Assam Higher Secondary Health Care cheat sheet

Primary health care (PHC) is the first point of contact; it emphasizes equity, community participation, and intersectoral collaboration.

The six building blocks of a health system are service delivery, health workforce, health information, medical products/vaccines/technologies, financing, and leadership/governance.

Levels of care in India: sub-centre (population 3,000–5,000 in plains), PHC (20,000–30,000), CHC (80,000–1,20,000), district hospital, and tertiary hospitals.

Universal Health Coverage (UHC) means all people receive needed health services without financial hardship; measured by service coverage and catastrophic out-of-pocket spending.

National Health Mission (NHM) in Assam includes NRHM (rural) and NUHM (urban); ASHA, ANM, and MPW are key frontline cadres.

Ayushman Bharat has two components: Health and Wellness Centres (now Ayushman Arogya Mandir) for primary care and PM-JAY for secondary/tertiary hospitalization cover.

Health is defined by WHO (1948) as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.

Determinants of health include biological, behavioral, environmental, social, and health-system factors; income and education strongly predict health outcomes.

The adult skeleton has 206 bones; the axial skeleton (80) includes skull, vertebral column, and rib cage; the appendicular skeleton (126) includes limbs and girdles.

Normal adult resting heart rate is 60–100 beats/min; stroke volume × heart rate = cardiac output (about 5 L/min at rest).

Normal adult respiratory rate is 12–20 breaths/min; tidal volume about 500 mL; vital capacity is the maximum volume exhaled after maximum inhalation.

Blood pressure is cardiac output × peripheral resistance; normal adult values are systolic <120 mmHg and diastolic <80 mmHg.

The nephron is the functional unit of the kidney; glomerular filtration rate averages about 125 mL/min; kidneys regulate fluid, electrolytes, and acid-base balance.

The liver produces bile, stores glycogen, detoxifies drugs, and synthesizes albumin and clotting factors; jaundice indicates bilirubin accumulation.

Homeostasis is maintained by negative feedback loops (e.g., insulin lowers blood glucose; osmoreceptors trigger ADH release).

Blood groups follow the ABO and Rh systems; O-negative is the universal red cell donor and AB-positive the universal recipient.

Vital signs: temperature, pulse, respiration, blood pressure, and oxygen saturation (SpO2); normal SpO2 is 95–100% on room air.

The nursing process has five steps: assessment, diagnosis, planning, implementation, and evaluation (ADPIE).

Pressure ulcer risk is assessed with the Braden Scale; scores ≤12 indicate high risk; reposition immobile patients at least every 2 hours.

Intake-output charting: record all oral, enteral, and IV fluids in; urine, vomit, drainage, and insensible losses out; report urine output <0.5 mL/kg/h.

Pain is the fifth vital sign; use a 0–10 numeric scale for adults and Wong-Baker FACES for children; reassess after analgesia.

Body temperature routes: oral 36.5–37.5°C, axillary 36.0–37.0°C, rectal 37.0–38.0°C; rectal is contraindicated in diarrhea or neutropenia.

Hand hygiene is the single most effective infection control measure; follow WHO 5 Moments and use alcohol-based rub for 20–30 seconds.

Early mobilization and deep-breathing exercises reduce postoperative complications such as atelectasis and deep vein thrombosis.

DRSABCD sequence: Danger, Response, Send for help, Airway, Breathing, CPR, Defibrillation.

Adult CPR: compressions at 100–120/min, depth 5–6 cm, ratio 30 compressions to 2 breaths; minimize interruptions to <10 seconds.

Recovery position is for an unresponsive but breathing casualty; it maintains a patent airway and allows drainage of vomit.

Choking adult: encourage coughing; if ineffective, give up to 5 back blows then up to 5 abdominal thrusts; for infants use back blows and chest thrusts, not abdominal thrusts.

Severe bleeding: apply direct pressure with a clean cloth; use a tourniquet only if direct pressure fails and note the time applied.

Burns: cool with running water for at least 20 minutes; do not apply ice, butter, or toothpaste; cover with a sterile non-stick dressing.

Anaphylaxis: give intramuscular adrenaline (epinephrine) 0.5 mg (0.5 mL of 1:1000) into the anterolateral thigh for adults; repeat after 5 minutes if needed.

Stroke FAST: Face drooping, Arm weakness, Speech difficulty, Time to call emergency services; note the time symptoms began.

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

Epidemiological triad: agent, host, and environment; disease occurs when they interact to favor the agent.

Levels of prevention: primordial (risk-factor avoidance), primary (pre-disease), secondary (early detection), tertiary (disability limitation), quaternary (avoiding overmedicalization).

Herd immunity threshold depends on R0: for measles R0 ≈ 12–18, requiring about 92–95% two-dose coverage; for polio about 80–85%.

Cold chain: vaccines must be kept at 2–8°C at health facilities; OPV at −20°C for long-term storage; avoid freezing adsorbed vaccines (DPT, HepB, TT).

Notifiable diseases in India include polio, plague, cholera, dengue, and measles; immediate reporting triggers outbreak investigation.

ASHA (Accredited Social Health Activist) links the community to the health system; she is selected by the Gram Sabha and receives performance-based incentives.

Screening tests need high sensitivity to avoid missing cases; confirmatory tests need high specificity.

Balanced diet: 55–60% energy from carbohydrates, 10–15% from protein, 20–30% from fat; include vitamins, minerals, and fiber.

Protein-energy malnutrition: marasmus is severe wasting without edema; kwashiorkor shows edema, moon face, and fatty liver, often with adequate calorie but low protein intake.

Micronutrient deficiencies: vitamin A → night blindness; iron → anemia; iodine → goiter and cretinism; vitamin D → rickets/osteomalacia.

BMI = weight (kg) ÷ height (m)²; Asian Indian cutoffs: underweight <18.5, normal 18.5–22.9, overweight 23–24.9, obese ≥25.

Exclusive breastfeeding for the first 6 months, then complementary feeding from 6 months with continued breastfeeding up to 2 years.

Food hygiene: wash hands with soap before cooking and eating; keep cooked food above 60°C or below 5°C; boil drinking water or use chlorine tablets.

Sanitation: use toilets, avoid open defecation; safe disposal of waste prevents diarrheal diseases, soil-transmitted helminths, and vector breeding.

Health promotion uses the Ottawa Charter actions: build healthy public policy, create supportive environments, strengthen community action, develop personal skills, and reorient health services.

Antenatal care: at least 4 visits (WHO now recommends 8 contacts); first visit as early as possible, then monthly until 28 weeks, fortnightly until 36 weeks, weekly thereafter.

Danger signs in pregnancy: vaginal bleeding, severe headache with blurred vision, convulsions, high fever, reduced fetal movement, and leaking of fluid.

Eclampsia is convulsions in a woman with pre-eclampsia; give magnesium sulfate (loading dose 4 g IV + 10 g IM) and refer urgently.

Postpartum hemorrhage is blood loss >500 mL after vaginal birth or >1000 mL after cesarean; first-line drug is oxytocin 10 IU IM; massage the uterus and start IV fluids.

Newborn care: dry and wrap immediately, initiate breastfeeding within 1 hour, give vitamin K 1 mg IM to prevent hemorrhagic disease of the newborn.

Birth weight <2.5 kg is low birth weight; kangaroo mother care (skin-to-skin contact, exclusive breastfeeding) reduces mortality in stable preterm infants.

Immunization schedule (India): BCG, OPV-0, HepB at birth; 6, 10, 14 weeks pentavalent/OPV/PCV/rotavirus; 9–12 months measles-rubella; boosters at 16–24 months.

ORS and zinc are first-line for childhood diarrhea; zinc 20 mg/day (10 mg for infants <6 months) for 14 days reduces duration and recurrence.

The 'rights' of medication administration: right patient, drug, dose, route, time, and documentation; some add right reason and right to refuse.

Pharmacokinetics: absorption, distribution, metabolism (mainly liver), and excretion (mainly kidney); half-life determines dosing interval.

First-pass metabolism reduces oral bioavailability of drugs such as nitroglycerin and morphine; sublingual or IV routes avoid it.

Narrow therapeutic index drugs (digoxin, warfarin, lithium, phenytoin) require therapeutic drug monitoring.

Adverse drug reactions: Type A (dose-dependent, predictable) and Type B (idiosyncratic, unpredictable, e.g., anaphylaxis to penicillin).

High-alert medications (insulin, heparin, concentrated potassium chloride, chemotherapy) require independent double-checks and clear labeling.

Antibiotic stewardship: prescribe only for bacterial infections, complete the prescribed course, and avoid unnecessary broad-spectrum agents to limit resistance.

Look-alike/sound-alike (LASA) drugs (e.g., Lasix/furosemide vs. Losec/omeprazole) need tall-man lettering and separate storage.

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; break any link to prevent infection.

Standard precautions apply to all patients: hand hygiene, gloves, gown, mask, eye protection, and safe sharps handling.

Transmission-based precautions: contact (MRSA, scabies), droplet (influenza, pertussis; mask within 1–2 m), airborne (TB, measles; N95 and negative-pressure room).

Hand hygiene moments: before touching a patient, before clean/aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings.

Needlestick injury: wash with soap and water, do not squeeze, report immediately, and start HIV post-exposure prophylaxis within 2 hours if indicated.

Sterilization by autoclave: 121°C at 15 psi for 15–20 minutes; high-level disinfection with 2% glutaraldehyde for 20 minutes.

Biomedical waste segregation: yellow (human anatomical waste, soiled dressings), red (contaminated recyclable plastic), white (sharps), blue (glass and metallic implants).

Vaccine-preventable infections among health workers: hepatitis B vaccination and annual influenza vaccination are recommended.

The four principles of biomedical ethics are autonomy, beneficence, non-maleficence, and justice.

Informed consent requires capacity, adequate information (risks, benefits, alternatives), and voluntariness; document the discussion.

Confidentiality: patient information may be disclosed only with consent or when required by law (e.g., notifiable diseases, court order).

Professional boundaries: do not accept gifts that could influence care, and avoid dual relationships with patients.

Duty of care: health workers must act within their competence and refer when a situation exceeds their training.

Medical negligence requires four elements: duty, breach of duty, causation, and damages.

Respect for dignity and non-discrimination: care must not be denied based on caste, religion, gender, HIV status, or ability to pay in emergency situations.

Whistle-blowing and incident reporting protect patients; near-miss reporting is encouraged and should be non-punitive.

SBAR is a structured handover tool: Situation, Background, Assessment, Recommendation.

Active listening involves paraphrasing, reflecting, and clarifying; avoid interrupting and use open-ended questions.

Therapeutic communication: use empathy, silence, and touch appropriately; avoid false reassurance, judgmental remarks, and jargon.

Medical records must be accurate, legible, dated, timed, signed, and contemporaneous; never alter records retrospectively without a dated correction.

Patient confidentiality applies to records; access is on a need-to-know basis and secure storage is required.

Teach-back is a method to confirm understanding: ask the patient to explain instructions in their own words.

Interpreters and pictorial aids improve communication with low-literacy or non-local-language patients; family members should not be relied on for sensitive information.

Incident reports are not part of the clinical record; document the facts in the patient record and complete the incident form separately.