D Pharma 2nd year Hospital and Clinical Pharmacy laboratory manual

1. PRACTICAL LAB MANUAL
(D. Pharm IInd Year)
LAB MANUAL Hospital and clinical
pharmacy

2. LIST OF EXPERIMENTS
1. To design a community Pharmacy to incorprate all Pharmaceutical care services (as per schedule N)
2. To sterilize conical flask, pipette by dry heat sterilization method.
4. To prepare 50 ml of 5% Dextrose solution and sterilize it by filtration method.
5. To perform the identification test for absorbent cotton wool.
6. To find out the percentage variation in length and width of the given sample of bandage.
7. To perform thread count for given sample of dressing/gauge.
8. To study various components of computer.
9. To study and to operate the health screening equipment for blood pressure, measurement
(sphygmomanometer.)
10. To study and operate the health screening equipment for blood glucose level measurement
(Glucometer)
3. To sterilize the following objects by moist heat sterilization method using autoclave :
(i) Rubber gloves, (ii) Rubber closures, (iii) Surgical dressings

3. Experiment No. 2
Object: To sterilize conical flask, pipette by dry heat sterilization method.
Reference –
Theory: The methods of sterilization can be divided into three main categories;
(a) Physical Methods;
(i) Dry heat sterilization
(ii) Moist heat sterilization
(iii) Radiation sterilization
(b) Chemical Methods :
(i) Sterilization by heating with bactericide.
(ii) Gaseous sterilization
(c) Mechanical Methods: Sterilization involves the filter action of parenterals preparations
through the following bacterial proof filters.
(i) Ceramic filters
(ii) Sintered glass fillers
(iii) Sintered metal filters
(iv) Membrane filters
(v) Seitz filter
Dry Heat Sterilization:
Substances which gets destroyed by moist heat sterilization are sterilized by this method.
Ovens are designed especially for this purpose which arc electrically heated and thermostatically
controlled. (Fig 1). Substances which are sterilized by dry heat include:
Fig. 1. Hot Air Oven.
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4.  fixed oils
 glycerin
 liquid paraffin
 propylene glycol
 glassware’s
 powders (ZnO and talcum)
 Surgical instruments etc.
Principle:
During dry heat sterilization the micro-organisms and bacterial spores are killed by
oxidation. Since dry heat is less effective than moist heat, hence higher temperature and longer
period of exposure are required. Exposure time depends upon packaging of materials, thickness
of glass, volume of container etc. eg : syringes and needles may be sterilized at t 60 o
C for one
hour. Materials getting decomposed at higher temperature may be sterilized at lower temperature
exposed for longer duration of time. Dry heat sterilization can be done by using hot air oven
(160°C for 1 hour).
Advantages:
(i) This method is suitable for the sterilization of substances which get destroyed by moisture
e.g.: oily substances and powders.
(ii) Glassware’s like conical flasks, Lest tubes, pipettes and all glass syringes can be easily
sterilized by dry sterilization.
Disadvantages :
(i) It requires long healing, high temperature, and long exposure.
(ii) Moist medicaments, rubber and plastic articles are destroyed by this method.
(iii) Preparations containing water, alcohol or other volatile substances cannot be sterilized
by this method.
(iv) It is unsuitable for surgical dressings; the natural moisture in the fibers quickly
evaporates which leads to deterioration.
Procedure:
1) Conical flask and pipette should be thoroughly washed in following order
(a) acid washing (b) detergent washing (c) apyrogenic washing.
Cleaning of Container and Glassware:
Cleaning can be done carefully using following agents
(i) Organic Detergents: They are satisfactory in hard and soft water.
(ii) Inorganic Detergents: They are easy to rinse and provide brilliant appearance.
(iii) Soap Flakes and Powder: They have limitations due to formation of precipitates of
Ca and Mg soaps which occurs in hard water.
5

5. (iv) Chromic Acid solution: It is prepared by dissolving 70 gm of sodium potassium
dichromate in about 40 ml of water using heat and then after cooling making upto 1
litre with cone. H2S04.
It has two main applications;
(i) It helps in removal of difficult strains.
(ii) Helpful in destruction of pyrogen films.
(iii) B.P.C. recommends cleaning agent containing 46 parts by volume H2S04 and 6 parts
of NaNO3 and 46 parts of water.
(2) Then they are dried in a drying oven at 65o
C.
(3) Conical flasks can be plugged with non absorbent cotton wool. The covered mouth is
covered with a piece of brown paper, held by string as shown in Fig. 2 and 3, half bow
that can be quickly untied by forceps.
Fig. 2. Conical Flask.
Fig. 3. Pipette.
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6. (4) The graduated pipettes are plugged with non absorbent cotton wool for about half an inch,
by cutting or burning of the projecting ends.
(5) Pipettes can be enrolled in brown paper, taking care to enclose the tip adequately and tightly.
(6) B.P. suggests that an exposure time of not less than one hour and not Iowa than 160o
C is
suitable for dry heat sterilization.
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7. Experiment No. 3
Object: To sterilize the following objects by moist heat sterilization method using autoclave :
(l) Rubber gloves
(ii) Rubber closures
(iii) Surgical dressings
Reference:
Theory: Sterilization by moist heat can be done by following methods:
(i) By heating in an autoclave.
(ii) By heating in presence of bactericidal agent.
(iii) By steaming at atmosphere pressure.
(iv) Sterilization with boiling water.
(v) By method of tyndallization.
(vi) By method of pasteurization.
(vii) Heating at about 60o
C.
Principle of Moist Heat Sterilization
In this method micro-organisms are killed due to coagulation or denaturation of proteins
in living cell of micro-organisms. It is more effective than dry heat because saturated steam has
more penetrating power than dry heat. Moreover thermal capacity of steam is much higher than
that of thermal capacity of dry heat. In presence of moisture coagulation of proteins occur, at
lower temperature. In this method steam is used under pressure which provides enough high
temperature to kill micro-organisms quickly. Saturated Steam Saturated steam is that steam
which has a temperature corresponding to the liquid boiling point approximate to its pressure.
Table: 1
Temperature of Saturated Steam
Pressure
(lb/sq inch)
Approximate Temp. of
Saturated Steam
5 107o
-l08o
C
10 115o
-116o
C
15 l20o
-121°C
20 125°-126°C
30 134°-135o
C
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8. Fig. 1. Autoclave.
Working of an Autoclave:
Autoclave is a strong metallic chamber usually made up of stainless steel. The material to
be sterilized is packed in clean fabric cloth and is placed in perforated chamber of an autoclave.
Water level is checked so that it should not touch the bottom perforated metallic chamber. The
lid is closed with the help of nuts and bolts. Autoclave is switched on and water is allowed to
boil. Steam vent is then closed and the pressure is allowed to rise upto 10 lb/sq inch and at this
pressure saturated steam has a temperature of about 115o
C. The pressure is maintained for 30
min. The autoclave is switched off and allowed to cool while the pressure falls to zero
(sometimes the sterilization is done at a pressure of 15 lb/sq inch at a temperature of 121o
C for
15 minutes).
Advantages:
1. Solutions packed in sealed containers as ampoules can be sterilized by this method.
2. solutions, glassware, surgical dressings. rubber glovesand surgical instruments are
efficiently sterilized by this method.
3. Because of high penetration power of steam under pressure micro organisms are killed in
lesser time and at low temperature.
4. In large sized autoclaves large quantity of materials can be sterilized in one hatch.
Disadvantages :
1. This method cannot be used for oily injections. Fats, ointments, Oils because steam cannot
penetrate them.
2. It cannot he used for thermolabile substances (heat sensitive substances).
3. This method is unsuitable for materials which cannot withstand the heating temp of 115°C or
more.
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9. Rubber Gloves, Rubber Closures and Surgical Dressing
Rubber gloves require packing in such a way that It should encourage steam penetration
inside the fingers and all the surfaces arc kept apart as well as possible (Fig. 2). The gloves are
lubricated with dusting powder, with talcum powder or starch powder before sterilization. The
wrists are turned back so that the outside need not he handled when the gloves are put on and
gauzed pads are inserted an shown in (fig. 2).
Fig. 2 Gloves.
The matched pair is placed in a fabric envelope held loosely with tapes and kept in flat
perforated plate in single layer for sterilization.
Rubber closures: There are four types of materials which are used as closure material
for sterile products.
1. Butyl rubber with co-polymers of isoethylene with 1-3% of isoprene of butadiene.
2. Nitrite rubber (butadiene acrylonitrile copolymers).
3. Chloroprene rubber with polymers (of 1 : 4 chloroprene).
The rubber closures to be sterilized are kept in a stainless steel container/suitable
container and packed in a fabric cloth for moist heat sterilization. Similarly surgical dressing’s
arc packed in fabric cloth and are placed in a perforated tray (single layer for sterilization).
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10. Experiment No. 4
Object: To prepare 50 ml of 5% Dextrose solution and sterilize it by filtration method.
Reference:
Theory: Dextrose solution is a sterile solution of anhydrous dextrose or an equivalent quality of
dextrose monohydrate for parenterals solution. If the concentration is not mentioned, 5% w/v
solution should he supplied because it is isotonic with blood. Dextrose decomposes on heating.
Types of Filters:
(i) Bacteria proof filter
(ii) Seitz filler
(iii) Sintered glass filter
(iv) Membrane filters
(v) Millipore filters
Sintered Glass Filter: It consists of ground glass particles which are fused together by heating
to its sintering point (it is that temperature at which the glass particles are fused together to
become solid without melting) (Fig 1). The fused particles have interstitial space between
themselves which forms the suitable system for filtration. They are prepared in the form of discs
of suitable size and shape which are then sealed by beat into a pyrax glass funnel having the
shape of Buchner funnel. These fused funnels are known as 'Sintered glass funnel' (fig. 2) and
are made in several porosities. For bacterial filtration grade '5' having the pore size of 2m (max)
is used while as for clarification of solution, filters with other porosities are used.
Fig. 1. Filtration Assembly for Dextrose Solution.
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11. Fig. 2. Sintered Glass Filter.
Precautions: These filters are very fragile and must be hence handled carefully. After use they
should be cleaned thoroughly, the washing is with hot hydrochloric acid and then with distilled
water until the medium is free from acid.
Advantages:
(i) If properly cleaned nothing can enter into the filtrate. So, they are generally used for the
filtration of solution to be injected.
(ii) They are useful for filtering small as well as large volumes.
(iii) Only very little amount of the medicament is absorbed.
(iv) Volume of filtrate retained in the medium is negligible.
Disadvantages:
(i) They are very costly.
(ii) The medium is unsuitable for large volume filtration because it requires large discs which are
mechanically weak.
Uses: It is used as rapidly available source of energy in the retreatment and prevention of toxic
effects of drugs on liver, in fever and other conditions. When nitrogen concentration is increased
it prevents the loss of nitrogen. Its mixture with sodium chloride is used in severe nutritional
disturbances of infant, particularly when they suffer from diarrhoea and vomiting.
Doses: As per the condition of the patient.
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12. Experiment No. 5
Aim: To perform the identification test for absorbent cotton wool.
Reference:
I. Ignition Test: Ignition test can be done by two methods.
(a) By advancing the fibre towards the flame.
(b) By heating ill a porcelain dish.
Cotton bums with a flame and gives very bitter odour or fumes.
2. Cotton fibers are moistened with N/50 Iodine and when dry 80% w/w. Sulphuric acid is added,
blue colour is produced.
3. Absorbent cotton wool dissolves completely with uniform swelling in ammonical copper
oxide solution.
4. In cold sulphuric acid 80%w/w solution dissolves.
5. In cold sulphuric acid 60% w/w solution is insoluble.
6. In warm HCL (40o
C B.P.) it is insoluble.
7. It is insoluble in 5% potassium hydroxide solution.
8. It gives no red slain with fluroglucinol and hydrochloric acid.
9. It is insoluble in formic acid (90%). phenol (90%).
10. It is insoluble in acetone.
13

13. Experiment No. 6
Object: To find out the percentage variation in length and width of the given sample of bandage.
Reference:
Materials Required:
(i) Roll of bandage.
(ii) Meter scale
(iii) Thin wire
Theory: The capacity or self repair of biochemical system like human body is universal which
tends to heal the wound gently and efficiently but a proper dressing prevents unwanted
microbial growth during the process of tissue repair.
Bandage: It is a strip of plain woven cloth for wrapping and binding body parts. It is available in
continuous length which is used along with medicaments on wounded surface. Fabric is woven
from the staples of bleached white cotton having no taste or odour. Cloth is free from defects of
weaving, leaf residue, seed coat and other impurities which are expected during processing such
as acids, non-volatile matter, starch, etc.
Gauge: It is tight cotton of open texture in multilayer’s. A cloth should he free from processing
impurities just like-a bandage. Gauge in the form of pads is used to hold medicaments such as
mercurochrome. Nitrofurazone, cetrimide. These medicaments have antiseptic effects which help
in healing of wounds.
Procedure for measurement or calculation of percentage variation in length or width.
Length: Length of bandage is measured after equilibrating the sample in a hurnidiry
chamber/cabinet at 65 ± 20% hours or more and 27 ± 2o
C temperature for 24 hours or more.
The sample of bandage are unrolled and stretched from one end onwards. The length is measured
from one end to other end with a meter scale avoiding any wrinkles or creases. Percentage of
length is calculated from the following formula.
A = % of length = 100
where,
M = Measured length of bandage.
D = Declared length of bandage on label.
The variation in length can be calculated as :
V=A-100
Where, A = % of declared length available. The variation is indicated by the sign + or -. Similar
samples from different sources are subjected to conditioning for 24 hours. Their lengths and
widths are measured exactly in the same manner and the variations are calculated.
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14. Experiment No. 7
Object: To perform thread count for given sample of dressing/gauge.
Reference:
Theory: Thread count is number of threads/dm of length or width. The duck cloth is used to
stretch the bandage for thread count because of appropriate roughness that neither stretches the
fabric too much, decreasing the thread-count nor stretches too less, allowing shrinking and
wrinkling of thread. Number of threads per unit length controls the aperture of mesh cloth. This
is controlled to allow proper ventilation of the wound. If the mesh size is very less it shall not
allow the passage of air which is necessary for the healing of wound. The loosely woven
bandage cannot put proper pressure on the wound which will result in swelling of wound
surroundings and decrease in blood flow.
Warp thread count is kept more because the cloth is stretched in warp direction and
therefore more strength is required. The value of warp and weft count of gauge during bandaging
In ISI units are
warp = 160 / decimeter
weft = 90 / decimeter
Procedure :
Thread Count Test: The sample is conditioned in standard atmosphere for 24 hours and number
of threads/dm are counted.
For counting threads the bandage is unrolled and stretched on a duck-cloth. A hollow
cardboard block of 5-10 cm is put over the stretched bandage and the threads are counted with a
fine wire in warp (lengthwise) and weft (widthwise). Threads are counted within 5 cm and then
the number is doubled for calculating threads/dm. Threads are counted at five different places
and average is taken to give thread counts in both the directions as:
(i) Warp threads count
(ii) Weft threads count
(iii) Variation: V = I - 80 (for warp)
where I = warp thread count for weft variation ;
V = J - 60
where J = weft thread count
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15. Experiment No. 8
Object: To study various components of computer.
Reference:
Computer: Computer is an electronic device capable of programming various tasks. It receives
data from input device according to the instruction given to it and produces results in a
meaningful manner. It has two possible states, on and off. We use binary system in which they
are represented by '1' ON and '0' by OFF.
Binary digits are known as bits.
Hardware: The physical equipment and device related to computer system arc called hardware.
Software: A program that controls and commands the hardware as to how to perform its task. A
computer is to be instructed to perform various jobs using program called software.
Components of a Computer System:
(i) CPU
(ii) Input device and output device
(iii) Auxiliary memory
(i) CPU: It consists of 3 subunit; its full meaning is Central Processing Unit.
Fig. 1. Components of Computer.
(a) ALU (Arithmetic Logical Unit)
It performs arithmetic and logical operation on data.
(b) MMU· (Main Memory Unit)
The ALU needs data upon which to act as per the instructions. These are obtained from
memory unit. The memory unit is made up of number of locations.
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16. (c) Controlled Unit (CU)
It is responsible for overall control of processing done in the CPU. It also coordinates
storage and internal movement of data as well as sequence of execution of these instructions.
(ii) Input and Output Device: It acts as an interface between user and machine. Their function
is to get information in and out of CPU. The input devices are: keyboard, floppy disc, magnetic
disc, hard disc, punch card, magnetic disc, mouse, MCR, OMR etc.
Output devices are: paper tape, magnetic disc, printer, monitor, plotter, floppy disc,
magnetic tape, hard disc, etc.
(iii) Auxiliary Memory Device: It is also called as Secondary memory device. It stores data and
-instructions permanently. Computers main memory is limited inside and it stores information
on a temporarily basis and that is why auxiliary memory is used. We can store large amount of
data in it.
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17. Object -Recording the blood pressure of one’s own body.
Reference - S.R. Kale and K.K. Kale, Practical Anatomy and Physiology, Nirali Publication, page No. 36–38.
Theory -
Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels, and is
one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the
arterial pressure of the systemic circulation. During each heartbeat, BP varies between a maximum (systolic) and
a minimum (diastolic) pressure. The mean BP, due to pumping by the heart and resistance to flow in blood
vessels, decreases as the circulating blood moves away from the heart through arteries. Blood pressure drops most
rapidly along the small arteries and arterioles, and continues to decrease as the blood moves through the
capillaries and back to the heart through veins. Gravity, valves in veins, and pumping from contraction of skeletal
muscles are some other influences on BP at various places in the body.
The measurement blood pressure without further specification usually refers to the systemic arterial
pressure measured at a person's upper arm. It is measured on the inside of an elbow at the brachial artery, which is
the upper arm's major blood vessel that carries blood away from the heart. A person's BP is usually expressed in
terms of the systolic pressure over diastolic pressure (mmHg), for example 120/80.
Classification
The following classifications of blood pressure are from the American Heart Association, and apply to
adults 18 years and older.
Classification of blood pressure for adults
Category systolic, mmHg diastolic, mmHg
Hypotension < 90 < 60
Desirable 90–119 60–79
Prehypertension 120–139 or 80–89
Stage1Hypertension 140–159 or 90–99
Stage2Hypertension 160–179 or 100–109
HypertensiveCrisis ≥ 180 or ≥ 120
Average blood pressure in (mmHg):
1 year 6–9 years adults
95/65 100/65 110/65 – 140/90
Physiology
There are many physical factors that influence arterial pressure. Each of these may in turn be
influenced by physiological factors, such as diet, exercise, disease, drugs or alcohol, stress, obesity, and
so-forth.
Experiment No. 9

18. Some physical factors are:
 Rate of pumping. In the circulatory system, this rate is called heartrate, the rate at which blood
(the fluid) is pumped by the heart. The volume of blood flow from the heart is called the
cardiacoutput which is the heartrate (the rate of contraction) multiplied by the strokevolume (the
amount of blood pumped out from the heart with each contraction). The higher the heart rate, the
higher the meanarterialpressure, assuming no reduction in stroke volume or central venous
return.
 Volume of fluid or blood volume, the amount of blood that is present in the body. The more
blood present in the body, the higher the rate of blood return to the heart and the resulting cardiac
output. There is some relationship between dietary salt intake and increased blood volume,
potentially resulting in higher arterial pressure, though this varies with the individual and is
highly dependent on autonomic nervous system response and the renin-angiotensin
system.Resistance. In the circulatory system, this is the resistance of the blood vessels. The
higher the resistance, the higher the arterial pressure upstream from the resistance to blood flow.
Resistance is related to vessel radius (the larger the radius, the lower the resistance), vessel
length (the longer the vessel, the higher the resistance), blood viscosity, as well as the
smoothness of the blood vessel walls. Smoothness is reduced by the buildup of fatty deposits on
the arterial walls. Substances called vasoconstrictors can reduce the size of blood vessels,
thereby increasing BP. Vasodilators (such as nitroglycerin) increase the size of blood vessels,
thereby decreasing arterial pressure. Resistance and its relation to volumetric flow rate (Q) and
pressure difference between the two ends of a vessel are described by Poiseuille'sLaw.
 Viscosity, or thickness of the fluid. If the blood gets thicker, the result is an increase in arterial
pressure. Certain medical conditions can change the viscosity of the blood. For instance, anemia
(low red blood cell concentration), reduces viscosity, whereas increased red blood cell
concentration increases viscosity. It had been thought that aspirin and related "blood thinner"
drugs decreased the viscosity of blood, but instead studies found that they act by reducing the
tendency of the blood to clot.
In practice, each individual's autonomic nervous system responds to and regulates all these
interacting factors so that, although the above issues are important, the actual arterial pressure response
of a given individual varies widely because of both split-second and slow-moving responses of the
nervous system and end organs. These responses are very effective in changing the variables and
resulting BP from moment to moment.
Moreover, blood pressure is the result of cardiac output increased by peripheral resistance: blood
pressure = cardiac output X peripheral resistance. As a result, an abnormal change in blood pressure is
often an indication of a problem affecting the heart's output, the blood vessels' resistance, or both. Thus,
knowing the patient's blood pressure is critical to assess any pathology related to output and resistance.
Recording of Blood Pressure:
Indirect Method: In the indirect method commonly the pressure of the brachial artery is measured. The
instrument with which pressure is measured is known as sphygmomanometer.
These are the three methods for the recordation of blood pressure-
i. Oscillatory Method
ii. Palpatorymehod
iii. Ascultatory Method

19. Palpatory Method: A minimum systolic value can be roughly estimated by palpation, most often used in
emergency situations, but should be used with caution. It has been estimated that, using 50% percentiles,
carotid, femoral and radial pulses are present in patients with a systolic blood pressure > 70 mmHg, carotid
and femoral pulses alone in patients with systolic blood pressure of > 50 mmHg, and only a carotid pulse in
patients with a systolic blood pressure of > 40 mmHg.
A more accurate value of systolic BP can be obtained with a sphygmomanometer and palpating the radial
pulse. The diastolic blood pressure cannot be estimated by this method. The American Heart Association
recommends that palpation be used to get an estimate before using the auscultatory method.
Ascultatory Method: In this method the instrument is kept at the level of the heart. The cuff is tied round the
upper arm. Pressure is raised to 200mm Hg heard with a stethoscope placing its chest piece on the brachial artery,
just below the cuff. The sound are heard due to occurrence of turbulence in the flow of blood through the
narrowed blood vessels when the monometric pressure just coincides with systolic pressure. Due to giving air
pressure in the cuff, the vessel is pressed and the blood flow is obliterated. But while releasing air pressure
gradually, blood just begins to flow through the narrowed blood vessels. The systolic pressure undergoes
considerable functions- e.g. excitement, exercise, meals etc. increase the pressure while sleep, rest decrease it.
The height of systolic pressure informs about –
i. The extent of work done by heart.
ii. The force with which the heart is working.
iii. The degree of pressure which the arterial walls have to withstand.
The diastolic undergoes much less fluctuations in health. Increase in the diastolic pressure is of very much
importance as it is the measure of peripheral resistance. It indicates the constant load against which heart has
to work.
Oscillometric:The oscillometric method was first demonstrated in 1876 and involves the observation of
oscillations in the sphygmomanometer cuff pressure which are caused by the oscillations of blood flow, i.e.,
the pulse. The electronic version of this method is sometimes used in long-term measurements and general
practice. It uses a sphygmomanometer cuff, like the auscultatory method, but with an electronic pressure
sensor (transducer) to observe cuff pressure oscillations, electronics to automatically interpret them, and
automatic inflation and deflation of the cuff. The pressure sensor should be calibrated periodically to
maintain accuracy.
Oscillometric measurement requires less skill than the auscultatory technique and may be
suitable for use by untrained staff and for automated patient home monitoring.
The cuff is inflated to a pressure initially in excess of the systolic arterial pressure and then
reduced to below diastolic pressure over a period of about 30 seconds. When blood flow is nil (cuff
pressure exceeding systolic pressure) or unimpeded (cuff pressure below diastolic pressure), cuff
pressure will be essentially constant. It is essential that the cuff size is correct: undersized cuffs may
yield too high a pressure; oversized cuffs yield too low a pressure. When blood flow is present, but
restricted, the cuff pressure, which is monitored by the pressure sensor, will vary periodically in
synchrony with the cyclic expansion and contraction of the brachial artery, i.e., it will oscillate. The
values of systolic and diastolic pressure are computed, not actually measured from the raw data, using an
algorithm; the computed results are displayed.

20. Functions of Blood Pressure:
1) It maintains a sufficient pressure head to keep the blood flowing.
2) It provides the motive force of filteration at the capillary bed. Thus assuming nutrition to the tissue cells,
formation of urine lymph, in change in the pattern of the flow from streamline flow (silent) to turbulent
flow (noisy). When the pressure is further released normal streamline flow sets in and the sound is no
longer heard. At this point manometric pressure coincides with diastolic blood pressure.
Variations of sound are heard as pressure is released.
Phase I: Sudden appearance of a clear tapping sound indicates systolic pressure.
Phase II: Tap sound is replaced by murmur.
Phase III: Murmur is replaced by a clear loud gong sound.
Phase IV: Loud sounds fade rapidly. This indicates diastolic pressure.
Phase V: All sounds vanishes.
Result: The systolic pressure obtained was _____ mm Hg.
The diastolic pressure obtained was ____ mm Hg.

21. Experiment No. 10
Objective– To study and operate the health screening equipment for blood glucose level
measurement (Glucometer)
Reference –
Theory –Blood sugar level is defined as amount of glucose level in blood at any given time. It is
also known as serum glucose level.
Blood glucose level is expressed in millimole/l, mg/dl, mg %, blood sugar remain
within narrow range but at time rises sharply mainly after meals and is least at morning
time.
Measurement of blood sugar level
 A very high level of blood sugar if present for many years will have a damaging effect
on the body.
 In diabetic patients this causes late stage complications such as Retinopathy,
Nephropathy and various cardiovascular diseases.
 Blood sugar can be determined by an instrument called Glucometer.
 Glucometer has display screen and a specific strip meant for measuring blood glucose
level.
 This can be measured in two means with glucometer
a. Colour change method.
b. Digital display method.
Ideal blood sugar values of blood glucose is 4 – 7millimole/ L (before meal)
Less than 10millimole/L (90 min after meals)
Control of blood sugar level
The lifestyle of physical instructor is much more different than software engineer. Blood
sugar should be measured at once or twice a month and desirable to be controlled therefore
following action should also be taken –
a. Controlling B.P. more vigorously
b. Lowering cholesterol level.
c. Starting or increasing exercise
d. Smoking ceasing
e. Meditation.
Procedure –
 Firstly finger surface was cleaned with alcohol or any other antiseptic.
 Finger surface was pricked by the sterilized needle.
 Discarding the first drop of blood
 Applied blood sample on the strip, after 45sec, the reading was appeared
 The hand was washed after test completed
Result –The blood sugar level was found _____ mg/dl.