate;
extra water is absorbed from the faeces, resulting in a hardened stool
 Diarrhoea – results of increased motility of the small intestine, causing decreased
absorption of water and electrolytes and a watery stool

Step 9: Key points (5 minutes)

 Digestive secretions are secretions which are important for the process of digestion
 Mucus and water lubricates, protects and facilitates mixing of chime
 Gastric activity is divided into three stages called the cephalic, gastric, and intestinal
phases
 Pancreatic secretion is stimulated by several hormones released by intestinal mucosa
 Enzymes of the intestinal mucosa are bound to the membranes of the absorptive cell
microvilli. These enzymes are not secreted into the intestine.

Step 10: Evaluation questions (15 minutes)

 Mention two types of digestion process
 Mention enzymes that digest protein

Teaching Guides for NTA Level 4 MLS Curriculum Page 276

 What is the end product of chemical digestion of protein, carbohydrate and fats

References
 Drake R .L, Vogl W, Mitchell A W M (2007). Gray’s Anatomy for Students, United
Kingdom: Churchill Livingstone Elservier
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 277

Session 19: Carbohydrate Metabolism
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Define metabolism and its division
 Explain carbohydrates metabolism
 Explain citric acid cycle
 Recognise other source of glucose
 Explain control of glucose metabolism

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 25.1: Citric Acid Cycle
 Handout 25.2: Hormones that Influence Blood Glucose Level

SESSION OVERVIEW
Step Time Activity/ Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Introduction to Metabolism
3 20 minutes Presentation Carbohydrates Metabolism
4 20 minutes Presentation Citric Acid Cycle
5 10 minutes Presentation Other Source of Glucose
6 40 minutes Presentation Control of Glucose Metabolism
7 05 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Introduction, Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Introduction to Metabolism (10 minutes)

 Activity: brainstorm (5 minutes)
 ASK student to define what is metabolism
 ALLOW them to respond

Teaching Guides for NTA Level 4 MLS Curriculum Page 278

 SUMMARISE their response using the information below

 Metabolism refers to the complex, interactive set of chemical process that makes life
possible.
 It is made up of two major processes, catabolism and anabolism. Each of these in turn
consists of a series of enzyme-catalyzed chemical reactions known as metabolic pathway.
 Catabolism breaks food molecules down into smaller molecular compounds and, in so
doing, releases energy from them. While anabolism does the opposite. It builds nutrient
molecules up into larger molecular compounds in so doing, uses energy
 Catabolism is a decomposition process while anabolism is a synthesis process. Both
catabolism and anabolism takes place inside cells.
 Catabolism releases energy in two forms heat and chemical energy. The amount heat
generated is relatively large; so large in fact it would hardboiled cells if it were released in
one large burst. Fortunately, this does not happen.
 Heat is practically useless as an energy source for cell in that they cannot use it to do their
work. However this heat is important in maintaining the homeostasis of body temperature
 Chemical energy released by catabolism is more obviously useful. It cannot, however, be
used directly for biological reactions. First it must be transferred to the high-energy
molecule of adenosine triphosphate (ATP)
 ATP is one of the most important compounds in the world because it supplies energy
directly to the energy-using reactions of all cells in all kind of living organisms. Adding
water (H2O) to ATP yield a phosphate group, adenosine diphosphate (ADP) and energy
which is used for anabolism and other cell work.

Step 3: Carbohydrates Metabolism (20 minutes)

 Activity: Buzz (5 minutes)
 ASK student what is the end product of digestion of starch
 ALLOW them to buzz in pair for 2 minutes
 ASK few students to respond
 SUMMARISE their response by referring to the previous session of digestion

 Carbohydrates are found in most of the foods that we eat. Complex carbohydrates –
polysaccharides (such as starches in vegetables, grains and other plant tissue) are broken
down into simpler carbohydrates before they are absorbed as Monosaccharides.
 Cellulose – a major compound of most plant tissue is an important exception to this
principle. Since human do not make enzymes that chemically digest this complex CHO, it
passes through our system without being broken down. Also called dietary fibres or
roughage, cellulose and other indigestible polysaccharides keep chyme thick enough for
the digestive system to push it easily
 The monosaccharide in the form of glucose is the carbohydrate that is the most useful to
the typical human cell. Other important monosaccharide – fructose and galactose are
usually converted by liver cells into glucose for use by other cells of the body.
 Carbohydrates metabolism begins with the movement of glucose through cell
membranes.

Teaching Guides for NTA Level 4 MLS Curriculum Page 279

 Immediately on reaching the interior of a cell, glucose reacts with ATP to form glucose 6-
phosphate. This step, named glucose phosphorylation prepares glucose for further
metabolic reactions.
 It is an irreversible reaction in most cells of the body except those of the intestinal
mucosa, liver, kidney tubules where this process is reversible. These cells contain
phosphatase, an enzyme that splits phosphate off from glucose-6-phosphate. This reverse
glucose phosphorylation reaction forms glucose, which then moves out of the cells into
the blood. (Glucose-6-phosphate cannot pass through cell membranes)
 Glucokinase is an enzyme that facilitates phosphorylation of glucose to glucose-6-
phosphate. Glucokinase occurs in cells in the liver, pancreas, gut, and brain of humans
 The major reason for the immediate phosphorylation of glucose is to prevent diffusion out
of the cell. The phosphorylation adds a charged phosphate group so the glucose 6-
phosphate cannot easily cross the cell membrane.
 Glycolysis is the first process of carbohydrate catabolism. It is a metabolic pathway found
in the cytoplasm of cells that converts one molecule of glucose into two molecules of
pyruvate, (pyruvic acid) and makes energy in the form of two net molecules of ATP.
Glycolysis results in the net production of 2 ATP and 2 NADH ions.
 Glycolysis consists of a series of chemical reactions. A specific enzyme catalyzes each of
these reactions. The initial phosphorylation of glucose is required to destabilize the
molecule for cleavage into two triose sugars.
 Glycolysis is an anaerobic process, that is, it does not use oxygen. It is the only process
that provide cells with energy when their oxygen supply is inadequate or even absent
 Glycolysis is an essential process because it prepares glucose for second step in
catabolism, namely the citric acid cycle. Glucose itself cannot enter the cycle but it must
be converted to pyruvic acid then to a compound called acetyl-CoA (coenzyme A)
 In the presence of oxygen, the product of glycolysis, pyruvate, can enter the citric acid
cycle, where it is converted into carbon dioxide. The free energy released in that process
is used to produce considerably more ATP and NADH.

Step 4: Citric Acid Cycle (20 minutes)

 Before each pyruvic acid molecules can proceed into the citric acid cycle, it must be
converted into an acetyl group (acetate), releasing a carbon dioxide molecules and carried
into the citric acid cycle by co enzyme A (CoA).
 This process is known as Oxidative decarboxylation of pyruvate.
 The pyruvate is oxidized to acetyl-CoA and CO2 by the Pyruvate dehydrogenase
complex, a cluster of enzymes; multiple copies of each of three enzymes located in the
mitochondria.
 In the process one molecule of NADH is formed per pyruvate oxidized, and 3 moles of
ATP are formed for each mole of pyruvate. This step is also known as the link reaction,
as it links glycolysis and the Krebs cycle.
 Citric acid cycle
o Glycolysis takes place in the cytoplasm of cell, whereas the citric acid cycle occurs in
their mitochondria.
o This is also called the Krebs cycle or the tricarboxylic acid cycle. When oxygen is
present, acetyl-CoA is produced from the pyruvate molecules created from glycolysis.
Once Acetyl CoA is formed, two processes can occur, aerobic or anaerobic
respiration. When oxygen is present, the mitochondria will undergo aerobic

Teaching Guides for NTA Level 4 MLS Curriculum Page 280

 respiration which leads to the Krebs cycle. However, if oxygen is not present,
fermentation of the pyruvate molecule will occur.
o In the presence of oxygen, when acetyl-CoA is produced, the molecule then enters the
citric acid cycle (Krebs cycle) inside the mitochondrial matrix, and gets oxidized to
CO2 while at the same time reducing NAD to NADH.
o NADH can be used by the electron transport chain to create further ATP as part of
oxidative phosphorylation. To fully oxidize the equivalent of one glucose molecule,
two acetyl-CoA must be metabolized by the Krebs cycle. Two waste products, H2O
and CO2, are created during this cycle.
o The citric acid cycle is an 8-step process involving 8 different enzymes. Throughout
the entire cycle, Acetyl CoA changes into Citrate, Isocitrate, α-ketoglutarate,
succinyl-CoA, succinate, fumarate, malate, and finally, oxaloacetate.
o The net energy gain from one cycle is 3 NADH, 1 FADH, and 1 ATP. Thus, the total
amount of energy yield from one whole glucose molecule (2 pyruvate molecules) is 6
NADH, 2 FADH, and 2 ATP.This is a vital part of our life.
 Oxidative phosphorylation
o High energy electrons removed during the citric acid cycle enter a chain of carrier
molecules, which is embedded in the inner membrane of mitochondria and is known
as the electron transport system. Oxidative phosphorylation occurs in the
mitochondrial cristae.
o It comprises the electron transport chain that establishes a proton gradient
(chemiosmotic potential) across the inner membrane by oxidizing the NADH
produced from the Krebs cycle. ATP is synthesised by the ATP synthase enzyme
when the chemiosmotic gradient is used to drive the phosphorylation of ADP. The
electrons are finally transferred to exogenous oxygen, and with the addition of two
protons, water is formed.
 Anaerobic respiration
o Without oxygen, pyruvate is not metabolized by cellular respiration but undergoes a
process of fermentation.
o The pyruvate is not transported into the mitochondrion, but remains in the cytoplasm,
where it is converted to waste products that may be removed from the cell. This
serves the purpose of oxidizing the hydrogen carriers so that they can perform
glycolysis again and removing the excess pyruvate.
o This waste product varies depending on the organism. In skeletal muscles, the waste
product is lactic acid. This type of fermentation is called lactic acid fermentation.
o Anaerobic respiration is less efficient at using the energy from glucose since 2 ATP
are produced during anaerobic respiration per glucose, compared to the 38 ATP per
glucose produced by aerobic respiration. This is because the waste products of
anaerobic respiration still contain plenty of energy.
Refer students to Handout 25.1: Citric Acid Cycle for more elaboration

Step 5: Other Source of Glucose (10 minutes)

 Glycogenesis; the process of glycogen formation is called glycogenesis, this takes
place in the liver and stored there. This process level increases above the midpoint of
its normal range. As a result of glycogenesis the blood glucose level decreases.
 Glycogenolysis

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 o Glycogen molecules do not remain in the cell permanently but are eventually
broken apart (hydrolysed).
o This process of splitting glycogen is called glycogenolysis.
o Liver, kidney and intestinal mucosa cells have the enzymes phosphate, which
allow free glucose to form and possibly leave the cell and increase blood glucose
level.
o Glycogenolysis alone can maintain homeostasis of blood glucose concentrate for
only a few hours, since the body can store only small amount of glycogen.
 Gluconeogenesis
o Gluconeogenesis means the formation of the new glucose in the sense that it is
made from protein or less frequently from the glycerol or fats.
o The process occurs chiefly in the liver.
o The new glucose produced from protein or fats by gluconeogenesis diffuses out of
the liver cells into the blood.
o Gluconeogenesis, therefore can add glucose to the blood when needed. Obviously,
then the liver is the most important organ for maintaining blood glucose
homeostasis.

Step 6: Control of Glucose Metabolism (40 minutes)

 Activity: Small group discussion (10 minutes)
 DIVIDE students into 5 groups.
 For each group assign one endocrine gland. The glands are: Pancreatic islets, Adrenal
medulla, Adrenal cortex, Anterior pituitary gland and Thyroid gland
 ASK them how these glands control glucose metabolism.
 GIVE them 10 minutes for preparation
 ALLOW them to present their work. 4 minutes for each group.

 Below information will GUIDE you during their presentations.

 The complex mechanism that normally maintains homeostasis of blood glucose
concentration consists of hormonal and neural devices. Five endocrine glands are
involved at least 8 hormones are secreted by those glands, which functions as the key
parts of the glucose homeostasis mechanisms.
 The glands are:
o Pancreatic islets
o Adrenal medulla
o Adrenal cortex
o Anterior pituitary gland
o Thyroid gland
 The pancreatic islets
o β-cells of the pancreatic islets secrete the most well known sugar-regulating hormone
of all – insulin
o Effect of insulin on glucose uptake and metabolism. Insulin binds to its receptor,
which in turn starts many protein activation cascades. These include: translocation of
Glut-4 transporter to the plasma membrane and influx of glucose, glycogen synthesis,
glycolysis and fatty acid synthesis. In this way it decreases blood glucose level. By
moving the glucose into cells.

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 o It also increases the activity of enzymes glucokinase. Glucokinase catalyses glucose
and phosphorylation
o Insulin deficiency will result into increase glucose level in blood, slow glycogenesis
and low glycogen storage decrease glucose catabolism.
o α-cell of the pancreatic islets secretes the sugar-regulating hormone glucagon.
o Glucagon tends to increase blood glucose level
o Glucagon increases the activity of the enzyme phosphorylase and this accelerates liver
glycogenolysis and releases more of its product, glucose into the blood
 Adrenal medulla.
o Epinephrine (adrenaline) is a hormone secreted in large amount by the adrenal
medulla in times of emotional or physical stress
o Like glucagon, epinephrine increases phosphorylase activity.
o This makes glycogenolysis occur at a faster rate
o Epinephrine accelerates both liver and muscle glycogenolysis. Whereas, glucagon
accelerates only liver glycogenolysis
o Both hormone increase the blood glucose level
o Epinephrine is the only hormone whose release into the systemic circulation is
directly under the control of the nervous system
o Adrenal cortex
o Adrenocorticotropic hormone (ACTH) and glucocorticoids (e.g. cortisone) there are
two hormone that increase blood glucose concentration.
o ACTH stimulates the adrenal cortex to increase secretions of glucocorticoids
o Glucocorticoids accelerate gluconeogenesis. They do this by mobilizing protein i.e the
breakdown or hydrolysis, of the tissue protein to amino acid. Liver cells step up their
production of new glucose from the mobilized amino acid. More glucose stream out
of liver cell into the blood and add to the blood glucose level.
o Anterior pituitary gland
o Growth hormone (GH) made by the anterior pituitary also increase blood glucose
level but by different mechanism
o GH causes the shift from CHO to fat metabolism.
o It does this by limiting the storage of fat and fat deposit. Instead more fat are
mobilised and catabolised. In this way GH “spares” carbohydrates from catabolism,
and the level of glucose in the blood is increased.
 Thyroid stimulating hormone (TSH)
o TSH from the anterior pituitary gland and its target secretion, thyroid hormone (T3
and T4) has complex effect on metabolism.
o Some of these raise and some lower the glucose level.
o One of the effects of the thyroid is to accelerate catabolism, and since glucose is the
body’s preferred fuel the result may be decrease in the blood level

Refer students to Handout 25.2: Hormones that Influence Blood Glucose Level for the
summary of the above information.

Step 7: Key Points (5 minutes)

 Metabolism refers to the complex, interactive set of chemical process that makes life
possible.
 Glycolysis is the first process of carbohydrate catabolism.

Teaching Guides for NTA Level 4 MLS Curriculum Page 283

 The glands whose hormones participate in regulating carbohydrate metabolism are:
o Pancreatic islets
o Adrenal medulla
o Adrenal cortex
o Anterior pituitary gland
o Thyroid gland

Step 8: Evaluation (10 minutes)

 Mention hormones controlling carbohydrates metabolism
 Describe steps in carbohydrate metabolism
 Define Gluconeogenesis

References
 Ganong. W. F, (2005). Review of Medical Physiology, United States of America:
McGraw-Hill Companies, Inc.
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 284

Handout 25.1: Citric Acid Cycle

 Thus, during short bursts of strenuous activity, muscle cells use anaerobic respiration to
supplement the ATP production from the slower aerobic respiration, so anaerobic
respiration may be used by a cell even before the oxygen levels are depleted, as is the
case in sports that do not require athletes to pace themselves, such as sprinting.

Handout 25.2: Hormones that Influence Blood Glucose Level

Hormone Tissue of Origin Metabolic Effect Effect on Blood

Glucose
Insulin Pancreatic β Cells Enhances entry of Lowers
glucose into cells
Enhances storage of
glucose as glycogen, or
conversion to fatty acids;
Enhances synthesis of
fatty acids and proteins;
Suppresses breakdown of
proteins into amino
acids, of adipose tissue
into free fatty acids
Somatostatin Pancreatic D Cells Suppresses glucagon Raises
release from α cells (acts
locally)
Suppresses release of
Insulin, Pituitary tropic
hormones, gastrin and
secretin

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Glucagon Pancreatic α cells Enhances release of Raises
glucose from glycogen
Enhances synthesis of
glucose from amino
acids or fatty acids
Epinephrine Adrenal medulla Enhances release of Raises
glucose from glycogen
Enhances release of fatty
acids from adipose tissue
Cortisol Adrenal cortex Enhances Raises
gluconeogenesis
Antagonizes Insulin
ACTH Anterior pituitary Enhances release of Raises
cortisol
Enhances release of fatty
acids from adipose
tissue.
Growth Hormone Anterior pituitary Antagonizes Insulin Raises
Thyroxine Thyroid Enhances release of Raises
glucose from glycogen
Enhances absorption of
sugars from intestine

Teaching Guides for NTA Level 4 MLS Curriculum Page 286

Session 20: Lipid and Protein
Metabolism
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Explain lipid metabolism
 Explain control of lipid metabolism
 Explain protein metabolism
 Explain control of protein metabolism

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 26.1: Summary of metabolism in general
 Handout 26.2: Essentiality; Conditional Essentiality/Nonessential Amino Acids

Step Time Activity/Method Content

1 05 minutes Presentation Introduction, Learning Objectives
2 30 minutes Presentation Lipid Metabolism
3 15 minutes Presentation Control of Lipid Metabolism
4 10 minutes Presentation Protein Metabolism
5 25 minutes Presentation Control of Protein Metabolism
6 20 minutes Presentation Key Points
7 05 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Introduction, Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Lipid Metabolism (30minutes)

 Lipids are the class of organic compounds that includes fat, oil and related substance. The
most common lipids in the diet are triglycerides
 Dietary fat are often classified as saturated or unsaturated
 Saturated fats are usually solid at the room temperature

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 Unsaturated are usually liquid at room temperature
 Lipids are transported in the blood as chylomicrons, lipoprotein and free fatty acids
 Chylomicrons are small fat droplets present in the blood following fat absorption
 Chylomicrons composed of triglycerides, cholesterol and phospholipids. Within 4 hours
after meal all chylomicrons are moved into adipose tissue cells
 Lipoprotein are produced mainly in the liver consist of the lipid (triglycerides, cholesterol
and phospholipids) and protein
 At all times blood contains three types of lipoprotein namely Very-Low-Density
lipoprotein (VLDL), Low-Density-Lipoprotein and High Density Lipoprotein (HDL)
 A diet high in saturated fat and cholesterol tend to produce an in increase in the blood
LDL concentration, which is inturn is associated with incidence of coronary artery
disease and atherosclerosis. A high blood HDL concentration, in contrast is associated
with low incidence of heart disease.
 Lipid catabolism, like carbohydrates catabolism, consists of several processes. Each of
these in turn consists of the series of chemical reactions:
 Triglycerides are first hydrolysed to yield fatty acid and glycerol
 Glycerol is then converted to glyceraldehydes-3-phosphate, which enter the glycolysis
pathways.
 Fatty acids are broken down by a process called beta-oxidation to release acetyl-CoA,
which then is fed into the citric acid cycle. These are then catabolised via the citric acid
cycle
 The final process of lipid catabolism therefore consists of the same reactions as
carbohydrates catabolism.
 Catabolism of lipids, however, yield considerably more energy than catabolism of
carbohydrates 1gm of CHO yield 4.1kcal of heat while 1 gm of fat yield 9 Kcal
 When fat catabolism occurs at accelerated rate as in diabetes mellitus (when glucose
cannot enter cell or fasting) excessive number of acetyl- CoA units are formed.
 Liver cells then temporarily condense acetyl- CoA units together to form four – carbon
acetoacetic acid. Acetoacetic acid is classified as a ketone body and can be converted to
two other types of ketone bodies, namely acetone and beta-hydroxybutyric acid, hence the
name ketogenesis for this process.
 Liver cells oxidize a small portion of the ketone bodies for their own energy needs but
most of them are transported by the blood to other tissue cells for the change back to
acetyl- CoA and oxidation via the citric acid cycle.

Refer students to Handout 26.1: Summary of Metabolism in General

 Lipid anabolism also called lipogenesis consists of the synthesis of various types of lipid
notably triglycerides cholesterol, phospholipids and prostaglandins.
 Triglycerides and structural lipid (e.g. phospholipids) are synthesized from fatty acids and
glycerol or from excess glucose or amino acids. So it is possible to get fat from foods
other than fat.
 Triglycerides are stored mainly in adipose tissue cells
 Most fatty acids can be synthesized by the body
 Certain of the unsaturated fatty acids must be provided by the diet and so are called
essential fatty acids.

Teaching Guides for NTA Level 4 MLS Curriculum Page 288

Step 3 Control of Lipid Metabolism (15 minutes)
 Fatty acid metabolism requires a balance between degradation and synthesis according to
the energy need of cells and an organism as a whole.
 In humans the liver plays a role in lipid blood homeostasis analogous to its role as
glucostat organ.
 For the control of beta oxidation the major regulatory mechanism is the availability of
substrate.
 In liver, fatty acids come from three major sources:
 as fatty acids released by extra cellular lipase from triglycerides coming from fat
absorption in the form of chylomicrons,
 as unesterified (free) fatty acids in blood plasma (complexed with albumin) originating
from adipose tissue (adipocyte lipase), and
 from intracellular triglycerides where a liver specific lipase deesterifies triglycerides
releasing free fatty acids.
 The cellular lipases of adipocytes and hepatocytes are under hormonal control, with
glucagon activating the lipase and insulin inhibiting it. Other hormones that activate
lipase are epinephrine and nor-epinephrine, and ACTH (adrenocorticotropic hormone).
These positive stimulators all work through cAMP mediated kinase phosphorylation.
 A second regulatory mechanism is metabolic control related to the energy charge of the
cell. Beta oxidation is strictly coupled to oxidative phosphorylation and depends on the
ADP/ATP ratio, with a high ratio (low energy charge) stimulating degradation. High ATP
levels stimulates both fatty acid synthesis as well as phosphatidic acid synthesis.
 A third control mechanism is the transport of fatty acids across mitochondrial inner
membranes.
 The reason for the control of fatty acid entry into mitochondria lies in the fact that fatty
acids, once inside the matrix compartment, will be oxidized to acetyl-CoA which can be
used for TCA oxidation, retro-transport into the cytoplasm or, when abundant, is
transformed into acetoacetate, the precursor of so called ketone bodies. Ketone body
excess is formed in liver when glucose levels are low and fatty acid concentrations are up.
 Low pyruvate concentration reduces the availability of oxaloacetate and thus overloads
the citric acid cycle with acetyl-CoA from both pyruvate and fatty acid degradation.
 Acetyl-CoA molecules are then combined to acetoacetate and is in turn converted to
either beta-hydroxybutyrate (the reduced form of acetoacetate) or acetone, the product of
a spontaneous decarboxylation reaction of acetoacetate in the presence of protons.
 In liver, ketone bodies cannot be metabolized any further and are secreted into the blood
pool where they are catabolized in muscle and brain cells alongside glucose.
 Excess ketone bodies found in the blood are removed by the kidney in form of ketonuria,
which is an indicator of metabolic acidosis, a disorder resulting from high levels of
ketone bodies in the blood.
 The heart and brain are organs that rely on ketone bodies as fuel molecule. While skeletal
muscle under strenuous activity uses glycolysis as major energy production pathway,
resting muscles primarily burn fatty acids and ketone bodies, while neurons burn glucose
and ketone bodies. Both organs strictly depend on respiration.
 The rate of fat catabolism is inversely related to the rate of carbohydrate catabolism. In
some conditions such as diabetes mellitus causes carbohydrate catabolism to decrease
below energy needs.

Teaching Guides for NTA Level 4 MLS Curriculum Page 289

Step 4: Protein Metabolism (30 minutes)
 Proteins are assembled from a pool of 20 different kinds of amino acids. If any type of
amino acid is deficient, vital protein cannot be synthesised a serious health threats. One
way the body maintains a constant supply of amino acid is by synthesizing them form
other compounds already present in the body. Only about half of the required 20 types of
amino acids must be supplied in the diet
 In protein metabolism, anabolism is primary and catabolism is secondary. In carbohydrate
and fat metabolism are the opposite is true; catabolism is primary and anabolism is
secondary. Protein is primary tissue-building foods carbohydrates & fat are primary
energy supplying foods
 Protein anabolism, is the process by which protein are synthesized by the ribosomes of all
cells
 Every cell synthesise its own structural proteins and its own enzymes.
 Some cells, such as liver and glandular cells, synthesize special protein for export, e.g.
liver cells manufacture the plasma protein found in blood.
 Amino acids are made into proteins by being joined together in a chain by peptide bonds.
Each different protein has a unique sequence of amino acid residues: this is its primary
structure. Just as the letters of the alphabet can be combined to form an almost endless
variety of words, amino acids can be linked in varying sequences to form a huge variety
of proteins.
 Proteins are made from amino acids that have been activated by attachment to a transfer
RNA molecule through an ester bond. This aminoacyl-tRNA precursor is produced in an
ATP-dependent reaction carried out by an aminoacyl tRNA synthetase. This aminoacyl-
tRNA is then a substrate for the ribosome, which joins the amino acid onto the elongating
protein chain, using the sequence information in a messenger RNA.

Refer students to Handout 26.2: Essentiality; Conditional Essentiality/ Nonessential

Amino Acids for more information

 Protein catabolism. The first step in protein catabolism takes place in liver cells called
deamination, it consists of the splitting off of an amino (NH2) group from an amino acid
molecule to form a molecule of ammonia and one of keto acid (e.g. α- ketoglutaric acid).
 Most of the ammonia is converted by liver cells to urea and later excreted in the urine.
 The keto acid may be oxidized via the citric acid cycle or may be converted to
gluconeogenesis or fat (lipogenesis)

Refer students to Handout 26.1: Summary of Metabolism in General

Step 6: Control of Protein Metabolism (20 minutes)

 Protein metabolism, like that of carbohydrates and fats, is controlled largely by hormones
rather than by the nervous system.
 Growth hormone and the male hormone testosterone both have a stimulating effect on
protein synthesis or anabolism. For this reason, they are referred to as anabolic hormones.
 The protein catabolic hormones of greatest consequence are glucocorticoids. They speed
up tissue protein mobilization that is the hydrolysis of cell protein to amino acids, their

Teaching Guides for NTA Level 4 MLS Curriculum Page 290

 entry into the blood and their subsequent catabolism. ACTH functions indirectly as a
protein catabolism hormone because of its stimulating effect on glucocorticoid secretion
 Thyroid hormone is necessary for and tends to promote protein anabolism and therefore
growth when plenty of carbohydrates and fats are available for energy production. On the
other hand, under different conditions, for example, when the amount of thyroid hormone
is excessive or when the energy foods are deficient, this hormone may then promote
protein mobilization and catabolism.
 Protein balance and Nitrogen balance
o Usually a state of protein balance exists in the normal health adult body that is the rate
of protein anabolism equals or balances the rate of protein catabolism. When the body
is in protein balance it is also in a state of nitrogen balance because the amount of
nitrogen taken into the body (in protein foods) equals the amount of nitrogen in
protein catabolic waste products excreted in the urine, faeces and sweats.
o When protein catabolism exceeds protein anabolism the amount of nitrogen in the
urine exceeds the amount of nitrogen in the protein foods ingested. The individual is
then said to be in a state of negative nitrogen balance or in a state of “tissue wasting”
because more of the tissue protein are being catabolised than are being replaced by
protein synthesis.

Step 7: Key Points (10 minutes)

 Most fatty acids can be synthesized by the body
 Protein anabolism, is the process by which protein are synthesized by the ribosomes of all
cells
 Protein metabolism, like that of carbohydrates and fats, is controlled largely by hormones
rather than by the nervous system

Step 8: Evaluation (10 minutes)

 Mention three types of lipoproteins
 Which lipid is associated with coronary heart diseases?
 What is the difference between protein metabolism and carbohydrate metabolism?

References
 Essential amino acid retrieved March 26, 2010 from en.wikipedia.org
 Ganong. W. F, (2005). Review of Medical Physiology, United States of America:
McGraw-Hill Companies, Inc.
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 291

Handout 26.1: Summary of metabolism in general

Source: en.wikipedia.org

Handout 26.1: Essentiality; Conditional Essentiality/Nonessential Amino Acids

Essential Nonessential
Isoleucine Alanine
Arginine
Lysine Aspartate
Methionine Cysteine
Phenylalanine Glutamate
Threonine Glutamine
Tryptophan Glycine
Valine Proline
Histidine Serine
Tyrosine Asparagine
Leucine Selenocysteine

Amino acid synthesis

 Amino acids are synthesized from Glutamate, which is formed by amination of α-
ketoglutarate:

 Afterwards, Alanine and Aspartate are formed by transamination of Glutamate. All of the
remaining amino acids are then constructed from Glutamate or Aspartate, by
transamination of these two amino acids with one α-keto acid.
 Human beings can synthesize 12 of the basic set of 20 amino acids. These amino acids
are called nonessential, in contrast with the essential amino acids, which must be supplied
in the diet. The pathways for the synthesis of nonessential amino acids are quite simple.
Glutamate dehydrogenase catalyzes the reductive amination of α-ketoglutarate to
glutamate. A transamination reaction takes place in the synthesis of most amino acids. At
this step, the chirality of the amino acid is established.
 Alanine and aspartate are synthesized by the transamination of pyruvate and
oxaloacetate, respectively. Glutamine is synthesized from NH4+ and glutamate, and
asparagine is synthesized similarly. Proline and arginine are derived from glutamate.
Serine, formed from 3-phosphoglycerate, is the precursor of glycine and cysteine.
Tyrosine is synthesized by the hydroxylation of phenylalanine, an essential amino acid.

Teaching Guides for NTA Level 4 MLS Curriculum Page 292

 The pathways for the biosynthesis of essential amino acids are much more complex than
those for the nonessential ones.
 Cortisol inhibits protein synthesis

Teaching Guides for NTA Level 4 MLS Curriculum Page 293

Session 21: Introduction to
Cardiovascular System
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Define circulatory and cardiovascular system
 Explain organisation of the cardiovascular system
 Describe structure of the heart
 Describe blood supply to the heart
 Describe conducting system of the heart
 Describe foetal circulation

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 10.1: The Human Heart
 Handout 10.2: The Surface Anatomy of The Heart
 Handout 10.3: Blood Supply of the Heart
 Handout 10.4: Conducting System of The Heart
 Handout 10.5: Foetal Circulation

SESSION OVERVIEW
Step Time Activity/Method Content
1 05minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Definition of Cardiovascular System
Brainstorming
3 10 minutes Presentation Organisation of the Cardiovascular System
4 25 minutes Buzzing, presentation Structure of the Human Heart
5 15 minutes Presentation Blood Supply to the Heart
6 20 minutes Presentation Conducting System of the Heart
7 20 minutes Presentation Foetal Circulation
8 05 minutes Presentation Key Points
9 10 minutes Presentation Evaluation

SESSION CONTENT

Teaching Guides for NTA Level 4 MLS Curriculum Page 294

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify
 ASK students if they have any questions before continuing

Step 2: Definition of Cardiovascular System (10 minutes)

 Activity: Brainstorming (5 minutes)
 ASK students what is circulatory system and what cardiovascular system is
 ALLOW students to respond.
 WRITE their responses on the flip chart.
 SUMMARISE their responses using the below information

 The circulatory system is an organ system that passes nutrients (such as amino acids and
electrolytes), gases (such as oxygen and CO2) , hormones, blood cells, , etc. to and from
cells/tissue in the body, and help stabilize body temperature and pH to maintain
homeostasis.
 The main role of the circulatory system is to transport nutrients, gases, to/from
cells/tissues of the body
 Circulatory system is composed of the cardiovascular system, which distributes blood,
and the lymphatic system, which distributes lymph.
 Humans, have a closed cardiovascular system (meaning that the blood never leaves the
network of arteries, veins and capillaries).
 Therefore cardiovascular system is the system that include the heart and the blood vessels

Step 3: Organisation of the Cardiovascular System (10 minutes)

 The main components of the cardiovascular system are the heart, the blood, and the blood
vessels.
 Blood circulates within a fast, high capacity system made up of the heart, which is the
central pump and main motor of the system; arteries, which lead away from the heart and
carry the blood to the peripheral parts of the body; and veins which return the blood to the
heart.
 The heart can be thought of as a pair of muscular pumps, one feeding a minor loop
(pulmonary circulation), which serves the lungs and oxygenates the blood, the other
feeding a major loop (systemic circulation), which serves the rest of the body. With
limited exceptions, each loop is a closed system of tubes, so that blood by itself does not
usually leave the circulation.
 From the centre to the periphery, the vascular tree shows three main modifications. The
arteries increase in number by repeated bifurcation and by sending out side branches, in
both the systemic and the pulmonary circulation.
 The aorta, which carries blood from the heart to the systemic circulation, gives rise to
about 4 × 106 arterioles and four times as many capillaries.
 The arteries also decrease in diameter, although not to the same extent as their increase in
number, so that a hypothetical cross-section of all the vessels at a given distance will
increase in total area with increasing distance from the heart.
 The blood flow is faster near the heart than at the periphery.
 Venules: are vessels which return blood from the periphery, converge on each other
forming a progressively smaller number of veins of increasingly larger size. As with
arteries, the hypothetical total cross-sectional area of all veins at a given level reduces

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 nearer to the heart. Eventually, only the two largest veins, the superior and inferior vena
cava, open into the heart from the systemic circulation.
 A similar pattern is found in the pulmonary circulation, but here the vascular loop is
shorter and has fewer branch points, and consequently, the number of vessels is smaller
than in the systemic circulation

Step 4: Structure of the Human Heart (25 minutes)

o Activity: Buzzing (10 minutes)
o ASK students how many chambers does the heart have and how are they communicated?
o ALLOW them to buzz in pair for 3 minutes then ASK few students to respond to the
above question
o WRITE their answers on the flip chart
o SUMMARISE their responses using the information below

o The heart is a roughly cone-shaped hollow muscular organ. It is about 10 cm long and it
is about the size of the owner’s fist. It weighs about 300g

 Location of the heart

o Lies in the mediastinum, behind the body of the sternum; approximately two thirds of
its mass is to the left of the midline of the body and one third to the right.
o Posteriorly the heart rests on the bodies of thoracic vertebrae five through eight.
o Apex lies on the diaphragm, pointing to the left.
o Base lies just below the second rib.
o Boundaries of the heart are clinically important as an aid in diagnosing heart disorders
 Covering of the heart
o Heart is made up of three distinct layers
o Epicardium: the outer layer of heart which provides protection against friction. It is
divided into:
 Fibrous pericardium: a tough, loose – fitting inextensible sac
 Serous pericardium: parietal layer lies inside the fibrous pericardium, and visceral
layer (pericardium) adheres to the outside of the heart pericardial fluid separates
the two layers
 Myocardium: thick, contractile middle layer
 Endocardium: delicate inner layer of endothelial tissue
 Chambers of the heart
o The heart is divided into four chambers, the two atria and the two ventricles.
 Atria
- Two superior chambers (the atria), known as receiving chambers, since they
receive blood from veins.
- Myocardial wall of each atrium is not very thick, since little pressure is needed
to move blood such a small distance.
- The right atrium receives venous blood from the body through inferior and
superior vena cava, then pumps it the right ventricle.
- The left atrium receive oxygenated blood from pulmonary veins and pumps it
to the left ventricle.
 Ventricles
- Two lower chambers(Ventricles)are known as pumping chambers, since they
push blood into the large network of vessels

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 - Ventricular myocardium is thicker than the myocardium of the atria, since
great force must be generated to pump blood outside the heart.
- Since the left Ventricle pumps blood via Aorta to the whole body, its walls are
thicker than those of right Ventricle (which pumps blood to the lung).
 Valves of the heart
o These are mechanical devices that permit the flow of blood in one direction only .
o Atrioventricular (AV) valve: This prevent blood from flowing back into the atria from
the ventricles when the ventricles contract. These includes:
 Tricuspid valve (right AV valve) guards the right atrioventricular orifice
 Bicuspid or mitral, valve (left AV valve) similar in structure to tricuspid valve
except only two flaps
 Semilunar (SL) valve. These are half-moon-shaped flaps growing out from the
lining of the pulmonary artery and aorta; prevents blood from flowing back into
the ventricles from the aorta and pulmonary artery.
 Pulmonary semilunar valve, located at the entrance of the pulmonary artery
 Aortic semilunar valve, located at the at entrance of the aorta

Refer students to Handout 10.1: The Human Heart and Handout 10.2: The Surface
Anatomy of the Heart for more information.

Step 5: Blood Supply to the Heart (15 minutes)

 The heart, like all tissues in the body, requires oxygen to function. Indeed, it is the only
muscle in the body that never rests. Thus, the heart has reserved for itself its own blood
supply.
 This blood flows to the heart muscle through a group of arteries that begins less than one-
half inch from where the aorta begins. These are known as the coronary arteries, the first
branch to come off the aorta they are two, the right and left coronary artery
 These arteries deliver oxygen to both the heart muscle and the nerves of the heart.
 Both ventricles receive their blood supply from branches of the right and left coronary
arteries
 Each atrium, in contrast, receives blood only from a small branch of the corresponding
coronary artery
 The most abundant blood supply goes to the myocardium of the left ventricle, since the
left ventricle does the most work and so needs the most oxygen and nutrients delivered to
it.
 Anastomoses exist between the large branches of coronary arteries. These provide detours
in which arterial blood can travel if the main route becomes obstructed i.e. they provide
collateral circulation to a part. This phenomenon is important in cases of coronary artery
diseases; when the interruption of coronary blood flow lasts only a few minutes, the
symptoms are called angina, and there is no permanent damage to the heart. When the
interruption lasts longer, that part of the heart muscle dies. This is referred to as a heart
attack (myocardial infarction).
 Most of the venous drainage of the heart is through the coronary sinuses which open into
the right atrium. The remainder passes directly into heart chambers through the little
venous channels.
Refer students to Handout 10.3: Blood Supply of the Heart for more elaboration

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Step 6: Conducting System of the Heart (20 minutes)
 Cardiac plexuses located near the arch of the aorta made up the combination of
sympathetic and parasympathetic fibres
 Fibres of the cardiac plexus accompany the right and left coronary artery and enter the
heart
 Most fibres ends in the sinoatrial node (SA), but some end in the atrioventricular node
(AV) and in the atrial myocardium
 Sympathetic nerves, accelerator nerves
 Vagus fibres, inhibitory or depressor nerves
 The heart contains special tissue that produces and sends electrical impulses to the heart
muscle. It is these impulses that trigger the heart to contract. Each time the heart beats, it
sends out an electric-like signal.
 The heart's electrical signals can be measured with a special machine called an
electrocardiogram (ECG).
 The sinoatrial node (SAN), located within the wall of the right atrium (RA), normally
generates electrical impulses that are carried by special conducting tissue to the
atrioventricular node (AVN).
 AVN is located between the atria and ventricles; the electrical impulse from AVN is
relayed down the conducting tissue (Bundle of His) that branches into pathways that
supply the right and left ventricles.
 These paths are called the right bundle branch (RBB) and left bundle branch (LBB)
respectively.
 Electrical impulses generated in the SAN cause the right and left atria to contract first
 All heart cells muscle and conducting tissue are capable of generating electrical impulses
that can trigger the heart to beat.
 The SAN is known as the "heart's pacemaker" because electrical impulses are normally
generated here. At rest the SAN usually produces 60-70 signals a minute. It is the SAN
that increases its' rate due to stimuli such as exercise, stimulant drugs, or fever.
 Should the SAN fail to produce impulses, the AVN can take over. The resting rate of the
AVN is slower; generating 40-60 beats a minute.
 The AVN and remaining parts of the conducting system are less capable of increasing
heart rate due to stimuli previously mentioned than the SAN.

Refer students to the handout 10.4 Conducting System of the Heart

Step: 7 Foetal Circulation (20 minutes)

 Circulation in the body before birth necessary differs from circulation after birth for one
main reason. Foetal blood secures oxygen and food from maternal blood instead of from
foetal lungs and digestive organs therefore foetal blood reaches the placenta via two
umbilical arteries and returns by one umbilical vein
 Blood from the placenta is carried to the foetus by the umbilical vein. About half of this
enters the foetal ductus venosus (the ductus venosus, arises and ascends posterior to the
liver to join the left hepatic vein near its termination in the inferior vena cava) and is
carried to the inferior vena cava, while the other half enters the liver proper from the

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 inferior border of the liver. The branch of the umbilical vein that supplies the right lobe of
the liver first joins with the portal vein.
 The blood then moves to the right atrium of the heart. In the foetus, there is an opening
between the right and left atrium (the foramen ovale), and most of the blood flows
through this hole directly into the left atrium from the right atrium, thus bypassing
pulmonary circulation. The continuation of this blood flow is into the left ventricle, and
from there it is pumped through the aorta into the body. Some of the blood moves from
the aorta through the internal iliac arteries to the umbilical arteries, and re-enters the
placenta, where carbon dioxide and other waste products from the foetus are taken up and
enter the woman's circulation.
 Some of the blood entering the right atrium does not pass directly to the left atrium
through the foramen ovale, but enters the right ventricle and is pumped into the
pulmonary artery. In the foetus, there is a special connection between the pulmonary
artery and the aorta, called the ductus arteriosus, which directs most of this blood away
from the lungs (which aren't being used for respiration at this point as the foetus is
suspended in amniotic fluid).
 At birth, when the infant breathes for the first time, there is a decrease in the resistance in
the pulmonary vasculature, which causes the pressure in the left atrium to increase
relative to the pressure in the right atrium. This leads to the closure of the foramen ovale,
which is hence referred to as the fossa ovalis. Additionally, the increase in the
concentration of oxygen in the blood leads to a decrease in prostaglandins, causing
closure of the ductus arteriosus.
 These closures prevent blood from bypassing pulmonary circulation, and therefore allow
the neonate's blood to become oxygenated in the newly operational lungs. After closure,
the duct becomes the ligamentum arteriosum, which connects the left pulmonary artery
(near its origin) with the aortic arch. The ductus venosus shuts down by an unknown
mechanism, its fibrous remnant is the ligamentum venosum.
 If these opening persist after birth may lead to a serious conditions known as congenital
heart diseases

Refer students to the handout 10.5 Foetal Circulation

Step 8: Key Points (5 minutes)

 Cardiovascular system is the system that include the heart and the blood vessels
 The heart lies in the mediastinum, behind the body of the sternum
 The heart is divided into four chambers, the two atria and the two ventricles.
 Atria are separated from ventricles by atrial ventricular valves
 The sinoatrial node (SAN), located within the wall of the right atrium (RA), normally
generates electrical impulses that are carried by special conducting tissue to the
atrioventricular node (AVN).
 Foetal blood reaches the placenta via two umbilical arteries and returns by one umbilical
vein

Step 9: Evaluation (15 minutes)

 Mention the components of cardiovascular system
 Name the chambers of the heart

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 How does blood flow from the right side of the heart to the peripheral
 The heart gets its blood supply from which vessels
 What is the meaning of pacemaker?

References
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

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Handout 10.1: The Human Heart

Lippincott Williams & Wilkins, 2007

Handout 10.2: The Surface Anatomy of The Heart

2007 Lippincott Williams & Wilkins

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Handout 10.4: Conducting System of The Heart

2007 Lippincott Williams & Wilkins

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Handout 10.5: Foetal Circulation

Source: Elsevier Ltd 2005.

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Session 22: Physiology of the Heart
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Define cardiac circle
 Explain stages of cardiac circle
 Explain factors affecting the blood pressure
 Explain factors that affect the heart rate

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 11.1: Graphic Illustration of Cardiac Cycle
 Handout 11.2: Phases of Cardiac Circle

SESSION OVERVIEW
Step Time Activity/ Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 15 minutes Brainstorming, The Definition of Cardiac Circle
Presentation
3 30 minutes Presentation Stages of Cardiac Cycle
4 25 minutes Presentation Factors Affecting the Blood Pressure
5 25 minutes Buzzing, Presentation Factors that Affect the Heart Rate
6 05 minutes Presentation Key Points
7 15 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify
 ASK students if they have any questions before continuing

Step 2: Cardiac Circle (15 minutes)

The function of the heart is to maintain a constant circulation of blood throughout the body.

 Activity: Brainstorm (5 minutes)

 ASK students what is cardiac cycle

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 LISTEN to their answers and
 WRITE their responses on the flip chart
 SUMMARISE their responses using the information below.

 The heart acts as a pump and its action consists of series of events known as cardiac
cycle.
 Cardiac cycle is the term referring to all or any of the events related to the flow of blood
that occurs from the beginning of one heartbeat to the beginning of the next. The
frequency of the cardiac cycle is the heart rate.
 The cardiac cycle describes the complete movement of the heart or heartbeat and includes
the period from the beginning of one heartbeat to the beginning of the next one. The cycle
consists of diastole (ventricular relaxation and filling) and systole (ventricular contraction
and emptying). The right heart is the pump for the pulmonary circuit; the left heart is the
pump for the systemic circuit
 The term diastole is synonymous with relaxation of a muscle. Throughout the cardiac
cycle, the blood pressure increases and decreases. The period of contraction is called
Systole
 The cardiac cycle is co-ordinated by a series of electrical impulses that are produced by
specialized heart cells found within the sino-atrial node and the atrio-ventricular node.
The cardiac muscle is composed of myocytes which initiate their own contraction without
assistance of external nerves
Refer student to Handout 11.1: Graphic Illustration of Cardiac Cycle and Session 11:
Step 6: Conducting System of the Heart, for more information.

Step 3: Stages of Cardiac Cycle (30 minutes).

 Every single 'beat' of the heart involves three major stages: Atrial systole, ventricular
systole and complete cardiac diastole.
 The normal number of cardiac cycles per minutes ranges from 60 to 100 beats per minute.
 The cycle consists of:
 Atrial Systole: Contraction of the atria
 Ventricular Systole: Contraction of the ventricles
 Complete cardiac Diastole: Relaxation of atria and ventricles

The atrial systole

 Atrial systole is the contraction of the heart muscle (myocardia) of the left and right atria.
 Normally, both atria contract at the same time.
 The term systole is synonymous with contraction (movement or shortening) of a muscle.
 Electrical systole is the electrical activity that stimulates the myocardium of the chambers
of the heart to make them contract. This is soon followed by Mechanical systole, which is
the mechanical contraction of the heart.
 As the atria contract, the blood pressure in each atrium increases, forcing additional blood
into the ventricles (see Fig.1); 70% of the blood flows passively down to the ventricles, so
the atria do not have to contract a great amount.

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Figure 1: Atrial systole.

Source: Lippincott Williams & Wilkins, 2007

Ventricular systole
 Ventricular systole is the contraction of the muscles (myocardia) of the left and right
ventricles.
 During ventricular diastole, the pressure in the (left and right) ventricles drops from the
peak that it reaches in systole. When the pressure in the left ventricle drops to below the
pressure in the left atrium, the mitral valve opens, and the left ventricle fills with blood
that was accumulating in the left atrium (Fig.2). Likewise, when the pressure in the right
ventricle drops below that in the right atrium, the tricuspid valve opens, and the right
ventricle fills with blood that was accumulating in the right atrium.

Figure 2: Ventricular systole

Source: Lippincott Williams & Wilkins, 2007

 Cardiac Diastole is the period of time when the heart relaxes after contraction in
preparation for refilling with circulating blood. Ventricular diastole is when the ventricles
are relaxing, while atrial diastole is when the atria are relaxing. Together they are known
as complete cardiac diastole.

 Heart sounds
o The closing of the mitral and tricuspid valves (known together as the atrioventricular
valves) at the beginning of ventricular systole cause the first part of the "lub-dub"
sound made by the heart as it beats. Formally, this sound is known as the First
o Heart Tone, or S1. This first heart tone is created by the closure of mitral and tricuspid
valve and is actually a two component sound

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 o The second part of the "lub-dub" (the Second Heart Tone, or S2), is caused by the
closure of the aortic and pulmonary valves at the end of ventricular systole. As the left
ventricle empties, its pressure falls below the pressure in the aorta, and the aortic
valve closes. Similarly, as the pressure in the right ventricle falls below the pressure in
the pulmonary artery, the pulmonary valve closes.
o The second heart sound is also two components, A2, P2. The aortic valve closes
earlier than the pulmonary valve and they are audibly separated from each other in the
second heart sound. This "splitting" of S2 is only audible during inhalation.
o These sounds can be heard on the chest wall by using a stethoscope.

Refer student to Handout 11.1: Graphic Illustration of Cardiac Cycle and Handout
11.2: Phases of Cardiac Circle for more information

Step 4: Factors Affecting the Blood Pressure (25 minutes)

 Blood pressure is the force or pressure that blood exerts on the walls of blood vessels.
 Blood pressure varies according to the time of the day, the body posture and age of
individual.
 During bed rest at night blood pressure tends to be lower, it increases with age usually
higher in males than females.
 Blood pressure = cardiac output x peripheral resistance

Cardiac output
 The cardiac output is the amount of blood ejected from the heart. The amount of blood
expelled by each contraction of ventricles is the stroke volume.
 Cardiac output = stroke volume X heart rate
 Cardiac output is expressed in litres per minute. In a healthy adult at rest the stroke
volume is approximately 70 ml. If the heart is 72 per minute, the cardiac output will be
about 5 litres per minute. This can be increased during exercise to meet the increased
demand.
 Stroke volume is determined by the volume of blood in the ventricles immediately before
they contract.
 Heart rate determines the cardiac output, if the heart rate rises cardiac output increases
and if it falls cardiac output decreases too.
 The following factors affect the stroke volume:
 Ventricular end diastolic volume
 Venous return
 Strength of myocardium contraction
 Blood volume
 Arterial blood pressure
 Primary determinant of arterial blood pressure is the volume of blood in arteries; a direct
relationship exists between arterial blood volume and arterial pressure
 Cardiac output (CO): Determined by stroke volume and heart rate
 stroke volume (SV) = volume pumped per heartbeat
 CO (volume/min) = SV (volume/beat) x Heart rate (beats/min)
 Heart rate and stroke volume determine CO, so anything that changes either also tends to
change CO, arterial blood volume and blood pressure in the same direction

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Stroke volume
 Influenced mainly by Starling’s law of the heart
 Within limits, the longer or more stretched, the heart fibres at the beginning of
contraction, the stronger the contractions
 The amount of blood in the heart at the end of diastole determine the amount of stretch
placed on the heart fibres

Step 5: Factors that Affect the Heart Rate (25 minutes)

 Activity: Buzzing (10 minutes)
 ASK student what are the factors affecting Heart rate
 ALLOW them to buzz in pairs for 2 minutes then ASK few students to respond to the
above question
 WRITE their responses on the flip chart
 SUMMARISE their response using the information below

 Sinoatrial node normally initiate each heart beat however various factors can and do
change the rate of heart beats
 Cardiac pressoreflexes – aortic baro-receptors and carotid baro-receptors located in the
aorta and carotid sinus, are extremely important because they affect the autonomic
cardiac control centre and therefore parasympathetic and sympathetic outflow to aid in
control of blood pressure.
 Other reflexes that influence heart rate – various important factors influence the heart
rate, reflexive increases in heart rate often result from increased sympathetic stimulation
of the heart
 Anxiety, fear, and anger often increase heart rate
 Grief tends to decrease heart rate
 Emotion produce changes in heart rate through the influence of impulses from the
cerebrum via the hypothalamus
 Exercise – heart rate normally increases
 Increased blood temperature or stimulation of skin heat receptors increases heart rate
 Decreased blood temperature or stimulating of skin cold receptors decrease heart rate
 Peripheral resistance to the blood flow imposed by the force of friction between the blood
and the walls of its vessels

Step 6: Key Points (5 minutes)

 The function of the heart is to maintain a constant circulation of blood throughout the
body.
 Cardiac cycle is the term referring to all or any of the events related to the flow of blood
that occurs from the beginning of one heartbeat to the beginning of the next.
 During ventricular systole, there is closure of atrioventricular valves, producing the first
heart sound. While the second heart sound is produced by closure of aortic and
pulmonary valves during diastole.
 The frequency of the cardiac cycle is the heart rate.
 Cardiac output = stroke volume X heart rate

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Step 7: Evaluation (15 minutes)
 What is cardiac circle?
 What is the meaning of diastole?
 What is the meaning of systole?
 Mention 3 factors affecting the heart rate

References
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 309

Handout 11.1: Graphic Illustration of Cardiac Cycle

Source: The McGraw-Hill Companies, Inc. 2006

Events of the cardiac cycle at a heart rate of 75 beats/min. The phases of the cardiac cycle
identified by the numbers at the bottom are as follows: 1, atrial systole; 2, isovolumetric
ventricular contraction; 3, ventricular ejection; 4, isovolumetric ventricular relaxation; 5,
ventricular filling. Note that late in systole, aortic pressure actually exceeds left ventricular
pressure. However, the momentum of the blood keeps it flowing out of the ventricle for a
short period. The pressure relationships in the right ventricle and pulmonary artery are
similar. Abbreviations: Atr. syst., atrial systole; Ventric. syst., ventricular systole

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Handout 11.2: Phases of Cardiac Circle

Source: Lippincott Williams & Wilkins, 2007

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Session 23: Structure of Blood Vessels &
their Response to Injury
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Identify types and general structure of blood vessels
 Explain structure of arteries and arteriole
 Explain structure of Capillaries
 Explain structure of venule and veins
 Recognise vascular shunts and anastomoses
 Recognise vascular response to injury

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 12.1: Structural Features of the Larger Muscular Artery
 Handout 12.2: Types of Capillaries
 Handout 12.3: Internal Structure of Vein
 Handout 12.4: Clotting Mechanism

SESSION OVERVIEW
Step Time Activity/ Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 20 minutes Brainstorming, Types and General Structure of
Presentation Blood Vessels
3 15 minutes Presentation Structure of Arteries and Arteriole
4 15 minutes Presentation Structure of Capillaries
5 15 minutes Presentation Structure of Venule and Veins
6 15 minutes Presentation Vascular Shunts and Anastomoses
7 20 minutes Presentation, Buzzing Recognise Vascular Response to
Injury
8 5 minutes Presentation Step 8: Key Points
10 minutes Presentation Step 9: Evaluation

SESSION CONTENT

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Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Types and General Structure of Blood Vessels (20 minutes)

 Activity: Brainstorm (5 minutes)
 ASK students to mention different types of blood vessels and their functions
 SUMMARISE their responses by using the information below

Types of blood vessels

 Artery is a vessel that carries blood away from the heart, small artery is arteriole. All
arteries carry oxygenated blood except pulmonary artery. Arteries carry blood to
arterioles. Arterioles are smaller than arteries and they carry blood from arteries to
capillaries. There are two types of arteries
o Elastic arteries
o Muscular arteries
 Veins are vessels that carry blood toward the heart, small vein is venule. All veins carry
deoxygenated blood except pulmonary vein. Veins act as collector and as reservoir
vessels, called the capacitance vessels
 Capillary are microscopic vessel that carries blood from arteriole to venule. They are the
most important vessels functionally because they allow the delivery and collection of
substances, called the exchange vessels

General structure of vessels

 Blood vessels, irrespective of size, and with the exception of capillaries and venules, have
walls consisting of three concentric layers (tunicae).
 The intima (tunica intima), is the innermost layer. Its main component, the endothelium,
lines the entire vascular tree, including the heart, and the lymphatic vessels.
 The media (tunica media) is made of muscle tissue, elastic fibres and collagen. While it is
by far the thickest layer in arteries, the media is absent in capillaries and is comparatively
thin in veins.
 The adventitia (tunica adventitia) is the outer coat of the vessel, and consists of
connective tissue, nerves and vessel capillaries. It links the vessels to the surrounding
tissues.
 Vessels differ in the relative thicknesses and detailed compositions of their layers and, in
the smallest vessels, the number of layers represented.

Step 3: Structure of Arteries and Arteriole (15 minutes)

 Elastic arteries
 The aorta and its largest branches (brachiocephalic, common carotid, subclavian and
common iliac arteries) are large elastic arteries which conduct blood to the medium-sized
distributing arteries.
 Their intima is made of an endothelium, resting on a basal lamina, and a subendothelial
connective tissue layer. The subendothelial layer is well developed, contains elastic fibres
and type I collagen fibrils, fibroblasts and small, smooth muscle-like myointimal cells.
The latter accumulate lipid with age and in an extreme form, this feature contributes to

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 atherosclerotic changes in the intima. Thickening of the intima progresses with age and is
more marked in the distal than in the proximal segment of the aorta.
 Elastic arteries have the effect of sustaining blood flow despite the pulsatile cardiac
output.
 The media has a markedly layered structure, in which fenestrated layers of elastin (elastic
lamellae) alternate with interlamellar muscle cells, collagen and fine elastic fibres.
 The adventitia is well developed. In addition to collagen and elastic fibres, it contains
flattened fibroblasts with extremely long thin processes, macrophages and mast cells,
nerve bundles and lymphatic vessels.

Muscular arteries
 Muscular arteries are characterized by the predominance of smooth muscle in the media.
The intima consists of an endothelium, similar to that of elastic arteries. The internal
elastic lamina is a distinct, thin layer, and is occasionally absent.
 The relative amount of extracellular matrix is therefore less than in large arteries,
however, fine elastic fibres which run mainly parallel to the muscle cells are present.
 The adventitia is mainly collagenous connective tissue, and can be as thick as the media
in the smaller arteries.
Refer students to Handout 12.1: Handout 12.1: Structural Features of the Larger
Muscular Artery for more information.

Arteriole
 In arterioles the endothelial cells are smaller than in large arteries, but their nuclear region
is thicker and often projects markedly into the lumen.
 The basal surface of the endothelium contacts a basal lamina, but an internal elastic
lamina is either absent or is highly fenestrated and traversed by the cytoplasmic processes
of muscle cells or endothelial cells.
 The muscle cells are larger in cytoplasmic volume than those of large arteries and they
form layer one or two cells thick.
 Their contractility controls the flow of blood into the capillary bed, and they act
functionally as precapillary sphincters.
 Closure of the sphincter is thought to be under myogenic, rather than neurogenic, control
and is responsive to local vasoactive and metabolic factors.
 Arteriolar adventitia is very thin.
 Arterioles are usually densely innervated by sympathetic fibres, via small bundles of
varicose axons packed with transmitter vesicles, mostly of the adrenergic type
 Autonomic neuromuscular junctions are very common in arterioles.

Step 4: Structure of Capillaries (15 minutes)

 Capillaries are the vessels closest to the tissue they supply and their wall is a minimal
barrier between blood and the surrounding tissues.
 Capillary structure varies in different locations. Their lumen is just large enough to admit
the passage of single blood cells, usually with considerable deformation.
 Typically a single endothelial cell forms the wall of a capillary, so that the junctional
complex occurs between extensions of the same cell. The endothelial cells of some
capillaries have fenestrations, or pores, through their cytoplasm.

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 Fenestrated capillaries occur in renal glomeruli, where they lack a diaphragm, in intestinal
mucosae, and in endocrine and exocrine glands.
 Capillaries without fenestrations, such as those in the brain, striated and smooth muscles,
lung and connective tissues, are known as continuous capillaries.
 Capillary permeability varies greatly among tissues, and this can be correlated partly with
the type of endothelium.
 Sinusoids; Sinusoids are expanded capillaries, and are large and irregular in shape. They
have true discontinuities in their walls, allowing intimate contact between blood and the
parenchyma. The discontinuities are formed by gaps between endothelial cells, which are
also fenestrated. Sinusoids occur in large numbers in the liver (where a basal lamina is
completely absent), spleen, bone marrow and suprarenal medulla.
Refer students to Handout 12.2: Types of capillaries for more information.

Step 5: Structure of Venule and Veins (15minutes)

 Venule
o When two or more capillaries converge, the resulting vessel is larger and is known as
a venule (postcapillary venule). Venules are essentially tubes of flat, oval or
polygonal endothelial cells surrounded by basal lamina and, in the larger vessels, by a
delicate adventitia of a few fibroblasts and collagen fibres mainly running
longitudinally.
o Postcapillary venules are sites of leukocyte migration. In venules of mucosa-
associated lymphoid tissue, particularly of the gut and bronchi, and in the lymph
nodes and thymus, endothelial cells are taller and have intercellular junctions through
which lymphocytes and other blood components can readily pass. These are known as
high endothelial venules.
o Venules are believed to be a major site where migration of neutrophils, macrophages
and other leukocytes into extravascular spaces occurs, and where neutrophils may
temporarily attach, forming marginated pools.
o In general, the endothelium of venules has few tight junctions, and is relatively
permeable. The intercellular junctions of venules are sensitive to inflammatory agents
which increase their permeability to fluids and defensive cells, and facilitate leukocyte
extravasation by diapedesis.
o Venules with outer diameter of 50 μm acquire musculature and are known as
muscular venules. This distinction is important, because postcapillary venules, which
lack muscle in their walls, are as permeable to solutes as capillaries and are thus part
of the microcirculatory bed.
o Muscular venules converge to produce a series of veins of progressively larger
diameter.
o Venules and veins are capacitance vessels, i.e. they have thin distensible walls which
can hold a large volume of blood and accommodate luminal pressure changes.
 Veins
o Veins are characterized by a relatively thin wall in comparison to arteries of similar
size and by a large capacitance. Wall thickness is not correlated exactly to the size of
the vein, and varies in different regions, e.g. the wall is thicker in veins of the leg than
it is in veins of a similar size in the arm.

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 o The structural plan of the wall is similar to that of other vessels, except that the
amount of muscle is considerably less than in arteries, while collagen and, in some
veins, elastic fibres, predominate.
o In most veins, e.g. those of the limbs, the muscle is arranged approximately circularly.
Longitudinal muscle is present in the iliac, brachiocephalic, portal and renal veins and
in the superior and inferior vena cavae.
o Muscular tissue is absent in the maternal placental veins, dural venous sinuses and
pial and retinal veins, veins of trabecular bone and the venous spaces of erectile
tissue. These veins consist of endothelium supported by variable amounts of
connective tissue.
o Distinction between the media and adventitial layers is often difficult, and a discrete
internal elastic lamina is absent.
o Tethering of some veins to connective tissue fasciae and other surrounding tissues
may prevent collapse of the vessel even under negative pressure.
o Pressure within the venous system does not normally exceed 5 mmHg, and it
decreases as the veins grow larger and fewer in number, approaching zero close to the
heart. Because they contain only a small amount of muscle, veins have limited
influence on blood flow. However, during a sudden fall in blood pressure, e.g.
following a haemorrhage, elastic recoil and reflex constriction in veins compensate
for the blood loss and tend to maintain venous return to the heart.
o Vasoconstriction in cutaneous veins in response to cooling is important in
thermoregulation.
o Most veins have valves to prevent reflux of blood. A valve is formed by an inward
projection of the tunica intima, strengthened by collagen and elastic fibres, and
covered by endothelium which differs in orientation on its two surfaces.
o The valves are semilunar (cusps) and attached by their convex edges to the venous
wall. Their concave margins are directed with the flow and lie against the wall as long
as flow is towards the heart. When blood flow reverses, the valves close and blood
fills an expanded region of the wall, a sinus, on the cardiac side of the closed valve.
o This may give a 'knotted' appearance to the distended veins, if these have many
valves.
o In the limbs, especially the legs where venous return is against gravity, valves are of
great importance to venous flow. Blood is moved towards the heart by the intermittent
pressure produced by contractions of the surrounding muscles.
o Valves are absent in veins of the thorax and abdomen

Refer students to Handout 12.3: Internal structure of vein for more information.

Step 6: Vascular Shunts and Anastomosis (15 minutes)

 Communications between the arterial and venous systems are found in many regions of
the body. In some parts of the microcirculation (e.g. mesentery), the capillary circulation
can be bypassed by wider thoroughfare channels formed by metarterioles. These have
similarities to both capillaries and the smallest arterioles, and have a discontinuous layer
of smooth muscle in their walls.
 Metarterioles can deliver blood directly to venules or to a capillary bed, according to local
demand and conditions.

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 When functional demand is low, blood flow is largely limited to the bypass channel, with
most precapillary sphincters, i.e. the smooth muscle of distal arteriole and metarteriole
walls, closed. Periodic opening and closing of different sphincters irrigates different parts
of the capillary network.
 Arteriovenous anastomoses are direct connections between smaller arteries and veins.
Connecting vessels may be straight or coiled, and often possess a thick muscular tunic.
 Simple arteriovenous anastomoses are widespread and occur notably in the skin of the
nose, lips and ears, nasal and alimentary mucosae, erectile tissue, tongue, thyroid gland
and sympathetic ganglia.
 In the newborn child, there are few arteriovenous anastomoses, but they develop rapidly
during the early years. In old age they atrophy, sclerose and diminish in number. These
factors may contribute to the less efficient temperature regulation which occurs at the two
extremes of age.

Arterial anastomoses
 Arteries can be joined to each other by an anastomosis, so that one can supply the
territory of the other. An end-to-end anastomosis occurs when two arteries communicate
directly, e.g. the vaginal and ovarian arteries, the right and the left gastroepiploic arteries,
the ulnar artery and the superficial palmar branch of the radial artery.

Step 7: Recognise Vascular Response to Injury (20 minutes)

 Activity: Buzzing (5 minutes)
 ASK students define haemostasis
 ALLOW them to buzz in pair for 1 minute then listen to their responses
 WRITE their responses on the flip chart
 SUMMARISE their responses by using the information below

 Haemostasis is the process of forming clots in the walls of damaged blood vessels and
preventing blood loss while maintaining blood in a fluid state within the vascular system.
A collection of complex interrelated systemic mechanisms operates to maintain this
balance between coagulation and anticoagulation.
 When a small blood vessel is damaged, the injury initiates a series of events that lead to
the formation of a clot (haemostasis). This seals off the damaged region and prevents
further blood loss. The initial event is constriction of the vessel and formation of a
temporary haemostatic plug of platelets that is triggered when platelets bind to collagen
and aggregate (Fig1: below). This is followed by conversion of the plug into the
definitive clot.
 The vasoconstriction is due to serotonin and other vasoconstrictors liberated from
platelets that adhere to the walls of the damaged vessels.
 Coagulation the most effective haemostatic mechanism causes formation of blood clot by
a series of reactions, each one activating the next in a chain reaction, or cascade.
Coagulation may occur extrinsically or intrinsically. Release of biochemical from broken
blood vessels or damaged tissue triggers the extrinsic clotting mechanism. Blood contact
with foreign surfaces in the absence of tissue damage stimulates the intrinsic clotting
mechanism.

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 Refer students to Handout 12.4: the Clotting Mechanism for more information.

Figure1: Response to Blood Vessel Injury

Source: McGraw-Hill Companies, Inc 2006

Step 8: Key Points (5 minutes)

 Artery are vessels that carries blood away from the heart while Vein carries blood toward
the heart
 Blood vessels, irrespective of size, and with the exception of capillaries and venules, have
walls consisting of three concentric layers tunica intima, tunica media and tunica
adventitia
 The aorta and its largest branches are large elastic arteries
 Veins are characterized by a relatively thin wall in comparison to arteries
 When a small blood vessel is damaged, the injury initiates a series of events that lead to
the formation of a clot

Step 9: Evaluation (10 minutes)

 Mention types of blood vessels
 Describe the general structure of blood vessel
 Describe the blood vessel respond to minor injury
 Mention three clotting factors

References
 Drake R .L, Vogl W, Mitchell A W M (2007). Gray’s Anatomy for Students, United
Kingdom: Churchill Livingstone Elservier
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins

Teaching Guides for NTA Level 4 MLS Curriculum Page 318

 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 319

Handout 12.1: Structural Features of the Larger Muscular Artery

Source Elsevier Ltd, 2005

Handout 12.2: Types of Capillaries

 Continuous capillaries have a close connection between adjacent cells and will permit
only small molecules < 10nm in diameter to cross. Continuous capillaries surround
muscle, skin lungs, adipose tissue CNS, retina and mammary glands.
 Fenestrated capillaries

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 Fenestrated capillaries contain 'windows' that offer easy passage to larger molecules (10-
100nm) and are found around the kidneys, pancreas, gallbladder and intestine.

 Discontinuous have wide gaps between the cells and will allow practically anything (even
cells) across. Permeable to substances <600-300nm Discontinuous capillaries surround
the liver, spleen, ovaries and some endocrine glands.

Source: Peter M. Smith 1998

Handout 12.3: Internal Structure of Vein

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Source Elsevier Ltd, 2005

Handout 12.4: Clotting Mechanism

 The clotting mechanism responsible for the formation of fibrin involves a cascade of
reactions in which inactive enzymes are activated, and the activated enzymes in turn
activate other inactive enzymes.
 The fundamental reaction in the clotting of blood is conversion of the soluble plasma
protein fibrinogen to insoluble fibrin. The process involves the release of two pairs of
polypeptides from each fibrinogen molecule. The remaining portion, fibrin monomer,
then polymerizes with other monomer molecules to form fibrin. The fibrin is initially a
loose mesh of interlacing strands. It is converted by the formation of covalent cross-
linkages to a dense, tight aggregate (stabilization). This latter reaction is catalyzed by
activated factor XIII and requires Ca2+.

Figure 1

Source: McGraw-Hill Companies, Inc 2006

 The conversion of fibrinogen to fibrin is catalyzed by thrombin. Thrombin is a serine

protease that is formed from its circulating precursor, prothrombin, by the action of
activated factor X.
 Factor X can be activated by reactions in either of two systems, an intrinsic and an
extrinsic system. The initial reaction in the intrinsic system is conversion of inactive
factor XII to active factor XII (XIIa).
 Activation in vivo occurs when blood is exposed to the collagen fibers underlying the
endothelium in the blood vessels. Active factor XII then activates factor XI, and active
factor XI activates factor IX. Activated factor IX forms a complex with active factor VIII,
which is activated when it is separated from von Willebrand factor. The complex of IXa

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 and VIIIa activate factor X. Phospholipids from aggregated platelets (PL) and Ca2+ are
necessary for full activation of factor X. The extrinsic system is triggered by the release
of tissue thromboplastin, a protein–phospholipid mixture that activates factor VII. The
tissue thromboplastin and factor VII activate factors IX and X. In the presence of PL,
Ca2+, and factor V, activated factor X catalyzes the conversion of prothrombin to
thrombin. The extrinsic pathway is inhibited by a tissue factor pathway inhibitor that
forms a quaternary structure with TPL, factor VIIa, and factor Xa.
 Anticlotting Mechanisms
 The tendency of blood to clot is balanced in vivo by limiting reactions that tend to prevent
clotting inside the blood vessels and to break down any clots that do form. These
reactions include the interaction between the platelet-aggregating effect of thromboxane
A2 and the antiaggregating effect of prostacyclin, which causes clots to form at the site
when a blood vessel is injured but keeps the vessel lumen free of clot
 Antithrombin III is a circulating protease inhibitor that binds to the serine proteases in the
coagulation system, blocking their activity as clotting factors. This binding is facilitated
by heparin, a naturally occurring anticoagulant that is a mixture of sulfated
polysaccharides with molecular weights averaging 15,000–18,000. The clotting factors
that are inhibited are the active forms of factors IX, X, XI, and XII.

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Session 24: Blood Circulation to the
Head and Neck
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Identify arterial blood supply to the neck, face and scalp
 Explain venous drainage from the scalp, face and neck
 Recognize arterial blood supply to the brain
 Recognize venous drainage from the brain

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 13.1: Superficial arteries of face
 Handout 13.2: Branches of External Carotid Artery
 Handout 13.3: Venous Drainage from the Scalp and Face
 Handout 13.4: Arterial Blood Supply to the Brain
 Handout 13.5: The Circle of Wills
 Handout 13.6: Venous Drainage from the Brain

SESSION OVERVIEW
Step Time Activity/ Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 25 minutes Presentation Arterial Blood Supply of the Face and
Neck
3 25 minutes Presentation Venous Drainage of the Face and Neck
4 30 minutes Presentation Arterial Blood Supply to the Brain
5 20 minutes Presentation Venous drainage of the Brain
6 05 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

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Step 2: Arterial Blood Supply to the Neck, Face and Scalp (25 minutes)

Activity: Brainstorming (5 minutes)

 ASK students to brainstorm on the following questions
 What are the branches of the arch of aorta:
 ALLOW time for them to respond.
 WRITE their answers on a flip chart.
 SUMMARIZE the discussion by providing answers as per contents below.
 REFER to the atlas or handouts when explaining

 The arterial blood supply to the neck, face and scalp arise from the branches of the arch of
aorta.
 The first branch from the aorta is brachiocephalic artery which forms right common
carotid artery and right subclavian, then left common carotid braches which comes
directly from the aorta and lastly the left subclavian artery.
 The common carotid arteries are the main vessels supplying the head and neck region.
Each divides into external carotid and internal carotid arteries.
 Each external carotid artery branches gives several branches which supply structures of
neck and face.The main arterial which supply to the face is derived from the facial and
superficial temporal arteries. Is also supplied by branches of the maxillary and ophthalmic
arteries. The back of the scalp is supplied by the posterior auricular and occipital arteries.
There are numerous anastomoses between the branchesFacial Artery
 The facial artery arises in the neck from the external carotid artery. It passes onto the face
at the anteroinferior border of masseter (where its pulse can be felt as it crosses the
mandible).
 The facial artery sends branches to the upper and lower lips (superior and inferior labial
arteries) and to the side of the nose (lateral nasal artery) and then terminates as the
angular artery, which supplies the medial angle of the eye.Superficial Temporal Artery
 This is the smaller terminal branch of the external carotid artery. It arises in the parotid
gland behind the neck of the mandible, where it is crossed by temporal and zygomatic
branches of the facial nerve. Initially deep, it becomes superficial as it passes over the
posterior root of the zygomatic process of the temporal bone.
 The superficial temporal artery supplies skin and muscles at the side of the face and in the
scalp, the parotid gland and the temporomandibular joint. Its named branches are the
transverse facial, auricular, zygomatico-orbital, middle temporal, frontal and parietal
arteries.
 The middle temporal artery arises just above the zygomatic arch and perforates the
temporal fascia to supply temporalis. It anastomoses with the deep temporal branches of
the maxillary artery.
 Frontal (anterior) branch passes upwards towards the frontal tuberosity and supplies
adjacent muscles, skin and pericranium in this region. It anastomoses with its fellow of
the opposite side and with the supraorbital and supratrochlear branches of the ophthalmic
artery.The parietal branch is larger than the frontal branch of the superficial temporal
artery, and curves upwards and backwards. It remains superficial to the temporal fascia,
and anastomoses with its fellow of the opposite side and with the posterior auricular and
occipital arteries.

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 The maxillary artery is the larger of the two terminal branches of the external carotid
artery, and has three branches that supply the face, namely the mental, buccal and
infraorbital arteries.The mental artery arises from the first part of the maxillary artery as a
terminal branch of the inferior alveolar artery. It emerges onto the face from the
mandibular canal at the mental foramen, and supplies muscles and skin in the chin region.
The mental artery anastomoses with the inferior labial and submental arteries.
 The occipital artery arises in the neck from the external carotid artery, and enters the back
of the scalp by piercing the investing layer of deep cervical fascia connecting the cranial
attachments of trapezius and sternocleidomastoid, The posterior auricular artery arises in
the neck from the external carotid artery, ascends between the auricle and mastoid process
and gives off an auricular branch supplying the cranial surface of the auricle and an
occipital branch to supply the occipital belly of occipitofrontalis and the scalp behind and
above the auricle. The posterior auricular artery anastomoses with the occipital artery.

Refer students to Handout 13.1: Superficial arteries of face and Handout 13.2:
Branches of External Carotid Artery for more elaboration

Step 3: Venous Drainage from the Scalp, Face and Neck (25 minute)
 The venous blood from the head and neck is returned by deep and superficial veins
 Superficial veins with the same names as the branches of the external carotid artery
returns venous blood from the superficial structure of the face and scalp unite to form the
external jugular vein.
 The facial vein which begins at the medial angle of the eye as the angular vein is the
primary venous drainage of the face.
 Inferior to the margin of the mandible, the facial vein is joined by the anterior branch of
the retromandibular vein.
 The superficial temporal vein drains the scalp and the temporal regions. It joins with
maxillary vein to form the retro mandibular vein which divides into posterior and anterior
branches.
 The posterior auricular vein drains into the posterior retromandibular vein to form the
external jugular vein. The anterior branch of retromandibular vein joins with facial vein
and drains directly or indirectly into the internal jugular vein.
 The anterior jugular vein which drain the neck may also communicate with facial vein
and drains into subclavian vein.
 The external jugular drains into subclavian vein at the root of the neck.

Refer students to Handout 13.3: Venous Drainage from the Scalp and Face; Figure: 1
and 2 for more elaboration

Step 4: Arterial Blood Supply to the Brain (30 minute)

 Activity: Buzzing (5 minutes)
 ASK students which branches of aorta supply the brain
 ALLOW students to buzz for 2 minutes then LISTEN to their responses
 SUMMARIZE their responses using the information below

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 The brain receives its arterial supply from two pairs of vessels, the vertebral and internal
carotid arteries which are interconnected in the cranial cavity to produce an arterial circle
(of Willis).

Internal carotid arteries

 The two internal carotid arteries arise as one of the two terminal branches of the common
carotid arteries. They proceed superiorly to the base of the skull where they enter the
carotid canal on either side.
 Entering the cranial cavity each internal carotid artery gives off the ophthalmic artery, the
posterior communicating artery, the middle cerebral artery, and the anterior cerebral
artery
 The major branches that arise from the internal carotid artery; the anterior and middle
cerebral arteries, form the anterior circulation that supplies the forebrain.
 Each gives rise to branches that supply the cortex and branches that penetrate the basal
surface of the brain, supplying deep structures such as the basal ganglia, thalamus, and
internal capsule.

Vertebral arteries
 Each vertebral artery arises from the first part of each subclavian artery in the lower part
of the neck, and passes superiorly through the transverse foramina of the upper six
cervical vertebrae. On entering the cranial cavity through the foramen magnum each
vertebral artery gives off a small meningeal branch.
 Continuing forward, the vertebral artery gives rise to three additional branches before
joining with its companion vessel to form the basilar artery:
 One branch joins with its companion from the other side to form the single anterior spinal
artery, which then descends in the anterior median fissure of the spinal cord;
 A second branch is the posterior spinal artery, which passes posteriorly around the
medulla then descends on the posterior surface of the spinal cord in the area of the
attachment of the posterior roots-there are two posterior spinal arteries, one on each side;
 Just before the two vertebral arteries join, each gives off a posterior inferior cerebellar
artery.
 The right and left vertebral arteries come together at the level of the pons on the ventral
surface of the brainstem to form the midline basilar artery.
 The basilar artery joins the blood supply from the internal carotids in an arterial ring at
the base of the brain (in the vicinity of the hypothalamus and cerebral peduncles) called
the circle of Willis.
 The basilar artery travels in a rostral direction along the anterior aspect of the pons. Its
branches in a caudal to rostral direction include the anterior inferior cerebellar arteries,
several small pontine arteries, and the superior cerebellar arteries. The basilar artery ends
as a bifurcation, giving rise to two posterior cerebral arteries.

Refer students to Handout 13.4 Arterial Supply to the Brain for elaboration

Arterial circle

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 The cerebral arterial circle (of Willis) is formed at the base of the brain by the
interconnecting vertebrobasilar and internal carotid systems of vessels. This anastomotic
interconnection is accomplished by:
 An anterior communicating artery connecting the left and right anterior cerebral arteries
to each other;
 Two posterior communicating arteries, one on each side, connecting the internal carotid
artery with the posterior cerebral artery.
 Conjoining the two major sources of cerebral vascular supply via the circle of Willis
presumably improves the chances of any region of the brain continuing to receive blood if
one of the major arteries becomes occluded
 The posterior circulation of the brain supplies the posterior cortex, the midbrain, and the
brainstem; it comprises arterial branches arising from the posterior cerebral, basilar, and
vertebral arteries.
 The physiological demands served by the blood supply of the brain are particularly
significant because neurons are more sensitive to oxygen deprivation than other kinds of
cells with lower rates of metabolism.

Refer students to Handout 13.5: The Circle of Wills

Step 5: Venous Drainage from the Brain (20 Minutes)

 Venous drainage of the brain begins internally as networks of small venous channels lead
to larger cerebral veins, cerebellar veins, and veins draining the brainstem, which
eventually empty into dural venous sinuses.
 The dural venous sinuses are endothelial-lined spaces between the outer periosteal and the
inner meningeal layers of the dura mater, and eventually lead to the internal jugular veins
 Emptying into the dural venous sinuses are diploic veins, which run between the internal
and external tables of compact bone in the roof of the cranial cavity, and emissary veins,
which pass from outside the cranial cavity to the dural venous sinuses
 The emissary veins are important clinically because they can be a conduit through which
infections can enter the cranial cavity because they have no valves.

Dural venous sinuses

 The dural venous sinuses include the superior sagittal, inferior sagittal, straight,
transverse, sigmoid, and occipital sinuses, the confluence of sinuses, and the cavernous,
sphenoparietal, superior petrosal, inferior petrosal and basilar sinuses
 The cavernous sinus is located bilaterally on each side of the sella turcica on the body of
the sphenoid bone. The cavernous sinus consists of a venous plexus of extremely thin-
walled veins. The cavernous sinus receives blood from the superior and inferior
ophthalmic veins, superficial middle cerebral vein, and sphenoparietal sinus. The
cavernous sinuses drain postero-inferiorly through the superior and inferior petrosal
sinuses.
 These connections provide pathways for infections to pass from extracranial sites into
intracranial locations. In addition, because structures pass through the cavernous sinuses
and are located in the walls of these sinuses they are vulnerable to injury due to
inflammation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 328

 Refer students to Handout 13.6: Venous Drainage from the Brain for more information

Step 6: Key Points (5 minutes)

 The blood supply to the head and neck depends on common carotid artery which divides
into internal and external.
 Internal carotid artery supplies the brain while external carotid arteries gives several
branches which supply the scalp, face and neck.
 The venous drainage of the brain is through series of sinuses which eventually form the
sigmoid sinus which continues as internal jugular vein.
 Superficial temporal and maxillary veins drain into retromandibular vein which together
with facial vein form the major venous drainage of the scalp and face.

Step 7: Evaluation (10 minutes)

 What are the structures supplied by branches of external carotid artery?
 Mention vessels making the circle of Wills
 Mention vessels which rain into the cavernous sinus

References
 Drake R .L, Vogl W, Mitchell A W M (2007). Gray’s Anatomy for Students, United
Kingdom: Churchill Livingstone Elservier
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc

Teaching Guides for NTA Level 4 MLS Curriculum Page 329

Handout 13.1: Superficial arteries of face

Source: Elsevier Ltd 2005

Handout 13.2: Branches of External Carotid Artery

Teaching Guides for NTA Level 4 MLS Curriculum Page 330

Source Elsevier Ltd 2005

Source: Lippincott Williams & Wilkins, 2007

Handout 13.3: Venous Drainage from the Scalp and Face

Figure: 1

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Handout 13.4: Arterial Blood Supply to the Brain

Artery Origin Distribution

Internal carotid Common carotid artery at Gives branches to walls of
superior border of thyroid cavernous sinus, pituitary
cartilage gland, and trigeminal
ganglion; provides primary
supply to brain
Anterior cerebral Internal carotid artery Cerebral hemispheres, except
for occipital lobes
Anterior communicating Anterior cerebral artery Cerebral arterial circle (of
Willis)
Middle cerebral Continuation of internal carotid Most of lateral surface of
artery distal to anterior cerebral cerebral hemispheres
artery
Vertebral Subclavian artery Cranial meninges and
cerebellum
Basilar Formed by union of vertebral cerebellum, and cerebrum
arteries Brainstem
Posterior cerebral Terminal branch of basilar Interior aspect of cerebral
artery hemisphere and occipital
lobe
Posterior communicating Posterior cerebral artery Optic tract, cerebral
peduncle, internal capsule,
and thalamus

Source: Lippincott Williams & Wilkins, 2007

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Handout 13.5: The Circle of Wills

Source Elsevier Ltd 2005

Teaching Guides for NTA Level 4 MLS Curriculum Page 333

Figure: 1

Source: Lippincott Williams & Wilkins, 2007

Teaching Guides for NTA Level 4 MLS Curriculum Page 334

Figure: 2

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 335

Session 25: Blood Circulation to the
Upper Limb and Thorax
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Identify Arterial Blood Supply to the Thorax
 Identify Venous Drainage of the Thorax
 Explain Blood Supply to the Shoulder
 Explain Arterial Blood Supply to the Forearm
 Explain Arterial Blood Supply to the Hand
 Explain Venous Drainage of the Upper Limb
 Demonstrate Pulse Points and Measuring Blood Pressure

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 14.1: Arteries and Veins of Thoracic Wall
 Handout 14.2: Arterial Supply to the Shoulder and Upper Limb
 Handout 14.3: Anastomosis Around The Elbow Joint
 Handout 14.4: Arteries of the Hand
 Handout 14.5: Venous Return of the Upper limb
 Handout 14.6: Pulse Points

SESSION OVERVIEW
Step Time Activity/ Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 15 minutes Brainstorming, Presentation Arterial Blood Supply to the Thorax
3 10 minutes Presentation Venous Drainage of the Thorax
4 15 minutes Presentation Blood Supply to the Shoulder
5 20 minutes Presentation Arterial Blood Supply to the
Forearm
6 15 minutes Presentation Arterial Blood Supply to the Hand
7 10 minutes Presentation Venous Drainage of the Upper
Limb
8 20 minutes Presentation, Demonstration Pulse Points and Measuring Blood
Pressure

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 9 05 minutes Presentation Key Points
10 05 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify
 ASK students if they have any questions before continuing.

Step 2: Arterial Blood Supply to the Thorax (15 minutes)

 Activity: Brainstorming (5 minutes)
 ASK students to What are the branches of arch of the aorta and ascending aorta?
 ALLOW time for them to respond.
 WRITE their answers on a flip chart.
 SUMMARIZE the discussion by providing the answers as per contents in sub-section
below:

The thoracic aorta

 Aorta start at the upper part of the left ventricle, it arches backwards to the left then
descend behind the heart through the chest cavity
 It is divided into ascending, arch and descending aorta.
 Ascending Aorta – the first part of the aorta it gives off two arteries right and left
coronary arteries
 Arch of Aorta – it gives three branches brachiocephalic, left common carotid artery and
left subclavian artery.
 Brachiocephalic artery branches into right subclavian artery and right common carotid
artery.
 Branches of the arch of the aorta supply blood to the upper part of the body i.e. the upper
limbs and the head, neck and brain.
 Descending Aorta
 It is divided into two parts; thoracic and abdominal part
 Thoracic part – It gives off many paired branches that supply the thoracic cavity. The
branches are as follows:
 It gives off intercostals arteries that run along the inferior border of the ribs and supply
intercosal muscles, the ribs and the skin and its underlying connective tissues.
 Oesophageal arteries that supply the oesophagus
 Bronchial arteries that supply the bronchi, connective tissues in the lungs and lymph
nodes at the root of the lungs.
 The thoracic aorta passes through the diaphragm at the level of thoracic vertebral number
12 (T12) into the abdominal cavity.
 Vasculature of Thoracic Wall
 As mentioned above, the arterial supply to the thoracic wall is derived from the thoracic
aorta through the
 Posterior intercostal
 Subcostal arteries,
 The subclavian artery through the internal thoracic and supreme intercostal arteries,
 Axillary artery through the superior and lateral thoracic arteries.

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 With the exception of the 10th and 11th intercostal spaces, each intercostal space is
supplied by three arteries:
o A large posterior intercostal artery (and its collateral branch)
o A small pair of anterior intercostal arteries.

Vasculature of the Breast

 The arterial supply of the breast is derived from:
 Medial mammary branches of perforating branches and anterior intercostal branches of
the internal thoracic artery, originating from the subclavian artery.
 Lateral thoracic and thoracoacromial arteries, branches of the axillary artery.
 The second to fourth posterior intercostal arteries, branches of the thoracic aorta in the
intercostal spaces.
 The venous drainage of the breast is mainly to the axillary vein, but there is some
drainage to the internal thoracic vein

Refer students to Handout 14.1 Arteries and Veins of Thoracic Wall for more
elaboration

Step: 3. Venous Drainage of the Thorax (10 minutes)

 Venous drainage of the thoracic cavity
 Most of the venous blood from the organs in the thoracic cavity is drained into azygos
vein and the hemizygos vein. Some of the main vein that join them are; bronchial,
oesophageal and intercostals veins. The intercostals veins accompany the intercostal
arteries and nerves and lie most superior in the costal grooves.
 There are 11 posterior intercostal veins and one subcostal vein on each side
 The azygos vein joins the superior vena cava while the hemizygos vein joins the left
brachiocephalic vein.
 Some oesophageal veins join the azygos vein while others join the left gastric vein. A
venous plexus is formed by anastomoses between the veins joining the azygos and those
joining the left gastric veins lead to linkage of general and portal circulations.
 Venous drainage of the diaphragm is by veins that generally parallel the arteries. The
veins drain into:
 The brachiocephalic veins in the neck;
 The azygos system of veins; or
 Abdominal veins (left suprarenal vein and inferior vena cava).

Refer students to Handout 14.1 Arteries and Veins of Thoracic

Step 4: Blood Supply to the Shoulder (15 minutes)

 Blood supply to the shoulder is coming mainly from branches of subclavian artery
 Three major arteries are found in the scapular region:
 The suprascapular,
 Anterior and posterior circumflex humeral
 Circumflex scapular arteries.

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 These arteries contribute to an interconnected vascular network around the scapula and
shoulder
 The suprascapular artery originates in the base of the neck as a branch of the
thyrocervical trunk, which in turn, is a major branch of the subclavian artery
 The vessel may also originate directly from the third part of the subclavian artery. The
suprascapular artery normally enters the posterior scapular region superior to the
suprascapular foramen, whereas the nerve passes through the foramen.
 In the posterior scapular region, the vessel runs with the suprascapular nerve.
 In addition to supplying the supraspinatus and infraspinatus muscles, the suprascapular
artery contributes branches to numerous structures along its course
 Anterior and posterior circumflex humeral artery
 Anterior and posterior circumflex humeral artery originates from the third part of the
axillary artery in the axilla
 The posterior circumflex humeral artery and axillary nerve leave the axilla through the
quadrangular space in the posterior wall and enter the posterior scapular region. The
vessel supplies the related muscles and the glenohumeral joint
 Encircle surgical neck of humerus anastomosing with each other laterally
 Circumflex scapular artery
 The circumflex scapular artery is a branch of the subscapular artery that also originates
from the third part of the axillary artery in the axilla.
 The circumflex scapular artery leaves the axilla through the triangular space and enters
the posterior scapular region, passes through the origin of the teres minor muscle and
forms anastomotic connections with other arteries in the region such as suprascapular
artery
 Veins in the scapular region generally follow the arteries and connect with vessels in the
neck, back, arm, and axilla

Refer students to Handout 14.2: Arterial Supply to the Shoulder and Upper Limb for
more elaboration

Step 5: Arterial Blood Supply to the Forearm (20 minutes)

 The subclavian artery after giving off branches to the neck continues into the arm. It
passes between the clavicle and the first rib and becomes the axillary artery.
 The axillary artery supplies branches to structures in the axilla, the chest wall and part of
the mammary gland; the upper end of the humerus, the shoulder joint & muscles in the
back shoulder & chest.
 As the axillary artery leaves the axilla it becomes the brachial artery.
 The brachial artery courses along the humerus to the elbow. It gives rise to a deep
brachial artery that curves posteriorly around the humerus and supplies the triceps
muscles. Shorter branches pass into the muscle on the anterior side of the arm, whereas
others descend on each side to the elbow.
 The supracondylar fracture commonly results into injury of the brachial artery.

Blood supply of the forearm

 The largest arteries in the forearm are in the anterior compartment, pass distally to supply
the hand, and give rise to vessels that supply the posterior compartment

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 The brachial artery enters the forearm from the arm by passing through the cubital fossa.
At the apex of the cubital fossa, it divides into its two major branches,
 the radial and ulnar arteries

 Radial artery
 The radial artery originates from the brachial artery at approximately the neck of the
radius and passes along the lateral aspect of the forearm
 It is:
o Just deep to the brachioradialis muscle in the proximal half of the forearm
 Related on its lateral side to the superficial branch of the radial nerve in the middle third
of the forearm
 Medial to the tendon of the brachioradialis muscle and covered only by deep fascia,
superficial fascia, and skin in the distal forearm.
 In the distal forearm, the radial artery lies immediately, lateral to the large tendon of the
flexor carpi radialis muscle and directly anterior to the pronator quadratus muscle and the
distal end of the radius.
 In the distal forearm, the radial artery can be located using the flexor carpi radialis muscle
as a landmark. The radial pulse can be felt by gently palpating the radial artery against the
underlying muscle and bone.
 The radial artery has muscular branches, which contribute to the supply of the extensor
muscles on the radial side of the forearm.
 The radial artery leaves the forearm, passes around the lateral side of the wrist, and
penetrates the dorsolateral aspect of the hand between the bases of metacarpals I and II
 Branches of the radial artery in the hand often provide the major blood supply to the
thumb and lateral side of the index finger.
 Branches of the radial artery originating in the forearm include:
o a radial recurrent artery, which contributes to an anastomotic network around the
elbow joint
o numerous vessels that supply muscles on the lateral side of the forearm a small palmar
carpal branch contributes to an anastomotic network of vessels that supplies the carpal
bones and joints
o the superficial palmar branch that enters the hand by passing through, or superficial
to, the thenar muscles at the base of the thumb, which anastomoses with the
superficial palmar arch formed by the ulnar artery

Ulnar artery
 The ulnar artery is larger than the radial artery and passes down the medial side of the
forearm. It leaves the cubital fossa by passing deep to the pronator teres muscle, and then
passes through the forearm in the fascial plane between flexor carpi ulnaris and flexor
digitorum profundus muscles.
 In the distal forearm, the ulnar artery often remains tucked under the anterolateral lip of
the flexor carpi ulnaris tendon, and is therefore not easily palpable.
 In distal regions of the forearm, the ulnar nerve is immediately medial to the ulnar artery.
 The ulnar artery leaves the forearm, enters the hand by passing lateral to the pisiform
bone and superficial to the flexor retinaculum of the wrist, and arches over the palm. It is
often the major blood supply to the medial three and one-half digits.
 Branches of the ulnar artery that arise in the forearm include:

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 The ulnar recurrent artery with anterior and posterior branches, which contribute to an
anastomotic network of vessels around the elbow joint;
 Numerous muscular arteries, which supply surrounding muscles;
 The common interosseous artery which divides into anterior and posterior interosseous
arteries;
 Two small carpal arteries (dorsal carpal branch and palmar carpal branch), which supply
the wrist.
 The posterior interosseous artery passes dorsally over the proximal margin of the
interosseous membrane into the posterior compartment of the forearm.
 The anterior interosseous artery passes distally along the anterior aspect of the
interosseous membrane and supplies muscles of the deep compartment of the fore arm
and the radius and ulna. It has numerous branches, which perforate the interosseous
membrane to supply deep muscles of the posterior compartment; it also has a small
branch, which contributes to the vascular network around the carpal bones and joints.
Perforating the interosseous membrane in the distal forearm, the anterior interosseous
artery terminates by joining the posterior interosseous artery.

Refer students to Handout 14.3: Anastomosis Around The Elbow Joint for more
elaboration

Step 6: Arterial Blood Supply to the Hand (15 minutes)

 There are two arches on the palm the deep palmar arch and superficial palmar arch
 Superficial palmar arch is the direct continuation of ulnar artery; arch is completed on
lateral side by superficial branch of radial artery.
 Deep palmar arch is the direct continuation of radial artery; arch is completed on medial
side by deep branch of ulnar artery.

Ulnar artery and superficial palmar arch

 The ulnar artery and ulnar nerve enter the hand on the medial side of the wrist. The vessel
lies between the palmaris brevis and the flexor retinaculum and is lateral to the ulnar
nerve and the pisiform bone. Distally, the ulnar artery is medial to the hook of the hamate
bone and then swings laterally across the palm, forming the superficial palmar arch,
which is superficial to the long flexor tendons of the digits and just deep to the palmar
aponeurosis. On the lateral side of the palm, the arch communicates with a palmar branch
of the radial artery.
 One branch of the ulnar artery in the hand is the deep palmar branch which arises from
the medial aspect of the ulnar artery, just distal to the pisiform, and penetrates the origin
of the hypothenar muscles. It curves medially around the hook of the hamate to access the
deep plane of the palm and to anastomose with the deep palmar arch derived from the
radial artery.
 Branches from the superficial palmar arch include:
 A palmar digital artery to the medial side of the little finger;
 Three large, common palmar digital arteries, which ultimately provide the principal blood
supply to the lateral side of the little finger, both sides of the ring and middle fingers, and
the medial side of the index finger - they are joined by palmar metacarpal arteries from

Teaching Guides for NTA Level 4 MLS Curriculum Page 341

 the deep palmar arch before bifurcating into the proper palmar digital arteries, which
enter the fingers.

Radial artery and deep palmar arch

 The radial artery curves around the lateral side of the wrist, passes over the floor of the
anatomical snuffbox and into the deep plane of the palm by penetrating anteriorly through
the back of the hand. It passes between the two heads of the first dorsal interosseous
muscle and then between the two heads of the adductor pollicis to access the deep plane
of the palm and form the deep palmar arch.
 The deep palmar arch passes medially through the palm between the metacarpal bones
and the long flexor tendons of the digits. On the medial side of the palm, it communicates
with the deep palmar branch of the ulnar artery
 Before penetrating the back of the hand, the radial artery gives rise to two vessels:
 A dorsal carpal branch, which passes medially as the dorsal carpal arch, across the wrist
and gives rise to dorsal metacarpal arteries, which subsequently divide to become small
dorsal digital arteries, which enter the fingers;
 The first dorsal metacarpal artery, which supplies adjacent sides of the index finger and
thumb.
 Two vessels, the princeps pollicis artery and the radialis indicis artery, arise from the
radial artery in the plane between the first dorsal interosseous and adductor pollicis. The
princeps pollicis artery is the major blood supply to the thumb, and the radialis indicis
artery supplies the lateral side of the index finger.

The deep palmar arch gives rise to:

 Three palmar metacarpal arteries, which join the common palmar digital arteries from the
superficial palmar arch; and
 Three perforating branches, which pass posteriorly between the heads of origin of the
dorsal interossei to anastomose with the dorsal metacarpal arteries from the dorsal carpal
arch.
Refer students to Handout 14.4: Arteries of the Hand for more elaboration

Step 7: Venous Drainage of the Upper Limb (10 minutes)

 The veins of the upper limb are divided into two groups, superficial and deep veins.
 The deep veins generally parallel the arteries in each region and are given similar names
such as radial vein, ulnar vein, brachial vein, and axillary vein
 The hand contains interconnected networks of deep and superficial veins. The deep veins
follow the arteries; the superficial veins drain into a dorsal venous network on the back of
the hand over the metacarpal bones.
 Superficial veins begin in the hand and consist of the following;
 Cephalic vein, Basilic vein and Median cubital vein
 The cephalic vein originates from the lateral side of the dorsal venous network and passes
over the anatomical snuffbox into the forearm. It collects blood from the superficial
tissues of the hand. At the cubital fossa it joins the median vein, cubital vein which
communicates with basilic vein. As it continues superiorly in the arm receives blood
from superficial tissues on the lateral aspect of arm. It courses upward on the lateral side

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 of the shoulder, it pierces the tissue and empties into the axillary vein beyond the axilla,
the axillary vein becomes the subclavian vein
 The basilic vein originates from the medial side of the dorsal venous network and passes
into the dorsomedial aspect of the forearm. It goes superior on the medial side of the fore
arm and upper arm and then joins the brachial vein. As the basilic and brachial vein
merge, they form the axillary vein. It received blood from the medial aspect of the hand
and fore arm and arm.
 The axillary vein is large vein is formed by the union of the accompanying brachial veins
and the basilic vein at the inferior border of the teres major. The axillary vein ends at the
lateral border of the 1st rib, where it becomes the subclavian vein. The subclavian vein
together with internal jugular vein drain into the brachiocephalic vein.

Refer students to Handout 14.5: Venous Return of the Upper limb for more
elaboration

Step 8: Pulse Points and Measuring Blood Pressure (20 minutes)

 Activity: Demonstration (15 minutes)
 DIVIDE students in small groups of 6 – 8 students. In their groups should be in pairs
 ASK students to take pulse from each other from different parts of the upper limb then to
take the blood pressure from each other

 Before starting the demonstration REVIEW with them different points where pulse can be
taken using the information below

Peripheral pulses can be felt at six locations in the upper limb:

 Axillary pulse: axillary artery in the axilla lateral to the apex of the dome of skin covering
the floor of the axilla
 Brachial pulse in mid-arm: brachial artery on the medial side of the arm in the cleft
between the biceps brachii and triceps brachii muscles. This is the position where a blood
pressure cuff is placed
 Brachial pulse in the cubital fossa: brachial artery medial to the tendon of the biceps
brachii muscle. This is the position where a stethoscope is placed to hear the pulse of the
vessel when taking a blood pressure reading.
 Radial pulse in the distal forearm: radial artery immediately laterals to the tendon of the
flexor carpi radialis muscle. This is the most common site for 'taking a pulse'.
 Ulnar pulse in the distal forearm: ulnar artery immediately under the lateral margin of the
flexor carpi ulnaris tendon and proximal to the pisiform.
 Radial pulse in the anatomical snuffbox: radial artery as it crosses the lateral side of the
wrist between the tendon of extensor pollicis longus muscle and the tendons of extensor
pollicis brevis and abductor pollicis longus muscles.

Compression of brachial artery in a bleeding patient

 The best place to compress the brachial artery to control hemorrhage is near the middle of
the arm. The biceps must be pushed laterally to detect pulsations of the artery
(Fig1.below) Because the arterial anastomoses around the elbow provide a functionally
and surgically important collateral circulation, the brachial artery may be clamped distal

Teaching Guides for NTA Level 4 MLS Curriculum Page 343

 to the inferior ulnar collateral artery without producing tissue damage. The anatomical
basis for this is that the ulnar and radial arteries still receive sufficient blood through the
anastomoses. Ischemia of the elbow and forearm results from clamping the brachial artery
proximal to the deep artery of the arm for an extended period.

Figure1: Compression of brachial artery

Source: Lippincott Williams & Wilkins, 2007

Measuring blood pressure

 A sphygmomanometer is used to measure arterial blood pressure. A cuff is placed around
the arm and inflated with air until it compresses the brachial artery against the humerus
and occludes it. A stethoscope is placed over the artery in the cubital fossa, the pressure in
the cuff is gradually released, and the examiner detects the sound of blood beginning to
spurt through the artery. The first audible spurt indicates systolic blood pressure. As the
pressure is completely released, the point at which the pulse can no longer be heard
indicates diastolic blood pressure.

Refer students to Handout 14.6: Pulse Points for more illustrations

Step: Key Points (5 minutes)

 The blood supply to the upper limb is by brachial artery which is the continuation of
axillary artery.
 Around the elbow the brachial artery divides into two major arteries ulnar and radial
arteries.
 The superficial venous drainage of the upper limb is by cephalic vein while the deep
veins drain into brachial vein which continue as axillary vein the subclavian vein which
joins with internal jugular vein to form brachiocephalic vein.

Teaching Guides for NTA Level 4 MLS Curriculum Page 344

 Blood supply to the thoracic cavity depends on several branches of the subclavian artery
and thoracic aorta. The posterior intercosal arteries, subcostal, oesophageal, bronchial
arteries emerge from thoracic aorta while the internal thoracic which give anterior
intercostals arteries arise from the subclavian artery.
 The venous drainage of the thorax is through veins which accompany the arteries which
drain into the azygos and hemizygos venous system.

Step: Evaluation (5 minutes)

 Name the main arteries supplying blood to the shoulder and forearm
 Mention main deep veins draining the upper limb
 Name the main branches of thoracic aorta

References
 Drake R .L, Vogl W, Mitchell A W M (2007). Gray’s Anatomy for Students, United
Kingdom: Churchill Livingstone Elservier
 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 345

Figure: 1

Source: Lippincott Williams & Wilkins, 2007

Teaching Guides for NTA Level 4 MLS Curriculum Page 346

 Fig
ure:
2

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 347

Handout 14.2: Arterial Supply to the Shoulder and Upper Limb

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 348

Handout 14.3: Anastomosis Around the Elbow Joint

Source: Elsevier Ltd 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 349

Session 26: Blood Circulation to the
Pelvis and Lower Limb
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Outline blood vessels supplying the pelvis
 Identify arteries and veins supplying the perineum
 Recognize arterial circulation to the thigh
 Recognize arterial circulation of the leg
 Recognize arterial circulation of the foot
 Describe venous drainage of the lower limb

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Anatomy books or Atlases
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 16.1: Arteries Supplying the Pelvis and Perineum
 Handout 16.2: Venous Drainage From Pelvis and Perineum
 Handout 16.3: Arterial Supply to the Thigh
 Handout 16.4: Arterial Supply to the Lower Limb
 Handout 16.5: Arteries of the Leg
 Handout 16.6: Arteries of the Foot
 Handout 16.7: Venous drainage of the lower limb

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
Brainstorming Blood Vessels Supplying the Pelvis
2 20 minutes
Presentation
Brainstorming, Arteries and Veins Supplying the Perineum
3 15 minutes
Presentation
4 20 minutes Presentation Arterial Circulation of the Thigh
5 15 minutes Presentation Arterial Circulation of the Leg
6 20 minutes Presentation Arterial Circulation of the Foot
7 15 minutes Presentation Venous Drainage of the Lower Limb and

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 Pelvis
8 5 minutes Presentation Key Points
9 5 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the Learning Objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Blood Vessels Supplying the Pelvis (20 minutes)

Activity: Brainstorming (5 minutes)

ASK students what are the branches of internal iliac artery which supply the pelvic region
ALLOW them to refer to the books/Handout and respond
SUMMARISE their answers using the information below.

 The pelvis is the part of the trunk inferoposterior to the abdomen and is the area of
transition between the trunk and the lower limbs.
 The major artery of the pelvis and perineum is the internal iliac artery on each side. In
addition to providing a blood supply to most of the pelvic viscera, pelvic walls and floor,
and structures in the perineum, including erectile tissues of the clitoris and the penis, this
artery gives rise to branches that follow nerves into the gluteal region of the lower limb.
 Other vessels that originate in the abdomen and contribute to the supply of pelvic
structures include the median sacral artery and, in women, the ovarian arteries.
 The internal iliac artery originates from the common iliac artery on each side,
approximately at the level of the intervertebral disc between LV and SI and lie
anteromedial to the sacro-iliac joint.
 The vessel courses inferiorly over the pelvic inlet, and then divides into anterior and
posterior trunks at the level of the superior border of the greater sciatic foramen. Branches
from the posterior trunk contribute to the supply of the lower posterior abdominal wall,
the posterior pelvic wall, and the gluteal region. Branches from the anterior trunk supply
the pelvic viscera, the perineum, the gluteal region, the adductor region of the thigh, and,
in the fetus, the placenta.
 Branches of the posterior trunk of the internal iliac artery are the iliolumbar artery, the
lateral sacral artery, and the superior gluteal artery:
 Branches of the anterior trunk of the internal iliac artery include the superior vesical
artery, the umbilical artery, the inferior vesical artery, the middle rectal artery, the uterine
artery, the vaginal artery, the obturator artery, the internal pudendal artery, and the
inferior gluteal artery
 Pelvic veins follow the course of all branches of the internal iliac artery except for the
umbilical artery and the iliolumbar artery. On each side, the veins drain into internal iliac
veins, which leave the pelvic cavity to join common iliac veins situated just superior and
lateral to the pelvic inlet.
 Within the pelvic cavity, extensive interconnected venous plexuses are associated with
the surfaces of the viscera (bladder, rectum, prostate, uterus, and vagina). Together, these
plexuses form the pelvic plexus of veins. The part of the venous plexus surrounding the

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 rectum and anal canal drains via superior rectal veins (tributaries of inferior mesenteric
veins) into the hepatic portal system, and via middle and inferior rectal veins into the
caval system. This pelvic plexus is an important portacaval shunt when the hepatic portal
system is blocked

Refer students to Handout 16.1: Arteries Supplying the Pelvis and Perineum and
Handout 16.2: Venous Drainage from Pelvis and Perineum for more information.

Step 3: Arteries and Veins Supplying the Perineum (15 minutes)

Activity: Brainstorm (5 minutes)

 ASK students what is perineum?
 ALLOW them to respond.
 WRITE their responses on the flip chart
 SUMMARISE their responses using the information below
 The correct answer is: The perineum refers to the area of the trunk between the thighs
and the buttocks, extending from the pubis to the coccyx and to the shallow
compartment lying deep to this area and inferior to the pelvic diaphragm

 The most significant artery of the perineum is the internal pudendal artery. Other arteries
entering the area include the external pudendal, the testicular, and the cremasteric arteries.
 The internal pudendal artery originates as a branch of the anterior trunk of the internal
iliac artery in the pelvis. Along with the pudendal nerve, it leaves the pelvis through the
greater sciatic foramen inferior to the piriformis muscle. It passes around the iliac spine,
where the artery lies lateral to the nerve, enters the perineum by coursing through the
lesser sciatic foramen, and accompanies the pudendal nerve in the pudendal canal on the
lateral wall of the ischio-anal fossa.
 The branches of the internal pudendal artery are similar to those of the pudendal nerve in
the perineum and include the inferior rectal and perineal arteries, and branches to the
erectile tissues of the penis and clitoris
 Branches that supply the erectile tissues in men include the artery to the bulb of the penis,
the urethral artery, the deep artery of the penis, and the dorsal artery of the penis
 Branches that supply the erectile tissues in women are similar to those in men, they
include:
o Arteries of the bulb of vestibule supply the bulb of the vestibule and related vagina.
o Deep arteries of the clitoris supply the crura and corpus cavernosum of the body.
o Dorsal arteries of the clitoris supply surrounding tissues and the glans.
 The single deep dorsal vein that drains erectile tissues of the clitoris and the penis does
not follow branches of the internal pudendal artery into the pelvic cavity. Instead, this
vein passes directly into the pelvic cavity through a gap formed between the arcuate pubic
ligament and the anterior margin of the perineal membrane.
 The vein joins the prostatic plexus of veins in men and the vesical (bladder) plexus of
veins in women. (Superficial veins that drain the skin of the penis and corresponding
regions of the clitoris drain into the external pudendal veins, which are tributaries of the
great saphenous vein in the thigh.)

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 Refer students to Handout 16.1: Arteries Supplying the Pelvis and Perineum and
Handout 16.2: Venous Drainage From Pelvis and Perineum for more information.

Step 3: Arterial Circulation of the Thigh (20 minutes)

Activity: Buzzing (5 minutes)

 ASK students what are the branches of external iliac artery supplying the thigh and leg
 ALLOW them to buzz in pair and refer to the book or Handout.
 ASK few students to respond and WRITE their responses on the flip chart
 SUMMARISE their responses using the information below.

 Three arteries enter the thigh: the femoral artery, the obturator artery, and the inferior
gluteal artery.
 The major artery supplying the lower limb is the femoral artery, which is the continuation
of the external iliac artery in the abdomen. The external iliac artery becomes the femoral
artery as the vessel passes under the inguinal ligament to enter the femoral triangle in the
anterior aspect of the thigh. Branches supply most of the thigh and all of the leg and foot.
 Other vessels supplying parts of the lower limb include
o The superior gluteal arteries
o Inferior gluteal arteries
o The obturator artery
 The superior and inferior gluteal arteries originate in the pelvic cavity as branches of the
internal iliac artery and supply the gluteal region. The superior gluteal artery leaves the
pelvis through the greater sciatic foramen above the piriformis muscle and the inferior
gluteal artery leaves through the same foramen, but below the piriformis muscle.
 The obturator artery is also a branch of the internal iliac artery in the pelvic cavity and
passes through the obturator canal to enter and supply the medial compartment of the
thigh.
 Branches of the femoral, inferior gluteal, superior gluteal and obturator arteries, together
with branches from the internal pudendal artery of the perineum, interconnect to form an
anastomotic network in the upper thigh and gluteal region, around the hip joint. The
presence of these anastomotic channels may provide collateral circulation when one of
the vessels is interrupted
 The femoral artery is palpable in the femoral triangle just inferior to the inguinal ligament
midway between the anterior superior iliac spine and the pubic symphysis.
 A cluster of four small branches; superficial epigastric artery, superficial circumflex iliac
artery, superficial external pudendal artery, and deep external pudendal artery originate
from the femoral artery in the femoral triangle and supply cutaneous regions of the upper
thigh, lower abdomen, and perineum
 The femoral artery passes vertically through the femoral triangle and then continues down
the thigh in the adductor canal. It leaves the canal by passing through the adductor hiatus
in the adductor magnus muscle and becomes the popliteal artery behind the knee.

Deep artery of thigh

 The largest branch of the femoral artery in the thigh is the deep artery of thigh (profunda
femoris artery), which originates from the lateral side of the femoral artery in the femoral

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 triangle and is the major source of blood supply to the thigh. The deep artery of thigh
immediately passes:
 Posteriorly between the pectineus and adductor longus muscles and then between the
adductor longus and adductor brevis muscles;
 Then travels inferiorly between the adductor longus and adductor magnus, eventually
penetrating through the adductor magnus to connect with branches of the popliteal artery
behind the knee.
 The deep artery of thigh has lateral and medial circumflex femoral branches and three
perforating branches.
Lateral circumflex femoral artery
 The lateral circumflex femoral artery normally originates proximally from the lateral side
of the deep artery of thigh, but may arise directly from the femoral artery. It passes deep
to the sartorius and rectus femoris and divides into three terminal branches:
 One vessel (ascending branch) ascends laterally deep to the tensor fasciae latae muscle
and connects with a branch of the medial circumflex femoral artery to form a channel,
which circles the neck of the femur and supplies the neck and head of the femur;
 One vessel (descending branch) descends deep to the rectus femoris, penetrates the vastus
lateralis muscle and connects with a branch of the popliteal artery near the knee;
 One vessel (transverse branch) passes laterally to pierce the vastus lateralis and then
circles around the proximal shaft of femur to anastomose with branches from the medial
femoral circumflex artery, the inferior gluteal artery, and the first perforating artery to
form the cruciate anastomosis around the hip.

Medial circumflex femoral artery

 The medial circumflex femoral artery normally originates proximally from the
posteromedial aspect of the deep artery of thigh, but may originate from the femoral
artery.
 It passes medially around the shaft of femur, first between the pectineus and iliopsoas and
then between the obturator externus and adductor brevis muscles. Near the margin of the
adductor brevis the vessel gives off a small branch, which enters the hip joint through the
acetabular notch and anastomoses with the acetabular branch of the obturator artery.
 The main trunk of the medial circumflex femoral artery passes over the superior margin
of the adductor magnus and divides into two major branches deep to the quadratus
femoris muscle:
 One branch ascends to the trochanteric fossa and connects with branches of the gluteal
and lateral circumflex femoral arteries;
 The other branch passes laterally to participate with branches from the lateral femoral
circumflex artery, the inferior gluteal artery, and the first perforating artery in forming an
anastomotic network of vessels around the hip.

The perforating arteries

 The three perforating arteries branch from the deep artery of thigh as it descends anterior
to the adductor brevis muscle-the first originates above the muscle, the second originates
anterior to the muscle, and the third originates below the muscle. All three penetrate
through the adductor magnus near its attachment to the linea aspera to enter and supply
the posterior compartment of thigh.

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 The vessels have ascending and descending branches, which interconnect to form a
longitudinal channel, which participates above in forming an anastomotic network of
vessels around the hip and inferiorly anastomoses with branches of the popliteal artery
behind the knee

Refer students to Handout 16.3: Arterial Supply to the Thigh and Handout 16.4:
Arterial Supply to the Lower Limb for more illustrations

Step 4: Arterial Circulation of the Leg (15 minutes)

 The popliteal artery is the major blood supply to the leg and foot and enters the posterior
compartment of leg from the popliteal fossa behind the knee
 The popliteal artery a continuation of femoral artery passes the popliteal fossa behind the
knee where the pulses can be felt. It supplies the knee joint and structures in this area.
 Vascular supply to the knee joint is predominantly through descending and genicular
branches from the femoral, popliteal, and lateral circumflex femoral arteries in the thigh
and the circumflex fibular artery and recurrent branches from the anterior tibial artery in
the leg. These vessels form an anastomotic network around the joint
 At the lower border it divides into anterior and posterior tibia artery.
 Anterior tibial artery passes forward between the tibia and fibula, supplies structures in
front of the leg. It runs downward in front of the ankle joint and continues over the
dorsum as dorsalis pedis artery.
 Distally, the anterior tibial artery gives rise to an anterior medial malleolar artery and an
anterior lateral malleolar artery, which passes posteriorly around the distal ends of the
tibia and fibula, respectively, and connect with vessels from the posterior tibial and
fibular arteries to form an anastomotic network around the ankle.
 Posterior tibia artery runs downward and medially on the back of the leg. Near its origin
gives fibular artery which supplies lateral aspect of the leg.
 The posterior tibial artery descends through the deep region of the posterior compartment
of leg on the superficial surfaces of the tibialis posterior and flexor digitorum longus
muscles. It passes through the tarsal tunnel behind the medial malleolus and into the sole
of the foot.
 In the leg, the posterior tibial artery supplies adjacent muscles and bone and has two
major branches, the circumflex fibular artery and the fibular artery:
 The circumflex fibular artery passes laterally through the soleus muscle and around the
neck of the fibula to connect with the anastomotic network of vessels surrounding the
knee
 The fibular artery parallels the course of the tibial artery, but descends along the lateral
side of the posterior compartment adjacent to the medial crest on the posterior surface of
the fibula, which separates the attachments of the tibialis posterior and flexor hallucis
longus muscles
Refer students to Handout 16.4: Arterial Supply to the Lower Limb and Handout 16.5:
Arteries of the Leg for more information.

Step 5: Arterial Circulation of the Foot (20 minutes)

 Blood supply to the foot is by branches of the posterior tibial and dorsalis pedis (dorsal
artery of the foot) arteries.

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 The posterior tibial artery enters the sole and bifurcates into lateral and medial plantar
arteries. The lateral plantar artery joins with the terminal end of the dorsalis pedis artery
(the deep plantar artery) to form the deep plantar arch. Branches from this arch supply the
toes.
 The dorsalis pedis artery is the continuation of the anterior tibial artery, passes on the
dorsal aspect of the foot and then inferiorly, as the deep plantar artery, between
metatarsals I and II to enter the sole of the foot.

Posterior tibial artery and plantar arch

 The posterior tibial artery enters the foot through the tarsal tunnel on the medial side of
the ankle and posterior to the medial malleolus.
 Midway between the medial malleolus and the heel, the pulse of the posterior tibial artery
is palpable because here the artery is covered only by a thin layer of retinaculum, by
superficial connective tissue, and by skin. Near this location, the posterior tibial artery
bifurcates into:
 A small medial plantar artery
 A much larger lateral plantar artery.

Lateral plantar artery

 The lateral plantar artery passes anterolaterally into the sole of the foot, first deep to the
proximal end of the abductor hallucis muscle and then between the quadratus plantae and
flexor digitorum brevis muscles.
 It reaches the base of metatarsal V where it lies in the groove between flexor digitorum
brevis and abductor digiti minimi muscles.
 From here, the lateral plantar artery curves medially to form the deep plantar arch, which
crosses the deep plane of the sole on the metatarsal bases and the interossei muscles.
 Between the bases of the metatarsals I and II, the deep plantar arch joins with the terminal
branch (deep plantar artery) of the dorsalis pedis artery, which enters the sole from the
dorsal side of the foot.
 Major branches of the deep plantar arch include:
 A digital branch to the lateral side of the little toe;
 Four plantar metatarsal arteries, which supply digital branches to adjacent sides of toes i
to v and the medial side of the great toe;
 Three perforating arteries, which pass between the bases of metatarsals ii to v to
anastomose with vessels on the dorsal aspect of the foot.

Medial plantar artery

 The medial plantar artery passes into the sole of the foot by passing deep to the proximal
end of the abductor hallucis muscle. It supplies a deep branch to adjacent muscles and
then passes forward in the groove between the abductor hallucis and the flexor digitorum
brevis muscles. It ends by joining the digital branch of the deep plantar arch, which
supplies the medial side of the great toe.
 Near the base of metatarsal I, the medial plantar artery gives rise to a superficial branch,
which divides into three vessels that pass superficial to the flexor digitorum brevis muscle
to join the plantar metatarsal arteries from the deep plantar arch.

Dorsalis pedis artery

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 The dorsalis pedis artery is the continuation of the anterior tibial artery and begins as the
anterior tibial artery crosses the ankle joint. It passes anteriorly over the dorsal aspect of
the talus, navicular, and intermediate cuneiform bones, and then passes inferiorly, as the
deep plantar artery, between the two heads of the first dorsal interosseous muscle to join
the deep plantar arch in the sole of the foot.
 The pulse of the dorsalis pedis artery on the dorsal surface of the foot can be felt by
gently palpating the vessel against the underlying tarsal bones between the tendons of
extensor hallucis longus and the tendon of extensor digitorum longus to the second toe.
 Branches of the dorsalis pedis artery include lateral and medial tarsal branches, an arcuate
artery, and a first dorsal metatarsal artery:
 The tarsal arteries pass medially and laterally over the tarsal bones, supplying adjacent
structures and anastomosing with a network of vessels formed around the ankle;
 The arcuate artery passes laterally over the dorsal aspect of the metatarsals near their
bases and gives rise to three dorsal metatarsal arteries, which supply dorsal digital arteries
to adjacent sides of digits ii to v, and to a dorsal digital artery that supplies the lateral side
of the digit v;
 The first dorsal metatarsal artery (the last branch of the dorsalis pedis artery before the
dorsalis pedis artery continues as the deep plantar artery into the sole of the foot) supplies
digital branches to adjacent sides of the great and second toes.
 The dorsal metatarsal arteries connect with perforating branches from the deep plantar
arch and similar branches from the plantar metatarsal arteries.

Refer students to Handout 16.4: Arterial Supply to the Lower Limb and Handout 16.6:
Arteries of the Foot figure 1 and 2 for more illustrations

Step 6: Venous Drainage of the Lower Limb and Pelvis (15 minutes)
 Veins that drain the blood from the lower limb can be divided into superficial and deep
veins. The superficial veins are in the subcutaneous tissue, and the deep veins are deep to
the deep fascia and accompany all major arteries. Superficial and deep veins have valves,
but they are more numerous in deep veins.
 The two major superficial veins are the great and small saphenous veins. The great
saphenous vein is formed by the union of the dorsal digital vein of the great toe and the
dorsal venous arch of the foot.

The great saphenous vein

 Ascends anterior to the medial malleolus.
 Passes posterior to the medial condyle of the femur (about a hand's breath posterior to the
medial border of the patella).
 Anastomoses freely with the small saphenous vein.
 Traverses the saphenous opening in the fascia lata.
 Empties into the femoral vein.

Small saphenous vein

 The small saphenous vein arises on the lateral side of the foot from the union of the dorsal
digital vein of the fifth digit with the dorsal venous arch.

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 The small saphenous vein ascends posterior to the lateral malleolus as a continuation of
the lateral marginal vein and passes along the lateral border of the calcaneal tendon.
 Empties into the popliteal vein in the popliteal fossa.

The deep veins

 The deep veins in the lower limb accompany all the major arteries and their branches.
Instead of occurring as a single vein in the limbs, the deep veins are usually paired,
frequently interconnecting veins that flank the artery they accompany. They are contained
within a vascular sheath with the artery, whose pulsations also help compress and move
blood in the veins.
 The deep veins from the leg flow into the popliteal vein posterior to the knee, which
becomes the femoral vein in the thigh. The deep vein of the thigh joins the terminal
portion of the femoral vein.
 The femoral vein passes deep to the inguinal ligament to become the external iliac vein in
the pelvis.
 External iliac vein it enters the pelvis lying close to the femoral artery passes along the
brim of the pelvis and at the level of sacroiliac joint. It is joined by internal iliac vein to
form common iliac vein.
 Internal iliac vein receives tributaries draining organs of the pelvic cavity
 Common iliac vein (on each on side) ascend obliquely and ends to the body of the 5 th
lumbar where the left and right join to form inferior vena cava.

Refer students to Handout 16.7: Venous drainage From the lower limb for more
illustrations

NB: When vein cannulation on peripheral becomes difficult among the alternatives is
accessing peripheral veins of the leg by doing venous cut down on the medial side of the
ankle joint (3 cm above the medial malleolus) to access posterior tibia vein which runs along
side of the artery.

Step 5: Key Points (5 minutes)

 The internal iliac artery originates from the common iliac artery on each side
 The major artery supplying the lower limb is the femoral artery
 The popliteal artery is a continuation of femoral artery
 Veins that drain the blood from the lower limb can be divided into superficial and deep
veins.
 The two major superficial veins are the great and small saphenous veins

Step 6: Evaluation (5 minutes)

 Mention branches of internal iliac artery
 Mention branches of external iliac artery
 Name the two superficial veins draining blood from lower limbs.

References
 Drake R .L, Vogl W, Mitchell A W M (2007). Gray’s Anatomy for Students, United
Kingdom: Churchill Livingstone Elservier

Teaching Guides for NTA Level 4 MLS Curriculum Page 358

 Moore, K. L. & Agur, A. M. R. (2007). Essential Clinical Anatomy, 3rd Edition
Lippincott Williams & Wilkins
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology. New York:
McGraw-Hill
 Shier A, Butler J & Lewis R (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
 Standring S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc
 Waugh A & Grant A (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.

Teaching Guides for NTA Level 4 MLS Curriculum Page 359

Handout 16.1: Arteries Supplying the Pelvis and Perineum

Source: Elsevier Ltd 2005.

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Handout 16.2: Venous Drainage from Pelvis and Perineum

Source: Elsevier Ltd 2005.

Handout 16.3: Arterial Supply to the Thigh

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Source: Elsevier Ltd 2005.

Handout 16.4: Arterial Supply to the Lower Limb

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Handout 16.6: Arteries of the Foot

Figure 1:

Source: Elsevier Ltd 2005.

Figure: 2

Source: Elsevier Ltd 2005.

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Handout 16.7: Venous drainage of the lower limb

Source: Lippincott Williams & Wilkins, 2007

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Session 27: Male Reproductive System
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Explain organisation of male reproductive system
 Describe structure of testes
 Describe process of sperm cell development
 Describe descending process of the testes
 Describe reproductive ducts

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout 18.1: Anatomical structure of testis

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation Organisation of Male Reproductive System
Brainstorming
3 30 minutes Presentation Structure of Testes
4 20 minutes Presentation Process of Sperm Cell Development
5 15 minutes Presentation Descending Process of the Testes
6 20 minutes Presentation Reproductive Ducts
7 5 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: The Organisation of Male Reproductive System (15 minutes)

 Activity: Brainstorming (5 minutes)
 ASK students the following questions
 What is reproductive system and
 What is the main function of male reproductive system? It’s important
 Which organs form the male reproductive system

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 ALLOW them to respond.
 SUMMARIZE the activity by clarifying on students responses.

 The ability to reproduce is one of the properties which distinguish living from non living
matter.
 In both sexes, organ of the reproductive are adapted for the specie sequence of functions
that are concern primarily with propagation of the species
 The male reproductive system consists of organs whose function are to produce, transfer
and ultimately introduce the mature sperm into the female reproductive tract, where
fertilization can occur
 Primary organs for the production of gametes (spermatozoa) is the gonads i.e. testes
 Accessory organs that play some type of supportive process these include:
 Genital ducts which convey sperm to the outside of the body these include epididymis,
paired vasa deferentia, pair of ejaculatory ducts and the urethra
 Accessory glands which produce secretions that nourish transport, and mature sperm. The
glands are a pair of seminal vesicles, one prostate and a pair of bulbourethral (cowper’s)
glands
 Supportive structure – scrotum, a pair of spermatic cords and penis
 The male gametes are called spermatozoa and female gametes are called ova. Both
contain the genetic material or genes on chromosomes, which pass inherited
characteristics on to the next generation. In other body cells there 46 chromosomes
arranged in 23 pairs but in the gametes there are only 23. When the ovum is fertilised by a
spermatozoa the resultant zygote contain 23 pairs of chromosomes one pair from the
father and one pair from the mother

Step 3: Structure of Testes (30 minutes)

 Testes are small ovoid glands measures about 4-5 cm in length and weigh 10 to 15 gm
each. Both testes are suspended in the pouch by attachment to scrotal tissue and by the
spermatic cords; a testicular temperature is 2-3 ºC lower than body temperature. This is
the ideal temperature for the spermatogenesis.
 Scrotum is a skin covered pouch suspended from perineal region. It is divided into two
compartments each sac containing a testis, epididymis and lower part of a spermatic cord,
the dartos fascia and dartos muscle are located just below the skin of the scrotum.
Contraction of the dartos muscle fibres causes slight elevation of the testes and wrinkling
of the scrotal pouch
 Contraction of the cremaster muscle will cause significant elevation of the testes. As a
result of contraction, the testes are pulled upward against the perineum.
 Spermatozoa are very sensitive to temperature do not develop normally at usual body
temperature. This is why the testes and epididymides (epididymis sing.) in which the
sperm cells develop are located outside the body cavity. In the scrotum, where the
temperature is lower.
 The testes are surrounded by three layers of tissue
 The tunica vaginalis is a double membrane forming the outer covering of the testes. This
is a down growth of the abdominal and pelvic peritoneum
 The tunica albuginea, this is a dense fibrous covering beneath the tunica vaginalis that
surrounds the testes and then enters the gland sending out partitions (septa) that radiate
through its interior dividing it into 200 or more cone-shaped lobules

Teaching Guides for NTA Level 4 MLS Curriculum Page 366

 The tunica vasculosa , this consists of a network of capillaries supported by delicate
connective tissue
 In each testis, there are 200 to 300 lobules. And within each lobule are 1-4 convoluted
loops composed of germinal epithelial cells called seminiferous tubule in which sperm
cells develop.
 Between the tubules are groups of interstitial cells of leydig that secretes the hormone
Testosterone after puberty.
 At the upper pole of the testes the tubules combine to form a single tubule. This tubule
about 6 metre in length is repeatedly folded and tightly packed into a mass called
epididymis. It leaves the scrotum as different duct (vas differens) in the spermatic cord.
 Blood and lymph vessels pass to the testes in the spermatic cord.
 Testes are located outside the body. This is to provide favourable temperature (below the
normal body temp) for spermatogenesis.

Step 4: Process of Sperm Cell Development (25 minutes)

 Before puberty, the testes remain relatively simple and unchanged from the time of their
initial development. The interstitial cells are not prominent during this period.
 The seminiferous tubules contain two types of cells.
 Sustentacular or sertoli cells
 Sustentacular cells are large cells that extend from the periphery to the lumen of the
seminiferous tubule.
 They nourish the germ cells and produce hormones such as androgen, oestrogens and
inhibins
 Tight junctions between the cells form a blood –testes barrier, which isolates the sperm
cells from the immune system. This is important because as the sperm cells develop, they
form surface antigens that could stimulate an immune response, resulting in their
destruction

Germ cells
 Sperm cells are derived from these cells
o They are arranged in such a way that the most immature cells are at the periphery and
most mature cells are near the lumen of the seminiferous tubule.
o The most peripheral cells, those adjacent to the basement membrane of the
seminiferous, are the spermatogonia, which divide by mitosis.
o Some of the daughter cells produced from these mitotic divisions remain
spermatogonia and continue to produce additional spermatogonia. The others divide
through mitosis and differentiate to form primary spermatocytes
o Meiosis begins when the primary spermatocytes divide. Each primary spermatocyte
passes through the first meiotic division to become two secondary spermatocytes.
Each secondary spermatocyte undergoes a second meiotic division to produce two
even smaller cells called spermatids. Each spermatid undergoes the last phase of
spermatogenesis called spermiogenesis to form a mature sperm cell or spermatozoon.
Each spermatid develops a head, mid piece and a tail, or flagellum. The head contains
chromosomes and at the leading end it has a cap, acrosome, which contains enzymes
necessary for the sperm cells to penetrate the female cell.
o The whole process is under the hormonal influence produced by interstitial cells and
sustentacular cells.

Teaching Guides for NTA Level 4 MLS Curriculum Page 367

Step 5: Descent of the Testes (15 minutes)
 Testes develop as retroperitoneal organs in the abdominal cavity adjacent to the kidney
and each testis is connected to the scrotum by a gubernaculums, a bundle of
fibromuscular connective tissue extends from each testis to the posterior wall of a small
anterior and inferior pocket of the peritoneum
 As the foetus grows, the gubernacula do not get any longer so they lock the testes in
position. As a result the relative position of each testis changes as the body enlarges. The
testis gradually moves inferiorly and anteriorly toward the anterior abdominal wall. It
moves through the abdominal musculature accompanied by small pockets of peritoneal
cavity
 In cryptochidism (hidden orchitis, testes)
 3% of all full term deliveries and in 30% of all premature birth the undescended testis
may occur, one or both testes
 The cryptorchid testes are lodged in the abdominal cavity or within the inguinal canal.
 Corrective measures should be taken before puberty because cryptorchid testis will not
produce spermatozoa as the higher temperature of the abdominal cavity prevents normal
sperm cell development. If both testes are cryptorchid, the individual will be stelile and if
not corrected 10% develop testicular cancer.

Step 6: Reproductive Ducts (20 minutes)

 After their release into the seminiferous tubule, the sperm cells pass through the tubuli
recti to rete testis. From the rete testis, they pass through the efferent ductules, which
leave testis and enter the epididymis to join the duct of the epididymis.
 Epididymis – the start of male reproductive tract consists of a single, tightly coiled tube
enclosed in a fibrous casing lies along top and side of each testis comma shaped, it is 6
metres in length
 Anatomical division , it consists of head the portion of the epididymis proximal to the
testis the head receive spermatozoa from efferent lobules
 The body begins distal to the last efferent ductless and extend inferiorly along the
posterior margin of the testis. The tapered inferior portion that is continuous with the vas
deferens and called the tail
 The duct of the epididymis has a pseudostratified columnar epithelium with elongated
long atypical microvilli called stereocilia although they neither contain the microtubular
structures of cilia nor function like cilia. These increase the surface area
 It contributes to the maturation of sperms, which spend from 1 to 3 weeks in this segment
of the duct system
 Spermatozoa formed in the testis enter the caput epididymis, progress to the corpus, and
finally reach the cauda region, where they are stored. Sperm entering the caput
epididymis are incomplete - they lack the ability to swim forward (motility) and to
fertilize an egg. During their transit in the epididymis, sperm undergo maturation
processes necessary for them to acquire these functions.
 During ejaculation, sperm flow from the lower portion of the epididymis (which functions
as a storage reservoir). They have not been activated by products from the prostate gland,
and they are unable to swim, but are transported via the peristaltic action of muscle layers
within the vas deferens, and are mixed with the diluting fluids of the seminal vesicles and
other accessory glands prior to ejaculation (forming semen).

Teaching Guides for NTA Level 4 MLS Curriculum Page 368

 Vas Deferens (ducts deferens)
 Is an extension of the tail of the epididymis. It has thick muscular wall and can be
palpated in the scrotal sac as a smooth movable cord. Consists of 3 layers – intermediate,
circular layer of muscle fibres and inner and outer longitudinal layer
 The vas deferens ascends from the scrotum and passes through the inguinal canal as part
of spermatic cord enclosed by fibrous connective tissue with blood vessels, nerves and
lymphatic into the abdominal cavity, over top and down posterior surface of the bladder
where an enlarged and tortuous portion called the ampulla joins the duct from the seminal
vesicle to form the ejaculatory duct.
 Therefore the spermatic cord consists of the ductus deferens, testicular artery and venous
plexus, lymphatic vessels, nerves and fibrous remnant of the tunica vaginalis.
 The covering of the spermatic cord include the external spermatic fascia the cremaster
muscles, an extension of muscle fibre of the internal abdominal oblique muscles of the
abdomen and the internal spermatic fascia
 During ejaculation the smooth muscle in the walls of the vas deferens contracts
reflexively, thus propelling the sperm forward. This is also known as peristalsis. The
sperm is transferred from the vas deferens into the urethra, collecting secretions from the
male accessory sex glands such as the seminal vesicles, prostate gland and the
bulbourethral glands, which form the bulk of semen

 Ejaculatory Duct: Adjacent to the ampulla of each ductus deferens is a sac-shaped gland
called the seminal vesicle. A short duct from each seminal vesicle joins the vas deferens
to form the ejaculatory duct approximately 2.5 cm long. These ducts project into the
prostate gland terminating in the urethra.

Step 7: Key Points (5 minutes)

 The male reproductive system consists of organs whose function is to produce, transfer
and ultimately introduce the mature sperm into the female reproductive tract.
 Testes develop as retroperitoneal organs in the abdominal cavity adjacent to the kidney
 Testes are located outside the body. This is to provide favourable temperature (below the
normal body temp) for spermatogenesis
 Sperm cells are derived from germ cells
 Epididymis contributes to the maturation of sperms, which spend from 1 to 3 weeks in
this segment of the duct system

Step 8: Evaluation (10 minutes)

 What is the principal organ of male reproductive system
 Name part of the reproductive duct
 Describe the constituents of spermatic cord

 ASK students if they have any comments or need clarification on any points.

References
 Elsevier .Drake et el: Gray’s Anatomy for students-www.studentsconsult.com
 Richard L.D, Grays’s Anatomy for students (electronic book)
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology McGraw-Hill

Teaching Guides for NTA Level 4 MLS Curriculum Page 369

 Thibodeau G. A. Patton K. T. (1999) Anatomy & Physiology Mosby, Inc. Von Hoffman
Press, Inc.
 Waugh A & Grant A (2006) Ross and Wilson Anatomy and physiology in Health and
illness Churchill Livingstone Elsevier. Elsevier Limited China.

Teaching Guides for NTA Level 4 MLS Curriculum Page 370

Handout 18.1: Anatomical structure of testis

`
Source: www.studentconsult.com

Teaching Guides for NTA Level 4 MLS Curriculum Page 371

Session 28: Accessory Organs and
Physiology of Male Reproductive System
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Describe organisation of accessory organs of male reproductive system
 Describe structure of seminal vesicles
 Describe structure and location of prostate gland
 Describe bulbourethral gland
 Describe structure and functions of penis
 Describe secondary male characteristics
 Explain secondary male characteristics

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout 19. 1: The Seminal Vesicle
 Handout 19.2: The Prostate Gland
 Handout 19.3: The Penis

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation Organisation of Accessory Organs of Male
2 10 minutes
Buzzing Reproductive System
3 10 minutes Presentation Structure of Seminal Vesicles
4 20 minutes Presentation Structure and Location Of Prostate Gland
5 10 minutes Presentation Bulbo-Urethral Gland
6 25 minutes Presentation Structure and Functions Of Penis
7 20 minutes Presentation Secondary Male Characteristics
8 10 minutes Presentation Key Points
9 10 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 372

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Organisation of Accessory Organs of Male Reproductive System (10 minutes)

 Activity: Buzzing (5 minutes)
 ASK students to pair up in two.
 Ask students to mention the accessory organs of the male reproductive system
 ASK one volunteer from one pair to come in front and present their findings.
 ALLOW the rest of the class to add on if they are having any additional information.
 SUMMARIZE the activity by clarifying on students responses.

 Accessory organs of male reproductive system play an important supportive role for the
existence and proper functioning of this system. These structures include,
 Accessory glands which produce secretions that nourish transport, and mature sperm
 The glands are a pair of seminal vesicles, one prostate and a pair of bulbourethral
(cowper’s) glands
 Reproductive ducts that propel and transport sperm from the site of production to the
outside of the body (this portion has been discussed in the previous session)
 Supportive structure – scrotum, a pair of spermatic cords and penis

Refer student to session 18: Male Reproductive System.

Step 3: The Structure of Seminal Vesicles (10 minute)

 Seminal vesicles are a pair of simple tubular glands postero-inferior to the urinary bladder
of a male
 Each seminal gland spreads approximately 5 cm, though the full length of seminal vesicle
is approximately 10 cm, but it is curled up inside of the gland's structure
 Each gland has a short duct that joins with the ductus deferens at the ampulla to form an
ejaculatory duct, which then empties into the urethra
 They secrete a significant proportion of the fluid that is alkaline viscous liquid ultimately
becomes semen. The alkalinity of semen helps neutralize the acidity of the vaginal tract,
prolonging the lifespan of sperm
 About 60% of the seminal fluid in humans originates from the seminal vesicles.
 The thick secretions contain proteins, enzymes, fructose, mucus, vitamin C, flavins,
phosphorylcholine and prostaglandins.
 The high fructose concentrations provide nutrient energy for the spermatozoa as they
travel through the female reproductive system. The fluid is expelled under sympathetic
contraction of the muscularis muscle coat.

Refer student to Handout 19. 1: The seminal vesicle

Step 4: Structure and Location of Prostate Gland (20 minutes)

 The prostate gland is a compound tubuloalveolar exocrine gland of the male reproductive
system. Located just below the bladder and is shaped like a doughnut. It lies in front of
the rectum and behind the symphysis pubis, surrounding the first part of the urethra.

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 It surrounds the prostatic urethra. It consists of both glandular and muscular tissue. The
glandular substance composed of columnar epithelial cells.
 It secretes a thin alkaline substance that constitutes about 30% of the seminal fluid
volume. Its alkalinity helps protects the sperm from acid in the male urethra and female
vagina and thereby increases sperm mortility
 The prostate has
 A base (superior aspect) that is closely related to the neck of the bladder.
 An apex (inferior aspect) that is in contact with fascia on the superior aspect of the
urethral sphincter and deep perineal muscles.
 A muscular anterior surface that features mostly transversely oriented muscle fibers
forming a vertical trough-like hemisphincter (rhabdosphincter), which is part the urethral
sphincter, separated from the pubic symphysis by retroperitoneal fat in the retropubic
space .
 A posterior surface that is related to the ampulla of the rectum.
 Inferolateral surfaces that are related to the levator ani.
 Although not clearly distinct anatomically, the following lobes of the prostate are
traditionally described.
 The isthmus of the prostate (historically, the anterior lobe) lies anterior to the urethra. It is
primarily muscular and represents the superior continuation of the urethral sphincter
muscle.
 The inferoposterior (posterior) lobe lies posterior to the urethra and inferior to the
ejaculatory ducts; it is readily palpable by digital rectal examination.
 The right and left (lateral) lobes on either side of the urethra form the major part of the
prostate.
 The middle (median) lobe lies between the urethra and the ejaculatory ducts and is closely
related to the neck of the bladder. Enlargement of the middle lobe is believed to be
partially responsible for the formation of the uvula that may project into the internal
urethral orifice.

Refer students to Handout 19.2: The prostate gland

Step 5: Bulbourethral Gland (10 minutes)

 The two bulbourethral or Cowper’s gland resemble peas in size and shape, lie below
prostate gland its ducts open into penile portion of urethra.
 It secretes alkaline fluid with mucus which contributes to seminal fluid and lubricates the
urethra.
 Bulbourethral glands are located posterior and lateral to the membranous portion of the
urethra at the base of the penis, between the two layers of the fascia of the urogenital
diaphragm, in the deep perineal pouch. They are enclosed by transverse fibers of the
sphincter urethrae membranaceae muscle
 The bulbourethral glands are compound tubulo-alveolar glands.
 During sexual arousal each gland produces a clear, viscous secretion known as pre-
ejaculate. This fluid helps to lubricate the urethra for spermatozoa to pass through, it
neutralizes traces of acidic urine in urethra, and helps flush out any residual urine or
foreign matter.

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 It is possible for this fluid to pick up sperm, remaining in the urethral bulb from previous
ejaculations, and carry them out prior to the next ejaculation. The Cowper's gland also
produces some amount of prostate specific antigen and Cowper's tumors may increase
PSA to a level that makes prostate cancer suspicious.

Step 6: Structure and Functions of Penis (25 minutes)

 Composed of three cylindrical masses of erectile tissue two larger and uppermost named
corpora cavernosa and lower small which contain urethra is called the corpus spongiosum
 The distal part of the corpus spongiosum overlaps the terminal end of the two corpora
cavernosa to form a slightly bulging structure the glans penis over which the skin is
folded doubly to form a loose-fitting, retractable casing known as the prepuce or foreskin
 The penis contain the urethra, the terminal duct for both urinary and reproductive tract
 The penis is supplied by branches of the internal pudendal arteries
 Dorsal arteries of the penis run in the interval between the corpora cavernosa on each side
of the deep dorsal vein, supplying the fibrous tissue around the corpora cavernosa and the
penile skin.
 Deep arteries of the penis pierce the crura and run distally near the center of the corpora
cavernosa, supplying the erectile tissue in these structures.
 Arteries of the bulb of the penis supply the posterior (bulbous) part of the corpus
spongiosum and the bulbourethral gland. They give off numerous branches (helicine
arteries of penis) that open directly into the cavernous spaces. When the penis is flaccid,
these arteries are coiled, restricting blood flow.
 Superficial and deep branches of the external pudendal arteries supply the penile skin,
anastomosing with branches of the internal pudendal arteries.
 Blood from the cavernous spaces of the corpora is drained by a venous plexus that
becomes the deep dorsal vein of the penis in the deep fascia. This vein passes deep
between the laminae of the suspensory ligament of the penis, anterior to the perineal
membrane, to enter the prostatic venous plexus. Blood from the superficial coverings of
the penis drains into the superficial dorsal vein(s), which ends in the superficial external
pudendal vein. Some blood also passes to the internal pudendal vein.
 Lymph from the skin of the penis drains initially to the superficial inguinal lymph nodes
that from the glans and distal spongy urethra drain to the deep inguinal and external iliac
nodes. The cavernous bodies and proximal spongy urethra drain to the internal iliac nodes
 The nerves derive from the S2 S4 segments of the spinal cord. Sensory and sympathetic
innervation is primarily from the dorsal nerve of the penis, a terminal branch of the
pudendal nerve, which arises in the pudendal canal and passes anteriorly into the deep
perineal pouch. It then runs along the dorsum of the penis lateral to the dorsal artery and
supplies the skin and glans. The penis is supplied with a variety of sensory nerve endings,
especially the glans penis. Branches of the ilioinguinal nerve supply the skin at the root of
the penis. Cavernous nerves, conveying parasympathetic fibers independently from the
prostatic nerve plexus, innervate the helicine arteries.
 Erection process
 During sexual intercourse the erectile tissue of the penis fills with blood causing the organ
to become rigid and enlarge in both diameter and length. This facilitate the sexual
intercourse
 Erection is a parasympathetic reflex initiated mainly by certain tactile, visual and mental
stimuli. It consists of dilatation of the arteries and arterioles of the penis which in turn

Teaching Guides for NTA Level 4 MLS Curriculum Page 375

 flood and distends space in its erectile tissue and compresses its veins. Therefore more
blood enters the penis through arteries than leaves it through the constricted veins. Hence
it becomes larger and rigid.
 Ejaculation
 Is the ejecting of semen from the penis, and is usually accompanied by orgasm. A series
of muscular contractions delivers semen, containing male gametes known as sperm cells
or spermatozoa, from the penis (and into the vagina, if for reproductive intention via
sexual intercourse). Ejaculation has two phases: emission and ejaculation proper
 Emission is the reflex movement of sex cells or spermatozoa and secretions from the
genital ducts, accessory glands into the prostatic urethra. Once emission has occurred
ejaculation follows. Is under control of the sympathetic nervous system
 Ejaculation of semen is also a reflex response it is the usual outcome of the same stimuli
that initiate erection. Ejaculatory phase is under control of a spinal reflex at the level of
the spinal nerves S2–4 via the pudendal nerve
 During ejaculation various responses occur notably accelerated heart rate, increased blood
pressure, hyperventilation, dilated skin blood vessels and intense sexual excitement- this
characterised the male orgasm or sexual climax
 Semen is a composite of sperm cells and secretion from,
 Testes and epididymis (5%)
 Seminal vesicles (60%)
 Prostate gland (30%)
 Bulbo urethral glands less than ( 5%)

Refer students to Handout 19.3: The penis

Step 7: Secondary Male Characteristics (20 minutes)

 Normal function of the male reproductive system depends on both hormonal and neural
mechanisms. Hormones are primarily responsible for the development of reproductive
structures and maintenance of their functional capacities, development of secondary
sexual characteristics, control of sperm cell formation and influencing sexual behaviour.
 Neural mechanisms are primarily involved in sexual behaviour and controlling sexual act.
 Hormonal mechanism that influence the male reproductive system involve the
hypothalamus, the pituitary gland and the testis
 Gonadotropin releasing hormone or lutenizing hormone releasing hormone is released
from the neurons in the hypothalamus and in turn stimulates the secretion of luteinizing
hormone and follicle stimulating hormone from the anterior pituitary gland. The two
hormones stimulate spermatogenesis, secretion of testosterone and secretion of inhibin in
the testes.
 Lutenizing hormone from anterior lobe of pituitary gland stimulates the interstitial cells of
the testis to increase the production of testosterone.
 Testosterone is the most important male hormone, its functions are:
 Stimulate spermatogenesis and promoting the functional maturation of spermatozoa,
through its effect on sustentacular cells
 Affect central nervous system function including the libido
 Stimulating metabolism throughout the body especially pathways concerned with protein
synthesis, blood cell formation and muscle growth

Teaching Guides for NTA Level 4 MLS Curriculum Page 376

 Establishing and maintaining male secondary sex characteristics such as the distribution
of facial hair, increased muscle mass and body size, enlargement of larynx and deepening
of voice
 Coarsening or rigidity of skin texture, due to less subcutaneous fat
 Maintaining the accessory glands and organs of the male reproductive tract
 It plays a part in fluid and electrolyte metabolism as it promotes kidney tubule excretion
of potassium.
 It inhibit anterior pituitary secretion of gonadotropins namely FSH and LH
 This occurs between 10 and 14 years.

Step 8: Key Points (10 minutes)

 Accessory organs of male reproductive system play an important supportive role for the
existence and proper functioning of this system
 Seminal vesicles are a pair of simple tubular glands postero-inferior to the urinary bladder
of a male producing about 60% of the seminal fluid
 Prostate consists of both glandular and muscular tissue. It secretes a thin alkaline fluid
 Bulbourethral gland secretes alkaline secretion with mucus which contributes to seminal
fluid and lubricates the urethra.
 The penis is an external genital organ composed of three cylindrical masses of erectile
tissue two larger and uppermost named corpora cavernosa and lower small which contain
urethra is called the corpus spongiosum
 The penis contain the urethra, the terminal duct for both urinary and reproductive tract

Step 9: Evaluation (10 minutes)

 Mention accessory organs of the male reproductive system
 Mention the accessory glands of male reproductive system
 List the constituent of semen
 List 5 secondary characteristics of male.

 ASK students if they have any comments or need clarification on any points.

References
 Copyright ©2007 Lippincott Williams & Wilkins
 Elsevier .Drake et el: Gray’s Anatomy for students-www.studentsconsult.com
 Moore, L., A M. R Agur. Essential Clinical Anatomy, 3rd Edition
 Richard L.D, Grays’s Anatomy for students (electronic book)
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology McGraw-Hill
 Standring S. Grays’s Anatomy (2008) the anatomical basis of clinical practice Churchill
Livingstone Elservier.
 Thibodeau G. A. Patton K. T. (1999) Anatomy & Physiology Mosby, Inc. Von Hoffman
Press, Inc.
 Waugh A & Grant A (2006) Ross and Wilson Anatomy and physiology in Health and
illness Churchill Livingstone Elsevier. Elsevier Limited China.

Teaching Guides for NTA Level 4 MLS Curriculum Page 377

Handout 19.1: The seminal vesicle

Source: www.studentsconsult.com

Handout 19.2: The prostate gland

Source: www.studentsconsult.com

Teaching Guides for NTA Level 4 MLS Curriculum Page 378

Handout 19.3: The penis

Source: www.studentsconsult.com

Teaching Guides for NTA Level 4 MLS Curriculum Page 379

Session 29: Structural Organisation of
Female Reproductive System
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Identify organs of the female reproductive system
 Explain the structure in the perineum and external genitalia
 Identify ovarian attachment and blood supply
 Describe structure of the ovary and formation of primordial follicles
 Describe follicular maturation and ovulation
 Describe hormonal role in follicle maturation
 Describe puberty in females

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout Handout 20.1: The female external genitalia
 Handout 20.2: Ovarian Ligaments
 Handout 20.3: Ovarian Blood Supply

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation Organs of The Female Reproductive System
2 15 minutes
Buzzing
Presentation Perineum and External Genitalia
3 20 minutes
Discussion
4 15 minutes Presentation Ovarian Attachment and Blood Supply
Presentation Structure of Ovary and Formation of Primordial
5 10 minutes
Follicles
6 25 minutes Presentation Follicle Maturation and Ovulation
7 15 minutes Presentation Hormonal Role and Puberty In Females.
8 05 minutes Presentation Key Points
9 10 minutes Presentation Evaluation
SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 380

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Organs of the Female Reproductive System (15 minutes)

 Activity: Buzzing (5 minutes)
 ASK students to pair up in two.
 ASK students what is the significance of female reproductive organs and which organs
make up the female reproductive system.
 GIVE them two minutes to discuss.
 ASK one volunteer from one pair to come in front and present their findings and the rest
of the class to add if they have additional points.
 SUMMARIZE the activity using the information below by clarifying on students
responses

 Without the reproductive system, the human species could not survive.
 The female reproductive system produces oocytes and can receive sperm cells, which
one of them may unite with an oocyte (female gamete) to form the first cell of an
offspring
 It is also involved in nurturing the development of a new individual until birth and usually
for some considerable time after birth i.e. it provide protection and nutrition to the
developing offspring for up to several years after conception.
 Female and male reproductive system all are derived from the same embryologic
structures
 In human being, essence of sexual reproduction is that each offspring has parents and a
combination of genes from both.
 The female reproductive organs are classified as
 Primary organs , gonads are the ovaries, which produce ova (gametes)
 Accessory organs
 External genital – the vulva
 Internal genitals – uterine tubes, uterus and vagina
 Additional sex glands such as the mammary gland
 Primary organ for female reproductive system is the ovary whose main functions are:
 Production of female gametes or oocytes
 Secretion of female sex hormones including oestrogen and progesterone
 Step 3: Perineum and External Genitalia (20 minutes)
 Perineum is the skin-covered muscular region between the vaginal orifice and the anus
 It is a roughly diamond shaped area between the thighs, extend from the symphysis pubis
anteriorly to the coccyx posteriorly.
 The perineum has great clinical importance because of the danger of being torn during
childbirth. Such tears are often deep, have irregular edges, to avoid these tears sometime
is necessary to do a surgical incision known as episiotomy during childbirth if there is a
threat for tear to occur
 Female external genital organ is known as vulva. This consists of the following
structures:
 The mons pubis is the rounded fatty eminence anterior to the pubic symphysis, pubic
tubercle, and superior pubic rami. The bulge of mons pubis is created by adipose tissue

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 just above the pubic symphysis and its amount increases at puberty and decreases after
menopause. After puberty, the mons pubis is covered with coarse pubic hairs.
 The labia majora are prominent folds of skin that bound the pudendal cleft, the slit
between the labia majora and indirectly provide protection for the urethral and vaginal
orifices
 The labia minora are folds of fat-free, hairless skin. They have a core of spongy
connective tissue containing erectile tissue and many small blood vessels. Although the
internal surface of each labium minus consists of thin moist skin, it has the typical pink
color of a mucous membrane and contains many sensory nerve endings. The labia minora
are enclosed in the pudendal cleft within the labia majora and surround the vestibule into
which the external urethral and vaginal orifices open
 The clitoris is an erectile organ located where the labia minora meet anteriorly. The
clitoris consists of a root and a body, which are composed of two crura, two corpora
cavernosa, and the glans of the clitoris. The glans is covered by the prepuce of the clitoris.
The clitoris is highly sensitive and enlarges on tactile stimulation. The glans is the most
highly innervated part of the clitoris. It is engorges with blood during sexual arousal and
derived from the same embryonic structures as penis in males
 The vestibule is the space surrounded by the labia minora, which contains the openings of
the urethra, vagina, and ducts of the greater and lesser vestibular glands
 Urinary meatus is the small opening of the urethra, situated between the clitoris and
vaginal orifice. On each side of the external urethral orifice are the openings of the ducts
of the paraurethral glands.
 Vaginal orifice is an opening that s larger than the urinary meatus. It is located posterior
to the meatus. The size and appearance of the vaginal orifice vary with the condition of
the hymen, a thin fold of mucous membrane within the vaginal orifice surrounding the
lumen. After its rupture, only remnants of the hymen, hymenal caruncles (tags) are visible
 The bulbs of the vestibule are paired masses of elongated erectile tissue that lie along the
sides of the vaginal orifice under cover of the bulbospongiosus muscles. The bulbs are
homologous with the bulb of the penis and the corpus spongiosum.
 The greater vestibular glands (Bartholin glands) are located on each side of the vestibule,
posterolateral to the vaginal orifice. These glands are round or oval and are partly
overlapped posteriorly by the bulbs of the vestibule, and both are partially surrounded by
the bulbospongiosus muscles. The slender ducts of these glands pass deep to the bulbs
and open into the vestibule on each side of the vaginal orifice. These glands secrete
mucus into the vestibule during sexual arousal. The lesser vestibular glands are smaller
glands on each side of the vestibule that open into it between the urethral and the vaginal
orifices. These glands secrete mucus into the vestibule, which moistens the labia and
vestibule.
 The arterial supply to the vulva is from the external and internal pudendal arteries. The
internal pudendal artery supplies most of the skin, external genitalia, and perineal
muscles. The labial arteries are branches of the internal pudendal artery, as are those of
the clitoris). The labial veins are tributaries of the internal pudendal veins and
accompanying veins. venae comitantes). Venous engorgement during the excitement
phase of the sexual response causes an increase in the size and consistency of the clitoris
and the bulbs of the vestibule. As a result the clitoris becomes turgid.

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 The vulva contains a rich network of lymphatic vessels that pass laterally to the
superficial inguinal lymph nodes. The glans of the clitoris and anterior labia minora may
also drain to the deep inguinal nodes or internal iliac nodes.
 The anterior aspect of the vulva is supplied by anterior labial nerves, derived from the
ilioinguinal nerve and the genital branch of the genitofemoral nerve. The posterior aspect
is supplied by the perineal branch of the posterior cutaneous nerve of the thigh laterally
and the pudendal nerve centrally.
 The pudendal nerve is the main nerve of the perineum. Its posterior labial nerves supply
the labia; deep and muscular branches supply the orifice of the vagina and superficial
perineal muscles; and the dorsal nerve of the clitoris supplies deep perineal muscles and
sensation to the clitoris.
 The bulb of the vestibule and erectile bodies of the clitoris receive parasympathetic fibers
via cavernous nerves from the uterovaginal plexus. Parasympathetic stimulation produces
increased vaginal secretion, erection of the clitoris, and engorgement of erectile tissue in
the bulbs of the vestibule.

Refer students to Handout 20.1: The female external genitalia

Step 4: Ovarian Attachment and Blood Supply (15 minutes)

 Ovaries are oval shaped small organs measuring approximately 3 cm x 1.5 cm x 1.5 cm.
 The ovary (for a given side) is located in the lateral wall of the pelvis in a region called
the ovarian fossa
 The ovaries develop high on the posterior abdominal wall and then descend before birth,
bringing with them their vessels, lymphatics, and nerves. Unlike the testes, the ovaries do
not migrate through the inguinal canal into the perineum, but stop short and assume a
position on the lateral wall of the pelvic cavity
 Ovaries are located near the attachment of the broad ligament to the lateral pelvic walls,
suspended from both by peritoneal folds, the mesovarium from the postero-superior
aspect of the broad ligament and the suspensory ligament of the ovary from the pelvic
wall.
 The suspensory ligament conveys the ovarian vessels, lymphatics, and nerves to and from
the ovary and constitutes the lateral part of the mesovarium. The ovary also attaches to
the uterus by the ligament of ovary, which runs within the mesovarium.
 Since the ovary is suspended in the peritoneal cavity and its surface is not covered by
peritoneum, the oocyte expelled at ovulation passes into the peritoneal cavity but is
usually trapped by the fimbriae of the uterine tube and carried to the ampulla.

Vasculature of Ovaries and Uterine Tubes

 The ovarian arteries arise from the abdominal aorta and descend along the posterior
abdominal wall. At the pelvic brim, they cross over the external iliac vessels and enter the
suspensory ligaments. The ovarian artery sends branches through the mesovarium to the
ovary and through the mesosalpinx to supply the uterine tube. The ascending branches of
the uterine arteries (branches of the internal iliac arteries) course along the lateral aspects
of the uterus to approach the medial aspects of the ovaries and tubes. The ovarian and
ascending uterine artery terminate by bifurcating into ovarian and tubal branches and
anastomose with each other, providing a collateral circulation from abdominal and pelvic
sources.

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 Ovarian veins draining the ovary form a pampini form plexus of veins in the broad
ligament near the ovary and uterine tube. The veins of the plexus merge to form a
singular ovarian vein, which leaves the lesser pelvis with the ovarian artery. The right
ovarian vein ascends to enter the inferior vena cava, the left ovarian vein drains into the
left renal vein. The tubal veins drain into the ovarian veins and uterine (uterovaginal)
venous plexus. The lymphatic vessels from the ovary join those from the uterine tubes
and fundus of the uterus as they ascend to the right and left (caval/aortic) lumbar lymph
nodes.

Refer students to Handout 20.2: Ovarian ligaments and Handout 20.3: Ovarian blood
supply

Step 5: Structure of Ovary and Formation of Primordial Follicles (10 minutes)

 The ovaries have two layers of tissues, the medulla and the cortex.
 The medulla lies in the centre and consists of fibrous tissue, blood vessels and nerves.
 The cortex surrounds the medulla. It has connective tissue or stroma covered by germinal
epithelium. It contains ovarian follicles in various stages of maturity
 Ovum production or oogenesis begins before a woman’s birth, accelerates at puberty and
ends at menopause. Between puberty and menopause oogenesis occurs on a monthly
basis as part of the ovarian cycle.
 Oogonia, The stem cells of female complete their mitotic division before birth. Between
the third and seventh months of fetal development
 The daughter cells or primary oocytes prepare to undergo meiosis I but then the process
comes to a halt. The primary oocytes remain in a state of suspended development until the
individual reaches puberty, when rising levels of FSH trigger the start of the ovarian
cycle.
 Primary oocyte and its follicle cells form a primordial follicle. Not all primary oocytes
produced during developmental survive until puberty. The ovaries have roughly 2
millions primordial follicles at birth, by the time of puberty the number has dropped to
about 400,000, the rest of the primordial follicles degenerates in a process called atresia

Step 6: Follicle Maturation and Ovulation (25 minutes)

 Ovarian follicles are specialized structure in the cortex of the ovaries where both oocytes
growth and meiosis I occur. Primary oocytes are located in the outer portion of the
ovarian cortex near the tunica albuginea, in cluster called egg nest. The ovarian cycle is
divided into follicular phase or preovulatory phase and a luteal phase or post ovulatory
phase.
 Step I, the formation of primary follicles. The cycle begins as activated primordial
follicles develop into primary follicles ,the follicle cells enlarge and undergo repeated
divisions that create several layers of follicle cells around the oocyte, these cells are
called granulosa cells
 As layers of granulosa cells develop around the primary oocyte, microvilli from the
surrounding granulosa cells intermingle with those of the primary oocyte forming zona
pellucida.
 As the granulosa cells enlarge and multiply, adjacent cells in the ovarian stroma form a
layer of thecal cells around the follicle.

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 The thecal cells and granulosa cells work together to produce sex hormones called
oestrogen
 Step 2, the formation of secondary follicle. Only few primary follicles develop into
secondary follicle. The transformation begins as the wall of the follicle thickens and the
granulosa cell begins secreting small amount of fluid. This follicular fluid accumulates in
small pockets that gradually expand and separate the inner and outer layer of the follicle.
 Step 3, the formation of a tertiary follicle. This takes 8-10 days after the start of the
ovarian cycle. Only one secondary follicle destined for further development. By the 10th
to 14th day of the cycle the follicle become a tertiary follicle or mature graafian follicle
15mm in diameter. As the development of the tertiary follicle ends LH levels begin rising,
prompting the primary oocyte to complete meiosis I instead of producing two secondary
oocytes the first meiotic division yield a secondary oocyte and a small non-functional
polar body. The secondary oocyte then enters meiosis II but stops once again upon
reaching metaphase.
 Meiosis II will not be completed unless fertilization occurs. Generally on day 14 of 28-
day cycle the secondary oocyte and the attached granulosa cells lose their connection with
the follicular wall and drift free within the antrum. The granulosa cell still associated with
the secondary oocyte form a protective layer known as corona radiate
 Step 4, ovulation. At ovulation the tertiary follicle releases the secondary oocyte. The
distended follicular wall suddenly ruptures ejecting the follicular contents including the
secondary oocyte.
 Step 5, the formation and degeneration of the corpus luteum. Ovulation marks the end of
follicular phase of the ovarian cycle and the start of luteal phase. The empty tertiary
follicle initially collapses and ruptured vessels bleed into the antrum. The remaining
granulosa cells then invade the area proliferating to create an endocrine structure known
as the corpus luteum. This process occurs under LH stimulation
 The cholesterol contained in the corpus luteum is used to manufacture steroid hormones
known as progestins, progesterone. Although the corpus luteum also secrete moderate
amount of oestrogen, levels are not as high as they were at ovulation and progesterone is
the principal hormone in the luteal phase.
 Progesterone primary function is to prepare the uterus for pregnancy by stimulating the
maturation of the uterine lining and the secretion of the uterine glands.
 Step 6, unless fertilization occurs, the corpus luteum begins to degenerate roughly 12
days after ovulation. Progesterone and oestrogens levels fall markedly fibroblasts invade
the non functional corpus luteum producing a knot of pale scar tissue called a corpus
albicans

Step 7: Hormonal Role and Puberty in Females (15 minutes)

 Maturation of the follicle is stimulated by follicle stimulating hormone (FSH)
from the anterior pituitary, and oestrogen secreted by the follicle lining cells.
 Ovulation is triggered by a surge of luteinising hormone (LH) from the anterior
pituitary, which occurs a few hours before ovulation.
 After ovulation, the follicle lining cells develop into the corpus luteum (yellow
body), under the influence of LH from the anterior pituitary.
 The corpus luteum produces the hormone progesterone and some oestrogen.
 If the ovum is fertilized it embeds itself in the wall of the uterus where it grows
and develops and produces the hormone human chorionic gonadotrophin (hCG),

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 which stimulates the corpus luteum to continue secreting progesterone and
oestrogen for the first 3 months of the pregnancy, after which time this function is
continued by the placenta.
 If the ovum is not fertilized the corpus luteum degenerates and a new cycle
begins with menstruation.
 At the site of the degenerate corpus luteum an inactive mass of fibrous tissue
forms, called the corpus albicans. Sometimes more than one follicle matures at a
time, releasing two or more ova in the same cycle.
 When this happens and the ova are fertilized the result is a multiple pregnancy.

Puberty in Females
 Puberty is the age at which the internal reproductive organs reach maturity. This
is called the menarche, and marks the beginning of the childbearing period.
 The ovaries are stimulated by the gonadotrophins from the anterior pituitary,
follicle stimulating hormone and luteinising hormone.
 The age of puberty varies between 10 and 14 years. And the number of physical
and psychological changes takes place at this time.
 Uterus, uterine tube and the ovaries reach maturity
 The menstruation cycle and ovulation begins
 The breasts develop and enlarge.
 Pubic and Axillary hairs begin to grow.
 Increase in height and widening of the pelvis
 Increase in fat deposited in subcutaneous tissue especially in the hips and breasts

Step 8: Key Points (5 minutes)

 Primary organ for female reproductive system is the ovary whose main functions are
production of female gametes or oocytes and secretion of female sex hormones including
oestrogen and progesterone
 The perineum has great clinical importance because of the danger of being torn during
childbirth.
 Oogonia, the stem cells of female complete their mitotic division before birth.
 Maturation of the follicle is stimulated by follicle stimulating hormone (FSH)
from the anterior pituitary, and oestrogen secreted by the follicle lining cells.

Step 9: Evaluation (10 minutes)

 Describe structure of the vulva
 Describe the blood supply of the ovary
 Mention ligaments of the ovary
 Name 5 features of female puberty

 ASK students if they have any comments or need clarification on any points.

References
 Elsevier .Drake et el: Gray’s Anatomy for students-www.studentsconsult.com
 Richard L.D, Grays’s Anatomy for students (electronic book)
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology McGraw-Hill

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 Thibodeau G. A. Patton K. T. (1999) Anatomy & Physiology Mosby, Inc. Von Hoffman
Press, Inc.
 Waugh A & Grant A (2006) Ross and Willson Anatomy and physiology in Health and
illness Churchill Livingstone Elservier. Elsevier Limited China.

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Handout 20.1: The female external genitalia

Source: www.studentsconsult.com

Handout 20.2: Ovarian ligaments

Source: www.studentconsult.com

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Handout 20.3: Ovarian blood supply

Source: www.studentconsult.com

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Session 30: Internal Female
Reproductive Organs and Accessory Gland
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Describe structure and function of vagina
 Describe structure and functions of the uterus
 Describe structure of fallopian tube
 Describe Endometrial and Menstruation Cycle
 Describe structure of a non-lactating breast

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout 21.1: The Vagina
 Handout 21.2: The Uterus
 Handout 21.3: The Uterine Tube
 Handout 21.4 The Menstrual Cycle
 Handout 21.5: The Breast

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation Structure and Function of Vagina
2 15 minutes
Brainstorming
3 40 minutes Presentation Structure and Functions of The Uterus
4 10 minutes Presentation Fallopian Tube
5 25 minutes Presentation Endometrial Cycle and Menstruation
6 10 minutes Presentation Structure of a Non-Lactating Breast
7 05 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

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Step 2: Structure and Function of Vagina (15 minutes)
 Activity: Brainstorming (5 minutes)
 ASK students to mention the internal structures of the female reproductive system.
 GIVE them one minute to think.
 LISTEN to their responses
 SUMMARIZE the activity by clarifying the students responses.

Refer students to session 20: Structural Organisation of Female Reproductive System.

 The internal organs of the female reproductive system lie in the pelvic cavity and consist
of the vagina, uterus, two uterine tubes (Fallopian tubes) and the two ovaries. Ovaries
have been discussed in the previous session as the primary the organ of the female
reproductive system.
 From the external genitalia the first structure of the female reproductive tract is the
vagina.
 The vagina is an elastic muscular tube extending between the cervix and the vestibule is
approximately 7.5 – 9cm long but its diameter varies because it is highly distensible
 It is located between the rectum posteriorly, urethra and bladder anteriorly.
 Is a collapsible tube capable of distension composed of smooth muscle and lined with
mucous membrane arranged in rugae.
 The anterior wall is shorter than posterior wall because the cervix protrudes into its
uppermost portion.
 Throughout childhood the vagina and vestibule are usually separated by the hymen a
mucous membrane that partially or complete blocks the entrance to the vagina. An intact
hymen is typically ruptured during sexual intercourse or tampon usage
 The vagina has three layers, outer covering of areolar tissue and middle layer of smooth
muscles and inner lining of stratified squamous epithelium that forms Rugae.
 It has no secretory glands, but the surface is kept moist by cervical secretions.
 The PH is between 3.5 and 4.9. The acid inhibits the growth of most Microbes hence
protecting ascending infections.
 It acts as a receptacle for the penis during intercourse and save as a passageway for the
elimination of menstrual fluids
 It provides an elastic passageways through which the baby passes during child birth
 The arteries supplying the superior part of the vagina derive from the uterine arteries, the
arteries supplying the middle and inferior parts of the vagina derive from the vaginal
arteries and internal pudendal arteries.
 The veins form the vaginal venous plexuses along the sides of the vagina and within the
vaginal mucosa. These veins communicate with the uterine venous plexus as the
uterovaginal plexus and drain into the internal iliac veins through the uterine vein.
 The lymphatic vessels drain from the vagina as follows
 Superior part, to the internal and external iliac lymph nodes.
 Middle part, to the internal iliac lymph nodes.
 Inferior part, to the sacral and common iliac nodes.
 External orifice, to the superficial inguinal lymph nodes

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 Refer students to Handout 21.1: The vagina

Step 3: Structure and Functions of the Uterus (40 minutes)

 The uterus is a pear-shaped organ about 7.5 cm length and diameter 5cm. which provide
mechanical protection, nutritional support and waste removal for the developing embryo.
 The uterus is located in the pelvic cavity between the urinary bladder and the rectum.
Age, pregnancy and distension of the related pelvic viscera such as the bladder will alter
the position of the uterus.
 In its normal position the uterus bends anteriorly near its base a condition known as
anteflexion.
 In this position the uterus covers the superior and the posterior surface of the urinary
bladder.
 If the uterus bends backward toward the sacrum, the condition is termed as retroflexion.
 It is oriented into the pelvic cavity with the larger, rounded part, the fundus, directed
superiorly and the narrow part the cervix directed inferiorly. The main part of the uterus,
the body is between the fundus and cervix. A slight constriction called the isthmus marks
the junction of the cervix and the body. Internally the uterine cavity continues as cervical
canal which opens through the ostium into the vagina.
 Functions of the uterus
 It permits sperm to ascend toward the uterine tubes
 Provides nutrients for the growing embryo after conception
 Myometrial contractions occur during labour and help push the offspring out of the
mother’s body
 The uterus descends between birth and puberty, from the lower abdomen to the true
pelvis. It begins to decrease in size at menopause.
 There are eight ligaments (3 paired and 2 single ones) holding the uterus in place but
allow some movements. These ligaments include:
 Broad ligament , are double folds of parietal peritoneum that form a kind of partition
across the pelvic cavity
 Uterosacral ligaments(the paired) are fold-like extensions of the peritoneum from the
posterior surface of the uterus to the sacrum
 The two round ligaments are fibro-muscular cords extending from the upper, outer angles
of the uterus through the inguinal canals and terminating in the labia majora.
 Cardinal ( transverse cervical) ligament, extend from the base of the uterus and vaginal to
the lateral walls of the pelvis
 Pubocervical fascia , this extends forward from the transverse cervical ligaments on each
side of the bladder and is attached to the posterior surface of the pubic bones
 The uterine wall is composed of three layers: The inner endometrium which is mucous
glandular lining composed of
 Functional zone
 It is a layer closest to the uterine cavity.
 It is the zone which contains most of the uterine glands and contributes most of the
endometrial thickness.
 It is this zone that undergoes the dramatic changes in thickness and structure during
menstrual cycle.
 During menstruation and following delivery of a baby this layer slough off

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 Basilar zone
 This is adjacent to the myometrium and contains the terminal branches of the tubular
endometrial glands.
 It is the layer from which the fresh functional layer is regenerated during each cycle.
 Muscle layer (A thick middle layer)
 The myometrium consists of three layers of smooth muscles fibres that extend in all
directions, longitudinally transversely and obliquely and give the uterus great strength.
 The myometrium is thickest in the fundus and thinner in the cervix
 Serous membrane (An external layer) consisting of, parietal peritoneum. It is incomplete,
since it covers none of the cervix and only part of the body. This is called perimetrium
 The uterus receives a generous supply of blood from uterine arteries, branches of the
internal iliac arteries. In addition blood from the ovarian and vaginal arteries reaches the
uterus by anastomosis with the uterine vessels.
 Uterine, ovarian and vaginal veins return venous blood from the uterus to the internal
iliac veins
 The uterine lymphatic vessels follow three main routes ,
 Most vessels from the uterine fundus and superior uterine body pass along the ovarian
vessels to the lumbar (caval/aortic) lymph nodes, but some vessels pass along the round
ligament of the uterus to the superficial inguinal lymph nodes.
 Vessels from most of the uterine body pass within the broad ligament to the external iliac
lymph nodes.
 Vessels from the uterine cervix pass along the uterine vessels, within the transverse
cervical ligaments, to the internal iliac lymph nodes and along the uterosacral ligaments
to the sacral lymph nodes

Refer students to Handout 21.2: The uterus.

Step 4: Fallopian Tube (10 minutes)

 Fallopian tube (Uterine tube) or oviducts are structures which are associated with ovary.
They are attached on the side of uterus on each side. Located along the superior margin of
the broad ligament
 They open directly into the peritoneal cavity to receive the oocyte from the ovary.
 It expands to form the infundibulum and long, thin processes called fimbriae surround the
opening of the infundibulum. The inner surface of the fimbriae consists of a ciliated
mucous membrane.
 The part of fallopian tube that is nearest the infundibulum is called the ampulla. It is
widest part of the tube and accounts for about 7.5 – 8 cm of the total 10 cm length of the
tube
 The part of the tube near the uterus is the isthmus is much narrow and has thicker wall
than ampulla
 The wall of each uterine tube consists of three layers.
 The outer serousa is formed by the peritoneum
 The middle muscular layer consists of longitudinal and circular smooth muscle cells
 Inner mucosa consists of mucous of simple ciliated columnar epithelium
 Mucosa of the uterine tube provides nutrients for the oocyte, if fertilization has occured.

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 Refer students to Handout 21.3: The Uterine tube.

Step 5: Endometrial Cycle and Menstruation (25 minutes)

 The uterine cycle begins at puberty. The first cycle is known as menarche, typically
occurs at age 11 – 12. The cycle continue until menopause, the termination of the uterine
cycle at age 45-55
 The endometrial cycle refers to changes that occur primarily in the endometrium of the
uterus during menstrual cycle. It is associated with the monthly cyclical production of
estrogens and progesterone by the ovaries. It occurs through the following phases,
 proliferation of the uterine endometrium,
 development of secretory changes in the endometrium, and
 Desquamation of the endometrium, which is known as menstruation. Proliferative Phase
(Estrogen Phase)
o At the beginning of each monthly cycle, most of the endometrium has been
desquamated by menstruation.
o After menstruation, only a thin layer of endometrial stroma remains and the only
epithelial cells that are left are those located in the remaining deeper portions of the
glands and crypts of the endometrium.
o Under the influence of estrogens, secreted in increasing quantities by the ovary during
the first part of the monthly ovarian cycle, the stromal cells and the epithelial cells
proliferate rapidly.
o The endometrial surface is re-epithelialized within 4 to 7 days after the beginning of
menstruation.
o Then, during the next week and a half-that is, before ovulation occurs, the
endometrium increases greatly in thickness, owing to increasing numbers of stromal
cells and to progressive growth of the endometrial glands and new blood vessels into
the endometrium.
o At the time of ovulation, the endometrium is 3 to 5 millimeters thick.
o The endometrial glands, especially those of the cervical region, secrete thin, stringy
mucus.
o The mucus strings actually align themselves along the length of the cervical canal,
forming channels that help guide sperm in the proper direction from the vagina into
the uterus.
 Secretory Phase (Progestational Phase)
o During most of the latter half of the monthly cycle, after ovulation has occurred,
progesterone and estrogen together are secreted in large quantities by the corpus
luteum.
o The estrogens cause slight additional cellular proliferation in the endometrium during
this phase of the cycle, whereas progesterone causes marked swelling and secretory
development of the endometrium.
o The glands increase in tortuosity, an excess of secretory substances accumulates in the
glandular epithelial cells.
o Also, the cytoplasm of the stromal cells increases, lipid and glycogen deposits
increase greatly in the stromal cells, and the blood supply to the endometrium further
increases in proportion to the developing secretory activity, with the blood vessels
becoming highly tortuous.

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 o At the peak of the secretory phase, about 1 week after ovulation, the endometrium has
a thickness of 5 to 6 millimeters.
o The whole purpose of all these endometrial changes is to produce a highly secretory
endometrium that contains large amounts of stored nutrients to provide appropriate
conditions for implantation of a fertilized ovum during the latter half of the monthly
cycle.
o From the time a fertilized ovum enters the uterine cavity from the fallopian tube
(which occurs 3 to 4 days after ovulation) until the time the ovum implants (7 to 9
days after ovulation), the uterine secretions, called "uterine milk," provide nutrition
for the early dividing ovum.
o Then, once the ovum implants in the endometrium, the trophoblastic cells on the
surface of the implanting ovum (in the blastocyst stage) begin to digest the
endometrium and absorb the endometrial stored substances, thus making great
quantities of nutrients available to the early implanting embryo. Menstruation.
o If the ovum is not fertilized, about 2 days before the end of the monthly cycle, the
corpus luteum in the ovary suddenly involutes, and the ovarian hormones (estrogens
and progesterone ) decrease to low levels of secretion, and Menstruation follows.
o Menstruation is caused by the reduction of estrogens and progesterone , especially
progesterone , at the end of the monthly ovarian cycle.
o The first effect is decreased stimulation of the endometrial cells by these two
hormones, followed rapidly by involution of the endometrium itself to about 65 per
cent of its previous thickness.
o Then, during the 24 hours preceding the onset of menstruation, the tortuous blood
vessels leading to the mucosal layers of the endometrium become vasospastic,
presumably because of some effect of involution, such as release of a vasoconstrictor
material, possibly one of the vasoconstrictor types of prostaglandins that are present
in abundance at this time.
o The vasospasm, the decrease in nutrients to the endometrium, and the loss of
hormonal stimulation initiate necrosis in the endometrium, especially of the blood
vessels. As a result, blood at first seeps into the vascular layer of the endometrium,
and the hemorrhagic areas grow rapidly over a period of 24 to 36 hours. Gradually,
the necrotic outer layers of the endometrium separate from the uterus at the sites of
the hemorrhages until, about 48 hours after the onset of menstruation, all the
superficial layers of the endometrium have desquamated. The mass of desquamated
tissue and blood in the uterine cavity, plus contractile effects of prostaglandins or
other substances in the decaying desquamate, all acting together, initiate uterine
contractions that expel the uterine contents.
o During normal menstruation, approximately 40 milliliters of blood and an additional
35 milliliters of serous fluid are lost. The menstrual fluid is normally nonclotting
because a fibrinolysin is released along with the necrotic endometrial material.
o If excessive bleeding occurs from the uterine surface, the quantity of fibrinolysin may
not be sufficient to prevent clotting. The presence of clots during menstruation is
often clinical evidence of uterine pathology.
o Within 4 to 7 days after menstruation starts, the loss of blood ceases because, by this
time, the endometrium has become re-epithelialized.

Refer students to Handout 21.4: The menstrual cycle.

Teaching Guides for NTA Level 4 MLS Curriculum Page 395

Step 6: Structure of a Non-Lactating Breast (10 minutes)
 Both males and females have breasts. Normally the mammary glands are well developed
only in women. Mammary glands in women are accessory to reproduction, but in men
they are functionless, consisting of only a few small ducts or cords.
 The mammary glands are modified sweat glands and therefore have no special capsule or
sheath. The contour and volume of the breasts are produced by subcutaneous fat, except
during pregnancy when the mammary glands enlarge and new glandular tissue forms.
During puberty (8 -15 years of age), the female breasts normally grow because of
glandular development and increased fat deposition. Breast size and shape result from
genetic, racial, and dietary factors.
 The roughly circular base of the female breast extends transversely from the lateral border
of the sternum to the midaxillary line and vertically from the 2-6th ribs. A small part of
the breast may extend along the inferolateral edge of the pectoralis major muscle toward
the axillary fossa, forming an axillary process or tail (of Spence). Two thirds of the breast
rests on the pectoral fascia covering the pectoralis major; the other third rests on the
fascia covering the serratus anterior muscle. Between the breast and the deep pectoral
fascia is a loose connective tissue plane or ‘potential space’ the retromammary space
(bursa). This plane, containing a small amount of fat, allows the breast some degree of
movement on the deep
 Pectoral fascia. The mammary gland is firmly attached to the dermis of the overlying skin
by the suspensory ligaments (of Cooper). These ligaments, particularly well developed in
the superior part of the gland, help support the mammary gland lobules.
 At the greatest prominence of the breast is the nipple, surrounded by a circular pigmented
area (the areola). The breast contains 15- 20 lobules of glandular tissue, which constitute
the parenchyma of the mammary gland. Each lobule is drained by a lactiferous duct,
which opens independently on the nipple. Just deep to the areola, each duct has a dilated
portion, the lactiferous sinus
 The arterial supply of the breast is derived from,
 Medial mammary branches of perforating branches and anterior intercostal branches of
the internal thoracic artery, originating from the subclavian artery.
 Lateral thoracic and thoracoacromial arteries, branches of the axillary artery.
 Posterior intercostal arteries, branches of the thoracic aorta in the intercostal spaces.
 The venous drainage of the breast is mainly to the axillary vein, but there is some
drainage to the internal thoracic vein.
 The lymphatic drainage of the breast is important because of its role in the metastasis
(spread) of cancer cells. Lymph passes from the nipple, areola, and lobules of the gland to
the subareolar lymphatic plexus ), and from it,
 Most lymph (> 75%), especially from the lateral quadrants of the breasts, drains to the
axillary lymph nodes (pectoral, humeral, subscapular, central, and apical), initially for the
most part to the pectoral (anterior) nodes. However, some lymph may drain directly to
other axillary nodes, or to interpectoral, deltopectoral, supraclavicular, or inferior deep
cervical nodes.
 Most of the remaining lymph, particularly from the medial breast quadrants, drains to the
parasternal lymph nodes or to the opposite breast. Lymph from the inferior breast
quadrants may pass deeply to abdominal lymph nodes (inferior phrenic nodes).

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 Lymph from the axillary nodes drains to infraclavicular and supraclavicular nodes and
from them to the subclavian lymphatic trunk. Lymph from the parasternal nodes enters
the bronchomediastinal trunks, which ultimately drain into the thoracic or right lymphatic
duct.
 The nerves of the breasts derive from the anterior and lateral cutaneous branches of the 4th
6th intercostal nerves. These branches of the intercostal nerves pass

Refer students to Handout 21.5: The breast

Step 7: Key Points (5 minutes)

 Vagina provides elastic passageways through which the baby passes during child birth
 The uterus is located in the pelvic cavity between the urinary bladder and the rectum.
 The uterine wall is composed of three layers – the endometrium, myometrium and
serousa
 The part of the tube near the uterus is the isthmus is much narrow and has thicker wall
than ampulla
 The uterine cycle begins at puberty. The first cycle is known as menarche, typically
occurs at age 11 – 12. The cycle continue until menopause, the termination of the uterine
cycle at age 45-55
 Both males and females have breasts. Normally the mammary glands are well developed
only in women.

Step 8: Evaluation (10 minutes)

 Name the parts of the uterus
 Mention uterine ligament
 Describe the hormonal changes during endometrial cycle.

 ASK students if they have any comments or need clarification on any points.

References
 Elsevier .Drake et el: Gray’s Anatomy for students-www.studentsconsult.com
 Richard L.D, Grays’s Anatomy for students (electronic book)
 Seeley R. R, Stephens T. D, Tate P. (2003) Anatomy and Physiology McGraw-Hill
 Thibodeau G. A. Patton K. T. (1999) Anatomy & Physiology Mosby, Inc. Von Hoffman
Press, Inc.
 Waugh A & Grant A (2006) Ross and Willson Anatomy and physiology in Health and
illness Churchill Livingstone Elservier. Elsevier Limited China.

Teaching Guides for NTA Level 4 MLS Curriculum Page 397

Handout 21.1: The vagina

Source:

Handout 21.2: The uterus

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Handout 21.3: The Uterine tube

Source: www.studentconsult.com

Teaching Guides for NTA Level 4 MLS Curriculum Page 399

Handout 21.4: The menstrual cycle

Source: www.studentconsult.com

Source: www.studentconsult.com

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Session 31: Introduction to Endocrine
System and Hypothalamus
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Define the endocrine system
 Explain classification of endocrines
 Describe the importance of endocrine system
 Describe how the endocrine system functions
 List major endocrine glands of the body.
 Describe structure hypothalamus
 Explain functions of hypothalamus hormones

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives.
2 20 minutes Presentation The Endocrine System
Importance and Functions of Endocrine
3 10 minutes Presentation
System.
Mechanism of Regulation of Hormones and
4 25 minutes Presentation
Major Endocrine Glands of the Body.
5 15 minutes Presentation Structure of Hypothalamus.
Presentation
6 30 minutes Functions of Hypothalamus.
Brainstorming
7 10 minutes Presentation Key Points.
8 05 minutes Presentation Evaluation.

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: The Endocrine System (20 minutes)

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 The endocrine system consists of glands widely separated from each other with no direct
links.
 Endocrine glands consist of groups of secretory cells surrounded by an extensive network
of capillaries that facilitates diffusion of hormones (chemical messengers) from the
secretory cells into the bloodstream.
 Hormone is a chemical substance produced in the body which has a specific regulatory
effect on the activity of certain cells or a certain organ.
 They are commonly referred to as the ductless glands because the hormones diffuse
directly into the bloodstream.
 The hormone is then carried in the bloodstream to target tissues and organs that may be
quite distant, where they influence cellular growth and metabolism.

Figure 1: Endocrine Glands and its Hormones

Source: http://en.wikipedia.org/wiki/Thyroid

Classification of Hormones: Hormones molecules can be classified in various useful ways

 By General Function Hormones Can Be Classified As

o Tropic hormones, hormones that target other endocrine glands and stimulate their
growth and secretion, tropic hormones are hormones produced and secreted by the
anterior pituitary which target endocrine glands. Tropic hormones include:
o Thyroid-stimulating hormone (TSH or thyrotropin) – stimulates the thyroid gland to
make and release thyroid hormone.
o Adrenocorticotropic hormone (ACTH or corticotropin) – stimulates the adrenal cortex
to release glucocorticoids.

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 o Luteinizing hormone (LH) – stimulates the release of steroid hormones in gonads—
the ovary and testes.
o Follicle-stimulating hormone (FSH) – stimulates the maturation of eggs and
production of sperm.
o The hypothalamus controls the release of tropic hormones by secreting a class of
hypothalamic neurohormones called releasing and release-inhibiting hormones, which
are released to the hypothalamo-hypophyseal portal system and act on the anterior
pituitary.
o Anabolic hormones (hormones that stimulate anabolism in their target cells),
Anabolism is the set of metabolic pathways that construct molecules from smaller
units.
o These reactions require energy. One way of categorizing metabolic processes,
whether at the cellular, organ or organism level is as 'anabolic' or as 'catabolic', which
is the opposite.
o Anabolism is powered by catabolism, where large molecules are broken down into
smaller parts and then used up in respiration. Many anabolic processes are powered
by adenosine triphosphate (ATP).
o Anabolic processes tend toward "building up" organs and tissues. These processes
produce growth and differentiation of cells and increase in body size, a process that
involves synthesis of complex molecules.
o Examples of anabolic processes include the growth and mineralization of bone and
increases in muscle mass.
o Endocrinologists have traditionally classified hormones as anabolic or catabolic,
depending on which part of metabolism they stimulate.
o The classic anabolic hormones are the anabolic steroids, which stimulate protein
synthesis and muscle growth.
o The balance between anabolism and catabolism is also regulated by circadian
rhythms, with processes such as glucose metabolism fluctuating to match an animal's
normal periods of activity throughout the day.
o Classic anabolic hormones
o Growth hormone
o IGF1 and other insulin-like growth factors
o Insulin
o Testosterone
o Estradiol
o Sex hormones, hormones that target reproductive tissue.
o Sex steroids, also known as gonadal steroids, are steroid hormones that interact with
vertebrate androgen or estrogen receptors.
o Their effects are mediated by slow genomic mechanisms through nuclear receptors as
well as by fast nongenomic mechanisms through membrane-associated receptors and
signaling cascades. The term sex hormone is nearly always synonymous with sex
steroid.
o Production, natural sex steroids are made by the (ovaries or testes), by adrenal glands,
or by conversion from other sex steroids in other tissue such as liver or fat.

Synthetic sex steroids, there are also many synthetic sex steroids.
 Synthetic androgens are often referred to as anabolic steroids. Synthetic estrogens and
progestins are used in methods of hormonal contraception.

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 Ethinylestradiol is a semi-synthetic estrogen. Specific compounds that have partial
agonist activity for steroid receptors, and therefore act in part like natural steroid
hormones, are in use in medical conditions that require treatment with steroid in one cell
type, but where systemic effects of the particular steroid in the entire organism are only
desirable within certain limits.
 Types, in many contexts, the two main classes of sex steroids are androgens and
estrogens, of which the most important human derivatives are testosterone and estradiol,
respectively.
 Other contexts will include progestagen as a third class of sex steroids, distinct from
androgens and estrogens.
 Progesterone is the most important and only naturally occurring human progestagen.
 In general, androgens are considered "male sex hormones", since they have masculinizing
effects, while estrogens and progestagens are considered "female sex hormones" although
all types are present in each gender, albeit at different levels.
 Sex steroids include
o androgens,testosterone,androstenedione,dehydroepiandrosterone,anabolic steroids
o estrogens,estradiol, estrone ,estriol
o progestagens, progesterone, progestins striker

By Chemical Structure are divided into

 Steroids hormones, these are manufactured by endocrine cells from cholesterol, they are
lipid soluble and can easily pass through the phospholipids plasma membrane of target
cells
 Non steroid Hormones
 Are synthesized primarily from amino acids. Some of non-steroids hormones are protein
hormones like growth hormones prolactin, parathyroid hormone, calcitonin,
adrenocorticotropic hormone (ACTH) insulin and glucagon.
 Protein hormones that have carbohydrates groups attached to their amino acid chains are
often classified as glycoprotein hormones these include Follicle-Stimulating Hormones
(FSH), Luteinizing hormone (LH), and chorionic gonadotropin (CG).
 Another group of nonsteroid hormones are antidiuretic hormones (ADH), oxytocin,
melanocyte-stimulating hormone (MSH), somatostatin, Thyrotropin-releasing hormone
(TRH) and Gonadotropin realising hormone
 Another category of nonsteroid hormones consists of the amino acid derivative hormones;
they are derived from a single molecule of amino acid they are divided into amine
hormones such as Noradrenaline, adrenalin and melatonin. The other group is synthesized
by adding iodine atom these are thyroxine T4 and Triiodothyronine T3

Step 3: Importance and Functions of Endocrine System (10 minutes)

 The autonomic nervous system is concerned with rapid changes, while hormones of the
endocrine system are mainly involved in slower and more precise adjustments.
 Hormones have the following effects on the body,
 stimulation or inhibition of growth
 mood swings
 induction or suppression of apoptosis (programmed cell death)
 activation or inhibition of the immune system
 regulation of metabolism

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 preparation of the body for mating, fighting, fleeing, and other activity
 preparation of the body for a new phase of life, such as puberty, parenting, and
menopause
 control of the reproductive cycle
 hunger cravings
 A hormone may also regulate the production and release of other hormones. Hormone
signals control the internal environment of the body through homeostasis.
 The endocrine system consists of a number of distinct glands and some tissues in other
organs.
 Energy balance, metabolism, & nutrition
 The endocrine system, like the nervous system, adjusts and correlates the activities of the
various body systems, making them appropriate to the changing demands of the external
and internal environment.
 Endocrine integration is brought about by chemical signals secreted by ductless glands
and transported in the circulation to target cells.
 The hormones regulate metabolic processes. The term metabolism, literally meaning
"change," is used to refer to all the chemical and energy transformations that occur in the
body.
 The animal organism oxidizes carbohydrates, proteins, and fats, producing principally
CO2, H2O, and the energy necessary for life processes. CO2, H2O, and energy are also
produced when food is burned outside the body.
 However, in the body, oxidation is not a one-step, semiexplosive reaction but a complex,
slow, stepwise process called catabolism, which liberates energy in small, usable
amounts. Energy can be stored in the body in the form of special energy-rich phosphate
compounds and in the form of proteins, fats, and complex carbohydrates synthesized from
simpler molecules. Formation of these substances by processes that take up rather than
liberate energy is called anabolism.
 Although the hypothalamus is classified as a part of the brain and not as an endocrine
gland it controls the pituitary gland and has an indirect effect on many others.
 When a hormone arrives at its target cell, it binds to a specific area called the receptor,
where it acts as a switch influencing chemical or metabolic reactions inside the cell.
 The receptors for peptide hormones are situated on cell membrane and those for lipid-
based hormone: inside the cell.
 Examples of lipid based hormones are glucocorticoids, mineralocorticoids and thyroid
hormones.
 Examples of peptide hormones are Adrenaline and Nor-adrenaline, Insulin and Glucagon.

Step 4: Mechanism of Regulation of Hormones and Major Endocrine Glands of the

Body. (25 minutes)
 In biology regulation means to control something. So regulating hormones means
controlling how much hormones are made and released from cells.

Negative Feedback
 Hormone regulation is mostly done by negative feedback.
 In negative feedback a hormone makes an effect. The cells that make the hormone see
that effect happen.
 When they see it happen, they stop making more hormones.

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 A good example of negative feedback is the hormone insulin. Insulin is a hormone that is
made by the pancreas.
 Insulin is released by the pancreas when you eat glucose (a kind of sugar). The glucose
goes from your stomach to the blood.
 The amount of glucose in the blood goes up. The pancreas sees this high glucose level. It
makes insulin and releases it into the blood.
 Then the insulin goes through the whole body and tells cells to take glucose out of the
blood. Cells use some of this for energy. But some extra is also saved in the cells to use
later.

Figure 2: Negative Feedback

Source:http://en.wikipedia.org/wiki/endocrine

 When cells take up glucose from the blood this makes the glucose level go down.
 The pancreas sees this and stops making insulin. When the pancreas stops sending this
message (insulin), the cells in the body stop taking extra glucose out of the blood.
 So the negative feedback works to keep the blood glucose level normal. If glucose is
high, the pancreas makes insulin.
 The insulin causes the glucose to fall. Then this lower level of glucose tells the pancreas
to stop making insulin.
 Counter Regulatory Hormones
 Sometimes two or more hormones control the same thing. For example, blood glucose is
very important to an organism.
 So it is not controlled by just one hormone. Other hormones also make the glucose level
go up or down.
 If the glucose level gets too low, the body releases hormones that do the opposite of
insulin. They do not tell the cells in the body to take up glucose from the blood. They tell
the cells to put glucose back into the blood.
 These kinds of hormones that work opposite of other hormones are called counter-
regulatory hormones.
 Counter-regulatory hormones for insulin are glucagon and epinephrine.

 Positive Feedback
 Most important things in an organism are kept in homeostasis by negative feedback and
counter-regulatory hormones.

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 However a few things are controlled in different ways. One rare way is positive feedback.
In negative feedback, the hormone's effect makes a gland stop making hormones.
 In positive feedback the opposite happens. The effect of the hormone tells the gland to
make even more hormones.
 An example of positive feedback is the hormone that causes childbirth (when babies are
born.)
 The hormone that causes this is oxytocin. This hormone is made by the pituitary gland.
 When the baby starts coming out, it stretches the muscle in the cervix (the bottom of the
womb.)
 Nerves in the cervix send a message to the pituitary. This message makes the pituitary
release more oxytocin.
 The oxytocin then causes the muscles of the womb to contract, or squeeze. This causes
more stretching in the cervix.
 This stretching then tells the pituitary to make even more oxytocin. So levels of oxytocin
keep rising until the squeezing or contractions of the womb force the baby out.

Figure 3: Positive feedback

Source:http://en.wikipedia.org/wiki/endocrine

 The level of a hormone in the blood is variable

and self-regulating within its normal range.
 A hormone is released in response to a
specific stimulus and usually its action reverses or negates the stimulus through a
negative feedback mechanism.
 The effect of a positive feedback mechanism is amplification of the stimulus and
increasing release of the hormone until a particular process is complete and the stimulus
ceases, e.g. release of oxytocin during labour.
Figure 4: Major Endocrine Glands

Source: Anne Waugh and Allison Grant (2001).

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 The major endocrine glands in the body are,
o Hypothalamus
o Pituitary gland
o Thyroid gland
o Parathyroid gland
o Adrenal gland
o Pancreatic Islet
o Ovaries
o Testes in males
Step 5: Structure of Hypothalamus (15 minutes)

Figure 5: Location of human Hypothalamus

Source: Moore, Keith, Agur, Anne (2007).

 The hypothalamus is a portion of the brain that contains a number of small nuclei with a
variety of functions.
 One of the most important functions of the hypothalamus is to link the nervous system to
the endocrine system via the pituitary gland (hypophysis).
 The hypothalamus is located below the thalamus, just above the brain stem. In the
terminology of neuroanatomy, it forms the ventral part of the diencephalon. All vertebrate
brains contain a hypothalamus. In humans, it is roughly the size of an almond.

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 The hypothalamus is responsible for certain metabolic processes and other activities of
the Autonomic Nervous System.
 It synthesizes and secretes neurohormones, often called hypothalamic-releasing
hormones, and these in turn stimulate or inhibit the secretion of pituitary hormones.
 The hypothalamus controls body temperature, hunger, thirst,[1] fatigue, and circadian
cycles.
 The hypothalamus is a complex region in the brain of humans, and even small nuclei
within the hypothalamus are involved in many different functions.
 The paraventricular nucleus for instance contains oxytocin and vasopressin (also called
antidiuretic hormone) neurons which project to the posterior pituitary, but also contains
neurons that regulate ACTH and TSH secretion (which project to the anterior pituitary),
gastric reflexes, maternal behavior, blood pressure, feeding, immune responses, and
temperature.
 The hypothalamus co-ordinates many hormonal and behavioural circadian rhythms,
complex patterns of neuroendocrine outputs, complex homeostatic mechanisms, and
many important behaviours.
 The hypothalamus must therefore respond to many different signals, some of which are
generated externally and some internally. It is thus richly connected with many parts of
the central nervous system, including the brainstem reticular formation and autonomic
zones, the limbic forebrain (particularly the amygdala, septum, diagonal band of Broca,
and the olfactory bulbs, and the cerebral cortex).

Step 6: Functions of Hypothalamus (30 minutes)

 The hypothalamus is responsive to,
 Light: day length and photoperiod for regulating circadian and seasonal rhythms
 Olfactory stimuli, including pheromones
 Steroids, including gonadal steroids and corticosteroids
 Neurally transmitted information arising in particular from the heart, the stomach, and the
reproductive tract
 Autonomic inputs
 Blood-borne stimuli, including leptin, ghrelin, angiotensin, insulin, pituitary hormones,
cytokines, plasma concentrations of glucose and osmolarity etc
 Stress
 Invading microorganisms by increasing body temperature, resetting the body's thermostat
upward.

 Olfactory Stimuli.
o Olfactory stimuli are important for sex and neuroendocrine function in many species.
o For instance if a pregnant mouse is exposed to the urine of a 'strange' male during a
critical period after coitus then the pregnancy fails (the Bruce effect).
o Thus during coitus, a female mouse forms a precise 'olfactory memory' of her partner
which persists for several days.
o Pheromonal cues aid synchronisation of oestrus in many species; in women,
synchronised menstruation may also arise from pheromonal cues, although the role of
pheromones in humans is doubted by many.
o Blood-Borne Stimuli

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 o Peptide hormones have important influences upon the hypothalamus, and to do so
they must evade the blood-brain barrier.
o The hypothalamus is bounded in part by specialized brain regions that lack an
effective blood-brain barrier; the capillary endothelium at these sites is fenestrated to
allow free passage of even large proteins and other molecules.
o Some of these sites are the sites of neurosecretion, the neurohypophysis and the
median eminence.
o However others are sites at which the brain samples the composition of the blood.
Two of these sites, the subfornical organ SFO and the OVLT (organum vasculosum of
the lamina terminalis) are so-called circumventricular organs, where neurons are in
intimate contact with both blood and CSF.
o These structures are densely vascularized, and contain osmoreceptive and sodium-
receptive neurons which control drinking, vasopressin release, sodium excretion, and
sodium appetite. They also contain neurons with receptors for angiotensin, atrial
natriuretic factor, endothelin and relaxin, each of which is important in the regulation
of fluid and electrolyte balance. Neurons in the OVLT and SFO project to the
supraoptic nucleus and paraventricular nucleus, and also to preoptic hypothalamic
areas.
o The circumventricular organs may also be the site of action of interleukins to elicit
both fever and ACTH secretion, via effects on paraventricular neurons.
o It is not clear how all peptides that influence hypothalamic activity gain the necessary
access. In the case of prolactin and leptin, there is evidence of active uptake at the
choroid plexus from blood into CSF.
o Some pituitary hormones have a negative feedback influence upon hypothalamic
secretion; for example, growth hormone feeds back on the hypothalamus, but how it
enters the brain is not clear. There is also evidence for central actions of prolactin and
TSH.
o The hypothalamus functions as a type of thermostat for the body. It sets a desired
body temperature, and stimulates either heat production or retention to raise the blood
temperature to a higher setting, or sweating and vasodilation to cool the blood to a
lower temperature.
o All fevers result from a raised setting in the hypothalamus; elevated body
temperatures due to any other cause are classified as hyperthermia. Rarely, direct
damage to the hypothalamus, such as from a stroke, will cause a fever; this is
sometimes called a hypothalamic fever. However, it is more common for such
damage to cause abnormally low body temperatures.

 Steroids.
o The hypothalamus contains neurons that react strongly to steroids and glucocorticoids
(the steroid hormones of the adrenal gland, released in response to ACTH). It also
contains specialised glucose-sensitive neurons (in the arcuate nucleus and
ventromedial hypothalamus), which are important for appetite.
o The preoptic area contains thermosensitive neurons; these are important for TRH
secretion.

 Neural Inputs.
o The hypothalamus receives many inputs from the brainstem, notably from the nucleus
of the solitary tract, the locus coeruleus, and the ventrolateral medulla. Oxytocin

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 secretion in response to suckling or vagino-cervical stimulation is mediated by some
of these pathways, vasopressin secretion in response to cardiovascular stimuli arising
from chemoreceptors in the carotid sinus and aortic arch, and from low-pressure atrial
volume receptors, is mediated by others.
o In the rat, stimulation of the vagina also causes prolactin secretion, and this result in
pseudo-pregnancy following an infertile mating.
o In the rabbit, coitus elicits reflex ovulation. In the sheep, cervical stimulation in the
presence of high levels of estrogen can induce maternal behavior in a virgin ewe.
o These effects are all mediated by the hypothalamus, and the information is carried
mainly by spinal pathways that relay in the brainstem. Stimulation of the nipples
stimulates release of oxytocin and prolactin and suppresses the release of LH and
FSH.
o Cardiovascular stimuli are carried by the vagus nerve, but the vagus also conveys a
variety of visceral information, including for instance signals arising from gastric
distension to suppress feeding. Again this information reaches the hypothalamus via
relays in the brainstem.

 Activity: Brainstorming (10 minutes)

 ASK students to brainstorm on the following.
 What are the functions of the Hypothalamus?
 GIVE them two minutes.
 ASK each student to give one function until they are finished.
 SUMMARIZE the activity by clarifying on students responses.

Step 7: Key Points (10 minutes)

 The endocrine system consists of glands widely separated from each other with no direct
links.
 Endocrine glands consist of groups of secretory cells surrounded by an extensive network
of capillaries that facilitates diffusion of hormones (chemical messengers) from the
secretory cells into the bloodstream.
 Hormone is a chemical substance produced in the body which has a specific regulatory
effect on the activity of certain cells or a certain organ.
 Tropic hormones, hormones that target other endocrine glands and stimulate their growth
and secretion.
 Anabolic hormones (hormones that stimulate anabolism in their target cells)
 Sex hormones ,hormones that target reproductive tissue
 By chemical structure are divided into
 Steroids Hormones ,These are manufactured by endocrine cells from cholesterol, they are
lipid soluble and can easily pass through the phospholipids plasma membrane of target
cells
 Non steroid Hormones are synthesized primarily from amino acids. Some of non steroids
hormones are protein hormones like growth hormones prolactin, parathyroid
 Hormones have the following effects on the body,
 stimulation or inhibition of growth
 mood swings
 induction or suppression of apoptosis (programmed cell death)
 activation or inhibition of the immune system

Teaching Guides for NTA Level 4 MLS Curriculum Page 411

 regulation of metabolism
 preparation of the body for mating, fighting, fleeing, and other activity
 preparation of the body for a new phase of life, such as puberty, parenting, and
menopause
 control of the reproductive cycle
 hunger cravings

 Negative Feedback
o Hormone regulation is mostly done by negative feedback.
o In negative feedback a hormone makes an effect. The cells that make the hormone see
that effect happen. When they see it happen, they stop making more hormone
 Positive Feedback
o Most important things in an organism are kept in homeostasis by negative feedback
and counter-regulatory hormones.
o However a few things are controlled in different ways. One rare way is positive
feedback. In negative feedback, the hormone's effect makes a gland stop making
hormones. In positive feedback the opposite happens.
o The effect of the hormone tells the gland to make even more hormones

 Hypothalamus: Is a portion of the brain that contains a number of small nuclei with a
variety of functions.
o One of the most important functions of the hypothalamus is to link the nervous system
to the endocrine system via the pituitary gland (hypophysis).
o The hypothalamus is responsive to:
 Light: day length and photoperiod for regulating circadian and seasonal rhythms
 Olfactory stimuli, including pheromones
 Steroids, including gonadal steroids and corticosteroids
 Neurally transmitted information arising in particular from the heart, the stomach,
and the reproductive tract
 Autonomic inputs
 Blood-borne stimuli, including leptin, ghrelin, angiotensin, insulin, pituitary
hormones, cytokines, plasma concentrations of glucose and osmolarity etc
 Stress
 Invading microorganisms by increasing body temperature, resetting the body's
thermostat upward.

Step 8: Evaluation (5 minutes)

 Define what endocrine gland is.
 Describe the importance and functions of endocrine system.
 Mention the major endocrine glands of the body.

 ASK students if they have any comments or need clarification on any points.

References
 Anne Waugh and Allison Grant (2001): Ross and Wilson Anatomy and Physiology in
Health and Illness. Churchill Livingstone (UK)
 Kenneth S. Saladin. (2005): Human Anatomy: McGraw –Hill Companies .USA

Teaching Guides for NTA Level 4 MLS Curriculum Page 412

 Moore, Keith, Agur, Anne (2007). Essential Clinical Anatomy, 3rd Edition. Lippincot
William & Wilkins
 Rod Seeley, Trent Stephens, Philip Tate. (2003): Anatomy & Physiology: McGraw-Hill
Companies. USA
 Williams & Wilkins Moore, Keith L.; Agur, Anne M. R. (2007): Essential Clinical
Anatomy, 3rd Edition. Lippincott.

Teaching Guides for NTA Level 4 MLS Curriculum Page 413

Session 32: Pituitary Gland.
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None

Learning Objectives
By the end of this session, students will be able are to:
 Describe the structure of Pituitary Gland
 Describe the function of Pituitary Gland
 Explain the feed mechanism by the Pituitary Gland
 Describe the effects of Pituitary secretion on other hormones and organs

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout 15.1: Medial View of Brain showing the Position of Hypothalamus
 Handout 15.2: Pituitary Stalk

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 40 minutes Presentation Structure of The Pituitary Gland
Presentation
3 45 minutes Function of The Pituitary Gland
Buzzing
4 15 minutes Presentation Key Points
6 15 minutes Presentation Evaluation

SESSION CONTENT

Step1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Structure of the Pituitary Gland (30 minutes)

 The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea and
weighing 0.5 g.
 It is a protrusion off the bottom of the hypothalamus at the base of the brain, and rests in a
small, bony cavity (sella turcica) covered by a dural fold (diaphragma sellae).
 The pituitary fossa, in which the pituitary gland sits, is situated in the sphenoid bone in
the middle cranial fossa at the base of the brain.

Teaching Guides for NTA Level 4 MLS Curriculum Page 414

 It is considered a master gland. The pituitary gland secretes hormones regulating
homeostasis, including tropic hormones that stimulate other endocrine glands. It is
functionally connected to the hypothalamus by the median eminence.

Figure 1: Mesal Aspect of a Brain Sectioned in the Median Sagittal Plane

Source: Strandring (2005),

Refer to Handout 15.1: Medial View of Brain showing the position of Hypothalamus
and Handout 15.2: Pituitary Stalk.

Figure 2: Pituitary and Pineal Glands

Source: Strandring (2005)

Teaching Guides for NTA Level 4 MLS Curriculum Page 415

Figure 3: Hormones Produced by the Anterior and Posterior Lobes of the Pituitary

Source: Strandring (2005)

 Located at the base of the brain, the pituitary is composed of two lobes: the anterior
pituitary (adenohypophysis) and the posterior pituitary (neurohypophysis). The pituitary
is functionally linked to the hypothalamus by the pituitary stalk, whereby hypothalamic
releasing factors are released and, in turn, stimulate the release of pituitary hormones.
Although the pituitary gland is known as the master endocrine gland, both of its lobes are
under the control of the hypothalamus.
 Anterior Pituitary (Adenohypophysis)
o The anterior pituitary synthesizes and secretes important endocrine hormones, such as
ACTH, TSH, PRL, GH, endorphins, FSH, and LH. These hormones are released from
the anterior pituitary under the influence of the hypothalamus.
o Hypothalamic hormones are secreted to the anterior lobe by way of a special capillary
system, called the hypothalamic-hypophyseal portal system. The anterior pituitary is
divided into anatomical regions known as the pars tuberalis, pars intermedia, and pars
distalis.

Pituitary Master Gland

Hormone Target Organ or Tissue
Adrenocorticotropic hormone (ACTH) Adrenal glands
Antidiuretic hormone Kidney
Beta-melanocyte–stimulating hormone Skin
Endorphins Brain and immune system
Enkephalins Brain
Follicle-stimulating hormone Ovaries or testes
Growth hormone Muscles and bones
Luteinizing hormone Ovaries or testes
Oxytocin Uterus and mammary glands
Prolactin Mammary glands
Thyroid-stimulating hormone Thyroid gland

Teaching Guides for NTA Level 4 MLS Curriculum Page 416

Figure 4: The Pituitary Gland

Source: www: becomehealthynow.com/../pituitary gland.htm

Figure 5: Pituitary Gland and Hypothalamus

Source: www: becomehealthynow.com/../pituitary gland.htm

 The Anterior Lobe of the Pituitary Produces and Releases (secretes) Six Main Hormones:
 Growth hormone (GH), which regulates growth and physical development and has
important effects on body shape by stimulating muscle formation and reducing fat tissue
 Thyroid-stimulating hormone (TSH), which stimulates the thyroid gland to produce
thyroid hormones
 Adrenocorticotropic hormone (ACTH, also called corticotropin, which stimulates the
adrenal glands to produce cortisol and other hormones
 Follicle-stimulating hormone (FSH)and luteinizing hormone (LH) (the gonadotropins),
which stimulate the testes to produce sperm, the ovaries to produce eggs, and the sex
organs to produce sex hormones (testosterone and estrogen)
 Prolactin (PRL), which stimulates the mammary glands of the breasts to produce milk
 The anterior lobe also produces several other hormones, including one that causes the
skin to darken (beta-melanocyte–stimulating hormone) and ones that inhibit pain
sensations and help control the immune system (endorphins).
 Posterior Pituitary (Neurohypophysis): The posterior pituitary stores and releases,

Teaching Guides for NTA Level 4 MLS Curriculum Page 417

 Oxytocin, most of which is released from the paraventricular nucleus in the hypothalamus
 Antidiuretic hormone (ADH, also known as vasopressin and AVP, arginine vasopressin),
the majority of which is released from the supraoptic nucleus in the hypothalamus.
 Oxytocin is one of the few hormones to create a positive feedback loop. For example,
uterine contractions stimulate the release of oxytocin from the posterior pituitary, which,
in turn, increases uterine contractions. This positive feedback loop continues throughout
labor.
 Oxytocin also stimulates contractions of the milk ducts in the breast, which move milk to
the nipple (the let-down) in lactating women.

Figure 6: neurohypophysis and adenohypophysis

Source: www: scholarpedia.org/wiki/images

 Intermediate Lobe
o There is also an intermediate lobe in many animals. For instance, in fish, it is believed
to control physiological color change. In adult humans, it is just a thin layer of cells
between the anterior and posterior pituitary.
o The intermediate lobe produces melanocyte-stimulating hormone (MSH), although
this function is often (imprecisely) attributed to the anterior pituitary.

Teaching Guides for NTA Level 4 MLS Curriculum Page 418

Figure 7: The Main System Connecting the Endocrine Secretory Activities of the Pituitary
Gland

Source: Strandring (2005)

Step 3: Functions of the Pituitary Gland (45 minutes)

Activity: Buzzing (10 minutes)

 ASK students to pair up in two.
 ASK students what are the functions of Pituitary gland
 GIVE them two minutes for discussion
 ALLOW one pair to present their findings on a flip chart, and ask the other pairs to add
on if they have any new findings
 SUMMARIZE the activity by clarifying on students responses

 The hormones released by anterior pituitary gland are influenced by the Hypothalamus.
The releasing and inhibiting hormones that stimulate and inhibit secretion of specific
anterior pituitary hormones are as follows:
 The release of an anterior pituitary hormone follows stimulation of the gland by a specific
releasing hormone produced by the hypothalamus and carried to the gland through the
pituitary portal system of blood vessels. The whole system is controlled by a negative
feedback

Teaching Guides for NTA Level 4 MLS Curriculum Page 419

Figure 8: Pituitary Influence on Other Organs

Source: www: scholarpedia.org/wiki/images

 Feedback Mechanism
o That is, when there is a low level of a hormone in the blood supplying the
hypothalamus it produces the appropriate releasing hormone that stimulates release of
a trophic hormone by the anterior pituitary.
o This in turn stimulates the target gland to produce and release its hormone. As a result
the blood level of that hormone rises and inhibits the secretion of releasing factor by
the hypothalamus
 Growth Hormone
o This is the most abundant hormone synthesized by anterior pituitary gland. It
stimulates growth and division of most body cells especially that of bones and skeletal
muscles.
o It also regulates metabolism in many organs example, stimulates protein synthesis and
break down of fats.
 Thyroid Stimulating Hormone
o It stimulates growth and activity of the thyroid gland, which secretes the hormones
thyroxine (T4) and triiiodothyronine (T3). Release is lowest in the early evening and
highest during the night.
o Secretion is regulated by a negative feedback mechanism .When the blood level of
thyroid hormones is high, secretion of TSH is reduced, and vice versa.
o Adrenocorticotrophic Hormone
o Corticotrophin releasing hormone (CRH) from the hypothalamus promotes the
synthesis and release of ACTH by the anterior pituitary.
o This increases the concentration of cholesterol and steroids within the adrenal cortex
and the output of steroid hormones, especially cortisol.
o ACTH levels are highest at about 8 a.m. and fall to their lowest about midnight,
although high levels sometimes occur at midday and 6 p.m. This circadian rhythm is
maintained throughout life.

Teaching Guides for NTA Level 4 MLS Curriculum Page 420

 o It is associated with the sleep pattern and adjustment to changes takes several days,
following, e.g., changing work shifts, travelling to a different time zone (Jet lag).
 Prolactin
o This hormone stimulates lactation (milk production) and has a direct effect on the
breasts immediately after Parturition (childbirth).
o The blood level of prolactin is stimulated by prolactin releasing hormone (PRH)
released from the hypothalamus and it is lowered by prolactin inhibiting hormone
(PIH, dopamine) and, by an increase in blood level of prolactin.
o After birth, suckling stimulates prolactin secretion and lactation. The resultant high
blood level is a factor in reducing the incidence conception during lactation.
o Prolactin together with oestrogens, corticosteroids, insulin and thyroxine is involved
in initiating and maintaining lactation. Prolactin secretion is related to sleep i.e. it is
raised during any period of sleep, night or day, Emotional stress decreases production.
 Gonadotrophin
o There are two gonadotrophins which are released by anterior Pituitary gland. These
are Follicle stimulating hormone and Lutenizing hormone.
o In both sexes follicle stimulating hormone stimulates production of gametes, Ova or
Spermatozoa.
o In females FSH and LH are involved in secretion of Oestrogen and Progesterone. In
males, Lutenizing hormone stimulates the secretion of testosterone.
 Posterior Pituitary
o This is formed from nervous tissue and consists of nerve cells surrounded by
suppporting cells called pituicytes.
o Posterior pituitary hormones are synthesised in the nerve cell bodies, transported
along the axons and then stored in vesicles within the axon terminals within the
posterior pituitary their release by exocytosis is trigggered by nerve impulses from the
hypothalamus.
o The gland secretes Antidiuretic hormone and Oxytocin. These are synthesized
hormones are synthesized in the hypothalamus and the stored in the axonal terminals
within the posterior Pituitary gland.
 Oxytocin: This stimulates two target tissues during and after child birth. These tissues are
uterine smooth muscles and muscle cells of lactating breast. Inhibition occurs after
delivery when uterine contractions no longer dilate (stretch) the cervix.
 Antidiuretic Hormone (ADH)
o The main effect of ADH is to regulate fluid balance in the body by reducing the urine
output, for instance during thirsty, hypotension and when there is high plasma
osmolarity and during stress.
o At high concentrations, for example after severe blood, ADH causes smooth muscle
contraction, especially vasoconstriction in the blood vessels of the skin and abdominal
organs. This has a pressor effect, raising systemic blood pressure; the alternative name
of this hormone, vasopressin, reflects this effect.

Teaching Guides for NTA Level 4 MLS Curriculum Page 421

Figure 9: Hormones produced by Pituitary Gland

Source: www: scholarpedia.org/wiki/images

Step 4: Key Points (10 minutes)

 The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea and
weighing 0.5 g.
 It is a protrusion off the bottom of the hypothalamus at the base of the brain, and rests in a
small, bony cavity (sella turcica) covered by a dural fold (diaphragma sellae)
 Located at the base of the brain, the pituitary is composed of two lobes: the anterior
pituitary (adenohypophysis) and the posterior pituitary (neurohypophysis)
 The anterior pituitary synthesizes and secretes important endocrine hormones, such as
ACTH, TSH, PRL, GH, endorphins, FSH, and LH
 The posterior pituitary stores and releases,
 Oxytocin, most of which is released from the paraventricular nucleus in the hypothalamus
 Antidiuretic hormone (ADH, also known as vasopressin and AVP, arginine vasopressin),
the majority of which is released from the supraoptic nucleus in the hypothalamus
 The hormones released by anterior pituitary gland are influenced by the Hypothalamus.
The releasing and inhibiting hormones that stimulate and inhibit secretion of specific
anterior pituitary hormones are as follows:
 The release of an anterior pituitary hormone follows stimulation of the gland by a specific
releasing hormone produced by the hypothalamus and carried to the gland through the
pituitary portal system of blood vessels. The whole system is controlled by a negative
feedback.
 Feedback mechanism: That is, when there is a low level of a hormone in the blood
supplying the hypothalamus it produces the appropriate releasing hormone that stimulates
release of a trophic hormone by the anterior pituitary.
 This in turn stimulates the target gland to produce and release its hormone. As a result the
blood level of that hormone rises and inhibits the secretion of releasing factor by the
hypothalamus.

Teaching Guides for NTA Level 4 MLS Curriculum Page 422

Step 5: Evaluation (15 minutes)
 Describe the structure of Pituitary Gland
 Describe the function of Pituitary Gland
 Explain the importance of Pituitary Gland on other hormones/ organs
 Describe feed mechanism of Pituitary Gland
 ASK students if they have any comments or need clarification on any points

References
 Anne Waugh and Allison Grant (2001): Ross and Wilson Anatomy and Physiology in
Health and Illness. Churchill Livingstone (UK)
 Kenneth S. Saladin. (2005): Human Anatomy: McGraw –Hill Companies .USA
 Moore, Keith, Agur, Anne (2007). Essential Clinical Anatomy, 3rd Edition. Lippincott
William & Wilkins
 Rod Seeley, Trent Stephens, Philip Tate. (2003): Anatomy & Physiology: McGraw-Hill
Companies. USA
 Williams & Wilkins Moore, Keith L.; Agur, Anne M. R. (2007): Essential Clinical
Anatomy, 3rd Edition. Lippincott

Teaching Guides for NTA Level 4 MLS Curriculum Page 423

Handout 15.1: Medial View of Brain showing the position of Hypothalamus

Source: Moore, Keith Agur, Anne 2007

Handout 15.2: Pituitary Stalk

(no diagram)

Source: Moore, Keith Agur, Anne 2007

Teaching Guides for NTA Level 4 MLS Curriculum Page 424

Session 33: Adrenal Glands, Pancreas
and Local Hormones.
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 Describe the structure of Adrenal gland
 Describe the functions of Adrenal gland
 List the hormones secreted by pancreas
 Describe the function of hormones secreted by endocrine pancreas
 Describe the function of local hormones

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout 16.1: Lymphatic drainage and Innervations of Adrenal Glands
 Handout 16.2: Lymphatic drainage and Innervations of Pancreas
 Handout 16.3: Function of Pancreas as Exocrine Gland

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 30 minutes Presentation Structure of Adrenal Glands
Presentation
3 40 minutes Small Group Function of Adrenal Glands
Discussion
4 30 minutes Presentation Hormones Secreted by Endocrine Pancreas
5 05 minutes Presentation Functions of Local Hormones
6 05 minutes Presentation Key Points
7 05 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 Minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Structure of the Adrenal Gland (Suprarenal) (30 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 425

 Anatomically, the adrenal glands (suprarenal) are located in the thoracic abdomen
situated 'on' top of the kidneys one on each side, specifically on their anterosuperior
aspect.
 They are also surrounded by the adipose capsule and the renal fascia. In humans, the
adrenal glands are found at the level of the 12th thoracic vertebra and receive their blood
supply from the adrenal arteries.
 The adrenal gland is separated into two distinct structures, both of which receive
regulatory input from the nervous system

Figure 1: Adrenal glands

Source: Moore, Keith, Agur, Anne (2007.

Figure 2: Gross Section Appearance, Microstructure Vasculature and Ultrastructure of The

Adrenal Glands

Source: Standring (2005),

Teaching Guides for NTA Level 4 MLS Curriculum Page 426

 Adrenal Cortex
o The adrenal cortex is devoted to the synthesis of corticosteroid hormones from
cholesterol. Some cells belong to the hypothalamic-pituitary-adrenal axis and are
the source of cortisol and corticosterone synthesis.
o Under normal unstressed conditions, the human adrenal glands produce the equivalent
of 35–40 mg of cortisone acetate per day Other cortical cells produce androgens
such as testosterone, while some regulate water and electrolyte concentrations by
secreting aldosterone.
o In contrast to the direct innervation of the medulla, the cortex is regulated by
neuroendocrine hormones secreted by the pituitary gland and hypothalamus, as
well as by the renin-angiotensin system.
 The cortex is divided into three zones, or layers. This division is sometimes referred to as
"functional zonation".Moving from the outermost layer in,
 Zona glomerulosa, the zona glomerulosa is the main site for production of
mineralocorticoids, namely aldosterone, which plays an important role in the body's
sodium homeostasis.
 Zona fasciculata, the zona fasciculata is responsible for producing glucocorticoids,
chiefly cortisol in humans. Cortisol secretion is stimulated by adrenocorticotropic
hormone (ACTH) from the anterior pituitary, by binding to a cell surface receptor and
in turn increasing intracellular cAMP. In the absence of ACTH, the zona fasciculata
secretes a basal level of cortisol.
 Zona reticularis, the zona reticularis produces androgens, mainly
dehydroepiandrosterone (DHEA) and DHEA sulfate in humans.
 Adrenal Medulla
o The adrenal medulla is the core of the adrenal gland, and is surrounded by the adrenal
cortex. The chromaffin cells of the medulla are the body's main source of the
circulating catecholamines adrenaline (epinephrine) and noradrenaline
(norepinephrine).
o These water-soluble hormones, derived from the amino acid tyrosine, are part of the
fight-or-flight response initiated by the sympathetic nervous system.
o The adrenal medulla can be considered as specialized ganglion of the sympathetic
nervous system, lacking distinct synapses, instead releasing secretions directly into
the blood.
o Noradrenaline is the postganglionic neurotransmitter of the sympathetic division of
the autonomic nervous system.
o Adrenaline and some noradrenaline are released into the blood from the adrenal
medulla during stimulation of the sympathetic nervous system they are structurally
very similar and this explains their similar effects. Together they potentiate the fight
or flight response by:
 Increasing heart rate
 Increasing blood pressure
 Diverting blood to essential organs including the heart, brain and skeletal muscles
by dilating their blood vessels and constricting those of less essential organs, such
as the skin
 Increasing metabolic rate
 Dilating the pupils.
 Adrenaline has a greater effect on the heart and metabolic processes whereas
noradrenaline has more influence on blood vessels.

Teaching Guides for NTA Level 4 MLS Curriculum Page 427

 Arteries and veins
 Although variations of the blood supply to the adrenal glands (and indeed the kidneys
themselves) are common, there are usually three arteries that supply each adrenal gland
 The superior suprarenal artery is provided by the inferior phrenic
 The middle suprarenal artery is provided by the abdominal aorta
 The inferior suprarenal artery is provided by the renal artery
 Venous drainage: Of the adrenal glands is achieved via the suprarenal veins
 The right suprarenal vein drains into the inferior vena cava
 The left suprarenal vein drains into the left renal vein or the left inferior phrenic vein.
 The suprarenal veins may form anastomoses with the veins, The adrenal glands and the
thyroid gland are the organs that have the greatest blood supply per gram of tissue. Up to
60 arterioles may enter each adrenal gland.

Refer to Handout 16.1: Lymphatic drainage and Innervation of Adrenal Glands

Step 3: Functions of the Adrenal Gland (40 minutes)

 The adrenal cortex produces three groups of steroid hormones from cholesterol. They are
collectively called adrenocorticocoids (corticosteroids, corticoids). They are,
 Glucocorticoids
 Mineralocorticoids
 Sex hormones (androgens).
 The hormones in each group have different characteristic actions but due to their
structural similarity the actions may overlap.
 Glucocorticoids
o Cortisol (hydrocortisone), is the main glucocorticoid but small amounts of
corticosterone and cortisone are also produced.
o They are essential for life, regulating metabolism and responses to stress. Secretion is
controlled through negative feedback system involving the hypothalamus and anterior
pituitary. It is stimulated by ACTH from the anterior pituitary and by stress
o In non stressful conditions, secretion has marked circadia variations.
o Glucocorticoids have widespread metabolic effects and these include:
o gluconeogenesis (formation of new sugar from, for example, protein) and
hyperglycaemia (raised blood glucose level)
o lipolysis (breakdown of triglycerides into fatty acids and glycerol for energy
production)
o stimulating breakdown of protein, releasing amino acids, which can be used for
synthesis of other proteins, e.g. enzymes, or for energy (ATP) production
o Promoting absorption of sodium and water from renal tubules (a weak mineral
corticoid effect).
o In pathological and pharmacological quantities glucoocorticoids also have other
effects including:
o anti-inflammatory actions
o suppression of immune responses
o delayed wound healing.
 Mineralocorticoids (aldosterone)

Teaching Guides for NTA Level 4 MLS Curriculum Page 428

 o Aldosterone is the main mineralocorticoid. Its functions are associated with the
maintenance of water and electrolyte balance in the body.
o Through a negative feedback system it stimulates the reabsorption of sodium (Na+)
by the renal tubules and excretion of potassium (K+) in the urine. Sodium
reabsorption is also accompanied by retention of water and therefore aldosterone is
involved in the regulation of blood volume and blood pressure too.
o The blood potassium level regulates the amount of aldosterone produced by the
adrenal cortex. When the blood potassium level rises, more aldosterone is secreted.
Low blood potassium has the opposite effect. Angiotensin also stimulates the release
of aldosterone.
 Renin-Angiotensin-Aldosterone System
o When renal blood flow is reduced or blood sodium levels fall, the enzyme renin is
secreted by kidney cells.
o Renin converts the plasma protein angiotensinogen, produced by the liver, to
angiotensin 1. Angiotensin converting enzyme (ACE), formed in small quantities in
the lungs, proximal kidney tubules and other tissues converts angiotensin 1 to
angiotensin 2, which stimulates secretion of aldosterone. It also causes
vasoconstriction and increases blood pressure.
 Sex Hormones
o Sex hormones secreted by the adrenal cortex are mainly androgens (male sex
hormones) and the amounts produced are insignificant compared with those secreted
by the testes and ovaries in late puberty and adulthood.

 Activity: Small Group Discussion (10 minutes)

 ASK the students to divide into three groups.
 GIVE each group a task.
 Group 1: Describe alpha cell secretion in pancreas
 Group 2: Describe beta cell secretion in pancreas
 Group 3: Describe delta cell secretion in pancreas
 GIVE five minutes to complete the task.
 ASK each group to choose a volunteer who will present the answers on a flip chart, and
other member of the class to add if they are having additional information.
 SUMMARIZE the activity by clarifying on students responses.

Teaching Guides for NTA Level 4 MLS Curriculum Page 429

Step 4: Hormones Secreted by Endocrine Pancreas (30 minutes)

Figure 3: Anterior relations of the pancreas

Source: Standring (2005),

Figure 4: Posterior Relations of the Pancreas

Source: Standring (2005),

 The cells that make up the pancreatic islets (islets of Langerhans) are found in clusters
irregularly distributed throughout the substance of the pancreas.
 Unlike the exocrine pancreas, which produces pancreatic juice, there are no ducts leading
from the clusters of islet cells. Pancreatic hormones are secreted directly into the
bloodstream and circulate throughout the body.
 There are three main types of cells in the pancreatic islets:
 α (alpha) cells, which secrete glucagon
 β (beta) cells, which secrete insulin
 ∆ (delta) cells, which secrete somatostatin
 The normal blood glucose level is between 3.5 and 8 mmol/litre (63 to 144 mg/100 ml,
blood glucose levels are controlled mainly by the opposing actions of insulin and
glucagon,
 Glucagon increases blood glucose levels
 Insulin reduces blood glucose levels.

Teaching Guides for NTA Level 4 MLS Curriculum Page 430

 Refer to Handout 16.2: Lymphatic drainage and Innervation of Pancreas

Figure 5: Microstructure and Control of Function of the Endocrine Pancreas

Source: Standring (2005),

 The most numerous cells, types alpha and beta, secrete glucagon and insulin respectively.
Alpha cells tend to be concentrated at the periphery of islets, and beta cells more
centrally.
 A third type, the delta cell, secretes somatostatin and gastrin, and like alpha cells, is
peripherally placed within the islets.
 A minor cell type, the F cell, secretes pancreatic polypeptide (PP), which is stored in
smaller secretory granules. The autonomic transmitter’s acetylcholine (ACh) and
noradrenalin affect islet cell secretion.
 ACh augments insulin and glucagon release, noradrenalin inhibits glucose-induced
insulin release and they may also affect somatostatin and PP secretion
 Insulin
o The main function of insulin is to lower raised blood nutrient levels, especially
glucose but also amino acids and fatty acids.
o When these nutrients, especially glucose, are in excess of immediate needs insulin
promotes their storage by:
o Acting on cell membranes and stimulating uptake and use of glucose by muscle and
connective tissue cells

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 o Increasing conversion of glucose to glycogen (glycogenesis), especially in the liver
and skeletal muscles
o Accelerating uptake of amino acids by cells, and the synthesis of protein
o Promoting synthesis of fatty acids and storage of fat in adipose tissue (lipogenesis)
o Decreasing glycogenolysis (breakdown of glycogen, into glucose)
o Preventing the breakdown of protein and fat, and gluconeogenesis (formation of new
sugar from, e.g., protein).
 Glucagon
o The effects of glucagon increase blood glucose levels by stimulating
o Conversion of glycogen to glucose in the liver and skeletal muscles (glycogenolysis)
 Gluconeogenesis.
o Somatostatin (GHRIH)
o The effect of this hormone, also produced by the hypothalamus, is to inhibit the
secretion of both insulin and glucagon in addition to inhibiting the secretion of GH
from the anterior pituitary.

Refer to Handout 16.3: Function of Pancreas as Exocrine Gland

Step 5: Functions of Local Hormones (5 minutes)

 A number of body tissues secret hormones that act locally, these are Histamine, serotonin,
and Prostaglandins.
 Others are gastrointestinal hormones including Gastrin, Secretin and Cholecystokinin.
 Histamine is secreted by mast cells and Basophils during inflammation. It increases
capillary permeability and causes vasodilatation.
 Prostaglandins have a wide range of physiological effects in:
o The inflammatory response
o Potentiating pain
o Fever
o Regulating blood pressure
o Blood clotting
o Uterine contraction during labour.

Step 6: Key Points (5 minutes)

 The adrenal cortex produces three groups of steroid hormones from cholesterol. They are
collectively called adrenocorticocoids (corticosteroids, corticoids). They are,
o Glucocorticoids
o Mineralocorticoids
o Sex hormones (androgens).
 There are three main types of cells in the pancreatic islets:
o α (alpha) cells, which secrete glucagon
o β (beta) cells, which secrete insulin
o ∆ (delta) cells, which secrete somatostatin
 The main function of insulin is to lower raised blood nutrient levels, especially glucose
but also amino acids and fatty acids. When these nutrients, especially glucose, are in
excess of immediate needs insulin promotes their storage by:
o Acting on cell membranes and stimulating uptake and use of glucose by muscle and
connective tissue cells

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 o Increasing conversion of glucose to glycogen (glycogenesis), especially in the liver
and skeletal muscles

Step 7: Evaluation (5 minutes)

 Describe the structure of Adrenal gland
 Describe the functions of Adrenal gland
 List the hormones secreted by endocrine pancreas
 ASK students if they have any comments or need clarification on any points.

References
 Anne Waugh and Allison Grant (2001): Ross and Wilson Anatomy and Physiology in
Health and Illness. Churchill Livingstone (UK)
 Kenneth S. Saladin. (2005): Human Anatomy: McGraw –Hill Companies .USA
 Moore, Keith, Agur, Anne (2007). Essential Clinical Anatomy, 3rd Edition. Lippincott
William & Wilkins
 Rod Seeley, Trent Stephens, Philip Tate. (2003): Anatomy & Physiology: McGraw-Hill
Companies. USA
 Williams & Wilkins Moore, Keith L.; Agur, Anne M. R. (2007): Essential Clinical
Anatomy, 3rd Edition. Lippincott

Teaching Guides for NTA Level 4 MLS Curriculum Page 433

Handout 16.1: Lymphatic drainage and Innervation of Adrenal Glands

Source: Moore, Keith, Agur, Anne (2007).

Teaching Guides for NTA Level 4 MLS Curriculum Page 434

Handout 16.2: Lymphatic drainage and Innervation of Pancreas

Source: Moore, Keith, Agur, Anne (2007).

Handout 16.3: Function of Pancreas as Exocrine Gland

Source: Standring (2005),

Teaching Guides for NTA Level 4 MLS Curriculum Page 435

Session 34: Thyroid and Parathyroid
Gland.
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time.120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students are expected to be able to
 Describe the structure of thyroid gland
 Describe the function of thyroid gland
 Describe the structure of Parathyroid gland
 Describe the function of Parathyroid gland

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Handout 17.1: Position of Thyroid Gland

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 30 minutes Presentation Structure of Thyroid Gland
Presentation
3 40 minutes Functions of Thyroid Gland
Small Group Discussion
4 10 minutes Presentation Structure of Parathyroid Gland
5 25minutes Presentation Functions of Parathyroid Gland
6 05 minutes Presentation Key Points
7 05 minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Structure of the Thyroid Gland (30 minutes)

 The thyroid is one of the largest endocrine glands in the body. This gland is found in the
neck inferior to (below) the thyroid cartilage (also known as the Adam's apple in men)
and at approximately the same level as the cricoid cartilage.

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 The thyroid controls how quickly the body burns energy, makes proteins, and controls
how sensitive the body should be to other hormones.
 The thyroid participates in these processes by producing thyroid hormones, principally
thyroxine (T4) and triiodothyronine (T3). These hormones regulate the rate of metabolism
and affect the growth and rate of function of many other systems in the body.
 Iodine and tyrosine are used to form both T3 and T4. The thyroid also produces the
hormone calcitonin, which plays a role in calcium homeostasis.
 The thyroid is controlled by the hypothalamus and pituitary. Hyperthyroidism
(overactive thyroid) and hypothyroidism (underactive thyroid) are the most common
problems of the thyroid gland.

Figure 1: Relationship of Thyroid Gland

Source: Moore, Keith, Agur and Anne (2007)

Figure 2: Lymphatic drainage of Thyroid Gland Larynx and Trachea

Source: Moore, Keith, Agur and Anne (2007)

Teaching Guides for NTA Level 4 MLS Curriculum Page 437

 Anatomy
o The thyroid gland is a butterfly-shaped organ and is composed of two cone-like lobes
or wings: (right lobe) and (left lobe), and is also connected with the isthmus.
o The organ is situated on the anterior side of the neck, lying against and around the
larynx and trachea, reaching posteriorly the oesophagus and carotid sheath.
o It starts cranially at the oblique line on the thyroid cartilage (just below the laryngeal
prominence or Adam's apple) and extends inferiorly to the fifth or sixth tracheal ring.
o It is difficult to demarcate the gland's upper and lower border with vertebral levels
because it moves position in relation to these during swallowing.
o The thyroid is supplied with arterial blood from the superior thyroid artery, a branch
of the external carotid artery, and the inferior thyroid artery, a branch of the
thyrocervical trunk, and sometimes by the thyroid artery, branching directly from the
brachiocephalic trunk.
o The venous blood is drained via superior thyroid veins, draining in the internal jugular
vein, and via inferior thyroid veins, left brachiocephalic vein.
o Lymphatic drainage passes frequently the lateral deep cervical lymph nodes and the
pre- and parathracheal lymph nodes.
o The gland is supplied by sympathetic nerve input from the superior cervical ganglion
and the cervicothoracic ganglion of the sympathetic trunk, and by parasympathetic
nerve input from the superior laryngeal nerve and the recurrent laryngeal nerve.

Refer Handout 17.1: Position of Thyroid Gland

Figure 3: Thyroid Gland with its Major Vasculisation and Muscles

Source: Standring, (2005).

 Physiology

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  The primary function of the thyroid is production of the hormones thyroxine (T4),
triiodothyronine (T3), and calcitonin.
 Up to 80% of the T4 is converted to T3 by peripheral organs such as the liver, kidney
and spleen. T3 is about ten times more active than T4.
 T3 and T4 Production and Action
 Thyroxine (T4) is synthesized by the follicular cells from free tyrosine and on
the tyrosine residues of the protein called thyroglobulin (Tg).
 Iodine is captured with the "iodine trap" by the hydrogen peroxide generated by
the enzyme thyroid peroxidase to T3.
 Thyroid hormone that is secreted from the gland is about 90% T4 and about 10%
T3.
 Cells of the brain are a major target for the thyroid hormones T3 and T4. Thyroid
hormones play a particularly crucial role in brain maturation during fetal
development.
 In the blood, T4 and T3 are partially bound to thyroxine-binding globulin,
transthyretin and albumin. Only a very small fraction of the circulating hormone is
free (unbound) - T4 0.03% and T3 0.3%. Only the free fraction has hormonal
activity.
 T3 and T4 Regulation
 The production of thyroxine and triiodothyronine is regulated by thyroid-
stimulating hormone (TSH), released by the anterior pituitary (that is in turn
released as a result of TRH release by the hypothalamus). The thyroid and
thyrotropes form a negative feedback loop. TSH production is suppressed when
the T4 levels are high, and vice versa.
 The TSH production itself is modulated by thyrotropin-releasing hormone
(TRH), which is produced by the hypothalamus and secreted at an increased rate
in situations such as cold (in which an accelerated metabolism would generate
more heat).
 TSH production is blunted by somatostatin (SRIH), rising levels of
glucocorticoids and sex hormones (estrogen and testosterone), and excessively
high blood iodide concentration.
 Calcitonin
 An additional hormone produced by the thyroid contributes to the regulation of
blood calcium levels.
 Parafollicular cells produce calcitonin in response to hypercalcemia. Calcitonin
stimulates movement of calcium into bone, in opposition to the effects of
parathyroid hormone (PTH). However, calcitonin seems far less essential than
PTH, as calcium metabolism remains clinically normal after removal of the
thyroid, but not the parathyroids.
 Significance of Iodine
 In areas of the world where iodine (essential for the production of thyroxine,
which contains four iodine atoms) is lacking in the diet, the thyroid gland can be
considerably enlarged, resulting in the swollen necks of endemic goitre.
 Thyroxine is critical to the regulation of metabolism and growth throughout the
animal kingdom.
 In humans, children born with thyroid hormone deficiency will have physical
growth and development problems, and brain development can also be severely
impaired, in the condition referred to as cretinism.

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  Newborn children in many developed countries are now routinely tested for
thyroid hormone deficiency as part of newborn screening by analysis of a drop of
blood.
 Children with thyroid hormone deficiency are treated by supplementation with
synthetic thyroxine, which enables them to grow and develop normally.
 The uptake mechanism with a large surplus of non-radioactive iodine, taken in the
form of potassium iodide tablets. While biological researchers making compounds
labelled with iodine isotopes do this, in the wider world such preventive measures
are usually not stockpiled before an accident, nor are they distributed adequately
afterward.
 The use of iodised salt is an efficient way to add iodine to the diet. It has
eliminated endemic cretinism in most developed countries, and some governments
have made the iodination of flour or salt mandatory. Potassium iodide and sodium
iodide are the most active forms of supplemental iodine.

 Step 3: Functions of The Thyroid Gland (30 minutes)

 Iodine is essential for the formation of the thyroid gland hormones, thyroxine (T4)
and tri-iodothyronine (T3).
 The body's main sources of iodine are seafood, vegetables grown in iodine-rich soil
and iodinated table salt in the diet. The thyroid gland selectively takes up iodine from
the blood, a process called iodine trapping.
 The thyroid hormones are synthesised as large preecursor molecules called
thyroglobulin, the major constituent of colloid. The release of T3 and T4 into the
blood is regulated by thyroid stimulating hormone (TSH) from the anterior pituitary.
 Secretion of TSH is stimulated by thyroid releasing hormone (TRH) from the
hypothalamus and secretion of TRH is stimulated by exercise, stress, malnutrition,
low plasma glucose and sleep.
 Secretion of T3 and T4 begins about the third month of fetal life and is increased at
puberty and in women during the reproductive years, especially during pregnancy.
Otherwise, it remains fairly constant throughout life.
 Thyroid hormones enter the target cells and regulate the expression of genes in the
nucleus, i.e. they increase or decrease the synthesis of some proteins including
enzymes. They combine with specific receptor sites and enhance the effects of other
hormones, e.g. adrenaline (epinephrine) and noradrenaline (norepinephrine).
 T3 and T4 Affect Most Cells of the Body By
 Increasing the basal metabolic rate and heat production
 Regulating metabolism of carbohydrates, proteins and fats.
 T3 and T4 are essential for normal growth and development, especially of the
skeleton and nervous system.
 Most other organs and systems are also influenced by thyroid hormones.
Physiological effects of T3 and T4 on the heart, skeletal muscles, skin, digestive
and reproductive systems are more evident when there is underactivity or
overactivity of the thyroid gland.
 Calcitonin
 This hormone is secreted by the parafollicular or C-cells in the thyroid gland (Fig.
9. It acts on bone and the kidneys to reduce the blood calcium (Ca2+) level when
it is raised.

Teaching Guides for NTA Level 4 MLS Curriculum Page 440

  It reduces the reabsorption of calcium from bones and inhibits reabsorption of
calcium by the renal tubules. Its effect is opposite to that of parathyroid hormone,
the hormone secreted by the parathyroid glands.
 Release of calcitonin is stimulated by an increase in the blood calcium level.
 This hormone is important during childhood when bones undergo considerable
changes in size and shape.

 Activity: Small Group Discussion (10 minutes)

 ASK students to divide into four groups
 ASK each group to discuss the function of the thyroid gland
 GIVE five minutes for discussion
 ASK one volunteer from one of the group to come and present their findings and the
other groups to add if they have any new observations
 SUMMARIZE the activity by clarifying on students responses

Figure 4: Thyroid and Parathyroid Glands and their Roles in the Control of Calcium

Source: Standring, (2005).

Step 4: Structure of the Parathyroid Gland (10 minutes)

 Two parathyroid glands lie against the posterior surface of each lobe and are sometimes
embedded in thyroid tissue.
 The recurrent laryngeal nerve passes upwards close to the lobes of the gland and on the
right side it lies near the inferior thyroid artery.
 The gland is composed of cuboidal epithelium that forms spherical follicles. These
secrete and store colloid, a thick sticky protein material. Between the follicles there are

Teaching Guides for NTA Level 4 MLS Curriculum Page 441

 other cells found singly or in small groups, para follicular cells, also called C-cells, which
secrete the hormone calcitonin

Step 5: Functions of the Parathyroid Gland (25 minutes)

 Regulation of serum calcium.
 Parathyroid hormone regulates serum calcium levels through its effects on the following
tissues,
Region Effects
Bone It enhances the release of calcium from the large reservoir contained in the
bones. Bone resorption is the normal destruction of bone by osteoclasts,
which are indirectly stimulated by PTH. Stimulation is indirect since
osteoclasts do not have a receptor for PTH; rather, PTH binds to osteoblasts,
the cells responsible for creating bone.
Kidney It enhances active reabsorption of calcium and magnesium from distal
tubules and the thick ascending limb. As bone is degraded both calcium and
phosphate are released. It also greatly increases the excretion of phosphate,
with a net loss in plasma phosphate concentration. By increasing the calcium:
phosphate ratio more calcium is therefore free in the circulation
Intestine via It enhances the absorption of calcium in the intestine by increasing the
kidney production of activated vitamin D. Vitamin D activation occurs in the kidney.
PTH up-regulates 25-hydroxyvitamin D3 1-alpha-hydroxylase, the enzyme
responsible for 1-alpha hydroxylation of 25-hydroxy vitamin D, converting
vitamin D to its active form (1,25-dihydroxy vitamin D). This activated form
of vitamin D increases the absorption of calcium (as Ca2+ ions) by the
intestine via calbindin

 Regulation of Serum Phosphate

o PTH reduces the reabsorption of phosphate from the proximal tubule of the kidney,
which means more phosphate is excreted through the urine.
o However, PTH enhances the uptake of phosphate from the intestine and bones into the
blood. In the bone, slightly more calcium than phosphate is released from the
breakdown of bone.
o In the intestines, which are mediated by an increase in activated vitamin D, the
absorption of phosphate is not as dependent on vitamin D as is that of calcium. The
end result is a small net drop in the serum concentration of phosphate.
 Vitamin D Synthesis
o PTH increases the activity of 1-α-hydroxylase enzyme, which converts 25-
hydroxycholecalciferol to 1, 25-dihydroxycholecalciferol, the active form of vitamin
D.
 Regulation of PTH Secretion
o Secretion of parathyroid hormone is chiefly controlled by serum [Ca2+] through
negative feedback, which is achieved by the activation of calcium-sensing receptors
located on parathyroid cells.
 Stimulators
o Decreased serum [Ca2+]
o Mild decreases in serum [Mg2+].
o An increase in serum phosphate (Since increased phosphate will complex with serum
calcium to form calcium phosphate, this causes the Ca sensitive receptors (CaSr) to

Teaching Guides for NTA Level 4 MLS Curriculum Page 442

 think that serum Ca has decreased, as CaSR do not sense Calcium phosphate, thereby
triggering an increase in PTH)
 Inhibitors
o Increased serum [Ca2+].
o Severe decreases in serum [Mg2+], which also produces symptoms of
hypoparathyroidism (such as hypocalcemia).
 Clinical Significance
o A high level of PTH in the blood is known as hyperparathyroidism.
o If the cause is in the parathyroid gland it is called primary hyperparathyroidism. The
causes are parathyroid adenoma, parathyroid hyperplasia and parathyroid cancer.
o If the cause is outside the gland, it is known as secondary hyperparathyroidism. This
can occur in chronic renal failure. In secondary hyperparathyroidism, serum Calcium
levels are decreased, which causes the hypersecretion of PTH from the parathyroid
glands. PTH acts on the proximal tubules in the kidney to decrease reabsorption of
Phosphate (increasing its excretion in urine, decreasing its serum concentration).
Note: however, in chronic renal failure, because the kidneys are failing they are
unable to excrete phosphate in the urine, so in this case of secondary
hyperparathyroidism, serum calcium will be decreased, but serum phosphate will be
increased.
o A low level of PTH in the blood is known as hypoparathyroidism. Causes include
surgical misadventure (eg inadvertent removal during routine thyroid surgery),
autoimmune disorder, and inborn errors of metabolism.
o Measurement
o PTH can be measured in the blood in several different forms: intact PTH; N-terminal
PTH; mid-molecule PTH, and C-terminal PTH, and different tests are used in
different clinical situations.
o The average PTH level is 10-60 pg/ml.

Step 6: Key Points (5 minutes)

 The thyroid is one of the largest endocrine glands in the body. This gland is found in the
neck inferior to (below) the thyroid cartilage (also known as the Adam's apple in men)
and at approximately the same level as the cricoid cartilage. The thyroid controls how
quickly the body burns energy, makes proteins, and controls how sensitive the body
should be to other hormones.
 The thyroid participates in these processes by producing thyroid hormones, principally
thyroxine (T4) and triiodothyronine (T3). These hormones regulate the rate of metabolism
and affect the growth and rate of function of many other systems in the body. Iodine and
tyrosine are used to form both T3 and T4. The thyroid also produces the hormone
calcitonin, which plays a role in calcium homeostasis.
 T3 and T4 affect most cells of the body by,
 Increasing the basal metabolic rate and heat production
 Regulating metabolism of carbohydrates, proteins and fats.
 T3 and T4 are essential for normal growth and development, especially of the skeleton
and nervous system. Most other organs and systems are also influenced by thyroid
hormones. Physiological effects of T3 and T4 on the heart, skeletal muscles, skin,
digestive and reproductive systems are more evident when there is underactivity or
overactivity of the thyroid gland.

Teaching Guides for NTA Level 4 MLS Curriculum Page 443

 Two parathyroid glands lie against the posterior surface of each lobe and are sometimes
embedded in thyroid tissue. The recurrent laryngeal nerve passes upwards close to the
lobes of the gland and on the right side it lies near the inferior thyroid artery.
 Parathyroid hormone regulates serum calcium levels.

Step 7: Evaluation (5 minutes)

 Describe the structure of thyroid gland
 Describe the function of thyroid gland
 Describe the structure of Parathyroid gland
 Describe the function of Parathyroid gland

 ASK students if they have any comments or need clarification on any points

References
 Anne Waugh and Allison Grant (2001): Ross and Wilson Anatomy and Physiology in
Health and Illness. Churchill Livingstone (UK)
 Kenneth S. Saladin. (2005): Human Anatomy: McGraw –Hill Companies .USA
 Moore, Keith, Agur, Anne (2007). Essential Clinical Anatomy, 3rd Edition. Lippincott
William & Wilkins
 Rod Seeley, Trent Stephens, Philip Tate. (2003): Anatomy & Physiology: McGraw-Hill
Companies. USA
 Williams & Wilkins Moore, Keith L.; Agur, Anne M. R. (2007): Essential Clinical
Anatomy, 3rd Edition. Lippincott

Teaching Guides for NTA Level 4 MLS Curriculum Page 444

Handout 17.1: Position of Thyroid gland

Source: Moore, Keith, Agur and Anne, (2007)

Teaching Guides for NTA Level 4 MLS Curriculum Page 445

Session 35: Sensory Organs and their
Functions
NTA LEVEL 4: SEMESTER 1: MODULE CODE MLT 04102: ELEMENTARY STRUCTURE AND
FUNCTION OF HUMAN BODY

Total session time: 120 minutes.

Pre-requisites
 None.

Learning Objectives
By the end of this session, students will be able are to:
 List five sensory organs found in the human body(Ear, nose, Eye, tongue and skin)
 Describe the organization of sensory organs( Ear, nose, Eye, tongue and skin)
 Identify the sketch diagram of each sensory organs
 Describe the basic functions of each sensory organ.
 Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Over head Projector and Transparencies or Slide Projector/LCD and Computer
 Coloured Atlas for individual sense organs.

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
Presentation
2 10 minutes Sensory organs of the human body.
Brainstorming.
3 60 minutes Presentation Organization of sensory organs.
Presentation,
4 25minutes Illustrated diagrams of sensory organs
Brainstorming
5 10 minutes Presentation Basic functions of each sensory organ.
6 5 minutes Presentation Key points
7 5 minutes Presentation Evaluation.

SESSION CONTENT:
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Sensory organs of the human body (10minutes)

 Activity: Brainstorming (5 minutes)
 Ask students following question:-
 Mention one sensory organ of the human body:-

Teaching Guides for NTA Level 4 MLS Curriculum Page 446

  Record the responses and write them on a flip chart.
 Conclude: by listing five sensory organs as follows:-

The following are the five sensory organs of the human body.
 Ear.
 Eye.
 Nose.
 Tongue.
 Skin.

Step 3: Organization of each sensory organ.( 60minutes)

 The Ears:
o The ear is organized as follows:-
 Ears are paired sensory organs comprising,
 The auditory system, involved in the detection of sound, and
 The vestibular system, involved with maintaining body balance/ equilibrium.
 The ear divides anatomically and functionally into three regions
o The external ear,
o The middle ear, and
o The inner ear.
 All three regions are involved in hearing. Only the inner ear functions in the vestibular
system.
 The external ear (or pinna, the part you can see) serves to protect the tympanic membrane
(eardrum), as well to collect and direct sound waves through the ear canal to the eardrum.
About 1¼ inches long, the canal contains modified sweat glands that secrete cerumen, or
earwax. Too much cerumen can block sound transmission.
 The middle ear, separated from the external ear by the eardrum, is an air-filled cavity
(tympanic cavity) carved out of the temporal bone. It connects to the throat/nasopharynx
via the Eustachian tube.
 This ear-throat connection makes the ear susceptible to infection (otitis media). The
eustachian tube functions to equalize air pressure on both sides of the eardrum. Normally
the walls of the tube are collapsed.
 Swallowing and chewing actions open the tube to allow air in or out, as needed for
equalization. Equalizing air pressure ensures that the eardrum vibrates maximally when
struck by sound waves.
 Adjoining the eardrum are three linked, movable bones called ossicles, which convert the
sound waves striking the eardrum into mechanical vibrations.
 The smallest bones in the human body, the ossicles are named for their shape. The
hammer (malleus) joins the inside of the eardrum. The anvil (incus), the middle bone,
connects to the hammer and to the stirrup (stapes). The base of the stirrup, the footplate,
fills the oval window which leads to the inner ear.
 The inner ear consists of a maze of fluid-filled tubes, running through the temporal bone
of the skull. The bony tubes, the bony labyrinth, are filled with a fluid called perilymph.
Within this bony labyrinth is a second series of delicate cellular tubes, called the
membranous labyrinth, filled with the fluid called endolymph.
 This membranous labyrinth contains the actual hearing cells, the hair cells of the organ of
Corti. There are three major sections of the bony labyrinth,

Teaching Guides for NTA Level 4 MLS Curriculum Page 447

 The front portion is the snail-shaped cochlea, which functions in hearing.
 The rear part, the semicircular canals, helps maintain balance.
 Interconnecting the cochlea and the semicircular canals is the vestibule, containing the
sense organs responsible for balance, the utricle and saccule.
 The inner ear has two membrane-covered outlets into the air filled middle ear, the oval
window and the round window.
 The oval window sits immediately behind the stapes, the third middle ear bone, and
begins vibrating when "struck" by the stapes. This sets the fluid of the inner ear sloshing
back and forth.
 The round window serves as a pressure valve, bulging outward as fluid pressure rises in
the inner ear. Nerve impulses generated in the inner ear travel along the vestibulocochlear
nerve (cranial nerve VIII), which leads to the brain.
 This is actually two nerves, somewhat joined together, the cochlear nerve for hearing and
the vestibular nerve for equilibrium.
 The Eye
o The eye is organized into the following major parts :( Orbital cavity, eye balls)
o The eye is an organ of the sense of sight situated in the orbital cavity
o It is almost spherical in shape and is about 2,5 cm in diameter
o The space between the eye and the orbital cavity is occupied by adipose tissue. The
bony walls of the orbit and the fat help to protect the eye from injury.
o Human being has two eyes. They function as a pair.
o The orbital cavity.
o Seven bones contribute to the framework of each orbital cavity. They are the maxilla,
zygomatic, frontal, ethmoid, lacrimal, sphenoid, and palatine bones.
o Together they give the bony orbital cavity the shape of a pyramid, with its wide base
opening anteriorly onto the face, and its apex extending in a posteromedial direction.
o There are two groups of muscles within the orbit,
o Extrinsic muscles of eyeball (extra-ocular muscles)
o Intrinsic muscles within the eyeball.
o The arteries of the orbit are mainly from the ophthalmic artery, a branch of the
internal carotid artery and the infraorbital artery, from the external carotid artery, also
contributes to the supply of this region.
o There are two venous channels in the orbit, the superior and inferior ophthalmic veins
o Numerous nerves pass into the orbit and innervate structures within its bony walls.
They include
 The optic nerve [II]
 The oculomotor nerve [III]
 The trochlear nerve [IV]
 The abducent nerve [VI]
 Autonomic nerves.
 Other nerves such as the ophthalmic nerve [V1] innervate orbital structures and then
travel out of the orbit to innervate other regions
 The eyelids and lacrimal fluid, secreted by the lacrimal glands, protect the cornea and
eyeball from injury and irritation.
 The Eye ball.

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 The globe shaped eyeball occupies the anterior part of the orbit. Its rounded shape is
disrupted anteriorly, where it bulges outward. This outward projection represents about
one sixth of the total area of the eyeball and is the transparent corn ea
 Posterior to the cornea and in order from front to back are the anterior chamber, the iris
and pupil, the posterior chamber, the lens, the postrenal (vitreous) chamber, and the retina
 The anterior chamber and posterior chambers.
 The anterior chamber is the area directly posterior to the cornea and anterior to the
colored part of the eye (iris). The central opening in the iris is the pupil. Posterior to the
iris and anterior to the lens is the smaller posterior chamber.
 The anterior and posterior chambers are continuous with each other through the pupillary
opening. They are filled with a fluid (aqueous humor), which is secreted into the posterior
chamber, flows into the anterior chamber through the pupil, and is absorbed into the
scleral venous sinus
 The aqueous humor supplies nutrients to the avascular cornea and lens and maintains the
intraocular pressure. If the normal cycle of its production and absorption is disturbed so
that the amount of fluid increases, intraocular pressure will increase. This condition
(glaucoma) can lead to a variety of visual problems.
 Lens and vitreous humor. The lens separates the anterior one-fifth of the eyeball from the
posterior four-fifths. It is a transparent, biconvex elastic disc attached circumferentially to
muscles associated with the outer wall of the eyeball. This lateral attachment provides the
lens with the ability to change its refractive ability to maintain visual acuity. The clinical
term for opacity of the lens is a cataract
 The posterior four-fifths of the eyeball, from the lens to the retina, is occupied by the
postrenal (vitreous) chamber. This segment is filled with a transparent, gelatinous
substance-the vitreous body (vitreous humor). This substance, unlike aqueous humor,
cannot be replaced
 The Nose:
o The nasal cavity is the main route of air entry and consists of a large irregular cavity
divided into two equal passages by a septum
o The posterior bony part of the septum is limited by perpendicular plate of the
ethmoid bone and the vomer
o Anteriorly it consists of hyaline cartlage.
o The roof is formed by cribriform plate of the ethmoid bone.
o The floor is formed by the roof of the mouth and consists of the hard palate in front
and the soft palate behind.
o The opening to the nasal cavity includes the anterior and posterior nares.
o The anterior nares or nostrils are the openings from the exterior into the nasal cavity ,
nasal hair are found here coated in a sticky mucous
o The posterior nares are the openings from the nasal cavity into the pharynx
o Paranasal sinuses are cavities in the bones of the face and the cranium containing air
 The Skin:
o The skin and its accessory structures(hairs, nails and gland) are organized as follows:
o The skin and its accessory structures make the so called integumentary
o System.
o Integumentary means covering, it covers the outside of the body
o The integumentary system consists of the skin and the accessory structures such as
hair, nails and glands.

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 o The skin rest on the hypodermis.
o Hypodermis is located between the dermis and underlying deep fascia
o Hypodermis is not a part of skin. It is also known as subcutaneous tissue. This
consists of loose connective tissue with collagen and elastin fibres. The main cells in
the hypodermis are the fibroblasts, adipose cells and macrophages. Approximately
half of the body stored adipose tissue is in the hypodermis. Although the amount and
location vary with age, sex and diet.
o The skin is made up of the two major tissue layers,
 Dermis
 Epidermis
 The dermis is divided into two layers
o The deeper reticular layer, is dense irregular connective tissue, is the main layer of the
dermis consisting of layers of interlacing collagen fibers. This layer is of elastic and
collagens are oriented more in some areas than others creating tension lines (cleavage
lines) and wrinkle lines in the skin.
o The more superficial papillary is called from projections called papillae that extend
toward the epidermis. It is less dense than reticular and sometimes called loose
connective tissue, it also contain large number of blood vessels
o These fibers provide skin tone and account for the strength and toughness of the skin.
The pattern of collagen fibers in a particular region determines the characteristic
o The deep layer of the dermis contains hair follicles, with their associated smooth
arrector muscles and sebaceous glands.
o Contraction of the arrector muscles erects the hairs (causing goose bumps), thereby
compressing the sebaceous glands and helping them secrete their oily product onto the
skin.
o The dermis composed of , nerve endings, hair follicles, smooth muscles, glands, and
lymphatic vessels
o The nerve ending are varied in structure and function,
o Free nerve endings are for pain, itch, tickle and temperature sensation
o Hair follicle receptors are for light touch
o Pacinian corpuscles are for deep pressure
o Meissner’s corpuscles for the ability to detect simultaneous stimulation at two points
on the skin
o Ruffini’s end organs for touch or pressure
o Skin ligaments, consisting of numerous small fibrous bands, extend through the
subcutaneous tissue and attach the deep surface of the dermis to the underlying deep
fascia. The length and density of these ligaments determine the mobility of the skin
over deep structures.
 Epidermis: The epidermis is a keratinized stratified (layered) epithelium with a tough
outer surface composed of keratin (a fibrous protein).
o The epidermis is made up of several layers (strata of cells) which extends from the
deepest germinative layer to the surface stratum corneum namely
o Basal layer (stratum basale)
o Spinous or prickle cell layer (stratum spinosum)
o Granular layer (stratum granulosum),
o Clear layer (stratum lucidum)
o And cornified layer (stratum corneum)

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 o The outer layer of the epidermis is continuously or rubbed away with replacement of
new cells from the basal layer.
o The cells of epidermis include,
o Most of the cells are called keratinocytes because they produce protein called keratin.
o Melanocytes which contribute to skin colour,
o Langerhans’ cells which are part of immune system,
o Merkel’s which are specialized epidermal cells associated with nerve endings
responsible for detecting light touch and superficial pressure,
o This process renews the epidermis of the entire body every 25 to 45 days. The
epidermis is avascular (no blood vessels or lymphatics) and is nourished by the
vessels in the underlying dermis.
o The skin is supplied by afferent nerve endings that are sensitive to touch, irritation
(pain), and temperature.
o Most nerve terminals are in the dermis, but a few penetrate the epidermis.
 The hair
o A hair is divided into
 Shaft , protrude above the surface of the skin and
 Root, the root is located below the surface. The root is expanded to form the hair
bulb. Most of the root and the shaft of the hair are composed of columns of dead
keratinized epithelial cells arranged in three concentric layers
 Medulla – is the central axis of the hair consists of the two or three layers of the cells
containing soft keratin,
 The cortex – forms the bulk of the hair consisting of the cells containing hard keratin,
 The cuticle is a single layer of cells that forms hair suface,
 The hair follicle consists of a,
 Dermal root sheath , is the portion of the dermis that surrounds the epithelial root sheath
 Epithelial root sheath , is divided into external and internal part
 The hair bulb is an expanded knob at the base of the hair root. Inside the hair bulb is a
mass of undifferentiated epithelial cells, the matrix, which produced the hair and the
internal epithelial root sheath.
 The Glands and a Nail
 The major glands of the skin are,
o Sebaceous gland
o Sweat glands
 Sebaceous glands are located in the dermis, are simple or compound alveolar glands that
produce sebum, an oily, white substance rich in lipids.
 Sweat glands are of two types
o Merocrine gland
o Apocrine gland
 Merocrine sweat glands are the most common type of sweat gland. They are simple
coiled tubular glands that open directly onto the surface of the skin through sweat pores.
When the body temperature starts to rise above normal levels, the sweat glands produce
sweat, which evaporates and cool the body.
 Merocrine gland are more numerous in the palms of the hands and soles of the feet, but
absent from the margin of the lips, labia minora, and tips of the penis and clitoris

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 Apocrine sweat glands are compound coiled tubular glands that usually open into hair
follicles superficial to the opening into hair follicles superficial to the opening of the
sebaceous glands.
 They are found in the axillae and genitalia (scrotum and labia majora) and around the
anus and do not help to regulate temperature. They become active at puberty as a result of
the influence of sex hormones.
 Their secretion contain organic substance the 3-methyl-2-hexenoic acid, that are
essentially odourless when first released but quickly metabolized by bacteria to cause
what is known body odour.
 Other glands include
o Ceruminous glands are modified merocrine glands located in the ear canal (external
auditory meatus) produce cerumen (earwax)
o Mammary glands these are modified apocrine sweat glands located in the breast. They
produce milk. This has been discussed in detail in the session of accessory organs of
female reproductive system.
 Nail
o A nail is a horn-like envelop covering the dorsal aspect of the terminal phalanges of
fingers and toes
o The parts of the nail are,
o Matrix, the only living part of the nail. It is situated behind and underneath the nail
fold and produces the keratin which makes up the nail plate. If the matrix is damaged,
growth of the nail plate is affected.
o Eponychium, Dead skin that forms around the cuticle area. It can be lifted and
trimmed during a professional manicure treatment. Tends to be more prominent on
males.
o Paronychium, The 'live' skin that folds around the cuticle area, giving protection to the
matrix.
o Hyponychium, The area of attachment between the nail plate and nail bed that lies
underneath the free edge. Anatomical terms of location: proximal and distal, end of
the nail.
o Nail plate, the hard and translucent part of the nail composed of layers of keratin.
o Nail bed, Tissue underneath the nail plate, responsible for the pink colour of the nail.
It also determines what shape the nail will grow. It is informally referred to as "the
quick", especially the end nearest the fingertip.
o Lunula, The visible part of the matrix, a whitish crescent shape around the base of the
nail plate. Tends to only be visible in larger nails.
o Nail fold, A fold of hard skin overlapping the base and sides of a fingernail or toenail
o Free edge or distal edge, the part of the nail that extends past the finger, beyond the
nail plate. There should always be a free edge present to prevent infections.
o Nail groove, Grooves that guide the direction of nail growth. They are located down
the sides of the nail fold.
 The Tongue.
o The Tongue is organized in the following ways:
o The tongue is a highly muscular organ of deglutition, taste and speech
o It is made up of skeletal muscles covered by a mucous membrane. It has the root, tip
and the body.
o It is attached by its base to the hyoid bone and by the lingual frenulum to the floor of
the mouth.

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 o There are two types of muscles forming the tongue;
o Intrinsic muscles; they originate and insert in the tongue itself. An example of the
intrinsic muscles includes Genioglossus. They are responsible for changing the shape
of the tongue such as flattening and elevating the tongue during drinking and
swallowing
o Extrinsic muscles are those muscles that insert into the tongue but originate from
other structures such as hyoid bone. An example of the muscles includes hyoglossus.
They are responsible for protruding and retract the tongue, move it from side to side
and change its shape.
o The dorsal mucosa is covered by numerous papillae; tiny projections, some of which
bear taste buds. There are three types of papillae; vallate, fungiform and filariform
(Fig. 1)
o Circumvallate papillae, arranged in an inverted V shape at the base of the tounge. Are
the largest papillae
o Fungiform pappilae; are situated mainly at the tip ad the edge of the tongue.
o Filiform papillae; are the smallest of all three. Most numerous on the surface of the
anterior two-thirds of the tongue.
o There are four basic taste sensation:
o Sweetness; apex (tip)
o Saltiness; lateral margins
o Sourness; posterior part of the tongue
o Bitterness; posterior part of the tongue
o Although it is commonly stated that particular areas of the tongue are specialized to
detect these different tastes, evidence indicates that all areas of the tongue are
responsive to all taste stimuli. Each afferent nerve fibre is connected to widely
separated taste buds and may respond to several different chemical stimuli. Some
respond to all four classic categories, others to fewer or only one
o Blood supply of the tongue is by lingual branch of the external carotid artery and
venous drainage is by lingual veins, which joins the internal jugular vein.
o Nerve innervations of the tongue is through:
o The hypoglossal nerve (12th cranial nerves)
o The lingual branch of the mandibular nerves
o The facial and glossophayngeal nerves (7th and 9th CN) the nerves of taste.
o The parasympathetic innervation of the various glands of the tongue is from the
chorda tympani branch of the facial nerve
o The postganglionic sympathetic supply to lingual glands and vessels arises from the
carotid plexus

Step 4: Illustrated diagrams of sensory organs( 25minutes)

 Activity: Brainstorming. (5 minutes)
 Ask the students to mention the names to the letters representing unlabeled parts of the
sensory organ.
 Eg. What does the later A, B and C represents.
 Write their answers on a flipchart or chalkboard.
 SUMMARIZE: by showing a well labelled diagram of the human cell.-
The following is the diagram of the human ear in different views:-

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Source: standring 2005

The following is the diagram of the human Eye - The orbital cavity

Source: www.studentconsult.com

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The eye ball

Source: www.studentconsult.com

The following is the diagram of the human Skin - The dermis and hypodermis of the skin

Source: standring 2005.

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The skin epidermis of the layers of the skin

Source: standring 2005.

Source: standring 2005.

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Hair follicle

Source: standring 2005.

The nail

Source: standring 2005.

The Tongue

Source: Elsevier Ltd 2005.

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Step 5: Basic functions of each sensory organ. (10minutes)
 The basic functions of the ear includes the following:
o Detection of sound(hearing)
o Maintaining body balance/ equilibrium.
 The basic function of the Eye includes the following:
o The main function of an eye is to focusing images of object on the retina
 The basic function of the Nose includes the following:
o The nose is the first of the respiratory passages through which the inspired air passes.
o To begin the process by which the air is warmed, moistened and filtered
 The basic function of the skin and the accessory structures includes the following:
o Protection for the body from environmental effects, such as,
o Abrasions,
o Melanin absorb ultraviolet light and protect underlying tissue,
o Skin prevent the entry of microorganisms and other harmful substances,
o Prevent dehydration by reducing water loss from the body because its lipids act as
barrier to the diffusion of water,
o Nail protect the ends of the digits from damage and can be used in defence,
o Hair follicles act as insulator and protect from ultraviolet light,
o Temperature regulation through sweat glands, blood vessels, and fat deposits,
o Sensation , the integumentary system has sensory receptors that can detect heat, cold,
pain, touch, temperature and pressure)
o Synthesis and storage of vitamin D, when exposed to ultraviolet light, the skin
produces a molecule that can be transformed into vitamin. D
o Excretion, small amount of waste products are lost through the skin and in gland
secretions
 The basic functions of the Tongue includes the following:-
o The tongue is a highly muscular organ of deglutition, taste and speech
o There are four basic taste sensation:
o Sweetness; apex (tip)
o Saltiness; lateral margins
o Sourness; posterior part of the tongue
o Bitterness; posterior part of the tongue

Step 6: The Key points (5minutes)

 Ears are paired sensory organs comprising of auditory system, involved in the detection
of sound, and vestibular system, involved with maintaining body balance/ equilibrium.
 The eye is an organ of the sense of sight situated in the orbital cavity
 The nasal cavity is the main route of air entry and consists of a large irregular cavity
divided into two equal passages by a septum
 The integumentary system consists of the skin and the accessory structures such as hair,
nails and glands.
 The tongue is a highly muscular organ of deglutition, taste and speech

Step 7: Evaluation (5minutes)

 Describe the structure of the ear.
 Mention chambers of the eye
 List two functions of the nasal cavity.

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 What are the functions of skin What are the basic functions of the tongue.

References:
 ROSS AND WILSON (1996): Anatomy and Physiology in Health and Illness; 8th Edition
Churchill Livingstone, New York, London;
 ROSS AND WILSON (2001): Anatomy and Physiology in Health and Illness9 th Edition
Churchill Livingstone Inc.;
 McMinn (1996): Lat’s Anatomy Regional & Applied, 9th ed. Persons Professional Ltd;
 Snell R. S. (1996) Clinical Anatomy, 7th Ed, Lippincott Williams & Wilkins; and
 Wilson K. J. W. (1995) Anatomy & Physiology in Illness, 7th Ed, Medical Division of
Pearson Professional Ltd.

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 CHAPTER THREE

MODULE CODE MLT04103:

LABORATORY SAFETY AND
WASTE MANAGEMENT

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Session 1: Control Work Place
Contamination
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define contamination in the workplace, antiseptics and disinfectants
 List types of contamination in the workplace
 Demonstrate control of contamination in workplace
 Describe antiseptics and disinfectants for decontamination
 Perform preparation of antiseptics and disinfectants for decontamination
 Apply antiseptics and disinfectants in the laboratory for decontamination

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Flasks
 Pipets
 Parafilm
 Distilled Water
 Concentrated disinfectants (Jik®)
 Personal protective equipment

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise Definitions
3 15 minutes Presentation Types of Contamination
Control of Contamination in working
4 25 minutes Presentation
place
5 15 minutes Presentation Antiseptics and Disinfectants
Preparation of antiseptics and
6 25 minutes Presentation
disinfectants
7 15 minutes Presentation Apply antiseptics and disinfectants
8 5 minutes Presentation Key Points

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 9 10 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
 Activity: In class exercise (5 minutes)
 ASK the students: Define contamination in the working place.
 SUMMARIZE their responses and confirm correct answers using notes below

Definitions:
 Contamination: making inferior by contact or mixture as by introduction of chemical,
radioactive particles or infectious organism onto a laboratory surface or into a wound,
water, milk, food or external surface of the body or bandage or any dressings.

Other Definitions:
 Antiseptic: Substance used on humans and other animals that destroy harmful
microorganisms or inhibit their activity.
 Disinfectant: Substance used on inanimate objects that destroy harmful microorganisms
or inhibit their activity.
 Antibacterial: agent that has lethal or inhibitory effect on the microbes that causes
contamination.

Step 3: Types of Contamination (15 minutes)

 Chemical
 Radioactive particles
 Infectious organisms
 Sources of chemical contamination: spillage of harmful powders or liquid chemicals can
be harmful to the workers and patients in the laboratory
o Formaldehyde
o Absolute methanol
o Glacial acetic acid
o Concentrated bleach (Jik®)
 Radioactive: emits harmful rays or particles. Sources of radioactive contamination: in
higher laboratories radioactive reagents are used that must be handled with care so that
contamination with radioactive particles and rays are minimized.

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 Sources of infectious organisms in the laboratory: laboratory specimens and cultures.
 Infectious organisms include bacteria, viruses, fungi and parasites.
 Laboratory specimens: sputum, serum or plasma, whole blood, stool, urine, unfixed
tissue, pus swabs and other body fluids all can contain infectious organisms.
 Cultures are defined as: the media to grow bacteria for laboratory examination.
 Cultures include liquid tubes containing broth and solid media.

Step 4: Controlling Workplace Contamination (25 minutes)

 Frequent hand-washing is important. Hands should be washed before starting a procedure
and after finishing a procedure, after removal of gloves and before having contact with a
patient such as in blood collection.
 Laboratory surfaces and equipment should frequently have contamination removed to
destroy chemicals and infectious organisms. This process is called decontamination.
 Disposal of specimens, cultures and other material which may contain infectious
organisms is important.
 Frequent decontamination of the following equipment used in laboratory testing is
important:
o Glassware
o Plastic ware
o Rubber gloves
o Protective clothing
o Equipment
 Sterilization of the special syringes used to collect body fluids is important.
 Control of contamination in the laboratory is by:
o Boiling
o Autoclaving
o Chemical Disinfectant Use
 Boiling should be at 100oC for 20 minutes at low altitude and 30 minutes at higher
altitude will kill fungi, parasites, viruses (including hepatitis and HIV) and some bacteria.
 Autoclaving is defined as: using an autoclave to sterilize infectious waste.
 Autoclave is a machine that used pressure and high temperature to produce steam. 121oC
for 15 minutes with pressure is used to sterilise infectious waste.

Source: GAP Safety Workshop

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 Sterilisation: killing all fungi, parasites, viruses and bacteria commonly through the use of
an autoclave.
 Chemical Disinfectants: Chemical substances used to destroy harmful microorganisms or
inhibit their activity on inanimate objects such as laboratory benches and other surfaces

Step 5: Disinfectants and Antiseptics (15 minutes)

 Common Disinfectants: 10% bleach and 5% Lysol ®
o Bleach solution is a 30-35% solution of sodium hypochlorite.
o 10% bleach solution (Common brand name of Jik®) is a common laboratory
disinfectant.

Concentrated bleach solution

 Lysol® is a commercially prepared disinfectant containing phenols.

o 5% Lysol® solution is used to cleanse laboratory surfaces such as benches,
instrument covers to eliminate most harmful bacteria, viruses and other micro-
organisms. 5% Lysol is commonly used for disinfection in microbiology laboratory
areas.

Phenol containing Disinfectant

 Antiseptics:
o Common Antiseptics: 70% methanol and isopropyl alcohol
 70% methylated spirit (absolute methanol) and isopropyl alcohol. These two
antiseptics are used for cleansing the skin of micro-organisms prior to venous or
capillary puncture in blood collection.

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 Methylated Spirits

 A simple hand-washing antiseptic is made by 2% bleach solution.

Step 6: Preparation of Antiseptics and Disinfectants (25 minutes)

 Antiseptics and disinfectants are prepared by diluting a specific amount of concentrated
solution with distilled water.
 A pipet or measuring cylinder is used to measure the amount in millilitres of concentrated
disinfectant.

Measuring cylinder Conical Flask

 Usually a measuring cylinder is used to measure the amount of distilled water added to
dilute the measured amount of concentrated disinfectant.
 Conical flasks are used to mix the diluted disinfectant.
 Commonly 10% bleach (Jik®) is prepared by mixing 10 parts of concentrated bleach with
90 parts of distilled water to make 10+ 90 or 100 total parts.
 The tutor should now demonstrate how to prepare 10 % bleach solution by pouring out 10
mL of Jik® into a measuring cylinder and adding that to 90 mL of water poured into the
conical flask. Then after mixing, the solution should have a label put on (tape with
marker) to identify as 10% bleach with preparation date and technician name.
 Antiseptics:
o The same process is used to prepare diluted antiseptic, such as methylated spirits, to
make 70% methylated spirits.
 Commonly is prepared by mixing 70 parts of concentrated methylated spirits with 30
parts of distilled water to make 70+30 or 100 total parts.
o 2% bleach solution is also sometimes used for antiseptic hand-washing after handling
infective material. This is prepared by diluting 2 parts of concentrated bleach with 98
parts of distilled water (2+98 = 100 total parts).

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 The tutor should now demonstrate how to prepare antiseptic hand-washing solution by
pouring out 2 mL of bleach into a measuring cylinder and adding that to 98 mL of water
poured into the conical flask. Then after mixing, the solution should have a label put on
(tape with marker) to identify as 2% bleach with preparation date and technician name.

Step 7: Application of Antiseptics and Disinfectants (15 minutes)

 Procedure for disinfection of glassware
o Add concentrated bleach to a pan of tap water (approximately 10%) and add rinsed
glassware or plastic ware and soak overnight (at least 8 hours). Rinse well in tap
water, rinse in distilled or filtered rain water and air dry.
 Procedure for Clothing and Rubber (reusable gloves)
o Soak in 1% bleach overnight prior to washing with detergent water.
 Procedure for routine disinfection of laboratory bench:
o Wipe with clean cloth soaked in 10% bleach or 5% Lysol. Wipe with a clean cloth to
remove remains.
 Procedure after spillage on laboratory bench or other surfaces:
o Wipe with clean cloth soaked in 10% bleach or 5% Lysol. Allow to sit for 10 minutes.
Wipe with a clean cloth or mop soaked with detergent water to remove remains.
 Procedure for Routine Hand Washing:

How to Wash Hands

1. Wet hands with tap water
then add soap
2. Use friction to generate
lather and wash hands
for at least 15 seconds
3. Rinse well under a
stream of water
4. Dry hands thoroughly
5. Turn off tap/faucet with
paper towel or clean cloth

Source: ASCP Safety Management

 Procedure: Antiseptic Hand washing:

o Wash with soap and water for 2 minutes. Wash with 2% bleach solution or 2 % Lysol
solution. Air dry or dry with a towel.
 Demonstration of Procedures
o The tutor will now demonstrate the procedure for routine disinfection of laboratory
bench. Next the tutor will demonstrate the procedure for antiseptic hand washing used
after handling infective material.

Step 8: Key Point (5 minutes)

 Types of contamination in working place are chemical, radioactive and infectious
material of micro-organisms.
 Methods of controlling contamination in working place include boiling, autoclave and
chemical disinfection with 10% bleach or 5% Lysol. Antiseptics can be used to
decontaminate skin.

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Step 9: Evaluation
 Question: How are antiseptics and disinfectants used for decontamination in the
laboratory?
 Answer:
o Antiseptics are used to decontaminate the skin of the arm, finger or heel prior to blood
collection. Antiseptic solution may be used to decontaminate the hands during the
hand-washing procedure when infective material has spilled on the hands.
 Disinfectants such as 10% bleach solution are used to decontaminate laboratory benches
and other inanimate surfaces.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 467

Session 1B: Observe Work Place
Decontamination
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 300 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Observe sources of clinical laboratory contamination
 Observe preparation in the clinical laboratory of antiseptics and disinfectants for
decontamination
 Observe antiseptics and disinfectants and disinfection methods used in the clinical
laboratory for decontamination

Resources Needed
 Checklist
 Personal protective equipment

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes Presentation Introduction
3 60 minutes Presentation Observe Types of Contamination
Observe Preparation of antiseptics and
4 80 minutes Presentation
disinfectants
5 90 minutes Presentation Observe use of antiseptics and disinfection
6 60 minutes Evaluation

* This session will carry-over several days and will not be completed in one day.

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)

ASK the students to make introduction to clinical supervisor and provide checklist and
expected timetable.
SUMMARIZE their responses and confirm correct answers using notes below

Teaching Guides for NTA Level 4 MLS Curriculum Page 468

Step 3: Observe Types of Contamination (60 minutes)
 Record on the checklist observations:

Date: _____________________________
Student Name:______________________
Observed Types and Sources of Yes or No Comments
Contamination
Specimens (list specific types in comments
e.g. blood, urine, sputum, stool, other body
fluids, unfixed tissue and culture)
Laboratory surfaces and equipment (list
specific types)
Name of Clinical Supervisor:____________________________________________
Signature of Clinical Supervisor:__________________________________________

Step 5: Observe Preparation of Disinfectants and Antiseptics (80 minutes)

Date: _____________________________
Student Name:______________________
Activity Yes or No Type or Name
Preparation (dilution) of disinfectant
Preparation (dilution) of antiseptic
Name of Clinical Supervisor:____________________________________________
Signature of Clinical Supervisor:__________________________________________

Step 6: Observe Decontamination with Antiseptics and Disinfectants (80 minutes)

Date: _____________________________
Student Name:______________________
Activity Yes or No
Disinfection of glassware and plastic ware
Disinfection of laboratory bench
Disinfection of spillage on laboratory bench
Antiseptic Hand washing
Waste disposal
Autoclave operation
Incinerator use
Name of Observer___________________________________________
Name of Tutor:____________________________________________
Signature of Tutor:__________________________________________

Step 7: Evaluation Follow up to Clinical Practical (60 minutes)

 Discuss the observations by the students and any comments by the clinical tutor using a
checklist in terms of sources of contamination, preparation of antiseptics and disinfectants
and decontamination methods in the clinical laboratory

Teaching Guides for NTA Level 4 MLS Curriculum Page 469

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 470

Session 2: Protective Gear in Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define protective gears in laboratory practice
 List types of protective gears in laboratory practice
 Describe protective gears in laboratory practice
 Apply the use of protective gears in laboratory practice

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Gloves
 Illustrations

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise
3 5 minutes Presentation Define protective gears
4 15 minutes Presentation Protective gears
5 45 minutes Presentation Description of Protective gears
6 30 minutes Presentation Use of Protective gears
7 5 minutes Presentation Key Points
8 10 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
ASK the students to define protective gear.
SUMMARIZE their responses and confirm correct answers using notes below
Equipment used to shield the body from micro-organisms and dangerous chemicals.

Teaching Guides for NTA Level 4 MLS Curriculum Page 471

Step 3: (5 minutes)
Define protective gear: shields major parts of the body from splashes and droplets of
containing microorganisms and dangerous chemicals.

Step 4: List Protective Gear (15 minutes)

 Laboratory coat
 Closed toe shoes
 Disposable Gloves
 Rubber Gloves (reusable)
 Aprons
 Eye-goggles
 Face shield
 Dust mask
 Respirator
 Overalls (Coveralls)
 Padded Gloves
 Gumboots

Laboratory Coat, Gloves,

Eye Goggles

Source: ASCP Management Module

Step 5: Description of Protective Gears (45 minutes)

 Types and Importance:
o Laboratory coat: must be worn by all handlers of patient specimens and when
handling cultures or health-care waste. It should be suitable fabric such as poly cotton
that can be bleached and frequently laundered; it should be suitable for tropical
climates. There are different types, some of which prevent soaking through with
splashes.
o Closed toe shoes: are footwear that covers the toes and tops of the feet of laboratory
workers. It is important to wear closed shoes when performing any work in the
laboratory to protect the feet from infectious material or chemical splashes.
o Gloves
 Disposable gloves should be warm when collecting patient specimens and when
handling samples or cultures.

Teaching Guides for NTA Level 4 MLS Curriculum Page 472

  Rubber gloves (non-disposable) should be decontaminated with disinfection prior
to using again. Soak in 1% bleach overnight prior to washing with detergent
water.

Wearing laboratory coat, eye

goggles and disposable gloves in
preparation of disinfectant

Source: ASCP Safety Management Module

o Aprons: a plastic apron worn when handling health-care waste disposal. Full theatre
type aprons must be worn if there is a risk of splashing, spraying of blood or other
body fluids. Aprons must be wiped clean with 70% methylated spirits prior to each
use and when visibly soiled.
o Eye-goggles: protective gear worm if there is a risk of splashing, spraying of blood or
other body fluids. Contaminated goggles must be washed with soap and water and
rinsed with 70% methylated spirit prior to each use and when visibly soiled.
o Face shield: protective gear covering eyes, nose and mouth, worm if there is a risk of
splashing, spraying of blood or other body fluids
o Dust mask: protective gear worm if there is a risk of inhaling particles of chemicals
that are toxic or an irritant.
o Respirator: protective gear worm if there is a risk of splashing, spraying of blood or
other body fluids and must be considered to protect staff working with M
tuberculosis.
o Overalls (coveralls) should be made of suitable fabric such as poly cotton that can be
bleached and frequently laundered; it should be suitable for tropical climates. Anti-
static and flame-resistant is important.
 Should be left in the laboratory and never taken home
 Should be clean when attending outpatients or inpatients
 When soiled, placed in special bag and soak in 1% bleach overnight prior to
washing with detergent water
o Padded gloves: thick heat resistant material for handling hot containers to avoid
burning of skin.
o Gumboots: to protect the shoes, light-weight rubber boots should be worm when
handling or disposing of health-care waste from the central waste storage area. Boots
are washed with soap and water after each daily use.

Teaching Guides for NTA Level 4 MLS Curriculum Page 473

 This man is wearing many types of
personal protective gear

Source: GAP Safety Module

Step 6: Application of Protective Gear (30 minutes)

 Laboratory coat and closed toe shoes should be worn in the laboratory at all times
including the demonstration laboratory and the clinical laboratory.
 The tutor will demonstrate proper putting on, wearing, removal and disposal of disposable
gloves.

How To Safely Remove Gloves

1 4

2 5

3 6

o Step 1: Pull one glove near your wrist towards your fingertips until the glove folds
over.
o Step 2: Carefully grab the fold and pull towards your fingertips. As you pull you are
turning the inside of the glove outwards.
o Step 3: Pull the fold until the glove is almost off. To avoid contamination of your
environment, continue to hold the removed glove. Completely remove your hand
from the glove.
o Step 4: Slide a finger from your glove-free hand under the remaining glove. Continue
to slide your finger towards your fingertips until almost half of your finger is under
the glove.

Teaching Guides for NTA Level 4 MLS Curriculum Page 474

 o Step 5: Turn you finger 180 degrees and pull the glove outwards and towards your
fingertips. As you do this, the first glove will be encased in the second glove. The
inside of the second glove will also be turned outwards.
o Step 6: Grab the gloves firmly, by the uncontaminated surface (the side that was
originally touching your hand). Release your grasp of the first glove you removed.
Pull your second hand free from its glove. Dispose of the gloves properly.
 Students will each practice in pairs putting on, taking off gloves and disposing of
contaminated gloves in the correct manner and record on each other’s checklist.

Date: _____________________________
Student Name:______________________
Activity Yes or No
Put on gloves correctly?
Put off gloves correctly?
Dispose of gloves correctly?
Name of Observer___________________________________________
Name of Tutor:____________________________________________
Signature of Tutor:__________________________________________

Step 7: Key Point (5 minutes)

 Protective gear commonly used in the laboratory include: laboratory coats, disposable
gloves, closed toe shoes and often, eye goggles or face shields.
 Use of Protective gears is important to shield the laboratory personnel from splashes of
chemicals and infectious materials. The wearing, removal and disposal of gloves was
practiced.

Step 8: Evaluation
 List all the protective gears used in the laboratory.
 Answer:
o Laboratory coat, Closed toe shoes, Disposable Gloves, Rubber Gloves
(reusable),Aprons, Eye-goggles, Face shield, Dust mask, Respirator, Overalls
(Coveralls) and Gumboots

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;

Teaching Guides for NTA Level 4 MLS Curriculum Page 475

 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 476

Session 2B: Observation of Protective
Gear in Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Apply the use of personal protective gears in clinical laboratory practice
 Observe use of protective gears in clinical laboratory practice

Resources Needed
 Checklist
 Personal Protective Gear

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise Introduce Clinical observation checklist
3 5 minutes Activity Wear personal protective gears
Clinical
4 60 minutes Observe use of Protective gears
Observation
5 45 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
ASK the students to make introduction to the clinical supervisor and show the activity
checklist.
SUMMARIZE

Step 3: Apply personal protective gear (5 minutes)

 Students will come to the clinical laboratory wearing closed toe shoes and put on their
laboratory coats. They will wear gloves when instructed or when coming in contact with
contamination.

Step 4: Observation of Protective Gear (60 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 477

 Students will observe the use of personal protective equipment and record on the
checklist.

Date: _____________________________
Student Name:______________________
Observe Use of Yes or No Where (what section of clinical
laboratory)
Laboratory coat
Closed toe shoes
Disposable Gloves
Rubber Gloves (reusable)
Aprons
Eye-goggles
Face shield
Dust mask
Respirator
Overalls (Coveralls)
Padded Gloves
Gumboots
Name of Clinical Supervisor:____________________________________________
Signature of Clinical Supervisor:__________________________________________

Step 5: Evaluation of Clinical Practice (60 minutes)

 Discuss the observations by the students and any comments by the clinical tutor using a
checklist in terms of protective gear used in the clinical laboratory

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;

Teaching Guides for NTA Level 4 MLS Curriculum Page 478

Session 3: Apply Safety Rules in
Laboratory Practice
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define safety rules
 List the fourteen laboratory safety rules
 Explain laboratory safety rule
 List the international symbols for safety
 Explain the significance of each international symbol
 Observe the use of laboratory safety rules

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise Define
3 30 minutes Presentation List safety rules
4 50 minutes Presentation Safety rules
5 20 minutes Presentation International Safety Symbols
6 60 minutes Presentation Significance of each Safety Symbol
7 45 minutes Presentation Demonstration
8 5 minutes Presentation Key Points
9 20 minutes Evaluation Significance of Symbols

* This session may carry-over to another day.

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity

Teaching Guides for NTA Level 4 MLS Curriculum Page 479

  Activity: In class exercise (5 minutes)
 ASK the students to.
 SUMMARIZE their responses and confirm correct answers using notes below

Step 3: Fourteen General Safety Rules (30 minutes)

 Eating, drinking or smoking is prohibited in the laboratory
 Mouth pipetting is prohibited. Use mechanical pipets that provide suction.
 Food or drinks should not be stored in the refrigerators used for clinical or research
specimens
 Wear new disposable gloves when handling blood and body fluids and do not touch
telephones, pens, lockers, etc. with gloves on.
 Always cover them end of the blood collection tubes with a cloth or gauze and point away
from anyone’s face when opening;.
 Wear protective face shields or masks and goggles if splashes of blood, body fluids or
infectious material are likely to happen.
 Wear a laboratory coat while in the laboratory and remove it when leaving to go to areas
such as offices, libraries, canteens, etc.
 Do not open centrifuges while still in motion
 Decontaminate work surface areas daily or when contaminated such as after spills with
10% bleach solution.
 Use puncture-resistant leak-proof containers for sharps.
 Place infectious waste materials in appropriate plastic bags or containers
 Secure the lid of the specimen container tightly
 Label specimens clearly with names or other identifier dates, time of collection and type
of specimens and the site of collection.
 The laboratory should be kept neat clean and free of materials that are not pertinent to
work.

Step 4: Importance of Safety Rules (50 minutes)

 It is important to avoid ingesting infectious material or harmful chemicals. The safety
rules that address this are:
o Eating, drinking or smoking is prohibited in the laboratory
o Mouth pipetting is prohibited.
o Food or drinks should not be stored in the refrigerators used for clinical or research
specimens
 It is important to avoid contaminating the skin, hands, face and toes with infectious
materials or harmful chemicals. The following rules protect these parts of the body:
o Wear new disposable gloves when handling blood and body fluids and do not touch
telephones, pens, lockers, etc. with gloves on.
o Wear a laboratory coat while in the laboratory and remove it when leaving to go to
areas such as offices, libraries, canteens, etc.
o Secure the lid of the specimen container tightly
o Label specimens clearly with names or other identifier dates, time of collection and
type of specimens and the site of collection.
 Small droplets of infectious materials that can be spread in the air and inhaled are called
aerosols. Safety rules to help avoid aerosols are:

Teaching Guides for NTA Level 4 MLS Curriculum Page 480

 o Always cover them end of the blood collection tubes with a cloth or gauze and point
away from anyone’s face when opening;
o Wear protective face shields or masks and goggles if splashes of blood, body fluids or
infectious material are likely to happen.
o Do not open centrifuges while still in motion. This rule also helps to prevent injury of
hands on a moving centrifuge.
 To protect the laboratory personnel, health-care personnel and even the patients from
infectious material the following safety rules are followed:
o Decontaminate work surface areas daily or when contaminated such as after spills
with 10% bleach solution.
o Place infectious waste materials in appropriate biohazard plastic bags or containers.
Proper separation of waste is important (sharps, biohazard waste, ordinary waste,
uncontaminated broken glass)
o The laboratory should be kept neat clean and free of materials that are not pertinent to
work.
 To protect the laboratory personnel and patients from puncturing their skin and
introducing infectious materials, the following safety rule is applied:
o Use puncture-resistant leak-proof containers for sharps.

Step 5: International Safety Symbols (20 minutes)

 Biohazard
 Radioactive
 Chemical
o Explosive
o Corrosive
o Irritant
o Harmful
o Toxic
o Flammable
o Oxidising
 UV Light Exposure
 Eye Wash Station Sign
 Eating and Drinking is Prohibited
 Smoking is Prohibited
 Access to the Laboratory is Restricted
 Mouth Pipetting is Prohibited

Teaching Guides for NTA Level 4 MLS Curriculum Page 481

Step 6: Significance of International Symbols (60 minutes)
 Biohazard Symbol:
o The background must be red/orange in color with a black universal biohazard symbol
and black lettering.
 All areas of the laboratory, including in dispensaries and health centres, which have
specimens and cultures, could contain biohazardous agents (infectious micro-organisms).
Therefore all specimens and cultures are treated as contaminated. This biohazard warning
sign must be placed in these areas.
 Radioactive Symbol:
o Radioactive means the substance emits harmful rays or particles. The symbol is a red/
orange circle with 3 triangles surrounding to represent an atom. It is found with words
of caution.
o Exposure to radioactive substances is rare in laboratories unless specialised testing is
performed.
 UV light exposure:
o When ultraviolet light (UV) is part of the testing process, such as use of a fluorescent
microscope or some safety cabinets, it is important to warn about the hazard with a
special sign.
o UV light exposure is dangerous to the eyes and may provide other hazard. Wearing
special goggles or face shield may be required.
 Chemical Symbols:
o All laboratory reagents are harmful if taken internally or exposed to skin or eyes.
Some are also hazardous if inhaled (irritant), contacted with skin and mucous
membranes (irritant or corrosive) so good laboratory practice avoids spilling, inhaling
and drinking laboratory reagents and solutions.
o In addition many reagents and solutions fit into one or more of the seven hazard
categories. Special care is needed for handling and storage of these chemicals.
o If exposed to any of the harmful reagents or solutions, you must consult your
supervisor and information in the materials safety data sheet that is provided with
purchased chemicals.

Teaching Guides for NTA Level 4 MLS Curriculum Page 482

 Symbols of Laboratory Hazards

Explosive (E) Corrosive (C) Irritant Harmful

Toxic Flammable Oxidizing

agent(O)

Step 7: Demonstration of Laboratory Safety Rules (45 minutes)

 The tutor will demonstrate the following safety rules:
o Mouth pipetting is prohibited. Use mechanical pipets that provide suction.
o Always cover them end of the blood collection tubes with a cloth or gauze and point
away from anyone’s face when opening;
o Wear a laboratory coat while in the laboratory and remove it when leaving to go to
areas such as offices, libraries, canteens, etc.
o Do not open centrifuges while still in motion.
o Use puncture-resistant leak-proof containers for sharps.
o Place infectious waste materials in appropriate plastic bags or containers
o Secure the lid of the specimen container tightly (also during centrifugation
o Label specimens clearly with names or other identifier dates, time of collection and
type of specimens and the site of collection.

Step 8: Key Point (5 minutes)

 There are fourteen important safety rules for the laboratory. Mouth pipetting, drinking
fluids, eating and smoking are prohibited. Other safety rules are written to avoid
inhalation of chemical or infectious agent droplets.
 There are eight major international symbols used in routine laboratories: biohazard and
chemical symbols for toxic, flammable, oxidizing, explosive, corrosive, irritant and
harmful chemicals.
 Other signs and symbols may be present when testing specialised or conditions require.

Step 9: Evaluation (20 minutes)

 Students work in groups to discuss the significance of following eight international
symbols.
 Explain the significance of the
o biohazard symbol
o flammable
o harmful
o toxic
o explosive
o oxidizing
o corrosive
o irritant

Teaching Guides for NTA Level 4 MLS Curriculum Page 483

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 484

Session 3b: Observe the Safety Rules in
the Clinical Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Observe the fourteen safety rules in the clinical laboratory
 Identify which safety rules are not practiced in clinical laboratory’s first aid kit

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Checklist
 Personal Protective Gear

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise Introduce Clinical observation checklist
Clinical
3 60 minutes Safety Rules in the Clinical Laboratory
Observation
4 50 minutes Evaluation Rules not observed

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
ASK the students to make introduction to the clinical supervisor and show the activity
checklist.
SUMMARIZE

Step 3: Observation of Fourteen General Safety Rules (60 minutes)

 Students will observe the Use of Safety Rules and record on the checklist.

Date: _____________________________
Student Name:______________________

Teaching Guides for NTA Level 4 MLS Curriculum Page 485

 Observe Use of Safety Rules Yes or Where (what section
No of clinical laboratory)
Eating, drinking or smoking is prohibited in the
laboratory except in separate designated area.
Mouth pipetting is prohibited. Use mechanical pipets
that provide suction.
Food or drinks should not be stored in the refrigerators
used for clinical or research specimens
Wear new disposable gloves when handling blood and
body fluids and do not touch telephones, pens, lockers,
etc. with gloves on.
Always cover them end of the blood collection tubes
with a cloth or gauze and point away from anyone’s face
when opening;.
Wear protective face shields or masks and goggles if
splashes of blood, body fluids or infectious material are
likely to happen.
Wear a laboratory coat while in the laboratory and
remove it when leaving to go to areas such as offices,
libraries, canteens, etc.
Do not open centrifuges while still in motion
Decontaminate work surface areas daily or when
contaminated such as after spills with 10% bleach
solution.
Use puncture-resistant leak-proof containers for sharps
Place infectious waste materials in appropriate plastic
bags or containers
Secure the lid of the specimen container tightly
Label specimens clearly with names or other identifier
dates, time of collection and type of specimens and the
site of collection.
The laboratory should be kept neat clean and free of
materials that are not pertinent to work.

Name of Clinical Supervisor:____________________________________________

Signature of Clinical Supervisor:__________________________________________

Step 4: Evaluation of Clinical Practice (60 minutes)

 Discuss the observations by the students and any comments by the clinical tutor using a
checklist of safety rules used in the clinical laboratory. Each student will give a verbal
report of what safety rules are not being observed in the clinical laboratory.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;

Teaching Guides for NTA Level 4 MLS Curriculum Page 486

 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 487

Session 4: Hazards in the Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define laboratory hazard and biohazards.
 List five types of hazards in the laboratory
 List sources of laboratory hazards
 Explain sources for five types of laboratory hazards

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Illustration

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise Define
3 15 minutes Presentation List five laboratory hazards
4 25 minutes Presentation List sources of laboratory hazards
5 60 minutes Presentation Explain sources of hazards
6 5 minutes Presentation Key Points
7 10 minutes Evaluation
Assignment

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
 ASK the students to define hazard and biohazard
 SUMMARIZE their responses and confirm correct answers using notes below
 Definition of hazard: exposure to unsafe conditions in the laboratory and potential for
harm.
 Definition of biohazard: exposure to infectious micro-organisms in the laboratory.

Teaching Guides for NTA Level 4 MLS Curriculum Page 488

Step 3: List the five laboratory hazards (15 minutes)
 Fire
 Electrical
 Physical
 Chemical
 Microbiological

Step 4: List of Hazard Sources (25 minutes)

 Fire
 Electrical shock
 Physical:
o laceration,
o trauma,
o mechanical injury;
 Chemical:
o irritant,
o corrosive,
o toxic,
o explosive,
o flammable,
o oxidising;
 Microbiological:
o Infectious micro-organisms

Step 5 Sources for five types of hazards: (60 minutes)

 Fire: flammable chemicals, paper or wood
A potential hazard in any environment
 Electrical: electrical shock or burns.
Instruments and equipment that use electrical power can be a source of shock and fire
hazards, especially with careless operation.
 Physical: burns from fires, trauma from laceration, explosion, crushing or punctures,
mechanical injury from improper lifting techniques. It is important to take care when
lifting boxes or heavy instruments to use the two-handed method and to lift using the legs
rather than the back. Lacerations are common laboratory injuries caused by accidents
involving glassware, scalpels and scissors.
 Chemical: inhalation of irritant chemicals or toxic chemicals harm the lungs, corrosive
chemicals harm skin and, eyes, flammable and oxidizing chemicals can cause burns,
explosive can cause burns or trauma.
The use of harmful chemicals in the laboratory can cause serious injury if safe handling
practices are not used. Exposure without protective gear can cause serious damage.
 Microbiological: in specimens and cultures through biohazard ingestion, puncture.
These hazards are found in microbiology areas of the laboratory and when handling
specimens and cultures. Following standard operating procedures will help to minimize
risk of microbiological hazards. Taking care with sharps handling and disposal and waste
disposal is important.

Teaching Guides for NTA Level 4 MLS Curriculum Page 489

Step 6: Key Points (5 minutes)
 There are five types of laboratory hazards: fire, electrical, chemical, physical and
microbiological.
 Following standard operating procedures and taking care with handling and disposal of
wastes can help to limit exposure to these hazards.
 Personal protective equipment (PPE) can also limit exposure to these hazards.

Step 7: Evaluation (10 minutes)

 Describe sources of two of the five laboratory hazards.
 Suggested Assignment:
o Worksheet:
 Students could be assigned to the clinical laboratory and after observation of chemical
hazard symbols, they should draw the symbol.

Date: _____________________________
Student Name:______________________
Observe Chemical Draw Symbol Name of Reagents or Chemicals
Hazard Symbol
Harmful
Irritant
Toxic
Flammable
Oxidising
Explosive
Corrosive
Name of Clinical Supervisor:____________________________________________
Signature of Clinical Supervisor:__________________________________________

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 490

Session 5: Control Measures for Common
Laboratory Hazards
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 List different control measures for common laboratory hazards
 Categorize different control measures for common laboratory hazards
 Describe control measures for common laboratory hazards

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Illustrations

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes In Class Exercise Case study
Different control measure for laboratory
3 30 minutes Presentation
hazard
4 30 minutes Presentation Control measures categories
5 30 minutes Presentation Description of Control Measures
6 10 minutes Presentation Key point
7 10 minutes Evaluation Discussion

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
ASK the students to. list different control measures for laboratory hazards
SUMMARIZE their responses and confirm correct answers using notes below

 Answer:
o Label of chemical properly

Teaching Guides for NTA Level 4 MLS Curriculum Page 491

 o Prohibit mouth pippeting
o Provide safety goggles or full-face respirators
o Electrical equipment should be grounded
o Provide information regarding master switch
o Uninterrupted source of power should be provided
o Provide hand washing
o Adequate sterilization before washing or disposing waste
o Provide safety hoods
o Ensure tissues are handled and disposed properly
o Provide mechanical pippeting devices
o Provide disposable containers for needle and lancets

Step 3: List Control Measures for Hazards (30 minutes)

 Prohibit mouth pippeting
 Provide safety goggles or full-face respirators
 Electrical equipment should be grounded
 Provide information regarding master switch
 Uninterrupted source of power should be provided
 Provide hand washing
 Adequate sterilization before washing or disposing waste
 Provide safety hoods
 Ensure tissues are handled and disposed properly
 Provide mechanical pippeting devices
 Provide disposable containers for needle and lancets

Step 4: Categories of Control Measures of Laboratory Hazards (30 minutes)

 Fire hazards
o No smoking
o Proper storage of chemicals
o Prominent display of emergency directions
o Fire drills,
o Fire exits kept unblocked
o Fire extinguishers
o Fire alarm installed

 Physical hazards
o Proper training and care in handling sharp objects
o Caution when using glassware
o Proper mechanics when lifting objects
 Chemical hazards
o Prohibit mouth pippeting
o Provide safety goggles or full-face respirators
 Electrical hazards
o Provide information regarding master switch
o Electrical equipment should be grounded
o Uninterrupted source of power should be provided
 Microbiology hazards

Teaching Guides for NTA Level 4 MLS Curriculum Page 492

 o Provide hand washing
o Prohibit mouth pippeting
o Adequate sterilization before washing or disposing waste
o Provide safety hoods
o Ensure tissues are handled and disposed properly
o Provide mechanical pippeting devices
o Provide disposable containers for needle and lancets

Prohibit mouth pipetting

7
Step 5: Description of Control Measures (Minutes)
 Fire hazards
o Declare laboratory as no smoking
o Proper storage of flammables and explosive chemicals
 Explosion-proof and flammable cabinets
o Prominent display of emergency directions
o Fire drills, some without warning
o Fire exits kept unblocked
o Fire extinguishers available, function and staff trained in used
o Fire alarm installed

Source: ASCP Safety Management

 Physical hazards

Teaching Guides for NTA Level 4 MLS Curriculum Page 493

 o Proper training and care in handling sharp objects
o General cautionary note when using glassware
 Make every effort to discard chipped or broken glassware so it doesn’t cause
injury to laboratory staff
 Be sure to work with glassware safely
 Substitute plastic wherever possible
 Proper mechanics when lifting objects
o Keep a wide base of support.
o Squat down, bending at the hips and knees only.
o Maintain good posture.
o Slowly lift by straightening your hips and knees (not your back).
o Hold the load as close to your body as possible.
o Use your feet to change direction, taking small steps.
o Lead with your hips as you change direction.
o Set down your load carefully, squatting.
o Do not attempt to lift by bending forward.
o Never lift a heavy object above shoulder level.
o Avoid turning or twisting your body while lifting or holding a heavy object.

Proper Lifting Techniques

 Chemical hazards
o Prohibit mouth pippeting
o Provide safety goggles or full-face respirators
o Prepare for a spill before it occurs by stocking appropriate spill cleanup kits in the
laboratory. Sand can be used to absorb a chemical spill.
o If chemical spill on eyes occurs, used eyewash and if on body, use chemical shower

Teaching Guides for NTA Level 4 MLS Curriculum Page 494

 Source: ASCP Safety Management

 Electrical hazards
o Provide information regarding master switch
o Electrical equipment should be grounded
o Uninterrupted source of power should be provided
o Avoid spillage of water or liquid waste into electric equipment.

 Microbiology hazards
o Provide for hand washing
o Prohibit mouth pipetting
o Adequate sterilization before washing or disposing waste
o Provide safety hoods
o Ensure tissues are handled and disposed properly
o Provide mechanical pipetting devices
o Provide disposable containers for needle and lancets
o Centrifuge with caps are on tubes and balance cups
o Centrifuge cover is on bucket
o Open Centrifuge lid only when its completely stopped
o Disinfect regularly at least weekly and after breakage/spill

Source: ASCP Safety Management

Step 6 Key Points (10 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 495

 The list of main laboratory hazards are chemical, fire, physical, microbiological and
electrical hazards and control measures can be put in place to prevent or minimise these
hazards.
 The most important control measures for Fire hazards are no smoking and proper storage
of chemicals.
 Physical hazards can be controlled by proper training and care in handling sharp objects.
 Chemical hazards may be prevented by prohibiting mouth pipetting and using safety eye
goggles when available.
 Electrical hazards can be controlled by using electrical equipment that is grounded and
kept dry.
 Control measures for Microbiology hazards is hand washing, no mouth pippeting and
adequate sterilization before washing or disposing waste and using disposable puncture-
proof containers for needle and lancets (sharps.)

Step 7: Evaluation Group work (5 minutes)

 Have students work in groups and assign each one of the five different hazard categories.
 Of the assigned laboratory hazard, give a description of the control measures.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 496

Session 6: First Aid in the Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define first aid, first aid kit
 List the components in a first aid kit
 Explain the function of each component in the first aid kit
 List conditions requiring first aid in the laboratory
 Observe the use of each first aid kit component

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 10 minutes In Class Exercise Define
3 10 minutes Presentation List first aid kit components
4 30 minutes Presentation Function of first aid kit components
5 30 minutes Presentation Conditions that require first Aid Attention
6 30 minutes Presentation Use of each component n the kit
8 5 minutes Presentation Key points
9 10 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity (5 minutes)

Activity: In class exercise (5 minutes)
 ASK the students to define first aid and first aid kit
 SUMMARIZE their responses and confirm correct answers using notes below

Teaching Guides for NTA Level 4 MLS Curriculum Page 497

 First aid: is treatment by people who are not formally trained as clinicians but who may
assist to preserve life minimizes consequence of injury or sudden illness until qualified
personnel is available. First aid also means to deal with minor injuries.

Step 3: First Aid Kit Components (30 minutes)

 Antiseptic cream
 Antiseptic (Savlon/ Dettol)
 Mouth piece Plasters
 Cotton wool
 Methylated spirits
 Alcohol swab
 Gauze/ dressing (150 mm x 200mm)
 Sterile gauze swab (packed; 10 mm)
 Bandage (100 mm x 75 mm)
 Triangular bandage
 Scissors
 Tweezer
 Splint
 Eye protection pad
 Eye protection cap
 Fabric rock tape (ProFab; 25 mm x 3 mm)
 Incident report form

Step 4: Function of each of the first aid kit components (30 minutes)
 Add complete list including:
o Antiseptic cream is applied to wound on skin to inhibit growth of harmful micro-
organisms
o Antiseptic (Savlon/ Dettol) is applied to wound on skin to inhibit growth of harmful
micro-organisms
o Mouth piece Plasters is used to cover and seal minor wounds on the lips
o Cotton wool is used to apply methylated spirit antiseptic
o Methylated spirits is applied to mild wound on skin to inhibit growth of harmful
micro-organisms; also may be used to cleanse the tweezers or scissors before
contacting the skin
o Alcohol swab is applied to mild wound on skin to inhibit growth of harmful; also may
be used to cleanse the tweezers or scissors before contacting the skin micro-organisms
o Gauze/ dressing (150 mm x 200mm) is used to cover an wound to keep out dirt and
harmful microorganisms
o Sterile gauze swab (packed; 10 mm)
o Bandage (100 mm x 75 mm) is used to cover an wound to keep out dirt and harmful
microorganisms
o Triangular bandage is used to support the arm and shoulder when injured; sling
o Scissors: used to cut the tape or cut the size of bandage to meet the needs
o Tweezer: is used to remove glass or other foreign body that is punctured into skin;
note: it is important to clean with methylated spirits or alcohol swab before touching
the wound with a tweezers.

Teaching Guides for NTA Level 4 MLS Curriculum Page 498

 o Splint: is used to provide support to finger or toe to keep the bone and joints straight
until qualified medical personnel can examine
o Eye protection pad: is used to to cover an injury or wound to the eye or eyelids keep
out dirt and harmful microorganisms
o Eye protection cap covers the eye protection pad to help keep it in place
o Fabric rock tape (ProFab; 25 mm x 3 mm) is used to hold splints, gauze dressing and
eye pad and cap in place; it also may be used to secure plasters in place.
o Incident report form: is filled to record the details of the accident

Step 5: Conditions (30 minutes)

 Note: Conditions That Require First Aid Attention In The Laboratory
o Chemical burns
o Corrosive poison
o Contamination (infectious material)
 Puncture
 splashes
o Electrical shock
o Trauma causing bleeding

Step 6: (30 minutes)

 Tutor will demonstrate the use of each component in the kit for student observation:
o Antiseptic cream
o Antiseptic (Savlon/ Dettol)
o Mouth piece Plasters
o Cotton wool
o Methylated spirits
o Alcohol swab
o Gauze/ dressing (150 mm x 200mm)
o Sterile gauze swab (packed; 10 mm)
o Bandage (100 mm x 75 mm)
o Triangular bandage
o Scissors
o Tweezer
o Splint
o Eye protection pad
o Eye protection cap
o Fabric rock tape (ProFab; 25 mm x 3 mm)
o Incident report form

Step 7: Key Point (5 minutes)

 First aid is emergency treatment to minor injuries that don’t require qualified medical
personnel or life preserving measures until qualified medical personnel become available.
 A first aid kit should include: Antiseptic cream, Antiseptic (Savlon/ Dettol), Mouth piece
plasters, Cotton wool, Methylated spirits, alcohol swab, Gauze/ dressing (150 mm x
200mm), Sterile gauze swab (packed; 10 mm), Bandage (100 mm x 75 mm), Triangular
bandage, Scissors, Tweezer, Splint, Eye protection pad, Eye protection cap, Fabric rock
tape (ProFab; 25 mm x 3 mm), and Incident report form

Teaching Guides for NTA Level 4 MLS Curriculum Page 499

Step 9: Evaluation (10 minutes)
 Student will be asked to:
 List required components of the first aid kit and the function of each.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press;
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Ed. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;

Teaching Guides for NTA Level 4 MLS Curriculum Page 500

Session 6b: Observe the First Aid Kit in
the Clinical Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Observe the use of first aid kit in the clinical laboratory
 Identify which first aid components are not found in clinical laboratory’s first aid kit

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Checklist
 Personal Protective Gear

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise Introduce Clinical observation checklist
Clinical
3 60 minutes First Aid Kit in the Clinical Laboratory
Observation
4 50 minutes Evaluation Kit Components not observed

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)

ASK the students to make introduction to the clinical supervisor and show the activity
checklist.
SUMMARIZE

Step 3: Observation of First Aid Kit and Components (60 minutes)

 Students will observe the Use of First Aid Kit and record on the checklist.

Date: _____________________________

Teaching Guides for NTA Level 4 MLS Curriculum Page 501

Student Name:______________________
First Aid Kit present?
Observe Components of First Aid Kit Yes or No
Antiseptic cream
Antiseptic (Savlon/ Dettol)
Mouth piece Plasters
Cotton wool
Methylated spirits
Alcohol swab
Gauze/ dressing (150 mm x 200mm)
Sterile gauze swab (packed; 10 mm)
Bandage (100 mm x 75 mm)
Triangular bandage
Scissors
Tweezer
Splint
Eye protection pad
Eye protection cap
Fabric rock tape (ProFab; 25 mm x 3 mm)
Incident report form

Name of Clinical Supervisor:____________________________________________

Signature of Clinical Supervisor:__________________________________________

Step 4: Evaluation of First Aid Kit in Clinical Laboratory (50 minutes)

 Discuss the observations by the students and any comments by the clinical tutor using a
checklist of first aid kit used in the clinical laboratory. Each student will give a verbal
report of what components of the first aid kit are not being observed in the clinical
laboratory.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health, AMREF.

Teaching Guides for NTA Level 4 MLS Curriculum Page 502

Session 7: Fire Fighting in the Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define fire, fire fighting, fire fighting tools
 List types fire
 List types fire fighting tools (extinguishers, sand bucket, hose pipes, extinguisher blanket)
 Describe use of fire fighting tools

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 LCD projector and computer/laptop
 Wall papers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Brainstorming Definition
3 15 minutes Presentation Types Fire
4 15 minutes Presentation Types of fire fighting tools
5 50 minutes Presentation Use of fire fighting tools
6 15 minutes Presentation Key points
7 10 minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition (10 minutes)

 Activity: Brainstorming (5 minutes)
 ASK the students the following question
 What is the meaning of the following terminologies; fire, fire fighting and fire fighting
tools?
 INVITE responses from students
 RECORD their response on the flip chart or chalk board

Teaching Guides for NTA Level 4 MLS Curriculum Page 503

  SUMMARIZE their responses with information below

 Fire is the state of combustion producing heat, flames and often smokes.
Fire fighting is an act of putting off fire for the purpose of rescuing people and/or
properties.
Fire fighting tool(s) is equipment that is used for putting off fire.

Step 3: Types Fire (15 minutes)

 For fire to occur there must be fuel, oxygen (air) and heat at once. The three makes what
is called fire-triangle.
 Picture/diagram is needed
 Types of fire are grouped based on cause/source.
o Class A fires are ordinary combustible materials such as paper, wood, cardboard, and
most plastics.
o Class B fires involve flammable or combustible liquids such as gasoline, kerosene,
grease and oil.
o Class C fires involve flammable gases such as such as propane, butane, methane etc
o Class D fires are commonly found in a chemical laboratory. They are fires that
involve combustible metals, such as magnesium, titanium, potassium and sodium.
o Class E fires involve electrical equipment, such as appliances, wiring, circuit breakers
and outlets. Never use water to extinguish class E fires - the risk of electrical shock is
far too great (flammable gases-propane, butane, methane)
o Class F fires involve cooking oil and fats.
 Observe the symbol that warns on the possibilities of causing fire:

It is important to keep flammable chemicals/reagents in metal cabinet

Teaching Guides for NTA Level 4 MLS Curriculum Page 504

Step 4: Types of Fire fighting tools (15 minutes)
 These are equipments/tools that are used for stopping/quenching fires. In fighting fires,
omission of one of the three element of fire-triangle is important i.e. oxygen, heat or fuel.
 Fire fighting tools include:-
o Fire blankets
o Bucket of water
o Bucket of sand or dry soil
o Hose pipe
o Fire extinguishers
 Fire Safety Equipments:
o These should not be confused with fire fighting tools. Fire safety equipments include;
 Fire alarm
 Fire extinguishers
 Sprinklers

Step 5: Use of Fire fighting tools (50 minutes)

 Fire blankets
o These are blankets that have been made from heavy cotton twill treated with fire
retardant chemical or preferably a manufactured fire blanket made from woven fibre
glass sandwiched between a fire retardant material, to extinguish fire on personal
clothing or a small fire on the floor or bench.
 Bucket of water
o Used to extinguish paper, fabric and wood fires. Water, however, must never be used
to extinguish an electrical fire or one caused by a flammable chemical.
 Bucket of sand or dry soil (kept free of refuse)
o Is used to smoother flames and contain and extinguish a free flowing liquid fire.
 Hose pipe
 Fire extinguishers
o Fire extinguishers are divided into four categories, based on different types of fires.
 The most common types of extinguishers are:
- Water- solid red
- Suitable for Class A fires. Not considered effective for Class B and Class C
fires, and dangerous if used for electrically energised equipment or cooking
oils or fats.
 Foam- red with blue band or label (previously solid blue)

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 - Suitable for Class A and Class B fires, with limited effectiveness for Class F
fires. Not considered effective for Class C fires, and dangerous if used for
electrically energised equipment
o Powder- red with a white band or label
 These extinguishers are rated as either ABE or BE. ABE rated extinguishers are
considered suitable for Class A, Class B, Class C and Class E fires. They are not
considered effective for Class F fires. BE rated extinguishers are considered
suitable for Class B, Class C and Class E fires, and may be used with limited
effectiveness on Class F fires. They are considered effective for Class A fires.
o Carbon Dioxide (CO2)- Red with a black band or label
 Suitable for Class E fires. Has limited effectiveness on Class A, Class B and Class
F fires.
o Vaporising Liquid –Red with yellow band or label
 Suitable for Class A and Class E fires. Has limited effectiveness on Class B fires.
Not considered effective for Class F fires
o Wet Chemical- Red with an oatmeal band or label (previously oatmeal colour)
 Suitable on Class F fires and may be used on Class A fires. Not considered
effective for Class B or Class C fires and dangerous if used on Class E fires.
o Class D fires require special purpose extinguishers.

CO2 fire extinguisher

Teaching Guides for NTA Level 4 MLS Curriculum Page 506

Range of Fire Extinguishers - the colour of the extinguisher is an indicator of its contents.

Step 6: Key Points (15 minutes)

 Definition of terminologies (fire, fire fighting , fire fighting tools)
 List class of fire
 List types fire fighting tools
 Mention general use of fire fighting tools

Step 7: Evaluation (10 minutes)

 ASK students to:
o Define fire and fire fighting tools
o List five classes of fires
o Mention use of any two fire fighting tools
 ASK students if they have any comments or need clarification on any points.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health, AMREF.

Teaching Guides for NTA Level 4 MLS Curriculum Page 507

Session 8: Demonstration of Use of Fire
Fighting Tools
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 List fire fighting tools
 Identify emergency exit(s) in their respective laboratory/building.
 Use fire fighting tools to specific types of fires.
 Handle fire fighting tools (date of fire extinguisher, horse pipe blockage, showers)

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 LCD projector and computer/laptop
 Wall papers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Brainstorming Review fire fighting tools
3 20 minutes Presentation Review use of fire fighting tools
4 55 minutes Presentation Use of fire fighting tools
5 15 minutes Presentation Handling fire fighting tools
6 10 minutes Presentation Key points
7 05 minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Review fire fighting tools

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 Activity: Brainstorming (5 minutes)
 ASK the students the following question
 List fire fighting tools.
 List classes of fires that are common to be fund in the laboratory.
 INVITE responses from students
 RECORD their response on the flip chart or chalk board
 SUMMARIZE their responses with information below

 Fire fighting tools include:-

o Fire blankets
o Bucket of water
o Bucket of sand or dry soil
o Horse pipe
o Fire extinguishers
 Classes of fires that are common to be found in the laboratory are:
o Class A
o Class B
o Class C
o Class D
o Class E

Step 3: Review use of fire fighting tools (20 minutes)

 The tutor should review in summary on the application of the basic fire fighting tools
with respect to the fire hazards that can occur in the laboratory.
 Identification of emergency exit(s) Emergency symbol
 Whenever you enter to any building observe for the presence of emergence exit/door.
 Entrance point is an emergence exit. Other exits are indicated by the EXIT symbol (a
word “EXIT” or a “running person” under green background)

 Fire protection procedures:

o Do not panic; and raise alarm
o Start evacuation the premises
o Close all doors and windows
o Turn off all gas and electrical appliances
o Fight the fire if possible
o Divide tasks amongst other personnel
o Never take personal risks

Step 4: Use of fire fighting tools (30 minutes)

 Perform demonstration in an open area (out of the class/demonstration laboratory)
 Demonstrate to students the use of fire fighting equipment one after another in the
absence of fire;-
o Fire blankets
o Bucket of water
o Bucket of sand or dry soil
o Horse pipe and
o Fire extinguishers

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 Set fire of Class A, B, C, D and E. To them apply appropriate fire fighting tool(s)
S/No. Class of Fire fighting tool(s)
fire
1 A Fire blanket, bucket of water, bucket of sand, horse pipe, fire
extinguisher (all types except wet chemicals fire extinguisher)
2 B Bucket of sand, fire extinguisher (foam, powder, Carbondioxide, wet
chemical types)
3 C Fire blanket, bucket of sand, fire extinguisher (powder)
4 D Fire blanket, bucket of sand, fire extinguisher (powder)
5 E Bucket of sand, fire extinguisher (powder, carbon dioxide, vaporizing
liquid)

Step 5: Handling fire fighting tools (25 minutes)

 Fire blankets
o It is important to keep blankets at moisture free area, and be away from area that ants,
mice, rat or rodent could have an access.
o Bucket of water
 Put the bucket at site that is accessible to every person on wooden surface. Check
frequently for any leakage and presence of moulds. Clean and replace water.
o Bucket of sand or dry soil
 Put the bucket at site that is accessible to every person. Always make sure that the
sand/soil is kept free of refuse.
 Note: Do not use sand bucket as dust bin.
o Horse pipe and
 Make sure always is connected to a reliable water source, no leakage points and
any blockage. It should not be locked.
o Fire extinguishers
 Be put at the site that is accessible to every person.
 Don’t put on the ground or on top of higher “surfaces” like bench, fridges, and
cupboard. Always check for the expire date and do preventive maintenance as
indicated on the log card.

Step 6: Key Points (5 minutes)

 List fire fighting tools
 Identify emergency exit(s) in their respective laboratory/building.
 Tips on use fire fighting tools to specific types of fires.
 Important point in handling fire fighting tools
o Accessibility and use
o Working order
o Awareness of the user (fire drills)

Step 7: Evaluation (15 minutes)

 ASK students to:
o List fire fighting tools
o How can you identify an emergency exit?
o List important thing in handling fire fighting tools.

Teaching Guides for NTA Level 4 MLS Curriculum Page 510

 ASK students if they have any comments or need clarification on any points.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 511

Session 9: Sterilization in the Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define Sterilisation
 Explain the importance of sterilisation
 Categorize three sterilization methods used in the laboratory
 Explain each type of sterilization method used in the laboratory
 List the steps of sterilisation by the autoclave method in the laboratory
 Observe the use of the sterilizer in the clinical laboratory

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Laboratory coat

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 10 minutes In Class Exercise Define sterilisation
3 10 minutes Presentation Importance of sterilisation
4 5 minutes Presentation Types of sterilisation
5 20 minutes Presentation Explain sterilisation
6 15 minutes Presentation List steps of autoclave sterilisation
7 5 minutes Presentation Key points
Observation in
8 45 minutes Steps of physical sterilisation
clinical Laboratory
9 5 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity (5 minutes)

Activity: In class exercise (5 minutes)
ASK the students to define sterilisation

Teaching Guides for NTA Level 4 MLS Curriculum Page 512

 SUMMARIZE their responses and confirm correct answers using notes below
Answer: list definition of sterilisation

Step 3: Importance of sterilisation (10 minutes)

 Explain the importance of sterilization

Step 4: Three types of Sterilisation (5 minutes)

 Physical
 Chemical
 Mechanical

These will be explained in more detail.

Step 5: Explain Sterilisation (20 minutes)

 Physical sterilization is achieved by
o [Give details of autoclaving, temperature, pressure, etc.]
 Chemical
o Give details
 Mechanical
o Give details

Step 6: List the steps of Autoclaving (15 minutes)

 Follow the SOPs

Step 7: Key Point (5 minutes)

 Importance of sterilisation
 List types of sterilisation

Step 8: Observation of Autoclaving in the clinical laboratory (45 minutes)

 Use checklist for student to observe each step.

Step 9: Evaluation (10 minutes)

 Student will be asked to report on their observations of sterilization by the autoclave
method in the clinical laboratory.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;

Teaching Guides for NTA Level 4 MLS Curriculum Page 513

 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;

Teaching Guides for NTA Level 4 MLS Curriculum Page 514

Session 10: Application of Bio-safety and
Bio-security in Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define bio-safety and bio-security
 List bio-safety/bio-security gears and equipments
 Describe use of safety equipment

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 LCD projector and computer/laptop
 Wall papers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 10 minutes Definition
Brainstorming
Biosafety and biosecurity gears and
3 20 minutes Presentation
equipment
4 30 minutes Presentation Use of safety gears and equipment
5 05 minutes Presentation Key Points
6 15 minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition
Activity: Brainstorming (5 minutes)
ASK the students the following question
What is the meaning of “biosafety” and “biosecurity”?
INVITE responses from students
RECORD their response on the flip chart or chalk board

Teaching Guides for NTA Level 4 MLS Curriculum Page 515

 SUMMARIZE their responses with information below

 Laboratory Bio-safety:-
o Entails prevention of employee exposures to occupationally acquired infections, and
release of organisms to the environment through appropriate safety measures
 Laboratory Bio-security
o Refers to protection of biological agents from loss, theft, or misuse. They can be non-
intentional or intentional

Step 3: Bio-safety/bio-security gears and equipments (20 minutes)

 Bio-security is concern with:
o Protecting agents from theft or misuse
o Protect pathogens from dangerous people
o Limit access to Labs that contain certain biological agents
o At this level the concern to bio-security is limited.

 Biosafety:
o Since this is concern with protecting the worker, then it is important to learn basic
skills in laboratory biosafety.
 This section summarizes various forms of personal and laboratory safety equipments
o Personal Protective gears
 Head protection
- Caps, elastic bands or hair nets
 Eye protection
- Goggles
- Protective glass shield
 Hand protection
- Gloves( of various synthetic materials, size and strength)
 Foot protection
- Shoes (steel-toed), treated shoes, rubber boots, plastic shoe covers, insulated
shoes.
 Protective clothing
- Laboratory coats, laboratory apron
 Respiratory protection
- Mask, safety cabinet class I
 Picture BLS-I
o Laboratory safety equipment
 Laboratory safety cabinet class I
 Individual storage containers
 Refrigerator
 Eye wash station
 Safety shower

Step 4: Use of safety gears and equipment (30 minutes)

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 Personal Protective gears
o Head protection
 Caps, elastic bands or hair nets will prevent the hair from coming in contact
with instrument/machinery parts, chemicals or flame-producing sources
o Eye protection
 Goggles and face shield- protect microbes from splashing on the eye face
respectively.
 Protective glass shield- protects microbes from splashing on the face and chest.
o Hand protection
 Gloves (of various synthetic materials, size and strength)
 Apart from acting as a shield between hands and hazardous materials, some
gloves can also absorb perspiration or protect the hands from heat.
o Foot protection
 Shoes (steel-toed), treated shoes, rubber boots, plastic shoe covers, insulated
shoes.
 Foot protection is designed to prevent injury from corrosive chemicals, heavy
objects, electrical shock, as well as giving traction on wet floors
o Protective clothing
 Laboratory coats, laboratory apron- protect the clothing and skin from microbes
and chemicals that may be spilled or splashed on them.
o Respiratory protection
 Mask, safety cabinet class I- protects an individual from inhaling microbes and
fumes.
 Laboratory safety equipment
o Laboratory safety cabinet class I
o Protect an individual against
o Individual storage containers
o Refrigerator
o Eye wash station
o Safety shower

Step 5: Key points (25 minutes)

o Define bio-safety and bio-security
o List bio-safety/bio-security gears and equipments
o Give uses of any three safety equipments.

Step 8: Evaluation (15 minutes)

 ASK students to:
o Define biosafety and biosecurity
o List five safety gears and two safety equipments
o Explain the use of at least two safety gears and one safety equipment.
 ASK students if they have any comments or need clarification on any points.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;

Teaching Guides for NTA Level 4 MLS Curriculum Page 517

 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 518

Session 11: Control Intentional and
Unintentional Exposure to Biological
Materials
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define intentional and unintentional exposure of biological materials.
 List methods to control intentional / unintentional exposure of biological materials.
 Explain methods to control international / unintentional exposure of biological materials.
 Categorize biological materials according to biosafety levels of containments
 List agents of bioterrorism

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes In Class Exercise Definition
Methods to control intentional /
3 20 minutes Presentation unintentional exposure of biological
materials
Categorize biological materials
according to biosafety levels of
4 30 minutes Presentation
containments

Agents of bioterrorism
5 30 minutes Presentation
6 5 minutes Presentation Key Points
7 10 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 519

Step 2: Activity
Activity: In class exercise (5 minutes)
ASK the students to.
SUMMARIZE their responses and confirm correct answers using notes below

Step 3: Methods to control intentional / unintentional exposure of biological materials

(20 minutes)
Step 4: Categorize biological materials according to biosafety levels of containments (30
minutes)
Step 5: Agents of bioterrorism (30 minutes)

Step 6: Key Point (5 minutes)

Step 7: Evaluation

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 520

Session 12: Safety Measures when Using
Laboratory Containers
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 List safety measures when using containers for laboratory investigations
 Explain each safety measures when using containers for laboratory investigations
 List five risks in using containers for laboratory investigations
 Explain risks in using containers for laboratory investigations

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Checklist
 Illustrations

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise List safety measures for containers
3 30 minutes Presentation Explain each Container safety measures
4 15 minutes Presentation List Risks in using laboratory containers
Explain Risks in using laboratory
5 50 minutes Presentation
containers
6 5 minutes Presentation Key Points
7 10 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)

 ASK the students to list safety measures in using containers for laboratory
investigations
 SUMMARIZE their responses and confirm correct answers using notes below

Teaching Guides for NTA Level 4 MLS Curriculum Page 521

List of safety measures for containers:
 avoid contamination of requisition papers, register book and other specimens
 protection yourself
 avoid environmental pollution
 avoid spillage of specimen containers

Step 3: Explain safety measures (30 minutes)

 Containers must be strong to withstand stress of normal use
 The correct container for the specimen is important
o E.g. sputum in plastic container with screw top and not in a blood collection tube

Sputum containers
with screw lids

Source: CDC TB Training

Blood Collection Tubes

ASCP Management Training

 Container must be properly closed to:

o avoid contamination of papers and other specimens
o avoid spillage of specimen containers
 protection yourself
 avoid environmental pollution

Step 4: List five risks in laboratory containers for laboratory investigations (15 minutes)
 leakage
 breakage

Teaching Guides for NTA Level 4 MLS Curriculum Page 522

 high temperature
 corrosion
 volatilization or forming aerosol

Step 5: Explain risks laboratory specimen containers ( 50 minutes)

 Leakage is important because laboratory specimens may contain infectious
microorganisms that could infect the laboratory personnel, patients or other people
coming in contact with the container. Leakage of urine containers may also release
preservatives such as acids that could be harmful. Use care that specimen containers do
not leak, especially by closing the lid.
 Breakage of specimen containers is important to avoid because the specimen may leak. If
the container is glass such as blood tubes or slides, the sharp glass could injure laboratory
personnel, patients or other people coming in contact with the container.
 Glass blood tubes that are centrifuged may break in the centrifuge when it is operated
improperly (unbalanced or too high of speed). Use care when handling specimen
containers, especially those of glass.

Tubes must be balanced

and correct speed to avoid
breakage

Source: ASCP Management Training

 Exposing specimen containers to high temperature when washing and sterilizing for re-
used is a risk because it could cause the container to develop holes or make the lid fit
improperly to cause a leak when used again. Exposing the specimens in the container to
high temperatures is a problem because it destroys the contents and makes the test
inaccurate.
 Corrosion of specimen containers can occur when washing with strong brush and
disinfecting with strong bleach for re-use. This becomes a risk because it could cause the
container to develop holes or make the lid fit improperly to cause a leak when used again.
 Volatilization or forming aerosols from specimens in a container occurs when it is rapidly
mixed or shaken. When the lid is in place the droplets of specimen will drop down given
a short time. However, if you immediately remove the lid after rapid shaking or
centrifugation, aerosols will form in the air around you and can be inhaled. This causes a
risk for inhaling infectious micro-organisms.
 This same problem occurs following centrifugation unless time is allowed. Always cover
the lid with a gauze for blood collection tubes before removing the lid and open away
from your face.

Step 6: Key Point (5 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 523

 Specimen containers must be handled with care to avoid leakage, breakage, exposure to
high temperature, corrosion during washing and volatilization or forming aerosols.
 Container must be properly closed to avoid contamination of papers and other specimens,
avoid spillage of specimens, protection yourself and to avoid environmental pollution.

Step 7: Evaluation
 Explain five risks in using specimen containers for laboratory investigations.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 524

Session 13: Safety Measures when Using
Containers in the Clinical Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Observe safety measures when using containers in the Clinical Laboratory
 Record observations of safety measures when using containers in the Clinical Laboratory

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Checklist

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Objectives
2 5 minutes In Class Exercise
Clinical
3 60 minutes Safety Measures of handling containers
Observation
4 50 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)

ASK the students to Introduce themselves to the clinical supervisor and discuss the
checklist with the supervisor.
SUMMARIZE their responses and confirm correct answers using notes below

Step 3: (60 minutes)

Date: _____________________________
Student Name:______________________
Where Observed
Observe Safety Measures when Handling Specimen Yes or

Teaching Guides for NTA Level 4 MLS Curriculum Page 525

 Containers No
Specimens for leakage
Control leakage
Fixative in histological specimen container leakage
Breakage of specimen containers in centrifuge
Contamination of register book and requisition
Contamination of other specimens
Name of Clinical Supervisor:____________________________________________
Signature of Clinical Supervisor:__________________________________________

Step 4: Evaluation of Observation in Clinical Laboratory (50 minutes)

 Discuss the observations by the students and any comments by the clinical tutor using a
checklist of safety measures regarding containers used in the clinical laboratory. Each
student will give a verbal report of what safety measures were observed in the clinical
laboratory.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 526

Session 14: Safety Measures in Specimen
Collection in the Clinical Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 List safety measures in specimen collection for laboratory investigations (avoid
contamination, self protection, avoid spread of disease).
 Explain each safety measure in specimen collection for laboratory investigations.
 List safety practices in specimen collection for laboratory investigations (wearing
protective gears, use of appropriate specimen collection materials).
 Explain safety practices in specimen collection for laboratory investigations.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction and Learning Objectives
In Class Exercise
2 15 minutes Specimen collection safety
Buzzing
3 10 minutes Presentation List safety measures in specimen collection
Explain safety measures in specimen
4 35 minutes Presentation
collection
5 10 minutes Presentation List safety practices in specimen collection
Explain safety practices in specimen
6 35 minutes Presentation
collection
7 10 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity (15 minutes)

 Activity: In class exercise

Teaching Guides for NTA Level 4 MLS Curriculum Page 527

  ASK the students to buzz in pairs and allow them to answer the following questions:
 What are three safety measures that can be used in specimen collection?
 Why is safety important in specimen collection?
 SUMMARIZE their responses and confirm correct answers using notes below

Step 3: List safety measures in specimen collection (5 minutes)

 Avoid contamination
 Self protection
 Avoid spread of disease

Step 4: Explain safety measures in specimen collection (35 minutes)

 Avoid contamination
o Dispose of needles in sharps containers without recapping
o Disinfect surfaces with 5% sodium hypochlorite or 5% Lysol
o Incinerate contaminated needles and other materials used in specimen collection
 Self protection
o Wash hands regularly
o Do not eat or drink during blood collection
o Keep objects (fingers and pencils) out of your mouth
o Do not wear jewellery to the laboratory workplace
o Use personal protective equipment (PPE)
o Dispose of contaminated sharps and glass ware (tubes) in biohazard container
o A first aid kit should be available in the specimen collection area
o Report accidental needle pricks or punctures to the laboratory in charge
 Avoid spread of disease
o Disinfect surfaces with 5% sodium hypochlorite or 5% Lysol
o Decontaminate spills of blood
o Perform adequate sterilization before washing or disposing waste

Step 5: List safety practices in specimen collection (10 minutes)

 Wearing protective gears
 Use of appropriate specimen collection materials

Step 6: Explain safety practices in specimen collection (30 minutes)

 Wear protective gears
o Gloves
o Masks if a patient has an upper respiratory tract infection
o Laboratory coats
o Closed-toe shoes
 Use of appropriate specimen collection materials
o Do not recap specimen collection needles
o Do not reuse specimen collection needles and other materials
o Inspect all needles, evacuated tubes and other supplies before use
o Ensure that appropriate equipment and supplies are available

Step 7: Key Point (10 minutes)

 Never recap needles.

Teaching Guides for NTA Level 4 MLS Curriculum Page 528

 Dispose of needles and other materials in appropriate containers.
 Wash hands before and after blood collection on each patient.
 Wear appropriate protective gears.

Step 8: Evaluation (10 minutes)

 Ask the students to list and explain personal protective equipment.
 Explain safety practices necessary in specimen collection.
 Ask the students if they have any comments or need clarification of any points.

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 529

Session 15: Safety Measures on Specimen
Preservation in the Clinical Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the terms: preservation and fixation
 Mention common specimen preservation methods.
 Describe different chemical preservatives.
 Describe preservation by temperature.
 Describe safety measures in handling specimen preservatives

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction and Objectives
2 5 minutes Presentation Definition of terms
3 30 minutes Presentation Common specimen preservation methods
4 30 minutes Presentation Different chemical preservatives
5 10 minutes Presentation Preservation by temperature.
Safety measures when handling
6 20 minutes Presentation
preservation steps
7 15 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 Interact with students on previous session on importance of confidentiality and privacy in
laboratory practices
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition of terms (5 minutes)

 Preservation:

Teaching Guides for NTA Level 4 MLS Curriculum Page 530

 Fixation:

Step 3: Common specimen preservation methods (30 minutes)

Step 4: Different chemical preservatives (10 minutes)

Step 5: Preservation by temperature (20 minutes)

Step 6: Safety measures when in contact with Preservation Methods (20 minutes)
 Safety from exposure to fixative exposure
 Safety from exposure to dry ice-cold chain,
 Safety from exposure to chemical preservatives
 Safety from freeze-dry process

Step 7: Key Point (15 minutes)

Step 8: Evaluation (10 minutes)

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 531

Session 16: Safety Measures during
Specimen Collection in the Health Setting
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Identify protective gear during specimen collection (gloves, laboratory coats, wearing
appropriate shoes)
 Observe use of appropriate specimen collection materials in safe practice (needles,
lancets, tourniquet, tubes, syringe, vacutainer adapter, cotton wool, methylated spirits and
plaster.
 Observe safety rules during specimen collection (no eating, drinking, smoking)

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Learning Objectives
2 5 minutes In Class Exercise Introduction
Observe specimen collection and safety
3 60 minutes Presentation
rules
4 50 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identify protective gear during specimen collection (5Minutes)

Activity: In class exercise (5 minutes)

 ASK the students to.

 SUMMARIZE their responses and confirm correct answers using notes below

Step 3: Observe specimen collection and safety rules (60 minutes)

 Checklist for Student Observations:

Teaching Guides for NTA Level 4 MLS Curriculum Page 532

Step 4: Evaluation (50 Minutes)

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 533

Session 17: Waste Materials from the
Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define waste material from the laboratory
 List types of waste material from the laboratory
 Categorise types of waste material from the laboratory
 Perform sorting of laboratory wastes

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction to learning objectives
2 10 minutes In Class Exercise Waste materials
Types of wastes materials from the
3 15 minutes Presentation
laboratory
4 15 minutes Presentation Categorize waste materials
Presentation/
5 60 minutes Sorting of laboratory wastes
Activity
6 5 minutes Presentation Key points
7 10 minutes Presentation Evaluations

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
 Activity: Buzzing (10 minutes)
 ASK the students to answer the following question
 Define waste material?
 SUMMARIZE their responses and confirm correct answers using notes below

Teaching Guides for NTA Level 4 MLS Curriculum Page 534

 Waste materials are those materials generated from the laboratory

Step 3: Types of waste materials from the laboratory (15 minutes)

 Types of laboratory material are
o Specimens
o Cultures
o Reagents
 Laboratory supplies such as syringes, test tubes, pipets, gauze, cotton wool, gloves and
prickers

Step 4: Category of Waste Materials (15minutes)

 Waste materials are categorize into the following
 Chemical waste such as acids and alkalis
 Microbiological waste such as culture, effusion, blood, autopsy
 Physical waste such sharps(syringes and prickers) and non sharps(gloves ,cotton wool and
gauze)

Step 5: Sorting of laboratory wastes (60 minutes)

 Activity: Identify lab wastes in clinical laboratory
 ASK the students to record laboratory wastes in the clinical laboratory
 Allow the to present in the class session
 After presentation correct their mistakes and give feedback

Step 6: Key points (5 minutes)

 Waste materials are those materials generated from the laboratory
 Waste materials includes; specimens, cultures, reagents
 Category of waste materials; chemical wastes, microbiological waste and physical waste

Step 7: Evaluation (10 minutes)

 Categorize three types of laboratory wastes

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;

Teaching Guides for NTA Level 4 MLS Curriculum Page 535

 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 536

Session 18: Handling Laboratory Wastes
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Describe handling of laboratory wastes
 List methods of handling laboratory wastes
 Identify handling laboratory wastes in the clinical laboratory

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Illustrations
 Colour Code Labels

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction to learning objectives
2 20 minutes Presentation Handling laboratory wastes
3 20 minutes Presentation Methods of handling laboratory wastes
Presentation Laboratory wastes in the clinical
4 60 minutes
activities laboratory
4 5 minutes Presentation Key points
5 10 minutes Presentation evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: handling laboratory wastes (20 minutes)

Activity: In class exercise (5 minutes)
 ASK the students to answer the following question
 Describe methods of handling laboratory wastes
 SUMMARIZE their responses and confirm correct answers using notes below

 Wastes must be properly handled within health facility setting even before it is taken for
incineration, burial or other disposal, to protect clients, staff and the community.
 Restriction of purchase of supplies that produce a lot of healthcare waste

Teaching Guides for NTA Level 4 MLS Curriculum Page 537

 Use of recyclable product at the onsite or of site
 Use of all content in each open container before opening another container
 Frequent of checking expiring date at the time of delivery
 Good management and control practices e.g. pharmaceuticals and chemical through
centralized purchasing
 Frequent of ordering small quantities rather than large amount t one time

Step 3: Methods of handling laboratory wastes (20 minutes)

 Non contaminated wastes This poses no risk of infectious to person who handled it and
includes paper, trash, boxes, food remain bottles and plastic containers
 Contaminated wastes s are potentially infectious or toxic if not disposed properly and
includes blood, body fluids, sharps, laboratory supplies

Step 4.Recording of laboratory wastes (60 minutes)

Activity: This activity should be carried out in the clinical laboratory.
 ASK the students to list methods of handling laboratory wastes and differentiate
between contaminated and non contaminated wastes
 DISCUSSION
 SUMMARIZE their responses and correct if there is mistakes

Step 5: key points (5minutes)

 Wastes must be properly handled within health facility setting even before it is taken for
incineration, burial or other disposal, to protect clients, staff and the community.
 Handling of laboratory waste depends on the type waste such as
o Non contaminated wastes This poses no risk of infectious to person who handled it
and includes paper, trash, boxes, food remain bottles and plastic containers
o Contaminated wastes s are potentially infectious or toxic if not disposed properly and
includes blood, body fluids, sharps

Step 6: Evaluation (5minutes)

 List two methods of handling laboratory waste

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;

Teaching Guides for NTA Level 4 MLS Curriculum Page 538

 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 539

Session 19: Clinical Laboratory Waste
Disposal
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 State methods of disposing laboratory wastes
 Explain safe site for construction of waste disposal units

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Illustrations

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Learning Objectives
2 5 minutes In Class Exercise Methods of disposing laboratory wastes
Safe site for construction of waste
3 50 minutes Presentation
disposal units
Presentation/
4 50 minutes Observe waste disposal site
Activity
5 5 minutes Key :Points Key points
6 5 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Methods of disposing laboratory wastes (5Minutes)

Activity: In class exercise (5 minutes)
 ASK the students to list methods of disposing laboratory wastes
 SUMMARIZE their responses and confirm correct answers using notes below

 Methods of laboratory wastes disposal are

Teaching Guides for NTA Level 4 MLS Curriculum Page 540

 o Burning; rural health centres and dispensaries can use these options to burn waste in
burning pits as MINISTRY OF HEALTH SOCIAL WELFARE guideline. Open
burning of contaminated wastes is not recommended because it is hazardous
o Burying if incineration is not possible, all contaminated wastes must be protected and
buried in a burial pit and covered with fresh soil daily to prevent:
 wastes from scattering
 scavenging of the waste material by people and or animals
 Attraction of insects
 Odour
NB: Rural health facilities can us this option of disposal to dispose sharps and other
anatomical wastes/physiological wastes
 Incineration
o Incineration which is a dry oxidation process/is used to reduce organic and
combustible wastes in organic incombustible matter at high temperature
o Incineration provides high temperatures and destroys microorganisms and therefore is
the best method for disposal of contaminated wastes
o Incineration also reduces bulk size of waste to be buried
o There are incinerators that can burn up to a temperature of 1300oC

Step 3: Safe site for construction of waste disposal units (50 minutes)
 The following should be considered during construction of wastes disposal
o Incinerators, burning and burying should be away from pedestrians, water sources,
human settlement and restricted areas.
o Ensure that sharp containers are out of reach small children
o Both incinerator and burial sites should be fenced with a gate and rock to prevent
scavenging by both animals and people

Step 4: Observe of the waste disposal sites(50 minutes)

Activity: observe waste disposal sites within the health facility
 Ask the students to list if the waste disposal sites meet the required criteria
 Classroom discussion
 SUMMARIZE their responses and confirm correct answers using notes below

Step 5: Key Points

 Methods of laboratory wastes disposal are
o Burning
o Burying
o Incineration
 During construction of waste disposal the following factors should be considered
o Incinerators, burning and burying should be away from pedestrians, water sources,
human settlement and restricted areas.
o Ensure that sharp containers are out of reach small children
o Both incinerator and burial sites should be fenced with a gate and rock to prevent
scavenging by both animals and people

Step 6: Evaluation (5 minutes)

 List three methods of laboratory waste disposal

Teaching Guides for NTA Level 4 MLS Curriculum Page 541

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 542

Session 20: Containers for Waste
Disposal in the Laboratory
NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Describe segregation of laboratory waste materials for disposal
 List different types of containers for laboratory waste disposal (colors)
 Classify laboratory waste material in proper containers for disposal (activity)

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Illustrations
 Colour Code Labels

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduce learning objectives
2 5 minutes In Class Exercise Segregation of laboratory waste
different types of containers for laboratory
3 40 minutes Presentation
waste disposal
Laboratory waste materials in proper
5 60 minutes Presentation/activity
waste containers
8 5 minutes Presentation Key Points
9 5 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: segregation of laboratory waste materials for disposal (5 minutes)

Activity: Buzzing
 ASK the students to answer the following question
 Explain what is segregation of laboratory waste material
 SUMMARIZE their responses and confirm correct answers using notes below

Teaching Guides for NTA Level 4 MLS Curriculum Page 543

 The segregation of waste laboratory materials consists of separating the different waste
materials based on the type, treatment and disposal practices. Containers suitable for each
type should be available and used as intended.
 Segregation takes place at the point where waste is generated. Segregation of waste shall
be applied uniformly throughout the country
 Never sort mixed wastes (e.g. do not try to separate uncontaminated from contaminated
waste or combustible from non combustible ,after they have being combined)
 No bags should be removed from the segregation point unless they are labelled
 Waste should not be allowed to accumulate at the point of production
 Waste should be collected daily or as frequently as possible
 A supply of collection bags or containers should be readily available at all location where
wastes are produced

Step 3: different types of containers for laboratory waste disposal (40 minutes)
 Containers for laboratory wastes are grouped according the international colour codes
 Yellow colour-safety containing the following needles and syringes ,blades, broken glass,
lancets, scissors, slides and slides covers
 Red containers –wet, infectious materials such as blood, body tissues, body fluids,
specimens (stool, sputum)
 Blue-black containers-for non-infectious materials such as laboratory papers, plastic
bottles, laboratory packaging

Step 4: Classify laboratory waste material in proper containers for disposal (60
minutes)
Activity: Identify containers for disposing different types of wastes in clinical laboratory
 Ask the students to record three types of containers for disposable of laboratory waste
 Classroom discussion
 SUMMARIZE their responses and confirm correct answers using notes below

Step 5: Key points (5 minutes)

 Different types of containers for laboratory waste disposal and these containers for
laboratory wastes are grouped according the international colour codes. Yellow colour-
safety containing the following needles and syringes, blades, broken glass, lancets,
scissors, slides and slides covers. Red containers –wet, infectious materials such as blood,
body tissues, body fluids and specimens (stool, sputum). Blue-black containers-for non-
infectious materials such as laboratory papers, plastic bottles, laboratory packaging

Step 6: Evaluation (5 minutes)

 List three types of containers for laboratory waste disposal according to their colors

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries Part 1 & 2
(2002) Cambridge University Press;

Teaching Guides for NTA Level 4 MLS Curriculum Page 544

 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood Et All (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 545

Session 21: Safety Measures on Specimen
Preservation in the Clinical Laboratory
(Fixation, cold chain, chemical, freeze-dry)

NTA LEVEL 4: SEMESTER I: MODULE CODE: 3 MLT 4103 - LABORATORY SAFETY AND
WASTE MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives:
By the end of this session, students are expected to be able to:
 Define the terms: preservation ,fixation and Freeze drying
 Describe common specimen preservation methods.
 Describe safety measures in handling specimen preservatives
 Describe different chemical preservatives.
 Describe preservation by temperature.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction and Objectives
2 10 minutes Presentation Definition of terms
3 40 minutes Presentation Common specimen preservation methods
Safety measures in handling specimen
4 30 minutes Presentation
preservatives
5 20 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 Interact with students on previous session on
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition of terms (10 minutes)

 Preservation: Substances capable of retarding or arresting the deterioration or changes to
a specimen.
 Fixative: A solution used to preserve and harden fresh tissue for microscopic
examination.

Teaching Guides for NTA Level 4 MLS Curriculum Page 546

 o Therefore a fixative can be described as a substance which will preserve after death
the shape, structure, relationship and chemical constituents of tissues and cells. It is
mainly due to the action of fixatives on the protein elements of cells and tissues that
the structural stabilization is achieved. The preservation should be such that the fixed
tissue resembles as closely as possible the form which it had during life.
 Freeze drying is to preserve by rapid freezing and drying in a vacuum.

Step 3: Common types of specimen preservation (30 minutes)

 Chemical preservation: this is preservation by using different categories of chemicals
depending on the investigation and or type of specimen as follows:
o In haematological specimens anticoagulants such as Ethylene Diamine Tetraacetic
Acid, Heparin, and Ammonium Oxalate are used to preserve whole blood (cell
morphology).
o In serology Sodium Azide is used to preserve serum.
o In Clinical chemistry Sodium Fluoride, Heparin is used to preserve whole blood.
o In Microbiology Stuart transport medium help to prevent micro-organisms from dying
due to enzyme action, change of pH , or lack of nutrients .Carry-Blair medium is used
as transport medium for faeces that many contain ; Salmonella , Shigella, and Vibrio
species.
o In Histopathology chemical fixatives such as 10%Formal saline, Mercuric Chloride,
Ethyl Alcohol and Alcohol Ether are used to preserve tissues, and cell morphology.
o In parasitology chemical fixatives such as Beyer’s solution preserves morphology of
cysts, and eggs; Methiolate Iodine Formaldehyde is used as fixative and stain for cysts
and E. histolytica amoebae it also stains eggs.
 Temperature preservation: Different temperatures are used to preserve different types
of specimens as follows:
o Freezing temperatures up to -20 degrees Celsius are used to preserve serum, plasma
for longer periods as advised by expert.
o Freeze drying is used to preserve serum and plasma
o Refrigeration at temperature ranges of between 2 to 8 degrees Celsius are used for
preservation of Blood and other specimens taken for bacteriological examination such
as culture for up to two days.

Step 4 Safety measures in handling specimen preservatives

 Most specimen preservatives are poisonous, corrosive, and irritant; therefore safety
measures have to be instituted while handling them. Measures which have to be employed
included:
o Air Extractor hood: is used when handling volatile and irritant chemicals such as
formalin in preparation of formal saline or when dealing with fixed specimens.
Gloves: Are used to avoid corrosive or any chemical preservatives.
o Masks and Goggles: Are used to protect face and eyes from chemical fumes.
o Laboratory coat: Is used to protect personal clothes and skin from corrosive
chemicals and general contamination.

Step 5: Key Point (20 minutes)

 Safety measures in handling specimen preservatives
o Chemical preservation: this is preservation by using different categories of
chemicals depending on the investigation and or type of specimen as follows:

Teaching Guides for NTA Level 4 MLS Curriculum Page 547

  In haematological specimens anticoagulants such as Ethylene Diamine Tetraacetic
Acid, Heparin, and Ammonium Oxalate are used to preserve whole blood (cell
morphology).
 In serology Sodium Azide is used to preserve serum.
 In Clinical chemistry Sodium Fluoride, Heparin is used to preserve whole blood.
 Safety measures in handling specimen preservatives
o Most specimen preservatives are poisonous, corrosive, and irritant; therefore safety
measures have to be instituted while handling them. Measures which have to be
employed included:
 Air Extractor hood: is used when handling volatile and irritant chemicals such as
formalin in preparation of formal saline or when dealing with fixed specimens. Gloves:
Are used to avoid corrosive or any chemical preservatives.
 Masks and Goggles: Are used to protect face and eyes from chemical fumes.
 Laboratory coat: Is used to protect personal clothes and skin from corrosive chemicals
and general contamination.

Step 6: Evaluation (10 minutes)

 Define terms: dry freezing, preservation and fixation.
 Mention: Safety measures in handling specimen preservatives

References:
 F.J. Baker, R.E. Silverton, Introduction to Medical Laboratory Technology, 7th Edition,
(2001) Oxford University Press
 Monica Cheesbrough – Medical Laboratory Manual for Tropical Countries Volume I, 2nd
Edition (1981) Butterworth & Co (Publishers) Ltd;
 Monica Cheesbrough - District Laboratory Practice in Tropical Countries, Part 1 & 2
(2002) Cambridge University Press;
 Barbara H. Estride: Basic Medical Laboratory Techniques 4th Edit. By Delmar Thomson
Learning;
 Pearson C.A. (1995) Medical Administration for Frontline Doctors 2nd Ed. FSG
Communication Ltd;
 MOH (1994) Proposals for Health Sector Reforms;
 MOH (2000) District Health Management Training Modules - 1, 3 and 4, 2nd Version;
 Kanani S. Maneno J. & Schluter P. (1984) Health Service Management for Health
Workers;
 C. H. Wood et al (1981) Community Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 548

 CHAPTER FOUR

MODULE CODE GST04101:

CUSTOMER CARE AND
COMMUNICATION SKILLS

Teaching Guides for NTA Level 4 MLS Curriculum Page 549

Session 01: Importance of Interpersonal
Relationships
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Define interpersonal relationships
 List three functions of interpersonal relationships
 Describe functions of interpersonal relationships
 Explain importance of interpersonal relationships

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Buzzing Definition of terms
3 15 minutes Presentation/Buzzing Functions of interpersonal relationships
4 35 minutes Presentation Functions of interpersonal relationships
5 35 minutes Presentation Importance of interpersonal
relationships
6 5 minutes Presentation Key points
7 5 minutes Presentation Evaluation Methods
Total 120
Time minutes

Step 1: Introduction, Learning Objectives:

Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Teaching Guides for NTA Level 4 MLS Curriculum Page 550

Step 2: Definition of terms:
Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question:
 Define the following term:
 Interpersonal relationships
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

Definition of terms
 Interpersonal relationship is defined as positive ways of relating to family members and
others in the society. This means being able to make and keep friendly relationships as
well as ending relationships constructively.

Step 3: List functions of interpersonal relationships:

 Linking function
 Mentation function
 Regulatory function

Step 4: Functions of each interpersonal relationships:

 Linking function: provides linking between a person and their environment
 Mentation function: allows for conceptualization, remembering and planning
 Regulatory function: serves to regulate our own and others’ behaviour

Step 5: Importance of interpersonal relationships:

 Builds trust
 Allows self disclosure
 Enables one to make and keep relationships
 Facilitates feedback and feed forward

Step 6: Key points:

 Definition of interpersonal relationships
 Functions of interpersonal relationships
 Importance of interpersonal relationships

Step 7: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on principles of
interpersonal relationship
o Define interpersonal relationships
o State functions of interpersonal relationships

References:
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;

Teaching Guides for NTA Level 4 MLS Curriculum Page 551

 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 552

Session 02: Elements of Interpersonal
Relationships
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 List the common elements of interpersonal relationships:
 Define element of interpersonal relationships
 Describe significance of elements interpersonal relationships

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 35 minutes Presentation/Buzzing Common elements of interpersonal
relationships
3 35 minutes Presentation Element of interpersonal relationships
4 35 minutes Presentation Significance of element interpersonal
relationships
5 5 minutes Presentation Key points
6 5 minutes Presentation Evaluation Methods
Total 120 minutes
Time

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: List the common elements of interpersonal relationships:

Teaching Guides for NTA Level 4 MLS Curriculum Page 553

 Activity: Presentation/Buzzing (5 minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question:
 List common elements of interpersonal relationships
 WRITE (or ASK one student to write) the responses on flip chart/white board/black
board
 SUMMARIZE their responses using notes below

 Elements of interpersonal relationships

o Do not criticize, condemn or complain about people
o Appreciate people
o Solve your own problems by solving other people’s problems
o Be genuinely interested in others
o Smile
o Be a good listener
o Make others feel important
o Avoid arguing and understand that you really are not always right
o If you are wrong admit
o Save your anger
o Suggest, do not tell

Step 3: Define each element of interpersonal relationships:

 Do not criticize, condemn or complain about people
o Instead of telling someone, there are doing something wrong, consider asking them
questions to find out why they do what they do
 Appreciate people
o Improves your interpersonal relations very quickly
 Solve your own problems by solving other people’s problems
o If you would like someone to do something or act in a certain way, try to figure out
how what you want might benefit him or her
 Be genuinely interested in others
o Make more friends by being interested in others than trying to get people interested in
you
 Smile
o Smile is infectious, it makes others warm inside and warmer towards you
 Be a good listener
o Focus on the person, listen more than you speak and encourage others to talk about
themselves
 Make others feel important
o If someone is important to you in any way, let them know about it. This applies to all
types of relationships
 Avoid arguing and understand that you really are not always right
o When two people argue, no one is listening, its better off to remain calm and listen to
the other person’s thoughts
 If you are wrong admit
o Failing to admit you are wrong can harm your interpersonal relations and damage
their trust in you

Teaching Guides for NTA Level 4 MLS Curriculum Page 554

 Save your anger
o You approve someone in anger, they immediately go into defence and your discussion
will go nowhere
 Suggest, do not tell
o Interpersonal relations are strained when you tell someone how to do something or
how to do it

Step 4: Describe significance of each element interpersonal relationships:

 Do not criticize, condemn or complain about people
o This will cause
 Appreciate people
o It shows you care
 Solve your own problems by solving other people’s problems
o Solving your own problem males others understand you better
 Be genuinely interested in others
o Allows others to express their feelings and emotions to their fellows
 Smile
o Shows someone is appreciated, respected and willingness to hear
 Be a good listener
o Helps listener to understand someone’s concern
 Make others feel important
o Shows that you value humanity
 Avoid arguing and understand that you really are not always right
o Shows that even the listener do make mistakes
 If you are wrong admit
o Shows that even the listener do make mistakes and willing to be corrected
 Save your anger
o Allows amicable solutions to problems
 Suggest, do not tell
o Shows you are not dictating on someone’s views and understanding

Step 5: Key points:

 Common elements of interpersonal relationships:
 Elements of interpersonal relationships
 Significance of elements of interpersonal relationships

Step 6: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on elements of
interpersonal relationship
o List at least five elements of interpersonal relationships
o Define at least five elements of interpersonal relationships

References:
 www.positive-attitude-tips.com/interpersonal/relationships
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)

Teaching Guides for NTA Level 4 MLS Curriculum Page 555

 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 556

Session 03: Importance of Relating
Client’s Information against Request Form
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Define the term identity
 Explain the importance of verifying client identity
 Define request form
 Describe key identification elements in the client request form
 Describe common errors associated with wrong client identification
 Explain the procedure for getting missing information on the request form

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Buzzing Definitions of terms
3 20 minutes Presentation/Buzzing Importance of verifying client identity
4 40 minutes Presentation/Buzzing Key identification elements
5 20 minutes Presentation/Buzzing Errors associated with wrong
identification
6 15 minutes Presentation/Buzzing Procedure for getting missing
information on the request form
7 5 minutes Presentation Key points
8 5 minutes Presentation Evaluation Methods
Total 120
Time minutes

Teaching Guides for NTA Level 4 MLS Curriculum Page 557

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Definition of terms:

Activity: Presentation/Buzzing (minutes)

 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
 Client’s Identity and Request form
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Client’s identity is defined a set of unique identifiers that separate individual from the
rest, these include names, age, sex, registration number and facility name
 Request Form is defined as a record of client’s information including brief clinical history
and test result(s)

Step 3: Importance of verifying client identity:

Activity: Presentation/Buzzing (minutes)

 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
 Importance of verifying client identity
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Distinguishes one individual from the rest

o Using unique identifiers, clients are distinguished from one another
 Maintain identifications to create medical reports
o Clinical history
o Helps to know test(s) ordered and completed
o Treatment planned and given
 Prevent harm to the client
o Correct management given to correct client
 Obtain reimbursement for services
o Rational use of drug
o Cost effectives of services
o Proper planning and budgeting

Step 4: Key identification elements:

Activity: Presentation/Buzzing (minutes)
ASK the students to buzz among each other in pairs; and give them time to answer the
following question
Define the following term:
 Key identification elements

Teaching Guides for NTA Level 4 MLS Curriculum Page 558

  WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Facility name
o Identifies the name of service provider (institution)
 Registration number
o Is a set of alphanumerical unique identifier given to individual client, for example:
XYZ/000001, XYZ/000001/MM/YY
o The numbers are generated sequentially by:
 Manual method
 Numbering machine
 Computer
 Barcode
 Name(s)
o Three names are preferred (Surname, First Name and Middle Name)
o Important to remain consistent because one’s surname is another person’s first or
middle name or vice versa
 Age/Date of birth
o States the exact age and date of birth
o Written as numerical, for example age (14) years or by date of birth (14-01-1952)
 Sex
o Stated as Male (M) or Female (F)
 Address
o States the residence of the client

Step 5: Errors associated with wrong identification:

Activity: Presentation/Buzzing (minutes)

 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Errors associated with wrong identification
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 No medical reports maintained

 Harm done to client
 No reimbursement for services rendered
 No records for planning

Step 6: Procedure for getting missing information on the request form:

 Identify the missing information
 Refer the patient to the requesting clinician
 State the missing information
 If unable to refer the client,
o Communicate with the requesting clinician by calling, contact in person, through the
nurse
o For in-patient communicate by calling or contact in person the nurse in-charge

Teaching Guides for NTA Level 4 MLS Curriculum Page 559

 Verify the corrected information before providing service

Step 7: Key points:

 Definition of identity and request form
 Importance of verifying client identity
 Key identification elements in the client request form
 Errors associated with wrong client identification

Step 7: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on importance of
identity and relating client’s information against request form
o Explain the importance of client’s identity?
o List elements in the request form
o Explain errors associated with wrong client identification

References:
 www.aacc.org/SiteCollectionDocument
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 560

Session 04: Importance of Attending
Customers and Reasons for Prioritization
According to Problems
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Explain the importance of attending customer in person
 Explain reasons prioritization
 List ways of prioritizing customers
 Explain advantages and disadvantages of prioritizing customers

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Buzzing Definition of terms
3 30 minutes Presentation/Buzzing Importance of attending customer in
person
4 35 minutes Presentation/Buzzing Reasons prioritization
5 30 minutes Presentation/Buzzing Advantages and disadvantages of
prioritizing customers
6 5 minutes Presentation Key points
7 5 minutes Presentation Evaluation Methods
Total 120
Time minutes

Teaching Guides for NTA Level 4 MLS Curriculum Page 561

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Definition of terms:

Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
 Customer/client
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 A customer or client is a person seeking services from health facilities, institution,

organization or from a service provider

Step 3: Importance of attending customer in person:

Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Importance of attending customer in person
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Improves management of services

 Builds relationships and trust
 Reduces customer complaints

Step 4: Reasons prioritization:

Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Reasons prioritization
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Customer in critical condition

o Refers to customer with life threatening conditions such accidents, infectious
diseases)
 Infants and children
o Refers to children below the of 5 years
 Pregnant mothers
o Refers women with pregnancy
 Senior customers
o Refers persons of 65 years old and above
 Customer with special conditions
o Refers to prisoners, in-patients, persons with disabilities, students

Teaching Guides for NTA Level 4 MLS Curriculum Page 562

Step 5: Advantages and disadvantages of prioritizing customers:
Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Advantages and disadvantages of prioritizing customers
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Advantages
o Reduces morbidity and mortality
o Improves management cost
 Disadvantages
o Can be misused
o Can be source of complaints
o Long turnaround time
o Additional work for staff

Step 6: Key points:

 Importance of attending customer in person
 Reasons prioritization
 Ways of prioritizing customers
 Advantages and disadvantages of prioritizing customers

Step 7: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on the reasons for
prioritization of clients according to problems
o Mention importance of customer prioritization
o List five reasons for customer prioritization
o Mention two advantages and two disadvantages of customer prioritization

References:
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 563

 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 564

Session 05: Applying FIFO in Attending
to Clients
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Explain FIFO and FILO
 Differentiate FIFO from FILO
 Explain the importance of FIFO
 Discuss failures to follow FIFO

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Buzzing Definition
3 15 minutes Presentation/Buzzing Differentiation FIFO from FILO
4 40 minutes Presentation/Buzzing Importance of FIFO
5 35 minutes Presentation/Buzzing Failures to follow FIFO
6 5 minutes Presentation Key points
7 10 minutes Presentation Evaluation Methods
Total 120
Time minutes

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Definition of terms:

Teaching Guides for NTA Level 4 MLS Curriculum Page 565

 Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
 FIFO and FILO
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 FIFO is defined as first-in, first-out. In terms of customer service, this means, the first
customer/client to come in for service gets served first.
 FILO is defined as first-in, last-out

Step 3: Differentiation FIFO from FILO

Activity: Presentation/Buzzing (minutes)

 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
 Differentiation FIFO from FILO
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 In FIFO, the first customer gets served first and depart early, while in FILO, the first
customer delayed in receiving services thus getting out late
 FILO is not applicable in good customer care

Step 4: Importance of FIFO

Activity: Presentation/Buzzing (minutes)

 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
 Importance of FIFO
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Improves customer satisfaction

 Reduces turnaround time
 Maximises staff efficiency
 Builds trust
 Reduces costs

Step 5: Failures to follow FIFO

Activity: Presentation/Buzzing (minutes)

 ASK the students to buzz among each other in pairs; and give them time to answer the

Teaching Guides for NTA Level 4 MLS Curriculum Page 566

 following question
 Define the following term:
 Failures to follow FIFO
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Customer dissatisfaction
 Increased turnaround time
 Minimises staff efficiency
 Destroys trust
 Increases costs

Step 6: Key points:

 Differentiate FIFO from FILO
 Importance of FIFO
 Failures to follow FIFO

Step 7: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on the application of
FIFO in attending to clients
o State the differences between FIFO and FILO
o Give two importance of FIFO
o Mentions three failures to follow FIFO

References:
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 567

Session 06: Reassuring the Client about
the Procedure
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Explain the importance of reassuring the client
 Describe the procedures used for assuring the client
 Explain elements of reassuring the client
 Demonstrate procedure for reassuring the client

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Buzzing Importance of reassuring the client
3 15 minutes Presentation/Buzzing Procedures used for assuring the client
4 30 minutes Presentation/Buzzing Elements of reassuring the client
5 45 minutes Role play Procedure for reassuring the client
6 5 minutes Presentation Key points
7 10 minutes Presentation Evaluation Methods
Total 120
Time minutes

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Importance of reassuring the client:

Teaching Guides for NTA Level 4 MLS Curriculum Page 568

 Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Importance of reassuring the client
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Importance of reassuring:
o Builds trust
o Alleviates fear and anxiety
o Increases expectation
o Ensures proper specimen collection

Step 3: Procedures used for assuring the client:

Activity: Presentation/Buzzing (minutes)

 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Procedures used for assuring the client
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Procedures used for assuring the client

o Greet the client
o Introduce yourself
o Offer a sit
o Explain the importance or significance of the test
o Explain the specimen required and method of collection
o Explain the expected TAT
o Ask client for any fears or anxiety
 In case of a minor, please relate to the parent or guardian

Step 4: Elements of reassuring the client:

 Safety
o Assure the client that his/her safety is guaranteed
 Sterile/clean materials will be used
 Personal Protective Equipment (PPE) will be used
 Pain
o Assure the client that minimal pain will be experienced in case of a needle prick
 Length of time
o Assure the client that the procedure for specimen collection will not take a long
o Give the client the estimated TAT for results

Step 5: Procedure for reassuring the client:

Activity: Role-play (minutes)

 Scenario

Teaching Guides for NTA Level 4 MLS Curriculum Page 569

 o A 45 year old male complaining of headache, general body malaise, vomiting, chills
for 7 days is sent by the attending clinician to the laboratory with a laboratory
request for malaria investigation.
 SELECT two students, one to role play as the client, while the other role-plays as the
service provider (health laboratory worker)
 ASK the rest of class to watch the role-play and make observations
 SUMMARIZE their responses using notes below

 The role-play should depict following elements of reassuring the clients

o Courtesy
o Safety
o Pain alleviation
o Length of time for specimen collection and release of test results

Step 6: Key points:

 Importance of reassuring the client
 Procedures used for assuring the client
 Elements of reassuring the client
 Demonstrate procedure for reassuring the client

Step 7: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on importance of
reassuring the client about the procedure
o List two importance of reassuring client about the prodedure.
o Mention procedure used reassuring the client about the prodedure.
o Mention three elements of reassuring the client.

References:
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 570

Session 07: Importance of Turnaround
Time (TAT)
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Define turnaround time
 List three importance of turnaround time
 Explain each importance of turnaround time
 Discuss setting of turnaround time

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Buzzing Turnaround time
3 10 minutes Presentation/Buzzing List three importance of turnaround
time
4 40 minutes Presentation/Buzzing Importance of turnaround time
5 40 minutes Presentation/Buzzing Setting of turnaround time
6 5 minutes Presentation Key points
7 10 minutes Presentation Evaluation Methods
Total 120
Time minutes

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Definition of terms

Teaching Guides for NTA Level 4 MLS Curriculum Page 571

 Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
 Turnaround time
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Turnaround time in relation to customer care is defined as “time taken by a service

provider to provide prescribed service(s) to the customer”

Step 3: List three importance of turnaround time:

 Customer satisfaction
 Affordable
 Efficiency

Step 4: Importance of turnaround time:

 Customer satisfaction
o Directly affects customer care and outcome of services.
o Influences future decisions to use same service provider
 Affordable
o Impacts on length of service
o Reduced service costs.
 Efficiency
o Influences provider efficiency
o Cuts unnecessary running cost
o Improves quality of service

Step 5: Setting of turnaround time:

 Gather information regarding service to be provided
 Gather materials and resources required for provision of a particular service
 Put in place adequate human resource for each stage of service provision
 Allocate time required to accomplish each stage of service
 Document time required to accomplish each stage of service
 Display to customers the set turnaround for each service provided

Step 6: Key points:

 Definition
 Importance of TAT
 Setting of TAT for services

Step 7: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on importance of
turnaround time

References:

Teaching Guides for NTA Level 4 MLS Curriculum Page 572

 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 573

Session 08: Elements of Turnaround
Time
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Define elements of turnaround time
 List three elements of turnaround time
 Discuss each element of turnaround time

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 15 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation/Buzzing Definition terms
3 20 minutes Presentation/Buzzing Elements of turnaround time
4 45 minutes Presentation Elements of turnaround time
5 15 minutes Presentation Key points
6 10 minutes Presentation Evaluation Methods
Total 120
Time minutes

Step 1: Introduce the session by revising Session 13; and state the learning objectives of
Session 14 before guiding students to the activities of this session.
 READ or ASK students to read the learning objectives.

Step 2: Definition of terms:

Activity: Presentation/Buzzing (minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 574

  ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
 Elements of turnaround time
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Perform service immediately, is defined as “the shortest time taken to commence service
provision”
 Plan work flow, is define as “systematic planning of activities to be performed to
accomplish service(s) required”
 Communicate results in appropriate time, is define as “the shortest time between
completion of services and informing the customer”

Step 3: Elements of turnaround time:

 Perform service immediately
 Plan work flow
 Communicate results in appropriate time

Step 4: Elements of turnaround time:

 Perform service immediately:
o This requires the service provider to listen effectively to the customer’s complaint and
determine the type(s) of services required
o Determine the cost of service(s)
o Agree with customer on the service to be done and its cost
o Document agreement
 Plan work flow:
o Assign task to a dedicated service provider
o Gather all tools and materials required to perform particular service
o Perform the actual service or job required
o Document each step performed and results
o Verify quality of service done or given
 Communicate results in appropriate time:
o Report results to your supervisor
o Supervisor verify results
o Document service outcome and completion
o Communicate results to customer
 Oral through telephone or other relevant communication media
 Written through job completion notification/request forms
o Keep documents and records of service(s) provided

Step 5: Key points:

 Definition
 List elements of turnaround time
 Brief explain of elements of turnaround time

Step 6: Evaluation Methods:

Teaching Guides for NTA Level 4 MLS Curriculum Page 575

 Summarise the discussion using question and answers with emphasis on elements of
turnaround time
 Examples of Q&A
o Mention one element turnaround and its importance in customer care?
o What is the importance of retaining documents and records of service(s) provided?

References:
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 576

Session 09: Importance of
Communication
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Define communication
 Explain the importance of communication
 List two types of communication
 Explain verbal and non-verbal communication
 Describe functions of verbal and non-verbal communication

Resources Needed:
 Computer/Laptop
 Liquid Crystal Display (LCD) projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes Presentation/Buzzing Definition of terms
3 5 minutes Presentation/Buzzing Importance of communication
4 70 minutes Presentation/Buzzing Types of communications
5 10 minutes Presentation/Buzzing Differences between verbal and non-
verbal communication
6 10 minutes Presentation/Buzzing Application of verbal and non-verbal
communications
7 5 minutes Presentation Key points
8 10 minutes Presentation Evaluation Methods
Total 120
Time minutes

Teaching Guides for NTA Level 4 MLS Curriculum Page 577

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Definition of terms:

Activity: Presentation/Buzzing (5 minutes)

 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
 Communication
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Communication is defined as:

o “the process of exchanging information, thoughts, feelings, ideas, instructions and
knowledge”.

Step 3: Importance of communication:

 Communication is necessary to share knowledge and experiences, build relationships,
motivate, inform, teach, persuade, entertain, inspire and give or receive directions.

Step 4: Types of communications:

 There are two types of communications
o Verbal communication
o Non-verbal communication
 Verbal, that is through spoken words which is about 7 to 11 percent of all communication
or
 Non-verbal, which is through gestures such as smiling, leaning forward or nodding, the
way we stand, the way we sit, facial expressions, silence and eye contact. 89 to 93 percent
of all communication is non-verbal.
 Note:
o Non-verbal gestures may not always match a verbal message. This discrepancy leads
to confusion. For example, crying while saying “I am fine,” or saying that you are
listening when you are not making eye contact with the speaker, looking all around
the room while the speaker is talking. Another example is saying that you are not
bored or tired when you are yawning. Therefore, it is very important to be able to
understand the meaning of non-verbal communication.
o Non-verbal symbol completely replace verbal message, for example, a tutor with
cold, fixed stare can easily tell a student to be quiet with the tutor uttering a word.
 Functions:
o Verbal and Non-verbal conveys message from a sender to receiver
o Note: Non-verbal also emphasises uttered symbols. In a role-play, ASK one student
to say the following words to another student, “I HATE YOU!”, while letting the
class observe body language responses from both actors, that is the sender and
receiver

Step 5: Difference between verbal and non-verbal communication:

Teaching Guides for NTA Level 4 MLS Curriculum Page 578

 Verbal communication refers to symbols that have universal meaning for all involved in
the process. These spoken and written verbal symbols are known as language
 Non-verbal refers to symbols other than written or spoken words also known as non-
verbal symbols. These include gesture (such as nodding), body actions, tone of voice, use
of space and touch
 Verbal can be recorded while non-verbal communication can only be recorded through an
observer or visual media

Step 6: Application of verbal and non-verbal communications:

Activity: Presentation/Buzzing (10 minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 When do you apply verbal and non-verbal communication in life?
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses:

 CONCLUDE - Verbal and non-verbal communications are used to send messages

Step 7: Key points:

 Definition of communication
 Communication can be either Verbal: Uses words in such applications as speaking,
writing, listening and reading or Nonverbal: Employs gesture expressions, movements
and actions and reactions.
 Communication is a means of getting your feeling to reach the other person.
o It may build or break a relationship•
 Importance of communication
 List types of communication
 Differences between verbal and non-verbal
 Applications of verbal and non-verbal

Step 8: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on importance of
communication. ASK the following questions:
o Define the term “communication” in relation to your job.
o List two differences between verbal and non-verbal communication.
o Briefly explain the difference between verbal and non-verbal communications.
o Is non-verbal communication important in your life? If YES or NO give reasons

References:
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Barker L.L., (1987), Communication, 4th Edition, Prentice-Hall, Inc., New Jersey, USA
 Ministry of Health and Social Welfare (2007), Semester I: NTA Level 4 Curriculum: CM
04101 Communication & Counselling Skills, Participant Handbook, Version 1.0
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;

Teaching Guides for NTA Level 4 MLS Curriculum Page 579

 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 580

Session 10: Elements of Communication
Process
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 List five elements of communication process
 Define who a sender is in the communication process
 Define message/channel
 Define medium
 Define receiver
 Define feedback
 Explain the relationships between the five elements of the communication process

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning
Objectives
2 5 minutes Presentation/Buzzing Definition
3 10 minutes Presentation/Buzzing Elements of communication
process
4 60 minutes Presentation/Buzzing Elements of communication
process
5 25 minutes Presentation Communication process
6 5 minutes Presentation Key points
7 10 minutes Presentation Evaluation Methods
Total 120

Teaching Guides for NTA Level 4 MLS Curriculum Page 581

 Time minutes

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Definition of terms:

Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
o Communication process
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Communication process is defined as “a system that involves an inter-related,

interdependent group of elements working together as whole to achieve a desired
outcome or goal”

Step 3: List five elements of communication process:

Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 List the elements of communication:
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 The five elements of communication process are as follows:

o Sender
o Message
o Medium
o Receiver
o Feedback

Step 4: Define elements of communication:

Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following terms:
o Sender, Message, Medium, Receiver and Feedback
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 The Sender
o A sender initiates the communication by transforming information into a message.
 The Message
o The message is information created and initiated by the sender in the process of
communication.

Teaching Guides for NTA Level 4 MLS Curriculum Page 582

 The Channel
o In order to convey the message the sender uses some kind of a channel or medium.
Common channels of communication include speaking, writing, body language, sign
language, telephone and the media such as television, newspapers and radios. Other
channels of communication include pictures, symbols, diagrams, drumming, dancing,
visual images and hand signals.
 The Receiver
o The receiver is the person receiving the message and translating it into meaning.
 Feedback
o Feedback is an essential part of communication; the receiver has to respond to show
that he or she understood the message or not. The sender had to find out whether he or
she has been understood by the receiver. Feedback can be verbal or non-verbal
response. The receiver and the sender use feedback to ask for more information get
answers and find out whether the message is understood.

Step 5: Relationships between the five elements of the communication process:

 Communication process has five components, namely: sender, message, channel, receiver
and feedback. The diagram below illustrates the communication flow or process.

Channel

SENDER Message RECEIVER

Feedback

Channel

Diagram 1: Communication Flow or Process

Step 6: Key points:

 Communication process
 Definition of terms
 Elements of communication
 Relationships between the five elements of the communication process

Step 7: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on communication
process

References:

Teaching Guides for NTA Level 4 MLS Curriculum Page 583

 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Barker L.L., (1987), Communication, 4th Edition, Prentice-Hall, Inc., New Jersey, USA
 Ministry of Health and Social Welfare (2007), Semester I: NTA Level 4 Curriculum: CM
04101 Communication & Counselling Skills, Participant Handbook, Version 1.0
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 584

Session 11: Communication Methods
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 List four types communication methods
 Explain the four types of communication methods
 Explain application of each communication method
 List three advantages and three disadvantages of each communication method

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes Presentation/Buzzing Types of communication methods
3 30 minutes Presentation/Buzzing Types of communication methods
4 30 minutes Presentation/Buzzing Application of communication
methods
5 30 minutes Presentation/Buzzing Advantages and three disadvantages
of each communication method
6 5 minutes Presentation Key points
7 5 minutes Presentation Evaluation Methods
Total 120
Time minutes

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Types of communication methods:

Activity: Presentation/Buzzing (minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 585

  ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 List types of communication methods
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 The following are communication methods:

o Oral communication method
o Written communication method
o Telephone communication method
o Electronic communication method

Step 3: Types of communication methods:

 Oral communication method:
o Refers to messages that are transmitted “out loud” from one person to another. These
messages are verbal with complimentary non-verbal messages.
o Media of this type of communication is airwaves (megaphones)
 Written communication method:
o Refers to messages that are primarily verbal. Written messages can be affected non-
verbal characteristics. For example, hand-written versus type.
 Telephone communication method:
o Refers to messages that are transmitted from one person to another through the
telephones
 Electronic communication method:
o Refers to messages that are transmitted by electronic means through films, TV,
cassettes, CDs. VCDs, DVDs, Flash drive, videos and microchips

Step 4: Application of each communication method:

 Oral communication method:
o General conversations in meeting, family and social gatherings
 Written communication method:
o These are print or hand written messages/information designed to suit general or
specialized audiences
 Telephone communication method:
o This refers oral messages communicated from one person to another or conference
calls through the telephone system
 Electronic communication method:
o Refers to various forms messages conveyed by the use of electronic devices CD,
DVD, VCD, mobile phones, internet and intranet

Step 5: Advantages and disadvantages of each communication method:

 Oral communication method:
o Advantages:
 Reaches intended target at the same time
 Used in general conversations in meeting, family, social and political gatherings
 Can be recorded and archived
o Disadvantages:

Teaching Guides for NTA Level 4 MLS Curriculum Page 586

  Oral messages can reach those not intended to receive it
 Easily misinterpreted
 Written communication method:
o Advantages:
 Permanent, can be read over and over for many years
 Many formats such as newspapers, journals, books
o Disadvantages:
 Easily destroyed by water, fire
 Can be misused such as forged
 Telephone communication method:
o Advantages:
 Instant message delivery
o Disadvantages:
 Can reach unintended target when wrong number is dialled
 Electronic communication method:
o Advantages:
 Popular, easily shared, live pictures, audio-visual, speed
o Disadvantages:
 Security risk prone, privacy issues, system failures common, requires hardware
and software, expensive

Step 6: Key points:

 Types communication methods
 How each communication method works?
 Application of each communication method
 List three advantages and three disadvantages of each communication method

Step 7: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on methods of
communication
o List types of communication methods
o List few advantages and disadvantages of two methods

References:
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 587

 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 588

Session 12: Barriers to Effective
Communication
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Define communication barriers
 Identify barriers to effective communication
 Explain components of barrier to effective communication
 Describe the impact of each barrier in communication

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes Presentation/Buzzing Definition of terms
3 35 minutes Presentation/Buzzing Barriers to effective communication
4 30 minutes Presentation/Buzzing Components of barrier to effective
communication
5 35 minutes Presentation/Buzzing Impact of barrier in communication
6 5 minutes Presentation Key points
7 5 minutes Presentation Evaluation Methods
Total 120
Time minutes

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Definition of terms:

Teaching Guides for NTA Level 4 MLS Curriculum Page 589

 Activity: Presentation/Buzzing (5 minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define Barrier to communications
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Barriers are factors that cause incorrect meanings, or no meanings, to be communicated.

 Barriers also keep us from understanding other’s ideas and thoughts.
 Barriers can appear at any point of the communication process

Step 3: Identify barriers to effective communication (35 minutes):

Activity: Buzzing (5 minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Identify barriers to effective communications
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

Step 3a: Presentation (30 minutes):

 Barriers from the Sender
 Barriers from the Receiver
 Barriers from in Channel
 Other barriers to effective communications are:
o Language
o Environment
o Source of information
o Lack of clarity
o Gender
o Culture
o Religion
o Physical
o Technology

Teaching Guides for NTA Level 4 MLS Curriculum Page 590

 Picture 1: Barrier to effective communication with customer/client
Source: CM 04101 Communication & Counselling Skills, Participant Handbook, Version
1.0

NOTE:
 Barriers keep us from understanding other’s ideas and thoughts. Barriers can appear at
any point of the communication process.
 From the picture above the following can be barriers to communication: a dirty office
with other patients’ information all over the table, interruptions and distractions, lack of
privacy, and concentrating on something else instead of the client. In this picture, the
clinician is taking a call on his mobile phone and not talking to the patient.
 Other barriers to communication can include looking out of the window, looking at the
clock or watch, or starting to speak to someone else other than the client and shuffling
papers

Step 4: Components of barrier to effective communication:

 Barriers from the Sender
o The sender has the primary responsibility for starting an effective communication
flow. These are common barriers: talking too much, not giving client time to express
him or herself, being critical and judgemental, laughing at or humiliating the client,
showing signs of being upset, self ego, not listening or accepting feedback. Other
barriers from the sender include using an inappropriate channel, not listening and not
paying attention, lack of knowledge of the subject of discussion, using difficult or
different language and using contradictory verbal information with non-verbal
gestures.
 Barriers from the Receiver
o Barriers from the receiver include: using the inappropriate channel, no listening and
not paying attention, interrupting before sender completes the message and not
sending feedback
 Barriers from in Channel

Teaching Guides for NTA Level 4 MLS Curriculum Page 591

 o Blockage or interference with the free flow of message to or from destinations. For
example noise or frequency interferences from radio or other electronic devices
 Other barriers to effective communications are:
o Language: refers to use jargon, slang, abbreviations, acronyms, complex words, use
native languages and use of words that sound similar but have different meaning in
another language
o Environment: refers to physical and gatherings of people. For example inability to
speak or express oneself in a gathering or new environment.
o Source of information: refers to sender or through audio visual channel or from a
unreliable source
o Lack of clarity: refers to a situation where a the message sent is not clear or does not
make sense or when message sent is received in portions
o Gender: refers to barriers which are based traditions and taboos that one sex is
inferior to the other. For example in some society, women are not allowed to respond
to questions from strangers
o Culture: refers to barriers which are based traditions and taboos. For example, fathers
cannot discuss sexual issue with their daughters and mothers with their sons
o Religion: refers to barriers which are based on religious believe and tie
o Physical: refers to barriers which are physical in nature or man-made such walls,
fences, windows, tables, curtains
o Technology: refers to barriers which are based technology such as inability to use
electronic devices such as computers, mobile phones, ATM cards

Step 5: Impact of barrier to effective communication:

Activity: Presentation/Buzzing (35 minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Impact of barriers to effective communications
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Denial of services refers to a situation where a client is denied service because of barriers
such as: language (difficulty in understanding each other), religious beliefs (which does
not allow a follower to seek medical attention)
 Deadlines are missed refers
 Productive diminishes refers a situation where
 Treatment failures refers a situation when treatment failed because the client did not
follow instructions
 Poor quality of services refers
 Increased cost of services refers
 Social conflicts refers

Step 6: Key points:

 Effective communication is communication that ensures the correct message from the
sender reaches the receiver. It involves the ability to listen, pay attention, perceive and
respond non-verbally and/or verbally. It also involves seeking for clarification and getting
the answers.

Teaching Guides for NTA Level 4 MLS Curriculum Page 592

 Listing barriers to effective communication
 List impact of barriers to effective communication

Step 7: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on barriers to
effective communication
o Define barriers to effective communications.
o Mention at two barriers to effective communications - Randomly select students (4)

References:
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Barker L.L., (1987), Communication, 4th Edition, Prentice-Hall, Inc., New Jersey, USA
 Ministry of Health and Social Welfare (2007), Semester I: NTA Level 4 Curriculum: CM
04101 Communication & Counselling Skills, Participant Handbook, Version 1.0
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 593

Session 13: Overcoming Communication
Barriers
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 Session 19

Learning Objectives:
By the end of this session, the student will be able to:
 List ways of overcoming communication barriers
 Explain each way of overcoming communication barriers

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 10 minutes Presentation Introduction, Learning
Objectives
2 30 minutes Presentation/Buzzing Ways of overcoming
communication barriers
3 60 minutes Presentation/Buzzing/Activity Ways of overcoming
communication barriers
4 10 minutes Presentation Key points
5 10 minutes Presentation Evaluation Methods
Total 120 minutes
Time

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Ways of overcoming communication barriers:

Activity: Presentation/Buzzing (30 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 594

With reference to Session 19, ASK the students to buzz among each other in pairs; and
give them time to answer the following question
 List barriers to effective communications
 List ways of overcoming each communication barrier:
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

Barriers Remedies
1. Barriers from the Sender  Clear and concise messages, change of attitude to self
and listeners
2. Barriers from the Receiver  Being attentive, avoid interruptions
3. Barriers from in Channel  Must clear, concise, no noise
4. Language  Use common language, avoid using jargon, unfamiliar
terms
5. Environment  Choose a language based on environment
6. Source of information  Use a trusted source
7. Lack of clarity  Be clear and concise,
8. Gender  Change of attitudes
9. Culture  Change of attitudes
10. Religion  Respect other people’s religion
11. Physical  Removal
12. Technology  Learn and encourage use of technology

Step 3: Way of overcoming communication barriers:

Picture 2: Showing barriers to communication

Source: CM 04101 Communication & Counselling Skills, Participant Handbook, Version
1.0

 TUTOR: Using the picture above, ASK the students to sit in a pair

Teaching Guides for NTA Level 4 MLS Curriculum Page 595

 ACTIVITY:
o Study the picture and list down all possible barriers to communication as seen in the
this picture
o ASK each pair to write their responses on flip chart
o ASK one student from each pair to present their responses to class
o DISCUSS with class and SUMMARIZE the responses

 RESPONSES:
o Physical barrier: Table is a barrier between client and service provider
o Sender: Harsh action, attitude towards the receiver is not good, age
difference
o Receiver: Closed eyes, not responsive, possibly crying

Step 4: Key points:

 Senders and receivers can overcome barriers by using appropriate channels, creating good
rapport, being attentive both verbally and non-verbally, using a common language,
avoiding medical terminology and jargon, being self-aware, using feedback from each
other and asking questions for clarification in order to understand feedback.

Step 5: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on ways of
overcoming communication barriers
o In your own words, state what you understand by the statement “Ways of overcoming
communication barriers”
o Mention at least two ways of overcoming communication barriers - Randomly select
students (4)

References:
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Barker L.L., (1987), Communication, 4th Edition, Prentice-Hall, Inc., New Jersey, USA
 Ministry of Health and Social Welfare (2007), Semester I: NTA Level 4 Curriculum: CM
04101 Communication & Counselling Skills, Participant Handbook, Version 1.0
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 596

Session 14: Effective Communication
Skills
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Define effective communication skills
 List importance of effective communication skills
 Explain use of effective communication skills
 Explain terminologies used in effective communication skills

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Buzzing Definition
3 15 minutes Presentation/Buzzing Effective communication skills
elements
4 55 minutes Presentation/Buzzing Use of effective communication
skills
5 20 minutes Presentation/Buzzing Importance of effective
communication skills
6 5 minutes Presentation Key points
7 10 minutes Presentation Evaluation Methods
Total 120 minutes
Time

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Teaching Guides for NTA Level 4 MLS Curriculum Page 597

Step 2: Definition of terms:
Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:
 Effective communication
 Effective communication skills
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below:

 Effective communication:
o “Effective communication is defined as good working relationships between and the
health professional.
 Through effective communication a client feels respected and understood,
understands recommendations from the clinical staff and client feels motivated to
return to the clinic.
 Effective communication skills:
o Effective communication skills is defined as “ability to use and employ all
components of communication skills in relating to a client satisfaction”
o Effective communication skill is essential to the promotion of quality health care

Step 3: Effective communication skills elements:

Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 List elements of Effective communication skills
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below:

 The following are the essential elements of effective communication skills:

o Telling
o Probing
o Observing
o Understanding
o Listening
o Use proper language

Step 4: Use of effective communication skills:

 Telling:
o This is verbal way of conveying or communicating or sending or giving a message to
a client. Its purpose is success in winning agreement, inspiring confidence, or
promoting action upon the client. While telling do not use offensive words or
statements. Avoid dominating during the communication. Give the client opportunity
to talk.
 Probing:

Teaching Guides for NTA Level 4 MLS Curriculum Page 598

 o This is a verbal communication which is intended to gather or extract information
from a client. The information given will be used to assist the client resolve a situation
or problem. While probing do not use close ended questions or questions that will
result in resistance or denial.
 Observing:
o This is a skill that records the non-verbal responses seen during communication with a
client. In this skill, use of eye contact is very important to record all non verbal
responses. Ask the client reason for demonstrating a non-verbal behaviour such as
biting nails, frowning, crying, and sobbing.
 Understanding:
o This skill involves analysis of a symbol we have seen and heard during
communication. For successful communication the listener must understand the
intended meaning and context assumed by the sender.
 Listening:
o Listening is paying attention to what is being said so that you may respond
accordingly
 Use proper language:
o This involves the use of both verbal and non-verbal languages. It is important to use
the same language as client and avoid using terminology, jargon and discriminative
languages

Step 5: Importance of effective communication skills:

Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 List importance of effective communication skills
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below:

 Promotes of quality health care

 Increases customer satisfaction
 Enhances trust in the health services
 Increases health profession satisfaction
 Minimises cost and loss of time

Step 6: Key points:

 Effective communication is communication that ensures the correct message from the
sender reaches the receiver. It involves the ability to listen, pay attention, perceive and
respond non-verbally and/or verbally. It also involves seeking for clarification and getting
the answers.

Step 7: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on importance of
using effective communication skills
o Mention at least three importance of effective communication
o Mention six elements of effective communication skills

Teaching Guides for NTA Level 4 MLS Curriculum Page 599

References:
 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Barker L.L., (1987), Communication, 4th Edition, Prentice-Hall, Inc., New Jersey, USA
 Ministry of Health and Social Welfare (2007), Semester I: NTA Level 4 Curriculum: CM
04101 Communication & Counselling Skills, Participant Handbook, Version 1.0
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 600

Session 15: Demonstration of Effective
Communication Skills
NTA LEVEL 4: SEMESTER 1: MODULE CODE: GST04101 - CUSTOMER CARE AND
COMMUNICATION SKILLS

Total Session Time: 120 minutes

Prerequisites:
 None

Learning Objectives:
By the end of this session, the student will be able to:
 Role play effective communication skills

Resources Needed:
 Computer/Laptop
 LCD projector
 Flip chart stand/flip charts
 Marker pens/White board markers/Chalks
 Masking tape/Glue tag
 Black/white boards
 White board erasers/dusters
 Laser pointer

Session Overview:
Steps Time Activity/Method Contents
1 5 minutes Presentation Introduction, Learning
Objectives
2 5 minutes Presentation/Buzzing Definition of terms
3 30 minutes Presentation/Buzzing/Activities Building rapport
4 60 minutes Role plays Building rapport
6 10 minutes Presentation Key points
7 10 minutes Presentation Evaluation Methods
Total 120
Time minutes

Step 1: Introduce the session and state the learning objectives before guiding students to the
activities of the session. READ or ASK students to read the learning objectives.

Step 2: Definition of terms:

Activity: Presentation/Buzzing (minutes)
 ASK the students to buzz among each other in pairs; and give them time to answer the
following question
 Define the following term:

Teaching Guides for NTA Level 4 MLS Curriculum Page 601

 Building rapport
 WRITE (or ASK one student to write) the responses on flip chart/white board
 SUMMARIZE their responses using notes below

 Rapport is building a comfortable connection so that people can share information; it is a

process of creating a relationship based on trust and respect. This relationship is created
through verbal and non-verbal actions. Establishing rapport is the first phase of effective
communication

Step 3: Rapport in communication:

 Poor Rapport

Picture 1: Barriers to effective communication

Source: CM 04101 Communication & Counselling Skills, Participant Handbook, Version
1.0

 ACTIVITY 1: TUTOR displays picture no. 1 to students. ASK the each student to list
all observable actions that show poor rapport
 ACTIVITY 2: ASK the students to buzz in pair and share the findings. Then write list of
observable findings
 ACTIVITY 3: ASK one member from each pair to present their observable findings to
the rest of the class. TUTOR selects one student to write and tally responses from each
pair as they present.
 ACTIVITY 4: TUTOR SUMMARISES responses as shown below:
o No confidentiality and privacy
o Service provider is talking on the phone
o Interrupted conversation
o Client is confused or lost
o The sitting posture of the provider is not friendly
o Service provider’s poor dress code
o Other client in the room

Teaching Guides for NTA Level 4 MLS Curriculum Page 602

 o Children are peeping
o Table content not arranged
o There is a cup of tea on the table

 Good Rapport

Picture 2: Building rapport

Source: CM 04101 Communication & Counselling Skills, Participant Handbook, Version
1.0

 ACTIVITY 1: TUTOR displays picture no. 2 to students. ASK the each student to list
all observable actions that show good rapport
 ACTIVITY 2: ASK the students to buzz in pair and share the findings. Then write list of
observable findings
 ACTIVITY 3: ASK one member from each pair to present their observable findings to
the rest of the class. TUTOR selects one student to write and tally responses from each
pair as they present.
 ACTIVITY 4: TUTOR SUMMARISES responses as shown below:
o Confidentiality and privacy
o Door is closed
o A friendly welcome
o Shaking hands, (introducing yourself)
o Showing patience
o Making eye contact
o Attending one client at a time
o Room arrangement is good

Step 4: Role-plays:
 Role-play I: Based on picture no. 1 concept, select 5 students to role-play a similar
situation in the laboratory setting
 Role play II: Based on picture no. 2 concept, select 5 students to role-play a similar
situation in the laboratory setting

Teaching Guides for NTA Level 4 MLS Curriculum Page 603

Step 5: Key points:
 Establishing rapport includes:
o Greeting
o Welcoming,
o Offering a seat and showing that you care and have time for the client.
o Shaking hands,
o Introducing yourself,
o Using the same me language as client and
o Avoid using medical terminology and jargon,
o Showing patience,
o Not interrupting,
o Making eye contact,
o Attending one client at a time
o Using verbal gestures like “yes”, “um-hum” or use a non-verbal gesture like nodding,
that they know you are interested

Step 6: Evaluation Methods:

 Summarise the discussion using question and answers with emphasis on good effective
communication skills
o TUTOR gives HOMEWORK by distributing picture no. 3 to students in groups of
four and are required to answer the following questions
o Look at the picture and state the type of rapport.
o Write down your group’s finding for presentation to the larger class

Picture 3:
Source: CM 04101 Communication & Counselling Skills, Participant Handbook, Version
1.0

References:

Teaching Guides for NTA Level 4 MLS Curriculum Page 604

 Department of Human Resources Development, Ministry of Health and Social Welfare
(May 2009), Curriculum for Basic Technician Certificate Course in Medical Laboratory
Sciences (NTA Level 4)
 Barker L.L., (1987), Communication, 4th Edition, Prentice-Hall, Inc., New Jersey, USA
 Ministry of Health and Social Welfare (2007), Semester I: NTA Level 4 Curriculum: CM
04101 Communication & Counselling Skills, Participant Handbook, Version 1.0
 Jayasinghe, M. (2001), Counselling in Careers Guidance, 1st Edition, Oxford University
Press;
 Behaviour Change Communication Training Toolkit, International Training and
Education Center on HIV, 2006
 Ministry of Health and Social Welfare, 2005; National Guidelines for Voluntary
Counselling and Testing, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; National Guidelines for Provider Initiated
Testing and Counselling, National AIDS Control Programme, The United Republic of
Tanzania
 Ministry of Health and Social Welfare, 2007; Manuals for In-service Training on
Collaborative TB and HIV activities, National AIDS Control Programme and National
TB and Leprosy Control Programme, The United Republic of Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 605

 CHAPTER FIVE

MODULE CODE MLT04104:

PROFESSIONAL ETHICS

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Session 1: Introduction to Ethics and Code
of Professional Conduct.
NTA LEVEL 4, SEMESTER 1, MODULE 5 - CODE: MLT04104 HEALTH ETHICS AND
PROFESSIONAL CODE OF CONDUCT.

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the following terms: Health Laboratory Practitioner, Legislation, Ethics and Code
of Conduct.
 Explain the background information of Health Laboratory Services
 Explain the background information on legislation of Health Laboratory Professionals.
 List the main components of Ethics and Code of Professional Conduct.

Resources Needed
 Flip charts, marker pens, masking tape, lap top computer, and LCD
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Definition of Terms
Background information of Health Laboratory
3 40 minutes Presentation Services and legislation of Health Laboratory
Professionals.
Presentation
Main components of Ethics and Code of
4 40 minutes Group
Professional Conduct.
Discussion
5 10 minutes Presentation Key Points
6 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (10 minutes)
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition of Terms (10 minutes)

 Select a few students to give their own versions of definitions.
 Present definitions as follows :

Teaching Guides for NTA Level 4 MLS Curriculum Page 607

 o Health Laboratory Practitioner includes a Health Laboratory Scientist, Health
Laboratory Technologist and Health Laboratory Assistant.
o Legislation: Process of making Laws.
o Ethics: The moral practices, believes and standards of individual stand or groups.
o Code of conduct: A formal statement by a group that is established and prescribed
moral and non moral standards and behaviours of the group.

Step 3: Background information of Health Laboratory Services and legal legislation of

Health Laboratory Professionals. (40 minutes)
 Medical Laboratory Services in the then Tanganyika was established in the late 19th
Century during the German administration. In 1897 the first Government Health
Laboratory was established at Ocean Road in Dar es Salaam by Dr. Robert Koch who
visited and worked in the laboratory on several occasions while investigating malaria,
sleeping sickness and other endemic disease, which were a major health problem in the
country.
 The Ocean Road Laboratory in Dar es Salaam was therefore the first site of a health
laboratory in Tanzania. Since them laboratory services continued to grow countrywide.
The Ocean Road Laboratory becomes the Central Pathology Laboratory (CPL) in early
1960s under the Ministry of Health.
 Laboratory roles are to provide relevant reports and epidemiological data that should
allow for a better surveillance, recognition of epidemic or unusual infections, control of
prevalent communicable and non communicable diseases as well as in the follow up care
of patients,
o To provide other health workers with laboratory information that will help in reaching
an early and correct diagnosis and prompt treatment or management and
o To produce and test the efficacy of laboratory supplies, drugs and vaccines.
o The current laboratory services are organised in such a way that they serve both
clinical and public health needs as follows:
 Central Pathology Laboratory (National Reference and Public Health Laboratory)
 Level III laboratory –(Group A)
 Level II laboratory –(Group B1)
 Level I laboratory -(Group B2)
 Health Centre and Dispensary –(Group C)
 Specimen collection points
 The Parliament ENACTED – two Acts as follows:
o The Private Health Laboratories Regulations Act, No. 10 of 1997
o The Health Laboratory Technologists Registration Act, No. 11 of 1997
o The Private Health Laboratories Board and Health Laboratory Technologists Council
have been established in 1998, as legal bodies responsible for the implementation of
the two Acts respectively.
o The Health Laboratory Technologists Registration Act, number 11 of 1997 was
repealed and a new Health Laboratory Practitioners Act No. 22 of 2007 has been
Enacted.
o Health Laboratory Practitioners Council has been established.
o Regulations on General Regulations, Fees charged by the Council and Ethics and
Code of professional conduct have been developed and signed by the Minister
responsible for Health.

Teaching Guides for NTA Level 4 MLS Curriculum Page 608

Step 4: Main components of Ethics and Code of Professional Conduct (40 minutes).
 Preamble
o The Health Laboratory Practitioners in Tanzania operate in a wide variety of context
ranging from public to private health facilities in clinical chemistry, haematology,
blood transfusion, histopathology, cytology, microbiology, immunology, parasitology
and medical entomology disciplines including molecular biology, as may be
applicable.
o The Health Laboratory Practitioners play an important role in the health services
delivery by providing relevant diagnostic information and epidemiological data which
allow better surveillance, recognitions of epidemics or unusual infections as wells as
communicable and non-communicable diseases, including follow up of patient’s
care;
o Whereas in the course of performing his duties, the Health Laboratory Practitioners
interacts with patients and other health care providers; the interaction assumes a noble
task requiring dedication, commitment and understanding for which medical
laboratory investigations are ordered; thus requiring them high ethical standards and
professional conduct to ensure dignity and integrity of every Health Laboratory
Practitioner in Tanzania
o The ongoing reforms, advancements in technology, emerging and re-emerging
diseases create challenges for Health Laboratory Practitioners in the delivery of
services thus requiring establishment and adherence to ethical codes and professional
conduct;
o Now therefore for the promotion and better implementation of the aforesaid
dedication, commitment and understanding, this Health Laboratory Practitioners Code
of Ethics and Conduct falls under the following main components.
 Principles such as:
- confidentiality and privacy;
- accountability;
- competence and professional advancement;
- truthfulness, fidelity loyalty;
- Personal presentation and attire:
 Special situations
- Research and Consultancy
- HIV /AIDS
- Disaster and emergency situations
- Publicity, advertisement and canvassing
- Conflict of interest
 A pledge or oath is a promise for commitment to abide to Code of Ethics and
Professional Conduct in accomplishment of professional duties.

Step 5: Key Points (10 minutes)

 Main components of Ethics and Code of Professional Conduct
o Principles of Ethics and Code of Professional Conduct
o Special situations
o Pledge or oath

Step 6: Evaluation (10 minutes)

 Define ethics, code of conduct

Teaching Guides for NTA Level 4 MLS Curriculum Page 609

 Mention main components of Ethics and Code of Professional Conduct
 ASK students if they have any comments or need clarification on any points.

References
 Mellish, J.M. and Paton, Frieda. (1999). An Introduction to the Ethics of Nursing,
Heinemenn. Capetown.
 Furrow, Dwight. (2005). Ethics: Key Concepts in Philosophy. Continuum. New York.

Teaching Guides for NTA Level 4 MLS Curriculum Page 610

Session 2: Principles of Ethics and Code of
Professional Conduct
(confidentiality and privacy, obligation to do good; accountability; self confidence;
competence and professional advancement; truthfulness, fidelity; loyalty; safety and
protection; justice; good relationship; and Personal presentation and attire).

NTA LEVEL 4, SEMESTER 1, MODULE 5 - CODE: MLT04104 HEALTH ETHICS AND

PROFESSIONAL CODE OF CONDUCT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the following terms: Confidentiality and Privacy.
 Describe Principles of Ethics and Professional Conduct for Health Laboratory
Practitioners

Resources Needed
 Flip charts, marker pens, masking tape, lap top computer, and LCD
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Definition of Terms
Principles of Ethics and Professional Conduct
3 60 minutes Presentation
for Health Laboratory Practitioners
Presentation, Relationships
4 20 minutes
Group Discussion
5 10 minutes Presentation Key Points
6 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives, and clarify.

 ASK students if they have any questions before continuing.

Step 2: Definition of Terms (10 minutes)

 Select a few students to give their own versions of definitions.
 Present definitions as follows :

Teaching Guides for NTA Level 4 MLS Curriculum Page 611

 o Confidentiality: The ethical obligation to keep someone’s personal and private
information secret or private.
o Privacy: Self ownership; the right of an individual to be free of undesirable
interaction.

Step 3: Principles of Ethics and Professional Conduct for Health Laboratory Practitioners (60
minutes)
 The Principles for ethics and code of professional conduct
o The underlining Principles for Ethics and Code of Professional conduct for health
laboratory technologists are based on the following principles:
 Obligation to do good
o The Obligation to do good and to avoid doing harm, is a human value which guides
the Health Laboratory Practitioners to act positively to safeguard and promote the
interest of the individual, client and society in general. In so doing, the Health
Laboratory Practitioner shall:
 Be constantly on guard in judgment in the face of many outside pressures that may
be exerted on him.
 Be entitled to decline to collect specimen and conduct health laboratory
investigations, which believes to be inappropriate or detrimental to the client’s
welfare.
 Refuse to condone, facilitate, allow or coordinate laboratory investigations which
are detrimental to the client’s welfare.
 Practice his profession with conscience and dignity.
 Not delegate to a person who is not a qualified health laboratory practitioner tasks
of health laboratory work.
 Take appropriate action if the workload and pressure on professional colleagues
and juniors may endanger safe standards of practice.
 Confidentiality and privacy
o Confidentiality is the principle, which refers to limitation to access to clients private
information; it is a foundation upon which a Health Laboratory Practitioner’s
relationship with a client is built and it underlies the trust and willingness of the client
that allow the Health Laboratory Practitioner to access the client’s information.
o Thus the Health Laboratory Practitioner shall
 Respect the confidential and personal nature of professional records.
 Protect the patient’s right to privacy by keeping the information in the strictest
confidence.
 Be aware that the information a patient gives to the Health Laboratory Practitioner
remains the property of the patient in that respect shall be confidential.
 Be aware that the findings, which the health laboratory practitioners obtain as a
result of laboratory investigations, remains to be confidential.
 Accountability
o Accountability and responsibility shall be based on the context that the Health
Laboratory Practitioner is ready and willing to ensure and account for any action
taken, the consequence arising and to accept fault from such action.
 Thus the Health Laboratory Practitioners shall:
- Comply with provisions of the act and other laws regulating the profession.
- Observe professional responsible for practice and adhere to standards of
practice and total quality system.

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 - Only accept requests for laboratory investigation or analysis which are
properly authorized in accordance with established or recognized criteria.
- Be accountable for his work.
- In the event that an accident is occasioned to a client in the course of
management, inform the relevant authority measures taken or to be
undertaken.
- Handle the client and any person accompanying with due courtesy and respect.
- Avoid interpersonal relationships that can impair professional judgment and
proper assessment of risks.
- Be responsible for the logical process from the acquisition of the specimens to
the production of data and the final report of the results.
- Be accountable for the quality and integrity of clinical laboratory services.
 Self confidence
o Confidence is based on the concept that a Health Laboratory Practitioner is required
to build and develop positive and realistic attitude towards himself. It further requires
a Health Laboratory Practitioner to trust his personal ability and possessing sense of
control of decisions or judgment; this involves capability to:
 Uphold and maintain the dignity and respect of the profession and strive for
maintaining a reputation of honesty, integrity and reliability.
 Hold himself out as a person who, by training and experience, is professionally
qualified to diagnosis diseases
 Competence and professional advancement;
o Perform his work within the scope of his competence and professional preparation.
o Take every reasonable opportunity to improve and sustain his knowledge, skills and
professional competence.
o Request for support when he perceives the need.
o Provide expert advice and consult other health professionals. Be dedicated to the use
of health laboratory sciences to benefit mankind.
o Exercise professional judgment, skills and care while meeting established standards
and quality systems.
o Strive for improvement of professional skills and knowledge and adopt scientific
advancement that benefits the patient and other users.
o Strive for improvement of the delivery of reliable test results.
 Truthfulness, fidelity loyalty;
o The principle of truthfulness imposes duty on the Health Laboratory
o Practitioners to be honest and truthful in the course of their practice
o The Health Laboratory Practitioner is obliged to respect the inherent trust that exists
in his relationship with the clients. It requires him to communicate truthfully and
without deception or deceit.
o In the event of adverse events to a procedure, drug, device or reagent, the Health
Laboratory Practitioner shall communicate that information to relevant authorities.
o The Health Laboratory Practitioner shall observe fidelity by keeping promises that are
made and requires not representing in a false or misleading manner.
o The Health Laboratory Practitioner shall not perform or recommend laboratory
investigation procedures that are not necessary or share fees for providing laboratory
services in a false or misleading manner.
 Safety and protection;

Teaching Guides for NTA Level 4 MLS Curriculum Page 613

 o Workers in Health (Medical) laboratories are exposed to many dangers, not only from
infected material, but also from the dangerous compounds and apparatus which they
use in their daily routine. Similarly, laboratory and equipment needs to be protected
from fire hazards. To minimize the risk of infections and accidents, certain safety
precautions must be enforced.
o These precautions should be observed by all members of the laboratory staff to
protect themselves and those who are obliged to visit the laboratory.
o In so observing, the Health Laboratory Practitioners shall:
o Follow safe working practices to ensure that patients and others are not put at risk.
o Know what to do should any accident or fire occur and how to apply emergency First
Aid.
o Use equipment and laboratory reagents correctly and avoid wastage of reagents or
other laboratory supplies.
o Properly de-contaminate all bench surfaces, wastes or re-usable materials before
disposal or re-use.
o Keep laboratory premises in clean and tidy conditions at all time.
o Display and abide by the laboratory safety rules and regulations.
 Justice
o Justice is manifested in fairness, equitableness and impartiality in what is due or
required by another person. Health care systems, including health laboratory services,
face shortages and scarcity of resources. Given the circumstances, a Health
Laboratory Practitioner shall:
o Use wisdom and judgment to ensure that the limited resources are used fairly.
o Treat all clients fairly and equitably based on needs, regardless of factors such as
economic status, religion, race, sex, tribe, age, political affiliation or physical
attributes.
 Good relationship;
o Trust and honesty are the benchmarks of the relationship between a Health Laboratory
Practitioner, clinician, client and other stakeholders. With reference to relationship
with clients and patients, it is the duty of every Health Laboratory Practitioner to:
 Inform a person with whom he has a professional contact, the nature of the
relationship.
 Respect the customs, value, spiritual beliefs and human dignity of patients.
 Respect the physical and physiological needs of patients.
 Avoid any abuse of the privilege relationship with patients.
 Promote and safeguard the well being and interests of patients.
 Refuse to accept any gift, favour or hospitality that might be interpreted as seeking
to exegete under influence to obtain preferential treatment;
 Take into consideration that clients, patients and accompanying relatives can
easily be embarrassed, ashamed or fearful in the course of collecting specimen for
laboratory investigations; thus health laboratory practitioner shall:-
- show humanity, kindness and understanding towards them;
- do his best to relieve them of hidden fears and apprehension;
- Encourage and restore confidence in the client with regard consent to
laboratory investigation.
 With regard to consent to laboratory investigations, the trust of patients and clients
that the consent to laboratory investigation will not be misused is essential in the

Teaching Guides for NTA Level 4 MLS Curriculum Page 614

 relationship with the Health Laboratory Practitioner. For Health Laboratory
Practitioner, even to touch the patient without consent is an assault. Thus:-
- Consent shall be valid only when given freely and readily if the client
understand the nature, purpose and consequences of what is proposed; and
- Assumed consent or consent obtained by undue influence is valueless. It is
thus unethical to carry out health laboratory investigation on a client or patient
if there is no direct benefit.
 With regard to colleagues:
o Every Health Laboratory Practitioner shall have a responsibility to cooperate
professionally with colleagues and other health related professionals. In so doing, a
Health Laboratory Practitioner shall:
 Regard colleagues as brothers and sisters and respect each other;
 Share knowledge, skills and experiences with colleagues;
 Avoid any action, which may be regarded as self-praise; condemning or belittling
colleagues or using derogatory language about them.
 Recognize and respect the expertise and contribution of other workers and
collaborate with them to provide the best laboratory investigation services and
care.
 Personal presentation and attire.
o At a place of work, a Health Laboratory Practitioner shall:
 Appear smart, properly and decently dressed in proper attire with identification
tags and behave in a manner becoming of professional;
 Be at all times courteous to patients and clients, and be considerate to colleagues;
and
 Do not consume alcohol or take unprescribed drugs that could interfere with his
performance during laboratory working hours or when on emergency stand-by.

Step 4: Group work on relationship (20 minutes)

 Discuss best ways of creating good relationship

Step 5: Key Points (10 minutes)

 Client right for privacy and confidentiality
 Accountability
 Safety and protection
 Good relationship

Step 6: Evaluation (5 minutes)

 Ask the students to:
o Define confidentiality and privacy.
o Mention ten principles of Ethics and Code of Professional Conduct.

 ASK students if they have any comments or need clarification on any points.

References:
 Mellish, J.M. and Paton, Frieda. (1999).An Introduction to the Ethics of Nursing,
Heinemenn. Capetown.
 Furrow, Dwight. (2005). Ethics: Key Concepts in Philosophy. Continuum. New York.

Teaching Guides for NTA Level 4 MLS Curriculum Page 615

Session 3: Principles of Ethics and Code of
Professional Conduct
(Special situations, confidentiality and privacy)

NTA LEVEL 4, SEMESTER 1, MODULE 5 - CODE: MLT04104 HEALTH ETHICS AND

PROFESSIONAL CODE OF CONDUCT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the following terms: Research, Consultancy, Disaster, Canvassing and Conflict of
Interest.
 Describe Special situations to be considered by the Health Laboratory Practitioner.
 Differentiate between confidentiality and privacy

Resources Needed
 Flip charts, marker pens, masking tape, lap top computer, and LCD
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation Definition of Terms
3 50 minutes Presentation, Special situations
Differentiate between confidentiality and
4 20 minutes Presentation,
privacy
5 15 minutes Presentation Key Points
6 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (10 minutes)
 Interact with students on previous session on importance of confidentiality and privacy in
laboratory practices
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition of the following terms: Research, Consultancy, Disaster, Canvassing

and Conflict of Interest (15 minutes)
 Research: is systematic investigation to establish facts or collect information on a
subject.
 Consultancy is the act of advising on professional matters

Teaching Guides for NTA Level 4 MLS Curriculum Page 616

 Disaster is an accident that causes great distress or destruction.
 Canvassing is to try to persuade people to vote for a particular candidate or party in an
election or advertise convincingly on where to obtain services.
 Conflict of interest is a situation in which a person has a duty to more than one person or
organization, but cannot do justice to the actual or potentially adverse interests of both
parties.

Step 3: Special situations (50 minutes)

 The ongoing reforms, advancements in technology, emerging and re-emerging diseases
create challenges for Health Laboratory Practitioners in the delivery of services thus
requiring special attention on the following special situations.
o Research and Consultancy:
 Advancement of Health Laboratory Science depends on doing research and
consultancy, which ultimately involves experimentation on human subjects.
 In the circumstances, the Health Laboratory Practitioner shall:
- Ensure protection of the welfare and rights of subjects used in research.
- Ensure that research is conducted after approval by an approved Ethical
Review Committee and only qualified persons are allowed to conduct a
research.
- Preserve dignity and privacy of research subject at all times.
- Ensure that consent to do research is obtained and observe the rights of the
subject to withdraw consent.
- Be aware of current advancements in science and technology, including
genetic engineering.
o HIV/AIDS
 In the testing and diagnosis of HIV/AIDS, the Health Laboratory Practitioner may
be faced with ethical problems associated with the natural history of the disease,
absence of cure, stigma and accompanying social economical problems.
o Thus, the Health Laboratory Practitioner shall:
 Observe confidentiality in saving human life against deliberate acts likely to infect
potential victims;
 Acquire adequate knowledge of HIV/AIDS transmission, prevention and skills on
counselling.
 Educate individuals infected with HIV/AIDS on the opportunity to agree or
decline from being research subjects and on the methods applied for scientific
research and teaching, including taking of photographs.
 Have a duty to take appropriate precautions to protect their patients and staff from
cross-infection.
o Disaster and emergency situations:
 The Health Laboratory Practitioner shall practice his profession with conscience
and dignity and the health of the clients shall be his first consideration.
 In so doing, the Health Laboratory Practitioner shall have an obligation during the
threatening emergencies to take immediate steps to ensure that necessary
investigations and tests are performed to the patients without discrimination or
undue delay.
o Publicity, advertisement and canvassing:
 Good relationship between a Health Laboratory Practitioner and colleagues is
essential for fostering teamwork in the health laboratory profession. Health

Teaching Guides for NTA Level 4 MLS Curriculum Page 617

 Laboratory Practitioner shall be aware that matters of general interest are sacred
and refrain from adopting methods aimed at advertising a particular person
institutions, test or technique.
 Subject to sub paragraph (1), a Health Laboratory Practitioner shall not:
- Advertise and sign using professional qualifications to encourage the sale of
commercial products;
- Use any professional premises to display the name of commercial product.
- Publish any article or personal photograph or otherwise indulge in any form of
self –advertisement or publicity.
- Encourage any practice, which is of a nature that invites attention to
professional position, skill, and qualification of achievements.
- Publish or cause to be published in a lay media articles likely to publicize,
advertise and canvass.
- Communicate or address to the lay public, use or permit the use of personal
professional qualification as an advertisement for the organization or the
company or be personally involved in advertising company services.
- Talk in a derogatory manner about the professional skills; knowledge,
qualification or services of another practitioner.
- Canvas purposes of obtaining whether done directly or through an agent
associated with or employed by an organization or a company.
o Conflict of interest:
 The Health Laboratory Practitioner shall abide to regulations and avoid situations,
which may create conflicts of interest including observation of the Government
Procurement Act in obtaining supplies.

Step 4: Differentiate between confidentiality and privacy (15 minutes)

 Confidentiality is the principle, which refers to access limitation to clients private
information; it is a foundation upon which a Health Laboratory Practitioner’s relationship
with a client is built and it underlies the trust and willingness of the client that allow the
Health Laboratory Practitioner to access the client’s information. This includes:
o Respect the confidential and personal nature of professional records;
o Protect the patient’s right to privacy by keeping the information in the strictest
confidence;
o be aware that the information a patient gives to the Health Laboratory Practitioner
remains the property of the patient in that respect shall be confidential; and
o be aware that the findings, which the health laboratory practitioners obtain as a result
of laboratory investigations, remains to be confidential.
o Exceptions to the principles of confidentiality whereby the confidential
information can be disclosed are:
 Where a patient gives consent to disclosure;
 The clinician or other authorized health care professional ordering laboratory
investigation on patient requests the results
 Information is required by the due legal process
 Information required, is to be shared with other Health Laboratory Practitioners
or other members of health professions given in the official clinical reports.
 Privacy
o Privacy implies to self ownership or the right of an individual to be free of
undesirable interaction. Therefore every patient or Laboratory client shall have the

Teaching Guides for NTA Level 4 MLS Curriculum Page 618

 right to respectfulness and privacy as it relates to; his / her medical care program,
Laboratory results discussion, consultation, and treatment are confidential and should
be conducted discretely.
 The difference between confidentiality and privacy lies in the fact that, whereas
confidentiality deals with person’s information, privacy deals with both personal affairs
as well as personal information.

Step 5: Key Points (15 minutes)

 Difference between privacy and confidentiality.
 Conflict of interest
 Disaster and emergency situations

Step 6: Evaluation (10 minutes)

 Ask the students to define the terms Research, Consultancy, Disaster, Canvassing and
Conflict of Interest

ASK students if they have any comments or need clarification on any points.

References:
 Mellish, J.M. and Paton, Frieda. (1999).An Introduction to the Ethics of Nursing,
Heinemenn. Capetown.
 Furrow, Dwight. (2005). Ethics: Key Concepts in Philosophy. Continuum. New York.

Teaching Guides for NTA Level 4 MLS Curriculum Page 619

Session 4: Importance of Confidentiality
and Privacy in Laboratory Practices
NTA LEVEL 4, SEMESTER 1, MODULE 5 - CODE: MLT04104 HEALTH ETHICS AND
PROFESSIONAL CODE OF CONDUCT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Explain the importance of confidentiality and privacy in laboratory practices
 Describe obligations of the Health Laboratory Practitioner in maintaining Confidentiality
and Privacy.
 Describe consequences of the Health Laboratory Practitioner for not Observing
Confidentiality and Privacy.

Resources Needed
 Flip charts, marker pens, masking tape, lap top computer, and LCD
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Importance of confidentiality and privacy in
laboratory practices
3 10 minutes Presentation, Obligations of the Health Laboratory
Practitioner in maintaining Confidentiality and
Privacy.
4 20 minutes Presentation, Consequences of the Health Laboratory
Group Discussion Practitioner for not Observing Confidentiality
and Privacy.
5 05 minutes Presentation Key Points
6 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 Interact with students on previous session on confidentiality, privacy, ethics and code of
conduct.

Remind students about areas covered on confidentiality and privacy from previous session as;
a foundation upon which a Health Laboratory Practitioner’s relationship with a client is built

Teaching Guides for NTA Level 4 MLS Curriculum Page 620

and it underlies the trust and willingness of the client that allow the Health Laboratory
Practitioner to access the client’s information.
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Importance of confidentiality and privacy in laboratory practices

 First of all according to the health laboratory practitioners Act No. 22 of 2007 definition,
a Health Laboratory Practitioners includes; Health Laboratory Scientist, Health
Laboratory Technologist and Health Laboratory Assistants and according to the
Regulations on Ethics and Code of Professional Conduct, Health Laboratory Practitioners
are required to undertake an oath as a promise for commitment to abide to Code of Ethics
and Professional Conduct in accomplishment of professional duties which include
ensuring confidentiality and privacy in laboratory practices as an important component
of the Regulations. The Health Laboratory Practitioner therefore is obliged to respect the
inherent trust that exists in his relationship with the clients. It requires the laboratory
assistant to communicate truthfully and without deception and also obtaining consent
before touching client or patient.
 It is important to take into consideration that clients, patients and accompanying relatives
can easily be embarrassed, ashamed or fearful in the course of collecting specimen for
laboratory investigations. Thus specimen collection procedures by the health laboratory
practitioner should be carried out in strict privacy and in so doing:
o Show humanity, kindness and understanding towards them;
o Do best to relieve them of hidden fears or worries.
o Encourage and restore confidence in the client with regard consent to laboratory
investigation.

Step 3: Obligations of the Health Laboratory Practitioner in maintaining

Confidentiality and Privacy (10 minutes).
 In the course of performing duties, the Health Laboratory Practitioners role require
interacts with patients, dedication, commitment and understanding laboratory
investigations ordered; high ethical standards and professional conduct to ensure dignity
and integrity of every Health Laboratory Practitioner. For the promotion and better
implementation of the aforesaid dedication, commitment and understanding, the Health
Laboratory Practitioner is obliged to abide to Ethics and Code of Professional Conduct
which includes Confidentiality and Privacy.
 Benefits if confidentiality and privacy in laboratory practices is observed:
o It creates confidence between the patients or clients and the integrity of laboratory
services.
o It creates good relationship between the patients or clients and the laboratory
practitioner
o It creates patients and clients trust that, laboratory investigation will not be misused or
even to touch the patient without consent.
o It is in compliancy with the Health Laboratory Practitioners Act and Regulation
provisions.
o It helps to maintain a name in the Health Laboratory Practitioners Register

Step 4: Consequences of the Health Laboratory Practitioner for not observing

Confidentiality and Privacy (20 minutes).

Teaching Guides for NTA Level 4 MLS Curriculum Page 621

 If confidentiality and privacy in laboratory practices is not observed:
o It is breaching the oath or committed pledge.
o The Health Laboratory practitioners will be held accountable for any action taken and
consequence arising from non observance of confidentiality and privacy in laboratory
practices.
o It is practicing against Health Laboratory Practitioners Act and Regulation provisions.
o It may lead the Health Laboratory Practitioner to face legal charges under the Health
Laboratory Practitioners Council or Court proceedings.

Step 5: Key Points (5 minutes)

 Specimen collection procedures by the health laboratory practitioner should be carried out
in strict privacy and in so doing show humanity, kindness and understanding towards
patients or clients.
 Consequences of the Health Laboratory Practitioner for not Observing Confidentiality
and Privacy

Step 6: Evaluation (5 minutes)

 Mention benefit for observing confidentiality and privacy in laboratory practices.
 Mention consequences of the Health Laboratory Practitioner for not observing
Confidentiality and Privacy.

Step 7: References:
1. The Health Laboratory Practitioners Act No. 22 of 2007
2. Mellish, J.M. and Paton, Frieda. (1999).An Introduction to the Ethics of Nursing, Heinemenn.
Capetown.
3. Furrow, Dwight. (2005). Ethics: Key Concepts in Philosophy. Continuum. New York

Teaching Guides for NTA Level 4 MLS Curriculum Page 622

Session 5: Methods of Maintaining
Confidentiality
(Protect data, give results to requester, restrict access to laboratory, keep data in safe and
follow procedure of releasing results)

NTA LEVEL 4, SEMESTER 1, MODULE 5 - CODE: MLT04104 HEALTH PROFESSIONAL

ETHICS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Explain the importance of protecting laboratory data
 Describe procedure applied in safe data keeping.
 Describe procedures of releasing laboratory results.
 Describe the importance of restricting access to the laboratory.

SESSION OVERVIEW
Step Time Activity/Method Content
1 15 minutes Presentation Introduction, Learning Objectives
2 20 minutes Presentation Importance of protecting laboratory data
3 20 minutes Presentation procedure applied in safe data keeping
4 15 minutes Presentation, Procedures of releasing laboratory results
Presentation, Group Importance of restricting access to the
5 30 minutes
Discussion laboratory
6 10 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (15 minutes)
 Interact with students on previous session on importance of confidentiality and privacy in
laboratory practices
 Remind students about areas covered on confidentiality and privacy from previous
session as; a foundation upon which a Health Laboratory Practitioner’s relationship with a
client is built and it underlies the trust and willingness of the client that allow the Health
Laboratory Practitioner to access the client’s information.

 READ or ASK students to read the learning objectives, and clarify.

 ASK students if they have any questions before continuing.

Step 2: Importance of protecting laboratory data (20 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 623

 The Health Laboratory Practitioners play an important role in the health services delivery
by providing relevant diagnostic information and epidemiological data which allow better
surveillance, recognitions of epidemics or unusual infections as well as communicable
and non-communicable diseases. Based on the aforesaid, it is crucial to ensure that this
information is well secured and retrievable whenever required by authorised persons.
o Only accept requests for laboratory investigation or analysis which are properly
authorized in accordance with established or recognized criteria.
o Be aware that the findings, which the health laboratory practitioners obtain as a result
of laboratory investigations, remain to be confidential.
o Health Laboratory Practitioners shall be responsible for the overall management of a
client’s specimen, investigation, testing and production of timely correct results data,
which includes the logical process from the acquisition of the specimens to the
production of data and the final report of test results.
o Records describe the result of what was done and must be created and retained.
o The importance of protecting laboratory data lies in the fact that the data, helps to:
 Provide relevant reports and epidemiological data that should allow for a better
surveillance, recognition of epidemic or unusual infections, control of prevalent
communicable and non communicable diseases as well as in the follow up care of
patients.
 Provide other health workers with laboratory information that will help in
reaching an early and correct diagnosis and prompt treatment or management.
 Plan for Health care intervention strategies, forecasting future laboratory supplies,
equipment, human and other resources requirements.

Step 3: Procedure applied in safe data keeping (20minutes)

 The Health Laboratory Practitioner shall observe fidelity by protecting the patient’s right
to privacy by keeping the information in the strictest confidence;
 Laboratory data should be kept in such a way that easy retrieval of all documents and
records are ensured.
 The period of retention depends on:
o Clinical needs for retrieval of patient records
o Government or accrediting requirements
o Storage capacity
o Auditing and assessment needs
 Records must be organized, secure, and easily retrievable
 Records must be traceable to performing staff and reviewing supervisor
 Records should be retained in secure, water-resistant boxes according to date, type of
record and disposal date. Forms of record keeping include:
o Paper Storage Systems, data entry on manual records must be accurate, legible,
permanent ink, and kept as follows:
 Well secured room
 Well secured cupboards or file cabinets.
 File shelves
o Electronic record-keeping provides advantages over paper systems in ease of storage,
retrieval, traceability, legibility and ensures security. However there should be
password for authorised personnel to access information or data.

Step 4: Procedures of releasing laboratory results (15 minutes).

Teaching Guides for NTA Level 4 MLS Curriculum Page 624

 Results for all basic laboratory tests should be available to the clinicians within the same
day if specimens are sent to the laboratory in good time (before eleven a.m.).
 All laboratory practitioners should adhere to assigned turn around time (TAT) in releasing
results for each type of requested test.
 Strive for improvement of the delivery of reliable test results.
 Laboratory results should be collected by clinical staff for submission to the clinicians
who requested the tests.
 Patients should never be allowed to collect their results from the laboratory.
 In the event of adverse events to a procedure, device, equipment or reagent, the Health
Laboratory Practitioner shall communicate that information to the relevant authorities.

Step 5: Importance of restricting access to the laboratory (30 minutes).

 The laboratory is a place where various specimens most of them being infectious are
received and processed. Moreover there are poisonous, explosive, and dangerous
chemicals. Also patient confidential records are kept in this place. It is there mandatory
that access to laboratory working place be restricted to laboratory staff only, so that the
following issues are enhanced:
o Safety to laymen from infectious materials and chemicals
o Safeguard patients records from unauthorized people
o Avoid disturbing Laboratory staff when conducting delicate procedures

Step 6: Key Points (10 minutes)

 Importance of protecting laboratory data
o The importance of protecting laboratory data lies in the fact that the data, helps to:
 Provide relevant reports and epidemiological data that should allow for a better
surveillance, recognition of epidemic or unusual infections, control of prevalent
communicable and non communicable diseases as well as in the follow up care of
patients.
 Provide other health workers with laboratory information that will help in
reaching an early and correct diagnosis and prompt treatment or management.
 Plan for Health care intervention strategies, forecasting future laboratory supplies,
equipment, human and other resources requirements.
o Procedures of releasing laboratory results
 Results for all basic laboratory tests should be available to the clinicians within
the same day if specimens are sent to the laboratory in good time (before eleven
a.m.).
 All laboratory practitioners should adhere to assigned Turn Around Time (TAT-
that is from the time the specimen is received in the laboratory to the time results
are released) in releasing results for each type of requested test.

 Importance of restricting access to the laboratory

o Safety to laymen from infectious materials and chemicals
o Safeguard patients records from unauthorized people
o Avoid disturbing Laboratory staff when conducting delicate procedures

Step 7: Evaluation (10 minutes)

 Explain the importance of protecting laboratory data

Teaching Guides for NTA Level 4 MLS Curriculum Page 625

 Describe procedures of releasing laboratory results.
 Describe the importance of restricting access to the laboratory

ASK students if they have any comments or need clarification on any points.

References:
 Mellish, J.M. and Paton, Frieda. (1999).An Introduction to the Ethics of Nursing,
Heinemenn. Capetown.
 Furrow, Dwight. (2005). Ethics: Key Concepts in Philosophy. Continuum. New York.

Teaching Guides for NTA Level 4 MLS Curriculum Page 626

Session 6: Methods of Maintaining Privacy
NTA LEVEL 4, SEMESTER 1, MODULE 5 - CODE: MLT04104 HEALTH PROFESSIONAL
ETHICS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Explain how to create a privacy environment
 Describe how to attend a client in privacy environment

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation How to create a privacy environment
3 40 minutes Presentation, How to attend a client in privacy environment.
4 40 minutes Role play How to create a privacy environment
5 10 minutes Presentation Key Points
6 5 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Introduction, Learning Objectives (10 minutes)
 Interact with students on previous session on Importance of protecting laboratory data,
procedure applied in safe data keeping, Procedures of releasing laboratory results and
Importance of restricting access to the laboratory
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: How to create a privacy environment (15 minutes)

 Taking into consideration that clients, patients and accompanying relatives can easily be
embarrassed, ashamed or fearful in the course of collecting specimen for laboratory
investigations, it is therefore the duty of the Hospital or Laboratory Management to make
sure that:
 There is a conducive environment for attending clients or patients within the Laboratory
premises.
 There should be a secured well ventilation room (about 2.5m x 2.5m) with:
o One table and two chairs,
o Three waste bins for disposable wastes.
o One washing sink or basin.
o Keep the door closed when attending a client or patient.

Step 3: How to attend a client or patient in privacy environment (40 minutes).

Teaching Guides for NTA Level 4 MLS Curriculum Page 627

 With reference to relationship with clients and patients, it is the duty of every Health
Laboratory Practitioner to:
o Greet and inform a client or patient being attended the nature of the relationship, type
of procedure required to be undertaken; so as to establish trust, honesty and obtain
consent.
o Respect the customs, value, spiritual beliefs and human dignity of patients;
o Respect the physical and physiological needs of patients;
o Avoid any abuse of the privilege relationship with patients;
o Promote and safeguard the well being and interests of patients;
o Refuse to accept any gift, favour or hospitality.
o Show humanity, kindness and understanding towards them;
o Do his best to relieve them of hidden fears and apprehension
o Encourage and restore confidence in the client with regard consent to laboratory
investigation.
o With regard to consent to laboratory investigations, the trust of patients and clients
that the consent to laboratory investigation will not be misused is essential in the
relationship with the Health Laboratory Practitioner. For Health Laboratory
Practitioner, even to touch the patient without consent is an assault. Thus:-
 Consent shall be valid only when given freely and readily if the client understand
the nature, purpose and consequences of what is proposed; and
 Assumed consent or consent obtained by undue influence is valueless. It is thus
unethical to carry out health laboratory investigation on a client or patient if there
is no direct benefit.

Step 4: Role play on how to create a privacy environment (40 minutes)

 The Tutor organise two pairs of students: One pair to play the role of best way of creating
privacy environment and another pair play the role of bad way of creating privacy
environment.
 In all cases let one student play a role of a patient seeking Blood analysis and another
student play the role of a Health Laboratory Practitioner attending the patient in obtaining
the blood. Other students should observe the role play and thereafter discuss and give
comments.

Step 5: Key Points (10 minutes)

 Conducive environment for attending clients or patients

Step 6: Evaluation (5 minutes)

 Mention the importance of creating a conducive environment for attending a patient or
client.
 Mention conducive features of a room for attending a client or patient should be.
 ASK students if they have any comments or need clarification on any points.

References
 Mellish, J.M. and Paton, Frieda. (1999). An Introduction to the Ethics of Nursing,
Heinemenn. Capetown.
 Furrow, Dwight. (2005). Ethics: Key Concepts in Philosophy. Continuum. New York.

Teaching Guides for NTA Level 4 MLS Curriculum Page 628

Session 7: Personal Presentation and Attire
NTA LEVEL 4, SEMESTER 1, MODULE 5 - CODE: MLT04104 HEALTH PROFESSIONAL
ETHICS

Total Session Time: 360 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the terms attire
 List elements of personal presentation and attire
 Explain the importance of personal presentation and attire
 Demonstrate personal presentation and attire

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 05 minutes Presentation Definition of terms
3 20 minutes Presentation, Elements of personal presentation and attire
4 20 minutes Presentation Importance of personal presentation and attire
Demonstrate ideal personal presentation and
5 40 minutes Role play
attire
Clinical laboratory visit to observe personal
6 120 minutes Observation
presentation and attire
7 120 minutes Discussion Clinical laboratory visit findings
8 15 minutes Presentation Key Points
9 10 minutes Presentation Evaluation

* Note that the module tutor should set additional two sessions for clinical laboratory
visits to observe personal presentations and attire (2hrs) and plenary to discuss finding
(2hrs)

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (10 minutes)
 Interact with students on previous session on confidentiality, privacy, ethics and code of
conduct.

Remind students about areas covered on confidentiality and privacy from previous session as;
a foundation upon which a Health Laboratory Practitioner’s relationship with a client is built
and it underlies the trust and willingness of the client that allow the Health Laboratory
Practitioner to access the client’s information.
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 629

Step 2: Definition of terms (5 minutes)
 Attire: Clothes especially fine or formal ones

Step 3: Elements of personal presentation and attire (20 minutes).

 At a place of work, a Health Laboratory Practitioner shall:
o Appear smart, properly and decently dressed in proper attire with identification tags
and behave in a manner becoming of professional;
o Appropriate protective clothing (White Laboratory Coat) must be worn at all times
when in the Laboratory and whenever necessary gloves should be worn. It should be
noted that the laboratory coat should be worn in the laboratory and left in the
laboratory after work.
o Footwear shall be comfortable with nonslip soles. Open ended sandals are
inappropriate as Laboratory footwear. Leather or synthetic fluid impermeable
footwear is recommended. Disposable fluid –resistant shoes covers may be worn for
jobs where splashing is anticipated.
o Be at all times courteous to patients and clients, and be considerate to colleagues; and
o Do not consume alcohol or take un prescribed drugs that could interfere with
performance during laboratory working hours or when on emergency stand-by.

Step 4: Importance of personal presentation and attire (20 minutes).

 It is important that a Health Laboratory Practitioner appear smart, properly and decently
dressed so as:
o It is a legal requirement that a Laboratory Practitioner should appear in proper attire in
a manner expected of a professional;
o To gain confidence of the patients and other laboratory clients.
o The wearing of identification tags helps the client to know the name of the
Practitioner attending him or her.
o Wearing of laboratory protective coat and shoes helps the Practitioner from
contamination and injuries.

Step 5: Demonstrate ideal personal presentation and attire (20 minutes)

 The Tutor organise two pairs of students: One pair to play the role of best way of personal
presentation and attire and another pair play the role of bad way of personal presentation
and attire.
 In all cases let one student play a role of a patient seeking Blood analysis and another
student play the role of a Health Laboratory Practitioner attending the patient in obtaining
the blood. Other students should observe the role play and thereafter discuss and give
comments.

Step 6: Clinical laboratory visit to observe personal presentation and attire (120
minutes)

Step 7: Clinical laboratory visit findings (120 minutes)

Step 8: Key Points (15 minutes)

 Importance of personal presentation and attire.
o Legal requirement how a Laboratory Practitioner should appear.

Teaching Guides for NTA Level 4 MLS Curriculum Page 630

 o Gaining confidence of the patients and other laboratory clients.
o The wearing of identification tags helps the client to know the name of the
Practitioner attending him or her.
o Protection of the Practitioner from contamination and injuries.

Step 9: Evaluation (10 minutes)

 Mention five elements of personal presentation and attire
 Explain the importance of personal presentation and attire

ASK students if they have any comments or need clarification on any points.

References
 Mellish, J.M. and Paton, Frieda. (1999). An Introduction to the Ethics of Nursing,
Heinemenn. Capetown.
 Furrow, Dwight. (2005). Ethics: Key Concepts in Philosophy. Continuum. New York.

Teaching Guides for NTA Level 4 MLS Curriculum Page 631

Session 8: Health Laboratory Guidelines in
Health Care Delivery
(National Standard Guidelines for Health Laboratory Services, National Health Laboratory
Strategic Plan )

NTA LEVEL 4, SEMESTER 1, MODULE 5 - CODE: MLT04104 HEALTH PROFESSIONAL

ETHICS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Define a guideline
 Explain the importance of health Laboratory Guidelines
 Describe main components of the National Standard Guidelines for Health Laboratory
Services
 Explain objectives and strategies of the National Health Laboratory Strategic Plan

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 05 minutes Presentation Definition of terms
3 10 minutes Presentation, Importance of health Laboratory Guidelines
Main components of the National Standard
4 35 minutes Presentation,
Guidelines for Health Laboratory Services
Objectives and Strategies of the National Health
5 35 minutes Presentation
Laboratory Strategic Plan
6 15 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (10 minutes)
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition of terms (5 minutes)

 A guideline: A principle put forward to set standards or determine a course of action.

Step 3: Importance of health Laboratory Guidelines (10 minutes)

 To maintain good quality, accessible, effective and efficient health laboratory services in
supporting the provision of Essential Health Package at all Health Care Levels

Teaching Guides for NTA Level 4 MLS Curriculum Page 632

 To be used as reference material by the district and Regional Health Management Teams
Referral Hospitals, Training Institutions and Health Laboratory Personnel in both Public
and Private Institutions
 To set management organizational structure for laboratory services.

Step 4: Main components of the National Standard Guidelines for Health Laboratory
Services (35 minutes).
 Objectives:
o To set minimum standard of physical infrastructure for health laboratories.
o To provide a guide to equipping and setting range of essential tests at each level of
laboratory services.
o To set minimum personnel requirements at all health laboratory levels.
o To set ethical code of conduct
o To set methodology standardisation.
o To develop performance assessment systems.
o To set management organizational structure for laboratory services.

 Laboratory Levels
o Health Laboratories in Mainland Tanzania are organised in the following main
levels:-
 Specimen collection point (SCP)
- Level of laboratory services at which specimens will be collected and be
transported to higher level for processing. This can be in a dispensary or
operate as an autonomous service.
 Centre and Dispensary Laboratories (Group C – Laboratories)
- This is the lowest level of health laboratory services, which is attached to a
Dispensary, Health Centre or can operate as an autonomous private health
laboratory.
 Level I laboratories (Group B2 Laboratories)
- This is the health laboratory facility, which is attached to a level I hospital or
can operate as an autonomous health laboratory. It serves as the first referral
laboratory for dispensary and Health Centre laboratories.
 Level II laboratories (Group B1 Laboratories)
- This is the health laboratory facility, which is attached to a level II hospital or
can operate as an autonomous health laboratory. It serves as a referral
laboratory for level I laboratories.
 Level III Laboratories (Group A Laboratories)
- This is the health laboratory facility which is attached to level III hospital or
can operate as an autonomous health laboratory. It serves as a referral
laboratory for level II laboratories.
- The level III laboratories can operate as:-
- Level III single purpose laboratory: This type of laboratory operates with
one discipline of the laboratory specialities (Group A2).
- Level III multipurpose laboratory. This type of laboratory operates with
two or more disciplines of the laboratory, specialities (Group A1).
 National Reference and Public Health Laboratory
- This is the top most National Reference Health Laboratory for both diagnostic
and Public Health investigations in the country.

Teaching Guides for NTA Level 4 MLS Curriculum Page 633

 Minimum Standards For Health Laboratory Premises (Refer Guidelines).
 Equipment and Supplies:
o Should have appropriate standard equipment and supplies according to the
recommended standards for each level
 Equipment Maintenance:
o Each equipment should have a regular system of planned preventive maintenance.
Also the operation and service manuals should be available.
 Environment Sanitation
 Human Resource (Refer Guidelines)
 Laboratory Safety
 Training Qualifications Of Laboratory Staff (Refer Guidelines).
 Ethics and Code of Professional Conduct
 Essential major equipment and tests at each level (Refer Guidelines).
 Essential supplies
 Management, Committees and Sub Committees at each Level (Refer Guidelines).
 Monitoring and evaluation
 Technical Practice of Health Laboratory Personnel
o All practising professional laboratory staff must be registered or licensed to render
laboratory services under the Health laboratory Technologists Council.
o All Private Health Laboratories must be Registered under the Private Health
Laboratories Board.
o There must be an internal quality control in every laboratory for every test using
acceptable standard methods and quality assurance procedures.
o It is compulsory for all laboratories to participate in all organised external quality
assessment programmes. The performance of each laboratory shall be evaluated by
the quality assurance sub-committee (Refer Guidelines).
 Inter professional links and relationship
o Health laboratory personnel should recognise and respect the expertise of other health
workers and collaborate with them in the interest of providing the best possible health
care.
o Health laboratory personnel should co-operate fully with all laboratory levels, in the
interest of providing the best possible health care for the community.
 Quality Assurance Scheme
o At the National level, there shall be a Quality Assurance Sub-Committee to oversee
that laboratories are performing at the required standard.
o The Co-ordinator for quality assurance MOHSW shall be secretary to the sub-
committee.
o At the Zonal Level there shall be the Zonal Quality Assessment Task Force which
will be required to prepare and distribute the quality assessment samples within the
zone.
o At the Regional Level there shall be a Regional Quality Assessment Team which will
receive quality assessment samples from the zonal centre and distribute within the
region.
o The Regional Health Laboratory Technologist shall be the chairperson to the team and
a member of the Regional Health Management Team.

Teaching Guides for NTA Level 4 MLS Curriculum Page 634

 o The Private Health Laboratories Board and the Health Laboratory Technologists
Council shall be responsible to set their standard targets and verifiable indicators
basing on provisions of the respective Acts and Regulations.
 Organogram for Health Laboratory services

Step 5: Objectives and Strategies of the National Health Laboratory Strategic Plan (35
minutes).
 Objective 1: Ensure equitable and Gender sensitive standardized health laboratory
services provided at all health care levels.
o Strategies
 Establish minimum standard testing capabilities at all health laboratory levels
 Strengthen supply chain management system of quality laboratory reagents and
supplies
 Ensure availability of adequate and standardised health laboratory facilities and
equipment at all levels
 Objective 2: An efficient and effective governance system for delivery of public and
private health laboratory services established.
o Strategies
 Strengthen organisation and management of the laboratory services to be
responsive for both public health and clinical laboratory functions
 Give mandate to the different levels of the Laboratory network
 Strengthen coordination and communication throughout the health sector
(MOHSW, local government, private sector) to improve quality of laboratory
services and networking.
 Strengthen Clinical, Public Health Laboratory and Forensic Pathology Services
 Objective 3: HIV and other infectious diseases at health Laboratory work places
prevented
o Strategies
 Establish sustainable and effective laboratory safety and bio-security programs
 Link Health Laboratory and mortuary workers with existing Prevention programs
 Objective 4: Improve Quality of laboratory services provided at all levels of the public
and private health laboratories
o Strategies
 Define and strengthen Health Laboratory Network at all levels
 Implement Quality Management System at all levels
 Strengthen data collection, analysis and reporting from private and public health
laboratories
 Establish and strengthen Corrective and Planned Preventive Maintenance (PPM)
for health facilities and equipment.
 Create awareness and institute health laboratory accreditation to meet national and
international standards
 Objective 5: Enhance Research, Training, Recruitment and Retention mechanism for
Laboratory and Biomedical Engineering professionals enhanced
o Strategies
 Build Laboratory Human resource capacity using pre-service training
 Build Human resource capacity using in-service training and technical assistance
 Build Biomedical Engineering Capacity
 Recruit and retain appropriate laboratory and biomedical engineering personnel

Teaching Guides for NTA Level 4 MLS Curriculum Page 635

  Health Laboratory operational research promoted

 Objective 6: Establish Quality Health laboratory services provision in both public and
private facilities
o Strategies
 Transform NHLQATC into an executive agency of the MOHSW
 Enable NHLQATC to oversee implementation of laboratory quality systems and
training to public and private health laboratories.
 NHLQATC serve as a resource centre and National Reference Laboratory for
clinical and public health laboratory services.

Step 6: Key Points (15 minutes)

 Objective on Improving the quality of laboratory services provided at all levels of the
public and private health laboratories
o Strategies
 Define and strengthen Health Laboratory Network at all levels
 Implement Quality Management System at all levels
 Strengthen data collection, analysis and reporting from private and public health
laboratories
 Establish and strengthen Corrective and Planned Preventive Maintenance (PPM)
for health facilities and equipment.
 Create awareness and institute health laboratory accreditation to meet national and
international standards

Step 7: Evaluation (10 minutes)

 Mention at least ten main components of the National Standard Guidelines for Health
Laboratory Services

ASK students if they have any comments or need clarification on any points.

References
 National Standard Guidelines for Health Laboratory Services (2003)
 National Health Laboratory Strategic Plan 2009

Teaching Guides for NTA Level 4 MLS Curriculum Page 636

Session 9: Health Laboratory Guidelines in
Health Care Delivery
(National Guidelines for Integrated Disease Surveillance and Response, National Laboratory
system to support HIV/AIDS Care and Treatment, National Laboratory Quality Assurance
Framework to support Health Care Interventions)

NTA LEVEL 4, SEMESTER 1, MODULE 5 - CODE: MLT04104 HEALTH PROFESSIONAL

ETHICS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Define terms: Surveillance, Response, Quality Assurance, Internal quality control and
External quality assessment.
 Describe the laboratory roles in Integrated Disease Surveillance and Response (IDSR)
 Mention the laboratory roles to support HIV/AIDS Care and Treatment
 Describe the main component of the Laboratory Quality Assurance Framework

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Definition of terms
Laboratory roles in Integrated Disease
3 30 minutes Presentation,
Surveillance and Response (IDSR)
Laboratory roles to support HIV/AIDS Care and
4 10 minutes Presentation
Treatment
Main components of the Laboratory Quality
5 40 minutes Presentation
Assurance Framework
6 10 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (10 minutes)
 Interact with students on previous session on personal presentation and attire
 Remind students about areas covered on Health Laboratory guidelines in health care
delivery
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition of terms (10 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 637

 Surveillance: Is being watchful or vigilant for health problem and determinants with the
intention for improvement of health of a population.
 Quality: Is the extent to which an actual performance is in conformity with pre-set
criteria or set standards for good performance.
 Quality Assurance: Planned and systematic activities to provide adequate confidence
that requirements for quality will be met (ISO) or Includes IQC, EQA, pre-analytic phase,
test standardization, post-analytic phase, management, and organization (WHO, 1992)
 Internal quality control: Internal quality control (IQC) – set of procedures for
continuously assessing laboratory work and the emergent results; immediate effect,
should actually control release of results (WHO, 1981)
 External quality assessment: is a procedure by which the entire testing process
including the quality of results generated by a particular laboratory is assessed by eternal
agency by using materials of known value but undisclosed to the participating laboratory.

Step 3: Laboratory roles in Integrated Disease Surveillance and Response (IDSR) (30
minutes).
 Integrated Disease Surveillance and Response (IDSR) is a strategy that will assist health
workers to detect and respond to disease of epidemic potential, of public health
importance, and those targeted for eradication and elimination. The information can help
health teams respond as quickly as possible to outbreaks, set priorities, plan interventions,
mobilize and allocate resources. In Tanzania the IDSR disease of priority are as follows:
o Epidemic prone diseases :
 Cholera
 Bacillary dysentery
 Plague
 Measles
 Yellow fever
 Cerebral spinal Meningitis
 Rabies / animal bite
o Diseases which are targeted for eradication / elimination
 Acute flaccid paralysis
 Neonatal tetanus
o Disease of Public Health Importance
 Diarrhoea in Children Under 5 years
 Pneumonia in Children Under 5 years
 Malaria
 Typhoid
o The Laboratory roles in the Integrated Disease Surveillance and Response
include ( Refer guidelines):
 Planning for specimen collection
 Selecting the laboratory for specimen testing
 Logistics for management
 Safety and decontamination procedures
 Storage, packaging and transport of specimens
 Specimen processing
 Timely reporting of results to the relevant authority.

o Diseases required to be reported weekly:

Teaching Guides for NTA Level 4 MLS Curriculum Page 638

  Cerebral spinal meningitis
 Cholera
 Plague
 Measles
 Yellow fever
 Rabies / animal bite
 Acute flaccid paralysis
o Diseases required to be reported monthly:
 Diarrhoea in children Under 5 years
 Pneumonia in children Under 5 years
 Malaria
 Typhoid
 Bacillary dysentery
 Neonatal tetanus

Step 4: Laboratory roles to support HIV/AIDS Care and Treatment (10 minutes)
 The National Guidelines for the care and treatment of HIV/AIDS in Tanzania outlines the
laboratory tests required to support anti-retroviral therapy within the public health
laboratory system. These tests include:
o HIV diagnosis (HIV rapid assays, ELISA, PCR)
o Disease staging and monitoring assays (CD4 count)
o Drug safety assays (haematology and clinical chemistry)
o Diagnosis of common and treatable sexually transmitted infections (syphilis) and
other opportunistic infections (TB) as required by routine standard of care
o Other tests, non- essential to the initial start of the program include viral load and drug
resistance testing, capacity for which may be developed once clinical guidelines for
the use of these assays are established and the required laboratory infrastructure is
developed.

Step 5: Main component of the Laboratory Quality Assurance Framework (40 minutes)
 Laboratory quality assurance is implemented by instituting planned and systematic
activities in order to provide adequate confidence and quality requirements.
 Key components of a laboratory QAS include:
o Internal Quality Controls (IQC).
o External Quality Assessment (EQA).
o Standardization of processes and procedures (pre-analytic, analytic and post-analytic
phases).
o Management and organization.
 Laboratory quality system is made up of 12 elements which contribute to the quality of
services of laboratories directly or indirectly. The elements of laboratory quality system
are :
o Organization
o Personnel
o Equipment
o Purchasing and Inventory
o Process control
o Documents and Records
o Information Management

Teaching Guides for NTA Level 4 MLS Curriculum Page 639

 o Occurrence Management
o Assessment
o Process Improvement
o Customer Service
o Facilities and Safety

Step 6: Key Points (10 minutes)

 The Laboratory roles in the Integrated Disease Surveillance and Response include (
Refer guidelines):
o Planning for specimen collection
o Selecting the laboratory for specimen testing
o Logistics for management
o Safety and decontamination procedures
o Storage, packaging and transport of specimens
o Specimen processing
o Timely reporting of results to the relevant authority.

 Laboratory roles to support HIV/AIDS Care and Treatment (10 minutes)

o The National Guidelines for the care and treatment of HIV/AIDS in Tanzania outlines
the laboratory tests required to support anti-retroviral therapy within the public health
laboratory system. These tests include:
 HIV diagnosis (HIV rapid assays, ELISA, PCR )
 Disease staging and monitoring assays (CD4 count)
 Drug safety assays ( haematology and clinical chemistry)
 Diagnosis of common and treatable sexually transmitted infections (syphilis) and
other opportunistic infections (TB) as required by routine standard of care
 Other tests, non- essential to the initial start of the program include viral load and
drug resistance testing, capacity for which may be developed once clinical
guidelines for the use of these assays are established and the required laboratory
infrastructure is developed.

Step 7: Evaluation (10 minutes)

 Define the terms: Surveillance, Quality, Quality Assurance, Internal quality control and
External quality assessment:

References
 National Guidelines for Integrated Disease Surveillance and Response. Ministry of Health
and Social Welfare- September, 2001.
 National Laboratory Quality Assurance Framework to support health care interventions.
Ministry of Health and Social Welfare –June, 2007.
 Operational Plan for the national health laboratory system to support HIV/AIDS care and
treatment. Ministry of Health and Social Welfare –September, 2005.

Teaching Guides for NTA Level 4 MLS Curriculum Page 640

Session 10: Use of Health Laboratory
Guidelines in Health Care Delivery
(National Health Laboratory Service Supplies List, The private health laboratories regulation
Act No. 10 -1997 and The health laboratories practitioners Act No. 22 of 2007)

NTA LEVEL 4, SEMESTER 1, MODULE 5 - CODE: MLT04104 HEALTH PROFESSIONAL

ETHICS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Define Act, Board, Private Health Laboratory, Council
 List the categories in the National Health Laboratory Service Supplies List.
 List Parts of the Private Health Laboratories Regulation Act No. 10 of 1997.
 Describe Parts of the Health Laboratories Practitioners Act No.22 of 2007.

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Definition of terms
Categories in the National Health Laboratory
3 10 minutes Presentation,
Service Supplies List.
Private health laboratories regulation Act No. 10 of
4 20 minutes presentation
1997
Health laboratories practitioners Act No. 22 of
5 50 minutes Presentation
2007
6 10 minutes Key Points
7 10 minutes Presentation Evaluation*
* 4 HOURS HAVE BEEN SET ASIDE FOR MODULE ASSESSMENT

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (10 minutes)
 Interact with students on previous session on; Integrated Disease Surveillance and
Response, National Laboratory Quality Assurance Frame work to support health care
interventions and Operational plan for the National Laboratory System to support
HIV/AIDS care and treatment.
 READ or ASK students to read the learning objectives, and clarify.
 ASK students if they have any questions before continuing.

Step 2: Meaning of terms (5 minutes)

 Act is law passed by law-making body.

Teaching Guides for NTA Level 4 MLS Curriculum Page 641

 Board means the Private Health Laboratories Board established under Part II section 4,
responsible for the registration, control, and regulation of private health laboratories.
 Private health laboratory means any health laboratory registered by the board to
provide private health laboratory services in accordance with the private health
laboratories regulation Act No. 10 of 1997.
 Council means the Health Laboratory Practitioners established under Part II Section 4 of
the health laboratories practitioners Act No. 22 of 2007

Step 3: Categories in the National Health Laboratory Service Supplies List (10
minutes).
The dramatic increase or growth in the different expertise has resulted into emergency of new
products. In order for MOHSW to ensure that the supplies received in the country do meet
the required quality, the standardised supplies list has been developed. The supplies in the list
are grouped in the following categories:
 Health Laboratory Reagents, Reagent Kits, Chemicals and Stains.
 Sterilizing Controls, Disinfectants and Antiseptics.
 Culture Media and Antimicrobial Susceptibility Discs.
 Laboratory Consumables, Apparatus and Instruments.
 Equipment and Instruments.

Step 4: Private Health Laboratories Regulation Act No. 10 of 1997 (20 minutes)
 Part I: Preliminary
o Commencement: The Act came into operation with effect from 1st December, 1997.
o Application: The Act applies to all private health laboratories, approved persons, and
to any other person engaged in the management of private health laboratory, whether
as the owner or an employee of the private health laboratory.
o Interpretation: Is the description of meaning of terms used in the Act.

 Part II: Establishment and Functions of the Board

o Establishment of the Board
o Functions of Board
o Power of Board to approve persons and set fees

 Part III: Appointment of Registrar and Management of Private Health Laboratories

o Appointment of Registrar and Assistant Registrar
o Duties of Registrar in relation to registered private health laboratories
o Registration and publication of particulars of approved persons
o Registration on management by private health laboratories
o Identification of private health laboratories

 Part IV: Registration of private health laboratories ( Refer to the Act )

 Part V : General provisions

o Inspection and search.
o Offences by approved persons.
o Regulations.
o Entitlement to practise for fees.

Teaching Guides for NTA Level 4 MLS Curriculum Page 642

Step 5: Health Laboratories Practitioners Act No. 22 of 2007 (50 minutes)
 Part I: Preliminary Provision
o Commencement: The Act came into operation with effect from 1st February, 2009.
o Application: this Act applies to Mainland Tanzania.
o Interpretation: Is the description of meaning of terms used in the Act.

 Part II: The Health Laboratory Practitioners’ Council

o Establishment of the Health Laboratory Practitioners’ Council.
o Composition of the Council
o Functions and Powers of the Council
o Committees of the Council
o Establishment of other Committees of the of the Council
o Appointment of the Registrar
o Appointment of the Deputy Registrar
o Secretariat
o Appointment and duties of a supervisors

 Part III: Registration , Enrolment and Licensing

o Eligibility for Registration
o Procedures for registration
o Provisional registration
o Full registration
o Temporary registration
o Certificate of registration
o Qualification for enrolment
o Procedures for enrolment
o Certificate of enrolment
o Eligibility for licensing
o Procedures for Licensing
o License
o Determination of applications
o Register, role and record
o Surrender of certificates to the council
o De-registration, erase and suspension
o Cancelation or Suspension of Certificates and License.
o Reinstatement
o Annual retention fees

 Part IV: Duties of Health Laboratory Practitioners

o Duties of health laboratory practitioner and licensed persons

 Part V: Complaints, Inquiries, and Appeals

o Receipt of complaint by the Registrar
o Preliminary inquiry
o Conduct of the preliminary inquiry by the Registrar
o Procedure for holding an inquiry
o Notification of the decision of the Council

Teaching Guides for NTA Level 4 MLS Curriculum Page 643

 o Appeals

 Part VI: Financial Provisions

o Funds of the Council
o Financial year of the Council
o Estimates
o Accounts and Audit
o Financial report
o Remuneration

 Part VII: Offences and Penalties

o Offence for illegal practicing.
o Offence for procurement of illegal registration, enrolment, or licensing.
o Penalty for giving false information or uttering forged documents.
o General offences.

 Part VIII: Miscellaneous provisions

o Indemnity
o Regulation

Step 6: Key points (10 minutes)

 Main parts of the Private Health Laboratories Regulation Act N0. 10 of 1997
 Offences and penalties applicable under provisions of the Health Laboratory Practitioners
Act No.22 of 2007
o Offence for illegal practicing.
o Offence for procurement of illegal registration, enrolment, or licensing.
o Penalty for giving false information or uttering forged documents.
o General offences

Step 7: Evaluation (10 minutes)

 Mention meaning of terms:
o Act,
o Board
o Council
 Mention offences and penalties applicable under provisions of the Health Laboratory
Practitioners Act No.22 of 2007

References
 National Health Laboratory Services Supplies List
 Private Health Laboratories Regulation Act No. 1997
 Health Laboratory Practitioners Act No. 22 of 2007
* Note that 6 hrs have been set aside for module continuous assessment and end of
semester examinations

Teaching Guides for NTA Level 4 MLS Curriculum Page 644

 CHAPTER SIX

MODULE CODE MLT04205:

BASIC LABORATORY
INVESTIGATIONS

Teaching Guides for NTA Level 4 MLS Curriculum Page 645

Session 1A: Module 6: Haemoglobin
Estimation
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes in teaching laboratory

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the term haemoglobin, anaemia, and whole blood.
 Mention two methods of haemoglobin estimation.
 State the purpose and principle of the haemoglobin estimation.
 Mention the materials and supplies used for haemoglobin estimation.
 Mention the sample for haemoglobin estimation (EDTA or finger prick).
 Explain the safety precautions, procedure with limitations, calculations, quality control,
results and with reference value.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 20ml beakers
 Filter paper
 Brown reagent bottle with Drabkin’s solution
 Test tubes (100 x 13 mm)
 5 ml pipette
 20L pipette
 Gauze
 Test tube rack
 Colorimeter
 Cuvettes
 Disposal bucket
 Sample Capillary or EDTA - anticoagulated venous blood
 Low and High controls
 Standard haemoglobin solution (haemiglobincyanide)

SESSION OVERVIEW
Step Time Activity/Method Content

Teaching Guides for NTA Level 4 MLS Curriculum Page 646

 1 05 minutes Presentation Introduction, Learning Objectives
2 20 minutes Presentation Definitions of terms
Buzzing
3 15 minutes Presentation Purpose and principle of the haemoglobin
cyanide method
4 20 minutes Presentation Reagents, materials, equipment and types of
sample
5 40 minutes Presentation Safety precautions, procedure with
limitations, calculations, quality control,
reporting results and reference values
6 10 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms and Buzzing (20 minutes)

Activity: Discuss definitions and buzzing

ASK the students to buzz in pairs and allow them to answer the following questions
Define the following terms
 Haemoglobin
 Anaemia
 Whole blood
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Definitions of Terms
 Haemoglobin: Is an iron containing protein in red blood cells that transports oxygen
around the body
 Anaemia: Is a reduction in the concentration in the Haemoglobin in the peripheral blood
below the normal for the age and sex of the patient
 Whole blood: Whole blood: is the red fluid composed of cells and plasma that has not
clotted or been allowed to separate.

Step 3: Purpose and principle of the haemoglobin cyanide method (15 minutes)
 Purpose:
o Haemoglobin estimation is performed to screen for anaemia, determine the level of
anaemia, and monitor the treatment of anaemia.
 Principle:
o Haemoglobin is converted into stable haemoglobin cyanide pigment using Drabkin’s
solution. The intensity of the colour of the pigment is directly proportional to the
concentration of haemoglobin in the blood sample.

Step 4: Reagent, materials, equipment, and types of sample (20 minutes)

 Reagents

Teaching Guides for NTA Level 4 MLS Curriculum Page 647

 o Drabkin’s solution which contains potassium cyanide, potassium ferricyanide, sodium
bicarbonate and distilled water.
o Standard haemoglobin solution (haemiglobincyanide)
 Materials
o Conical flask
o Gauze
o Filter paper
o Brown reagent bottle with stock Drabkin’s solution
o Test tubes (100 x 13 mm)
o 5 ml pipette
o 20L pipette
o Test tube rack
o Cuvettes
o Disposal bucket
o Pipette sucking bulb
o Rubber cork (or parafilm)
 Equipment
o Colorimeter
 Type of Sample (whole blood)
o Capillary blood
 EDTA- anticoagulated venous blood

Step 5: Safety precautions, procedure with limitations, quality control results, and
calculations (40 minutes)
 Safety Precautions
o Appropriate biosafety practices should be used when handling specimens and
reagents. Refer to the Laboratory Safety and Waste Management Module for more
detailed information.
o Procedure
o Switch on the colorimeter. Set the colorimeter to a wavelength of 540 nm. Allow the
colorimeter to warm up as you undertake the next steps.
o Arrange the test tubes in a test tube rack: one for each patient or sample to be tested,
one for the blank, and two for the control samples. Label the test tubes with the
patient’s laboratory number, B for the blank, and C1 and C2 for the control samples,
using a grease pencil.
o Dispense 5 ml of Drabkin’s solution into each test tube using a 5 ml volumetric
pipette.
o When using capillary blood, allow the blood to flow freely without excessive
squeezing. When using anticoagulated venous blood, mix the blood thoroughly. Be
careful not to introduce air bubbles.
o Wipe the outside of the pipette tip with dry cotton wool or gauze. Expel the blood into
the Drabkin’s solution in the correct test tube. Flush the pipette tip carefully five times
with the Drabkin’s solution by sucking in and releasing the Drabkin’s solution using a
pipette bulb.
o Stopper the test tube with parafilm or a rubber cork and mix by inversion. Repeat the
procedure for all the test samples.

Teaching Guides for NTA Level 4 MLS Curriculum Page 648

 o Now repeat the procedure using blood lysate of known haemoglobin concentration
(control), in duplicate. Pipette 20l of the lysate sample into the test tubes marked C1
and C2. Leave all the tubes to stand for 10 minutes.
o Pour Drabkin’s solution from the test tube marked B into a clean cuvette. Dry the
outside of the cuvette with dry cotton wool or gauze and make sure there are no air
bubbles in the solution. Place the cuvette in the cuvette chamber with the arrow facing
the light source and adjust the colorimeter to read zero absorbance (blank).
o Replace the Drabkin’s solution in the cuvette with the haeminglobincyanide solution
in the tube marked C1, followed by C2. Record the absorbance of the solutions.
Obtain the haemoglobin concentrations corresponding to the absorbance from the
prepared table of values. Check that the readings of the two controls are acceptable.
o Measure the absorbance of all the test samples. Obtain the haemoglobin
concentrations from the table of values. Record the results.
o Rinse the test tubes, specimen containers and cuvettes in running tap water in a sink.
Rinse the pipettes and cuvettes immediately with clean water followed by distilled
water and place upside down on clean gauze or tissue paper to drain and dry. Place
test tubes and rubber corks/stoppers in the bucket of 5% Lysol disinfectant marked
“TEST TUBES”. Place specimen containers in the bucket of 5% Lysol marked
“REUSABLE CONTAINERS”. Place used cotton wool, gauze or parafilm in the
bucket marked “INCINERATION”.
o Each laboratory must determine the time necessary to perform the procedure
(turnaround time).
 Limitations
o Potassium cyanide is very poisonous and must be kept locked at all times.
o Store Drabkin’s solution in a brown reagent bottle because it decomposes on exposure
to light.
o Preferably use glass cuvettes. If plastic cuvettes are used, make sure they are free
from scratches.
o The side of the cuvette with the arrow mark must face the light path.
o The volume of sample used in the procedure is critical and must be measured
accurately.
o Use the same colorimeter and cuvette type to obtain the haemoglobin concentration of
blood samples from the table of values. If the colorimeter or cuvette type changes,
prepare a new calibration curve and table of values.
 Quality control
o If the difference between the results of the two control samples is more than 0.5 g/dl,
or if the average of the two results differs by more than 0.5 g/dl from the known value
of the control sample, carry out the following procedures:
o Check the Drabkin’s solution for turbidity or fading;
o Carefully repeat the preparation of the control samples in duplicate, paying special
attention to mixing of the control sample and accurate volume measurements;
o Clean the cuvette, cuvette chamber and removable filters to remove dust particles
from the light path;
o If the results still differ from the known value by more than 0.5 g/dl, recalibrate the
colorimeter so that the control samples give the correct value and prepare a new
calibration curve and table of values.
o Obtain haeminglobincyanide standards (with known haemoglobin concentrations) in
vials.

Teaching Guides for NTA Level 4 MLS Curriculum Page 649

 Reporting results
o Report haemoglobin results in g/dl (or g/L).
o Example: Hb = 8.9 g/dl or Hb = 89g/L.
o Indicate date and name of technical staff reporting.
o (Calibration will be discussed in NTA Level 5)
 Calculation of Hb Concentration:
o Hb Concentration of Test =
Optical Density (OD) of test x Concentration of Standard
Optical Density of standard
 Reference ranges:
o Reference values for haemoglobin are:
o Men (adults) 13.0 – 18.0 g/dl
o Women (adults) 12.0 – 16.0 g/dl
o Infants, full term 13.5 – 19.5 g/dl
o Children, 1– 9 years 11.0 – 14.0 g/dl
o Children, 10 – 12 years 11.5 – 15.0 g/dl

Step 6: Key points for haemoglobin cyanide method (10 minutes)

 Haemoglobin is an iron containing protein in red blood cells that transports oxygen
around the body.
 Preferably use glass cuvettes. If plastic cuvettes are used, make sure they are free from
scratches.
 The side of the cuvette with the arrow mark must face the light path.
 The volume of samples used in the procedure is critical and must be measured accurately.

Step 7: Evaluation (10 minutes)

 Ask the students to define haemoglobin. Explain the purpose and the principle of the
haemoglobin cyanide procedure.
 Ask the students if they have any comments or need clarification of any points.

References
 Baker F.J., Silverton R.E. and Pallister P.J.(1998). Introduction to Medical Laboratory
Technology, 7th Edition, Butterworth-Heinemann, England
 Carter J, Lema O (1994). Practical Laboratory Manual for Health Centres in Eastern
Africa. AMREF.
 Dacie, Lewis (1993). Practical Haematology, 7th Edition. Longman Group UK Ltd.
 Kaplan A, Lawrence, Pesce A. J., Kazmierczak S.C. (1996). Clinical Chemistry, Theory,
Analysis, Correlation, 4th Edition, Mosby Inc., USA.
 Standard Operating Procedures Essential Laboratory Tests, (2008), The African Medical
and Research Foundation

Teaching Guides for NTA Level 4 MLS Curriculum Page 650

Session 1B: Module 6: Haemoglobin
Estimation Practical
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes performing in teaching laboratory (*60 minutes remain+
60 minutes from assignment will provide another 120 minutes of practical sessions)

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify the reagents and materials used for haemoglobin cyanide estimation.
 State the uses of each reagent and materials of haemoglobin cyanide method.
 Perform the haemoglobin cyanide method according to the SOP.
 Calculate the result according to the formula.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout including SOP of haemoglobin cyanide method
 LCD and lap top computer
 20ml beakers
 Filter paper
 Brown reagent bottle with Drabkin’s solution
 Test tubes (100 x 13 mm)
 5 ml pipette
 20L pipette
 Gauze
 Test tube rack
 Colorimeter
 Cuvettes
 Disposal bucket
 Sample Capillary or EDTA - anticoagulated venous blood
 Low and High controls
 Standard haemoglobin solution (haemiglobincyanide)

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 05 minutes Presentation Identification of reagents, materials and

Teaching Guides for NTA Level 4 MLS Curriculum Page 651

 Buzzing equipment
3 10 minutes Presentation Uses of reagents, materials and equipment
4 20 minutes Demonstration Demonstrate haemoglobin cyanide method
according to SOP.
5 60 minutes Performance Perform haemoglobin cyanide method
according to SOP
6 10 minutes Calculation Calculate the results
7 05 minutes Presentation Key Points
8 05 minutes Presentation Evaluation
*9 60 minutes Observation Observe haemoglobin cyanide determination
at hospital laboratory or practice in the
teaching laboratory
*10 60 minutes Assignment Observation in the hospital laboratory or
practice in the teaching laboratory

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identification of reagents, materials and equipment (05 minutes)

Activity: Discuss identification and buzzing (05 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions:
 Identify the reagent and materials for the determination of haemoglobin
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Identification of reagents and materials, and equipment of haemoglobin cyanide method.

o Reagent
 Brown reagent bottle with stock Drabkin’s solution
o Materials
 Conical flask
 Gauze
 Filter paper
 Test tubes (100 x 13 mm)
 5 ml pipette
 20L pipette
 Test tube rack
 Cuvettes
 Disposal bucket
 Pipette sucking bulb
 Rubber cork (or parafilm)
o Equipment
 Colorimeter

Step 3: Uses of the reagents, materials and equipment to perform the haemoglobin
determination (10 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 652

 Reagent (Drabkin’s solution)
o Haemoglobin is converted into stable haemoglobin cyanide pigment using Drabkin’s
solution. The intensity of the colour of the pigment is directly proportional to the
concentration of haemoglobin in the blood sample.
 Materials
o The use of the materials will be explained during the performance of the procedure.
 Equipment (Colorimeter)
o Measures the optical density (absorbance) of solutions.

Step 4: Demonstration haemoglobin cyanide method according to the SOP (20 minutes)
 Demonstrate the procedure for haemoglobin determination according to the SOP.

Step 5: Performance haemoglobin cyanide method (60 minutes)

 Students perform the haemoglobin cyanide procedure according to the SOP.

Step 6: Calculation of the results (10 minutes)

 Calculate Hb Concentration according to the formula
Hb Concentration of Test =
Optical Density (OD) of test x Concentration of Standard
Optical Density of standard

Step 7: Key points for haemoglobin cyanide method (05 minutes)

 The volume of samples used in the procedure is critical and must be measured accurately.

Step 8: Evaluation (05 minutes)

 Assess students’ performance of the haemoglobin cyanide method.

Step 9: Observe the haemoglobin cyanide determination at the hospital laboratory or

practice in the teaching laboratory (60 minutes)
 Observation of the haemoglobin cyanide determination at the hospital laboratory or
practice of the haemoglobin cyanide procedure in the teaching laboratory.

*This session could be scheduled during another day.

Step 10: Observation in the hospital laboratory or practice in the teaching laboratory
(60 minutes)
 More opportunity for students to observe the haemoglobin cyanide determination at the
hospital laboratory or practice the haemoglobin cyanide procedure in the teaching
laboratory.

*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 653

Session 2A: Module 6: HIV Rapid Testing
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes teaching laboratory

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the National HIV testing algorithm, antigen, antibody and ‘window period’.
 State the purpose and principle of the rapid test for HIV.
 Mention the reagents and materials used for rapid HIV tests (SD Bioline, Determine, and
Uni-Gold).
 Mention the type of samples used for HIV rapid tests.
 Explain the safety precautions, procedure with limitations, quality control and reporting
results.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 SD Bioline test kit, Determine test kit and Uni-Gold test kit
 Pre-calibrated pipettes
 Pipette tips
 Instruction manual
 Control sera – positive and negative
 Whole blood from EDTA sample or finger prick, or serum, or plasma
 Gloves
 Sharps box or container
 Disposal bucket

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 15 minutes Definitions of terms
Buzzing
3 20 minutes Presentation Purpose and principle of the HIV rapid tests
4 15 minutes Presentation Reagents, materials, and types of samples
Safety precautions, procedure with
5 45 minutes Presentation
limitations, quality control, and reporting

Teaching Guides for NTA Level 4 MLS Curriculum Page 654

 results
6 10 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms and Buzzing (15 minutes)

Activity: Discuss definitions and buzzing (05 minutes)

ASK the students to buzz in pairs and allow them to answer the following questions
 Define the terms
o National HIV testing algorithm
o Antigen
o Antibody
o Window period
 Mention three rapid HIV tests
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Definition of Terms
 National HIV testing algorithm:
o The combination and sequence of specific tests (Bioline, Determine and Uni-Gold)
used in a given strategy for HIV testing.
 Antigen
o Substance, usually a protein, on the surface of a cell or bacterium, that stimulates the
production of antibody.
 Antibody
o A protein that is produced by the immune system as a result of stimulation by antigen.
The antibody reacts with the antigen that stimulated its production.
 Window period
o The time delay between infection and the development of antibodies.
 Mention three rapid HIV tests
o SD Bioline
o Determine and
o Uni-Gold

Step 3: Purpose and principle of the HIV rapid tests (20 minutes)
 Purpose:
o The purpose of the test is to determine if a person has been exposed to HIV, the virus
that causes AIDS.
 Principle:
o An Immuno-Chromatographic Test (ICT) is used for the qualitative detection of
antibodies to HIV-1 and HIV-2 in blood. When a blood sample is added to the sample
pad it migrates through the conjugate (colouring compound) and reconstitutes and

Teaching Guides for NTA Level 4 MLS Curriculum Page 655

 mixes with the conjugate. This mixture continues to migrate through the solid phase
to the immobilised antigens at the sample window site.
o If antibodies to HIV-1 and/or HIV-2 are present in the sample, they bind to the
conjugate and to the antigen at the client window site, forming a red band. If
antibodies to HIV-1 and/or HIV-2 are absent, no red band is formed at the client
window site.
o To ensure assay validity, a procedural control bar is incorporated in the assay device.

Step 4: Reagents, materials, and types of samples (15 minutes)

 Reagents and Materials
o HIV rapid test kits
o Pre-calibrated pipettes
o Pipette tips
o Instruction manual
o Control sera – positive and negative
o Gloves
o Sharps box or container
o Disposal bucket
 Sample required
o Whole blood from EDTA sample or finger prick, or serum, or plasma depending on
type of test kit

Step 5: Safety precautions, procedure with limitations, quality control, and reporting
results (45 minutes)
 Safety Precautions
o Appropriate biosafety practices should be used when handling specimens and
reagents. Refer to the Laboratory Safety and Waste Management Module for more
detailed information.
 Procedure
o Bring reagents and specimens to room temperature (18oC to 25oC) before use.
o Take the required number of test strips or devices, allowing sufficient for controls.
o Label the strips/devices with the sample or test number.
o Carefully follow the instructions in the kit insert for performing the tests.
o Validate and interpret the results.
o Record the results in a worksheet.
o Discard all strips/devices and used droppers in the bucket marked
“INCINERATION”. If the sample is serum or plasma it must be saved and frozen for
quality assurance purposes.
o Each laboratory must determine the time necessary to perform the procedure
(turnaround time).
 For serum or plasma samples
o Apply the required volume of sample (usually 10 µL) to the pad using a micropipette.
o Wait for a minimum of 15 minutes (up to 60 minutes) and read the results.
 For whole blood (venipuncture) samples
o Apply the required volume of sample (usually 10 µL) to the pad using a micropipette.
o Wait for 1 - 3 minutes as recommended in the instruction manual, then apply one drop
of buffer to the pad.
o Wait for a minimum of 15 minutes (up to 60 minutes) and read the results.

Teaching Guides for NTA Level 4 MLS Curriculum Page 656

 For whole blood (fingerprick) samples
o Apply the required volume of sample (usually 10 µL collected in an EDTA capillary
tube) to the pad.
o Wait for a minimum of 15 minutes (up to 60 minutes) and read the results.
 Limitations
o Follow the storage instructions for each test kit. Some ICT test kits may be stored at
room temperature in a cool dry place; other kits require refrigeration.
o Check carefully the expiry dates on the test kits.
o False negatives may occur if the person is tested during the window period.
 Quality control
o To ensure the validity of each test, a procedural control line is incorporated in the
strip/device and is labeled “Control”. The control line must appear in all tests,
whether positive or negative.
o If one RED line appears in the patient window: the test is invalid and the test must be
repeated
o If no RED lines appear in the patient and control windows: the test is invalid and the
test must be repeated
 Interpretation
o Two RED lines (patient and control windows) indicate a reactive or positive result.
o One RED line (control window only) indicates a non-reactive or negative result.
 Reporting results
o Report the results as “Reactive” (Positive) or “Non-Reactive” (Negative).
o Indicate date and name of technical staff reporting.

Source: AMREF: From left to right: Reactive HIV test for SD Bioline, Non reactive results
for Determine and Uni-Gold (for sample #B373/49571)

Teaching Guides for NTA Level 4 MLS Curriculum Page 657

 Tanzania HIV Rapid Test Algorithm
Test 1 - BioLine

If the result is non-reactive If the result is reactive

Report Negative Test 2 - Determine

If the result is non-reactive If the result is reactive

Test 3 - UniGold
Report Positive

If the result is non-reactive If the result is reactive

Report Negative Report Positive

Source: MOHSW

Step 6: Key Points (10 minutes)

 Compare the controls with test sample results.
 The meaning of reactive and non-reactive results.

Step 7: Evaluation (10 minutes)

 Ask students on HIV testing algorithm.
 Ask students if they have any comments or need clarification on any points of the HIV
test procedures.

References
 Constantine Neil T, Callahan Johnny D, Watts Douglas M, (1991). HIV Testing and
Quality Control, a Guide for Laboratory Personnel. Family Health International.
 Munafu C, Guma G B, Igune M, Rwandembo M W, Olupot-Olupot P, et al (2000).
Management and Control of Diseases of Epidemic Potential in Uganda. Ministry of
Health, WHO, AMREF.
 Standard Operating Procedure Essential Laboratory Tests (2008), African Medical and
Research Foundation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 658

Session 2B: Module 6: HIV Rapid Testing
Practical
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes performing in teaching laboratory (*60 minutes remain+ 60
minutes from assignment will provide another 120 minutes of practical sessions)

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify the reagents and materials used for the rapid tests for HIV.
 State the uses of each reagent and materials of the rapid tests for HIV.
 Perform rapid tests for HIV according to the SOPs.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 SD bioline test kit, Determine test kit and Uni-Gold test kit
 Pre-calibrated pipettes
 Pipette tips
 Instruction manual
 Control sera – positive and negative
 Whole blood from EDTA sample or finger prick, or serum, or plasma
 Gloves
 Sharps box or container
 Disposal bucket

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Identification of reagents and materials
Buzzing
3 10 minutes Presentation Uses of reagents and materials
4 20 minutes Demonstration Demonstrate the rapid tests for HIV
according to the SOPs
5 60 minutes Performance Perform the rapid tests for HIV according to
the SOPs

Teaching Guides for NTA Level 4 MLS Curriculum Page 659

 6 10 minutes Presentation Key Points
7 05 minutes Presentation Evaluation
*8 60 minutes Observation Observe rapid tests for HIV at hospital
laboratory or practice in the teaching
laboratory
*9 60 minutes Assignment Observation in the hospital laboratory or
practice in the teaching laboratory

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identification of reagents and materials (10 minutes)

Activity: Discuss identification and buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions:
 Identify the reagents and materials for the rapid tests for HIV.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Identification of reagents and materials for the rapid tests for HIV.
o Reagent
 There are three rapid tests for HIV: Bioline, Determine and Uni-Gold. There is a
specific kit of reagents for each test.
o Materials
 HIV rapid test kits
 Pre-calibrated pipettes
 Pipette tips
 Instruction manual
 Control sera – positive and negative
 Gloves
 Sharps box or container
 Disposal bucket

Step 3: Uses of the reagents and materials to perform the rapid tests for HIV (10
minutes)
 Reagents
o All reagents kits are based on an Immuno-Chromatographic Test (ICT) that is used
for the qualitative detection of antibodies to HIV-1 and HIV-2 in blood.
 Materials
o The use of the materials will be explained during the performance of the procedure.

Step 4: Demonstration rapid tests for HIV according to the SOPs (20 minutes)
 Demonstrate the procedure for rapid tests for HIV according to the SOPs.

Step 5: Performance of rapid tests for HIV (60 minutes)

 Students perform rapid tests for HIV according to the SOP.

Teaching Guides for NTA Level 4 MLS Curriculum Page 660

Step 6: Key points for the rapid tests for HIV (10 minutes)
 Compare the controls with test sample results.
 The meaning of reactive and non-reactive results.

Step 7: Evaluation (05 minutes)

 Assess students’ performance of rapid tests for HIV.

Step 8: Observe rapid tests for HIV at the hospital laboratory or practice in the
teaching laboratory (60 minutes)
 Observation of rapid tests for HIV at the hospital laboratory or practice of rapid tests for
HIV in the teaching laboratory.

*This session could be scheduled during another day.

Step 9: Observation in the hospital laboratory or practice in the teaching laboratory (60
minutes)
 More opportunity for students to observe rapid tests for HIV at the hospital laboratory or
practice rapid tests for HIV in the teaching laboratory

*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 661

Session 3A: Module 6: Stool Analysis
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes in teaching laboratory

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the terms stool and motility.
 Mention three types of direct wet preparations for the examination of a stool sample.
 State the purpose and principle of the direct wet preparation and examination of a stool
sample.
 Mention the reagents, materials and equipment used for the direct preparation and
examination of a stool sample.
 Mention the types of samples to be used for the preparation and examination of stool
tests.
 Explain the safety precautions, procedure with limitations, quality control and reporting
results for the direct wet preparation and examination of a stool sample.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Physiological saline
 Glass slides
 Grease pencil/lead pencil
 Cover slips
 Applicator sticks or glass rod
 Stool containers
 Gloves
 Microscope
 Sharps box or container
 Disposal bucket
 1% eosin
 Dobell’s iodine

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives

Teaching Guides for NTA Level 4 MLS Curriculum Page 662

 2 15 minutes Presentation Definitions of terms
Buzzing Mention three direct wet preparations
3 15 minutes Presentation Purpose and principle of direct wet
preparations of stool samples
4 15 minutes Presentation Reagents, materials, equipment and types of
samples
5 50 minutes Presentation Safety precautions, procedure with
limitations, quality control, and reporting
results
6 10 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of terms and buzzing (15 minutes)

Activity: Discuss definitions and Buzzing

ASK the students to buzz in pairs and allow them to answer the following questions
 Define the terms
o Stool
o Motility
 Mention three types of direct wet preparations
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Definitions of Terms
 Stool – is a waste material excreted from the intestine.
 Motility – is the way in which a parasite or microorganism is capable of moving from one
place to another.
 Mention three types of direct wet preparations
o Direct saline preparation
o Direct iodine preparation
o Direct eosin preparation

Step 3: Purpose and principle of the direct wet preparation and examination of stool
samples (15 minutes)
 Purpose:
o A direct wet preparation of a stool sample is used to look for the presence of intestinal
protozoa and helminths microscopically. Sometimes, organisms can also be seen
macroscopically in the stool sample.
 Principle:
o A small amount of stool is mixed with a drop of physiological saline or iodine or
eosin on a slide and examined microscopically.

Step 4: Reagents, materials, and equipment (15 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 663

 Reagents and Materials
o Physiological saline
o 1% eosin
o Dobell’s iodine
o Glass slides
o Grease pencil/lead pencil
o Cover slips
o Applicator sticks or glass rod
o Stool containers
o Gloves
o Sharps box or container
o Disposal bucket
 Equipment
o Microscope
 Types of Sample
o Fresh stool samples (within 1 hour of collection) or a stool swab from children.

Step 5: Safety precautions, procedure with limitations, quality control, and reporting
results (50 minutes)
 Safety precautions
o Appropriate biosafety practices should be used when handling specimens and
reagents. Refer to Laboratory Safety and Waste Management Module for more
detailed information.
 Procedure
o Direct saline preparation
 Label the container and slides clearly with the patient's laboratory number using a
grease pencil.
 Observe the stool for colour, consistency, presence of blood, mucus, and parasites
visible to the naked eye such as segments of tapeworms and adult worms.
 Perform a microscopic examination immediately on any sample which is watery,
or contains blood or increased amounts of mucus.
 A swab taken from the anal area is mixed with saline on a slide and examined
microscopically for ova of Enterobius vermicularis.
 Place a drop of physiological saline on a clean slide. Select a portion of stool that
appears abnormal, e.g. coated with blood or mucus.
 Take a small sample with a wooden applicator stick and mix with the saline on the
slide. Put on a cover slip.
 Label the frosted end of the slide with the patient's laboratory number using a
grease pencil or a lead pencil.
 Place the slide on the microscope stage.
 Examine the preparation systematically using the x10 objective.
 Examine in more detail using the x40 objective for trophozoites and cysts of
protozoa, and ova and larvae of helminths.
 Discard the slide into a sharps container for “INCINERATION”.
 Clean the microscope lens with lens paper
 Direct 1% Eosin preparation
o If trophozoites of protozoa are seen in the direct saline preparation, place a drop of
1% eosin solution on a clean slide.

Teaching Guides for NTA Level 4 MLS Curriculum Page 664

 o Select a portion of stool that appears abnormal, e.g. coated with blood or mucus.
o Take a small sample with a small glass rod or wooden applicator stick and mix with
the eosin on the slide.
o Put on a cover slip. Label the frosted end of the slide with the patient's laboratory
number using a grease pencil or an ordinary pencil.
o Examine the smear systematically using the x10 followed by the x40 objectives for
unstained trophozoites of protozoa.
 Direct Dobell’s iodine preparation
o If cysts of protozoa are seen in the direct saline preparation, place a drop of Dobell’s
iodine on a clean slide.
o Take a small sample of stool with a wooden applicator stick and mix with the iodine
on the slide.
o Put on a cover slip. Label the frosted end of the slide with the patient's laboratory
number using a grease pencil or a lead pencil.
o Place the slide on the microscope stage, swing the x10 objective into position and
focus. Examine the smear systematically using the x10 objective for cysts of protozoa.
Examine cysts in more detail using the x40 objective.
o Place used covers lips in the sharps box or container of 5% Lysol marked "SHARPS".
Place slides in the container of 5% Lysol marked "SLIDES".
o Place capped disposable stool containers, applicator sticks and plastic Pasteur pipettes
in the bucket marked “INCINERATION”.
o Each laboratory must determine the time necessary to perform the procedure
(turnaround time).
 Limitations
o Portions of stool with blood or mucus are more likely to yield pathogenic organisms.
o Do not make the smears too thick. Smears must be thin enough to allow light to pass
through.
 Quality control
o It is essential to examine stool that is watery or contains blood or mucus immediately
to detect motile trophozoites and blood cells. If the stool is not examined
immediately, request a fresh specimen.
o Refer to a book, chart or atlas if you find structures or organisms that are not easily
identified.
 Reporting results
o Report macroscopic examination of stool: colour, form, presence of blood, mucus,
parasites, methods used for microscopic examination, cells and parasites seen.
Indicate if parasites are usually non-pathogenic.
o Example:
 Macroscopic examination: Soft brown-formed stool coated with mucus
 Direct saline preparation: No ova or cysts seen. Few pus cells and red blood cells
seen
o Indicate date and name of technical staff reporting

Egg of Hookworm Egg of Taenia

Teaching Guides for NTA Level 4 MLS Curriculum Page 665

 (Source: ASCP) (Source: CDC)

Egg of Ascaris Enterobius egg

(Source: CDC) (Source: ASCP)

Step 6: Key points (10 minutes)

 Portions of stool with blood or mucus are more likely to yield pathogenic organisms.
 Do not make the smears too thick. Smears must be thin enough to allow light to pass
through.
 Carefully observe the sample because some parasitic stages look very similar.

Step 7: Evaluation ((10 minutes)

 Ask students the definition of stool and motility. Ask students if they have any comments
or clarification on any points of the procedure.

References
 J Carter, O Lema. 1994. Practical Laboratory Manual for Health Centres in Eastern
Africa. AMREF.
 Monica Cheesbrough (1998). Part 1: District Laboratory Practice in Tropical Countries.
Tropical Health Technology, UK.
 Standard Operating Procedures Essential Laboratory Tests (2008), African Medical and
Research Foundation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 666

Session 3B: Module 6: Stool Analysis
Practical
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes performing in teaching laboratory (*60 minutes remain+
60 minutes from assignment will provide another 120 minutes of practical sessions)

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify the reagents, materials and equipment used for direct wet preparations for the
examination of stool samples.
 State the uses of each reagent, materials and equipment for direct wet preparations for the
examination of stool samples.
 Perform direct wet preparations for the examination of stool samples according to the
SOPs.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Physiological saline
 Glass slides
 Grease pencil/lead pencil
 Cover slips
 Applicator sticks or glass rod
 Stool containers
 Gloves
 Microscope
 Sharps box or container
 Disposal bucket
 1% eosin
 Dobell’s iodine

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Identification of reagents, materials and
Buzzing equipment

Teaching Guides for NTA Level 4 MLS Curriculum Page 667

 3 10 minutes Presentation Uses of reagents, materials and equipment
4 10 minutes Demonstration Demonstrate direct wet preparations for the
examination of stool samples
5 75 minutes Performance Perform direct wet preparations for the
examination of stool samples according to
the SOPs
6 05 minutes Presentation Key Points
7 05 minutes Presentation Evaluation
*8 60 minutes Observation Observe direct wet preparations for the
examination of stool samples at the hospital
laboratory or practice in the teaching
laboratory
*9 60 minutes Assignment Observation in the hospital laboratory or
practice in the teaching laboratory

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identification of reagents and materials (10 minutes)

Activity: Discuss identification and buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions:
 Identify the reagents and materials for the direct wet preparations for examination of
stool samples.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Identification of reagents, materials and equipment for the direct wet preparations for the
examination of stool samples.
o Reagents
 Physiological saline
 1% eosin
 Dobell’s iodine
o Materials
 Glass slides
 Grease pencil/lead pencil
 Cover slips
 Applicator sticks or glass rod
 Stool containers
 Gloves
 Sharps box or container
 Disposal bucket
o Equipment
 Microscope

Teaching Guides for NTA Level 4 MLS Curriculum Page 668

Step 3: Uses of the reagents, materials and equipment for the direct wet preparations
for the examination of stool samples (10 minutes)
 Reagents
o The reagents help make a suspension of the stool sample and assist in visualizing the
organisms in the stool sample.
o Materials
 The use of the materials will be explained during the performance of the procedure.
o Equipment
 A microscope is used to view parasites in the stool sample.

Step 4: Demonstration of direct wet preparations for the examination of stool samples
according to the SOP (10 minutes)
 Demonstrate direct wet preparations for the examination of stool samples according to the
SOP.

Step 5: Performance of direct wet preparations for the examination of stool samples (75
minutes)
 Students perform direct wet preparations for the examination of stool samples according
to the SOP.

Step 6: Key points of direct wet preparations for the examination of stool samples (05
minutes)
 Portions of stool with blood or mucus are more likely to yield pathogenic organisms.
 Do not make the smears too thick. Smears must be thin enough to allow light to pass
through.
 Carefully observe the sample because some parasitic stages look very similar.

Step 7: Evaluation (05 minutes)

 Assess students’ performance of direct wet preparations for the examination of stool
samples.

Step 8: Observe direct wet preparations for the examination of stool samples at the
hospital laboratory or practice in the teaching laboratory (60 minutes)
 Observation of direct wet preparations for the examination of stool samples at the hospital
laboratory or practice direct wet preparations for the examination of stool samples in the
teaching laboratory.

*This session could be scheduled during another day.

Step 9: Observation in the hospital laboratory or practice in the teaching laboratory (60
minutes)
 More opportunity for students to observe direct wet preparations for the examination of
stool samples at the hospital laboratory or practice direct wet preparations for the
examination of stool samples in the teaching laboratory.

*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 669

Session 4A: Module 6: Urine Analysis
(Physical, chemical and microscopic)

NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY

INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes in teaching laboratory

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the terms physical, chemical, microscopic, casts, crystals and amorphous salts as
applied to the examination of the urine.
 State the purpose and principle for the routine examination of urine.
 Mention the materials and equipment used for routine examination (physical, chemical
and microscopic) of urine.
 Mention the types of samples for routine examination (physical, chemical and
microscopic) of urine.
 Explain the safety precautions, procedure with limitations, quality control and reporting
results for routine examination (physical, chemical and microscopic) of urine.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Coloured atlas, diagrams, and pictures
 Urine dipsticks: commercially available – singly or in combination, for detecting pH,
protein, glucose, ketones, blood, bilirubin and urobilinogen in urine.
 Centrifuge tubes
 Glass slides
 Coverslips
 Microscope
 Centrifuge
 Grease pencil/lead pencil
 Sharps box or container
 Disposal bucket
 Test tube rack
 Gloves

SESSION OVERVIEW
Step Time Activity/Method Content

Teaching Guides for NTA Level 4 MLS Curriculum Page 670

 1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 15 minutes Definitions of terms
Buzzing
Purpose and principle of urine analysis
3 15 minutes Presentation
(physical, chemical and microscopic)
Materials, equipment and types of samples
4 15 minutes Presentation used for urine analysis (physical, chemical
and microscopic)
Safety precautions, procedure with
limitations, quality control and reporting
5 50 minutes Presentation
results for urine analysis (physical, chemical
and microscopic).
6 10 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

Step 1: Presentation of session title and learning objectives, (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of terms and buzzing (15 minutes)

Activity: Discuss definitions and Buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions
 Define the terms physical, chemical, microscopic, casts, crystals and amorphous salts as
applied to examination of the urine.
 Mention three tests found in the urine analysis.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Definitions of Terms
 Physical: macroscopic appearance of the urine; includes colour, turbidity and
presence/absence of foam.
 Chemical: determination of elements or compounds in urine using a commercially
produced reagent strip.
 Microscopic: the examination of urine sediment using a microscope.
 Casts: the result of solidification of protein within the space of the tubules in the kidney.
 Crystals: salts that precipitate out of solution when the salt concentration in urine is
greater than the solubility threshold for that salt.
 Amorphous salts: salts without shape or form. Amorphous urates are seen in acid urine
and amorphous phosphates are seen in alkaline urine.

 Mention three tests found in the analysis of urine.

o Physical, chemical and microscopic. Each test has many sub-tests.

Step 3: Purpose and principle of urine analysis (15 minutes)

 Purpose:

Teaching Guides for NTA Level 4 MLS Curriculum Page 671

 o Urine is examined to detect diseases of the kidneys and urinary tract as well as
metabolic diseases of the body, such as diabetes.
 Principle:
o Urine is observed for colour, turbidity and foam prior to chemical and microscopic
examination. It is also tested qualitatively using chemical strips for pH (potential of
hydrogen ions; measurement of acidity or alkalinity), protein (substance composed of
smaller components called amino acids), glucose (simple sugar produced by the
metabolism of carbohydrates), ketones (products of fat metabolism), blood, bilirubin
(breakdown product of hemoglobin) , and urobilinogen (breakdown product of
bilirubin). The presence of any of these substances in urine is abnormal and indicates
that the person may have kidney or other disease. Then, microscopic examination is
performed after centrifugation for cells, casts, crystals, amorphous phosphates,
bacteria, and parasites.

Step 4: Materials, equipment and types of samples used for the routine examination
(physical, chemical and microscopic) of urine (15 minutes)
 Materials
o Urine dipsticks: commercially available – singly or in combination, for detecting pH,
protein, glucose, ketones, blood, bilirubin and urobilinogen in urine
o Coloured atlas, diagrams, and pictures
o Centrifuge tubes
o Glass slides
o Coverslips
o Grease pencil/lead pencil
o Sharps box or container
o Disposal bucket
o Test tube rack
o Gloves
 Equipment
o Centrifuge
o Microscope
 Types of Samples
o Random, first morning, mid-stream or terminal urine sample.

Step 5: Explain the safety precautions, procedure with limitations, quality control and
reporting results for urine analysis (50 minutes)
 Safety precautions
o Appropriate biosafety practices should be used when handling specimens and
reagents. Refer to Laboratory Safety and Waste Management Module for more
detailed information.
 Procedure
o Label the container clearly with the patient's laboratory number using a grease pencil.
Secure the lid of the container and gently shake the urine sample. Observe the
appearance of the urine for colour, turbidity and foam. Record the findings.
o Pour about 10 ml of the urine sample into a centrifuge tube. Label the centrifuge tube
with the patient's laboratory number. Centrifuge at 3,000 rpm (medium speed) for 5
minutes. If chemical analysis is required, carefully dip the reagent strip (for pH,
protein, glucose, ketones and blood) into the supernatant, without disturbing the

Teaching Guides for NTA Level 4 MLS Curriculum Page 672

 deposit. Wait for the recommended time interval and compare the colour changes on
the reagent strip with the colour chart on the bottle. Record the results. It is not
necessary to perform chemical analysis routinely on every urine sample.
o Dip the reagent strip for bilirubin and urobilinogen into the supernatant only if
indicated. Indications include a request by the clinician, urine sample from a
jaundiced patient, the urine sample is dark brown or dark yellow, or the urine sample
produces yellow foam on shaking. Record the results.
o Decant the supernatant into the sink with running water. Resuspend the deposit by
tapping the bottom of the centrifuge tube. Transfer a small quantity of the deposit
onto a clean glass slide. Put on a coverslip. Label the slide on the frosted end with the
patient's laboratory number using a grease pencil or a lead pencil.
o Place the slide on the microscope stage. Reduce the iris diaphragm. Examine the slide
systematically using the x10 objective for cells, casts, crystals and amorphous salts
and parasites. These structures are more likely to be seen around the edges of the
coverslip. Note the presence of parasites.
o Swing the x40 objective into position. Open the iris diaphragm very slightly to allow
just enough light to provide a contrast of cells and casts against the bright
background. Cells and casts cannot be seen if a very bright light is used. Examine the
above structures in more detail.
o Count the number of white (pus) cells in 5 high power fields (hpf). Find the average
number of cells. Note the presence of casts, crystals and amorphous salts. Consult an
atlas, diagram or picture and record the results.
o In a fresh mid stream urine (MSU) sample, or in urine collected from infants into a
sterile container, count the number of pus cells in 5 high power fields (hpf). Find the
average number of pus cells per hpf and record the results. If bacteria are seen, refer
to a higher level (Health centre for a Gram stain). If yeasts or parasites are seen,
report the results (for example, Trichomonas vaginalis).
o Place coverslips in the sharps box or container of 5% Lysol marked "SHARPS". Place
slides in the container of 5% Lysol marked "SLIDES". Place test tubes in the
container of 5% Lysol marked "TEST TUBES". Empty the contents of the specimen
container into a sink with running water. Place the specimen container in the bucket
of 5% Lysol marked "REUSABLE CONTAINERS".
o Clean the microscope lens with lens paper
o Each laboratory must determine the time necessary to perform the procedure
(turnaround time).
 Limitations
o Do not consider bacteria in urine samples that have been standing for more than 6
hours at room temperature because bacteria may multiply in urine.
o Organisms and cells that may contaminate urine are T. vaginalis (in females), yeast
cells (Candida albicans) from the glans penis and vagina, squamous epithelial cells
from the vulva and vagina, ova and larvae of helminths, and adult female Enterobius
vermicularis, especially in children. The presence of these organisms and cells in
urine require further examination of the appropriate specimens.
 Quality control
o Do not use dipsticks that are beyond the expiry date. If possible, check new packs of
dipsticks with commercially prepared control strips.
o Refer to a book, chart or atlas if you find casts, crystals or other structures that are not
easily identified.

Teaching Guides for NTA Level 4 MLS Curriculum Page 673

 o As a check on the reagent strip, a glucose solution can be made and tested. This will
indicate if the strip is working properly.
o The glucose solution can be made by adding one gram of glucose to 5.0 ml of distilled
water.
 Reporting results
o Include the type of urine sample examined, appearance of the urine, chemical
composition (as determined by reagent strips) and microscopy.
o Example 1: MSU. Appearance: turbid, pale yellow; microscopy (wet preparation): pus
cells 20/hpf; epithelial cells moderate.
o Example 2: Random urine. Appearance: clear, dark yellow; pH 6; protein: negative;
glucose: negative; ketones: negative; bilirubin: positive ++; urobilinogen: increased
(30 mg/100 ml); microscopy (wet preparation): pus cells 2/hpf.
 Indicate date and name of technical staff reporting.

Multistix Urine Dipsticks for Chemical Analysis of Urine

(Source: ASCP)

Dipstick showing positive glucose reaction on top and negative reaction on bottom

(Source: ASCP)

Microscopic Examination of Urinary Sediment

Teaching Guides for NTA Level 4 MLS Curriculum Page 674

  These Epithelial cells, shown
in low power (lp), are stained
with Sternheimer-Malbin
 Cells appear pink to violet
 Smaller cell in circle is a RBC
 Rod like objects in the
squares are bacteria

(Source: ASCP)

Microscopic examination of urinary sediment

(Source: ASCP)

Step 6: Key points (10 minutes)

 List at least 5 materials used in urine analysis.
 Do not consider bacteria in urine samples that have been standing for more than 6 hours
at room temperature because bacteria may multiply in urine.

Step 7: Evaluation (10 minutes)

 Ask students to explain the urine analysis procedure.
 Ask students if they have any questions or comments for clarification on the urine
analysis procedure.

References

Teaching Guides for NTA Level 4 MLS Curriculum Page 675

 Ames (1982). Modern Urine Chemistry, application of urine chemistry and microscopic
examination in health. Miles Laboratory Inc. USA.
 Baker F.J., Silverton, R.E., Pallister, P.J.(1998). Introduction to Medical Laboratory
Technology, 7th Edition, Butterworth-Heinemann, England
 Carter J, Lema O (1994). Practical Laboratory Manual for Health Centres in Eastern
Africa, AMREF.
 Cheesbrough, Monica (1998). District Laboratory Practice in Tropical Countries, Part 1,
Tropical Health Technology, U.K.
 Varley Harold (1988). Practical Clinical Chemistry, Fourth Edition, CBS Publishers &
Distributors.
 Sitati, Vitalis Wafula (1997). A handbook of clinical chemistry for laboratory technicians.
Kenya Literature Bureau, Nairobi.
 Sebishibo Bimenya Gabriel (2000). A pocket guide to International System of Units in
Clinical Sciences.
 Kotter Dolphe (1977). Rapid clinical diagnostic tests. Urban & Schwerzenberg, Germany.
 Standard Operating Procedures Essential Laboratory Tests (2008) African Medical and
Research Foundation

Teaching Guides for NTA Level 4 MLS Curriculum Page 676

Session 4B: Module 6: Urine Analysis
Practical
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes performing in teaching laboratory (*60 minutes remain+
60 minutes from assignment will provide another 120 minutes of practical sessions)

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify the reagents and materials used for the routine examination of urine.
 State the uses of the reagents and materials for the routine examination of urine.
 Perform the routine examination of urine according to the SOP.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Coloured atlas, diagrams, and pictures
 Urine dipsticks: commercially available – singly or in combination, for detecting pH,
protein, glucose, ketones, blood, bilirubin and urobilinogen in urine.
 Centrifuge tubes
 Glass slides
 Coverslips
 Microscope
 Centrifuge
 Grease pencil/lead pencil
 Sharps box or container
 Disposal bucket
 Test tube rack
 Gloves

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation Identification of reagents, materials and
2 10 minutes
Buzzing equipment
3 10 minutes Presentation Uses of reagents, materials and equipment

Teaching Guides for NTA Level 4 MLS Curriculum Page 677

 Demonstrate the routine examination of
4 10 minutes Demonstration
urine
Perform the routine examination of urine
5 75 minutes Performance
according to the SOP
6 05 minutes Presentation Key Points
7 05 minutes Presentation Evaluation
Observe the routine examination of urine
*8 60 minutes Observation samples at the hospital laboratory or
practice in the teaching laboratory
Observation in the hospital laboratory or
*9 60 minutes Assignment
practice in the teaching laboratory

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identification of reagents and materials (10 minutes)

Activity: Discuss identification and buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions:
 Identify the reagents, materials and equipment for the routine examination of urine.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Identification of reagents, materials and equipment for the routine examination of urine.
o Reagents
 Urine dipsticks: commercially available – singly or in combination, for detecting
pH, protein, glucose, ketones, blood, bilirubin and urobilinogen in urine.
o Materials
 Centrifuge tubes
 Glass slides
 Coverslips
 Microscope
 Centrifuge
 Grease pencil/lead pencil
 Sharps box or container
 Disposal bucket
 Test tube rack
 Gloves
o Equipment
 Microscope
 Centrifuge

Step 3: Uses of the reagents, materials and equipment for the routine examination of
urine (10 minutes)
 Reagents

Teaching Guides for NTA Level 4 MLS Curriculum Page 678

 o The reagents for the chemical examination of urine are impregnated on plastic strips
or dipsticks. Each pad on the dipstick corresponds to a test that can be performed on
the urine sample. The tests include: pH, protein, glucose, ketones, blood, bilirubin,
and urobilinogen.
 Materials
o The use of the materials will be explained during the performance of the procedure.
 Equipment
o Microscope
 Used to visualize cells, casts, crystals, bacteria and parasites in the urine sample.
o Centrifuge
 Used to prepare the sediment used for microscopic observation by spinning the
urine sample at an appropriate speed.

Step 4: Demonstration of the routine examination of the urine according to SOP (10
minutes)
 Demonstrate direct wet preparations for the examination of stool samples according to the
SOP.

Step 5: Performance of the routine examination of urine (75 minutes)

 Students perform the routine examination of urine samples according to the SOP.

Step 6: Key points of the routine examination of urine (05 minutes)

 Do not consider bacteria in urine samples that have been standing for more than 6 hours
at room temperature because bacteria may multiply in urine.
 Carefully observe the sample because some components in the urine look similar.

Step 7: Evaluation (05 minutes)

 Assess students’ performance of the routine examination of urine.

Step 8: Observe the routine examination of urine samples at the hospital laboratory or
practice in the teaching laboratory (60 minutes)
 Observation of the routine examination of urine samples at the hospital laboratory or
practice the routine examination of urine samples in the teaching laboratory.

*This session could be scheduled during another day.

Step 9: Observation in the hospital laboratory or practice in the teaching laboratory (60
minutes)
 More opportunity for students to observe the routine examination of urine at the hospital
laboratory or practice the routine examination of urine in the teaching laboratory.

*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 679

Session 5A: Module 6: Blood Smear
Examination for Parasites
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes in teaching laboratory

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the term blood smear and parasite.
 Prepare a thick blood smear for the examination of parasites.
 Mention two stains used to identify parasites on a blood smear.
 State the purpose and principle of the Field and Giemsa stains.
 Mention the reagents, materials and equipment used for the blood smear examination for
parasites.
 Mention the sample used for the blood smear examination for parasites.
 Explain the safety precautions, procedure with limitations, quality control, and reporting
of results for the examination of blood smears for parasites.
 List the parasites that can be found in blood.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Coloured atlas, diagrams, or pictures
 Field Stain A and B solutions
 Stock Giemsa solution
 Buffered water (pH 7.2)
 Clean tap water
 Filter paper (Whatman No. 1)
 Staining jars
 Slide drying rack
 Cotton wool or gauze
 Slide rack
 Timer
 Gloves
 Clean glass slides
 Pipettes, wooden sticks, or capillary tubes

Teaching Guides for NTA Level 4 MLS Curriculum Page 680

 Immersion oil
 Lens paper

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation Definitions of terms
2 05 minutes
Buzzing List of blood parasites
Purpose and principle of the blood smear
3 15 minutes Presentation
examination for parasites
Reagents, materials, equipment and types of
4 10 minutes Presentation
sample
Safety precautions, procedure with limitations,
5 20 minutes Presentation
quality control, reporting results
Preparation of thick blood smear, staining
6 10 minutes Demonstration
procedure and smear examination.
Preparation of thick blood smear, staining
7 40 minutes Performance
procedure and smear examination.
8 10 minutes Presentation Key Points
9 05 minutes Presentation Evaluation
Preparation of thick blood smear, staining
Clinical practice in
10 120 minutes procedure and smear examination in hospital
hospital laboratory
laboratory.
Follow up and examination at hospital
11 60 minutes Evaluation
laboratory

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms and buzzing

Activity: Discuss definitions and Buzzing (25 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
 Define the following terms
 Blood smear
 Parasite
 List the parasites that can be found in blood.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Definition of Terms
 Blood smear: a film of blood made on a glass slide by placing a small drop of blood on
the slide
 Parasite:
o A living organism that maintains itself at the expense of the host.

Teaching Guides for NTA Level 4 MLS Curriculum Page 681

 List of blood parasites:
o Malaria
o Microfilaria
o Trypanosomes
o Leishmania

Step 3: Blood smear (for parasites)

 Purpose:
o A dried blood film is stained and examined for the presence of parasites.
 Principle:
o A thick blood film is made from a small drop of blood spread in a circle on a glass
slide and allowed to dry. Then the smear is stained, allowed to dry, and examined
microscopically for parasites. The two types of stains that may be used for the
examination of parasites on blood smears are the Field and Giemsa stains. These
stains are similar in their principles.
 Field stain
o Field is an aqueous (water based) Romanowsky stain used for staining blood
preparations. Romanowsky stains contain Eosin Y, an anionic acidic dye, and Azure
B, an ionic basic thiazine dye obtained by oxidation of methylene blue. The anionic
dye stains the basic components (cytoplasm) of cells red, and the ionic dye stains the
acid components (nucleus) of cells blue.
o When these dyes are combined in an aqueous solution, the dye complex precipitates.
Therefore Field stain is prepared as two separate aqueous solutions.
 Giemsa stain
o Giemsa stain is one of the Romanowsky stains, used for staining blood preparations.
Romanowsky stains contain Eosin Y, an anionic acidic dye, and Azure B an ionic
basic thiazine dye obtained by oxidation of methylene blue. When these dyes are
diluted in buffer, the anionic dye stains the basic components (cytoplasm) of cells red
and the ionic dye stain the acid components (nucleus) of cells blue.

Step 4: Reagents, materials, equipment and types of sample

 Reagents and Materials
o Field Stain A and B solutions
o Stock Giemsa solution
o Buffered water (pH 7.2)
o Clean tap water
o Filter paper (Whatman No. 1)
o Staining jars
o Slide drying rack
o Cotton wool or gauze
o Timer
o Gloves
o Clean glass slides
o Pipettes, wooden sticks or capillary tubes
o Immersion oil
o Lens paper
o Coloured atlas, diagram, and pictures
 Equipment

Teaching Guides for NTA Level 4 MLS Curriculum Page 682

 o Microscope
 Types of sample
o Use capillary or venous blood anticoagulated with EDTA

Step 5: Safety precautions, procedure with limitations, quality control, and reporting
results
 Safety Precautions
o Appropriate biosafety practices should be used when handling specimens and
reagents. Refer to Laboratory Safety and Waste Management Module for more
detailed information.
 Procedure
o Field stain
 Prepare a thick blood film by placing a small drop (about the size of a zero) of
fresh blood on a glass slide and spreading it in a circle until the drop is about as
big as your fingernail; leave to dry in air.
 Stain the thick blood film using the Field stain technique by dipping the slide as
follows:
 Field stain A – 4 seconds
 Tap water – 5 seconds
 Field stain B – 4 seconds
 Tap water – 5 seconds.
 Clean the back of the slide with dry gauze or cotton and place the slide upright on
the drying rack. Allow the film to dry at room temperature away from direct
sunlight and hot objects.
 Place a drop of immersion oil on the thick film. Place the slide on the microscope
stage and swing the x10 objective into position. Bring the film into focus using the
coarse adjustment. Examine the film for malaria parasites. If other large parasites
are seen, refer the slide to a higher level laboratory.
 Swing the x 100 (oil immersion) objectives into position and focus using the fine
adjustment. Examine the thick film systematically starting from the top left hand
corner (as seen down the microscope) and move from field to field. If you do not
see any parasites, continue until you have examined the whole film.
 As soon as you see any type of malaria parasite, report the result.
 Clean positive slides with cotton wool to remove the oil and save the slide for
reference. Place negative slides in the container of 5% Lysol marked "SLIDES".
 Clean the microscope lens by using lens paper.
o Giemsa stain
 Dilute 5 ml of the stock Giemsa stain with 95 ml of buffered water at pH 7.2, to
make a 5% solution.
 Prepare a thick blood film and leave to dry in air.
 Immerse the film in a staining jar containing the freshly diluted Giemsa stain for
20 minutes.
 Wash in buffered water at pH 7.2 for 3 minutes.
 Clean the back of the slide with cotton wool or gauze and place the slide upright
on the drying rack. Allow the film to dry at room temperature away from direct
sunlight and hot objects.
 Limitations
o Timing is critical because the staining process is so rapid.

Teaching Guides for NTA Level 4 MLS Curriculum Page 683

 o Keep the Field stain jars covered to avoid dust and evaporation. Filter the stains
regularly to remove dirt and scum.
o It is vital to follow the procedure for making clean blood films and to use the correct
staining methods. Do not examine dirty or very thick films. It saves time to prepare
another film.
o Each laboratory must determine the time necessary to perform the procedure
(turnaround time).
 Results
o Report the absence or presence of any malaria parasite seen. If any other parasites are
seen, refer to a higher level laboratory.
o Indicate date and name of technical staff reporting.
 Quality Control
o Prepare two blood slides:
 Stain with old stain.
 Stain with the newly prepared stain.
 Compare the staining reaction.

Step 6: Key points for the examination of a blood smear for parasites (05 minutes)
 Timing is critical because the staining process is so rapid.
 Keep the stain jars covered to avoid dust and evaporation.
 Filter the stains regularly to remove dirt and scum.
 Carefully observe the blood smear because artifacts resemble parasites.

Step 7: Evaluation (05 minutes)

 Draw and label the parts of a malaria parasite.
 Ask students if they have any questions or comments of clarification for the malaria
microscopy procedure.
Plasmodium trophozoite ring form
using a Giemsa stain
(thin film)

(Source: ASCP)

References
 Baker F.J., Silverton, R.E. and Pallister,P.J. (1998). Introduction to Medical Laboratory
Technology, 7th Edition, Butterworth-Heinemann, England
 Carter J, Lema O (1994). Practical Laboratory Manual for Health Centres in Eastern
Africa, AMREF.

Teaching Guides for NTA Level 4 MLS Curriculum Page 684

 Cheesbrough, Monica (1998). District Laboratory Practice in Tropical Countries, Part 1,
Tropical Health Technology, U.K.
 JV Dacie, SM Lewis (1991). Practical Haematology. Seventh Edition. Churchill
Livingstone.
 O’Connor Barbara H. (1984). A Color Atlas and Instruction Manual of Peripheral
Morphology, Williams and Wilkins, USA
 Simmons Arthur (1996), Haematology, a Combined Theoretical and Technical Approach,
Second Edition, Butterworth-Heinemann, Oxford, England.
 Standard Operating Procedures Essential Laboratory Tests (2008) African Medical and
Research Foundation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 685

Session 5B: Module 6: Blood Smear for
Parasites Practical
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes performing in teaching laboratory (*60 minutes remain+ 60
minutes from assignment will provide another 120 minutes of practical sessions)

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify the reagents, materials and equipment used for the examination of blood smears
for parasites.
 State the uses of the reagents, materials and equipment for the examination of blood
smears for parasites.
 Perform the examination of blood smears for parasites according to the SOP.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Coloured atlas, diagrams, or pictures
 Field Stain A and B solutions
 Clean tap water
 Filter paper (Whatman No. 1)
 Staining jars
 Slide drying rack
 Cotton wool or gauze
 Slide rack
 Timer
 Gloves
 Clean glass slides
 Pipettes, wooden sticks, or capillary tubes
 Immersion oil
 Lens paper

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives

Teaching Guides for NTA Level 4 MLS Curriculum Page 686

 Presentation Identification of reagents, materials and
2 10 minutes
Buzzing equipment
3 10 minutes Presentation Uses of reagents, materials and equipment
Demonstrate the examination of blood
4 10 minutes Demonstration
smears for parasites
Perform the examination of blood smears
5 75 minutes Performance
for parasites according to the SOP
6 05 minutes Presentation Key Points
7 05 minutes Presentation Evaluation
Observe the examination of blood smears
*8 60 minutes Observation for parasites at the hospital laboratory or
practice in the teaching laboratory
Observation in the hospital laboratory or
*9 60 minutes Assignment
practice in the teaching laboratory

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identification of reagents and materials (10 minutes)

Activity: Discuss identification and buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions:
 Identify the reagents, materials and equipment for the examination of blood smears for
parasites.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Identification of reagents, materials and equipment for the examination of blood smears
for parasites.
o Reagents
 Field stain
 Giemsa stain
o Materials
 Clean tap water
 Filter paper (Whatman No. 1)
 Staining jars
 Slide drying rack
 Cotton wool or gauze
 Timer
 Gloves
 Clean glass slides
 Pipettes, wooden sticks or capillary tubes
 Immersion oil
 Lens paper
 Coloured atlas, diagram, and pictures
o Equipment

Teaching Guides for NTA Level 4 MLS Curriculum Page 687

  Microscope

Step 3: Uses of the reagents, materials and equipment for the routine examination of
blood smears for parasites (10 minutes)
 Reagents
o Field stain
 Field solutions A and B stain blood cells and parasites so they can be more easily
seen.
o Giemsa stain
 The Giemsa solution stains blood cells and parasites so they can be more easily
seen.
 Materials
o The use of the materials will be explained during the performance of the procedure.
 Equipment
o A microscope is used to view parasites in the stool sample.

Step 4: Demonstration of the examination of blood smears for parasites according to the
SOPs (10 minutes)
 Demonstrate direct wet preparations for the examination blood smears for parasites
according to the SOPs.

Step 5: Performance of the examination of blood smears for parasites (75 minutes)
 Students perform the examination of blood smears for parasites according to the SOPs.

Step 6: Key points for the examination of blood smears for parasites (05 minutes)
 Timing is critical because the staining process is so rapid.
 Keep the stain jars covered to avoid dust and evaporation.
 Filter the stains regularly to remove dirt and scum.
 Carefully observe the blood smear because artifacts resemble parasites.

Step 7: Evaluation (05 minutes)

 Assess students’ performance of the examination of blood smears for parasites.

Step 8: Observe the examination of blood smears for parasites at the hospital laboratory
or practice in the teaching laboratory (60 minutes)
 Observation of the examination of blood smears for parasitess at the hospital laboratory
or practice the examination of blood smears for parasites in the teaching laboratory.

*This session could be scheduled during another day.

Step 9: Observation in the hospital laboratory or practice in the teaching laboratory (60
minutes)
 More opportunity for students to observe the examination of blood smears for parasites at
the hospital laboratory or practice the examination of blood smears for parasites in the
teaching laboratory.

*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 688

Session 6A: Module 6: Ziehl Neelsen
Stain for Examination of Sputum for
Mycobacterium
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes in teaching laboratory

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the term Mycobacterium tuberculosis, sputum, and acid fast bacilli (AFB).
 State the purpose and principle of the Ziehl Neelsen stain for the examination of sputum
for M. tuberculosis.
 Mention the reagents, materials and equipment used for the the Ziehl Neelsen stain for
examination of sputum for M. tuberculosis.
 Explain the safety precautions, procedure with limitations, quality control, and reporting
results for the Ziehl Neelsen stain for the examination of sputum for M. tuberculosis.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Microscope
 Spirit lamp with absolute alcohol or Bunsen burner
 Pasteur pipette
 Beaker
 New glass slides
 Forceps
 Slide boxes
 Applicator stick or wire loop
 Prepared Ziehl Neelsen stain
 70% methanol
 Sand
 Immersion oil
 Cotton wool or gauze
 Disposal bucket
 Grease pencil

Teaching Guides for NTA Level 4 MLS Curriculum Page 689

 Diamond pencil or lead pencil
 Gloves
 Fume cupboard
 Lens paper
 Staining bridge
 Coloured atlas, diagrams, or pictures

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 10 minutes Definitions of terms
Buzzing
Purpose and principle of the Ziehl Neelsen
3 25 minutes Presentation stain for the examination of sputum for M.
tuberculosis
Reagents, materials, equipment and types
4 10 minutes Presentation
of sample
Safety precautions, procedure with
5 50 minutes Presentation limitations, quality control, reporting
results
6 10 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms and buzzing (10 minutes)

Activity: Discuss definitions and Buzzing (05 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
 Define the following terms
 Mycobacterium tuberculosis
 Sputum
 AFB (acid fast bacilli)
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Definition of Terms
 Mycobacterium tuberculosis (M. tuberculosis)
o M. tuberculosis is the microorganism that causes the upper respiratory disease called
pulmonary tuberculosis.
o Sputum is a fluid substance mixed with saliva and mucous brought up from the lungs
and airway when a person coughs or spits.
 AFB (acid fast bacilli)

Teaching Guides for NTA Level 4 MLS Curriculum Page 690

 o Microorganisms that are resistant to decolorization with acid during the staining
process are called “acid fast”

Step 3: Purpose and principle of the Ziehl Neelsen stain for the examination of sputum
for M. tuberculosis (25 minutes)

 Purpose:
o Sputum is examined microscopically to diagnose new cases, monitor progress of
disease, and assess effectiveness of treatment of Mycobacterium tuberculosis.
 Principle:
o Sputum is stained with Ziehl Neelsen stain and examined microscopically for the
presence or absence of Mycobacterium tuberculosis.

Step 4: Reagents, materials, equipment and types of specimen (10 minutes)

 Reagents and Materials
o Spirit lamp with absolute alcohol or Bunsen burner
o Pasteur pipette
o Beaker
o New glass slides
o Forceps
o Slide boxes
o Applicator stick or wire loop
o Prepared Ziehl Neelsen stain
o 70% methanol
o Sand
o Immersion oil
o Cotton wool or gauze
o Disposal bucket
o Grease pencil
o Diamond pencil or lead pencil
o Gloves
o Lens paper
o Staining bridge
o Coloured atlas, diagrams, or pictures
 Equipment
o Microscope
o Fume cupboard
 Types of specimen
o Sputum samples collected at three different periods of time.

Step 5: Safety precautions, procedure with limitations, quality control, and reporting
results (50 minutes)
 Safety Precautions
o Appropriate biosafety practices should be used when handling specimens and
reagents. Refer to Laboratory Safety and Waste Management Module for more
detailed information.
 Procedure

Teaching Guides for NTA Level 4 MLS Curriculum Page 691

 o Label the sputum container with the patient's laboratory number using a grease pencil.
Observe and report the appearance of the sputum specimen. If the sample is saliva
(watery), ask for another specimen. Sputum may appear white or yellow: this
indicates the presence of large numbers of white cells (neutrophils, eosinophils).
Green/yellow sputum indicates the presence of pus. Sputum containing pus is
described as "purulent" or "mucopurulent". Purulent sputum may have an unpleasant
odour. Sputum containing blood is described as "blood-stained". Occasionally sputum
specimens may contain frank blood.
o Clean a scratch-free new glass slide using gauze or dry cotton wool. Label the frosted
end of the slide with the patient's laboratory number and sequence of the sputum
sample (x1, x2, x3), using a diamond pencil or an ordinary pencil. Place 50 ml of 5%
Lysol in a beaker or on the bench.
o Care: Steps 3-5 must be carried out at arm's length behind a Bunsen flame or fume
cupboard. Hold the sputum container at arm’s length and open the container.
o Select a portion of sputum that appears abnormal, e.g. thick, blood-stained, or
containing pus. Pick up the sputum using an applicator stick or wire loop and replace
the cap firmly on the sputum container. Spread the sputum in the middle of the slide
to a size of 20 x 10 mm using a rotational movement. The smear should be neither too
thick nor too thin – the smear is of correct thickness if newsprint or the hands of a
watch is seen through it. Allow the smear to air dry completely. Do not dry the smear
in direct sunlight or over a flame.
o Discard the applicator stick into the bucket marked “INCINERATION”; always use a
separate applicator stick for each specimen. If using a wire loop, move the wire loop
in sand/70% methanol up and down to remove excess sputum, then heat in a spirit
lamp or Bunsen flame until red-hot.
o Fix the smear by passing over a flame 2-3 times, smear uppermost. Place the smear on
a staining rack over the staining sink. Flood the smear with strong carbol fuchsin.
Heat the underneath of smear (with a burning cotton swab soaked in alcohol) until
vapour rises, but do not allow to boil or dry. Keep the stain hot for 10 minutes.
o Rinse the smear with a thin stream of clean water over a sink or basin. Cover the
smear with 3% acid alcohol or 25% sulphuric acid and leave for about 3 minutes.
Rinse the smear with water. If the smear turns red, re-apply the acid and leave for a
further 2 minutes. The smear is properly decolorized when it appears pale pink after
rinsing with water.
o Counter stain by covering the smear with 0.3% methylene blue. Leave for not more
than 1 minute.
o Wash the smear in a thin stream of clean water. Place the slide upright on the drying
rack and allow to drain dry at room temperature.
o Place a drop of immersion oil on the smear. Place the slide on the microscope stage,
swing the x10 objective into position and focus. Swing the xl00 objective into
position and examine the smear systematically. M. tuberculosis appears as thin red
rods (AFB) singly, in a row, or in small clumps. Other bacteria and cells stain blue.
o As soon as AFB are seen, record the findings and report the result as “AFB seen”.
o All slides, positive and negative, must be saved.
o Discard disposable sputum containers in the bucket marked “INCINERATION”.
Remove oil from slides using cotton wool soaked in xylene and keep all slides for
reference.
o Clean the microscope lens with lens paper.

Teaching Guides for NTA Level 4 MLS Curriculum Page 692

 o Each laboratory must determine the time necessary to perform the procedure
(turnaround time).
 Limitations
o Do not recycle slides used for examination of mycobacteria as the mycobacteria may
remain on the slides and retain their staining properties after cleaning, leading to a
false positive result.
o Do not use scratched slides because carbol fuchsin can be trapped in the scratches
leading to a false positive result.
o Do not use a grease pencil for labeling as the grease will melt during heating and
wash off.
 Quality control
o Refer to a book, chart or atlas if you find structures that are not easily identified.
o Store stained positive slides for checking by a visiting supervisor.
o Send positive stained slides to a reference laboratory for an expert opinion.
 Reporting results
o Report the results of the three sputum samples separately. Report the appearance of
sputum, method used, and presence or absence of AFB.
o Example: Appearance: Blood stained purulent sputum
o ZN stain: AFB seen

o Indicate date and name of technical staff reporting.

Step 6: Key points of the Ziehl Neelsen stain for the examination of a sputum smear for
M. tuberculosis (10 minutes)
 The principle of the Ziehl Neelsen stain.
 Don’t confuse Mycobacterium with artifacts.

Step 7: Evaluation (10 minutes)

 Ask the students if they have any questions or comments for clarification on the
procedure.

General Characteristics

 “Acid fast”
 Ziehl Neelsen stain
 Resist decolorization
by acid alcohol
 Red bacilli against blue
background
 Distinguishes
Mycobacteria Photo courtesy of CDC public image library
Content provider Dr. George P. Kubica
from other genera

Teaching Guides for NTA Level 4 MLS Curriculum Page 693

 (Source: ASCP)

References
 CDC, WHO, USAID, APHL, RIT. Acid-Fast Direct Smear Microscopy. Current
Laboratory Practice Series. 2006.
 Aziz Abel Mohamed, Ba Fatoumata, et al. (2002). External Quality Assessment for AFB
smear microscopy. Association of Public Health Laboratories and CDC.
 Baker F.J., Silverton, R.E., Pallister P.J.,(1998), Introduction to Medical Laboratory
technology, 7th Edition, Butterworth-Heinemann, England

Teaching Guides for NTA Level 4 MLS Curriculum Page 694

Session 6B: Module 6: Ziehl Neelsen
Stain for Examination of Sputum for
Mycobacterium Practical
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes performing in teaching laboratory (*60 minutes remain+
60 minutes from assignment will provide another 120 minutes of practical sessions)

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify the reagents, materials and equipment used for the Ziehl Neelsen stain for the
examination of the sputum for Mycobacterium.
 State the uses of the reagents, materials and equipment for the Ziehl Neelsen stain for the
examination of sputum smears for Mycobacterium.
 Perform the Ziehl Neelsen stain for the examination of sputum smears for Mycobacterium
according to the SOP.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Microscope
 Spirit lamp with absolute alcohol or Bunsen burner
 Pasteur pipette
 Beaker
 New glass slides
 Forceps
 Slide boxes
 Applicator stick or wire loop
 Prepared Ziehl Neelsen stain
 70% methanol
 Sand
 Immersion oil
 Cotton wool or gauze
 Disposal bucket
 Grease pencil
 Diamond pencil or lead pencil

Teaching Guides for NTA Level 4 MLS Curriculum Page 695

 Gloves
 Fume cupboard
 Lens paper
 Staining bridge
 Coloured atlas, diagrams, or pictures

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation Identification of reagents, materials and
2 05 minutes
Buzzing equipment
3 10 minutes Presentation Uses of reagents, materials and equipment
Demonstrate the ZN stain for the
4 15 minutes Demonstration examination of sputum for Mycobacterium
according to SOP
Perform the ZN stain for the examination of
5 75 minutes Performance sputum for Mycobacterium according to
SOP
6 05 minutes Presentation Key Points
7 05 minutes Presentation Evaluation
Observe the ZN stain for the examination of
sputum for Mycobacterium in the hospital
*8 60 minutes Observation
laboratory or practice in the teaching
laboratory
Observation in the hospital laboratory or
*9 60 minutes Assignment
practice in the teaching laboratory

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identification of reagents and materials (10 minutes)

Activity: Discuss identification and buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions:
 Identify the reagents, materials and equipment for the examination of sputum for
Mycobacterium.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Identification of reagents, materials and equipment for the examination of blood smears
for parasites.
o Reagent
 Ziehl Neelsen (ZN) stain is used in this procedure
o Materials
 Clean tap water
 Filter paper (Whatman No. 1)

Teaching Guides for NTA Level 4 MLS Curriculum Page 696

  Staining jars
 Slide drying rack
 Cotton wool or gauze
 Timer
 Gloves
 Clean glass slides
 Pipettes, wooden sticks or capillary tubes
 Immersion oil
 Lens paper
 Coloured atlas, diagram, and pictures
o Equipment
 Microscope

Step 3: Uses of the reagents, materials and equipment for performing the Ziehl Neelsen
stain for the examination of sputum for Mycobacterium (10 minutes)
 Reagents
o The ZN stain contains carbol fuchsin, 0.1% methylene blue, and 20% sulphuric acid.
Carbol fuchsin stains all bacteria red. Then, the sulphuric acid decolorizers all bacteria
except Mycobacterium. The methylene blue is a counterstain.
 Materials
o The use of the materials will be explained during the performance of the procedure.
 Equipment
o A microscope is used to view Mycobacterium in sputum samples.

Step 4: Demonstration of the examination of sputum for Mycobacterium according to

the SOPs (15 minutes)
 Demonstrate of the ZN stain for the examination of sputum for Mycobacterium according
to the SOP.

Step 5: Performance of the examination of sputum for Mycobacterium (70 minutes)

 Students perform the examination of sputum for Mycobacterium according to the SOPs.

Step 6: Key points for the examination of sputum for Mycobacterium (05 minutes)
 The principle of the Ziehl Neelsen stain.
 Don’t confuse Mycobacterium with artifacts.

Step 7: Evaluation (05 minutes)

 Assess students’ performance of the Ziehl Neelsen stain for the examination of sputum
for Mycobacterium.

Step 8: Observe the examination of sputum for Mycobacterium at the hospital

laboratory or practice in the teaching laboratory (60 minutes)
 Observation of the examination of blood smears for parasitess at the hospital laboratory
or practice the examination of blood smears for parasites in the teaching laboratory.

*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 697

Step 9: Observation in the hospital laboratory or practice in the teaching laboratory (60
minutes)
 More opportunity for students to observe the examination of blood smears for parasites at
the hospital laboratory or practice the examination of blood smears for parasites in the
teaching laboratory.
*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 698

Session 7A: Module 6: Pregnancy Test
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes in teaching laboratory

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the terms human chorionic gonadotropin hormone (HCG), pregnancy test, antigen,
and antibody.
 State the purpose and principle of the rapid test for pregnancy.
 Mention the reagents and materials used for the rapid test for pregnancy.
 Mention the sample for the rapid test for pregnancy.
 Explain the safety precautions, procedure with limitations, quality control, and reporting
results.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Disposal bucket
 Pipettes
 Test kit reagents

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 15 minutes Definitions of terms
Buzzing
Purpose and principle of the rapid test for
3 15 minutes Presentation
pregnancy
Reagents, materials and types of sample for
4 15 minutes Presentation
the rapid test for pregnancy
Safety precautions, procedure with
5 30 minutes Presentation limitations, quality control, and reporting
results for the rapid test for pregnancy
6 10 minutes Presentation Key Points
7 30 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 699

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms and buzzing

Activity: Discuss definitions and Buzzing (15 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
 Define the following terms
 Human chorionic gonadotropin hormone (HCG)
 Pregnancy test
 Antigen
 Antibody
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Definition of Terms
 Human chorionic gonadotropin hormone (HCG)
o HCG is produced by the chorionic membrane of the placenta shortly after
implantation of the fertilized ovum in the uterine wall. Levels in urine rise and can be
detected within a few days of the first missed period. Levels continue to rise after 2-3
months, and then stabilise.
 Pregnancy test
o An excellent marker to confirm early pregnancy, and may be useful in the following
circumstances:
 Investigation of suspected ectopic pregnancy
 Investigation of threatened abortion or malignancy (hydatidiform mole or
choriocarcinoma)
 Confirming pregnancy in a woman of child-bearing age prior to surgical
investigation, X-ray or drug treatment that could harm the embryo
 Using ARV therapy: starting treatment or changing to another drug regimen
 Antigen
o Substance, usually a protein, on the surface of a cell or bacterium that stimulates the
production of antibody.
 Antibody
o A protein which is produced by the immune system as a result of stimulation by
antigen. The antibody reacts with the antigen that stimulated its production.

Step 3: Purpose and principle of the rapid test for pregnancy (15 minutes)
 Purpose:
o A pregnancy test is an excellent test to confirm early pregnancy and may also be
useful to investigate suspected ectopic pregnancy, threatened abortion, malignancy,
and to monitor treatment regimens in ARV (antiretroviral) therapy.
 Principle:
o Latex particles coated with monoclonal antibodies react with human chorionic
gonadotropin (HCG) in urine to give macroscopic agglutination.

Step 4: Reagents, materials, and types of sample (15 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 700

 Reagents and Materials
o Disposal bucket
o Pipettes
o Test kit reagents
 Types of Sample
o Spot (at the moment) urine sample (about 20 ml). An early morning urine sample is
more sensitive. Centrifuge turbid samples prior to testing. Note the storage
requirements for urine samples in the package insert.

Step 5: Safety precautions, procedure with limitations, quality control, and reporting
results (30 minutes)
 Safety Precautions
o Appropriate biosafety practices should be used when handling specimens and
reagents. Refer to Laboratory Safety and Waste Management Module for more
detailed information.
 Procedure
o Refer to the kit manufacturer’s instructions. Every laboratory should prepare its own
method sheet based on the type of kit used.
 Limitations
o If a first test is negative, the test can be repeated after 5 days.
o Store reagents at the correct temperature according to the manufacturer’s instructions.
o Check carefully the expiry dates on the test kits.
o Check that the catalogue numbers on the reagent containers match the numbers on the
kit procedures in the package insert.
o Note the precautions listed in the package insert.
o Each laboratory must determine the time necessary to perform the procedure
(turnaround time).
 Quality control
o Always use standards and controls according to the manufacturer’s instructions to
ensure the test results are reading correctly.
 Reporting results
o Report as pregnancy test positive or negative
o Indicate date and name of technical staff reporting.

Step 6: Key points (10 minutes)

 The pregnancy test can be used for more than diagnosing pregnancy.
 Store reagents at the correct temperature according to the manufacturer’s instructions.
 Check carefully the expiry dates on the test kits.
 Check that the catalogue numbers on the reagent containers match the numbers on the kit
procedures in the package insert.

Step 7: Evaluation (30 minutes)

 Ask students if they have any questions or comments for clarification about the
pregnancy test.

References

Teaching Guides for NTA Level 4 MLS Curriculum Page 701

 Cheesbrough, Monica. 1998. District Laboratory Practice in Tropical Countries, Part 1.
Low-priced edition, Butterworth & Co Ltd.
 Standard Operating Procedures Essential Laboratory Tests (2008), African Medical and
Research Foundation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 702

Session 7B: Module 6: Pregnancy Test
Practical
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 60 minutes performing in teaching laboratory (*60 minutes remain+ 60
minutes from assignment will provide another 120 minutes of practical sessions)

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify the reagents and materials used for pregnancy test.
 State the uses of the reagents and materials for the pregnancy test.
 Perform the pregnancy test according to SOP.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Disposal bucket
 Pipettes
 Test kit reagents

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 05 minutes Identification of reagents and materials
Buzzing
3 05 minutes Presentation Uses of reagents and materials
Demonstrate the pregnancy test according
4 15 minutes Demonstration
to the SOP
Perform the pregnancy test according to the
5 20 minutes Performance
SOP
6 05 minutes Presentation Key Points
7 05 minutes Presentation Evaluation
Observe the pregnancy test in the hospital
*8 60 minutes Observation laboratory or practice in the teaching
laboratory
Observation in the hospital laboratory or
*9 60 minutes Assignment
practice in the teaching laboratory

Teaching Guides for NTA Level 4 MLS Curriculum Page 703

*Suggested Assignments for remaining 60 minutes:

 Students can buzz about limitations of the pregnancy test.

 The Tutor can give an examination about the pregnancy test.
 Students can buzz about other causes of increased production of HCG.

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identification of reagents and materials (05 minutes)

Activity: Discuss identification and buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions:
 Identify the reagents and materials for the pregnancy test.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Identification of reagents and materials for the pregnancy test.

o Reagent: pregnancy test kit
o Materials
 Disposal bucket
 Pipettes

Step 3: Uses of the reagents and materials for the pregnancy test (05 minutes)
o Reagents
 Latex particles coated with monoclonal antibodies react with human chorionic
gonadotropin (HCG) in urine to give macroscopic agglutination.
o Materials
 The use of the materials will be explained during the performance of the
procedure.

Step 4: Demonstration of the pregnancy test according to the SOP (15 minutes)
 Demonstrate of the pregnancy test according to the SOP.

Step 5: Performance of the pregnancy test (20 minutes)

 Students perform the pregnancy test according to the SOP.

Step 6: Key points for the pregnancy test (05 minutes)

 Store reagents at the correct temperature according to the manufacturer’s instructions.

 Check carefully the expiry dates on the test kits.
 Check that the catalogue numbers on the reagent containers match the numbers on the kit
procedures in the package insert.

Step 7: Evaluation (05 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 704

 Assess students’ performance of the pregnancy test.

Step 8: Observe the performance of pregnancy tests at the hospital laboratory or

practice in the teaching laboratory (60 minutes)
 Observation of the performance of pregnancy tests at the hospital laboratory or practice
performing pregnancy tests in the teaching laboratory.

*This session could be scheduled during another day.

Step 9: Observation in the hospital laboratory or practice in the teaching laboratory (60
minutes)
 More opportunity for students to observe the pregnancy tests at the hospital laboratory or
practice the pregnancy tests in the teaching laboratory

*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 705

Session 8A: Module 6: Syphilis Rapid
Testing
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes in teaching laboratory + 180 minutes in hospital
laboratory

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the terms Venereal Disease Research Laboratory (VDRL), Rapid Plasma Reagin
(RPR), serum, and plasma.
 Mention two rapid methods to test for syphilis.
 State the purpose and principle for the rapid tests for syphilis.
 Mention the sample types that can be used in the rapid tests for syphilis.
 Explain the safety precautions, procedure with limitations, quality control, and reporting
results for the rapid tests for syphilis.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Dispensing bottles with needles
 Disposable test cards
 Disposable dropper pipettes
 Rubber teats
 Disposable mixing sticks
 VDRL carbon antigen reagent
 RPR test kit
 Controls – positive and negative
 Instruction manual
 Disinfectant
 Gloves
 Rotator
 Timer clock/stop watch
 Saline, 0.85%
 Disposal bucket

Teaching Guides for NTA Level 4 MLS Curriculum Page 706

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 15 minutes Definitions of terms
Buzzing
Purpose and principle of the rapid tests for
3 20 minutes Presentation
syphilis
Reagents, materials, equipment, and types
4 15 minutes Presentation
of sample for rapid tests for syphilis
Safety precautions, procedure with
5 45 minutes Presentation limitations, quality control, and reporting
results for the rapid tests for syphilis.
6 10 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms and buzzing (15 minutes)

Activity: Discuss definitions and Buzzing (05 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
 Define the following terms
 VDRL
 RPR
 Serum
 Plasma
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Definitions of Terms
o VDRL
 Venereal Disease Research Laboratory – a procedure used to determine if a person
has syphilis; visualized through agglutination.
o RPR
 Rapid Plasma Reagin – a procedure also used to determine if a person has
syphilis, but is visualized by using a reagent strip.
o Serum
 The fluid that separates from clotted blood.
o Plasma
 The fluid that separates from unclotted blood.

Step 3: Purpose and principle of the rapid tests for syphilis (RPR and VDRL) (20
minutes)
 Purpose:

Teaching Guides for NTA Level 4 MLS Curriculum Page 707

 o A syphilis test is used to detect antibodies present in serum or plasma in patients with
a syphilis infection.
 Principle:
o The test is used to detect reagin (non-specific) antibodies present in serum or plasma
in patients with a syphilis infection. The antigen is a modified RPR/VDRL antigen
bound to microparticulate carbon, which enhances the visual detection of aggregation
in the presence of reagin antibodies. If reagin antibodies are absent, no aggregation
takes place.

Step 4: Reagents, materials, equipment and types of sample (15 minutes)

 Reagents and Materials
o Dispensing bottles with needles
o Disposable test cards
o Disposable dropper pipettes
o Rubber teats
o Disposable mixing sticks
o VDRL carbon antigen reagent
o RPR test kit
o Controls – positive and negative
o Instruction manual
o Disinfectant
o Gloves
o Timer clock/stop watch
o Saline, 0.85%
o Disposal bucket
 Equipment
o Rotator
 Types of Sample
o Plasma or serum is the specimen of choice, depending on the manufacturer’s
instructions for the type of kit used.

Step 5: Safety precautions, procedure with limitations, quality control, and reporting
results (45 minutes)
 Safety Precautions
o Appropriate biosafety practices should be used when handling specimens and
reagents. Refer to Laboratory Safety and Waste Management Module for more
detailed information.
 Procedure
o VDRL Carbon Antigen Slide
o Bring the test kit reagents to room temperature.
o Using a rubber teat and dropper pipette, dispense 1 drop (0.05ml) of sample on one of
the test card circles.
o Dispense the positive and negative control sera in the same way
o Spread the sample over the entire test circle. Do the same for control sera.
o Mix by shaking the reagent bottle (R1) and using a free flowing needle, dispense one
drop on each circle.
o Use the automatic rotator at 100 rpm to rotate the test card for 8 minutes. If a rotator
is not available, use your hands to rotate the slide.

Teaching Guides for NTA Level 4 MLS Curriculum Page 708

 o Read the results macroscopically in a good light.
o Rinse used cards and pipettes with running tap water and place in the bucket marked
“INCINERATION”.
o Rinse used cards and pipettes with running tap water and place in the bucket marked
“INCINERATION”.
 RPR for syphilis
o Bring reagents and specimens to room temperature (18oC to 25oC) before use.
o Take the required number of test strips or devices, allowing sufficient for controls.
o Label the strips/devices with the sample or test number.
o Carefully follow the instructions in the kit insert for performing the tests.
o Validate and interpret the results.
o Record the results in a worksheet.
o Store positive strips/devices after drying in a plastic bag, for reference. Place
negative strips/devices and used droppers in the bucket marked “INCINERATION”.
o Each laboratory must determine the time necessary to perform the procedure
(turnaround time).
 Limitations:
o The quantitative test procedure must be performed by a higher level facility on all
positive samples.
o The RPR slide test reagent and the VDRL carbon antigen reagent must be stored at 2
– 8oC.
o Check carefully the expiry dates on the test kits.
 Quality control
o Always run positive and negative controls when performing the test, and make sure
the control samples are reading correctly.
 Reporting results
o Large aggregates in the centre and periphery of the test circle indicate a positive
result. Small aggregates in the centre and around the edges of the test circle indicate a
weak positive result. No visible aggregates indicate a negative result.
o Report the results as “Reactive” (Positive) or “Non-Reactive” (Negative).

*Indicate date and name of technical staff reporting.

Positive result (agglutination) for the carbon antigen test (VDRL)

(Source: ASCP)

Teaching Guides for NTA Level 4 MLS Curriculum Page 709

Step 6: Key points (10 minutes)
 The RPR slide test reagent and VDRL carbon antigen reagent must be stored at 2 – 8oC.
 Check carefully the expiry dates on the test kits.
 VDRL means Venereal Disease Research Laboratory.
 RPR means Rapid Plasma Reagin.

Step 7: Evaluation (10 minutes)

 Ask students to explain the VDRL rapid test and the RPR test for syphilis.
 Ask students if they have any questions or comments for clarification of the VDRL and
RPR tests.

References
 Carter J, Lema O (1994). Practical Laboratory Manual for Health Centres in Eastern
Africa, AMREF.
 Cheesbrough, Monica (1998). District Laboratory Practice in Tropical Countries, Part 1.
Tropical Health Technology, U.K.
 Hunter George W., Frye William W., Swartzwelder (1963). A Manual of Tropical
Medicine, Third Edition. W.B. Saunders Co., USA.
 Munafu C, Guma G.B., Igune M, Rwandembo M.W., Olupot-Olupot P., et al (2000).
Management and Control of Diseases of Epidemic Potential in Uganda. Ministry of
Health, WHO, AMREF.
 Munafu C., Tenywa T., Musoke Bukenya M. (1998). Validation of Syndromic
Management of Sexually Transmitted Infections, Volume 1, AMREF.
 Nduba John, Mabey D (1991). Self Instructional Manual on Sexually Transmitted
Diseases, AMREF.
 World Health Organization. 2005. Sexually Transmitted and other Reproductive Tract
Infections – a Guide to Essential Practice.
 Standard Operating Procedures Essential Laboratory Tests (2008), African Medical and
Research Foundation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 710

Session 8B: Module 6: Syphilis Rapid
Testing Practical
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes performing in teaching laboratory (*60 minutes remain+
60 minutes from assignment will provide another 120 minutes of practical sessions)

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify the reagents and materials used for the rapid tests for syphilis.
 State the uses of each reagent and materials of the rapid tests for syphilis.
 Perform rapid tests for syphilis according to the SOPs.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Dispensing bottles with needles
 Disposable test cards
 Disposable dropper pipettes
 Rubber teats
 Disposable mixing sticks
 VDRL carbon antigen reagent
 RPR test kit
 Controls – positive and negative
 Instruction manual
 Disinfectant
 Gloves
 Rotator
 Timer clock/stop watch
 Saline, 0.85%
 Disposal bucket

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Identification of reagents and materials

Teaching Guides for NTA Level 4 MLS Curriculum Page 711

 Buzzing
3 10 minutes Presentation Uses of reagents and materials
Demonstrate the rapid tests for syphilis
4 20 minutes Demonstration
according to the SOPs
Perform the rapid tests for syphilis
5 60 minutes Performance
according to the SOPs
6 10 minutes Presentation Key Points
7 05 minutes Presentation Evaluation
Observe rapid tests for syphilis at the
*8 60 minutes Observation hospital laboratory or practice in the
teaching laboratory
Observation in the hospital laboratory or
*9 60 minutes Assignment
practice in the teaching laboratory

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identification of reagents and materials (10 minutes)

Activity: Discuss identification and buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions:
 Identify the reagents and materials for the rapid tests for syphilis.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Identification of reagents and materials for the rapid tests for syphilis.
o Reagent
 VDRL carbon antigen reagent
 RPR test kit
o Materials
 Dispensing bottles with needles
 Disposable test cards
 Disposable dropper pipettes
 Rubber teats
 Disposable mixing sticks
 Controls – positive and negative
 Instruction manual
 Disinfectant
 Gloves
 Timer clock/stop watch
 Saline, 0.85%
 Disposal bucket

Step 3: Uses of the reagents and materials to perform the rapid tests for syphilis (10
minutes)
 Reagents

Teaching Guides for NTA Level 4 MLS Curriculum Page 712

 o The reagents for the rapid tests for syphilis are provided in a test kit. The reagents
detect reagin (non-specific) antibodies present in serum or plasma in patients with a
syphilis infection.
 Materials
o The use of the materials will be explained during the performance of the procedure.

Step 4: Demonstration rapid tests for syphilis according to the SOPs (20 minutes)
 Demonstrate the procedure for rapid tests for syphilis according to the SOPs.

Step 5: Performance of rapid tests for syphilis (60 minutes)

 Students perform rapid tests for syphilis according to the SOPs.

Step 6: Key points for the rapid tests for syphilis (10 minutes)
 Compare the controls with test sample results.
 The meaning of reactive and non-reactive results.

Step 7: Evaluation (05 minutes)

 Assess students’ performance of rapid tests for syphilis.

Step 8: Observe rapid tests for syphilis at the hospital laboratory or practice in the
teaching laboratory (60 minutes)
 Observation of rapid tests for syphilis at the hospital laboratory or practice of rapid tests
for syphilis in the teaching laboratory.

*This session could be scheduled during another day.

Step 9: Observation in the hospital laboratory or practice in the teaching laboratory (60
minutes)
 More opportunity for students to observe rapid tests for syphilis at the hospital laboratory
or practice rapid tests for syphilis in the teaching laboratory.

*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 713

Session 9A: Module 6: Hepatitis Rapid
Testing
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes in teaching laboratory

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the term hepatitis.
 Mention the method to test for hepatitis.
 State the purpose and principle for the rapid test for hepatitis.
 Mention the sample types that can be used in the rapid test for hepatitis.
 Explain the safety precautions, procedure with limitations, quality control, and reporting
results for the rapid test for hepatitis.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Hepatitis test kit
 Controls – positive and negative
 Instruction manual
 Disinfectant
 Gloves
 Timer clock/stop watch
 Disposal bucket
 Sharps box or container

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 10 minutes Definition of term
Buzzing
Purpose and principle of the rapid test for
3 15 minutes Presentation
hepatitis
Reagents, materials, and types of samples
4 20 minutes Presentation
for the rapid test for hepatitis

Teaching Guides for NTA Level 4 MLS Curriculum Page 714

 Safety precautions, procedure with
5 30 minutes Presentation limitations, quality control, and reporting
result for the rapid test for hepatitis
6 15 minutes Presentation Key Points
7 25 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definitions of Terms and buzzing (10 minutes)

Activity: Discuss definitions and Buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions
 Define the term
 Hepatitis
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Definition of Term:
 Hepatitis: is an inflammation of the liver causing fever, yellowish skin and eyes,
abdominal pain, and weakness.

Step 3: Purpose and principle of the rapid test for hepatitis (15 minutes)
 Purpose:
o Determine if a person has been exposed to hepatitis.
 Principle:
o An immuno-chromatographic test (ICT) is used for the qualitative detection of
antibodies to the hepatitis virus in the blood. The blood sample flows along the strip
and if the hepatitis antibodies are present, the antigen/antibody complex binds with a
conjugate (colouring compound) forming a red band. If antibodies are absent, no red
band is formed. Also, the control line must be red.

Step 4: Reagents, materials and types of sample (20 minutes)

 Reagents and materials
o The hepatitis latex agglutination test kit is supplied with all required reagents and
supplies necessary to perform a pre-determined number of tests. The test kit includes
the following:
 Pre-calibrated pipettes
 Pipette tips
 Reaction devices
 Black background template
 Instruction manual
 Control sera – positive and negative
 Gauze or tissue
 Disinfectant
 Gloves

Teaching Guides for NTA Level 4 MLS Curriculum Page 715

  Sharps box or container
 Disposal bucket
 Test tube rack
 Equipment
o Centrifuge
 Types of Sample
o Whole blood from EDTA sample or finger prick, or serum, or plasma depending on
type of test kit

Step 5: Safety precautions, procedure with limitations, quality control, and reporting
results (30 minutes)
 Safety Precautions
o Appropriate biosafety practices should be used when handling specimens and
reagents. Refer to Laboratory Safety and Waste Management Module for more
detailed information.
 Procedure
o Bring reagents and specimens to room temperature (18oC to 25oC) before use.
o Take the required number of test strips or devices, allowing sufficient for controls.
o Label the strips/devices with the number for each sample and control (positive and
negative) to be tested.
o Carefully follow the instructions in the kit insert for performing the tests.
o Validate and interpret the results.
o Record the results in a worksheet.
o Place all strips/devices, used droppers and other materials in the bucket marked
“INCINERATION”.
 For serum or plasma samples
o Apply the required volume of sample (usually 10 µL) to the pad using a micropipette.
o Wait for a minimum of 15 minutes (up to 60 minutes) and read the results.
o For whole blood (venipuncture) samples
o Apply the required volume of sample (usually 10 µL) to the pad using a micropipette.
o Wait for 1 - 3 minutes as recommended in the instruction manual, then apply one drop
of buffer to the pad.
o Wait for a minimum of 15 minutes (up to 60 minutes) and read the results.
 For whole blood (fingerprick) samples
o Apply the required volume of sample (usually 10 µL collected in an EDTA capillary
tube) to the pad.
o Wait for a minimum of 15 minutes (up to 60 minutes) and read the results.
 Limitations:
o Follow the storage instructions for each test kit.
o Some ICT test kits may be stored at room temperature in a cool dry place; other kits
require refrigeration.
o Check carefully the expiry dates on the test kits.
 Quality control
o To ensure the validity of each test, a procedural control line is incorporated in the strip
or device and is labeled “Control”. The control line must appear in all tests, whether
positive or negative.
o If only one RED line appears in the patient window: the test is Invalid; repeat the test.

Teaching Guides for NTA Level 4 MLS Curriculum Page 716

 o If no RED lines appear in the patient and control windows: the test is Invalid; repeat
the test.
 Reporting results
o Report the results as “Reactive” (Positive) or “Non-Reactive” (Negative).
o Indicate date and name of technical staff reporting.

Step 6: Key points (15 minutes)

 Follow the storage instructions for each test kit. Some ICT test kits may be stored at room
temperature in a cool dry place; other kits require refrigeration.
 Check carefully the expiry dates on the test kits.
 Hepatitis is an inflammation of the liver causing fever, yellowish skin and eyes,
abdominal pain, and weakness.

Step 7: Evaluation (25 minutes)

 Ask students to explain the purpose and principle of the hepatitis test procedure.
 Ask students if they have any questions or comments for clarification of the hepatitis test
procedure.

References
 Constantine Neil T, Callahan Johnny D, Watts Douglas M, (1991). HIV Testing and
Quality Control, a Guide for Laboratory Personnel. Family Health International.
 Munafu C, Guma G B, Igune M, Rwandembo M W, Olupot-Olupot P, et al (2000).
Management and Control of Diseases of Epidemic Potential in Uganda. Ministry of
Health, WHO, AMREF.
 Standard Operating Procedure Essential Laboratory Tests (2008), African Medical and
Research Foundation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 717

Session 9B: Module 6: Hepatitis Rapid
Testing Practical
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 60 minutes performing in teaching laboratory (*60 minutes remain+
60 minutes from assignment will provide another 120 minutes of practical sessions)

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify the reagents and materials used for the rapid test for hepatitis.
 State the uses of the reagents and materials for the rapid test for hepatitis.
 Perform the rapid test for hepatitis according to the SOP.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Hepatitis test kit
 Controls – positive and negative
 Instruction manual
 Disinfectant
 Gloves
 Timer clock/stop watch
 Disposal bucket
 Sharps box or container

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 05 minutes Identification of reagents and materials
Buzzing
3 05 minutes Presentation Uses of reagents and materials
Demonstrate the rapid test for hepatitis
4 15 minutes Demonstration
according to the SOP
Perform the rapid test for hepatitis
5 20 minutes Performance
according to the SOP
6 05 minutes Presentation Key Points

Teaching Guides for NTA Level 4 MLS Curriculum Page 718

 7 05 minutes Presentation Evaluation
Observe the rapid test for hepatitis in the
*8 60 minutes Observation hospital laboratory or practice in the
teaching laboratory
Observation in the hospital laboratory or
*9 60 minutes Assignment
practice in the teaching laboratory

*Suggested Assignments for remaining 60 minutes:

 Students can buzz about limitations of the rapid test for hepatitis.
 The Tutor can give an examination about the rapid test for hepatitis.
 Students can buzz about causes of hepatitis.

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identification of reagents and materials (05 minutes)

Activity: Discuss identification and buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions:
 Identify the reagents and materials for the rapid test for hepatitis.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Identification of reagents and materials for the rapid test for hepatitis.
o Materials
 Instruction manual
 Disinfectant
 Gloves
 Timer clock/stop watch
 Disposal bucket
 Sharps box or container

Step 3: Uses of the reagents and materials for the rapid test for hepatitis (05 minutes)
 Reagents
o The reagent is an immuno-chromatographic test (ICT) used for the qualitative
detection of antibodies to the hepatitis virus in the blood. The blood sample flows
along the strip and if the hepatitis antibodies are present, the antigen/antibody
complex binds with a conjugate (colouring compound) forming a red band. If
antibodies are absent, no red band is formed. Also, the control line must be red.
 Materials
o The use of the materials will be explained during the performance of the procedure.

Step 4: Demonstration of the rapid test for hepatitis according to the SOP (15 minutes)
 Demonstrate the rapid hepatitis test according to the SOP.

Step 5: Performance of the rapid test for hepatitis (20 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 719

 Students perform the rapid test for hepatitis according to the SOP.

Step 6: Key points for the rapid test for hepatitis (05 minutes)
 Store reagent kit at the correct temperature according to the manufacturer’s instructions.
 Check carefully the expiry dates on the test kits.
 Check that the catalogue numbers on the reagent containers match the numbers on the kit
procedures in the package insert.

Step 7: Evaluation (05 minutes)

 Assess students’ performance of the rapid test for hepatitis.

Step 8: Observe the performance of rapid tests for hepatitis at the hospital laboratory
or practice in the teaching laboratory (60 minutes)
 Observation of the performance of rapid tests for hepatitis at the hospital laboratory or
practice performing rapid tests for hepatitis in the teaching laboratory.

*This session could be scheduled during another day.

Step 9: Observation in the hospital laboratory or practice in the teaching laboratory (60
minutes)
 More opportunity for students to observe the rapid tests for hepatitis at the hospital
laboratory or practice the rapid tests for hepatitis in the teaching laboratory

*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 720

Session 10A: Module 6: Glucose Testing in
Urine by Benedict’s Method
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 120 minutes in teaching laboratory

Learning Objectives
By the end of this session, students are expected to be able to:
 Define the term glucose.
 State the purpose and principle of the Benedict method to determine glucose in urine.
 Mention the reagents and materials used for the Benedict method to determine glucose in
urine.
 Explain the safety precautions, procedure with limitations, quality control, and reporting
results for the Benedict method to determine glucose in urine.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Benedict’s reagent
 Test tube rack
 Gloves
 Pyrex test tubes
 Spirit lamp with absolute alcohol or Bunsen burner
 Match box
 Disposal bucket
 Pasteur pipettes

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 05 minutes Definition of term
Buzzing
Purpose and principle of the Benedict
3 10 minutes Presentation
method to determine glucose in urine
4 20 minutes Presentation Reagents, materials and type of sample
Safety precautions, procedure with
5 60 minutes Presentation
limitations, quality control, and reporting

Teaching Guides for NTA Level 4 MLS Curriculum Page 721

 results.
6 10 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition of Term and buzzing (05 minutes)

Activity: Discuss definition and Buzzing

ASK the students to buzz in pairs and allow them to answer the following question
Define the following term
 Glucose
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Definition of Term
 Glucose
o A simple sugar produced by the metabolism of carbohydrates. A carbohydrate is a
biological compound containing carbon, hydrogen and oxygen that is an important
source of food and energy in animals.

Step 3: Purpose and principle of the Benedict method to determine glucose in urine (10
minutes)
 Purpose:
o The Benedict test for urine glucose is used to detect the presence or absence of
glucose in urine. It is used if reagent strips (dipstick) or tablets are not available.
 Principle:
o Benedict’s solution is mixed with urine and boiled. Then the colour in the test sample
is compared to the test controls. Reduction of the reagent is indicated by a change in
colour. If the colour remains blue, the test is negative. If the colour changes from blue
to brick red, then the presence of glucose is indicated.

Step 4: Reagent, materials and type of sample (20 minutes)

 Reagent and Materials
o Benedict’s reagent
o Test tube rack
o Gloves
o Pyrex test tubes
o Spirit lamp with absolute alcohol or Bunsen burner
o Match box
o Disposal bucket
o Pasteur pipettes
 Type of Sample
o Urine sample from a fasting individual.

Teaching Guides for NTA Level 4 MLS Curriculum Page 722

Step 5: Safety precautions, procedure with limitations, quality control, and reporting
results (60 minutes)
 Safety Precautions
o Appropriate biosafety practices should be used when handling specimens and
reagents. Refer to the Laboratory Safety and Waste Management Module for more
detailed information.

 Procedure
o Measure 2.5 ml of Benedict solution into a test tube. Use one test tube for the test, one
for the positive control, and one for the negative control.
o Add 0.2 ml of urine to each tube for test samples.
o Add 0.2 ml of positive sample and 0.2 ml of negative sample to respective tubes
labelled as positive and negative.
o Mix the contents of each tube.
o Place the tubes in a container of boiling water for exactly 5 minutes.
o Remove the tubes and examine the solution in each tube for precipitate and change of
colour.
 Limitations
o Benedict’s test is not specific for glucose in urine because false positive results occur
in the presence of other substances in urine, such as galactose, lactose, fructose,
salicylates, high concentrations of uric acid or creatinine.
o This method provides a qualitative and semi-quantitative estimate of the glucose
concentration in urine.
 Reporting results
o Report the sugar concentration as follows:
Appearance of solution Sugar concentration
Blue, clear or cloudy Nil
Green, no precipitate Trace
Green with precipitate About 0.5 g%
Brown and cloudy About 1.0 g%
Orange and cloudy About 1.5 g%
Red and cloudy 2.0 g% or more

 Quality control
o A positive and negative control specimen should be tested at the same time the patient
sample is tested.
o Positive control: add one gram of glucose to a normal urine sample and mix.
o Negative control: use a urine sample from a normal person.

Step 6: Key points for determining glucose in urine by the Benedict method (10
minutes)
 Explain the test results.
 Explain the purpose and principle of the Benedict test.
 Explain the interpretation of the results of the Benedict test.
 Explain limitations of the glucose test in urine by the Benedict method.

Step 7: Evaluation (10 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 723

 Ask the students to define glucose. Explain the purpose and the principle of the Benedict
method to determine glucose in urine.
 Ask the students if they have any comments or need clarification of any points.

References
 Cheesebrough, M. Medical Laboratory Manual for Tropical Countries, Volume 1, 1987,
Butterworths Tropical Health Technology.
 Cheesebrough, M. District Laboratory Pracctice in Tropical Countries, 2nd edition, Part
1, 2005, Tropical Health Technology.

Teaching Guides for NTA Level 4 MLS Curriculum Page 724

Session 10B: Module 6: Glucose Testing in
Urine by Benedict’s Method Practical
NTA LEVEL 4: SEMESTER II: MODULE CODE: MLT04206 - BASIC LABORATORY
INVESTIGATIONS

Prerequisites
 None

Total Session Time: 60 minutes performing in teaching laboratory (*60 minutes remain+
60 minutes from assignment will provide another 120 minutes of practical sessions)

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify the reagents and materials used to test for glucose in urine by the Benedict
method.
 State the uses of the reagents and materials to test for glucose in urine by the Benedict
method.
 Perform the test for glucose in urine by the Benedict method according to the procedure.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board
 Chalk/whiteboard markers
 Handout
 LCD and lap top computer
 Benedict’s reagent
 Test tube rack
 Gloves
 Pyrex test tubes
 Spirit lamp with absolute alcohol or Bunsen burner
 Match box
 Disposal bucket
 Pasteur pipettes

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 05 minutes Identification of reagents and materials
Buzzing
3 10 minutes Presentation Uses of reagents and materials
Demonstrate the test for glucose in urine
4 20 minutes Demonstration
by the Benedict method
Perform the test for glucose in urine by
5 60 minutes Performance
the Benedict method according to the

Teaching Guides for NTA Level 4 MLS Curriculum Page 725

 procedure.
6 10 minutes Presentation Key Points
7 10 minutes Presentation Evaluation
Observe the test for glucose in urine by
the Benedict method in the hospital
*8 60 minutes Observation
laboratory or practice in the teaching
laboratory
Observation in the hospital laboratory or
*9 60 minutes Assignment
practice in the teaching laboratory

Step 1: Presentation of Session Title and Learning Objectives (05 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identification of reagents and materials (05 minutes)

Activity: Discuss identification and buzzing

 ASK the students to buzz in pairs and allow them to answer the following questions:
 Identify the reagents and materials for the glucose test in urine by the Benedict method.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Identification of reagents and materials for the glucose test in urine by the Benedict
method.
o Reagent
 Benedict’s solution
o Materials
 Test tube rack
 Gloves
 Pyrex test tubes
 Spirit lamp with absolute alcohol or Bunsen burner
 Match box
 Disposal bucket
 Pasteur pipettes

Step 3: Uses of the reagents and materials for the glucose test in urine by the Benedict
method (10 minutes)
 Reagents
o The Benedict test for urine glucose is used to detect the presence or absence of
glucose in urine. It is used if reagent strips (dipstick) or tablets are not available.
o Benedict’s solution is mixed with urine and boiled. Then the colour in the test sample
is compared to the test controls.
 Materials
o The use of the materials will be explained during the performance of the procedure.

Step 4: Demonstration of the glucose test in urine by the Benedict method (20 minutes)
 Demonstrate the glucose test in urine by the Benedict method according to the procedure.

Teaching Guides for NTA Level 4 MLS Curriculum Page 726

Step 5: Performance of the glucose test in urine by the Benedict method (60 minutes)
 Students perform the glucose test in urine by the Benedict method according to the
procedure.

Step 6: Key points for the glucose test in urine by the Benedict method (10 minutes)
 Explain the test results.
 Explain the interpretation of the results of the Benedict test.
 Explain limitations of the glucose test in urine by the Benedict method.

Step 7: Evaluation (10 minutes)

 Assess students’ performance of the glucose test in urine by the Benedict method.

Step 8: Observe the performance of pregnancy tests at the hospital laboratory or

practice in the teaching laboratory (60 minutes)
 Observation of the performance of glucose tests in urine by the Benedict method at the
hospital laboratory or practice performing glucose tests in urine by the Benedict method
in the teaching laboratory.

*This session could be scheduled during another day.

Step 9: Observation in the hospital laboratory or practice in the teaching laboratory (60
minutes)
 More opportunity for students to observe glucose tests in urine by the Benedict method at
the hospital laboratory or practice glucose tests in urine by the Benedict method in the
teaching laboratory

*This session could be scheduled during another day.

Teaching Guides for NTA Level 4 MLS Curriculum Page 727

 CHAPTER SEVEN

MODULE CODE MLT04106:

PREVENTION AND CONTROL
OF DISEASE TRANSMISSIONS

Teaching Guides for NTA Level 4 MLS Curriculum Page 728

Session 1: Common Bacteria causing
Diseases (Mycobacterium and Escherichia
Species)
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Classify Mycobacterium and Escherichia species
 Describe morphological features of Mycobacterium and Escherichia species
 List common pathogenic mycobacterium and Escherichia species
 Describe the mode of transmission of mycobacterium and Escherichia species
 Mention common diseases caused by mycobacterium and Escherichia species
(Tuberculosis, Leprosy and urinary tract infection (UTI) respectively)

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
Presentation
2 15 minutes Classification
Buzzing
Morphological features of mycobacterium
3 25 minutes Presentation
and Escherichia species
Modes of transmission of mycobacterium
4 10 minutes Presentation
and Escherichia species
Presentation Diseases caused by Mycobacterium and
5 15 minutes
Group Discussion Escherichia species
6 15 minutes Presentation Key Points
7 (a) 30 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 729

Activity: Buzzing (5 minutes)

ASK the students to buzz in pairs and allow them to answer the following questions
Classify the following :
 Mycobacterium
 Escherichia
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Step 2: Classification of bacteria

Bacteria are classified according to:
 Biological classification- Observable characters like physiological, immunological and
Ecological
 Morphological classification:
o Higher bacteria which are sub-classified into two major groups:
 Vegetative mycelium fragments which include: Anaerobic, acid fast, Anaerobic
non- acid fast
 Vegetative mycelium which does not fragment into bacillary or coccoid form
o Lower or true bacteria
 Are unicellular and never form mycelium.
 They are grouped on the basis of their shape:
- Cocci – spherical
- Bacilli – rod shaped
- Vibrio – comma shaped
- Spirilla – spiral twisted non-flexuous rods
- Spirochaetes- thin spirally twisted, flexuous rods

Mycobacteria
Bacteria which are acid fast bacilli on the basis of staining reaction to Ziehl – Neelsen stain
They are also weak Gram positive bacilli

Escherichia
Are Gram negative rods usually motile

Step 3: Morphological features of Mycobacterium species and Escherichia coli

 Mycobacterium tuberculosis
o Mycobacterium is slender, rod shaped, non spore forming, non motile and non
capsulated straight or slightly curved measuring 1 – 4 by 0.2 – 0.5 µm containing
waxy material (mycolic acid) in its wall
 Mycobacterium leprae
o Is a non motile, non-sporing, straight or slightly curved rod measuring 0.2 – 0.5 x 5 –
8 µm
o The organisms can be found singly and in groups called globi

Teaching Guides for NTA Level 4 MLS Curriculum Page 730

Fig. 1: shows Mycobacterium species in a ZN- Stained smear

 Escherichia coli
o A gram negative , non-capsulated, short, bacillus (rod) 2-4 µ x 0.4 to 0.7 µm in
diameter, appear singly or clustered
o Motile, non spore forming bacterium

Step 4: Common species of medical importance

(a) Mycobacterium Species
 Mycobacterium tuberculosis
 Mycobacterium leprae
(b) Escherichia species
 Escherichia coli

Step 5: Modes of transmission of mycobacterium species and Escherichia cli

(a) Mycobacterium tuberculosis
 Transmitted through inhalation of air droplets from infected individual by coughing,
sneezing or talking
 A cough or 5 minutes of talking can produce 3000 droplets
(b) Mycobacterium leprae
 Leprae bacilli are obligate parasites of man
 Portal of entry is most probably skin and nasal mucosa
 It needs close and prolonged contact with infective patients for contact
(c) Escherichia coli
 Contaminated water
 Contamination of body sites(urinary, wound, blood)

Step 6: Diseases caused by Mycobacterium species and Escherichia coli

(a) Mycobacterium specie
 Tuberculosis (Pulmonary and extra-pulmonary)
 Leprosy
(b) Escherichia coli
 Urinary Tract Infections (UTI)
 Wound infections
 Bacteraemia & Meningitis especially of the newborn
 Diarrhoeal disease especially in infants, but also adults

Teaching Guides for NTA Level 4 MLS Curriculum Page 731

Step 10: Key Points (Mycobacterium species and Escherichia coli)
 Classification of Mycobacterium species and Escherichia coli
 Common Species of Mycobacterium of medical importance
 Modes of transmission of Mycobacterium species

Step 11: Evaluation

 Mention diseases caused by Mycobacterium species and Escherichia coli
 List modes of transmission of Mycobacterium tuberculosis and Mycobacterium leprae

References:
 Baker J., R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition Oxford University Press
 Cook, G. (2000), Manson’s Tropical Diseases, 22nd Ed, W.B. Saunders Company Ltd,
London;
 Gupter S. (1989) Medical Microbiology 4th Ed .Jaypee brothers Medical Publisher.
 Gupter S(2010) Medical Microbiology,(Including Parasitology)10th Ed. Jaypee brothers
Medical Publisher.
 Monica Cheesbrough (1998) District Laboratory Practice in Tropical Countries Part II -
Tropical Health Technology;
 Monica Cheesbrough (1984) Medical Laboratory Manual for Tropical Countries Volume
II: Microbiology - Tropical Health Technology/ Butterworths

Teaching Guides for NTA Level 4 MLS Curriculum Page 732

Session 2: Common Bacteria causing
Diseases (Staphylococci, Streptococci, and
Treponema species.)
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, the student will be able to:
 Classify Staphylococci , Streptococci and Treponema species
 Describe morphological features of Staphylococci, Streptococci and Treponema species
 List the common Staphylococci, Streptococci and Treponema species of medical
importance
 Describe the mode of transmission of Staphylococci, Streptococci and Treponema
 Mention common diseases caused by Staphylococci, Streptococci and Treponema species

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 15 minutes Presentation Introduction, Learning Objectives
Presentation
2 10 minutes Classification
Buzzing
Morphological features of
3 20 minutes Presentation Staphylococcus, Streptococcus and
Treponema species
Modes of transmission of
4 10 minutes Presentation Staphylococcus, Streptococcus and
Treponema species
Diseases caused by Staphylococcus
Presentation
5 10 minutes aureus, Streptococcus pyogenes,
Buzzing
S.pneumoniae and Treponema species
Diseases caused by Staphylococcus
Presentation
6 10 minutes aureus, Streptococcus pyogenes,
Buzzing
S.pneumoniae and Treponema species
7 15 minutes Presentation Key Points

Teaching Guides for NTA Level 4 MLS Curriculum Page 733

 8 (a) 30 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (15 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
 Classify the following :
 Staphyloccoci and Streptococci
 Treponema
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Step 2: Classification of Staphylococci, Streptococci and Treponema

 Staphylococci are in the group of cocci (spherical) appear in groups called clusters
 Streptococci are also the group of cocci (spherical) arranged in chains
 Treponema species are spirochaetes group that appear thin spirally twisted, flaxous rods

Step 3: Morphological features of Taphyloccoccus, streptococcus and Treponema

Species
(a) Staphylococci
 a spherical organism which is non motile, non encapsulated, gram positive coccus, about
1µm in diameter.
 Staphylococci appear in groups called clusters.

Fig. 2 and 3: show staphylococcus species in a Grams’s -stained smear

(b) Streptococci
 Streptococci are spherical 0.5 – 1.0 µm and divided by fission, but they remain attached
and so grow in beadlike chains.
 Streptococci are gram positive, non motile and non sporing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 734

Fig. 4: Shows Streptococcus species Fig. 5: Shows Staphylococci Vs Streptococci

(c) Treponema
 Small, delicate, tightly coiled spirochaetes, measuring 6 x 15 x 0.2µ
 Cannot be observed by transmitted light (ordinary)
 Can be observed by dark-field microscope, or fluorescence microscope only

Step 4: Common Pathogenic Species of Staphylococcus, Streptococcus and Treponema

species
 Staphylococcus aureus
 Streptoccoccus pyogenes, and Streptoccocus pneumoniae
 Treponema pallidum

Step 5: Modes of Transmission of Staphylococcus, Streptococcus, and Treponema

species
(a) Staphylococcus aureus
 Direct or Indirect contact with an infected person
 Ingestion of contaminated food (poisoning from Staphylococci toxins )
 Carried on the hands of healthcare personnel
 Contaminated surfaces and medical equipment

(b) Streptococcus pygenes and streptococcus pneumoniae

 Inhalation of droplets
 Inhalation of organisms as neonate passes down birth canal

(C) Treponema pallidum

 Sexual
 Congenital

Step 6: Diseases caused by Staphylococci species

(a)Staphylococci
 Abscesses
 Skin disorders- impetigo, boils, Styes
 Conjunctivitis, especially in newborns
 Systemic, cross-infections in hospitals, septicaemia, endocarditis, pneumonia,empyema,
osteomyelitis, mastitis

Teaching Guides for NTA Level 4 MLS Curriculum Page 735

 Food poisoning
 Scalded skin syndrome in young children

(b) Streptococcus species

(i) In newborn
 Pneumonia
 Meningitis
 Respiratory diseases
 Skin infection

(ii) In adult
 Endocarditic
 Septicemia
 Meningitis
 Arthritis
 Wound sepsis

(c)Treponema-
 The causative agents of syphilis and yaws

Step 7: Key Points

 Common Species of Staphylococci, Streptococci, and Treponema of medical importance
 Morphological features of Staphylococcus, Streptococcus a and Treponema species
 Common modes of transmission of Staphylococcus, Streptococcus and Treponema
species

Step 8: Evaluation
 Describe morphological features of Staphyloccocus, Streptococccus and Treponema
species
 Mention one Staphyloccocus, Streptococccus and Treponema species of medical
importance

References:
 Baker, F.J, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition Oxford University Press.
 Cook, G. (2000), Manson’s Tropical Diseases, 22nd Ed, W.B. Saunders Company Ltd,
London;
 Gupte S. (1989) Medical Microbiology 4th Ed .Jaypee brothers Medical Publisher.
 Gupte S (2010) Medical Microbiology,(Including Parasitology)10th Ed. Jaypee brothers
Medical Publisher.
 Monica Cheesbrough (1998) District Laboratory Practice in Tropical Countries Part II -
Tropical Health Technology;
 Monica Cheesbrough (1984) Medical Laboratory Manual for Tropical Countries Volume
II: Microbiology - Tropical Health Technology/ Butterworths

Teaching Guides for NTA Level 4 MLS Curriculum Page 736

Session 3: Common Viruses causing
Diseases (HIV and Hepatitis)
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None
Learning objectives
By the end of this session student should be able to:

 Define virus, Human Immunodeficiency Virus (HIV), AIDS ,hepatitis, Hepatitis B

Virus (HBV) and Hepatitis C Virus ( HCV)
 List two common types of HIV
 Explain the geographical distribution of HIV, Hepatitis B virus (HBV) and Hepatitis
C Virus ( HCV)
 Describe morphological features of HIV
 Describe the modes of transmission of HIV, Hepatitis B virus (HBV) and Hepatitis C
Virus ( HCV)
 List common opportunistic infections associated with HIV infection ( Pneumocystis,
carinii pneumonia, Toxoplasmosis ,Tuberculosis, Salmonellosis, Histoplasmosis, and
Herpes zoster)
 Mention diseases caused by HBV and HCV

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW

Step Time Activity/Method Content

1 15 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Definitions
3 10 minutes Presentation Two types of HIV, Hepatitis virus
4 10 minutes Presentation Geographical distribution of HIV
Presentation Morphological features and modes of
5 15 minutes
Buzzing transmission of HIV, HBV, and HCV
Modes of transmission of both HIV,
15 minutes Presentation
HBV, and HCV
Infections associated with HIV infection
6 10 minutes Presentation
( opportunistic infections)
7 10 minutes Presentation Diseases caused by HBV, and HCV

Teaching Guides for NTA Level 4 MLS Curriculum Page 737

 12 5 minutes Presentation Key Points
13 (a) 20 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

ASK the students to buzz in pairs and allow them to answer the following questions
 Define Virus, HIV, and AIDS
 Classify Hepatitis viruses
WRITE THEIR answers on flip chart
SUMMARIZE their responses using notes below

Step 2: Definitions of Terms

Virus
A small infectious agent that can replicate only inside the living cell of organisms, too small
to be seen directly with a light microscope.

HIV (Human Immunodeficiency Virus)

A virus that attacks the immune system, the body’s natural defense system and cause AIDS

AIDS ( Acquired Immunodeficiency Syndrome)

A disease of the immune system caused by infection with HIV, which destroys some types
of white blood cells

Hepatitis
An inflammation of the liver characterized by the presence of inflammatory cells in the tissue
of the organ

Step 3: Types of HIV and hepatitis virus

(a)Types of HIV
(i) HIV 1
Transmitted by sexual contact, through blood, and mother to child and they appear
to cause clinically indistinguishable AIDS from that caused by HIV 2

(ii) HIV 2
IT is a second type of HIV discovered in 1986. It is transmitted in the same way as
HIV 1

(b) Types of Hepatitis virus

 HBV (Hepatitis B Virus)
 HCV (Hepatitis C Virus)

Step 4: Geographical distribution of HIV-1 and HIV-2

(a) HIV-1

Teaching Guides for NTA Level 4 MLS Curriculum Page 738

  Common in United States and Western Europe
 Spread primarily by homosexual behavior and intravenous drug abuse

(b) HIV-2
 Common in Africa and in the Caribbean and parts of Latin America
 Spread by heterosexual behavior
 Homosexuality and drug abuse are rare.

Step 5: Morphological features of HIV

 The unique morphologic feature of HIV is its cylindrical nucleoid in the mature
virion.
 The diagnostic bar-shaped nucleoid may be seen in electron micrographs.

Fig. 6: HIV molecule showing basic structures

Step 6: Modes of transmission of HIV, HBV and HCV

(a) HIV
 This virus is passed from one person to another :
 Through blood-to-blood and sexual contact
 Infected pregnant women can pass HIV to their baby during pregnancy or delivery
 Through breast-feeding.

(b) HAV (Hepatitis B Virus)

 Blood and body fluids (saliva, menstrual and milk)
 Needle stick injury
 From carrier mothers to their babies
 Sexual intercourse

(c) Hepatitis C Virus (HCV)

 Needle stick injury or cuts with sharps,
 Use of contaminated blood
 Sexual intercourse

Teaching Guides for NTA Level 4 MLS Curriculum Page 739

  During delivery and breast milking
 Saliva and tears

Step 7: Opportunistic Infections associated with HIV infection

 Pneumocystis carinii pneumonia
 Toxoplasmosis
 Tuberculosis
 Salmonellosis
 Histoplasmosis
 Herpes zoster

Step 8: Diseases caused by HBV and HCV

(a) Hepatitis B Virus (HBV)
 Liver diseases :
o liver cirrhosis
o liver cancer

(b) Hepatitis C Virus (HCV)

 Liver diseases :
o liver cirrhosis
o liver cancer

Step 9: Key points

 Medical importance of HIV
 Differences between viruses and bacteria
 Modes of transmission of both HIV and hepatitis

Step 10: Evaluation

 Mention two viral infections
 List four modes of transmission of HIV and Hepatitis

References:
 Baker, F.J., R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition Oxford University Press.
 Cook, G. (2000), Manson’s Tropical Diseases, 22nd Ed, W.B. Saunders Company Ltd,
London;
 Gupte S. (1989) Medical Microbiology 4th Ed .Jaypee brothers Medical Publisher.
 Gupte S(2010) Medical Microbiology,(Including Parasitology)10th Ed. Jaypee brothers
Medical Publisher.
 Monica Cheesbrough (1998) District Laboratory Practice in Tropical Countries Part II -
Tropical Health Technology;
 Monica Cheesbrough (1984) Medical Laboratory Manual for Tropical Countries Volume
II: Microbiology - Tropical Health Technology/ Butterworths

Teaching Guides for NTA Level 4 MLS Curriculum Page 740

Session 4: Entamoeba, Giardia and
Trichomonas species
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives
By the end of this session student should be able to:
 Classify Entamoeba , Giardia and Trichomonas species
 List two common Entamoeba , Giardia and Trichomonas species of medical importance
 Describe morphological features of Entamoeba , Giardia and Trichomonas species
 Describe modes of transmission of Entamoeba , Giardia and Trichomonas species
 Describe diseases caused by Entamoeba , Giardia and Trichomonas species
 Prevention and control measures against diseases caused by Entamoeba histolytica ,
Giardia lamblia and Trichomonas vaginalis

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 15 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Classification
Common Entamoeba, Giardia and
3 10 minutes Presentation Trichomonas species of medical
importance
Morphological features of Entamoeba
Presentation
4 20 minutes histolytica, Giardia lamblia and
Buzzing
Trichomonas vaginalis
Modes of transmission of Entamoeba
5 10 minutes Presentation histolytica, Giardia lamblia and
Trichomonas vaginalis
Diseases caused by Taenia Entamoeba
6 10 minutes Presentation histolytica, Giardia lamblia and
Trichomonas vaginalis
Prevention and control measures
7 15 minutes Presentation Entamoeba histolytica , Giardia lamblia
and Trichomonas vaginalis

Teaching Guides for NTA Level 4 MLS Curriculum Page 741

 8 10 minutes Presentation Key Points
9(a) 20 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

READ or ASK students to read the learning objectives and clarify.
ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
 Classify the following:
 Amoeba
 Giardia
 Trichomonas
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Step 2: Classification of Enatmoeba, Giardia and Trichomonas species

(a) Entamoeba
Genus parasitic protozoa of the class Rhizopoda and phylum protozoa

(b) Giardia
 Genus parasitic protozoa, the class Mastigophora of the phylum Protozoa
 Flagellates of the elementary tract

(c)Trichomonas
 Genus parasitic protozoa, the class Mastigophora of the phylum Protozoa
 Flagellates of the genital tract

Step 3: Common species of Entamoeba, Giardia and Trichomonas

(a) Enatmoeba
 Entamoeba histolytica ( pathogenic)
 Enatmoeba coli ( nonpathogenic)
 Entamopeba gingivalis ( non pathogenic)
(b) Giardia
 Giardia lamblia
(c) Trichomonas
 Trichomonas vaginalis ( pathogenic) - of the vagina
 Trichomonas hominis ( nonpathogenic) - of the intestine
 Trichomonas temax ( non pathogenic)– of the mouth,

Step 4: Morphological features or characteristics of of Entamoeba histolytica , Giardia

lamblia and Trichomonas
(a) Enatmoeba histolytica
(i)Trophozoite
 10 – 60 µ diameter
 Cytoplasm encloses RBCs

Teaching Guides for NTA Level 4 MLS Curriculum Page 742

  Possesses pseudopodia
 With active motility

Fig.7: unstained trophozoite Fig.8: stained trophozoite

(ii) Cyst
 5 - 20 µ diameter
 The cytoplasm contains 4 nuclei
 Chromatoid bodies often present, large bar or thick rodlike masses

Fig.9:showing cyst of E.histolytica

(b)Giardia lamblia
(i)Trophozoite
 Bilateally symmetrical, pear-shaped flagellate
 12 -15 µ
 With a broad, rounded anterior and a tapering posterior extremity
 Dorsal surface is convex
 Two nuclei with large central karyosomes, two axonemes
 Five (5) flagella for motility

(ii) Cyst
 Oval in shape
 9 – 12 µ
 Smooth well defined wall
 contains four(4) nuclei usually lying at one end or lie in pairs at opposite
pores
 Remnant flagella and margins of sucking disk lie inside cytoplasm

Teaching Guides for NTA Level 4 MLS Curriculum Page 743

 Fig.10: Giardia lamblia trophozoite ( left) and cyst ( right)

(c)Trichomonas vaginalis
 Pear-shaped flagellate measuring 10 – 30 µ by 5 – 10 µ
 Has short undulating membrane which comes up t o middle of the body
 Contains 3 – 5 anterior flagella , an axostyle and cytostome
 No cyst have been found

Fig. 11: Trichomonas vaginalis trophozoites

Step 5: Modes of transmission of Entamoeba histolytica, Giardia lamblia and

Trichomonas vaginalis
(a) Entamoeba histolytica
 Ingestion of water and food contaminated by infective cysts
 Anal and oral intercourse

(b) Giardia lamblia

 Through food and water contaminated by sewage , flies, or food handlers and by
hand- to – mouth
 Cyst is the infective stage
 Infection is more common in children than in adults
 Oral - anal intercourse

(c) Trichomonas vaginalis

 Sexual intercourse
 Direct contact with infected females, contaminated toilet, and toilet seats
 Infections acquired while passing through the birth canal

Teaching Guides for NTA Level 4 MLS Curriculum Page 744

Step 6: Diseases caused by by Entamoeba histolytica, Giardia lamblia and Trichomonas
vaginalis

(a) Entamoeba histolytica

 Amoebiasis associated with several conditions:
o Amoebic dysentery
o Amoebic liver abscess
o Intestinal ulcer ( flask-shaped ulcer)
o
(b) Giardia lamblia
 Giardiasis associated with several conditions:
o Impaired absorption of Vit B 12 “ Malabsorption syndrome”
o Weight loss
o Passage of foul-smelling and bulky stools
o Abdominal distension
o Nausea
(c)Trichomonas vaginalis
 Trichomonad vaginitis
 Urethritis
 Prostatovesiculitis

Step 7: Prevention and control measures against diseases caused by Entamoeba

histolytica, Giardia lamblia and Trichomonas vaginalis

(a) Entamoeba histolytica and Giardia lamblia

 Proper disposal of waste
 Drinking boiled water
 Proper cleansing of food
 Cooking vegetables thoroughly
 Personal hygiene
 Treatment of infected individuals

(b) Trichomonas vaginalis

 Personal hygiene
 Detection and treatment of infected males and females

Step 8: Key Points

 Common species of Entamoeba, Giardia, Trichomonas
 Modes of transmission of Entamoeba histolytica Giardia lamblia, and Trichomonas
vaginalis

Step 9: Evaluation
 List modes of transmission for Entamoeba histolytica and Giardia lamblia
 Mention Prevention and control measures against diseases caused Entamoeba
histoloyttica, Giardia lamblia , Trichomonas hominis and Trichomonas vaginalis

References:

Teaching Guides for NTA Level 4 MLS Curriculum Page 745

 Baker ,F.J., R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition Oxford University Press
 Cook, G. (2000), Manson’s Tropical Diseases, 22nd Ed, W.B. Saunders Company Ltd,
London;
 Gupte S. (1989) Medical Microbiology 4th Ed .Jaypee brothers Medical Publisher.
 Gupte S(2010) Medical Microbiology,(Including Parasitology)10th Ed. Jaypee brothers
Medical Publisher.
 Monica Cheesbrough (1998) District Laboratory Practice in Tropical Countries Part II -
Tropical Health Technology;
 Monica Cheesbrough (1984) Medical Laboratory Manual for Tropical Countries Volume
II: Microbiology - Tropical Health Technology/ Butterworths
 Neva, Franklin A (1994) Basic Clinical Parasitology, 16th Edition, Prentice-Hall, Inc

Teaching Guides for NTA Level 4 MLS Curriculum Page 746

Session 5: Plasmodium, Trypanasoma and
Borrelia species
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives
By the end of this session student should be able to:
 Classify Plasmodium, Trypanasoma and Borrelia species
 List four common species of Plasmodium,Trypansomes and Borrelia
 Describe the morphological features of Plasmodium falciparum,Trypanasoma
rhodesiense,Trypanasomagambiense and Borrelia duttoni and Borrelia recurrentis)
 Explain common modes of transmission of plasmodium, Trypansomes and Borrelia
species
 Describe the disease caused by plasmodium, Trypansomes and Borrelia species
 Describe prevention and control measures for Plasmodium, Trypanasoma and Borrelia
species

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Lap top, LCD projector
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 15 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Classification
Commone species Plasmodium,
3 10 minutes Presentation
Trypanasoma, and Borrelia species
Morphological features Plasmodium
Presentation
5 15 minutes falciparum, Trypanasoma rhodesiense
Buzzing
and gambiense and Borrelia species
Modes of transmission of Plasmodium,
6 10 minutes Presentation
Trypanasoma and Treponema species
Diseases caused by Plasmodium,
8 10 minutes Presentation
Trypasoma and Borrelia species
Prevention and control measures for
9 15 minutes Presentation Plasmodium, Trypasoma and Borrelia
species

Teaching Guides for NTA Level 4 MLS Curriculum Page 747

 10 10 minutes Presentation Key Points
11 (a) 25 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

ASK the students to buzz in pairs and allow them to answer the following questions
Classify the following :
 Plasmodium
 Trypamsomes
 Borrelia
 WRITE THEIR answers on flip chart
SUMMARIZE their responses using notes below

Step 2: Classification
(a) Plasmodium
 Genus of the class protozoan in which the asexual cycle ( schizogony) takes place in red
cells of vertebrates and sexual cycle (sporogony) in mosquitoes
(b) Trypanasoma
 Genus of the family Trypanasomtidae of the class Protozoan with flagella whose species
are pathogenic for humans and other mammals through the vectors Tsetseflies and
Triatomine bugs
(c) Borrelia
 Genus of Spirochaetes that belong to the order Spirochaetales

Step 3: Common species of Plasmodium, Trypanasoma and Treponema

(a) Plasmodium species affecting humans
 Plasmodium vivax
 Plasmodium falciparum ( the most common in Tanzania )
 Plasmodium ovale
 Plasmodium malariae
(b) Trypansoma species
 Trypanasoma rhodesiense and Trypanasoma gambiense (African species)
 Trypanasoma cruzi ( American species)
(c) Borrelia species
 Borrelia duttoni
 Borrelia recurrentis

Step 4: Morphological features Plasmodium falciparum, Trypanasoma rhodesiense and

Trypanasoma gambiense and Borrelia species
(a) Plasmodium falciparum
 The diagnostic morphological features of the human plasmodia are seen in blood smears
stained by Giemsa or Field stains.

Teaching Guides for NTA Level 4 MLS Curriculum Page 748

  The earliest form after invasion of the red cell is ring of bluish cytoplasm with dot like
nucleus of red chromatin.
 The infected red blood cells are of normal size
 The presence of more than one ring form in a cell is relatively common.
 Presence of double chromatin dots in an infected red cell
 The gametocyte is banana-shaped

Gametocyte Stage

 The Gametocyte
stage is the sexual
erythrocytic stage

Fig. 12: Plasmodium falciparum gametocyte which is banana-shaped

Fig.13: Plasmodium falciparum trophozoite two parasites infected one RBC

(b) Trypanasoma rhodesiense and Trypanasoma gambiense

 These parasites occur in trypomastigote form in the vertebrate host as a spindle-
shaped elongated organism with pointed anterior and blunted posterior ends.
 The size may vary from 10µ x 3 to 20µ x 3µ
 The morphology of Trypanasoma cruzi is same as Trypanasoma rhodesiense and
gambiense except that is C or U shaped in stained films of blood and measures 3 µ x
3µ

Teaching Guides for NTA Level 4 MLS Curriculum Page 749

 Left: Trypanosoma brucei sp. in thin blood smears stained with
Wright-Giemsa.
Right: Trypanosoma .brucei sp. in a thin blood smear stained with
Giemsa. The trypomastigote is beginning to divide; dividing forms
are seen in African trypanosomes, but not in American
trypanosomes.

C: Trypanosoma brucei sp. in thin blood smears stained

Fig.14 and 15: Left and right respectively

(a) Borrelia species

 Irregular, spiral with open or both pointed
 It is 8 – 20 µ x 0.2 – 0.4 µ in size
 Possesses 5 to 8 spiral coils
 Stains best with Giemsa and Leishman’s stain

Fig. 16: shows Borrelia species in darkfield microscopy

Step 5: Modes of transmission of Plasmodium, Trypanasoma and Borrelia Species

(a)Plasmodium species
 Mosquito bite (Female Anopheles mosquito)
 Blood transfusion
 Congenital
 Use of contaminated syringe as in drug addicts
(b) Trypanasoma rhodesiense and Trypanasoma gambiense
 By the bite of infected vector ( Glossina species/ Tsetse flies)
 Mechanical transmission during epidemics
 Ocassionary the disease may be transmitted by coitus and rarely congenitally
 Blood transfusion
(c) Trypanasoma cruzi
 By the infected vector ( Triatomine bugs) through fecal contamination

Teaching Guides for NTA Level 4 MLS Curriculum Page 750

 Ingestion of uncooked or insufficiently cooked meat of infected vertebrate host
 Blood transfusion
(d) Borrelia species
(i)Borrelia duttoni
 By the bite of infected tick ( Ornithodoros moubata)
 Contamination of bite wound by body fluids of the infected tick
(i) Borrelia recurrentis
 Through louse bite Pediculus humanus var corporis and Pediculus humanus var
capitis ( by contaminative method , the crushed body of a louse coming in contact
with the bite wound or abraded skin )
 Congenital
 Blood transfusion

Step 7: Diseases caused by Plasmodium falciparum, Trypanasoma rhodesiense and

Trypanasoma gambiense and Borrelia duttoni and Borreloia recurrentis
(a)Plasmodium falciparum
 Plasmodium falciparum is a causative agent of malaria in humans a disease associated
with the conditions:
o Anaemia
o Black -water fever
o cerebral malaria and others.
(b)Trypanasoma species
 African Trypanaspmiasis ( Sleeping sicknes) casues by Trypanasoma rhodesiense and
Trypanasoma gambiense
 American Trypanasomiasis ( Chaga’s disease ) caused by Trypanasoma cruzi.
(c) Borrelia species
 Tick borne relapsing fever caused by Borrelia duttoni
 Louse borne relapsing fever caused by Borrelia recurrentis

Step 8: Prevention and control measures against diseases causes by Plasmodium,

Trypanasoma and Borrerlia species
(a) Plasmodium species
 Measures against vectors harboring the parasites:
o Drying of breeding sites
o Application of insecticides and larvicides
o Use of Insecticide Treated Nets (ITNS)
o Application of repellents
 Treatment of infected persons
 Health education
(b) Trypanasoma brucei species
 Measures against vectors harboring the parasites
o Applictaion of insecticides both air and ground methods
o Use of traps
o Use of sterilized males
o Clearing of trees
 Treatment of infected persons
 Health education

Teaching Guides for NTA Level 4 MLS Curriculum Page 751

(c) Borrelia species
(i)Measures against vectors harboring the parasites (Borrelia duttoni):
 Living in houses which have no cracks on wall as well as floors
 Smoking in the areas infected by ticks
 Application of insecticides
 Use of Insecticide treated nets (ITNs)
 Pulling of tick from the infested host
 Treatment of infected persons
 Health education
(ii) Measures against vectors harboring the parasites (Borrelia recurrentis):
o Changing and washing the clothing in hotter water than 60°c
o Ironing clothes
o Application of insecticides
o Regular washing of hair with soap and warm water which has effects on nymph
o Regular combing which has effects on eggs glued on the hair
o Shaving the head
o Avoid sharing combs
 Treatment of infected individuals
 Health education to the community

Step 9: Key points

 Describe modes of transmission of Plasmodium, Trypanasoma and Borrerlia species
 Describe the morphological features of Plasmodium, Trypanasoma and Borrerlia species
 List two diseases caused by Plasmodium, Trypanasoma and Borrerlia species

Step 10: Evaluation

 Mention four Plasmodium species affecting humans
 List common modes of transmission of Plasmodium, Trypanasoma and Borrelia species
 Describe the morphological features of Plasmodium falciparum

References:
 Baker, F.J., R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition Oxford University Press.
 Cook, G. (2000), Manson’s Tropical Diseases, 22nd Ed, W.B. Saunders Company Ltd,
London;
 Gupte S. (1989) Medical Microbiology 4th Ed .Jaypee brothers Medical Publisher.
 Gupte S(2010) Medical Microbiology,(Including Parasitology)10th Ed. Jaypee brothers
Medical Publisher.
 Monica Cheesbrough (1998) District Laboratory Practice in Tropical Countries Part II -
Tropical Health Technology;
 Monica Cheesbrough (1984) Medical Laboratory Manual for Tropical Countries Volume
II: Microbiology - Tropical Health Technology/ Butterworths

Teaching Guides for NTA Level 4 MLS Curriculum Page 752

Session 6: Taenia and Schistosoma species
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives
By the end of this session student should be able to:
 Classify Taenia and Schistosoma species
 List two common Taenia and Schistosoma species of medical importance
 Describe morphological features of Taenia and Schistosoma species
 Describe modes of transmission of Taenia saginata ,Taenia solium, Schistosoma
haematobium and Schistosoma mansoni
 Describe diseases caused by Taenia saginata, Taenia solium , Schistosoma haematobium
and Schistosoma mansoni
 Prevention and control measures against diseases caused by Taenia saginata, Taenia
solium , Schistosoma haematobium and Schistosoma mansoni

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Laptop and LCD projector
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 15 minutes Presentation Introduction, Learning Objectives
2 5 minutes Presentation Classification
Common Taenia and Schistosoma
3 10 minutes Presentation
species
Presentation Morphological features of Taenia and
4 20 minutes
Buzzing Schistosoma species
Modes of transmission of Taenia and
5 10 minutes Presentation
Schistosoma species
Diseases caused by Taenia and
7 10 minutes Presentation
Schistosoma species
Prevention and control measures for
9 20 minutes Presentation
Taenia and Schistosome species
11 10 minutes Presentation Key Points
12 (a) 20 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 753

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
 Classify the following
 Taenia
 Schistosoma
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Step 2: Classification
(a)Taenia
 A genus of Cyclophillidean tapeworms of the family of the phylum Plathelminth,
family Taenidae and the class Cestoda.

(b) Schistosoma
Flukes parasitic worms of the class Trematoda of the phylum Plathelminthes.

Step 3: Common of Taenia and Schistosoma species

(a) Taenia species
 Taenia solium (Pork tapeworm)
 Taenia saginata (Beef tapeworm)

(b) Schistosoma
 Scistosoma haematobium
 Schistosoma mansoni

Step 4: Morphological features or characteristics of Taenia and Schistosoma Species

(a) Taenia species
(i) Taenia saginata
 The adult worm is 4-6 meters in length and is sometimes longer
 It is 1000 to 2000 segments.
 The scolex is 1 to 2 mm in diameter, with four prominent hemispherical
suckers but no well-developed rostellum or hooks.
 The mature segments have irregularly alternate lateral genital pores
 The gravid segments bears 15 to 30 lateral branches of the uterus on each
side

(j) Taenia Solium

 The adult worm is s 2-4 in length and when fully developed contains 800
to 1000 segments
 Has globular scolex about 1mm in diameter, equipped with four cup-
shaped suckers and a low, cushioned rostellum with a double crown of 25
to 30 hooks.
 The mature segment is roughly square, with unilateral or irregularly
alternate genital pores on consecutive segments.

Teaching Guides for NTA Level 4 MLS Curriculum Page 754

  The gravid segment is 7-12 thick lateral uterine branches on each side of
the main uterine stem

A B
Fig.17 and 18: (a)showing the scolex of T.solium and (b) showing scolex of T.saginata

Taenia eggs
 The yellow-brown eggs cannot be distinguished between the two species and are 30 to 40
µ in diameter
 The egg has a thin outer transparent shell surrounding an oncosphore that bears 3 pairs
of hooklets

Fig. 19 – 21: Eggs of Taenia species

(b) Schistosoma species

(a) Schistosoma haematobium
 The male is 10 to 15 mm long and 1 mm thick
 It is covered by finely tuberculated cuticle
 There are two muscular suckers: the oral sucker is small while the ventral sucker is large
and prominent
 The adult female is 20mm by 0.25 mm with cuticle tubercles confined to the two ends
 The eggs are ovoid 150µ by 50µ with a brownish transparent shell having a terminal
spine one pole.
(b) Schistosoma mansoni
 The male is 6 to 13 mm long and 1 mm thick
 It is covered by coarsely tuberculated cuticle
 There are two muscular suckers: the oral sucker is small while the ventral sucker is large
and prominent

Teaching Guides for NTA Level 4 MLS Curriculum Page 755

 The adult female is10 – 20 mm by 0.25 mm with cuticle tubercles confined to the two
ends
 The eggs are ovoid 140µ by 60µ with a brownish transparent shell having a lateral spine
one pole

Fig.22: Adult male and female Fig. 23: of Schistosoma Fig. 24: Egg of Schistosoma
in couple haematobium mansoni

Source: ASCP

Step 5: Modes of transmission of Taenia

(a)Taenia species
(i) Taenia saginata
 Ingestion of uncooked or insufficiently cooked beef

(ii) Taenia solium

 Ingestion of uncooked or insufficiently cooked pork
 Ingestion of infective egg (in autoinfection)

(b) Schistosoma species

(i) Schistosoma haematobium
 Transmission involves the snail intermediate host Bulinus species in which the
infective stage (cercaria) develops
 Human is infected through penetration of unbroken skin by cercaria when that
individual has contact with water containing the cercaria
 Transmission is associated by a number of activities: bathing, walking, fishing,
rice cultivation

(ii) Schistosoma mansoni

 Transmission involves the snail intermediate host Biomphalaria species in which
the infective stage (cercaria) develops
 Human is infected through penetration of unbroken skin by cercaria when that
individual has contact with water containing the cercaria
 Transmission is associated by a number of activities: bathing, walking, fishing,
rice cultivation

Step 6: Diseases caused by: Taenia and Schistosoma species

(a) Taenia species

Teaching Guides for NTA Level 4 MLS Curriculum Page 756

  Taeniasis saginata caused by T. saginata
 Taeniasis solium caused by T. solium
 Cysticercosis (epilepsy)

(b) Schistosoma species

(a) Schistosoma haematobium
 Schistosomiasis haematobium ( Bilharzia) associated with several
conditions:
o malignancy of bladder
o ulceration of the urinary bladder
o haematuria
 swimmer’s itch,

(b) Schistosoma mansoni

 Schistosomiasis haematobium ( Bilharzia) associated with several
conditions:
o malignancy of intestine
o ulceration of the intestinal wall invaded
 swimmer’s itch

Step 7: Prevention and control measures against diseases caused by:

(a)Taenia species
 Thorough cooking and processing of beef and pork
 Personal hygiene particularly for cysticercosis
 Proper waste disposal
 Freezing beef and pork at up – 10 0 c for 4 days or more
 Treatment of infected persons
 Inspection of beef and pork

(b) Schistosoma species

 Building and use of toilets
 Avoiding contamination of water bodies by urine and feaces
 Control of the snail intermediated host (by physical, chemical and biological methods)
 Treatment of infected individuals
 Health education

Step 8: Key points

 Mention two common species of Taenia and Schistosome of medical importance
 List the intermediate hosts for Schistosoma haematobium and S.mansoni
 How Taenias saginata and solium can be prevented

Step 9: Evaluation
 Mention the intermediate hosts of Schistosoma haematobium and S.mansoni
 Differentiate between Taenia saginata and Taenia solium

References:

Teaching Guides for NTA Level 4 MLS Curriculum Page 757

 Baker, F.J., R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition Oxford University Press.
 Cook, G. (2000), Manson’s Tropical Diseases, 22nd Ed, W.B. Saunders Company Ltd,
London;
 Gupte S. (1989) Medical Microbiology 4th Ed .Jaypee brothers Medical Publisher.
 Gupte S(2010) Medical Microbiology,(Including Parasitology)10th Ed. Jaypee brothers
Medical Publisher.
 Monica Cheesbrough (1998) District Laboratory Practice in Tropical Countries Part II -
Tropical Health Technology;
 Monica Cheesbrough (1984) Medical Laboratory Manual for Tropical Countries Volume
II: Microbiology - Tropical Health Technology/ Butterworths
 Neva, Franklin A (1994) Basic Clinical Parasitology, 16th Edition, Prentice-Hall, Inc

Teaching Guides for NTA Level 4 MLS Curriculum Page 758

Session 7: Ascaris, Trichuris and
Enterobius species
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives
By the end of this session student should be able to:
 Classify Ascaris, Trichuris and Enterobius species
 List common species of Ascaris, Trichuris and Enterobius
 Describe morphological features of Ascaris, Trichuris and Enterobius species
 Describe modes of transmission of Ascaris lumbricoides, Trichuris trichiura and
Enterobius vermicularis
 Describe diseases caused by Ascaris lumbricoides, Trichuris trichiura and Enterobius
vermicularis
 Prevention and control measures against diseases caused by Ascaris lumbricoides,
Trichuris trichiura and Enterobius vermicularis

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Laptop and LCD projector
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 15 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Classification
Common Ascaris, Trichuris and
3 5 minutes Presentation
Enterobius species
Morphological features of Ascaris
Presentation
4 20 minutes lumbricoides, Trichuris trichiura and
Buzzing
Enterobius vermicularis
Modes of transmission of Ascaris
5 10 minutes Presentation lumbricoides, Trichuris trichiura and
Enterobius vermicularis
Diseases caused by Ascaris lumbricoides,
7 10 minutes Presentation Trichuris trichiura and Enterobius
vermicularis
9 20 minutes Presentation Prevention and control measures against

Teaching Guides for NTA Level 4 MLS Curriculum Page 759

 diseases caused by Ascaris lumbricoides,
Trichuris trichiura and Enterobius
vermicularis
11 10 minutes Presentation Key Points
12 (a) 20 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (15 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
Classify the following
 Ascaris
 Trichuris
 Enterobius
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Step 2: Classification
(a) Ascaris
 A genus of parasitic nematoide worms known as the “ the giant intestinal round
worm”
 A genus found under the class nematoda of the phylum Nematohelminthes

(b) Trichuris
 A genus round worm family Trichuridae of the class Nematoda and the phylum
Nematohelminthes

(c) Enterobius
 A genus of intestinal nematodes of the class nematoda and the phylum
Nematohelminthes

Step 3: common species of Ascaris, Trichuris and Enterobius

(a)Ascaris
Ascaris lumbricoides

(b) Trichuris
Trichuris Trichiura

(c) Enterobius
Enterobius vermicularis

Step 4 : Morphological features of Ascaris, Trichuris and Enterobius

(a)Ascaris lumbricoides
Adult:

Teaching Guides for NTA Level 4 MLS Curriculum Page 760

  White or pink worm
 Elongated cylindrical measuring 10 – 30 cm male and 22 – 35 female by 2 – 6 mm
 Postwerior end of male is curved ventrally
 Male worm is smaller than female worm

Adult worms

Fig. 25: Adult Ascaris lumbricoides

Egg
 45 – 75 by 35 – 50 µ
 There is an outer, coarsely mammilated , albuminoius covering that serves as an
axilliary barrier to permeability but may be absent

Fig. 26: Egg of Ascaris lumbricoides

(b)Trichuris trichiura
(i) Adult
 A whip-like anterior, a more robust posterior, two fifth containing the intestine
and single set of reproductive organs
 30 – 35 mm male and 35 – 50 mm female
 Bluntly rounded posterior end of the female and the coiled posterior extremity of
the male with single spicule and retractile sheath

(ii) Egg
 Size ranges as 50 – 54 by 23 µ
 Barrel-shaped with plug-like translucent polar prominences
 yellowish outer and transparent inner shell

Teaching Guides for NTA Level 4 MLS Curriculum Page 761

Fig. 27: Egg of Trichuris Trichiura showing the polar plugs on both sides

(d) Enterobius vermicularis

Adult
 Female measures 8.0 – 13 mm by 0.4 mm
 Has a cuticular expansion at the anterior end , prominent esophageal and a long
pointed tail
 The male is 2 – 5 mm in length with a curved tail and a single spicule

Fig. 28: Anterior extremity of the adult worm (E. vermicularis) showing a bulbed
oesophogus

Egg
 Colourless ,plannoconvex ( flattened at one side)
Measure 50 – 60 by 30 µ surrounded by transparent shell and contains coiled tadpole
like larva

Fig. 29 - 31: Show eggs of Enterobium vermicularis

Step 5: Modes of transmission of Ascasris lumbricoides, Trichuris trichiura and

Enterobius Vermicularis

(a) Ascasris lumbricoides

 Ingestion of infective ( hand –to- mouth ):
o Drinking water

Teaching Guides for NTA Level 4 MLS Curriculum Page 762

 o Ingestion of contaminated vegetables

(b) Trichuris trichiura

 Ingestion of infective ( hand –to- mouth ):
o Drinking water
o Ingestion of contaminated vegetables

(c) Enterobius Vermicularis

 Ingestion of the infective eggs in:
o Hand to mouth from scratching the perianal areas
o Inhalation of air borne eggs in dust
 Retro-infection through the anus

Step 6: Diseases caused by Ascasris lumbricoides, Trichuris trichiura and Enterobius

Vermicularis

(a) Ascasris lumbricoides,

 Ascasriasis, Ascaris infection associated with conditions:
o Abdominal pain
o Pneumonia –like condition
o Hemorrhagic pneumonia
o Intestinal obstruction

(b) Trichuris trichiura

 Trichuriasis and Whipworm infection associated with conditions:
o Appendicitis
o In heavy infections there is rectal prolapsed
o Frequent small blood-streaked diarrhoeal stools
o Abdominal pains and tenderness
o Nausea and vomiting
o Anaemia
o Weight loss

(c) Enterobius Vermicularis

 Enterobiasis, Oxyuriasis, pin worm seat worm infections associated with conditions:
o Perianal, perineal, and vaginal irritation caused by migration of the gravid female
worm
o Local pruritis that can be annoying
o Poor appetite
o Loss of sleep
o Weight loss
o Hyperactivity
o Nausea , vomiting and abdominal pain

Step 7: Key points

 Classification of Ascasris lumbricoides, Trichuris trichiura and Enterobius Vermicularis
 Morphology of Ascasris lumbricoides, Trichuris trichiura and Enterobius Vermicularis
(eggs and adults)

Teaching Guides for NTA Level 4 MLS Curriculum Page 763

 Transmission of Ascasris lumbricoides, Trichuris trichiura and Enterobius Vermicularis

Step 8: Prevention and control of Ascaris lumbricoides, Trichuris trichura and

Enterobius vermicularis
(a) Ascaris lumbricoides and Trichuris trichura
 Avoid eating uncooked vegetables
 Use of latrine
 Treatment of infected individuals
 Health education

(b) Enterobius vermicularis

 Treatment of infected individuals
 Health education
 Proper washing of bedding
 Ironing of clothing

Step 8: Evaluation:
 Question: student must be able to differentiate between Ascaris lumbricoides, and
Trichuris trichiura
 student must be able to demonstrate identification of Enterobius vermicularis

References:
 Baker, F.J., R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition Oxford University Press.
 Cook, G. (2000), Manson’s Tropical Diseases, 22nd Ed, W.B. Saunders Company Ltd,
London;
 Gupte S. (1989) Medical Microbiology 4th Ed .Jaypee brothers Medical Publisher.
 Gupte S(2010) Medical Microbiology,(Including Parasitology)10th Ed. Jaypee brothers
Medical Publisher.
 Monica Cheesbrough (1998) District Laboratory Practice in Tropical Countries Part II -
Tropical Health Technology;
 Monica Cheesbrough (1984) Medical Laboratory Manual for Tropical Countries Volume
II: Microbiology - Tropical Health Technology/ Butterworths

Teaching Guides for NTA Level 4 MLS Curriculum Page 764

Session 8: Hookworms and Strongyloides
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives
By the end of this session student should be able to:
 Classify Hookworms and Strongyloides species
 List common species of Hookworms and Strongyloides of medical importance
 Describe morphological features of Hookworms and Strongyloides species
 Describe modes of transmission of Hookworms and Strongyloides species
 Describe diseases caused by Hookworms and Strongyloides species
 Prevention and control measures against diseases caused by Hookworms and
Strongyloides species

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Laptop and LCD projector
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 15 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Classification
Common Hookworms and Strongyloides
3 5 minutes Presentation
species
Presentation Morphological features Hookworms and
4 20 minutes
Buzzing Strongyloides species
Modes of transmission of Hookworms
5 10 minutes Presentation
and Strongyloides species
Diseases caused by Hookworms and
7 10 minutes Presentation
Strongyloides species
Prevention and control measures against
9 20 minutes Presentation diseases caused by Hookworms and
Strongyloides species
11 10 minutes Presentation Key Points
12 (a) 20 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (15 minutes)

READ or ASK students to read the learning objectives and clarify.

Teaching Guides for NTA Level 4 MLS Curriculum Page 765

ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
 Classify the following
 Hookworms
 Stronyloide
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Step 2: Classification of Hookworms and Strongyloides species

(a) Hookworms
Parasitic round worms of the class Nematoda and Phylum Nematohelminthes that
inhabit the intestines of vertebrate host (dog, cat or human).

(b) Strongyloides
Genus parasitic nematode of the class nematoda, and Phylum Nematohelminthes that inhabit
the intestine mammals

Step 3: Common species of Hookworms and Strongyloides of medical importa

(a) Hookworms
 Ancylostoma duodenale
 Necator americanus

(b) Stronyloides species

 Strongyloides stercolaris
Step 4: Morphological features of Hookworms and Strongyloides species
(a) Hookworms
Adult
 Are small, cylindrical, fusiform, gtreyish white
 Females are 9 – 13 mm by 0.4 – 0.6 mm and are larger than male
 Males are 5 – 11m by 0.3 – 0.4 mm
 The chief morphologic differences in the species are in the shape , buccal capsule, and
male bursa
 In the buccal capsule N.americanus has a dorsal pair of semilunar cutting plates
 Ancylostoma duodenale has two ventral pairs of teeth which help for attachment to
the intrestinal mucosa

Egg
 The egg has blunt rounded ends and a single thin transparent hyaline shell
 It is unsegmented at oviposition and in 2 – 8 cell stages of division in fresh feces.
 The eggs of the several species are almost indistinguishable differing only slightly in
size:
o Necator americanus : 64 – 76 by 36 – 40 µ
o Ancylostoma duodenale : 56 – 60 by 36 – 40 µ

Teaching Guides for NTA Level 4 MLS Curriculum Page 766

Fig. 32 – 33: show eggs of Hookworms in different developmental stages

(b) Strongyloides stercolaris

Adult
 Females are 2.5 mm x 40 – 50 µ ( hardly visible to the naked eye)
 Males are shorter and broader than female

Eggs
 Measure 30 x 5.5 µ
 Thin shelled, transparent and oval, containing larvae ready to hatch

Larvae
 Larvae are detected inn man’s stool.
 Larvae are of two types: Rhabditform andn filariform larvae

Step 5: Modes of transmission Hookworms and Strongyloides stercolaris

(a)Hookworms
 Penetration of unbroken skin by filariform larva
 Ancylostoma may also be acquired by the noral route by direct ingestion of infective
larvae viaa contaminated fruits and vegetables

(b) Strongyloides stercolaris

 Penetration of unbroken skin by filariform larva

Step 6: Diseases caused by Hookworms and Strongyloides stercolaris

(a) Hookworms
 The diseases are called : Ancylostomiasis, necatoriasis, and hookworm infections
associated with several conditions:
o Microcytic, hypochromic anaemia of the iron-deficiency type
o Ground itch ( dermatitis) due to penetrating larvae through the skin
o Bronchopneumonia due to migrating larvae in lungs
o Haemorrhage in the intestinal mucosae

(b) Strongyloides stercolaris

 The diseases are called : Stroingyloidiasis associated with several conditions:
o Ulticarial rash at the site of entry
o Bronchopneumonia due to migrating larvae in lungs

Teaching Guides for NTA Level 4 MLS Curriculum Page 767

Step 7: Prevention and control measures against diseases caused by Hookworms and
Strongyloides stercolaris
(a) Hookworms
 Wearing protective footwear
 Sanitary disposal of feacal wastes
 Treatment of infected individuals
 Health education

(b) Strongyloides stercolaris

 Wearing protective footwear
 Sanitary disposal of feacal wastes
 Treatment of infected individuals
 Health education

Step 8: Key points

 Modes of transmission of Hookworms
 Prevention and control measures of Strongyloides stercolaris

Step 9: Evaluation
 Mentions the pathological effects due to infection with hookworms
 List two species of hookworms

References:
 Baker, F.J., R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition Oxford University Press.
 Cook, G. (2000), Manson’s Tropical Diseases, 22nd Ed, W.B. Saunders Company Ltd,
London;
 Gupte S. (1989) Medical Microbiology 4th Ed .Jaypee brothers Medical Publisher.
 Gupte S(2010) Medical Microbiology,(Including Parasitology)10th Ed. Jaypee brothers
Medical Publisher.
 Monica Cheesbrough (1998) District Laboratory Practice in Tropical Countries Part II -
Tropical Health Technology;
 Monica Cheesbrough (1984) Medical Laboratory Manual for Tropical Countries Volume
II: Microbiology - Tropical Health Technology/ Butterworths

Teaching Guides for NTA Level 4 MLS Curriculum Page 768

Session 9: General Disease Transmission,
Modes of Transmission, and Diseases
Transmitted
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives
By the end of this session student should be able to:
 Define disease, infection and re-infection
 Define disease transmission
 Describe parasite, vector, carrier, host, intermediate host and definitive host
 Describe mode of diseases transmission and organisms transmitted
 List vectors involved in transmission of Plasmodium, Trypanosoma, and Borrellia
species),
 Describe water-borne, vector-borne, air-borne, contact, food-borne, milk-borne, blood-
borne and Sexually transmitted diseases

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Laptop and LCD projector
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 15 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Definitions
Parasite, vector, carrier, host,
3 10 minutes Presentation
intermediate host and definitive host
Presentation Modes of disease transmission and
4 25 minutes
Buzzing organisms transmitted
vectors involved in transmission of
5 5minutes Presentation Plasmodium, Trypanosoma, and
Borrellia species
water-borne, vector-borne, air-borne,
6 20 minutes Presentation contact, food borne, milk-borne, blood-
borne and Sexually transmitted diseases
8 15 minutes Presentation Key Points

Teaching Guides for NTA Level 4 MLS Curriculum Page 769

 9 (a) 20 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (15 minutes)

READ or ASK students to read the learning objectives and clarify.
ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
 Define the following terms
 Disease, infection and re-infection
 Disease transmission
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Step 2: Definitions
Disease
Pathological condition of a part, organ, or system of an organism resulting from various
causes, such as infection, genetic defect, or environmental stress and characterized by an
identifiable group of signs and symptoms

Infection
Invasion of the host body (tissue of a host) by pathogenic organism whereby they grow,
multiply and cause harmful effect

Re-infection
Subsequent infection with the same pathogenic organism in the same host
Disease transmission
The way that pathogens are passed or communicated from one individual to another in a
population of humans or in groups of other animals

Step 3: Vector, carrier, intermediate host and definitive host

(a) Parasite
 Defined as a weaker organism that obtains food and shelter from another organism and
derives all the benefit from the association
 Ticks acts as parasites on a number of mammals, e.g man, cattle etc.

(b) Vectors:
 Insects transmitting pathogens from one individual to another or from source of infection
to the susceptible individual
 Blood sucking insects such as mosquitoes, ticks, mites, flies, and lice act as vectors of a
number of human infections

(c) Carrier
 A person who harbours the pathogenic organisms but has never suffered from the disease
it causes
 A carrier does not show signs and symptoms of the disease.

Teaching Guides for NTA Level 4 MLS Curriculum Page 770

(d) Host
 The organism that harbours the parasite

(e) Definitive host

 The host that harbours the adult/mature or sexual stage of the parasite
 For example female Anopheles mosquito for Plasmodium species and man for beef
tapeworm

(f) Intermediate host

 The host that harbours the immature or asexual stage of the parasite
 Human for Plasmodium species and cattle for beef tapeworm

Step 4: Modes of disease transmission and organisms transmitted

(a) Inhalation
Inhaling aerosols (airborne droplets) containing pathogen secreted by infected person
coughing, spitting, sneezing, nose blowing, or laughing
 For example Mycobacterium Tuberculosis, Measles virus,

(b) Ingestion
(i) Ingesting pathogens in water or food contaminated with faeces from infected
person or disease carriers
 For example Mycobacterium Tuberculosis ,intestinal protozoa, worms, Vibrio
cholera, Salmonella and Shigella.
(ii) Ingesting pathogens in unpasteurized milk and dairy products
- For example Mycobacterium Tuberculosis, Brucella species

(c) Sexual contact

Direct transfer of pathogens from one person to another by sexual intercourse
o For example HIV, Neisseria gonorrhoea , Treponema pallidum, Hepatitis B virus,
Candida albicans

(d) Skin contact

Transfer of pathogens from the skin of one person to the skin another
For example : Sarcoptes scabiei , Tinea species,

(e) Contamination of cuts

Pathogens entering wounds, cuts or burns by way of contaminated hands or unsterile
instruments
For example: Clostridium tetanii, HIV, Hepatitis B and C virus, Staphylococci,

(f) Insect bite

Pathogens entering the blood and tissues through the bite of an arthropod vector
For example: Plasmodium species, Trypanasoma species, Borrelia, Wunchereria, Brugia,
Loa, Onchocerca

(g) Congenital
The transfer of pathogens from mother to foetus during pregnancy

Teaching Guides for NTA Level 4 MLS Curriculum Page 771

For example: HIV, Treponema pallidum, Toxoplasma gondi, Plasmodium species

(h) Blood transfusion

Transfer of pathogens in blood or blood products
For example: HIV, Treponema pallidum, Toxoplasma gondi, Plasmodium species

(i) Waterborne
Transfer of pathogens associated with water bodies (river, stream, pond etc.)

For example: (i)Bacterial

 Vibrio cholera
 Salmonella
 Shigella

(ii) Viral
 Hepatitis – A virus
 Polio-virus

(iii) Protozoa
 Entamoeba histolytica
 Giardia lamblia
 Balantidium coli

(iv) Helminths
 Ascaris lumbricoides
 Trichuris trichiura
 Enterobius vermicularis
 Echinococcus granulosus and Echinococcus multilocularis

(v) Aquatic host

 Dracunculus medinensis, Diphyllobothrium latums,
 Schistosoma haematobium and Schistosoma mansoni

Step 5: Vectors involved in transmission of Plasmodium, Trypanosoma, and Borrellia

Species
(a) Vectors of Plasmodium species
 Female Anopheles mosquito

(b) Vector of Trypanasoma species

 Glossina species(Tsetseflies) transmit Trypanasoma rhodesiense and Trypansoma
gambiense
 Triatomine bugs transmit Trypanasoma cruzi and Trypanasoma rangeli

(c) Vectors of Borrelia species

 Ticks ( Ornithodoros species) transmit Borrelia duttoni
 Lice ( Pediculus humanus corporis and Pediculus humanus capitis) transmit Borrelia
recurrentis

Teaching Guides for NTA Level 4 MLS Curriculum Page 772

Step 6: Water-borne, vector-borne, air-borne, milk-borne, blood-borne and sexually
transmitted Diseases
(a) Water-borne
(i)Bacterial
 Cholera
 Typhoid
 Diarrhoea
 Bacillary dysentery
(ii) Viral
 Hepatitis - A
 Poliomyelitis
(iii) Protozoa
 Amoebiasis
 Giardiasis
 Balantidium coli diarrhoea
(iv) Helminths
 Round worm
 Whipworm
 Thread worm
 Hydatid disease
(v) Aquatic host
 Cyclope ( Guinea, and fish tape worm infections)
 Snail ( Schistosomiasis)
(b) Vector-borne diseases
(i) Protozoal
 Plasmodiasis ( Malaria)
 Trypasomiasis ( Sleeping sickness)
 Trypansomiasis ( Chaga’s ) disease
(ii) Bacterial
 Plague
 Relapsing fever (tick and louse - borne)
(iii) Helminths
 Filariasis (Elephantiasis, Onchocerciasis)
(c) Air-borne
 Tuberculosis
 Whooping cough,
 Measles
 Meningitis
 Pneumonia
(d) Milk-borne
 Tuberculosis
 Brucellosis
(e) Food-borne
 Typhoid
 Helminthic infections

Teaching Guides for NTA Level 4 MLS Curriculum Page 773

  Diarrhoea
 Amoebic dysentery
(f) Skin contact- borne
 Scabies
 Fungal ( Tinea species)
(g) Blood-borne
 HIV infection
 Syphilis
 Trypanasomiasis
 Malaria
 Hepatitis – B, C and D
(h) Sexually transmitted
 HIV infection
 Hepatitis – B and C
 Gonorrhoea
 Syphilis
 Candidiasis
 Trichomoniasis vaginalis

Step 7: Key points

 List modes of disease transmission
 Mentions four vector-bone diseases
 Blood-borne diseases

Step 8: Evaluation
 List modes of disease transmission
 Mentions four vector-bone diseases
 Define parasite, host and vector

References:
 Baker, F.J., R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition Oxford University Press.
 Cook, G. (2000), Manson’s Tropical Diseases, 22nd Ed, W.B. Saunders Company Ltd,
London;
 Gupte S. (1989) Medical Microbiology 4th Ed .Jaypee brothers Medical Publisher.
 Gupte S(2010) Medical Microbiology,(Including Parasitology)10th Ed. Jaypee brothers
Medical Publisher.
 Monica Cheesbrough (1998) District Laboratory Practice in Tropical Countries Part II -
Tropical Health Technology;
 Monica Cheesbrough (1984) Medical Laboratory Manual for Tropical Countries Volume
II: Microbiology - Tropical Health Technology/ Butterworths

Teaching Guides for NTA Level 4 MLS Curriculum Page 774

Session 10: General Prevention and
Control Measures of Diseases – Part I
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives
By the end of this session student should be able to:
 Define health education, prevention, control, hygiene, sterility, biological method,
 Describe the importance of hygiene and health education in prevention and control of
diseases
 List four Ways by which health education can be communicated
 Explain the importance of sterility in prevention and control of diseases
 List methods for sterilization
 List three biological methods in preventing and controlling diseases
 Describe the importance of biological methods in preventing and controlling diseases

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Laptop and LCD projector
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Definitions
Importance of hygiene and health
3 15 minutes Presentation education in prevention and control of
diseases
Presentation
4 10 minutes Ways of health education
Buzzing
Importance of sterility in prevention and
5 10minutes Presentation
control of diseases
6 10 minutes Presentation Methods for sterilization
Biological methods in preventing and
7 10 minutes Presentation
controlling diseases
Importance of biological methods in
8 10 minutes Presentation
preventing and controlling diseases
9 15 minutes Presentation Key Points

Teaching Guides for NTA Level 4 MLS Curriculum Page 775

 10 (a) 20 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (15 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

ASK the students to buzz in pairs and allow them to answer the following questions
 Define the following terms
 Health education
 Prevention and control of diseases
 Hygiene
 Sterility
 Biological method in control of disease transmission
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Step 2: Definitions
Health education
 That which increases the awareness and favourable influences the attitudes and
knowledge relating to the improvement of health on a personal or community basis

Prevention of diseases
 Prevention covers measures not only to prevent the occurrence of disease, such as risk
factor reduction but also to arrest its progress and reduce the consequences once
established
 Used sometimes as a complementary term alongside health promotion

Control of diseases
 Restraining or reducing the prevalence of individual disease.
 Includes the range of strategies from limitation of occurrence to eradication.
 Implies legislative control of notifiable disease

Hygiene
 The science that deals with the promotion and preservation of health
 Conditions and practices that serve to promote or preserve health.
 Clean or healthy practices or thinking personal hygiene

Sterility
 A condition by which an article, a surface or a medium has been freed of all micro-
organisms including viruses, bacteria, their spores and fungi, both pathogenic and
nonpathogenic:
o Physical methods
o Chemical methods
o Gaseous methods

Teaching Guides for NTA Level 4 MLS Curriculum Page 776

Biological method (in control of disease transmission)
 A method of reducing or eliminating pests by introducing predators or microorganisms
that attack the targeted pests but spare other species in the area
 The use of natural enemies to reduce the damage caused by a pest population

Step 3: Importance of hygiene and health education in prevention and control of

diseases
(a)Importance of hygiene in prevention and control of diseases
 The aims of applying hygienic measures are:
o Reduction of diseases among humans
o Prevention of human diseases
 Personal hygiene may be described as the principle of maintaining cleanliness and
grooming of the external body. Personal hygiene can be controlled by sustaining high
standards of personal care and humans have been aware of the importance of hygiene for
thousands of years.
 Maintaining a high level of personal hygiene will help to increase self-esteem and
confidence whilst minimizing the chances of developing imperfections
 Failure to keep up a standard of hygiene can have many implications. Not only is there
an increased risk of getting an infection or illness, but there are many social and
psychological aspects
 Poor personal hygiene, in relation to preventing the spread of disease is paramount in
preventing epidemic or even pandemic outbreaks. To engage in some very basic
measures could help prevent many diseases from being passed from person to person

(b)Importance of health education in prevention and control of diseases

 Health education is to impact basic knowledge to people aware of all the aspect of
keeping good health by avoiding diseases.

 Health education is necessary for ensuring a good personal health as well as community
everyone wants to remain healthy but should know how to remain healthy.

This know-how for keeping good health is provided by health education. The concepts in
health education include people told about:
 Various common diseases
 Ways the diseases spread
 Methods to prevent the diseases from spreading
 Various vaccinations that are to be administered to children from time to time in order to
immunize them from preventable diseases
 Methods to ensure that the food and water they intake are clean and free from
microorganisms
 Methods of keeping their surrounding neat and tidy

Step 4: Ways by which health education can be communicated

Role plays
 Posters
 Group discussion
 Counseling

Teaching Guides for NTA Level 4 MLS Curriculum Page 777

 Handouts
 Newspapers
 Radio
 Television
 Meetings

Step 5: Importance of sterility in prevention and control of diseases

 Aseptic technique is of an utmost importance for maintaining a sterile field. Aseptic
technique is a controlled set of conditions that reduce the amount of microorganisms in a
field, the goal of which is to protect individuals from infection and to control the spread
of pathogens.

How sterility can be established:

 Cleaning working benches using disinfectants
 Use of antiseptics
 Use of Personal Protective Equipments (PPE) such as gloves, gowns, masks and others)
 Use of safety cabinet
 Use of aseptic procedures ( hot air oven, autoclaving)

Aseptic technique
 Is a set of specific practices and procedures performed under carefully controlled
conditions with the goal of minimizing contamination by pathogens.

Step 6: Methods for sterilization

Various agents used in sterilization and disinfection may be divided into:
(a) Physical agents
 Heat ( Moist and dry heat sterilization)
 Filtration
 Radiation
 Sunlight
 Drying
(b) Chemical agents
 Phenols and cresols
 Halogens
 Metallic salts
 Aldehydes
 Alcohols
 Dyes
 Vapour-phase disinfectants
 Surface active disinfectants

The mostly used methods in hospitals are moist and dry heat sterilization.
Due to the very high temperature and moisture associated with steam sterilization it may only
be used with heat and moisture stable medical devices, instruments, and compatible
materials.

Step 7: Biological methods in preventing and controlling diseases

Teaching Guides for NTA Level 4 MLS Curriculum Page 778

 These methods are used in reducing or eliminating pests by introducing predators or
microorganisms that attack the targeted pests but spare other species in the area.
 Biological method is one of the methods which is safe to the environment and is a non-
chemical means of reducing human –vector- contact.
 Common bio-control agents include:
o Parasitoids
o predators
o pathogens
 Bacteria used in biological control infect insects via their digestive tract.
 Bacillus thuringesis is the most widely applied species of bacteria used for biological
control.
 Fungi acts in biological control by causing diseases in insects

Use of predator: Fish have been put into ponds where mosquitoes breed, to eat the larva.

Step 8: Importance of biological methods in preventing and controlling Diseases

 Reduces the use of many pesticides and herbicides
 Biodiversity increases too, because of the reduction of chemical application that often do
affect not only the single species they are intended to kill, but other species as well.
 The advantages of using biological control methods also include:
o Does not create resistance power on pests
o Does not create resurgence power
o Does not poison the plant products ( food chains, fodders like straw ) that make ill
effect on human’s and livestock’s health
o Does not pollute the air, water , soil
 Example might be the use of DDT; This was a very effective pesticide and was used for
years , but it was realized many years later, that there were many unintended
consequences.(environmental)

Step 9: Key points

 Definitions : prevention, control and health education
 Ways of communicating health education
 Methods of sterilization

Step 10: Evaluation

 List three biological methods used in prevention and control of diseases
 Describe the importance of biological methods in preventing and controlling diseases

References
 Arora, D.R (2008) Text Book of Microbilogy, 3rd Editio. CBS Publisshers & Distributors.
 http://hubpages.com/hub/INFECTIOUS -DISEASES-TRANSMISSSION -
PREVENTION
 Internet search (google):
http://www.casemed.com/caseacademy/downloads/CASDF003.pdf

Teaching Guides for NTA Level 4 MLS Curriculum Page 779

Session 11: General Prevention and
Control Measures of Diseases –Part II
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives
By the end of this session student should be able to:
 Define physical contact, protective gears
 List common methods of avoiding physical contact in preventing and controlling diseases
 Describe the importance of avoiding physical contact in preventing and controlling
diseases
 Describe the uses of personal protective gear

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Laptop and LCD projector
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Definitions
Common methods of avoiding physical
Presentation
4 30 minutes contact in preventing and controlling
Buzzing
diseases
Importance of avoiding physical contact
5 15 minutes Presentation
in preventing and controlling diseases
6 15 minutes Presentation use of personal protective gear
7 15 minutes Presentation Key Points
8(a) 25 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions

Teaching Guides for NTA Level 4 MLS Curriculum Page 780

  Define the following terms
 Physical contact
 Protective gears
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Step 2: Definitions
Physical contact
 Act of contacting something with the hand/fingers
Protective gears
 These Are the same as Personal Protective Equipment that refer to protective clothing,
helmets, goggles, or other garment designed to protect the wearer’s body from injury by
blunt impacts.
 The terms “protective gears” and “protective clothing” are in many cases interchangeable;
protective clothing is applied to traditional categories of clothing and “gear” is a more
general term and preferably means uniquely protective categories, such as pads, guards,
shields, masks, etc.

Step 3: Common methods of avoiding physical contact in preventing and controlling

diseases
 Gloves
 Masks
 Gowns or Coats
 Goggles
 Shields
 Gumboot
 Helmet
 Safety cabinet

Essentials in personal protection:

 Use of appropriate barriers precautions to prevent skin and mucous membrane exposure ,
including wearing gloves, at all times and masks, goggles, gowns, or aprons if there is a
risk of splashes or droplets formations
 Thorough washing of hands and other skin surfaces after gloves are removed And
immediately after any contamination
 Taking special care to avoid injuries with sharp objects such as needles and scalpels
 Refraining from handling patient care equipment or patients if health- care workers have
exudative lesions or weeping dermatitis

Step 4: Importance of avoiding physical contact in preventing and Controlling diseases

 Personal protection from acquiring infection from infective objects
 Prevention from spreading pathogens to other people
 Preventing contamination of wounds/ cuts, specimens
 Protection against injurious objects like needles, scalpels, splashes etc.

Step 5: use of personal protective gear

Teaching Guides for NTA Level 4 MLS Curriculum Page 781

Gloves- Surgical gloves are personal protection equipment (PPE) designed to protect health
care workers and prevent possible transmission of diseases or pathogens during procedures.

Fig. 34 : Glove

Types of gloves
 Examination gloves ( non-sterile or sterile)
 Surgical gloves that have specific characteristics of thickness, elasticity and sstrength and
are sterile
 Chemotherapy gloves

Rationale for using medical gloves

 To reduce the risk of contamination of health-care workers hands with blood and other
body fluids
 To reduce the risk of germ dissemination to the environment and of transmission from the
health-care worker to the patient and vice versa, as well as from one Patient to another
 Gloves should therefore be used during all patient care activities that may involve
exposure to blood and all other body fluids (including contact with mucous membrane
and non-intact skin) during contact precautions and outbreak situations.

Inappropriate use of gloves

 The use of gloves when not indicated represents a waste of resources and does not
contribute to a reduction of cross transmission
 It may also result in missed opportunity for hand hygiene
 The use of contaminated gloves caused by inappropriate storage, inappropriate moments,
and techniques for donning and removing may also result in germ transmission.

Gowns or Coats - apparel to be worn over clothes to protect the health care worker from
spills, pathogens, or contamination.

Masks – protective gear, designed to protect the mucous membranes from splashes

Goggles – eye wear designed to protect the eyes from aerosols or splashes

Fig. 35: Goggle

Teaching Guides for NTA Level 4 MLS Curriculum Page 782

Face Shields - protective face wear that covers the entire face including eyes, and mucous
membranes

Gumboot - water proof footwear designed to protect the feet and ankles from aqueous
substances
Helmet - head gear that protects the head from impact

Safety cabinet- All biological safety cabinets use HEPA filters to treat exhaust air. Some
cabinets filter both exhausts and intake air to protect the worker and the environment from
contamination as well as to protect product in the cabinet

Fig. 36: A person protected by surgical cap, mask and gown

Step 7: Key points

 Importance of personal protection
 Knowledge of using personal protective equipments

Step 8: Evaluation
 Mention three types of gloves
 List six personal protective equipment

References
 Baron,E.J (1990) Bailey & Scott’s Diagnostic Microbiology , 18th Ed, the C.V. Mosby
Company
 http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf

Teaching Guides for NTA Level 4 MLS Curriculum Page 783

Session 12: Common causes of Non
Communicable Diseases and Common
Conditions
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives
By the end of this session student should be able to:
 Define communicable and non communicable diseases, investigation, Hypertention,
cancer, diabetes, nephrotic syndrome, sickle cell anaemia, asthma
 Describe causes of non communicable diseases
 List common non communicable diseases and their conditions ( Hypertention, cancer,
diabetes, nephrotic syndrome, sickle cell anaemia, asthma )
 Describe causes of each of the above mentioned non communicable diseases
 List investigations of common non communicable diseases (Hypertension ,Cancer
Diabetes, Nephrotic syndrome and Sickle cell anaemia )

Resources Needed
 Flip charts, marker pens and masking tape
 Black/white board and chalk/whiteboard markers
 Laptop and LCD projector
 Coloured atlas, diagrams, pictures and stained smears

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation Definitions
3 10 minutes Presentation Causes of non communicable diseases
Common non communicable diseases
Presentation and their conditions (Hypertention,
4 25 minutes
Buzzing cancer, diabetes, nephrotic syndrome,
sickle cell anaemia, asthma )
Causes of each of the above mentioned
5 10 minutes Presentation
non communicable diseases
Investigations of common non
communicable diseases (Hypertension
6 20 minutes Presentation
,Cancer, Diabetes, Nephrotic syndrome
and Sickle cell anaemia

Teaching Guides for NTA Level 4 MLS Curriculum Page 784

 7 10 minutes Presentation Key Points
8 (a) 20 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (15 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: Buzzing (5 minutes)

 ASK the students to buzz in pairs and allow them to answer the following questions
 Define the following terms:
 Communicable and non communicable diseases
 Investigation
 Hypertention
 Cancer
 Diabetes
 Nephrotic syndrome
 sickle cell anaemia
 Asthma
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

Step 2: Definitions
Communicable Disease
 A disease that is carried by microorganisms and transmitted through people, animals,
surfaces, foods, or air
 Illness caused by microorganisms and transmitted fro an infected person or animal to
another person or animal
 The disease might need a blood exchange via an injection, float along a sneeze in a movie
theatre, through childbirth or insect bite.

Non communicable diseases

An illness that is caused by something other than a pathogen; it might result from hereditary
factors, improper diet, smoking or other factors

Investigation
 A detailed inquiry or systematic examination
 An examination or inquiry into something , especially detailed one

Hypertension (High blood pressure)

 Blood pressure exceeding 140/90 mmHg
 A chronic medical condition in which the blood pressure in the arteries is elevated
 It is the opposite of hypotension.

Cancer
 A malignant tumor or growth caused when cells multiply uncontrollably, destroying
health tissues

Teaching Guides for NTA Level 4 MLS Curriculum Page 785

 Illness or condition that is caused by the presence of a malignant tumor

Diabetes
 Condition or disease inn which the body does not use or produce insulin properly. Insulin
is an important hormone necessary for the absorption of food sugar, also known as
glucose

Nephritic syndrome
 A collection of signs (known as syndrome) associated with disorders affecting the
kidneys, more specifically glomerular disorders.
 A condition when a large amounts of protein leak out into the urine. Normal urine should
contain almost no protein.

Sickle cell anaemia

 A serious disease in which the body makes sickle-shaped red blood cells” sickle shaped”
means that the red blood cells are shaped like “C”
 Sickle cells contain abnormal haemoglobin that causes the cells to have a sickle shape

Asthma
A disease of respiratory system sometimes caused by allergies, with symptoms including
coughing, sudden difficulty in breathing, and tight feeling in the chest

Step 3: Causes of non communicable diseases

 Hereditary factors
 Improper diet
 Smoking
 Environmental factors
 Chemicals
 Inactivity
 Chronic untreated diseases
 Irrational use of drugs
 Side effects of drugs

Step 4: Common non communicable diseases and their conditions

NO NON COMMUNICBLE CONDITION(S)
DISEASE
1 Hypertension Stroke, heart failure , rapid irregular heartbeat,
weakness, perspiration
2 Cancer, Dis figure, tumor, wasting, loss of organ function
3 Diabetes, Frequent urination, tiredness, dehydration, thirsty,
chronic ulcers, gangrene
4 Nephritic syndrome Protein in urine, edema, albumin in urine ,
Glomerulonephritis
5 Sickle cell anaemia Weakness, recurrent anaemia, bone pains
6 Asthma Difficulty in breathing, tight feeling in the chest

Step 5: Causes of each of the above mentioned non communicable diseases

Teaching Guides for NTA Level 4 MLS Curriculum Page 786

(a)Hypertension
 Dietary changes with obesity
 Increased salt and diminished potassium intake
 Physical inactivity
 Excess alcohol intake
(b) Diabetes
 Poor production of insulin in the pancrease
 Increased obesity
 Physical inactivity
 Viral infection
 Diety
 Age
 Emotional stress
 Smoking
(c) Cancer
 Exposure to certain chemicals/Environment
 Food
 Genetics
 Hormones
 Infectious agent
 Radiation Tobacco
d) Nephritic syndrome
 Infectious agents ( parasitic, viral, bacterial)
 Heart failure
 Systemic lupus erythromatus
 Blood clot in kidney
 Diabetic kidney disease
(e) Sickle cell anaemia
 Inheritance
(f) Asthma
 Seasonal allergies
 Dusts/pollen
 Perfumes
 Drugs
 Cigarette smoking
 Animals (fur)

Step 6: Investigations of common non communicable diseases

 Hypertension – Urea, createnine, electrolyte
 Cancer- Fine needle aspiration, biopsy examination
 Diabetes – Sugar in urine, blood sugar
 Nephrotic syndrome – protein in urine, Blood protein
 Sickle cell anaemia – Sickling test, Hb Electrophoresis
 Asthma – Lung function test (spirometry, exhaled nitric oxide test), allergy
 Test

Teaching Guides for NTA Level 4 MLS Curriculum Page 787

Step 7: Key points
 Common non communicable diseases
 Causes of non-communicable diseases
 Investigation of non-communicable diseases

Step 8: Evaluation
 Define non communicable diseases,
 Mention investigations tests for four non-communicable diseases
 Causes of non-communicable diseases

References
 Cook, G. (2000), Manson’s Tropical Diseases, 22nd Ed, W.B. Saunders Company Ltd,
London;
 Nicholson, N.W ( 1988) MEDICINE NON-COMMUNICABLE DISEASESIN
ADULTS, AMREF-Kenya
 Internet Search: http//www.bing.com/search?q,

Teaching Guides for NTA Level 4 MLS Curriculum Page 788

Session 1: Demonstration of
Mycobacterium Tuberculosis and
Mycobacterium leprae
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission
Total Session Time: 120 minutes
Prerequisites
 None
Learning Objectives
By the end of this session students should be able to:
 Identify Mycobacterium species
 Describe the colour and morphology of Mycobacterium species
Resources Needed
 Coloured atlas, diagrams, pictures
 stained smears, Microscopes

SESSION OVERVIEW
Step Time Activity/Method Content

1 10 minutes Presentation Introduction, Learning Objectives

2 20 minutes Demonstration Positive Mycobacterium species

3 90 minutes Observation Positive Mycobacterium species

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

READ or ASK students to read the learning objectives and clarify.
ASK students if they have any questions before continuing.

Activity: (90minutes)

ASK the students to work in pairs and allow them to answer the following questions
Observe r teaching slides:
 Positive slides
 Negative slides
 Submit results
SUMMARIZE their responses

Teaching Guides for NTA Level 4 MLS Curriculum Page 789

Session 2: Demonstration of Staphylococcus
and Streptococcus and Species
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Identify Staphylococcus and Streptococcus species
 Describe the colour and morphology of Staphylococcus species
 Describe the colour and morphology of Streptococcus species

Resources Needed
 Coloured atlas, diagrams, pictures
 stained smears, Microscopes

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 10 minutes Demonstration Positive Staphylococcus species
2 10 minutes Demonstration Positive Streptococcus species
Positive Staphylococcus and Streptococcus
3 90 minutes Observation
species

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.
Activity: (90 minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Observe teaching slides:
 Positive slides
 Negative slides
 Submit results
 SUMMARIZE their responses

Teaching Guides for NTA Level 4 MLS Curriculum Page 790

Session 4: Part I - Demonstration of
Entamoeba histolytica
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Identify Entamoeba histolytica,
 Describe the morphology of Entamoeba histolytica,

Resources Needed
 Coloured atlas, diagrams, pictures
 stained smears, stool specimen , Microscopes

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 20 minutes Demonstration Positive Entamoeba histolytica
3 90 minutes Observation Positive Entamoeba histolytica

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.
Activity: (90minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Observe teaching slides:
 Positive stool
 Negative stool
 Submit results
 SUMMARIZE their responses

Teaching Guides for NTA Level 4 MLS Curriculum Page 791

Session 4: Part II- Demonstration of
Giardia lamblia and Trichomonas vaginalis
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Identify Giardia lamblia and Trichomonas vaginalis
 Describe the morphology of Giardia lamblia and Trichomonas vaginalis

Resources Needed
 Coloured atlas, diagrams, pictures
 stained smears, stool specimen, Microscopes

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
Positive Giardia lamblia and Trichomonas
2 20 minutes Demonstration
vaginalis
Positive Giardia lamblia and Trichomonas
3 90 minutes Observation
vaginalis

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: (90minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Observe teaching slides:
 Positive stool
 Negative stool
 Submit results
 SUMMARIZE their responses

Teaching Guides for NTA Level 4 MLS Curriculum Page 792

Session 5: Demonstration of Plasmodium,
Trypanasoma and Borrelia species
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Identify Plasmodium, Trypanasoma and Borrelia species
 Describe the morphology of Plasmodium, Trypanasoma and Borrelia species

Resources Needed
 Coloured atlas, diagrams, pictures
 stained smears, Microscopes

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
Positive Plasmodium falciparum, Trypanasoma
2 20 minutes Demonstration
rhodesiense and T. gambiense, Borrelia species
Positive Plasmodium falciparum, Trypanasoma
3 90 minutes Observation
rhodesiense and T. gambiense, Borrelia species

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.
Activity: (90minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Observe teaching slides:
 Positive slides
 Negative slides
 Submit results
 SUMMARIZE their responses

Teaching Guides for NTA Level 4 MLS Curriculum Page 793

Session 6: Part I- Demonstration of Taenia
species
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Identify Taenia species
 Describe the morphology of Taenia species

Resources Needed
 Coloured atlas, diagrams, pictures
 stained smears, Microscopes, fixed worms

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 20 minutes Demonstration Positive Taenia species
3 90 minutes Observation Positive Taenia species

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: (90minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Observe teaching slides:
 Positive stool for Taenia species
 Negative stool for Taenia species
 Submit results
 SUMMARIZE their responses

Teaching Guides for NTA Level 4 MLS Curriculum Page 794

Session 6: Part II- Demonstration of
Schistosoma species
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Identify Schistosoma species
 Describe the morphology of Schistosoma species

Resources Needed
 Coloured atlas, diagrams, pictures
 stained smears, stool specimen Microscopes

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 20 minutes Demonstration Positive Schistosoma species
3 90 minutes Observation Positive Schistosoma species

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

READ or ASK students to read the learning objectives and clarify.
ASK students if they have any questions before continuing.

Activity: (90minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Observe teaching slides:
 Positive stool for Schistosoma species
 Negative stool for Schistosoma species
 Submit results
 SUMMARIZE their responses

Teaching Guides for NTA Level 4 MLS Curriculum Page 795

Session 7: Demonstration of Ascaris
lumbricoide, Trichuris trichiura and
Enterobius vermicularis
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Identify Ascaris lumbricoide, Trichuris trichiura and Enterobius vermicularis
 Describe the morphology of Ascaris lumbricoide, Trichuris trichiura and Enterobius
vermicularis

 Resources Needed
 Coloured atlas, diagrams, pictures
 stained smears, stool specimen Microscopes

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
Positive Ascaris lumbricoide, Trichuris
2 20 minutes Demonstration
trichiura and Enterobius vermicularis
Positive Ascaris lumbricoide, Trichuris
3 90 minutes Observation
trichiura and Enterobius vermicularis
Step 1: Presentation of Session Title and Learning Objectives (10 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: (90minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Observe teaching slides:
 Positive stool for Ascaris lumbricoide, Trichuris trichiura and Enterobius vermicularis
 Negative stool for the species
 Submit results
 SUMMARIZE their responses

Teaching Guides for NTA Level 4 MLS Curriculum Page 796

Session 8: Demonstration of Hookworms
and Strongyloides stercolaris
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Identify Hookworms and Strongyloides stercolaris
 Describe the morphology of Hookworms and Strongyloides stercolaris

Resources Needed
 Coloured atlas, diagrams, pictures
 stained smears, stool specimen Microscopes

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
Positive Ascaris lumbricoide, Trichuris
2 20 minutes Demonstration
trichiura and Enterobius vermicularis
Positive Ascaris lumbricoide, Trichuris
3 90 minutes Observation
trichiura and Enterobius vermicularis

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: (90minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Observe teaching specimen:
 Positive stool for Hookworms and Strongyloides stercolaris
 Negative stool for the species
 Submit results
 SUMMARIZE their responses

Teaching Guides for NTA Level 4 MLS Curriculum Page 797

Session 10: Demonstration of Sterilizing
Equipment
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 List the instruments demonstrated
 Describe the uses of each

Resources Needed
 pictures , manuals
 Autoclave, hot air oven

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 20 minutes Demonstration Operation of autoclave and hot air oven
3 90 minutes Discuss Uses of autoclave and hot air oven

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: (90minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Discuss :
 Discuss use of each
 Submit report
 SUMMARIZE their responses

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Session 11: Part I -Demonstration use of
Personal Protective Gears (gloves, masks)
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Identify Personal protective gears (gloves and masks)
 Describe the uses of each

Resources Needed
 Pictures, Gloves
 Masks

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
Personal protective gears (Gloves and
2 20 minutes Demonstration
masks)
Observe and Uses of Personal protective gears (Gloves
3 90 minutes
demonstrate and masks)

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.
Activity: (90minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Discuss :
 Demonstrate correct use of Personal protective gears (Gloves and masks)
 SUMMARIZE their responses

Teaching Guides for NTA Level 4 MLS Curriculum Page 799

Session 11: Part II: Demonstration use of
Personal Protective Gears (gowns, coats,
goggles)
NTA Level 4, Semester I, Module Code: MLT04206 Prevention and Control of Diseases
Transmission

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students should be able to:
 Identify Personal protective gears (Gowns, coats, goggles)
 Describe the uses of each

Resources Needed
 Pictures, goggles
 Gowns, coats

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
Personal protective gears (Gowns, coats,
2 20 minutes Demonstration
goggles)
Observe and Uses of Personal protective gears (Gowns,
3 90 minutes
demonstrate coats, goggles)

Step 1: Presentation of Session Title and Learning Objectives (10 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Activity: (90minutes)
 ASK the students to work in pairs and allow them to answer the following questions
 Discuss :
 Demonstrate correct use of Personal protective gears (Gown, coats, goggles)
 SUMMARIZE their responses

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 CHAPTER EIGHT

MODULE CODE MLT04207:

BASIC LABORATORY
SPECIMEN MANAGEMENT

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Session 1: Collection of Routine Specimens
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students are expected to be able to:
 Define routine specimens
 List five routine specimens
 Describe method of collecting stool specimen
 Identify sites for collecting venous and capillary blood
 Describe three Types and methods of Urine Collection (first, midstream and terminal)
 Describe conditions for colleting sputum specimen

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 05 minutes Definition of terms
Buzzing
3 15 minutes Presentation Five Routine Specimens
4 10 minutes Presentation Method of Collecting Stool Specimen
Presentation Sites for Collecting Venous and Capillary
5 40 minutes
Activity Blood
Three types and methods of Urine Collection
6 20 minutes Presentation
(first, midstream and terminal)
7 15minutes Presentation Conditions for colleting sputum specimen
8 05minutes Presentation Key Points
9 05minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Step 2: Definition of Terms (10Minutes)

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 Activity: Buzzing (5 minutes)
 ASK students to buzz on the following question:
 Define routine specimens
 ALLOW time for them to respond
 WRITE their answers on a flip chart
 SUMMARIZE by using the content below

 Specimen
o Is a small sample or part taken to show the nature of the whole, such as a small
quantity of urine for urinalysis, or a small fragment of tissue for microscopic study
 Routine specimens
o Are specimens which performed regularly in the laboratory

Step 3: Routine Specimens (15Mimutes)

 Routine specimens includes;
o Stool
 Is a waste material excreted from the intestines
o Urine
 Is a waste material/fluid excreted from the kidney
o Blood
 Blood is the fluid that circulates in the blood vessels of the body. Blood consists
of plasma and cells floating within it.
o Sputum
 Is a substance that is brought up from the lungs and airway when a person coughs
or spits. It is usually a mixture of saliva and mucus
o Pus
 Is a thick white or yellowish fluid that forms in areas of infection such as wounds
and abscesses. It is constituted of decomposed body tissue, bacteria or other micro
organisms that cause the infection, and certain white blood cells.

Step 4.Methods of Collecting Stool Specimen (10Minutes)

 Methods of Stool Specimen Collection Includes;
o Individual/Patient Collection
 Provide the patient with a wide-mouthed plastic container with a screw-cap lid.
 Tell the patient to collect at least a teaspoon full of stool. It is not necessary to fill
the container.
 Ask the patient to keep the outside of the container clean and not contaminate the
specimen with urine or antiseptic.
 Tell the patient to bring the specimen to the laboratory within one hour of
collection.
 Label the container clearly with the patient’s name and laboratory identification
number.
 If the specimen is to be examined for pinworm, the swab collection method
should be used.
o Swab Method
 Use a swab moistened with physiological saline and swabs the anal area.

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 Step 5: Sites for Collecting Venous and Capillary Blood (40 Minutes)
 Venous blood is collected in the following sites (veins)
o Median Cubital Vein. (NO.1)
 A superficial vein, most commonly used for venepuncture. It lies over the cubital
fossa and serves as an anastomosis between the cephalic and basilic vein
o Cephalic vein. (NO.2)
 Shown in both the forearm and arm, it can be followed where it empties into the
axillary vein
o Basilic Vein.(NO.3)
 Seen in the forearm and arm, it dives to join the brachial; best area for
venepuncture is antecubital fossa area

 The Diagram Below Shows the Location of Veins

Source: CDC (2009)


Collection of capillary blood
o Capillary blood is collected from the side of the finger in adults and children. Avoid
the tip of the finger as it is very sensitive. In infants, collect capillary from the side of
the heel.
Finger Prick:
Finger prickFinger Preparation

1. Position hand palm-side up. Choose 2. Apply intermittent pressure to

whichever finger is least calloused. the finger to help the blood to flow.

3. Clean fingertip with alcohol. Start in 4. Hold finger and firmly place a
middle and work outward to prevent new sterile lancet off-center on the
contaminating area. Allow area to dry. fingertip.
Source: CDC(2009) Slide 20

 Caution on Heel pricking Technique

o Infant heels are appropriate for blood collection until approximately 6 months to one
year

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 o Never exceed 2.4 mm in puncture depth
o Never puncture the posterior curvature of the heel or the arch of the foot
o Never use sites previously punctured, bruised, swollen or red in color
o Never puncture the heel more than twice for any one collection

 Heel pricking Procedure

o Wipe away the first drop of blood
o Ease thumb pressure and apply intermittent pressure. Avoid milking and scraping
o Follow recommended order of draw
o When blood collection is complete, clean area, apply pressure.
o Never apply band-aid under the age of two
o Label specimens immediately after the draw; never before

The figure below shows a Procedure of Heel pricking

Site for pricking

Source: CDC (2009)

Step 6: Three Types and Methods of Urine Collection (First, Midstream and Terminal
urine) (20minutes)
 Types of urine and method of collection
o First urine.
 A first morning urine sample is used for detection of urinary tract infection
especially mycobacterium
 Procedure of collecting first urine
 Provide the patient with a clean, dry container.
 Instruct the patient to provide about 20 ml of urine voided immediately after
arising in the morning.
 The patient should label the container with their name and date of collection
o Midstream urine
 is used for microscopy and culture to investigate bacterial infection of the urinary
tract
 Procedure of collecting midstream urine
 Provide the patient with a sterile container.
 Instruct the patient to pass a small amount of urine into the toilet. This ensures
that any organisms or cells in the urethra are flushed away.
 Instruct the patient to provide about 20 ml of urine in the container.

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 Instruct the patient to pass the remaining urine in their bladder into the toilet.
The patient or the laboratory technician should label the container with the
patient name and date of collection.
o Terminal urine
 A terminal urine sample is used to demonstrate ova of Schistosoma haematobium
 Procedure of collecting terminal urine
 Provide the patient with a clean container and tell the patient to.
 Void most of the urine into toilet
 Collect last portion of urine to the container
 Secure the lid of container immediately

Step 7: Conditions for Collecting Sputum Specimen

 Conditions for collecting sputum specimen
o Sputum specimen is collected from the patient when there is persistent coughing and
sometimes the sputum is mixed with blood. Sputum samples are used in order to
evaluate possible infections such as Mycobacterium tuberculosis.
o Morning specimen is ideal for collection and examination. However, multiple
specimens collected over time may yield more accurate results (as multiple samples
allow more opportunity to detect the organisms).
 Collection of sputum sample
o Procedure
 Ask the patient to go outside the building (open area) and take a deep breath and
then cough deeply, spitting what he or she brings up into the container. Secure the
top and label the container with the name and number of the patient

Step 8: Key Points (5 minutes)

 Routine specimens are specimens which performed regularly in the laboratory
 Routine specimens includes
o Stool
o Urine
o Blood
o Sputum
o Pus
 Methods of collecting routine specimens includes
o Individual collection
o Assisted collection such as blood

Step 9: Evaluation (5 minutes)

 Define routine specimens
 List five routine specimens
 List three sites (Veins) for collection of venous blood

 ASK students if they have any comments or need clarification on any points.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press.

Teaching Guides for NTA Level 4 MLS Curriculum Page 806

 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd; and
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1 &
2, Cambridge University Press.
 WHO(2003) Manual of basic laboratory techniques for health laboratory.2nd ED. World
Health organisation-Geneva
 WHO(1980) Manual of basic laboratory techniques for health laboratory.1st ED. World
Health organisation-Geneva

Teaching Guides for NTA Level 4 MLS Curriculum Page 807

Session 2: Demonstration (Collection of
Sputum Samples)
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT

Total Session Time: 120minutes

Prerequisites
 None

Learning Objectives
By the end of this session students are expected to be able to:
 Describe important instruction when collecting sputum
 Instruct the patient on spot sputum collection
 Instruct the patient when at home for morning sputum collection

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Advanced preparation
o The practical sessions are expected to be done at the Hospital laboratory. The tutor
needs to have made arrangements for student to go in groups of five every week.
o The tutor also needs to have arranged this plan with the Hospital Laboratory in-
charge and made the time table for rotation of students available at the laboratory
facility
o The tutor and the Hospital lab in-charge need to have prepared all the required
materials and arranged for patients to be available for the planned procedures
o Required materials to prepare for procedure include:
 Wide-mouthed, plastic container with screw-top lid
 Register books
 Gloves
 Sputum collecting containers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation Important Instructions When Collecting
2 10 minutes
Demonstration Sputum Sample
Demonstration, Instructions to the Patient on Spot Sputum
3 35 minutes
discussion Collection
Presentation Instruction to Patient When at Home for
4 20 minutes
Demonstration Morning Sputum Collection
Return Demonstration(Instruction to Patient
5 35 minutes Demonstration
When at Home For Morning Collection
6 05 minutes Presentation Key Points

Teaching Guides for NTA Level 4 MLS Curriculum Page 808

 7 05 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify
 ASK students if they have any questions before continuing.

Step 2: Important Instructions When Collecting Sputum Sample

(10 minutes)
 Use an appropriate container, with a wide mouth
 Before obtaining the specimen, label a clean sputum container on the side and on the
lid/cover
 Collect specimen in well-ventilated area, preferably outdoors in the sunlight
 Ensure that no one is standing in front of the patient while he/she is producing sputum
 Ensure that the container is labelled and the lid is closed firmly
 Wash your hands with soap and water after collecting the specimen

Step 3: Instructions to the Patient on spot sputum collection (35 minutes)

Activity: Discussion: Instructions to The Patient on Spot Sputum Collection
 EXPLAIN that you are going to demonstrate on how to instruct the patient to collect
sputum sample and inspect the sample after getting it from the patient; after that,
students will do their own demonstration.
 PREPARE your equipment and supplies while explaining to the students what you will
be doing.
 CALL one student to come in front to act as a TB suspect when demonstrating.
 EMPHASISE that the health care worker should stay in such a way that the air flows
from the window through him/her first, and then sit in that order.
 MAKE sure that everyone can see.
 ASK the suspect/patient for information to be filled in the Request Form for AFB
Microscopy and simulate the process of filling out the form.
 TELL the suspect/patient that you are going to give him/her the sputum container for
him to collect the sputum.
 LABEL the sputum container and provide it to the suspect/patient.
 EMPHASIZE that no actual sputum specimens will be collected, rather the process
will be simulated.

PROVIDE instruct the patients to do the following instructions:

 Inhale deeply 2-3 times, breathe out hard each time
 cover his/her mouth when coughing
 Cough deeply from the chest
 Place the open container close to the mouth to collect the specimen
 Close the sputum container after specimen collection
 Tell the patient to bring back the specimen after collection

AFTER the instructions, direct the patient to cough sputum in open air (outdoors
preferably) observe if the patients follows the instructions you provided
 Wear gloves before receiving the specimen from the patient

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  Examine the sputum carefully whether it is a good sputum sample or saliva
 Close the sputum container

Step 4: Instruction to Patient When at Home for Morning Sputum Collection (20
minutes)
Activity: Demonstration Instruction to Patient When at Home for Morning Sputum
Collection(20 minutes

INSTRUCT the patient on how to go about collecting a sputum sample at home, outside of
the clinic. Demonstrate giving the following instructions to the patient:
 Drink plenty of fluid/water the night before collection if possible
 Sit upright to collect sputum of the first cough in the morning
 Rinse mouth with water (if possible), but do not brush teeth before collecting sputum
 Unscrew the lid and hold the container very close to mouth
 Take a few deep breaths and on the third breath cough deeply from within the chest
 Do not contaminate the rim of the container with sputum
 Do not expectorate any saliva or postnasal discharge
 Close lid tightly and return sample to the laboratory
 Tell the patient the turn around time for results
 Thank the patient and allow him/her to go
 Take off gloves, wash hand properly

PUT on gloves when the suspect/patient returns with sputum.

EXAMINE the sputum carefully whether it is a good sputum sample or it is saliva.
CLOSE the sputum container and pack it in the container for sending it to lab.
EXPLAIN to the suspect/patient about the next step, when he/she should expect for his/ her
results.
REMOVE gloves and wash your hands with antiseptic.

Step 5: Return Demonstration (Instruction to Patient When at Home for Morning

Collection) (35 minutes)
Activity: Instruction to Patient When at Home for Morning Sputum Collection
(30 minutes)
CALL two students to come in front

EXPLAIN to them that they are going to do back demonstration and you are going to do
running comments for every step they make.
SUPPLY them with the Request Form for AFB Microscopy and the sputum container.
LET them start the activity.
MAKE comments if they are doing it right and correct them if they do in a wrong way.
SPEND the last five minutes debriefing the activity.
ASK if they have any questions.
PRACTICUM
LET the students go to the clinic for practicing this activity with patients.

Step 6: Key Points (5 minutes)

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 When Collecting Sputum Sample Use an appropriate container, with a wide mouth
 Before obtaining the specimen, label a clean sputum container on the side and on the
lid/cover (label the serial number from the register)
 Collect specimen in well-ventilated area, preferably outdoors in the sunlight
 Ensure that no one is standing in front of the patient while he/she is producing sputum
 Wash your hands with soap and water after collecting the specimen

Step 7: Evaluation (5 minutes)

 Mention four criteria used for sputum collection
 Explain importance of labeling specimen container

References
 Carter J, Lema.O. (1994). Practical laboratory manual for health centres in Eastern
Africa. AMREF.
 Cheesbrough M. (1998). District Laboratory Practice in Tropical Countries. Part 1.
Tropical Health Technology, Gapson Papers Ltd, NOIDA, India
 Cheesbrough M. (2000). District Laboratory Practice in Tropical Countries. Part 2.
Tropical Health Technology, Cambridge University Press UK
 Cheesbrough M. (1987). Medical Laboratory Manual for Tropical Countries. Volume 1
2nd Ed. ELBS Butterworth, Heinemann Ltd, Oxford
 NACP, NTLP (2007).In-service training on collaborative TB/HIV care and treatment.
Ministry of Health and Social Welfare-Tanzania

Teaching Guides for NTA Level 4 MLS Curriculum Page 811

Session 3: Practice to instruct patient on
collection of Urine Samples
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students are expected to be able to:
 Identify materials for urine collection
 Instruct patients to collect urine for routine analysis and culture

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Advance preparation
o This session is expected to be at the hospital laboratory. The tutor needs to have
made arrangements for students to go in groups of five.
o The tutor also needs to have arranged this plan with the hospital laboratory in-charge
for technical assistance during the activity.
o The tutor and the laboratory in charge need to have prepared all the required materials
and arranged for patients to be available for urine collection process.
o The required materials to prepare for this procedure include:-
 Urine specimen container
 Sticker for labeling
 Marker pen

SESSION OVERVIEW
Step Time Activity/Method Content
1 10 minutes Presentation Introduction, Learning Objectives
2 10 minutes Demonstration Materials for urine collection
Instruct patients to collect urine for routine
3 40minutes Practice
analysis
4 40minutes Practice Instruct patients to collect urine for culture
5 10 minutes Demonstration Key points
6 10minutes Demonstration Evaluation
6 05 minutes presentation Key points

SESSION CONTENT
Step I: Introduction of The Practical Session and Objectives.(5 minutes)
 READ or ASK the students to read the learning objectives

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Step 2: Practice Collection of Urine Samples (urine for Routine analysis)
Procedure for Collecting Urine Specimen for Routine Examination
 Provide the patient with a labeled clean urine container
 Instruct to Collect about 20 ml of urine into the clean container
 Secure the lid of the container immediately
OBSERVE the whole process and give feedback in the class

Step 3: Collection of Midstream urine

Procedure for Collecting Midstream Urine
 Provide the patient with a labeled clean urine container
 Instruct patient to clean the area around the urethra and how to collect midstream urine
 Collecting midstream urine:
o wash genital area
o begin to urinate without collecting urine
o after a few ml have passed, collect urine in container (10 ml if possible)
o finish urinating without collecting
OBSERVE the whole process and give feedback in the class

Step4: Key Points (5 minutes)

 For routine analysis 20ml of urine is ideal for analysis
 Midstream urine is used for culture

ASK students if they have any comments or need clarification on any points.

References
 Carter J, Lema.O. (1994) Practical laboratory manual for health centres in Eastern Africa.
AMREF.
 Cheesbrough M. (1998). District Laboratory Practice in Tropical Countries. Part 1.
Tropical Health Technology, Gapson Papers Ltd, NOIDA, India
 Cheesbrough M. (2000). District Laboratory Practice in Tropical Countries. Part 2.
Tropical Health Technology, Cambridge University Press UK
 Cheesbrough M. (1987). Medical Laboratory Manual for Tropical Countries. Volume 1
2nd Ed. ELBS Butterworth, Heinemann Ltd, Oxford

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Session 4: Practice to instruct patient on
collection of Stool Sample
NTA Level 4, Semester 2, Module Code: MLT 04207: Basic Laboratory Specimen
Management

Total Session Time: 60 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students are expected to be able to:
 Identify materials for stool collection
 Instruct patients to collect stool sample

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Advance preparation
o This session is expected to be at the hospital laboratory. The tutor needs to have made
arrangements for students to go in groups of five.
o The tutor also needs to have arranged this plan with the hospital laboratory in-charge
for technical assistance during the activity.
o The tutor and the laboratory in charge need to have prepared all the required materials
and arranged for patients to be available for stool collection process.

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes Demonstration Materials for stool collection
3 40 minutes Practice Instruct patients to collect stool sample
4 5 minutes Demonstration Key points
5 5 minutes Demonstration Evaluation

SESSION CONTENT
Step I: Introduction of the Practical Session and Objectives (5 minutes)
 READ or ASK the students to read the learning objectives

Step 2: Materials Used to Collect Stool Specimen (5minutes)

 Stool specimen container
 Sticker for labeling

Step 3: Instruct Patient to Collect Stool Sample (40minutes)

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 Procedure for Collecting Stool Specimen for Routine Examination
 Provide the patient with a labeled stool container
 Instruct to collect a teaspoonful specimen using the applicator found in the container
 Close the container tightly
OBSERVE the whole process and give feedback in the class

Step 4: Key Points (5 minutes)

 Empty clean container with a spoon like applicator attached into the cap is used to collect
stool for routine examination
ASK students if they have any comments or need clarification on any points.

Step 5: Evaluation
 Explain the characteristics of stool container

References
 Carter J, Lema.O. (1994) Practical laboratory manual for health centres in Eastern Africa.
AMREF.
 Cheesbrough M. (1998). District Laboratory Practice in Tropical Countries. Part 1.
Tropical Health Technology, Gapson Papers Ltd, NOIDA, India
 Cheesbrough M. (2000). District Laboratory Practice in Tropical Countries. Part 2.
Tropical Health Technology, Cambridge University Press UK
 Cheesbrough M. (1987). Medical Laboratory Manual for Tropical Countries. Volume 1
2nd Ed. ELBS Butterworth, Heinemann Ltd, Oxford

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Session 5: Handling of Routine Specimens
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session student are expected to be able to:
 Define protective gears
 Explain importance of protective gears
 Describe handling of routine specimens (Stool, Urine, Blood, Sputum and Pus)
 Explain the significance of proper handling of routine specimen
 Demonstrate wearing of protective gears(Gloves)

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Pairs of Gloves

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 05 minutes Buzzing Definition of Term
3 20 minutes Presentation Importance of Protective Gears
Handling of Routine Specimens
4 40minutes Presentation
Significance of Proper Handling of Routine
5 10 minutes Presentation
Specimen
Presentation
6 20.minutes Demonstrate wearing protective gears
activity
7 10minutes Presentation Key Points
8 10minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Step 2: Definition of Term (5 minutes)

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 Activity: Buzzing (5 minutes)
 ASK students to buzz on the following questions
 Define Protective Gears
 ALLOW time for them to respond
 WTITE their answers on a flip chart
 SUMMARIZE by using the content below
 Protective gears are the material worn to protect an individual from infection, and are
specialized clothing or equipment worn by health service provider for protection against
health and safety hazards. Protective gears are designed to protect many parts of the body
such as
o Hands
o Eyes
o Feet
o Nose and mouth
 Examples of potential eye, mouth and nose contamination
o Splashes and aerosols from contaminated materials
o Harmful rays from the use of lasers or other radiant light (as well as heat, glare,
sparks, splash and flying particles).

Step 3: Types and Importance of Protective Gears (20 minutes)

 Protective gears includes
o Gloves
 Are worn on the hands and protects hands contamination
o Laboratory Coat
 Protects health providers clothes from being contaminated)
o Masks
 Protects nose and mouth from fumes, aerosols and
o Gumboots
 Protects feet contaminations
o Eye Glasses
 Protects eyes contaminations
 Importance of Protective Gears
o Protects health provider from contamination
o Presents transferring of infections from work place to another area
o It can also reduce the overall costs of health care by preventing injury and illness in
the workplace

Step 4: Handling of Routine Specimens (40minutes

 Once a specimen is collected properly, it must be handled correctly otherwise results may
be compromised.
o Stool Specimen
 Never leave stool specimen exposed to the air in container without lid
 Never accept stool specimen mixed with urine (e.g. in a bed pan
 Never examine stool specimen without first putting on gloves
 Always examine stool specimen within 1-4 hours after collection. If several
specimens are received at the same time ,examine the liquid stools and those

Teaching Guides for NTA Level 4 MLS Curriculum Page 817

 containing mucous or blood first, as they contain motile amoebae(which dies
quickly
o Urine Specimen
 A urine specimen for routine urinalysis requires 15 ml of urine.
 Container for Collection of urine should be wide mouthed clean, and dry with a
screw-capped lid
 If urine has been collected for presence of Schistosoma haematobium ova but it
may not be examined for several hours should be acidified with a few drops of
10% acetic acid
o Sputum Specimen
 Sputum sample is collected in a plastic, wide mouthed, leak proof container with
lid, or waxed carton.
 Do not collect sputum in glass bottles (except when sending for culture of
mycobacterium tuberculosis) as glass bottles are difficult to treat.
 Avoid contaminating the outside of the container with sputum
 If the outside is contaminated discard the container and repeat with fresh
container
o Blood of Specimen
 Use appropriate collection containers for specific testing needs
 Store specimens upright, in racks at the appropriate temperature
 Note the time of taking the specimens to ensure processing in the correct
timeframe
 Results of laboratory investigations are only as good as the sample received by
the laboratory
o Pus specimen
 Pus is collected in order to examine micro organisms causing infection
 Must be collected by using sterile swab
 Do not make a smear for transporting when the specimen is from a patient with
suspect of anthrax or bubonic plague

Step 5: Significance of Proper Handling of Routine Specimen (10minutes)

 Reduces contamination
 Helps tracking down the specimens and results
 Helps to get quality results
 Avoids mixing specimen and request form
 Avoid leakages

Step 6: Demonstration of Wearing Protective Gears (gloves) (20minutes)

Activity: Demonstration of wearing protective gears (Gloves)

DEMONSTRATION (wearing glove)

 Distribute pairs of gloves to each student
 Show the steps of wearing gloves using the following guidelines
o Wash hands with soap
o Dry with a drier or disposable absorbent paper
o Arrange properly piece of gloves relating with hand
o Put on the gloves.

Teaching Guides for NTA Level 4 MLS Curriculum Page 818

 ALLOW: each student to practice.
DEMOSTRATION: (Putting off the Gloves)
 Use left hand to collect all contaminated material (non sharp)
 Using right hand remove the glove from left hand
 Again use left hand to remove right hand glove
 Tie up and dispose in the green bin
 Wash hands with soap or antiseptic and dry.

The figure below shows a picture of glove

Step 7: Key Points (10 minutes)

 Protective gears are the material worn to protect an individual from infection, and are
specialized clothing or equipment worn by health service provider for protection against
health and safety hazards.
 Protective gears includes
o Gloves
o Laboratory Coat
o Masks
o Gumboots
o Eye Glasses
 Significance of Proper Handling of Routine Specimen
o Reduces contamination
o Helps tracking down the specimens and results

Teaching Guides for NTA Level 4 MLS Curriculum Page 819

 o Helps to get quality results
o Avoids mixing specimen and request form
o Avoid leakages

Step 8: Evaluation (10minutes)

 Mention four protective gears used in the laboratory
 List three significance of protective gears
 Explain how to handle stool specimen

ASK students if they have any comments or need clarification on any points.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press;
 Carter J, Lema O (1994) Practical laboratory manual for health centres in eastern Africa.
AMREF
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd; and
 Monica Cheesbrough (2002)|: District Laboratory Practice in Tropical Countries Part 1 &
2, Cambridge University Press.

Teaching Guides for NTA Level 4 MLS Curriculum Page 820

Session 6: Collection Routine Specimens for
Laboratory Investigations
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session student are expected to be able to:
 Define the terms Specimen, SOPs, Finger prick and Venous blood
 List materials used for collecting venous blood and finger prick
 Describe the procedure of finger prick
 Describe venous blood collection

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation,
2 10 minutes Definition of Term
Discussion
Materials used for collecting venous blood and
3 15 minutes Presentation
finger prick
4 40 minutes Presentation Procedure of Finger Pricking
5 40 minutes Presentation Procedure of Venous Blood Collection
6 05 minutes Presentation Key Points
7 05 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (10 minutes)
 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Step 2: Definition of Term (10minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 821

 Activity: Discussion (5 minutes)

 ASK the students to buzz on the following questions

 Define the following terms
 Specimen
 SOPs
 Finger prick
 Venous blood
 ALLOW time for them to respond
 WRITE their answers on flip chart
 SUMMARIZE by using the contents below

 SOPs (Standard Operating Procedures)

o Is the established method for performing laboratory procedures and aim to
standardise procedures in the laboratory technical work
 Finger prick specimen
o Is a Capillary blood collected from a pierced finger
 Venous blood sample
o Blood collected from a vein

Step 3: Materials Used for Collecting Venous Blood and Finger Prick (15Minutes)
Common materials for both venous blood collection and finger prick
 Sterile swab
o Used for cleaning the skin
 70% alcohol
o Used for disinfecting the skin
 Gloves
o Used to protect the phlebotomist from contamination
 Disposal bucket
o Used for disposing used materials
 Sharps box or container
o Used for disposing sharp materials

Specific materials for finger prick

 Lancet
o Is used for piercing of the skin
 Specific materials for venous blood collection
o Syringes (2.5ml, 5ml and 10ml) and needles 19G, 21G and 23G)
 For drawing blood
o Vacuum (needle, holder and tubes)
 For drawing blood
o Blood containers
 For putting blood
o Tourniquet
 For dilating veins

Step 4: Procedure of Finger Prick (40minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 822

 Purpose of finger prick blood collection
o Is to obtain capillary blood which is may be used for haematological examinations,
including haemoglobin estimation, total and differential white blood cell counts and
blood cell morphology, detection of blood parasites, and sickle-cell screening.
 Procedure for Finger Prick
o Wear gloves
o Clean the puncture area with a cotton wool swab soaked in 70% methanol or an
alcohol swab; allow area to dry
o Using a sterile lancet, make a rapid puncture using the side of the finger in adults and
children sufficiently deep to allow the free flow of blood avoid the tip of the finger
o Wipe away the first drop of blood with a piece of dry cotton wool. Use the next few
drops and transfer onto clean glass slides or into a capillary tube or pipette.
o When sufficient blood has been collected, press the piece of dry cotton wool firmly
on the puncture area until the bleeding stops.
o Place used lancet in the sharps box or container marked “SHARPS”. Place the
materials for wrapping the lancet and the cotton wool in the bucket marked
“INCINERATOR”.
o Make sure the site is warm to ensure blood flows freely.
o Do not squeeze the finger too hard as this will lead to haemodilution from tissue fluid
and may give unreliable results.
o On cold days, sock the hand (or foot of an infant) in warm water and dry before
collecting the sample.

Procedure ofFinger Prick:

Finger Pricking Finger Preparation

1. Position hand palm-side up. Choose 2. Apply intermittent pressure to

whichever finger is least calloused. the finger to help the blood to flow.

3. Clean fingertip with alcohol. Start in 4. Hold finger and firmly place a
middle and work outward to prevent new sterile lancet off-center on the
contaminating area. Allow area to dry. fingertip.

Slide 20

Teaching Guides for NTA Level 4 MLS Curriculum Page 823

 Collecting Blood: Finger Prick

5. Firmly press lancet to 6. Wipe away the first drop of blood

puncture the fingertip with a sterile gauze pad or cotton ball

7. Collect specimen. Blood may 8. Apply a gauze pad or cotton ball

flow, best if the finger is held lower to the puncture site until the
than the elbow bleeding stops
Slide 21

9. Discard the used materials (sharps and infectious) in appropriate containers

Source: CDC (2009)

Step 5: Procedure of Venous Blood Collection (40minutes)

 Purpose of venous blood collection
o Venous blood is used for all blood examinations, including haematological,
parasitological, biochemical and serological tests, and for blood culture. Blood
samples are collected into plain tubes or tubes containing anticoagulant, or into blood
bottles, as required.
 Safety Precautions during Collection of Blood Sample from Patients
o Always follow standard safety precautions when drawing blood
 Consider every person (patient or staff) as potentially infectious and susceptible to
infection
 Wash hands before and after taking a sample from each patient
 Put on new gloves before collecting blood
 If blood is spilled, mop and disinfect area immediately
 Keep work area organized, clean, and disinfected
 Discard all used items in appropriate containers
 Overview of Vein Anatomy (Location of veins)
o Superficial Veins of the upper limb

Teaching Guides for NTA Level 4 MLS Curriculum Page 824

  Median Cubital Vein. A superficial vein, most commonly used for venepuncture.
It lies over the cubital fossa and serves as an anastomosis between the cephalic
and basilic vein
 Cephalic vein.Shown in both the forearm and arm, it can be followed where it
empties into the axillary vein
 Basilic Vein. Seen in the forearm and arm, it dives to join the brachial; best area
for venepuncture is antecubital fossa area

Source: CDC (2009)

Procedure for collecting venous blood

 Apply tourniquet to increase pressure in the veins and aid in site selection. Ask the
patient to make a tight fist, so the veins become more prominent.
 Note that the tourniquet is applied 7.5 – 10 cm above the intended site
 The tourniquet should not be left on for longer than ONE minute
 Using the index finger, feel for a suitable vein, selecting a sufficiently large vein that
does not roll and with a direction that can be felt.
 Wearing gloves clean the site with a cotton swab soaked in 70% methanol or an alcohol
swab and allow to air dry. Do not retouch the cleaned area.
 Screw the needle into the handle
 With the thumb of the left hand holding down the skin below the puncture site, insert the
needle along the line of the vein with the bevel of the needle facing directly upwards.
 Insert needle at a 15 to 30 degree angle using a quick smooth motion.
 Push the tube on to the end of the needle which is located in the handle.
 When sufficient blood has been collected, release the tourniquet and instruct the patient
to open his or her fist. Remove the needle from the vein and press firmly on the
venipuncture site with a piece of dry cotton. Remove the tourniquet and instruct the
patient to continue pressing on the puncture site with the arm raised until bleeding stops.
 Label the tubes
 Check to ensure bleeding from the venipuncture site has stopped. Cover the area with a
small dressing, if needed.
 Place the needle in the sharps box. Place other contaminated materials in the bucket
marked “INCINERATION”.

Procedure of Taking a Venous Blood Sample

Figure 1: Organise materials and equipment

Teaching Guides for NTA Level 4 MLS Curriculum Page 825

Source: CDC (2009)

Figure 2: Applying Tourniquet

Figure 3: Instruct the Patient to Form Fist

Figure 4: Clean Venepuncture Site with Alcohol Using a Circular Motion (after palpating
path of vein) and Allow Area to Dry

Source:CDC:(2009)

Teaching Guides for NTA Level 4 MLS Curriculum Page 826

Figure 5: Assemble Needle and Vacuum Tube Holder

Figure 6: Insert Collection Tube into Holder Until Tube Reaches Needle

Source: CDC (2009)

Figure 7: Remove Cap from Needle

Source: CDC (2009)

Figure 8: Use Your Thumb to Draw Skin Tight About 1- 2” Below Venepuncture Site

Teaching Guides for NTA Level 4 MLS Curriculum Page 827

Figure 9: Insert Needle, Bevel Side Up, Into Vein and Penetrate Vein at a 15 Degree Angle

Source: CDC (2009)

Figure 10: Push Vacutainer Tube Completely onto Needle. Blood Should Begin to Flow into
Tube and Release Tourniquet

Source: CDC (2009)

Figure 11: Place Dry Gauze over the Venepuncture Site and Apply Mild Pressure to Pad and
Slowly Remove Needle

Figure 12: Apply Mild Pressure Until Bleeding Has Stopped

Teaching Guides for NTA Level 4 MLS Curriculum Page 828

Figure 13:Label the tube

Source: CDC (2009)

Figure 14: Waste Disposal of used materials

Source: CDC:(2009)

Step 6: Key Points (5 minutes)

 SOPs (Standard Operating Procedures)
o Is the established method for performing laboratory procedures and aim to
standardise procedures in the laboratory technical work
 Finger prick specimen
o Is a Capillary blood collected from a pierced finger
 Venous blood sample
o Blood collected from a vein
 Purpose of finger prick blood collection is to obtain capillary blood which is may be
used for haematological examinations, including haemoglobin estimation, total and
differential white blood cell counts and blood cell morphology, detection of blood
parasites, and sickle-cell screening.

Step 7: Evaluation (5minutes)

 Define Standard Operating procedure (SOPs)
 List four materials used for venous blood collection
 Explain the purpose of venous blood collection

Teaching Guides for NTA Level 4 MLS Curriculum Page 829

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press;
 Carter J, Lema O (1994) Practical laboratory manual for health centres in eastern Africa.
AMREF
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd; and
 Monica Cheesbrough (2002)|: District Laboratory Practice in Tropical Countries Part 1 &
2, Cambridge University Press.

Teaching Guides for NTA Level 4 MLS Curriculum Page 830

Session 7: Demonstrations Collection of
Blood Samples (Venous blood and finger
prick)
*(More time should be allocated to this session preferably 10 hours)

NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY

SPECIMEN MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students are expected to be able to:
 Describe filling of laboratory request form
 Demonstrate blood collection procedure

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Advanced preparation
 Handout 6.1: Procedure of Finger Pricking
 Handout 6.2: Procedure of Venous Blood Collection
 Advanced Preparation. Required materials to prepare for blood collection procedure
include.
General materials
o Gloves
o Antiseptic (70% alcohol)
o Bio-hazard waste containers
o Safety box for contaminated sharps
o Register books
o Gauze (sterile
For Capillary Blood include
o Sterile lancets
o Capillary tube
For Venous Blood include
o Vacuum tubes
o Syringes
o Tourniquet (latex-free)

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives

Teaching Guides for NTA Level 4 MLS Curriculum Page 831

 Demonstrate blood collection procedure
2 25 minutes Demonstration
(Capillary blood drawing)
Demonstrate blood collection procedure
3 25 minutes Demonstration
(Return demonstration for finger pricking)
Demonstrate blood collection procedure
4 15 minutes Demonstration (Identification of Veins form which blood can
be drawn)
Demonstrate blood collection procedure
5 20 minutes Demonstration
(venous blood collection)
Demonstrate blood collection procedure
6 20 minutes Demonstration (Return demonstration for collection of
venous blood)
7 05 minutes Presentation Key points
8 05 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Step 2: Demonstration of Capillary Blood Drawing (20minutes)

Activity: Demonstration of Capillary Blood Drawing (5 minutes)

DISPLAY all the materials and supplies one by one with running comments on the function
of each
DEMONSTRATE arrangement of the materials and supplies
DEMONSTRATE the procedure of capillary blood collection from the patient
Procedure for Finger pricking
 Explain the procedure to the patient
 Ensure the patient has consented for the procedure
 Explain to the patient the turn around time and where to get the results
 Position the patient at a rested sitting position
 Position hand palm-side up. Choose the ring finger, or whichever finger is least calloused
 Apply intermittent pressure to the finger to help the blood to flow.
 Clean the fingertip with alcohol. Start in the middle and work outward to prevent
contaminating the area. Allow the area to dry
 Hold the finger and firmly place a new sterile lancet off-center on the fingertip.
 Firmly press the lancet to puncture the fingertip
 Wipe away the first drop of blood with a sterile gauze pad or cotton ball
 Collect the specimen. Blood may flow best if the finger is held lower than the elbow
 Apply a gauze pad or cotton ball to the puncture site until the bleeding stops
 13Discard the used materials in the appropriate containers
REFER students to Handout 9.1: Procedure of Finger Pricking

Step 3: Return Demonstration for Finger Pricking (20 minutes)

 At this point each student has to get an opportunity to practice finger pricking
 The tutor should allocate the first to the last for practicing

Teaching Guides for NTA Level 4 MLS Curriculum Page 832

Activity: Return Demonstration for Finger Pricking (15 minutes)
 ALLOW one student to begin the demonstration while others are observing
 CALL a patient to come in the laboratory
 INTRODUCE the students to the client
 EXPLAIN to the client that the students are going to conduct the procedure under your
supervision
 ENSURE that the client consents
 LET the first student conduct the procedure step by step
 ASSIST the student in case of any challenges
 THANK the patient at the end of the procedure and allow him/her to go
 DO for the second student to the last one.
 SUMMARIZE the activity by clarifying any challenges

Step 4: Identification of Veins Form Which Blood Can Be Drawn

(10 minutes)
Activity: Identification of Veins Form Which Blood Can Be Drawn (20minutes)
 EXPLAIN the procedure to students
 DIVIDE the students into two pairs and one becoming the observer
 PROVIDE each pair with a tourniquet.
 ASK a volunteer from each group to be the patient, the second to be the phlebotomist,
and the third to be the observer.
 ASK the “patient” to present the arm.
 ASK the “Phlebotomist” to apply a tourniquet.
 POINT out the antecubital fossa (i.e. the area of the arm in front of the elbow where the
veins are easy to see) and clean the area with an alcohol swab.
 ASK the phlebotomist to identify the three veins as shown in the picture below
 LET the “observer” comment on the procedure.
 LET the students in the group change the roles so that everyone gets the opportunity to
Preparation for Taking Blood Sample:
practice
 CLARIFY any challenges faced by students
Review of Vein Anatomy
 GO to the next step
Superficial Veins of the upper limb
1. Median Cubital Vein - A superficial
vein, most commonly used for
venepuncture. It lies over the cubital
fossa and serves as an anastomosis
between the cephalic and basilic vein
2. Cephalic vein – Shown in both the
forearm and arm, it can be followed
where it empties into the axillary vein
3. Basilic Vein - Seen in the forearm
and arm, it dives to join the brachial; Optimal sites for
best area for venepuncture is
venepuncture
antecubital fossa area
CM05308 Clinical Laboratory II: Session 1: Blood Collection and Specimen Handling
Version 000
Slide 10

Teaching Guides for NTA Level 4 MLS Curriculum Page 833

Step 5: Demonstration on Venous Blood Collection (20 minutes)
Activity: Demonstration on Venous Blood Collection (15 minutes)
DISPLAY all the materials and supplies one by one with running comments on the function
of each
DEMONSTRATE arrangement of the materials and supplies
DEMONSTRATE the procedure of venous blood collection from the patient
Procedure for Venous blood collection
 Explain the procedure to the patient
 Ensure the patient has consented for the procedure
 Explain to the patient the turn around time and where to get the results
 Position the patient at a rested sitting position
 Label the tube with patient ID number
 Put tourniquet on clients arm
 Have the patient form a fist so that the veins are more prominent
 After palpating path of vein, clean venepuncture site with alcohol using a circular
motion. Allow area to dry
 Assemble needle and vacuum tube holder
 Insert collection tube into holder until tube reaches needle
 Remove cap from needle
 Use your thumb to draw skin tight about 1- 2” below venepuncture site. Hold skin tight
through Step 13
 Insert needle, bevel side up, into vein and penetrate vein at a 15 degree angle.
 Push vacuum tube completely onto needle. Blood should begin to flow into tube.
 Release tourniquet
 Place dry gauze over the venepuncture site and apply mild pressure to pad and slowly
remove needle.
 Apply mild pressure until bleeding has stopped
 Discard vacuum tube and cotton wool in separate appropriate waste containers.
REFER students to Handout 6.2: Procedure of Venous Blood Collection

Step 6: Return Demonstration for Collection of Venous Blood (25 minutes)

 At this point each student has to get an opportunity to practice collection of venous blood
sample
 The tutor should allocate the first to the last for practicing

Activity: Return Demonstration for Collection of Venous Blood Sample (20minutes)

 ALLOW one student to begin the demonstration while others are observing
 CALL a patient to come in the laboratory
 INTRODUCE the students to the client
 EXPLAIN to the client that the students are going to conduct the procedure under your
supervision
 ENSURE that the client consents before the procedure is done
 LET the first student conduct the procedure step by step
 ASSIST the student in case of any challenges
 THANK the patient at the end of the procedure and allow him/her to go
 DO the same for the second student to the last one.

Teaching Guides for NTA Level 4 MLS Curriculum Page 834

 SUMMARIZE the activity by clarifying any challenges

Step 7: Key Points (5 minutes)

 Before collecting blood from patient it is important to make sure that all materials and
supplies are available
 The working bench is properly arranged to avoids unnecessary accidents
 IPC principles like wearing gloves, laboratory coat are essential for prevention of
diseases of disease transmission.
 Blood Collection activity should be done using sterile lancet and syringes
 For quality blood collection procedure it is important to adhere to SOPs

Step 8: Evaluation (5 minutes)

 List materials used for collecting venous blood
 Locate on the Arm the veins for which blood can be drawn

ASK students if they have any comments or need clarification on any points.

Reference
 Becker F.J and Silverton R.E (1985). Introduction to Medical Laboratory Technology.
Sixth Ed. Butterworth London
 Carter J, Lema.O. (1994). Practical laboratory manual for health centres in Eastern
Africa. AMREF.
 CDC. (2009). DPDx, Laboratory Identification of Parasites of Public Health Concern
http://www.dpd.cdc.gov/dpdx/HTML/Image_Library.htm/ Last modified on 20th July
2009

Teaching Guides for NTA Level 4 MLS Curriculum Page 835

 Finger Prick: Finger Preparation
Handout 9.1: Procedure of Finger Pricking

1. Position hand palm-side up. Choose 2. Apply intermittent pressure to

whichever finger is least calloused. the finger to help the blood to flow.

3. Clean fingertip with alcohol. Start in 4. Hold finger and firmly place a
Collecting Blood: Finger Prick
middle and work outward to prevent
contaminating area. Allow area to dry.
new sterile lancet off-center on the
fingertip.

Slide 20

5. Firmly press lancet to 6. Wipe away the first drop of blood

puncture the fingertip with a sterile gauze pad or cotton ball

7. Collect specimen. Blood may 8. Apply a gauze pad or cotton ball

flow, best if the finger is held lower to the puncture site until the
than the elbow bleeding stops
9. Discard the used materials (sharps and infectious) in appropriate containers
Slide 21
Source: CDC (2009)

Teaching Guides for NTA Level 4 MLS Curriculum Page 836

 Taking a Venous Sample : Preparation (1)
Handout 9.1: Procedure of Venous Blood Collection

2. Label tubes with patient ID

3. Put tourniquet on client about 4. Have patient form a fist so

3-4” above venepuncture site veins are more prominent
CM05308 Clinical Laboratory II: Session 1: Blood Collection and Specimen Handling
Version 000
Slide 13

Discard the used materials (sharps and infectious) in appropriate containers

Source: CDC (2009)

Teaching Guides for NTA Level 4 MLS Curriculum Page 837

Session 8: Demonstrations Collection of
Blood Samples (Finger Prick)
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT
*(More time should be allocated to this session preferably 6 hours)

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students are expected to be able to:
 List materials used for finger prick
 Demonstrate finger prick procedure (Capillary blood drawing)

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Advanced preparation
 Handout 10.1: Procedure of Finger Pricking

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation Materials for finger prick procedure
Demonstrate finger prick procedure
3 25 minutes Demonstration
(Capillary blood drawing)
Demonstrate blood collection procedure
4 60 minutes Demonstration
(Return demonstration for finger pricking)
5 10 minutes Presentation Key points
6 05 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Step 2: Materials for Finger prick (15 materials)

 Materials used for finger prick procedure
o Gloves
o Antiseptic (70% alcohol)
o Bio-hazard waste containers
o Safety box for contaminated sharps

Teaching Guides for NTA Level 4 MLS Curriculum Page 838

 o Register books
o Gauze (sterile
o Sterile lancets

Step 3: Demonstration of Capillary Blood drawing (25 minutes)

Activity: Demonstration of Capillary Blood Drawing (5 minutes)
 DISPLAY all the materials and supplies one by one with running comments on the
function of each
 DEMONSTRATE arrangement of the materials and supplies
 DEMONSTRATE the procedure of capillary blood collection from the patient

Procedure for Finger pricking

 Explain the procedure to the patient
 Ensure the patient has consented for the procedure
 Explain to the patient the turn around time and where to get the results
 Position the patient at a rested sitting position
 Position hand palm-side up. Choose the ring finger, or whichever finger is least
calloused
 Apply intermittent pressure to the finger to help the blood to flow.
 Clean the fingertip with alcohol. Start in the middle and work outward to prevent
contaminating the area. Allow the area to dry
 Hold the finger and firmly place a new sterile lancet off-center on the fingertip.
 Firmly press the lancet to puncture the fingertip
 Wipe away the first drop of blood with a sterile gauze pad or cotton ball
 Collect the specimen. Blood may flow best if the finger is held lower than the elbow
 Apply a gauze pad or cotton ball to the puncture site until the bleeding stops
 13Discard the used materials in the appropriate containers

REFER students to Handout 10.1: Procedure of Finger Pricking

Step 4: Return Demonstration for Finger Pricking (60 minutes)

 At this point each student has to get an opportunity to practice finger pricking
 The tutor should allocate the first to the last for practicing

Activity: Return Demonstration for Finger Pricking (15 minutes)

 ALLOW one student to begin the demonstration while others are observing
 CALL a patient to come in the laboratory
 INTRODUCE the students to the client
 EXPLAIN to the client that the students are going to conduct the procedure under your
supervision
 ENSURE that the client consents
 LET the first student conduct the procedure step by step
 ASSIST the student in case of any challenges
 THANK the patient at the end of the procedure and allow him/her to go
 DO for the second student to the last one.
 SUMMARIZE the activity by clarifying any challenges

Teaching Guides for NTA Level 4 MLS Curriculum Page 839

Step 5: Key Points (10 minutes)
 Before collecting blood from patient it is important to make sure that all materials and
supplies are available
 The working bench is properly arranged to avoids unnecessary accidents
 IPC principles like wearing gloves, laboratory coat are essential for prevention of
diseases of disease transmission.
 Blood Collection activity should be done using sterile lancet and syringes
 For quality blood collection procedure it is important to adhere to SOPs

Step 6: Evaluation (5 minutes)

 List materials used for collecting Capillary blood
 Locate on the Arm the veins for which blood can be drawn

ASK students if they have any comments or need clarification on any points.

Reference
 Becker F.J and Silverton R.E (1985). Introduction to Medical Laboratory Technology.
Sixth Ed. Butterworth London
 Carter J, Lema.O. (1994). Practical laboratory manual for health centres in Eastern
Africa. AMREF.
 CDC. (2009). DPDx, Laboratory Identification of Parasites of Public Health Concern
http://www.dpd.cdc.gov/dpdx/HTML/Image_Library.htm/ Last modified on 20th July
2009

Teaching Guides for NTA Level 4 MLS Curriculum Page 840

Handout 10.1: Procedure of Finger Pricking
Finger Prick: Finger Preparation

1. Position hand palm-side up. Choose 2. Apply intermittent pressure to

whichever finger is least calloused. the finger to help the blood to flow.

3. Clean fingertip with alcohol. Start in 4. Hold finger and firmly place a
Collecting Blood: Finger Prick
middle and work outward to prevent
contaminating area. Allow area to dry.
new sterile lancet off-center on the
fingertip.

Slide 20

5. Firmly press lancet to 6. Wipe away the first drop of blood

puncture the fingertip with a sterile gauze pad or cotton ball

7. Collect specimen. Blood may 8. Apply a gauze pad or cotton ball

flow, best if the finger is held lower to the puncture site until the
than the elbow bleeding stops
Slide 21

9. Discard the used materials (sharps and infectious) in appropriate containers

Source :CDC (2009)

Teaching Guides for NTA Level 4 MLS Curriculum Page 841

Session 9: Demonstration Collection of
Routine Specimens (Heel Prick)
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT
*(More time should be allocated to this session preferably 6 hours)

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session students are expected to be able to:
 List materials used for heel prick
 Describe precaution during heel prick procedure
 Demonstrate heel prick

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation Materials Used for Heel Prick
3 20 minutes Presentation Precaution During Heel Prick Procedure
4 15 minutes Presentation Demonstrate Heel Prick
5 50 minutes Presentation Return Demonstration of Heel Prick
6 10 minutes Presentation Key Points
7 10minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Step 2: Materials Used for Heel Prick (10 minutes)

 Materials used for heel prick procedure
o Gloves
o Antiseptic (70% alcohol)
o Bio-hazard waste containers
o Safety box for contaminated sharps
o Register books
o Gauze (sterile
o Sterile lancets

Teaching Guides for NTA Level 4 MLS Curriculum Page 842

Step 3 Precautions during Heel Prick Procedure (20 minutes)
 Precautions During Heel Prick Technique
o Infant heels are appropriate for blood collection until approximately 6 months to one
year
o Never exceed 2.4 mm in puncture depth
o Never puncture the posterior curvature of the heel or the arch of the foot
o Never use sites previously punctured, bruised, swollen or red in colour
o Never puncture the heel more than twice for any one collection

Step 4: Demonstrate Heel Prick (15 minutes)

Activity: Demonstration on Heel prick
 DISPLAY all the materials and supplies one by one with running comments on the
function of each
 DEMONSTRATE arrangement of the materials and supplies
 DEMONSTRATE the procedure of Heel prick
 Procedure for Heel prick
 Wipe away the first drop of blood
 Ease thumb pressure and apply intermittent pressure. Avoid milking and scraping
 Follow recommended order of draw
 When blood collection is complete, clean area, apply pressure.
 Never apply band-aid under the age of two
 Label specimens immediately after the draw; never before
 AREA OF PRICKING
 The figure below shows a Procedure of Heel pricking

Source: ASCP
Site For Pricking
Step 5: Return Demonstration for Heel Prick (50minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 843

 At this point each student has to get an opportunity to practice heel prick
 The tutor should monitor from the first to the last for practicing

Activity: Return Demonstration for Heel Prick

 ALLOW one student to begin the demonstration while others are observing
 CALL a patient to come in the laboratory
 INTRODUCE the students to the client
 EXPLAIN to the client that the students are going to conduct the procedure under your
supervision
 ENSURE that the client consents before the procedure is done
 LET the first student conduct the procedure step by step
 ASSIST the student in case of any challenges
 THANK the patient at the end of the procedure and allow him/her to go
 DO the same for the second student to the last one.
 SUMMARIZE the activity by clarifying any challenges

Step 6: Key Point (10 minutes)

 Materials used for heel prick procedure
o Gloves
o Antiseptic (70% alcohol)
o Bio-hazard waste containers
o Safety box for contaminated sharps
o Register books
o Gauze (sterile
o Sterile lancets
 Precautions During Heel Prick Technique
o Infant heels are appropriate for blood collection until approximately 6 months to one
year
o Never exceed 2.4 mm in puncture depth
o Never puncture the posterior curvature of the heel or the arch of the foot
o Never use sites previously punctured, bruised, swollen or red in colour
o Never puncture the heel more than twice for any one collection

Step 7: Evaluation (10 minutes)

 List materials used for heel prick
 ASK students if they have any comments or need clarification on any points.

Reference
 Becker F.J and Silverton R.E (1985). Introduction to Medical Laboratory Technology.
Sixth Ed. Butterworth London
 Carter J, Lema.O. (1994). Practical laboratory manual for health centres in Eastern
Africa. AMREF.
 CDC. (2009). DPDx, Laboratory Identification of Parasites of Public Health Concern
http://www.dpd.cdc.gov/dpdx/HTML/Image_Library.htm/ Last modified on 20th July
2009

Teaching Guides for NTA Level 4 MLS Curriculum Page 844

Session 10: Procedures of Accessioning
Specimens
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT

Total Session Time: 120

Prerequisites
 None

Learning Objectives
By the end of this session student are expected to be able to:
 Explain accessioning of specimens
 Describe criteria of accessioning specimens
 Describe criteria’s of rejecting specimens
 Explain importance of accessioning specimens
 Describe the procedure of accessioning specimen
 Describe Documentation of accessioning report

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Reception register book

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 05 minutes Accessioning of Specimens
Buzzing
3 15 minutes Presentation Criteria of Accessioning Specimens
4 20 minutes Presentation Criteria’s of Rejecting Specimens
5 15minutes Presentation Importance of Accessioning Specimens
6 15 minutes Presentation Procedure of Accessioning Specimen
7 15 minutes Presentation Documentation of Accessioning Report
8 15 minutes Presentation Key Points
9 15minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 845

Step 2: Definition of Terms (5 Minutes)
Activity: Buzzing (5 minutes)
ASK students to buzz on the following questions
 Explain accessioning of specimens
 ALLOW time for them to respond
 WTITE their answers on a flip chart
 SUMMARIZE by using the content below

 Accessioning of specimens
o Is a process of qualifying specimens for laboratory investigation

Step 3: Criteria’s for accessioning (15minutes)

 Request form should be well filled with;
o Health facility name
o Hospital Number
o Name of patient
o Date
o Age
o Sex
o Address
o Ward Number
o Clinical Note
o Laboratory investigation
o Time of request
 Sufficient quantity of specimen
 Right container
 Condition of the specimen

Step 4: Criteria’s of Rejecting Specimens (20 minutes

 Rejecting criteria
o Quantity is not sufficient
o Wrong container
o Long transport time
o Wrongly or incomplete filled request form
o Condition of the specimen is not ideal for the test (haemolysed blood, dried stool,
clots,
o Unlabelled/Mislabeled specimen

 Example of Specimen Rejection Form.

 Hospital Registration Number: …………………………Ward / Clinic …....……
 Patient Names (in full): ……………………………………………………......…..
 Date Sample Received: …………………………… Time: ………………......….
 Description of Problem encountered: (in brief): ..................................................
 Corrective Action(s) Needed: …………………………………………….....…….
 Form Completed by: ………………Signature: ……………Date: …...................
 For Clinic / Ward: Corrective Action taken ……………………………...………
 Corrective Action taken by: Name ………………………………………...…….

Teaching Guides for NTA Level 4 MLS Curriculum Page 846

  Signature: ………………………Date: …………………Time……………….
 Return this form to the laboratory with specimen indicating corrective actions taken

 Rejection Codes
1 No specimen/sample received 13 No specimen/sample ID
2 Quantity not sufficient 14 No specimen/sample ID cannot be
established
3 Haemolysed 15 Specimen/sample ID illegible
4 Lipemic 16 Collection site inappropriate
5 Damaged-broken or leaked in 17 Specimen /sample type unacceptable for
transit test
6 Damaged-contaminated 18 No test requisition received
7 Damaged-expired transport 19 N test ordered on requisition
media
8 Damaged-improper preservation 20 No collection date requisition
9 Damaged-improper transport 21 No specimen / sample collection site on
media requisition
10 Damaged-improper temperature 22 Test not available
11 Damaged-lab accident, 23 Clotted Sample
unsalvageable
12 Sample too old

Step 5: Importance of Accessioning (15minutes)

 Importance of Accessioning are
o Helps to get good results
o It helps to avoid mixing of specimen
o Helps track down specimen/results
o Helps mismanagement of specimen
o Helps to get results at right time
o Helps patient to get treatment at right time
o Helps the laboratory workers to plan their work
o Helps to process the right specimens
o It helps to keep records

Step 6: Procedure of Accessioning Specimen (15minutes)

 Correct specimen-quantity
o Quantity of specimen required for investigation
 Blood-3ml-5ml
 Urine-15ml-20ml
 Stool- teaspoonful
 Sputum-5ml
 Verify information on the request form
o A request form is used to write down basic information about the patient and to
request for a laboratory test. Information required are;
 Health facility name
 Hospital Number
 Name of patient

Teaching Guides for NTA Level 4 MLS Curriculum Page 847

  Date requesting
 Age of the patient
 Sex of the patient
 Address of the patient
 Ward Number
 Clinical Notes
 Laboratory investigation
 Verification of the Specimen Label
o Hospital Number
o Name of patient
o Date requesting
o Ward Number
o Name of collector

Step 7: Documentation of Accessioning Report (15 Minutes)

 Proper entering of information
o All information should be entered properly in the register book
 Specimen information
 Patient information
 Cause of specimen rejection
 Action taken
o Proper handling of information
o All information should be kept safely for reference
o Helps in statistics analysis
o Improves quality of work
o Proper storage of register books
o Helps tracking down information
o Proper use computer program for storing information
 Use excel program

Step 8: Key Points (15Minutes)

 Accessioning of specimens is a process of qualifying specimens for laboratory
investigation
 The following Criteria’s should be adhered during Accessioning of specimens
o Request form should be well filled with
o Sufficient quantity of specimen received
o The specimen should be collected in the right container
o Assessment of the specimen
 Criteria’s of Rejecting Specimens
o Quantity is not sufficient
o Wrong container
o Long transport time
o Wrongly or incomplete filled request form
o Condition of the specimen is not ideal for the test (haemolysed blood, dried stool,
clots,
o Unlabelled/Mislabeled specimen
 Documentation of Accessioning Report
o All information should be entered properly in the register book

Teaching Guides for NTA Level 4 MLS Curriculum Page 848

  Specimen information
 Patient information
 Cause of specimen rejection
 Action taken
o Proper handling of information
 All information should be kept safely for reference
 Helps in statistics analysis
 Improves quality of work
o Proper storage of register books
 Helps tracking down information
o Proper use computer program for storing information
 Use excel program
Step 9: Evaluation. (15Minutes)
 Explain accessioning of laboratory specimen
 List four criteria’s of rejecting laboratory specimens
 List four importance of accessioning of laboratory specimens
ASK students if they have any comments or need clarification on any points.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd; and
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1 &
2, Cambridge University Press.
 WHO(2003) Manual for Basic Techniques for a health laboratory.2nd Ed. Word Health
Organization

Teaching Guides for NTA Level 4 MLS Curriculum Page 849

Session 11: Demonstration of Laboratory
Accessioning Specimens
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT
*(More time should be allocated to this session preferably 4 hours)

Total Session Time: 120

Prerequisites
 None

Learning Objectives
By the end of this session student are expected to be able to:
 Practice receiving specimen
 Practice entering patient information in register book

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Register book
 Request form

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 60 minutes Receiving Specimen
Buzzing
3 45 minutes Presentation Entering Patient Information in Register Book
4 05 minutes Presentation Key Points
5 05minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Step 2: Role Play (Demonstration of Receiving Laboratory Specimens) (60 Minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 850

 Activity: demonstration of receiving laboratory specimens

 DIVIDE students into a group of 10

 Each group should choose two students one to be a patient coming with a
specimen(stool specimen) and another being a receiver of specimens
 (Rest of students will be observers)
 Instruct both students to practice giving and receiving the specimen
 What information’s to be observed by the receiver
o Request form should be well filled with;
 Health facility name
 Hospital Number
 Name of patient
 Date
 Age
 Sex
 Address
 Ward Number
 Clinical Note
 Laboratory investigation
 Time of request
o Sufficient quantity of specimen
o Right container
o Condition of the specimen
 Other students will be noting the sequence of proper receiving and verification of
information’s from the request form
 ALLOW other students to practice
 CORRECT Them if there is mistakes

Step 3: Entering Patient Information in Register Book (45 minutes)

 Information which should be entered in reception register book are
o Serial number
o Patient identification number
o Full name or patient identification number
o Age in number/years such as 65years
o Sex male/female
o File number
o Ward
o Address
o Nature of specimen
o Date collected
o Date received
o Investigation requested
o Name of requester
o Receipt number
o Amount paid
o Signature of receiver of money
o Comments

Teaching Guides for NTA Level 4 MLS Curriculum Page 851

Demonstration of entering of patient information’s

Activity: Demonstration Entering of patient information’s

 DIVIDE students into a group of 10
 Provide a copy of register book
 Ask each group to practice to enter information.
 CORRECT Them if there is mistakes

Step 4.Key Points (5Minutes)

 Information which should be entered in reception register book are
o Serial number
o Patient identification number
o Full name or patient identification number
o Age in number/years such as 65years
o Sex male/female
o File number
o Ward
o Address
o Nature of specimen
o Date collected
o Date received
o Investigation requested
o Name of requester
o Receipt number
o Amount paid
o Signature of receiver of money
o Comments

Step 5: Evaluation (5 Minutes)

 Mention five types of information’s to be entered in reception register book
 ASK students if they have any comments or need clarification on any points.

Teaching Guides for NTA Level 4 MLS Curriculum Page 852

Session 12: Containers for Laboratory
Investigations
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session student are expected to be able to:
 Define container
 List types of containers (wax carton, universal bottle, plastic container with cap, bijou
bottle)
 Describe significance of containers
 Identify containers for laboratory investigation (containers for stool, urine, blood, sputum
and pus swab)

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 5 minutes Buzzing Definition of Term
Types of Containers (Wax Carton, Universal
3 15 minutes Presentation Bottle, Plastic Container with Cap, Bijou
Bottle)
4 10minutes Presentation Significance of Containers
5 30minutes Presentation Containers for Laboratory Investigations
6 10minutes Presentation Key Points
7 5 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 853

Step 2: Definition of Term (5 minutes)
Activity: Buzzing (5 minutes)
 ASK students to buzz on the following questions
 Define Container
 ALLOW time for them to respond
 WTITE their answers on a flip chart
 SUMMARIZE by using the content below

 Container
o Is a carrier of specimen

Step 3: Types of containers (15minutes)

 Wax carton
o Wax cartons are made in the laboratory using cardboard and a stapler
o These cartons can be used only once for sputum collection in the laboratory
 Universal bottle
o These are glass or plastic bottles with screw caps
o have the capacity of 25 ml
 Plastic container with cap
o Are made of plastic materials
o Are containers with different capacities
 Bijou bottle
o These are glass or plastic bottles with screw caps
o Have the capacity of 5ml

Step 4: Significance of Containers

 Differentiates tests
 Stores specimens
 Prevents infections
 Identifies type of specimens
 Helps to handle and transport the specimens
 Easier to write patient information

Step 5: Containers for Laboratory Investigations

Container for Stool collection
 The following types of containers are suitable for the collection of stool specimens
o Wax container
o Empty clean container with a lid
o Plastic jar specially designed for stool collection, with a spoon attached to the stopper
 Container for Urine collection
o Routine analysis-use clean, dry, wide-mouthed
o Urine for culture-empty sterile universal container
 Container for blood collection
o Container with Red top color
 Are used for serological and biochemistry investigations
 Does not contain anticoagulant

Teaching Guides for NTA Level 4 MLS Curriculum Page 854

 o Container with Purple/lavender top color
 For hematological investigation such as full blood picture, Platelets count, ESR
and CD4 count
 Contains anticoagulant EDTA
o Container with Green top color
 Contains anticoagulant-Heparin
 For blood sugar
 Container for sputum collection
o Sputum sample is collected in a plastic, wide mouthed leak proof container
o These containers are supplied by NTLP (National TB and Leprosy programme)
 Container for collection of pus
o Sterile swab stick in plastic tube
o Transport media

Step 6: Key Points (10minutes)

 Container is a carrier of specimen
o Containers used for collecting specimens includes
 Wax carton
 Universal bottle
 Plastic container with cap
 Bijou bottle
 Significance of Containers includes
o Differentiates tests
o Stores specimens
o Prevents infections
o Identifies type of specimens
o Helps to handle and transport the specimens
o Easier to write patient information

Step 7: Evaluation (5minutes)

 Define a container
 List three significance of containers
 List three containers used for collecting specimens

References
 Becker F.J and Silverton R.E (1985). Introduction to Medical Laboratory Technology.
Sixth Ed. Butterworth London
 Carter J, Lema O (1994) Practical laboratory manual for health centres in eastern Africa.
AMREF
 Cheesbrough M (1987). Medical Laboratory Manual for Tropical Countries. Volume 1
2nd Ed. ELBS Butterworth, Heinemann Ltd, Oxford
 Cheesbrough M (1998). District Laboratory Practice in Tropical Countries. Part 1.
Tropical Health Technology, Gapson Papers Ltd, NOIDA, India
 Cheesbrough M (2000). District Laboratory Practice in Tropical Countries. Part 2.
Tropical Health Technology, Cambridge University Press UK

Teaching Guides for NTA Level 4 MLS Curriculum Page 855

Session 13: Select Containers for
Laboratory Investigations
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207(8): BASIC LABORATORY
SPECIMEN MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session student are expected to be able to:
 Define the term anticoagulant
 Identify containers for blood investigation (universal bottle, haematological bottle)
 Identify containers for urine investigation (Universal bottle, Winchester bottle)
 Identify containers for stool investigation (Empty clean, container with transport
medium)
 Identify containers for sputum investigation (wide mouth plastic with cap container)

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 10 minutes Definition of Terms
Buzzing
3 25 minutes Presentation Containers for blood investigation
4 15minutes Presentation Containers for urine investigation
5 15 minutes Presentation Containers for stool investigation
6 20 minutes Presentation Containers for sputum investigation
7 20 minutes Presentation Key Points
8 10minutes Presentation Evaluation

SESSION CONTENT

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Step 2: Definition of Term (10minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 856

 Activity: Buzzing (5 minutes)

ASK students to buzz on the following questions

 Define Anticoagulant
 ALLOW time for them to respond
 WRITE their answers on a flip chart
 SUMMARIZE by using the content below

 Anticoagulant is a substance which prevents blood from clotting

o Anticoagulant commonly used in haematological bottles are;
 EDTA
 Heparin
 Sodium Citrate

Step 3: Containers for Blood Investigation (Universal Bottle and Haematological Bottle)
(25minutes)
 Containers for blood investigations includes;
o Universal bottle
 Clean plain containers used to collect blood in order to get serum
o Haematological bottle
 These are bottles with anticoagulant
 Identification of haematological containers
o Containers are identified by color codes
 Red top color
 Purple/lavender top color
 Green top color
 Investigations performed using blood collected in haematological bottle are;
o Haemoglobin estimation
o Full blood picture
o Platelets count
o Sickling
o Erythrocytes sedimentation rate(ESR)
o CD4
o Blood sugar
o Haemoparasites concentration(Buffy coat)

Step 4: Identify Containers for Urine Investigation (Universal and Winchester Bottle)
(15minutes)
 Containers for Urine investigation
o Universal bottle
 Is a glass or plastic screw caped bottle with capacity of 25ml
o Winchester bottle
 It is a brown bottle having the Capacity of 2.5Litres
 Is used to collect 24 hours urine investigations such as protein, creatinine
clearance and hormones studies

Teaching Guides for NTA Level 4 MLS Curriculum Page 857

Step 5: Identify Containers for Stool Investigation (Empty Clean, Container with
Transport Medium) (15minutes)
 Containers for Stool Investigations
o Empty clean container, Are Wax container, wide mouthed with a lid
 They are used to collection stool for routine examination for parasites, eggs, larva
and cysts
o Container with Transport Medium
 These are containers intended for transportation of stool specimen for culture
including Vibrio cholera

Step 6: Identify Containers for Sputum Investigation (Wide Mouthed Plastic with Cap
Container) (20minutes)
 Containers for Sputum Investigations
o Are wide mouthed plastic with a screw cap
 Advantages
o Prevents leakages
o Easier to decontaminate (sterilize-incineration)

Step 7: Key Points (20 minutes)

 Anticoagulant is a substance which prevents blood from clotting
o Anticoagulant commonly used in haematological bottles are;
 EDTA
 Heparin
 Sodium Citrate
 Containers for blood investigations includes
o Universal bottle
o Haematological bottle
 Haematological Containers are identified by color codes
 Investigations performed using blood collected in haematological bottle are
o Haemoglobin estimation
o Full blood picture
o Platelets count
o Sickling
o Erythrocytes sedimentation rate(ESR)
o CD4
o Blood sugar
o Haemoparasites concentration(Buffy coat)
 Containers for Urine investigation includes
o Universal bottle
o Winchester bottle
 Containers for Stool Investigations
o Empty clean container, Are Wax container, wide mouthed with a lid
o Container with Transport Medium
 Containers for Sputum Investigations
o Are wide mouthed plastic with a screw cap
 Advantages
o Prevents leakages

Teaching Guides for NTA Level 4 MLS Curriculum Page 858

 o Easier to decontaminate (sterilize-incineration)

Step 8: Evaluation (10 minutes)

 Define the term anticoagulant
 List four investigations which are performed using blood collected from haematological
bottle
 List two advantages of sputum container

ASK students if they have any comments or need clarification on any points.

References
 Becker F.J and Silverton R.E (1985). Introduction to Medical Laboratory Technology.
Sixth Ed. Butterworth London
 Carter J, Lema O (1994) Practical laboratory manual for health centres in eastern Africa.
Amref
 Cheesbrough M (1987). Medical Laboratory Manual for Tropical Countries. Volume 1
2nd Ed. ELBS Butterworth, Heinemann Ltd, Oxford
 Cheesbrough M (1998). District Laboratory Practice in Tropical Countries. Part 1.
Tropical Health Technology, Gapson Papers Ltd, NOIDA, India
 Cheesbrough M (2000). District Laboratory Practice in Tropical Countries. Part 2.
Tropical Health Technology, Cambridge University Press UK
 WHO(1980) Manual of Basic Techniques for a Health Laboratory

Teaching Guides for NTA Level 4 MLS Curriculum Page 859

Session 14: Use Appropriate Containers
in Laboratory Investigations
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207: BASIC LABORATORY
SPECIMEN MANAGEMENT

Total Session Time: 120

Prerequisites
 None

Learning Objectives
By the end of this session student are expected to be able to:
 Describe characteristics of Sputum, Urine, Sputum, Blood and Stool containers
 Describe important information to be labelled on the container
 Describe decontamination and disposal of Sputum, Urine, Sputum, Blood and Stool
containers
 Describe storage of Sputum, Urine, Sputum, Blood and Stool containers
 Demonstrate how to decontaminate, dispose and storage of Sputum, Urine, Sputum,
Blood and Stool containers

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation Characteristics of Sputum, Urine, Sputum,
2 15 minutes
Buzzing Blood and Stool Containers
Important Information to be Labelled on the
3 15 minutes Presentation
Container
Decontamination and Disposal of Sputum,
4 15 minutes Presentation
Urine, Sputum, Blood And Stool Containers
Storage of Sputum, Urine, Sputum, Blood and
5 15minutes Presentation
Stool Containers
Demonstrate how to decontaminate, dispose
Presentation
6 35minutes and storage of Sputum, Urine, Sputum,
Demonstration
Blood and Stool containers
7 10 minutes Presentation Key Points
8 10minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK the students to read the learning objectives.

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 ASK students if they have any questions before continuing.

Step 2: Characteristics of containers (15 Minutes)

Activity: Buzzing (5 minutes)
ASK students to buzz on the following questions
 List characteristics of
o Sputum
o Urine
o Sputum
o Blood
o Stool Containers
 ALLOW time for them to respond
 WRITE their answers on a flip chart
 SUMMARIZE by using the content below

Characteristics of containers
 Sputum Container
o Is a plastic, wide mouthed leak proof with a lid
 These containers are supplied by NTLP (National TB and Leprosy programme
 Urine containers
o Are plastic or glass clean, dry wide-mouthed with a screw caped
 Blood containers are identified by their color
o Container with Red top color
 Are used for serological and biochemistry investigations
 Does not contain anticoagulant
o Container with Purple/lavender top color
 For hematological investigation such as full blood picture, Platelets count, ESR
and CD4 count
 Contains anticoagulant EDTA
o Container with Green top color
 Contains anticoagulant-Heparin
 Are used for collecting blood for sugar
o Stool Container
 These are plastic wide mouthed with or without a spoon like applicator attached into
the cap

Step 3: Important Information to be labelled on the Container (15minutes)

 Containers should be well labeled with patient information
o Hospital Number
o Name of patient
o Date
o Address
o Ward Number

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Step 4: Decontamination and Disposal of Sputum, Urine, Sputum, Blood and Stool
Containers (15 minutes)

 Disposal of container
o Sputum container
 After being used the container should be incinerated
o Urine containers. Sock in disinfectant overnight by using
 Lysol or
 Sodium hypochlorite
o Blood containers
 All used containers should be incinerated
o Stool container
 All used containers should be incinerated

Step 5: Storage of Sputum, Urine, Sputum, Blood and Stool Containers (15 minutes)
Storage of containers
 Sputum containers
o Sputum containers should be stored safely from dust environment
 Urine containers
o Keep urine containers tightly screw caped in a cupboard
 Blood containers
o Blood containers should be well kept away from sunlight
 Stool container
o Stool containers should be stored safely from dust environment

Step 6: Demonstrate how to decontaminate, dispose and storage of Sputum, Urine,

Sputum, Blood and Stool containers(35 minutes)
ACTIVITY: Demonstration of Decontamination, dispose and Storage of Sputum, Urine,
Sputum, Blood and Stool Containers
 DIVIDE: Students into 10 groups. demonstrate how to
 Decontaminate and storage of
o Urine containers
o Disposal and storage of
o Sputum containers
 Disposal and storage of
o Blood containers
 Disposal and storage of
o Stool containers
 Use information from the step 4.

Step 7.Key Points (10 minutes)

Characteristics of containers
 Sputum Container
o Is a plastic, wide mouthed leak proof with a lid
 These containers are supplied by NTLP (National TB and Leprosy programme
 Urine containers
o Are clean, dry wide-mouthed with a screw caped

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 Blood containers are identified by their color
o Container with Red top color
 Are used for serological and biochemistry investigations
 Does not contain anticoagulant
o Container with Purple/lavender top color
 For hematological investigation such as full blood picture, Platelets count, ESR
and CD4 count
 Contains anticoagulant EDTA
o Container with Green top color
 Contains anticoagulant-Heparin
 Are used for collecting blood for sugar
 Stool Container
o These are plastic wide mouthed with or without a spoon like applicator attached into
the cap
 Containers should be well labeled with patient information
o Hospital Number
o Name of patient
o Date
o Address
o Ward Number
 Disposal of container
o Sputum container should be incinerated after use
Urine containers should be socked in disinfectant overnight
o Blood containers should be incinerated
o Stool container should be incinerated
 Storage of containers
o Sputum containers should be stored safely from dust environment
o Urine containers should be Kept tightly screw caped in a cupboard
o Blood containers should be well kept away from sunlight
o Stool containers should be stored safely from dust

Step 8:Evaluation.(10Minutes)
 Explain how to dispose used sputum containers
 List four important information to be written on specimen container

ASK students if they have any comments or need clarification on any points.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd; and
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1 &
2, Cambridge University Press.
 WHO(2003) Manual for Basic Techniques for a health laboratory.2nd Ed. Word Health
Organization

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Session 15: Apply Aseptic Techniques
during Specimen Collection
NTA LEVEL 4: SEMESTER 2: MODULE CODE: MLT 04207: BASIC LABORATORY
SPECIMEN MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session student are expected to be able to:
 Define aseptic techniques
 Describe Types of aseptic techniques
 Explain significance of using sterile containers
 Significance of aseptic conditions during specimen collection
 Demonstrate proper hand washing

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 05 minutes Definition of Term
Buzzing
3 30 minutes Presentation Types of aseptic techniques
4 15minutes Presentation Significance sterile of Containers
Significance of aseptic conditions during
5 15 minutes Presentation
specimen collection
Presentation
6 30minutes Proper hand washing
demonstration
7 10minutes Presentation Key Points
8 10minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK the students to read the learning objectives.
 ASK students if they have any questions before continuing.

Step 2: Definition of Term (5 minutes)

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 Activity: Buzzing (5 minutes)

ASK students to buzz on the following questions

 Define aseptic techniques
 ALLOW time for them to respond
 WTITE their answers on a flip chart
 SUMMARIZE by using the content below

 Define aseptic techniques

o Aseptic technique is a set of specific practices and procedures performed under
carefully controlled conditions with the goal of minimizing contamination by
pathogens
 Aseptic technique is employed to maximize and maintain asepsis, the absence of
pathogenic organisms, in the laboratory. The goals of aseptic technique are to
protect the patient from infection and to prevent the spread of pathogens

Step 3: Types of Aseptic Techniques (30 minutes)

Types of Aseptic Techniques
 Hand washing
o Before and after attending a patient
o After removing gloves
o When hands are visibly dirty for any reason
o After contact with blood or body fluids
 Advantages of hand washing
o Hand washing helps stops the spread of germs between patients and between staff and
patients
o It protects both the patients and the caregivers
o The most important precaution for the prevention of infections
o Washing hands with soap and water eliminates microorganisms from the skin and
hands
 Use of antiseptics
Antiseptics commonly used for skin decontamination are
o Alcohol (Ethanol or Methanol)
 Absolute alcohol is not a very effective sterilizing agent, as at this concentration
its power of penetration is very poor
 When diluted with distilled water to a concentration of 70%, however, it is
becomes effective as a skin sterilizer and is used prior to inoculations or
venipuncture
o Mode of action of antiseptics works as sterilizing agent by the following lethal
mechanisms
 Interfering with the enzymatic system of the organism(enzyme poison)
 Disrupt of the cell membrane
 Coagulation of protein
 Oxidation
o Always prepare daily antiseptic in small quantities for use.
 Importance of antiseptic to sterilize collecting sites
o Cleaning of the skin before puncturing

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 o To wipe off micro organisms
o Reduces introduction of micro organism to the body
 Skin disinfection
o To remove micro organisms from the skin
o Reduces risk of introducing micro organisms in the body
o Hand washing is essential to laboratory staff after any procedure involving close
contact with the patient.
o Gloves must be worn every time when attending patient, collecting sample taking
specimen from one area to another.

Step 4: Significance Sterile of Containers (15 Minutes)

 Sterile Container
o Are containers which are free from micro organisms they can be commercially
acquired or prepared (sterilized)
 Specimen which are collected in sterile container
o All Specimens which needs culture
 Urine
 Cerebral spinal fluids
 Effusions
 Blood
 Puss
 Sputum
 Importance of using sterile containers
o It helps to isolate micro organisms from the specimen and not contaminants
o It helps to isolate the intended/suspected micro organism from the specimen
o Validates the origin of the isolate

Step 5: Significance of Aseptic Conditions during Specimen Collection (15 minutes)

 Aseptic technique is so important to avoid cross contamination and the potential spread
of microorganism in the laboratory such as
o Avoids specimen contamination
o avoid contamination to the client
o Avoid contamination to specimen handler
o Avoids contamination to the site of specimen collection

Step 6: Demonstration of Hand Washing (30minutes)

Activity: Demonstration of Hand Washing (10 minutes)

 DIVIDE the students into six groups

 TELL the first group to arrange themselves near running tape water, show to the group
each item prepared and its function.
 DEMONSTRATE the steps needed during hand washing
 ASK the group when to wash hands
 ALLOW each group to perform return demonstration
 ASK the students if they have any questions
 CLARIFY any misunderstandings from the questions
 SUMMARIZE their responses using the information below

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 Steps of Hand Washing
o Place soap on the palms under running water
o Rub surfaces vigorously for at least 10 seconds
o Rinse both hands under running water
o Dry the hands with a drier of disposable absorbent paper

The figure below shows hand washing

Source: ASCP

Step 7: Key Points (10minutes)

 Aseptic technique is a set of specific practices and procedures performed under carefully
controlled conditions with the goal of minimizing contamination by pathogens
 Aseptic Techniques includes;
o Hand wash
o Use of antiseptics
o Skin disinfection
 Sterile Container
o Are containers which are free from micro organisms they can be commercially
acquired or prepared (sterilized)
 Specimen which are collected in sterile container
o All Specimens which needs culture such as
 Urine
 Cerebral spinal fluids
 Effusions
 Blood
 Puss
 Sputum
 Importance of using sterile containers
o It helps to isolate micro organisms from the specimen and not contaminants
o It helps to isolate the intended/suspected micro organism from the specimen
o Validates the origin of the isolate
 Aseptic technique is so important to avoid cross contamination and the potential spread
of microorganism in the laboratory such as
o Avoids specimen contamination
o avoid contamination to the client
o Avoid contamination to specimen handler

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 o Avoids contamination to the site of specimen collection

Step 8: Evaluation (10 minutes)

 Define aseptic techniques
 List two importance of using sterile containers
 List four specimens which are collected using sterile containers

ASK students if they have any comments or need clarification on any points.

References
 Baker F.J and Silverton R.E (1985). Introduction to Medical Laboratory Technology.
Sixth Ed. Butterworth London
 Carter J, Lema O(1994)Practical laboratory manual for health centres in eastern Africa.
AMREF
 Cheesbrough M (1987). Medical Laboratory Manual for Tropical Countries. Volume 1
2nd Ed. ELBS Butterworth, Heinemann Ltd, Oxford
 Cheesbrough M (1998). District Laboratory Practice in Tropical Countries. Part 1.
Tropical Health Technology, Gapson Papers Ltd, NOIDA, India
 Cheesbrough M (2000). District Laboratory Practice in Tropical Countries. Part 2.
Tropical Health Technology, Cambridge University Press UK

Teaching Guides for NTA Level 4 MLS Curriculum Page 868

 CHAPTER NINE

MODULE CODE GST04202:

BASIC COMPUTER SKILLS
AND INFORMATION
MANAGEMENT

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Session 1: Introduction to Basic Computers
and its Application
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Define the term computer
 Explain the history of the personal computers
 Explain uses of computer
 Mention types of computer
 Describe basic parts of computer (keyboard, mouse, monitor, UPS, accessories, CPU)

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer parts
 Computer
 Liquid crystal display (LCD) projector

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
Presentation,
2 20 minutes Definition of Terms
Brainstorm
3 10 minutes Presentation The History of The Personal Computers
4 10 minutes Presentation Uses of Computer
5 15 minutes Presentation Types of Computer
Basic Parts of Computer and their function
6 30 minutes Presentation
(Keyboard, Mouse, Monitor, Cpu)
7 20 minutes Practical Computer parts
8 5 minutes Presentation Key Points
9 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives
 READ or ASK student to read the learning objectives and clarify.

 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 870

Step 2: Definition of Terms
Activity: Brainstorm (10 minutes)

ASK students to define the meaning of the term ‘computer’

WAIT for some student response, encourage all definitions of the term.
SUMMARIZE the responses using the information below.

 Computer
o An electronic device that can follow instruction to accept input, process that input and
produce information. It can also simply be defined as an electronic machine that takes
data, stores it, processes that data and produces information. (Data can be defined as
unprocessed facts and processing data gives information). Computer is made up by
hardware and software
 Hardware
o Hardware is the equipment that processes the data to create information and is
controlled by software. It includes
 Keyboard
 Mouse
 Monitor(Screen)
 Central Processing Unit(CPU)
 System unit
 Random Access Memory(RAM)
 Software
o Software is another name of a program or programs. The purpose of software is to
convert data (unprocessed facts) into information (processed facts).
o Software programs consist of the step-by-step instructions that tell the computer how
to do its work.

Step 3: The History of The Personal Computers (PC)

 Personal computers first appeared in the late 1970s.
 One of the first and most popular personal computers was the Apple II
 During the late 1970s and early 1980s, new models and competing operating systems
seemed to appear constantly.
 In 1981 a new standard was established in the micro-computer industry with the debut of
the IBM PC.
 The IBM PC quickly became the personal computer of choice, and most other personal
computer manufacturers fell by the wayside.
 In order to survive, other companies adjusted to IBM's dominance by building IBM
clones, computers that were internally almost the same as the IBM PC, but that cost less.
 Because IBM clones used the same microprocessors as IBM PCs, they were capable of
running the same software.
 Since then, hundreds of millions of PC-compatible systems have been sold as the original
PC has grown into an enormous family of computers.
 More software has been written for this computer family than for any other system on the
market.

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 Apple computer did survive and to date it remains a major player in the personal
computer marketplace.
 Today, the world of personal computers is basically divided between Apple Macintoshes
and PCs.
 Computer is an electronic device that can follow instruction to accept input, process that
input and produce information.
 Personal computers first appeared in the late 1970s. During the late 1970s and early
1980s, new models and competing operating systems appeared rapidly.
 Understanding the keyboard and the basic commands will help the user effectively
control the computer.
 Attention to health and safety is important for successful work with the computer

Step 4: Uses of Computer

There are two uses of computer, these are
 General purpose computer is design to solve wide variety of problems. Examples of
general purpose computer are
o School computers
o Hospital computers
o Office computers
 Special purpose computer is designed for particular job only to solve problem of
restricted nature. Examples of special purpose computer are
o Petroleum pumps
o Traffic lights
o Programmable pocket calculator
o Weapons guidance system

Step 5: Types of Computer

Computers are classified according to Size and Power
 Workstation
o A powerful, single-user computer.
o A workstation is like a personal computer, but it has a more powerful microprocessor
and a higher-quality monitor.
 Minicomputer
o A multi-user computer capable of supporting from 10 to hundreds of users
simultaneously.
 Mainframe
o A powerful multi-user computer capable of supporting many hundreds or thousands
of users simultaneously.
 Supercomputer
o An extremely fast computer that can perform hundreds of millions of instructions per
second.
 Personal Computer
o Personal computer (PC) is a small, relatively inexpensive computer designed for an
individual user
o Classified by size and portability as follows:
 Desktop Computers
 Laptops or notebooks

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  Personal Digital Assistants
 Portable Computers
 Tablet Computers
 Wearable Computers
 Cell Phones
o All are based on the microprocessor technology that enables manufacturers to put an
entire Central Processing Unit (CPU) on one chip

Step 6: Basic Parts of Computer

 Keyboard
 Mouse
 Speakers
 Central processing Unit
 Monitor
 Hard disk drive
 Random access memory
 Printers
 Power supply

Diagram of computer parts

Functions of each part are as follow

 Keyboard
o Keyboard is an input device, partially modeled after the typewriter keyboard, which
uses an arrangement of buttons or keys, to act as mechanical levers or electronic
switches. After punch cards and paper tape, interaction via teletype-style keyboards
became the main input device for computers. During the 1980's and 1990's almost all
computers came equipped with them as the main form of interaction. In normal usage,
the keyboard is used to type text and numbers into a word processor, text editor or

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 other program. In a modern computer, the interpretation of key presses is generally
left to the software. A computer keyboard distinguishes each physical key from every
other and reports all key presses to the controlling software. Keyboards are also used
for computer gaming, either with regular keyboards or by using keyboards with
special gaming features, which can expedite frequently used keystroke combinations.
A keyboard is also used to give commands to the operating system of a computer,
such as Windows' Control-Alt-Delete combination, which brings up a task window or
shuts down the machine
 Mouse
o Computer’s mouse controls a graphical mouse pointer or mouse cursor on the screen.
When you move the mouse around by rolling it on your desk, the pointer on the
screen moves in a similar manner. Roll the mouse left, and the pointer moves left; roll
it in circles, and the pointer mimics that action.
o Here are some of the more basic mouse operations:
 Point: When you’re told to “point the mouse,” you move the mouse on the
desktop, which moves the mouse pointer on the screen to point at something
interesting (or not).
 Click: A click is a press of the mouse button — one press and release of the main
button, the one on the left. This action makes a clicking sound, which is where this
maneuver gets its name.
 Clicking is often done to select something or to identify a specific location on the
screen.
 Right-click: This action is the same as a click, although the right mouse button is
used.
 Double-click: This one works just like the single click, although you click twice
in the same spot — usually, rather rapidly. This is most commonly done in
Windows to open something, such as an icon. Both clicks must be on (or near) the
same spot for double-click to work.
 Drag: The drag operation is done to graphically pick up something on the screen
and move it. To do that, you point the mouse at the thing you want to drag, press
and hold the mouse’s button (which “picks up” the object), and then move the
mouse to another location. When you move the mouse (and keep the button
down), the object moves. To release, or drop, the object, release the mouse button.
 Speakers
o This is output device which use to convert electrical energy into sound. It consist
essentially a thin flexible sheet called diaphragm that is made to vibrate by electrical
signal from amplifier
 Central processing Unit (CPU)
o CPU is also called a processor, significantly impacts overall computing power and
manages most of a computer’s operations. This is the component that actually
executes instructions.
 The CPU contains
- Control unit
- Arithmetic / logic unit (ALU)
 Control unit directs and coordinates most of the operations in the computer. For every
instruction, the control unit repeats a set of four basic operations called the machine
cycle: (1) fetching the instruction or data item from memory, (2) decoding the instruction

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 into commands the computer understands, (3) executing the commands, and, if
necessary, (4) storing, or writing the result to memory.
 Arithmetic/logic unit (ALU) performs the execution part of the machine cycle.
Specifically, the ALU carries out three operations:
o Arithmetic operations – performing calculations, which include addition,
subtraction, multiplication, and division
o Comparison operations – comparing data items to determine if the first item is
greater than, equal to, or less than the other item
o Logical operations – working with conditions and logical operators such as AND,
OR, and NOT
 Monitor
o This is sometimes called screen or visual display unit. This is an output device for
electronic visual display on computers. It allow user to see the data which entering
into a computer and results after processing the data
 Hard disk drive
o Is a non- is a non-volatile storage device for digital data. This means permanent
storage. Hard disk is used to store all programs used by computer permanently and it
is within the system.
 Random access memory (RAM)
o RAM is a form of computer data storage It enables computer to store at least
temporarily data and programs. RAM is often associated with volatile types of
memory. This means that its contents are lost when the computer is turned off. In
general, memory (RAM) is fast, short-term.
 Printer
o This is an output device which allow user to view results in paper page.
 Uninterrupted Power Supply (UPS)
o Is an electrical apparatus that provides emergency power to load when the input
power source fail.
 Power supply
o Is the component that supplies power to the other components in a computer system.
More specifically, a power supply unit is typically designed to convert general-
purpose alternating current (AC) electric power from the mains (100-127V in North
America, parts of South America, Japan, and Taiwan
o In addition to these components, many others make it possible for the basic
components to work together efficiently. For example, every computer requires a bus
that transmits data from one part of the computer to another

Step 7: Practical
 Bring computer for the purpose of showing its part and how they are connected.

Step 8: Key Points

 Computer is an electronic device that can follow instruction to accept input, process that
input and produce information.
 Personal computers first appeared in the late 1970s. During the late 1970s and early
1980s, new models and competing operating systems appeared rapidly.
 Understanding the keyboard and the basic commands will help the user effectively
control the computer.

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 Central Processing unit(CPU) is the engine of computer

Step 9: Evaluation
 Define the term ‘computer’.
 Describe the history of the personal computer.
 How does the CPU work?

References
 Cook, L.R. (2001). Computer Fundamentals –Understanding How they Work (1st Ed).
Ventage Press.
 CPU. Retrieved September 12, 2009 from www.webopedia.com/TERM/C/CPU.html
 Herniter, M.E. (2000). Personal Computer Fundamentals for Students, Hardware
Windows 2000 Application (2nd Ed). Prentice Hall.
 O’leary, T. & O’leary, L. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.

Teaching Guides for NTA Level 4 MLS Curriculum Page 876

Session 2: Operations of computer and
software
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Explain how the computer and software operate
 Describe different types of software
 Explain the procedure of operating computer (opening, closing)
 Describe various computer operating programs and its uses

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 25 minutes Presentation How the computer and software operate
Types computer operating programs and its
3 30 minutes Presentation
uses
Procedure of operating computer (opening,
5 20 minutes Presentation
closing)
6 5 minutes Presentation Key Points
7 15 minutes Presentation Evaluation
8 20 minutes Practical Computer programs

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: How do computer and software operate

 In order computer physical part (hardware) to work properly there must be software.
Software is set of instruction which tell computer what to do.
 There are two types of software, these are system software and application software

Teaching Guides for NTA Level 4 MLS Curriculum Page 877

 o System Software.
 System software consists of programs that control the operations of a computer
and its devices. System software serves as the interface between a user, the
application software, and the computer’s hardware. One type of system software
is the operating system. Before application software can be run, the operating
system, which contains instructions that coordinate the activities among computer
hardware devices, must be loaded from the hard disk into the computer’s memory.
 An operating system (OS) is a set of programs containing instructions that
coordinate all the activities among computer hardware devices. These are
- Windows 2003
- Windows XP
- Windows Vista
- Linux
- Unix
o Application Software
 Application software consists of programs designed to perform specific tasks for
users. Application software can be used as a productivity/business tool; to assist
with graphics and multimedia projects; to support home, personal, and educational
activities and to facilitate communications. Specific application software products
is called program and are available from software vendors.

Step 3: Various computer operating programs and its uses

 Computer Programs are:
o Word processing
o Excel
o Database software
o PowerPoint
o Internet
o E-mail software
o Web browser
 Uses of each programs
o Word processing software allows users to create and manipulate documents that
contain text and graphics. With word processing software, you can insert clip art into
a document; change margins; find and replace text; use a spelling checker to check
spelling; place a header and footer at the top and the bottom of a page; and vary font
(character design), font size (character scale), and font style (character appearance).
o Excel is a spreadsheet application in the Microsoft Office Suite. A spreadsheet is an
accounting program for the computer. Spreadsheets are primarily used to work with
numbers and text. Spreadsheets can help organize information, like alphabetizing a
list of names or ordering records, or calculate and analyze information using
mathematical formulas.
o Database software allows you to create and manage a database. A database is a
collection of data organized to allow access, retrieval, and use of that data. Database
is used to store records of employees, clients, equipments etc. Example of employees
records are Name, Age, Place of birth and occupation. A query is used to retrieve data
according to specified criteria, which are restrictions the data must meet.

Teaching Guides for NTA Level 4 MLS Curriculum Page 878

 o Power Point is the presentation graphics software in the Microsoft Office Suite. It
allows you to create dynamic presentations using its easy-to-use, predefined layouts
and templates.
o Internet allow computer to communicate with each other. This means Computer in
one region is able to communicate with other in other region. In internet is where
there is Electronic mail and web browser
o E-mail software is used to create, send, receive, forward, store, print, and delete e-
mail (electronic mail).
o A Web browser is a software application used to access and view Web pages. Web
browser help searching information of different types from different source

Step 4: Outline the procedure of operating computer (opening, closing)

 Computer is like other electronic equipment like Television or radio. It has on/off button.
When switch on computer you just press the button and it will start automatic. The
process is called booting.
 Turning off is different from other devices because you have to follow procedures

Step 5: Key Points

 Software is another name of a program or programs. Software controls hardware.
 There are two major kinds of software which are system software and application
software.
 Operating systems are programs that coordinate computer resources, provide an interface
between users and computer, and run applications.

Step 6: Evaluation
 Explain the difference between hardware and software and give some examples.
 List the two major kinds of software.
 Explain the two major kinds of software
 List three types of system software.

References
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they
Work. Ventage Press.
 Herniter, M.E. (2000). Personal Computer Fundamentals for Students, Hardware
Windows 2000 Application (2nd Ed). Prentice Hall.
 http://www.gcflearnfree.org/computer/
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J & O’leary, L. I. (2006). Computing Essentials, Introductory Edition.
Arizona State University: Boston Burr Ridge

Teaching Guides for NTA Level 4 MLS Curriculum Page 879

Session 3: Enter data into a computer
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT t

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Entering data into computer
 Use of computer keyboard and mouse
 Interpret computer commands
 Edit text

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 20 minutes Presentation Entering data into computer
3 15 minutes Presentation Interpret computer commands
4 15 minutes Presentation Edit text
5 5 minutes Presentation Key Points
6 10 minutes Presentation Evaluation
7 40 minutes Practical Entering data into computer

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Step 2: Entering data into computer

 The process of entering data into computer is called data entry. This process of entering
data to a computer is done by user, in which data will be processed in order to get
information. User will use input devices such as keyboard and mouse to enter data in
system then the data will be processed to produce information. The result which is output
will be shown in a monitor or through printed document. Below are the procedures and
diagram used by computer to execute data
 First

Teaching Guides for NTA Level 4 MLS Curriculum Page 880

 o Data is entered through input devices e.g. keyboard.
 Second
o Control Unit (CU) After receiving instruction from the main memory to sent signal
and commands , CU sent signal and commands to various part of the computer
system to prepare and accept the data. After the data is processed it is sent back to
main memory which stores it temporarily before the next command is executed. The
data is then sending to secondary storage devices after secondary storage device had
received command from the Control Unit. For the information to be put into a hard
copy i.e. paper, the information moves from the secondary storage device to the main
memory which waits for signals and commands from Control Unit. After receiving
signal from the Control Unit that the output devices are ready to receive data, the
main memory releases the data to the output devices like printers.

Step 3: Interpret computer commands

 Computer commands are all buttons and interfaces which tells computer what to do.
These commands are controlled by keyboard or mouse.

Step 4: Edit text

 Edit text is the process of modifying document like words in computer system.
o Save and retrieve data
 Save is process of storing your document after preparing it. Save will help you to
view the document for future use.
o Retrieve data is when you view data which had already save in a computer

Step 5: Key Points

 Data entered in computer are retrieved through monitor or printer

Step 6: Evaluation
 Explain the process of entering data in computer

References

Teaching Guides for NTA Level 4 MLS Curriculum Page 881

 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they
Work. Ventage Press.
 Herniter, M.E. (2000). Personal Computer Fundamentals for Students, Hardware
Windows 2000 Application (2nd Ed). Prentice Hall.
 http://www.gcflearnfree.org/computer/
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J & O’leary, L. I. (2006). Computing Essentials, Introductory Edition.
Arizona State University: Boston Burr Ridge

Teaching Guides for NTA Level 4 MLS Curriculum Page 882

Session 4: Categorize laboratory
information
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Know Laboratory Information System
 Identify Groups of laboratory information
 Differentiate among laboratory information

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation Laboratory Information System
3 20 minutes Presentation Groups of Laboratory Information
Differences among categories of laboratory
4 20 minutes Presentation
information
5 5 minutes Presentation Key Points
6 15 minutes Presentation Evaluation
7 40 minutes Practical Computer Programs

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Step 2: Laboratory information System (LIS)

 Laboratory information is the process of recording all activities relate to laboratory.
The system which used to manage those activities is called Laboratory Information
System
 LIS is a class of software that receive, process and stores information generated by
medical lab process. This system often must interface with instruments and other

Teaching Guides for NTA Level 4 MLS Curriculum Page 883

 information system such as hospital information system (HIS). A LIS is high configurable
application which is customized to facilitate a wide variety of laboratory workflow
models. Deciding on the LIS vendor is a major undertaking for all laboratories. Vendor
selection typically takes months of research to few years depending on the complexity of
organization. There are many laboratory discipline require the support of computerized
information. These include Haematology, Chemistry, Immunology, blood bank donor
centre, Surgical Pathology, Microbiology etc

Step 3: Groups of laboratory information

 Client information
 Inventory information
 Laboratory management records
 Reports -weekly monthly quarterly, annually

Step 4: Differences among categories of laboratory information

 Client information is all data of laboratory customers which entered in a system for
records keeping. This client information’s are Names, Age, Place of birth, blood group
and other information related to laboratory client
 Inventory Information All equipment in the workshop should be recorded on system.
All relevant information about the equipment must be entered, including its location,
records of repair and maintenance and the manufacturer. A reference number is given and
written on a printed paper label, which is attached to each item. This number is recorded
in a system of equipment with full identifying details.
 Laboratory Management Control is a process of manage and control all laboratory
activities. All activities are recorded in a system
 Report is to bring back an answer to announce in return; to relate, as what has been
discovered by a person sent to examine, explore, or investigate as an answer. Report can
be written weekly, monthly or annually. Report helps supervisor to know if the laboratory
needs any changes in order to increase performance.

Step 6: Key Points

 Laboratory information is the process of recording activities conducted by laboratory
staffs.
 System for record and stores laboratory information is called Laboratory Information
System (LIS)

Step 7: Evaluation
 List categories of laboratory information
 What is laboratory information?

References
 Bott, E. and Siechert, C. (2001). Microsoft Windows XP Inside Out.
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they
Work. Ventage Press.
 Herniter, M.E. (2000). Personal Computer Fundamentals for Students, Hardware
Windows 2000 Application (2nd Ed). Prentice Hall.
http://www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 884

 Joos, I. W., N. Smith, M., Nelson, R. et al. (2006). Introduction to Computers for
Healthcare Professionals (4th Ed). Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J & O’leary, L. I. (2006). Computing Essentials, Introductory Edition.
Arizona State University: Boston Burr Ridge.
 Sagman, S. (1999). Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window. Retrieved March 11, 2010 from
www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 885

Session 5: Tools for information collection
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Identify tools for information collection
 Explain uses of each tool of information collection
 Explain strength and weaknesses information collection tools

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD projector

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 15 minutes Presentation Tools for information collection
3 20 minutes Presentation Uses of each tool of information collection
Presentation Strength and weaknesses of information
4 20 minutes
collection tools
5 5 minutes Presentation Key Points
6 10 minutes Presentation Evaluation
7 45 minutes Practical Computer Program

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Tools used for collecting laboratory information are

 Registers
 Log books
 Ledger books
 Request forms
 Dispatch books

Step 3: Explain uses of each tool

Teaching Guides for NTA Level 4 MLS Curriculum Page 886

 Register is formal or official recording of items, names, transactions or actions.
 Log book is systematic daily or hourly record of activities, events, and/or occurrences.
Each document (usually arranged by date) is marked with the time of an event or action
of significance.
 Ledger book is a book which is used to keeps laboratory records.
 Request form is a form which is filled for purpose of requesting permission to do
something.
 Dispatch book is a paper document with details to send goods or message somewhere for
particular purposes.

Step 4: Strength and Weaknesses of Each Tool

 Register help to identify the record of employees in the working place. It is time
consuming when finding information in the registers.
 Log books help to know goods or equipments which were delivered. Person with this
book must be faithful otherwise equipments will not be seen in the book if it delivered
 Ledger book helps keeps records for future use. The weakness of ledger book is because
it is manual way of keeping records; there is a time the books increase in number so it
will not be easy to find the book which has record of few months back.
 Request form is the evidence which show who request any service. Request form takes
step to reach authorized person. So it will take time for action to be taken.
 Dispatch book help to keep record which will show when, who and where did someone
sent to deliver something. Its weakness is; record might not be recorded so it will cause
confusion.

Step 5: Key Points

 Mention tools used for collecting laboratory information

Step 6: Evaluation
 List tools used for collecting laboratory information.

Reference:
 Bott, E. and Siechert, C. (2001). Microsoft Windows XP Inside Out.
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Herniter, M.E. (2000). Personal Computer Fundamentals for Students, Hardware
Windows 2000 Application (2nd Ed). Prentice Hall.
http://www.gcflearnfree.org/computer/
 Joos, I. W., N. Smith, M., Nelson, R. et al. (2006). Introduction to Computers for
Healthcare Professionals (4th Ed). Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J & O’leary, L. I. (2006). Computing Essentials, Introductory Edition.
Arizona State University: Boston Burr Ridge.
 Sagman, S. (1999). Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window. Retrieved March 11, 2010 from
www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 887

Session 6: Handling and Dissemination of
Laboratory Information
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Describe types of handling Laboratory information
 Explain ways of handling confidential information
 Explain strength and weakness of handling confidential information

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD projector

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 30 minutes Presentation Types of handling Laboratory information
3 35 minutes Presentation Ways of handling confidential information
Strength and weakness of handling
4 35 minutes Presentation
confidential information
5 10 minutes Presentation Key Points
6 5 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Types of Laboratory information (30minutes)

 Types of Laboratory information
o Confidential Laboratory Information
 Is which can be accessed by authorized person only. Person with permission have
the right to view the system.
o Non-confidential Laboratory Information
 Can be accessed by anyone.

Teaching Guides for NTA Level 4 MLS Curriculum Page 888

Step 3: Ways of Handling Confidential Information (35minutes)
 Confidential information is handled by the following ways
o Keep locked is the process of keep system lock unless authorize person open it.
o Disclose with permission is the speech act of making something evident and which
will allow somebody to access information
o A password is a secret word or string of characters that is used for authentication, to
prove identity or gain access to a resource (example: an access code is a type of
password). The password should be kept secret from those not allowed access
o Putting into confidential files is method and a system for protecting business
confidential files by controlling access to it.

Step 4: Strength and weakness of handling confidential information (35minutes)

 Strengths and Weaknesses of Each method/way of handling information
o Keep locked
 Is a security policy which will give permission only authorised person to enter in a
certain room. Weakness of this approach is when the authorised person is not
there nothing will be done
o Disclose with permission,
 Here you won’t be allowed to view some information unless you have permission
from supervisor. The weakness of this is easy to forge the permit.
o Use password,
 This type of security is good because numbers are used in order to access the
system. Weakness of password is if you forget the numbers you can’t access
anything.
o Putting into confidential file
 Here secured document are kept into file which cannot be viewed by anyone.
Confidential file has weakness because it can be stolen or misplaced.

Step 5: Key Points (10minutes)

 Types of Laboratory information
o Confidential Laboratory Information
o Non confidential Laboratory Information
 Ways of handling confidential laboratory information
o Keep locked
o Disclose with permission
o Use passwords
o Putting into confidential files
 Strengths and Weaknesses of ways of handling information
o Keep locked is a security policy which will give permission only authorised person to
enter in a certain room. Weakness of this approach is when the authorised person is
not there nothing will be done
o Disclose with permission, here you won’t be allowed to view some information
unless you have permission from supervisor. The weakness of this is easy to forge the
permit.
o Use password, this type of security is good because numbers are used in order to
access the system. Weakness of password is if you forget the numbers you can’t
access anything.

Teaching Guides for NTA Level 4 MLS Curriculum Page 889

 o Putting into confidential file here secured document is kept into file which cannot be
viewed by anyone. Confidential file has weakness because it can be stolen or
misplaced

Step 6: Evaluation (5minutes)

 Mention two ways of handling confidential laboratory information

Reference:
 Bott, E. and Siechert, C. (2001). Microsoft Windows XP Inside Out.
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Herniter, M.E. (2000). Personal Computer Fundamentals for Students, Hardware
Windows 2000 Application (2nd Ed). Prentice Hall.
http://www.gcflearnfree.org/computer/
 Joos, I. W., N. Smith, M., Nelson, R. et al. (2006). Introduction to Computers for
Healthcare Professionals (4th Ed). Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J & O’leary, L. I. (2006). Computing Essentials, Introductory Edition.
Arizona State University: Boston Burr Ridge.
 Sagman, S. (1999). Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window. Retrieved March 11, 2010 from

Teaching Guides for NTA Level 4 MLS Curriculum Page 890

Session 7: Apply Planned Preventive
Maintenance on Computer
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 60 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Define planned preventive maintenance (PPM)
 Describe the of PPM procedures on computer

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD projector

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 20 minutes Presentation Define Planned preventive maintenance
3 20 minutes Presentation Procedures of PPM on Computer
4 10 minutes Presentation Key point
5 5 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Planned Preventive Maintenance (20 minutes)

 Planned preventive maintenance
o Is a regular, repetitive work done to keep equipment in good working order and to
optimize its efficiency and accuracy. This activity involves regular, routine cleaning,
lubricating, testing, calibrating and adjusting, checking for wear and tear and
eventually replacing components to avoid breakdown.
 Significance of PPM are
o Minimizes running cost
o Prolongs life of the equipment
o Reduce equipment breakdown and down-time

Teaching Guides for NTA Level 4 MLS Curriculum Page 891

 o Ensure quality of laboratory services

Step 3: Procedures of PPM on Computer (20minutes)

 PPM Procedures on Computer includes
o Protect computer from dust
o Protect computer from extreme temperature
o Protect compute from moisture
o Protect computer from virus

Step 4: Key points (10minutes)

 Planning preventive maintenance is repetitive regular activities involves, routine cleaning,
lubricating, testing, calibrating and adjusting, checking for wear and tear and eventually
replacing components to avoid breakdown or continuity of the system.

Step 5: Evaluation (5minutes)

 List two significance of PPM.
 Explain the procedure of Planning Preventive Maintenance on computer.

Reference:
 Bott, E. and Siechert, C. (2001). Microsoft Windows XP Inside Out.
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Herniter, M.E. (2000). Personal Computer Fundamentals for Students, Hardware
Windows 2000 Application (2nd Ed). Prentice Hall.
http://www.gcflearnfree.org/computer/
 Joos, I. W., N. Smith, M., Nelson, R. et al. (2006). Introduction to Computers for
Healthcare Professionals (4th Ed). Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J & O’leary, L. I. (2006). Computing Essentials, Introductory Edition.
Arizona State University: Boston Burr Ridge.
 Sagman, S. (1999). Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window. Retrieved March 11, 2010 from
www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 892

Session 8: Demonstration on Computer
parts and how to operate computer
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Identify computer parts
 Practice on Connecting computer parts
 Practice on Switching ON and OFF the computer

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation,
2 40 minutes computer parts
Assignment
Presentation,
3 35 minutes Connecting computer parts
Assignment
4 20 minutes Presentation, Practiced Switching ON and OFF the computer
5 05 minutes Presentation Key Points
6 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Step 2: Identify Computer and Connect Parts (40 Minutes)

 Computer
o An electronic device that can follow instruction to accept input, process that input and
produce information. It can also simply be defined as an electronic machine that takes
data, stores it, processes that data and produces information. (Data can be defined as

Teaching Guides for NTA Level 4 MLS Curriculum Page 893

 unprocessed facts and processing data gives information). Computer is made up by
hardware and software
 Hardware
o Hardware is the equipment that processes the data to create information and is
controlled by software. It includes
 Keyboard
 Mouse
 Monitor(Screen)
 Central Processing Unit(CPU)
 System unit
 Random Access Memory(RAM)

Activity 1: Demonstration on connecting computer parts

Use a computer parts to complete activities 1 through 4 listed below:

 Connect monitor and system unit together.
 Connect keyboard.
 Connect mouse
 Connect computer to electrical power.

Step 3: Switch Computer ON / OFF (35minutes)

 Computer is like other electronic equipment like Television or radio. It has on/off button.
When switch on computer you just press the button and it will start automatic. The
process is called booting.
 Turning off is different from other devices because you have to follow procedures.

Activity 2: Demonstration on Switch Computer on/off

After activity 1 continue with demonstration of switching on/off computer

 Switch on computer
 Switch off computer.

The figure below (1 and 2) shows the procedure of switching OFF the computer
Figure 1

Teaching Guides for NTA Level 4 MLS Curriculum Page 894

Figure 2

Step 4: Return Demonstration for connecting computer parts and switch ON/OFF
computer (20 minutes)
 At this point each student has to get an opportunity to practice
 The tutor should allocate the first to the last for practicing

Activity: Return Demonstration for connecting computer parts and switch ON/OFF
computer

ALLOW one student to begin the demonstration while others are observing
LET the first student conduct the procedure step by step
ASSIST the student in case of any challenges
DO for the second student to the last one.
SUMMARIZE the activity by clarifying any challenges

Step 5: Key Points (5minutes)

 Before collecting connecting computer it’s important to make sure that all parts are
available
 The working desk is properly arranged to avoids unnecessary accidents
 Electricity is available in the room.

Teaching Guides for NTA Level 4 MLS Curriculum Page 895

Step 6: Evaluation (15minutes)
 List computer parts which were used for connection
 Procedures in switching computer off.
 ASK students if they have any comments or need clarification on any points.

References
 Cook, L.R. (2001). Computer Fundamentals –Understanding How they Work (1st Ed).
Ventage Press.
 CPU. Retrieved September 12, 2009 from www.webopedia.com/TERM/C/CPU.html
 Herniter, M.E. (2000). Personal Computer Fundamentals for Students, Hardware
Windows 2000 Application (2nd Ed). Prentice Hall.
 O’leary, T. & O’leary, L. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.

Teaching Guides for NTA Level 4 MLS Curriculum Page 896

Session 9: Demonstration on Entering,
Editing, Saving and Retrieving Data into
Computer
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Identify parts of the Word window
 Practice saving document
 Practice Use backspace/delete and undo/repeat functions
 Practice Cut, copy, paste, drag and drop
 Practice Use of autocorrect, find and replace
 Practice Use of spell check and grammar check

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD
 Handout 4.1: Personal Letter

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation,
2 25 minutes Basic of the Word Window
Assignment
Presentation,
3 20 minutes Saving a File
Assignment
Presentation,
4 25 minutes Cut, Copy, Paste, Drag and Drop
Practiced
Presentation,
5 20 minutes AutoCorrect, Find and Replace
Practice
Presentation,
6 15 minutes Spell Grammar Check
Practice
7 05 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

Teaching Guides for NTA Level 4 MLS Curriculum Page 897

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Step 2: Basics of the Word Window (25 minutes)

 Word is the word processing software in the Microsoft Office Suite. It allows you to
create a variety of professional-looking documents such as letters, flyers, and more.
The Basics of the Word Window
 Shown below is the Microsoft Word default window. When Word is launched, a new
blank document, or default window, opens in Print Layout view. Although window
elements are fully explained in our Windows course, here is a brief explanation of the
Word window.
 Title Bar: displays the document name followed by a program name.
 Menu Bar: contains a list of options to manage and customize documents.
 Standard Toolbar: contains shortcut buttons for the most popular commands.
 Formatting Toolbar contains buttons used for formatting.
 Ruler: used to set margins, indents, and tabs.
 Insertions point the location where the next character appears.
 End-of-document Marker indicates the end of the document.
 Help provides quick access to Help topics.
 Scroll bars used to view parts of the document.
 Status Bar Displays position of the insertion point and working mode buttons.
 Task Pane provides easy access to commonly used menus, buttons and tools.
 View Buttons Changes the layout view of the document to Normal View, Web Layout
View, Reading Layout View, Print Layout View, or Outline View.
 Office Assistant Links to the Microsoft Office Help feature

Figure 1: Basic Component of Window

Source: Goodwill Community Foundation 2002.

Teaching Guides for NTA Level 4 MLS Curriculum Page 898

Change in View
 In an effort to provide various ways in which to view your work in progress and remain
organized, Word 2003 offers six different views for your document. The six views are
Normal View, Web Layout View, Reading Layout View, Print Layout View, Outline
View, and Full Screen View.
 Normal view is best used for typing, editing, formatting and proofreading. It provides a
maximum amount of space without rulers or page numbers cluttering your view.
 Web Layout view shows you what your text will look like on a web page.
 Reading Layout view is best for documents that you do not need to edit. The goal of this
view is to increase legibility so that the user can read the document easily.
 Print Layout view shows you what your document will look like when it is printed.
Under Print Layout view you can see all elements of the page. Print Preview shows you
this as well.
 Outline view is used to create and edit outlines. Outline view only shows the headings in
a document. This view is particularly handy when making notes.
 Full Screen view displays ONLY the document that you are working on. All the other
pieces of the Word window are removed except for one button that allows you to Close
View Screen.

Changing Your Document View

 Click View on the menu bar.
 Select the view of your choice. OR
 Click one of the five buttons at the bottom left of your Word window (View Full Screen
is not available in this location).

Figure 2: View Button

Source: Goodwill Community Foundation 2002

Pull-Down Menus
Each Office 2003 program features a menu bar. The menu bar is made up of many different
menus. Each menu contains commands that enable you to work within the program. If you
have used a previous version of Microsoft Word, you may notice the menu bar in Word 2003
operates a little differently than before. Word 2003 uses pull-down menus that initially
display commands that users most often need.

Operating the New Pull-Down Menus

To Open a Menu
Click on a menu name on the menu bar.
View the commands listed under the pull-down menu.
With the menu open, drag the mouse pointer to a command and click on it to select the
command. (As you drag your mouse pointer over the commands, each command is
highlighted in blue.)

Teaching Guides for NTA Level 4 MLS Curriculum Page 899

Using the Task Pane
When opened, the task pane will appear on the right side of the word window. The task pane
provides easy access to commonly used menus, buttons and tools. By default, the Task Pane
will appear when Word 2003 is first launched. If you do not see your task pane, you can
view it by either selecting certain commands or by manually opening it.
To Open the Task Pane
Click on View in the menu bar.
Select Task Pane.

Figure 2: Task Pane

Source: Goodwill Community Foundation 2002

Along the top bar of the task pane you should see small backwards and forwards buttons on
the left as well as a down arrow on the right. To view different task panes available to you,
click on the down arrow. Once you have opened different task panes, you can navigate
through them by clicking on the left and right arrow button on the left. To close your task
pane, click the x symbol on the far right of the bar.

Activity 1: Personal Letter (Assignment)

Use a computer and a Word document to complete activities 1 through 6 listed below:
Refer students to Handout 4.1: Personal Letter
After opening the document, change the view to Normal View.
Practice using the pull-down menus on the menu bar.
Find the Task Pane and become familiar with it.
Type today's date at the beginning of the document and type the letter content on the handout.
Save the document by selecting File >> Save from the main menu.
Close the document.

Step 3: Saving New File (20 minutes)

When Saving a File for the First Time
Click File on the Menu Bar.
Select Save - Ctrl+S.

Teaching Guides for NTA Level 4 MLS Curriculum Page 900

Figure 3: Save command

Source: Goodwill Community Foundation 2002

Using the Standard Toolbar to Save

Choose the Save button on the Standard Toolbar.

Save as Dialog Box

After selecting Save from the Menu Bar or the Standard Toolbar, the Save As Dialog Box
appears.

Figure 4: Save As Dialog Box

Source: Goodwill Community Foundation 2002

 To Specify a File Location

o Open the Save In: drop down list box.
o Choose 31/2 floppy (A:) if saving to a floppy disk.
o Choose (C:) if saving to your hard disk.
o Name your file in the File name: box.
o Click Save.

Teaching Guides for NTA Level 4 MLS Curriculum Page 901

 o If you do not choose a file name, Microsoft Word will assign a file name for you. It
assigns the first line of text in you document, unless you give it a different name when
prompted in the File name box.
o If you do not specify a file location, Office uses the My Documents folder as the
default location. So, if you can't find a file, check My Documents.
 After Naming and Saving a File Once
o Click the Save button on the Standard toolbar or
o Go to the File menu and choose Save. You will not get a Save As dialog box again.
 Saving a File under a New Name
o If you wish to create an exact copy of an original document for editing or revising
purposes, you should perform a Save As on the file and save it under a new name.
This will guarantee that you always have a saved, original copy.
o Follow these steps to perform a Save As
o Click File from the menu bar.
o Select Save As. The Save As Dialog Box appears.
o Type a new name for your file in the File name: box.
o Click Save.
o Choose Save As to rename a document. Be careful not to overwrite your original file.
 Backspace and Delete
o Use the backspace and delete keys (on your keyboard) to erase text in your document.
o The backspace key erases the text to the left of the insertion point one character at a
time.
o The delete key (located under the Insert key) erases the text to the right of the
insertion point.
 Using Undo - Ctrl + Z
o Have you made a mistake in your document and needed to go back and make
changes, but you thought it was too late? Good news! Word offers a feature that helps
prevent this from happening.
o The Undo command lets you "undo" or delete the last change made to your document.
As you can imagine, this is a very useful feature. If you make a change or mistake that
you do not want or did not mean to do, you can simply "undo" your action.
o Word remembers up to 300 actions in a document and allows you to undo any or all of
them as long as you haven't closed the document first.

 To Use Undo
o Click Edit on the menu bar.
o Select Undo - this command will change names depending on the action you just
took. If you accidentally deleted a sentence, it says Undo Clear.
o Press Ctrl + Z on your keyboard for a shortcut to Undo. OR
o Undo all your recent actions by repeatedly clicking the Undo button located on the
Standard toolbar.

Figure 5: Undo Button

Teaching Guides for NTA Level 4 MLS Curriculum Page 902

Source: Goodwill Community Foundation 2002

 Notice the small list arrow next to the Undo button. When you click on it, you see a list
of all the separate actions you have performed on the document you are working on. You
can select as many actions as you want to undo.

 IMPORTANT: If you undo an action in the middle of the list, you will also undo all the
actions above the one you select. For example, if you undo the 15th action in your list,
you will also be undoing the 14 actions that came before the one you select.

Figure 6: Undo and Redo Button

Source: Goodwill Community Foundation 2002

 Using Repeat - Ctrl + Y

o The Repeat feature allows you to repeat the last action and can help to save a lot of
time as you create your document.

 To Use Repeat:
o Click Edit on the menu bar.
o Select Repeat - this command will change names depending on the action you just
took. If you need to format a title on one page and wish to format another title the
same way using Repeat, it will say Repeat Style.
o Press Ctrl + Y on your keyboard for a shortcut to repeat.

 Activity 2: Personal Letter (Assignment)

o Instructions: Go back to your Personal Letter Word document to complete the steps
listed below:
Refer students to Handout 9.1: Personal Letter

o Write a new paragraph and discuss the following:

o Activities you face as a learner?
o What you hope to gain from completing tutorials?
o Any other important points about distance learning
o Click Enter twice.
o Practice using the Backspace, Delete, Undo, and Repeat functions as you type your
paragraph.
o Move the insertion point to the end of the final sentence in the letter and click Enter
twice.
o Write a Closing (i.e., Sincerely, Yours Truly, etc.).

Teaching Guides for NTA Level 4 MLS Curriculum Page 903

 o Save the document using the Save icon on the Standard Toolbar
o Close the document.

Step 4: Cut, Copy, Paste, Drag and Drop (25 minutes)

 Often in word processing, you will need to transfer information from one document to
another. Instead of having to re-type or replace this information, Word allows you to
move a block of text (a word, sentence, paragraph, page, document, or graphic). Cut,
Copy and Paste are extremely time-saving features. The Cut, Copy and Paste buttons are
located on the Standard toolbar.

Figure 7: Cut, Copy and Past

Source: Goodwill Community Foundation 2002

o Cut and Paste

 The Cut feature allows you to remove selected text from the document and
temporarily place it on the Office Clipboard.
 The Clipboard is a temporary storage file in your computer's memory. Items
placed on the Clipboard will remain there until you exit Word.
 The Paste feature allows you to get text from the Clipboard and place it in the
same or even another document.
o Copy and Paste
 The Copy feature allows you to copy selected text from the document and
temporarily place it on the Clipboard.
 The Clipboard is a temporary storage file in your computer's memory.
 The Clipboard can hold up to twenty-four items. Once you copy the 25th item, the
first copied item is deleted.
 The Paste feature allows you to select any of the collected items on the Clipboard
place it in the same or even another document. You can Copy information from
many different sources including Websites, Emails, and other Office applications
like Excel and PowerPoint.

 Working with Blocks of Text

o To Cut and Paste a Block of Text
 Select the text you want to move.
 Click the Cut button on the Standard Toolbar.
 Place the insertion point where you want the text inserted.
 Click the Paste button.
o To Copy and Paste a Block of Text
 Select the text you want to move.
 Click the Copy button on the Standard Toolbar.
 Place the insertion point where you want the text inserted.

Teaching Guides for NTA Level 4 MLS Curriculum Page 904

  Click the Paste button.
 Once the item has been pasted, you can determine the formatting by clicking on
the Paste Options button that appears just below your pasted selection. Check or de-
select any of the following options:
 Keep Source Formatting - maintains the text formatting of the original document.
 Match Destination Formatting - formats the pasted text to match the text
formatting in the document in which it was pasted.
 Keep Text Only - removes any graphics that you may have copied along with the
copied text.
 Apply Style or Formatting - allow you to choose a specific format from the Styles
and Formatting menu.
 Viewing the Clipboard items
o Click Edit on the Menu Bar.
o Select Office Clipboard.
o The clipboard will appear on the right side of the Word window in the Task Pane.
o The Clipboard will display any of the 24 items you have copied.
 Menu Commands
o Edit cut
o Edit copy
o Edit paste
 Keyboard Shortcuts
o Ctrl+C = copy
o Ctrl+X = cut
o Ctrl+V = paste
 Become comfortable using the keyboard shortcuts to increase your speed in word
processing. If you cut, copy, or paste something you didn't mean to, use the Undo button
or choose not to save changes to your document when you close your document.

Step 5: Auto Correct, Find and Replace (20 minutes)

 Word's AutoCorrect feature can assist you in word processing tasks. AutoCorrect can
help you locate misspelled words and correct them as you type. AutoCorrect can also be
customized so that commonly used words will be automatically entered without having to
type the entire word.
o Examples
 When typing the misspelled word ‘standd’ Word will automatically convert this
typo to the correct spelling, ‘stand’. Instead of having to write a long proper noun
like, GCFLearnFree.org, you can customize AutoCorrect to automatically
complete the rest of the proper noun once you type the letters GCF.
o Modifying AutoCorrect
o Click Tools
o Select AutoCorrect Options from the menu bar. The AutoCorrect Options dialog
box appears.
o Check or de-select any of the following options:
 Show AutoCorrect Options buttons.
 Correct two initial capitals.
 Capitalize the first letter of the sentence.
 Capitalize the first letter of table cells.

Teaching Guides for NTA Level 4 MLS Curriculum Page 905

  Capitalize names of days.
 Correct accidental usage of Caps Lock key.
 Replace text as you type.
 Use the Replace: box to type a word you frequently misspell or type a shorthand
word to represent a longer word or phrase, such as GCFLearnFree.org.
 Use the With: box to type the correct word.
 Click Add.

Figure 8: AutoCorrect

Source: Goodwill Community Foundation 2002

 If you type a misspelled word into AutoCorrect's with: box, AutoCorrect always misspells
that word.
 If AutoCorrect changes a word that you don't want it to change, you can hover the pointer
over the area where the Auto Correction was made and a Smart Tag will appear that
allows you to reset the original word. Click on the Smart Tag and a drop-down list with
options to reverse the action is displayed.

Figure 9: AutoCorrect Smart Tag

Source: Goodwill Community Foundation 2002

 Find and Replace

o Word 2003 allows you to search for specific words in your document as well as fonts,
special characters and formats. The Find and Replace functionality can really help
save you time and effort in your word processing goals.
o For example, consider a document you are editing that displays Word XP needs to be
updated to Word 2003. Currently the document has the text, Word XP, typed again

Teaching Guides for NTA Level 4 MLS Curriculum Page 906

 and again throughout the document. Using Find and Replace to replace Word XP
with Word 2003 will save you much time and effort in your editing process.
 Using Find - CTRL + F
o Click Edit on the menu bar
o Select Find. The Find and Replace dialog box appears.
o Type a word, phrase or format in the Find What box.
o Click Find Next to start the search.
o Word will jump to the first instance of this word and will highlight the word for easy
location.
o Continue Clicking the Find Next button to find all other instances of this word OR
o Check the Highlight all items found in: box to find all instances of the word at the
same time. Use the list box below to select all, or portions of your document.

Figure 10: Find and Replace

Source: Goodwill Community Foundation 2002

 You can perform a more detailed search by clicking the More button on the Find and
Replace dialog box:
o Click Edit on the menu bar
o Select Find. The Find and Replace dialog box appears.
o Type a word, phrase or format in the Find What box.
o Click More to conduct a detailed search.
o Click the Search list box if you want to limit your search to a specific part of the
document.
o Use the check boxes to limit your search.
o Click Format if you want to limit your search to words in a specific Font, Paragraph,
Tab, Language, Frame, Style or Highlight.
o Click Special to search for punctuation marks or section breaks.
o Click Find Next to start the search.
 Using Replace - CTRL + H
o Click Edit on the menu bar.
o Select Replace. The Find and Replace dialog box appears.
o Type the word, phrase or format in the Find What: box that you are searching for.
o Type the word, phrase or format in the Replace With: box that will replace what is in
the Find What: box.
o Click Find Next to conduct your search.
o When Word finds a word of phrase, do one of the following:
o Ignore it.
o Click Replace.

Teaching Guides for NTA Level 4 MLS Curriculum Page 907

 o Click Replace All to replace every occurrence of the selected text with the
replacement text.
o Click Find Next to bypass it and find the next.
o Click Cancel to quit.
 Using the Thesaurus
o Click Tools on the Menu Bar.
o Select Language and then follow the cascading menu to Thesaurus OR
o Use the quick key combination, Shift + F7
 Activity 3: Personal Letter (Assignment)
o Instructions: Go back to your Personal Letter Word document to complete bullet 1
to 4 listed below:
o Open the personal letter document.
o Use the Find and Replace feature to change the name of the person you are writing
from "Tom" to any name you choose.
o Go to Tools >> AutoCorrect Options. Look at the functions that AutoCorrect can do
for you.
o Save and close the document.

Step 6: Spell and Grammar Check (15 minutes)

 Not only does Word allow you to Undo possible mistakes in your document and Paste
corrections, it also automatically reviews your grammar and spelling as you type. Green
wavy lines are placed underneath possible grammar mistakes and a red wavy line under
possible spelling mistakes. All of Word's grammar and spelling errors may not be correct,
so you can choose to ignore these error markings and keep typing, or you can correct the
mistakes and/or add the corrections to Word's dictionary.
 Check Spelling as you Type
o Word puts a red wavy line under possible spelling mistakes. If you click on the
suspected misspelling, Word gives you one or more suggested corrections.

Figure 10: Spelling Check

Source: Goodwill Community Foundation 2002

Teaching Guides for NTA Level 4 MLS Curriculum Page 908

 To Use Spell Check as You Type
o Place your I-Beam over the misspelled word and right-click.
o A menu list displays the following options: boldfaced suggested spellings, Ignore All,
Add to Dictionary, AutoCorrect, Language, Spelling and Look Up.
o Select the boldfaced suggestion to replace the incorrectly spelled word in the
document.
o Select Ignore, and Word ignores all future instances of this spelling in this document.
o Select Add to Dictionary, and Word adds the underlined word to the dictionary so it
won't be flagged as an error in any other document you create.
o Select AutoCorrect to add the correct spelling to your list of words that Word
automatically corrects as you type.
o Select Language to specify a word as part of another language, preventing Word
from seeing this word as a mistake.
o If you select spelling, the Spelling and Grammar dialog box appears.
o If you select Look Up, a window opens in the Task Pane and you are given general
search parameters. This feature is helpful when dealing with words, such as proper
nouns, that are not found in the dictionary.
 To Work on Suspected Grammatical Mistake
o Place your I-beam over the grammatical mistake and right-click.
o A menu list displays the following options: boldfaced grammar suggestion, Ignore,
Grammar, About this Sentence.
o Select Ignore and Word ignores the grammatical mistake it believes to exist.
o Select Grammar, and the Grammar dialog box appears.
o Select About this Sentence and the Office Assistant will offer you reasons as to why
Word believes this to be a grammatical error.
 Spelling and Grammar Dialog Box
o To Use the Spelling and Grammar Dialog Box
o Choose one of the following options, depending on what you think of Word's
suggestions:
o Click Ignore Once to ignore this one instance of the grammatical error in your
document.
o Click Ignore Rule to ignore this grammatical error and all other grammatical errors of
this type in the document.
o Click Next Sentence to take you to the next grammatical error listed in your
document.
o Click Change to replace the error with what is in the Suggestion box.
o Click Explain to open the Office Assistant, which will offer you reasons for this error.
 To Turn off the Red or Green Wavy Line
o Choose Tools Options from the menu bar. The Options dialog box appears.
o Click the Spelling & Grammar tab.
o Un-check the Check Spelling as You Type or Check Grammar as You Type so the
check box so that it is empty.
o Click OK.
o Don't forget to use Spell and Grammar Check!

 Activity 4: Personal Letter (Assignment)

o Instructions: Go back to your Personal Letter Word document to complete bullet 1
to 3 listed below:

Teaching Guides for NTA Level 4 MLS Curriculum Page 909

  Open the personal letter document.
 Use the Spelling and Grammar feature to check the document.
 Save and close the document.
 Congratulations! If you have completed these activities, then you have
completed your first personal letter in Word 2003.

Step 7: Key Points (5 minutes)

 Word 2003 offers six different views for your document. The six views are Normal View,
Web Layout View, Reading Layout View, Print Layout View, Outline View, and Full
Screen View.
 Save periodically when you are working in an application. Losing information can
happen easily if you don’t. You can quickly save by using the quick-key combination Ctrl
+ S.
 Instead of having to re-type or replace information, Word allows you to move a block of
text (a word, sentence, paragraph, page, document, or graphic). Cut, Copy and Paste are
extremely time-saving features.
 AutoCorrect can help you locate misspelled words and correct them as you type.
AutoCorrect can also be customized so that commonly used words will be automatically
entered without having to type the entire word.

Step 8: Evaluation (10 minutes)

 List parts of the Word window
 Describe the difference in using “Save” and “Save As” command
 Demonstrate the use of Backspace/Delete keys and Undo/Repeat functions
 Demonstrate the use of Cut, Copy, Paste, Drag and Drop functions
 Demonstrate using Use AutoCorrect and Find and Replace functions
 Demonstrate using Spell Check and Grammar check function

Resources
 Bott, E. and Siechert, C. (2001). Microsoft Windows XP Inside Out.
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Herniter, M.E. (2000). Personal Computer Fundamentals for Students, Hardware
Windows 2000 Application (2nd Ed). Prentice Hall.
http://www.gcflearnfree.org/computer/
 Joos, I. W., N. Smith, M., Nelson, R. et al. (2006). Introduction to Computers for
Healthcare Professionals (4th Ed). Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J & O’leary, L. I. (2006). Computing Essentials, Introductory Edition.
Arizona State University: Boston Burr Ridge.
 Sagman, S. (1999). Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window. Retrieved March 11, 2010 from
www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 910

Handout 9.1: Personal Letter

Dear Tom,

My daughter just got a new digital camera and I will learn how to send you pictures soon! I
just recently enrolled in an online class with GCF Global Learning® and today I am working
on my first Microsoft Word assignment. They offer many online classes such as Word, Excel,
PowerPoint, Access, Basic Math, Career Development, and many more. When I finish taking
this class Tom I plan on taking some of the other classes that are offered.

I am very excited about the class and there are many positive things about being a distance
learner. I can use the website at anytime and from any computer, we have an online instructor
to help us, and the classes are free! Also, since my employer is now requiring that everyone
in our office earn 5 Continuing Education Units every two years, this will help me stay up-to-
date with my training.

Tom, I hope the rest of your family is doing well and that the kids are ready for summer.
Once you get your email account set-up, we’ll be able to write to each other all the time.

Teaching Guides for NTA Level 4 MLS Curriculum Page 911

Session 10: Demonstration on word
processor
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Practice Aligning Text
 Practice Set Line and Paragraph Spacing
 Practice Create Margins
 Practice Indent Text
 Practice Use of the Ruler
 Practice Formatting Text
 Practice Creating Bulleted and Numbered lists

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD
 Handout

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes Hands on Practice Align Text
3 20 minutes Hands on Practice Set Line and Paragraph Spacing
4 15 minutes Hands on Practice Create Margins
5 10 minutes Hands on Practice Indent Text
6 20 minutes Hands on Practice Use of Ruler
7 20 minutes Hands on Practice Create Bulleted and Numbered lists
8 10 minutes Presentation Key Points
9 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 Minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Teaching Guides for NTA Level 4 MLS Curriculum Page 912

Step 2: Aligning Text (10 minutes)
 Aligning text can be invaluable when trying to format your document to meet certain
standards. Most documents have text that is left aligned. However, if you were creating a
greeting card or advertisement, you might need to know how to center align, right align or
justify your text.
 Align Text Using the Alignment Buttons:
 Select the text you want to align.
 Click the Align Left, Center, Align Right, or Justify button on the Formatting toolbar.

Figure 1: Alignment Buttons

Source: Goodwill Community Foundation 2002

 Uses of left, right, center and justified Alignment Text

o Below you will view examples of text that are aligned using the left, right, center, and
justified alignment buttons.

Teaching Guides for NTA Level 4 MLS Curriculum Page 913

 Refer students to Handout 10.1: Personal Letter

 Activity 1: Personal Letter (5 minutes)

o Instructions: Use Personal Letter from Handout 10.1 help to do bullets 1 to 4 listed
below:
o Left align the entire letter.
o Center align only heading
o Right align Address at the top
o Save and close the document.

Step 3: Set Line and Paragraph Spacing (20 minutes)

 Line Spacing
o Document text can be formatted to show a number of line spacing options. The most
common spacing options are single-spaced and double-spaced.
 Line spacing is measured in lines or points.
o When line spacing is measured in points, it is referred to as leading (rhymes with
wedding). When you reduce the leading you automatically bring the lines of text
closer together, sometimes making it difficult to read. Increasing the leading will
space the lines out, allowing for improved readability. For example, the 10 point font
usually uses 12 point leading. This is the default and, in general, should be used.
 To Format Line Spacing
o Select the text you want to format.
o Choose Reveal Formatting on the Task Pane and click on any of the blue links
under the Paragraph heading OR
o Click Format on the menu bar.
o Select Paragraph. The Paragraph dialog box appears.

Teaching Guides for NTA Level 4 MLS Curriculum Page 914

 o Click on the Indents and Spacing tab.
o In the Line spacing drop down menu, you may select single, 1.5, or double spacing.
The default is single spacing.
o Click OK OR
o Select the text you want to format.
o Click on the Line Spacing button on the Formatting Menu.
o Select an option from the drop-down menu.

 Paragraph Dialog Box

o You can use the At Least, Exactly and Multiple options in the Paragraph Dialog Box
to customize your line spacing. If you select one of these options you will need to use
the At: box to further define your selection.
 Paragraph Spacing Figure 2: Paragraph
o Just as you can add spacing between lines in your document, you can also choose
spacing options between each paragraph. Typically, extra spaces are added between
paragraphs, headings, add emphasis and make a document easier to read.
 Choose extra space
o Before each paragraph.
o After each paragraph.
o Or, before and after each paragraph.

Source: Screen Shot from Microsoft Word

Teaching Guides for NTA Level 4 MLS Curriculum Page 915

 To Specify Paragraph Spacing
o Select the text you want to format.
o Choose Reveal Formatting on the Task Pane and click on any of the blue links
under the Paragraph heading OR
o Click Format on the menu bar.
o Select Paragraph, The Paragraph dialog box appears.
o Click the Indents and Spacing tab.
o Alignment: Choose left, right, center, or justified.
o Indentation: Adjust the left and right margins by clicking the up and down arrows.
Use the Special drop-down menu to select the first line as having the indent or to
create a hanging indent.
o Spacing: To emphasize a block of text, click the up and down arrows.
o Preview: Gives an idea how your text will look.

Refer students to Handout 6.1: Personal Letter

 Activity 2: Personal Letter (5 minutes)

o Instructions: Use Personal Letter from Handout 10.1 help to do bullet 1 to 4 listed
below:
 Select the text in paragraph 1 and change the line spacing from 1.5 lines to single
space
 Use the line spacing and paragraph spacing features to practice how the features
can change your document.
 Be sure to use the Undo feature (from Edit on the main menu or the Undo arrow
on the toolbar) to undo any of the changes you may have made while exploring
these features.
 Save and close the document

Teaching Guides for NTA Level 4 MLS Curriculum Page 916

Step 4.Using Page Setup to Specify Margins (15 minutes)

Figure 2: Margin Set

Source: Screen Shot from Microsoft Word

 In order to change the margins (space along the top, left, right and bottom) in your
document, you will need to access the Page Setup dialog box.
 Click File on the menu bar.

Figure 3: Page Setup

Source: Screen Shot from Microsoft Word

 Select Page Setup.

 Select Margins tab in the Page Setup dialog box OR
 Choose Reveal Formatting on the Task Pane and click on the blue link, Margin, under
the Section heading.

 You can change the margin in precise steps by clicking on the up or down arrows next to
the margin that you wish to change or you may type a number in the text box next to the
margin you wish to change.
 Click OK.

 More Options on the Page Setup Dialog Box

Teaching Guides for NTA Level 4 MLS Curriculum Page 917

 o The Page Setup dialog box gives you several other options for controlling the look of
your document. Not only can you control how your document looks on screen, but
you can also manage how your document will be printed. The Margins, Paper and
Layout Tab all contain valuable tools.
 Margins Tab
o Click the Default button in the lower left corner of the Page Setup dialog box to set
(or reset) Word's default margins.
o You can choose to apply these new margins to the whole document or from this
point forward by using the drop-down menu, Apply to:.
o Change the Page Orientation by clicking on either the Portrait box (8.5 x 11) or the
Landscape box (11 x 8.5).
 Paper Tab
o The default paper size is 8.5 x 11, but you can change the paper size entirely. You can
even customize the paper size to include note cards, envelopes, photo paper, index
cards, and much more.
o Layout Tab
o The Layout Tab includes options to customize page numbering, borders, and
headers/footers. A nice feature on the Layout Tab is creating a Title Page for your
document.
 To Create a Title Page for Your Document
o Enter the text you want on your title page.
o Click File on the Standard toolbar.
o Select Page Setup from the menu bar.
o Click the Layout tab.
o Under Vertical Alignment, you will find the following options:
o Top: Default. Text lines up with top margin.
o Center: Text on page is centered between the top and bottom margins.
o Justified: Text is spread out so each line is same distance apart.
o Bottom: Text lines up with the bottom page.

Refer students to Handout 10.1: Personal Letter

 Activity 3 Adjust the Margins in a Document Personal Letter (5 minutes)

o Instructions: Use Personal Letter from Handout 10.1 help to do bullet 1 to 5 listed
below:
o Open the letter document.
o Set the margins so the top margin is 2 inches and all other margins are 1 inch.
o Verify that the Page Orientation is set to Portrait.
o Change the Paper Size of the document to be 8.5" x 11"
o Save your changes and close the document.

Step 5.Indent Text (10 minutes)

 An indent is the space between your margin and your text. Don't confuse the margin and
the indent. The indent feature is often used to set a first-line indent for paragraphs.
 To Indent One or More Lines of Text
o You can use the Paragraph dialog box or select the blue Indentation link under
Paragraph on the Task Pane. This method allows for a great amount of precision for

Teaching Guides for NTA Level 4 MLS Curriculum Page 918

 setting left and right indents. Indenting is measured in inches. You can change the
indent in tenths of inches.

Figure 4: Indentation

Source: Screen Shot from Microsoft Word

o In the Indentation section, you can click the increment arrows to enter the amount of
indentation. OR
o Use the Increase/Decrease Indent buttons on the Formatting toolbar.
o Clicking the Increase/Decrease Indent buttons is the most convenient way of setting a
left or right indent. Each time you click the Increase or Decrease Indent button your
text is moved by the default .5 inches.

Figure 5: Indent buttons

Source: Screen Shot from Microsoft Word

 Remember, there is a difference between indents and tabs. If you set a tab, only one line
of text is indented. If you click one of the indent buttons or set an indent in the
Paragraph dialog box, all of the text you type afterwards will be indented.
 Hanging Indents
o When all the lines in a paragraph are indented except the first line, a hanging indent
is created. Hanging indents are not standard in documents such as business letters,
but you may see examples of the hanging indent on web pages, newsletters, and often
on bibliographic entries. Hanging indents are used for the MLA bibliographic format.

 To Create a Hanging Indent:

Teaching Guides for NTA Level 4 MLS Curriculum Page 919

 o Choose Reveal Formatting on the Task Pane.
o Click the blue link, Indentation, under the Paragraph heading. OR
o Click Format on the menu bar.
o Select Paragraph.
o In the Indentation section, you will see a Special: drop down menu with some
options.
o Select the Hanging Indent option in the Special: drop down menu.
o You may specify the amount of indentation in the By: box by clicking on the
increment arrows. These increments are measured in inches.

Refer students to Handout 10.1: Personal Letter

 Activity 4: Personal Letter (5 minutes)

o Instructions: Open Personal Letter from Handout 6.1 help to do bullet 1 to 11 listed
below
 Place the insertion point at the end of the first paragraph.
 Select Enter twice.
 Write a paragraph stating the skills you have that qualify you for the job.
 Select Format from the menu.
 Select Paragraph.
 Select the Hanging Indent option in the Special: drop down box, which is
located in the
 Indention section of the dialog box.
 In the by: drop down menu, click the increment arrow until it read .8".
 Click OK.
 Watch the ruler at the top of the document and you will see the .8” hanging
indent.
 Open Edit on the main menu and select Undo to cancel the change you made.
This activity was done simply so you could view how the Indent feature works.
 Save and close the document.

Step 6: The Ruler (20 minutes)

 You can adjust the width of margins, tabs, and indents in your document using Word's
Ruler.
 The Ruler is helpful when you need to create several columns, show column placement,
or the distance between columns.
 Hiding and Displaying the Ruler:
o Click View on the menu bar.
o Select Ruler.
o The Ruler will appear at the top of the document.

Figure 6: Ruler

Source: Screen Shot from Microsoft Word

Teaching Guides for NTA Level 4 MLS Curriculum Page 920

 If you switch to Print Layout View (Choose View Print Layout View), a vertical
ruler displays along the left hand side of the screen. To hide this vertical ruler, switch to a
different layout view.

 Setting Tabs, Indents and Margins using the Ruler

o The ruler provides a visual tool that allows you to quickly view, create and change
your documents tabs, margins and indents. Tabs Click on the small gray box to the
left of the ruler to move through the five different Tab Settings.
o Left tab : Moves text toward the right edge of the page as you type.
o Center tab : Centers text around the tab.
o Right tab : Moves text toward the left edge of the page as you type.
o Decimal tab : Aligns decimal numbers using the decimal point.

o For example
 Bar tab : Draws a vertical line on the document.
 Indent : Inserts the indent marking anywhere along the ruler
 Hanging Indent : Inserts a hanging indent anywhere along the ruler
 To Place a Tab or Indent on The Ruler:
o Click the cursor anywhere in the block of text you want to format.
o Click the tab selection button (upper left of the ruler).
o Click the Ruler where you want your tab or indent to be set.
o If you set up a new tab, press the tab key to move your text to the new tab.
o If you set up a new indent, place the cursor at the new indent location.
 Adjusting Tabs and Margins on the Ruler
o To Move an Existing Tab or Indent on the Ruler
 Point the mouse on the tab or indent that you want to move.
 Click and hold the left mouse button until a dotted line appears below the tab.
 Drag the mouse to move the tab or indent to a new location.
 Release the left mouse button.
o To Remove a Tab from the Ruler
 Point the mouse on the tab you want to remove.
 Click and hold the left mouse button until a dotted line appears below the tab.
 Drag the mouse off the Ruler.
 Release the left mouse button.
o To Adjust a Margin using the Ruler
 Point the mouse on the margin that you want to move.
 Click and hold the left mouse button once a double arrow appears over the margin
until a dotted line appears below.
 Drag the mouse to increase or decrease the margin.
 Release the left mouse button.

 Formatting Toolbar

Teaching Guides for NTA Level 4 MLS Curriculum Page 921

 o The Formatting Toolbar contains buttons that allows you to change the appearance
of your text. The formatting toolbar contains buttons for font size, font style, colors
and other options.
o To View the Formatting Toolbar
 Click View on the Menu Bar.
 Select Toolbars and then Formatting from the cascading menu.
 Bold, Italics and Underline
o Any text you type in Word, can be further customized by using the bold, italicized or
underlined options. You can even do a combination of all three options!
 To Change the Type Style of Text
o Select the text you want to change.
o Choose one or more of the following options: (to stress emphasis you might want to
try using the bold option)
o Click the Bold button on the Formatting toolbar. Ctrl + B
o Click the Italic button on the Formatting toolbar. Ctrl + I
o Click the Underline button on the Formatting toolbar. Ctrl + U
o Word automatically displays your changes.

Figure 7: Bold, Italics and Underline

Source: Goodwill Community Foundation 2002

 To avoid frustration, remember to select text before you apply style. If you choose a type
style without selecting any text, Word uses your chosen styles on whatever text you type
next.

 Using Color
o The use of color can add emphasis to your words and make your document easier to
read. If you own a color printer, you can print documents in different colors. If you do
not own a color printer, your document will only appear in color on the screen.
 To Change the Color of Text
o Select the text you want to change.
o Click the downward-pointing arrow on the Font Color button on the Formatting
toolbar. A color palette appears.
o Click the color you want to apply.
o Word changes the color of your text.

Teaching Guides for NTA Level 4 MLS Curriculum Page 922

Figure 8: Colour Table

Source: Goodwill Community Foundation 2002

 If you would like to see more color options, Click the More Colors button at the bottom
of the color palette. You can choose from a list of Standard Colors or Customize your
own color by clicking the Customize Tab.
 Font Dialog Box
o The Font Dialog Box gives similar options as the Formatting toolbar; however, it also
offers more advanced text features. You can use the Font Dialog Box to change your
font, font style, size, color and many other font effects.
 To Open the Font Dialog Box
o Click Format on the Menu Bar.
o Select Font from the menu list. The Font Dialog Box will appear.

Figure 9: Font Option

Source: Goodwill Community Foundation 2002

 Remember you can also access the Font Dialog Box from the Font menu on the Task
Pane.

Teaching Guides for NTA Level 4 MLS Curriculum Page 923

Figure 10: Font Box

Source
:
Goodwill Community Foundation 2002

 Font Size
o You can change the Font Size from both the Font Dialog Box and the Formatting
toolbar. You can use different font sizes to give emphasis to different parts of your
document. For example, the title of your document could be displayed larger than the
contents of your paper. Font size is commonly expressed in points. Font sizes range
from 8 point (extremely small) to 72 point (very big). Word allows you to choose
sizes smaller than 8 point and larger than 72 point, but you must type these in
manually in the Font Size box.
o Arial 10 Point
o Arial 12 Point
o Arial 20 Point
o Arial 30 Point
o The standard Font size for most documents is 12 Point. You can preview different
font sizes in the Preview window in the Font dialog box.
o Select Reveal Formatting on the Task Pane.
o Click the blue link, Font: under the Font Heading. The Font dialog box appears.
o Click on a font from the Font list.
o Select a size from the Font Size list.
o Look at the text in the preview window as you try different sizes.
o OR
o Click Format on the Menu Bar.
o Select Font from the menu list. The Font dialog box appears.
o Click on a font from the Font list.
o Select a size from the Font Size list.
o Look at the text in the preview window as you try different sizes.
 To Open the Templates Dialog Box
o Click File on the Menu Bar.
o Select New from the menu list. The Task Pane New Document window appears to
the right.
o Select an option under New from template.
o Letter Wizard - assists you in writing a standard letter
o Contemporary Letter - offers a letter template including artwork

Teaching Guides for NTA Level 4 MLS Curriculum Page 924

 o General Templates - preformatted documents including faxes, letters, memos, reports,
etc.
o Templates on my Web Sites - allows you to search for templates on other web servers
o Templates on Microsoft.com - allows you to search among hundreds of templates
offered through the Microsoft website

Refer students to Handout 10.1: Personal Letter

 Activity 5.Experiment with Fonts (5 minutes)

o Instructions: Use Personal Letter from Handout 6.1 help to do bullet 1 to 7 listed
below:
 Open the Personal Letter document.
 Modify the document so the text is not bolded, italicized, or underlined.
 Change the document so all the text is black.
 Modify the font size from 14 to 12.
 Change the font style from Arial to Times New Roman, or the font of your
choice.
 Read the document. Are there any words that you should emphasize? If so, make
those words bold.
 Save and close the document

Step 7: Bullets and Numbering (20 minutes)

 Word lets you make two types of lists: bulleted and numbered. Bulleted and numbered
lists help to simplify steps or items to the reader. Teachers often use bulleted lists to
highlight important pieces of their lessons. Manuals often include numbered lists to assist
the reader in step-by-step instruction. A bullet is usually a black circle but it can be any
other symbol used to highlight items in a list. Use bullets to list items that do not have to
be in any particular order. Numbers (or letters) are used when information has to be in a
certain order. You can use the default Bullets and Numbering settings by clicking on the
appropriate button on the Formatting toolbar.
 Create Bulleted and Numbered Lists
o To Create a Bulleted List
 Click the Bullets button on the Formatting toolbar.
 Type the first item on your list and press Enter.
 The next line will begin automatically with a new bullet.
 Type the next item on your list and press Enter.
 When your list is complete, press the Enter key twice to stop the bulleted list.
o To Create a Numbered List
 Click on the Numbering button on the Formatting toolbar.
 Type the first item on your list and press Enter.
 The next line will begin automatically with the next number.
 Type the next item on your list and press Enter.
 When your list is complete, press the Enter key twice to stop the numbered list.
 Review the following tips that will help you manage your numbered or bulleted
lists.

Teaching Guides for NTA Level 4 MLS Curriculum Page 925

  Remove a bullet by placing the insertion point to the right of the bullet or
number and press backspace (you will not be able to place your insertion point to
the left of the bullet).
 If you want to change a bulleted list to a numbered list (or vice versa), select the
entire list and click on the appropriate button.
 To create a line break between items in a bulleted or numbered list, place your
cursor where you want the line break and press Shift + Enter.

 The Bullets and Numbering Dialog Box

o Word offers you many other options for your bullets and numbers, other than the
default that you have seen so far.
o You can view the type of bullets and numbers available to you by opening the
Bullets and Numbering Dialog Box.
o Select the text you want to turn into a list.
o Click Format on the Menu Bar.
o Select Bullets and Numbering. The Bullets and Numbering Dialog Box appears.
o Click on the Bulleted Tab to view all the bullet options and click on the Numbered
Tab to view all the number options.
o Select what kind of bullets or numbers that you want, and click OK.
o The Bullets and Numbering Dialog Box also offers you Outline Numbered options.
By clicking on the Outline Numbered Tab you can view templates for creating an
outline. The List Styles Tab allows you to create your own list style using similar
alignment, bullets and characters.

Figure 11: Bullets and Number

Source: print screen from Microsoft Word 2003

 Congratulations! If you have completed these activities, then you have finished this
cover letter in Word 2003.

Step 8: Key Points (10 minutes)

 Aligning text can be invaluable when trying to format your document to meet certain
standards. Most documents have text that is left aligned. However, if you were creating a

Teaching Guides for NTA Level 4 MLS Curriculum Page 926

 greeting card or advertisement, you might need to know how to center align, right align or
justify your text
 When line spacing is measured in points, it is referred to as leading (rhymes with
wedding). When you reduce the leading you automatically bring the lines of text closer
together, sometimes making it difficult to read. Increasing the leading will space the lines
out, allowing for improved readability. For example, the 10 point font usually uses 12
point leading. This is the default and, in general, should be used.
 Clicking the Increase/Decrease Indent buttons is the most convenient way of setting a left
or right indent. Each time you click the Increase or Decrease Indent button your text is
moved by the default .5 inches.
 Remember, there is a difference between indents and tabs. If you set a tab, only one line
of text is indented. If you click one of the indent buttons or set an indent in the
Paragraph dialog box, all of the text you type afterwards will be indented.
 You can adjust the width of margins, tabs, and indents in your document using Word's
Ruler. The Ruler is helpful when you need to create several columns, show column
placement, or the distance between columns.

Step 9: Evaluation (10 minutes)

 Most documents have text that is left aligned. What are the other Alignments you know?
 What are the two most common spacing options?
 What type of Page Orientation do you know?
 The indent feature is often used to do what?
 The ruler provides a visual tool that allows you to do what?
 List steps to format text
 List steps to create bulleted and numbered lists

Resources
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 927

Dear Tom,

My daughter just got a new digital camera and I will learn how to send you pictures soon! I
just recently enrolled in an online class with GCF Global Learning® and today I am working
on my first Microsoft Word assignment. They offer many online classes such as Word, Excel,
PowerPoint, Access, Basic Math, Career Development, and many more. When I finish taking
this class Tom I plan on taking some of the other classes that are offered.

I am very excited about the class and there are many positive things about being a distance
learner. I can use the website at anytime and from any computer, we have an online instructor
to help us, and the classes are free! Also, since my employer is now requiring that everyone
in our office earn 5 Continuing Education Units every two years, this will help me stay up-to-
date with my training.
Tom, I hope the rest of your family is doing well and that the kids are ready for summer.
Once you get your email account set-up, we’ll be able to write to each other all the time.

Teaching Guides for NTA Level 4 MLS Curriculum Page 928

Session 11: Demonstration on Creating
Tables in Word Processor.
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Practice on Creating a table
 Practice on Editing Tables
 Practice Formatting Tables
 Practice on Create a Table of Contents by using TC Fields

Resources Needed
 Flip charts, marker pens, and masking tape.
 Black/white board and chalk/whiteboard markers.
 Computer.
 LCD.
 Handout.

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 25 minutes Presentation Create a table
3 20 minutes Hands on Practice Edit Tables
4 20 minutes Hands on Practice Format Tables
5 25 minutes Presentation Create a Table of Contents
6 15 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Step 2: Create a Table (25 minutes)

 Tables allow large amounts of text and/or numbers to be presented in an organized and
easy to read fashion. Student roll books, sport statistics, address books, math formulas,
menus and many other documents often incorporate tables to share information. Similar

Teaching Guides for NTA Level 4 MLS Curriculum Page 929

 to columns, Tables can be challenging at first. Word has created an entire menu to help
assist you in creating your first Table.
 A few important terms to know before you begin creating tables are:
 Row - A row runs horizontal in a table and is divided by borders.
 Borders - Separating lines in the table.
 Column - A column runs perpendicular in a table and is divided by borders.
 Cell - A cell is the box that is created when your rows and your columns intersect each
other. The cell contains your data or information.

Figure 1: Row and Column Direction

Source: Goodwill Community Foundation 2002

 Creating Tables Using the Insert Table Dialog Box

o Click Table on the Menu Bar.
o Select Insert and then Table from the cascading menu. The Insert Table dialog box
appears.
o Determine the number of columns and rows you need in your table. You can add
more lately, but save yourself some work. You can always add rows by pressing Tab
at the end of a row.
o To create a table as wide as your page, leave the Fixed Column Width setting on
Auto.
o Click OK. A table is inserted into your document.

Teaching Guides for NTA Level 4 MLS Curriculum Page 930

Figure 2: Insert Table

Source: Goodwill Community Foundation 2002

 Another automated way to create a quick table is by using the Insert Table Button on the
Standard toolbar.
o Creating Tables Using the Insert Table Button
o Click the Insert Table Button .
o Now, drag the number of columns and rows you want in your table.

Figure 3: Tool for Insert Table

Source: Goodwill Community Foundation 2002

 Custom-Made Tables
o The Insert Table Dialog Box and Insert Table button offer a quick solution to making
tables. If you would like to custom create your table by drawing it yourself, you can
use the Draw Table button.
o Creating Tables Using the Draw Tables Button
o Open the Tables and Borders toolbar by clicking View on the Menu Bar, Select
Toolbars and then Tables and Borders from the Cascading Menu. The Tables and
Borders toolbar will appear.

Teaching Guides for NTA Level 4 MLS Curriculum Page 931

 o Click the Draw Tables button on the Tables and Borders toolbar. The mouse pointer
turns into a pencil.

Figure 4: Tables and Borders

Source: Print Screen from Microsoft Word 2003

o Drag the pencil to create a rectangle about the size of the table you want.
o Release the mouse button. The border of the table appears in your document.
o Use the pencil again to draw in column and row borders.
o Click the Draw Table button again to change the pencil back into an I-beam.
o If you make a mistake while drawing your table, you can erase both rows and
columns by using the Eraser on the Tables and Borders toolbar. Once you select the
Eraser, the pointer will change to resemble the Eraser Button. Drag the Eraser
over parts of the table you wish to erase. When you are finished erasing, click the
Eraser button again to put the Eraser away.
 Entering Text
o Click inside any table cell to begin entering text or numbers.

o Moving Around in a Table:

o Use the Tab key or right arrow key to move right.
o Use Shift + Tab or the left arrow key to move left.
o The up and down arrow keys will move the insertion point above or below its current
location.
o Selecting Text in Tables
o A cell: triple click inside cell.
o A row: Move mouse to left of margins, point to the row, and click.
o Multiple rows: Select the first row, click and drag the number of rows desired.
o A column: Move the mouse above the column. It turns into a downward pointing
arrow. Click once.
o Multiple columns: Select the first column, click and drag the number of columns
desired.
o Entire Table: Choose Table and Select Table from the menu bar.

 Selecting Cells
o To act on a group of cells they must first be selected. To select a cell or group of Cells
use the selection arrow. This is shown when the cursor is placed near a left cell edge
or the top of a column.
o In a new document, create table 5 columns by 5 rows.
o Select the first cell by moving near to its left edge and clicking the left mouse button
when the arrow is displayed, as in the diagram.

Teaching Guides for NTA Level 4 MLS Curriculum Page 932

 Move the mouse down and click again to remove the selection. Select the Second column
by moving near to the top edge of the column and clicking the Mouse when the selection
arrow is displayed.

 Select the entire third row by double clicking when the arrow is displayed at the edge of
any cell in the row or by clicking once when the arrow is in the Selection bar on the left.

 Select the nine cells in the middle of the table by clicking and dragging.
 Close the document without saving.

Note: To select a row/column, position the cursor within the row/column then use Table |
Select Row/Column. Table | Select Table will select the entire tab

 Activity 1: Open Your Document from Activities 1 Session 10 (5 minutes)

o Insert a table into your document using one of the methods described in the lesson.
o Enter text into your table.
o Save and close your document.

Step 3: Editing Tables (20 minutes)

 Once you have created your table, you may find that you need to format text within your
table, insert or delete rows and columns, or perhaps just change the appearance of your
table so that it is more visually appealing.
 Formatting Text in Tables. Fortunately, whatever you do to format text in a paragraph
(make it bold green, for example), you can do to text in a table cell. Formatting text
within a table can be accomplished through a variety of means, including the Formatting
menu, the Tables and Borders toolbar, the Task Pane and keyboard shortcuts.
 Rotating Text in Tables. Many advertisements, for sale signs, menus, and other creative
documents use Word's text direction feature to change typical horizontal text to eye-
catching vertical text. You can rotate text so it runs vertically, facing either the right or
the left.
 To Rotate Text in a Table Cell.
 Select the cell(s) you want to rotate.

Teaching Guides for NTA Level 4 MLS Curriculum Page 933

 Click the Change Text Direction button : on the Tables and Borders toolbar.
 Clicking the Change Text Direction button once turns text to the vertically left, the
second click turns text to vertically right, and the third click will bring your text back to
a horizontal position.

Figure 5: Text Direction

Source: Goodwill Community Foundation 2002

 The insertion point rotates when entering vertical text, but editing vertical text is really no
different than editing horizontal text.
 Inserting and Deleting Columns and Rows
 Estimating how many rows and columns you will need in a table is not always easy.
Therefore, it is important to know how to insert and delete rows and columns in your
existing table.
 To Add Rows to Your Table
o Move the insertion point to the last cell in the table and press Tab.
 To Insert Rows in the Middle of the Table
o Place the insertion point anywhere in the table.
o Choose Table Insert Rows above OR Rows below.
 To Delete Rows
o Select the row(s) you want to delete.
o Choose Table Delete Rows.
o OR Right-click and choose Table Delete Rows from the shortcut menu.
o To Delete Single Table Cell:
o Place the insertion point inside the cell you wish to delete.
o Choose Table Delete Cells from the menu bar. The Delete Cells dialog box
appears.
o Click Shift cells left, Shift cells up, Delete entire row, or Delete entire column.

Figure 6: Delete Cells

Teaching Guides for NTA Level 4 MLS Curriculum Page 934

Source: Goodwill Community Foundation 2002

 To Insert a Column:
o Position the mouse pointer where you want to column to be located.
o Choose Table Insert Insert Columns to the Right or Insert Columns to the Left.

Figure 7: How to Insert Columns

Source: Goodwill Community Foundation 2002

 Resizing Tables
o You may need to adjust the size of columns, rows, and cells.
 To Adjust Columns, Rows, and Cell Size
o However the insertion point over any line in your table that borders the area you want
to change.
o The insertion point changes to a double-headed arrow.
o Drag the border either left or right OR up and down.

o To automatically adjust the size, select the entire Table and then choose Table
AutoFit AutoFit to Contents.

Step 4: Formatting Tables (20 minutes)

 AutoFormat
 Just as Word offers document templates for memos, faxes, reports and other items; Word
also offers templates for Tables.
 To use AutoFormat:
 Create your table.

Teaching Guides for NTA Level 4 MLS Curriculum Page 935

 Click anywhere in the table. Go to the toolbar and select Table and then Table
AutoFormat. The Table AutoFormat dialog box appears.
 Scroll through the Table Styles until you find a table you like. You can preview the Table
Style in the Preview Box.
 Check and uncheck the options in the Apply special Formats to: sections to slightly
change parts of your table. Check out your changes using the Preview box.
 Click the New button to customize your own Table Style.
 Click the Modify button to change parts of an existing Table Style.
 Click OK.

 Adding Borders
o Many of the tables in the AutoFormat Dialog Box use unique borders and shading
options. To add these special features to your own table, you can use the Tables and
Borders toolbar.

Figure 8: Table AutoFormat

Source: Goodwill Community Foundation 2002

 To Change Line Style or Line Weight on an Existing Table

o Click the drop down arrows (next to the buttons) to view and select from the list of
choices.
o The mouse pointer turns into a pencil
o Trace the line(s) you want to change.
o Click anywhere outside the table to change to pencil back into the I-beam.
o To Change the Border Color on an Existing Table
o Click the drop down arrow next to the Border Color button. A color menu appears.
o Select a color. The I-beam becomes the pencil.
o Using the pencil, trace the border(s) that you want to color.

Teaching Guides for NTA Level 4 MLS Curriculum Page 936

Figure 9: Selecting Colors

Source: Goodwill Community Foundation 2002

 To Apply a Border
o Select the Line Style, Line Weight, and Border Color you would like.
o Select the cells you want bordered.
o Click the Outside Border button drop down menu and choose the location of your
border.

Figure 10: Border Applications

Source: Goodwill Community Foundation 2002

Activity 2: Open Your Document From Activity 1 Above. (10 minutes)

 Edit the text, if necessary. Ask yourself:
 Is it the right font and size?
 What direction do I want the text?
 How do I want it aligned?
 Delete any unnecessary rows or columns.
 Add any needed rows or columns.
 Resize the table, if needed.
 Save and close the document.

Step 5: Creating a Table of Contents Using TC Fields 25 Minutes)

 Procedure
o Go to Page 2 and place the insertion point in front of the heading.
o You want to add a TC field here so that it will appear in the table of contents.
o Press <Alt> + <Shift> + <O> (the letter O, not the number 0) to mark the selected text
as a table of contents entry.
o The Mark Table of Contents Entry dialog box appears, as shown in Figure 12. Now
you need to enter what you want to appear in the table of contents entry.

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 o Type a Look at the Problem in the Entry box.
o Next, you need to specify the level of the table of contents entry by clicking the Level
list. Since you want this table of contents entry to appear at the top level of the table
of contents, you don’t need to change the Level list 4. Click Mark and then Close.
o You’ve just created a level 1 table of contents entry. Let’s add one more
o Go to Page 3.
o You want to add another TC field here. If you spot the text you want to appear in the
o TC field, you can highlight it before pressing <Alt> + <Shift> + <O>.
o Select the text Corporate Intranet and press <Alt> + <Shift> + <O>.
o The Mark Table of Contents Entry dialog box reappears. Since you selected
“Corporate
o Intranet” before pressing <Alt> + <Shift> + <O>, you don’t have to type a table of
contents entry, but you still need to specify the table of contents level.
o Type 3 in the Level box and click Mark and then Close.
o You’ve just created a level 3 table of contents entry. Now you have to create a table of
contents based on the Table of Contents Entries you’ve made.
o Press <Ctrl> + <Home> to go to the beginning of the document.
o You have to delete the old table of contents before you can insert the new one. Here’s
how to delete a table of contents.
o Select the table of contents. Right-click the table of contents and select toggle Fields
Codes from the shortcut menu.
o This is the field code that tells Word to create a table of contents. By displaying the
field code, you can easily delete the table of contents.
o Delete the table of contents field code by selecting it and pressing the <Delete> key.

 Insert the new table of contents.

o Select Insert → Reference → Index and Tables from the menu and lick the Table of
Contents tab if necessary.
o The Index and Tables dialog box appears with the Table of Contents tab in front. By
Default, Word builds the table of contents using any heading styles it finds in a
document, so you have to specify that you want to build the table of contents using
TC fields. To do this, you need to click the Options button first.
o Click the Options button.
o The Table of Contents Options dialog box appears, as shown in Figure 10-22. Here,
you can specify how you want to build your table of contents. You can build your
table of contents from:
o Styles: This option builds a table of contents based on the heading styles in your
document.
o Outline levels: This option builds a table of contents based on text marked with
outline levels in your document, instead of, or in addition to, styles.
o Table entry fields: This option builds a table of contents based on any table of
contents entries you’ve defined.
o Both: By checking more than one checkbox, you can build a table of contents that
includes both options in your document.
o Uncheck the Styles, and Outline levels options. Check the Table entry fields
checkbox, click OK, and OK again. Word builds a new table of contents based on the
TC fields you inserted in the document. Since you only inserted two TC fields, the
resulting table of contents

Teaching Guides for NTA Level 4 MLS Curriculum Page 938

Figure 12: Make Table of Content Entry and Options

Source Custom Guide Microsoft WORD 2003

 Changing column width

o The most important advantage of the tables feature over the tab stops is the ability to
change the width of the column interactively. Note that the total width of the table is
restricted by the space available between the margins. Reduce the width of small
columns before widening others.
o Open the document Table.
o Select View | Ruler to display the ruler if it is not already on the screen.
o Move the cursor into the table. When inside the table the ruler shows the table column
divides as symbols within the ruler.

o A column width can be changed by clicking on the divide, then dragging to a new
position before releasing the mouse button. A double-headed arrow appears when the
mouse pointer is over the division.
o Reduce the first three columns (make Cost Price fit on two lines).
o Now select Table | Select Table, then Table | Table Properties. Select the
o Row tab, check Specify height and enter 1 cm in the box. Click OK.

Teaching Guides for NTA Level 4 MLS Curriculum Page 939

Figure 12: Show Table Properties

Source: from Microsoft Word 2003

Note: Column width, cell size and text alignment can be changed from the Column and Cell
tabs.
Save the document as Table1.
Print a copy of the document and leave open for the next Session.

Note: Row Heights can also be changed using the ruler. Switch to Print Layout and use the
Vertical Ruler. Hold <Alt> whilst changing the row height to view the correct measurements
on the ruler.

Step 6: Key Points (15 minutes)

 Important terms
o Borders - Separating lines in the table.
o Column - A column runs perpendicular in a table and is divided by borders.
o Row - A row runs horizontal in a table and is divided by borders.
o Cell - A cell is the box that is created when your rows and your columns intersect
o Tables allow large amounts of text and/or numbers to be presented in an organized
and easy to read fashion. Student roll books, sport statistics, address books, math
formulas, menus and many other documents often incorporate tables to share
information.
o Once you have created your table, you may find that you need to format text within
your table, insert or delete rows and columns, or perhaps just change the appearance
of your table so that it is more visually appealing.
o Many of the tables in the AutoFormat Dialog Box use unique borders and shading
options. To add these special features to your own table, you can use the Tables and
Borders toolbar.
o Creating Tables Using the Insert Table Dialog Box
o Rotating Text in Tables. Many advertisements, for sale signs, menus, and other
creative documents use Word's text direction feature to change typical horizontal text

Teaching Guides for NTA Level 4 MLS Curriculum Page 940

 to eye-catching vertical text. You can rotate text so it runs vertically, facing either the
right or the left.

Step 7: Evaluation (10 minutes)

 List steps to create a table
 Describe steps in editing tables
 Describe steps to display The Table AutoFormat dialog box.
 Point out steps to creating a Table of Contents Using TC Fields

Resources
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window, Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 941

Session 12: Demonstration on Working
with Images
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Practice Insert and set objects
 Practice Insert and set pictures
 Practice on Creating and modifying Diagrams and Charts
 Practice on Use of AutoText and Data source

Resources Needed
 Flip charts, marker pens, and masking tape.
 Black/white board and chalk/whiteboard markers.
 Computer.
 LCD.
 Handout.

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 25 minutes Presentation Insert and set Object
Presentation
3 20 minutes Insert and Set Pictures
Create, Insert
Presentation
4 25 minutes Create, Modify Diagrams and Charts
organization chart
5 20 minutes Presentation AutoText and Data Source
6 10minutes Presentation Key points
7 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Insert and Set Objects (25 minutes)

 Introduction to Word Graphics

Teaching Guides for NTA Level 4 MLS Curriculum Page 942

 o Now that you are comfortable adding and formatting text, headers and footers,
columns, and tables, let's learn to enhance your documents by adding objects and
pictures. The Drawing Toolbar offers many options for including lines, lines with
arrows, and many types of shapes into your document.
o Drawing objects include
o AutoShapes: including Lines, Curves, and Textboxes
o WordArt drawing objects
 Drawing Objects
o To Draw Lines and Shapes
o Open the Drawing toolbar by clicking View on the Menu Bar, Select Toolbars and
then Drawing from the Cascading Menu.
o OR
o Right-click on any toolbar and select drawing.
o Click the Drawing button on the Standard toolbar.
o The Drawing toolbar will appear.

Figure 1: Drawing Button

Source: screen shot from Microsoft Word 2003

 Choose an AutoShape from the AutoShape drop down menu. OR Click any of the
drawing
 Tools in the first group of buttons.
 Line Tool -
 Arrow Tool -
 Rectangle Tool -
 Oval Tool -
 The mouse pointer changes to a crosshair .
 Drag the crosshair from a starting point until the object is the desired size.
 Release the mouse button to end the drawing object and turn off the Drawing tool.
 Hold the Shift key down to create straight lines, perfect circles, or perfect squares.
 AutoShapes are inserted (on their own layer) with the In front of text wrapping style
applied.

 WordArt Drawing Objects

Teaching Guides for NTA Level 4 MLS Curriculum Page 943

 o Also included on the Drawing toolbar is the WordArt Feature. Using WordArt, you
can create text graphics that bend, slant, and appear metallic or wooden and much,
much more. WordArt can even be shadowed, skewed, rotated, and stretched.

o Here are just a few examples of what WordArt allows you to do:

 To Insert WordArt
o Place the insertion point where you would like to insert WordArt.
o Click the WordArt button on the Drawing toolbar . The WordArt gallery opens.
o Choose (click) a WordArt style.
o The Edit WordArt Text dialog box appears.
o Edit the font, size, and style.
o Click OK.

Figure 2: Inserting Word art

Source: screen shot from Microsoft Word 2003

 Formatting Drawing Objects

o Use the Drawing toolbar to format AutoShapes and WordArt.

To select several objects hold down the Shift key and click on each object, or use the
Select Objects tool.
Fill color allow you to color all selected drawing objects. No fill is the color white.

Change the line color of a selected object.

Changes the text color of a selected object.

Teaching Guides for NTA Level 4 MLS Curriculum Page 944

 Changes the line style of a selected object.

Changes the line style of a selected object. Includes solid and dotted lines.

Changes the style of arrow.

Gives selected object some depth.

Gives selected object a 3D effect.

 Activity 1: Open Your Document from Activities 1 Session 9 (5 minutes)

 Using both AutoShapes and WordArt, create an image for your flyer.
 Edit the image.
 Save and close the document.

Step 3: Insert and Set Pictures (20 minutes)

 Clip Art
o Word comes bundled with hundreds of Clip Art images that are copyright free and
available for your personal use. The clip art images that are available through Word
cover many different categories and can really help enhance your pages. If you have
never inserted clip art before, Word will ask if you would like to catalog all of the
available resources (clip art, sound and video files) on your computer. It is a good
idea to go ahead and catalog all of these free resources.
 To Insert Clip Art
o Place the insertion point where you want to insert the clip.
o Click Insert on the Menu Bar.
o Select Picture and then Clip Art from the cascading menu. The Insert Clip Art
menu opens on the Task Pane.
o Type a keyword in the Search Text: field.
o Click Search. OR
o Specify your search by using the Other Search Options.
o Search in: - specifies where Word will search for clip art. As long as the check box
everywhere is checked, Word will search through All Collections
o Results should be: - specified what type of file Word will search for (video, audio,
photographs, clip art). As long as the check box for All Media Types is checked,
Word will search through All Media Files.
o Double-Click The Clip Art Or Picture To Add To The Document.
o To change your Search For text: Click the Modify button below the clip art results

o To preview video and sound clips, click the appropriate tab and click the Play button
to preview the file.
 To Delete a Picture
o Select the image (click on it).
o Press the delete key on your keyboard.
o Inserting Pictures from your Computer

Teaching Guides for NTA Level 4 MLS Curriculum Page 945

 o A picture doesn't have to be in the Clip Gallery in order for you to insert it into your
document. The Clip Gallery is just an easy place to store clips you want to use again
and again.
 To Insert a Picture that is NOT in the Clip Gallery
o Click Insert from the Menu Bar.
o Select Picture and From File from the cascading menu. The Insert Picture dialog
box opens.
o Locate and select the file to insert the selected picture into your document.

Figures 3: Inserting Picture to the File

Source: Goodwill Community Foundation 2002

Figure 4: clip Art

 Moving Clips
o Once you have inserted a graphic into your document you can re-position the graphic
until it is in the appropriate location. By default, when a picture is imported into
Word, it is aligned to the left margin. However, just as you would text, you can

Teaching Guides for NTA Level 4 MLS Curriculum Page 946

 change the alignment so the graphic is right-aligned or centered. You can also drag
the image anywhere on the page.
 To Move a Clip
o Select the clip.
o Use your mouse to drag a selected clip to any position on the page.
o The I-beam turns into a white pointer with a little box under it as you move the
picture. OR
o Use the Alignment buttons on the Formatting toolbar. Source: Microsoft Word 2003
 Sizing Handles
o You have two options when sizing your graphics. If it is important to maintain
proportions, which will prevent the image from looking skewed, then you should use
the corner handles to re-size the image. If you do not need to maintain the graphic's
proportions, you can use the top, bottom or side handles
 Changing Size While Maintaining Proportions
o Click the image you want to re-size.
o Place the cursor over one of the corner handles. The cursor will change into a double-
headed arrow.
o Drag the handles until the image is the size you need.

Figure 5: Resizing Shape

Source: Morris M & Charles, M., (2003)

o To keep the center of an object in the same place, hold down the CTRL key while
dragging the mouse.
 Changing Size While Not Maintaining Proportions
o If any of the middle handles are dragged (top, bottom, right, or left handles), only the
height and width changes, thus changing the proportion, or scale, of the picture.
o Be careful; using only the sizing handle can make your pictures blurry and distorted.
 Changing the Appearance of your Pictures
o Sometimes you may need to not only adjust the sizing of your pictures, but you may
notice the picture is too dark or too bright for your liking. You can adjust your picture
using the Picture toolbar.
 To use the Picture Toolbar
o Right-click the picture.
o Choose Show Picture Toolbar from the shortcut menu.

Teaching Guides for NTA Level 4 MLS Curriculum Page 947

  Crop, Recolor Object, and Set Transparent Color buttons are used with areas
of the picture. All other buttons affect the entire picture.

Figure 6: Picture Toolbar

Source: print screen Microsoft Word

Name of Button: Use it to:

Insert Picture from Insert another picture

File
Color Automatic, Grayscale, Black & White, or Watermark

More Contrast Increase color intensity

Less Contrast Decrease color intensity

More Brightness Add white to lighten all colors

Less Brightness Add black to darken the color

Crop Cut the sides of an image

Rotate Left Each click turns the image by 90 degrees to the left

Line Style Customize the border of an image

Compress Pictures Changes the Resolution of your image

Text Wrap Set how text wraps around the image

Format Picture Displays the Format Picture Dialog Box

Set Transparent Use eyedropper to make areas of the picture transparent (mainly for
Color web graphics)

Reset Picture Return picture to original format

 Activity 2: Create and Insert Clip Art (5 minutes)

 Create your document in Word.
 Insert a clip art or image from a file on your computer into your document. You may
insert multiple images.
 Resize, modify, and/or move the image to the location you want it to be in your
document. To re-position the image, practice clicking and dragging, centering, right-
alignment, etc.

Teaching Guides for NTA Level 4 MLS Curriculum Page 948

 This is your final challenge for Microsoft Word 2003. Does your flyer look the way that
you want it to? It probably does not look quite like you imagined. You should take the
time now to move around the symbols, text boxes, tables, columns, etc. Add any new
components that you would like. You have learned about the Word 2003 features. Now
spend a little time now making this flyer look the way you would like it to be. Some of
these features are a little difficult to learn, but the more you practice, the easier it
becomes.

Step 4: Creating and Modifying Diagrams and Charts (25 minutes)

 Word allows you to create basic diagrams using the templates in the Diagram Gallery.
The six diagram types are: Organization Chart, Cycle Diagram, Radial Diagram, Pyramid
Diagram, Venn diagram, and a Target Diagram. A description of each type of diagram is
included in the Diagram Gallery to help you decide which template will best meet your
needs

 To Insert a Diagram From the Diagram Gallery

o Select Insert Diagram from the main menu.
o Select a diagram.
o Click OK. The diagram will appear in your Word document.
 To Modify a Diagram
o Since each diagram is completely different, the modifications you can make will
differ depending on the diagram you insert. However, the tools you use to modify the
diagrams are the same.
o You can
o Right-click any shape or text box within the diagram to modify or delete it. The
menu will change depending on the item you select. OR Modify the diagram using
the Diagram Toolbar. The drop-down menus on the Diagram Toolbar will differ
depending on the type of diagram you choose.
 To Insert a Chart
o Select Insert from the main menu.
o Select Picture Chart from the cascading menu. A chart and datasheet will appear
in your document.
o Delete the existing data in the datasheet.
o Enter your own data in the datasheet.

Figure 7: Chart

Teaching Guides for NTA Level 4 MLS Curriculum Page 949

Source: from Microsoft Word 2003

 Close the datasheet. All of your changes will appear in the chart.
 Save and close the document.

Activity 3: Use Diagram Gallery to Insert an Organization Chart (5 minutes)

Open a new, blank Word document.

 Insert an Organization Chart using the Diagram Gallery.

o Enter the necessary data in the diagram.
o Modify the appearance of the diagram.
o Save and close the document.

Step 5: Using AutoText and Data Source (20 minutes)

 AutoText is a feature that recognizes commonly used words and phrases as you type
them. The AutoText feature can save you a great deal of time.
 To Insert a Word Recommended by AutoText:
 Type text into your document. If AutoText recognizes a word or phrase, a suggestion box
will hover over the word.
 Press Enter to accept the AutoText suggestion.
 To Insert Predefined Text from the AutoText List:
 Select Insert AutoText from the main menu.
 Choose the text you wish to insert from the predefined list of words and phrases.
 To Insert a New Word or Phrase into the AutoText list:
 Select Insert from the main menu.
 Select AutoText AutoText... from the cascading menu. The AutoCorrect dialog box
will appear.
 Select the AutoText tab.
 Enter the word or phrase in the Enter AutoText entries here: field.
 Click Add.
 Click OK.

Teaching Guides for NTA Level 4 MLS Curriculum Page 950

Figure 9: Inserting Word by AutoText

Source: print screen from Microsoft Word 2003

Creating the Main Document

 The first step in mail merging is to create the Main Document. A main document can take
a range of formats, such as form letters, mailing labels, envelopes or catalogues. Word
gives a great deal of assistance in the form of Mail Merge Helper.
 In a new document, open the Mail Merge Helper using Tools | Mail Merge.
 Select Create and choose Form Letters, selecting to use the Active Window.
 Select the Edit button then Form Letter:
o Document (The number may vary).
o The edit screen appears, showing the Merge toolbar. Use ToolTips to discover the use
of each button.
o Enter the current date (using Insert | Date and Time). From the Available formats,
select the date in the format 25 January 2001. Add 2 blank lines. Type the following
paragraph.

Dear
Just a brief reminder that the next annual conference of the Word Users Club is only a few
weeks away. Delegates are limited to 1500 this year, so please hurry and reserve your place!

Sincerely

Ms M S Word
 Save the document with the name Main. Use the Mail Merge Helper button, to continue

Teaching Guides for NTA Level 4 MLS Curriculum Page 951

Creating a Data Source
 A Data Source can be used with any number of Main Documents, so their creation must
be well thought out. They can be created before or after the Main document and can be
accessed at any time once created.
 The Get Data button will now be available from the Data Source heading.
 Click on it and select Create Data Source.

Figure 10: Create the Data Source

Source: International Computer Driving License 2000

 At the dialog box, remove field names so that only Title, Last Name, Company,
Address1, Address2 and City remain. Do this by clicking on the field name that is not
needed and then Remove Field Name.
 Add Initial by typing it in the Field name box and selecting to Add Field Name. Move it
to the appropriate place in the list using the Move keys, Click on OK and save the data
file as Data.
 Choose to Edit Data Source. The Data Form now appears.
 Enter your own details and those of 3 other people (fictional if necessary), at least two of
whom must live in Sunderland. Select Add New after each record. Click on OK to end.

Notes: The Edit Data Source button, can be used to add/remove records at a later stage, if
required.
Activity 4: AutoText (5 minutes)
ASK student to open a new, blank Word document.
ALLOW them to do below activity
 Type today's date.
 Press Enter twice.
 Type a short letter to a friend.
 Press Enter twice.
 Add the phrase Sincerely; You’re Name in the AutoText list of words and phrases.
 Save and close the document.

Step 6: Key Points (10 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 952

 The Drawing Toolbar offers many options for including lines, lines with arrows, and
many types of shapes into your document.
 Using WordArt, you can create text graphics that bend, slant, and appear metallic or
wooden and much, much more. WordArt can even be shadowed, skewed, rotated, and
stretched.
 A picture doesn't have to be in the Clip Gallery in order for you to insert it into your
document. The Clip Gallery is just an easy place to store clips you want to use again and
again.
 The six diagram types are: Organization Chart, Cycle Diagram, Radial Diagram, Pyramid
Diagram, Venn diagram, and a Target Diagram.
 Drawing Objects
o Right-click on any toolbar and select drawing.
o Click the Drawing button on the Standard toolbar.
o The Drawing toolbar will appear.
 Also included on the Drawing toolbar is the WordArt Feature. Using WordArt, you can
create text graphics that bend, slant, and appear metallic or wooden and much, much
more. WordArt can even be shadowed, skewed, rotated, and stretched.
 Word comes bundled with hundreds of Clip Art images that are copyright free and
available for your personal use. The clip art images that are available through Word cover
many different categories and can really help enhance your pages. If you have never
inserted clip art before, Word will ask if you would like to catalog all of the available
resources (clip art, sound and video files) on your computer. It is a good idea to go ahead
and catalog all of these free resources. Search in: - specifies where Word will search for
clip art. As long as the check box everywhere is checked, Word will search through All
Collections
 Results should be: - specified what type of file Word will search for (video, audio,
photographs, clip art). As long as the check box for All Media Types is checked, Word
will search through All Media Files.
 Moving Clips
o Once you have inserted a graphic into your document you can re-position the graphic
until it is in the appropriate location. By default, when a picture is imported into
Word, it is aligned to the left margin. However, just as you would text, you can
change the alignment so the graphic is right-aligned or centered. You can also drag
the image anywhere on the page.

Step 7: Evaluation (15 minutes)

 List steps to insert and set objects
 List steps to insert and set pictures
 Describe how to create and modify Diagrams and Charts
 List steps to insert Hyperlinks
 Describe how to use AutoText List

Resources
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.

Teaching Guides for NTA Level 4 MLS Curriculum Page 953

 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window , Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 954

Session 13: Demonstration on Printing
and Managing Documents
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students will be able to:
 Practice Print Envelopes
 Practice Print Labels
 Practice Use of Track Changes tool
 Practice Accepting and Rejecting Changes
 Practice Inserting Comments
 Practice View and Editing Comments

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD
 Handout 9.1: Monthly Budget

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 15 minutes Hands on Practice Print Envelopes
3 20 minutes Hands on Practice Print Labels
4 15 minutes Hands on Practice Track Changes tool
5 15 minutes Hands on Practice Accepting and Rejecting Changes
Hands on
6 10 minutes Inserting Comments
Practice, Buzz
Hands on
7 10 minutes View and Editing Comments
Practice, Buzz
8 15 minutes Presentation Key Points
9 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of session title and learning objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.

Teaching Guides for NTA Level 4 MLS Curriculum Page 955

 ASK students if they have any questions before continuing

Step 2: Printing Envelopes (15 minutes)

 To Address and Print Envelopes
 Select Tools from the main menu.
 Select Letters and Mailings Envelopes and Labels from the cascading menu. The
Envelopes and Labels dialog box will appear.
 Enter the Delivery Address. This will appear automatically if you are working with a
letter at the same time.
 Enter the Return Address.
 Click Options to set the envelope and printing options. The Envelope Options dialog box
will appear.

Figure 1: Envelopes

Source: Print Screen from Ms Word 2003

 Click the Envelope Options tab.

 Make any changes to the envelope size or font.

Teaching Guides for NTA Level 4 MLS Curriculum Page 956

 Click the Printing Options tab.
 Choose the correct feed method for your printer.
 Click OK.
 Click Add to Document if you are working with a letter. This will display a version of
the completed envelope. OR
 Click Print to just print the envelope.

Activity 1: Envelopes and Labels (5 minutes)

Handout 13.1: Envelopes and Labels to complete this Challenge.

 Open the Envelopes and Labels document.

 Create a size 10 envelope with a delivery address and a return address.
 Close the document.

Step 3: Printing Labels (20 minutes)

 Word allows you to print a single mailing label or a full sheet of mailing labels.
 To Print Mailing Labels
 Select Tools from the main menu.
 Select Letters and Mailings Envelopes and Labels from the cascading menu. The
Envelopes and Labels dialog box will appear.
 Select the Labels tab.
 Enter the address in the Address: field.
 Select Full Page of same label or Single label.

Figure 3: Labels

Source: Print Screen from Ms Word 2003

 Click Options. The Labels Options dialog box will appear.

 Select the product number for the labels you are using.
 Select the printing tray.
 Click OK.
 Click New Document to view the labels in a new document. OR
 Click Print to just print the labels.

Teaching Guides for NTA Level 4 MLS Curriculum Page 957

Activity 2: Complete Below Bullet (5 minutes)
ASK student to refer Envelopes and Labels from
Handout 13.1: Envelopes and Labels to complete this Challenge.

 Open the Envelopes and Labels document.

 Create a full page of address labels for ABC Construction.
 Close the document.

Step 4: Tracking Changes (15 minutes)

 The Track Changes feature of Word allows multiple people to work on a document, and
for suggested changes to be tracked.
 To Track Changes to a Document
 Select Tools Track Changes from the main menu. The Track Changes feature will
be active.
 Change the document formatting or edit the text. Notice how the changes are documented
on the screen.

Figure 4: Red Word Represent Tracking Changes

Source: Goodwill Community Foundation 2002.

Activity: Track Changes (10 minutes)

Refer students to Handout 13.2 Cover Letter

 Open the Cover Letter document.

 Turn on the Track Changes feature.
 Insert a new paragraph.
 Delete a sentence.
 Save and close the document

Teaching Guides for NTA Level 4 MLS Curriculum Page 958

Step 5: Accepting and Rejecting Changes (15 minutes)
 When you receive a Word document that has been edited using the Track Changes
feature, you will need to decide whether you want to accept or reject each of the
changes.
 To Accept or Reject Changes
 Select View from the main menu.
 Select Toolbars Reviewing. The Reviewing Toolbar will appear.

Figure 4: Reviewing Toolbar

Source: Goodwill Community Foundation 2002.

 Position your cursor next to the first proposed change.

 Click the Accept Change or Reject Change button.
 Use the Next and Previous buttons to navigate through each proposed change. Choose to
accept or reject each change.

Activity 3: Use Reviewing Toolbar to Do Below Bullets (5 minutes)

 Use the Next and Previous buttons to review the changes.
 Use the Accept Changes button to accept several proposed changes.
 Use the Reject Change button to reject several proposed changes.
 Save and close the document.

Step 6: Inserting Comments (10 minutes)

 Microsoft Word provides several tools for document collaboration. One of these
features allows you to insert comments into a document and provide suggestions to the
document's author without changing the original text.
 To Insert a Comment
 Position your cursor next to the word where you would like to insert a comment.
 Select Insert Comment from the main menu. The Reviewing toolbar will appear at the
top of the page and a comment balloon will appear in the margin.
 Type your comment in the balloon.
 Click outside the balloon.

Teaching Guides for NTA Level 4 MLS Curriculum Page 959

Activity 4: BUZZ (5 minutes)
 Open any Word document on your computer.
 Insert at least three comments.
 Save and close the document

Step 7: Viewing and Editing Comments (10 minutes)

 Word provides you with several document collaboration tools. One of these tools allows a
person to insert comments into a document, and a different person to view and edit
those comments.
 To View and Edit Comments
 Select View Markup from the main menu.
 View the comments in each comment balloon and decide whether to modify the
document based on the comment. Right-click each comment balloon after reviewing the
comment.
 Select Delete Comment.
 Click the Next Tool on the Reviewing Toolbar to move to the next comment in the
document.

Activity 5: Buzzing (5 minutes)

 Open any word document on your computer.
 Insert at least three comments.
 Save and close the document.
 Open the same document.

Teaching Guides for NTA Level 4 MLS Curriculum Page 960

 View each comment balloon.
 Edit the document, as necessary.
 Delete all the comments in the document.

Step 8: Key Points (15 minutes)

 To address and print envelopes: Select Tools from the main men, then Select Letters and
Mailings Envelopes and Labels from the cascading menu. The Envelopes and Labels
dialog box will appear
 The Track Changes feature of Word allows multiple people to work on a document, and
for suggested changes to be tracked. To Track Changes to a Document: Select Tools
Track Changes from the main menu. The Track Changes feature will be active.
 When you receive a Word document that has been edited using the Track Changes
feature, you will need to decide whether you want to accept or reject each of the
changes. To Accept or Reject Changes: Select View from the main menu. Select
Toolbars Reviewing. The Reviewing Toolbar will appear. Position your cursor next to
the first proposed change. Click the Accept Change or Reject Change button
 To Insert a Comment: Position your cursor next to the word where you would like to
insert a comment. Select Insert Comment from the main menu
 To View and Edit Comments: Select View Markup from the main menu. View the
comments in each comment balloon and decide whether to modify the document based on
the comment. Right-click each comment balloon after reviewing the comment. Select
Delete Comment. Click the Next Tool on the Reviewing Toolbar to move to the next
comment in the document.

Step 9: Evaluation (15 minutes)

 List steps to print envelopes
 List steps to labels
 List steps to use track changes tool
 Describe steps to accept and reject changes
 List steps to insert comments in a document
 How do you view and edit comments?

Reference
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.

Teaching Guides for NTA Level 4 MLS Curriculum Page 961

 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 962

Handout 13.1: Envelope Labels

ABC CONSTRUCTION
1511 Main Street
Sanford, SC 37222
(999) 333-2222

January 9, 2007
Jones Distributing Company
3918 Chelsey Drive
Carrington, GA 40211

Dear Mr. Jones:

Thank you for your interest in using ABC Construction as your Consultant on the
construction of your new facility. We’d be pleased to meet with you to discuss the details of
this exciting endeavor.

Sincerely,

Teaching Guides for NTA Level 4 MLS Curriculum Page 963

Handout 13.2: Envelope Labels

Date

Your name
Your address
Your address
Your telephone number

Mr. Joe Smith

Health Insurance Corporation, Inc.
Director of Sales
123 Page Street
Raleigh, NC 12345

Dear Mr. Smith:

I am interested in the administrative assistant position with Health Insurance Corporation,

Inc. (job #3456) that was advertised through www.trianglejobs.com. I am familiar with your
company because I am one of the 2.5 million North Carolinians you insure. As a group
member, I am impressed by the flexibility of your health care plans and commitment to
helping people learn how to make their health a priority. Because Health Insurance
Corporation was recently named the largest stand-alone HMO plan in the state, I understand
that your need for capable assistants is growing. Please take a moment to review some of my
strengths that qualify me for the position:

I would like to meet with you to further explore the contribution I could make at Health
Insurance Corporation, Inc. I will call you in 10 days to confirm that you've received this
package, answer any questions, and see if we can arrange a meeting or phone interview. I
invite you to call me at 213-555-1212 if you need more information. Thank you for your
consideration.
Sincerely,

Your Name (Your signature)

Your Name (Typed)

Teaching Guides for NTA Level 4 MLS Curriculum Page 964

Session 14: Demonstration on Excel
Windows Features
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 Introduction to Computer

Learning Objectives
By the end of this session, students are expected to be able to:
 Identify basic parts of the Excel window
 Practice on Creating, opening and saving workbooks
 Practice on Entering, editing and deleting data
 Practice Moving, Copying and Deleting Cell Contents

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD
 Handout 14.1: Monthly Budget

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 20 minutes Presentation Identifying basic parts of the Excel window
3 35 minutes Hands on Practice Create, open and save workbooks
4 20 minutes Hands on Practice Enter, edit and delete data
5 20 minutes Hands on Practice Moving, Copying and Deleting Cell Contents
6 5 minutes Presentation Key Points
7 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Identifying Basic Parts of the Excel Window (20 minutes)

Activity 1: Brainstorm (5 minutes)
 ASK student: what is the difference between Excel and Word? What are some specific
purposes of Excel (as different from Word)?

Teaching Guides for NTA Level 4 MLS Curriculum Page 965

 Allow for some responses.
 Summarize responses from students by explaining:
 Microsoft Excel is a spreadsheet application in the Microsoft Office Suite. A spreadsheet
is an accounting program for the computer. Spreadsheets are primarily used to work with
numbers and text. Spreadsheets can help organize information, like alphabetizing a list of
names or ordering records, or calculate and analyze information using mathematical
formulas.
 The Excel Window
o Many items you see on the Excel 2003 screen are standard in most other Microsoft
software programs like Word, PowerPoint and previous versions of Excel. Some
elements are specific to this version of Excel.

Figure 1: Microsoft excel elements

Source: Goodwill Community Foundation 2002

 Workbook
o Also called a spreadsheet, the Workbook is a unique file created by Excel.

Figure 2: Title bar

Source: Goodwill Community Foundation 2002

 The Title bar displays both the name of the application and the name of the spreadsheet.

Figure 3: Menu bar

 The Menu bar displays all the menus available for use in Excel 2003. The contents of any
menu can be displayed by clicking on the menu name with the left mouse button.

Teaching Guides for NTA Level 4 MLS Curriculum Page 966

 Toolbar
o Some commands in the menus have pictures or icons associated with them. These
pictures may also appear as shortcuts in the Toolbar.

Teaching Guides for NTA Level 4 MLS Curriculum Page 967

Figure 4: Toolbar

Source: Goodwill Community Foundation 2002

Figure 5: Column Headings

Source: Goodwill Community Foundation 2002

 Each Excel spreadsheet contains 256 columns. Each column is named by a letter or
combination of letters.

Figure 6: Row Headings

Source: Goodwill Community Foundation 2002

 Each spreadsheet contains 65,536 rows. Each row is named by a number.

Figure 7: Name Box

 Shows the address of the current selection or active cell

Figure 8: Formula Bar

Source: Goodwill Community Foundation 2002

 Displays information entered-or being entered as you type-in the current or active cell
 The contents of a cell can also be edited in the Formula bar.
 Cell

Teaching Guides for NTA Level 4 MLS Curriculum Page 968

Figure 9: Active Cell B3

Source: print screen from Microsoft Excel

 A cell is an intersection of a column and row. Each cell has a unique cell address. In the
picture above, the cell address of the selected cell is B3. The heavy border around the
selected cell is called the cell pointer.

Navigation Buttons and Sheet Tabs

 Navigation buttons allow you to move to another worksheet in an Excel workbook. Used
to display the first, previous, next or last worksheets in the workbook.
 Sheet tabs separate a workbook into specific worksheets. A Workbook defaults to three
worksheets. A Workbook must contain at least one worksheet

 Workbooks and Worksheets

o A Workbook automatically shows in the workspace when you open Microsoft Excel
2003. Each workbook contains three worksheets. A worksheet is a grid of cells,
consisting of 65,536 rows by 256 columns. Spreadsheet information--text, numbers or
mathematical formulas--is entered in the different cells.

Figure 10: workbook

Source: Goodwill Community Foundation 2002

 Column headings are referenced by alphabetic characters in the gray boxes that run across
the Excel screen, beginning with the Column A and ending with Column IV.

Teaching Guides for NTA Level 4 MLS Curriculum Page 969

 Rows are referenced by numbers that appear on the left and then run down the Excel
screen. The first row is named Row 1 and the last row is named 65536.
o Important Terms
 A workbook is made up of three worksheets.
 The worksheets are labelled Sheet1, Sheet2, and Sheet3.
 Each Excel worksheet is made up of columns and rows.
 In order to access a worksheet, click on the tab that says Sheet#.
The Cell
 An Excel worksheet is made up of columns and rows. Where these columns and rows
intersect, they form little boxes called cells. The active cell, or the cell that can be acted
upon, reveals a dark border. All other cells reveal a light gray border. Each cell has a
name. Its name is comprised of two parts: the column letter and the row number.

Figure 11: Cell Point

Source: Goodwill Community Foundation 2002

 In the following picture the cell C3, formed by the intersection of column C and row 3,
contains the dark border. It is the active cell.

Figure 12: Active

Source: Goodwill Community Foundation 2002

 Important Terms
o Each cell has a unique cell address composed of a cell's column and row.
o The active cell is the cell that receives the data or command you give it.
o A darkened border, called the cell pointer, identifies it.
 Moving around the worksheet

Teaching Guides for NTA Level 4 MLS Curriculum Page 970

 o You can move around the spreadsheet in several different ways.
o To Move the Cell Pointer
o To activate any cell, point to a cell with the mouse and click.
o To move the pointer one cell to the left, right, up, or down, use the keyboard arrow
keys.
 To Scroll through the worksheet
o The vertical scroll bar located along the right edge of the screen is used to move up
or down the spreadsheet. The horizontal scroll bar located at the bottom of the
screen is used to move left or right across the spreadsheet.

Figure 13: Vertical Scrolling Bar

Source: Goodwill Community Foundation 2002

 The Page Up and Page Down keys on the keyboard are used to move the cursor up or
down one screen at a time. Other keys that move the active cell are Home, which moves
to the first column on the current row, and Ctrl+Home, which moves the cursor to the
top left corner of the spreadsheet or cell A1.
 To Move between worksheets
o As mentioned, each Workbook defaults to three worksheets. These worksheets are
represented by tabs-named Sheet1, Sheet2 and Sheet3-that appear at the bottom of the
Excel window.
 To Move from one worksheet to another worksheet:
o Click on the sheet tab (Sheet1, Sheet2 or Sheet 3) that you want to display

Activity 2: Icons association with Menu (Take-home assignment)

 ASK student to display the contents of every menu in the menu bar and note the icons
associated with specific menu choices

o ALLOW to try and find the matching pictures or shortcuts in the standard toolbar
o Click on each of the three worksheet tabs -- Sheet1, Sheet2 and Sheet3 --to practice
moving from sheet-to-sheet in the workbook

Teaching Guides for NTA Level 4 MLS Curriculum Page 971

 o Practice scrolling in the worksheet by using the Page Up (PgUp) and Page Down
(PgDn) keys
o Use the horizontal and vertical scrollbars to practice scrolling up, down, left and right
in the worksheet

Step 3: Create, Open and Save Workbooks (35 Minutes)

 Understanding File Terms
 The File menu contains all the operations that we will discuss in this lesson: New, Open,
and Close, Save and Save As.

Figure 14: Save, Save As and Close

Source: Goodwill Community Foundation 2002

 New-Used to create a new Workbook

 Open-Used to open an existing file from a floppy disk or hard drive of your computer
 Close-Used to close a spreadsheet
 Save As-Used when to save a new file for the first time or save an existing file with a
different name.
 Save-Used to save a file that has had changes made to it. If you close the workbook
without saving then any changes made will be lost.

 Creating a workbook
o A blank workbook is displayed when Microsoft Excel is first opened. You can type
information or design a layout directly in this blank workbook.
 To Create an Excel Workbook
o Choose File New from the menu bar.

Figure 15: Show How to Open New Worksheet

Source: Goodwill Community Foundation 2002

Teaching Guides for NTA Level 4 MLS Curriculum Page 972

 The New Workbook task pane opens on the right side of the screen.

Figure 16: Blank Workbook

Source: Goodwill Community Foundation 2002

 Choose Blank Workbook under the New category heading.

 A blank workbook opens in the Excel window. The New Workbook task pane is closed.

 Saving a workbook
o Every workbook created in Excel must be saved and assigned a name to distinguish it
from other workbooks. The first time you save a workbook, Excel will prompt you to
assign a name through the Save As operation. Once assigned a name, any additional
changes made to the text, numbers or formulas need to be saved using the Save
operation

 To Save a new Workbook:

o Choose File Save As from the menu bar.

Figure 17: Save As command

Source: Goodwill Community Foundation 2002

Teaching Guides for NTA Level 4 MLS Curriculum Page 973

 o The Save As Dialog Box appears.
o Click on the Save In: dropdown menu and locate where the file will be saved. Choose
3 1/2 Floppy (A:) to save the file to a floppy disk or Local Disk (C:) to save the file
to your computer.
o Type a name for your file in the File Name: box.
o Click the Save button.

Figure 18: Uses of Save As Button, Save in.

Source: Goodwill Community Foundation 2002

 To Save Changes Made to an Existing Workbook

o Choose File Save from the menu bar, or
o Click the Save button on the Standard toolbar.
o If you're saving the file for the first time and you do not choose a file name, Microsoft
Excel will assign a file name for you.
o It is a good idea to Save frequently when working in a spreadsheet. Losing
information is never fun! You can quickly save your spreadsheet by using the quick-
key combination Ctrl + S.
 Opening a workbook
o You can open any workbook that has previously been saved and given a name.
o To Open an Existing Excel 2003 Workbook
o Choose File Open from the menu bar.

Figure 20: Opening Workbook

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The Open dialog box opens.

Source: Goodwill Community Foundation 2002

 In the Look in list, click the drive, folder, or Internet location that contains the file you
want to open.
 In the folder list, open the folder that contains the file. Once the file is displayed, click on
the file you want to open.
 Click the Open button.

 Closing a Workbook
o To close an existing Excel 2003 Workbook
o Choose File Close from the menu bar. The workbook in the Excel window is
closed.

Figure 21: Close Workbook

Source: Goodwill Community Foundation 2002

 Excel 2003 will prompt you to save information if any has been typed between the last
save and the time you close the file.

Activity 3: Create a Spreadsheet (Take-home assignment)

 In this Activity you will create a spreadsheet that allows you to track your monthly
income and expenses. This file will be used in all of the remaining Excel 2003 Activities.
 Create a new blank file and save as Monthly Budget.
 Close the blank file.

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 Important Reminder: If you are using a public computer, such as one at a library or
learning centre, you may not be able to use the same computer each time. It is very
important to understand the policies on saving documents to public computers. Some
places do not allow you to use floppy disks due to the risk of computer viruses. Ask
someone in charge of the public computers where you are. If you are unsure how you will
keep a recent copy of the assignment, you can always email a copy of the document to
yourself when you finish working on the document.

Step 4: Enter, Edit and Delete Data (20 minutes)

 Entering Text in a Cell
o You can enter three types of data in a cell: text, numbers, and formulas. Text is any
entry that is not a number or formula. Numbers are values used when making
calculations. Formulas are mathematical calculations.
 To Enter Data into a Cell
o Click the cell where you want to type information.
o Type the data. An insertion point appears in the cell as the data is typed.

The data can be typed in either the cell or the Formula bar.

Figure 22: Text area

Figure 23: Data being typed appears in the both active cell and in the formula bar.

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Source: Goodwill Community Foundation 2002

Notice the Cancel and Enter buttons in the formula bar.

 Click the Enter button to end the entry and turn off the formula bar buttons.
 Excel's AutoComplete feature keeps track of previously-entered text. If the first few
characters you type in a cell match an existing entry in that column, Microsoft Excel fills
in the remaining characters for you
 Editing Information in a Cell
o Information in a spreadsheet is likely to change over time. Information can be
changed in either of two ways.
 Quick and Easy Method
o Click the cell that contains the information to be changed.
o Type the new entry. The old entry is replaced by the new entry.
o If the original entry is long and requires only a minor adjustment (in spelling, for
example), then you can directly edit the information in the cell.
 To Edit Information in a Cell
o Direct Cell Editing
o Double-click on the cell that contains the information to be changed. The cell is
opened for direct editing.

Figure 24: Direct Editing

Source: Goodwill Community Foundation 2002

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 Make the necessary corrections.
 Press Enter or click the Enter button on the Formula bar to complete the entry.
 Formula Bar Editing
 Click the cell that contains the information to be changed.
 Edit the entry in the formula bar.

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Figure 25: Editing Toolbar

Source: Goodwill Community Foundation 2002

 Deleting Information in a Cell

 To Delete Data that Already Appears in a Cell
 Click the cell that contains the information to be deleted.
 Press the Delete key, or
 Right-click and choose Clear Contents from the shortcut menu.

Figure 26: Clear Contents

Source: Goodwill Community Foundation 2002

 To Delete Data Being Typed But Not Yet Added to the Cell
o Cancel an entry by pressing the Escape key.
o Performing Undo and Redo
o Sometimes, you might do something to a spreadsheet that you didn't mean to do, like
type the wrong number in a cell. Excel 2003 allows you to undo an operation. Use the

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 Undo button on the Standard toolbar to recover an error. The last single action
is recoverable.
o To Undo Recent Actions (typing, formatting, etc), One at a Time
o Click the Undo button.
o To Undo Several Recent Actions at Once:
o Click the arrow next to the Undo button.

Figure 27: Microsoft Excel Reverses the Selected Action and All Actions That Appear in The
List Above it.

Source: Goodwill Community Foundation 2002

 Select the desired Undo operation(s) from the list.

o An Undo operation can be cancelled by applying a Redo. This is useful when an
Undo operation was mistakenly applied. Remember, a Redo is possible only if you
have not changed an Excel spreadsheet since the last Undo operation was completed:
 To Redo an Undo Operation
o Press the Redo button.
 To Redo several recent Undo actions at once:
o Click the arrow next to Redo button.
o Select the desired Redo operation from the list.
o Microsoft Excel reverses the Undo operation.
 Selecting Multiple Cells
o The currently-selected cell in Excel is called the active cell. You can also select a
group of adjacent cells, or a cell range. Many operations can be done against a cell
range: move it, copy, it, delete it or format it. A cell range can be defined in different
ways: select a specific range of cells, select multiple columns or rows, or select the
entire worksheet.
 To Select a Range of Cells
o Move to the first cell in the range.
o The mouse pointer becomes a large cross.
o Click-and-hold the left mouse button and drag left or right, up or down to the last cell
you want to select.
o Release the mouse button.

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Figure 28: The Cells You Selected are Shaded.

Source: Goodwill Community Foundation 2002

 To Select All Cells in a Column or Row

 Click the gray Column heading to select the entire column. (Click and drag the cursor
across other column headings to select those columns).

Figure 29: How to Select Column

Source: Goodwill Community Foundation 2002

 Click the gray Row heading to select the entire row. (Click and drag the cursor down
through the row headings select those rows).

Figure 30: How to Select Row

Source: Goodwill Community Foundation 2002

 To Select the Entire Worksheet:

o Click the gray rectangle in the upper left corner to select entire worksheet.

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Figure 31: How to Select Entire Worksheet

Source: Goodwill Community Foundation 2002

 If the cells and columns you want to select are not directly next to one another, select one
of the ranges you want to select, and hold down the Control key while selecting other
ranges.

Figure 31: Selected Area

Source: Goodwill Community Foundation 2002

Activities 4: Monthly bills (Take-home assignment)

Refer Handout 14.1: Monthly Budget.

 Type the following data in the spreadsheet

o In cell A1, type Monthly Budget.
o In cell A2, type Rent or Mortgage.
o In cell A3, type Car Payment.
o In cell A4, type Cable.
o In cell A5, type Power.
o In cell A6, type Phone.
o In cell A7, type Insurance.
o In cell A8, type Credit Cards.
o In cell A9, type Groceries.
o In cell A10, type Gas.
o Type your other monthly bills in Column A, cells A11-A14 (if you have any)
o Type Total Monthly Expenses in cell A15

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 o Type Income in cell A16
o Type Savings in cell A17
o Save and close the Monthly Budget file

Step 5: Moving, Copying and Deleting Cell Contents (20 minutes)

 Cut, copy, paste defined
 Cut, Copy and Paste are very useful operations in Excel. You can quickly copy and/or
cut information in cells (text, numbers or formulas) and paste them into other cells. These
operations save you a lot of time from having to type and retype the same information.

The Cut, Copy and Paste buttons are located on the Standard toolbar.

Figure 32: The Cut, Copy and Paste operations also appear as choices in the Edit menu:

Source: Goodwill Community Foundation 2002

The Cut, Copy and Paste operations can also be performed through shortcut keys:
Cut Ctrl+X
Copy Ctrl+C

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Paste Ctrl+V

 Copy and Paste Cell Contents

o The Copy feature allows you to copy selected information from the spreadsheet and
temporarily place it on the Clipboard, which is a temporary storage file in your
computer's memory. The Paste feature allows you to select any of the collected items
on the Clipboard and paste it in a cell of the same or different spreadsheet.

 To Copy and Paste:

o Select a cell or cells to be duplicated.
o Click on the Copy button on the standard toolbar.
o The border of the copied cell(s) takes on the appearance of marching ants.

Figure 33: Marching Ants Appear

Source: Goodwill Community Foundation 2002

 Click on the cell where you want to place the duplicated information. The cell will be
highlighted. If you are copying contents into more than one cell, click the first cell
where you want to place the duplicated information.

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 Press the Enter key. Your information is copied to the new location.
 Be careful if you paste copied cell information into cells that already contain data. If you
do, the existing data is overwritten.
 You can copy information from many different sources including Web sites, emails or
other Office applications like Word and PowerPoint and paste it into an Excel
spreadsheet.
 Cut and Paste Cell Contents
o The Cut feature allows you to remove information from cells in the spreadsheet.
Information that is cut can be pasted in another cell, as long as the pasting occurs
before you perform another operation. If you don't paste the cut information
immediately, it is removed from the Office clipboard.
 To Cut and Paste:
o Select a cell or cells to be cut.
o Click on the Cut button on the Standard toolbar.
o The information in the cell is deleted.
o The border of the cut cell(s) take on the appearance of marching ants.
o Click on the cell where you want to place the duplicated information. The cell will be
highlighted. If you want to paste the contents into more than one cell, click the first
cell where you want to place the duplicated information.

o Press the Enter key. Your information is pasted to the new location. You do not have
to paste information that has been cut. You can use Cut to delete information from a
cell.
o Moving Information Using Drag-and-Drop
o Another way to move information from one cell to another is to use the drag-and-drop
method. You use the cursor to point to the information to be moved and then drag the
cell to its new location.
 To Use Drag and Drop
o Highlight and select the cell(s) you want to move to a new location.
o Position the mouse pointer near one of the outside edges of the selected cell(s). The
mouse pointer changes from a large, white cross and becomes a slender, black cross
with arrows at all ends.

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 Keep the mouse pointer on the outer edge of the selected cell, click and hold the left
mouse button and drag the cell(s) to a new location.

 Release the mouse button to move the information to its new location.

Refer to activity 4: Monthly Budget.

Activities 5: Monthly Bills (Take-home assignment)

 ASK student to refer to Handout 14.1 Monthly Budget.
 Move the word Insurance from cell A7 to A4 and the word Cable from A4 to A7 using
the cut, copy, and paste, and drag and drop features you learned in this lesson.
 Type January in C2.
 Type the corresponding amounts for your monthly expenses and income in Column C.
 In cell C3, type your rent/mortgage bill amount
 In cell C4, type your Car Payment amount
 In cell C5, type your Car Payment amount
 In cell C6, type your Power bill amount
 In cell C7, type your Phone bill amount
 In cell C8, type your Cable bill amount
 In cell C9, type your Credit Card bill amount
 In cell C10, type your Grocery/Food bill estimate
 In cell C11, type your Gas bill estimate
 In cells C12 - C16, type the amount of any additional bills you have listed
 In cell C17, type your Income
 Save and close the Monthly Budget file

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Note: Be sure to leave cells C15 and C17 blank

Step 6: Key Points (5 minutes)

 Spreadsheets can help organize information, like alphabetizing a list of names or ordering
records, or calculate and analyze information using mathematical formulas.
 Every workbook created in Excel must be saved and assigned a name to distinguish it
from other workbooks.
 You can enter three types of data in a cell: text, numbers, and formulas
 You can quickly copy and/or cut information in cells (text, numbers or formulas) and
paste them into other cells.

Step 7: Evaluation (15 minutes)

 What are the tasks of the following Excel window parts:
 Title bar, Menu bar, Toolbar, Formula Bar?
 List steps on how to create, open and save workbooks
 List steps in entering, edit and delete data in worksheet
 List steps in moving, copying and deleting cell contents in worksheet

Reference
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

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Handout 14.1: Monthly Budget

Figure

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Session 15: Demonstration on Creating
Formulas in Excel
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 Introduction to Computer

Learning Objectives
By the end of this session, students are expected to be able to:
 Practice on Creating Simple Formulas
 Practice on Creating Complex Formulas
 Practice on Use of functions

Resources Needed
 Flip charts, marker pens, and masking tape.
 Black/white board and chalk/whiteboard markers.
 Computer.
 LCD.
 Handout 15.1 Monthly Budget spreadsheet

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 30 minutes Hands on Practice Create Simple Formulas
3 30 minutes Hands on Practice Create Complex Formulas
4 35 minutes Hands on Practice Use functions
5 10 minutes Presentation Key Points
6 10 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Create Simple Formulas (30 minutes)

Activity 1: Brainstorm (5 minutes)

 ASK student: What are formulas?
 ALLOW for some responses.
 SUMMARIZE and go to information below for formulas.

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Formulas
In school, you learned formulas used to calculate math problems. Microsoft Excel uses these
same formulas to perform calculations in a spreadsheet.
A formula can be a combination of values (numbers or cell references) and math operators (+,
-, /, *, =) into an algebraic expression. Excel requires every formula to begin with an equal
sign (=).
The following table illustrates the mathematical operators learned in school and those
represented in Excel 2003.

School Excel 2003

Addition + +
Subtraction - -
Multiplication X *
Division ÷ /
Equals = =

 The result of a formula-the answer to 2+3, for example-displays in the cell on the Excel
worksheet. The formula is visible only in the formula bar. A formula's result will change
as different numbers are entered into the cells included in the formula's definition.

 Creating a Simple Addition Formula

o A simple formula in Excel contains one mathematical operation only: one number
plus a second number equals a third number. Writing a simple formula is really no
more difficult than that: 1+1. The only difference in Excel is that all formulas must
begin with the equal sign (=). It is not enough to type 1+1 in Excel because what will
appear in the cell is "1+1." You must begin the equation with an equal sign, or =1+1.
This holds true for any formula, simple or complicated, that adds, subtracts, multiplies
or divides.
o Let's add two numbers to create a third, 128+345=473. In Excel, this would be
expressed by the formula, =128+345, as shown below.

Figure 1: Example of Simple Mathematics

Source: Goodwill Community Foundation 2002

 To Create a Simple Formula that Adds Two Numbers

o Click the cell where the formula will be defined.
o Type the equal sign (=) to let Excel know a formula is being defined.

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 o Type the first number to be added (128, for example)
o Type the addition sign (+) to let Excel know that an add operation is to be performed.
o Type the second number to be added (345, for example
o Press Enter or click the Enter button on the Formula bar to complete the formula.

 Creating a Simple Addition Formula (continued)

o But what if a column contains many numbers, each of which regularly changes? You
don't want to write a new formula each time a number is changed. Luckily, Excel
2003 lets you include cell references in formulas.
o A formula can add the value of two cells-B2 and B3, for example. Type any two
values in these two cells and the formula will adjust the answer accordingly.
o Using this method to calculate two numbers-128 and 345, for example-requires that
you type 128 in cell B2, for example, and 345 in cell B3. The Excel formula,
=B2+B3, would then be defined in cell B4.

Figure 2: Show Formula and Total

Source: Goodwill Community Foundation 2002

 To Create a Simple Formula that Adds the Contents of Two Cells:

o Type the numbers you want to calculate in separate cells (for example, type 128 in
cell B2 and 345 in cell B3).
o Click the cell where the answer will appear (B4, for example).
o Type the equal sign (=) to let Excel know a formula is being defined.
o Type the cell number that contains the first number to be added (B2, for example).
o Type the addition sign (+) to let Excel know that an add operation is to be performed.
o Type the cell number that contains the first number to be added (B3, for example).
o Press Enter or click the Enter button on the Formula bar to complete the formula.

 Creating a Simple Subtraction Formula Using the Point-and-Click Method

o Formulas can be created by using either numbers or cell references in the definition.
You can also use the mouse to select the cells to be used in the formula instead of
typing the cell number or cell reference. Using this method, we are going to write a
simple formula that subtracts one cell from another: =B3-B2.

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Teaching Guides for NTA Level 4 MLS Curriculum Page 992
Figure 3: Subtraction Formula

Source: Goodwill Community Foundation 2002

 To Create a Simple Formula using the Point and Click Method

o Type the numbers you want to calculate in separate cells (for example, type 128 in
cell B2 and 345 in cell B3).
o Click the cell where the answer will appear (B4, for example).
o Type the equal sign (=) to let Excel know a formula is being defined.
o Click on the first cell to be included in the formula (B3, for example).
o Type the subtraction sign (-) to let Excel know that a subtraction operation is to be
performed.
o Click on the next cell in the formula (B2, for example).
o If you include multiple cells in the formula, repeat steps 4 and 5 until the entire
formula is entered.
o Press Enter or click the Enter button on the Formula bar to complete the formula.

 Creating Simple Multiplication Formulas

o Creating multiplication formulas is very similar to addition and subtraction formulas.
To multiply two cells the formula, B2 and B3, you would need to insert a
multiplication operator * between them, =B2*B3.

Figure 3: Multiplication Formula

Source: Goodwill Community Foundation 2002

 To Create a Simple Formula that Multiplies the Contents of Two Cells

o Type the numbers you want to calculate in separate cells (for example, type 128 in
cell B2 and 345 in cell B3).
o Click the cell where the answer will appear (B4, for example).
o Type =
o Click on the first cell to be included in the formula (B2, for example).

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 o Type a mathematical operator (Ex: the multiplication symbol *). The operator
displays in the cell and Formula bar.
o Click on the next cell in the formula (B3, for example).
o If you include multiple cells in the formula, repeat steps 4 and 5 until the entire
formula is entered.
o Press Enter or click the Enter button on the Formula bar to complete the formula.

 Creating Simple Division Formulas

o Creating division formulas is very similar to the addition, subtraction and
multiplication formulas. To divide the contents of cell B2 by cell B3, you would need
to insert a division operator / between them, =B2/B3.

Figure 4: Divides Formula

Source: Goodwill Community Foundation 2002

 To Create a Simple Formula that Divides One Cell by Another

o Type the numbers you want to calculate in separate cells (for example, type 128 in
cell B2 and 345 in cell B3).
o Click the cell where the answer will appear (B4, for example).
o Type the equal sign (=) to let Excel know a formula is being defined.
o Click on the first cell to be included in the formula (B2, for example).
o Type a mathematical operator (Ex: the division symbol /). The operator displays in
the cell and Formula bar.
o Click on the next cell in the formula (B3, for example).
o If you include multiple cells in the formula, repeat steps 4 and 5 until the entire
formula is entered.
o Very Important: Press Enter or click the Enter button on the Formula bar. This
step ends the formula.

Activities 2: Monthly bills1 (Take-home assignment)

 ASK student to use monthly Budgets to accomplish the task below:
 Add cells C2 through C10 using a handheld calculator, the calculator on your computer,
or pencil and paper.
 If you included additional monthly bills in cells C11 through 14, add cells C2 through
C14 together to get your total monthly expenses

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Monthly Budget

 How long did it take you to add all those numbers? Well, in the next three modules you
will learn how Excel can do the math for you!
 Type the total you came up with in cell C15.
 Type a subtraction formula in C17 that subtracts the amount in C15 from the amount in
C16.
 Save and close the Monthly Budget file

Step 3: Create Complex Formulas (30 Minutes)

 Complex Formulas Defined
 Simple formulas have one mathematical operation. Complex formulas involve more than
one mathematical operation.
 The order of mathematical operations is very important. If you enter a formula that
contains several operations--like adding, subtracting and dividing--Excel 2003 knows to
work those operations in a specific order. The order of operations is:
 Operations enclosed in parenthesis
 Exponential calculations (to the power of)
 Multiplication and division, whichever comes first
 Addition and subtraction, whichever comes first
 Using this order, let us see how the formula 120/ (8-5)*4-2 is calculated in the following
picture:

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 Let's take a look at another example:
o 2*(6-4) =?
o Is the answer 8 or 4? Well, if you ignored the parentheses and calculated in the order
in which the numbers appear, 2*6-4, you'd get the wrong answer, 8. You must follow
the order of operations to get the correct answer.
 To Calculate the Correct Answer:
o Calculate the operation in parenthesis (6-4), where the answer is 2.
o Multiply the answer obtained in step #1, which is 2, to the numeric 2* that opened the
equation. In other words, multiply 2*2.
o The answer is 4.
o When using formulas with cell references, the results change each time the numbers
are edited.
o Remember: In Excel, never do math "in your head" and type the answer in a cell
where you would expect to have a formula calculate the answer.
 Complex Formulas Defined (continued)
o Before moving on, let's explore some more formulas to make sure you understand the
order of operations by which Excel calculates the answer.

5*3/2 Multiply 5*3 before performing the division operation because the
multiplication sign comes before the division sign. The answer is 7.5.
5/3*2 Divide 5/3 before performing the multiplication operation because the
division sign comes before the multiplication sign. The answer is 3.333333.
5/(3*2) Perform the operation in parentheses (3*2) first and divide 5 by this result.
The answer is 0.833333.
5+3-2 Add 5+3 before performing the subtraction operation because the addition
sign comes before the subtraction sign. The answer is 6.
5-2+3 Subtract 5-2 before performing the addition operation because the
subtraction sign comes before the addition sign. The answer is 6.
5-2*3 Multiply 2*3 before performing the subtraction operation because the
multiplication sign is of a higher order than the subtraction sign. The
answer is -1.
(5-2)*3 Perform the operation in parenthesis (5-2) first and then multiply by 3. The
answer is 9.

 Creating Complex Formulas

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 o Excel 2003 automatically follows a standard order of operations in a complex
formula. If you want a certain portion of the formula to be calculated first, put it in
parentheses.
o If we wanted to add the contents of cell B2 and cell B3, for example, and then take
that answer and multiply it by the data in cell A4, then we would need to define the
following formula: =(B2+B3)*A4.

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Figure 5: Complex Formula Box

Source: Goodwill Community Foundation 2002

 Enter the numbers you want to calculate.

o Click the cell where you want the formula result to appear.
o Type the equal sign (=) to let Excel know a formula is being defined.
o Type an open parenthesis, or (
o Click on the first cell to be included in the formula (cell B2, for example).
o Type the addition sign (+) to let Excel know that an add operation is to be performed.
o Click on the second cell in the formula. The reference B3 displays where you want
your result.
o End the B2+B3 operation by adding the close parenthesis, or )
o Type the next mathematical operator, or the multiplication symbol (*) to let Excel
know that a multiply operation is to be performed.
o Click on the third cell to be included in the formula, cell A4.
o Very Important: Press Enter or click the Enter button on the Formula bar. This
step ends the formula.
o Try changing one of the values in the formula and watch the answer to the formula
change.
 Filling Formulas to Other Cells
o Sometimes, you will write a formula that gets used a lot in different places of a
worksheet. For example, a spreadsheet may contain several columns of numbers.
Each column will contain a formula that adds all the numbers in it. You could write
the formula several times, once in each column. Or you could copy-and-paste it into
each column. The fill formula method allows you to copy a formula and fill it into
many different consecutive cells at the same time.
o The mouse pointer changes to a black crosshair when passed over the fill handle, or
the square box in the lower right corner of the cell.

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Figure 6: Filling Formulas to Other Cell

Source: Goodwill Community Foundation 2002

 To Use the Fill Handle to Copy a Formula to a Surrounding Cell

o Click on the cell that contains the formula to be copied.
o Position the mouse pointer over the fill handle.
o Click and hold the left mouse button, and then drag the contents to the cell that's to
receive the fill formula.
o Release the mouse button.
o Select the Copy Cells option in the fill formula drop-down menu.

Figure 7: Fill Handle to Copy a Formula

Source: Goodwill Community Foundation 2002

 The cell references in a formula are automatically updated when the formula is copied to
other cells in the spreadsheet.
 You can also use copy and paste to copy a formula to other cells. Click next to learn
more about the copy and paste method.
 Copy and Paste Formulas
o The process to copy and paste a formula is identical to that process used to copy and
paste text.

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 To Copy and Paste a Formula
o Select the cell that contains the formula to be copied.
o Click the Copy button. Marching "ants" appear around the copied cell(s).

Figure 8: Marching ants appear

Source: Goodwill Community Foundation 2002

 Select the cell where the copied formula is to be pasted.

 Press the Enter key. The formula is copied to the new location.

 Revising Formulas
o You can revise any formula that was previously written in a worksheet.
 To Revise a Formula using the Keyboard
o Double-click the cell that contains the formula you want to revise.
o The cursor can now move left and right between the values in the formula in cell B5.

Figure 9: To Replace Cell

Source: Goodwill Community Foundation 2002

Teaching Guides for NTA Level 4 MLS Curriculum Page 1000

 Make the necessary changes to the formula.
 Press the Enter key or click the Enter button to accept the new formula.
 Creating an Absolute Reference
o In earlier lessons we saw how cell references in formulas automatically adjust to new
locations when the formula is pasted into different cells.
o Sometimes, when you copy and paste a formula, you don't want one or more cell
references to change. Absolute reference solves this problem. Absolute cell
references in a formula always refer to the same cell or cell range in a formula. If a
formula is copied to a different location, the absolute reference remains the same.
o An absolute reference is designated in the formula by the addition of a dollar sign ($).
It can precede the column reference or the row reference, or both. Examples of
absolute referencing include:

$A$2 The column and the row do not change when copied.
A$2 The row does not change when copied.
$A2 The column does not change when copied.

 To Create an Absolute Reference

o Enter the numbers you want to calculate (e.g., 34,567 in cell B2 and 1,234 in cell B3).
o Then, create a simple formula (=B2+B3).

Figure 10: Simple Formula

Source: Goodwill Community Foundation 2002

 To create an absolute reference in the formula just created, insert a $ value before the B
(column reference) and 2 (row reference) in the reference to B2 so the new formula reads,
(=$B$2+B3)

Figure 11: Absolute Column and Absolute Row Reference

Teaching Guides for NTA Level 4 MLS Curriculum Page 1001

Source: Goodwill Community Foundation 2002

 Copy and Paste the formula to another adjacent cell. The formula now includes an
absolute reference to B2, (=$B$2+D3).

Figure 12: Copy and Paste Formula

Source: Goodwill Community Foundation 2002

Activities 3: Monthly Budget (Take-home assignment)

Refer students to Handout 15.1 Monthly Budget spreadsheet.

 Fill the formula defined in cell C17 to D17 through N17.

 Type Percent Saved in A18.
 Write a formula in C18 that divides your monthly Savings amount (C17) by your monthly
Income (C16).
 Save and close the Monthly Budget spreadsheet.

Step 4: Using Functions (35 minutes)

 Using Functions
 A function is a pre-defined formula that helps perform common mathematical
functions. Functions save you the time of writing lengthy formulas. You could use an
Excel function called Average, for example, to quickly find the average of range of

Teaching Guides for NTA Level 4 MLS Curriculum Page 1002

 numbers. Or you could use the Sum function to find the sum of a cell range. Excel 2003
contains many different functions.
 Each function has a specific order, called syntax, which must be strictly followed for the
function to work correctly.
 Syntax Order:
o All functions begin with the = sign.
o After the = sign define the function name (e.g., Sum).
o One or more arguments-numbers, text or cell references-enclosed by parentheses. If
there is more than one argument, separate each by a comma.
o An example of a function with one argument that adds a range of cells, B3 through
B10:

o An example of a function with more than one argument that calculates the average
of numbers in a range of cells, B3 through B10, and C3 through C10:

o Excel literally has hundreds of different functions to assist with your calculations.
Building formulas can be difficult and time-consuming. Excel's functions can save
you a lot of time and headaches.
 Excel's Different Functions
o There are many different functions in Excel 2003. Some of the more common
functions include:
 Statistical Functions
 SUM - summation adds a range of cells together.
 AVERAGE - average calculates the average of a range of cells.
 COUNT - counts the number of chosen data in a range of cells.
 MAX - identifies the largest number in a range of cells.
 MIN - identifies the smallest number in a range of cells.
 Financial Functions
 Interest Rates
 Loan Payments
 Depreciation Amounts
 Date and Time functions:
 DATE - Converts a serial number to a day of the month
 Day of Week
 DAYS360 - Calculates the number of days between two dates based on a 360-day
year
 TIME - Returns the serial number of a particular time
 HOUR - Converts a serial number to an hour
 MINUTE - Converts a serial number to a minute
 TODAY - Returns the serial number of today's date

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  MONTH - Converts a serial number to a month
 YEAR - Converts a serial number to a year
 You don't have to memorize the functions but should have an idea of what each
can do for you.
 Finding the Sum of a Range of Data
o The AutoSum function allows you to create a formula that includes a cell range-
many cells in a column, for example, or many cells in a row.

Figure 13: AutoSum function

Source: Goodwill Community Foundation 2002

 To Calculate the AutoSum of a Range of Data

o Type the numbers to be included in the formula in separate cells of column B (Ex:
type 128 in cell B2, 345 in cell B3, 243 in cell B4, 97 in cell B5 and 187 cell B6).
o Click on the first cell (B2) to be included in the formula.
o Using the point-click-drag method, drag the mouse to define a cell range from cell B2
through cell B6.
o On the Standard toolbar, click the Sum button.
o The sum of the numbers is added to cell B7, or the cell immediately beneath the
defined range of numbers.

Figure 14: formula, =SUM (B2:B6), has been defined to cell B7.

Source: Goodwill Community Foundation 200

 Finding the Average of a Range of Numbers

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 o The Average function calculates the average of a range of numbers. The Average
function can be selected from the AutoSum drop-down menu.
o To Calculate the Average of a Range of Data
o Type the numbers to be included in the formula in separate cells of column B (Ex:
type 128 in cell B2, 345 in cell B3, 243 in cell B4, 97 in cell B5 and 187 cell B6).
o Click on the first cell (B2) to be included in the formula.
o Using the point-click-drag method, drag the mouse to define a cell range from cell B2
through cell B6.
o On the Standard toolbar, click on the drop-down part of the AutoSum
button.
o Select the Average function from the drop-down Functions list.
o The average of the numbers is added to cell B7, or the cell immediately beneath the
defined range of numbers.

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Figure 15: Average Function from the Drop-Down

Source: Goodwill Community Foundation 2002

Figure 16: Notice the Formula, =AVERAGE (B2:B6), Has Been Defined To Cell B7.

Source: Goodwill Community Foundation 2002

 Accessing Excel 2003 Functions

o To Access Other Functions in Excel
 Using the point-click-drag method, select a cell range to be included in the
formula.
 On the Standard toolbar, click on the drop-down part of the AutoSum button.
 If you don't see the function you want to use (Sum, Average, Count, Max, Min),
display additional functions by selecting More Functions.
 The Insert Function dialog box opens.
 There are three ways to locate a function in the Insert Function dialog box

Teaching Guides for NTA Level 4 MLS Curriculum Page 1006

Figure 17: Accessing Excel 2003 Functions

Source: Goodwill Community Foundation 2002

 You can type a question in the Search for a function box and click GO, or
 You can scroll through the alphabetical list of functions in the Select a function field, or
 You can select a function category in the Select a category drop-down list and review the
corresponding function names in the Select a function field.

Figure 18: Search for a Function Box

Source: Goodwill Community Foundation 2002

 Select the function you want to use and then click the OK button.

Activities 4: Monthly Budget 2 (Take-home assignment)

Refer s students to Handout 15.1: Monthly Budget spreadsheet
 Type the following in Row 1
February in D1
March in E1
April in F1
May in G1
June in H1
July in I1
August in J1

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September in K1
October in L1
November in M1
December in N1
Total in O1.
Type the amount of your expenses in each cell in Column D (cells 2 through 17), just like
you did with Column C in a previous challenge.
Delete the number in C15.
Type a function in cell C15 that adds the range of cells, C2 through C14.
Fill the formula from C15 to D15 through O15.
Type your Income for the month of February in D16.
Type a formula in O17 that adds your savings for the year. Since you have only entered data
for the month of January and February, this amount indicates your savings for the two
months.
Save and close the Monthly Budget spreadsheet.

Step 5: Key Points (10 minutes)

 A formula can be a combination of values (numbers or cell references) and math
operators (+, -, /, *, =) into an algebraic expression. Excel requires every formula to begin
with an equal sign (=).
 The order of mathematical operations is very important. If you enter a formula that
contains several operations--like adding, subtracting and dividing--Excel 2003 knows to
work those operations in a specific order. The order of operations is:
 Operations enclosed in parenthesis
 Exponential calculations (to the power of)
 Multiplication and division, whichever comes first
 Addition and subtraction, whichever comes first
 Each function has a specific order, called syntax, which must be strictly followed for the
function to work correctly. Syntax Order:
 All functions begin with the = sign.
 After the = sign define the function name (e.g., Sum).
 One or more arguments-numbers, text or cell references-enclosed by parentheses. If
there is more than one argument, separate each by a comma.

Step 6: Evaluation (10 minutes)

 When is the equal sign (=) used?
 What is the order of mathematical operations?
 If there is more than one argument, how do you separate them?

Reference
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1008

 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 1009

Handout 15.1: Monthly Budget spreadsheet

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Session 16: Demonstration on Dealing
with Excel Cells
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 Introduction to Computer

Learning Objectives
By the end of this session, students will be able to:
 Practice on Inserting and Deleting Cells
 Practice on Managing Text and Cell Alignments
 Practice on Formatting Numbers
 Apply Font, Colour and Borders to Cells

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD
 Handout 16.1: Monthly Budget

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 20 minutes Hands on Practice Inserting and Deleting Cells
3 20 minutes Hands on Practice Managing Text and Cell Alignments
4 25 minutes Hands on Practice Format Numbers
5 30 minutes Hands on Practice Applying Font, Colour and Borders to Cells
6 5 minutes Presentation Key Points
7 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Step 2: Inserting and Deleting Cells (20 minutes)

Activity 1: Brainstorming (5minutes)
 ASK student what is a cell in excel worksheet?
 WAIT for some responses

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 Summarize by explaining that a cell is

 Inserting a cell
o When working in an Excel 2003 worksheet, you may need to insert or delete cells
without inserting or deleting entire rows or columns.
 To Insert Cells
o Select the location where the new cell(s) should be inserted. It can be a single cell or a
range of cells.
o Right-click and choose Insert. Note: You could also choose Insert Cell on the
menu bar.

Figure 1: Inserting A Cell

Source: Goodwill Community Foundation 2002

 The Insert dialog box opens. Select either:

 Shift cells right to shift cells in the same row to the right.
 Shift cells down to shift selected cells and all cells in the column below it downward.

Figure 2: Inserting Dialog Box

Source: Goodwill Community Foundation 2002

 Choose an option and click the OK button.

 Your result displays in the spreadsheet.

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Teaching Guides for NTA Level 4 MLS Curriculum Page 1013
Figure 3: Inserted Figure

Source: Goodwill Community Foundation 2002

 Deleting a cell
o To Physically Delete the Cell from the Spreadsheet
o Right-click and choose Delete.

Figure 4: Deleting Cell

Source: Goodwill Community Foundation 2002

o The Delete dialog box opens. Select either:

 Shift cells left to shift cells in the same row to the left.
 Shift cells up to shift selected cells and all cells in the column above it upward.

Figure 5: Shifting Cell

Teaching Guides for NTA Level 4 MLS Curriculum Page 1014

Source: Goodwill Community Foundation 2002

o Choose an option and click the OK button.

o Your result displays in your spreadsheet.
 Merging cells
o In Excel 2003, you have another alignment option available to you: merge and
center. This is performed when you want to select one or more cells and merge them
into a larger cell. The contents will be centered across the new merged cell.
o The picture below shows why we might want to merge two cells. The spreadsheet
presents Last Month and This Month Sales and Expenses for Sally. Notice that Sally's
name appears above the Last Month column. To evenly centre Sally's name across the
two cells we would perform a merge and centre.

Figure 6: Merging Cell

Source: Goodwill Community Foundation 2002

 To Merge Two Cells into One

o Select the cells that you want to merge. It can be cells in a column, row or both
columns and rows.
o Click the Merge and Center button on the standard toolbar.

Figure 7: Merging Cell More Than Two

The two cells are now merged into one.

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Source: Goodwill Community Foundation 2002

Activities 2: Monthly Budget (Take-home assignment)

Refer students to Handout 16.1: Monthly Budget

Insert a blank row above the current Row 1, which contains the months of the year.
Type My Budget in A1.
Use the merge and center function to center My Budget over Columns A through N.
Save and close the document.

Step 3: Manage Text and Cell Alignments (20 minutes)

 Using the Standard Toolbar to Align Text and Numbers in Cells
 You've probably noticed by now that Excel 2003 left-aligns text (labels) and right-aligns
numbers (values). This makes data easier to read.

Figure 8: Align and Numbers in cells

Source: Goodwill Community Foundation 2002

 You do not have to leave the defaults. Text and numbers can be defined as left-aligned,
right-aligned or centered in Excel 2003. The picture below shows the difference between
these alignment types when applied to labels.

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 Text and numbers may be aligned using the left-align, center and right-align buttons of
the Formatting toolbar:

 To Align Text or Numbers in a Cell

o Select a cell or range of cells
o Click on the Left-Align, Center or Right-Align buttons in the standard toolbar.
o The text or numbers in the cell(s) take on the selected alignment treatment.
 Changing Horizontal Cell Alignment
o We've previously seen how to align text or numbers using the left-align, center and
right-align buttons in the standard toolbar. You can also define alignment in the
Alignment tab of the Format Cells dialog box.

Figure 9: Horizontal Alignment

Source: Goodwill Community Foundation 2002

 The Horizontal section features a drop-down that contains the same left, center, and
right alignment options in the picture above and several more:
 Fill-"Fills" the cell with the current contents by repeating the contents for the width
of the cell.
 Justify-If the text is larger than the cell width, Justify wraps the text in the cell and
adjusts the spacing within each line so that all lines are as wide as the cell.
 Center Across Selection-Contents of the cell furthest to the left are centered across
the selection of cells. Similar to merge and center, except the cells are not merged

 To Change Horizontal Alignment using the Format Cells Dialog Box

o Select a cell or range of cells.
o Choose Format Cells from the menu bar.

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Figure 10: Format-Cell Option

Source: Goodwill Community Foundation 2002

o (You could also right-click and choose Format Cells from the shortcut menu)
o The Format Cells dialog box opens.
o Click the Alignment tab.

Figure 11: Alignment Text Option

Source: Goodwill Community Foundation 2002

o Click the Horizontal drop-down menu and select a horizontal alignment treatment.
o Click OK to apply the horizontal alignment to the selected cell(s).

 Changing Vertical Cell Alignment

o You can also define vertical alignment in a cell, similar to how it is done for
horizontal alignment. In Vertical alignment, information in a cell can be located at
the top of the cell, middle of the cell or bottom of the cell. The default is bottom.

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Figure 12: Vertical Alignment view

Source: Goodwill Community Foundation 2002

 To Change Vertical Alignment using the Format Cells Dialog Box:

o Select a cell or range of cells.
o Choose Format Cells from the menu bar
o (You could also right-click and choose Format Cells from the shortcut menu.)
o The Format Cells dialog box opens.
o Click the Alignment tab.
o Click the Vertical drop-down menu and select a vertical alignment treatment.
o Click OK to apply the vertical alignment to the selected cell(s).
 Changing Text Control
o Text Control allows you to control the way Excel 2003 presents information in a cell.
There are three types of Text control: Wrapped Text, Shrink-to-Fit and Merge
Cells.

Figure 14: Text Control

Source: Goodwill Community Foundation 2002

o The Wrapped Text wraps the contents of a cell across several lines if it's too large
than the column width. It increases the height of the cell as well.
o Shrink-to-Fit shrinks the text so it fits into the cell; the more text in the cell the
smaller it will appear in the cell.
o Merge Cells can also be applied by using the Merge and Center button on the
standard toolbar.
 To Change Text Control using the Format Cells Dialog Box
o Select a cell or range of cells.

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 o Choose Format Cells from the menu bar.
o The Format Cells dialog box opens.
o Click the Alignment tab.
o Click on either the Wrapped Text, Shrink-to-Fit or Merge Cells check boxes-or
any combination of them-as needed.
o Click the OK button.
 Changing Text Orientation
o The fourth type of cell alignment in the Format Cells dialog box is Text Orientation,
which allows text to be oriented 90 degrees in either direction up or down.

Figure 15: Changing Text Orientation

Source: Goodwill Community Foundation 2002

 To Change Text Orientation using the Format Cells Dialog Box

o Select a cell or cell range to be subject to text control alignment.
o Choose Format Cells from the menu bar.
o The Format Cells dialog box opens.
o Click the Alignment tab.
o Increase or decrease the number shown in the Degrees field or spin box.
o Click the OK button.

Activities 3: Monthly Budget (Take-home assignment)

Refer students to Handout 16:1 Monthly Budget

Center the text horizontally in Column A and Row 2.

Apply a distributed vertical text alignment to Row 2.
Save your document.
Use the text control and text orientation features so that you are familiar with them.
Close the document without saving any of the formatting from the text control and text
orientation features.

Step 4: Formatting Numbers (25 minutes)

 Formatting Numbers in the Format Cells Dialog Box
 Numbers in Excel can assume many different formats: Date, Time, Percentage or
Decimals.

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 To Format the Appearance of Numbers in a Cell
 Select a cell or range of cells.
 Choose Format Cells from the menu bar.

Figure 16: Formatting Option

Source: Goodwill Community Foundation 2002

 (You could also right-click and choose Format Cells from the shortcut menu.)
 The Format Cells dialog box opens.
 Click the Number tab.

 Click Number in the Category drop-down list.

 Use the Decimal places scroll bar to select the number of decimal places (e.g., 2 would
display 13.50, 3 would display 13.500).
 Click the Use 1000 Separator box if you want commas (1,000) inserted in the number.
 Use the Negative numbers drop-down list to indicate how numbers less than zero are to
be displayed.
 Click the OK button.

Figure 13: Formatting Cells

Source: Goodwill Community Foundation 2002

 Formatting Date in the Format Cells Dialog Box

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 o The date can be formatted in many different ways in Excel 2003. Here are a few ways
it can appear:
o October 6, 2003
o 10/06/03
o 10-Oct-03
 To Format the Appearance of a Date in a Cell:
o Select a cell or range of cells.
o Choose Format Cells from the menu bar.
o The Format Cells dialog box opens.
o Click the bullet one to three tab.
o Click Date in the Category drop-down list.
o Select the desired date format from the Type drop-down list.
o Click the OK button.

Figure 14: Formatting Date

Source: Goodwill Community Foundation 2002

 Formatting Time in the Format Cells Dialog Box

o The time can be formatted in many different ways in Excel 2003. Here are a few
ways it can appear:
o 13:30
o 1:30 PM
 To Format the Appearance of Time in a Cell
o Select the range of cells you want to format.
o Choose Format Cells from the menu bar.
o The Format Cells dialog box opens.
o Click the Number tab.
o Click Time in the Category drop-down list.
o Select the desired time format from the Type drop-down list.
o Click the OK button.

Figure 15: Formatting Time

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Source: Goodwill Community Foundation 2002

 Formatting Percentage in the Format Cells Dialog Box

o There may be times you want to display certain numbers as a percentage. For
example, what percentage of credit cards bills account for your total monthly
expenses?
 To Express Numbers as a Percentage in a Spreadsheet
o Select a cell or range of cells.

Figure 16: Formatting cells Dialog box

Source: Goodwill Community Foundation 2002

o Choose Format Cells from the menu bar.

o The Format Cells dialog box opens.
o Click the Number tab.
o Click Percentage in the Category drop-down list.

Figure 17: Formatting Percentage

Source: Goodwill Community Foundation 2002

 Define the Decimal Places that will appear to the right of each number.
 Click the OK button.

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Figure 18: Completed Formatted Percentage

Source: Goodwill Community Foundation 2002

Step 5: Applying Font, Colour and Borders To Cells (30 minutes)

 Change font type, size and colour
o In Excel 2003 a font consists of three elements: Typeface or the style of the letter;
Size of the letter; and Colour of the letter. The default font in a spreadsheet is Arial
10 points, but the typeface and size can be changed easily.
 Selecting a Font Typeface
o The amount of typefaces available for use varies depending on the software installed
on your computer.

Figure 19: Box for Different Font

Source: Goodwill Community Foundation 2002

 To Apply a Typeface to Information in a Cell

o Select a cell or range of cells.
o Click on the down arrow to the right of the Font Name list box on the Formatting
toolbar.

Figure 20

Teaching Guides for NTA Level 4 MLS Curriculum Page 1024

Figure 20: A Drop-Down List Of Available Fonts Appears.

Source: Goodwill Community Foundation 2002

o Click on the Typeface of your choice.

o The selection list closes and the new font is applied to the selected cells.
 Change font type, size and colour (continued)
o To Apply a Font Size to Information in a Cell
 The "Font Size" list varies from typeface to typeface. The Arial font sizes, for
example, are 8, 9, 10, 11, 12, 14, 16, 18, 20, 22, 24, 26, 28, 36, 48, and 72.

Figure 21: Example of Different Font Size

Source: Goodwill Community Foundation 2002

 Select a cell or range of cells.

 Click on the down arrow to the right of the font size list box on the Formatting
toolbar.

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Figure 22: A Drop Down List of Available Font Sizes Appears.

Source: Goodwill Community Foundation 2002

 Click on the Font Size of your choice.

 The selection list closes and the new font size is applied to the selected cells.

 Change font type, size and colour (continued)

o To Apply Colour to Information in Cells
o Select a cell or range of cells.
o Click on the down arrow to the right of the font Colour list box.

Figure 23: A drop-down list of available Colours appears.

Source: Goodwill Community Foundation 2002

o Click on the Colour of your choice.

o The selection list closes and the new font Colour is applied to the selected cells.

 Underline, italics and bold

o In addition to the typeface, size and Colour, you can also apply Bold, italics, and/or
underline font style attributes to any text or numbers in cells.

 To Select a Font Style

o Select a cell or range of cells.
o Click on any of the following options on the Formatting toolbar.
o Bold button (Ctrl + B).
o Italics button (Ctrl + I).

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 o Underline button (Ctrl + U).
o The attribute(s) selected (bold, italics, or underline) are applied to the font.

o The Bold, Italics, and Underline buttons on the Formatting toolbar are like toggle
switches. Click once to turn it on, click again to turn it off.

 Design and apply styles

o Styles can save a lot of time when formatting a spreadsheet. A Style is a unique
collection of font attributes (Number, Alignment, Font, Border, Patterns and
Protection). Many different styles can be created in a spreadsheet, each with different
attributes and names. When applied to a cell, information in it resembles the attributes
defined for that style.

 To Apply a style
o Select the cell or range of cells.
o Choose Format Style from the menu bar.

Figure 24: Formatting Style Box

Source: Goodwill Community Foundation 2002

Figure 25: Select A Style From The Style Name Drop-Down List.

Source: Goodwill Community Foundation 2002

 You can change the style attributes (Number, Alignment, Font, Border, Patterns and
Protection) for any Style Name.

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 You can create new styles by clicking on the Add button in the Style dialog box.

 Adding a border to cells

o Borders can be applied to cells in your worksheet in order to emphasize important
data or assign names to columns or rows.
o To Add a Border to a Cell or Cell Range
o Select a cell or range of cells.
o Click on the down arrow next to the Borders button.
o The Border drop-down appears.

o Choose a borderline style from the Border drop-down menu.

o The selected cells display the chosen border.

 Adding Colour to Cells

o Colours can be applied to cells in your worksheet in order to emphasize important data
or assign names to columns or rows.

 To Add Colour to a Cell

o Select a cell or range of cells.
o Click the down arrow next to the Fill Colour button. A Fill Colour drop-down menu
displays.

Figure 26: Figure 27: Choose a Fill Colour From The Fill Colour Drop-Down Menu.

Source: Goodwill Community Foundation 2002

Activities 4: Monthly Budget (Take-home assignment)

Refer students to Handout 16.2: Monthly Budget
ASK student to refer example Handout 14.1

Teaching Guides for NTA Level 4 MLS Curriculum Page 1028

ALLOW them to do first the compare with Handout
Bold the words My Budget in Row 1 and change the font to Verdana, size 14.
Format the other labels (Rent, Car Payment, Insurance, etc.) as Arial, bold, size 10.
Use AutoFit to format Columns A, J, L, and M.
Change the font Colour of all your expenses to RED.
Change the font Colour of all your income to GREEN.
Apply at least one border.
Save and close the document.

Step 6: Key Points (5 minutes)

 When working in an Excel 2003 worksheet, you may need to insert or delete cells
without inserting or deleting entire rows or columns.
 Text and numbers can be defined as left-aligned, right-aligned or centered in Excel 2003.
 Numbers in Excel can assume many different formats: Date, Time, Percentage, Currency
or Decimals.
 In Excel 2003 a font consists of three elements: Typeface, or the style of the letter; Size
of the letter; and Colour of the letter. The default font in a spreadsheet is Arial 10 points,
but the typeface and size can be changed easily.

Step 7: Evaluation (15 minutes)

 List steps in inserting and deleting cells
 List steps to align text at 45 degrees
 Numbers in Excel can assume many different formats; which are these formats?
 A Style is a unique collection of font attributes; what are these attributes?

Reference
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International,
Barb House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 1029

Handout 16.1: Monthly Budget

Handout 16.2: Monthly Budget

Teaching Guides for NTA Level 4 MLS Curriculum Page 1030

Session 17: Demonstration on Charts in
Excel
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 Introduction to Computer

Learning Objectives
By the end of this session, students will be able to:
 Practice on Creating a Chart
 Practice on Moving, Resizing, and Deleting Charts
 Practice on Editing Charts
 Practice on Formatting a Chart

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD
 Handout 17.1: Monthly Budget

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
Presentation,
2 20 minutes Creating a Chart
Brainstorm, Take home
Hands on Practice,
3 20 minutes Moving, Resizing, and Deleting Charts
monthly budget
Hands on Practice, take
4 30 minutes Editing Charts
home assignment
Hands on Practice,
5 25 minutes Formatting a Chart
formatting chart
6 5 minutes Presentation Key Points
7 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 Minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Creating Charts (20 Minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1031

Activity 1: Brainstorm (5 minutes)
 ASK student: What is a chart?
 ALLOW for some responses.
 Summarize and go to information below for Charts Types

 Understanding the Different Chart Types

 Excel 2003 allows you to create many different kinds of charts.
 Area Chart
 An area chart emphasizes the trend of each value over time. An area chart also shows
the relationship of parts to a whole.

 Column Chart
o A column chart uses vertical bars or columns to display values over different
categories. They are excellent at showing variations in value over time.

 Bar Chart
o A bar chart is similar to a column chart except these use horizontal instead of
vertical bars. Like the column chart, the bar chart shows variations in value over time.

 Line Chart

Teaching Guides for NTA Level 4 MLS Curriculum Page 1032

 o A line chart shows trends and variations in data over time. A line chart displays a
series of points that are connected over time.

 Pie Chart
o A pie chart displays the contribution of each value to the total. Pie charts are a very
effective way to display information when you want to represent different parts of the
whole, or the percentages of a total.

 Other Charts
o Other charts that can be created in Excel 2003 include: Doughnut; Stock XY
(scatter); Bubble; Radar; Surface; or Cone, Cylinder, and Pyramid charts.

 Identifying the Parts of a Chart

o Have you ever read something you didn't fully understand but when you saw a chart
or graph, the concept became clear and understandable? Charts are a visual
representation of data in a worksheet. Charts make it easy to see comparisons,
patterns, and trends in the data.

Figure 1: Parts of a Chart

Teaching Guides for NTA Level 4 MLS Curriculum Page 1033

Source: Goodwill Community Foundation 2002

 Source Data: The range of cells that make up a chart. The chart is updated automatically
whenever the information in these cells change.
 Title: The title of the chart
 Legend: The chart key, which identifies each colour on the chart represents
 Axis: The vertical and horizontal parts of a chart. The vertical axis is often referred to as
the Y axis, and the horizontal axis is referred to as the X axis
 Data Series: The actual charted values, usually rows or columns of the source data
 Value Axis: The axis that represents the values or units of the source data
 Category Axis: The axis identifying each data series.

 Creating a Chart Using the Chart Toolbar

o Charts can be created in a number of ways in Excel 2003. The quickest way to create
and edit your charts is to use the Chart Toolbar.

 To Show the Chart Toolbar

o Choose View Toolbars Chart on the menu bar.

Figure 2: Using the Chart Toolbar

Source: Goodwill Community Foundation 2002

o Parts of the Chart Toolbar

Teaching Guides for NTA Level 4 MLS Curriculum Page 1034

 o Chart Objects List Box: This list box lets you select different parts of a chart for
editing
o Format Chart Area: Used to format that part of the chart which is currently selected
o Chart Type: A drop-down menu that lets you selects different types of charts. The
chart type can be changed at any time
o Legend: Used to show or hide the chart legend
o Data Table: Used to show or hide the actual Source Data used to create the chart
o By Row: Plots the Data Series using the row labels (Y-axis)
o By Column: Plots the Data Series using the column labels (X-axis)
o Angle Text: Use to rotate the angle of the X-axis and Y-axis labels

 Creating an Embedded Chart

o Charts can be created in either of two ways in Excel 2003: Embedded Charts and a
Chart Sheet. Excel creates an embedded chart by default. An embedded chart is
placed on the same worksheet as the source data used to create it.

 To Embed a Chart in a Worksheet

o Choose View Toolbars Chart on the menu bar.
o Select the range of cells that you want to chart. Your source data should include at
least three categories or numbers.

Figure 3: Selected Data for Embedding Chart

Source: Goodwill Community Foundation 2002

o Click the chart type pull down on the chart toolbar and select the chart that you would
like to use.

Figure 4: Use Chart Bar To Select Different Type Of Chart

Teaching Guides for NTA Level 4 MLS Curriculum Page 1035

Source: Goodwill Community Foundation 2002

o Open the chart options dialog box: Chart Options to add a title to your chart.

Figure Chart Option

Source: Goodwill Community Foundation 2002

Figure 4: Select the Titles tab and type the title of the chart in the Chart Title text box.

Source: Goodwill Community Foundation 2002

o Different charts work best with different data. A pie chart, for example, can only
display one data series at a time.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1036

 o Excel 2003 includes a 4-step Chart Wizard that you can use to guide you through the
steps for creating a chart. Highlight the cell range you want to chart, choose Insert
Chart on the menu bar and follow the instructions in the wizard.

 Creating a chart sheet

o Sometimes, you may want to create a chart and place it on a separate sheet in the
workbook. This is called a Chart Sheet. Chart sheets can make your charts stand out,
particularly when working with complicated spreadsheets.
o To Move an Embedded Chart to a Chart Sheet
o Create an embedded chart.
o Select the chart to be moved to a chart sheet.
o Choose Chart Location from the menu bar.

Figure 5: Represent Chart Location

Source: Goodwill Community Foundation 2002

 In the Chart Location dialog box, select the As a new sheet radio button.
o (The As object in radio button adds the chart as an embedded object on the
Worksheet.)

Figure 6: Chart Location Dialog Box

Source: Goodwill Community Foundation 2002

Teaching Guides for NTA Level 4 MLS Curriculum Page 1037

Figure 7: Inserted Chart into Worksheet

Source: Goodwill Community Foundation 2002

o Click the OK button. The chart is displayed on a separate Chart Sheet in the
Workbook.
o You can also use the Chart Location dialog box to rename the Chart Sheet.

Activities 2: Monthly Budget (Take-home assignment)

Refer students to Handout 17.1: Monthly Budget
 ASK student to do below activities by refer handout.
 ALLOW them to share in group.
 Type your income for the month of March in D17.
 Type your expenses for the month of March in the appropriate cells of Column D. The
Total Expenses and Savings will be calculated for you because of the formula in each
cell.
 Create an embedded Column Chart using the expense data for the months of January
and February.
 Important Note: Do not include the data for rows 16 through 18 and do not include the
data for the month of March.
 Create a title for your chart and name it My Budget.
 Save and close the document.

Figure 8: An Example

Teaching Guides for NTA Level 4 MLS Curriculum Page 1038

Source: Goodwill Community Foundation 2002

Step 3: Moving, Resizing, and Deleting Charts (20 minutes)

 Moving a chart
o An embedded chart can be moved anywhere on a worksheet. The easiest way to move
a chart is to drag it around the worksheet.
 To Move a Chart
o Click anywhere on the white space in the chart and use the cursor to drag the chart
anywhere on the worksheet.

Figure 8: How to Move Graph into Worksheet

Source: Goodwill Community Foundation 2002

o Release the mouse button to place the graph in its new location

Teaching Guides for NTA Level 4 MLS Curriculum Page 1039

 Resizing a Chart
o Charts can be resized-made larger or smaller-to fit on a worksheet. Chart Titles are
sized in proportion to how large or small you make the chart. And within the Chart
Area, the Legend and/or Plot Area can be made larger or smaller. Chart Titles can be
moved but not resized.

 To Resize a Chart
o Click anywhere on the white space of the chart area, plot area or legend you want to
move or resize.

Figure 9: Completed Chart

Source: Goodwill Community Foundation 2002

o Point the mouse to one of the Grab Handles or Resize Cursor-the pointer changes to a
double-headed arrow-to resize the chart.

Figure 10: How to Resize Chart

Source: Goodwill Community Foundation 2002

 Use the mouse to drag the sizing handle until the chart is resized to the desired size.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1040

 Deleting a Chart
o Any embedded chart or chart sheet can be deleted from a worksheet. A chart sheet is
deleted in the same manner a worksheet is deleted. This section discusses how to
delete an embedded chart.
 To Delete a Chart
o Click anywhere on the white space of the chart area to select the chart.
o Press the Delete key on your keyboard.
o If you have difficulty deleting a chart, click anywhere outside of the chart and then
select the chart again.

Activities 3: Monthly Budget (5 minutes)

Refer students to Handout
 ASK student to practice below
 Move the chart so that it is located below Row 19 and all the data.
 Resize the chart so that it is larger than its current size.
 Save and close the document.

Step 4: Editing Charts (30 minutes)

 Changing Chart Data
o When you add a chart to your worksheet, Excel creates a link between the chart and
your source data. Any changes made to the original source data are automatically
reflected in the chart.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1041

Figure 11: Changing chart Data

Source: Goodwill Community Foundation 2002

 To Change Chart Values Directly in Worksheet Cells

o Open the worksheet that contains the chart to be changed.
o Click in the cell whose value will change and type the new value.
o Press Enter to accept the new value.

 Changing Chart Data (continued)

o To Add Data to an Existing Chart
o Rows or columns of data can be added to an existing chart by selecting the Add Data
option on the Chart Menu.
o Input any new Source Data into the worksheet (e.g., a new column called South
America).

Figure 12: Changing Chart with Additional Column E

Source: Goodwill Community Foundation 2002

o Click on the chart to select it for editing.

o Choose Chart Add Data from the menu bar.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1042

Figure 13: Data additional

Source: Goodwill Community Foundation 2002

 The Add Data dialog box appears.

o Select the cell range of new data to be added to the chart. Marching ants appear
around the cell range. The selected cells are added to the Add Data dialog box.
o Click the OK button to add the new data to the chart.

Figure 14: Add Data Dialog Box

Source: Goodwill Community Foundation 2002

 Changing the Chart Title

o The Chart Title can be changed at any time to a name that's meaningful to you.
o To Change the Chart Title on the Chart
o Click on the Chart Title.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1043

Figure 15: How to Change Chart Title

Source: Goodwill Community Foundation 2002

 Click anywhere in the title name and make any changes to the text.

Figure 16: Finished Chart

Source: Goodwill Community Foundation 2002

 Click anywhere outside of the title to apply your changes.

 Changing the Data Series Names or Legend Text

 Data Series Names and Legend Text are changed in much the same manner as when
you changed Chart Values in the worksheet.

 To Change the Data Series Names or Legend Text on the Worksheet

o Click the cell that contains the Data Series name or Legend that you want to change.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1044

Figure 17: Data Series and Legend Text

Source: Goodwill Community Foundation 2002

 Type the new name.

o Press the Enter key to add the new name to the chart.
 Changing the Chart Type
o There are 14 different types of charts in Excel 2003, and, with each chart type, there
can be several variations. You can see that you can create any number of different
charts. The Chart Type can be changed at any time with a couple of clicks of the
mouse.
 To Select a Different Chart Type
o Click on the chart to select it for editing.
o Click on the Chart Type dropdown list box and select a different chart.

Figure 18: Different Type of Chart

Teaching Guides for NTA Level 4 MLS Curriculum Page 1045

Figure 19: The New Chart Replaces That One Selected For Change.

Source: Goodwill Community Foundation 2002

Activities 4: Monthly Budget (Take-home assignment)

ASK student to refer Handout
Refer to Handout 17.1 Monthly Budget
 ALLOW them to share in group or individual
 Change the dollar amount of Gas you spent in the month of February (cell C11) and press
Enter to accept the new value.
 Notice how the chart changes when you make that modification. Also, the values in C16
and C18 change automatically.
 If you did not see the chart change, try entering another number into C11.
 Add the data for the month of March to the chart.
 Change the chart title from My Budget to whatever you wish to name it.
 Save and close the document.

Step 5: Formatting Charts (25 minutes)

 Formatting the Chart Title
o The Chart Title can be formatted to change colour, pattern, typeface, size and
alignment using the Format Chart Title dialog box.
 To format the chart title
o Select the Chart Title.

Figure 20: Formatting Chart Title

Teaching Guides for NTA Level 4 MLS Curriculum Page 1046

Source: Goodwill Community Foundation 2002
Click the Format Button on the Chart Toolbar (or double click the Chart Title).

o The Format Chart Title dialog box contains three different tabs-Patterns, Font and
Alignment-that can be used to format the Chart Title.
o The Patterns tab lets you define borders and fill colours (see lesson 13).
o The Font tab lets you define Font, Font Style, Size and Colour (see lesson 11).
o The Alignment tab lets you define horizontal and vertical cell placement, as well as
text orientation (see lesson 11).
o Click the OK button to accept the Chart Title format changes

Figure 21: Chart Font

Source: Goodwill Community Foundation 2002

 Formatting the Chart Legend

o The chart legend displays very useful information about the chart. Like a roadmap,
the Legend identifies what different colours or objects represent in the chart. The
Chart Legend, like the Chart Title and Category Axis Labels, can be formatted to your
liking.

 To Format the Chart Legend

o Press the show/hide legend button on the Chart Toolbar to turn on the Legend
display. (This button acts like a toggle by turning the display on or off.)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1047

Figure 22: Formatting Chart Legend

Source: Goodwill Community Foundation 2002

o Click to select the Chart Legend.

o Click the Format Button on the Chart Toolbar (or double click the chart legend).

o The Format Legend dialog box contains three different tabs-Patterns, Font and
Alignment-that can be used to format the Chart Title.
o The Patterns tab lets you define borders and fill colours.
o The Font tab lets you define Font, Font Style, Size and Colour.
o The Placement tab lets you define the location where the Legend will appear on the
chart.
o Click the OK button to accept the Chart Legend format changes.

Figure 23: Format Legend Placement Option

Source: Goodwill Community Foundation 2002

Teaching Guides for NTA Level 4 MLS Curriculum Page 1048

 The only way to change the actual text that appears in the Chart Legend is to change the
Source Data in the worksheet.

 Formatting the Axis Labels

o We've previously made reference to a Y-axis and an X-axis in Excel. In Excel, a
graph represents a data in two dimensions. The number of items sold in January is
data on two dimensions: number of items and month. The number of items might be
plotted on one axis, Y-axis, while the month may be plotted on the X-axis. The Y-axis
runs up-and-down on the graph. The X-axis runs left-to-right.
o When formatting the Axis labels in your chart, you can adjust the numbers on the
Scale of the chart as well as change font, colour, and style.

 To Format an Axis
o Click anywhere in the Axis label that you want to edit:

Figure 24:X-Axis and Y-Axis Found in Chart

Source: Goodwill Community Foundation 2002

o Click the Format Button on the Chart Toolbar (or double click the chart axis).

Teaching Guides for NTA Level 4 MLS Curriculum Page 1049

 The Format Axis dialog box contains five different tabs-Patterns, Font and Alignment-
that can be used to format the Chart Title.
 The Patterns tab lets you define borders and tick marks.
 The Scale tab lets you define numeric intervals on the Value (Y) Axis scale.
 The Font tab lets you define Font, Font Style, Size and Colour.
 The Number tab lets you define the format of numbers displayed in the Axis .
 The Alignment tabs let you define text orientation.
 Click the OK button to accept the Axis format changes.

Figure 25: Format Axis Number

Source: Goodwill Community Foundation 2002

 You can also use the angle axis buttons on the chart toolbar to change the angle of the
value and category axis.

 Changing the Data Series Colour

o When a chart is created in Excel 2003 you notice that colour is automatically applied
to the Data Series. You can keep this format or change it for each Data Series in the
chart. Many different aspects of each data series can be changed, but you'll probably
change the colour of bars, columns, pie slices and areas most often.
 To Change the Colour of a Data Series
o Select the data series that you wish to edit.

Figure 26: Color To Selected Data Sharing

Teaching Guides for NTA Level 4 MLS Curriculum Page 1050

Source: Goodwill Community Foundation 2002

o Click the Format Button on the Chart Toolbar (or double click the data series).

Figure 27: Use the Format Data Series Dialog Box to Pick a New Colour.

Source: Goodwill Community Foundation 2002

o Click the OK button to accept the Data Series colour changes.

Activities 5: Monthly Budget (Take-home assignment)

ASK student to refer Handout
Refer to Handout 17.1 Monthly Budgets
 ALLOW them to share in group or individual
 Format the chart title to Verdana, size 12 font
 Select the show/hide legend button until the legend is visible on the chart
 Format the legend placement so that it is to the left of the chart
 Format the y-axis so the currency amount has a dollar symbol ($) in front of it
 Modify the colour of the January data series so that the January column appears
GREEN
 Save and close the document

Teaching Guides for NTA Level 4 MLS Curriculum Page 1051

Step 6: Key Points (5 minutes)
 Charts are a visual representation of data in a worksheet. Charts make it easy to see
comparisons, patterns, and trends in the data.
 Charts that can be created in Excel 2003 include: Area charts, Column charts, Bar charts,
Line charts, Pie charts, and others (Doughnut; Stock XY (scatter); Bubble; Radar;
Surface; or Cone, Cylinder, and Pyramid charts).
 Charts can be resized-made larger or smaller-to fit on a worksheet. Chart Titles are sized
in proportion to how large or small you make the chart. And within the Chart Area, the
Legend and/or Plot Area can be made larger or smaller. Chart Titles can be moved but not
resized.
 When you add a chart to your worksheet, Excel creates a link between the chart and your
source data. Any changes made to the original source data are automatically reflected in
the chart.
 The Chart Title can be formatted to change colour, pattern, typeface, size and alignment
using the Format Chart Title dialog box.

Step 7: Evaluation (15 minutes)

 List steps in creating a Chart
 Describe steps of moving, resizing, and deleting charts
 What is only way to change the actual text that appears in the Chart Legend
 The Format Chart Title dialog box contains which three different tabs?

Reference
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 1052

Handout 17.1: Monthly Budget

Teaching Guides for NTA Level 4 MLS Curriculum Page 1053

Session 18: Demonstration on Printing
Management for Excel
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 Introduction to Computer

Learning Objectives
By the end of this session, students will be able to:
 Define page setup options
 Manage printing document

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD
 Handout 18.1 Monthly Budget

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
Hands on
2 40 minutes Defining page setup options
Practice
Hands on
3 55 minutes Manage printing document
Practice
4 5 minutes Presentation Key Points
5 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Defining Page Setup Options (40 minutes)

Activity 1: Brainstorm (5 minutes)
 ASK student: What is the difference between hard copy and soft copy?
 ALLOW for some responses.
 SUMMARIZE by explaining that a hard copy is an image output on paper by a printer or
plotter and a soft copy is an image or character output on a monitor screen.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1054

Setting Page Margins
 The Page Margins define where on the page Excel will print the worksheet. By default,
the top and bottom margins are set at 1 inch in Excel 2003. The left and right margins are
set at .75 inch. Margin settings can be changed to whatever you want. Different margins
can be defined for each worksheet in the workbook.

 To Change the Margins in the Page Setup Dialog Box

o Select the correct worksheet.
o Choose File Page Setup from the menu bar.

Figure 1: Page Setup Optional Figure 2: Page Setup Dialog Box

Source: Goodwill community foundation 2002

o Select the Margins tab.

o Use the spin box controls to define the settings for each page margin-Top, Bottom,
Left, Right, Header and Footer.
o Click the OK button to change the margin settings.

 Changing the Page Orientation and Paper Size

o The Page tab of the Page Setup dialog box lets you change page orientation (portrait
or landscape) or paper size (e.g., letter size or legal size). The default paper size in
Excel 2003 is 8.5 X 11 inches, with a portrait orientation (prints up and down on the
long side of the page). A landscape orientation, on the other hand, prints up and down
on the short side of the page.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1055

 To Change Page Orientation
 Select the correct worksheet.
 Choose File Page Setup from the menu bar.
 Click on the Page tab.

Figure 3: Changing Page Orientation Dialog Box

Source: Goodwill Community Foundation 2002

o Choose an Orientation (Portrait or Landscape) for the worksheet.

o Select a Paper Size from the list of available paper size options that appear in the list
box.
o Click on the paper size.
o Click the OK button to accept the page settings.
o The Page tab of the Page Setup dialog box lets you shrink the spreadsheet data so it
fits on a specified number of pages when you print. Click the Fit to: option button
and enter the desired number of pages wide and pages tall.
o The Page tab of the Page Setup dialog box lets define the resolution of the print job.
Print Quality is measured in dpi, or dots per inch. High dpi provides a better print
quality.
 Creating Headers and Footers
o Headers and Footers can be added to any worksheet, although not required. A Header
is any information that appears at the top of each page. A Footer prints at the bottom
of the page. If you want a header or footer inserted onto a page then you will have to
define them. Excel 2003 defaults to no header and no footer.
 To Create a Header
o Choose File Page Setup from the menu bar.
o Select the Header/Footer tab in the Page Setup dialog box.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1056

Figure 4: Changing Page Header/Footer Dialog Box

Source: Goodwill Community Foundation 2002

o Click the Header drop down list and select and of the predefined headers:

OR
o click the Custom Header button to create your own header. Follow the instructions in
the Header dialog box to make your entry.

Figure 5: Header Options Dialog Box

Source: Goodwill Community Foundation 2002

o Click the OK button to return to the Page Setup dialog box

 To Create a Footer
o Choose File Page Setup from the menu bar.
o Select the Header/Footer tab in the Page Setup dialog box.
o Click the Footer drop down list and select one of the predefined footers.

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 o You can insert Placeholder buttons into both the header and footer to format text,
insert page numbers, date, time, filename, or tab name. Excel replaces those
placeholders with the information each represents when the worksheet is printed.
Follow the instructions in the Header and Footer dialog boxes.
 Creating Sheet Settings
o The Sheet tab in the Page Setup dialog box provides additional print options you may
want to add to your worksheet.

Figure 5: Sheet Options Dialog Box

Source: Goodwill Community Foundation 2002

 Print Area: By default, Excel prints from the A1 to the last occupied cell in a worksheet.
You can specify a different range of cells to print
 Print Titles: Prints column and row labels on each page of the printout. Specify these
rows or columns in the Rows to Repeat at Top and Columns to Repeat at Left textboxes
 Print – Gridlines: Determines whether gridlines are printed. However, turning off
gridlines does not affect their appearance in Normal View
 Print - Black and White: If you used colors in your worksheet but don't want to waste the
ink in your color printer, use black and white
 Print - Draft Quality: Choose draft quality to print the worksheet without gridlines or
graphics
 Print - Row and Column Headings: Click this option to include row numbers and
columns letters in your printed document
 Page Order: Determines the order in which worksheets are printed

Activities 2: Monthly Budget (10 minutes)

Refer students to Handout 18.1 Monthly Budget

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ALLOW student to share idea in pair
Change the right and left margins to .5".
Verify the top and bottom margins are 1".
Change the Page Orientation to Landscape and verify the page size is 8.5 X 11".
Create a custom footer with your name or GCF username in the left section and the date
in the right section.
Save and close the document.

Step 3: Manage Printing Document (55 Minutes)

 In Excel 2003 you can print an entire workbook, a worksheet, a cell range or a cell. Excel
defaults to printing the entire worksheet. But if you want to print only a certain area of a
spreadsheet then you can define a print area.
 To Specify a Print Area
o Choose View Page Break Preview from the menu bar.

o A reduced image of the chart is displayed on the screen.

o Click on one of four blue-colored borders and drag to highlight and select the area to
print.

Figure 6: Represent Selected Area for Printing

Source: Goodwill Community Foundation 2002

o Choose File Print Area Set Print Area on the menu bar.

Figure 7: Print Area Setup Options

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Source: Goodwill Community Foundation 2002

o Only that area you defined in the print range will print when the worksheet is
submitted to the printer for printing.

 Preview a page before printing

o Excel 2003 provides a Print Preview capability that shows a smaller picture of the
printed page directly on the computer screen. Print Preview is a good way for you to
review the formatting and make sure the columns, rows and margins appear exactly
where you want them.
 To Print Preview
o Choose File Print Preview on the menu bar, or Click the Print Preview button on
the standard toolbar.
o In Print Preview window, the document is sized so the entire page is visible on the
screen. Simply check the spreadsheet for overall formatting and layout.

Figure 8: Print Preview Box

Source: Goodwill Community Foundation 2002

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 o The Zoom button in Print Preview will enlarge the data so it can be read.

 Inserting and Removing a Page Break

o There are two different kinds of page breaks in Excel: soft page breaks and hard page
breaks. A soft page break is automatically inserted into a spreadsheet when there is
too much data to fit on one page. A hard page break is one that you can insert into a
spreadsheet, wherever you want it to appear.
 To Insert a Page Break
o Move the cursor to the row where a page break needs to be inserted. This row will be
the first row on the new page.
o Choose Insert Page Break from the menu bar.

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Figure 9: Insert Page Break Dialog Box

Source: Goodwill Community Foundation 2002

o A page break, indicated by a dashed line, is inserted into the worksheet.

 To Delete a Page Break
o Move the cursor to the row where a page break appears
o Choose Insert Remove Page Break from the menu bar.

Figure 10: Removing Page Break

Source: Goodwill Community Foundation 2002

o The page break (represented by a dashed line) is removed from the page.

 Printing a Worksheet or Workbook

o Printing in Excel is much like printing in other Office applications like Microsoft
Word. As previously mentioned, Excel defaults to printing the entire worksheet.
 To Print a Worksheet
o Choose File Print from the menu bar.

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Figure 11: The Print Dialog Box Opens.

Source: Goodwill Community Foundation 2002

 Specify the Printer Name where the spreadsheet will print. If you only have one printer in
your home or office, Excel will default to that printer.
 In Print Range, choose whether to print All or a certain range of pages (Pages From n to
y, where n and y are the beginning and ending page numbers.
 In print what; choose whether to print a Selection, the Active sheet or the Entire
Workbook (all worksheets in the workbook). Excel defaults to the Active Sheet.
 Choose the Number of Copies to print by clicking on the up or down arrows.
 Click the OK button to print the worksheet.
 Don't print your Excel spreadsheet without checking spelling first! Excel includes two
tools to help correct spelling errors: AutoCorrect and Spelling.

Activities 2: Worksheet Preview (10 minutes)

 ASK student to create worksheet which contain row with data.
 Regina, first name, second name, marks 1, marks 2 and Total with no more than ten
column of data.
 ALLOW them to do individual
 Use Print Preview to view the sheet and then Print the document.
 Save and close.

Step 4: Key Points (5 minutes)

 The Page Margins define where on the page Excel will print the worksheet. By default,
the top and bottom margins are set at 1 inch in Excel 2003. The left and right margins are
set at .75 inch. Margin settings can be changed to whatever you want.
 Excel 2003 provides a Print Preview capability that shows a smaller picture of the
printed page directly on the computer screen. Print Preview is a good way for you to
review the formatting and make sure the columns, rows and margins appear exactly
where you want them.

Step 5: Evaluation (15 minutes)

 List steps in changing page orientation
 Describe steps in specifying a print area

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Reference
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

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Handout 18.1: Monthly Budget

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Session 19: Demonstration on
PowerPoint Basics
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT
*(More time should be allocated to this session preferable 6hours)
Total Session Time: 120 minutes

Prerequisites
 Introduction to Computer

Learning Objectives
By the end of this session, students will be able to:
 Identify components of PowerPoint Window
 Practice on Creating a Blank Presentation
 Practice Inserting, Copying and Deleting Slides
 Practice on Viewing slides with different Slide information
 Apply and Design Template
 Practice Use the AutoContent Wizard

Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD
 Handout 19.1: PowerPoint Sample Slides in Word

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 15 minutes Hands on Practice The PowerPoint Window
3 30 minutes Hands on Practice Creating a Blank Presentation
4 10 minutes Hands on Practice Inserting, Copying and Deleting Slides
5 10 minutes Hands on Practice Working with Slide Views
6 15 minutes Hands on Practice Applying a Design Template
7 15 minutes Hands on Practice Using the AutoContent Wizard
8 5 minutes Presentation Key Points
9 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of session title and learning objectives (5 minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

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Step 2: Components of the PowerPoint Window (15 minutes)
Activity 1: Brainstorm (5 minutes)
 ASK student: What is PowerPoint programme used for?
 ALLOW for some responses.
 SUMMARIZE and go to information below for PowerPoint

 PowerPoint 2003 is the presentation graphics software in the Microsoft 2003 Office
Suite. It allows you to create dynamic presentations using its easy-to-use, predefined
layouts and templates.
 Microsoft PowerPoint 2003, part of the Office 2003 suite, is a presentation graphics
application. A presentation is a combination of slides, handouts, notes, and outlines all in
one file. You can add text, graphics, photos, clip art, sound and video to your slides.
PowerPoint 2003 can help you present a topic at work, home, or school.
 The Parts of the PowerPoint Window
 The PowerPoint Window has toolbars and panes to help you quickly create
presentations. Most of the toolbars are common in Office applications but may feature
options unique to PowerPoint.
 Title Bar - displays the document name followed by a program name.
 Menu Bar - contains a list of options to manage and customize documents.
 Standard Toolbar - contains shortcut buttons for the most popular commands.
 Formatting Toolbar - contains buttons used for formatting.
 Status Bar - displays slide position and the type of design in PowerPoint.
 Drawing Toolbar - contains tools for drawing lines, shapes and objects.
 Task Pane - located on the right side of the computer screen, this pane allows you to
select tasks in different categories and allows you to quickly enhance your slides in a few
steps. It provides quick access to the most common actions and features in PowerPoint.
 Outline and Slides Tabbed Pane - allows the user to easily view the presentation in
outline format (text), as well as a list of all the slides in the presentation (with visuals).
 Help - provides quick access to Help topics.
 The default view for PowerPoint 2003 is the Tri-Pane View. This view, which opens
when you launch PowerPoint, allows you to see multiple parts of a presentation at once.

Figure 1: PowerPoint components/parts

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Source: Goodwill Community Foundation 2002

 The Outline and Slides Tabbed Panes are located on the left side of the screen. Click on
the tabs to view an outline or a slide of your presentation. The tabs render differently
based on the size of the pane.

 You can show or hide PowerPoint's toolbars. Click on the View menu and choose
Toolbar. Decide which ones you want to show or hide.

 View Buttons and Slide Views

 The view buttons at the left bottom corner of the screen allow three slide views: Normal
View, Slide Sorter View and Slide Show.

 The view buttons can be useful as you prepare your presentation. They control the way
slides are displayed on the screen. Click a view button to see a different view.
 Normal View contains the Outline and Slides Tabbed Panes on the left, the Slide
pane in the center and the Task Pane on the right.
 The Outline View shows the text of your presentation for easy editing while Slides View
shows text and graphics of the slide you're working on. Click on the tabs to switch
between the two views. Under the center slide area is a place for notes.

Figure 2: Text Area of PowerPoint

Source: Goodwill Community Foundation 2002

 You can hide or show the different panes in Normal View. To hide the Task Pane, click
on the View menu and choose Task Pane. (The View menu also allows you to choose
other views). To hide the Outline View and Slide Tabbed Panes, click on the X to the
right of the Slides Tab.

 More Views
o Here are some other views that may be useful as you create your presentations:

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 o Slide Sorter View lets you see small versions of all the slides you have created.
You can delete, copy, and move slides in this view.
o Slide Show lets you see your presentation electronically as it will appear to an
audience.
 The Task Pane
o The PowerPoint 2003 Task Pane is located on the right side of the screen. The down-
pointing arrow in the top, right corner of the pane allows you to select different menus
and tools. By default, the Task Pane appears when PowerPoint 2003 is launched.

Figure 3: Task Pane

Source: Goodwill Community Foundation 2002

o The Slide Layout and Slide Design panes within the Task Pane help organize
layouts, design templates, and color schemes. When you select a design option, your
slides are quickly updated with the new look.
o You can view the Slide Layout and Slide Design panes by clicking on the down-
pointing arrow next to New Presentation in the Task Pane.

Figure 4: Task Pane Show Slide Design

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Source: Goodwill Community Foundation 2002

o Select Slide Layout or Slide Design (Design Templates, Color Schemes, Animation
Schemes). You'll learn more about using these panes later in this course.

Figure 5: Selection of Slides

Source: Goodwill Community Foundation 2002

 Using the Task Pane

o If you do not see the Task Pane on the right side of the PowerPoint window, you can
easily access it.
o To Open the Task Pane:
o Click View Task Pane

Figure 6: Task Pane dialog box

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Source: Goodwill Community Foundation 2002

 To View Different Panes

o Click on the down-pointing arrow next to New Presentation and select different
panes.
o Once you open different panes, you can move through them by clicking on the
backward and forward arrow buttons at the top of the task pane.

 To Close the Task Pane

o Click the X on the right corner of the bar.
o You can hide or view the Task Pane by clicking on View Task Pane.

 Pull-Down Menus
o PowerPoint 2003's menu bar initially displays commands that you most often use. To
view infrequently used commands from a menu, use pull-down menus.
o To View Commands in a Pull-Down Menu
o Click on a menu in the menu bar. (File, Edit, View, Insert, etc.)
o Move your mouse pointer over the double arrows at the bottom of the pull-down
menu.

Figure 7: Edit Button before Click

Source: Goodwill Community Foundation 2002

o Notice that some menus have black arrows to the right. Slide your mouse pointer over
the arrow to view more options. These are called cascading menus.

Figure 8: More Options from View

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Source: Goodwill Community Foundation 2002

Activities 2: Parts of the PowerPoint Window (5 Minutes)

 ASK student to use Microsoft PowerPoint 2003

 ALLOW them to make practice in order to be memorable with Parts.

 Open Microsoft PowerPoint 2003 from the Start menu.
 Review the parts of the PowerPoint window.
 Familiarize yourself with the Task Pane. Click to see the other panes.
 Click on the menu bar and view pull-down menus.
 Click on the View Buttons.
 Click on the Outline tab and the Slides tab.
 Close PowerPoint and do not save anything you have done.

Step 3: Creating a Blank Presentation (30 minutes)

 PowerPoint offers three ways to create a presentation: Blank presentation, From Design
Template or From AutoContent Wizard.
 The Blank presentation option is one of the more commonly used methods. It offers
several blank slides with layouts for text and graphics.
 To Create a Blank Presentation
 Open PowerPoint.
 A slide featuring a place for a title and subtitle appears by default. You may begin your
presentation with this slide or choose a different slide layout.

Figure 9: Blank Presentation

Source: Goodwill Community Foundation 2002

 The New Presentation Pane appears on the right side of the screen.
 Under New, click Blank Presentation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1072

 A list appears.

 Choosing a Slide Layout

o As you work on your presentation, think about the type of layout you want. Do you
want a slide with text and lots of clip art or one with text and a chart? PowerPoint
offers many layout options.
o To Choose a Slide Layout
o Move your arrow pointer over the layouts or use the scroll bar in the Slide Layout
Pane.
o A gray bar appears on the right of each layout.
o When you find a layout that you like, click the down-pointing arrow and choose
Apply to Selected Slide.

Figure 10: Slide Layouts Dialog Box

Source: Goodwill Community Foundation 2002

o You can also click on the slide layout to apply it. Notice that the slide you are
currently working on has a dark border in the Outline Pane.

 Placeholders
o Once you choose a layout for your slides, you can begin adding text, graphics or other
items. You do this with placeholders - specials places within a slide where you can
add content.
 To Add Text to a Placeholder
o Click on the placeholder.
o Start typing.

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Figure 11: Place Where You Can Us to Prepare PowerPoint Presentation

Source: Goodwill Community Foundation 2002

o (You'll le learn about inserting clip art and other graphics into placeholders later in
this course)

 Saving a Presentation
o You can save, close, and exit presentations in PowerPoint just as you would while
using other Microsoft applications.
 To Save a Presentation
o Click on File Save. (Ctrl + S)

Figure 12: Save Option

Source: Goodwill Community Foundation 2002

o Choose the location where you want to save your presentation. (My Documents is a
good place).
o Type a name in the File Name box or keep the one that PowerPoint has provided.

 Closing a Presentation and Exiting PowerPoint

o Once you've finishing working on your presentation, you can quickly close it.
 To Close a Presentation
o Click the X in the PowerPoint presentation window (Ctrl + W).

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 o The PowerPoint application remains open and you can start a new presentation. (See
next page for details).
 To Exit PowerPoint
o Click the X in the far right top corner.

o Choose File Exit. (Alt + F4)

o Before you exit PowerPoint, make sure that you save any work that you want to keep.

 Creating a New Presentation Using the Traditional Method

o Remember, after you have closed one presentation, you can easily start a new one
while PowerPoint is still open by using the traditional new file creation method.
 To Start a New Presentation
o Click on File New. (Ctrl + N)

Figure 13: Creation of New Presentation Dialog Box

Source: Goodwill Community Foundation 2002

o In the New Presentation Pane, under New choose Blank Presentation.

Figure14: New Presentation Pane

Teaching Guides for NTA Level 4 MLS Curriculum Page 1075

Source: Goodwill Community Foundation 2002

o Choose the design layout that you want.

o Remember, if your Task Pane disappears from the right side of the screen, click on
View Task Pane.

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Activities 3: Where you learn (Take-home assignment)
 In this series of activities you are going to prepare a presentation about where you learn.
This presentation can contain facts about the city or town where you learn and the place
you use the GCFLearnFree.org® website (home, library, learning center, internet cafe,
etc.).
 Start PowerPoint.
 Use the downward pointing arrow, beside Getting Started in the Task Pane, to select
New Presentation Blank Presentation.
 Choose a slide layout with a title and a subtitle placeholder.
 Type Where I Learn in the title placeholder.
 Type your name or username and today's date in the subtitle placeholder.
 Save the document as Where I Learn.
 Exit PowerPoint.

 Important Reminder: If you are using a public computer, such as one at a library or
learning center, you may not be able to use the same computer each time. It is very
important to understand the policies on saving documents to public computers. Some
places do not allow you to use floppy disks due to the risk of computer viruses. Ask
someone in charge of the public computers where you are. If you are unsure how you will
keep a recent copy of the assignment, you can always email a copy of the document to
yourself when you finish working on the document.

o For Example:

Step 4: Inserting, Copying and Deleting Slides (10 minutes)

 You can quickly open a presentation that you've previously saved by using the Task Pane.
 To Open a Presentation
o Start PowerPoint.
o In the Task Pane, click on from existing presentation and select the presentation
that you want to open.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1077

Figure15: Task Pane

Source: Goodwill Community Foundation 2002

OR
o Choose File Open.
o Navigate to the file you want to open.

 Inserting a New Slide

o Once you've created your opening slide, you'll want to add more slides to your
presentation.
 To Insert a New Slide
o Click on Insert New Slide. (Ctrl + M)
o Move your arrow pointer over layouts or use the scroll bar and choose a slide layout.

Figure 16: Slide Layout Application

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Source: Goodwill Community Foundation 2002

o A gray bar appears on the right

o Click the down-pointing arrow and choose Insert New Slide.
OR
o Click the New Slide button at the top of the screen

o Move your arrow pointer over layouts or use the scroll bar and choose a design
layout.
o A gray bar appears on the right
o Click the down-pointing arrow and choose Insert New Slide.

 Copying a Slide
o Copying is another technique that you may use as you work on your slide
presentation. For example, you may want to repeat a slide later in the presentation or
copy a slide and make slight changes to it to make a different point.

 To Copy a Slide
o Click the slide you want to copy in the pane on the left.
o Click on the Copy Button on the Standard Toolbar. (Ctrl + C)
o Move the arrow pointer to where you want the copied slide to appear.
OR
o Right click the slide you want to copy in the pane on the left.
o Move the arrow pointer to where you want the copied slide to appear.
o A horizontal cursor appears.
o Click the Paste Button on the Standard Toolbar or right click Paste. (Ctrl + V)

Figure 17: Example of Prepared Slide

Source: Goodwill Community Foundation 2002

Teaching Guides for NTA Level 4 MLS Curriculum Page 1079

Note: This example of how to copy a slide was shown in the Slide Sorter View; however,
the same instructions apply for copying a slide in Normal View.

 Deleting a Slide
o Sometimes you may want to take one or more slides out of your presentation.
 To Delete a Slide
o Click the slide.
o Press Delete on your keyboard.
OR
o Right click the slide you want to delete in the pane to the left Delete Slide.

Figure 18: How to Delete Slide

Source: Goodwill Community Foundation 2002

You'll learn more about working with slides in different views in the next lesson.

Activities 4: Where I learn (Take-home assignment)

 Open the Where I Learn presentation you created in the previous activity
 Insert a new slide with title and text placeholders.
 Type the name of the city and state/province where you live in the title line.
 Type details about this location in the bulleted list.
 Copy and paste the slide you just created.
 Delete the copy you just made.
 Insert a new slide with title and text placeholders.
 Type the name of the place where you learn in the title placeholder. For example, if you
use the GCFLearnFree.org website from your home, you would type Home in the title
placeholder.
 In the bulleted list type information about the location where you learn.
 Save and close your presentation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1080

Figure 19: Examples of Slides

OR

Source: Goodwill Community Foundation 2002

Step 5: Different Slide Views (10 minutes)

 As you are working on your presentation, you may want to change the order of your
slides. You can rearrange slides in Slide Sorter View. It allows you to view miniature
slides that you can drag and drop.
 To Move Slides in Slide Sorter View
o Click on the Slide Sorter View button in the left bottom corner of the page.
o Click the slide you want to move.
o Hold down the left mouse button and drag the slide to its new location. A pointer with
a box appears as you drag the slide.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1081

Figure 20: Slide Sorted View

Source: Goodwill Community Foundation 2002

o Click on the Normal View button to return to Normal View.

 Working with Slides in Normal View

 You can also easily move slides in Normal View. Remember, this is the Tri-Pane View
that shows small slides on the left, a slide in the center and the Task Pane on the right.
 To Move Slides in Normal View
o Click on the Normal View button .
o Click a slide in the left pane and drag and drop it to its new location.
o Hold down the left mouse button and drag the slide to its new location. A pointer with
a box appears as you drag the slide.

Figure 21: Tri-Pane View

Source: Goodwill Community Foundation 2002

Teaching Guides for NTA Level 4 MLS Curriculum Page 1082

 To toggle between the different views in PowerPoint 2003, click on the View buttons or
click on View Slide Sorter, Normal or Slide Show

 Changing and viewing Slides in Outline View

 Outline View also allows you to make changes to slides. While you can drag and drop
slides in this view, it's also useful for making changes to the text of your slides or for
viewing multiple slides.

 To View or Make Changes to Text in Outline View

o Click the Outline View tab in the left pane.

o An outline view of your slides appears with text.

o Click on the small gray slide you want to make changes to.
o Scroll through the slides in outline view.
o Select the slide in the outline and then type changes directly onto the center slide.
o You can view the text of all of your slides in this view.
o Return to Normal View by clicking the Slides tab in the left pane.

o Viewing Slides in Slide Show View

o After you have made some changes to your PowerPoint presentation, you can get an
idea of how it will look as a slide show.
 To View Slides in Slide Show View
o Click on the Slide Show button at the bottom left corner of the screen.
OR
o Click on View Slide Show.

Figure 22: Slide Show

Source: Goodwill Community Foundation 2002

o Click on each slide until you reach the end of the slide show. (black screen)

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 o Click to exit and return to Normal View.

Activities 5: Where I learn (Take-home assignment)

 Open the presentation, Where I Learn, which you have worked with in the last two
activities
 View the presentation in Slide Sorter View. Currently, you should have three slides.
Your slides may look something like this:
 Move the city/state slide (currently your second slide) so that it is the third slide in the
slide show.
 View the slides in Outline View.
 Add an exclamation point (!) to the first slide after Where I Learn!
 View the slides in Slide Show View.
 Save and close your presentation.

Step 6: Applying a Design Template (15 minutes)

 PowerPoint offers Design Templates to make it easy to create an attractive presentation.
These templates come in a variety of colors and styles. You can apply a design to existing
slides or begin a new presentation with a template.
 To Begin a New Presentation with a Design Template
 Open PowerPoint.
 In the Task Pane under New, click on From Design Template.

Figure 23: Design Template Feature Figure 24: Apply a Design Template

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Source: Goodwill Community Foundation 2002

 A list of templates appears.

 Move your mouse pointer through the different designs or use the scroll bar.
 Click on the down-pointing arrow in the gray box next to the template that you like.
 Choose Apply to All Slides

 Adding a Design to an Existing Presentation

 Do you have an existing presentation that you want to add a design to? PowerPoint makes
it easy to enhance existing slides with a design template.
 To Apply a Design to an Existing Presentation
o Open PowerPoint.
o In the Getting Started Task Pane, under Open, click on the presentation you want or
select More... to browse through the files.
o Click on the down-pointing arrow in the Getting Started pane and choose Slide
Design - Design Templates.
o A list of templates appears.
o Move your mouse pointer through the different designs or use the scroll bar.
o Click on the down-pointing arrow in the gray box next to the template that you like.
o Choose Apply to All Slides.

 Applying a Design Template to Selected Slides

o As you are working on your presentation, you can choose Apply to Selected Slides if
you want one or more slides to have a different look.

Figure 25: Application of Design Template

Source: Goodwill Community Foundation 2002

 A Closer View of Design Templates

 If you want a closer look at the Design Templates, follow these steps:
 With a presentation open, click on a template.

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 Click on the down-pointing arrow in the gray bar to the left.
 Choose Show Large Previews. (It is now checked).

 To return to the smaller views of the slides, click in the gray bar of any template and
uncheck Show Large Previews.

 Choosing a Color Scheme

 PowerPoint's Design Templates have pre-selected colors but you can choose your own
color scheme. A color scheme is a combination of colors for the text and background of
your slides.
 To Choose a Different Color Scheme
o In the Task Pane, click on the down-pointing arrow in the gray bar next and choose
Slide Design - Color Schemes.
o A list of color schemes appears.
o Move your arrow pointer through the different color scheme options or use the scroll
bar.
o When you find a color scheme that you like, click on the down-pointing arrow in the
gray box and choose Apply to All Slides.

Activities 6: Where I learn (Take-home assignment)

Open the presentation, Where I Learn.

 Apply a Design Template to your slides such as Capsules, Blends, Ripple, etc. Choose
any design template other than the white default design.
 View the various Color Schemes and apply a different color scheme to your slides.
 Save and close your presentation.
 PowerPoint has an AutoContent Wizard to help you create a presentation. This wizard
provides several slides with different content guides. Presentation guides are available in
several areas including General, Corporate, and Sales/Marketing.

Step 7: Use of AutoContent Wizard (15 minutes)

 In the Task Pane under New Presentation, choose From AutoContent Wizard.

Figure 26: AutoContent Wizard start

Teaching Guides for NTA Level 4 MLS Curriculum Page 1086

Source: Goodwill Community Foundation 2002

 Click Next to see the different presentation options that are available

 Choosing a Presentation Type

 As you continue working in the Wizard, think about what you presentation best fits your
needs. If you're not sure which choice to make, try General - Generic.
 Click Next after you have chosen a presentation type.

Figure 26: AutoContent Wizard Presentation

Source: Goodwill Community Foundation 2002

 Type of Output
o The next screen asks, What type of output will you use?
o Since you will likely be doing an On-screen presentation, click inside the circle next
to On-screen presentation. Or, choose another presentation type.
o Click Next.
o On the next screen, you can type in your Presentation Title. Add footer, if necessary.

Figure 27: AutoContent Wizard Presentation Options

Teaching Guides for NTA Level 4 MLS Curriculum Page 1087

Source: Goodwill Community Foundation 2002

o Click Next.
o The last AutoContent Wizard dialog box appears.
o Click Finish.
o Your slides will appear and you can go through each one and make changes to the
content. Edit the slides in Outline View in the left pane or type directly onto the
slides in the center pane.

 Making Changes to Content

o When you use the AutoContent Wizard, the slides that result are a guide for your
actual content. Make the changes necessary to fit your presentation.
o For example, if you are working on a General - Generic presentation about your
organization and how it helps the community, your first slide might look like this:

Figure 28: Slide

o You may want to add or delete some of the slides based on your content or add a
different design or color scheme.

Activities 7: AutoContent Wizard (Take-home assignment)

Part 1: In this section of the challenge you are going to practice using the AutoContent
wizard. You do not need to save this presentation

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Open the AutoContent Wizard.
Choose a Presentation Type.
Add a Presentation Title.
When you Finish, make changes to the first page of the presentation.
Click through the presentation in Outline View.
Close this presentation without saving the document.
Part 2: In this section of the challenge you are going to make changes to the presentation you
previously created, Where I Learn.
Open the Where I Learn presentation.
Insert a new slide with a title placeholder and a bulleted list placeholder (Title and Text).
Type a title and type some interesting information about where you learn. Format this
information so it is not in a bulleted list.
Save and close the document.
Congratulations! You just completed your first Activity presentation in PowerPoint 2003.

Step 8: Key Points (5 minutes)

 Microsoft PowerPoint 2003, part of the Office 2003 suite, is a presentation graphics
application. A presentation is a combination of slides, handouts, notes, and outlines all in
one file. You can add text, graphics, photos, clip art, sound and video to your slides.
 Copying is another technique that you may use as you work on your slide presentation.
For example, you may want to repeat a slide later in the presentation or copy a slide and
make slight changes to it to make a different point.
 As you are working on your presentation, you may want to change the order of your
slides. You can rearrange slides in Slide Sorter View. It allows you to view miniature
slides that you can drag and drop.
 PowerPoint offers Design Templates to make it easy to create an attractive presentation.
These templates come in a variety of colors and styles. You can apply a design to existing
slides or begin a new presentation with a template.

Step 9: Evaluation (15 minutes)

 What is the default view for PowerPoint 2003?
 List steps in creating a Blank Presentation
 List steps in inserting, copying and deleting slides
 Describe the procedure for opening a presentation that you've previously saved.

Reference
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1089

 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

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Handout 19.1: PowerPoint Sample Slides in Word
Slide 1

Container Gardening
Starr City Garden Club

By: Maxine Greene

Slide 2

Gather Your Tools

 Container
 Fertilizer
 Soil
 Water Hose
 Spade
 Bedding Plants

Slide 3

Container Placement

 Temperate Zone
 Plant Types
 Amount of Sun Exposure

Slide 4

Container Preparation

 Drainage
 Light Exposure
 Fill Level of Soil
 Placement of Bedding Plants

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Slide 5

Transplanting Bedding Plants

SOIL LEVEL POTTING SOIL

GRAVEL
DRAINAGE LEVEL

Slide 6

Slide 7

Maintenance

 Watering
 Fertilizing

Slide 8

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 How Important is Water?

 Very Important to Keep Right Amount

of Water in Potting Mix
– Dry Mix = Hungry Plants
– Soggy Mix = Rotting Roots
 Choose a Non-Porous Container
– Helps Retain Water
 Water Slowly
– Pay Attention to the Weather

Slide 9

What About Windy Areas?

 Some Locations Make

Container Gardening
Difficult
 High Wind Areas

 Can be Done Anywhere

– Just Plant Your Beds
Inside

Slide 10

Budget

 Container Gardening Can Be Done

Inexpensively
OR
 You Can Easily Spend A Lot of Money

 Take a Look at My Budget

Teaching Guides for NTA Level 4 MLS Curriculum Page 1093

Session 20: Demonstration on Enhancing
Power Point Presentation
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 Introduction to Computer

Learning Objectives
By the end of this session, students will be able to:
 Practice Formatting Text
 Practice on Formatting Bulleted and Numbered Lists
 Practice on Adding Clip Art and Pictures
 Practice on Adding Charts, Diagrams and Tables
 Practice Adding AutoShapes, WordArt and Hyperlinks

Resources Needed
 Flip charts, marker pens, and masking tape.
 Black/white board and chalk/whiteboard markers.
 Computer.
 LCD
 Handout

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 20 minutes Hands on Practice Formatting Text
3 20 minutes Hands on Practice Formatting Bulleted and Numbered Lists
4 20 minutes Hands on Practice Adding Clip Art and Pictures
5 15 minutes Hands on Practice Adding Charts, Diagrams and Tables
6 20 minutes Hands on Practice Adding AutoShapes, WordArt and Hyperlinks
7 5 minutes Presentation Key Points
8 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Step 2: Formatting Text (20 minutes)

 Activity 1: Brainstorm (5 minutes)

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 ASK students: How can you add text to a slide?
 ALLOW for some responses.
 SUMMARIZE and go to information below for adding text.

 Adding Text to an Original Slide

o Many of PowerPoint's slides have text boxes already included and ready for you to
add information. To add text to a slide, you can just click inside the text box on the
slide. However, if you create an original slide you'll need to add a text box or two.
 To Add Text to an Original Slide
o Insert a blank New Slide.

o Click on the Text Box button in the Drawing Toolbar.

o Click and drag your mouse pointer to create a text box on the slide.

o Click on Insert Text Box.

o Click and drag your mouse pointer to create a text box.

 The Formatting Toolbar

o PowerPoint's default font or text type is Arial. However, you may want to change the
font type, font size and more. Use the Formatting Toolbar to set the color, size, and
overall look of your text. It doesn't matter whether the text is an original slide or is in
a preset layout.
o Here are some of the formatting options
o Font type
o Font size
o Bold, Italics, and Underline
o Center, Align Left, and Align Right
o Bullets and Numbering
o Font color
o Increase Font Size
o Decrease Indent

Teaching Guides for NTA Level 4 MLS Curriculum Page 1095

Figure 1: Formatting Toolbar

Source: Goodwill Community Foundation 2002

 For more formatting buttons, click on the down-pointing arrow at the end of the toolbar.
Choose Add or Remove Buttons - Formatting. Choose any additional options you want
on the Formatting Toolbar. You can also choose Show Buttons on Two Rows.

 Formatting Text
o The Formatting Toolbar allows you to make many changes to your text to give it the
look you want for your presentation.
 To Format Text
o In the Formatting Toolbar, click on the down-pointing arrow OR button for the item
you want to format.
o For example, to set the font size for text you haven't typed yet, click on the down-
pointing arrow next to the number and choose the font size. To change the font color,
click on the down-pointing arrow next to the "underlined" A.

Figure 2 Formatting Text Bar

Source: Goodwill Community Foundation 2002

 To make formatting changes to existing text, highlight the text and click on the down-
pointing arrow OR button for the formatting change.

 Take some time to experiment with the different formatting options to decide what's best
for your presentation.

 The Format Menu

o You can also use the Format menu to make formatting changes to the text in your
presentation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1096

 To Use the Format Menu
o Click on Format Font.

Figure 3: Font Option from Formatting

Source: Goodwill Community Foundation 2002

Figure 4: A Dialog Box Opens.

Source: Goodwill Community Foundation 2002

o Choose the font, font style, and/or size.

o Click OK

 Cut, Copy, and Paste

o Once you've determined how your text will appear in your slides, you may need to cut
copy or paste some information.
 To Copy and Paste
o Select the text you want to copy.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1097

 o Click the copy button on the Standard Toolbar. (Ctrl + C)
o Move your mouse pointer to the location on the slide where you want the text to
appear.
o Click the paste button on the Standard Toolbar. (Ctrl +V)
o To Cut and Paste
o Select the text you want to cut.
o Click the cut button on the Standard Toolbar. (Ctrl + X )
o Move your mouse pointer to the location on the slide where you want the text to
appear.
o Click the paste button on the Standard Toolbar. (Ctrl +V)

 The keyboard shortcuts - Ctrl + C, Ctrl + X, and Ctrl + V - can help make cutting,
copying and pasting faster. If you don't already know them, learn these shortcuts.

Activities 2: Create a Presentation (15 minutes)

 ASK student to do below task and make sure everyone participate full.
 ALLOW them to do either computer laboratory or outside the college.
 In this series of activities you will create a presentation about how you spend your free
time (i.e., what your hobbies are). PowerPoint is a great program and it allows you to be
creative with the way you display information, so have fun!
 Open PowerPoint.
 Choose a slide with a title and a subtitle placeholder.
 Type the title How I Spend My Free Time.
 Format the title using a 44 point Arial font. Make the title bold and in some color other
than the default black.
 Type a subtitle with your name or GCF username and today's date.
 Format the subtitle using a 28 point, Arial font.
 Insert a Title and Text placeholder slide.
 Type the title My Hobbies Are... on that slide.
 Type at least three things you like to do in your free time in the bulleted list text
placeholder.
 Insert a Blank Slide.
 Add a text box and type some information about the first item in your bulleted list that is
on the previous slide, My Hobbies Are...
 Format slide 2 and 3 with whatever font and font size you wish.

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 Apply a design template to your presentation, if you wish.
 Save your presentation as My Hobbies and close PowerPoint.

Step 3: How to Format Bulleted and Numbered Lists (20 Minutes)

 Bulleted Lists
o PowerPoint provides several bulleted lists slides for you to choose from for your
presentation. You can use these slides or create bulleted list slides of your own.

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Figure 5: Bullet List Show Below

Source: Goodwill Community Foundation 2002

o Bullets can be dots, check marks, arrows, squares and more.

o Picture bullets - colorful bullets in various shapes - are also available.

Figure 6: Picture Bullet dialog

Source: Goodwill Community Foundation 2002

 Formatting a Bulleted List

o You can format the look of bullets from the Format menu.
 To Format a Bulleted List
o Place your cursor in the section of the slide you want your bullet or bulleted list. Click
on Format Bullets and Numbering.

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Figure 7: Bullets and Number Dialog Box

Source: Goodwill Community Foundation 2002

Figure 8: A Dialog Box Opens. Make Sure the Bulleted Tab is Selected.

Source: Goodwill Community Foundation 2002

 Choose the bullet style that you want from the examples that appear on the screen or
click Picture and choose a style from the bullets that appear. (You can also choose size
and color).
 Click OK.

 Customizing a Bulleted List

o If you don't like the traditional bullets or the picture bullets that PowerPoint offers,
you can customize your own.
 To Customize a Bulleted List
o Place your cursor in the section of the slide you want your bullet or bulleted list. Click
on Format Bullets and Numbering.
o A dialog box appears. Make sure the Bulleted tab is selected.

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Figure 9: Selected Bullet From Bullet and Number

Source: Goodwill Community Foundation 2002

o Click on Customize near the bottom right corner of the dialog box.
o A dialog box appears.

Figure 10: Symbols Dialog Box

Source: Goodwill Community Foundation 2002

o Choose a symbol from the list that appears. Note that you can change the font by
clicking on font in the upper left corner of the dialog box.
o Click OK.

 Formatting a Numbered List

o PowerPoint also gives you different options for formatting a numbered list.
 To Format a Numbered List
o Place your cursor in the section of the slide you want your bullet or bulleted list. Click
on Format Bullets and Numbering.
o A dialog box opens. Make sure the Numbered tab is selected.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1102

Figure 11: Number Tab Dialog Box

Source: Goodwill Community Foundation 2002

o Choose the number style that you want. (You can also choose size, color, and the
number you wish to start from.
o Click OK

Activities 3: My Hobbies-Bullet styles (10 minutes)

 ASK student to use previous work (activity 2)
 Open the presentation, My Hobbies, which you created earlier.
 Insert a new slide with title and text placeholders. This is the fourth slide in your
presentation.
 Type a title for the slide. You may want this slide to be about the second hobby on your
list from slide 2, My Hobbies Are..
 Format a different bullet style for the slide.
 Type a list of things related to the topic of the slide.

Figure 12: Example slides created

Teaching Guides for NTA Level 4 MLS Curriculum Page 1103

Source: Goodwill Community Foundation 2002
o Save and close the document.
o Resize pictures and clip art

Step 4: Adding Clip Art and Pictures (20 minutes)

 Inserting Clip Art into a Slide
 Clip art is a collection of graphical images. You can easily enhance your presentation
with clip art in a few easy steps.
 To Insert Clip Art into a Slide
o In the Outline view in the left pane, select the slide in which you want the clip art to
appear.
o Click the Clip Art button on the Drawing Toolbar.

OR
o Select the slide you want to work on.
o Click on the down-pointing arrow in the Task Pane Clip Art.
o If you are working with a slide that has an icon for clip art, click on the icon. You'll
learn more about this later in this lesson.

 Searching for Clip Art

o Once you activate the Clip Art option, a search menu appears on the screen.
 To Search for Clip Art
o With the Search dialog box open, type the name of the image that you are looking
for. For example, people, buildings, winter.
o Click on Go.

Figure 13: Clip Art

Teaching Guides for NTA Level 4 MLS Curriculum Page 1104

Source: Goodwill Community Foundation 2002

o Click on the clip art that you want to insert.

o Click OK.
o The clip art appears in your slide.
 You can move or resize clip art and other content once it has been inserted into a slide.
You'll learn more about this later in this lesson.

 Searching for Clip Art on the Webtions

o To find a larger selection of clip art, you can browse for clip art on the Web. To
begin, make sure that you are logged onto the Internet.
 To Search for Clip Art on the Web
o With the Search dialog box open, type the name of what you are looking for. For
example, people, buildings, winter.
o Under Search in:, click the down-pointing arrow next to Selected collections and
check the box next to Web Collections.

Figure 14: Clip Art (Web Collect)

Source: Goodwill Community Foundation 2002

o Browse through the different clip art options.

o Click on the clip art that you want to insert.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1105

 Inserting Pictures from File
o Adding pictures to your presentation may also help engage the audience's attention.
You can insert pictures that you have on file on your computer.
 To Insert a Picture from File
o Click on Insert Picture From File.

Figure 15: Inserting Pictures Options

Source: Goodwill Community Foundation 2002

 Navigate to the folder where you've saved your picture.

 Click on the picture you want to insert into the slide. OR
 Click the Insert Picture button on the Drawing Toolbar.

 Navigate to the picture that you want to use.

 Select the picture and click Insert.

 Inserting Pictures or Clip Art Using a Slide Design Layout

 Some slide layouts already have icons for clip art and pictures. PowerPoint allows you to
insert pictures though these slide design layouts.
 To Insert Pictures Using a Slide Design Layout
 Browse the slide design layouts to find one with an icon for a picture.
 Click on the picture icon.

Figure 16: Clip Art for Inserting Pictures

Teaching Guides for NTA Level 4 MLS Curriculum Page 1106

Source: Goodwill Community Foundation 2002

 Navigate to the picture you want to insert.

 Select the picture and click Insert.

 Resizing Pictures and Clip Art

 Once you insert clip art or a picture, you may need to resize it to better fit your slide.
 To Resize Pictures or Clip Art
o Click the cursor the edge of the graphic and a resizing handle appears. A resizing
handle is a black, double-headed arrow that changes to a "plus sign", + ,once you
start resizing the image:
o Drag the graphic to the size that you want.

Figure 17: Inserted Picture into PowerPoint Area For Resize

Source: Goodwill Community Foundation 2002

Activities 4: My Hobbies-Clip Arts (Take home assignment)

 ASK student to use previous activity 3 above.
 ALLOW them to do below activities
 Open your My Hobbies presentation.
 Select the fourth slide.
 Choose a Title, Text and Contents layout from the list in the Slide Layouts pane.
(Make sure it contains placeholders for clip art and a bulleted list.)

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 Click Apply to Selected Slide.
 You now have a slide with a bulleted list and a place for clip art.
 Click on Insert Clip Art.
 Insert clip art to enhance this slide, when the Select Picture dialog box appears.
 Close and save your presentation.

Step 5: Adding Charts, Diagrams and Tables (15 minutes)

 Inserting a Chart
 PowerPoint allows you to insert charts into your slide presentation to display different
types of information to your audience.
 To Insert a Chart
 Insert a new slide with a title and a chart icon.
 When the slide appears, click the Insert Chart icon.

Figure 18: How to Insert Chart into Presentations

Source: Goodwill Community Foundation 2002

Figure 19: A Chart Appears With a Data Sheet and Sample Data

Source: Goodwill Community Foundation 2002

Teaching Guides for NTA Level 4 MLS Curriculum Page 1108

 Replace the sample data in the data sheet with actual data that you want to present. The
Y axis is for values or numbers. For example, number of hours worked or amount of
money earned. The X axis is the label for the information. It now reads East, West,
North.
 You can delete some information in columns or rows of the sheet. Right click on the row
or column and choose Cut, Delete or Clear Contents.
 NOTE: You can expand the chart columns to fit your data or titles. Place your mouse
pointer over the end of the column in the gray heading. A black cross with double
arrows appears. Right click and drag the columns to the size you want.
 To format column width, click on Format Column width.
 Notice that as you enter the new data and titles etc., the chart on the slide changes to show
this new information.
 If the datasheet disappears, double click on the chart and choose View Datasheet.

 Setting a Maximum Value for a Chart

 As you enter numbers in your chart, a maximum value for your chart will automatically
be set, or you can set a maximum value of your own. The top value will automatically
round up from the top value of the data that you are entering. So, depending on your data,
it will be rounded to the nearest ten, hundred, or thousand.
 To Set a Maximum Value
o Double click on a value on the side of the chart.
o The Format Axis dialog box appears.
o Click on the Scale tab.

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Figure 20: Format Axis (scale)

Source: Goodwill Community Foundation 2002

o Change the number for Maximum to the maximum number in your presentation. For
example, 100.

Figure 21: Format Axis dialog box

Source: Goodwill Community Foundation 2002

o Click OK.

 Choosing a Different Chart Type

o If you don't want to use the chart that automatically appears when you double click
the chart icon in a slide, you can choose a different chart type
o To Choose a Different Chart Option
o Click on Chart Chart Type.

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Figure 22: A list of different charts appears, including Column, Bar, Line, Pie, and
Pyramid.

Source: Goodwill Community Foundation 2002

o Choose the best chart type for your presentation.

o Click OK.

 Labeling a Chart
o You may also want to label your chart with such information as the title and what the
X and Y axes represent. In the default chart, the X axis is the horizontal information
while the Y axis is the vertical information.
 To Label a Chart
o Click on Chart Chart Options.
o A dialog box appears.
o Click on the Titles tab (if it is not already selected).

Figure 23: Chart Option Dialog Box

Source: Goodwill Community Foundation 2002

 In the box below Chart Title, type in the title.

 In the box below Category (X) axis, type in the label for this information. It appears in
the rows on the left of the datasheet and in a box on the right of the chart.
 In the box below Value (Y) axis, type in the label for this information.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1111

 Click OK.
 To Change Text Alignment of Label:
o Right click on the text and choose Format Axis title.

o Click on the Alignment tab.

o Choose your text alignment and orientation options.

Figure 24: Format Axis -Alignment

Source: Goodwill Community Foundation 2002

o Click OK.

 Inserting a Diagram or Organization Chart

o Does your presentation require a diagram or organization chart? An organization
chart shows hierarchal relationships in a company or organization such as president,
vice president etc. Diagrams are used to show relationships between various
elements.
 To Insert a Diagram or Organization Chart strong
o Insert a new slide with a Diagram or Organization Chart icon.
o Click on the Insert Diagram or Organization Chart icon.

Figure 25: Inserting an Organization Chart

Teaching Guides for NTA Level 4 MLS Curriculum Page 1112

Source: Goodwill Community Foundation 2002

 When the Diagram Gallery dialog box appears, select a diagram or chart type.

Figure 26: Diagram Gallery dialog box

Source: Goodwill Community Foundation 2002

 Click OK.
OR
 If working in a blank slide, click the Insert Diagram or Organization Chart button on
the Drawing Toolbar.

 Inserting a Table
o PowerPoint also gives you the option of displaying information within your
presentation in a table.
 To Insert a Table:
o Insert a new slide with a table icon.

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 o Click on the Insert Table icon.
o When the dialog box appears, set the number of columns and rows for your table.

Figure 27: Insert Table Dialog Box

Source: Goodwill Community Foundation 2002

o Click OK.
o Enter the data for your table.
o To format the table, choose Format Table.

Figure 28: Table Options

Source: Goodwill Community Foundation 2002

o Click on the tabs and make any necessary changes.

o Click OK.

Activities 5: My Hobbies - Charts (Take home assignment)

 Open the presentation, My Hobbies.
 Insert a new slide that contains a chart icon. This will be the fifth slide in the
presentation.
 Decide whether you would like to insert a chart or a table. This chart or table needs to be
related to the topic of your presentation, how you spend you free time/your hobbies.
 An example of a table related to your hobbies: You could create a table to track how
many hours you spend on each activity for a week. To do this, insert a table with 8
columns and 4 rows. It might look like this:

Teaching Guides for NTA Level 4 MLS Curriculum Page 1114

 An example of a chart related to your hobbies: You could create a chart that shows the
estimated amount of time you spend on each hobby in a week (out of 168 hours (7 days *
24 hours). It might look like this:

 Format the table or chart, as necessary.

 Save and close your presentation.
 Insert a Hyperlink

Step 6: Adding AutoShapes, WordArt and Hyperlinks (20 minutes)

 Inserting an AutoShape
 PowerPoint provides many different items that you can use to enhance your slides. For
example, an AutoShape can be a useful graphical element. AutoShapes include lines,
arrows, banners, stars and other shapes that you can add to your presentation.
 To Insert an AutoShape
 Click Insert Pictures AutoShapes.

Figure 29: Auto shapes. Option

Teaching Guides for NTA Level 4 MLS Curriculum Page 1115

Source: Goodwill Community Foundation 2002

 A small AutoShapes toolbar appears.

 Click on the various options and a list of AutoShapes appears.

 Choose the one for your presentation.
 To format an AutoShape, right click on it and choose Format AutoShape.
 A dialog box appears with various formatting options.
OR
 Insert AutoShapes by clicking on the Drawing Toolbar at the bottom of the PowerPoint
screen. A list of options appears.

Figure 30: Drawing Toolbar

Source: Goodwill Community Foundation 2002

Teaching Guides for NTA Level 4 MLS Curriculum Page 1116

 You can click and drag an AutoShape to increase its size and you can add text by
choosing Insert Text Box.

 Inserting WordArt
o WordArt is colorful and artful text that is available in a variety of styles. It allows
you to create interesting titles, logos and text in your PowerPoint presentation.
 To Insert Word Art
o Click the WordArt button on the Drawing Toolbar.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1117

Figure 31: The Word art Gallery Appears.

Source: Goodwill Community Foundation 2002

 Choose the WordArt that best fits your slide presentation.

 Click OK.
 When the Edit WordArt Text dialog box appears, click on Your Text Here to add text.
Type the text for your slide. You can also make any formatting changes to your font.
 Click OK.
 The WordArt appears in your slide. You may drag it to where you want it to appear on
your slide.

Figure 32: Click Insert Pictures Word Art

Source: Goodwill Community Foundation 2002

 Inserting a Hyperlink

Teaching Guides for NTA Level 4 MLS Curriculum Page 1118

 o PowerPoint also allows you to add hyperlinks to your slides to make them more
interactive. A hyperlink can link to a web site which provides more information for
your presentation.
 To Insert a Hyperlink
o Select the text in your document that you want to be a hyperlink. For example,
www.gcflearnfree.org or Free Computer and Career Classes.
o Click the Hyperlink button on the Standard Toolbar.

o (If this button does not show, you may want to add it to your toolbar by clicking on
the down-pointing arrow at the end of the bar to display Toolbar Options. Click on
Insert Hyperlink to add the button to your toolbar.
o Click the Existing File or Web Page button.

Figure Insert Hyperlink

Source: Goodwill Community Foundation 2002

o Type any text that you want to display. For example: Free Computer and Career
Classes. This type will display instead of the web address.
o Click OK.
o To make sure that the hyperlink works, click the Slide Show button and click on the
link on the slide.

Activities 6: My Hobbies-Hyperlink (Take home assignment)

 ASK student: How can insert Title in slide.
 Open the My Hobbies presentation.
 Insert a new Title Only slide. This is your sixth and final slide.
 Type a title for the slide. You may want to make this slide about the final hobby you have
listed.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1119

 Insert a text box and type any necessary information related to the topic of the slide.
 Insert an AutoShape, WordArt, or a Hyperlink onto the slide.
 Save and close the presentation. The Challenge presentation about your hobbies is now
complete. The presentation should have a total of six slides with information about the
things you do in your free time.

Step 7: Key Points (5 minutes)

 Many of PowerPoint's slides have text boxes already included and ready for you to add
information. However, if you create an original slide you'll need to add a text box or two.
 PowerPoint provides several bulleted lists slides for you to choose from for your
presentation. You can use these slides or create bulleted list slides of your own.
 Clip art is a collection of graphical images. You can easily enhance your presentation
with clip art in a few easy steps. To Insert Clip Art into a Slide: In the Outline view in the
left pane, select the slide in which you want the clip art to appear. Click the Clip Art
button on the Drawing Toolbar. OR Select the slide you want to work on. Click on the
down-pointing arrow in the Task Pane Clip Art.
 PowerPoint allows you to insert charts into your slide presentation to display different
types of information to your audience.
 An AutoShape can be a useful graphical element. AutoShapes include lines, arrows,
banners, stars and other shapes that you can add to your presentation.

Step 8: Evaluation (15 minutes)

 List steps for formatting text
 Describe ways of formatting bulleted and numbered lists
 List steps in adding clip art and pictures
 List steps in adding charts, diagrams and tables
 Describe the procedure for adding AutoShapes, WordArt and Hyperlinks

Resources
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 1120

Session 21: Demonstration on Creating a
PowerPoint Slide Show
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT
*(More time should be allocated to this session preferably 6 hours)

Total Session Time: 120 minutes

Prerequisites
 Introduction to Computer

Learning Objectives
By the end of this session, students will be able to:
 Practice on Animating Slides
 Practice on Creating a Slide Master
 Practice Use of Spelling Check
 Practice on Print a slide presentation
 Practice Adding Transition

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD
 Handout

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 20 minutes Hands on Practice Animating Slides
3 20 minutes Hands on Practice Creating a Slide Master
4 30 minutes Hands on Practice Spell Check and Printing
5 25 minutes Hands on Practice Printing a Slide Presentation
6 15 minutes Presentation Adding Transition
7 10 minutes Presentation Key Points
8 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Step 2: Animating Slides (20 minutes)

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Activity 1: Brainstorm (5 minutes)
 ASK student: What is animation in slides?
 ALLOW for some responses.
 SUMMARIZE and go to information below for Animating slides

 Animating slides involves adding movement and sometimes sound to text or to the slides
in a presentation. Animation can help create a livelier and more interesting slide show.
PowerPoint provides some preset animation or allows you to customize the animation to
fit your needs.
 To Animate Slides using Animation Schemes
o Open the PowerPoint presentation that you want to work on.
o Select the slide that you want to animate.
o In the Task Pane, click the down-pointing arrow and select Slide Design -
Animation Schemes.

Figure 1: Application of Animation Schemes

Source: Goodwill

Community Foundation 2002

 Choosing Animation for Your Slides

o PowerPoint offers several options for animating your slides.
o Once you click on Slide Design Animation Schemes, the Slide Design pane
appears with a list of options.
o Click on an Animation Scheme that you think might work well in your presentation.
(To preview your choice, make sure that the Auto Preview option is checked).
o Preview different schemes to see which one best fit your slides.
o You can apply different animation to each individual slide or click on APPLY TO
ALL SLIDES.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1122

 o Once you have applied your animation you can click on Play or Slide Show to view
it.
o Remove animation by selecting No Animation in the white box.

 Adding Custom Animation

o You can also decide how text and other slide elements 'perform' by using custom
animation. You can add effect, set speed and direction, and animate text on your
own.
o For example, you can decide how words or graphics enter or exit a slide. You may
want to begin by adding effect to the titles in your presentation.
 To Add Effect to Text
o Open the presentation you want to add an effect to.
o Click on the down-pointing arrow in the Task Pane Custom Animation.

Figure 2: Task Pane (Custom Animation)

Source: Goodwill Community Foundation 2002

o Click the text that you want to add an effect to.

o The Add Effect button will be activated. (Note the button is inactive until you select a
part of the slide to work on)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1123

Figure 3: Addition of Effect in the slide

Source: Goodwill Community Foundation 2002

 Click on Add Effect Entrance.

o A list of options appears for the entrance including Blinds, Box, Checkboard, and Fly
In.
o Decide how your text will appear on the screen and choose an option.
o You can easily remove the effect by clicking Remove. Or, you can modify it by
setting direction and speed underneath Modify. (PowerPoint lets you know the
specific effect by listing it next to Modify. For example, Modify: Blinds).
 Emphasis and Exit
o If you want to add an effect to make text or graphics grow, shrink, or change in
another way, click on Add Effect Emphasis. Choose an effect. If you want to add
an effect to have text or graphics exit the slide, click on Add Effect Exit. Choose
the effect.
 Setting Direction and Speed
o Once you choose an effect, decide the direction for that effect. For example, you may
want text to Fly In from the bottom. (Make sure your animation doesn't cross
important graphics or text in your presentation).
 To Set Direction
o Underneath Modify in the Custom Animation pane, click on the down pointing
arrow beneath Direction. (Note that direction options vary depending on the type of
effect).

Figure 4: Modify Blinds Options (Direction)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1124

Source: Goodwill Community Foundation 2002

o Choose the side of the slide from which you want the title to enter.
o Underneath Modify next to Start, select With Previous (Animation starts
automatically) or On Click (Animation starts when you click the mouse).
o Decide the speed at which you want effects to happen in your slides. You can choose
very slow, slow, medium, fast or very fast to fit the rhythm of your presentation.
 To Set Speed
o Click on the down-pointing arrow underneath Speed and choose an option

Figure 5: Modify Blinds (Speed)

Source: Goodwill Community Foundation 2002

 Animating a Bulleted List

o A bulleted list may be another area that you might want to animate.
 To Add Animation to a Bulleted List
o Open the slide with the bulleted list you want to animate.
o Click on the text box that contains the text you want to animate.
o Click on the down-pointing arrow in the Task Pane Custom Animation.
o The Add Effect button is now active.

 Controlling Your Text

o With the Add Effect button active, you can control the text in your bulleted list:
 To Set Animation in a Bulleted List
o Select the line of text you want to animate.
o Once a line is selected, the Add Effect button becomes active.
o Select whether you would like to add Entrance, Emphasis, Exit, and/or Motion Paths.
o Using the downward pointing arrow to the right of each category:
o Decide if you want this animation to occur On the Click, With Previous, or After
Previous.
o Select the Direction the animation will occur (direction options will differ depending
on the animation.
o Choose a Speed for the animation.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1125

 o To make changes to an animation, simply locate the number of the animation you
wish to change and use the downward pointing arrow to the right of that numbered
animation.
o To set the direction/timing, you can select Effect Options from the menu.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1126

Figure 6: Effect Option

Source: Goodwill Community Foundation 2002

o Click on the Text Animation tab.

Figure 7: Blinds a Dialog Box Appears.

Source: Goodwill Community Foundation 2002

 The default option is By 1st level paragraphs. This is the level for the main bullet points.
Bullets points will enter one at a time on the slide
 If you want the bullet points to enter as a group, choose As one object.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1127

 If you have multiple levels of bullets in a slide and you want to animate all levels, choose
by 2nd level paragraphs if you have 2nd level bullets, and choose by 3rd level paragraphs
if you have three levels of bullets etc.

Activities 2: My Hobbies – Fly In (15 minutes)

 In this series of activities you will complete one of the PowerPoint presentations you have
been working on. Decide whether you would like to continue working on your My
Hobbies presentation or the Where I Learn presentation.
 Open the presentation you would like to continue working on.
 Add an Entrance effect to the title on the first slide in your presentation. Have the text
Fly In.
 Set the speed and direction-- Have the text come in from the left -- very fast.
 Save your changes.
 Select the second slide.
 Apply the same Entrance effect to the title of this slide as you did for the first slide. (Fly
In from left - very fast).
 Animate the bulleted list by having all of the bullets Fly In as one object from the left at
medium speed.
 Save your changes and close the presentation

Step 3: Creating a Slide Master (20 minutes)

 The Slide Master
o If you work for a company, you may be asked to prepare long presentations. Or, you
may want to prepare slides about a special event or occasion. A Slide Master allows
you to create a presentation with different types of slides but enable them to all have
the same "look".
o The elements that you add to the Slide Master - such as a company logo, background,
and font color - will be applied to all of your slides.
 Creating a Slide Master
o If you have a Slide Master, you don't have to format every single slide in a
presentation with the same basic design and text.
 To Create a Slide Master
o Start a new presentation or open an existing one.
o Click on View Master Slide Master.
o A slide with placeholders appears.

Figure 8: Slide Master Dialog Box

Teaching Guides for NTA Level 4 MLS Curriculum Page 1128

Source: Goodwill Community Foundation 2002

o Click on Format Background.

Figure 9: Background Dialog Box Appears.

Source: Goodwill Community Foundation 2002

o Choose a background color. For more colors, click on More Colors.

o Select the text in the Master title style placeholder.
o Click on the down-pointing arrow next to the font in the Formatting toolbar.
o OR
o Choose Format Font and choose a font, font color and font style. Close Master
View to save changes.

 Choosing Fonts for Levels of the Slide Master

o As you continue working on your Slide Master, notice that the Master text styles
placeholder contains a model of up to five bullets in which the text gets smaller for
each level.
o In the Slide Master, the font sizes are pre-selected. The sizes are based on what a
normal person is able to read from a reasonable distance. You can change the font
size, but this is fine-tuning that you might want to do later.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1129

 o Generally, you should keep the text the same color for the title and all text levels.
 To Edit the Text Styles for Each Level
o Start a new presentation or open an existing one.
o Click on View Master Slide Master.
o Select the text and then choose a font and font color in the Formatting Toolbar.

Figure 10: Formatting Toolbar.

Source: Goodwill Community Foundation 2002

 Viewing the Slide Master Elements

o After creating or making changes to your Slide Master, you can view all of the basic
design elements in your presentation.
 To See the Slide Master Elements Applied
o Click on View Normal OR
o Click the Normal View button.
o A slide or slide appears with the design elements of the Slide Master.

Figure 11: Designed Slides

Source: Goodwill Community Foundation 2002

 The Title Master

o When you create your Slide Master, you can also create a Title Master. This is the
second slide that appears in the left pane when you are working on the Slide Master of
a presentation using a Design Template.
o This is a special slide for the title slide of your presentation. Remember, the Slide
Master is a basic blueprint for all the slides of your presentation while the Title
Master only addresses the elements of your title slide
 To Edit the Title Master
o Select the text in the Master title style placeholder.
o Choose Format Background and choose a background color.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1130

 o Click on the down-pointing arrow next to the font in the Formatting Toolbar OR
o Choose Format Font and choose a font, font color and font style.

Activities 3: My Hobbies – Slide Master (10 minutes)

 Open the My Hobbies presentation or the Where I Learn presentation that you worked
on in the previous challenge.
 Design a Slide Master for this presentation.
 Choose such elements as font and background color.
 Type your name in the footer area.
 Choose Normal View.
 Insert a New Slide and notice that all the elements of the Slide Master are present in this
new slide.
 Save and close the presentation.

Step 4: Spell Check (30 minutes)

 Using Spell Check
 The Spell Check tool allows you to check your entire presentation for spelling errors.
PowerPoint has a dictionary that you can customize with words typically not included in a
standard dictionary.
 To Use the Spell Check Tool
 Click on Tools Spelling.

Figure 12: Spelling Check Tool

Source: Goodwill Community Foundation 2002

o Click the Spelling button on the Standard Toolbar.

 Scanning for Errors

o Once you launch the Spell Check tool, a couple of scenarios can occur:

Teaching Guides for NTA Level 4 MLS Curriculum Page 1131

 o PowerPoint quickly scans your presentation, searching for words that aren't in its
dictionary. If there are no recognizable errors, a dialog box will appear stating that the
spelling check is complete.

Figure 13: Spelling Check Notification

Source: Goodwill Community Foundation 2002

o If there are possible spelling errors, the Spelling dialog box opens and offers you a
number of options. Any unrecognized word appears in the Not in Dictionary box.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1132

Figure 14: Spelling Check Dictionary

Source: Goodwill Community Foundation 2002

Figure 15: Spell Check Options

Source: Goodwill Community Foundation 2002

 You can choose from one of the options in the Spelling dialog box:
 Ignore - the word is correct and does not need to be added to the custom dictionary.
 Ignore All - ignore all occurrences of the word.
 Change - correct the word.
 Change All - change all occurrences of the spelling of a word.
 Add - add a word to the custom dictionary.
 Suggest - PowerPoint suggests possible correct spellings of a word. Scroll through the list
to find the correct spelling. Select the appropriate one and click the Change button.
 AutoCorrect - automatically corrects many common spelling, typing, and grammatical
errors.
 Once the entire presentation has been checked for spelling errors, and you have made
your corrections or changes, click Close.
 The Spell Check tool does not catch all errors. Be sure to read through your text carefully
to find any typographical errors.

Step 5: Printing a Slide Presentation (25 minutes)

 Previewing and Printing
o Once you've corrected any errors in your document, it's time to print. PowerPoint
2003 allows you to preview your presentation before you print. You can preview and
print slides, handouts, notes pages and outlines.
 To Preview and Print a Presentation

Teaching Guides for NTA Level 4 MLS Curriculum Page 1133

 o Click on File Print Preview.

Figure 16: Print Preview Option

Source: Goodwill Community Foundation 2002

OR
o Click the Print Preview button on the Standard Toolbar.

o On the Print Preview Toolbar, click the down-pointing arrow next to the Print What
box.

Figure 17: Different Layout That You Want To Preview

Source: Goodwill Community Foundation 2002

o Select the layout that you want to preview and/or print.

o Click the Close button to return to the presentation or choose Print to print the
layout.

 Printing a Slide Presentation

Teaching Guides for NTA Level 4 MLS Curriculum Page 1134

 o If you don't want to preview your presentation in the various formats, you can simply
print it.
o To Print a Presentation
o Click on File Print.

Figure 18: Print Dialog Box Option

Source: from Ms PowerPoint print screen

 The Print dialog box opens.

 Click the down-pointing arrow next to the Print What box.
 Choose Slides, Notes, Handouts, or Outline.
 Select the print range and number of copies.

Figure 19: Print Dialog Box Component

Source: Goodwill Community Foundation 2002

o Click OK.

Activities 4: My Hobbies-Spell Check (5 minutes)

 ASK student to refer previous activities to complete the task below

Teaching Guides for NTA Level 4 MLS Curriculum Page 1135

 Open the My Hobbies presentation or the Where I Learn presentation that you worked
on in the previous activity
 Use Spell Check to check your spelling.
 Make any necessary corrections.
 Preview Handouts (6 slides per page).
 Print a Handout and keep this copy for your records.
 Save and close the document.

Step 6: Adding Transition (15 minutes)

 Adding Transition
o Once you've completed all of your slides, create a cohesive presentation by adding
transition. You can move from slide to slide with interesting transitions that affect the
timing, entrance and exit of your slides. A transition is an effect that is applied to
some or all of the slides in a presentation.
 To Make Transitions from Slide to Slide
o Click on Slide Show Slide Transition.

Figure 20: Slide Transition

Source: Goodwill Community Foundation 2002

OR
o In the Task Pane, click on the down-pointing arrow and select Slide Transition.

Figure 21: Slide Transition Option

Teaching Guides for NTA Level 4 MLS Curriculum Page 1136

Source: Goodwill Community Foundation 2002

 In the Slide Transition pane, choose the effect, you want from the drop-down menu. Ex.
Blinds Horizontal, Blinds Vertical, Box In and Box Out.
 Automatically preview each transition by clicking on it. (Auto Preview has to be
selected).
 Click Apply to All when you have chosen an effect.
 Choose to advance from slide to slide on mouse click or automatically after the number
of seconds that you select.
 To see how your transition works, preview the slide show. Learn more about this later in
this lesson.
 Some transitions work well with effects that have been added to text and graphics. Others
do not. Preview a variety of transitions before finalizing your slide presentation.

 Previewing a Slide Show

o If you want to get an idea of what your completed show will look like to an audience,
preview it. PowerPoint allows you to view your show in slide show format.
 To Preview a Slide Show
o Click on View Slide Show. (F5)

Figure 22: Slide Show

Source: Goodwill Community Foundation 2002

OR
o Click on Slide Show View Show.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1137

OR
o Click on the Slide Show button to start the presentation.
o To move to the next slide, click the mouse. (Space bar or Enter).
o When the screen goes dark, click the screen to return to the PowerPoint screen.
o You can exit the slide show by pressing ESC on the keyboard at any time.

o If you have set the slides to advance automatically, you don't need to click through
the slides. Just sit back and enjoy the show. At the end of the show, click the left
mouse button to return to the PowerPoint Screen.
 Setting Up a Slide Show
o Once you have added created a presentation and previewed it, set up a show. Take the
necessary steps to make sure your slides are ready for a real audience.
 To Set Up a Slide Show
o Click on Slide Show Set Up Show.

Figure 23: Set Up Show

Source: Goodwill Community Foundation 2002

Figure 24: The Set up Show dialog box appears.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1138

Source: Goodwill Community Foundation 2002

o Choose your show type. Typically, it's presented by a speaker.

o Choose which slides you will show. For example, all or slides 3 - 12.
o Choose show options. You can leave these blank unless you're planning to run a
show continuously on a kiosk or want to show it without animation etc.
o Next, decide how you plan to advance your slides.
o Click OK.

Activities 5: My Hobbies – Add Transition (10 minutes)

 ASK student How to add transition
 Open the My Hobbies presentation or the Where I Learn presentation that you worked
on in the previous activity.
 Add transition.
 Preview it in Slide Show view.
 Set up your show.

Step 7: Key Points (10 minutes)

 Animating slides involves adding movement and sometimes sound to text or to the slides
in a presentation. Animation can help create a livelier and more interesting slide show.
 A Slide Master allows you to create a presentation with different types of slides but
enable them to all have the same "look".
 The elements that you add to the Slide Master - such as a company logo, background, and
font color - will be applied to all of your slides.
 The Spell Check tool allows you to check your entire presentation for spelling errors.
PowerPoint has a dictionary that you can customize with words typically not included in a
standard dictionary.
 Once you've completed all of your slides, create a cohesive presentation by adding
transition. You can move from slide to slide with interesting transitions that affect the
timing, entrance and exit of your slides. A transition is an effect that is applied to some or
all of the slides in a presentation.

Step 8: Evaluation (15 minutes)

 List steps in animating slides

Teaching Guides for NTA Level 4 MLS Curriculum Page 1139

 Describe steps in creating a Slide Master
 List steps in spell checking and printing
 Describe the ways of adding transition to slides for presentation

References
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006), 4th Edition, Introduction to
Computers for Healthcare Professionals, Jones & Bartlett’s Publishers International, Barb
House, Barb Mews, London W6 7PA UK
 O’leary, T. J, O’leary, L. I, (2006), Computing Essentials, Introductory Edition, Arizona
State University, Boston Burr Ridge
 Morris M & Charles, M. , (2003) Logol Computer Designer Fundamentals, #rd Edition,
Prentice Hall
 Herniter, M.E. (2000), 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application, Prentice Hall
 Cook, L.R. (2001), 1st Edition, Computer Fundamentals –Understanding How they Work,
Ventage Press
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide
 Ed Bott and Carl Siechert, (2001), Microsoft Windows XP Inside out
http://www.gcflearnfree.org/computer/

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Session 22: Demonstration on Internet,
Web and Computer Communications
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT
*(More time should be allocated on this session preferable 6 hours)

Prerequisites
 Introduction to Computer

Learning Objectives
By the end of this session, students will be able to:
 Describe how the internet and the Web started.
 Difference between the internet and the Web?
 List five common uses of the internet and the Web
 Describe ways of access the internet
 Describe how to access the web using browser.
 Describe Internet communications.
 Describe steps on conducting group discussion on the internet

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer
 LCD
 Handout

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 15 minutes Hands on Practice Introduction to the internet
3 20 minutes Hands on Practice Differences between internet and Web
4 20 minutes Hands on Practice Uses of the internet and Web
5 20 minutes Hands on Practice ways to access the internet
6 20 minutes Hands on Practice Browser and Communications
7 5 minutes Presentation Key Points
8 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Step 2: Introduction to the Internet (15 minutes)

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Activity 1: Brainstorm (5 minutes)
ASK students: “What is the internet?”
ALLOW for some responses.
SUMMARIZE Continue with the following explanation below.

 What is internet?
o In simple words, internet is a huge number of computers that are worldwide
connected to each other.
o These computers are situated in many different countries and are connected through
telephone lines, cables in the ground and even satellites in space.
o Do you want to communicate with a friend across town, in another state, or even in
another country? Perhaps you would like to send a drawing, a photo, or just a letter.
o Looking for travel or entertainment information? Perhaps you're researching a term
paper or exploring different career paths.
o Where do you start? For these and other information-related activities, try the internet
and the web.
o The internet is often referred to as the information superhighway. It is like a highway
that connects you to millions of other people and organizations. Unlike typical
highways that move people and things from one location to another, the internet
moves your ideas and information. Rather than moving through geographic space,
you move through Cyberspace-the space that moves ideas and information
electronically.
o The web provides an easy-to-use, exciting, multimedia interface to connect to the in-
ternet and to access the resources available in cyberspace. It has become an everyday
tool for all of us to use. For example, you can create personal web sites to share
information with others and use instant messaging to chat with friends and collaborate
on group projects.
o Competent end users need to be aware of the resources available on the Internet and
the web. Additionally, they need to know how to access these resources, to effectively
communicate electronically, to efficiently locate information, to understand electronic
commerce, and to use web utilities.
o The internet is a worldwide network. The web, introduced at CERN, is a multimedia
interface. Internet uses includes communication, shopping, searching, entertainment,
and education.
o The Internet, or Net, was launched in 1969 when the United States funded a project
that developed a national computer network called Advanced Research Project
Agency Network (ARPANET). The internet is a large network that connects together
smaller networks all over the globe.
o The Web, also known as www and the World Wide Web, was introduced in 1992 at
the Center for European Nuclear research (CERN) in Switzerland. Prior to the web,
the internet was all text-no graphics, animations, sound, or video. The web made it
possible to include these elements.
o It provided a multimedia interface to resources available on the internet. From these
early research beginnings, the internet and the web have evolved into one of the most
powerful tools of the 21st century.

Figure 1: Internet – A Worldwide Network of Computers, Making Information

Available To Everyone

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Source: Jamani's Guide to Computers

Figure 2:Yahoo.Com Look Like

Source: T. J, O’Leary, L. I, 2006

Step 3: Differences between Internet and Web (20 minute)

 It is easy to get the internet and the web confused, but they are not the same
thing.
 The internet is the actual physical network. It is made up of wires, cables, and
satellites. Being connected to this network is often described as being online. The
internet connects millions of computers and resources throughout the world.
 The web is a multimedia interface to resources available on the internet. Every
day over a billion users from every country in the world use the internet and the
web.

Getting Text from the Internet

 Click the cursor at the beginning of the text and keep the left mouse button pressed down
 Move the cursor to the end of the text to select the text

To copy the selected text into the computer’s memory:

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 Move the cursor above the selection and click the right button
 In the menu that appears, choose ‘Copy’
 Go to MS Word by clicking the button in the taskbar
 Click on the ‘Paste’-button to put the text in your document

Note: The selected text remains in the memory until you copy another text or picture.

Getting pictures from the internet

 To copy a picture into the computer’s memory:
o Move the cursor on a picture and click the right mouse button
o In the menu that appears, choose ‘Copy’

Note: To save the picture as a separate document in your folder, choose ‘Save picture As
 Go to MS Word by clicking the button in the taskbar
 Click on the ‘Paste’-button to put the picture in your document and create a colorful
leaflet.

Step 4: The Most Common Uses of Internet and Web (20 minutes)
 Communicating is by far the most popular internet activity. You can exchange e-
mail with your family and friends almost anywhere in the world. You can join
and listen to discussions and debates on a wide variety of special-interest topics.
You can even create your own personal web page for friends and family to visit.
 Shopping is one of the fastest-growing internet applications. You can visit
individual stores or a cybermall, which provides access to a variety of different
stores. You can window shop, look for the latest fashions, search for bargains,
and make purchases. You can purchase goods using checks, credit cards, or
electronic cash.

Figure 3: Shopping over the internet is one of the Web’s growing activities

Source: T. J, O’Leary, L. I, 2006

 Searching for information has never been more convenient .You can access some of the
world’s largest libraries directly from your home computer. You can visit virtual libraries,
search through their stacks, read selected items, and even check out books. You will also

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 find the latest local, national, and international news. Most newspapers maintain an online
presence and include interactive and multimedia presentation related to current news
stories.

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Using Google
You can also use Google to search for pictures or images on internet:
 Click on ‘Images’ to go to Google’s Image Search
 In the text-box, type the subject of the pictures you are looking for, for example
‘Bagamoyo’
 Click the button ‘Google search’ and wait for the results
 The next screen shows the results: Google found 313 images related to ‘Bagamoyo’.

Figure 4: Searching Engine

Source: Jamani’s Guide to Computers

 Each result is a ‘link’ to a website containing an image. To go to the website, just click on
an image.
 Use the ‘Back’-button to go back to Google’s results and click on another image
 Scroll down the page to see more images…
 Google shows a little text from each website.
 Google also shows the address of the website.
 At the bottom of each page, you can click to see the next ten results.

Figure 5: result from search engine

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Source: Jamani’s Guide to Computers

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Figure 6: Searching For Information

Source: Jamani’s Guide to Computers

 Entertainment options are nearly endless. You can find music, movies, magazines, and
computer games. You will find live concerts, movie previews, book clubs, and interactive
live games.
 Education or e-leaning is another rapidly emerging Web application.
 You can take classes on almost any subject. There are courses just for fun and there are
courses for high school, college, and graduate school credit. Some cost nothing to
take and others cost a lot. The first step to using the Internet and Web is to get
connected, or to gain access to the Internet.

Step 5: Access to the Internet (20 minutes)

 Providers give us access to the Internet. National, regional, and wireless are the three
types of ISPs. Browsers provide access to Web resources.
 The Internet and the telephone system are similar-you can connect a computer to the
Internet much like you connect a phone to the telephone system. Once you are on the
Internet, your computer becomes an extension of what seem like a giant computer-a
computer those branches all over the world. When provided with a connection to the
Internet, you can use a browser program to search the Web.

What is e-mail?
 You use electronic mail or e-mail to send information to someone. The big difference
with normal mail is speed. One second after you press a button to send an e-mail, it
arrives at the e-mail address you used. Even if you send it to the other end of the world! If
your computer is connected to the internet, you can use e-mail for communicating with
friends and business relations. You can also ‘attach’ documents to an e-mail; such as
reports or digital photographs. There are special websites that give you e-mail service free
of charge. If you want to use e-mail, you simply visit one of these websites and open an
‘e-mail account’. You get a private e-mail address which you give to your friends, and
then they can send you e-mail. To read your e-mail and to send e-mails yourself, you visit
the website again and open your personal ‘mailbox’

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Internet Explorer
 After you find a computer with internet connection, first start the right program. On most
computers this is Microsoft® Internet Explorer or Netscape® Navigator. For this Guide,
we will use Internet Explorer.

Example of a website
 When Internet Explorer is running, the first thing you see is a website. On the picture here
we show you how a website might look. The one you opened may look very different.
 Move your cursor over the website. You will notice that your cursor sometimes changes
into a hand. When that happens, you found a ‘link’ back address-bar stop refresh go
 The role of providers (internet service providers
 The most common way to access the Internet is through an Internet service provider
(ISP). The providers are already connected to the Internet and provide a path or
connection for individuals to access the Internet. Your college or university most likely
provides you with free access to the Internet either through its local area networks or
through a dial-up or telephone connection. There are also some companies that offer free
Internet access. Commercial Internet service providers offer national, regional, and
wireless service.

 Activity: Opening an E-Mail Account (Take home assignment)

 ASK student to create account for e-mail.
 ALLOW them to choose internet Explorer type e.g. www.yahoo.com.
 In the address bar of Internet Explorer type www.hotmail.com Click the ‘Go’-button and
wait for the website to appear
 Click on ‘New Account Sign Up’: a new page appears
 Click in the first text box ‘First Name’ and type your name; type your last name in the
second text box.
 Choose your country: click on the arrow and select Tanzania (or another) from the list.
 After you selected Tanzania, wait until the website changes the next option. Then select
the time you want to work with.
 Click on one of the white circles to select your gender
 Specify your birth date and choose an occupation from the list
 Now type the e-mail address you want to use.
 Type a good password, using at least 6 letters and numbers. You should remember this
password well, because you need it To check your e-mail the next time To make sure you
typed it right, you have to type the same password again.
 .If you have forgotten your password, you can use this secret question to get access to
your account and create a new Password. Select a question you like and type your
answer.
 Type the letters you see in the drawing. With this ‘registration check’ you prove you are a
human and not a computer!
 .Look through the text of the agreement and click the button ‘I agree’
 If you see this message, your address is already used: Choose one of the addresses
Hotmail suggests and continue or Try typing other addresses until you find one that is still
available.
 If you see this message, you have opened your account:
 .When the registration is complete, click ‘Continue’

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 At the bottom of the next page, click ‘Continue’ to enter your e-mail account. Turn the
page and teach yourself how to use it!

Step 6: Browsers and Communications (20 minutes)

 Activity 1: Brainstorming (10 minutes)
 ASK students: What do you understand by the following terms?
 ALLOW for some responses.
 DIVIDE into 2 to 5 group of students.
 URLs
 HTML
 Web server
 Applets
 How Instant Messaging Works
 How Spam Filter Work
 Mention four (4) common Uses of internet
 SUMMARIZE the respond and allow them to search from internet and books .

 Browsers are programs that provide access to Web resources. This software connects you
to remote computers, opens and transfers files, displays text and images, and provides in
one tool an uncomplicated interface to the Internet and Web documents. Browsers allow
you to explore, or to surf, the Web by easily moving from one Web site to another. Two
well-known browsers are Netscape Navigator and Microsoft Internet Explorer.
 For browsers to connect to resources, the location or address of the resources must be
specified. These addresses are called Uniform Resource Locators (URLs).

PART of URL
 All URLs have at least two basic parts.
o Protocol
 Protocols are rules for exchanging data between computers. The protocol http:// is
the most widely used Web protocol.
o Domain name (top level domain)
 It is the name of the server where the resource is located.www.mtv.com is an
example of Server (Many URLs have additional parts specifying directory paths,
file names, and pointers.) The last part of the domain name following the dot (.) is
the domain code. It identifies the type of organization. For example, com indicates
a commercial site. The URL http:// www.mtv.com connects your computer to a
computer that provides information about MTV.
o Domain code (example com)

How Does The Browser Work?

 Once the browser has connected to the Web site, a document file is sent back to your
computer. This document contains Hypertext Markup Language (HTML) commands. The
browser interprets the HTML commands and displays the document as a Web page. For
example, when your browser first connects to the Internet, it opens up to a Web page
specified in the browser settings. This page presents information about the site along with
references and hyperlinks or links that connect to other documents containing related
information-text files, graphic images, audio, and video clips.

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 These documents may be located on a nearby computer system or on one halfway around
the world. The computer that stores and shares these documents is called a Web server.
The references appear as underlined and colored text and/or images on the Web page. To
access the referenced material, all you do is click on the highlighted text or image.
 A connection is automatically made to the computer containing the material, and the
referenced material appears on your display screen.
 As previously mentioned, communication is the most popular Internet activity, and its
impact cannot be overestimated. At a personal level, friends and family can stay in
contact with one another even when separated by thousands of miles. At a business level,
electronic communication has become a standard, and many times preferred, way to stay
in touch with suppliers, employees, and customers.

TYPES OF INTERNET COMMUNICATION

 There are three types of Internet Communication. Those are e-mail, instant messaging,
and discussion groups.

 E-MAIL
o E-mail or electronic mail is the transmission of electronic messages over the internet.
At one time, e-mail consisted only of basic text messages. Now e-mail routinely
includes graphics, photos, and many different types of file attachments. People all
over the world send e-mail to each other. You can e-mail your family, your co-
workers, and even your senator. All you need to send and receive e-mail is an e-mail
account, access to the internet, and an e-mail program. Two of the most widely used
e-mail programs are Microsoft’s Outlook Express and America 0n Line's Netscape
mail.
o A typical e-mail message has three basic elements:
 Header this appears first and typically includes the following information
o Addresses: Addresses of the persons sending, receiving, and, optionally, anyone else
who is to receive copies. E-mail addresses have two basic parts i.e:[email protected]
(dcoats is a user domain, usc.edu is domain name, edu is the domain code)
o The first part is the user's name and the second part is the domain name, which
includes the domain code. In our example e-mail, dcoats is user name. The server
providing e-mail service for the user is usc.edu. The domain code indicates that the
provider is an educational institution.
o Subject: A one-line description, used to present the topic of the message. Subject lines
typically are displayed when a person checks his or her mailbox.
o Attachments: Many e-mail programs allow you to attach files such as documents and
worksheets. If a message has an attachment, the file name appears on the attachment
line.
o The letter or message comes next. It is typically short and to the point. Finally, the
signature line provides additional information about the sender. Typically, this
information includes the sender's name, address, and telephone number.
 Message, is the text area where you can type anything so as ready for send
 Signature.

 SPAM
o E-mail can be a valuable asset in your personal and professional life. However, like
many other valuable technologies, there are drawbacks too. Americans receive

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 billions of unwanted and unsolicited e-mails every year. This unwelcome mail is
called spam. While spam is indeed a distraction and nuisance, it also can be
dangerous. For example, computer viruses or destructive programs are often attached
to unsolicited e-mail.
o In an attempt to control spam, anti-spam laws have been added to our legal system.
This approach, however, has had minimal impact since over 50 percent.
o The figure below illustrates the three basic elements of E-mail

 INSTANT MESSAGE (IM)

o Instant messaging (IM) is an extension of e-mail that allows two or more people to
contact each other via direct, live communication. To use instant messaging, you
specify a list of friends (also known as buddies or contacts) and register with an
instant messaging server. Whenever you connect to the Internet, special software
informs your messaging server that you are online. In response, the server will notify
you if any of your contacts are online. At the same time, it notifies your contacts that
you are online. You can then send messages directly back and forth to one another.
Many new instant messaging programs also include videoconferencing features, file
sharing, and remote assistance. To see how Instant Messaging works, visit us at
www.olearyseries.com/CE06 and select Animations.
o The most widely used instant messaging services are AOLs Instant Messenger,
Microsoft's MSN Messenger, and Yahoo Messenger. One limitation, however, is that
many instant messaging services do not support communication with other services.
For example, at the time of this writing, a user registered with AOL cannot use AOLs
Instant Messenger software to communicate with a user registered with Yahoo
Messenger. Recently, however, some software companies have started providing
universal instant messenger programs that overcome this limitation. For example,
Gain, Odigo, and Trillian provide instant messaging services that do support
communication with other services.

DISCUSSION GROUPS
 You can also use e-mail to communicate in discussion groups with people you do not
know but with whom you wish to share ideas and interests. You can participate in forums
and debates that range from general topics like current events and movies to specialized
forums like computer troubleshooting and Hollywood animations. Discussion groups
include mailing lists, newsgroups, and chat groups.
 Mailing lists allow members to communicate by sending messages to a list address. Each
message is then copied and sent via e-mail to every member of the mailing list. To
participate in a mailing list, you must first subscribe by sending an e-mail request to the
mailing list subscription address.

Step 7: Key Point (5 minutes)

 The internet is the actual physical network. It is made up of wires, cables, and
satellites. Being connected to this network is often described as being online. The
internet connects millions of computers and resources throughout the world.
 The web is a multimedia interface to resources available on the internet. Every
day over a billion users from every country in the world use the internet.
 Communicating is by far the most popular internet activity. You can exchange e-
mail with your family and friends almost anywhere in the world

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 Shopping is one of the fastest-growing internet applications. You can visit
individual stores or a cybermall, which provides access to a variety of different
stores.
 Entertainment options are nearly endless. You can find music, movies, maga-
zines, and computer games. You will find live concerts, movie previews, book
clubs, and interactive live games.
 E-mail
o E-mail (electronic mail) is the transmission of electronic messages. Basic
elements: header (including addresses, subject, and attachments), message,
and signature line. Spam is unwanted and unsolicited e-mail that may include
a computer virus. Anti-spam programs (junk mail filters, spam blockers)
identify and eliminate spam.
 Instant Messaging
o Instant messaging (1M) extends e-mail to support live communication with
friends (buddies or contacts). Universal instant messengers support
communication with other services.
 Discussion Groups
o Discussion groups use e-mail to communicate with people who may have
never met face-to-face.
o Includes mailing lists (using list and subscription addresses), newsgroups
(using the UseNet), and chat groups (using channels; IRC is a popular chat
service).
o Associated terms include flaming terms, RFD, saint, thread, and wizard.

Step 8: EVALUATION (15 minutes)

 Describe how the internet and the Web started.
 What is the difference between the internet and the Web?
 List and describe five of the most common uses of the internet and the Web.
 Describe how to access the web using browser.
 Describe Internet communications.
 Describe discussion groups
 Describe how to access the web using browser.
 Describe Internet communications.
 Describe discussion groups

References
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How
they Work. Ventage Press.
 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for
Students, Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition,
Introduction to Computers for Healthcare Professionals. Jones & Bartlett’s
Publishers International, Barb House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals.
Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1153

 Arizona State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start
Guide.
 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

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Session 23: Demonstration on Computer
Prevention and Maintenance
NTA LEVEL 4: SEMESTER 2: MODULE: GST 04202 - BASIC COMPUTER SKILLS AND
INFORMATION MANAGEMENT

Total Session Time: 120 minutes

Prerequisites
 Introduction to Computer

Learning Objectives
By the end of this session, students will be able to:
 Describe Keeping computer running at peak performance
 Describe Maintenance and Reduction of Computer Problems
 Practice steps of Clean the Computer
 Practiced fragment Computer
 Practice Removing spyware / adware

Resources Needed:
 Flip charts, marker pens, and masking tape.
 Black/white board and chalk/whiteboard markers.
 Computer.
 LCD.
 Handout.

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
Presentation Keeping computer running at peak
2 20 minutes
performance
Presentation Computer maintenance and reduction of
3 20 minutes
computer problems
4 20 minutes Presentation Steps of Cleaning the Computer
5 20 minutes Presentation De-fragmentation on the Computer
6 15 minutes Presentation removing spyware/adware
7 5 minutes Presentation Key Points
8 15 minutes Presentation Evaluation

SESSION CONTENT
Step 1: Presentation of Session Title and Learning Objectives (5 Minutes)
 READ or ASK student to read the learning objectives and clarify.
 ASK students if they have any questions before continuing

Step 2: Keeping Computer Running at Peak Performance (20 minutes)

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Activity 1: Brainstorm (5 minutes)
 ASK student: What is computer safety?
 ALLOW for some responses.
 SUMMARIZE and go to information below for computer safety.

 With the amount of information available for download on the internet, it's easy to
quickly fill up your valuable hard drive space and turn your computer into a sluggish,
unresponsive monster. Keeping your hard drive clean is essential to the high performance
that the latest computers can achieve. Fortunately, it's a simple process; one that can
easily be performed on a regular basis and, with some organization, keeps your computer
running like a well-oiled machine.
 You can discover how much hard drive space is available on your computer by accessing
the DriveSpace program in your System Tools. A pie graph will show you the amount of
used and unused space for each of your drives. Check this often to keep an idea of how
much space you are using.

There are six simple steps to clearing up your hard drive

 Uninstall unused programs.
o Many times a new program will come along that looks fun to have or play with, but
after a week or two you simply stop using it. These programs clutter up your drive
and take up valuable space. You might be tempted to delete these programs from your
drive, but doing so will cause problems. You must use the uninstall function of
Windows for the program to be removed safely and completely.
 Clean out temporary files.
o When your computer is not shut down properly, it will pass information from memory
into fragmented files. Also, while you are running programs, your computer will write
information that it does not immediately need into temporary files. Installation files
will also expand themselves into the temporary folder and will not always clean up
after themselves. You can delete these temporary files safely by using the Disk
Cleanup option in your System Tools.
 Empty your internet cache.
o As you surf the internet your computer stores web pages and images into a temporary
internet cache so that it can quickly recall and access information when you move
back and forth between pages. This backup information can quickly add up and eat
hard drive space.
o Whether you use Internet Explorer, Netscape, or one of the many other browsers
available, emptying out your cache is quick and easy. Simply follow the instructions
in the Help files located within those programs. You may also wish to set a specific
maximum file size for your cache folder, so that it is not allowed to run rampant.
 Empty your mail programs of clutter.
o It's easy to browse through your email and leave old messages there, promising
yourself you'll sort them out later. One or two messages don't take up much space, but
hundreds certainly do. Take the time to sort through these old emails now and delete
what is not important. Create folders and organize what is left. Make it a habit that
when new emails come in, they are either filed immediately or thrown away. Set your
email program to empty your deleted items folder each time you close your mail
program.

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 Empty your recycle bin.
o Once you've emptied your drive of cluttering, unnecessary programs; empty your
recycle bin to remove what has been placed there in the process.
 Scandisk and Defrag.
o When Windows installs programs, it will put the files it needs anywhere that it finds
free space, and not directly after the last program installed. As a result, your hard
drive has patches of empty space on it that are not big enough to fit a full program,
and will result in a drive space error if you attempt to install something new. Scandisk
your drive to check for lost file fragments and to fix any errors it finds, then Defrag to
pack all of the program files together at the beginning of your drive. This will clear
out those empty patches and move all of the free space you've just created to the end
of your drive.
o Now that you've got it clean, keep it that way. Perform this quick maintenance routine
every week. For your work computer, Friday afternoon before you leave for the
weekend is the perfect time. When you return to work on Monday, you'll have a
computer that is clutter-free and as responsive as it should be.
o Organize your surfing habits. Direct all of your downloads to the same folder, so that
you can easily find them and delete them when necessary, or move them to zip disks
for storage. Keep track of the programs that you install. For trial versions, note the
date that they will expire on a calendar. This will remind you to uninstall the
programs that you can no longer use rather than allowing them to clutter up your
drive. Also, if you run into problems, keeping track of new downloaded and installed
programs and the date they were installed can help you track down the cause of
problems.
o Remember that the cleaner your hard drive is, the better your machine will respond!
In order for your computer to be user friendly, it must have a friendly user. Be your
computer's best friend and clean out the cobwebs regularly.

Tips for keeping your Computer Running Smoothly

 Never turn your computer off with the power switch until Windows has shut down.
 This rule prevents permanent HD defects caused by the hard drive heads contacting the
surface of the drive disc and can also result in lost data or Windows files
 The one exception to this rule is when your computer locks up and HD is not running
(HD light is not blinking). Recover from crashes by pressing the Ctrl + Alt + Delete keys
at the same time. Press them again to reboot your computer.
 Use UPS (uninterruptable power supply) for your computer. This will keep your
computer from crashing during power outages, and will protect your computer from low
and high voltage occurrences.
 Backup any data you cannot afford to lose to at least two separate physical drives
(external HD, Zip disks, CD-RWs etc.). Don't wait until tomorrow.
 Run Scandisk and Defragment at least once a month to keep your HD healthy and prevent
crashes.
 Never unplug peripherals (except "hot pluggable") from the computer when it is powered
up to avoid short out the connector socket or the motherboard.
 Do keep at least 300 MBs of your C: drive free for Windows to use. If you use Windows
XP or Vista then you should have 400-600 MBs of free space on your C: drive.

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 Inadequate free space chokes Windows and it will start dumping data to your hard drive,
or it will just get really, slow. Use the ADD/Delete tool in the Windows Control Panel to
delete unneeded programs from your drive.
 Do not let a lot of programs load up when you start your computer. They use valuable
memory and Windows Resources (Windows internal workspace). All programs in your
Windows System Tray (in the lower left of your screen) are running on your computer.
Close them if you don't need them or run them and configure them not to load when you
boot up. Other programs running in the background can be found by pressing Ctrl + Alt +
Delete at the same time.
 Do use a virus checker regularly. The best type of protection is continuous monitoring
from a dedicated anti-virus program like Norton Antivirus.
 If you have a high speed Internet connection you need a firewall program. A firewall
program keeps those who want to hijack your computer from gaining access to your
system. You really do not want someone else running your computer.
 Keep track of the software disks you receive with your computer and new peripherals.
These disks contain valuable software drivers and programs for Windows and are needed
when Windows must be reloaded. Keep these disks and your Windows software disks in
a safe, dry, place -- you never know when you will need them.

Step 3: Maintenance and reduction of computer Problems (20 minutes)

 It is not rocket science and you don’t have to be an IT professional to keep your PC in
good shape. Any computer user can follow the guidelines mentioned below, and can
reduce their PC problems dramatically.
 Use a good anti-virus program. This is the most important piece of work in preventive
maintenance. Installing the anti virus program is not good enough. You should do
following as well:
o Set-up the program to download and install updates automatically.
o Schedule periodic full system scans.
o Check the virus definitions date regularly and see whether it is up to date.
 Set-up your PC to Download and install “Windows Updates" automatically. Windows
updates include Operating System patches for bugs and PC security related issues. These
patches can reduce many unknown computer problems.
 Install anti Spyware program to detect Spyware tools.
 Install a Personal Firewall. Most of the anti virus programs are bundled with Personal
Firewalls these days. Personal firewall is a barrier between your PC and the outside
world. This can protect your PC from hackers and Spyware tools.
 Do not download and install unknown software from Internet. This is the biggest mistake
most of the PC users are doing. Some of this software can damage the Windows registry,
which cause lot of errors.
 Uninstall unnecessary programs installed in your PC.
 Be very careful when you download music from the Internet. Always stick to one
trustworthy web site.
 Perform Scandisk periodically to check the Hard Drive.
 Delete temporary Internet files. To automatically delete these files in IE6, goto Tools -
Internet Options - Advanced. Scroll to bottom and select "Empty Temporary Internet
when browser is closed."

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 If possible, try not to use Internet Explorer because it has major security breaches which
could be potentially harmful for your system. Two alternative web browsers you can try
are Mozilla Firefox and Opera or at File Hippo. Java to get the latest Java download.
 Download Web Security Guard at Web Security Guard or download the Site Advisor
plug-in, both protect you from most web based security threats and annoyances. Both
give you a safety rating for the sites you are on and give a rating on your Google searches
as well, from green (safe) to red (dangerous). Web Security Guard will have a pop-up
saying that if a particular website has been reported as dangerous. You can choose to
continue and go to the site or don't go to the site. One example of a dangerous site is
http://www.smileycentral.com. One example of a safe site is http://www.google.com.
Web Security Guard will also have gold "shield" if the website has been reported but is
not severely dangerous and will not give you pop-up about the website. This will help to
prevent you visiting sites that are likely to damage your computer. Site Advisor can be
found on Site Advisor

Step 4: Steps of cleaning the Computer (20 minutes)

 This will show you how to clean up your Windows based PC. With these steps, you can
do a disk cleanup, defragment, remove spyware and everything in between...

This will help you clean your computer.

 Do a Windows Update. This will be on your Start Menu; if it isn't, then click on "All
Programs" then "Accessories", then "System Tools". This will take you to the Page. Or
try windowsupdate.microsoft.com. It is very important that you do the updates; it doesn't
matter if you use the new updates or not, but they are for security, very important these
days.
 Get rid of cookies. These are the little crumbs that are left behind on your computer after
you visit a website. Click on Start>> Control Panel>>Internet Options. The second row
down will say Delete Cookies, click on that. Click on Delete Temporary file; when the
little box comes up that says "delete offline," you don't have to click on that. Click on
Delete temporary Files.
 Complete Disk Cleanup. After clicking on "Start", move your cursor on All Programs,
then up to Accessories, then "System Tools". Click on Disk Cleanup from the list that
appears. Click the "More Options" tab at the top of the page, and select all three of the
following: "Windows Components," "Installed Programs," and "System Restore". Clean
up all three by clicking on their respective tabs. You may want to delete all but your most
recent system restore point -- you probably don't need the others.
 Defragment your computer. Defragmenting your computer moves all your files to
where they are supposed to be.
 Remove spyware. Use a search engine to find "Lava soft Ad Aware 2007". This will take
you to a site to download the software. Download and install this program—you can also
use "Spybot Search & Destroy." Spyware Blaster is a good preventative measure to use as
well. All have easy-to-follow instructions.
 Install anti-virus software. Kaspersky, AVG, Bitdefender, Antivira, and Avast are free for
personal use.
 Go to My Computer. Now go to tools at the top. Folder Options... View, then check the
box "Show Hidden Files and Folders" then go to Local Disk, Documents & Settings,
Your Account, and delete everything in: My Recent Documents, Local Settings History

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 (Do not delete everything in local settings, just delete everything in the history folder of
local settings) (and while in Local Settings) Delete everything in temporary internet files.
 Remove unwanted programs by going to start, control panel, add/remove programs, then
remove unwanted programs.
 When your computer is running in ship-shape, then go to start, all programs, accessories,
system tools, then system restore. Create a restore point, and when your computer is
running poorly, restore it to the day.

Tips
 When you are new at a computer, try to relax. You are likely to get a little stressed. try to
find a friend to help you.
 If you use Norton Antivirus, then set it to scan your computer as often as possible. (daily
is best) To do this, click "scan for viruses" then click the button that has a clock on next to
"scan my computer". This will take you to the scheduling window. It is best to schedule
this when you are not using the computer, like when you're asleep, as it can take quite a
few hours to finish, especially if you have a larger computer. This will cause it to detect
many viruses, but also delete a lot a of spyware and adware, too.
Warning
 Be very careful of websites with pornography or free games -- they are usually full of
spyware that is difficult to get rid of.
 Not all cookies are worthless. Some Web-sites use cookies as a way of customizing your
display for subsequent visits. For example, a weather website may ask you to enter your
zip code to display your local weather. It then puts a very small "cookie" file containing
that info on you hard drive. Days later, when you re-visit that Web-site, the site looks for
its cookie on your drive and displays the weather in your area. This way, you don’t have
to enter your location each time. Deleting all cookies will require you to re-enter the
information each time.
 Deleting the wrong files may ruin your computer. Make sure when you are looking for
old files that you don't want anymore, that these files you absolutely don't need, and have
nothing to do with the way the system runs itself.

Step 5: De-fragment on the Computer (20 minutes)

 When your computer writes information onto your hard drive, it does not always write
information in the same location on the actual hardware. A section of a file can be written
near the beginning of the disc, whereas the rest of that file could be written near the end.
This causes programs to run slowly, as the computer spends time in retrieving these file
clusters from all over the disc. Defragmenting your computer sorts all of your files [as
well as free space] in an orderly manner, in effort to reduce loading time. Here is how to
do it.
 Start Windows in Safe Mode. This is not mandatory, but it helps to avoid complications
from other programs that are running in the background. This also speeds up and
streamlines the process.
 Uninstall any programs you do not use or need. It is best to uninstall programs prior to
a defragmentation, as the newly-acquired free space will generally be located all over the
hard drive, thereby giving rise to fragmentation.
 Make sure that all unnecessary programs are closed. If you have already started in Safe
Mode, then this has already been done.

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 Cancel any programs that are scheduled to run. If you have not manually scheduled any
programs to run, then skip this step.
 Delete any temporary files. This is done by running Disk Cleanup. To run the program,
go to: START -> Run, and enter cleaning in the window.
 Run the Disk Defragmenter Program. Go to START -> Run, and enter dfrg.msc in the
window. Alternatively, launch it by going to Start -> Programs (or All Programs) ->
Accessories -> System Tools -> "Disk Defragmenter". A window similar to the one on
the right should appear. Click Analyze so you can see what the damage is, and then look
at the report. If you want to continue: Make sure that your desired drive is selected [C:
being the default drive], and click on the Defragment button.
 Wait until the process is complete. Sit back and relax as your computer organizes your
fragmented files.

Tips
 Defragment your computer overnight. If you have never defragmented your computer
before, and you have a large hard drive, the process can take several hours.
 You can also access the Disk Defragmenter via the Start menu by going to START ->
Programs -> Accessories -> System Tools -> Disk Defragmenter.
 The more often that you run the defragmenter, the quicker the process will be. Generally,
once per month is good.
 Remember that defragmenting takes the saved portions of all of your files and organizes
them to help your computer run more efficiently. Keep in mind that some files (such as
critical system files and boot procedure files) cannot be moved.
 If the Defragmenter keeps restarting, and you have not already run your computer in Safe
Mode, do so. See the Related wikiHows section below for the steps to start your computer
in Safe Mode.
 The free Defragmenter provided with the Operating System does a reasonable job as far
as it goes, however it cannot defragment system files such as MFT or prioritise file
placement according to usage. Commercial Defragmenters (such as Diskeeper, Perfect
Disk and O&O) do a better job with these more difficult tasks.
 Defragmentation is not needed on most Linux operating systems because the file system
is designed to keep fragmentation at minimal.

Warnings
 Unless you choose "Safe Mode with Networking", you will not be able to access the
Internet while in Safe Mode. Make sure that you know how to access the Defragmenter
program before you enter Safe Mode.
 If you are using Windows 95, 98, or ME, do not use your computer during the
defragmenting process, since this may restart or hinder the process.
 While uninstalling, if you are unsure what a program does, don't remove it until you know
for sure if you need it or not. -EM

Step 6: Removing Spyware/Adware (15 minutes)

 Spyware/Adware. These are illegal programs which come onto your computer usually
while browsing the internet. This software will mostly slow your computer down and also
will sometimes report your actions and files to the programmer.

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 When a computer is infected with spyware/adware, it will become a little slower and you
will be getting a lot of pop-ups while browsing the internet. These pop-ups can be ads or
false computer warning.
 In order to remove spyware/adware you require some special removal software. One
example of this software is ad-aware by Lavasoft which can be downloaded for free from
www.lavasoft.com. Once you have downloaded and installed ad-aware you will see the
following screen bellow.

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Figure 1: Ad –Aware Software View

Source: lavasoft

 Click on start to scan the computer for Adware. And select the default settings and click
next. Once the scan is complete, you can see as shown in the picture bellow that your
computer has 9 New Critical objects.
 Click next and select the objects you would like to remove (Usually just select all).

Activity: How to Solve Virus Problem (15 minutes)

ASK student: How would you

DIVIDE them into small groups depend of number of class.

 Detect virus to your computer?
 What to do if you discover a virus on your computer?
 Remove install and uninstall antivirus
 Define Antivirus?
 Defragment computer
 SUMMURISE the ideas from students group

Figure 2: Show Completed Scanned Object

Source :lavasoft

 Please note that it is important you update you ad-aware program and before scanning for
adware on you system. In order to update your ad definitions click on the globe on the top
right

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Removing a virus
 Virus is illegal program designed to corrupt your computers files and there for eventually
either slow or crash your system. With the help of virus removal software such as Norton,
AVG and MacAfee anti virus software you can mostly find and remove viruses from a
machine. AVG is free antivirus software.
 It is important you make sure you update your anti virus software regularly to make sure
your virus software is aware of the latest virus threats and there for can protect your
computer from them.
 In IFM we have been using Norton System works to protect our computers from viruses
and maintaining our computer.
o Click Start  All ProgramsNorton System Works  Norton System Works

Figure 3: Norton System dialog box

Source: Norton system works 2003

 Click Norton Antivirus  Scan for Viruses  Scan drives

Figure 4: Scan for Virus

Source: Norton system works 2003

 Select the drives you would like to scan and click scan.

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Figure 5: Selected Drives for Scanning

Source: Norton system works 2003

 Once you have scanned follow the instructions, provided. If you require more help you
can always use Norton help.

Step 7: Key Points (5 minutes)

 With the amount of information available for download on the internet, it's easy to
quickly fill up your valuable hard drive space and turn your computer into a sluggish,
unresponsive monster.
 When Windows installs programs, it will put the files it needs anywhere that it finds free
space, and not directly after the last program installed. As a result, your hard drive has
patches of empty space on it that are not big enough to fit a full program, and will result
in a drive space error if you attempt to install something new.
 When your computer writes information onto your hard drive, it does not always write
information in the same location on the actual hardware. A section of a file can be written
near the beginning of the disc, whereas the rest of that file could be written near the end.
This causes programs to run slowly, as the computer spends time in retrieving these file
clusters from all over the disc. Defragmenting your computer sorts all of your files [as
well as free space] in an orderly manner, in effort to reduce loading time.
 Virus is illegal program designed to corrupt your computers files and there for eventually
either slow or crash your system. With the help of virus removal software such as Norton,
AVG and MacAfee antivirus software you can mostly find and remove viruses from a
machine.

Step 8: Evaluation (15 minutes)

 List steps to keep computer running at peak performance
 Describe steps of computer maintenance and reduce computer problems
 How do you clean your computer?
 List steps in defragmenting computer
 List steps in removing spyware / adware

References
 Cook, L.R. (2001). 1st Edition, Computer Fundamentals –Understanding How they Work.
Ventage Press.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1165

 Ed Bott and Carl Siechert. (2001). Microsoft Windows XP Inside Out.
 Herniter, M.E. (2000). 2nd Edition, Personal Computer Fundamentals for Students,
Hardware Windows 2000 Application. Prentice Hall.
 Joos, I. Whitman, N. Smith, M. Nelson, R. et al. (2006). 4th Edition, Introduction to
Computers for Healthcare Professionals. Jones & Bartlett’s Publishers International, Barb
House, Barb Mews: London.
 Morris M & Charles, M. (2003). Logol Computer Designer Fundamentals. Prentice Hall.
 O’leary, T. J, O’leary, L. I. (2006). Computing Essentials, Introductory Edition. Arizona
State University: Boston Burr Ridge.
 Steven Sagman (1999), Microsoft Office 2000 for Windows: Visual Quick Start Guide.
 The Basics of the Word Window (n.d) Retrieved March 11, 2010, from
http://www.gcflearnfree.org/computer/

Teaching Guides for NTA Level 4 MLS Curriculum Page 1166

 CHAPTER TEN

MODULE CODE MLT04208:

OCCURRENCE MANAGEMENT
AND RECORD KEEPING

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Session 1: Laboratory Accidents
NTA LEVEL 4, SEMESTER I, MODULE CODE: MLT04208 OCCURRENCE MANAGEMENT
AND RECORD KEEPING

Total Session Time: 120 minutes

Prerequisites
 None

Leaning Objectives
At the end of this session, students should be able to:
 Define Laboratory accident, documentation and Management
 List types of agents causing laboratory Accidents
 Explain Laboratory accidents
 Explain how accidents can occur in the laboratory
 Explain methods of documentation of laboratory accident

Resources Needed
 Flip charts, marker pens, masking tape, black /white board and chalk/whiteboard markers,
LCD projector and computer/laptop

SESSION OVERVIEW
Steps Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 10 minutes Definition of terms
Brainstorming
Types of agents causing laboratory
3 15 minutes Presentation
Accidents
25 minutes Laboratory accidents
How accidents can occur in the
4 25 minutes Presentation
laboratory
5 25 minutes Presentation Management of laboratory accidents
6 05 minutes Presentation Key Points
7 10minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition
Activity: Brainstorming (5 minutes)
 ASK the students the following question
 Define the following terms; laboratory accidents, management of laboratory accidents,
occurrence log and aerosol.

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  INVITE responses from students
 RECORD their response on the flip chart or chalk board
 SUMMARIZE their responses with information below

 Laboratory accident- Incidences and disasters which occurs in the Laboratory

(occupational hazards)
 Management of Laboratory accidents-pertains to how disasters are handled with the aim
of preventing them from reoccurring.
 Complaint- Client protest on Laboratory Services
 Process deviations- Making short cats, moving away from standard procedures
 Instrument problems-Problems resulting from Instrument not functioning well
 Occurrence log- A register or form in which all laboratory incidences are recorded
 Aerosol, i.e. Infected airborne droplets, into the atmosphere consisting of bacteria or
viruses

Step 3: Types of agents causing laboratory Accidents

The following agents can cause laboratory accidents:

 Acids
 Alkalis
 Toxic substances
 Heat
 Broken glass
 Contamination
 Electric Shock

Step 4: Explain Laboratory accidents

 Accidents in the laboratory may be caused by Acids or Alkalis through splashes on the
skin, splashes in the eyes and swallowing. Toxic substances which are chemicals that
cause death or serious ill health if swallowed, inhaled or if they come in contact with skin
(e.g. Potassium cyanide, Sodium Azide and formaldehyde solution). Heat can cause
accidents by exposure to open flames. Hot liquids, Inflammable liquids and Explosives
 If not properly handled and stored can cause accidents. Broken glass can cause cuts,
bleeding and infection. Contamination by infected material and electric shock can be the
cause of laboratory accidents.

Step 5: How accidents can occur in the laboratory

 Infection through Percutaneous: Injury
o Accidents can arise from these hazards, Percutaneous: Injury –Injury though the skin
needle sticks, cut, puncture etc Splashes through the mucous membranes, namely
eyes, nose and mouth can enable the microorganism to gain access of the human body
 Infection through broken skin
o When the human body is not intact due to wound or bruises can enable the
Microorganisms to enter the body, intact skin provides a good barrier
 Infection through Mouth
o Microorganisms may be ingested during mouth pipetting, either by direct aspiration or
from the mouth end of the pipettes which have been touched by contaminated fingers.

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 Food may become contaminated in from benches or fingers contaminated with
infected material or food stored in Refrigerator with contaminated material
 Infection through the respiratory tract
o Many common laboratory procedures with microorganisms release aerosols, i.e.
infected airborne droplets, into the atmosphere consisting of bacteria or viruses

Step 6: Explain management of laboratory accidents

 Percutaneous injury
o If exposed to blood borne pathogens (e.g., needle stick), what can one do? Wash,
wash, wash, Wash with soap and water for 5 minutes, Notify supervisor immediately,
Complete exposure report and evaluate the source patient with local needle stick
evaluation team, regarding possible treatment and follow-up. When the source of
accident is the mucous membrane flush thoroughly the affected area.

Sharps Safety
– Sharps injuries -- the riskiest route of
exposure
– Sharps include: syringes, pipettes,
razors, broken test tubes, scalpels,
suture needles

Courtesy of: Shanna Nesby-O’Dell, International Implementation of Biosafety & Biosecurity

Programs U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

Laboratory personnel clearing garbage-Bad Laboratory practice

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 Sharps Safety
– Whenever possible avoid the use of sharps
– NEVER, NEVER recap a contaminated
needle or sharp with a two-handed method
– Ensure sharps container is nearby, well
placed, & not over-filled

Courtesy of: Shanna Nesby-O’Dell, International Implementation of Biosafety & Biosecurity

Programs U.S.
Centers for Disease Control and Prevention, Atlanta, Georgia

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 Emergency treatment when someone is electrocuted
o When someone is electrocuted, immediately turn off the mains, remove the plug or
wrench the cable free. DO NOT TOUCH THE PERSON FLESH WITH YOUR
HANDS until the contact has been broken. Important: On no account try to free an
electrocuted person from the electrical contact without using some form of insulation
material, such as a dry thick cloth, folded laboratory coat, folded newspapers wooden
or plastic stool or chair. If insulations is not used the person rescuing will also be
electrocuted
 Emergency treatment of heat and chemical burns
Heat burn
o If clothing is alight, smoother nth flames using a fire bracket. Remove the person
from the danger area. Immediately plunge the burnt area into cold water or apply a
pad socked in cold water (or any other non inflammable liquid) to the affected part for
10 minutes. Cover the wound with dry dressing, remove any constricting articles such
as rings, bracelets before the affected area starts to swell and become blistered,
provide frequent small cold drinks.
 Chemical burn
o Wash immediately in running water for several minutes, remove any contaminated
clothing neutralize with a suitable chemical as follows:- If an acid burn neutralize
with Sodium bicarbonate powder, if an alkali burn neutral with boric acid powder –
seek medical attention.
 Chemical Injury to the eye
o Wash the affected eye as quickly as possible under running tape water or water from
an eye wash bottle. Neutralize with suitable chemical as follows, If an acid injury
neutralize with 5% Sodium bicarbonate solution, If an Alkali injury neutralize with
5% acetic acid or vinegar diluted 1in 5. Immediately seek medical attention.

Splashes to the
Eye
• Know How to Use
the Eyewash
Station
– flush 5 minutes for
pathogens
– flush at least 15
minutes for most
chemicals

Courtesy of: Shanna Nesby-O’Dell, International Implementation of Biosafety & Biosecurity

Programs U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

 Emergency treatment for poisoning

o Swallowing of an Acid or an Alkali

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 Immediately rinse the mouth well with water, neutralize with a suitable chemical as
follows, if Acid has been swallowed neutralize by drinking 8%W/V Magnesium
hydroxide suspension (milk of magnesia) or milk. f an Alkali has been swallowed
neutralize by drinking lemon juice or 1% Acetic Acid, drink 3 or 4 cups of water, seek
medical attention.
 Swallowing of Infected material
o Immediately seek medical treatment, provide follow-up tests. Note: Mouth pipetting
is main cause of accidental swallowing of chemicals or infected materials in the
laboratory

Step 7: Key Points (5 minutes)

 Define Laboratory Accident
 List 5 types of laboratory Accidents
 Explain how accidents can occur in the laboratory
 Explain management of laboratory accidents

Step 8: Evaluation
 List types of Laboratory accidents
 Explain how accidents can occur in the Laboratory
 Explain methods of documentation of Laboratory accidents

References:
 Cheesbrough M. (2000). District Laboratory Practice in Tropical Countries. Part 2.
Tropical Health Technology, Cambridge University Press UK.
 MOHSW Laboratory Management Training Modules 2008
 Ramanik Sood (2006) Medical Laboratory Technology First Edition 2006: JAYPEE
BROTHERS Medical Publishers (P) LTD New Delhi

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Session 2: Post Exposure Prophylaxis (PEP)
NTA LEVEL 4, SEMESTER I, MODULE CODE: CMT04208, OCCURRENCE MANAGEMENT
AND RECORD KEEPING

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives
At the end of this session, students should be able to:
 Define post exposure prophylaxis (PEP)
 Explain the importance of post exposure prophylaxis
 Explain the process of PEP
 Outline PEP SOP’s
 Perform demonstration of PEP

Resources needed
 Flip charts, Marker pens, Masking tape, Black/white board, Chalk, white board marker

SESSION OVERVIEW
Steps Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Brainstorming Definition of terms
Importance of post exposure
3 15 minutes Presentation
prophylaxis
4 25 minutes Process of PEP
5 25 minutes Presentation PEP SOPs
6 25 minutes Presentation Demonstrate application PEP
7 05 minutes Presentation Key Points
8 10minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
READ or ASK students to read the learning objectives and clarify.
ASK students if they have any questions before continuing.

Step 2: Definition
Activity: Brainstorming (5 minutes)
 ASK the students the following question
 What is the meaning of “post exposure prophylaxis”?
 INVITE responses from students
 RECORD their response on the flip chart or chalk board
 SUMMARIZE their responses with information below

Teaching Guides for NTA Level 4 MLS Curriculum Page 1174

 Definition: Post-Exposure Prophylaxis (PEP):
o Post - after
o Exposure – someone has been exposed to a disease or infection…
o Prophylaxis – the means by which that person may still be able to prevent disease

 Antiretroviral medications which may reduce the risk of HIV sero-conversion in an

exposed employee
 To be most effective, the medications must be taken as soon as possible after exposure,
usually within 72 hours
 Medications are taken for 4 weeks

Step 3: Importance of Post Exposure Prophylaxis (PEP)

 Antiretroviral medications, which reduces the risk of HIV seroconversion in an exposed
employee. PEP should be administered, when source patient is known to be HIV +, when
source patient is at high risk for HIV, When the HIV status of source is unknown. Often
an exposed employee will begin the PEP medications until HIV status of source patient is
clarified.

Step 4: Process of PEP

 When PEP might be indicated? When source patient is known to be HIV +,
 When source patient is at high risk for HIV, When the HIV status of source is unknown.
Often an exposed employee will begin the PEP medications until HIV status of source
patient is clarified
 If exposed to blood borne pathogens (e.g., needle stick), what do I do? Immediate care:
wash wounds with soap and running water; flush mucous membranes with water wash,
wash, wash skin with soap and water for 5 minutes
 Notify supervisor immediately, Complete Exposure Report, evaluate the source patient.
Consult with local needle stick evaluation team regarding possible treatment and follow-
up, Refer to local PEP protocols

Step 5: PEP SOPs

 Confidential testing may be offered at baseline, 3, and 6 months
 Status of source patient, if known, will be communicated
 Employees with high risk exposures may be advised for the next 6 months to:
 Avoid sharing body fluids (ex. have only protected sex)
 Stop breast feeding
 Avoid pregnancy Re-visit flesh

Teaching Guides for NTA Level 4 MLS Curriculum Page 1175

 Exposed to HIV – contaminated material (occupational)

Preferably less than 24 hrs, not more than 72 hours: More than 72 hours: no PEP
Counsel and recommend test
offer support and counselling

Consent denied: Consent given:

test NOT done TEST PERFORMED HIV
positive
No PEP
HIV Negative

PEP Refer for regular

HIV management
Perform follow up HIV
test after 3months
HIV negative: counsel
how to stay negative HIV positive
Unit 14T: Universal Precautions and Post Exposure Prophylaxis 33

MOHSW………

Step 6: Demonstration of PEP

 Case Study
o A laboratory assistant sustained a deep needle stick when drawing blood from
uncooperative patient, from Medical ward. How would you handle this occurrence?

Answer:
 Refer to PEP SOP;
o Percutaneous injury— wash with soap and water for 5 minutes
o When source patient is at high risk for HIV
o When the HIV status of source is unknown
o Often an exposed employee will begin the PEP medications until HIV status of source
patient is clarified.
o Confidential testing may be offered at baseline, 3, and 6 months
o Status of source patient, if known, will be communicated
o Document the incidence in The laboratory Occurrence log
o Demonstrate Accident log
o Occurrence form

 Notify supervisor immediately

o Complete Exposure Report
o Evaluate the source patient
o Consult with local needle stick evaluation team regarding possible treatment

Teaching Guides for NTA Level 4 MLS Curriculum Page 1176

 Safety Needles and Blades

Courtesy of: Shanna Nesby-O’Dell, International Implementation of Biosafety & Biosecurity

Programs U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

 Use Vacuum Containers, Safety-Lok for Blood Collection Set

Step 7: Key Points (5 minutes)

 Define post exposure prophylaxis (PEP)
 Explain the importance of post exposure prophylaxis
 Explain the process of PEP
 Outline PEP SOP
 Perform demonstration of PEP

Step 8 Evaluation (10 minutes)

 When should PEP be administered?
 Outline the PEP SOPs
 Explain briefly the importance of PEP.

References:
 MOHSW-NACP Presentation on HIV, UNIT 14T: Universal Precautions and Post
Exposure Prophylaxis

Teaching Guides for NTA Level 4 MLS Curriculum Page 1177

Session 3: Biosafety and Biosecurity
Guidelines in the Laboratory
NTA LEVEL 4, SEMESTER I, MODULE CODE: MLT04208 OCCURRENCE MANAGEMENT
AND RECORD KEEPING

Total Session Time: 120 minutes

Prerequisites
 None

Leaning Objectives
At the end of this session, students should be able to:
 Define biosafety, biosecurity
 List different types of biosafety guidelines
 List different types of biosecurity guidelines
 Explain different types of biosafety guidelines
 Explain different types of biosecurity guidelines

Resources needed
 Flip charts, marker pens, masking tape, black/white board and chalk; white board marker
LCD projector and Computer

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 10 minutes Presentation/Brainstorming Definition of terms
3 10 minutes Presentation Types of biosafety guidelines
4 40 minutes Presentation Explanation of biosafety guidelines
5 10 minutes Presentation Type of biosecurity guideline
Explanation of biosecurity
6 30minutes Presentation
guidelines
7 05 minutes Presentation Key Points
8 10minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition
Activity: Brainstorming (5 minutes)

 ASK the students the following question

 What is the meaning of the following terms “biosafety” and “biosecurity”?

Teaching Guides for NTA Level 4 MLS Curriculum Page 1178

  INVITE responses from students
 RECORD their response on the flip chart or chalk board
 SUMMARIZE their responses with information below

Laboratory Biological Safety:

 Entails prevention of employee exposures to occupationally acquired infections, and
release of organisms to the environment through appropriate safety measures

Laboratory Biosecurity:
 Refers to protection of biological agents from loss, theft, or misuse. They can be non-
intentional or intentional.

Step 3: Type of biosafety guidelines

 All biosafety guidelines are based four on the biosafety levels which are:
o Level 1 biosafety (Agents not known to cause disease)
o Level 2 biosafety (Agents associated with human disease)
o Level 3 biosafety.( Indigenous/exotic agents associated with human disease and with
potential for aerosol transmission)
o Level 4 biosafety (Indigenous Dangerous/exotic agents of life threatening nature)

Step 4: Types of biosafety guidelines

 Safety begins with the collection of the specimen. Specimens should be collected in
sturdy containers with adequate closure to prevent spillage or leakage. Clinical
information must be available for instituting adequate precautions and proper handling.
Specimens suspected of containing highly infectious agents should not be placed in a
container with numerous routine specimens. The laboratory worker must treat each
specimen as a potential hazard to his health and that of his colleagues in the laboratory
 Good laboratory practices protect the specimen and worker. Rules of good technique and
hazard awareness are especially important in the clinical laboratory because most highly
infectious agents isolated from clinical specimen as a surprise to clinicians as well as to
laboratory potential
 Level 1 biosafety (Agents not known to cause disease) with pathogenic bacteria. This is
applicable to basic practices appropriate for not appropriate for undergraduate and
secondary school educational training and teaching laboratories. Emphasis is placed on:
Use of mechanical pipetting aids
o Hand washing
o Not eating, drinking or smoking in the work area
o Daily decontamination of the work area
o Examples of microorganisms that can be handled at BSL1 are Bacillus subtilis, and
staphylococcus epidermidis .Many microorganisms not associated with diseases
process in humans, capable of causing infection in the very young, in the aged and in
immunodeficient or immunosuppressed individuals.

 Level 2 biosafety (Agents associated with human disease) Practices are obligatory for
most laboratory activities involving known pathogens and for experiments involving
known pathogens and for experiments involving either the introduction of recombinant
DNA from pathogenic bacteria into nonpathogenic prokaryotes

Teaching Guides for NTA Level 4 MLS Curriculum Page 1179

 o The practices equipment and facilities are applicable to clinical, diagnostic, and other
facilities in which work is done with a broad spectrum of indigenous, moderate risk
agents present on the community and associated with human diseases of varying
severity. With good laboratory techniques, these microorganisms can be used safely
in activities conducted on open bench provided the potential of producing aerosols is
low. Hepatitis B virus, salmonellae and Toxoplasma species are microorganisms
assigned to this containment level.
o Primary hazards to personnel working with these agents are accidental
autoinoculation or ingestion of infectious materials. Procedures with high aerosol
potential that may increase the risk of exposure of personnel should conduct in
primary containment equipment or devices such as biological safety cabinet.

Class II - Biological Safety Cabinets

Courtesy of: Shanna Nesby-O’Dell, International Implementation of Biosafety & Biosecurity

Programs U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

 Level 3 biosafety. Includes organisms that cause severe human disease and which are a
serious hazard to laboratory personnel. There may be risk of spread in the community.
Effective prophylaxis or treatment is available (i.e. Mycobacteria tuberculosis, Yesinia
pestis)
 Level 4 biosafety. Includes organisms causing severe human disease and serious hazard
to laboratory workers. There is a high risk of spread in the community and usually no
effective treatment or prophylaxis is available, (e.g. Ebola virus)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1180

 BSL’s 1, 2, 3, 4 - Laboratories

BSL-1 BSL-2

BSL-3 BSL-4

Courtesy of: Shanna Nesby-O’Dell, International Implementation of Biosafety & Biosecurity

Programs U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

Step 5: Type of biosecurity

 In biosecurity there is only one type which serves the purpose of:-
 Protecting agents from theft or misuse
 Protect pathogens from dangerous people
 Limit access to Laboratories that contain certain biological agents

Step 6: Explanation of biosecurity guidelines

(#11) Agent Biosecurity

Biosecurity:
 Protecting agents from theft or misuse
 Protect pathogens from dangerous people
 Limit access to Labs that contain certain
biological agents

Biosafety:
▪Protecting the worker

Courtesy of: Shanna Nesby-O’Dell, International Implementation of Biosafety & Biosecurity

Programs U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

Agent Biosecurity
10-Components of a biosecurity program:

1) Program Management & Responsibilities

2) Physical Security and Access Control
3) Personnel Management
4) Inventory & Accountability
5) Information Security
6) Transport of Biological Material
7) Accidents, Injuries & Emergency Response
8) Reporting & Communication
9) Training, Practice, Drills
10) Updates and Re-evaluation

Teaching Guides for NTA Level 4 MLS Curriculum Page 1181

Courtesy of: Shanna Nesby-O’Dell, International Implementation of Biosafety & Biosecurity
Programs U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

Laboratory Biosecurity
Examples- Access Controls

Courtesy of: Shanna Nesby-O’Dell, International Implementation of Biosafety & Biosecurity

Programs U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

Step 7: Key points

 Definition of biosafety and biosecurity
 Levels of biosafety
 Level of biosecurity

Step 8: Evaluation
 List 4 types biosafety levels
 Mention two purposes that biosecurity guidelines serve.
 Differentiate BSL 1 and BSL 2.

References:
1. World Health Organization (2003): Quality Assurance in Bacteriology and Immunology,
2nd Edition. Regional Office for South East Asia. New Delhi
2. Shanna Nesby-O’Dell, International Implementation of Biosafety & Biosecurity
Programs U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

Teaching Guides for NTA Level 4 MLS Curriculum Page 1182

Session 4: Importance of Record Keeping
in the Laboratory
NTA LEVEL 4, SEMESTER I, MODULE CODE: CMT04104 OCCURRENCE MANAGEMENT
AND RECORD KEEPING

Total Session Time: 120 minutes

Prerequisites
 None

Leaning Objectives
At the end of this session, students should be able to:
 Define Laboratory record keeping
 Explain importance of record keeping (Document clients information and determine work
load, Use data as reference material, Use data for planning and reports production
(disease intervention, operational research, financial management and laboratory work
load)
 Outline advantages and disadvantages of laboratory record keeping

Resources needed
 Flip charts, marker pens, masking tape, black/white board and chalk; white board marker

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 15 minutes Definition of terms
Brainstorming
3 45 minutes Presentation Importance of record keeping
Advantages and disadvantages of
4 30 minutes Presentation
laboratory record
5 10 minutes Presentation Key Points
6 15 minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition
Activity: Brainstorming (5 minutes)
 ASK the students the following question
 What do you understand by the term “Laboratory record keeping”?
 INVITE responses from students
 RECORD their response on the flip chart or chalk board

Teaching Guides for NTA Level 4 MLS Curriculum Page 1183

  SUMMARIZE their responses with information below

 Laboratory records are:- Worksheets, forms, charts, labels, used to capture client’s
information, activities, or results generated in the laboratory, May be paper or electronic
based

Step 3: Importance of record keeping

 Laboratory records save a large number of purposes, amongst them being:-
 Documentation of whatever has occurred
 Point of reference for establishing facts regarding an incident
 An aid in the recognition of trends and resolution of problems
 A way to establish credibility of the laboratory.
 It is mandatory to maintain records in a uniform pattern; the uniformity is to in protested
and standardized performance which will vary according to requirements

 Reportable/Notifiable disease Records

o This record reports cases of infectious diseases as required by the government. The
report may be based on a clinical syndrome, the isolation of the microorganisms or
positive serological test. The information to be included are:
 Patient demographics:
- Name
- Address
- Hospital registration number
- Occupation
- Disease
- Test results
- Name and address of physician
o Similarly personnel record which includes information on the ongoing personnel
training and the level of certification and training should also be maintained.
Documentation is the key to quality system. It helps to ensure consistence of the
process and procedures. Documentation facilities traceability helps in identifying
problems and assists in decision making to improve quality. Good documentation
indicates a good functional quality system.
 Significant serving can be made when the laboratory participate in local disease
surveillance and control. This is because
o The spread of infectious disease can be contained more rapidly
o Disease control measures can be selected and targeted more effectively
o Source of infection and disease carriers can be identified
 Reliable laboratory test results with relevant patient’s data provide information on the
health status of a community, health pattern and disease trends. This information is
needed to establish health care priorities plan:-
o Health care programs and location of health facilities
 Training of healthy personnel and delivery of health services
 Treatment schedules and changes in drug usage.
 Financing of health care programs

Teaching Guides for NTA Level 4 MLS Curriculum Page 1184

Step 4: advantages and disadvantages of laboratory record keeping
 Maintenance of detailed records for all aspects of laboratory activities is an absolute
requirement for validating any activity. In the absence of such records it can very well be
surmised that no work has been done. “If it is not recorded, it has not been done”
 Documentation is valuable in that:
o Defines responsibilities and authorities and interrelationships
o Ensures processes and outcomes are traceable e.g. a process may refer to the addition
of a reagent to complete the laboratory test and outcome refers to the report meeting
the product specifications.
o Proves that the job was done according to referential standards
o Facilitates training and makes it easier to train the staff to approved procedures than to
ad hoc information
o Reminds one what to be done
o Assists in making decisions
o Helps in investigation of problems
o Helps in improving efficiency
 Types of Documentation
o Various types of documents are used in the quality systems of the laboratories. These
includes:-
 Policy and plans
 Manuals
 Standard operating procedures (SOPs)
 Work instructions
 Data sheets
 Specifications
 Forms
 Standards
 Records
 Labels
 Reports

Step 5: Key Points (5 minutes)

 Define record keeping
 Importance of record keeping
 Advantages and disadvantages of laboratory record

Step 6: Evaluation
 Define record keeping
 List 5 types of Laboratory records
 Outline the advantages of laboratory record keeping

References:
1. World Health Organization (2003): Quality Assurance in Bacteriology and Immunology
2nd Edition. Regional Office for South East Asia, New Delhi
2. Cheesbrough M. (2000). District Laboratory Practice in Tropical Countries. Part 2.
Tropical Health Technology, Cambridge University

Teaching Guides for NTA Level 4 MLS Curriculum Page 1185

Session 5: Types of Record Keeping in the
Laboratory
NTA LEVEL 4, SEMESTER I, MODULE CODE: CMT04104 OCCURRENCE MANAGEMENT
AND RECORD KEEPING

Total Session Time: 120 minutes

Prerequisites
 None

Leaning Objectives
At the end of this session, students should be able to:
 Define Laboratory record keeping
 List types of laboratory record keeping
 Describe paper based record keeping
 Describe Electronic based record keeping

Resources needed
 Flip charts, marker pens, masking tape, black/white board and chalk; white board marker,
LCD projector, Computer

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 15 minutes Definition of terms
Brainstorming
3 05 minutes Presentation Types of laboratory record keeping
4 35 minutes Presentation Paper based record keeping
5 35 minutes Electronic based record keeping
6 10 minutes Presentation Key Points
7 15 minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition
Activity: Brainstorming (5 minutes)
 ASK the students the following question
 What are the Laboratory records?
 INVITE responses from students
 RECORD their response on the flip chart or chalk board
 SUMMARIZE their responses with information below

Teaching Guides for NTA Level 4 MLS Curriculum Page 1186

Laboratory records:
 Are worksheets, forms, charts, labels, used to capture client’s information, activities, or
results generated in the laboratory, may be paper or electronic based.

Step 3: Types of laboratory record keeping

 Paper based
 Electronic based Systems

Step 4: Paper based record keeping

 Refers to keeping laboratory records ii papers e.g. requisition forms, worksheets, register
books, monthly reports on reagents inventory register etc. Record keeping provides
continuous monitoring of quality system:-
o For specimen tracking throughout process
o To identify failures in equipment
o To revisit information; reference
o For use as a management tool
 Advantages
o They provide permanent record
o books bound
o pages numbered
o permanent ink
o Facilitate controlled storage
o Security
o controlled distribution confidentiality
o safe from environmental hazards
 Disadvantages
o Fire hazard
o Legible for destruction by:
 moisture and water
 Rodents
 insects

Step 5: Electronic based record keeping

 Computers and information technology have come in a big away in laboratories. Many
laboratories utilize a Laboratory Information Management system (LIMS) to improve
efficiency of the laboratory and assure quality of its services
 Role of computers in improving laboratory efficiency:
o Report generation
o Data analysis
o Traceability
o Validation checks
o Mandatory data checks
o Code checks
o Data entry devices
o Detection of abnormal/unusual results
o Test control
o Appropriate interpretation of test results
o Quality assessment of specimens

Teaching Guides for NTA Level 4 MLS Curriculum Page 1187

 o Stock control
o Maintenance schedule
 Advantages of Electronic based records:-
o They provide permanent records if there is system maintenance e.g., backups
o Provides security
o With the use of password there is restricted access and confidentiality
 Disadvantages:-
o Expensive in Installment and maintenance
o Requires good infrastructure (Air condition rooms free from dusts)
o Requires reliable power source

Step 6: Key Points (5 minutes)

 Define Laboratory record keeping
 List 2 types of laboratory record keeping
 Mention advantages and disadvantages of paper based record keeping
 Mention advantages and disadvantages of Electronic based record keeping

Step 7: Evaluation
 Define Laboratory record keeping
 List 2 types of laboratory record keeping
 Mention 2 advantages and disadvantages of paper based record keeping
 Mention 2 advantages and disadvantages of Electronic based record keeping

References:
1. MOHSW Lab. Quality System Training Module (2005) Documents and records
2. World Health Organization (2003): Quality Assurance in Bacteriology and
Immunology.2nd Edition. Regional Office for South East Asia, New Delhi

Teaching Guides for NTA Level 4 MLS Curriculum Page 1188

Session 6: Methods of Record Keeping
NTA LEVEL 4, SEMESTER I, MODULE CODE: CMT04104 OCCURRENCE MANAGEMENT
AND RECORD KEEPING

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives:
At the end of this session, students should be able to:
 Display and explain the use of Laboratory management tools(temperature charts,
occurrences logs, specimen log books, equipment maintenance logs)
 Effect client information in the register book (name, sex, age, address, registration
number, investigation requested, results, and dispatch)
 Enter client information by means of the computer(computerized record system which
simply keeps client Laboratory records-stand alone) Laboratory information system
where equipment is linked with computer

Resources needed
 Flip charts, marker pens, masking tape , black/white board and chalk, white board marker

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 10 minutes Definition of terms
Brainstorming
3 30 minutes Presentation Laboratory management tools
4 25 minutes Presentation Client information in the register book
Client information by means of the
5 25minutes Presentation
computer
6 10 minutes Presentation Key Points
7 15 minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition
Activity: Brainstorming (5 minutes)
 ASK the students the following question
 What do you understand by the term “Laboratory management tools”?
 INVITE responses from students
 RECORD their response on the flip chart or chalk board

Teaching Guides for NTA Level 4 MLS Curriculum Page 1189

 SUMMARIZE their responses with information below

 Laboratory Management tools- Refers to forms, registers and worksheets used for
capturing client information’s in the laboratory

Teaching Guides for NTA Level 4 MLS Curriculum Page 1190

Step 3: Laboratory Management Tool: Refrigerator 2-8oC

Teaching Guides for NTA Level 4 MLS Curriculum Page 1191

Source: AMREF

Teaching Guides for NTA Level 4 MLS Curriculum Page 1192

 Temperature Monitoring Tool: Freezer -20oC

Teaching Guides for NTA Level 4 MLS Curriculum Page 1193

Teaching Guides for NTA Level 4 MLS Curriculum Page 1194
Source: AMREF

Teaching Guides for NTA Level 4 MLS Curriculum Page 1195

 Temperature monitoring tool: Freezer -70oC to -80oC (Kisyombe to provide)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1196

  Occurrence log
OCCURANCE MANAGEMENT LOG

DEPARTMENT: ______________________________

REPORTING FOLLOW UP

DATE TIME PROBLEM Reported By TITLE Reported To SIGNATURE ACTION TAKEN Action by

Teaching Guides for NTA Level 4 MLS Curriculum Page 1197

  Specimen Rejection Form
SPECIMEN REJECTION
FORM

Name of the patient/client (ID); ___________

Age ______ Sex ______

Address ____________________________________

Date specimen received: ______/_____/20____

Reason for rejection; _________________________________________________________

Name of rejecting officer; _____________________________________________

Signature : ____________________ Date: __/____/ 20 ____

Date rejected specimen dispatched: _______________________

Means of specimen dispatch: ____________________________

Teaching Guides for NTA Level 4 MLS Curriculum Page 1198

Step 4: Client information in the register book
 Client information in the register book
 The laboratory register should have the following information:-
o Patients full name, age, and gender
o In patient or outpatient identification number
o Date of Collection
o Date of receipt
o Time of receipt
o Specimen provided
o Receiving Officer
o Specific tests required
o Specimen provided
o Name of medical officer

Step 5: Client information by means of the computer

 Electronic record pertains to keeping client information under the below mentioned
headings electronically: Patients full name, age, and gender
 In patient or outpatient identification number
 Date of Collection
 Date of receipt
 Time of receipt
 Specimen provided
 Receiving Officer
 Specific tests required
 Specimen provided
 Name of medical officer

Step 6: Key Points (5 minutes)

 Display and Explain the use of Laboratory management tools (temperature charts,
occurrences logs, specimen log books, equipment maintenance logs)
 Effect client information in the register book (name, sex, age, address, registration
number, investigation requested, results, and dispatch)
 Enter client information by means of the computer (computerized record system which
simply keeps client Laboratory records-stand alone) Laboratory information system
where equipment is linked with computer

Step 7: Evaluation
 List 5 types of Laboratory management tools
 Outline the components of client information in the register book
 Explain entrance of client information by means of the computer

References:
1. MOHSW Laboratory Management tools (2009)
2. World Health Organization (2003): Quality Assurance in Bacteriology and Immunology,
2nd Edition. Regional Office for South East Asia. New Delhi
3. Cheesbrough M. (2000). District Laboratory Practice in Tropical Countries. Part 2.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1199

Session 7: Maintain Records of Collected
Specimen
NTA LEVEL 4, SEMESTER I, MODULE CODE: CMT04104 OCCURRENCE MANAGEMENT
AND RECORD KEEPING

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives:
At the end of this session, students should be able to:
 Explain the significance of maintaining records for collected specimen (easily retrieval of
clients information’s, maintenance of data. control of laboratory cheating, controls
income, for management plan)
 Perform procedure for recording collected specimen according to set standards (register,
computer)
 Show safe keeping of reception register (Not being accessible to unauthorized person,
under lock)

Resources needed
 Flip charts, marker pens, masking tape, black/white board and chalk; white board marker

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 10 minutes Definition of terms
Brainstorming
Significance of maintaining records for
3 25 minutes Presentation
collected specimen
4 25 minutes Presentation Client information in the register book
5 25minutes Presentation Procedure for recording collected specimen
6 15 minutes Presentation Safe keeping of reception register
7 5 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1200

Step 2: Definition
Activity: Brainstorming (5 minutes)
 ASK the students the following question
 What do you understand by the term “specimen”?
 INVITE responses from students
 RECORD their response on the flip chart or chalk board
 SUMMARIZE their responses with information below
 Specimen- A sample used for testing and diagnosis

Step 3: Significance of maintaining records for collected specimen

 Why is it important?
o Records for collected specimen, directly affects patient care and patient outcome. It
Influences therapeutic decisions. Poor records of specimen can result into unnecessary
re-draw/re-test of specimen, incorrect diagnosis/ treatment, injury and death. Well
maintained specimen records provide chain of custody by assisting in tracing of the
sample through the testing process. The records should have the following
information’s:
 Receipt time, who?
 Registration time, who?
 Testing time, who?
 Reporting time, who?
 Dispatch time, who?

Step 4: Client information in the register book

 The laboratory register should have the following information:-
o Patients full name, age, and gender
o In patient or outpatient identification number
o Date of Collection
o Date of receipt
o Time of receipt
o Specimen provided
o Receiving Officer
o Specific tests required
o Specimen provided
o Name of medical officer

Step 5: Safe keeping of reception register

 Laboratory Registers and other client information should be kept in lockable draws, as
shown below

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 A familiar sites in our laboratories

Picture from MOHSW: Laboratory Quality System Training Module (2006)

 Laboratory Register kept in poor way

 Laboratory staff must never disclose any information they may learn about a patient or a
test result to anyone other than the health personnel caring for the patient. Respecting
patient’s confidentiality must also extend to when laboratory reports are issued’ reports
should be delivered in sealed envelopes (labelled confidential Laboratory report or in
labelled sealed folder which can be returned to the laboratory for use.
 Computerized records
 Have the advantage of Permanence when they kept with backups. It is easy to strict
access, and Confidentiality

Step 6: Key Points (5 minutes)

 Explain the significance of maintaining records for collected specimen, controls income,
for management plan)
 Perform procedure for recording collected specimen according to set standards (register,
computer)
 Show safe keeping of reception register (Not being accessible to unauthorized

Step 7: Evaluation
 Explain the significance of maintaining records for collected specimen
 Explain the components of the specimen register and their importance
 Outline the importance of safe keeping of reception register

References:
1. MOHSW (2008): Laboratory Quality Training Module(Documents and Records)
developed in Collaboration with ASCP
2. Cheesbrough M. (2000). District Laboratory Practice in Tropical Countries. Part 2.

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Session 8: Planned Preventive Maintenance
for Basic Laboratory Equipments
NTA LEVEL 4, SEMESTER I, MODULE CODE: CMT04104 OCCURRENCE MANAGEMENT
AND RECORD KEEPING

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives:
At the end of this session, students should be able to:
 Define laboratory PPM, Equipment occurrences
 Complete maintenance of log book
 Fill in occurrence forms
 Fill in occurrence job cards

Resources needed
 Flip charts, marker pens, masking tape , black/white board and chalk, white board marker

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
Presentation
2 05 minutes Definition of terms
Brainstorming
3 30 minutes Presentation maintenance of log book
4 30 minutes Presentation Occurrence forms
5 30minutes Presentation Occurrence job cards
6 05 minutes Presentation Key Points
7 15 minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify
 ASK students if they have any questions before continuing.

Step 2: Definition:
Activity: Brainstorming (5 minutes)
 ASK the students the following question
 What do you understand by the term “Laboratory PPM”?
 INVITE responses from students
 RECORD their response on the flip chart or chalk board
 SUMMARIZE their responses with information below

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 Laboratory PPM: planned preventive maintenance is defined as a program of scheduled
inspection of equipment and instruments resulting in minor adjustment or repairs for the
purpose of delaying or avoiding major repairs and emergency or premature replacements.
It provides the following advantages over break down maintenance
 Better quality results
 Identification of components showing excessive wear
 Greater safety
 Fewer interruptions in services
 Lower repair costs
 Less standby equipment requirements

Step 2: Maintenance of log book

 It is essential that laboratory personnel know and document that all equipment is in good
working condition each day of use. This can accomplished by undertaking function
checks, often referred to as calibration and validation
 Calibration: That process which is applied quantitative measuring metering of equipment
to assure its accurate operation throughout its measuring limits.
 Validation: the step taken to confirm and record the proper operation of equipment at a
given point of time in the range in which tests are performed.

Temperature monitoring of Incubators, water baths and refrigerators

 Temperatures should be checked daily and recorded. If the readings are beyond tolerance
limits, staff should know what needs to be done. Some of the suggested acceptable
temperature ranges, as recommended in national standards of few developed counties are
shown below;

Temperature Acceptable range oC Purpose

Refrigerator 2-8oC Storage of media, reagents and stock
cultures
Freezer at -20oC +/-5oC Storage of specimens, sera, reagents
and stock cultures
Freezer at -70oC +/-10oC Storage of reference culture and sera

Documentation
 The assurance that a piece of equipment is operating properly can best be judged by
examining its performance over time. Records of performance parameters, therefore, are a
vital element, in the proper operation of laboratory equipment. Some suggested
information is provided below:
o Name and serial number of Equipment
o Elements to be checked and kind of data to be collected
o Frequency of checking
o Record of data
o Comments on data
o Changes made to restore accuracy and precision if any
o Signature with date of the person performing these tasks

Step 3: Complete occurrences forms.

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 Maintenance of equipment is an extremely important function in the Laboratory.
Unfortunately, this is often grossly neglected because of indifference on the part of
Laboratory workers and on the erroneous belief that it is too costly. The expense of such
maintenance policies as inspection, lubrication and adjustment of instruments is
insignificant when compared with the cost of emergency repairs, rebuilding or
overhauling equipment, and the additional personnel time and materials involved in
producing test results when equipment is down.

Step 4: Complete job cards

 A job card is assigned to each specimen so that procedures performed on the specimen,
notes by the Laboratory personnel, results obtained and interaction between the physician
and the laboratory staff can be recorded. A properly completed job card can be used to
reconstruct and assess the accuracy of the final report, It should contain the following
information:-
o Name, age and sex of patient
o Identifying number (OPD and/or admission number)
o Name of test requested
o Specimen type and source
o Initials of Laboratory personnel perfuming procedures
o Procedure, date performed
o Preliminary results
o Final diagnosis
o Any discussion with physician

Step 5: Key Points (5 minutes)

 Define laboratory: PPM, Equipment occurrences
 Complete maintenance of log book
 Fill in occurrence forms
 Fill in occurrence job cards

Step 6: Evaluation
 Define PPM how does differ from PM
 Explain the maintenance of Equipment log book
 Describe filling of occurrence job cards

References:
1. World Health Organization (2003): Quality Assurance in Bacteriology and
Immunology.2nd Edition. Regional Office for South East Asia, New Delhi

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Session 9: Documentation and Reporting
Occurrences of Laboratory Instruments
NTA LEVEL 4, SEMESTER I, MODULE CODE: CMT04104 OCCURRENCE MANAGEMENT
AND RECORD KEEPING

Total Session Time: 120 minutes

Prerequisites
 None

Learning objectives:
At the end of this session, students should be able to:
 Define documentation of equipment occurrences
 Outline the importance of documenting equipment occurrences
 Explain the use of occurrence management log book and corrective action log sheet
 Explain reporting of occurrences

Resources needed
 Flip charts, marker pens, masking tape, black/white board and chalk; white board marker,
LCD and Computer

SESSION OVERVIEW
Step Time Activity/Method Content
1 05 minutes Presentation Introduction, Learning Objectives
2 05 minutes Presentation Definition of terms
Documentation of equipment
3 25 minutes Presentation
occurrences
Importance of documenting of equipment
4 20 minutes Presentation
occurrences
Use of occurrence management log book
5 30 minutes Presentation
and corrective action log sheet
6 20 minutes Presentation reporting of occurrences
7 5 minutes Presentation Key Points
8 10 minutes Presentation Evaluation

SESSION CONTENTS
Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Definition
 Activity: Brainstorming (5 minutes)
 ASK the students the following question
 What do you understand by the term “Documentation of equipment occurrences”?

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  INVITE responses from students
 RECORD their response on the flip chart or chalk board
 SUMMARIZE their responses with information below

 Documentation of equipment occurrences:- Refers to writing down all equipment faults

or malfunctioning of Equipment in occurrence log or register

Step 3: Importance of documenting of equipment occurrences

 It is essential that laboratory personnel know and document that all equipment is in good
working condition each day of use. This can accomplished by undertaking function
checks, often referred to as calibration and validation
 Calibration: That process which is applied quantitative measuring metering of equipment
to assure its accurate operation throughout its measuring limits.
 Validation: the step taken to confirm and record the proper operation of equipment at a
given point of time in the range in which tests are performed.
 Temperature monitoring of Incubators, water baths and refrigerators
 Temperatures should be checked daily and recorded. If the readings are beyond tolerance
limits, staff should know what needs to be done. Some of the suggested acceptable
temperature ranges, as recommended in national standards of few developed counties are
shown below:

Temperature Acceptable range Purpose

oC

Refrigerator 2-8oC Storage of media, reagents and stock

cultures
Freezer at -20oC o
+/-5 C Storage of specimens, sera, reagents
and stock cultures
Freezer at -70oC o
+/-10 C Storage of reference culture and sera

Documentation:
 The assurance that a piece of equipment is operating properly can best be judged by
examining its performance over time. Records of performance parameters, therefore, are a
vital element, in the proper operation of laboratory equipment. Some suggested
information is provided below:-
o Name and serial number of Equipment
o Elements to be checked and kind of data to be collected
o Frequency of checking
o Record of data
o Comments on data
o Changes made to restore accuracy and precision if any
o Signature with date of the person performing these tasks

Step 4: Occurrence management log book and corrective action log sheet
 A process for documenting and addressing equipment problems or its malfunctioning that
occur in the laboratory occurrence Log or register. The occurrence management should
explain the following:-
o Investigation occurrence report

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 o corrective action taken
o Report results / trends
o Prioritization of problems and assignment of a process for improvement (PI) team
o Conduct focused audit to ensure resolution

Step 5: Reporting of Occurrences

 Occurrence logs are used to capture:
o Who was involved?
o What occurred?
o When did it occur?
o Where in the laboratory process did the problem occur?
o Management will:
o Review and evaluate the data on the occurrence
o Determine how the event occurred including any contributing factors
o Determine the root cause by evaluating system or people issues (knowledge and
behaviour)
o Occurrence documentation is part of quality reporting system
o Occurrence data and trends are used to identify problems for process improvement
activities
o Management prioritizes the problems
o Management assigns the process improvement (PI) team to develop solutions

Step 6: Key Points (5 minutes)

 Define documentation of equipment occurrences
 Outline the importance of documenting equipment occurrences
 Outline the use of occurrence management log book and corrective action log sheet
 Explain briefly on reporting of occurrences

Step 7: Evaluation
 Mention 3 possible Equipment occurrences
 Explain how accidents can occur in the laboratory
 Explain the importance of reporting of Laboratory occurrences

Reference
1. MOHSW (2008): Laboratory Management training Module (occurrence management)
developed in Collaboration with ASCP
2. World Health Organization (2003): Quality Assurance in Bacteriology and
Immunology.2nd Edition. Regional Office for South East Asia, New Delhi

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 CHAPTER ELEVEN

MODULE CODE MLT04209:

PREPARATION OF BASIC
LABORATORY REAGENTS
AND SOLUTIONS

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Session 01: Dilution Methods for
Antiseptics and Disinfectants
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 define the terms: antiseptic, disinfectant, solution and dilution
 list common types antiseptics and disinfectants used in the laboratory (disinfectants:
bleach solution, Lysol solution, antiseptics: methylated spirits)
 explain types of concentration for antiseptics and disinfectants: Volume/Volume,
Weight/Volume, Weight/Weight
 explain the method for preparing Volume/Volume, Weight/Volume and Weight/Weight
dilutions of antiseptics and disinfectants

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Lap top computer and LCD projector

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes Presentation Definition of Terms
3 5 minutes Presentation Types of antiseptics and disinfectants
4 30 minutes Presentation Types of concentration
Presentation
5 60 minutes Method for preparing dilutions
Group Discussion
6 5 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

READ or ASK students to read the learning objectives and clarify.
ASK students if they have any questions before continuing.

Step 2: Definitions of Terms

Activity: Group Discussion (5 minutes)
 ASK the students to discuss in pairs and allow them to answer the following questions
 Define antiseptic

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  Define disinfectant
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses using notes below

 Definition of Terms
o Antiseptic: Substance used on humans and other animals that destroy harmful
microorganisms or inhibit their activity. Anti: against. Septic: The presence of
disease-causing microorganisms or their toxins in tissues or in the blood. So antiseptic
also means against the presence of micro-organisms.
o Disinfectant: Substance used on inanimate objects that destroy harmful
microorganisms or inhibit their activity.
 Antiseptics are used to eliminate most bacteria and other micro-organisms from human
skin such as the median cubital vein of arm prior to venipuncture.
 Disinfectants are also used to eliminate most bacteria and micro-organisms from
inanimate objects such as laboratory surfaces. Both are used to eliminate micro-organisms
for clinical laboratory use.

 Solution: mixture made up of a solute, the main component or active ingredient, and the
solvent, inert diluting component.
o Solute: the main component of a solution
o Solvent: the inert diluting component
 Dilution: A solution made less concentrated by the addition of more diluents or solvent.
Diluent: solvent used to lower concentration of a solute in a solution

Step 3: Types antiseptics and disinfectants (5 minutes)

Common Antiseptics: 70% methanol and isopropyl alcohol
 70% methylated spirit (methanol) and isopropyl alcohol. These two antiseptics are
used for cleansing the skin of micro-organisms prior to venous or capillary puncture
in blood collection.

Antiseptics:

Methanol

Common Disinfectants: 10% bleach and 5% Lysol ®

Bleach solution is a 30-35% solution of sodium hypochlorite.
 10% bleach solution (Common brand name of Jik®) is a common laboratory disinfectant.

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 Lysol ® is a commercially prepared disinfectant containing phenols.
5% Lysol ® solution is used to cleanse laboratory surfaces such as benches, instrument
covers to eliminate most harmful bacteria, viruses and other micro-organisms. 5% Lysol
is commonly used for disinfection in microbiology laboratory areas.

Step 4: Types of concentration (30 minutes)

 Volume per volume (V/V) in units such as millilitres or liter. For example V/V may be
measured as mL/ mL or mL/ 100 mL. The numerator of the proportion equals volume of
solute and the denominator equals the total volume made up of volume of solute +
volume of diluent. Total volume = volume solute + volume diluents

 A pipet or measuring cylinder is used to measure the volume of solute.

Measuring cylinder

 Usually a measuring cylinder is used to measure the volume of diluents. Conical flasks
are used to mix the solution.

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 Weight/Volume stands for a proportion of weight or mass per volume in g/ mL or g/ 100
mL and is abbreviated W/V. The proportion equals g of solute/ total volume of solute +
diluents. Gram/ millilitre or g/ mL also is the unit for specific gravity.

Step 5: Method for preparing V/V, W/V and W/W dilutions (60 minutes) Preparing V/V
dilutions:
 Start with measuring out mL of stock antiseptic or disinfectant with a pipet for small
volume or graduated measuring cylinder for larger volume.
 Next dilute the measured volume of stock to a final volume in a graduated cylinder. For
example, if you are to dilute 5 mL of Lysol ® to the total volume of 100 mL, use a
graduated cylinder that can hold 100 mL. You will be adding approximately 95 mL of
diluents to the 5 mL of Lysol ®.

 The tutor may bring a measuring cylinder and pipet to illustrate the point or refer to the
pictures above of pipets and cylinder.

Preparing W/V dilutions:

 Start with weighing out g of solute antiseptic or disinfectant powder with a balance.
 Next, put the weighed powder into a graduated measuring cylinder that holds the final
volume. Add enough diluent to dilute to the final volume.

Preparing W/W dilutions:

 Start with weighing out grams of solute antiseptic or disinfectant powder.
 Next, dilute to a final weight with diluent.
 The density of pure water is 1 g/ mL. Since 1 gram of pure water has a volume of 1 mL,
based on its density, gram/gram can use the solvent if it is pure water by measuring in
either millilitres or grams.

Step 6: Key Points (5 minutes)

 Definition of disinfectant is a substance that destroys harmful bacteria on inanimate
objects while an antiseptic is a substance that destroys harmful bacteria on human skin or
mucous membranes.
 The methods for preparation of disinfectants and antiseptics is generally by pouring out a
specific volume of concentrated stock antiseptic or disinfectant and diluting up to a final
volume with distilled water.
 This is called a volume/ volume or V/V dilution.

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 Another kind of dilution you may encounter is measuring the required weight of
concentrated stock powder and diluting up to a final volume with distilled water to make
a weight/ volume (W/ V) dilution.

Step 7: Evaluation (10 minutes)

 Ask the question to students:
o How do you prepare 50 mL of 10 w/v% bleach solution from stock Jik®?

 Answer for tutor to know: 10 w/v% x 50 mL = 5 mL. 5 mL of bleach is put in a 50

mL flask and diluted to final volume with approximately 45 mL distilled water.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

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Session 02: Application of Laboratory
Mathematics to Determine Concentration
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 180 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Define terms relevant to the metric system: litres, grams, nano, pico, micro, milli, deci,
kilo.
 Define terms relevant to laboratory concentration: pH, molarity, mole, millimoles,
micromoles, normality, density, specific gravity, % solution and buffer including
formulas.
 Calculate pH, mole, equivalent weight, molarity, normality, specific gravity, g to mg, mg
to g, mL to L, and microliter to millilitres.
 Calculate concentration conversions factors: % solution to molarity, molarity to
normality, millimoles to micromoles.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes In Class Exercise Definition of Terms
3 20 minutes Presentation Definition of Terms
Calculate pH, mole, equivalent weight,
molarity, morality, normality, specific
4 75 minutes Presentation
gravity, g to mg, mg to g, mL to L,
microliter to millilitre.
Presentation Calculate concentration conversions
5 60 minutes
Group Discussion factors
6 5 minutes Presentation Key Points
7 10 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

READ or ASK students to read the learning objectives and clarify.
ASK students if they have any questions before continuing.

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Step 2: Definitions of Terms

Activity: In class exercise (first 5 minutes)

ASK the students to answer individually the following questions:
 Define liter
 Define gram
 Define kilo
 One or two students can demonstrate their answers
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

Answers: Relevant to the metric system:

Litres: standard unit of metric volume
Grams: standard unit of metric mass (weight)
Kilo: 1 x 10 3

Step 3 Definition of Terms (20 minutes)

It is important to learn metric unit terms of unit and prefixes.
Metric Unit Prefix Number/Conversion
Kilo 1000
Deci 1/10
Milli 1/1000
Micro 1 x 10 -6
Nano 1 x 10 -9
Pico 1x 10-12

Relevant to laboratory concentration:

 pH: potential of hydrogen ions
 molarity: moles per liter (mol/L)
 molality: moles per kilogram (Mol/Kg)
 mole: unit represented by the molecular weight of the compound in gram
 millimoles: unit represented by the molecular weight of the compound in milligram
 micromoles: unit represented by the molecular weight of the compound in microgram
 normality: unit represented by the equivalent weight of the compound in gram/ valence
 density: standard unit of concentration unique for a chemical solution in g/mL
 specific gravity: The ratio of the mass of a solid or liquid to the mass of an equal volume
of distilled water at 4°C.
 % solution: concentration represented by parts of solute/ 100 total parts. This could be
specific to V/V, W/V and W/W.
 Buffer: mixture of strong base and weak acid that is able to stabilize pH and resist
changes in pH.

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 This Equals Equals
1 Kiloliter (KL) 1000 L 1,000,000 mL
1 Liter (L) 1000 mL 1,000,000 µL
1 deciliter (dL) 100mL 100,000 µL
1 milliliter (mL) 1000 µL 1,000,000 nL
1 microliter (µL) 1000nL 1,000,000 pL

This Equals Equals

1 Kilogram (Kg) 1000 g 1,000,000 mg
1 gram (g) 1000 mg 1,000,000 µg
1 decigram (dg) 100mg 100,000 µg
1 milligram (mg) 1000 µg 1,000,000 ng
1 microgram (um) 1000ng 1,000,000 pg

Step 4: Formulas and Calculations (75 minutes)

Formulas
 molarity = gram molecular weight/ L
 molality = gram molecular weight/ Kg
 mole= gram molecular weight
 milimoles= miligram molecular weight
 micromoles = microgram molecular weight
 normality = Eq weight/ L
 density= g/mL
 specific gravity = g/mL/ g/mL water
 % solution = parts solute/ total parts
 pH = - log (H + mmol/L) pH + pOH = 14

Calculations:
 % W/V = g/ 100 mL
Question: If 6 g of disinfectant powder is diluted to a total volume of 200 mL what is the
% w/v?
6g/ 200 mL = x g/ 100 mL
6 x 100 = 200 x
600 = 200 x
x = 3 g 3g/ 100 mL = 3%
 Mole 1 mole = g (from molecular weight) 1 mole of NaCl is how many grams?
Add up A.W. of Na and Cl to get M.W. in gram (A.W. Na 23; Cl 35) 1 mole NaCl = 58 g
How many grams in 1 mole H2O? (A.W. H 1; A.W. O = 16) 1 mole H2O = 18 g
 Molarity = mole/L. How do you make 1 mol/L NaCl?. (A.W. Na 23; Cl 35) 1 mole NaCl
= 58 g dissolved in 1 L to make 58g/L NaCl
How many grams H2O in 2 mol/L? 1 mole H2O = 18 g so 1 mol/L so 2 mole/L x 18
g/mole = 36 g in 1 L. Molarity x gram M.W.
 Molality =mole/ Kg of solution

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 How do you make 1 mol/Kg of H2O? (A.W. H 1; A.W. O = 16) 1 mole H2O = 18 g in 1
Kg
 Equivalent weight = g/ valence (from molecular weight)= Eq
Example (A.W. Na 23; Cl 35; valence 1) Eq weight of NaCl = 58g/1 = 58
Normality=Eq/L
specific gravity = g/mL
 g to mg: g x 1000 = mg
How many mg in 1.7 g? 1.7 x 1000 = 1700 mg
 mg to g: mg / 1000 = g
How many g in 230 mg? 230/ 1000 = 0.23 g
 mL to L: mL/ 1000 = L
How many L in 750 mL? 750 / 1000 = 0.75 L
 microliter to milliliter: ul / 1000 = mL
How many mL in 450 microliter? 450 µL /1000 = 0.45 mL
 pH strong acid and base
pH = - log - log (H+mmol/L)
 Example: What is the pH of acid with 1 x 10-3 mmol/L?
pH = - log (1 x 10-3) pH = - (-3) = 3.0
 What is the H+mmol/L of acid with pH 7.0?
7.0 = - log (H+mmol/L) = 1 x 10-7
 pH + pOH = 14
Example if pOH is 11 what is pH? pH = 14 – 11 = pH 3
If pOH is 7.0 what is pH? pH = 14 – 7 = pH 7
 pOH = –log (OH- mmol/L)

Step 5 Concentration Conversion Factors (60 minutes)

 %W/V solution to molarity: g/100 mL x 1 mole/ g M.W. x 1000 mL/ 1 L = % W/V x
10/ g MW = mol/L
What is the molarity of 0.85% W/V NaCl?
0.85/100 mL x 1 mole/ 58 g M.W. x 1000 mL/ 1 L = 0.15 mole/L
Shorter method:
0.85 x 10/ 58 = 0.15 mol/L
 Molarity to normality: moles/ L x g/ mole x eq/ g = Eq/L
moles/L x valence = Eq/L
What is the normality of 2 mol/L NaCl?
2 moles/ L x 58 g/ mole x 1 eq/ 58g = 2 Eq/L
Shorter method:
2 moles/ L x 1 = 2 Eq/L
 Convert millimoles to micromoles: mmoles x 1000 = umoles
How many micromoles of NaCl in 350 millimoles?
350 mmoles x 1000 = 350,000 umoles

Step 6: Key Points(5 minutes)

 Calculations of concentrations:
 % w/v = g/ 100 mL
 Molarity = moles/L
 Density = g/mL

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 pH = -log (H+ mol/L)

 Conversion of concentrations from one type to another

o % W/V converted to molarity: W/V x 10/ g MW = mol/L
o Molarity converted to Normality: moles/L x valence = Eq/L
o millimoles converted to micromoles: mmoles x 1000 = µmoles

Step 7: Evaluation (10 minutes)

 In Class Individual Assignment:
 How many millimole/L of H+ in HCl solution of pH 1.0?
 What is the normality of 0.3 mol/L of NaCl solution?
 How many liters is there in 500 mL?

 Answers: pH 1 H+ 1 x 10 -1 mole/L
o Normality = eq/L Valence = 1 Na+Cl- so 58 g/ Eq. 0.3 mol/L = 0.3 Normality
o 500 mL/ 1000 = 0.5 L

 Homework Assignment:
o Possible
 Give the students a worksheet that includes laboratory calculations for
concentration and concentration conversion factors. Feedback will be provided on
the following session.
- For calibration of the 100 µL micropipette, you dispense pure water into a
weighing boat, tare the balance and determine the mass and use the conversion
factor of water density to determine volume. The volume was determined to
be 0.098 mL. What is the volume in microliters dispensed by this pipette?
Show your work.
- 150 mg of NaCl is to measured out into a flask using a balance that measures
in g. What is the correct mass in g for making this solution? Show your work.
- How many milliliters in a liter?
- How do you determine the molecular weight of KOH?
- How many g in 1 mole of NaCl? (A.W. Na 23; CL 35)

 Answer to Homework:
o Question 1) 0.098 mL = 98 uL
o Calculation: 1 mL = 1000 uL
o 0.098 x 1000 = 98 uL

 Answer to Question
o Answer: 150 mg = 0.15 g
o 1000 mg per 1 g
o 150 mg/ 1000 = 0.15 g
o 1000 mL = 1 L
o molecular weight of KOH is determined by molecular weight (sum of A.W.
determined from periodic table) per mole. 1 mole = g. M.W.
o 23+ 35 = 58 M.W. for NaCl. 1 mole NaCl = 58 g

Teaching Guides for NTA Level 4 MLS Curriculum Page 1219

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1220

Session 03: Ingredients for Preparing
Antiseptics and Disinfectants
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives

By the end of this session, students are expected to be able to:

 List the proportion of antiseptic and disinfectant with distilled water

 Calculate the proportion of antiseptics and disinfectants to make different total volumes.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise Dilutions of disinfectant
List the proportion of antiseptic and
3 20 minutes Presentation
disinfectant with distilled water
Calculate the proportion of antiseptics and
4 60 minutes Presentation disinfectants to make different total
volumes
5 5 minutes Presentation Key Points
In Class Case
6 10 minutes Evaluation
Study

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Ingredients in Diluted Disinfectant

Activity: In class exercise (10 minutes)
 ASK the students to answer individually the following questions:
 What are the two main ingredients needed to prepare 10% bleach solution?
 What is the proportion of these two main ingredients needed to prepare 10% bleach

Teaching Guides for NTA Level 4 MLS Curriculum Page 1221

 solution?
 One or two students can demonstrate their answers
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

 Answer: stock bleach solution and distilled water are needed to prepare 10% bleach. The
proportion to make 10 % is 10 parts of stock bleach and distilled water to make 100 total
parts.
 10 mL of stock bleach + 90 mL distilled water = 10/100 or 10%

Step 3: List (20 minutes)

The proportion of antiseptic and disinfectant with distilled water to make:
 10% bleach (Jik) is 10 parts of concentrated bleach solution in 100 total parts including
the diluent. This is a volume/ volume %V/V solution since it involves measuring out
volume of concentrated bleach and diluting to a total volume.
 5% Lysol is 5 parts of Lysol in 100 total parts. 5 parts of Lysol® concentrated solution in
100 total parts including the diluent. This is a volume/ volume %V/V solution since it
involves measuring out volume of concentrated Lysol and diluting to a total volume.
 70% methylated spirit (methanol) is 70 parts of methylated spirit in 100 total parts. 70
parts of concentrated (absolute) methanol in 100 total parts including the diluent. This is a
volume/ volume %V/V solution since it involves measuring out volume of concentrated
methanol and diluting to a total volume.

 The two main ingredients needed to prepare 10% bleach solution are Jik® and water. The
proportion of these two ingredients is 10 parts concentrated bleach (Jik), and 90 parts
water since the total parts is 100.

 The ingredient in diluted disinfectant such as Lysol® is stock disinfectant and water.
5%V/V Lysol® solution is 5 parts of Lysol® concentrated solution in 100 total parts
including the distilled water.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1222

 The ingredients in diluted antiseptic 70%V/V methylated spirit is stock concentrated
antiseptic and water. For example 70% methylated spirit has 70 parts of absolute
methanol and 30 parts of water.

Step 4: Calculations (60 minutes)

 Calculations are used to determine the proportion of antiseptics and disinfectants to make
different total volumes.
 100 mL of 5% Lysol® is made from the formula 5% x 100 mL =5 mL the volume of
Lysol® to make the dilution. Total volume is 100 mL – 5 mL Lysol so approximately 95
mL of water is added. Actually you add water to the 5 mL of strong Lysol in a 100 mL
measuring graduate cylinder until the total volume is 100 mL which is approximately 95
mL of distilled water.
 To determine how to make a specific volume, multiply the final volume times the percent
solution desired to calculate the volume of stock solution needed. Total volume – volume
of stock = approximate volume of diluent added. So to make 200 mL of 5% Lysol
solution 200mL x 5% = 200 x .05 = 10 mL Lysol added to measuring cylinder. Add
remaining volume, approximately 190 mL distilled water to make 200 mL total volume.
 How do you make 5 L of 5% Lysol disinfectant? 5 L of 5%V/V Lysol® is made from 5%
x 5000mL = .05 x 5000 = 250 mL the volume of Lysol to make the dilution in a 5 L flask.
5000-250 = approximate volume of distilled water added = 4750 mL
 How do you make 500 mL of 10% bleach? 500 mL of 10%V/V Jik® is made from 10%
x 500 mL = 500 x 0.10 = 50 mL. 50 mL of concentrated Jik® is diluted with distilled
water to a total volume of 500 mL in a measuring graduate cylinder. Approximately 500 –
50 mL or 450 mL of distilled water is added.
 How do you make 20 mL of 70% V/V methanol antiseptic? 20 mL of 70%V/V
methylated spirit is made from 70% x 20 mL = 0.70 x 20 = 14 mL, the volume of
absolute methanol needed. 14 mL of methanol is diluted to a final volume of 20 mL by
adding 20-14 or 6 mL of distilled water.
 How do you make 250 mL of 70% V/V methanol antiseptic? 250 x 70% = 250 x 0.7 =
175 mL of absolute methanol is diluted to a total volume of 250 mL with distilled water.

Step 5: Key Point (5 minutes)

 5% Lysol disinfectant is made up of 5 parts Lysol concentrate into 100 total parts
including distilled water. 10% diluted disinfectant bleach (JIK) is made from 10 parts
concentrated bleach and 90 parts distilled water for 100 total parts. 70% methylated
spirits is the most common antiseptic and it is made from 70 parts of absolute methanol
and 30 parts of distilled water to make 100 total parts.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1223

 In order to determine how to make up specific volumes of antiseptics and disinfectants it
is important to calculate based on the proportion. For example total volume needed x % to
determine the volume of concentrated disinfectant or antiseptic needed.

Step 6: Evaluation (5 minutes)

 Case Study: Homework Assignment with Feedback provided in the next of the session:
 Juma, the laboratory Technician received concentrated (stock) Jik® and needed to make
200 mL of 10% v/v Jik® solution to use today. How will he go about preparing this?

 Answer will be discussed in Session 4

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1224

Session 04: Demonstration of the
Preparation of 70% Methylated Spirits,
10% Bleach and 5% Lysol Disinfectants
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List the supplies (equipment and materials) needed to prepare diluted disinfectants and
antiseptics
 Retrieve the supplies (equipment and materials) needed to prepare diluted disinfectants
and antiseptics
 Perform preparation of 70% methylated spirits, 10% bleach and 5% Lysol disinfectants

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Flasks
 Pipets
 Parafilm
 Distilled Water
 Concentrated antiseptics and disinfectants (Jik®, Lysol®, Methylated spirits)
 Personal protective equipment

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise Case study from session 3
3 15 minutes Presentation List supplies
4 30 minutes Presentation Tutor demonstration of preparation of
Antiseptics and Disinfectants
5 5 minutes Presentation Key Points
6 45 minutes Student Evaluation of Student Preparation of
Preparation in Antiseptics and Disinfectants
Teaching
Laboratory

Teaching Guides for NTA Level 4 MLS Curriculum Page 1225

 7 10 min Evaluation Follow up to practical

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Case Study Feedback

Activity: In class exercise (10 minutes)
 ASK the students to share their answer to the Session 3 case study (making 200 mL of
10% v/v Jik® solution)
 One or two students can demonstrate their answers
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

 Case Study:
o Juma, the laboratory Technician received concentrated (stock) Jik® and needed to
make 200 mL of 10% v/v Jik® solution to use today. How will he go about preparing
this?

 Answer: 200 mL x 10% = 20 mL of Jik and 200-20= 180 mL water. 20 mL Jik is added
to a measuring cylinder that can hold 200 mL total volume and containing slightly less
than 180 mL of distilled water. After allowing to mix add the rest of the water so the total
volume is 200 mL and mix.

Step 3: (15 minutes)

 List Supplies needed to Prepare Antiseptics and Disinfectants
Equipment:
 Measuring graduated cylinder
 Flasks
 Pipets
Material:
 Parafilm
 Distilled Water
 Concentrated Jik® and Lysol
 Concentrated methylated spirit (methanol)

Graduated Measuring Cylinder

Teaching Guides for NTA Level 4 MLS Curriculum Page 1226

 Lysol Disinfectant

Gather All Supplies and give general information for handling

Equipment:
 Measuring Graduated cylinder
 Flasks
 Pipets
 Material:
 Parafilm
 Distilled Water
 Concentrated Jik® and Lysol
 Absolute methylated spirit (methanol)

Step 4: Tutor Demonstration (30 minutes)

 Steps for preparing 5% Lysol® noting correct use of equipment and safety precautions.
Lysol is harmful if swallowed and can cause irritation if exposed to skin, eyes or mouth.
o 5% means 5 parts of concentrate out of total volume of solution. Total volume is 100
mL – 5 mL concentrate = 95 mL diluents needed.
o Add 5ml of concentrated Lysol to approximately 95ml distilled water in a graduated
measuring cylinder.
o Mix by covering with parafilm and by inverting.
o Add water to final volume of 100 mL).
o 10% means 10 parts of concentrate out of total volume of solution. Total volume is
100 mL – 10 mL concentrate = 90 mL diluents needed.

 Steps for preparing 10% Jik® bleach; noting correct use of equipment and safety
precautions: Concentrated bleach is corrosive and cause irritation if exposed to skin or
inhaled and damage to eyes, mouth if splashed.
o Add 10ml of concentrated Jik® to approximately 90ml distilled water in a measuring
cylinder.
o Mix by covering with parafilm and by inverting.
o Add water to final volume of 100 mL.
o 70% means 10 parts of concentrate out of total volume of solution. Total volume is
100 mL –70 mL concentrate = 30 mL diluents needed.

 Steps for preparing 70% Methylated spirit noting correct use of equipment and safety
precautions: Absolute methanol is flammable and an irritant to lungs, skin, eyes and
mouth. Avoid splashes and prolonged inhalation.
o Add 30ml of methylated spirit (absolute methanol) to approximately 70ml of water in
a measuring cylinder.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1227

 o Mix by covering with parafilm and by inverting.
o Add water to final volume of 100 mL.

Step 5: Key Point (5 minutes)

 The materials and equipment used in diluted disinfectants and antiseptics are measuring
cylinder and flasks, distilled water and concentrated stock of bleach, Lysol and absolute
methanol.
 Calculations of proportions in diluted disinfectants and antiseptics. Percentage is
determined as volume amount of concentrate per total volume. The volume of diluents is
the total volume – volume of concentrate.
 Example: 5% = 5/ 100 (100= 5 + 95)
 Steps in preparation: The concentrated antiseptic or disinfectant is measured into cylinder
containing slightly less than expected diluent volume. Solution is mixed. The remaining
diluent is added to make the final volume.

Step 6: Skill (45 minutes)_

 Students will be assigned to prepare 3 solutions:
o 5% Lysol® (5ml of concentrated Lysol and 95ml distilled,
o 10% Jik® (10ml of concentrate Jik and 90ml distilled water)
o 70% Methylated spirit (30ml of methylated spirit and 70ml of water)

 Student should use the correct equipment and materials according to the SOP. The
disinfectants and antiseptics will be saved for evaluation and feedback by the tutor using a
checklist.

Date_______________________________
Student Name_______________________
Antiseptic or Disinfectant Name Antiseptic or Disinfectant Prepared Correctly (yes or
no)

Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 7: Evaluation (10 minutes)

 Discuss the feedback written by the clinical tutor using a checklist or anecdotal evaluation
form in terms of how well antiseptics and disinfectants were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1228

Teaching Guides for NTA Level 4 MLS Curriculum Page 1229
Session 05: Preparation of Antiseptics
and Disinfectants
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Prepare antiseptics for laboratory use
 Prepare disinfectants for laboratory use

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Flasks
 Pipets
 Parafilm
 Distilled Water
 Concentrated antiseptics and disinfectants (Jik®, Lysol®, Methylated spirits)
 Personal protective equipment

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
8 225 minutes Clinical Practice Student Preparation of Antiseptics and
in Hospital Disinfectants
Laboratory
9 10 min Evaluation Follow up to practical at clinical site

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Clinical Practice (105 minutes)

 Steps for preparing 5% Lysol ® noting correct use of equipment and safety precautions:
Add in the following proportion, 5 parts of concentrated Lysol to approximately 95parts
distilled water in a graduated measuring cylinder. Show care when handling concentrated
Lysol so it doesn’t splash on skin, eyes or mouth.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1230

 Mix by covering with parafilm and by inverting.
Add water to final volume.
 Steps for preparing 10% Jik® noting correct use of equipment and safety precautions
Add in a proportion of 10 parts of concentrated Jik® to approximately 90 parts of
distilled water in a measuring cylinder. Use care when handling concentrated bleach
solution so as not to inhale fumes for prolonged periods. Avoid splashing into eyes,
mouth and on skin.
Mix by covering with parafilm and by inverting.
Add water to final volume.
 Steps for preparing 70% Methylated spirit noting correct use of equipment and safety
precautions of avoiding inhalation and exposure to skin.
 Students will be assigned to prepare 5% Lysol®, 10% Jik® and 70% Methylated spirit
using the correct equipment and materials according to volumes specified by clinical tutor
and according to SOP and label. The disinfectants and antiseptics will be saved for
evaluation with the checklist.

Date_______________________________
Student Name_______________________

Antiseptic or Disinfectant Antiseptic or Disinfectant Prepared Correctly (yes or no)

Name

Clinical Supervisor Name:________________________________________

Clinical Supervisor Signature:_____________________________________

Step 3: Follow up to Clinical Practical (10 minutes)

 Discuss the feedback written by the clinical tutor using a checklist or anecdotal evaluation
form in terms of how well antiseptics and disinfectants were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1231

Session 06: Demonstrate the Application
of Antiseptics and Disinfectants
NTA LEVEL 4, SEMESTER II, MODULE CODE: MLT04209 - PREPARATION AND STORAGE
OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Describe the use of antiseptics for laboratory
 Describe the use of disinfectants for laboratory
 Explain the use antiseptics and disinfectants in the laboratory
 Apply antiseptics and disinfectants in the clinical laboratory

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Gloves
 Cotton Wool
 Gauze
 Antiseptics and disinfectants (Jik, Lysol, Methylated spirits)

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
5 minutes In Class Exercise Questions about the use of antiseptics and
2
disinfectants
3 10 minutes Presentation The use of antiseptics for laboratory
4 10 minutes Presentation The use of disinfectants for laboratory
15 minutes Presentation Tutor Demonstration of Use antiseptics
5
and disinfectants in the laboratory
6 5 minutes Presentation Key Points
30 minutes Student Use antiseptics and disinfectants in the
Demonstration in laboratory
7
Teaching
Laboratory
30 minutes Clinical Practice Use antiseptics and disinfectants in the
8 in Hospital laboratory
Laboratory
9 10 min Evaluation Follow up to use of disinfectants in

Teaching Guides for NTA Level 4 MLS Curriculum Page 1232

 clinical site

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2:
Activity: In class exercise (5 minutes)
 ASK the students to:
 Explain the difference between antiseptic and disinfectants for the laboratory
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

 The difference between antiseptics and disinfectants for laboratory use is that
disinfectants are used to remove micro-organisms from inanimate objects such as the
laboratory benches and surfaces while antiseptics are used to cleanse the skin of
microorganisms. The use will be described in the next steps.

Step 3: The use of antiseptics for laboratory (10 minutes)

 The correct way to apply antiseptic to the medial antecubital skin before venipuncture is
as follows:
o Clean the median antecubital area of the arm using 70% methylated spirits.
o Clean area in concentric circles starting at site and ending outside of site
o Let air dry before introducing the needle.

 Correct way to cleanse the median antecubital area.

 The correct way to apply antiseptic to the finger for the finger prick:
o Position hand palm-side up.
o Clean the middle finger using 70% methylated spirits.
o Clean area in concentric circles starting at site and ending outside of site
o Let air dry before introducing the needle.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1233

 The correct way to apply antiseptic to the infant heel for the heel prick
o Position the bottom of the foot up.
o Clean the median and lateral portion of the heel using 70% methylated spirits.
o Clean area in concentric circles starting at site and ending outside of site
o Let air dry before introducing the needle.

Step 4: The use of disinfectants for laboratory (10 minutes)

 General laboratory bench disinfection:
o Wear gloves and laboratory coat.
o 10% bleach is applied to gauze or cotton wool to fully saturate the gauze.
o Wipe the entire surface with the saturated gauze.
o Allow to air dry.
o Wipe the bench surface with clean dry gauze to remove the remains.
Note: some laboratories may use 5% Lysol® in place of 10% bleach (Jik®)

 After a spill of specimens or other harmful solutions

o Wear gloves and laboratory coat.
o 10% bleach is poured directly on the spill
o Cover the spill with gauze or cotton wool.
o Allow to sit undisturbed for 10 minutes.
o Removed the saturated gauze and dispose.
o Wipe the entire surface with gauze saturated with 10% bleach.
o Allow to air dry.
o Wipe the bench surface with clean dry gauze to remove the remains.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1234

Note: some laboratories may use 5% Lysol® in place of 10% bleach (Jik®)

Step 5: Tutor Demonstration ( 15 minutes)

 The tutor will demonstrate cleaning the general laboratory bench surfaces with 10%
bleach and 5% Lysol.
 The tutor will demonstrate cleaning a spill in the general area with 10% bleach (10%
Jik®) and with 5% Lysol®.
 The tutor will demonstrate cleansing the arm and middle finger with 70% Methylated
spirit for antisepsis.

Step 6: Key Point (5 minutes)

 Antiseptics are used in the laboratory to cleanse the arm, finger or heel prior to blood
collection using 70% methylated spirits.
 Disinfectants are used for cleansing laboratory benches and surfaces to remove micro-
organisms. The commonly used disinfectant is 10% bleach but 5% Lysol may sometimes
be used.
 When cleansing a spill, more disinfectant is applied for 10 minutes prior to wiping to
better remove micro-organisms.

Step 7: Evaluation (30 minutes)

 Students will be assigned to use 5% Lysol®, distilled, 10% Jik® and 70% Methylated
spirit according to the instructions given. The use of disinfectants and antiseptics will be
evaluated by the tutor using a checklist.

Date_______________________________
Student Name_______________________
Antiseptic or Disinfectant Antiseptic or Disinfectant Used Correctly (yes or no)
Name

Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 8: Clinical Practice (30 minutes)

 Students will be assigned to use 10% Jik® and 70% Methylated spirit using the specified
by clinical tutor and according to SOP. The proper use of disinfectants and antiseptics
will be evaluated by the clinical tutor using a checklist or anecdotal evaluation form.

Date_______________________________
Student Name_______________________

Antiseptic or Disinfectant Antiseptic or Disinfectant Used Correctly (yes or no)

Name

Teaching Guides for NTA Level 4 MLS Curriculum Page 1235

Clinical Supervisor Name:________________________________________
Clinical Supervisor Signature:_____________________________________

Step 9: Evaluation (10 minutes)

 The student’s use of disinfectants and antiseptics will be evaluated by the tutor using a
checklist prepared at the clinical site.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1236

Session 07 Apparatus and Materials Needed
for Preparation of Basic Laboratory
Reagent
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List apparatus needed to prepare respective reagent
 List materials needed to prepare respective reagents for clinical laboratory
 (Drabkin’s, Field stain, Giemsa, Acridine orange, saline, iodine, ZN stain and distilled
water)
 Illustrate apparatus and materials preparing basic reagents and solutions (laboratory use
and principles of each reagent, ingredients within each reagent)

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Pictures of measuring cylinder, beakers, weighing balance, storage containers,
ingredients, distilled water

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes In Class Exercise List the apparatus
3 5 minutes Presentation List of apparatus needed for preparation
List materials needed to prepare
4 5 minutes Presentation
respective reagents for clinical laboratory
Illustrate apparatus and materials
5 90 minutes Presentation
preparing basic reagents and solutions
6 5 minutes Presentation Key Points
7 10 minutes Evaluation Ingredients and use of basic reagents

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1237

Step 2: Activity
Activity: In class matching exercise (5 minutes)
 ASK the students to: list the apparatus needed to prepare a solution starting with
powder and diluting with distilled water.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below
 measuring cylinder
 beakers or flasks
 pipets
 weighing balance and spatula
 Storage containers

Step 3: List the apparatus (5 minutes)

 List apparatus needed to prepare respective reagents for clinical laboratory
o measuring cylinder
o beakers or flasks
o pipets
o weighing balance and spatula
o Storage containers

Step 4: List the materials (5 minutes)

 List materials needed to prepare respective reagents for clinical laboratory:
o Powder or solid solute
o Distilled water or other solvent
 For example: When preparing Field stain one needs Field Stain A powder and Field Stain
B and distilled water.

Step 5: Illustrate apparatus and materials (90 minutes)

 The apparatus needed for preparing basic reagents and solutions are shown.

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 The balance is used to weigh out the specific amount of powder using a spatula to
dispense the powder onto a filter paper. The measuring cylinder can be used to measure
specific amount of distilled water or other diluents added to the flask. The powder is then
added to the diluents to make the solution. The solution is mixed by swirling the flask.
 Drabkin’s solution: potassium cyanide, potassium ferricyanide and sodium bicarbonate,
distilled water. This reagent is used to measure haemoglobin and the potassium
ferricyanide is the main active ingredient.

 Field stain: Field A powder, distilled water, sodium azide used along with Field B
powder, distilled water, sodium azide. Field stain is used to colour cells in whole blood
smears for viewing blood cells or parasites.

 Giemsa: Giemsa powder, absolute methanol glycerol, buffered water or distilled water
(pH 7.2) Giemsa stain is used to colour cells in whole blood smears for viewing blood
cells or parasites.

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 Acridine orange: Acridine orange powder, glacial acetic acid, distilled water. Acridine
orange is a special stain for viewing blood parasites using a fluorescent microscope.
 Physiological Saline: sodium chloride and distilled water. Saline is used as a diluent for
whole blood since it is the correct salt solution to prevent rupture of cells. It is also used
as a diluent to blood plasma and in making up solutions and reagents used in the
laboratory.
 Iodine Stain: potassium iodide, iodine, distilled water. This stain is used to colour
parasite egg components so that they can be better visualized with a microscope.

 Ziehl Neelsen stain: strong Carbol Fuchsin, absolute (70%) methanol, phenol crystals,
3% HCl in methanol, 25% sulphuric acid, (3% HCl in alcohol may be substituted), 0.3%
Methylene blue. This stain is used to colourise the acid fast bacilli (AFB) that cause
tuberculosis, Mycobacterium spp.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1240

Step 6: Key Point (5 minutes)
 Measuring cylinder, beakers, weighing balance, Storage containers are the apparatus
needed to prepare respective reagent.
 Drabkin’s, Field stain, Giemsa, Acridine orange, saline, eosin, iodine, ZN stain and
distilled water are the materials needed to prepare respective reagents for clinical
laboratory.

Step 7: Evaluation (10 minutes)

 In class exercise: Students should answer the following questions:
 Show these 3 reagents in class: Z-N stain, Field Stain, and Iodine.
 Write on the flipchart: stool examination, sputum examination, urine examination, blood
smear examination

 Answers:
 Correct answers: Z-N stain for sputum, Field Stain for blood smear, and Iodine for
stool

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1241

Session 08: Introduction to Weighing
Basic Reagents and Solutions
NTA LEVEL 4, SEMESTER II, MODULE CODE: MLT 4209 - PREPARATION AND STORAGE OF
BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List the equipment and supplies needed to weigh the ingredient (balance, containers,
spatula, Whatman filter paper)
 Explain how to weigh the ingredients according to SOP
 Discuss the verification of equipment function and quality of ingredients

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Pictures of balance and other equipment

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes In Class Exercise Questions about use of the balance
3 5 minutes Presentation List the equipment and supplies
How to weigh the ingredients according
4 10 minutes Presentation
to SOP
Verification of equipment function and
5 60 minutes Presentation
quality of ingredients
6 5 minutes Presentation Key Points
Weighing out ingredients of reagents and
7 10 minutes Evaluation
solutions

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
 ASK the students to list the equipment and supplies needed to weigh the ingredients.
 WRITE THEIR answers on flip chart

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  SUMMARIZE their responses and confirm correct answers using notes below

 Balance, Containers, Spatula and Whatman filter paper

Step 3: List the apparatus and equipment for weighing (5 minutes)

 Balance,
 Containers,
 Spatula
 Whatman filter paper

Step 4: List the steps for weighing the ingredients (10 minutes)
 Determine the balance is centered, clean and turn on power, if applicable
 Adjust the balance to zero with no sample
 Place a weighing boat or filter paper on scale and zero or tare
 Place the estimated amount of dry powder on the scale with a clean spatula
 Read the mass after the reading has become stable
 Adjust by adding more powder or subtracting away powder
 Read the mass
 Continue adding or subtracting powder with a spatula until the mass reads the desired
amount
 Carefully remove the filter paper or weighing boat containing the powder and pour into
the measuring cylinder or flask containing the estimated amount of diluent.
 Turn off power or arrest the pan to neutral.
 Wipe any spilled powder off the balance with a soft brush.

Step 5: Quality of Equipment and Reagents(60 minutes)

 Verification of equipment function:

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 Check that the balance maintenance is current and documented in the book

 With each use: With the weighing pan secured (arrested) use a clean camel- hairbrush to
sweep away remnants of dust or chemicals into a dustpan. Verify that weighing pan is
free from dust and fingerprints prior to use.
 With each use: Verify placement on a vibration-free bench, in an area free from air
drafts, and direct sun. Adjust the lengths of the centering screw legs using the level
bubble, as available. Zero the balance with empty pan. Place a weighing vessel or paper
on the pan and adjust the tare button to subtract out the mass of the vessel. Always secure
the pan in standby mode before adding weight to the balance.
 Periodically: Check the accuracy and precision of the balance by weighing known
weights (50, 100, 200, 500, 2000 and 4000 mg) in triplicate taking care to handle with
clean cotton gloves or forceps in order to protect the standardized weights. Calculate the
accuracy and precision based on the standard procedure or manual.

Known Weights

 Quality of ingredients:
o Ingredients and water is properly labeled
o Ingredients and water are not expired
o Ingredients and water generally appear adequate
 quantity (there is enough amount to be dispensed)
 quality appears correct
- (water is clear and colorless)
- (other ingredients appear the correct color and not hydroscopic (hydrated)

Step 6: Key Point (5 minutes)

 The equipment and supplies needed to weigh the ingredient include the balance, spatula,
weighing boat or filter paper.

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 The process to weigh the ingredients is to follow the SOP. Measure the weight of the boat
or filter paper and adjust to zero and then add slowly the amount of weight needed for the
final grams using the spatula.
 Verification of equipment function is important to make certain the balance is providing
the proper weight. This helps to ensure quality of ingredients for the solution.

Step 7: Evaluation
 Homework assignment: Students should answer the following questions:
 Question:
o What are 3 criteria for a good functioning balance?

Answer:
 Able to adjust to zero (balanced)
 Provide correct weight within guidelines (maintenance is up to date)
 Placed on a level surface
 Placed on a non-vibrating surface

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

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Session 09: Dissolution and Mixing of
Solutions and Reagents for Laboratory Use
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List the diluents for each basic reagent or solution.
 List special apparatus needed to mix and dissolve some reagents (glass rod, magnetic
stirring bar, magnetic stirrer, water bath,)
 Describe the procedure for preparing basic reagents and solutions for clinical laboratory
use

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Pictures of stirring and hot plate equipment

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes In Class Exercise Questions about proper dissolving
3 5 minutes Presentation List the diluents
List special apparatus for dissolving
4 10 minutes Presentation
reagents
Description of preparation of reagents and
5 60 minutes Presentation
solutions
6 5 minutes Presentation Key Points
Homework assignment about reagent
7 10 minutes Evaluation
dissolution

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
 List common diluents used in preparation of laboratory reagents.

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  WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below
 Distilled water or filtered rain water
 Saline
 Buffer (pH 7.2)
 Methanol
 Glycerol

Step 3: 5 (minutes)
 List common diluents for each basic reagent or solution:
 Diluents include:
 distilled water or filtered rain water
 physiological saline
 buffer solution (pH 7.2)
 absolute methanol

Step 4: List the special apparatus for dissolving reagents (10 minutes)
 Some reagents do not go into solution when simply mixed together.
 The following special equipment may need to be employed:
o glass rod
o magnetic stirring bar
o magnetic stirrer
o hot plate
o water bath

Step 5: (60 minutes)

 Description of preparation of reagents that requires heated diluents:
o Stain A
 Heat 600 mL distilled water to boiling.
 Weigh out 6 g of stain powder and add to 500 mL volumetric flask containing
some hot water
 Mix by swirling to dissolve
 Add the remaining volume of distilled water to make 500 mL.
 Parafilm and mix thoroughly.
 Filter and place in brown bottle.

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  Label with correct using tape or label and marker pen (name of reagent, amount
prepared, date of preparation. Technician who prepared)
 Add the solute to the diluent. (A portion of the diluent is measured into the measuring
cylinder. Some procedures require that the diluent is heated.)
 The solution is homogenously mixed until the solute goes into solution (this may require
the use of stirring rod, or magnetic stirrer and magnetic bar.)
 The remaining diluent is added to make the final volume.
 The solution is mixed again.

Note: The next sessions will deal with the containers, labels, storage and quality check.

Step 6: Key Point (5 minutes)

 The diluents for each basic reagent or solution.
Special apparatus needed to mix and dissolve some reagents (glass rod, magnetic stirring
bar, magnetic stirrer, hot plate)
The procedure for preparing basic reagents and solutions for clinical laboratory use

Step 7: Evaluation
 What is the procedure for preparing basic reagents and solutions for clinical laboratory
use?
 Answer:

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1248

Session 10: Containers, Labels and
Storage of Basic Reagents and Solutions
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - DESCRIPTION OF
PREPARATION AND STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List the types of containers and their application for reagents
 List the reagent labeling requirements
 List the type of storage requirements
 Describe specific reagent and solution labeling and storage requirements

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Pictures of brown, plastic, clear glass containers and their lids, labels, refrigerator,
cupboard

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes In Class Exercise Questions about containers
Types of containers and their application
3 10 minutes Presentation
for reagents
Reagent labeling and storage
4 10 minutes Presentation
requirements
Specific reagent and solution labeling and
5 60 minutes Presentation
storage requirements
6 5 minutes Presentation Key points
7 10 minutes Evaluation Questions about Storage and Labels

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
 ASK the students to discuss the following questions:

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  List 3 different kinds of containers that reagents or solutions may be stored.
 Why would some reagents be stored in a brown bottle?
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below
 Answer: brown glass, brown plastic bottle, clear glass, clear plastic,
 Brown bottles protect the contents from background light.

Step 3: Types of containers and their application for reagents

 Plastic with screw top lids: distilled water, saline, alcohol, acids, bases, most reagents and
solutions.

 Glass with screw top lids: some chemical solutions and reagents cannot be stored in
plastic
 Glass with ground glass lids: strong acids and base solutions are often stored in this type
of container to prevent fumes from leaking around the lid. They also may have a pouring
spout to control pouring.
 Brown plastic: reagents such as stains that require protection from background light
 Brown glass: some chemical solutions and reagents cannot be stored in plastic and require
protection from background light

Step 4: Reagent Labeling Requirements

 The label from a newly prepared solution or reagent must have this information at a
minimum:
o Name of solution
o Date of preparation
o Name of technician
o Date of expiry
o In addition some reagents require the following:

Teaching Guides for NTA Level 4 MLS Curriculum Page 1250

 o Specific Use
o Special storage requirements
o Safety precautions

Examples of labels should be shown in class.

Step 5: (60 minutes) Description of specific reagent and solution labeling and storage
requirements
 Drabkin’s: Labeled as toxic. Stored in a brown plastic or glass bottle at room
temperature. Expiration is generally in 12 months if stored at room temperature but 18-24
months if stored at 4-8oC. Follow SOP to label the expiry date. Reagent is placed in a
safety cupboard
 Field stain: Field stain A and B are stored in separate in a clean brown plastic or glass
bottles at room temperature. Expiration depends on SOP.
 Giemsa: The methanol in the stain makes it toxic and highly flammable so should be
labeled as flammable. Storage in a clean brown plastic or glass bottle at room
temperature. Expiration depends on the SOP.
 Acridine orange: Storage in clean brown plastic or glass bottle at 2oC temperature.
 Gentian Violet: Storage in clean brown plastic or glass bottle at room temperature.
 Glacial acid: is corrosive so stain is labeled corrosive. Storage in clean brown plastic or
glass bottle at room temperature.
 0.85 % W/V Physiological saline: Storage in a clean clear plastic or glass bottle at room
temperature. It is stable for several months so it should be discarded when it becomes
contaminated. Expiration depends on the SOP
 0.25% Iodine: Solution may stain the skin or cause hypersensitivity. Label should
include possible skin hypersensitivity. Storage in a clean brown plastic or glass bottle at
room temperature. Expiration depends on the SOP.

ZN stain:
 70% alcohol: Labeled as flammable and toxic. Storage in a clean clear plastic or glass
bottle at room temperature. Expiration depends on the SOP.
 Carbol Fuchsin: Storage in a clean brown plastic or glass bottle at room temperature.
Expiration depends on the SOP.
 25% Sulphuric acid: Labeled as corrosive. Storage in a clean clear plastic or glass bottle
at room temperature. Expiration depends on the SOP.
 0.1% Methylene blue: Storage in a clean brown plastic or glass bottle at room
temperature. Expiration depends on the SOP.
 Distilled water: Storage in a clean clear plastic or glass bottle at room temperature.
 Filtered rain water: Whatman filter is used to filter rain water and use in place of
distilled water. Storage in a clean clear plastic or glass bottle at room temperature.

Step 6: Key Point

 General labeling requirements
 General storage requirements
 Specific labeling and storage requirements

Step 7: Evaluation

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 Homework Assignment
o What is the purpose of using brown bottles for storage of reagents?
o What may be used in place of distilled water for making some reagents?
o Why are some reagents stored in the refrigerator (4-8oC)?

 Answers:
o Some reagents should be protected from light so storage in a brown bottle provides
protection from background light.
o When distilled water is not available, filtered rain water may be used.
o Some reagents expire quickly if stored at room temperature but can be stable longer if
stored in the refrigerator. For example Drabkin’s reagent has a longer expiry date if
refrigerated.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1252

Session 11: Description of Testing for
Quality of Reagents and Solutions
NTA LEVEL 4, SEMESTER II, MODULE CODE: MLT 04209 - PREPARATION AND STORAGE
OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List general types of tests for quality of recently prepared laboratory reagents.
 Describe testing for quality of prepared laboratory specific reagent and solution
requirements

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Pictures

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 5 minutes In Class Exercise Questions about testing quality
List of testing methods for quality of
3 15 minutes Presentation
reagents
Testing quality of Specific reagents and
4 80 minutes Presentation
solutions
5 5 minutes Presentation Key points
6 10 minutes Evaluation In class questions.

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
 WRITE THEIR answers on flip chart
 List a method for testing quality of reagents.
 SUMMARIZE their responses and confirm correct answers using notes below

Teaching Guides for NTA Level 4 MLS Curriculum Page 1253

 Answer: Observe the appearance of the reagent to see if it is the correct colour and
clarity.

Step 3: List of quality testing measures (15 Minutes)

 General types of tests for quality of recently prepared reagents:
o Looking for the condition of the solution compared with expectation: volume, colour
and clarity.

Drabkin’s Reagent

Turk’s Reagent

o Patient whole blood samples with known results are often used as quality control. For
example. Test the patient whole blood with known haemoglobin using the previous
batch of Drabkin’s and newly prepared Drabkin’s. Test the patient whole blood with
previous batch of Turk’s reagent and newly prepared Turk’s reagent to compare
results.
o Patients with known parasites are used as quality control blood smear slides. For
example, stain the patient blood film with known malaria parasites using the previous
batch of Field and Giemsa stain and the new batch of batch of Field and Giemsa stain
and compare results.

Step 4: Specific quality testing measures (80 minutes)

 Drabkin’s:
o Adhere to the expiry date. Observe that condition of the solution is clear and yellow.
This is verified spectrophotometrically.
o Adjust the spectrophotometer to 540 nm and allow to warm up according to SOP.
Blank the colorimeter with 5.0 mL of freshly prepared reagent in a clean cuvette.
Pipet 20 µL of well mixed blood of known haemoglobin concentration into a test tube
containing 5.0 mL reagent, mix well and pour into a clean dry cuvette.
o Read the absorbance at 540 nm. Determine the haemoglobin result from the prepared
calibration curve (table of values).

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 o The result should agree within + 0.5 g/dL from the previous result to verify quality
from freshly prepared reagent.

 Turk’s Reagent
o Note: observe that the freshly prepared reagent appears as a purple colour and clear
compared to the previous batch.
o Pipet 20 µL of mixed whole blood into a labeled test tube containing 380 µL fresh
Turk’s reagent according to SOP.
o Pipet 20 µL of mixed whole blood into a second labeled test tube containing 380 µL
previous batch Turk’s reagent.
o Mix both tubes by tapping and allow to sit for at least 1 minute.
o Take a clean Neubauer counting chamber and fill one chamber with the fresh batch of
Turk’s and the other chamber with the previous batch of Turk’s according to SOP.
o After waiting for 2 minutes, observe that red blood cells are absent on both chambers.
Observe that the white blood cells are easy to visualize on both chambers according to
SOP and compare results.

 Field stain:
o Prepare 2 thin blood films from a patient with confirmed P falciparum.
o Stain with the previous batch and the fresh batch of Fields stain according to SOP.
Compare the staining results.
o If staining is poor of the fresh stain, allow the fresh stain to “mature” for 3-7 days
before use on patient testing. Recheck the staining quality of P falciparum thin blood
film. If staining is still poor, discard the stain and make new.

 Giemsa:
o Prepare 2 thin blood films from a patient with confirmed P falciparum.
o Stain with the previous batch and the fresh batch of stain according to SOP. Compare
the staining results.
o If staining is poor of the fresh stain, discard the stain and make new. This quality
testing of the reagent should be repeated every 2-3 weeks.

 Acridine orange:
o Prepare 2 thin blood films from a patient with confirmed P falciparum.
o Stain with the previous batch and the fresh batch of stain according to SOP. Compare
the staining results using the fluorescent microscope.
o The quality can only be checked at hospitals with this microscope. If staining is poor
of the fresh stain, discard the stain and make new.

 0.85 % W/V Physiological saline:

o Observe that condition of the solution is clear and colourless.

 0.25% Iodine:
o Prepare fresh stool sample containing parasite egg or cysts for two microscope slides.
Stain one with previously prepared iodine stain and one with new batch of iodine stain
according to the SOP.
o Compare results when observing cysts and egg staining of parasites.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1255

 1% Eosin stain:
o Prepare fresh stool sample containing parasite trophozoites for two microscope slides.
Stain one with previously prepared eosin stain and one with new batch of stain
according to the SOP.
o Compare results when observing staining of parasite trophozoites.

 ZN stain:
o Prepared 2 slides of positive AFB sputum smears.
o Test 1 slide with new stain batch of Carbol Fuchsin and the other slide with old stock
stain.
o Compare the staining reactions. If the new stain gives poor staining, discard and make
new reagents.

 Distilled water:
o Observe that condition of the solution is clear and colourless.

 Filtered rain water:

o Use Whatman filter paper.
o Observe that condition of the solution is clear and colourless.

Step 5: Key Point (5 minutes)

 General types of tests for quality of recently prepared reagents involved looking at the
colour and clarity of the newly prepared reagent and comparing to the previous batch.
 In addition, known positive samples are analysed with both the previous batch of reagent
and newly prepared batch of reagent and the results are compared.

Step 6: Evaluation
 In class Assignment
o What are the criteria for judging quality of newly prepared Giemsa?
o What method is used to determine the quality of newly prepared Drabkin’s reagent?

 Answer:
o Old stock stain and new stock stain give the same quality results in staining known
malaria in blood smears.
o New Drabkin’s reagent is tested for haemoglobin by the spectrophotometric method
in a patient sample with known Hb result. The result must agree within 0.5 g/dL.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1256

Session 12: Describe Basic Reagents for
Parasitological Testing
NTA LEVEL 4, SEMESTER II, MODULE CODE: MLT 4209 - PREPARATION AND STORAGE OF
BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Define terms relevant to parasitological reagent and solutions
 List down reagents and solutions used in basic parasitological testing
 Explain the principle of each reagent in basic parasitological testing
 List advantages and disadvantages of each reagent in basic parasitological testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Illustrations

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise Definition
3 5 minutes Presentation Definition
4 15 minutes Presentation List of reagents and solutions
5 75 minutes Presentation Principle of each reagents and solutions
6 5 minutes Presentation Key points
7 10 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity (5 minutes)

Activity: In class exercise (5 minutes)
ASK the students to define “reagent”
SUMMARIZE their responses and confirm correct answers using notes below

 Answer:
o Reagent: A substance reacting with another substance to produce a chemical reaction

Teaching Guides for NTA Level 4 MLS Curriculum Page 1257

Step 3: Define terms (5 minutes)

 Reagent: A substance reacting with another substance to produce a chemical reaction.

 Stain: To colourise in order to make easier to visualize.
o E.g. Field, Giemsa which are used for visualization of haemato-parasites. Stains are
also used in Bacteriology and Haematology.

Step 4: List down reagents

 Basic Parasitological Testing involves stains to help visualize parasites in specimens.
 The basic stains used are:
o Field stain,
o Giemsa,
o Acridine orange
o Iodine
o Eosin
 Solutions needed in Parasitological testing:
o Normal saline
o 10% formal Saline
o Distilled Water
o Absolute Methanol
o pH 7.2 Buffer
o Glycerol

Step 5: Principle of each reagent and solution (75 minutes)

Reagents:
 Field stain: polychromatic stain to help visualize blood parasites. There are two main
reagents: Field stain A and Field Stain B which provide pink and blue staining to cells in
blood.
 The significance is to allow malaria and other blood parasites to be seen. The advantage is
that this is an inexpensive and easy to use stain that is visible with a simple light
microscope. It can help to visualize different stages of blood parasites.

Blood film stained with Field Stain showing malaria parasites as bluish cytoplasm with dark
dots.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1258

 Giemsa: Another polychromatic stain to help visualize blood parasites. There are two
main reagents: basic Fuchsin and Methylene blue stain which provide pink and blue
staining to cells in blood.
 The significance of this stain is to allow malaria and other blood parasites to be seen. This
provides the advantage of helping to determine the type of organism. The disadvantage to
this stain is that it is more difficult to prepare. Also the staining process of blood may take
much longer than the Field Stain.

Solutions:
 Normal saline: maintains red blood cells
 10% formal saline: This solution is significant as a fixative for stool specimens and tissue
 Distilled Water: for dilution of reagents. Also used a pH stabilizer for Field stain in place
of pH 7.2 buffer.
 Absolute Methanol: dissolves the Fuchsin and Methylene blue stain in the Giemsa satin
 pH 7.2 Buffer: pH stabiliser for the Field Stains
 Glycerol: dissolves the Fuchsin and Methylene blue stain in the Giemsa stain preparation

Giemsa stained blood film with red blood cells and malaria organism.

 Acridine orange: a specialised fluorescent stain to allow parasites in blood to be better

visualized using a fluorescent microscope. The advantage is that it is used to confirm
results from Giemsa but the disadvantage is that it requires specialized equipment, the
fluorescent microscope, only found in larger hospital laboratories. Storage of the stain
needs more attention in comparison to other stains.
 Iodine: brownish-yellow stain is added to fresh stool to detect nuclei and contents of
cysts of protozoa as well as eggs of parasites.
 The significance is to detect intestinal parasites in stool specimens. The advantage of this
stain’s use is to see inside cysts and eggs to help determine the type of parasite. The
disadvantage is that this stain will kill any live parasite trophozoite forms so should not be
the only stain used.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1259

 Iodine stain of parasitic egg found in stool specimens

 Eosin: red stain added to fresh stool to detect motile protozoa which appear unstained.
This is advantageous to see the trophozoite forms which are motile and distinguish from
non-motile forms. This helps to identify the type of parasite. It is not used to stain eggs or
cysts.

Step 6: Key Point (5 minutes)

 Definition of Reagent: A substance reacting with another substance to produce a chemical
reaction.
 Definition of Stain: a reagent that provides colour to better visualize.
 The main Parasitology reagents are Field Stain, Giemsa stain, iodine stain and eosin stain.
The principles of parasitological reagents are to stain parasitic organisms to visualize
them better in specimens. Field Stain and Giemsa stain are used to stain haematological
parasites such as malaria. Iodine and eosin stain are used to visualize parasites in stool.

Step 7: Evaluation (5 minutes)

 What are advantages and disadvantages of using iodine stain and eosin stain for stool
parasite staining?

 Answer for tutor:

o Iodine: The advantage of using iodine stain is to see inside cysts and eggs to help
determine the type of parasite. The disadvantage is that this stain will kill any live
parasite trophozoite forms so should not be the only stain used.

Eosin is advantageous to see the living trophozoite forms which are motile and distinguish
from non-motile forms. It is not so useful for staining the cyst or eggs

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1260

Session 13: Materials for Microbiology
Reagents and Solutions
NTA LEVEL 4, SEMESTER II, MODULE CODE: MLT 4209 - PREPARATION AND STORAGE OF
BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
 Categorise materials for preparation of basic solutions and reagents for routine
Microbiology testing
 Explain the actions of each solution and reagent in basic Microbiology testing
 List the significance of each solution and reagent in basic Microbiology testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Lap top computer and LCD projector
 Illustrations

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise
List equipment and ingredients of
3 30 minutes Presentation preparation of Microbiology reagents and
solutions
Actions and significance of Microbiology
4 60 minutes Presentation
reagents and solutions
5 5 minutes Presentation Key point
6 10 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
ASK the students to list equipment needed to prepare Microbiology solutions and reagents
SUMMARIZE their responses and confirm correct answers using notes below
 Answer: distiller, balance, spatula, flasks, cylinder, pipets, funnel, parafilm, tape, filter
paper, and markers

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Step 3: List down Materials For Preparation
 Materials include equipment, supplies and ingredients.
 Equipment and Supplies:
o Distiller
o Balance
o Spatula
o Cylinder
o Flasks
o Pipets
o Funnel
o Whatman filter paper
o Parafilm
o Tape or Label
o Markers

Equipment to prepare Z-N and Wayson’s Stain

 Ingredients:
o physiological saline: NaCl and distilled water
o glacial acetic acid: concentrated glacial acetic acid
o water: distilled water or filtered rain water
o methanol: absolute (concentrated ) methanol
o 25% sulphuric acid: sulphuric acid and distilled water
o 3% HCl: HCl and distilled water
o 5% aqueous phenol: phenol crystals and distilled water
o Basic Carbol Fuchsin: powder used in making strong Carbol Fuchsin
o 0.3% Methylene blue: Methylene powder and water
o Wayson Solution A: Fuchsin and Methylene blue
o Wayson Solution B: 5% aqueous phenol
o Wayson’s stain: Wayson Solution A mixed with Wayson Solution B

Step 4: Principle of each solution for microbiological testing

Teaching Guides for NTA Level 4 MLS Curriculum Page 1262

 Principle of each reagent and solution will be described for microbiological testing.
Sputum smears are tested using the Ziehl Neelsen (Z-N) method and the Wayson’s stain
method.
 Z-N stain is performed on a sputum smear to detect Mycobacterium spp, acid fast bacilli
(AFB). The AFB retains the red colour from Carbol Fuchsin after decolourisation with
acid solution. Other bacteria and cells take on the blueish counterstain.

Basic fuchsin powder

 Strong Carbol Fuchsin is used in the Ziehl-Neelsen stain: causing pinkish staining of
cells
 0.3% Methylene blue: causing bluish counter-staining in the Ziehl-Neelsen stain

Methylene Blue powder

 25% Sulphuric acid or 3% HCl and are used in the decolourisation step in ZN staining
 Wayson’s stain: Polychramatic stain which causes bacterial cells to appear pink-blue with
granules at the ends of the cells, making the bacterial cells look like a closed safety pin.
Wayson stain is used for detecting Yersinia pestis in sputum.
 Wayson Reagent A: Fuchsin and methylene blue bind to bacterial cells.
 Wayson Reagent B: 5% aqueous phenol as part of the combined Wayson’s stain

Step 5: Significance of Each Solution for Microbiological testing

 Strong Carbol Fuchsin stain is used in Ziehl Neelsen stain for acid fast bacilli (AFB)
which are Mycobacterium, the cause of tuberculosis.

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 0.3% Methylene blue is the counterstain in Ziehl Neelsen stain for AFB. AFB will not
stain with the Methylene blue because they retain the pink colour of Carbol Fuchsin stain.
The background stains blue.
 Wayson Reagent A: Fuchsin and Methylene blue needed to make Wayson’s stain.
 Wayson Reagent B: 5% aqueous phenol needed to make Wayson’s stain
 Wayson’s stain: This polychromatic stain is used to provide contrasting staining so that
bacteria, tissue and blood cell components are easily seen. It is frequently used to detect
Yersinia pestis in sputum smears.

Step 6: Key Point

 The principle of the Z-N stain is to detect acid fast bacilli, Mycobacterium. The Carbol
Fuchsin stains the cells. Acid solution is used to wash away stain in all but the acid- fast
bacilli, Mycobacterium. The counter-stain is Methylene blue. The significance is
detecting AFB, due to tuberculosis.
 The principle of Wayson’s stain (Fuchsin, methelyene blue and aqueous phenol) is to
provide contrasting staining so that bacteria, tissue and blood cell components are easily
seen. It is frequently used to detect Yersinia pestis in sputum smears.

Step 7: Evaluation
 What is the use of a balance in reagent preparation?
o Answer: A balance is used to weigh out powder or solid chemical versus known
weights either internal to the balance or added externally.
 What are the reagents strong carbol fuchsin and 0.3% methylene blue are used for?
o Answer: Strong Carbol fuchsin and 0.3% methylene blue are used for staining sputum
smears in testing for acid fast bacilli in the Z-N method.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1264

Session 14: Materials for Basic
Haematology and Blood Transfusion
Reagent and Solution Preparation
NTA LEVEL 4, SEMESTER II, MODULE CODE: MLT 4209 - PREPARATION AND STORAGE OF
BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
 Categorise materials for preparation of basic solutions and reagents basic haematology
and blood transfusion testing
 Explain the actions of each solution and reagent in basic haematology and blood
transfusion testing
 List the significance of each materials ,solution and reagent in basic haematology and
blood transfusion testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Lap top computer and LCD projector
 illustrations

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction of objectives
List material for basic reagents and
2 10 minutes In Class Exercise
solution
List equipment, ingredients of Haem and
3 30 minutes Presentation
Blood transfusion reagent
4 40 minutes Presentation Actions of solutions and reagents
5 20 minutes Presentation Significance of solutions and reagents
6 5 minutes Presentation Key point
Principle actions of basic solutions and
7 10 minutes Evaluation
reagents

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1265

Step 2: Activity
Activity: In class exercise (5 minutes)
 ASK the students to list materials used for preparation of basic reagents and solution
for haematology and blood transfusion
 SUMMARIZE their responses and confirm correct answers using notes below
 Answers:
o Material for preparation solutions

 Equipments
o Balance
o Spatula
o Measuring cylinders
o Pipets
o Filter paper
o Distiller
o Filter paper
o Funnel
o Measuring cylinder
o Tapes
o Markers

 Ingredients for Drabkin’s

o Potassium cyanide
o Potassium ferricyanide
o Sodium carbonate
o Sodium tri-citrate
o Distilled water

 Ingredient for Turk’s

o 0.3% Gentian violet
o Glacial acetic acid
o Distilled water

Step 3: List materials for preparation of reagents and solution

 Material for preparation of solutions
o Distilled water
o Rain water
o glacial acetic acid
o Gentian violet
o Physiological saline
o Balance
o Spatula
o Measuring cylinders
o Pipets
o Filter paper
o Distiller

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 Material for preparation of reagents
o Drabkin’s reagent
 Potassium cyanide
 Potassium ferricyanide
 Sodium bicarbonate
 Distilled water
 Balance
 Spatula
 Measuring cylinder

o Turk’s reagents
 0.3% Gentian violet
 Glacial acetic acid
 Distilled water

Material for preparation of solutions

 Physiological saline
 Distilled water
 Sodium chloride

0.3% Gentian violet

 Gentian violet
 Distilled water

Step 4: Actions of each of solutions and reagents

Solutions:
 Physiological saline: This solution is used in the dilution of concentrated mixtures
 Distilled water; This solution is used in the preparation of reagents and dilution of
concentrated mixtures
 0.3% Gentian violet: Used as a stain in white blood cells counting

Reagents
 Drabkin’s: converts haemoglobin into stable haeminglobincyanide pigment to form a
colour directly proportional to the concentration of haemoglobin.
 Turk’s: Turk’s reagent: ruptures red blood cell (with its 2% acetic acid) leaving the white
blood cells intact. The Gentian violet provides easier visualization of the cells.

Step 5: Significance of each of material, reagents and solution

Materials

Teaching Guides for NTA Level 4 MLS Curriculum Page 1267

 Potassium ferricyanide-convert the haemoglobin into stable coloured compound
 Potassium cyanide- convert the haemoglobin into stable coloured compound
 Sodium bicarbonate-
 Gentian violet-Used for the staining of white blood cells count
 Glacial acetic acid-Used to rupture red blood cells in white cells counts
 Sodium chloride-used for the preparation of physiological saline

Solution
 0.3% gentian violet- stains in white cells counts
 2%acetic acid –ruptures of blood cells in white cells counts
 Physiological saline-diluents
 Distilled water-diluents

Reagents
 Drabkin’s –Used for haemoglobin estimation
 Turk’s-Used for white blood cells count

Step 6: Key Point

 Basic reagents for haematology and blood transfusion are Drabkin’s and Turk’s reagents.
 Drabkins reagent contains Potassium cyanide, Potassium ferricyanide, Sodium
bicarbonate and Distilled water
 Turk’s reagents contains; 0.3% Gentian violet, Glacial acetic acid and Distilled water

Step 7: Evaluation
 Students will be assigned group discussion on principle actions on basic reagents and
solution in haematology and blood transfusion

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1268

Session 15: Materials for Clinical
Chemistry Reagent and Solution
Preparation
NTA LEVEL 4, SEMESTER II, MODULE CODE: MLT 4209 - PREPARATION AND STORAGE OF
BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Categorise materials for preparation of basic solutions and reagents basic clinical
chemistry testing
 Explain the actions of each solution and reagent in basic clinical chemistry testing
 List the significance of each solution and reagent in basic clinical chemistry testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Lap top computer and LCD projector
 illustrations

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation
2 5 minutes In Class Exercise
List equipment, ingredients of sulpho-
3 30 minutes Presentation salicylic acid, acetic acid solutions and
Benedict’s reagent
Actions and significance of sulpho-
4 60 minutes Presentation salicylic acid, acetic acid solutions and
Benedict’s reagent
5 5 minutes Presentation Key point
6 5 minutes Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1269

  ASK the students to explain why parafilm is needed to prepare the sulpho-salicylic
acid solutions.
 SUMMARIZE their responses and confirm correct answers using notes below

 Parafilm is used to cover the cylinder or flask for final mixing so that solution won’t leak
out during the mixing process and the total volume is accurate.

Step 3: List equipment and supplies in preparation of solutions (30 minutes)

 Whatmann filter paper
 Parafilm
 Cylinder
 Balance
 Spatula
 Flasks
 Pipets

Ingredients in preparation of Clinical Chemistry solutions and reagents

 Saline is made of water and NaCl in the proportion of 0.85 %W/V
 Benedict’s reagent is made up of sodium (III) citrate, copper (II) sulphate, sodium
carbonate and distilled water
 33% acetic acid solution is made of glacial acetic acid and distilled water
 20% sulpho-salicylic acid solution is made of sulpho-salicylic acid and distilled water

Step 4: Actions and Significance of each of solution and Reagent (60 minutes)
Actions:
 Distilled water is used in preparation of the diluted sulpho-salicylic acid and acetic acid
and in Benedict’s reagent. It is a neutral, non-reactive solvent in the reagent.
 Benedict’s reagent contains sodium (III) citrate, anhydrous sodium carbonate, copper (II)
sulphate and distilled water. The main reactant in the reagent is the copper (II) sulphate
which reacts with urinary glucose, a reducing substance for testing in urinalysis by copper
reduction. The result is a change in colour from blue to green or yellow. Heat is required
for the reaction. The sodium carbonate and sodium citrate help to adjust the urine to
alkaline pH for better reaction.
 Saline is used as a diluent for blood and body fluids.
 33% acetic acid reacts with proteins by causing a turbidity which can be seen compared
to the centrifuged urine without reagent as a blank. The result is either positive (turbidity
seen) or negative (no turbidity seen.). It is important to centrifuge the natural sediment in
the urine before performing this test. Acid solutions will react with one part of the protein
molecule causing it to precipitate which causes turbidity.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1270

 Urine can be tested for
protein or glucose to help
diagnose diseases

 20 % sulpho-Salicylic acid reacts with protein by causing a turbidity which can be seen
compared to the centrifuged urine without reagent as a blank. This is the same principle
as the 33% acetic acid method for urine protein detection.

No turbidity Positive Turbidity

Significance of each of solution and Reagent

 Distilled water is needed for making Benedict’s reagent, 33% acetic acid and 20%
sulpho-salicylic acid as the diluents.
 Benedict’s reagent reacts with glucose and other reducing sugars in urine to form a colour
change. Glucose may be found in diseases affecting blood sugar control such as diabetes
mellitus.
 33% acetic acid is used as a reagent in testing for urinary proteins. Urinary protein is
found in diseases of the urinary tract and kidneys.

The kidney can

develop diseases such
as infections causing
positive urine protein

Teaching Guides for NTA Level 4 MLS Curriculum Page 1271

 20% sulpho-salysilic acid (SSA) is used as a reagent just as 33% acetic acid can be used
in testing for urinary proteins. Urine protein is found in patients with diseases affecting
protein levels especially in urinary tract infections and kidney diseases.
 20% Sulpho-salicylic acid can also be used to detect protein in cerebrospinal fluid (CSF).
o CSF is removed from the spinal cord by insertion of a needle in the lower back, called
lumbar puncture. Increased CSF protein is found in meningitis and other bacterial
infections affecting the central nervous system.
o Meningitis is an inflammation of the meninges (membranes) which cover the brain
and spinal cord is caused by a variety of organisms.

Step 5: Key Point (5 minutes)

 The ingredients for preparation of urine protein testing reagents include sulpho-salicylic
acid, glacial acetic acid and distilled water.
 Copper II sulphate, sodium III citrate and sodium carbonate are dissolved in distilled
water to prepare Benedict’s reagent to test for urinary glucose.
 A balance, spatula, measuring cylinder and flasks are the main equipment needed to
prepare clinical chemistry solutions and reagents.
 20% sulpho-salicylic acid and 33% acetic acid reagents precipitate urinary protein to
make a turbid reaction.
 Copper II sulphate in Benedict’s reagent is reduced by reducing sugars such as glucose in
urine to cause a colour change from blue to green or yellow.

Step 6: Evaluation (5 minutes)

 List reagents used in basic clinical chemistry testing for measuring urine protein.

 Answer: 33% acetic acid or 20% sulpho-salicylic acid are basic reagents used for urine
protein testing. 33% acetic acid is made from glacial acetic acid and distilled water. 20%
sulpho-salicylic acid is made from sulpho-salicylic acid and distilled water.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1272

 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1273

Session 16: Prepare Saline and Formal
Saline Solutions for Parasitology
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 180 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List materials to prepare saline and formal saline solution
 Prepare filtered rainwater
o Prepare saline and formal saline solution

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Flasks
 Whatman filter paper
 Balance
 spatula
 Funnel
 Pipets
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 rain water
 distilled water
 NaCl powder
 40% Formalin/ formaldehyde

Teaching Guides for NTA Level 4 MLS Curriculum Page 1274

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise Case study
3 5 minutes Presentation General Materials needed
Tutor demonstration of preparation of
4 30 minutes Presentation filtered rainwater, saline, formal saline
solutions
5 5 minutes Presentation Key Points
Student
Preparation in
6 115 minutes Student Preparation of Solutions
Teaching
Laboratory
8 10 min Evaluation Follow up to practical

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Case Study Feedback

Activity: In class exercise (10 minutes)
 ASK the students to answer the question asked in the case study.
 One or two students can demonstrate their answers
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

 Case Study:
o Assume you are working in the laboratory and discover that saline is out of stock.
How do you go about preparing 1 L? (Remember that the concentration needed is
0.85%W/V.
 Answer: Determine the total volume you need. Prepare using the general formula of 0.85
g/ 100 mL = x g/ 1000 mL. Remember 1 L = 1000 mL. 0.85 g x 1000 mL / 100 mL = x
g = 8.5 g of NaCl
 0.85 g is added to a 1 L volumetric flask containing some distilled water. Mix by
swirling to dissolve and add the remaining volume of distilled water, parafilm and mix
thoroughly. Label according to directions (name of reagent, amount prepared, date of
preparation. Technician who prepared)

Step 3: (5 minutes)
List General Materials needed to Prepare Solutions
Equipment:
 Measuring Graduated cylinder
 Flasks (volumetric)
 Pipets
 Balance
 Spatula

Teaching Guides for NTA Level 4 MLS Curriculum Page 1275

 Funnel

Material:
 Parafilm
 Whatman Filter Paper
 Label or tape
 Marker pen
 Distilled Water
 Rain water
 NaCl powder
 40% Formalin/ formaldehyde

Step 4 Tutor Demonstrations of Parasitology Solutions (30minutes)

 Solutions to make up:
o Distilled water or filtered rain water
 Demonstrate the use of water distiller. Demonstrate the use of Whatman filter paper for
rain water)

o Normal saline (0.85 g NaCl to total volume of 100 mL with distilled water)
o Weigh out 0.85 g of NaCl using a balance.
o 0.85 g is added to a 100 mL volumetric flask containing some distilled water.
o Mix by swirling to dissolve
o Add the remaining volume of distilled water
o Parafilm and mix thoroughly.
o Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. Technician who prepared)

 10% Formal Saline (0.85 g NaCl, 10 mL 40% formaldehyde, to total volume 100 ml
(approximately 90 mL distilled water)
 Safety precaution: Formaldehyde is an irritant to the lungs and skin. Use caution in
inhalation and avoid contact with skin.

 Weigh out 0.85 g of NaCl

 0.85 g of NaCl is added to a 100 mL volumetric flask containing a small amount of
distilled water.
 Mix by swirling to dissolve.
 Measure 10 mL 40% formaldehyde with a glass pipet.
 Add formaldehyde to volumetric flask containing NaCl.
 Add some (approximately 30-40 mL) distilled water to the flask to dissolve the NaCl.
 Mix.
 Add the remaining volume of distilled water to make 100 mL.
 Parafilm and mix thoroughly.
 Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. Technician who prepared)

Step 5: Key Point (5 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1276

 The Materials and Equipment used in preparation of basic laboratory solutions is
measuring balance, spatula, cylinder and flasks, distilled water and NaCl powder for
0.85%w/v saline, and 40% formaldehyde for Formal saline.
 Powder is weighed on a balance. Exact amount of powder is poured into a volumetric
flask containing less than expected diluent volume. Solution is mixed. The remaining
diluent is added to make the final volume.
 When a liquid, such as 40% formaldehyde is added with the powder, it should be poured
into the flask before the diluent is added so that it may be mixed into the solution.

Step 6: Evaluation of Skill (1150 minutes)_

 Students will be assigned to prepare 2 solutions of normal saline and formal saline. The
tutor will evaluate the solutions’ volumes and labels.

Date_______________________________
Student Name_______________________
Solution Name Solution Prepared Correctly (yes or no)

Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 7: Evaluation (10 minutes)

 Discuss the feedback written by the tutor using a checklist or anecdotal evaluation form in
terms of how well saline and formal solutions were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1277

Session 17: Prepare Solutions for Ziehl
Neelsen Stain
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List materials needed to prepare 25% sulphuric acid, 10% HCl, 5% phenol and 0.3%
Methylene blue solutions
 Prepare 25% sulphuric acid, 10% HCl, 5% phenol and 0.3% Methylene blue solutions for
Ziehl Neelsen staining

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Flasks
 Balance
 Spatula
 Pipets
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 Filtered rain water
 concentrated sulphuric acid
 concentrated HCl
 phenol crystals
 Methylene blue powder

Teaching Guides for NTA Level 4 MLS Curriculum Page 1278

SESSION OVERVIEW
Step Time Activity/Method Content
1 5minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise List ingredients
3 5 minutes Presentation General Materials needed
Preparation of 25% sulphuric acid, 10%
4 45 minutes Presentation HCl, 5% phenol and 0.3% methylene blue
solutions
5 5 minutes Presentation Key Points
Student
Preparation in
6 160 minutes Student Preparation of Solutions
Teaching
Laboratory
7 10 min Evaluation Follow up to practical

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Case Study Feedback

Activity: In class exercise (10 minutes)
 ASK the students to answer the question: List the ingredients to prepare 3% HCl.
 One or two students can demonstrate their answers
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

Answer: 3% HCl is made from concentrated HCl solution and distilled water.

Step 3: (5 minutes)
List General Materials needed to Prepare Solutions
Equipment:
 Measuring Graduated cylinder
 Flasks (volumetric)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1279

 Pipets
 Balance
 Spatula

Material:
 Parafilm
 Label or tape
 Marker pen
 Distilled Water or filtered Rain water
 concentrated sulphuric acid
 concentrated HCl
 phenol crystals
 Methylene blue powder

Step 4 Tutor Demonstration of Preparation of Ziehl Neelsen Solutions (45 minutes)

Safety precautions:
 Never add acid before water. You should always add acid to water.
 Avoid mouth pipetting.
 Avoid spilling concentrated acid on your skin, eyes or mouth.
 Avoid spilling on the bench or other surfaces. Use sand or other spill kit to absorb spilled
concentrated acid.
 Avoid inhaling fumes by keeping face at a distance from the open container and the lid on
as much as possible.
 Wear PPE including gloves, laboratory coat and closed shoes.

Solutions to make up:

Solution 1: 25% sulphuric acid:
 25 mL sulphuric acid added to 75 mL distilled water and 100 mL total volume
 With measuring cylinder, pour out 25 mL concentrated sulphuric acid and add slowly
down the side of the 100 mL volumetric flask containing some (approximately 25 mL)
distilled water.
 Swirl to mix.
 Add enough distilled water to make a final volume of 100 mL.
 Parafilm and mix by inversion.
 Label with tape or label using a marker pen. (name of reagent, amount prepared, date of
preparation. Technician who prepared)

Solution 2: 3% HCl:
 3 mL HCl added to 100 mL total volume (97mL distilled water) Review safety
precautions for handling concentrated acids.
 With glass pipet measure out 3 mL concentrated HCl and add to a 100 mL volumetric
flask containing some distilled water.
 Swirl to mix.
 Add enough distilled water to make a final volume of 100 mL.
 Parafilm and mix by inversion.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1280

 Label with tape or label using a marker pen. (name of reagent, amount prepared, date of
preparation. Technician who prepared)

Solution 3: 5% aqueous phenol

 Weigh out 5 g of phenol crystals using a balance.
 5 g phenol is added to a 100 mL volumetric flask containing some distilled water.
 Mix by swirling to dissolve
 Add the remaining volume of distilled water (approximately 95 mL water in the solution.)
 Parafilm and mix thoroughly.
 Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. Technician who prepared)

Solution 4: 0.3% methylene blue

 Weigh out 0.3 g of methylene blue using a balance.
 0.3 g methylene blue is added to a 100 mL volumetric flask containing some distilled
water.
 Mix by swirling to dissolve
 Add the remaining volume of distilled water (approximately 95 mL water in the solution.)
 Parafilm and mix thoroughly.
 Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. Technician who prepared)

Step 5: Key Point (5 minutes)

 The Materials and Equipment used in preparation of 25% sulphuric acid, 10% HCl, 5%
phenol and 0.3% Methylene blue measuring balance, spatula, cylinder and flasks, distilled
water and concentrated sulphuric acid, concentrated HCl, phenol crystals and Methylene
blue powder.
 Powder is weighed on a balance. Exact amount of powder is poured into a cylinder
containing slightly less than expected diluent volume. Solution is mixed. The remaining
diluents is added to make the final volume.
 Concentrated acid is diluted with water to a final volume.
 There are many safety precautions for concentrated acid solutions. 1) Never add acid
before water. You should always add acid to water. 2) Avoid mouth pipetting. 3) Avoid
spilling concentrated acid on your skin, eyes or mouth. 4) Avoid spilling on the bench or
other surfaces. Use sand or other spill kit to absorb spilled concentrated acid. 5) Avoid
inhaling fumes by keeping face at a distance from the open container and the lid on as
much as possible. 6) Wear PPE including gloves, laboratory coat and closed shoes.

Step 6: Evaluation of Skill (160 minutes)_

Students will be assigned to prepare 4 solutions:
 3% HCl
 25% sulphuric acid
 0.3% methylene blue
 5% aqueous phenol
 Use the checklist for student preparation of solutions.

Date_______________________________

Teaching Guides for NTA Level 4 MLS Curriculum Page 1281

Student Name_______________________
Solution Name Solution Prepared Correctly (yes or no)

Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 7: Evaluation (10 minutes)

 Discuss the feedback written by the tutor using a checklist or anecdotal evaluation form in
terms of how well microbiology testing solutions were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1282

Session 18: Preparation of Solutions for
Ziehl Neelsen Stain for Clinical Laboratory
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Perform preparation of basic laboratory solutions for Ziehl Neelsen testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Balance
 spatula
 Flasks
 Pipets
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 Filtered rain water
 concentrated sulphuric acid
 concentrated HCl
 phenol crystals
 methylene blue powder

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
Clinical Practice in
2 225 minutes Hospital Preparation of Ziehl Neelsen Solutions
Laboratory
3 10 min Evaluation Follow up to practical at clinical site

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1283

Teaching Guides for NTA Level 4 MLS Curriculum Page 1284
Step 2: Student Preparation of Ziehl Neelsen Solutions (225 minutes)
Four Solutions to make up:
 25% sulphuric acid:
 Review safety precautions for handling concentrated acids.
o With measuring cylinder, pour out 25 mL concentrated sulphuric acid and add slowly
down the side of the 100 mL volumetric flask containing some (approximately 25
mL) distilled water.
o Swirl to mix.
o Add enough distilled water to make a final volume of 100 mL.
o Parafilm and mix by inversion.
o Label with tape or label using a marker pen. (name of reagent, amount prepared, date
of preparation. Technician who prepared)

 Solution 2) 3% HCl:
 Review safety precautions for handling concentrated acids.
o With glass pipet measure out 3 mL concentrated HCl and add to a 100 mL volumetric
flask containing some distilled water.
o Swirl to mix.
o Add enough distilled water to make a final volume of 100 mL.
o Parafilm and mix by inversion.
o Label with tape or label using a marker pen. (name of reagent, amount prepared, date
of preparation. Technician who prepared)

 Solution 3) 5% aqueous phenol

o Weigh out 5 g of phenol crystals using a balance.
o 5 g phenol is added to a 100 mL volumetric flask containing some distilled water.
o Mix by swirling to dissolve
o Add the remaining volume of distilled water (approximately 95 mL water in the
solution.)
o Parafilm and mix thoroughly.
o Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. Technician who prepared)

 Solution 4) 0.3% Methylene blue

o Weigh out 0.3 g of methylene blue using a balance.
o 0.3 g methylene blue is added to a 100 mL volumetric flask containing some distilled
water.
o Mix by swirling to dissolve
o Add the remaining volume of distilled water (approximately 95 mL water in the
solution.)
o Parafilm and mix thoroughly.
o Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. Technician who prepared)

 Use the checklist for student preparation of solutions.

Date_______________________________
Student Name_______________________
Solution Name Solution Prepared Correctly (yes or no)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1285

Clinical Supervisor Name:________________________________________
Clinical Supervisor Signature:_____________________________________

Step 3: Follow up to Clinical Practical (10 minutes)

 Discuss the feedback written by the clinical tutor using a checklist or anecdotal evaluation
form in terms of how well microbiology testing solutions were prepared according to
SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1286

Session 19: Prepare Solutions for White
Blood Cell Count and Urine Protein
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List the materials needed to prepare Turk’s reagent
 Prepare 0.5% Gentian violet solution for Turk’s reagent
 List materials needed to prepare 10% acetic acid and 20% sulpho-salicylic acid for urine
protein testing
 Prepare 10% acetic acid and 20% sulpho-salicylic acid solutions for urine protein testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Flasks
 Pipets
 Balance
 spatula
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 Filtered rain water, distilled water
 Gentian violet crystals
 sulpho-salicylic acid
 glacial acetic acid

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise
3 5 minutes Presentation General Materials needed
Preparation of 0.5% Gentian violet, 10%
4 60 minutes Presentation
acetic acid, 20% sulpho-salicylic acid

Teaching Guides for NTA Level 4 MLS Curriculum Page 1287

 solutions
6 5 minutes Presentation Key Points
Student
Preparation in Evaluation of Student Preparation of
7 150 minutes
Teaching Solutions
Laboratory
9 5 min Evaluation Follow up to practical

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Case Study Feedback

Activity: In class exercise (15 minutes)
 ASK the students to answer the question asked in the case study.
 One or two students can demonstrate their answers
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

 Case Study: Making 0.5% Gentian Violet

 The technician measured out 10 g Gentian violet powder and dissolved to a total volume
of 100 mL with distilled water. Is this the correct % concentration? Show your
calculations. How will you rectify this problem?
 Answer: The solution required is 0.5% Gentian violet but the actual concentration is: 10g/
100 mL which is 10%. This is the incorrect concentration. 0.5%/ 10% x 100 mL = 50/10
= 5 mL So take 5 mL of the strong solution and dilute up to 100 mL with distilled water.
It is important not to waste reagents so calculate how to make dilutions when possible.

Step 3: (5 minutes)
List General Materials needed to Prepare Solutions
Equipment:
 Measuring Graduated cylinder
 Flasks (volumetric)
 Pipets
 Balance
 Spatula

Material:
 Parafilm
 Label or tape
 Marker pen
 Distilled Water or filtered Rain water
 Gentian violet crystals
 Sulpho-salicylic acid
 Glacial acetic acid

Teaching Guides for NTA Level 4 MLS Curriculum Page 1288

Step 4 Tutor Demonstration of Haematology and Blood Transfusion (60 minutes)
Solutions to make up:
 0.5% Gentian violet (0.5 g Gentian violet powder to total volume 100 mL with distilled
water) Precaution: This solution will cause a strong stain to clothing and hands so use
care when handling.
o Weigh out 0.5 g of Gentian violet powder
o 0.5 g gentian violet is added to a 100 mL volumetric flask containing some distilled
water.
o Mix by swirling to dissolve
o Add the remaining volume of distilled water.
o Parafilm and mix thoroughly.
o Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. Technician who prepared)

 Solution 2) 20% sulpho-salicylic acid (20 g sulpho-salicylic acid and total volume 100
mL distilled water)
o Weigh out 20 g of sulpho-salicylic acid
o 20 g is added to a 100 mL volumetric flask containing some distilled water.
o Mix by swirling to dissolve.
o Add the remaining volume of distilled water.
o Parafilm and mix thoroughly.
o Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. Technician who prepared)

 Solution 3) 10% Acetic acid (10 mL glacial acetic acid and total volume 100 mL distilled
water)

Safety Precaution: glacial acetic acid is flammable, corrosive and an irritant. Be certain to
handle with care, avoid inhalation or spilling on skin and add the acid to water already in the
volumetric flask during preparation.
 Pour out 10 mL glacial acetic acid
 Add to 100 mL volumetric flask containing some distilled water.
 Mix by swirling.
 Add the remaining volume of distilled water.
 Parafilm and mix thoroughly.
 Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. Technician who prepared)

Note to instructor: Save this reagent for adjusting pH of urine protein control samples.

Step 5: Key Point (5 minutes)

 The Materials and Equipment used in preparation of haematology and clinical chemistry
solutions are balance, spatula, measuring cylinder and flasks, distilled water and gentian
violet crystals to make up 0.5% Gentian violet, glacial acetic acid for making 10% v/v
solution and sulpho-salicylic acid powder for making 20%W/V solution.
 Powder is weighed on a balance. Exact amount of powder is poured into a cylinder
containing slightly less than expected diluent volume. Solution is mixed. The remaining

Teaching Guides for NTA Level 4 MLS Curriculum Page 1289

 diluent is added to make the final volume. Always remember to add acid to the distilled
water to prevent toxic fumes and splashing.

Step 7: Evaluation of Skill (150 minutes)

 Students will be assigned to prepare 2 solutions:
 Gentian Violet and 20% sulphosalicylic acid

Use the checklist for student preparation of solutions.

Date_______________________________
Student Name_______________________
Solution Name Solution Prepared Correctly (yes or no)

Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 8: Evaluation (5 minutes)

 Discuss the feedback written by the tutor using a checklist or anecdotal evaluation form in
terms of how well solutions were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1290

Session 20: Prepare Field Stain for Blood
Parasite Examination
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List the materials needed to prepare Field Stain A and B.
 Prepare Field stain for blood parasite testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Flasks
 Balance
 spatula
 Pipets
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 Field Stain A
 Field Stain B
 Distilled Water

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise
3 5 minutes Presentation General Materials needed
4 45 minutes Presentation Preparation of Field Stain reagents
5 5 minutes Presentation Key Points
Student
Preparation in Student Preparation of Field Stain
6 160 minutes
Teaching Reagents
Laboratory

Teaching Guides for NTA Level 4 MLS Curriculum Page 1291

 7 10 min Evaluation Follow up to practical

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2:
Activity: In class exercise (10 minutes)
 ASK the students to answer:
 List the materials needed to prepare Field Stain A and B.
 One or two students can demonstrate their answers
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

Step 3: (5 minutes)
List General Materials needed to Prepare Parasitology Reagents
Equipment:
 Measuring Graduated cylinder
 Flasks (volumetric)
 Pipets
 Balance
 Spatula
 Waterbath (above 1000C)

Material:
 Parafilm
 Label or tape
 Marker pen
 Distilled Water or filtered Rain water
 Field stain A powder
 Field stain B powder

Step 4: Tutor Demonstration of Preparation of Field Stain Reagents (45 minutes)

 Reagents to be prepared:
 Field stain A and B,

Note: In order to speed the process for step 1. The tutor should have containers of distilled
water in the waterbath heated to boiling just prior to beginning the Laboratory session.

 Field Stain A
o Heat 600 mL distilled water to boiling.
o Weigh out 6 g of Field stain A powder and add to 500 mL volumetric flask containing
some hot water
o Mix by swirling to dissolve
o Add the remaining volume of distilled water to make 500 mL.
o Parafilm and mix thoroughly.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1292

 o Filter and place in brown bottle.
o Label Field Stain A using tape or label and marker pen (name of reagent, amount
prepared, date of preparation. Technician who prepared)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1293

 Field Stain B
o Heat 600 mL distilled water to boiling.
o Weigh out 5 g of Field stain B powder and add to 500 mL volumetric flask containing
some hot water
o Mix by swirling to dissolve
o Add the remaining volume of distilled water to make 500 mL.
o Parafilm and mix thoroughly.
o Filter and place in brown bottle.
o Label Field Stain B using tape or label and marker pen (name of reagent, amount
prepared, date of preparation. Technician who prepared)

Step 5: Key Point (5 minutes)

 The Materials and Equipment used in preparation of Field Stain A and B reagents are
balance, spatula, measuring cylinder and flasks, boiling distilled water and Field stain A
and B powders.
 Powder is weighed on a balance. Exact amount of powder is poured into a cylinder
containing slightly less than expected of boiling distilled water. Solution is mixed. The
remaining boiling distilled water is added to make the final volume. Boiled distilled water
is required to have the stain powder completely dissolve. After cooling the stain is stored
in a brown bottle or one covered with aluminium foil is required.

Step 6: Skill (160 minutes)_

 Students will be assigned to prepare 2 reagents: Field stain A, Field Stain B using the
correct equipment and materials according to volumes specified by the tutor and
according to SOP and label. The reagents will be saved for evaluation with a checklist

Date_______________________________
Student Name_______________________
Reagent Name Reagent Prepared Correctly (yes or no)

Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 8: Evaluation (10 minutes)

Discuss the feedback written by the tutor using a checklist or anecdotal evaluation form in
terms of how well Field Stain A and B reagents were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;

Teaching Guides for NTA Level 4 MLS Curriculum Page 1294

 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1295

Session 21: Prepare Giemsa Stain for
Blood Parasite Examination
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List materials and equipment needed to prepare Giemsa stain.
 Prepare Giemsa stain for blood parasite testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Balance
 Spatula
 Waterbath
 Flasks
 Pipets
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 Distilled Water or filtered Rain water
 Absolute methanol
 Glycerol
 Giemsa powder

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise Ingredients of Giemsa stain
3 5 minutes Presentation General Materials needed
Demonstration of Preparation of Giemsa
4 60 minutes Presentation
Stain
5 5 minutes Presentation Reagent Preparation -Key Points
6 145 minutes Student Preparation of Giemsa stain

Teaching Guides for NTA Level 4 MLS Curriculum Page 1296

 Preparation in
Teaching
Laboratory
7 10 minutes Evaluation Checklist

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2:
Activity: In class exercise (10 minutes)
 ASK the students to answer:
 One or two students can demonstrate their answers
 What are the ingredients in Giemsa stain?
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

 Answer:
o Giemsa powder, glycerol and absolute methanol are the ingredients in Giemsa power.

Step 3: (5 minutes)
List General Materials needed to Prepare Parasitology Reagents
Equipment:
 Measuring Graduated cylinder
 Flasks (volumetric)
 Pipets
 Balance
 Spatula
 Waterbath

Material:
 Parafilm
 Label or tape
 Marker pen
 Distilled Water or filtered Rain water
 Absolute methanol
 Glycerol
 Giemsa powder

Step 4: Tutor Demonstration of Preparation of Giemsa Stain (60 minutes)

 Note: That after the mixture is placed in the waterbath to heat, the students will be
instructed to begin their preparation. When the solution is completely dissolved the tutor
will direct the students to observe the final steps of the demonstration.

Reagents to be prepared:
 Giemsa stain

Teaching Guides for NTA Level 4 MLS Curriculum Page 1297

 o Weigh out 3.8 g of Giemsa powder and place in brown bottle.
o Add 250 mL methanol.
o Mix well.
o Add 250 mL glycerol.
o Mix well.
o Heat to 60oC for 90 minutes or when the powder is completely dissolved
o Allow the stain to cool down.
o Label Giemsa stain using tape or label and marker pen (name of reagent, amount
prepared, date of preparation. Technician who prepared)

Step 5: Key Point (5 minutes)

 The Materials and Equipment used in preparation of Giemsa stain are balance, spatula,
measuring cylinder and flasks, absolute methanol, glycerol and Giemsa powder.
 Powder is weighed on a balance. Exact amount of powder is poured into a cylinder
containing methanol. Solution is mixed. The remaining diluent, gycerol is added to make
the final volume. Heating is required to have the stain powder completely dissolve.
Storage in a brown bottle or one covered with aluminium foil is required.

Step 6: Skill (145 minutes)

 Students will be assigned to prepare 1 reagent: Giemsa stain using the correct equipment
and materials according to volumes specified by clinical tutor and according to SOP and
label. The reagents will be saved for evaluation with a checklist

Date_______________________________
Student Name_______________________
Reagent Name Reagent Prepared Correctly (yes or no)

Tutor Name:________________________________________
Tuor Signature:_____________________________________

Step 7: Evaluation (0 minutes)

 Discuss the feedback written by the tutor using a checklist or anecdotal evaluation form in
terms of how well the reagents were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1298

Session 22: Prepare Iodine and Eosin
Stains for Parasitology Testing
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List the materials and equipment needed to prepare iodine and eosin stains
 Prepare iodine and eosin stains for stool parasite testing.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet
 Measuring Graduated cylinder
 Flasks
 pipets
 Balance
 Spatula
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 Distilled Water or filtered Rain water
 Saline
 Potassium iodide
 Iodine
 Eosin

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise
3 5 minutes Presentation General Materials needed
Tutor demonstration of preparation of
4 45 minutes Presentation
iodine and eosin reagents
5 5 minutes Presentation Reagent Preparation -Key Points
6 160 minutes Student Student Preparation of Reagents

Teaching Guides for NTA Level 4 MLS Curriculum Page 1299

 Preparation in
Teaching
Laboratory
7 10 min Evaluation

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2:
Activity: In class exercise (10 minutes)
 ASK the students to answer:
 How will you prepare 100 mL of 1 %w/v eosin reagent in the laboratory for stool
examinations?
 How will you prepare Lugol’s iodine reagent in the laboratory for stool examinations?
 One or two students can demonstrate their answers
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

 1% eosin is made by weighing out 1 g of eosin powder and diluting to 100 mL distilled
water. 1 g/ 100 mL = 1% w/v

 Lugol’s iodine reagent is made by weighing out potassium iodide powder and iodine
powder and diluting with distilled water.

Step 3: (5 minutes)
List General Materials needed to Prepare Iodine and Eosin Stains
Equipment:
 Measuring Graduated cylinder
 Flasks (volumetric)
 Pipets
 Balance
 Spatula

Material:
 Parafilm
 Label or tape
 Marker pen
 Distilled Water or filtered Rain water
 Potassium iodide
 Iodine
 Eosin powder

Step 4: Tutor Demonstration of Preparation of Iodine and Eosin Reagents (45 minutes)
 Reagents to be prepared:
o Lugol’s Iodine stain

Teaching Guides for NTA Level 4 MLS Curriculum Page 1300

 o Eosin stain

 Lugol’s Iodine
o Weigh out 2 g of potassium iodide powder and place in 100 mL volumetric flask
containing some distilled water.
o Add 1 g iodine.
o Mix well.
o Add remaining distilled water to make total volume 100 mL.
o Mix well.

 1% Eosin
o Weigh out 1 g of eosin powder and place in 100 mL volumetric flask containing some
distilled water.
o Mix well.
o Add remaining distilled water to make total volume 100 mL.
o Mix well.

Step 5: Key Point (5 minutes)

 The Materials and Equipment used in preparation of iodine and eosin reagents are
balance, measuring cylinder and flasks, distilled water and specific chemicals such as
iodine, potassium iodide, and distilled water and eosin and distilled water.
 The steps in preparation involve weighing powder on a balance. Exact amount of powder
is poured into a cylinder containing slightly less than expected diluent volume. Solution is
mixed. The remaining diluent is added to make the final volume. Storage in a brown
bottle or one covered with aluminium foil is required.

Step 6: Evaluation of Skill (160 minutes)_

 Students will be assigned to prepare 2 reagents: Eosin reagent and Lugol’s iodine stain
using the correct equipment and materials according to volumes specified by clinical tutor
and according to SOP and label. The reagents will be saved for evaluation with a
checklist

Date_______________________________
Student Name_______________________
Reagent Name Reagent Prepared Correctly (yes or no)

Tutor Name:________________________________________
Tuor Signature:_____________________________________

Step 7: Evaluation (10 minutes)

 Discuss the feedback written by the tutor using a checklist or anecdotal evaluation form in
terms of how well iodine and eosin reagents were prepared according to SOPs.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1301

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1302

Session 23: Prepare Basic Reagents for
Parasitology for Clinical Laboratory
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Prepare basic laboratory reagents for parasitology testing

Resources Needed
 Worksheet xx
 Measuring Graduated cylinder
 Flasks
 Pipets
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 Distilled Water or filtered Rain water
 Saline
 Absolute methanol
 Glycerol
 Giemsa powder
 Field stain A powder
 Field stain B powder
 Potassium iodide
 Iodine
 Eosin

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
Clinical Practice
2 225 minutes in Hospital Student Preparation of Solutions
Laboratory
3 10 min Evaluation Follow up to practical at clinical site

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1303

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Student Preparation of Parasitology Reagents (225 minutes)

Reagents to be prepared:
 Field stain A and B,
 Giemsa stain,
 Lugol’s Iodine stain
 Eosin stain

 Field Stain A
o Heat 600 mL distilled water to boiling.
o Weigh out 6 g of Field stain A powder and add to 500 mL volumetric flask containing
some hot water
o Mix by swirling to dissolve
o Add the remaining volume of distilled water to make 500 mL.
o Parafilm and mix thoroughly.
o Filter and place in brown bottle.
o Label Field Stain A using tape or label and marker pen (name of reagent, amount
prepared, date of preparation. Technician who prepared)

 Field Stain B
o Heat 600 mL distilled water to boiling.
o Weigh out 5 g of Field stain B powder and add to 500 mL volumetric flask containing
some hot water
o Mix by swirling to dissolve
o Add the remaining volume of distilled water to make 500 mL.
o Parafilm and mix thoroughly.
o Filter and place in brown bottle.
o Label Field Stain B using tape or label and marker pen (name of reagent, amount
prepared, date of preparation. Technician who prepared)

 Giemsa
o Weigh out 3.8 g of Giemsa powder and place in brown bottle.
o Add 250 mL methanol.
o Mix well.
o Add 250 mL glycerol.
o Mix well.
o Heat to 50- 60oC for 2 hr or when the powder is completely dissolved
o Label Field Stain A using tape or label and marker pen (name of reagent, amount
prepared, date of preparation. Technician who prepared)

 Lugol’s Iodine
o Weigh out 2 g of potassium iodide powder and place in 100 mL volumetric flask
containing some distilled water.
o Add 1 g iodine.
o Mix well.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1304

 o Add remaining distilled water to make total volume 100 mL.
o Mix well.

 1% Eosin
o Weigh out 1 g of eosin powder and place in 100 mL volumetric flask containing some
distilled water.
o Mix well.
o Add remaining distilled water to make total volume 100 mL.
o Mix well.

Date_______________________________
Student Name_______________________
Reagent Name Reagent Prepared Correctly (yes or no)

Clinical supervisor Name:________________________________________

Clinical supervisor Signature:_____________________________________

Step 3: Follow up to Clinical Practical (10 minutes)

 Discuss the feedback written by the clinical tutor using a checklist or anecdotal evaluation
form in terms of how well Parasitology reagents were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1305

Session 24: Prepare Basic Laboratory
Reagent for Ziehl Neelsen Staining in
Microbiology
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 300 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Prepare basic laboratory reagents for Ziehl Neelsen staining in microbiology testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Balance
 spatula
 Flasks
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 Phenol crystals
 water
 methanol
 Strong Carbol fuchsin
 0.3% Methylene blue

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise Z-N stain
3 5 minutes Presentation General Materials needed
Demonstration of preparation of Ziehl
4 30 minutes Presentation
Neelsen reagent
5 5 minutes Presentation Key Points
Student
6 105 minutes Student Preparation of Reagents
Preparation in

Teaching Guides for NTA Level 4 MLS Curriculum Page 1306

 Teaching
Laboratory
Clinical Practice
7 120 minutes in Hospital Preparation of Reagents
Laboratory
8 10 min Evaluation Follow up to practical at clinical site

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2:
Activity: In class exercise (10 minutes)
 ASK the students to answer:
 One or two students can demonstrate their answers
 What are the main ingredients in preparing Z-N stain?
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

 The Z-N stain has strong Carbol Fuchsin stain containing phenol crystals and Methylene
blue stains. The Methylene blue is used as a counter-stain in Z-N.

Step 3: (5 minutes)
List General Materials needed to Prepare Ziehl Neelsen Reagent
Equipment:
 Measuring Graduated cylinder
 Flasks (volumetric)
 Balance

Material:
 Parafilm
 Label or tape
 Marker pen
 Distilled Water or filtered Rain water
 Basic Fuchsin
 Absolute methanol
 0.3% Methylene blue
 Phenol crystals

Step 4: Tutor Demonstration of Preparation of Microbiology Reagents (30 minutes)

Reagents to be prepared:
 Ziehl Neelsen stain:
 Strong Carbol Fuchsin

 Ziehl Neelsen Strong Carbol Fuchsin Reagent

o Dissolve 1 g basic fuchsin in 10 mL absolute methanol in a flask.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1307

 o Dissolve 4.5 g phenol crystals in 90 mL distilled water in separate flask.
o Mix the 2 solutions in a 100 mL flask.
o Filter into a brown bottle and label using tape or label and marker pen (name of
reagent, amount prepared, date of preparation. Technician who prepared)

Step 5: Key Point (5 minutes)

 The Materials and Equipment used in preparation of basic microbiology reagents is
balance, measuring cylinder and flasks, distilled water and phenol crystals, absolute
methanol and basic Fuchsin.
 In preparation, powder is weighed on a balance. Exact amount of phenol crystal is poured
into a cylinder containing slightly less than expected diluent volume. Solution is mixed
and filtered. The remaining diluent is added to make the final volume. The same process
is used for measuring basic fuchsin but it is dissolved in absolute methanol. The two
solutions are mixed to form strong carbol fuchsin stain. Storage in a brown bottle or one
covered with aluminium foil is required.

Step 6: Evaluation of Skill (105 minutes)_

 Students will be assigned to prepare Strong carbol fuchsin stain, using the correct
equipment and materials according to volumes specified by clinical tutor and according to
SOP and label. The reagents will be saved for evaluation with a checklist.

Date_______________________________
Student Name_______________________
Reagent Name Reagent Prepared Correctly (yes or no)
Strong carbol fuchsin
Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 7: Clinical Practice (120 minutes)

 Students will be assigned to prepare strong carbol fuchsin staining reagents. Discuss the
feedback written by the clinical tutor using a checklist or anecdotal evaluation form in
terms of how well the reagents were prepared according to SOPs.

Date_______________________________
Student Name_______________________
Reagent Name Reagent Prepared Correctly (yes or no)
Strong carbol fuchsin
Clinical supervisor Name:________________________________________
Clinical supervisor Signature:_____________________________________

Step 8: Follow up to Clinical Practical (10 minutes)

 Discuss the feedback written by the clinical tutor using a checklist or anecdotal evaluation
form in terms of how well Parasitology reagents were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1308

 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1309

Session 25: Prepare Wayson’s Reagents
for Microbiology
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Prepare basic laboratory reagents for microbiology testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Flasks
 Pipets
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 physiological saline
 glacial acetic acid
 water
 methanol
 25% sulphuric acid
 3% HCl
 5% aqueous phenol
 Strong Carbol fuchsin
 0.3% Methylene blue
 Wayson Solution A
 Wayson Solution B

Teaching Guides for NTA Level 4 MLS Curriculum Page 1310

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise Wayson’s stain
3 5 minutes Presentation General Materials needed
Tutor demonstration of list materials,
4 30 minutes Presentation gather materials and preparation of
Wayson’s reagents
5 5 minutes Presentation Key Points
Student
Preparation in
6 75 minutes Student Preparation of Wayson’s Reagents
Teaching
Laboratory
Clinical Practice
7 100 minutes in Hospital Preparation of Reagents
Laboratory
8 10 min Evaluation Follow up to practical at clinical site

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Brain-storming
Activity: In class exercise (10 minutes)
 ASK the students to answer:
 One or two students can demonstrate their answers
 What are the main ingredients in Wayson’s A.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

 The Wayson’s stain contains basic Fuchsin and Methylene blue which are combined to
make Reagent A.

Step 3: (5 minutes)
 The following is the list of Equipment and Materials needed to Prepare Wayson’s
Reagents:
Equipment:
 Balance
 Measuring Graduated cylinder
 Flasks (volumetric)
 Pipets

Materials:
 Parafilm
 Label or tape
 Marker pen

Teaching Guides for NTA Level 4 MLS Curriculum Page 1311

 Distilled Water or filtered Rain water
 basic Fuchsin
 absolute methanol
 phenol crystals
 5% aqueous phenol
 0.3% Methylene blue

Step 4: Tutor Demonstration of Preparation of Microbiology Reagents ( 30 minutes)

Reagents to be prepared:
 Wayson’s A
 Wayson’s B
 Wayson’s stain

 Wayson’s Reagent A:
o Weigh 0.2 g basic Fuchsin and 0.75 g Methylene blue powders.
o Mix by swirling to dissolve the basic Fuchsin and Methylene blue powders with 20
mL absolute methanol in a conical flask.
o Filter through Whatman No. 1 filter paper into a bottle.
o Label Wayson’s solution A using tape or label and marker pen (name of reagent,
amount prepared, date of preparation. Technician who prepared)

 Wayson’s Reagent B:
o Measure 5 mL 5% aqueous phenol solution into a conical flask.
o Add 195 mL distilled water to flask.
o Parafilm and mix.
o Place into a bottle.
o Label Wayson’s reagent B using tape or label and marker pen (name of reagent,
amount prepared, date of preparation, technician who prepared)

 Wayson’s stain:
o Pour Wayson’s Reagent A (20 mL) in a brown bottle.
o Add Wayson’s Reagent B (200 mL) in the bottle.
o Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation, technician who prepared, storage at Room Temperature)

Step 5: Key Point (5 minutes)

 The Materials and Equipment used in preparation of basic microbiology reagents is
measuring cylinder and flasks, distilled water and specific chemicals.
 For Wayson’s A, basic Fuchsin and Methylene blue powders are dissolved in absolute
methanol. For Wayson’s B, 5% aqueous phenol solution is dissolved in distilled water.
 For Wayson’s stain, Wayson’s A is combined with B.
 It is important to follow the procedure.

Step 6: Evaluation of Skill (75 minutes)_

 Students will be assigned to prepare 3reagents: Wayson’s A, Wayson’s B and Wayson’s
stain using the correct equipment and materials according to volumes specified by clinical

Teaching Guides for NTA Level 4 MLS Curriculum Page 1312

 tutor and according to SOP and label. The reagents will be saved for evaluation with a
checklist.
Date_______________________________
Student Name_______________________
Reagent Name Reagent Prepared Correctly (yes or no)

Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 7: Clinical Practice (100 minutes)

 Students will be assigned to prepare Microbiology staining reagents. Discuss the
feedback written by the clinical tutor using a checklist or anecdotal evaluation form in
terms of how well the reagents were prepared according to SOPs.

Date_______________________________
Student Name_______________________
Reagent Name Reagent Prepared Correctly (yes or no)

Clinical Supervisor Name:________________________________________

Clinical Supervisor Signature:_____________________________________

Step 8: Follow up to Clinical Practical (10 minutes)

 Discuss the feedback written by the clinical tutor using a checklist or anecdotal evaluation
form in terms of how well Wayson’s reagents were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1313

Session 26: Prepare Basic Reagents for
Haematolology, Blood Transfusion and
Clinical Chemistry
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 04209 - PREPARATION AND
STORAGE OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Prepare basic laboratory reagents for haematology and blood transfusion testing
 Prepare basic laboratory reagents for clinical chemistry testing

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Worksheet xx
 Measuring Graduated cylinder
 Pipets
 Parafilm
 Label or tape
 Marker pen
 Personal protective equipment
 Flasks (volumetric)
 Whatman Filter No. 1
 Distilled Water or filtered Rain water
 glacial acetic acid
 0.5% Gentian violet solution
 sodium (III) citrate
 anhydrous sodium carbonate
 copper (II) sulphate

Teaching Guides for NTA Level 4 MLS Curriculum Page 1314

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Introduction, Learning Objectives
2 10 minutes In Class Exercise
3 5 minutes Presentation General Materials needed
Tutor demonstration of Haematology and
4 30 minutes Presentation
Clinical Chemistry reagent preparation
5 5 minutes Presentation Key Points
Student
Preparation in
6 75 minutes Preparation of Reagents
Teaching
Laboratory
Clinical Practice
7 100 minutes in Hospital Preparation of Reagents
Laboratory
8 10 min Evaluation Follow up to practical at clinical site

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2:
Activity: In class exercise (10 minutes)
 ASK the students to answer:
 One or two students can demonstrate their answers
 List the ingredients for Turk’s reagent.
 WRITE THEIR answers on flip chart
 SUMMARIZE their responses and confirm correct answers using notes below

 Answer: Turk’s reagent is made from 0.5% Gentian violet, glacial acetic acid and
distilled water.

Step 3: (5 minutes)
List General Materials needed to Prepare Haematology, Blood Transfusion and Clinical
Chemistry Reagents
Equipment:
 Measuring Graduated cylinder
 Flasks (volumetric)
 Pipets

Material:
 Parafilm
 Whatman Filter No. 1
 Label or tape
 Marker pen
 Distilled Water or filtered Rain water

Teaching Guides for NTA Level 4 MLS Curriculum Page 1315

 glacial acetic acid
 0.5% Gentian violet solution
 Sodium (III) citrate
 Anhydrous sodium carbonate
 Copper (II) sulphate

Step 4: Tutor Demonstration of Preparation of Haematology, Blood Transfusion and

Clinical Chemistry Reagents (30 minutes)
 Reagents to be prepared:
 Turk’s reagent
 Benedict’s reagents 1 and 2

Reagent 1: Turk’s reagent

 Measure 980 mL distilled into a conical flask.
 Add 20 mL glacial acetic acid to the flask.
 Add 2-3 drops of 0.5% Gentian violet solution.
 Transfer to a clean reagent bottle and label using tape or label and marker pen (name of
reagent, amount prepared, and date of preparation. technician who prepared)

Reagent 2:
 Benedict’s Solution 1: SOP procedure calls for make 300 mL total volume: 65 g sodium
(III) citrate, 50 g anhydrous sodium carbonate in 300 mL distilled water. This Laboratory
calls to make 30 mL total volume.
o Weigh out 6.5 g sodium (III) citrate and 5 g anhydrous sodium carbonate.
o Add the 6.5 g sodium (III) citrate and 5 g anhydrous sodium carbonate to a 50 mL
measuring cylinder containing some (approximately 10 mL) distilled water.
o Mix by stirring to dissolve.
o Add the remaining volume of distilled water to make up 30 mL total volume.
o Parafilm and mix thoroughly.
o Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. Technician who prepared)

Reagent 3: Benedict’s Reagent 2: SOP calls for making 500 mL total volume of 8.5 g
copper (II) sulphate in 500 mL distilled water. This laboratory calls for making 50 mL total
volume of 0.85 g in 50 mL distilled water.
 Weigh out 0.85 g copper (II) sulphate
 Add the copper (II) sulphate to a 50 mL measuring cylinder containing some distilled
water.
 Mix by stirring to dissolve.
 Add the remaining volume of distilled water to make up 50 mL total volume.
 Parafilm and mix thoroughly.
 Label using tape or label and marker pen (name of reagent, amount prepared, date of
preparation. technician who prepared)

Step 5: Key Point (5 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1316

 The Materials and Equipment used in preparation of basic Haematology reagents is
measuring cylinder and flasks, distilled water and for Turk’s reagent, glacial acetic acid,
0.5% Gentian violet and distilled water.
 General steps in preparation of Turk’s Reagent was measuring out Gentian violet solution
and glacial acetic acid and diluting with distilled water.
 For Benedict’s solution A: sodium (III) citrate, sodium carbonate and distilled water and
for Benedict’s solution B: copper (II) sulphate and distilled water.
 General steps in preparation of Benedict’s Solution A and B: Powder is weighed on a
balance. Exact amount of powder is poured into a cylinder containing slightly less than
expected diluent volume. Solution is mixed and filtered. The remaining diluent is added
to make the final volume. Storage in a brown bottle or one covered with aluminium foil is
required.

Step 6: Evaluation of Skill (75 minutes)

 Students will be assigned to prepare 3 reagents: Turk’s, Benedict’s 1 and 2 using the
correct equipment and materials according to volumes specified by clinical tutor and
according to SOP and label. The reagents will be saved for evaluation with a checklist.

Date_______________________________
Student Name_______________________
Reagent Name Reagent Prepared Correctly (yes or no)
Turk’s
Benedict’s A
Benedict’s B

Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 7: Clinical Practice (100 minutes)

 Students will be assigned to prepare 3 reagents: Turk’s, Benedict’s 1 and Benedict’s 2.
 Discuss the feedback written by the clinical tutor using a checklist or anecdotal evaluation
form in terms of how well the reagents were prepared according to SOPs.

Date_______________________________
Student Name_______________________

Reagent Name Reagent Prepared Correctly (yes or no)

Turk’s
Benedict’s A
Benedict’s B

Clinical Supervisor Name:________________________________________

Clinical Supervisor Signature:_____________________________________

Step 8: Follow up to Clinical Practical (10 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1317

 Discuss the feedback written by the clinical tutor using a checklist or anecdotal evaluation
form in terms of how well Haematology reagents were prepared according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1318

Session 27: Quality of Laboratory
Reagents and Solutions
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 4209 - PREPARATION AND STORAGE
OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Illustrate the steps to be followed in determining the quality of laboratory solutions and
reagents.
 Explain the importance of determining the quality of laboratory solutions and reagents
 Outline the importance and steps of determining the quality of Parasitology solutions and
reagents
 Outline the importance and steps of determining the quality of Haematology, Blood
Transfusion and Clinical Chemistry solutions and reagents
 List the importance and steps of determining the quality of Microbiology solutions and
reagents

Resources Needed
 Flip charts, marker pens, and masking tape
 Black or white board and chalk or whiteboard markers
 Lap top computer and LCD projector

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Objectives
2 5 minutes In Class Exercise Observations
3 10 minutes Presentation Steps of Determining Reagent Quality
Importance of Determining Reagent and
4 5 minutes Presentation
Solution Quality
Determining Quality of Specific Reagents
5 90 minutes Presentation
and Solutions
6 5 minutes Presentation Key points
7 10 minutes Evaluation Case study

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity

Teaching Guides for NTA Level 4 MLS Curriculum Page 1319

 Activity: In class exercise (5 minutes)
 ASK the students to list what the first step in determining quality of a newly prepared
reagent.
 SUMMARIZE their responses and confirm correct answers using notes below

 Answer: The first step is to observe the colour of the newly prepared reagent. For
example: 1. Drabkin’s is pale yellow 2. Field Stain A is blue, 3. Carbol Fuchsin is pink
and 4. physiological saline is colourless. If the colour is not correct, the reagent is most
likely not of good quality.

Step 3: General Steps (10minutes)

 These are the two general steps to be followed in determining the quality of laboratory
solutions and reagents.
o Observe that all freshly prepared reagents appear the proper colour and clarity. For
example fresh Turk’s reagent should be a clear, purple colour and Drabkin’s reagent
should be pale yellow and clear. Benedict’s reagent should be blue and clear.
o Follow standard operating procedures (SOP) to compare results from new batch of
reagent with old batch of reagent. This assumes that the old batch of reagent is the
proper colour and clarity and has continued to provide expected results.

Step 4: Importance of Determining Quality of Reagents

 The importance of determining the quality of laboratory solutions and reagents is to check
the reliability of the test method and the results.
 The results should be accurate and precise. Accuracy means the results are what is
expected and precise means the results from one can be repeated and still get the same
values.
 Newly prepared reagents of good quality will give the same type of results that the
previous batch of reagents give.

Step 5: Quality Check of Specific Reagents (90 minutes)

 The importance and steps of determining the quality of specific laboratory solutions and
reagents will be discussed by laboratory sections.

For Parasitology Testing

Giemsa: This stain is important to detect blood parasites.
Note: observe that all freshly prepared reagents appear the proper colour and clarity.
 Prepare two thick blood films from known positive P. falciparum
 Stain 1 film with old stain
 Stain the other film with the new stain
 Compare the staining reaction

Field Stain: This stain is important to detect blood parasites.

Note: observe that all freshly prepared reagents appear the proper colour and clarity.
 Prepare two thick blood films from known positive P. falciparum
 Stain 1 film with old stain
 Stain the other film with the new stain
 Compare the staining reaction.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1320

Iodine Stain: This stain is important to detect faecal parasite cysts.
Note: observe that all freshly prepared reagents appear the proper colour and clarity.
 Prepare two fresh stool samples known positive for parasite cysts according to SOP
 Stain 1 sample with old stain
 Stain the other sample with the new stain
 Compare the staining reaction.

1 % Eosin Stain: stain is important to detect faecal parasite trophozoites

Note: observe that all freshly prepared reagents appear the proper colour and clarity.
 Prepare two fresh stool samples known positive for parasite trophozoites according to
SOP
 Stain 1 sample with old stain
 Stain the other sample with the new stain
 Compare the staining reaction. Eosin will stain non-motile while motile trophozoites
remain unstained.

Microbiology
Ziehl Neelsen: stain is important to detect AFB in sputum smears
Note: observe that all freshly prepared reagents appear the proper colour and clarity.
 Prepare two sputum smears from known positive AFB
 Stain 1 film with old stain
 Stain the other film with the new stain
 Compare the staining reaction.

Counterstaining

Carbol Fuchsin

21
27

Wayson’s: stain is important to detect Y. pestis in sputum

Note: observe that all freshly prepared reagents appear the proper colour and clarity.
 Prepare two sputum smears from known positive Y. pestis
 Stain 1 film with old stain
 Stain the other film with the new stain
 Compare the staining reaction.

Haematology and Blood Transfusion

Drabkin’s: reagent is important to measure haemoglobin

Teaching Guides for NTA Level 4 MLS Curriculum Page 1321

 Observe that the fresh Drabkin’s is clear and pale yellowish.
 Warm up colorimeter and adjust to zero (blank) with the freshly prepared Drabkin’s
reagent
 Pipet 20 µL of mixed whole blood of known haemoglobin concentration into a test tube
containing 5 mL fresh Drabkin’s solution.
 Measure the haemoglobin concentration according to SOP
 Repeat starting with blank with previous batch of Drabkin’s, measuring the haemoglobin
according to SOP.
 If the haemoglobin values differ by more than + 0.5 g/dL, discard the freshly prepared
Drabkin’s solution and prepare a new batch.

Note important aspects: clean glassware and cuvettes, accurate measurement in preparation
and analysis. Previous batch of Drabkin’s reagent should be clear and pale yellowish. Discard
if turbid.

Turk’s: reagent is important to lyse red blood cells and make white blood cells more visible

Note: observe that the freshly prepared reagent appears as a purple colour and clear
compared to the previous batch.
 Pipet 20 µL of mixed whole blood into a labeled test tube containing 380 µL fresh Turk’s
reagent according to SOP.
 Pipet 20 µL of mixed whole blood into a second labeled test tube containing 380 µL
previous batch Turk’s reagent
 Mix both tubes by tapping and allow to stand for at least 1 minute.
 Take a clean Neubauer counting chamber and fill one chamber with the fresh batch of
Turk’s and the other chamber with the previous batch of Turk’s according to SOP.
 After waiting for 2 minutes, observe that red blood cells are absent on both chambers.
 Observe that the white blood cells are easy to visualize on both chambers according to
SOP and compare results.

Physiological Saline: is important to wash or dilute red blood cells without lysing them.
Note: observe that all freshly prepared saline appears a colourless and clear.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1322

 Add 1 drop of well mixed whole blood to a test tube containing 2-3 drops of freshly
prepared saline.
 Mix.
 Place a drop of the diluted blood on a microscope slide.
 Observe with a microscope under low and high power.
 Properly prepared saline will not lyse the red blood cells.

Clinical Chemistry
Benedict’s reagent is important to estimate glucose in urine
Note: observe that all freshly prepared reagents appear a blue colour and clear

Benedict’s reagent

 Use two control urine samples: one with known positive glucose and one negative for
glucose.
 Test according to SOPs
 Negative control should give a negative glucose result and the positive control sample
should give at least 1+ glucose result.

Note: Glucose is used in the preparation of control samples.

 Glucose reacts with Benedict’s reagent to change the blue to green or yellow or possibly
orange

Step 6: Key Point

 General steps for checking quality of reagents include checking the colour and clarity
against expected and then following the standard operating procedures to compare results
from new batch of reagent with old batch of reagent.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1323

 It is important to check each new batch of reagent again the old batch of reagent before
analyzing patient samples and reporting their results.
 Specific methods and steps for checking quality of Parasitology, Microbiology,
Haematology, Blood Transfusion and Clinical Chemistry reagents were discussed.

Step 7: Evaluation
 Case study: The current Drabkin’s reagent is turning darker and appears turbid.
What is your best course of action?

 Answer: You must prepare fresh reagent because the old batch should no longer be used.
The results from the old batch will no longer be accurate and precise. Follow the SOP for
preparation of new batch of Drabkin’s. The quality check should include a known
haemoglobin result and the new batch of reagent should give results within + 0.5 g/dL.

 Match question: Match the expected proper color for the following reagents:
o Drabkin’s, Turk’s reagent, Field Stain A, Carbol Fuchsin and physiologic saline.

 Answer: 1. Drabkin’s is pale yellow 2. Turk’s reagent is purple 3. Field Stain A is Blue,
4. Carbol Fuchsin is pink and physiologic saline is colourless.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries Volume
I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1324

Session 28: Standardization of
Parasitology and Microbiology Reagents
and Solutions with Validation Procedures
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 4209 - PREPARATION AND STORAGE
OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Standardise the freshly prepared Parasitology reagents according to SOPs
 Standardise the freshly prepared Microbiology reagent according to SOPs

Resources Needed
 Flip charts, marker pens, and masking tape
 Black or white board and chalk or whiteboard markers
 Sputum smears from positive AFB
 Blood films positive for P. falciparum
 Microscopes
 Immersion oil
 Lens paper
 Spirit lamps with spirit
 Field Stain A and B
 Ziehl Neelsen stains
 SOPs
 Colorimeter Operating manual

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Objectives
2 5 minutes In Class Exercise Importance of Standardisation
3 10 minutes Presentation Equipment
Tutor Demonstration of Standardisation of
4 30 minutes Presentation
Specific Reagents and Solutions
5 5 minutes Presentation Key points
Evaluation in
Practice standardisation of reagents and
6 75 minutes Teaching
solutions
Laboratory
7 100 minutes Clinical Practice Standardisation of Reagents

Teaching Guides for NTA Level 4 MLS Curriculum Page 1325

 8 10 minutes Evaluation Evaluation of Clinical Checklists

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
 ASK the students to work in groups to answer the case study.
 Assume you are in charge of the health center laboratory and you receive a new batch of
Field Stain A powder from the vendor. How will you determine the quality of the
reagent?
 SUMMARIZE their responses and confirm correct answers using notes below

 Answer: You must verify the quality of the vendor’s Field Stain A and B. You will stain
a known positive blood film with previously used batch of Field stain A and B and with
the newly prepared Field Stain A and B. The results will be compared. The new stain
should give the same staining quality as the old stain in order to be assured that the new
batch of reagent is standardized.

Step 3: Gather Equipment (10minutes)

Equipment for determining the quality of laboratory solutions and reagents
 Quality Control Samples
o Positive AFB sputum smears
o Positive malaria parasite whole blood films
 Microscopes
 Immersion oil
 lens paper
 bibulous paper
 Spirit lamps with spirit
 Student and instructor reagents:
o Field Stain
o Z-N stains

Step 4: Tutor Demonstration (30 minutes)

Procedure for Standardisation of Specific Reagents and Solutions
Parasitology

Field Stain:
Note: observe that all freshly prepared reagents appear the proper colour and clarity.
 Prepare two thick blood films from known positive malaria
 stain 1 film with old stain
 stain the other film with the new stain
 compare the staining reaction using the microscope.

Microbiology
Ziehl Neelsen:

Teaching Guides for NTA Level 4 MLS Curriculum Page 1326

Note: observe that all freshly prepared reagents appear the proper colour and clarity.
 Prepare two sputum smears from known positive AFB
 stain 1 film with old stain
 stain the other film with the new stain
 compare the staining reaction using the microscope.

Step 5: Key Point

 General equipment and materials that were needed for checking quality of Parasitology
and Microbiology reagents were the previous batch of reagents, the newly prepared batch
of reagents (by the student), quality control samples such as the blood films with known
parasite and the sputum smears positive for AFB.
 Microscopes were used to compare the staining of smears and films with previous stain
and the newly prepared stain.

Step 6: Skill (75 minutes)

 Students will be assigned to standardize the Field Stain A and B and the Ziehl Neelsen
stain. The tutor will evaluate with a checklist that student followed the procedure and
made the correct decision regarding the quality of the prepared reagent.

Date_______________________________
Student Name_______________________
Reagent Name Reagent Standardised Correctly Reagent Good Quality (yes or
(yes or no) no)
Field Stain A and B
Ziehl Neelsen stains
Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 7: Clinical Practice (100 minutes)

 Students will be assigned to standardise, Z-N stain and Field stain. The clinical
supervisor will evaluate the quality of the reagents. Students are expected to use the
correct equipment and materials specified by clinical tutor and according to SOP.

Student Name_______________________
Reagent Name Reagent Standardised Correctly Reagent Good Quality (yes or
(yes or no) no)
Field Stain A and B
Ziehl Neelsen stains

Clinical Supervisor Name:________________________________________

Clinical Supervisor Signature:_____________________________________

Step 8: Evaluation Follow up to Clinical Practical (10 minutes)

 Discuss the feedback written by the clinical tutor using a checklist or anecdotal evaluation
form in terms of how well reagents were validated according to SOPs.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1327

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1328

Session 29: Documentation of Validated
Reagents and Solutions
NTA Level 4, Semester II, Module 11 Code: MLT 4209 - Preparation and Storage of
Basic Laboratory Reagents and Solutions

Total Session Time: 180 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Describe the significance for documenting the validation process of laboratory reagents
 List the eight components of the laboratory reagent register book
 Describe the importance of labeling laboratory reagents and solutions with the six
components of the reagent label
 Demonstrate the use of the laboratory reagent register book and proper labeling of
laboratory reagents and solutions.
 Observe the use of the laboratory reagent register book and proper labeling of laboratory
reagents and solutions in the clinical laboratory.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black or white board and chalk or whiteboard markers
 Lap top computer and LCD projector
 Reagent label
 Tape and marking pen
 Reagent register book

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Objectives
2 5 minutes In Class Exercise Observations
3 10 minutes Presentation Components of the Reagent Register book
4 10 minutes Presentation Importance and Components of Labels
Tutor Demonstration of Reagent Register
5 20 minutes Presentation
book and Labeling
6 5 minutes Presentation Key points
Evaluation in Student documentation of reagents and
7 40 minutes Teaching solutions validation in the register and
Laboratory label
Documentation and labeling of reagents
8 75 minutes Clinical Practice
and solutions
9 10 minutes Evaluation Evaluation of Clinical Checklists

Teaching Guides for NTA Level 4 MLS Curriculum Page 1329

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)
 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
 ASK the students to work in groups to answer the question.
 Assume you are in charge of the health center laboratory and you prepared a new batch
of Field Stain A and B. How will you document these reagents?
 SUMMARIZE their responses and confirm correct answers using notes below

 Answer: You must label the reagents you prepared and then document the quality of the
reagents you prepared following the standardisation procedure. This is important so that
you and other laboratory personnel know what the reagent is and its quality.

Step 3: Reagent Register Book (10 minutes)

 The tutor will describe the components of the Reagent Register book using the following
form:

Reagent Volume Date Technician Date Technician Quality Uses

Name Prepared Prepared Validated Validated Check

Step 4: Importance and Components of Labels (10 minutes)

The tutor will describe the importance of Labels:
 It is to provide required information for proper use and quality of the reagent.
 Safety precautions can appear on the label to protect the laboratory personnel and to guide
the storage and handling requirements. Safety precautions, such as harmful, may not
always are listed since all reagents are considered harmful. Safety precautions such as
toxic, flammable, explosive, oxidizing, irritant and corrosive are listed on the label.

There are six main components of the reagent label:

Components of Label
Reagent Name
Technician Prepared
Date Prepared
Date of Expiry
Storage Temperature
Safety Precautions

Step 5: Tutor Demonstration of Reagent Register Book and Labeling (20 minutes)
Tutor will use one prepared reagent and fill in the register to demonstrate the use of the
register book.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1330

 Reagent Volume Date Technician Date Technician Quality Uses
Name Prepared Prepared Validated Validated Check

Tutor will use one prepared reagent and fill in the label according to the components of
Label
Reagent Name
Technician Prepared
Date Prepared
Date of Expiry
Storage Temperature
Safety Precautions

Step 6: Key Point 5 minutes

 The Reagent Register book is importance so that reagent conditions can be recorded after
preparation. The eight main components of the reagent register book include:
Reagent Volume Date Technician Date Technician Quality Uses
Name Prepared Prepared Validated Validated Check

 It is important to proper label the Reagents and Solutions after preparation with the
following information:
Reagent Name, Technician Prepared, Date Prepared, Date of Expiry, Storage Temperature
and Safety Precautions.

Step 7: Evaluation of Skill (45 minutes)_

 Students will be assigned to fill in the labels for their Field Stain A and B and fill in the
laboratory reagent register book in the demonstration laboratory. A checklist will be used
to determine if the label and register is filled properly.

Date_______________________________
Student Name_______________________
Reagent Name Reagent Labeled Correctly (yes or no) Reagent logged into Register
book Correctly (yes or no)

Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 8: Clinical Practice (75 minutes)

 Students will be assigned to observe the labels of reagents in the clinical laboratory for all
components. They will also be assigned to observe the reagent register. The student will
fill in a checklist of their observations.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1331

Date_______________________________
Student Name_______________________
Reagent Name Reagent Labeled Correctly (yes or no) Reagent logged into Register
book Correctly (yes or no)

Clinical Supervisor Name:________________________________________

Clinical Supervisor Signature:_____________________________________

Step 9: Evaluation Follow up to Clinical Practical (10 minutes)

 Discuss the checklist written by students from their observations of reagent labeling and
documentation in the laboratory reagent register book.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1332

Session 30: Standardize Haematology
and Clinical Chemistry Reagents and
Solutions with Validation Procedures
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 4209 - PREPARATION AND STORAGE
OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 240 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Standardise the freshly prepared Haematology and Blood Transfusion reagents according
to SOPs
 Standardise the freshly prepared Clinical Chemistry reagent according to SOPs

Resources Needed
 Flip charts, marker pens, and masking tape
 Black or white board and chalk or whiteboard markers
 Positive and negative urine glucose controls
 Positive and negative urine protein controls
 Whole blood sample with known haemoglobin
 Colorimeter
 Cuvettes
 Test tubes
 Microscopes
 Pipettes
 Spirit lamps
 Tongs
 Drabkin’s
 Benedict’s
 Sulpho-salicylic acid
 Saline
 SOPs
 Colorimeter Operating manual

Teaching Guides for NTA Level 4 MLS Curriculum Page 1333

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Objectives
2 5 minutes In Class Exercise Importance of Standardisation
3 10 minutes Presentation Equipment
Tutor Demonstration of Standardisation
4 45 minutes Presentation
of Specific Reagents and Solutions
5 5 minutes Presentation Key points
Evaluation in Practice standardisation of reagents and
6 100 minutes
Teaching Lab solutions
7 60 minutes Clinical Practice Standardisation of Reagents
8 10 minutes Evaluation Evaluation of Clinical Checklists

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
 ASK the students to work in groups to answer the case study.
 Assume you are in charge of the health center laboratory and you receive a new batch
of Drabkin’s reagent from the vendor. How will you determine the quality of the
reagent?
 SUMMARIZE their responses and confirm correct answers using notes below

 Answer: You must verify the quality of the vendor’s Drabkin’s in the same way you
would for reagents you prepare. You will measure haemoglobin using the reagent with a
specimen of known haemoglobin concentration. The result must be within + 0.5 g/dL in
order to be assured that the new batch of reagent is standardized.

Step 3: Gather Equipment (10minutes)

Equipment for determining the quality of laboratory solutions and reagents
 Quality Control Samples
o Positive and negative urine glucose controls
o Positive and negative urine protein controls
o Whole blood sample with known haemoglobin
 Colorimeter
 Cuvettes
 Test tubes
 Microscope
 Pipettes
 Spirit lamps
 Tongs
 Microscope slides
 Student and instructor reagents:
o Drabkin’s

Teaching Guides for NTA Level 4 MLS Curriculum Page 1334

 o Benedict’s
o Sulphosalicylic acid
o Saline

Step 4: Tutor Demonstration (45 minutes)

Procedure for Standardisation of Specific Reagents and Solutions
Haematology and Blood Transfusion
Drabkin’s:
 Observe that the fresh Drabkin’s is clear and pale yellowish.
 Warm up colorimeter and adjust to zero (blank) with the freshly prepared Drabkin’s
reagent
 Pipet 20 µL of mixed whole blood of known haemoglobin concentration into a test tube
containing 5 mL fresh Drabkin’s solution.
 Measure the haemoglobin concentration according to SOP
 Repeat starting with blank with previous batch of Drabkin’s, measuring the haemoglobin
according to SOP.
 If the haemoglobin values differ by more than + 0.5 g/dL, discard the freshly prepared
Drabkin’s solution and prepare a new batch.

Note: important aspects: clean glassware and cuvettes, accurate measurement in

preparation and analysis. Previous batch of Drabkin’s reagent should be clear and pale
yellowish. Discard if turbid.

Physiological Saline:
Note: observe that all freshly prepared saline appears a colourless and clear.
 Add 1 drop of well mixed whole blood to a test tube containing 2-3 drops of freshly
prepared saline.
 Mix.
 Place a drop of the diluted blood on a microscope slide.
 Observe with a microscope under low and high power.
 Properly prepared saline will not lyse the red blood cells.

Clinical Chemistry
Benedict’s Reagent:
Note: observe that all freshly prepared reagents appear a blue colour and clear.
 Place 5 mL of Benedict’s reagent each into two test tubes and label one positive control
and another negative control.
 Hold the negative control test tube with tongs over spirit lamp for 1 minute
 Check for colour change from green to yellow in the reagent due to false positive
reaction. This is the first check of the reagent.
 Add 8-10 drops (0.5 mL) of negative control urine and boil for 2 minutes.
 Allow to cool slowly and observe colour change to green, yellow or reddish brown. The
negative control test should remain blue.
 Repeat with positive control test tube to check the positive urine control. The positive
control test should turn green to yellow if the reagent is acceptable.

20% Sulpho-salicylic Acid

Teaching Guides for NTA Level 4 MLS Curriculum Page 1335

Note: observe that all freshly prepared reagents appear colourless and clear.
 Centrifuge urine controls if they appear turbid.
 Check the pH of the positive and negative urine controls with litmus paper.
 If the pH of the urine is blue, alkaline or neutral, add drop by drop 10% acetic acid until
pH is acidic, red.
 Add 2 mL of negative urine control to a test tube and label as negative control.
 Add 3 drops of 20% sulpho-salicylic acid and mix.
 Compare the turbidity to a second test tube containing about 2 mL of urine control. The
negative control test should have no turbidity.
 Repeat this procedure with the positive control sample. The positive control test should
have turbidity after the addition of sulpho-salicylic acid.

Step 5: Key Point

 General equipment and materials that were needed for checking quality of Haematology,
 Blood Transfusion and Clinical Chemistry reagents were the previous batch of reagents,
the newly prepared batch of reagents (by the student), quality control samples such as the
whole blood with known haemoglobin concentration and the urine positive and negative
controls for glucose and protein.
 Microscopes were used to check for good quality saline by observation of haemolysis.
 The colorimeter was used to determine the haemoglobin concentration in checking the
quality of the Drabkin’s reagent.

Step 6: Evaluation of Skill (100 minutes)_

 Students will be assigned to standardize the Drabkin’s reagent, saline, Sulpho-salicylic
acid and Benedict’s reagent. The tutor will evaluate with a checklist that student followed
the procedure and made the correct decision regarding the quality of the prepared reagent.

Date_______________________________
Student Name_______________________
Reagent Name Reagent Standardised Correctly (yes Reagent Good Quality (yes or
or no) no)

Tutor Name:________________________________________
Tutor Signature:_____________________________________

Step 7: Clinical Practice (60 minutes)

 Students will be assigned to standardize Drabkin’s or HemoCue® cuvettes, Sulpho-
salicylic acid and Benedict’s reagent. The clinical supervisor will evaluate the quality of
the reagents. Students are expected to use the correct equipment and materials specified
by clinical tutor and according to SOP.

Date_______________________________
Student Name_______________________

Teaching Guides for NTA Level 4 MLS Curriculum Page 1336

 Reagent Name Reagent Standardised Correctly (yes Reagent Good Quality (yes or
or no) no)

Clinical Supervisor Name:________________________________________

Clinical Supervisor Signature:_____________________________________

Step 8: Evaluation Follow up to Clinical Practical (10 minutes)

 Discuss the feedback written by the clinical tutor using a checklist or anecdotal evaluation
form in terms of how well reagents were validated according to SOPs.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 3. Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries
Part 1 & 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1337

Session 31: Methods of Storing Reagents
and Solutions
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 4209 - PREPARATION AND STORAGE
OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 List the seven types of hazards which can be encountered in the laboratory
 Classify the basic laboratory reagents and solutions by which ingredients in cause them to
be classified as a hazard
 List different types of storage areas for laboratory reagent and solution
 Explain the disadvantage of improper storage of laboratory solutions and reagents.
 Classify the basic laboratory reagents and solutions by storage area.

Resources Needed
 Flip charts, marker pens, and masking tape
 Black or white board and chalk or whiteboard markers
 Laptop computer and LCD projector

SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Objectives
2 5 minutes In Class Exercise Types of laboratory reagent hazards
Laboratory reagents and solutions by
3 15 minutes Presentation
hazard.
Hazardous Ingredients in Reagents and
4 20 minutes Presentation
Solutions
Specific Reagents and Solution Storage
5 45 minutes Presentation
Conditions
6 5 minutes Presentation Key points
7 10 minutes Evaluation Case study

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1338

Step 2: Activity
Activity: In class exercise (5 minutes)
 ASK the students to list the 7 types of laboratory hazards.
 SUMMARIZE their responses and confirm correct answers using notes below:

 Answer: 1. Explosive, 2. Corrosive, 3. Irritant, 4. Harmful, 5. Toxic, 6. Flammable, 7.

Oxidising.

Step 3: Classify Laboratory Reagents and Solutions by Hazard ( 15 minutes)

 All laboratory reagents are harmful if taken internally or exposed to skin or eyes. Some
are also hazardous if inhaled (irritant), contacted with skin and mucous membranes
(irritant or corrosive) so good laboratory practice avoids spilling, inhaling and drinking
laboratory reagents and solutions.
 In addition many reagents and solutions fit into one or more of the 7 hazard categories. If
exposed to any of the harmful reagents or solutions, you must consult your supervisor and
information in the materials safety data sheet.

Symbols of Laboratory Hazards

Explosive (E) Corrosive (C) Irritant Harmful

Toxic Flammable Oxidizing

agent(O)

Example Material Safety Data Sheet is shown

Step 4: Hazardous Ingredients in Laboratory Reagents and Solutions (20 minutes)

Teaching Guides for NTA Level 4 MLS Curriculum Page 1339

Teaching Guides for NTA Level 4 MLS Curriculum Page 1340
Basic laboratory reagents are classified by Hazard.
Reagents: Hazard
Giemsa Corrosive and toxic due to phenol, harmful and
irritant due to Carbol Fuchsin
Field Stain A Harmful
Field Stain B Harmful
Iodine Stain Harmful
Eosin Stain Harmful
Strong Carbol Fuchsin Harmful, Irritant
Methylene Blue Harmful
Wayson’s Corrosive and toxic due to phenol, harmful and
irritant due to Carbol Fuchsin
Drabkin’s: potassium ferricyanide Highly Toxic due to cyanide
and potassium cyanide
Turk’s Flammable and Corrosive due to acetic acid
Benedict’s Irritant
Conc. HCl Corrosive and irritant
Conc. Sulphuric acid Oxidising and toxic
Sulpho-salicylic Acid Corrosive
Glacial Acetic Acid Flammable and Corrosive
Absolute Methanol Flammable
Formaldehyde Irritant and Corrosive
Glycerol Harmful and irritant
Lysol concentrate Harmful
Jik® concentrate Irritant and Corrosive

Step 5: Storage Conditions of Laboratory Reagents and Solutions (45 minutes)

List types of Storage Conditions:
Flat surface on ground:
 All solutions and reagents should be stored so that they will not easily spill.
 Ground level is safer than above eye level in case a spill does occur especially for those
hazardous reagents and solutions.
 Reagents and solutions should be stored so that the label can be read and there is proper
spacing between containers.

Locked cupboard:
 Some chemicals and reagents are so highly toxic that they must be locked such as cyanide
containing compounds.

Refrigeration:
 Some of the reagents are refrigerated to prolong their expiring date.
 Other chemicals or reagents must be refrigerated to decrease their flammability. For
example, chloroform, concentrated nitric acid and concentrated hydrochloric acid.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1341

Room temperature-sensitive to light:
 Many chemicals and reagents deteriorate when exposed to light.
 For example, most of the stains are stored in a brown bottle or covered with aluminium
foil to protect from light. Stock chemicals are also stored in a dark place.

Brown Bottle

Wooden cabinet at ground level:

 Special chemical cupboards are often used to store concentrated nitric acid, sulphuric acid
and HCl as well as flammable chemical solutions and reagents such as methanol, ethanol,
ether and isopropyl alcohol.
 An alternative to the wooden cabinet is a metal cabinet.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1342

Under water:
 Some reagents are explosive when exposed to air so should be stored under water.

Storage Conditions by Types of Laboratory Hazard

 Explosive: Well stoppered bottle, store under water, or in explosion –proof cabinets.
 Flammable: Well stoppered bottle, Store in wooden cabinet, ground level, outside store,
well ventilated
 Corrosive: Well stoppered bottle, Store in wooden cabinet, Low level
 Harmful: Well stoppered bottle, Storage at room temperature in conditions that avoid
contact with skin, mouth and eyes.
 Toxic: Well stoppered bottle, under locked cupboard
 Irritant: Well stoppered bottle and wooden cabinet
 Oxidising: Well stoppered bottle, Store away from organic materials, reducing agents,
and flammable chemicals

Basic Laboratory Reagents and Their Storage Condition

Reagents: Storage Condition
Giemsa Room temperature, brown bottle
Field Stain A Room temperature, brown bottle
Field Stain B Room temperature, brown bottle
Iodine Stain Room temperature, brown bottle
Eosin Stain Room temperature, brown bottle
Strong Carbol Room temperature, brown bottle
Fuchsin
Methylene Blue Room temperature, brown bottle
Wayson’s Room temperature, brown bottle
Drabkin’s: potassium Room temperature, Working solution; Refrigeration for Stock
ferricyanide and Drabkin’s; Cyanide ingredients stored in locked cabinet
potassium cyanide
Turk’s Room temperature,
Benedict’s Room temperature,
Conc. HCl Room temperature, Cabinet Ground Level
Sulpho-salicylic Acid Room temperature, Cabinet Ground Level

Teaching Guides for NTA Level 4 MLS Curriculum Page 1343

 Glacial Acetic Acid Room temperature, brown bottle, Cabinet Ground Level
Methanol Room temperature, Cabinet Ground Level
Formaldehyde Room temperature, Cabinet Ground Level
Glycerol Room temperature
Lysol concentrate Room temperature, Ground Level, brown bottle or white or brown
plastic
Jik® concentrate Room temperature, Ground Level, white plastic bottle

Step 6: Key Point (5 minutes)

 There are seven types of laboratory hazards: corrosive, explosive, toxic, flammable,
harmful, irritant and oxidizing
 Storage conditions are specific for categories of laboratory hazards: corrosive in wooden
storage cabinet, explosive-underwater, toxic-ground level, flammable-wooden storage
cabinet, harmful-ground level, irritant-ground level and oxidizing-wooden storage cabinet
 Specific storage conditions for basic laboratory reagents and solutions are based on the
type of hazard.

Step 7: Evaluation In Class ( 10 minutes)

 Question for Students:
o Why you are not allowed to expose yourself to the ingredients found in Drabkin’s
solution?
 Answer for tutor: Drabkin’s reagent contains potassium ferricyanide and potassium
cyanide. These are highly toxic chemicals. They may be stored at room temperature but in
a locked cabinet. Since these chemicals are controlled, it is often difficult or nearly
impossible to find this chemical. Drabkin’s reagent is generally supplied commercially
prepared.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1344

Session 32: Storage Procedures for
Laboratory Reagents and Solutions
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 4209 - PREPARATION AND STORAGE
OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 Observe storage of explosive, flammable, corrosive, toxic, irritant and oxidising
laboratory reagents and chemicals in the laboratory.
 Record observations of laboratory reagent and chemical storage conditions with a form

Resources Needed
 Flip charts, marker pens, and masking tape
 Black or white board and chalk or whiteboard markers
 Laptop computer and LCD projector
 Forms and checklist

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Objectives
2 5 minutes In Class Exercise Laboratory hazard labels
3 Demonstrate use of Checklist for Reagent
15 minutes Presentation
Storage
4 Student observe storage conditions using
20 minutes Presentation
checklist
5 Clinical
Student record storage conditions using
30 minutes Laboratory
form
Practice
6 5 minutes Presentation Key points
7 10 minutes Evaluation Case study

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Step 2: Activity
Activity: In class exercise (5 minutes)
 ASK the students what is indicated on the label of laboratory reagents or solutions to
help decide the storage condition.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1345

  SUMMARIZE their responses and confirm correct answers using notes below
 The label should have indicated one of the 7 laboratory hazards which will help to
determine the proper storage.

1. Explosive, 2. Corrosive, 3 Irritant, 4 Harmful, 5 Toxic, 6 Flammable, 7 Oxidising.

Symbols of Laboratory Hazards

Explosive (E) Corrosive (C) Irritant Harmful

Toxic Flammable Oxidizing

agent(O)

Step 3: Observe Label and Storage Conditions of Laboratory Reagents (15 minutes)
 The tutor will show laboratory reagents and point out the hazard label and the storage
conditions:
Reagents: Hazard Label Storage Condition
Giemsa None Room temperature, brown bottle
Field Stain A None Room temperature, brown bottle
Field Stain B None Room temperature, brown bottle
Iodine Stain Harmful Room temperature, brown bottle
Eosin Stain None Room temperature, brown bottle
Strong Carbol Harmful (inhalation and Room temperature, brown bottle,
Fuchsin ingestion) and irritant (skin
and eyes)
Methylene Blue Harmful Room temperature, brown bottle
Wayson’s Corrosive, Toxic, due to Room temperature, brown bottle,
phenol, Harmful and Irritant corrosive and toxic
due to carbol fuchsin
Drabkin’s: Toxic. Caution: Contains Room temperature, Locked cabinet,
potassium Cyanide and may be fatal if
ferricyanide and ingested.
potassium cyanide
Turk’s Corrosive due to acetic acid Room temperature, brown bottle
Benedict’s Irritant due to sodium Room temperature, brown bottle
carbonate, sodium citrate
and copper sulphate
Conc. HCl Corrosive to skin and Room temperature, Cabinet Ground
Irritant when inhaled Level,
Sulpho-salicylic Corrosive Room temperature, Cabinet Ground

Teaching Guides for NTA Level 4 MLS Curriculum Page 1346

 Acid Level
Glacial Acetic Flammable, Corrosive Room temperature, brown bottle,
Acid Cabinet Ground Level,
Absolute Flammable liquid and Room temperature, Cabinet Ground
Methanol vapour Level,

Formaldehyde Irritant if inhaled. Room temperature, Cabinet Ground

Corrosive: skin and eyes Level
Glycerol Harmful: May be harmful if Room temperature
inhaled or swallowed.
Irritant: May cause eye
burns.
May cause skin irritation
Lysol concentrate Harmful if inhaled or Room temperature, Ground Level
swallowed.
Jik® concentrate Irritant if inhaled Room temperature, Ground Level
Corrosive: skin and eyes

Step 4: Form to record Storage Conditions of Laboratory Reagents and Solutions (45
minutes)
 Students are instructed to use the Form to record Storage Conditions of Laboratory
Reagents and Solutions. They will observe a reagent, record if the hazard label is present
(yes or not), the storage condition is (fill in) and if the storage condition is correct (yes or
no) for that type of hazard based on the previous information presented.

Form:
Reagent Name Hazard Level Storage Observed Correct Storage
(Fill in) Observed on Label (Fill in Condition) Condition (Yes or No)
(Yes or No)
Conc. HCl
Glacial acetic
Conc. Sulphuric
acid
40% Formaldehyde
Absolute methanol
Field stain A
Field stain B
Drabkin’s reagent
Strong Carbol
Fuchsin
0.3% Methylene
Blue
Turk’s reagent
Benedict’s Reagent
Lysol concentrate
Jik concentrate

Teaching Guides for NTA Level 4 MLS Curriculum Page 1347

Tutor’s marking key to correct checklist
Reagent: Storage Condition
Giemsa Room temperature, brown bottle
Field Stain A Room temperature, brown bottle
Field Stain B Room temperature, brown bottle
Iodine Stain Room temperature, brown bottle
Eosin Stain Room temperature, brown bottle
Strong Carbol Fuchsin Room temperature, brown bottle
Methylene Blue Room temperature, brown bottle
Wayson’s Room temperature, brown bottle
Drabkin’s: potassium ferricyanide Room temperature, Locked cabinet
and potassium cyanide
Turk’s Room temperature, brown bottle
Benedict’s Room temperature,
Conc. HCl Room temperature, Cabinet Ground Level
Sulpho-salicylic Acid Room temperature, Cabinet Ground Level
Glacial Acetic Acid Room temperature, brown bottle, Cabinet Ground
Level
Absolute Methanol Room temperature, Cabinet Ground Level
Formaldehyde Room temperature, Cabinet Ground Level
Glycerol Room temperature
Lysol concentrate Room temperature, Ground Level
Jik ®concentrate Room temperature, Ground Level

Step 5: Clinical Practice

 Students will use this form to observe the storage conditions of these reagents and
solutions in the clinical laboratory.
Reagent Name Hazard Level Storage Observed Correct Storage
(Fill in) Observed on Label (Fill in Condition) Condition (Yes or No)
(Yes or No)
Conc. HCl
Glacial acetic
Conc. Sulphuric
acid
40% Formaldehyde
Absolute methanol

Step 6: Key Point (5 minutes)

 There are seven types of laboratory hazards which are: toxic, irritant, corrosive,
explosive, flammable, oxidizing and harmful.
 It is important to store laboratory reagents in their appropriate storage condition based on
their category of laboratory hazard.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1348

 Specific storage conditions for basic laboratory reagents and solutions were demonstrated
including corrosive and flammable reagents in a wooden or metal cabinet. Many of the
reagents are stored in brown bottles.

Step 7: Evaluation In Class (10 minutes)

Practical application:
 Give students 4 bottles of laboratory reagents that are properly labelled. Ask the student
to list the appropriate storage conditions.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1349

Session 33: Document Storage of
Laboratory Reagents and Solution
NTA LEVEL 4, SEMESTER II, MODULE 11 CODE: MLT 4209 - PREPARATION AND STORAGE
OF BASIC LABORATORY REAGENTS AND SOLUTIONS

Total Session Time: 120 minutes

Prerequisites
 None

Learning Objectives
By the end of this session, students are expected to be able to:
 list two types of documentation for laboratory reagent storage
 describe the significance for documenting the storage of laboratory reagents
 list the components of the laboratory reagent storage logbook
 demonstrate the use of the laboratory reagent storage logbook or computer database

Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 MOHSW reagent storage form or register book
 Computer (optional)
 Electronic reagent storage software (optional)

SESSION OVERVIEW
Steps Time Activity/Method Content
1 5 minutes Presentation Objectives
2 5 minutes In Class Exercise Observations
3 10 minutes Presentation Importance of documentation storage
Components of Laboratory Reagent
4 10 minutes Presentation
Storage Register book
Tutor Demonstration of Laboratory
5 10 minutes Presentation
Reagent Storage Register book
6 5 minutes Presentation Key points
Evaluation in
Students document reagents storage in
7 20 minutes Teaching
register
Laboratory
Students Observe documentation of
8 40 minutes Clinical Practice
reagents and solutions storage
9 10 minutes Evaluation Evaluation of Clinical Checklists

Step 1: Presentation of Session Title and Learning Objectives (5 minutes)

 READ or ASK students to read the learning objectives and clarify.
 ASK students if they have any questions before continuing.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1350

Step 2: Activity
Activity: In class exercise (5 minutes)
 ASK the students:
 What are 2 methods to document storage of laboratory reagents?
 SUMMARIZE their responses and confirm correct answers using notes below
 Paper-based: register or logbook
 e-computer based: electronic database

Step 3: Reagent Storage Register Book (10 minutes)

 The Components of the Reagent Storage Register book are described from the actual
MOHSW form.

Item Qty Date Qty Date Lot # Expiry

Name (units) Requested Received Received Date
Requested

Step 4: Importance Laboratory Reagent Storage Documentation (10 minutes)

 The importance of documentation is to provide evidence and track proper storage
conditions of the laboratory reagents.
 Storage conditions are an important aspect of both safety and quality of reagents.
 For example, some reagents become more hazardous if stored at the wrong temperature.
Chloroform and other volatile chemicals may become more hazardous at room
temperature so are stored at cold temperatures.
 Many reagents lose their quality if stored exposed to light or too high of a temperature.
Refrigeration and placing in a dark place can prolong the quality of reagents.

Step 5: Tutor Demonstration of Reagent Storage Register Book

 Tutor will demonstrate the filling in the MOHSW form for specific reagent storage
register based on one specific reagent to demonstrate.

Item Qty Date Qty Date Lot # Expiry

Name (units) Requested Received Received Date
Requested

Teaching Guides for NTA Level 4 MLS Curriculum Page 1351

Step 6: Key Point (5 minutes)
 The Reagent Storage Register book is very important for maintaining safety and quality
of laboratory reagents. This document allows you to track the storage conditions for
types of reagents. Additional forms are used for tracking the number of reagents on hand.
 The process of using the reagent storage register book was demonstrated. Students will
now be given time to fill the reagent storage register book using example reagents.

Step 7: Evaluation of Skill (20 minutes)

 Students will be assigned to fill in the reagent storage register book for their Field Stain A
and B and other assigned reagents.

Step 8: Clinical Practice (40 minutes)

 Students will be assigned to observe documentation of reagent storage in the clinical
laboratory. They will also be assigned to observe the use of the reagent storage register.
The student will fill in a checklist of their observations of either paper based or electronic
documentation of specific laboratory reagent storage.

Date: _____________________________
Student Name:______________________
Name of Reagent Paper Based or Computer e-based documentation

Name of Clinical Supervisor:________________________________________________

Signature of Clinical Supervisor:____________________________________________

Step 9: Evaluation Follow up to Clinical Practical (10 minutes)

 Discuss the checklist written by students from their observations of laboratory storage
reagent register book.

References
 F.J. Baker, R.E. Silverton (2001): Introduction to Medical Laboratory Technology, 7th
Edition, Oxford University Press; Oxford, England.
 Monica Cheesbrough (1981): Medical Laboratory Manual for Tropical Countries
Volume I, 2nd Edition Butterworth & Co. (Publishers) Ltd;
 Monica Cheesbrough (2002): District Laboratory Practice in Tropical Countries Part 1
& 2, Cambridge University Press; Cambridge, England.

Teaching Guides for NTA Level 4 MLS Curriculum Page 1352

 LIST OF PARTICIPANTS
SN FULL NAME DESIGNATION DUTY STATIONS PHONE NO. & EMAILS
1 Mwanaisha H. Jumbe Principal Laboratory School, Zanzibar +255 754 875 785
[email protected]
2 Asmaa H. Nassor DHL MMH - ZNZ +255 777 414 448
[email protected]
3 Thomson J. Mhema Vice Principal Mvumi. HLATC +255 717 192 085
[email protected]
4 Colman P. Msuya Principal SMLS Muhimbili +255 754 681 032
[email protected]
5 Manase A. Nsunza Principal Singida, HLATC +255 756 469 153
[email protected]
6 Peter M. Kusuhibwa Principal Nkinga School of Laboratory +255 784 402 057/ 0753 441 512
Sciences [email protected]
7 Sostenes D. Tutor SMLS, Muhimbili +255 713 518 822
Ntambuto [email protected]
8 David Ocheng Project Manager AMREF +255 784 274 355/0715 274 355
[email protected]
9 Dr. Khalidi Msangi Medical Doctor Singida Regional Hospital +255 754 427 911
[email protected]
10 Nestory Bukuru Head Laboratory School Ruaha University +255 786 010 264
[email protected]
11 John A. Mpiluka Tutor Mvumi, COTC +255 717 129 546
[email protected]
12 N. A. Towo Quality System Officer NBTS - EZ +255 713 464 491
[email protected]
13 Fildorin Msami Laboratory Technologist Mt. Meru Hospital +255 784 474 990
[email protected]

Teaching Guides for NTA Level 4 MLS Curriculum Page 1353

 SN FULL NAME DESIGNATION DUTY STATIONS PHONE NO. & EMAILS
14 Karen A. Brown Consultant ASCP, USA [email protected]
15 Kay Harris Consultant ASCP, USA [email protected]
16 Wendy Arneson Consultant ASCP, USA [email protected]
17 Dickson M. Majige POLT MOHSW +255 754 462 442
[email protected]
18 Vincent Y. Mgaya HLS & RHLPC MOHSW +255 715 855 600/0754 855 600
[email protected]
19 Peter A. Mburah POLT MOHSW +255 755 451 323/0784 451 323
[email protected]
20 Gamaliel Kisyombe Laboratory Scientist MOHSW +255 754 761 070
[email protected]
21 Godfrey Hongoli Laboratory Scientist MUHAS +255 784 913 636
[email protected]
22 James Mwesiga Principal Laboratory CEDHA +255 754 374 008
Technologist [email protected]
23 Jackson Shayo Computer Analyst CEDHA +255 754 561 781
[email protected]
24 Paschal Njayaga Driver MOHSW +255 715 414 906
[email protected]
25 Neema Lyoka Secretary MOHSW +255 657 493 350
[email protected]

Teaching Guides for NTA Level 4 MLS Curriculum Page 1354

Teaching Guides for NTA Level 4 MLS Curriculum Page 1355