N&MC Ghana Exam cheat sheet

Nursing process sequence: assessment, diagnosis, planning, implementation, evaluation; reassessment restarts the cycle when goals are unmet.

Maslow hierarchy order: physiological, safety, love/belonging, esteem, self-actualization; lower-level needs generally take priority in acute crisis.

Normal adult vital signs: oral temperature 36.1–37.2°C, pulse 60–100/min, respirations 12–20/min, ideal BP below 120/80 mmHg, SpO2 at least 95% at sea level.

WHO five moments for hand hygiene: before patient contact, before aseptic task, after body-fluid exposure risk, after patient contact, after contact with patient surroundings.

Chain of infection links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; interrupting any link prevents transmission.

Therapeutic communication techniques include open-ended questions, reflection, silence, and clarification; false reassurance and why questions tend to block communication.

Documentation standards: factual, timely, accurate, complete, legible, and signed; late entries are labelled as late and original records are not altered.

Evidence-based practice steps: formulate a PICO question, search evidence, appraise quality, apply with patient preference, and evaluate outcomes.

SBAR structured handover: Situation, Background, Assessment, Recommendation.

Four ethical principles: autonomy, beneficence, nonmaleficence, justice; confidentiality and veracity are related professional duties.

Valid informed consent elements: capacity, disclosure, understanding, voluntariness, and authorization.

Consent exceptions include emergency treatment when a patient lacks capacity and no surrogate is available, statutory public-health reporting, and court order.

Negligence elements: duty of care, breach of duty, causation, and damages; all four must be established.

Professional misconduct examples: practising outside scope, falsifying records, breach of confidentiality, and working while impaired.

Ghana Health Professions Regulatory Bodies Act, 2013 (Act 857) establishes councils, including the Nursing and Midwifery Council, with registration and disciplinary functions.

Scope of practice: a nurse or midwife performs only activities authorized by training, law, and employer policy; delegation requires competence and supervision.

Mandatory reporting includes suspected child abuse, sexual assault, specified communicable diseases, and unsafe practitioner conduct; gunshot reporting depends on jurisdiction.

Ethical decision framework: identify the problem and facts, stakeholders, options, relevant principles, decision, action, and evaluation.

ABCDE primary survey: Airway, Breathing, Circulation, Disability, Exposure; life-threatening problems are managed in that sequence.

Shock signs: tachycardia, hypotension, tachypnoea, cool clammy skin, oliguria, and altered mentation; cardiogenic shock may show crackles and raised JVP.

Mean arterial pressure formula: MAP = (systolic BP + 2 × diastolic BP) ÷ 3; a common adult resuscitation target is at least 65 mmHg.

Cardiac output = heart rate × stroke volume; normal adult resting cardiac output is about 4–8 L/min.

Acid-base normal values: pH 7.35–7.45, PaCO2 35–45 mmHg, HCO3 22–26 mmol/L; respiratory disorders move opposite to pH and metabolic disorders move in the same direction.

Anion gap = sodium − (chloride + bicarbonate); normal is about 8–12 mmol/L and elevation suggests high-anion-gap metabolic acidosis.

Hypokalaemia ECG changes include flattened T waves and U waves; hyperkalaemia shows peaked T waves and widened QRS.

Hypoglycaemia is glucose below 70 mg/dL; a conscious patient receives 15 g fast-acting carbohydrate and recheck after 15 minutes, while an unconscious patient needs IV dextrose or glucagon.

Post-operative priorities include early ambulation to reduce DVT and pneumonia, plus assessment of bowel sounds, wound, pain, and vital signs.

GTPAL summarises obstetric history: gravida, term births, preterm births, abortions, and living children.

Naegele's rule: estimated delivery date = first day of last menstrual period + 7 days − 3 months + 1 year, adjusted for cycle length.

Labour stages: first stage from onset to full cervical dilation, second stage from full dilation to birth, third stage from birth to placenta delivery, fourth stage the first 1–2 hours postpartum.

Normal fetal heart rate baseline is 110–160 beats/min; early decelerations reflect head compression, variable decelerations cord compression, and late decelerations uteroplacental insufficiency.

Preeclampsia: BP at least 140/90 mmHg after 20 weeks plus proteinuria or end-organ signs; severe features include BP at least 160/110, platelets below 100,000, raised liver enzymes, creatinine above 1.1 mg/dL, pulmonary oedema, or cerebral/visual symptoms.

Magnesium sulfate toxicity signs: loss of deep tendon reflexes, respiratory depression, and oliguria; antidote is calcium gluconate.

Postpartum haemorrhage: more than 500 mL after vaginal birth or more than 1000 mL after caesarean; uterine atony is the most common cause and initial management includes uterine massage, oxytocin, and tranexamic acid.

Active third-stage management includes a uterotonic, controlled cord traction, and uterine massage.

WHO recommends eight antenatal contacts: before 12 weeks, then at 20, 26, 30, 34, 36, 38, and 40 weeks.

APGAR is scored at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration; each 0–2, total 0–10, with 7–10 generally normal.

Normal newborn ranges: heart rate 120–160/min, respiratory rate 30–60/min, axillary temperature 36.5–37.5°C; weight loss up to 10% in the first week is common.

Ghana EPI schedule includes BCG and OPV0 at birth; Penta, PCV, and OPV at 6, 10, and 14 weeks; measles-rubella at 9 and 18 months; yellow fever at 9 months.

ORS for some dehydration: 75 mL/kg over 4 hours, continued breastfeeding, and zinc 10–20 mg daily for 10–14 days in childhood diarrhoea.

Severe dehydration signs: lethargy or unconsciousness, sunken eyes, very slow skin pinch, and inability to drink; urgent IV rehydration is required.

Growth monitoring uses weight-for-age, length/height-for-age, weight-for-height, and MUAC; bilateral pitting oedema indicates severe acute malnutrition.

Developmental milestones: social smile at about 6 weeks, head control at 3 months, sitting unsupported at 6–8 months, walking at 12–15 months, and two-word phrases at 18–24 months.

Fever in an infant younger than 3 months is an urgent assessment because serious bacterial infection may present non-specifically.

Levels of prevention: primary prevents disease before onset, secondary detects and treats early, tertiary limits disability and supports rehabilitation.

Incidence = new cases ÷ population at risk over time; prevalence = all existing cases ÷ total population at a point or period.

Herd immunity threshold depends on the basic reproduction number R0; higher R0 requires a higher proportion of the population to be immune.

Vaccine cold chain: most vaccines are kept at 2–8°C; freeze-sensitive vaccines such as DTP, hepatitis B, and PCV must not be frozen, while freeze-dried BCG and measles vaccines may be frozen.

Community diagnosis steps: collect demographic and epidemiological data, identify and prioritise problems, plan, implement, and evaluate.

Ghana CHPS uses resident community health officers and volunteers to deliver primary care close to households in underserved communities.

Screening test validity: sensitivity = true positives ÷ (true positives + false negatives); specificity = true negatives ÷ (true negatives + false positives).

Outbreak investigation steps: verify diagnosis, confirm outbreak, define and find cases, analyse person-place-time, implement control, and communicate findings.

Mental health assessment covers suicide/violence risk, mental status, possible physical causes, social supports, and medication adherence.

Depression core symptoms: depressed mood or anhedonia for at least 2 weeks plus additional symptoms and functional impairment.

Suicide risk assessment: ideation, plan, intent, means, previous attempts, and protective factors; direct inquiry does not increase suicide risk.

Psychosis features include hallucinations, delusions, disorganized speech or behaviour, and impaired reality testing; medical and substance causes are excluded before treatment.

Therapeutic relationship boundaries: maintain confidentiality, avoid self-disclosure, avoid dual relationships, and recognise the power imbalance.

Public health surveillance types: passive routine reporting, active health-worker search, and syndromic surveillance based on symptoms.

Notifiable disease reporting in Ghana includes suspected cholera, measles, yellow fever, meningitis, polio, and viral haemorrhagic fever for immediate notification.

Ghana Mental Health Act, 2012 (Act 846) provides for mental health care, rights of patients, and safeguards for voluntary and involuntary admission.